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Assessment of Caregiver Burden in a Memory Loss Clinic
Get PDFBackground: Over 131,000 people in Illinois identify themselves as caregivers of someone with memory loss. The family caregiver may provide care including, but not limited to, assistance with activities of daily living, financial responsibilities, behavior management, and scheduling, and transportation to medical appointments. The care provided by the caregivers may lead to caregiver burden symptoms of depression, anxiety, and perceived stress. Purpose: Health care providers at a central Illinois memory clinic are not currently completing formal assessments of caregiver burden. This quality improvement project was done to determine if the current memory loss program services provide enough support to prevent caregiver burden in caregivers of people with memory loss or if further intervention is needed. Methods: Assessments were completed during a ten-day clinical period in a memory loss clinic. The Zarit Burden Interview (ZBI) and a demographic questionnaire were offered to each caregiver presenting to the memory clinic. Results: Twenty-five caregivers participated in this project, and all participating caregivers reported some degree of caregiver burden. Demographic information, patient Mini Mental State Exam scores from the clinic visit, and ZBI scores were evaluated to determine trends of contributory factors for caregiver burden and/or control of caregiver burden. The caregiver burden results revealed by the ZBI assessment, support the need for implementation of a formal caregiver burden assessment within the clinic. Further study into interventions is recommended to help reduce the symptoms of caregiver burden
Empowering Nurses to Recognize Post-Stroke Depression in the African American Community
Get PDFAfrican Americans (AA) have the highest prevalence of stroke and death compared to other racial groups in the United States. Post-stroke depression (PSD) affects approximately 1/3 of all stroke patients and is underdiagnosed in the African American community.
Aim: By using a mHealth mobile app and a Psychiatry provider list at discharge, PSD can be identified, and interventions initiated, thus decreasing the sequela of PSD in AA.
Methods: Nurses were provided education on PSD, expressions of depression in African-Americans, cultural humility, implicit bias, and the importance of the nurse\u27s role in developing a therapeutic relationship.
Results: Quantitative analysis revealed the mean score of the pre-education test was 56% and the post-education test was 95%. There was a 59% increase in recipient knowledge after education was provided compared to pre-education. Stroke nurse navigators provided quantitative data to measure PHQ2 at seven and 30-day follow-ups and whether the provider list and mHealth app were utilized. 100% of the post-implementation surveys demonstrated the use of the knowledge gained during the implementation and an increase in comfortability discussing PSD.
Limitations: Stroke unpredictability, therapy needs, hospital discharge timing, small sample size, time limit of implementation, and no 30-day post-stroke follow-up data. Of the 31 patients discharged that received a seven-day follow-up call, only three were AA.
Conclusion: With education nurses are empowered to recognize PSD and initiate intervention, reducing the sequela of PSD in the AA community
The Use of Point of Care Ultrasound to Assess Gastric Contents and Determine Aspiration Risk in the Obese Patient Presenting for Elective Surgery
Get PDFPulmonary aspiration of gastric content is a potentially injurious and fatal complication of anesthesia. Obese patients with a BMI ≥ 35 presenting for elective surgery are at an increased risk of aspiration due to increased gastric pressure, delayed gastric emptying, and higher gastric volumes. Point of care ultrasound (POCUS) is a tool that allows the nurse anesthetist to assess gastric content and assign aspiration risk based on the scan results. A knowledge improvement project in the form of a lecture and hands-on tutorial focused on using POCUS to assess gastric content and assign aspiration risk was designed. This project was implemented for the anesthesia providers at a community hospital in central Illinois. Four pre and post-test surveys were collected which demonstrated an improvement in knowledge and a high willingness to utilize the tool in the future. All anesthesia providers agreed upon the value that POCUS brings to preoperative assessment of gastric content and determination of aspiration risk, and that this tool could be used in other patient populations including those with chronic kidney disease and diabetes mellitus
Introduction of Enhanced Recovery After Cesarean Section (ERAC) Protocol
Get PDFCesarean section is one of the most performed in-patient surgeries worldwide (Wilson et al., 2018; Liu et al., 2020). Births by cesarean section have been increasing globally. Cesarean birth rate has remained above 31% in the United States, even with the consistent two percent decrease in birth rate per year (Martin et al., 2019). Illinois has also maintained a high cesarean birth rate above 30% (Hamilton et al., 2021). Cesarean patients experience inflammatory and neurohormonal changes with many adverse effects in direct response to surgical stress (Mullman et al., 2020). The post-cesarean physiological effects, including pain, reduced gastric motility, pulmonary complications, delayed ambulation, prolonged hospitalization, delayed mother-baby bonding, and fatigue, directly impact maternal health, and indirectly affect the neonates (Gramlich et al., 2017). Improved anesthesia care can mitigate against the physiological stressors of cesarean surgery to promote rapid surgical recovery, improved safety, and patient satisfaction. The Society of Obstetric Anesthesia and Perinatology adopted ERAC in 2019 to provide standardized, evidence-based, multidisciplinary care to cesarean patients (SOAP, 2019). The objectives of ERAC can be achieved by adopting, implementing, and complying with the developed ERAC protocol by healthcare providers, specifically anesthesia providers, in the community hospital
Utilizing a Personal Health Coach in the Management of T2DM
Get PDFManagement of type 2 diabetes mellitus (T2DM) can reduce hemoglobin a1c values and ultimately reduce the risk of morbidity and mortality. Many adults live with uncontrolled T2DM due to a lack of knowledge of disease management. The purpose of this project was to evaluate the implementation of a personal health coach for the management of T2DM in adult patients. An extensive literature review was conducted, and the use of the Diabetes Management Self-Efficacy Scale (DMSES) was chosen to evaluate participants’ self-efficacy regarding their T2DM. Adult patients aged 21-75 with a diagnosis of T2DM and a hemoglobin a1c \u3e7 in a federally qualified healthcare clinic in southern Illinois were asked to complete a pre-and post- DMSES and a pre-and post- hemoglobin a1c. Seven participants were initially enrolled, with three completing the project in its entirety. During the implementation period, participants were engaged in routine phone calls with the investigators to discuss areas of diabetic management. Results revealed a mean decrease in hemoglobin a1c values by 0.93% and improvements in DMSES scores examining the ability to check blood sugars and correct as necessary, ability to perform foot exams, adjust meals based on dietary needs and blood glucose levels, and to follow a healthy meal plan and take medication appropriately. The DSMES scores showed a mean decrease or no change for questions 5, 9, and 10, which examined weight and exercise. Overall, results revealed participants gained confidence in their perceived abilities to manage their T2DM
Development of Evidence-Based Rubrics and Instructional Videos for Anesthesia Induction Sequences
Get PDFSafe and effective induction of anesthesia is a vital component of any anesthesia provider’s skill set. Although both typical sequence and rapid sequence induction are common procedures, much variance in technique exists among providers. Clear, standardized rubrics are an important element in teaching these skills. The purpose of this project was to update the typical and rapid sequence induction rubrics for the Southern Illinois University Edwardsville Nurse Anesthesia Program with the current best practice recommendations. To utilize and reinforce observational learning, instructional videos were also created to accompany the updated rubrics. These materials were presented to the student registered nurse anesthetists (SRNAs) in the course NURS 529 - Orientation to Nurse Anesthesia Practicum prior to beginning clinical rotations. The SRNAs completed a 20-question pretest and viewed the rubrics and instructional videos. One week later, the SRNAs completed an identical posttest and overall evaluation of the educational experience. Results showed that scores improved between the pretest and posttest (78% and 89% respectively) indicating a potential gain in knowledge and skills. Survey results indicated overall buy in and acceptance of the new materials by the SRNAs. These results highlight the importance of multimodal learning in mastering critical, high-level skills such as induction of anesthesia
Improving Depression Surveillance at the We Care Clinic
Get PDFDepression is one of the most underdiagnosed and untreated disorders affecting more than 16 million people in the United States each year (Henry et al., 2020). Unmanaged depression can lead to emotional suffering, decreased productivity, reduced income, impaired relationships, and an increased risk for comorbidities (Sinisalchi et al., 2020). It can affect anyone, however, individuals who are non-white, female, undereducated, disabled, pregnant or postpartum, have low socioeconomic status, or lack social support are at an increased risk (United States Preventative Services Task Force, 2019). The Southern Illinois University Edwardsville We Care Clinic provides primary care to minority patient populations who are uninsured and have chronic comorbid health conditions. Despite providing care to a high-risk population for depression, the clinic did not have a standardized process to screen patients; therefore, an evidence-based quality improvement project was developed to address this inconsistency in care. The project’s goals were to develop a depression screening protocol for adult patients, improve staff knowledge of depression screening, and increase depression surveillance. Methods utilized included staff education, pre-and post-implementation staff surveys, and patient screenings. Results demonstrated an overall increase in the number of depression screenings conducted, improved staff confidence in administering depression screenings, and staff recognition of the protocol as a useful tool in clarifying when to screen patients. Continued use of the depression screening protocol has the potential to identify patients with depression and improve patient outcomes
A Micro-Typology of Contact Effects in Four Tibeto-Burman Languages
Get PDFWhen minority languages with similar typological profiles are in long-term contact with a genealogically unrelated socioeconomically dominant language, the perfect context is provided for investigating which observed contact effects are demonstrably allied to sociolinguistic dynamics rather than purely structural ones. This paper investigates the factors determining the different extent of contact effects in four Tibeto-Burman languages (Gurung, Gyalsumdo, Nar-Phu, and Manange) spoken in a geo-politically defined and multilingual region of Nepal. Using corpus data and sociolinguistic interviews collected in the field, we demonstrate that a range of social, economic and geo-spatial factors contribute to asymmetries where contact effects are observed in the four speech communities. These notably include factors specifically relevant in mountain-based communities, including proximity to transport and trekking routes, outward migration effects on small settlements, and the primary economies of the different parts of the Manang District
The Development of an Evidenced-Based Guideline for the Anesthetic Management of Surgical Cases Utilizing Evoked Potential Monitoring
Get PDFRecent increases in the prevalence of neuromonitoring cases have contributed to the utilization of evoked potential (EP) monitoring during surgery. Evoked potentials are electrical signals measured in response to a stimulus. Intraoperative neuromonitoring is used to alert the surgeon, anesthesia provider, and neuromonitoring technician of changes before permanent nerve injury occurs. There are many factors that can affect neuromonitoring quality including hypothermia, hypotension, positioning, anemia, and anesthesia medications. The latter is especially important since certain anesthetic medications can have a profound inhibitory effect on the nervous system, leading to decreased amplitude and prolonged latency of EP signals. As a result, anesthetic agents negatively affect neuromonitoring and the technician’s ability to measure EP signals that can alert the surgeon of potential injury to the patient. Total intravenous anesthesia (TIVA) is a type of general anesthesia that utilizes only intravenous medications administered by infusion or bolus. This anesthesia technique can provide safe and optimal conditions for effective EP signal monitoring. Despite the widespread use of TIVA for EP monitoring surgical cases, significant variance in this technique existed among anesthesia providers at a tertiary care center in central Illinois. A guideline was implemented at the host facility that focused on current best practice recommendations in anesthesia management for surgical cases requiring EP monitoring. The guideline was implemented via a PowerPoint presentation along with a thirteen-question post-implementation survey. Results indicated overall provider acceptance of the TIVA guideline for EP cases and demonstrated that the presentation and guideline were effective tools that could aid in the facility’s ability to administer optimal anesthesia. As a result, the continued use of the guideline has the potential to improve patient safety, ensure reliable results, and optimize outcomes in patients undergoing EP surgical procedures
Computer-Based Learning Module: Local Anesthetic Systemic Toxicity
Get PDFLocal anesthetic systemic toxicity (LAST) is the result of rapid absorption of local anesthetics (LAs) into the systemic circulation resulting in toxic plasma levels of the drugs. With the advent of ultrasound-guided regional anesthesia and improvements in injection techniques, the incidence of LAST has decreased significantly over the years. Even though LAST is rare, it is a potential, life-threatening complication associated with any administration of LAs. Providers and staff members taking care of patients receiving LAs should be astutely aware of potential complications so that LAST signs and symptoms can be recognized, and treatments can be implemented as swiftly as possible. The project aimed to develop and implement a computer-based learning module about LAST and its management. The module was disseminated via HealthStream, a web-based learning management system, to Registered Nurses, Certified Registered Nurse Anesthetists, and Physician Anesthesiologist at a tertiary care center in central Illinois. The project was based on a non-experimental pretest-posttest single group design to assess participants’ knowledge before and after implementation of the CBL module. The module was completed by 116 participants, and results were evaluated. The average pretest score was 55%; the average of the posttest was 87% with an average of 1.3 attempts, which was 32% higher compared to the pretest. This project identified knowledge deficits regarding LAST and emphasized the necessity for further education on LAST. Thus, this project supported the use of a CBL module as a means to educate providers and staff members and will help promote awareness, vigilance, and readiness among healthcare providers and has the potential to keep the patient safe should this life-threatening complication occur