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Feasibility of Remote Management of Uncomplicated Urinary Tract Infection: A Quality Improvement Project
Get PDFUncomplicated cystitis is a common condition that many women encounter in their lifetimes. The subjective symptoms that patients provide to their clinician are a critical component in the providers’ diagnosis. Traditionally, uncomplicated cystitis is diagnosed and treated during a face-to-face consultation in primary care offices, urgent care centers and emergency departments. Quite often, clinicians treat their patients based upon their initial presenting symptoms, regardless of the point of care testing and before urine culture results are available. The purpose of this project was to determine how often subjective symptoms of uncomplicated urinary tract infections (UTIs) are associated with treatment sensitive to subsequent urine cultures. A comprehensive literature review was performed. The ACE Star Model of Knowledge Transformation was utilized to guide the research process. Data collection took place at Concentra Urgent Care in Warwick, RI after agency approval and IRB review. Eighty-four medical records of premenopausal (ages 18-45) non-pregnant females treated for UTI between January 1, 2016 and July 1, 2016 were reviewed during a retrospective chart review. Thirty-seven participants met the inclusion criteria for uncomplicated cystitis and presented with subjective symptoms of dysuria, urinary frequency and urinary urgency. Findings were consistent with research performed by Barry et al. (2001) and Hooton (2012). Barry et al. concluded that 64% of patients were appropriately treated remotely based upon subjective symptoms. Hooton also concluded that 90% of patients could be treated with appropriate antibiotics based upon their subjective symptoms. This research validated that 85.29% of patients could have been treated appropriately based solely on their subjective symptoms of uncomplicated cystitis. Recommendations and implications for advanced practice nursing are discussed
Does Early Mobility Lead to Decreased Ventilator Days?
Get PDFIt is well documented that bedrest has adverse outcomes for hospitalized patients. This is especially true for critically ill patients due to life support measures, invasive catheters, and mechanical ventilation. Consequences associated with bedrest in critical care patients include venous thromboembolism, ventilator associated pneumonia, pressure ulcer development, and muscle weakness. Respiratory muscle weakness is associated with prolonged ventilator support and delayed extubation. The Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle uses evidence based practice to prevent and treat ICU acquired delirium and weakness. The bundle aims to do this by standardizing care processes in collaboration with the ICU team to promote early mobility in ventilated patients. The purpose of this research study was to determine if the implementation of an early mobility protocol decreased the number of ventilator days for patients who receive mechanical ventilation. A retrospective chart review was conducted at a 16 bed ICU. Group A included 30 subjects (n=30) who were treated pre implementation of the ABCDE bundle and Group B included 39 (n=39) subjects who were treated post implementation of the ABCDE bundle. There were less average ventilator days found in Group A in comparison to Group B. Additionally, there was a significant difference found in the ICU length of stay pre implementation (M=9.4, SD=4.4) and post implementation (M=5.7, SD=2.6) of the ABCDE bundle for early mobility, t (65) =4.3, p = 0.00005. The APRN can use the evidence in the ABCDE bundle to guide care to critically ill patients that are mechanically ventilated. Utilizing the ABCDE bundle additionally allows the APRN to be instrumental in improving patient outcomes through interdisciplinary collaboration
What Does It Mean to be well? Understanding the Acehnese Youth Refugees\u27 Resettlement Experience
Get PDFThis qualitative study describes the extent to which there is a perception of wellbeing among Acehnese refugees who arrived as adolescents to the United States and settled in the Mid - Atlantic States. Aceh is a province in Northwestern Indonesia consisting of approximately four million people. During 1990 to 2005, approximately 20,000 people left the province due to political conflict to seek asylum in Malaysia, their neighboring country, before resettling in a third country. The participants in this research study are Acehnese refugees that were resettled to the United States as adolescents during that peak migration phase. Results describe how these Acehnese refugees perceive their resettlement with regards to wellbeing, in general, and the development of their identities, sense of belonging and ecological systems of support, specifically. The results of this study shed light on how these Acehnese refugees perceive the many changes in their wellbeing from the early days of their arrival to present day. This study contributes to the literature on refugee studies, highlighting the developmental transition from childhood to adulthood and, at the same time, the cultural transition from home country to host country
First woman to lead R.I. State Police attributes her achievement in part to Portuguese-American ancestry
Get PDFInstitute intern Sabrina Brum \u2719 interviewed Col. Ann C. Assumpico, 13th Superintendent of the Rhode Island State Police for the IPLWS Elected and Appointed Officials Project and authored this news article, published on July 7, 2017 by O Jornal/The Herald News of Fall River. The IPLWS is grateful for the assistance of the Rhode Island College\u27s Office of Communications and Marketing
Eye on Ethics: Ethical Challenges in Nontraditional Programs
No full textThe wilderness therapy model emerged primarily in the 1970s. Wilderness therapy programs offer highly structured intensive therapy in remote locations that remove adolescents from the distractions available in their home communities (such as television, music, computers, cars, drugs and alcohol, movies, and delinquent peer groups). The challenges of living full-time outdoors and developing wilderness survival skills help teens develop self-confidence, problem-solving skills, and prosocial behaviors
A Computer-Based Stroke Education Orientation Program for Nurses on a Designated Stroke Unit: A Program Development, Quality Improvement Project
Get PDFEvidence of improved outcomes for patients admitted to a dedicated stroke unit supports the need for specialized stroke education and protocols. The Joint Commission now requires all stroke patients be admitted to a PSC and receive care on a designated stroke unit. Care on the stroke unit is focused on preventing further debilitation, deterioration and reducing medical complications. Nurses working at a primary stroke center are required by TJC to have initial orientation stroke education and annual competency review to ensure stroke patients receive high quality, current care. The Joint Commission also requires core stroke team members receive at least eight hours of education annually, as determined by the stroke program manager. The stroke program manager determines composition of the stroke team in collaboration with hospital leadership and other stakeholders (Daniels, Johnson & Mackovjak, 2011). It is the responsibility of each primary stroke center to develop an education program for clinical staff.
The purpose of this quality improvement project was to develop a computer-based stroke education orientation program for nurses on a recently designated stroke unit within a PSC facility
A Systematic Review Comparing Ephedrine Versus Phenylephrine During Spinal Anesthesia for Cesarean Delivery
Get PDFThis systematic review compared the efficacy and safety of ephedrine with phenylephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery. Hypotension during cesarean section delivery can have detrimental effects on both the mother and the neonate. Some vasoactive medications such as ephedrine and phenylephrine have been found to be detrimental to the neonate and divert fetal blood flow. After a systematic search of the electronic database PubMed, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart was used to identify appropriate research. Studies were illustrated in a table to identify key variables and were then critically appraised. Outcomes included oxygen supplementation use, ASA classification, IV fluid prehydration, hypotension incidence after spinal anesthesia, spinal solution and technique, umbilical artery pH, Apgar scores, and nausea and vomiting during the case. Findings revealed no difference in the use of oxygen supplementation, ASA classification, IV fluid prehydration, spinal solution or technique on fetal umbilical artery pH. Women given phenylephrine had neonates with higher umbilical artery pH values than those given ephedrine but there was no significant difference between the two vasopressors in the incidence of true fetal acidosis (umbilical artery pH \u3c 7.20 or Apga