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Building Blocks of Reintegration: Practical reentry guides as support for justice-involved individuals\u27 reintegration into communities.
Full text linkAs justice-involved individuals are released from incarceration, are the reentry guides provided by correctional facilities comprehensive to their intended audience? Are they inclusive of information needed to reintegrate into their communities successfully? This study aims to determine the content and readability of the reentry guides available upon release from US prisons. Deedose is used for content analysis, and readability is determined using the Flesch Kincaid Readability Scale and the Flesch Kincaid Grade Level. Sixteen unique guides from sixteen states were retrieved from Department of Corrections websites, email requests, or FOIA submittals. Readability levels average thirteen (college level) on the Flesch Kincaid Scale Grade Level. The guides shared common content such as money, employment, and education, while content on record expungement, behavioral changes, and victim services were limited. The guides in the sample are all above the reading level of the intended audience and focus more on addressing immediate needs than helping to make overall behavioral and lifestyle changes to prevent recidivism
Promoting Acceptance of a Community Doula Program for Black Women Among Labor and Delivery Nurses: An Educational Intervention
Full text linkA trend of increased maternal mortality, both locally and nationally, among Black women has become a significant public health and social justice issue with a notable increase documented in recent years. Doula support programs have been demonstrated as an innovative method of improving maternal child health outcomes for this population. This quality improvement proposal project uses the Social Ecological Model, including individual, interpersonal, community, and societal factors, to design an educational intervention for labor and delivery nurses at an acute care women\u27s hospital. The education will be developed with the aim of increasing labor and delivery nurses\u27 knowledge of the issue of increased maternal mortality among African American women. In addition, the role of doulas in improving maternal outcomes will be highlighted with an emphasis on communication and interprofessional collaboration skills. This quality improvement project will propose that if we educate labor and delivery nurses and the healthcare delivery team about the importance of doula support, there are possibilities of decreased maternal death rate among black women
Efficacy and Safety of Dpp-4 Inhibitor Use in the Hospital Setting
Full text linkCurrent practice in the hospital is to hold oral antidiabetic drugs and administer insulin to prevent adverse reactions. This can lead to issues including hypoglycemic events, high glycemic variability, and poorly controlled blood glucose. Newer incretin analog drugs such as DPP-4 inhibitor do not cause hypoglycemia. A literature review was performed, and the results showed that DPP-4 inhibitors are both safe and effective in the inpatient setting with fewer hypoglycemic events, lower mean BG, and lower glycemic variability. The proposed study will compare patients with type diabetes treated with standard basal-bolus insulin therapy, against those continued on their home DPP-4 inhibitors on inpatient medical-surgical units at a single center to evaluate safety and efficacy of the different treatment modalities. A clinical support resource to better assist providers to treat type II diabetes will also be disseminated and include situations where DPP-4 inhibitor use would be contraindicated, or additional considerations such as holding a dose on the morning on surgery. The goal is for either improved or non-inferior outcomes in the treatment group in measures including mean blood glucose, hypoglycemic events, readings of poorly controlled blood glucose (\u3e200 mg/dL) or hyperglycemic events (\u3e350 mg/dL), and glycemic variability. Implications for APRN practice include adding to research findings supporting DPP-4 inhibitor use in the hospital, education of providers and patients, adopting the clinical decision-making tool into practice, and modifying hospital policy to reflect study findings
Exploring Nurses\u27 Confidence in Supporting Family Presence During Resuscitation in the Emergency Department: A Quality improvement Project
Full text linkCardiac arrest is a common event in hospitals and integrating family presence during highly stressful situations such as resuscitation and invasive procedures can be problematic for members of the interprofessional team. The purpose of this quality improvement project is to explore nurses\u27 confidence in supporting family presence during resuscitation. A sample of 27 out of 50 registered nurses voluntarily participated in the survey. Utilizing a modified NCSBN confidence survey, confidence levels were lower when asked about interventions, communication, and policy prior to any education recommendations about family presence during resuscitation. This study provides insight into why nurses may or may not utilize the practice of family presence during resuscitation (FPDR). Improvement was achieved in assessment, intervention, and evaluation of interventions related to FPDR after education was received. Categories including communication, performing interventions, family presence, policy, and existing education were explored. The highest improvement in confidence was found with performing medication administration in the presence of family at 23%-after receiving education. Understanding the nurses’ level of confidence during a high-stress resuscitation and providing education increases their confidence during FPDR. The results of this quality improvement project are a strong indicator of future success and confidence in the use of FPDR. Understanding what nurses know and think about a practice helps determine how to increase utilization in healthcare facilities. This project may help guide healthcare organizations when implementing and educating about FPDR
Food Insecurity and Food Justice in the Rhode Island Food Bank
Full text linkIn 2021, 18% of Rhode Islanders were food insecure, with a higher prevalence for Black, Latino, and Indigenous communities, as well as households with children (Rhode Island Community Food Bank, 2021). Levels of food insecurity were also heightened during the COVID-19 Pandemic both nationally, and locally, in Rhode Island. This project inquires about the experiences of food insecurity and food justice among Rhode Island residents. The purpose of this study is to understand on a deeper level the recent scope of food insecurity in Rhode Island with respect to food insecurity disparities. A secondary purpose of this project is to conduct a needs assessment of the people in RI who are food insecure to see what is missing in the current system of assistance, and in which areas individuals need or want more assistance. This study reaffirmed previous research results that people with a low income, people who are unemployed, and households with children experience higher levels of food insecurity. Moreover, the main barriers to accessing food pantries in Rhode Island are either gas prices, time, weather, or food prices. The implications of this study are that employment, income, and the size of the household are indicators of food security. Another implication is that including Spanish translation is a necessary part of analyzing and researching food insecurity in order to receive accurate and representative data
Insomnia: A Sleep-Stealing Disorder
Full text linkAnyone who’s suffered from sleep deprivation has likely experienced some negative effects the next day. Tiredness, fatigue, and an inability to focus are just a few of them (Watson, 2021). These issues could make anyone’s day challenging, but for those who struggle with insomnia, they can be a regular occurrence. Thomas Roth (2007) at The Journal of Clinical Sleep Medicine defines insomnia as difficulty falling asleep and staying asleep. Roth adds that “approximately 30% of a variety of adult samples drawn from different countries report one or more of the symptoms of insomnia.” Eric Suni (2022) of the Sleep Foundation adds that this rate can vary among different groups, including the elderly, pregnant women, and teens. With different risk factors, treatments, and psychophysiological effects, insomnia is an issue that affects the world in more ways than one might think
Increasing Referral to Cardiac Rehabilitation
Full text linkBackground: Heart disease is the leading cause of death in the United States (US), killing 610,000 Americans each year (CDC, 2017). Cardiac rehabilitation (CR) is a Class I recommendation by the American Heart Association and American College of Cardiology Foundation for patients after coronary artery (Thomas et al., 2018). Completing a 12-week cardiac rehabilitation program after coronary revascularization can reduce all-cause mortality by 20% to 50% (Sandesara et al. 2015). Despite the proven benefits of CR, only 14-35% of heart attack survivors attend CR (Balady et al. 2011; Ades, et al., 2017; AHA, 2017).
Purpose/Specific Aims: There is a gap in the literature on the best approach to improve referrals. The Million Hearts Initiative was created by the CDC with a goal to increase CR participation from 20-30% to 70%. This quality improvement project aims to implement evidence-based interventions to increase referral rates to CR to over 70%.
Methods: Multi-level interventions including the creation of a multidisciplinary team, leveraging the electronic medical record (EMR), automating CR discharge instructions, and 1:1 advanced practice provider education. Documentation was standardized to address NCDR requirements.
Results:There was a statistically significant increase in patient referrals of 32.8% (p\u3c 0.01, 95% CI 23.57% – 41.22%) from Quarter 4 2021 to Quarter 4 2022.
Conclusion: Cardiac rehabilitation is an underutilized resource after coronary artery stenting. Leveraging the EMR and providing 1:1 education to the discharging advanced practice providers was shown to have a statistically significant improvement on patient referral to CR
Increasing Influenza Vaccination Rates Among Long-Term Care Facility Health Care Workers
Full text linkSeasonal influenza is a serious public health problem that is responsible for a significant number of illnesses, hospitalizations, and death. Influenza is of particular concern for individuals 65 years of age and older living in long-term care facilities. Historically health care workers working in long-term care facilities have had the lowest influenza vaccination rates compared to other health care facilities. Despite numerous efforts to increase health care worker vaccination rates, vaccination rates remain low. The purpose of this quality improvement project was to understand long-term care facility health care workers\u27 knowledge, beliefs, and attitudes toward influenza vaccination with the aim of increasing vaccination rates by 5% from the previous influenza season. Methods included health care worker interviews and an educational toolkit with targeted themes identified from the interview data from two participating long-term care facilities. Results identified several key areas for education. Preliminary post-intervention data demonstrated an increase in influenza vaccination rates for both long-term care facilities from the previous influenza season. Conclusion: Based on feedback from health care workers who participated in the intervention, education is clearly important and should be a priority in facilities with low health care worker vaccination rates. Ensuring health care workers have easy access to getting vaccinated at their place of employment is a method to ensure access is convenient
Nursing self-care Through Reiki Practice in the Clinical Setting
Full text linkThis pilot proposal project articulates a call to action to lessen nurses\u27 burnout. Extant literature supports Reiki energy therapy to aid with anxiety, stress, and fatigue, which supports the project\u27s purpose of helping teach nurses self-care using the complementary practice of Reiki as an alternative stress reduction tool to promote a healthy work environment that will improve nurses\u27 well-being and their ability to provide optimum patient care.
Method:The study will begin with a short questionnaire to measure initial Reiki knowledge in nurses. Then, nurses will undergo classroom lectures followed by lab instruction and practice. After the study, nurses will self-report their experiences and take a questionnaire on Reiki to measure their knowledge.
Findings: The study aims to establish a foundational understanding of Reiki in nurses. The study also seeks to ensure participating nurses can demonstrate Reiki knowledge and practice. In the longer term, nurses will be able to practice more Reiki self-care to mitigate burnout.
Implications for advanced practice: This study will help facilitate more emphasis on nurse self-care by utilizing Reiki. Reiki will help reduce the adverse effects of burnout, increase job satisfaction, and lead to optimum patient care. Reiki\u27s positive effects to mitigate burnout are applied as a complementary tool for self-care. Nurse leaders must take a proactive approach at the practice level and influence local policy to help reduce nurses\u27 burnout and allow time for Reiki self-care. Including holistic practices such as self-care Reiki may reduce nursing burnout and increase work satisfaction
Accuracy of Emergency Department COVID-19 Symptom Screening: A Retrospective Chart Review
Full text linkSARS-CoV-2 or the COVID-19 virus originated in late 2019 in Wuhan, China and spread throughout the world causing a global pandemic. Patients with respiratory symptoms presenting to hospitals are screened by frontline healthcare workers and those with COVID-19 symptoms are separated from the others. Appropriate screening is necessary to keep the disease from being transmitted to other patients and staff members. The purpose of this study was to identify commonly seen symptoms in patients that screened negative for COVID-19 by the initial triage screening but tested positive for COVID-19. A retrospective chart review of adult patients in a community hospital emergency department examining COVID-19 prescreening was performed. Patients who screened negative but tested positive for COVID-19 via PCR testing within 12 hours of the start of their emergency department encounter were included. 123 patient records were included. Provider\u27s notes were reviewed for symptomology and records that mentioned respiratory symptoms, which should have caused them to screen positive, were excluded as missed triage screens. Of the remaining records, the most commonly seen symptom category was gastrointestinal followed by neurological symptoms and then psychiatric. The importance of appropriate triage screening cannot be overemphasized. As COVID-19 virus has evolved, so should symptom screening. High risk populations such as the elderly, behavioral health patients and those with substance use disorder should be recognized and assessed for immediate testing