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Inpatient Observation Safety Assistant Practices
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Introduction. Sitter usage is a patient safety practice used across healthcare organizations and the world. Sitters go by many other names, such as patient safety assistants, patient care assistants, care partners, and observation partners. There is literature that supports different variations of practices in healthcare facilities. A scoping review of the literature revealed multiple initiatives to reduce sitter cost and observation through nurse empowerment.
Purpose of Root Cause Analysis. The purpose of this root cause analysis is to determine why personnel inconsistently use the sitter policy. The appraised data will be used to improve the sitter process at this agency.
Conceptual Model or Theory. Joanne Duffy\u27s Quality Caring Model guides this root cause analysis and professional practices. This theory will simultaneously recommend nursing interventions and better understand the patient sitter process through collaboration and interactive relationships.
Methods. Email sent to registered nurses with QR code link to participate in an online survey questionnaire with a maximum of 21 Likert-scale and open-ended questions related to the agency sitter policy/ algorithm process.
Results. The analyzed results from Qualtrics showed 45.7% of the staff feel that the sitter policy is hard to locate. Also, 87% of the staff recommended it would be easier to find if built into Epic.
Conclusion. The Sitter Policy/ algorithm is hard to locate. Future work will involve placing the sitter policy/ algorithm on all computer desktops and providing education related to more accessible access to the policy
Promoting Secure Attachment in Parent-Child Dyads: A Head Start Approach
Get PDFThis grant proposal focuses on a partnership with SIUE Head Start centers in providing educational child-rearing resources, community building and parent-child dyad work to promote a more secure attachment in parent-child relationships. This proposed art therapy program will serve up to fourteen parent and child dyads within an academic year period at the estimated cost of $91,005. This program utilizes the existing Head Start staff members and enrolled families who have already expressed the need for attachment-based work.
SIUE Head Start currently serves 1,181 students who are 3-5 years of age under the curriculum and program outline of the National Head Start Association “NHSA” (East St. Louis Center 2020).The NHSA’s mission statement is to provide “support for the whole child, the family and the community—and to advocate—to work diligently for policy and institutional changes that ensure all vulnerable children and families have what they need to succeed” (Vinci, 2020). This program will follow the NHSA’s mission by anticipating outcomes to improve a child’s emotional awareness, increase positive interactions between parent and child, increase parental community and increase a child’s interest of school readiness in a different approach than any other offered by SIUE Head Start
Development of a Protocol for Perioperative Management of the Breastfeeding Mother
Get PDFFacilitating breastfeeding is a public health priority, as disruption in lactation is associated with adverse health outcomes for the breastfeeding mother and child (ACOG, 2016). The need to take medication, maternal illness, and hospitalization are among the most common reasons women cite for ceasing breastfeeding before their projected goal (Odom, Li, Scanlon, Perrine, & Grummer-Strawn, 2013). Providing a healthcare team that encourages breastfeeding during the perioperative period can minimize interruptions in breastfeeding and optimize the benefits for both the mother and infant (Simon, Carabetta, Rieth & Barnett, 2018). Unfortunately, many anesthesia providers lack confidence related to breastfeeding and drug transfer. An evidenced-based protocol utilizing reverse stoplight color-coding was created for the anesthesia department at a rural hospital in Illinois. The protocol allows for rapid identification of drugs that are safe or unsafe, to avoid a delay in breastfeeding after recovery from anesthesia. Participants surveyed after protocol introduction expressed willingness to adopt the protocol. Anesthesia providers will use the protocol as a guide when caring for breastfeeding mothers to streamline decision-making and minimize interruptions in lactation
Voyage: A Passage Through Orientation
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This DNP project is dedicated to my husband, Jim who carried my school bags to and from the car on every hockey trip, dance competition trip, camping trip, and every other trip, just so I could say I had my homework in case I found time to study. Thank you for making dinners, doing dishes, vacuuming, and providing unwavering support for me through these past years. I also dedicate this project to my children Jacob and Sophia, who always seemed to migrate their way into the dining room late at night for talks when I was up studying. No matter how tired I was back then, I would never trade those precious moments for anything in the world. I love all three of you to the moon and back and could never have done this without your encouragement and love.
Acknowledgments
This DNP project was not a work completed in a silo, for it took many people to make the Voyage: A passage through orientation a success. I have been so blessed to have leaders like, Rea, Annette, Tom, and Teri that have provided me with ongoing support throughout the years and believed that I could succeed. I am so grateful for their leadership and most of all their friendship. What awesome humans they are.
Thank you to the professors at SIUE, who guided me through the DNP process. I want to especially thank Dr. Wendy Hochreiter who took me on and got me back on the DNP track. Without her guidance and expert knowledge, I know for sure I would not have continued a course for my DNP. She has been my faithful and patient advisor and I am so thankful to have taken this voyage with her.
The unit educators, past and present, were the ones who made the Voyage orientation model a success. Without Jocelyn Wyms, Cheryle Phillips, Katelyn Bartels, Jacqueline Curtis, Tiffany Cornelius, and Angel Wilson writing the competencies for their units, the Voyage would not have come to fruition. Without the dedication of Jocelyn’s, Tiffany’s, Katelyn’s, Angel’s, and Stacey’s desire to improve the on-boarding process for new graduate nurses, the Voyage model would not have become the standard of practice for orientation. They endured a pandemic and rolled out the Voyage all at the same time. Collaborating with this group of professionals has been so enjoyable and most inspiring to me. I am forever grateful to them.
My CTD family has been so supportive throughout this process. Angela, Lisa, Donna, Jeremy, MaryAnn and now Stacey, have been my rocks through the challenges and successes of my DNP journey. Their listening ears and constructive feedback has been invaluable. I cannot thank each of them enough for always being there for me. A special thanks to MaryAnn, my mentor, who while on her own PhD journey, still found time to assist me when I asked for her expertise. A special thanks to Jeremy for standing with me through the Covid-19 summer of 2020. Your presence in our vacant office, made the lonely times more bearable. Lisa and Jeremy, your DNP journey will also end this year. I am so very proud of what you are accomplishing.
Lastly, I want to thank my family and my extended family of friends. You know who you are, and you know that I could never be successful without your steadfast support. Whether you just listened, or you were just there, your love and friendship was what made me stay strong in my pursuit of my DNP. Thanks so much to all of you for being there for me every time, all the time. A special thank you to Zandra who told me we had to start our DNP together. It was wonderful having you there in classes and you there to validate my DNP woes. Though I took a little longer than you to finish, we persisted and we did it! We are Doctors in Nursing now! To Julie, my BFF, words are not enough to tell you what it means to have someone like you love me always and forever. And to my parents, who without their solid foundation given to me at the beginning of life, this DNP would not have happened. They instilled in me that learning is a lifetime event, not a onetime event.
Thanks again to everyone who has been on this DNP voyage with me. The waters may have been rough at times, but the beauty of accomplishment, made the rough waters calm again.
Abstract
In the summer of 2020, 21 new graduate nurses (NGN) began their orientation at a community hospital in the St. Louis metropolitan area. It was at the height of the COVID-19 pandemic. The transition from an academic environment to a hospital environment was stressful enough for an NGN without a pandemic. It was imperative that a structured orientation plan be implemented to promote a smooth transition into professional practice in a hospital setting for the NGN. A tiered skills acquisition model (TSAM) was developed and entitled, Voyage: A passage through orientation, which incorporated a married state between the NGN and preceptor. Though the Voyage TSAM was initiated during a pandemic, the model was accepted and valued as the standard of practice for NGN orientation. After completing orientation, the NGNs were still overwhelmed, but with the Voyage, the NGNs were better organized, confident, and more prepared to care for patients independently
Insulated Blackness: The Cause for Fracture in Black Political Identity
Get PDFThe Black Political Identity is often treated as a monolith in American politics, with interest groups and political parties employing blanket policy solutions to appease and engage African Americans. However, observations and scholarship show that Black Americans are not monolithic, possessing divergent views about social policies, so much so that some Black Americans can hold political positions that are oppositional to collective Black advancement. Therefore, this work theorizes the concept of insulated Blackness – the extent to which self-identified African Americans oppose pro-Black remedial policies and/or disagree with commonly held ideologies about the Black condition, as a result of an existence insulated from frequent experiences of racial discrimination. This analysis will use the 2016 American National Election Study to assess experientially constructed political Blackness in terms of policies and ideologies considered synonymous with Blackness. The analysis also presents predicted probability models that demonstrate that political Blackness is rooted in the heightened racial discrimination experiences. We conclude that self-identified Blacks may exist outside of the identity of political Blackness because they perceive they are insulated from racial discrimination
Development and Implementation of an Enhanced Recovery After Surgery Protocol for Thoracic Surgery Procedures
Get PDFA high prevalence of lung and esophageal cancers leads to significant healthcare dollars utilized for treatment and management. Surgical resection is regarded as a key component for multidisciplinary treatment and management of these cancers. By standardizing multidisciplinary patient care and utilizing evidence-based practice, Enhanced Recovery After Surgery (ERAS) protocols for thoracic surgery have offered better outcomes with fewer complications and reduced healthcare costs. The anesthesia providers at the host facility were deficient in basic knowledge related to ERAS protocols and best practice management of thoracic surgery patients. The purpose of this project was to educate anesthesia providers on ERAS principles and introduce a thoracic surgery ERAS protocol tailored to host institution resources. Through multidisciplinary collaboration, a thoracic ERAS protocol was developed at a tertiary care center. An educational presentation was delivered utilizing Powerpoint to introduce ERAS principles and a standardized thoracic ERAS protocol. A post education survey was utilized to assess understanding of ERAS principles and willingness to implement the protocol into practice. Results of the project confirmed all respondents had a better understanding of ERAS principles and goals after the PowerPoint presentation. Anesthesia providers also indicated a high intent to implement the protocol into their practice. Limitations of this project are selection bias through volunteer participation and lack of generalizability with the protocol being customized to host facility needs and resources
Diabetic Education in an Uninsured Patient Population
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Patient education is an important factor in the management of Type 2 Diabetes. Successful outcomes can be causally related to proper patient education. Many times, patients are left with more questions than answers about their newly diagnosed condition. Some groups of patients are affected by prediabetes and diabetes more than other groups. Differences in health status or access to health care among racial, ethnic, geographic, and socioeconomic groups are referred to as health disparities. This is a major concern in the United States for health care providers.
A spreadsheet was used to record the blood glucose levels of each patient weekly. An A1c was recorded during the first office visit and then an ending A1c was recorded after 91 days. These levels are used to evaluate the effectiveness of the education provided. Patient education was provided via Power Point presentation. Demographic and financial barriers provided a huge barrier to patient education. There were some patients who were unable to afford most diabetic monitoring supplies. This caused several patients to decline participation in the project.
Of the twenty patients, the average beginning A1c was 10.7 and average ending A1c of 8.6. In conclusion, there was a 2.1 reduction in A1c readings. This project has shown that proper patient education in the uninsured patient population can lead to a reduction in the A1c, thus preventing any future complications of Diabetes
Implementation of a Risk Assessment Tool to Increase Screening for Extragenital Gonorrhea and Chlamydia in Men Who Have Sex with Men
Get PDFINTRODUCTION: Gonorrhea and chlamydia account for the majority of sexually transmitted infections (STIs) in the United States and are often thought to infect only the urogenital tract. Infections can also be harbored at extragenital sites (rectum and oropharynx), and these infections can increase susceptibility to HIV. Extragenital screening recommendations exist for populations deemed high risk, including men who have sex with men (MSM); yet, routine screening is not consistently completed.
PURPOSE: To improve screening rates for extragenital gonorrhea and chlamydia in MSM within a primary care setting by using an STI risk assessment tool.
METHODS: Clinicians completed a baseline knowledge survey. Clinicians were then provided education on extragenital STI infections and how to use the risk assessment tool. The risk assessment tool was given to eligible patients during preventative and STI screening office visits. Clinicians completed a follow-up questionnaire seven weeks after the risk assessment tool was implemented.
RESULTS: Clinicians reported improved knowledge base with extragenital STIs and felt more comfortable screening patients when appropriate. Clinicians reported being more likely to offer extragenital screenings using the risk assessment tool.
LIMITATIONS: Limitations included the number of clinicians participating as well as a narrow population focus. This limited the ability to evaluate the risk assessment tool for effectiveness.
IMPLICATIONS FOR PRACTICE: Clinicians are better equipped to consistently offer extragenital STI screening to patients when appropriate. On a larger scale, this process may reduce susceptibility to HIV and create opportunities to discuss and offer HIV prevention options such as pre-exposure prophylaxis (PrEP)
Improving Access to Reproductive Life Planning Following Implementation of One Key Question® in Practice
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Inadequate reproductive life planning (RLP) education is a widespread problem for women in the United States. This deficit leaves women without necessary guidance regarding contraceptive choices and maximizing pre-conception health. Use of RLP is endorsed by the American College of Obstetricians & Gynecologists (ACOG) and the Center for Disease Control (CDC). Lack of use of an RLP tool in a large, multi-site obstetrical and gynecological practice located in the Metro East is an issue that greatly impacts the patient population. The goal was to initiate the use of an evidence-based RLP tool, known as One Key Question®. The use of this tool provides a simple, yet effective, way to open the conversation and educate the patient on maximizing health prior to starting a family. This project sought feedback from the staff involved with the implementation. The results overwhelmingly supported the ease of use, as well as saw the majority supporting the desire for continued use. Over 75 percent of staff members felt that using One Key Question® in practice positively impacted patient interactions. Lack of customization of the RLP for the lesbian, gay, bisexual, trans-sexual, and questioning (LGBTQ?) population is a limitation. The use of this tool introduces the discussion of RLP goals in an unbiased and positive way that is readily accepted by patients. Long-term use would enable providers to incorporate evidence-based practice concepts into patient care. Over time, implementation of One Key Question® has the potential to positively impact the incidence of short-interval and unintended pregnancy
Increasing Patient Access to Medication-Assisted Treatment Programs for Opioid Use Disorder
Get PDFThe project sought to explore the perceived need for Medication-Assisted Treatment (MAT) for opioid use disorder among primary care providers in a rural central Illinois county. This project’s primary goal was to measure the prevalence of OUD in the community and the likelihood of primary care providers referring to an outpatient MAT program. A secondary objective was to utilize the survey results as a tool for the development of a MAT program. A cohort of twenty-five primary care providers were invited to participate in a survey to assess the perceived prevalence of OUD as well as the need for increased access to outpatient MAT utilizing Buprenorphine. The majority of respondents indicated that there are not adequate outpatient treatment options for OUD, and there needs to be more access to MAT for OUD. Community support will be a vital component of moving a MAT program forward, so an education plan to promote community engagement would be essential within the proposal for a MAT program development and could be a continuance of this project. An additional option for this project\u27s continuation would be to perform a cost analysis and develop an outpatient MAT program to treat OUD using Buprenorphine