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Implementation of an Interprofessional Fall Prevention Program to Reduce Falls on an Older Adult Inpatient Psychiatric Unit
Get PDFBackground. Falls are the most reported incidents in the hospital setting, especially among older adults. According to the National Database of Nursing Quality Indicators (NDNQI), the number of falls in inpatient psychiatric units is 13-25 per 1,000 patient days, compared to 4 per 1,000 days for medical-surgical units. This DNP project aims to implement an interprofessional fall risk team to reduce falls in an older adult inpatient psychiatric unit. Problem. The psychiatric inpatient units had a total of 31 falls, with 13 (40%) occurring on the older adult unit. Interventions. Education of nursing staff, providers, and physical therapy (PT) was done on the Wilson Sims Fall Risk Assessment Tool. Providers were educated on high-risk fall scores and related medications. Screening for high-risk patients upon admission or status change was performed by nursing staff, and fall scores were discussed during interprofessional rounds. Medication review sheets were created for providers to record medication changes based on fall risk scores. PT consults are ordered in the electronic health record (EHR) upon admission. Results. During the first three quarters of 2021, there were a total of 19 falls on the inpatient psychiatric units, with 3 (16%) occurring on the older adult psychiatric unit. Implications for Practice. The outcomes of this QI project help expand on the dearth of literature regarding falls on psychiatric inpatient units. This project also highlights The Joint Commissions’ recommendation of establishing an interprofessional team, making fall prevention everyone’s responsibility by increasing awareness of fall risk patients and developing strategies for fall prevention
Providing Resources to Caregivers of Pediatric Mentally Ill Clients and Assessing for Caregiver Burden
Get PDFBackground. Provision of educational and supportive resources to the caregivers of children with mental illness can help create an environment of advocacy and understanding between the child, caregiver, and provider. In depth and comprehensive learning about their child’s mental illness cannot be accomplished in a one-hour new patient appointment or established patient appointment of 20 minutes. Purpose. The purpose of this practice improvement project was to facilitate educational and community support for caregivers of pediatric clients with mental illness and evaluate if caregivers require additional support due to burden. Objectives. (a) 100% of caregivers of pediatric clients who have appointments during the 10-week implementation period were contacted via telephone and offered the caregiver resource flyer and burden assessment by email, (b) 75% of the caregivers contacted during the 10-week implementation period were provided with the caregiver resource flyer and burden assessment via email, (c) 30% of the caregivers who were sent the resource flyer returned the burden assessment and demographic data sheet, and (d) 100% of caregivers identified as having severe burden were referred to social services. By meeting these objectives, it was expected that caregivers would have the opportunity to access resources available to further educate themselves and access local community groups for support to help lessen their burden. Results. Telephone callbacks to receive the resource flyer were imperfect with approximately 30% of the caregivers receiving the flyer via email. Further results will be presented during the SCMF Lecture. Implications. Other means of receipt for the resource flyer and burden assessment are needed to capture 100% of caregivers of pediatric clients at this private practice
Women in Direct Combat Arms: A Constructivist Grounded Theory Study of U.S. Army Active-Duty Military Intelligence and Cyber Command Women Perspectives and Current Career Opportunities and Policies in the Military Combat Fields
Get PDFEffective January 1, 2016, the Department of Defense implemented a new policy pertaining to a full work role gender integration for service women in all U.S. military fields and positions. Active-duty women struggled to participate, adapt, and be completely integrated into the full institutional direct combat arms positions and careers. Research on such gender participation to date has focused specifically on physical fitness standards, unit morale and cohesion, successful entry into training pipeline for direct combat arms fields, and outcomes measured by current attrition rates. A constructivist qualitative grounded theory research study was needed to understand how current active-duty women in military intelligence, a combat support field, and Army cyber career, a combat arms field, perceive how this full integration decision affects them. The purpose of this study was to explore the perspectives, experiences, and expectations of full direct (combat) arms participation opportunities for military intelligence and cyber career field active-duty women. The aim of this study was to analyze how these active-duty women understood the U.S. Army’s full gender integration efforts and its impact on them while serving in their current careers or potential service career fields. This study discovered how these active-duty military intelligence and cyber career field women understood and participated in the full gender integration process while identifying the access and acceptance factors explained within an adaptation, integration, assimilation, and inclusion constructs for a total military service inclusion theory system
Herpetic Keratitis, Patience is a Virtue: HSK in Immunocompromised Patient
Get PDFBackground: The Herpes virus is ubiquitous in our patient population. Often it is present without symptoms, however, it may present with pain, irritation, and decreased vision. In high-risk populations a longer course of treatment is often required.
Case Report: This case report will detail the treatment options and outcome in a patient with herpes keratitis who also is HIV positive and addresses concerns about treating immunocompromised patients.
Conclusion: This case serves as a review of common and uncommon treatment options for herpes keratitis as well as a review of potential causes of this presentation. Herpetic keratitis is likely to be something most providers will encounter during their careers. Use of oral antivirals is often more cost effect, better tolerated, and improves compliance
Break the Fall: Orbital Blowout Fracture
Get PDFBackground: Head trauma can lead to multiple ocular complications, among the most concerning is an orbital blowout fracture. Common associations with an orbital fracture would include periorbital ecchymosis, subconjunctival hemorrhage, eyelid edema, and crepitus, among others. Concerning complications, such as retinal detachment, need to be ruled out at the time of presentation. Surgical intervention may be warranted in certain cases. An emergent head computed tomography scan must be performed to evaluate and determine management.
Case Report: This case features a 66-year-old Caucasian male with an orbital blowout fracture following a fall. In addition to discussing the details regarding this patient’s case, this report highlights fracture types, pertinent imaging, determination of muscle entrapment, and other underlying complications.
Conclusion: Careful evaluation is critical in proper management of potential orbital fracture cases. Entrance testing such as visual acuity measurement, pupil assessment, and extraocular muscle motility evaluation provide useful information regarding suspected severity of an orbital fracture. A dilated fundus examination is necessary for assessing concerning posterior complications. Computed tomography imaging must be obtained in all instances of questionable orbital fracture. Surgical intervention may be needed in some instances. Regardless of the necessity for surgical intervention, careful monitoring of these cases for resolution is advisable
Belief and Belonging: A Case Study of the Maronite in San Antonio, Texas
Get PDFThis study focuses on a religious group in America and how it has managed to engage the third and fourth generations who have assimilated into the American cultural milieu while maintaining allegiance to the Church of Lebanon-the Maronite Catholic church. Understanding the history of the Lebanese American people and their connection to this Church is essential when studying this group because it offers a deep awareness of the existing phenomena in America, the natural progression of an immigrant population, and its subsequent generation’s progression into the American society. Most of these individuals in this study are the descendants of the early Lebanese Christian immigrants who arrived in America nearly a century ago. The first wave of these immigrants came at the turn of the 20th century as a result of religious persecution, economic stagnation, and regional discrimination against the Christians in Lebanon during the Ottoman regime. As a means of preserving their cherished religious beliefs in America, Maronite Catholic churches established to provide both a place for spiritual worship and secular culture renewal for the Lebanese communities across America. The Maronite Church struggles with providing a place of prayer and renewal through the celebration of the Eucharist and with the image of being merely a secular institution of heritage. The role that this religious institution plays in maintaining community spiritual cohesion and shaping ethnic identity has received little attention from scholars, an inexplicable omission since religion plays a dominant role in shaping the Lebanese American identity. This study examines the relationship between the Maronite Church as an ethnic Eastern-rite Church and the identity formation of Lebanese Americans affiliated with the Maronite Church in San Antonio, Texas. This study explores the Maronite rite history, liturgical traditions, as well as its role in the lives of Lebanese Americans. The analysis offers a greater understanding of the Maronite rite and its role in the Lebanese communities and adds to the body of knowledge in this field of study. Through an exploration of the third- and the fourth-generation Lebanese Americans and the attendance patterns at the Maronite sites and engagement in the faith-based community, the factors that influence involvement are identified and studied in terms of its relevance to the longevity of the Maronite Church in America
Choroidal Melanoma: Screening for metastasis and frequency of incidental second primary cancer diagnosis.
Get PDFBackground: Choroidal melanoma is the most common primary intraocular malignancy in adults. This case report reviews clinical diagnostic features, imaging techniques, treatment, prognosis, and systemic work-up of choroidal melanomas. It also addresses choroidal melanoma metastasis and the incidental finding of second primary cancers through whole-body screening.
Case Report: A 71-year-old white male reported to the Cleveland VA Medical Center optometry retina clinic for a second opinion exam of an asymptomatic choroidal lesion in the right eye. The lesion was a 6 mm gray choroidal mass in the inferior peripheral fundus, with orange pigmentation, retinal pigmented epithelial hypertrophy along the superior border, and drusen. B-scan ultrasound showed a mass that was elevated by 2.5 mm with moderate reflectivity, suggestive of choroidal melanoma.
Conclusion: Early diagnosis of choroidal melanoma is important due to improved survival rates in those diagnosed when the choroidal melanoma is small. In addition to the clinical assessment, diagnosis may be aided by ancillary imaging such as OCT. Prognosis generally is poor due to late diagnosis and is dependent on choroidal melanoma size, genetic profile, and presence of metastasis. Whole-body screening for metastasis leads to the discovery of additional primary tumors at a rate nearly equal to that of metastasis
Occlusive Retinal Vasculitis Secondary to Sjogren’s Syndrome: A Case Report and Review
Get PDFBackground: To bring attention to the potential and serious ophthalmic sequalae of Sjogren’s syndrome, specifically occlusive retinal vasculitis.
Case: A 70-year-old male patient without previous ocular pathology presented with acute onset, bilateral, painless vision loss. Fundus evaluation revealed extensive retinal occlusive disease with bilateral disc edema, cystoid macular edema, and diffuse phlebitis. The patient was admitted, received a full systemic work-up and was carefully co-managed by ophthalmology, neurology, infectious disease, vascular surgery, dermatology, rheumatology and medicine. Evaluation supported a leading diagnosis of Sjogren’s syndrome associated vasculitis.
Conclusion: The patient underwent treatment with oral steroids and intravitreal injections of anti-vascular endothelial growth factor; treatment successfully restored usable vision in one eye. This case will highlight the importance of prompt and thorough evaluation of patients diagnosed with or with suspected diagnosis of Sjogren’s syndrome since severe ocular manifestations can mirror severe, potentially life-threatening, levels of systemic complications