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Implementation of the Edinburgh Postnatal Depression Scale in a Midwest Primary Care Clinic
Get PDFRecent data from the World Health Organization reveals that the prevalence of postpartum depression is about 13%. Research portrays that untreated postpartum depression can have a detrimental impact on maternal and child outcomes. The American Academy of Pediatrics recommends integrating postpartum depression screening at the 1-, 2-, 4-, and 6-month well-child visits. The purpose of this project was to increase early identification of women with postpartum depression (PPD) by increasing the frequency of the Edinburgh Postpartum Depression Scale (EPDS) and evaluating the adherence of the recommended protocol at a Midwestern Primary Care clinic. The healthcare staff received training that included the clinical relevance of postpartum depression, the clinical validity of the Edinburg Postpartum Depression screening tool, and a protocol based on the recommendation of evidence based practice guidelines for routine postpartum screening. After the initial 8-week implementation period, data was collected and evaluated. There was a 56.5% increase in completed postpartum depression screenings and a 15.4% increase is in identifying mothers with postpartum depression. While the project led to individual practitioners adopting the protocol, further follow up is needed to evaluate the use of the evidence-based protocol as an organization
Improving Nurse Resilience
Get PDFThe national average nurse turnover rate was 18.2% in 2017 (Ackerson & Stiles, 2018). A contributing factor for nursing turnout rates was nurse burnout and compassion fatigue (Barratt, 2018; Cleary, Kornhaber, Thapa, West, & Visentin, 2018; Cope, Jones, & Hendricks, 2016; Magtibay, Chesak, Coughlin, & Sood, 2017; Delaney, 2018; Manomenidis, Panagopoulou, & Montgomery, 2019; Poulsen, 2015). Improvement in nurse resilience was revealed to reduce burnout and compassion fatigue in nurses (Ackerson & Stiles; Delaney). The primary goal of this quality improvement project was to evaluate the use and impact of resiliency education on the resiliency of nurses in the hospital setting whose turnover rate was 22.4%. The focus of the education included compassion fatigue, signs of burnout, and methods of mitigating risks of burnout and compassion fatigue. The implementation of the education was through a computer based learning module required to be completed by primary care nurses. A pre and post assessment using the CD-RISC was administered to assess the effectiveness of resilience training at the facility. The CD-RISC mean score pre-intervention was 78.99, and the post-intervention survey CD-RISC mean score decreased to 75.82 meaning the education was not effective in improving resilience. Despite the unexpected results of this project, useful information was gleaned regarding the importance of delivery methods with resilience education programs. The dedication to improve nurse resilience, however, remains a tenet and with necessary modifications, resilience education will continue to be delivered. Improvements in educational delivery and the implementation of interventions by nurse leaders serve as core ideologies to be utilized in the future to increase the important efforts of increasing nurse resilience
Cultural Competency Training for U.S. Army Security Force Assistance Brigade (SFAB) Brigade Medical Teams
Get PDFThe United States Army began standing up Security Force Assistance Brigades (SFAB) in February 2018. The Brigade Medical Team (BMT) is an 11-person, interdisciplinary Army National Guard team. National Guard Soldiers only have one weekend per month and two weeks of annual training per year to develop/maintain cultural competence. The researcher investigated the efficacy of the Cross-Cultural Competence Trainer (3CT) V2 course to develop and maintain cultural competency in BMT personnel. Pre-test results were obtained from three military medical personnel and a post-test immediately after the course. Participants completed a longitudinal test 28-31 days after the post-test. There was a statistically significant increase in cultural competency scores from pre-test (76.34%) to post-test (91.40%). Participants maintained the cultural competency gained from the course after one month (longitudinal test 91.40%).
These results demonstrate Cross-Cultural Competence Trainer (3CT) V2 is a valid method to develop cultural competency. Competency was not degraded over 28-31 days without further cultural training, suggesting additional instruction between Army National Guard training periods is not indicated
Tranexamic Acid Use
Get PDFBleeding is a risk associated with every surgery. The pediatric population represents unique challenges during surgery due to differences in anatomy and physiology when compared to the adult population. Historically, blood transfusions were the treatment for excessive surgical blood loss. Transfusion of blood products have associated risks: infection, volume overload, and immunological reactions (Fraser, Porte, Kouides, & Lukes, 2008; Porte & Leebeek, 2002; Yuan, Zhao, & Xu, 2016). Interventions to decrease blood loss are essential to improve surgical outcomes. Tranexamic acid (TXA) use decreases the number of required blood transfusions thereby decreasing transfusion-related morbidity (Lei, Xie, Xu, Xie, Huang, & Pei, 2017; Li, Sun, Luo, & Zhang, 2016; Porte & Leebeek, 2002; Sui, Ye, & Yang, 2016; Yuan, Zhao, & Xu, 2017). Decreased hemorrhage leads to improved hemodynamic stability, fewer transfusion requirements, and overall improved surgical outcomes in both adult and pediatric surgical procedures. The purpose of the project was to improve pediatric outcomes undergoing non-cardiac surgery in a tertiary care center in central Illinois through the development of a TXA infusion protocol. The results of the project implied there was an understanding of the protocol and intent on implementation. Recommendations for follow up to determine if the protocol is still being implemented could include a survey to anesthesia staff regarding protocol use and chart review of major non-cardiac pediatric surgeries
Managing, Mitigating and Minimizing Patient Violence in the Emergency Department
Get PDFPatient violence in the Emergency Department (ED) is common, varied, and has lasting effects on nurses. Survey and questionnaire responses from 18 nurses in a Midwestern hospital ED revealed mindsets and perceptions of short and long term effects of potential and realized patient violence situations. Patient verbal and physical abuse directed at nurses is generally viewed as an acceptable job risk by the general public, hospital administrators, and nurses. Nurse surveys indicated daily anticipation of physical harm, a sense of helplessness from lack of administrative support, and emotional stress related to acts of patient violence. Support from Occupational Safety and Health Administration (OSHA), The Joint Commission, and the Emergency Nurse Association was aimed at protecting nurses physically and emotionally from patient violence through education, empowerment, and encouraging hospital administrative support. ED staff were provided education to manage, mitigate, and minimize patient aggression via a bulletin board. Definitions, literature, statistics, hospital policy and reporting process, and a Crisis Prevention Intervention (CPI) link were easily accessed by ED staff. Pre- and post-education surveys were constructed, distributed, and analyzed to determine changes in nurse knowledge and perceptions related to patient aggression. Sixty nine percent of Registered Nurses completed the pre-questionnaire and 50% completed the post-questionnaire. A prevalent shared theme revealed basic mistrust that hospital administration would respond to reported patient violence. One hundred percent response indicated violence toward nurses was an expectation of the job. Fifty three percent of nurses reported some form of patient violence daily. Presentation of knowledge, new skills, and firm stakeholder support empowered ED nurses to learn to recognize, diffuse, safely react, and report patient violence. Post-project survey and questionnaire results indicated an increased confidence identifying and managing aggressive patients. Overall sense of safety and job satisfaction also increased. However, a hopeless belief that reporting violence would result in meaningful change remained. A positive outcome of the project was the hospital administration gained insight to guide future efforts to protect staff as evidenced by requiring patient aggression management technique training. The innovative inclusion of CPI training during the annual nurse competency fair was a clear example of sustainable support for nurse safety
Opioid Free Anesthesia
Get PDFPatients undergoing surgery are often given opioids intraoperatively. Administration of opioids is associated with untoward side effects that include nausea, respiratory depression, constipation, ileus, hyperalgesia, prolonged length of stay, and the potential for dependence (Garimella & Cellini, 2013). Emerging research on the topic of opioid-free anesthesia (OFA) is available and indicates several benefits of OFA, including reduction in postoperative pain, reduction in postoperative nausea and vomiting, reduction in postoperative shivering, and improved oxygen saturation levels (Mulier et al., 2018). This quality improvement project aimed to advance anesthesia providers\u27 understanding of OFA by creating an OFA guideline and providing a learning session to educate providers on its use. A pre-and-post intervention survey was conducted to evaluate the effectiveness of the learning session. The results show a statistically significant increase in knowledge scores across time from pre-intervention (M = 28.8, SD = 25.6) to post-intervention (M = 96.5, SD = 4.9), t(16) = -11.44, p \u3c 0.001. Given the statistical significance in the results, it can be concluded that a learning session is a successful way to improve anesthesia provider knowledge and comfort with OFA. A future project to evaluate the effectiveness of the OFA interventions is recommended
Extensible Interface for a Compact Spectrophotometer for Teaching Molecular Absorption in the Undergraduate Laboratory
Get PDFA simple computer interface for controlling a compact spectrograph for use as a spectrophotometer in an undergraduate teaching laboratory was developed. The project was implemented on a Raspberry Pi computer which permits the integration of a light source into the software. The interface was written in Python to facilitate modification by the user and because of its compatibility with several computing platforms. An implementation of the project in Linux on a Raspberry Pi computer is described
Pain Control Options for the Parturient: Pamphlet Development for Patient Education
Get PDFEpidural analgesia has traditionally been requested by the parturient population as the primary choice of pain control during labor, despite the availability of other viable options (Pitter & Preston, 2001). Viable pain control options available during labor include, neuraxial anesthesia, peripheral nerve blocks, pharmacological, and non-pharmacological measures. Lack of education regarding the availability of various pain control options for parturient women is identified as a cause of missed pain relief opportunities (Vargens, Silva, & Progianti, 2013). The purpose of this project was to develop a pamphlet prototype for an obstetrics department at a tertiary care center in central Illinois, explaining the physiology of labor pain, neuraxial anesthesia, general anesthesia, pharmacologic agents, and non-pharmacologic agents available at the facility for pain control. Information on who provides the pain relief options available in the facility\u27s obstetrics department was also included. The pamphlet was written to reflect a reading level deemed appropriate by the literature and the marketing department at the host facility. After presenting the pamphlet prototype to nurse anesthetists and obstetric nurses, a post implementation survey concluded the pamphlet’s content, look, readability, and usability was appropriate for educating parturient women on the various pain relief options available at the host facility
Developing the PEDIS Pediatric Obstructive Sleep Apnea Screening Tool
Get PDFObstructive sleep apnea (OSA) is the most common type of apnea in the pediatric population. Its prevalence is 0.7%-3.0% (Garcia et al., 2016). The dangers of OSA are multiplied in conjunction with anesthesia because anesthesia resembles a state of sleeping, relaxing the airway, and requiring more intense airway monitoring. Childhood OSA includes increased risk for developing neurocognitive impairment, behavioral problems, failure to thrive, hypertension, cardiac dysfunction, systemic inflammation, and increased healthcare costs (Kothare et al., 2015). A perioperative pediatric OSA screening tool is necessary to reduce airway risks. The PEDIS screening tool is a brief, efficient, and evidence-based tool capable of preoperatively alerting anesthesia providers of a child at risk for developing respiratory concerns intraoperatively.
Project implementation involved a brief, educational PowerPoint presentation regarding the development and use of the screening tool with completion of an anonymous post survey. Based upon all key healthcare providers’ responses in attendance at the tertiary medical center, six (100%) Certified Registered Nurse Anesthetists supported screening tool adoption. Future perioperative implementation, data collection, and analysis of the collected data will reveal its efficacy. The tool has begun the process of being adopted, but more support will be needed prior to implementation
Diabetes Management
Get PDFDiabetes Self-Management Education and Support (DSMES) has been shown to improve diabetes management. A Midwest, private family practice did not offer formal diabetes education. The purpose of this project was to increase patient education for recently diagnosed patients with type 2 diabetes who had not yet reached their management goals. A second purpose was to develop quality educational material for the provider in this practice. These objectives were met by identifying patients who were not at the optimal goal of HgA1c of 7% per the American Diabetes Association (ADA) guidelines and providing quality diabetes education and follow up to these individuals. Patients were provided comprehensive education regarding the disease process, meal plans, plate configurations, medication information, names and phone numbers of dietitians in the area, and education on foot and eye care. An education binder with DSMES literature and new patient packets were developed along with waiting and exam room signs to remind the provider and patients that diabetes education is available. Ninety-five percent of patients surveyed stated that the education was helpful, and they learned something they did not know regarding the management of diabetes. Following review and implementation of the educational binder, the provider reported satisfaction with the content and plans to continue implementation of this educational program