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Implementing a Validated Developmental Screening Tool in a Rural Pediatric Primary Care Clinic to Enhance Early Diagnosis of Developmental Delays from Birth to 36 Months
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Evaluation of childhood development with a validated screening tool has been the gold standard for best practice recommended by the American Academy of Pediatrics (AAP) since 2006. A rural pediatric clinic was the setting for this quality improvement project. The goals of the project were to 1) increase the number of children identified with developmental delays, 2) identify children with delays earlier, and 3) maximize the number of children receiving early intervention (EI) services between the ages of birth to 36 months. The Ages and Stages Questionnaire (ASQ-3) was the selected screening tool adopted by the clinic in June 2020. Data was collected on 1) the number of children screened, 2) the ages at the time of screening, 3) the number of EI referrals, and 4) the number of qualified EI referrals. Pre- and post-implementation data was analyzed and showed a statistically significant decrease in the number of referrals made for EI services, as well as those that qualified for EI services. The concluding results show that using a validated screening tool decreased the number of futile referrals made for EI services after screening for developmental delays in children birth to 36 months for this clinic. The ages of children referred for EI services did show that children were identified at a younger age comparative to the previous methods used by clinicians in the pediatric clinic, but the data was skewed due to COVID-19.
Keywords:
Developmental delays, pediatric growth and development, developmental screening, early intervention, EI, birth to 36 months, quality improvement, pediatric screening, primary care screenin
Culturally appropriate health education: Translation of a parturient pain relief options pamphlet into French and Spanish
Get PDFThe rise of immigration worldwide introduces a diverse, multicultural population of patients seeking healthcare in the United States. Barriers to communication, both spoken language and culturally associated communication norms, limit immigrant women’s ability to seek, gain access, and follow through with perinatal care. In order to provide safe, effective, and culturally sensitive care, recognition of language and cultural differences of all individuals must be considered when providing patients with educational materials (Perera et al., 2012; Plumbaum et al., 2014). The aim of this project was to translate an existing pain relief options pamphlet into French and Spanish in order to help reduce communication barriers and increase health literacy amongst non-English speaking parturients at the host facility. Stakeholders were introduced to the translated pamphlets and literature review findings with a virtual presentation. Following the educational opportunity, participants completed a survey to evaluate the pamphlet. Fifteen of the 16 providers agreed or strongly agreed the pamphlet provided culturally relevant information and would be a valuable education tool. All providers agreed or strongly agreed the pamphlet included relevant information and may increase autonomy for non-English speaking mothers. Culturally relevant and translated pain relief education materials will potentially help increase parturient health literacy and maternal-fetal outcomes.
Keywords: immigrant, parturient, cultural sensitivity, health literacy, patient education, translatio
Developing a Peer Mentoring Program for SRNAs
Get PDFFaculty of a nurse anesthesia program at a Midwestern University requested evidence of the impact a peer mentoring program could make in reducing stress levels for SRNAs. To better tailor a peer mentoring program, surveys were developed and distributed to the university’s SRNAs and to program directors of CRNA programs across the country.
Based on the literature, a survey was developed and distributed to 81 SRNAs at this university to evaluate their stress and their perceptions of the impact of peer mentoring on stress. Another survey was developed and distributed to 118 program directors to learn if they have a peer mentoring program and their perceptions of the impact on students.
For both genders in all years of the program, there was a significant increase in baseline stress from prior to anesthesia school to during anesthesia school (p \u3c0.05). On a scale from 0-10 (with 10 being the most helpful), students rated the perceived helpfulness of a peer mentoring program with a mean score of 6.9. The majority of program directors reported successful mentoring programs with increased academic success.
Results from the literature review and surveys determined a peer mentoring program would positively impact stress experienced by SRNAs, leading to higher academic success and ultimately better patient outcomes. We met with CRNA program administrators and recommended a structured peer mentorship program be initiated. The administration indicated they plan to develop a peer mentoring program and will use our information during the design
Death Anxiety, Artmaking and the Facilitation of Death Discourse
Get PDFDiscussion about death, known as death discourse, has been historically limited to the confines of the palliative care, elderly and hospice arenas (Bradshaw, 1996; Granek, 2013; Safrai, 2013; Zimmerman, 2012). This study examined the impact of artmaking on facilitating death discourse in college-aged students from a midwestern United States campus. A mixed methods design was implemented in which participants completed the Communication Apprehension about Death Scale (CADS; Carmack & DeGroot, 2016), an artmaking directive addressing feelings about death, followed by a Post-Artmaking Reflection about their artwork. Following a 10-day time period after the artmaking session, participants were re-administered the CADS electronically, and questioned about their thoughts and patterns concerning discussion of death since the artmaking directive. Quantitative analyses of CADS scores from both sessions revealed an overall decrease in scores after making art about death. A thematic analysis of all artwork and essays created by the participants revealed themes of feeling conflicted emotions regarding death, with visual art featuring circles, human figures, and dark saturated colors most prominently. Findings suggest that apprehension levels discussing death can be decreased through artmaking and that artmaking could facilitate discussions surrounding death
Dataset for Characterization of ‘Cool’ and ‘Warm’ White LEDs
No full textThe emission properties of “cool” and “warm” white LEDs were studied. The suitability of pulse-width modulation as a method to control LED brightness was examined. Both types of LED demonstrated emission standard deviation minima at a PWM frequency greater than 2000 Hz. The functional wavelength ranges of the LEDs were approximated using the linearity of brightness as a function of pulse-width modulation duty-cycle and the root mean squared deviation from mean for absorbance measurements. Both LED types demonstrated good stability in absorbance measurements over long operation times. The “warm” LED demonstrated a broader range of wavelengths useful for spectrophotometry. This is the dataset of the investigation
Integration of the SVS WIfI Classification System for Ulcer Staging and Management in an Amputation Prevention Program
Get PDFChronic limb-threatening ischemia is a significant problem with increased morbidity and mortality along with the risk of amputation. With the increased prevalence of diabetes worldwide, the population of patients presenting with nonhealing ulcers shifted from purely ischemic ulcers to a more complex picture for wound healing. Amputation prevention programs were developed to care for this heterogeneous population of patients. However, with multiple disciplines, there was no unified classification system in use. The historical classification systems were not inclusive to evaluate all aspects of wound healing, the extent of the wound, amount of ischemia, and the presence of infection. The Society for Vascular Surgery (SVS) developed the wound, ischemia, foot infection (WIfI) classification system to address all three aspects of wound care and evaluate the risk of amputation at one year, along with the benefit of revascularization. This DNP project aimed to implement the SVS WIfI classification system into a local amputation prevention program. The SVS WIfI classification system education was provided through PowerPoint presentation during the monthly amputation prevention meeting; it was also disseminated through E-mail. A survey was conducted to evaluate the provider\u27s attitudes and beliefs using the SVS WIfI classification system. The results demonstrated improvement in knowledge of the SVS WIfI classification system. A chart review was conducted after initial education throughout a two-month period, which revealed increased SVS WIfI classification system documentation
The Impact of a Cultural Competence Assessment Tool on Teaching Strategies in the DNP Curriculum at Southern Illinois University of Edwardsville
Get PDFProviding culturally competent and culturally congruent care to patients leads to better outcomes and reduction of poor outcomes due to health disparities. Providing care that is not culturally congruent can contribute to communication barriers, resulting in deficient diagnostic testing, miscommunication about etiologies, treatment plans that are not individualized, and discounting of patient\u27s ideas. Individuals from diverse cultures face health disparities which contribute to inadequate care and poor outcomes. The purpose of this project was to survey former graduates of the Southern Illinois University of Edwardsville (SIUE) family nurse practitioner (FNP) program to assess their level of cultural competence and areas where curriculum changes can be implemented to improve cultural competence levels of future graduates. An extensive literature review was conducted, and a survey tool was identified. Alumni of the SIUE FNP were invited via email to voluntarily participate in a survey about their experiences regarding culturally competent care in practice and culturally competent care learning opportunities in the SIUE FNP program. Results revealed participants possess high levels of cultural competence; however, a majority of participants described confidence levels as “somewhat competent” and “somewhat incompetent”. Additionally, participants identified which teaching strategies they found most useful, and provided suggestions for curriculum improvement, such as teaching strategies and including learning opportunities focused on culturally competent care throughout all courses in the program
Presurgical Optimization Videos for Patients Undergoing Elective Spine Surgery
Get PDFSpine surgery is a growing healthcare trend with more than 199,000 lumbar fusions alone being performed in the United States in 2015 and annual costs of more than $10 billion. Spine surgery represents a major life-altering event for patients, with high complication rates and extensive recovery periods for which patients often feel unprepared. Presurgical optimization and education have the potential to decrease medical complications, improve outcomes, and reduce patient anxiety related to surgery. The purpose of this project was to implement presurgical education videos focused on modifiable risk factors for patients undergoing spinal surgery at an urban academic medical center. Current literature was reviewed and used to establish recommendations in the areas of smoking cessation, nutrition, exercise, and pain management and coping. Videos were filmed and the link distributed over the course of six weeks to patients during clinic visits or through secured electronic medical record messaging. Surveys collecting demographic information and feedback regarding the videos were included with the link. There were 13 responses to the survey. Patients rated them positively as being helpful, clearly presented, habit changing, improving preparedness for surgery, and would recommend them to others. Many of the patients provided additional feedback and suggestions for future video topics. The surgeons and their staff found the videos to be beneficial for their patients and further video education plans are underway at this institution
Interventional Techniques for Chronic Low Back Pain and Migraine Headaches: Development of Educational Pamphlets
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Chronic low back pain, migraine headaches, radiofrequency ablation, greater occipital nerve blocks, sphenopalatine blocks, botox injections.
Abstract
Chronic low back pain and migraine headaches affect millions of adults in the United States. Traditionally, opioid and non-opioid pain medications were the mainstay pharmacological treatment of choice. However, due to the highly addictive nature of opioids, practitioners are seeking alternatives for pain management. Radiofrequency ablation (RFA), a minimally invasive technique has been shown to alleviate chronic back pain while botox injections and other non-invasive opioid sparing techniques, such as greater occipital nerve blocks and sphenopalatine blocks have been found to be effective in the treatment of migraine headaches. A critical access hospital in rural Illinois that offers these interventions proposed the creation of an educational presentation for referring practitioners and patient pamphlets in order to increase awareness of minimally invasive opioid-sparing interventions available at the pain clinic. A presentation for healthcare workers, including primary care providers, ER Physicians, and surgeons was held. Following the presentation, a survey was administered. The results shows that the majority of referring practitioners (81.8%, n=11) are more likely to refer patients to the pain clinic and distribute the pamphlets to patients after attending the presentation. The patient educational pamphlets were also adopted by the hospital’s media department for mass production and distribution
IDENTIFYING BARRIERS TO KEEPING APPOINTMENTS IN MENTAL HEALTH
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Accessing healthcare for mental illness is important but has been challenging to resolve. Due to barriers, individuals are missing appointments leading to long-term negative effects of poor patient outcomes, such as homelessness and suicide. Understanding why individuals cancel or do not show up to their appointments is crucial to resolve this nationwide problem. Further investigation is needed to identify what barriers cause individuals to miss appointments so interventions can be created to resolve it and improve patient care. For this study, those who did not attend their first or second appointments were called and given an eight-question survey. The information obtained revealed barriers that kept the individual from attending their appointments. Results of the data were used to formulate possible strategies or interventions that would alleviate the barriers affecting this patient population. There were 95 individuals who met criteria for the study, 49 participated. The top barriers identified were fear of contracting COVID-19 (n=12), treatment at a different facility due to wait times (n=9), lack of understanding why psychiatric evaluation was needed (n=6), and financial hardship (n=5). The other 17 participant barriers were: insurance problems, forgetting appointments, relocation, and transportation issues. Fear of contracting COVID-19 and financial hardship were the top barriers found and focused on in this project. The significance of this quality improvement project is to show that identifying barriers can lead to interventions that benefit this patient population. The success seen in this study revealed interventions that can be used by other offices experiencing similar appointment issues