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A Comparison of Erector Spinae Plane Block and Epidural Analgesia for Major Abdominal Surgery
Get PDFA large tertiary care center in central Illinois saw an increase in erector spinae plane (ESP) block administration for abdominal surgery patients, but many anesthesia providers at the facility were not acquainted with the ESP block. This project aimed to develop a comprehensive educational program concerning the ESP block compared to thoracic epidural analgesia for major abdominal surgery patients and ultimately improve patient care. The program introduced the relevant anatomy, indications, technique, advantages, and disadvantages of ESP block and epidural analgesia. Additionally, the risks, benefits, and costs of both adjunctive therapies were compared. The current literature shows that the thoracic epidural is the gold standard for pain control following major abdominal surgery, but the ESP block can be an effective alternative for patients where an epidural is contraindicated or undesirable. The ESP block has fewer complications compared to an epidural, but the safety profile depends on vigilant monitoring and management. Seven anesthesia providers attending the educational seminar agreed to take an anonymous pretest and posttest to evaluate the knowledge they gained from the program. The mean of the pretest and posttest were 65% and 86% respectively. The two-tailed P value equaled 0.0002 meaning that the posttest scores showed an extremely statistically significant improvement compared to the pretest scores. This project gave anesthesia providers the information necessary for them to make clinical judgments that are in the best interest of their patients thus improving patient care, safety, and satisfaction
Use of Anticipatory Guidelines in Late Infants and Toddlers 12 to 24 Months in Primary Care
Get PDFAnticipatory guidance is a well-known and utilized method that has been implemented in a majority of pediatric primary care offices. As the need for efficiency grows and increasing patient volumes climb, there is a growing need for strategies to provide this information effectively and efficiently. Prior evidence can be utilized to identify the most critical knowledge caregivers and parents will require. Our findings indicate safety, communication, nutrition, social development, and behavior as cornerstone topics for anticipatory guidance. To increase the volume of education provided to parents and caregivers, alternate methods beyond verbal discussion could be used. After gathering scientific literature on the foundational topics of anticipatory guidance we created handouts and educational videos. The videos explored communication, potty training, immunizations, drowning prevention, burn prevention, medication safety, and fall prevention. These were implemented at a rural pediatric clinic where they were met with positive feedback. Participants endorsed an array of topics (i.e., dental, nutritional, sleep, and potty training) as very satisfactory additions to their knowledge base. A review of the literature concludes that education and anticipatory guidance are foundational for preventing childhood illness and injury
Improving Pulmonary Rehabilitation Referral and Uptake for Chronic Obstructive Pulmonary Disorder
Get PDFAbstract
Participation in pulmonary rehabilitation (PR) for patients with Chronic Obstructive Pulmonary Disease (COPD) improves exercise capacity and quality of life and reduces readmissions and mortality. Despite its benefits, PR is underutilized in the treatment of COPD. Referral to PR is impacted by provider knowledge of who and how to refer, the burden of making a referral, the provider’s positive or negative influence and accessibility to a PR program. In contrast uptake of PR by patients is impacted by patient knowledge of what PR entails and how it will help their health. This project aimed to increase referrals to PR at a rural health clinic in Southern Illinois by increasing provider knowledge of what PR entails, improving confidence in who, when and how to refer to PR and improving patient knowledge about PR and how it can improve health. This project equipped providers with materials to use when discussing PR with patients, provided educational posters in examination rooms at the clinic, and measured PR referrals as well as provider’s knowledge and comfort levels in referring COPD patients to PR. The project increased provider confidence in discussing PR and knowing how and when to refer. It is unclear whether the project led to increased referrals to PR. Suggestions for further interventions to improve uptake of PR by COPD patients at this clinic include implementing a prompt in the EHR, annual reassessment and documentation of COPD symptoms, and a post COPD exacerbation bundle.
Keywords:
Chronic Obstructive Pulmonary Disease COPD, Pulmonary rehabilitation, pulmonary rehabilitation referral, COPD treatment, COPD management, pulmonary rehabilitation benefits
Art Therapy: Mechanisms of Change and Identity: A Heuristic Study
Get PDFThe aim of this arts based heuristic study was to uncover emergent themes through an intensive immersion in clay work to deepen my own embodiment and understanding of my identity as an art therapist in training and artist. As I moved through the immersion process, I experienced several mechanisms of change often theorized as reasons why art therapy works. By experiencing these mechanisms of change on a personal level, I have strengthened my ability to understand how these mechanisms work and their potential effects on clients. This has led to a better understanding and acceptance of my identity and the state of liminality in which I often feel suspended. I strengthened my identity as an artist and art therapist and experienced unexpected evolutions in imagery that pointed to the inner workings of mechanisms of change
Utilizing the Anatomage Virtual Dissection Table for Learning Neuroanatomical Structures in Nurse Anesthesia Programs
Get PDFCertified registered nurse anesthetists are responsible for developing expertise in neuraxial anesthesia. A thorough understanding of anatomy and physiology is essential in the performance of subarachnoid and epidural blocks. Although cadaveric dissection is considered the gold standard for learning anatomy, student use of cadavers can become limited due to supervisory, ethical, accessibility, and financial constraints (Periya and Moro, 2019). In recent years, the evolution of technology has produced a virtual option for cadaver dissection (Washmuth et al., 2020). The anatomage virtual dissection table is a tool that could be used to increase knowledge of neuroanatomical structures and their spatial relationships in place of cadaveric dissection. Learning modules were developed utilizing the anatomage table to learn and review anatomy pertinent to neuraxial anesthesia. Second-year anesthesia students at the host Nurse Anesthesia Program in their Fall 2022 semester participated in implementing these modules. Pre- and post- surveys analyzed with a Paired Two Sample t-test demonstrated significant improvement in the student’s knowledge and confidence when administering neuraxial anesthesia after completing the provided modules. The improvement in knowledge in neuroanatomy leads to greater success and patient satisfaction when performing epidural or spinal anesthesia.
Keywords: virtual dissection, neuraxial anesthesia, anatomage tabl
New Graduate Nurse Professional Development Planning
Get PDFA 150-bed urban hospital in Chicago lacked a formal process to assist new graduate nurses (NGRN) in developing incremental goals as a part of their longitudinal plan during their first year of professional nursing practice. This left NGRNs feeling unsupported in their journey from novice to expert. With many NGRNs choosing to leave the nursing profession within the first year of practice, organizations must invest in programs to support their transition from academia to practice. This project implemented First Year Coaches and regularly scheduled touchpoints with NGRNs to increase intent to stay at the organization, feelings of support, and future professional development activity involvement.
Fifteen NGRNs were enrolled in the Transition to Practice Program during project implementation, and nine participated in professional development planning meetings. All NGRNs enrolled in the Transition to Practice Program completed the Casey Fink New Graduate Nurse Experience Survey and a confidential survey on intent to stay and intent to participate in future professional development activities.
NGRNs participating in monthly professional development planning meetings felt supported in their new professional nursing role, and 100% of program participants reported their intent to stay at the organization for one year after their start date. In addition, participants reported a desire to participate in future professional development activities
Telehealth Integration in Primary Care
Get PDFTelehealth has been proven to be a useful and integral tool in primary care settings. Carlinville Family Health Care Clinic, a rural health clinic, has the current ability to conduct Telehealth visits but is not currently doing so. They have several programs available that are equipped with Telehealth capabilities. The physicians cite lack of education on these programs and lack of a standard streamlined practice for which program to use or how to use it.
According to the physicians in this practice, along with their patients, the use of Telehealth has multiple advantages. Because visits in this clinical are usually done in person, including minor issues such as medication refills or lab result reviews, physicians and patients feel that there is not enough time for patients with more cumbersome needs or requiring in office procedures. Patients also complain that it is difficult to fit appointment times in and the availabilities of appointment times. Lastly, patients complain that there are long waiting room times among other patients, which is an issue during the COVID-19 pandemic.
The physicians at Carlinville Family Health Care Clinic are motivated to make Telehealth visits a routine part of their practice. Understanding the use of a standardized Telehealth program and which visits would qualify for Telehealth to improve convenience for the physician and patient, will increase Telehealth compliance in this clinic. The goal of this project is to educate physicians on a standardized Telehealth program to improve Telehealth use in Carlinville Family Health Care Clinic
Adjuncts and Additives to Regional Anesthesia
Get PDFWith regional anesthesia becoming increasingly popular, an emphasis has been placed on choosing appropriate adjunct medications to local anesthetics for prolonging peripheral nerve blocks- lengthening postoperative pain control and decreasing perioperative narcotic usage. This project aimed to increase provider knowledge of the proven efficacy of block and adjunct selection for breast, shoulder, and knee surgeries with intended results being prolonged block duration and increased patient satisfaction post-operatively. A focused lecture along with a Likert-scale questionnaire and quiz were administered to a small sample of anesthesia providers at a rural Illinois hospital. Half (55.6%) of the providers showed evidence of knowledge gained in PNB choice as well as adjunct selection. The remaining 44.4% did not reach out after the presentation and post-presentation knowledge was unable to be assessed. Thus, the results of the post-test and efficacy of the training may not be applicable to larger populations
Enhancement of a Peer Mentorship Program for Student Registered Nurse Anesthetist
Get PDFNurse anesthesia programs are associated with rigorous didactic work, doctoral projects, long clinical days, and high levels of financial debt (Mesisca & Mainwaring, 2021). Doctoral students experience significantly higher levels of stress than other graduate students, necessitating resources that support emotional wellness (Griffin et al., 2017). A mentorship program for student registered nurse anesthesiologists (SRNA) may help minimize perceived stress and lessen the adverse physical and psychological effects. While mentorships foster both personal and professional success for mentees, mentors also report increased interest in professional development, productivity, and satisfaction (Flexman & Gelb, 2011). This study aimed to evaluate the effectiveness of an established SRNA peer mentorship program in reducing stress and anxiety and improving confidence levels. The literature review identified four recommendations to foster program improvement: (1) match mentees with mentors of similar backgrounds, (2) integrate more structure, (3) assign mentors after admission and (4) involve faculty as mentors. Student mentors and mentees were surveyed to assess perceptions about the current program and the literature review findings. Results revealed SRNAs would like to be matched with peer mentors from similar backgrounds, ages, and life experiences and, during their third year, certified registered nurse anesthetists
A Multifaceted Approach to Promoting Speaking Up Behavior in a Community Hospital
Get PDFIntroduction
This project describes results of a multifaceted approach to promoting Speaking Up Behavior (SUB) among nurses in a community hospital. Patient safety outcomes, perception of healthy work environment, and nurse retention are connected to caregiver communication.
Methods
Interventions included development of a structured SUB communication and debriefing tool, SUB administrative policy, leadership rounding and verbal support for SUB, formal recognition of SUB, and SUB education including role-playing activities. Cross-sectional surveys evaluating nurse comfort and confidence with SUB using validated tools were implemented before and after the multifaceted interventions.
Results
The bedside nurse voluntary turnover rate reduced from 14.5% to 13.0% and the rate of patient safety events with communication as a factor reduced from as high as 2.25 to 0.76 per 1,000 patient days. Nurses had higher levels of comfort speaking up for patient safety and professionalism, as well as higher levels of engagement and trust in speaking up that were statistically significant following the interventions.
Implications for Practice
Interventions that promote SUB involving organizational culture, policy, leadership, recognition, and education may result in improved outcomes in patient safety, nurse turnover, and likelihood of SUB