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A Quality Improvement Initiative to Improve Depression Screening in Prenatal and Postpartum Mothers
Get PDFScreening for depression during the prenatal and postpartum period is essential. The United States has the highest mortality rate in the developed world, with mental health complications being 1 of the top 5 reasons women expire within the 1st year of childbirth. The purpose of this quality improvement project was to increase depression screening during the gestational and postpartum periods in an obstetric and gynecological clinic. An administration schedule was created to administer the Edinburgh Postnatal Depression Scale (EPDS). The EPDS was administered during the initial prenatal, 32-weeks prenatal, and 6-week postpartum appointments. Women scoring 10 or higher on the EPDS were to receive a mental health referral. A retrospective chart review was completed to evaluate the assessment and diagnosis of the patients’ depression. Out of 40 participants, 37 (92%) women were screened with the EPDS. Eighteen out of 21 participants were screened during the initial prenatal appointment, 6 out of 6 (100%) of the participants were screened during the 32-week appointment, and 13 out of 13 (100%) were screened during the 6-week postpartum appointment. Of the women screened, 10 women scored equal to or higher than 10 on the EPDS. Of the women that qualified for a mental health referral, 5 out of the 10 (50%) of the participants received a referral. Perinatal depression screening is easy to accomplish and effective in identifying depressive symptoms. The implementation of this project increased the screening for depression in perinatal mothers and increased mental health referrals
Managing Childhood Obesity in a Primary Care Clinic
Get PDFBackground: Childhood obesity and overweight have increased health burdens on health care systems, and contribute to chronic diseases such as diabetes, heart disease, asthma, and cancer. Childhood obesity is very complex for healthcare providers to manage in primary care settings.
Purpose: To improve childhood overweight and obesity approach and management in a selected primary care practice (Clinic A) in a large east Texas urban community.
Objectives: 1. Increase the percentage of children and adolescents ages 2 to 19 years seen in Clinic A, who received adequate weight management and obesity counseling, to 75%. 2. Increase the number of referrals to the weight management care team and improve the referral process in the patient population ages 2 to 19 years.
Intervention: The quality improvement project was an educational and practice intervention aimed at improving the primary care practice’s obesity management including providers’ provision of obesity guidance to patients and their parents using the Fifteen-Minute Obesity Prevention Protocol (FMOPP).
Results: Objective 1, post-intervention, 90% of 20 pediatric children with BMIs over the 85th percentile had obtained adequate weight management and obesity. Objective 2, post-intervention, the rate increased dramatically such that 75% of children with BMIs over the 85th percentile received referrals to Texas Children’s Hospital.
Implications for practice/Conclusion: The FMOPP was effective and worked for Clinic A patients. The initiatives should be validated and then implemented in all pediatric practices. Continuing to reinforce the approaches used in this project would benefit a community where obesity is an epidemic
Refugee Livelihood: Understanding the Vocational Training Experiences of Foreign Refugee Women Living in Malawi
Get PDFWith Africa holding 26% of the world’s refugees, it is critical to understand the educational opportunities that are accessible for refugees, especially in the context of African women who are historically excluded as the primary target for education (UNHCR, 2018a).Despite the policies and institutional commitment to education for the refugee population, there is little evidence to ensure quality, or access to education, at the regional or local levels. For women and young girls in displacement, access to education is particularly limited to the secondary level (UNHCR, 2011a).In response to the need for quality education for refugee women, Malawi’s vocational training and secondary education institutions have centered on activities to increase opportunities for formal secondary education of both refugee and Malawian women (UNESCO, 2008). As opportunity and awareness of quality secondary education for refugee women becomes more prevalent, there is a need to understand how these programs have influenced their sense of livelihood. For these reasons, this study explored the individual experiences of African refugee women focusing on how their experiences in completing a vocational training program have influenced their lives in terms of self-efficacy and empowerment in creating a livelihood.
Findings of this study revealed participant livelihood experiences were influenced in varying degrees as a result of their vocational training. Vocational training was perceived by participants as a positive influence on livelihood capabilities as well as their positive feelings of self-efficacy and empowerment. However, education alone was only part of these outcomes, as other experiences of relationship building, creating alternative solutions for income-producing activities, and sharing their knowledge also influenced their feelings of self-efficacy and empowerment
A Grounded Theory Study of Orientation Leaders\u27 Perspectives on the Impact of Their Involvement in Orientation
Get PDFTheory suggests students benefit when they become involved in co-curricular activities outside the classroom (Astin, 1993). While there is some literature on college orientation programs, most is dated and focuses on the participants attending orientation, providing little knowledge on the student orientation leaders (OLs) who help execute the programs (Pierson & Timmerman, 2004). Therefore, this grounded theory study was conducted to describe the details of the participants’ lived experiences serving as orientation leaders. The intent of this qualitative study was to extract meaning and understanding from the OLs personal accounts and their unique interpretations of their experiences. Individual in-depth interviews were conducted with 8 OLs who led orientation at a private university. I analyzed data using a constant comparative method resulting in 13 codes emerging from the first phase of analysis. After a more in-depth analysis and further categorization, three dominant categories emerged from the codes and observation notes. Although initial feelings of nervousness, insecurity, and hesitation to participate were shared, many participants mentioned feeling a sense of accomplishment and growth as they collaborated through the experience with their peers. In addition, OLs felt that working as a leader on campus helped them feel more positively connected to the university. It is anticipated that study results will help to inform the discipline and profession about the dynamics, which explain how student leaders are impacted through the orientation leader process. It is also hoped that this research will vi inform faculty and college administrators concerning community building through engagement, be responsive to student’s needs, and aid in the development of student leaders and the orientation program
Exploring Chinese International Degree-Seeking Students’ Perceptions About Their Acculturation in the United States
Get PDFStudying abroad is attractive for increasing numbers of Chinese students. The United States belongs among the favorite destinations for Chinese students seeking to obtain a university degree. In past years, China was the number one country of origin of all foreign students enrolled in U.S. tertiary education institutions. This study is aimed at exploring Chinese degree-seeking international students’ perceptions about their acculturation in the United States. This qualitative study was conducted at a faith-based private university in South Texas. Eight Chinese international students participated in this research in order to share the perceptions and experiences linked to their acculturation in their host destination. The data was collected through personal interviews and follow up interviews. The data analysis, following the six steps of Interpretative Phenomenological Analysis recommended by Smith, Flowers, and Larkin (2009), revealed findings that enrich the field of acculturation and international higher education literature. Four themes emerged during the data analysis: Cultural Assessment and Learning; Language Acquisition and Learning; Academic and Social Support; and Individual Development. The findings of this study will help interested audiences to better understand and learn about Chinese international students’ acculturation process in the United States. Based on the findings, recommendations for practice were set, such as evaluation and development of prev-arrival orientation for Chinese international students, focus on more multi-cultural approach to advising and teaching, and emphasis on peer programs that would help to increase interactions among Chinese, international and domestic students. Further, it was concluded that more research studies need to be conducted, including studies focusing on finding best practices for pre-arrival orientation, teachers’ levels of cultural competence and their skills to effectively teach in multi-cultural classroom, and methods to encourage domestic and international students to interact closer together
Preventive Healthcare Usage in the United States: Does Health Insurance Matter
Get PDFThe Centers for Disease Control in the United States has maintained that adults who avoid preventive care services are more likely to suffer from long term chronic diseases because they are not addressed or treated in a timely manner. Examining the effects of providing access to healthcare to uninsured adults and increasing preventive services can help in reducing chronic diseases and enable adults to live longer, healthier lives. The purpose of this study was to identify the relationship between the utilization of preventive health services and socioeconomic factors such as insurance status, race/ethnicity, household income, marital status, education, gender, age, source of usual care, and perceived health status in the United States. Using Medical Expenditure Panel Survey data from the year 2015, this study presents logistic regression estimates of the odds ratios for each independent variable in the context of utilization of four different types of preventive care services: cancer screenings, hypertension screenings, cholesterol screenings, and physical checkups. Separate estimates of these models are also obtained for the insured and uninsured sub-samples to identify if there are statistical variations based upon access to health insurance. These estimates offer insights into the association between lack of health insurance and the influences of other socioeconomic characteristics with utilization of various preventive health care services. The intent of this research is to present a comprehensive analysis of usage of preventive care services and to identify which socioeconomic characteristics should be targeted by policies in order to ensure improved access to and use of preventive care services in the population. We find that targeted policies that improve access to preventive care by lowering costs of preventive care services by improving access to health insurance would allow for early diagnosis and possible prevention of chronic diseases among more people, leading to better health outcomes for the whole nation
Surviving Sepsis: A Treatment Process Improvement in High Volume Emergency Departments
Get PDFSepsis is the 3rd leading cause of death in the United States, accounting for approximately 270,000 deaths annually (CDC, 2017). It is the number one cause of death in hospitals, the number one cause of hospital readmissions, and the costliest diagnosis in the hospital setting (Fingar & Washington, 2015; Torio & Andrews, 2015). This quality improvement project aimed to increase the percentage of antibiotics administered within 1 hour for sepsis patients. Mortality rates significantly decrease when this goal is met (Howell & Davis, 2017). There is an 8% increase in mortality risks with every hour that passes with elevated lactic acid and white blood cell counts without treatment (Kumar et al., 2006). Nearly 80% of deaths related to sepsis could be prevented with rapid treatment (Kumar et al., 2006). There was a significant lag in laboratory specimen processing time at two San Antonio, Texas emergency departments. Everything was ordered stat, rendering nothing stat. This was delaying lifesaving treatment for sepsis patients. An ultra-stat method was introduced that encompassed the utilization of a yellow biohazard bag to transport sepsis serum specimens to the laboratory indicating ultra-stat priority processing to improve the result time of laboratory specimens screened as sepsis. The goal was to improve antibiotic administration time for emergency department sepsis patients at these two facilities. Mortality rates and antibiotic delivery times pre- and post-intervention were collected. The results showed that ultra-stat yellow biohazard bag utilization increased antibiotic administration under 1-hour rates and decreased sepsis related mortality
Improving Diabetic Foot Screening in a Primary Care Clinic for Homeless Adults: A Quality Improvement Project
Get PDFThe purpose of this project was to increase the adherence of clinic providers at the homeless primary care clinic by implementing the American Diabetes Association Clinical Guidelines for the evaluation and management of Type 2 diabetes with foot care. Type 2 diabetes is a chronic condition that affects 13% of the Texas adult population (Centers for Disease Control and Prevention, 2014). The homeless person\u27s main method of transportation is walking. The complications of undiagnosed foot problems include reduced mobility, pain, lower limb amputations, and difficulty controlling chronic diseases including diabetes and depression. Provider responsibilities include screening for diabetes in all patients over the age of 18, documenting positive diagnosis in the electronic medical record, screening patients with diabetes for foot problems with appropriate screening tools and appropriate referral to podiatry.
A retrospective chart review was conducted where 35 patient charts were reviewed and de-identified. The pre- and post interventions were analyzed. At project completion, high no-show rates among patients for appointments and the short project duration were major limitations of the project. The interventions implemented were helpful in increasing provider documentation of the patients that did show up. Homeless people are exposed to the elements adding to their daily struggles, which indicate a need for continuous work on intervention models that will facilitate provider adherence with subsequent referral for treatment if needed
12th Annual Research Week--Event Proceedings
Get PDF12th Annual Research Week
A Celebration of Student Researc
Quality Improvement Initiative to Increase Comprehensive Eye Exams in Patients With Diabetes
Get PDFDiabetic retinopathy is the most common microvascular complication associated with poorly controlled diabetes. Yet, only 60% of the diabetic population receives an annual eye examination by an eye specialist. Retinal imaging increases surveillance of retinopathy, however, it does not take the place of a comprehensive eye examination by an ophthalmologist or optometrist. The aim of this quality improvement project was to increase comprehensive eye examinations in patients with diabetes aged 18 to 75 years in a family practice that recently purchased a retinal imager. This quality improvement project occurred over a 10-week period. Project objectives included increasing comprehensive dilated eye examinations in diabetic patients, provider referral rates to eye specialists, and patient adherence to eye specialist referrals. Interventions included an educational session, diabetes eye exam checklist, patient reminder card, electronic medical record alert, and an informational brochure for patients to take home. After 10 weeks, the eye examination rate for patients with diabetes at the family practice increased from 45% to 63% and 67 new referrals were sent to eye specialists by providers. Providers at the clinic with the retinal imager were less likely to send out referrals. Lastly, patients who received reminder cards had an 85% adherence rate to referrals. The use of a checklist and an electronic alert increases provider referral rates to eye specialists, while a reminder card increases patient adherence to referrals. However, the presence of a retinal imager in a clinic reduces the likelihood that a patient will receive a referral to an eye specialist