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Standardized Nurse Leader Rounding
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Project Title: Standardized nurse leader patient rounding
Problem: The problem was that there is an expectation of nurse leader rounding (NLR) on the inpatient units, however, there was not a standardized process in place to support this expectation. In addition, patient falls, and patient falls with injury remain high in this acute care setting.
Purpose: The purpose of this DNP quality improvement project was to determine if standardized nurse leader rounding on hospitalized inpatients improves nursing outcomes, specifically, patient falls, patient falls with injury and overall patient satisfaction.
Goals: The goals of this quality improvement project included decreasing/improving patient falls and patient falls with injury, and increasing/improving overall patient satisfaction on the inpatient acute care nursing unit.
Objectives: The objectives included the implementation of a standardized NLR process through standardized education and competency validation. The standardized process defined who conducts NLR, how often NLR was conducted, the time of day rounding occurred and what was covered in a patient round.
Plan: This quality improvement project utilized a quasi-experimental design, with a convenience sample of hospitalized inpatients, to evaluate three outcome variables impacted by the intervention of nurse leader rounding. Pre-intervention data, a baseline of three months, was compared to post-intervention data, three months of data, to determine the overall impact of standardized NLR.
Outcomes and Results: Standardized NLR positively impacted the dependent variables of patient falls, patient falls with injury and the overall HCAHPS patient satisfaction scores. Patient falls decreased/improved 48%. Patient falls with injury decreased/improved 100%. Overall patient satisfaction score increased/improved 43%. This quality improvement project demonstrated the positive results of standardized NLR on nursing quality outcomes and patient satisfaction. In addition, the standardized approach ensured that all patients receive the same intervention from nursing leaders. All nursing leaders must conduct NLR consistently in approach and frequency to increase the impact on patient outcomes and patient satisfaction
The effect of dry needling on gastrocnemius muscle stiffness and strength in participants with latent trigger points.
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Exploring the Locker
Get PDFThis article is an effort to foster grace and to create genuine, humble community. A new sense of community, that is not conditional on our abilities to censor ourselves to be more palatable to those around us. Instead, the birth of a new way of relating that considers our deep inner selves that feel shame, remember traumas, and cower in fear of these experiences. Perhaps most of all, this article is an invitation to explore our deepest inner selves, and the cost of censoring this self. This exploration is not a leisurely dive into the corners of ourselves that lie in the shallows. It is an adventure that will require a full set of SCUBA gear, and a courageous spirit. A courageous spirit that is not only willing to dig through the shame, fear, and anger that covers our raw selves, but a spirit that will then sit with these wounded and forgotten parts, and begin to build a new sense of balance
The effect of dry needling on gastrocnemius muscle stiffness and strength in participants with latent trigger points
Get PDFAbnormal muscle stiffness is a potential complication after injury and identifying interventions that modify muscle stiffness may be useful to promote recovery. The purpose of this study was to identify the short-term effects of dry needling (DN) on resting and contracted gastrocnemius muscle stiffness and strength of the triceps surae in individuals with latent myofascial trigger points (MTrPs). In this randomized controlled trial, 52 individuals received two DN treatment sessions to latent MTrPs and 50 individuals received two sham needling sessions. Resting and contracted muscle stiffness were assessed both at the treatment site and a standardized central site in the medial gastrocnemius head immediately post-treatment and one week after the last session. There were significant group by time interactions for resting muscle stiffness at the site of the MTrP (p = .03), but not at the central site (p = .29). Post-needling between group comparison indicated that the DN group had significantly lower resting muscle stiffness at the site of the MTrP than the sham group after adjusting for baseline differences. There were no significant between group differences in contracted muscle stiffness or muscle strength. Identifying strategies that can reduce aberrant muscle stiffness may help to guide management of individuals with neuromuscular pain-related conditions. Level of evidence: Therapy, level 2
Systemic Corticosteroid-Related Complications and Costs in Adults with Persistent Asthma
No full textBackground: Systemic corticosteroids (SCS) may cause complications for patients with asthma. Objective: We sought to better understand the burden of SCS use in persistent asthma, including health care costs. Methods: Adult patients with persistent asthma were identified in the IBM MarketScan Databases from January 2003 to July 2016. The index date was set as the first SCS prescription for SCS users or an algorithm-matched date for non-SCS users. Patients were required to have ≥1 year of data before and after the index date. Based on the number of SCS claims in the first year after index, patients were categorized into 3 SCS groups: 0 SCS claims, 1 to 3 claims, and 4+ claims. Inverse probability of treatment weights were applied to adjust for differences between SCS and non-SCS users. Analyses included weighted and multivariate modeling to assess SCS-related complications and costs during a 3-year follow-up. Results: A total of 86,786 SCS users (1-3 claims: 76,690; 4+ claims: 10,096) and 91,409 non-SCS users were included; 45% remained 3 years after index. In multivariate analysis, the 3-year risk of developing any chronic complication was 6% greater for those with 1 to 3 claims and 26% greater for those with 4+ claims compared with non-SCS users (P \u3c .001). Multivariate-adjusted health care costs over 3 years were significantly greater as 4+ users incurred 4627 greater asthma-related costs, and $2647 greater chronic complication–related costs than non-SCS users (P \u3c .001). Conclusions: In this study, adults with persistent asthma receiving SCS treatment had greater odds of complications and greater associated costs over 3 years than matched non-SCS asthma patients
The benefits of academically oriented peer mentoring for at-risk student populations
No full textThis article examines an academically oriented peer-mentoring program at St. John’s University. The program targeted at-risk first-year students who were having difficulty making the transition to college and matched them with trained student mentors within their major discipline. In addition to meeting with one another bi-weekly, all of the students came together for a series of organized events over the course of the academic year. The goals of the program were that mentees would (1) feel an increased sense of belonging at the university, (2) raise their GPAs, and (3) show improved retention to the second year. After examining how successful the program was relative to these goals, the authors recommend some best practices for peer-mentoring programs. These recommendations are based on both features of the program in the study that contributed to its success and areas where the program could have been improved based on the results
Healthcare resource utilization, expenditures, and productivity in patients with asthma with and without allergies
No full textObjective: To compare healthcare resource utilization (HCRU), healthcare expenditures, and work productivity and activity impairment within a general asthma population with persistent asthma and evidence of allergy (PA-EA) and persistent asthma with no evidence of allergy (PA-NEA). Methods: We conducted a retrospective analysis of survey responses and claims from the Observational Study of Asthma Control and Outcomes (OSACO) study. Eligible patients with persistent asthma aged ≥12 years were sent four surveys over 15 months. Regression models were used to assess the association between: (1) PA-EA (defined as a positive response to a survey question about hay fever/seasonal allergies AND ≥1 diagnostic code for atopic conditions) and HCRU and expenditures; and (2) PA-EA and Work Productivity and Activity Impairment (WPAI)-Asthma questionnaire scores (vs. PA-NEA). Results: Adjusted data showed that, vs. PA-NEA (n = 312), patients with PA-EA (n = 971) incurred 1.34-times more all-cause prescriptions (95% confidence interval [CI], 1.20–1.48), 22.03–243.56), and 279.67–1572.54), per 4-month period. Patients with PA-EA were 4.1% less productive while working (95% CI, 3.75–4.48%) and experienced a 6.5% reduction in all activities (95% CI, 6.11–6.88%) vs. those with PA-NEA. Conclusions: Patients with PA-EA had greater HCRU, healthcare expenditures, and lower productivity compared with those patients with PA-NEA. These results highlight the burden of atopy in patients with persistent asthma and underscore the importance of allergic endotype identification for more vigilant disease management
Effectiveness of percutaneous electrical nerve stimulation for musculoskeletal pain: A systematic review and meta-analysis
No full textBackground and Objective: To evaluate the effects of percutaneous electrical stimulation (PENS) alone or as an adjunct with other interventions on pain and related disability in musculoskeletal pain conditions. Databases and Data Treatment: Search of MEDLINE, EMBASE, AMED, CINAHL, EBSCO, PubMed, PEDro, Cochrane Library, SCOPUS and Web of Science databases. Randomized controlled trials where at least one group received any form of PENS for musculoskeletal condition. Studies had to include humans and collect outcomes on pain and related disability in musculoskeletal pain. Risk of bias was assessed by the Cochrane Guidelines, the quality of evidence by using the GRADE approach. Standardized mean differences (SMD) were calculated. Results: Sixteen studies were included and included heterogeneous musculoskeletal conditions with short- or midterm follow-ups. PENS alone had a large effect (SMD −1.22, 95% CI −1.66 to −0.79) on pain and a small effect (SMD −0.33, 95% CI −0.61 to −0.06) on related disability at short-term as compared with sham. A moderate effect of PENS alone (SMD −0.71, 95% CI −1.23 to −0.19) on pain when compared with other interventions was observed. The inclusion of PENS with other interventions had a moderate effect for decreasing pain at short- (SMD −0.70, 95% CI −1.02 to −0.37) and midterm (SMD −0.68, 95% CI −1.10 to −0.27). No effect at midterm (SMD −0.21, 95% CI −0.52 to 0.10) on related disability was seen. The risk of bias was generally low; but the heterogenicity of the results downgraded the level of evidence. Conclusion: There is low level of evidence suggesting the effects of PENS alone or in combination for pain, but not related disability, in musculoskeletal pain. Level of Evidence: Therapy, level 1a. Registration number: CRD42019131331. Significance: This meta-analysis investigating the effectiveness of PENS for the management of pain and related disability in musculoskeletal pain conditions found that PENS could decrease level of pain intensity but not relateddisability in musculoskeletal pain disorders