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Effectiveness of Virtual Reality in Anesthesia Machine Education
Get PDFThe anesthesia machine is an essential part of anesthesia practice, as it connects the patient to the provider and provides a constant stream of vital information. Therefore, the Certified Registered Nurse Anesthetist (CRNA) should be trained to utilize and troubleshoot the anesthesia machine to deliver high-quality patient care. Education about the anesthesia machine begins with Student Registered Nurse Anesthetists (SRNAs) through various learning opportunities. Immersive virtual reality simulation has emerged as a potential educational aid to engage active learners. This project aimed to determine the effectiveness of utilizing the immersive virtual reality simulator SIMVANA for first-year Southern Illinois University Edwardsville (SIUE) SRNAs to learn about the components of the anesthesia machine. The study involved a pre-implementation survey, a hands-on session with SIMVANA, and a post-implementation survey. An additional survey was provided five months after the participants had experienced clinicals. The comparative analysis of the survey results showed that SIMVANA reduced the SRNAs’ anxiety surrounding the anesthesia machine and improved the SRNAs’ ability to utilize the anesthesia machine with confidence. Overall, the SRNAs recommended that SIMVANA be incorporated with future cohorts to become more confident practitioners with the anesthesia machine in preparation for clinical
Anesthetic Management of the Parturient with Increased Intracranial Pressure Disorders
Get PDFThe parturient experiences various physiologic changes that contribute to the potential for increased intracranial pressure (ICP). Patients with preexisting neurologic conditions such as Chiari Malformation I, pseudotumor cerebri, and mass occupying lesions are at significant risk of increased ICP. A literature review was conducted to determine the safest labor anesthesia options for the parturient with increased intracranial pressure. After the literature review, a PowerPoint presentation and reference guide were given to a group of anesthesia providers at a central Illinois hospital that discussed the evidence-based recommendations. A voluntary survey was completed after the presentation to assess an improvement in knowledge and staff willingness to use a reference tool to decide the safest anesthesia labor option. The survey showed improved knowledge of the anesthesia options for the parturient with increased ICP and willingness among providers to use the reference guide to determine the most appropriate and safest anesthesia option. The overall acceptance of this project promotes safe care for the mother and fetus while potentially reducing morbidity and mortality in a unique population
Human Trafficking and Resources Provision in the ED
Get PDFHuman trafficking is both a human rights violation and a national health crisis. Despite nearly 165,000 identified cases in the United States since 2007, studies hypothesize that many more victims remain undetected despite up to 88% of trafficked persons interacting with the healthcare system during the time they are being trafficked. The lack of identification of these victims has often been attributed to healthcare providers\u27 lack of knowledge regarding human trafficking indicators and lack of confidence in how to address trafficking situations when they are encountered. Emergency department care providers of a 500-bed central Illinois hospital received education and resource binders containing screening tools, action steps, and contact information for local human trafficking resources. A statistically significant increase in the confidence of the participants about identification and knowledge of how to care for human trafficking victims was observed. Increased awareness encouraged the identification of two possible victims of human trafficking and the development of an organization policy about how to care for potential human trafficking victims. Further recommendations for continued work would include a computer-based learning module to ensure completion of education, education provision to affiliate hospitals, and customization of education for areas offering outpatient services. Swift and easy access to protocols for actions to be taken and accessible support resources for trafficked persons appear to be the most impactful intervention of this quality improvement project
Implementation of Electronically integrated Pediatric Screening Templates
Get PDFEvidence-based clinic guidelines improve patient outcomes by providing clinicians with research-based recommendations, and when combined with the electronic health record (EHR), clinicians have the potential to improve their documentation and reduce the time it takes to document a patient encounter. A pediatric clinic in the metro-east area of Southern Illinois lacked EHR templates during patient encounters that focused on depression, anxiety, ADHD, and concussion screening. Templates embedded in the EHR were created in a SOAP note format to aid the clinicians during patient encounters and aid in documentation. Clinicians were asked to utilize the templates over a 6-week period. The intervention was evaluated before and after the implementation. Post-implementation note quality and documentation time improved by 33% after implementing the intervention. Documentation also showed a 20% increase in thoroughness and organization. A multiple-choice survey was also used to determine the provider’s current knowledge of the diagnoses and patient population being treated for depression, anxiety, ADHD, and concussions. There were many limitations in this study, including a lack of provider buy-in, limited sample size, and limited patient encounters. A larger provider buy-in and sample size would better represent the effectiveness of the templates in practice
External Direct Sum Invariant Subspace and Decomposition of Coupled Differential-Difference Equations
Get PDFThis article discusses the invariant subspaces that are restricted to be external direct sums. Some existence conditions are presented that facilitate finding such invariant subspaces. This problem is related to the decomposition of coupled differential-difference equations, leading to the possibility of lowering the dimensions of coupled differential-difference equations. As has been well documented, lowering the dimension of coupled differential-difference equations can drastically reduce the computational time needed in stability analysis when a complete quadratic Lyapunov-Krasovskii functional is used. Most known ad hoc methods of reducing the order are special cases of this formulation
Evaluation and Education of Enhanced Recovery After Surgery Protocols for Total Knee Arthroplasty
Get PDFEnhanced recovery after surgery (ERAS) utilizes a multimodal, multidisciplinary perioperative protocol to minimize hospital length of stay, surgical complications, readmissions, and patient hospital costs (Frassanito et al., 2020). The protocols were initially established for abdominal and colorectal surgical patients; however, ERAS protocols are now widely used in other areas, including orthopedic surgery (Kaye et al., 2019). To achieve the maximum benefits, ERAS protocols must contain preoperative, intraoperative, and postoperative components. A rural critical access hospital in Eastern Illinois, Crawford Memorial Hospital, serves numerous patients requiring total knee arthroplasties (TKA). While the providers utilize some aspects of ERAS protocols for these surgeries, they lack a formal ERAS protocol and full utilization in practice. To promote the future implementation of an ERAS protocol for TKAs at Crawford Memorial Hospital, staff education about ERAS protocols is imperative and the primary goal of this project. To achieve this goal, the research was reviewed to obtain current evidence-based practices regarding all aspects of ERAS protocols for TKAs. A voiceover PowerPoint was assembled with the literature review results and emailed to the appropriate providers. The providers who participated in the PowerPoint presentation were asked to complete a pre-survey and a post-survey to assess increased knowledge about ERAS protocols and their willingness to implement the protocol in the future. The results of the surveys proved there was knowledge gained by the providers
Creation of an Educational Pamphlet for Patients Receiving Upper Extremity Peripheral Nerve Blocks
No full textUpper extremity peripheral nerve blocks (PNB) are utilized in anesthesia as a sole anesthetic or in combination with another technique for pain management. Perioperative registered nurses (RN) are directly involved in PNB procedures, patient care, and patient education. Patients typically do not have access to anesthesia personnel to address questions and education preoperatively, leading to increased importance of patient education and educational resources concerning anesthesia. After a literature review, a PowerPoint presentation and patient education pamphlet were implemented at a surgery center in Edwardsville, Illinois. The PowerPoint presentation was created for RN education, and the pamphlet was utilized as a patient education resource. A pre-implementation and post-implementation survey assessed an improvement in RN knowledge and buy-in and effectiveness of the patient education pamphlet. The post-implementation survey showed improved RN understanding of PNBs, patient care, and patient education. The majority of RNs who participated in the post-implementation survey agreed that the patient education pamphlet was an effective patient resource and that the providers were willing to use the pamphlet to improve patient education. The overall acceptance of this project promotes best practice in perioperative care for patients receiving PNBs
Improving Depression Screening in Primary Care
No full textDepression remains an increasingly prevalent and underdiagnosed disorder affecting approximately 21 million adults in the United States with only 66% seeking treatment (NIMH, 2022). Untreated depression can lead to worsening mental and physical health which negatively impacts a person’s quality of life. The implementation of routine depression screening in primary care is recommended by the US Preventive Services Task Force (USPSTF) to improve early detection leading to improved outcomes (USPSTF, 2023). Despite increased depression prevalence and USPSTF recommendation, there remained an absence of routine depression screening in a primary care practice in Midwest Illinois which led to the development of this evidence-based quality improvement project (QIP). The goal of this QIP was to implement routine depression screening using the PHQ-2 and PHQ-9 to improve depression screening in adults encountered at this primary care practice. Methods utilized included integrating the PHQ-2 and PHQ-9 depression screening tools into the EMR, a staff educational session, a pre-and post-intervention staff questionnaire, and a post-intervention staff satisfaction survey. Results showed a 43% improvement in patients screened with 10% scoring positive on the PHQ-2; pre- and post-intervention staff questionnaires showed an overall improvement in knowledge, confidence, and frequency of screening; and the post-intervention staff satisfaction survey showed depression identification as a valuable aspect and concern was related to time constraints during patient visits. A recommendation to continue routine depression screening for all adult patients was conferred with this practice\u27s personnel
Nurses\u27 Experience Implementating Weighted Blankets in Inpatient Psychiatric Unit
Get PDFThe complexity of treating sleep difficulties in patients with concurrent psychiatric disorders continues to be a struggle for the medical community. The mechanism that causes psychiatric disorders can induce insomnia or hypersomnia (Khurshid, 2018). There is also a growing interest in disturbed sleep ability to induce psychiatric episodes (Verkhratsky et al., 2020). This classic “Chicken or Egg Scenario” meets the modern focus on creating the best outcome for patients with the least medication, spurring interest in the holistic management of sleep disorders. The literature has little information on the use of weighted modalities for sleep management and anxiety in an inpatient psychiatric unit due to the difficulty of studying this population and the safety concerns. This DNP Project aimed to understand the nurses\u27 experience using weighted modalities and identify barriers and safety concerns for future studies. Data was collected via anonymous surveys of nurses during the implementation of weighted modalities on a 13-bed secure acute psychiatric unit at a midwestern hospital. Results showed that using weighted lap pads for anxiety and weighted blankets for sleep could improve patient outcomes. Weighted modalities were well received by nurses and patients alike due to their positive impact on patients and the milieu while maintaining safety
How Poor Leadership and Favoritism Intersect to Create Toxic Work Environments
Get PDFDiscussions about leadership in academic libraries rarely focus on the negative; they mostly focus on best practices of leadership. There is hardly any discussion of poor leadership, nor is there a rigorous discussion of concerning behaviors that poor leaders engage in, such as favoritism. Concomitantly, there is little to no discussion about how to identify and address behaviors that poor leaders engage in and how academic libraries can change toxic institutional culture. In this chapter, we are interested in defining poor leadership and favoritism to change toxic institutional cultures and give voice to those who are affected by poor leadership and favoritism. We will attempt to add to the literature on toxic workplace cultures in academic libraries by exploring the intersection between poor leadership and favoritism and how they manifest to cultivate a toxic workplace culture in academic libraries.
We will discuss how poor leaders weaponize favoritism to silence, manipulate, bully, and exclude lower-ranked faculty and staff, create de facto leaders, cultivate the wrong type of leaders, and allow egregious behaviors to not be addressed. We will also discuss the long-term implications of poor leadership and favoritism and demonstrate how favoritism is in direct conflict with the espoused values of LIS, particularly diversity, equity, and inclusion (DEI). This chapter aims to help identify the signs of poor leadership and favoritism and validate the experiences of those working in academic libraries saddled by poor leadership and favoritism and empower them to overcome a culture of control and transform it into one of inclusion and engagement