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Assessing the Need for Mental Health Interventions Within the Law Enforcement Community
Get PDFThis research explored mental health interventions within the police. There is a need for mental health in law enforcement (O’Hara, 2018; Blue Help, 2019; Waters & Ussery, 2007; Mohandie & Hatchert, 1999; Miller, 1999; Violanti, 2010). Having been a law enforcement officer myself, I have experienced the stigma and the need of mental health care. I used a cross-sectional survey design to obtain further information on police officers in a Midwest county in the United States to assess the need for mental health interventions. I created response artwork prior to obtaining the survey results (to help assess and sort through my biases) and immediately following (in order to process the results with clarity). Findings include a warranted lack of trust that most officers seem to have in both the mental health industry and within their departments; a high presence of uncertainties among officers regarding fears and negative stigmas associated with seeking professional counseling; and barriers to seeking therapy in the law enforcement community depicting a sense of fear related to misunderstanding, repercussion, and judgment
Fascia Iliaca Blocks for the Treatment of Hip Fractures in the Emergency Department
Get PDFDue to the aging population, the number of falls are increasing, leading to an increased number of individuals with hip fractures presenting in emergency departments (ED). Opioids are often administered for intraoperative pain related to hip fractures, which may result in a number of adverse effects, especially in the elderly. There is strong evidence suggesting that the use of fascia iliaca blocks (FIBs) in the ED can minimize opioid use, and improve patient outcomes and recovery. FIB is a compartment block that delivers local anesthetic around the lumbar plexus to provide analgesia associated with hip fractures.
The purpose of this project was to develop and create a guideline for the administration of FIB in the ED of a small rural hospital in Central Illinois. The guideline was developed in collaboration with the agency stakeholder. A face-to-face session with CRNAs was held to provide information on FIB, present the guideline, and encourage open discussion. A survey was provided to gain staff’s perceptions of the guideline and how it could be improved. Results indicated the staff strongly approved the FIB guideline and were interested in its implementation. The stakeholder plans to implement the guideline once approved by ED and orthopedic surgeons
CRNA to CVICU RN: Implementation of a Standardized Patient Handoff Checklist for Post-Surgical Heart Patients
Get PDFPatient handoffs occur when the information and responsibility of the patient is transferred from one health professional to another. Ineffective communication during the critical postoperative phase of the transfer of care (TOC) has been associated with extended hospital stays, increased healthcare costs and patient dissatisfaction. In 2007, the Joint Commission National Patient Safety Goals proclaimed the importance of a standardized handoff process for effective handoffs. The purpose of this quality improvement doctoral project was to assess if the utilization of a standardized TOC checklist from the operating room to the cardiac intensive care unit (CVICU) for post-heart patients improved communication between providers. A review was performed on the current literature regarding the use of a standardized handoff. The results showed the use of a standardized form to be an effective tool for patient handoffs. Cardiac certified registered nurse anesthetists (CRNAs) and CVICU RNs received education on the current literature and the utilization of the handoff tool. Collection of the pre-implementation surveys occurred after the education, and the post-implementation surveys were collected after the implementation period. The results showed improvement of missing information, a quieter environment, and the completeness of report
Development and Implementation of an Orthopedic Enhanced Recovery after Surgery Protocol
Get PDFAbstract
As life expectancy rates have grown and individuals desire a more active lifestyle the number of total hip arthroplasty and total knee arthroplasty surgeries performed has grown significantly. Enhanced recovery after surgery (ERAS) protocols have been shown to decrease the financial impact and improve patient outcomes in total joint surgeries. After a literature review a multidisciplinary team met and developed an ERAS protocol for total joint replacement surgeries to be implemented at a 250-bed community hospital in central Illinois. After an eleven-question pre-test was given to 34 participants consisting of perioperative nursing staff, anesthesia, and surgeons assessing their knowledge of ERAS protocols, a PowerPoint presentation highlighting the key elements, goals, and benefits of the ERAS protocol was presented. After completing the PowerPoint presentation and utilization of the ERAS protocol for one month, a post-test following the same format was given to the 34 participants identifying that all respondents could correctly identify key components, goals, and benefits of an ERAS protocol. This project is sustainable by continued use of the PowerPoint educational presentation and continued review of quality metrics to confirm decreased length of hospital stays, decreased complications, and improved patient satisfaction
Impact of a Standardized Neurologic Exam on Diagnosis of and Referral Pattern for Neurologic Disorder in Pediatric Toe Walking
Get PDFSuccessful management of toe walking, a common patient complaint addressed by pediatric orthopedic providers, requires detection of concerning neurologic causes for toe walking. However, nurse practitioners in an outpatient orthopedic clinic were not following recommended guidelines for the history and physical exam for children who toe walk, resulting in delayed referrals and poorer patient outcomes. A performance improvement project was initiated that included an educational intervention, chart review, and data analysis. The goal was to improve the performance and documentation of neurologic exam when nurse practitioners saw patients for an initial visit for toe walking. A literature review provided evidence-based guidelines for practice and informed the educational intervention. The Institute for Healthcare Improvement’s Models, including Plan-Do-Study-Act cycles, were utilized for implementation and evaluation. Descriptive statistics were used for analysis of pre- and post- intervention findings. The number of pertinent history and physical points charted improved post-intervention. Post-intervention data did not have enough power to determine impact because of the small number of patients seen and referred, but a trend towards increased referral occurred. The nurse practitioners verbalized understanding of the education provided and expressed willingness to apply this knowledge to practice. A standardized neurologic exam does have an impact on the diagnosis of and referral pattern for neurologic disorders in pediatric toe walking. An educational intervention had an impact on the understanding of the neurologic exam, with some improvement of documentation of salient points
Improving Emotional Intelligence Skills in Student Registered Nurse Anesthetists
Get PDFBecoming a certified registered nurse anesthetist (CRNA) involves didactic and clinical course work that challenges the student’s cognitive, mental, and emotional well-being. Standardized cognitive factors, such as grade point average, are utilized for nurse anesthesia program admission, but those factors do not take into account the student’s emotional intelligence. The ability to manage one’s emotions has a positive correlation with academic success (Beauvais, Stewart, DeNisco, & Beauvais, 2014) and has been correlated with greater success in nurse anesthesia programs (Collins, 2013).
The goal of this doctoral project was to increase the emotional intelligence of first-year students in the nurse anesthesia program at Southern Illinois University Edwardsville. A two-hour emotional intelligence educational seminar was created and delivered to the students during their second semester. During the first hour of the seminar the students were presented information on emotional intelligence and during the second hour the students worked in small groups to discuss emotional intelligence case scenarios. Upon completion of the seminar the students completed an anonymous survey. The survey results indicated the seminar was well received, and the students felt the information on emotional intelligence would help them adapt to the high demands of the nurse anesthesia program
Discharge Opioid Guidelines for the Postpartum Woman
Get PDFIn spite of the alarming opioid abuse epidemic, the number of opioids prescribed to women who give birth has been overlooked and underregulated. In a large metropolitan hospital that has over 3,500 deliveries a year, this problem was identified through first-hand encounter and data collection from an electronic medical record. Women in the postpartum period were prescribed an unnecessary number of opioids upon discharge. The goal of this project was to create guidelines that would decrease opioid use and increase the overall well-being of postpartum women. Guidelines were based off of type of delivery and women were not allotted more than 20, 5mg Oxycodone at discharge. Once implemented, the providers were surveyed based off their experience with the guidelines and perceived outcomes regarding their patient’s pain control. Approximately 81% of survey respondents believe the new guidelines will provide adequate pain control for patient’s after discharge. This change has significantly decreased the number of opioids prescribed from this unit. These guidelines will continue to improve patient care and develop positive long-term outcomes as they are related to opioid use. Further need for evaluating patient satisfaction is desirable and will lead to possible alterations in future guidelines
Addressing Hypertension Health Literacy in Black Individuals who English is their Second Language
Get PDFHypertension is a primary preventable risk factor for cardiovascular disease. Despite advances in preventive and treatment measures, related to blood pressure control, the prevalence of hypertension in the United States remains high among Black People of immigrant and non immigrant communities. Healthcare is increasingly complex, and health literacy problems have increased due to demands by healthcare stakeholders for patients to assume a more independent role in taking charge of their health. A quality improvement project was conducted in a Faith based community to improve the knowledge of participants about hypertension. The objective of this project was to enhance lifestyle management of participants in this at-risk community, as measured by participants self-report in post- session survey. Outcomes, as measured by a Likert scale revealed that all the participants who attended, reported a collective increase in their knowledge base. Twenty participants had a better understanding of hypertension and were willing to modify their behavior (80%). Findings showed a statistically significant commitment to lifestyle modification. This project promotes patient autonomy by encouraging improved communication between patients and providers. It also shows promise in enhancing lifestyle management of black people with hypertension
Sharp Safety and Supply Containment in Procedural Areas
Get PDFTo improve safety in procedural areas, a Midwest hospital piloted supply and sharps counts to reduce both sharp injuries and patient retained supplies. Supply counts are a standard of practice for decades within surgical-operational departments. Despite improved standards within surgical-operational departments, safety measures within procedure areas are limited. With current recommendations for sharp and supply counts and reported sharp injuries in the procedural area, the need to develop and implement a supply count and sharp containment policy was evident. A four-week doctoral project was implemented within the electrophysiology studies (EP) procedural area. EP staff reported using non-standardized techniques to count sharps and supplies, documentation varied, and tracking by leadership was not consistent. Eighty-one EP studies were performed during the project, with a 100% documentation compliance rate. The estimated cost of a sharp injury is 5,000, depending on the treatment required. There were 13 reported sharp injuries from 2016-2018. Zero sharp injuries were reported during the project, saving an estimated 65,000 from the previous two years of sharp reporting. Although the procedural area had no record of retained items, the cost savings are estimated at $166,000 per incident. Implementation of a supply count and sharp containment process allows for policy development, best practice education, potential cost savings, and increased patient and staff safety. To ensure sustainability, leadership was encouraged to be involved during the project and internal staff were educated as superusers. Through quality improvement efforts, the procedural area is at the forefront of current evidence-based practice that is generalizable to other procedural areas
Perioperative Advanced Directives
Get PDFTechnology and surgical techniques continue to improve, resulting in more clients with advanced directives presenting to the operative suite for surgery or procedures requiring anesthesia. Anesthesia providers are in a critical position to discuss with the surgical patient or surrogate any alteration or reconsideration to their advanced directive. Unfortunately, patients and anesthesia provider discussions at a North Texas hospital were limited due to a knowledge deficit, an outdated hospital policy rescinding all directives perioperatively, and an inadequate consenting mechanism. The perioperative advanced directives project involved updating the hospital policy to current national guidelines and developing a “DNR Under Anesthesia” consenting tool. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of maintaining patient autonomy and the right to self-determination perioperatively. The results demonstrated improvement in all areas of knowledge and comfort when dealing with the perioperative directives. With the project\u27s success, education is now included in all perioperative staff\u27s yearly competency modules, thus promoting sustainability. Most importantly, the patients now retain their rights to autonomy and self-determination in the perioperative arena