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Reducing Disparities in Breastfeeding Among African American Women Through Professional Support
Get PDFThis project involved developing a toolkit and implementing a staff education program to increase provider self-efficacy and knowledge concerning breastfeeding, increase provider understanding of the importance of a toolkit for addressing the gap in breastfeeding among African American women, and increase the intention of providers to use the toolkit by a minimum of 20%. The clinic reported breastfeeding in only 21% of African American patients, attributing this mainly to provider lack of breastfeeding self-efficacy and knowledge. It is essential for providers to deliver evidence-based, culturally sensitive breastfeeding information. This project involved evaluating provider self-efficacy, knowledge, understanding the importance of a toolkit, and intention to use the toolkit. Findings of evidence-based interventions indicated a percentage change increase in provider self-efficacy (43.47%), knowledge (24.33%), understanding the importance of a toolkit (66.67%), and intention to use the toolkit (50%). Provider self-efficacy, breastfeeding knowledge, and toolkit use intention were affected by education. The results may promote positive social change for patients and providers by improving maternal and newborn outcomes in the African American community and contributing to a broader, more supportive environment for patients and providers. This may lead to a systemic change that supports clinical- and societal-level infant breastfeeding. Recommendations include reviewing breastfeeding rates among African American patients regularly to assess improvements, continuing provider support, and incorporating a breastfeeding education session into new provider orientations
Teachers\u27 Perceptions of Response to Intervention Implemented in Grades 3 – 5 for Minority Males
Get PDFThe Individuals with Disabilities Education Improvement Act (IDEIA) added Response to Intervention (RTI) to its policy to close the social and economic disadvantages that suppress the academic achievement of minority students. The problem that was addressed through this study is that teachers struggle to implement RTI to support minority male students in Grades 3 – 5 at four local elementary schools in the Central United States. The purpose of the study was to explore the perceptions of Grades 3 – 5 teachers for implementing RTI to support minority males and the training and resources available and needed at four elementary schools. The study was grounded by Bandura\u27s social cognitive theory. For this basic qualitative study, semistructured interviews with eight teachers were conducted. The participants\u27 responses were analyzed through descriptive coding, which evolved the following training needs by the participants (a) reoccurring RTI framework training, (b) collaboration with an RTI committee, and (c) culturally responsive teaching. The findings revealed that while teachers recognize RTI as a valuable tool, inconsistent training, insufficient collaboration, and limited culturally relevant instructional strategies hinder effective implementation. By strengthening educators’ implementation of RTI practices through requested professional development as well as heightened awareness of cultural diversity, the results from the study might positively influence social change by fostering an equitable and inclusive learning environment for all learners
GAD-7 Screening Tool Implementation
Get PDFThe purpose of this doctor of nursing practice (DNP) project was to provide a staff education program to improve staff knowledge about the use of the GAD-7 screening tool. Generalized anxiety disorder (GAD) remains an underdiagnosed condition, often due to inadequate use of standardized tools in clinical settings, leading to delayed treatments and suboptimal outcomes for patients experiencing anxiety disorders. The identified gap in practice necessitated an educational intervention to equip healthcare providers with the skills to effectively use the GAD-7 screening tool. To address this gap, a 2-hour staff education program was delivered via in-person sessions and online modules. The practice-focused question guiding this project was: What is the effect of implementing a staff education program to improve staff knowledge to effectively implement changes that affect the use of the GAD-7 screening tool to identify, measure, and track treatment progress and outcomes for patients with GAD? A pretest/posttest design was used for this project. Findings were analyzed using descriptive statistics and a Wilcoxon signed-rank test, which showed a significant difference (p \u3c .05) between the pretest and posttest evaluation of knowledge scores. These findings show that educating staff could improve their knowledge of the use of the GAD-7 screening tool to improve outcomes. Implementation of GAD-7 education is recommended and emphasizes the importance of standardized screening in improving mental health outcomes, mental health diagnoses, and care. By promoting evidence-based screening practices, the project fosters an inclusive environment and prioritizes all patients’ mental well-being regardless of background or circumstances
Executive Summary: Quality Improvement Initiative Reducing ER Readmissions Among Homeless Individuals with Schizophrenia Using Integrated Care
Get PDFThis evaluation of the effectiveness of a quality improvement initiative project aimed to reduce ER readmissions and improve medication adherence among homeless individuals with schizophrenia by implementing an integrated care model. These individuals face substantial barriers to healthcare, including housing instability and limited access to resources, leading to frequent ER visits that strain healthcare systems. Addressing this issue is essential for nursing practice to optimize resource use and improve patient outcomes. The project examined whether a coordinated approach integrating medical and social services could lower ER visits and enhance adherence to treatment. Statistical analyses showed that postimplementation medication adherence increased significantly from 72.97% to 81.46%, indicating the model’s effectiveness in supporting adherence among this high-risk population. ER readmission rates showed a slight, statistically insignificant decline from 58.82% to 57.14%, suggesting that additional interventions may be needed to achieve substantial reductions. The findings underscore the value of integrated care in enhancing medication adherence and managing complex needs in vulnerable populations. Recommendations include expanding integrated care models for similar groups and implementing additional strategies to reduce readmissions. This project highlights the role of nursing in addressing both medical and social determinants of health, promoting positive social change by advancing diversity, equity, and inclusion in healthcare for underserved populations
Clinical Practice Guideline for Nurse Practitioners: Diabetes Type Two Self-Care Management
Get PDFThis project was a clinical practice guideline (CPG) for nurse practitioners regarding evidence-based guidelines for type 2 diabetes (T2DM) self-care management at a primary care practice in Ohio. The practice problem of T2DM is a prevalent disease affecting approximately 37.3 million people. T2DM can lead to complications of kidney disease, heart disease, diabetic neuropathy, eye damage, foot damage, and infections. Self-care in T2DM can improve outcomes and decrease complications. However, evidence-based guidelines are lacking to guide practitioners in self-care management of T2DM at this site. The practice-focused question was, “Does the evidence support development of a self-care, T2DM, CPG for primary care providers, that receives a quality score of 70% or greater by an expert panel using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument and receives approval for use in practice by end users?” A comprehensive literature review and synthesis of 20 current articles on T2DM management using the Johns Hopkins Model supports the project. A panel of three experts assessed the CPG via the AGREE II Instrument. Domain scores ranged from 100% to 92%. Two global domain scores were 100% each, resulting in end users\u27 approval for the use of this CPG in practice. The results indicate a quality CPG. This self-management, T2DM CPG may help reduce inequalities in healthcare by ensuring that all patients, regardless of their social or ethnic background, have access to the same high level of care. An important aspect of this project is the integration of principles of positive social change, diversity, equity, and inclusion into the approach to treatment
Improving Staff Knowledge Regarding Culturally Competent Care and Implicit Bias
Get PDFMental health staff in the project site outpatient office lacked knowledge of cultural competence and the risk for implicit biases. This staff education project was implemented to improve their knowledge related to cultural competence and implicit bias in an outpatient mental health setting. Nursing theories and frameworks are imperative for bettering the health outcomes of diverse patient populations, and the nursing theory that informed this project was Leininger’s transcultural nursing framework. This Doctor of Nursing Practice (DNP) project addressed staff knowledge regarding cultural competence specifically implicit bias towards diverse mental health populations in an outpatient setting. The project was designed to enhance the mental healthcare staff’s knowledge regarding the complex needs of culturally diverse patients challenged by social determinants of health (SDOH) barriers. Nine clinic staff participated in the project. They were two advanced nurse practitioners, two licensed clinical social workers, one nurse, one medical assistant, one medical records clerk, one secretarial staff, and the office practice manager. Each participant completed the staff education project, which included four evidence-based practice (EBP) training objectives outlining seven case studies for the interactive PowerPoint training lessons. The staff education was evaluated using a pretest followed by the lessons and concluding with a posttest. The results showed a pretest (μ = 43.56%) and posttest (μ = 95.78%) score outcome, indicating the staff development project’s effectiveness in increasing staff knowledge of the potential for implicit bias in an outpatient mental health setting
Strategies for Patient-Centered Care Implementation in Independent Medical Practices
Get PDFMethod: Qualitative Design: Pragmatic Inquiry Why the study is being done: Explore strategies some independent medical practice professionals used to implement patient-centered care, ensuring quality patient care and practice profitability. How the data was collected. Semistructured interviews, audio, and examining public records Identify the population from which the researcher will collect data: six professionals from six medical practices in the St. Louis MSA who implemented patient-centered care to improve patient care quality and practice profitability. How data was analyzed. Qualitative with Themes Communication Financial Consciousness Quality Patient Care Time Management How will data contribute to social change: Implementing best practices of: Better relationship building through communication Being more cognitive of the patient’s financial circumstances Improving the quality of life for the patient Respecting and investing quality time with the patien
Factors Associated With Parental Substance Use and Child Welfare in Nevada 2019-2021
Get PDFSubstance use is a growing public health concern that is adversely impacting reproductive-aged individuals and families (Bruzelius & Martins, 2022). Parental substance use is increasingly driving family separation through the child welfare system. Substance use and family separation intersect with trauma and adverse childhood experiences in a variety of ways. Risk factors and race/ethnicity may contribute to family surveillance, bias, and disproportionality in child welfare and impact reunification and cause further trauma. This study explored associations between household characteristics and risk factors and services provided to families with reunification goals for families with child welfare involvement due to substance use in Nevada from 2019 through 2021. It used a sample of 931 cases of children placed in out-of-home care, for which parental substance use was a factor for removal, from the linked administrative datasets of the National Child Abuse and Neglect Data System (NCANDS) and Adoption and Foster Care Analysis and Reporting System (AFCARS) and was framed by the social-ecological model. A regression model was used to test the associations between the household characteristics, risk factors, and services with reunification goals. The analysis revealed that the child\u27s age at the time of the report or family structure were not predictors of reunification goals. Race, inadequate housing, multiple risk factors, and transitional housing were all predictors of reunification goals. This study promotes positive social change that can inform policies, programs, and practices aimed at disrupting family separation, intergenerational trauma, and substance use
Clinical Practice Guideline for Lifestyle Management of Clients on Second Generation Antipsychotic Medications
Get PDFSecond-generation antipsychotics (SGAs) are a category of medications principally employed for the treatment of certain mental illnesses. One major downside of the medications is their tendency to induce weight gain, which can result in negative metabolic consequences and raise the likelihood of cardiovascular disease. The clinic setting was focused on the mental health component for the patients on SGAs, and there was little time and ability to address physical health needs, such as weight gain, nutrition, and exercise, which led to comorbidities and possible exacerbation of the mental health issues. Therefore, the purpose of this doctor of nursing practice (DNP) project was to develop and evaluate a clinical practice guideline (CPG) for lifestyle management of clients on SGAs. The project questions were two-fold. The first question was: Will the evidence-based literature support the CPG? The second question was relative to the guideline being evaluated by an expert panel using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument: Will the clinical practice patient education guidelines (CPPEG) meet the AGREE threshold of 7 (100%)? The CPPEG did not reach a perfect score of 7, but did earn 6.66 (94%), which is within the acceptable range. Five end users/stakeholders evaluated and unanimously agreed to support the implementation of the CPPEG in the clinic. The CPPEG will guide the interdisciplinary team in the promotion of weight management in tandem with mental health services for clinic patients on SGAs. The guideline is inclusive of all communities, which will result in positive social change as patients on SGAs experience decreased stigmatization relative to being overweight and recognize the benefits from achieving optimal physical health, thus improving the human condition
Effective Retention Strategies Retail Sector Leaders Use to Reduce Voluntary Employee Turnover
Get PDFRetail business owners who lack effective retention strategies to address voluntary employee turnover may struggle to maintain a stable workforce. The challenges can result in increased hiring and training costs, decreased productivity, and lower employee morale, ultimately jeopardizing the profitability and long-term sustainability of their businesses. Grounded in Herzberg’s two-factor motivation-hygiene theory, the purpose of this qualitative pragmatic inquiry study was to identify and explore effective retention strategies some St. Kitts-based retail small business leaders use to reduce voluntary employee turnover. Data were collected using semistructured interviews and a publicly available industry document review that included strategies to reduce high voluntary employee turnover in retail-based and small business industries. Through thematic analysis, four themes were identified: (a) offering competitive pay and benefits fosters employee loyalty, (b) providing job skills training and development enhances retail employee retention, (c) cultivating a positive work environment reduces voluntary turnover, and (d) supporting work-life balance motivates employees to stay. Key recommendations are for business leaders to establish opportunities for skills acquisition, career progression, and financial security for retail workers to encourage retention. The implications for positive social change include the potential for organizational leaders to foster individual growth, promote organizational innovation, and create more supportive work environments within the St. Kitts community