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In the Spirit of St. Peter Claver: Social Justice and Black Catholicism in San Antonio
Get PDFThe editors want to take the space reserved for the abstract to say that this is the final piece of research that Phil Lampe completed before his passing. We publish it here posthumously in tribute to Phil’s tireless work for social justice, as editor of Verbum Incarnatum, as researcher of social-justice efforts in South Texas and Mexico, and as an educator committed to inspiring students to pursue justice in their lives outside the academy
Respite for Acute Care Nurses With the Use of a Resilience Room
Get PDFBackground and Significance of the Problem. Nurses are exposed to higher levels of occupational stress in acute care units when compared to other departments within the hospital (Faraji et al., 2019). A qualitative assessment identified a need for resources to be provided for acute care nurses experiencing occupational stress. Purpose. To establish an area for respite and increase nurses’ knowledge about a Resilience Room and a support system to manage occupational stress. Objectives. To educate 75% of acute care nurse on respite care, have 50% of the nurses report utilization of Resilience Room, and increase the nurses use of a support system by 25%. Methods. In a quality improvement project conducted in a large metropolitan hospital a respite area with a massage chair, music and aromatherapy was established. All acute care nurses received education on the room and support system with a follow-up survey administered at week three and six of project. Results. The Resilience Room was used by 100% of nurses with the massage chair the most commonly used feature in the room. Seventy-one percent of the nurses who completed the survey reported a positive response. There was also a 36% increase in use of the support system. Implications for Nursing. The provision of a Resilience Room and support system is an effective way to assist acute care nurses. The overall response to the Resilience Room was positive and will be maintained for future use. The establishment of additional respite sites may be useful to other staff
Ocular Characteristics of Non-COVID-19 Patients: A Retrospective Study of Time-Sensitive Ophthalmic Care during the Pandemic
Get PDFPurpose: To analyze the cohort of clinical patients seen during the COVID-19 pandemic shutdown at Emory Eye Center in comparison with prior weeks.
Method: We conducted a retrospective chart review from three outpatient clinical sites over a period of eighteen weeks, which covered pre-COVID-19 dates as well as the dates of when our clinics were closed near the beginning of the COVID-19 pandemic. We utilized data from providers assigned to daily triage coverage for in-person exams. Primary diagnosis and visit type data were extracted to look for trends and commonalities among urgent or time-sensitive patients.
Results: For the nine weeks prior to clinic closure, there were 11,700 primary visit codes. During the nine-week closure, there were 1,624 in-person visit codes. We were able to observe some trends for descriptive purposes. Diagnoses of patients seen in person with higher frequency during the closure included vitreous disorders (i.e., posterior vitreous detachment), corneal ulcer, optic nerve disorders, idiopathic intracranial hypertension and post-operative care. We also looked at our telehealth visit numbers. However, there were very few telehealth visits (n=25), which rendered the telehealth analysis statistically insignificant.
Conclusion: Through an analysis of the pool of non-COVID patients who were seen during the shutdown in our clinics via in-person urgent or time-sensitive exams, we were able to observe a breakdown of visit type and diagnosis. A comparison of those patients with the distribution seen in person during the previous nine weeks was reviewed. Although our numbers for data analysis during closure were too small to devise an evidence-based algorithm, there were still several lessons we learned from this first wave of the COVID-19 pandemic such as: 1) how to predict which patients may be more time-sensitive or urgent from a pre-determined list of diagnoses; and 2) how to immediately establish an ophthalmologist/optometrist (MD/OD) daily triage coverage schedule. We found it difficult to successfully incorporate a significant number of telehealth visits because most eye conditions, which were already deemed urgent by our call center, were in general considered conditions that required further evaluation by a provider. We hope that these take-away lessons will further improve ophthalmic care for any future pandemic or widespread closure
Quality Improvement Project: Communication Guidance During and Following Maternal Hemorrhage
Get PDFBackground. Maternal hemorrhage is a significant cause of worsening maternal morbidity and mortality in the United States. If timely, effective, and compassionate communication is not provided during and following traumatic birth events, negative mental health problems may result that affect maternal well-being, bonding with the baby, and family relationships. A gap analysis carried out at the clinical site showed that a written, evidence-based guidance on communication with patients and families during and after a maternal hemorrhage event was needed. Compliance through documentation is required by the Joint Commission. Trauma-Informed Care is an evidence-based communication approach that incorporates principles of safety, choice, collaboration, trustworthiness, empowerment, cultural/historical/gender that can address traumatic stress developed during or following traumatic events (Morton et al., 2020). Purpose. The aim is to implement best practice for addressing the psychological aspect of maternal hemorrhage events and to meet Joint Commission safety and communication requirements. Goals. Develop and implement communication guidance with greater than 50% documentation adherence. Methods. Using a quality improvement approach, maternal patients meeting hemorrhage criteria received timely communication developed in collaboration with an interprofessional healthcare team. Obstetric staff was educated on the communication approach and a process to prompt obstetric providers to document communication in the medical record was instituted. Results. A post-intervention review of 36 records of maternal hemorrhage patients occurring over an 8-week period revealed 52% documentation of the communication. Implications. An evidence-based communication approach can be implemented to avoid retraumatizing maternal patients and potentially decrease the incidence of future psychological issues
Strategies to Prevent Hospital Acquired Pressure Injuries in the Intensive Care Unit
Get PDFBackground. Despite prevention strategies, hospital acquired pressure injuries continue to occur, especially in intensive care units. This led to an impetus for nurses to have a robust knowledge of pressure injuries to promulgate prevention strategies in their practice. Significance of the Problem. The hospital acquired pressure injury rate in the medical surgical intensive care unit for the year 2019 at Hospital X was greater than the national benchmark. Purpose. The global aim statement was to improve the quality of patient care by developing an evidence based educational suite in collaboration with interdisciplinary team members for prevention of hospital acquired pressure injuries. Objectives. The objectives included creating an evidence based educational suite, utilizing a standardized scale to assess risk factors, and refining the visual documentation of high-risk anatomy. Methods. This Quality Improvement Project took place in the intensive care unit of Hospital X. The educational session in a dedicated classroom was followed a tandem integumentary assessment. The utilization of a standardized scale and the visual documentation of high risk anatomy was logged on a daily basis. Outcomes. Among 48 nurses, 43 (90%) attended the evidence based educational suite and performed a tandem integumentary assessment. Among 1,896 opportunities for a skin risk, 1,580 (83%) were completed. The visual documentation of high-risk anatomy by ICU staff went from 17% to 65% compliance. Implications for Practice. A multidisciplinary team looked at the evidence-based care regarding hospital acquired pressure injuries and assisted the care team to be able to work within the means of the technology and equipment which is available
Improving the Early Detection and Management of Peripheral Artery Disease in Patients With Diabetes Within the Primary Care Setting
Get PDFBackground. Diabetes is a significant risk factor for peripheral artery disease. Individuals with diabetes, greater than 50 years of age, having at least one other risk factor should be screened for peripheral artery disease with an ankle brachial index. Purpose. Improve detection and management of peripheral artery disease in persons with diabetes within primary care. Evidence. Individuals with diabetes and peripheral artery disease have an increased risk of adverse cardiac and limb events, impairing the patient’s quality of life and causing long-term disability (Berger & Newman, 2020). Methods. During a 10-week period, these processes were implemented: (a) screening all patients with diabetes for peripheral artery disease risk factors; (b) conducting ankle brachial indexes for those with risk factors; (c) assessing for statin and antiplatelet medication coverage; (d) providing diet, exercise, and smoking cessation counseling; (e) referring patients with abnormal results for vascular evaluation. Results. 257 (83%) patients were high-risk for peripheral artery disease and needed ankle brachial index screening. A total of 23 ankle brachial indexes were completed with 3 abnormal tests requiring referrals. Of the 257 evaluated, antiplatelet therapy was utilized by 172 (67%) while statin therapy was utilized by 223 (86.7%). Education was provided to 110 of the patients. Fourteen of those were active smokers. Barriers included staffing issues and the COVID pandemic. Implications. Results emphasize the importance of screening and evaluating all patients with diabetes for peripheral artery disease risk factors and implementing comprehensive guidelines. For sustainment, consideration must be given to same-day ankle brachial index testing
How Positive Practices in Organizations are Associated with Employee Engagement via the Moderating Effects of Generational Cohorts in U.S. Customer Service Organizations
Get PDFThe purpose of this study is to examine the moderating role that the respective workforce generational cohorts may have on the relationship between positive practices in organizations and levels of employee engagement of U.S. based adult customer service representatives of all races. Studies show that higher employee engagement positively affects employee motivation, satisfaction, productivity, and ultimately the financial success of the organization. However, the levels of engagement for front line customer service positions are some of the lowest of occupations measured by Gallup and have actually declined in recent years. The broaden and build theory of positive emotions shows that a person who frequently experiences positive emotions not only has greater personal resources, wider range of responses, and scope of attention, but that it leads to an upward spiral of more positive emotions and overall well-being (Fredrickson & Joiner, 2002). Positive practices in organizations include phenomena such as excellence, trust, vitality, flourishing, teamwork, appreciation, respect, empathy, and those processes that are generative, strengthening, and enriching (Cameron et al., 2003; Peyrat-Guillard & Glinska-Newes, 2010). In addition, in a multigenerational workforce, critical events of their history shape each generation resulting in shared norms, values, and expectations in the workplace for that generation (Alwin, 1997; Strauss & Howe, 1991). Therefore, because of these different experiences and values, positive practices may affect some employees more acutely than others.
This study is a quantitative non-experimental correlational study (Creswell, 2014) using a non-probability data collection method of crowdsourcing to collect responses from 249 adult customer service representatives in the United States listed on the LinkedIn website about their attitudes and practices in their workplace. Employee engagement was measured using the employee engagement scale (EES) developed by Shuck et al. (2017). Positive practices in the organization used Cameron et al.’s (2011) 29-item Positive Practices scale.
This study showed that the use of positive practices in organizations predicts higher levels of employee engagement. In addition, the study found that generation does moderate the relationship between positive practices and employee engagement, showing a significant difference in the employee engagement in the Millennials’ generation based on whether positive practices is used in their organization versus the reactions of other generations. This study provides a valuable resource to customer service executives, because the results imply that those employees that are the least engaged today (Millennials) would respond the most dramatically to the use of positive practices in their organizations
Pre-Admission Patient Education for a Prostatectomy Enhanced Recovery After Surgery Pathway
Get PDFBackground. In the United States, prostate cancer is the most common cancer diagnosed in men and a common treatment choice is a radical prostatectomy. The Enhanced Recovery After Surgery® Society developed evidence-based guidelines to optimize treatment and improve outcomes in prostatectomy patients, yet not all hospitals are utilizing these guidelines or employing all of the elements, including pre-admission education. Purpose and Objectives. The purpose of this quality improvement project was to develop, implement, and evaluate a pre-admission patient education component for a prostate surgery pathway based on the Enhanced Recovery After Surgery guidelines. Objectives included assessing the nurse’s intention to use the tools and the patients’ perception of satisfaction with the education. Methods. The project leader collaborated with physicians, nurses, information technology, and other stakeholders to develop, implement, and evaluate the prostatectomy pre-admission education component of the ERAS pathway at a large southeastern hospital. Components of the education portion of the pathway include a bi-lingual patient prostate surgery education book, a patient surgery checklist, and a nurse teaching tool. Results. Survey findings showed that 100% of patients participating in the ERAS prostatectomy teaching visit with the nurse received the new education book and rated the visit as satisfied or highly satisfied. Implications for Practice. Completing a comprehensive patient education component for a prostate ERAS pathway can lead to pre-admission nurses delivering consistent education to patients preparing to undergo prostatectomy surgery. The role of the Doctor of Nursing Practice leader working with the interdisciplinary team was instrumental in completing this project
The Correlation Between Dietary Intake, Stress, Food Insecurity, Physical Activity, Sleep, and Screen Time in College Students During Covid-19
Get PDFCollege students with high stress levels are more likely to engage in unhealthy behaviors, which may negatively impact their health. During COVID-19, college student’s lives were disrupted on multiple levels. The aim of this study was to investigate the relationship between dietary intake, perceived stress, food insecurity, sleep, screen time, and physical activity among college students during the COVID-19 pandemic. College students at the University of the Incarnate Word (N=154) completed an online survey to assess dietary choices (Dietary Screener Questionnaires (DSQ) in the NHANES 2009-10: DSQ), food insecurity (6-item Short Form of the US Household Food Security Survey), stress (Perceived Stress Scale-10), physical activity (International Physical Activity Questionnaire Short Form), screen time, and sleep. Students self-reported demographic information. Independent t-test, ANOVA test, multiple-linear regression, and Sobel test were used to analyze the data. Males consumed significantly more added sugar, whole grains, and fruits and vegetables than females (P \u3c .001). Higher levels of stress (P \u3c .05) and less intense physical activity (P \u3c .05) were significantly related to a lower consumption of fruits and vegetables. Food insecurity was significantly related to greater stress levels (P\u3c .05). Finally, regression models explained approximately 13.5% of consumption of food and vegetables. The higher college students perceived stress scores, the more likely they are to consume less fruits and vegetables. Programs aimed at reducing stress and its potential causers, providing resources for food insecure students, promoting physical activity, and enhancing nutritional education can help improve college students\u27 diet and life quality
Occipital Lobe Abscess Causing Homonymous Hemianopsia After a Dental Procedure
Get PDFBackground: A homonymous hemianopsia visual field defect is defined as vision loss on the same side of the vertical midline in both eyes. Although the vast majority are caused by an ischemic stroke, other neurologic etiologies must be considered and ruled out. This case highlights the importance of a rapid and thorough investigation of a patient’s symptoms using both clinical examination and imaging to reduce the risk of permanent complications and potential fatality.
Case Report: A 67-year-old Caucasian male presented to the eye clinic with sudden onset reduced peripheral vision to his right side in both eyes. Entering visual acuities were 20/40 OD and 20/60 OS. Humphrey visual field (HVF) testing confirmed a complete right homonymous hemianopsia. Magnetic resonance imaging (MRI) revealed a large, left occipital lobe intracranial mass. Neurosurgical intervention was necessary to confirm the diagnosis of a brain abscess, thought to be related to a prior dental procedure with tooth extraction.
Conclusion: A brain abscess is a focal area of necrosis within the brain parenchyma that typically results from an infectious process. Though rare, the condition has potentially devastating neurologic complications which can be mitigated with early detection and treatment. In this case, the abscess caused a right homonymous hemianopsia field defect, which prompted his urgent request for an appointment with the eye clinic