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Adverse Effects of Early Exposure to Pornography and the Utilization of Art Therapy
Get PDFPornography is not a new phenomenon in our culture or world. With the expansion of the affordability, accessibility, and anonymity of pornography, demand and consumption rates have also escalated, along with the adverse impact associated with this growth (Coopersmith, 2006 as cited by Dines, 2017). This two-year grant proposal seeks to focus its efforts on serving children, the population being exposed to this widespread phenomenon (Wright, Paul, et al., 2021). The full-time art therapist will carry out trauma-informed prevention and intervention methods to advocate for the mental and physical health of children in individual, relational, and community contexts. This will be accomplished through direct and indirect services by establishing an art therapy position to provide individual counseling, facilitating small-group psychoeducation sessions, and organizing community screening events
Art as Experienced by a Female Combat Veteran Using the El Duende Process Painting.
Get PDFThis single-participant phenomenological case study seeks to determine how a female combat veteran experiences art therapy. The case study participant is a female veteran who served in Iraqi Freedom and Enduring Freedom. While painting on a single canvas, the participant followed Miller’s El Duende process painting procedure (2012) and kept a written and pictorial journal of the experience. The research involved five sessions during which the participant annotated her thoughts and feelings on the experiential expressions chart for each session. These charts were analyzed to identify the mechanism of change in art therapy for the participant. The participant’s journals indicated initial tension followed by insight and relaxation by the end of each session, signifying that the process provided a means for emotional release as the veteran explored her inner feelings and memories by painting them into her artwork
The Effects of Postpartum Hemorrhage Simulation
Get PDFPostpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. Evidence supports the importance and impact simulation has had on preparation for postpartum hemorrhage. Preparation with hands-on education is imperative for a safe outcome during a real-life hemorrhage situation. Lack of frequent education and simulation can equate to negative outcomes for all involved. The purpose of this project was to increase exposure to a safe environment to explore knowledge and skills during a postpartum hemorrhage event. This quality improvement project surveyed postpartum nurses pre and post-mock postpartum hemorrhage simulation. The setting allowed for mistakes, discussion, and open communication among staff. Before the simulation, participants self-reported not feeling prepared for a PPH should it occur in their nursing unit. Post-simulation revealed enhanced readiness for PPH, increased awareness of agency policy and protocols for PPH, and a desire for more hands-on, practice experience to ensure positive outcomes for both patients and staff
Education for Oncology Providers on the Benefits, Uses, and Local Resources of Medical Marijuana
Get PDFMedical marijuana is used to reduce symptoms of medical conditions including cancer. Medical marijuana can increase quality of life among patients with cancer by treating symptoms such as pain, nausea, and vomiting. For providers to care for this population, they must understand the implications for treatment, pharmacological properties, and legal issues related to medical marijuana use.
Nurse practitioners at a cancer clinic in rural Illinois were unable to prescribe medical marijuana because they did not have the necessary knowledge about medical marijuana. The nurse practitioners at the clinic were requesting a “toolbox” containing medical marijuana resources such as uses for medical marijuana, benefits and risks of treatment, and ethical considerations. The nurse practitioners completed a pre-quiz to test their knowledge about medical marijuana. Then, the toolbox was presented to them, and they completed a post-quiz. The implementation of the toolbox immediately impacted the clinical site because it increased the knowledge of the nurse practitioners as evidenced by their post-test scores. Each nurse practitioner who attended the presentation stated they felt confident about prescribing medical marijuana. The long-term goal for this project was for the providers to share the toolbox with non-informed providers to increase evidence-based use of medical marijuana in the oncology clinic
Remifentanil in Labor Analgesia
Get PDFLabor has the potential to be the most excruciating and intense physical pain a woman experiences in her life. Neuraxial anesthesia, which includes epidural, spinal, or combined spinal-epidural technique, is the gold standard for pain control in laboring patients (Lee et al., 2017). Seemingly forgotten, a subset of parturients cannot experience the benefits of neuraxial anesthesia due to several absolute and relative contraindications. These women rely on other options for labor pain control. Remifentanil has emerged as a preferred opioid option for labor and delivery due to its rapid onset (peak effect in 1.1 minutes) and rapid metabolism by non-specific plasma esterases (Glass et al., 1999). The purpose of this project was to educate obstetrical anesthesia providers, obstetricians, residents, and pharmacists at a level 3 perinatal center in Central Illinois on remifentanil patient-controlled analgesia (PCA) for laboring parturients as an alternative to neuraxial analgesia. An evidence-based remifentanil PCA dosing regimen was also recommended. The results of the project implied that there was an increased understanding of remifentanil and an increased buy-in for the implementation of a remifentanil PCA at the facility. A recommendation is to follow up to determine if a remifentanil PCA standardized protocol has been implemented
Recognizing Barriers in the Elderly Population and Increasing Access to Case Management Services
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Implementing case management can lead to fewer hospitalizations in the elderly population. Barriers influencing the number of hospitalizations include low socioeconomic status, transportation needs, health literacy, financial strain, multiple comorbidities, underserved populations, medication availability, availability of community resources, and access to primary care. A review of the available literature revealed that by addressing these barriers in a primary care setting and implementing case management, the number of hospitalizations can be decreased and the quality of life in the elderly population can be improved. This quality improvement project implemented a screening and referral process for chronic care management in the primary care setting. Patients aged 65 and above completed a questionnaire regarding their demographics and chronic medical conditions. Based on their answers, the participants’ providers placed a case management order if appropriate given their social needs and/or their chronic conditions. Ten patients out of 280 were referred to case management. This is because most of the patients understood their conditions and did not require case management. This quality improvement project could be implemented in the future in other primary care clinics to increase the need for case management referrals. By implementing case management, we can address our patients needs and decrease the need for unwanted hospitalizations.
Keywords: Case management, elderly population, hospital admissions, primary care, demographics, chronic medical conditions, community resources, access to care, health literac
Primary Care Management of Breast Cancer Screening
Get PDFBreast cancer remains the most prevalent cancer diagnosis and is the second leading cause of cancer death among women in the United States. Mammograms have been identified as an effective screening tool that can detect breast cancer in the early stages of the disease, before symptoms develop, and allow the possibility of a cure. The project aimed to identify women in the primary care setting with outstanding mammography orders and implement a more systemic outreach program to improve patient adherence. The intervention was a telephone outreach program in which the students conducting the project contacted patients with unsatisfied mammogram orders to determine a date and time that would work for a mammogram appointment. The primary outcomes that were measured included the effectiveness of identifying unfulfilled and/or overdue mammogram screenings, success in reaching patients to schedule mammogram appointments, and patient adherence to completing scheduled mammograms. The project demonstrated that an outreach program to improve mammogram screening adherence could be successfully implemented in a primary care setting. Patients have reported that the outreach program is convenient for them in terms of hassle-free scheduling and holding them accountable. Some patient limitations included patients who refused to get a mammogram despite education, declining due to lifestyle, busy schedule, insurance coverage, and declining due to comorbidities. Project limitations included staff limitations in the office, lack of call back direct line for scheduling, limited time for staff education, and EHR limitations. Primary care providers and office personnel can help to improve patient compliance rates by implementing an outreach program to assist in scheduling patient mammograms
Emergency Department Nurse Preceptor Development
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The Emergency Department (ED) new graduate nurse (NGN) requires an orientation to prepare them to work with patients with complex medical issues in a challenging, fast-paced environment. Clinically competent and effective preceptors are essential to prepare an NGN to work in an emergency environment while adopting multiple active learning strategies. Preceptor education and training are necessary to improve the confidence and competence of the ED nurse preceptor. Currently, the project site lacked preceptor training specifically for the ED nurse preceptor.
This project aimed to develop a preceptor workshop to meet the training needs of the ED nurse preceptor. Qualitative and quantitative data were collected using a pre-and post-survey design. Workshop participants (n =16) attended an 8-hour event focused on communication, adult learning theory, performance evaluation, and teaching strategies for the ED nurse preceptor. The workshop used interactive learning methods, including group activities, case discussions, hands-on learning, and simulations.
The post-workshop survey results demonstrated increased confidence and ability to effectively perform the ED nurse preceptor role. The average weighted confidence level pre-workshop was 2.57 and post-workshop 3.69. Qualitative data suggested that the participants found the workshop valuable and provided them with teaching strategies for the ED preceptor role. The quantitative and qualitative data results were encouraging and supported the effectiveness of the ED preceptor workshop. One limitation identified for the project was the small sample size. Additional support-specific training may be required by the ED nurse preceptor to be confident and capable in the role
Subcutaneous infusions for comfort care patients
Get PDFOver 75% of hospice cases fail to eliminate pain despite high quality hospice care (Herr et al., 2010). The purpose of this quality project was to improve pain management in end-of-life patients via subcutaneous medication administration. An orderset was created to include subcutaneous infusion medications using the collaborative efforts of pharmacy leadership and palliative medicine leadership. Patients requiring pain management who were under hospice or palliative care and, lost intravenous (IV) access, were considered for this quality improvement project. A total of eleven patients met project qualifications, but unfortunately, two patients passed away before receiving pain medications subcutaneously. Project findings demonstrated similar pain scores when comparing the subcutaneous to intravenous route in nine of eleven patients
CBT Technology Implementation with Pediatric and Adolescent Populations
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Digital therapy is a growing healthcare intervention improving limited access to specialty care for specific populations and geographic areas. Cognitive Behavioral Therapy (CBT) applications focus on treating anxiety and depression and assist pediatric and adolescent patients in learning behavioral techniques as they wait for 3-6 months or longer to see a mental health provider. Such delays are attributed to the national shortage of mental health practitioners and the further scarcity of fewer psychiatric providers in rural areas, causing the potential for adverse patient outcomes. The setting for this 8-week quality improvement project was a pediatric care clinic that sees an average of 30 to 60 patients a day. The practice had four providers at project commencement, but the number of providers unexpectedly reduced to two, dramatically decreasing project participation. Several pediatric patients aged 11-18 were referred to the CBT applications, but only one patient accessed the app, used it, and found benefits. The remaining three patients were lost to follow-up. The execution of this intervention is straightforward for providers to incorporate into their practice. Providers can suggest smartphone CBT apps to patients, knowing it may take months to complete an initial mental health referral and evaluation. Future considerations include more significant support from all providers and clinic staff, applying this intervention in a larger clinic, and re-tooling the project for primary care patients across the lifespan who present with symptoms of anxiety or depression.
Keywords: Anxiety, depression, CBT technology, CBT apps, digital therapies, mental health shortag