3511 research outputs found
Sort by
Improving Perioperative Pain Management: Development of an Adult Lidocaine Infusion Protocol
Get PDFAbstract
Postoperative pain is a challenge in healthcare, with more than 50% of patients reporting inadequate pain control (Zengin, Saracoglu, Eti, Umuroglu, & Gogus, 2015). Inadequately controlled pain can negatively impact a patient’s quality of life, recovery, and cause postsurgical complications (Chou et al., 2016). Aims for acute pain management focus on reducing the incidence and severity of pain in order to improve patient function, minimize side effects, and prevent further complications (Gordon et al, 2016). Implementing a multimodal approach to pain control that includes a lidocaine bolus followed by continuous infusion has resulted in reduced opioid consumption, fewer adverse side effects, and lower pain scores postoperatively. This projects purpose was to review the literature regarding perioperative lidocaine infusions for adults, determine best practice, and provide education to anesthesia providers at a tertiary care center in central Illinois. The results of the project implied there was an increase in provider knowledge about lidocaine infusions and support for the implementation of an adult lidocaine infusion protocol
Improving Emergence and Awaken Time in the Obese Population: Development of a Desflurane Protocol in the Obese Population
Get PDFStudies have shown that obese patients are at an increased risk for apnea and aspiration during the postoperative period due to comorbidities associated with obesity (Nason, 2015). Complications such as apnea and aspiration can increase the length of stay in the post-operative care unit (PACU). Slower emergence further increases the risk for apnea and aspiration because of delayed return of protective reflexes (Brousseau, Dobson, & Milne, 2014). Evidence-based research has shown Desflurane to have the fastest wake-up times in obese patients when compared to Sevoflurane, Isoflurane, and Propofol (Juvin, Vadam, Malek, Dupont, Marmuse, & Desmonts, 2000). The goal of this project was to create a Desflurane protocol to be used in the obese population and educate the staff at a rural hospital in Central Illinois. The results of the project showed an increase in support from the anesthesia staff to use the Desflurane protocol in the obese population
Implementing an Enhanced Recovery After Surgery Protocol in a Critical Access Hospital
Get PDFEnhanced recovery after surgery (ERAS) protocols provide numerous benefits for patients undergoing colorectal surgery. The goal of the protocol is to decrease surgical complications, patient’s length of hospital stay, recovery time, and increase patient satisfaction. The purpose of this doctoral project was to create and implement an ERAS protocol for a 25-bed critical access hospital. The findings obtained from the literature review were presented to the multi-disciplinary team. The specific needs of the surgical team were identified, and the ERAS protocol was created. Lastly, the ERAS protocol was finalized and implemented in the institution. The outcome measures examined were the patient’s length of stay and opioid use. In addition, a blinded survey was provided to clinical staff to examine perceptions of the ERAS protocol. The findings seem to indicate a positive trend toward decreased length of stay and lower opioid consumption. The survey suggested that providers perceived patients had a better recovery, pain control, improved activity tolerance, and increased patient satisfaction. Limitations of this project are relative to the low numbers of procedures at this institution. However, institutional outcome measures were compared with national ERAS data. The findings showed that this institution met or exceeded the national outcome-measure data
Mindfulness-based stress reduction activities via smartphone in advanced practice providers: A pilot quality improvement project to reduce perceived stress, burnout, and intent to leave
Get PDFAbstract
Burnout, attrition, and decreased work engagement among Advanced Practice Providers (APPs) are growing concerns and can have a negative influence on health care provider wellbeing. Chronic workplace stress is linked to various physical health problems, such as fatigue, insomnia, heart disease, depression, anxiety, and obesity. Chronic provider burnout is costly and extends to organizations and hospitals due to higher attrition, increased absenteeism, and decreased work engagement. Mindfulness-based stress reduction (MBSR) programs focus on the intent of practicing mindfulness to cultivate a state of being that is nonjudgmental, openhearted, friendly, curious, accepting, and compassionate. MBSR programs afford clinicians a way to decrease stress and burnout.
Interventions for providers that improve work-life balance are limited and not well understood. Initiation of the project was started to investigate whether an abbreviated mindfulness intervention could decrease burnout, perceived stress, and reduce intent to leave the organization among a cohort of APPs working at a large Midwest academic center with high attrition rates. The primary goal of the project was to introduce daily mindfulness exercises using a structured smartphone application to Nurse Practitioners (NP) and Physician Assistances (PA) during a two-week time frame. The desired outcome of the project was to determine if there was a reduction in burnout, perceived stress, and intent to leave.
A total of 85 APPs including 70 NPs, 14 PAs, and two certified nurse-midwives were invited to participate. The response rate was poor, 18.82% (n=16). Thirteen respondents (n=13) or 15.29% completed both the pre-and post-surveys. The project goals were evaluated using pre-and-posttest assessment tools along with a post-intervention survey to a convenience sample at a single institution. Using the Turnover Intention Scale (TIS-6), a six-item five-point Likert scale, and the Mini Z burnout (MZB) survey, a 10 item and one open-ended question to assess outcomes. Results of the pre-post intervention show no appreciative changes on intent to leave and burnout respectively. Because of the poor response rate statistical analysis was not possible. The pre-intervention survey responses indicate 56.25% of participants perceived their stress as high, 35.72% felt burned out, and 21.43% intended to leave the organization. Post-intervention survey responses indicate 42.86% of participants perceived stress their stress as high and 31.25% felt burned out, and 18.75% planned to leave as soon as possible.
A 10 item Likert-scale with 1 representing little impact and 10 representing maximum impact was utilized post-intervention to measure the general effectiveness of the project’s impact on APPs lives. Overall, 80 % of participants reported a positive impact on their lives and daily functioning. This quality improvement project supports the idea that smartphone MBSR interventions can be successfully delivered and implemented. However, further work is needed to evaluate if long term implementation of MBSR programs via smartphone application would be successful in reducing burnout and intent to leave
Physical Activity Group on an Inpatient Behavioral Health Unit
Get PDFPhysical activity is beneficial for the wellness of both the body and mind. Preventable physical diseases are the cause of the majority of deaths in individuals with severe mental illness (SMI) (Vancampfort et al., 2017). Motivation can be a barrier to regular physical activity. Learning by observation can facilitate maintaining behavior change. Thus, physical activity groups on an inpatient behavioral health unit were facilitated by exercise physiologists to improve mental health and physical health (Kaur et al., 2013; WHO, 2015). Lack of physical activity on inpatient behavioral health units is a common practice. The primary aim of this project was to educate patients with severe SMI regarding physical activity and how it relates to wellness for the mind and body, along with increasing motivation to continue post-discharge. The focus of the project was on the development and implementation of a physical activity group three days a week for patients admitted to the behavioral health unit. The primary outcome measure was the patients’ perception of the value and usefulness of the physical activity group. Patients completed a survey after participation. A descriptive statistical analysis was performed from a 7-point Likert survey, showing the physical activity group to be clinically and statistically significant to the value and usefulness of physical activity with an overall mean of 6.27 (p: 0.001- 0.049), with the exception of one outlier (p: .608). Further research is needed to determine if the perceived motivation to participate in physical activity continues post-discharge
Improving Perioperative Warming of Surgical Patients: Implementation of a Warming Protocol
Get PDFDespite the ample amount of knowledge and interventions available to keep patients warm in the operating room, the issue of inadvertent perioperative hypothermia continues to be a problem affecting surgical patients. Unfortunately, even a mild degree of hypothermia can increase a patient’s chance for negative outcomes such as surgical site infections, bleeding, and higher risk for mortality. The project involved development of a warming protocol/guideline for a small community hospital. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of warming patients, reimbursement initiatives, and appropriate interventions.
The project study design utilized a non-experimental pretest-posttest evaluation. Results were used to evaluate both knowledge and utility of protocol after the educational presentations. A total of 20 providers did the pre-survey while only 9 did the post-survey. Data analyzed from the surveys included descriptive information such as demographics, knowledge-based, and protocol effectiveness. The data showed no variation in provider knowledge. Alternatively, the effectiveness of the protocol showed mixed results as most providers (66%) responded to a delay in utilizing the protocol. Over time, further feedback was able to confirm changes made within the facility to incorporate warming methods to improve patient outcomes
Navigating the Path to Presence: Ideology, Politics, and the Campaign for Gender Balanced Boards and Commissions in Iowa
Get PDFFrom 1986 through 1988, Iowa adopted and strengthened a gender balance law that required men and women be equally represented on state boards and commissions. In 2009, Iowa extended this law to also require its counties, municipalities, and school districts to gender balance their boards and commissions. Iowa’s law remains unique in the United States. Through archival research and interviews, my research investigates how advocates navigated the ideological landscape associated with this policy issue. My research unveils the mechanisms that substantially deradicalized gender balance in Iowa, enabling its passage and shifting Iowans’ perceptions of gender, governance, and affirmative action—disembedding gender segregation, normatizing and institutionalizing gendered representation practices, and prioritizing an ideology of good governance. Based on my findings and analyses, I argue for reconceptualizing ideology through navigation theory—actors simultaneously hold multiple complementary and competing ideologies and must negotiate how these ideologies are (de)activated, (de)prioritized, and interpreted and applied to the issue under consideration. In Iowa, advocates employed collective action frame management to facilitate and steer this navigation such that a majority of legislators voted for and governors signed these affirmative action legislation
Transition of Care from Pediatrics to Adult Health Care
Get PDFTransition planning is essential for continuity of healthcare for adolescents approaching adulthood. Transition of care should start in early adolescence to help pediatric patients find and establish an adult healthcare provider. The purpose of this project was to assess and increase awareness of transition planning and assess the feasibility of instituting a transition program in a rural health pediatric clinic. Staff and providers were educated about transition of care planning and current recommendations from the American Academy of Pediatrics. Pre and post surveys were collected. Staff reported the program as beneficial to their patients and would like to see further steps towards successful transition planning. However, they noted that both providers and upper management involvement would be necessary, and that patient and family reluctance, along with staff time requirements could be barriers to implementation of the program. Despite an increasing understanding of the benefits of a transition of care program, follow-up evaluation four months post-implementation of the project revealed that various factors such as time, lack of a staff champion, and administrative support hindered implementation of the program. Further efforts are needed to address these barriers so that transition of care programs can be successful
Developing an Online Wellness Curriculum for Nurse Anesthesia Students
Get PDFStudent Registered Nurse Anesthetists (SRNAs) begin graduate school as confident critical care nurses, unaware of the impact that constant, daily stress will have on their lives. Wildgust (1986) presented the earliest known research and concluded stress negatively impacted the physiologic wellbeing of SRNAs. It has been reported that students in anesthesia programs experiencing high levels of stress and burnout are more likely to make critical errors when caring for their patients (de Oliveira, 2013). The goal of this doctoral project was to promote wellness and stress management among students enrolled in Southern Illinois University Edwardsville’s Nurse Anesthesia program by proposing an accessible and structured electronic wellness resource, highlighting evidence-based stress reduction techniques applicable to SRNAs as well as licensed anesthesia providers.
A readily accessible Wellness E-portal was created and made available to students via the Blackboard student platform. The E-Portal contains resources for wellness, mind-body therapies, and peer support targeted specifically for SRNAs. Second-year nurse anesthesia students at SIUE were given a live tutorial of the E-Portal, and provided feedback to the E-portal designers via an anonymous survey. Survey results indicated an improved understanding of wellness among students after the presentation. Additionally, most students felt a tutorial to the E-Portal would be a valuable addition to the nurse anesthesia program orientation for incoming students
Effects of a Multi-Tiered Approach to Impact Immunization Compliance of Students Attending a Medium-Sized Public University
Get PDFBackground: College students in Illinois must comply with laws regarding proof of immunity for specific vaccines. These laws, however, do not guarantee compliance with immunizations. Unvaccinated persons living in highly-vaccinated communities, such as college campuses, are at risk for many preventable diseases. Objective: The primary aim of this project is to collaborate with Southern Illinois University Edwardsville (SIUE) Health Service to develop, implement, and evaluate the effects of multi-tiered interventions to increase immunization compliance rates of first-semester college students. Methods: A brief YouTube video was presented to freshmen students, an eye-catching educational flyer was distributed by advisors and throughout campus, and an ad was played on the closed-circuit televisions across campus as well as placed in residence hall newsletters. A post-intervention student survey was developed by the student team and administered by Academic Advising. The number of compliant students was compared with the previous year to determine effectiveness of the interventions. A survey was also given to the SIUE Health Service administrative team to measure the impact of the interventions on staff effort and time consumption associated with the issue of student vaccine compliance. Results: Results showed an overall lack of knowledge among first-semester freshmen regarding required immunizations. The percentage of compliant students rose from 2016 (54.39%) to 2017 (70.84%). Conclusions: While there is no discernible way to demonstrate that the increased compliance rates were attributed solely to the project interventions, SIUE Health Service plans to continue to use all of the student project team interventions in the future