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Open Strategy for Social Impact: An Action Research Study of a Multistakeholder Open Strategy Planning Process
Get PDFAs social and environmental challenges become increasingly dire, organizations are focusing on creating positive social impacts beyond generating profits. Traditional strategic planning tools were originally created for the purposes of profit maximization and are not sufficient for organizations with the aim of addressing complex social issues. Open strategy offers a promising alternative by increasing multistakeholder involvement in the formulation of organizational strategy. Existing research has supported the idea that multistakeholder collaboration is an effective means for creating positive social impact since societal challenges are too complex for any one organization to sufficiently address. Despite these promises, there are risks and challenges inherent in the process of bringing together multiple stakeholders with divergent interests in an open strategy planning process. This action research focused on the process by which a nonprofit organization opens the idea generation phase of their strategic planning process to engage multiple stakeholders in order to increase their positive social impact. This study was informed by stakeholder theory, which offers the theoretical grounding to understand how organizations identify and engage stakeholders
Implementing a Brief Intervention for Smoking Cessation in an Inpatient Psychiatric Facility
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Problem: Smoking is a leading cause of various preventable diseases, and those who experience mental illness smoke cigarettes at a higher rate than the general population. Brief intervention is a type counseling that has proven successful in encouraging smokers to quit. The “5 A’s” is a type of brief intervention which stands for: Ask, Advise, Assess, Assist, Arrange. Addressing the smoking epidemic among individuals with mental illness is not only essential for improving their overall well-being, but also for reducing health disparities and enhancing the effectiveness of existing mental health interventions.
Methods: The approach to this project was a quality improvement initiative. Specifically, the design of this study was descriptive and survey based. Participants were selected from a convenience sample of adult patients hospitalized on an inpatient psychiatric unit. The flowsheet collected information regarding participants’ interest in quitting smoking, self-reported rating of their readiness to quit, interest in receiving pharmacologic and non-pharmacologic cessation tools, and receipt of follow-up information.
Results: The number of self-identified smokers that received the full 5 A’s brief counseling intervention was 15 (n = 15), comprising 44.1% of all patients who reported smoking cigarettes (n = 34). Mean readiness to quit ratings were similar for each psychiatric diagnosis. Furthermore, findings suggest that diagnosis and 5 A’s receipt could be independent of one another.
Implications for Practice: Patients on the inpatient psychiatric unit should be offered opportunities to receive education and support regarding smoking cessation. Smoking cessation initiatives may be equally beneficial to psychiatric patients regardless of diagnosis
River City Blues: The Quest for Municipal Home Rule & Economic Security in St. Louis
Get PDFThe Great Divorce in St. Louis, the separation of the City and County of St. Louis in 1876 is one of the most impactful events in the region’s history. Most people will think of the Great Divorce in simple terms like The County didn\u27t like the City. or The City didn\u27t want to pay tax money that went to the County alone. Few, however, go further and ask why. Why didn\u27t the City want to pay taxes to the County? The answer is economics. I found in my research compelling evidence that the City leadership believed that the municipal relationship with the County, seen as an extension of its relationship with the State of Missouri, was so detrimental to the City\u27s future growth that a radical change in that relationship was needed. Spending was only growing along with the City of St. Louis itself and had no signs of stopping. Separation became the chosen solution to a County government seen as corrupt and swindling and a government in Jefferson City that had to approve many City civic measures, many tax or funding related, before local enactment could happen. The City felt fact money going to projects that mostly benefited the County and its non-City residents was unfair. Meanwhile, the state legislature, although usually permissive to St. Louis interests, was seen as an unnecessary bottleneck and a potential pain point legislatively as Jefferson City could turn down civic legislation for St. Louis that could be direly needed or have broad public legislative support in St. Louis. Both of these were threats to the future investment and success of St. Louis, City leaders felt. A state constitution change in 1875 made possible for the City to annul its undesired relationship with the forces of Jefferson City. City leaders pounced later that year and began the process that created today\u27s political situation in the St. Louis region. Then all that was left was the County and the City with their very different trajectories. City leaders knew they needed to be able to take the steps to fund development on their own, and felt the option we are currently in to be the one that would assure St. Louis\u27s future growth. While my findings merely scratch the surface of this rabbit hole, the details I have seen give credence that there was a belief among the pro-separation City forces that separating from the County was vital for St. Louis\u27s economic security and future growth
Pain Interference in Chronic Musculoskeletal Pain: Examining a Resilience Model of Dispositional Optimism, Coping Responses, and Mind-Body Practices
Get PDFChronic musculoskeletal pain is the leading cause of disability in the United States. Pain interference, or the ways chronic pain negatively interferes with everyday life, is the biggest problem impacting individuals with chronic musculoskeletal pain. Although previous research has targeted risk factors associated with poor health outcomes, the adaptive functioning of some patients with chronic pain highlights a need for research investigating resilience factors. The purpose of this study was to investigate the direct and indirect relationships between resilience factors of optimism, coping responses, and mind-body practices on pain interference for individuals with chronic musculoskeletal pain. Specifically, the resilience model of chronic pain was used to investigate a path leading from dispositional optimism to pain interference through problem-focused and emotion-focused coping responses and engagement in mind-body practices. A subsample of participants from the MIDUS-3 study with an arthritic condition and chronic pain was assessed for each of the resilience factors of interest, and the main outcome variable, pain interference. Results demonstrated that each resilience factor, excluding mind-body practice engagement, was significantly associated with pain interference. Path analysis revealed an indirect effect of optimism on pain interference through emotion-focused coping. Results from this study demonstrate the importance of optimism and its impact on other resilience factors. Future research is needed to determine ways optimism can be targeted through intervention to improve overall quality of life for patients with chronic musculoskeletal pain
Wiping Out Central Line Associated-Bloodstream Infections: Cleaning High Touch Surfaces in the PICU
Get PDFProblem: Central line-associated bloodstream infections (CLABSIs) are a significant, preventable healthcare-related complication of hospital admission and medical management of critically ill and medically complex patients. CLABSIs result in significant adverse outcomes such as increased morbidity and mortality, prolonged length of stay (LOS) in the intensive care unit (ICU) and in the hospital, increased cost of treatment, and increased rates of readmission. Direct and indirect contact within the patient’s hospital environment are potential means of transmission for microorganisms, increasing the inherent risk of acquiring a CLABSI.
Method: For this quality improvement (QI) project, a pre-post design was utilized to evaluate the effect of a standardized high touch surface cleaning protocol on CLABSIs. This was completed with the utilization of retrospective and prospective chart review three months prior to and following the implementation of this protocol. Nurses were provided with education via a virtual staff meeting four weeks prior to implementation as well as the utilization of infographic bathroom flyers. The QI project evaluated number of CLABSIs, nursing compliance, and LOS in the ICU.
Results: Seventy-six patients with 87 central lines met criteria and were included in this QI project. There was one CLABSI in three months prior to implementation and one CLABSI during the study period. The average PICU LOS was 18.29 days. RN compliance with cleaning high touch surfaces together was 11.54%.
Implications for Practice: After evaluating the implementation of the new high touch surface cleaning protocol in the pediatric ICU (PICU), the number of CLABSIs were the same. Clinical significance was exemplified as the PICU remained CLABSI-free for over 100 days after the study period ended. More research is necessary, including future studies containing more pediatric patients, greater sample sizes, multiple ICUs or institutions, and longer study periods
Interdisciplinary Medication Reconciliation Approach for Arabic-Speaking Patients
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Problem: Limited English Proficiency (LEP), which includes Arabic speakers, presents challenges in healthcare and can impact medication reconciliation and adherence. Interdisciplinary collaboration involving patients and interpreters is crucial for improving medication reconciliation and adherence. This project aimed to examine the impact of an interdisciplinary medication reconciliation approach on medication adherence with Arabic-speaking patients ages 18-99 over three months.
Methods: This quality improvement (QI) pilot project utilized a descriptive cohort design. A translated validated Morisky, Green, and Levine (MGL) adherence survey consisting of four questions was administered pre- and post-implementation to a convenience sample of Arabic-speaking patients 18 years or older but under 99 years old, prescribed two or more medications and had an in-person interpreter. Data collected included demographic data, patient surveys, the number of medications prescribed, and interventions recommended by pharmacists.
Results: There were (N=29) who participated in completing the initial survey, there were (n=15; 52%) who did not meet with the pharmacist for initial medication reconciliation, (n=14; 48%) completed the initial medication reconciliation with the pharmacist; (n=9, 64%) patients met with the pharmacist and completed a medication reconciliation visit but did not come back for a follow-up and to complete the post-survey, (n=5; 17%) returned for a one-month follow-up visit. The number of medications pre-reconciliation (n=5) (M=18.80; SD= 6.140) and the number of medications post-reconciliation (M=16.40; SD =6.025) decreased by 2.40. Interventions provided by the pharmacist included medication education, medication changes, pillboxes, and refill support. The MGL survey resulted in a (p-value = .248). This result may be due to the small sample size.
Implications for Practice: Early identification of medication reconciliation utilizing an interdisciplinary approach and interventions recommended by a pharmacist could benefit patient education and medication adherence, especially in the LEP population
360 Degree Clinical Competence Evaluation for Pediatric Hospitalist Advance Practice Provders
Get PDFProblem: Advanced practice provider (APP) peer reviewed clinical competencies is an expected part of professional, organizational, and The Joint Commission (Joint Commission) requirements, however, is not well defined and subject to organizational application and interpretation. Providers favor peer review as a means to improve professional practice. There is a lack of data to support frequency of feedback and method of feedback to support readiness to change practice and comfort giving and receiving feedback.
Methods: The quality improvement project utilized an analytical experimental design.
The Cardin Hospitalist Advanced Practice Provider - Readiness Assessment (CHAPP-RA) tool was implemented to a convenience sample of 18 APPs. Quantitative data was collected via survey via pre and post CHAPP-RA tool implementation. Data collected included readiness to change practice and comfort giving and receiving feedback.
Results: Following CHAPP-RA tool implementation, 75% (n = 3) APPs reported changing practice based on peer and attending feedback. This resulted in a 50% and 12.5 % increase in APPs changing their practice based on peer and attending feedback.
Comfort giving and receiving feedback was unchanged.
Implications for Practice: Use of the CHAPP-RA tool was one method to promote changing practice based on peer and attending feedback
A Multi-Site Qualitative Analysis of the Juvenile Justice and Child Welfare Systems: Implications for Dual System Youth
Get PDFResearchers have been studying juveniles who experience both child maltreatment and delinquency for decades. These studies document the prevalence, outcomes, and demographics of youth who navigate child welfare and juvenile justice systems, also known as dual system youth. However, there is a lack of investigation into the complex processes occurring at the intersection of these two systems. This dissertation aims to fill that gap by building on previous research, organizational theory, and the growing area of punishment literature in criminal justice. The goal is to better understand how juvenile justice and child welfare systems organizationally manage dual system youth. Specifically, the research explores the differences in processes, legal structures, and formal and informal policies observed at the state, local, and frontline levels. It also examines how these practices are creating racial and gender inequalities. To investigate, 36 semi-structured, in-depth interviews were conducted with practitioners such as caseworkers, judges, officers, court administrators, attorneys, and others who work at the juvenile justice and child welfare nexus across three study sites. Additionally, three focus groups were conducted in each site to fill gaps in the individual interview data and confirm the accuracy of the findings. The research found that there is wide variation in how juvenile justice and child welfare services are administered for dual system youth populations. These practices have a far-reaching impact, including the continuation of inequalities based on race and gender, as well as how youth with complex behavioral needs are handled. The study proposes a comprehensive policy solution while recommending strategies for fostering collaboration and supporting families
Exploring Strategies for Placement Stability Among Foster Care Children
Get PDFChildren in foster care are considered a vulnerable population because of the maltreatment and abuse that previously occurred. In addition to the trauma resulting from previous abuse or neglect, children in foster care face ongoing exposure to trauma due to the lack of stability within the system. Instability in the foster care system is displayed by frequent changes in placement providers, multiple school changes, inconsistent mental and physical health treatment, prolonged permanency, and loss of connections with biological family members. The aim for this study is to fill the gap in the literature on foster parent’s experiences with successful placement outcomes for foster care children. This research utilized a grounded theory approach to analyze the experiences of 13 foster parents in the state of Missouri. The findings were grouped into three different themes. The three major themes that were utilized to develop the theory for this study focused on child focused placements, trauma aware foster parents, and connection and community engagement. This research examined current foster parent’s experiences with successful placement outcomes in order to develop strategies for placement stability for foster care children