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Improving Suicide Screening and Safety Plan Documentation Rates in Behavioral Health Clinics
Get PDFSuicide is the 10th leading cause of death in the United States with over 47,000 people dying in 2017 from suicide alone (NIMH, 2019). In the United States, one in three people who die by suicide were seen by a behavioral health provider within the same year (McCabe et al., 2018). The purpose of this project was to determine if suicide screenings and safety plans are being completed and documented properly; how many patients are refusing to complete the patient health questionnaire (PHQ-9) and is there a pattern present in these patients. Objectives are to improve the rates of suicide risk screening, safety plan documentation, decrease patient refusals, and determine if a pattern is present. The aims of this project are to determine the rate of suicide screenings and suicide safety plan documentation and increase rate to 95%; determine rate of patient questionnaire refusals and decrease by 10%; and implement alert system for 100% of patients at risk for suicide. The project was implemented over a 10-week period of which two psychiatric nurse practitioners participated. Results indicate that there was a 15% decrease in screening and safety plan documentation; 100% of patients at risk for suicide had an alert placed; PHQ-9 refusals decreased by 27%, however, 25% of patients were not asked to complete the PHQ-9 once providers switched to tele-visits. A pattern was observed in patients who refused to complete the PHQ-9
HPV Vaccination in Adults 18 Through 45: Reducing Missed Vaccination Opportunities in the Primary Care Setting
Get PDFHPV is the most prevalent sexually transmitted infection in the United States and is linked to six different types of cancer cell development. Prevention of infection from this virus could save hundreds of thousands of lives worldwide. An evidence-based quality improvement project was designed to increase the identification of HPV vaccination opportunities in the adult primary care setting to improve HPV vaccination rates. A protocol and patient eligibility algorithm were developed to align primary care practice with recently updated CDC guidelines. Interventions included clinic staff and provider education, designation of a vaccination champion, a flag within the patient chart to alert the provider, the use of a strong provider recommendation, and patient education through handouts, posters, and provider instruction. Response to COVID-19 pandemic required the project leader to restructure interventions, which effectively sustained the project with improved outcomes. Providers identified vaccination opportunities in 100 of the 184 patients 18 through 45 years of age, improving rate of identified vaccination opportunities from 0% to 54.3% during the 41 days of active implementation. There was a statistically significant relationship (p \u3c .000) between a strong provider recommendation and the patient’s willingness to start or complete their HPV vaccination. Identifying HPV vaccination opportunities in adults aged 18 through 45 in the primary care setting improves patient’s quality of health through promotion of health and cancer prevention. Future clinics should consider the value of DNP prepared NPs being experts in implementing evidence-based practice
Readiness for Insulin Pump Use in Pediatric Type I Diabetes: A Quality Improvement Project
Get PDFBackground: Insulin pumps are essential in the management of type 1 diabetic pediatric patients because of their versatility in meeting the developmental needs of childhood and adolescence. Summary of the Evidence: There is lack of evidence for standardized pump initiation program in pediatric patients (ADA, 2019). Moreover, adverse events from insulin pump misuse, such as diabetic ketoacidosis, arise from lack of anticipatory guidance of pump management and troubleshooting (Evert et al., 2016; Grunberger et al., 2014, Wheeler et al, 2014). Project Purpose: The purpose of this quality improvement (QI) project was to reduce and prevent adverse outcomes of insulin pumps secondary to an inefficient initiation process, management, and patient/family understanding. Project Objectives: Objectives of this QI were: the implementation of a streamlined initiation process, assessment of patient knowledge through an additional education session including a pre-and post-test patient skills questionnaire, and to decrease adverse effects related to new insulin pump use. Results: 100% staff education was achieved, 67.5% of patients/families attended the new education session achieving an average score of 80% or higher on the skills questionnaire, and adverse effects related to new insulin pump usage decreased from a rate of 66% to 50% after implementation. Implications for Practice: Use of practice guidelines to implement a structured process for insulin pump initiation is a cost-effective strategy to promote patient ownership, improve patient knowledge, lower potential costs of clinic or hospital visits for adverse effects, and guide provider oversight in effective use of technology to improve patient outcomes and decrease barriers to care
Beauty for Ashes: Reflections on Aesthetic Experience and Suffering
Get PDFIn this essay, I examine the relationship between aesthetic experience and suffering, and I specifically explore how and why the former can potentially serve to meliorate the severity of the latter. Of course, that art and beauty can provide a certain measure of comfort and healing to the afflicted is a universally acknowledged truth; however, the reasons why this should be so could be considered an equally universal mystery. “I feel we understand too little about the psychology of loss,” writes Arthur Danto, “to understand why the creation of beauty is so fitting a way of marking it.” By exploring how a number of thinkers (from philosophers to physicians to literary theorists) have viewed the relationship between aesthetic experience and suffering, I advance two theses: first, that aesthetic experience can, in fact, potentially serve to restore a measure of wholeness to an individual whose suffering has damaged or even destroyed the integrity of their personhood and second, that despite this potential benefit of aesthetic experience, the severity and uniqueness of individual suffering will always resist any endeavor to formalize attempts to treat its various manifestations
Improving Colorectal Cancer Screening and Testing in a Primary Care Clinic
Get PDFColorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related deaths worldwide (World Health Organization, 2019a). In the United States, CRC was the fourth most common cancer in 2016 (Centers for Disease Control and Prevention, 2019a). The American Cancer Society (2020a) estimated that there will be 147,950 estimated new cases and 53,200 estimated deaths of CRC in the U.S. in 2020. The purpose of the project was to improve CRC screening completion rates and follow up referrals from 27.5% to 35% for adult patients, 50-75 years of age, within a family medicine clinic using the U.S. Preventive Services Task Force (USPSTF) (2016) and Health Resources & Services Administration (HRSA) (2018b) clinical practice guidelines utilizing fecal immunochemical tests (FIT) kits. FIT is a huge benefit to the underinsured, uninsured, and underserved populations in detecting CRC (Riehman et al., 2018). The objectives were to increase the percentage of patients meeting screening guidelines who receive an order for CRC screening through staff and patient education made readily available; increase the percentage of FIT results through FIT kit distribution within the clinic and live communication follow up for those with no results in the EHR; and increase the percentage of those with a positive FIT who receive a referral for follow up testing within two weeks through standardized EHR communication process and use of clinic tracking sheets. HRSA provides funding to the organization for preventive services based on performance on CRC screening. CRC is 100% treatable and the impact of improving CRC screening will improve patient outcomes by preventing and decreasing disability and mortality from CRC
Understanding Effectuation Theory as an Entrepreneurial Cognitive and Behavioral Process in Firm Creation and Expansion to Create Local, Contextual Knowledge in Morocco
Get PDFThe purpose of this 2-year case study in the Kingdom of Morocco was to understand the entrepreneurial cognitive and behavioral processes expressed in the creation and expansion of a venture by American owners and Moroccan and American team members. The study used an interpretative design and narrative analysis methodology to develop themes. In the first phase of the study, I interviewed the co-founders and associates to learn to what extent the five principles of effectuation theory and other entrepreneurial cognitive processes played a role in the first few years of the school’s creation. In the second phase, I worked in tandem with, observed, and recorded the expansion team’s sessions during the spring months of 2017 to July of 2019. Themes that emerged from the data were persisting and resilience, maneuvering ambiguity, shifting assets, creative and collaborative solutions, and weighing options and developing criteria. The data tell us that cultural context, original aspirations, and social/human/spiritual capital ground the entrepreneurial decision-making experience in Morocco and are entwined with the principles of effectuation. A design plan was generated from the findings to create local, contextualized knowledge for the community of learners in Morocco. It documents creation elements and informs future practice for the purpose of building entrepreneurial expertise. Future research might include the mitigating role of spirituality in persistence of entrepreneurship, the virtue of trust in intercultural studies, and the emotional and psychological trauma associated with failure or threats to life-long investments
Alternative Therapies for Treatment of Keratoconjunctivitis Sicca Associated with Sjogren\u27s Syndrome
Get PDFBackground: Sjogren’s syndrome is a chronic, systemic autoimmune disorder, which often results in significant ocular surface disease. Dry eye associated with Sjogren’s syndrome is a multifactorial disease which leads to decreased function of the lacrimal glands and altered tear composition. There currently are numerous anti-inflammatory methods used for treatment of this disease.
Case Report: This case report will focus on the use of amniotic membrane placement and autologous serum tears to facilitate a successful scleral contact lens fit allowing for reduced ocular inflammation and discomfort associated with Keratoconjunctivitis sicca due to Sjogren’s syndrome.
Conclusion: Clinical management of keratoconjunctivitis sicca due to Sjogren’s syndrome can be challenging. Diagnosis often requires numerous in office testing including Schirmer I/II, TBUT, sodium fluorescein stain, and osmolarity. Such testing can be repeated over time to monitor for improvement with addition of each new therapy. Various treatment modalities such as topical lubricants, cyclosporine, autologous serum tears, or amniotic membranes have been proven to provide short-term benefits and excellent maintenance of symptoms. Utilizing such treatments to promote an ideal scleral contact lens fit provides lasting benefits of corneal clarity and stable vision
A Basic Interpretive Study of Co-Teaching Perceptions: Collaboration of General and Special Education Elementary School Teachers
Get PDFOver the past several decades, federal legislation (IDEA, 1990, 1997, 2004; NCLB, 2002) regulated the manner in which students with special learning needs receive instruction and placed greater emphasis on their achievements. This qualitative study examined the perceptions of general education (n=6) and special education (n=6) elementary teachers about co-teaching collaboration in the inclusive classroom. Concerning individuals with academic learning disabilities, inclusion secures opportunities for students with disabilities to learn alongside their non-disabled peers in general education classrooms. Teacher collaboration helps to create the best learning environment possible for all students. This study took place in a Title One district located in a southwest region of Texas. Using a basic interpretive qualitative research design approach, data was collected through one-on-one interviews with general and special education teachers. The interviews gathered data on the perceptions of teachers’ collaboration experiences and professional development. The results of this study disclose themes for consideration in co-teaching collaborative practices, and approaches based on the participants\u27 perceptions
Through the Lens of Latinas: The Influences of an Out-of-School Time STEM Program
Get PDFScience, Technology, Engineering, and Mathematics (STEM) have been the foundation for discovery and technological innovation in the United States. The United States considers STEM education as a national priority to compete in the global economy and protect the nation’s innovation ecosystem. The high demand for careers in STEM fields promotes the importance of STEM education. However, Latinos, as the fastest-growing ethnic group in the United States, face many challenges in STEM education relating to a lack of progress, degree attainment, and participation in STEM professions.
This research aimed to explore the learning experience in an out-of-school (OST) STEM program, called “Girls in STEM”, and how it influenced Latinas’ self-efficacy, interest, and career development. The research focused on a single-case study of a STEM OST program in South Texas and utilized eight embedded cases to explore three research questions. The sample for this study consisted of 41 middle school and high school girls (grades 7 to 12) who had long-term participation experiences in the STEM program. The data for this qualitative study consisted of in-depth interviews, presentations from art-based activities, and visual arts. Followed by the case study design, the researcher purposefully sought in-depth information from embedded “unit of analysis,” which represented eight participants in the study (Yin, 2013, p. 23). Each case presented different aspects to answer research questions. The researcher analyzed interviews and art-based activities from participants through the lens of social cognitive theory and social cognitive career theory (Bandura, 2001; Lent et al., 1994).
The findings explored Latinas’ learning experiences in an OST STEM program. Participants expressed the program created a beneficial learning environment for them, where they engaged in various activities and interacted with adults in the program. The learning experience, as the starting point of SCCT model, had influences on the development of self-efficacy and the formation of interests. In this study, the integration of different subjects, opportunities for collaborative work and conversational interactions with professionals, are three characteristics of cultivating Latinas’ interest in STEM. Additionally, many girls in this study noticed the stereotypes of women in STEM, and gender bias exists in many STEM fields. Socioeconomic status may limit Latina’s options and affected their career development
Case Report: The Dilemma of Imaging an Isolated Sixth Nerve Palsy
Get PDFBackground: Traditionally, eyecare providers employ a wait-and-see approach with respect to older patients presenting with a presumed vasculopathic isolated sixth nerve palsy. However, given review of recent literature and the potential of morbidity in these patients, acute neuroimaging should be strongly considered. Eyecare providers are often faced with challenging decisions when patients present with acute isolated oculomotor nerve palsies. This case highlights the diagnostic dilemma of an older patient with significant vasculopathic risk factors who presents with an isolated sixth nerve palsy. For patients older than 50, a vasculopathic etiology is the most likely cause, however, a small but significant percentage of these patients may suffer from a more ominous condition such as, giant cell arteritis, intracranial mass, or aneurysm. As evidenced by our case, acute neuro imaging should be considered in all isolated sixth nerve palsies.
Case Report: A 69- year old Caucasian male presented to the VA Connecticut Healthcare System with new onset diplopia. The patient reported a recent history of mild orbital pain and headaches. Evaluation revealed an isolated left sixth nerve palsy. A microvascular etiology was presumed given his strong vasculopathic history. One week later the patient returned to clinic with a new left pupil-sparing third nerve palsy in addition to his original left sixth nerve palsy. Magnetic resonance imaging of the brain and orbits with and without contrast revealed a left cavernous sinus mass. The patient was transferred to the Smilow Cancer Hospital at Yale-New Haven and received gamma knife radiosurgery for the presumed neoplastic lesion.
Conclusion: Although support can be made for both a “wait-and-see” approach and acute diagnostic imaging, our case highlights the benefits of early imaging. Appropriate acute neuro imaging in patients with presenting isolated sixth nerve palsies can be lifesaving