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Teaching and Learning Courageous Followership: An Action Research Study
Get PDFFollowership has been shown to be a developmental stage of leadership. Yet, there is a lack of followership theory in the health-care context. The purpose of this qualitative action research study was to explore how introducing Chaleff’s dimensions of courageous followership influences the undergraduate nursing students’ views of the follower role and informs their nursing practice. Secondary research questions asked how knowledge of these dimensions influences the nursing students’ views while advocating, collaborating, and addressing lateral violence. Using purposeful sampling, 12 participants were recruited for this study. After attending a followership seminar, they completed online reflections and participated in individual and focus group interviews. Other data collection methods used were field notes and a researcher’s reflective journal. Domain analysis, transcription, memo writing, axial coding, and thematic analysis were used to analyze the data. Brinkmann and Kvale’s stages of validation guided interview validity. And Herr and Anderson’s criteria for action research validity guided design validity. In summary of this study’s findings, learning followership was found to influence students’ views by providing a new understanding of accountability, responsibility, and power to initiate action and engage in exemplary behaviors when advocating and collaborating. Willingness or unwillingness to follow was situational to contextual factors, and influenced students’ sense of engagement. Lived experiences were also seen to influence students’ engagement and sense of power, and provided participants with a sense of certainty to move forward in their advocating and collaborating attempts. Finally, sight was identified as students’ strength when advocating for others
Implementation of a Parental Notification System for the Improvement of Well-Child Care Delivery
Get PDFThis quality improvement project aimed to improve routine well-child exam rates in accordance with the American Academy of Pediatrics and Texas Health Steps recommendations through the implementation of a parental notification system. Missed well-child appointments impact health care by disturbing continuity of care and complicating preventive care services. Implementation of the parental notification system during June 2017 to August 2017 consisted of 100 patients from birth to 18 years of age for scheduled well-child visits in a pediatric clinic with a large Hispanic and Medicaid population. Interventions consisted of staff training, reminder phone calls 24 to 48 hours prior to the appointment, distribution of appointment reminder cards, follow-up on missed appointments, and a parental caregiver questionnaire. Overall, 88% received an appointment reminder with 65% having spoken directly to a staff member and 23% receiving a voicemail. The well-child completed rate was at 64% with a well-child no-show rate of 21%, a cancellation rate of 9%, a reschedule rate of 6% and a recall rate of 62%. The parental notification system was found to not have an effect on scheduled well-child delivery (p = .243), however well-child visits were more likely to be completed when a parent spoke directly to a clinical staff member versus voicemail (p = .004). The increase in the well-child cancellation and reschedule rates provided the clinic with opportunities to schedule additional appointments. Parents found the reminders to be helpful, would like to continue receiving them, and recommend them
Evidence-Based Discharge Education Guidelines to Improve Adherence to Self-Care and Decrease 30-Day Readmissions for Older Heart Failure Patients
Get PDFHeart failure is a complex, debilitating, chronic disease characterized by high mortality and frequent hospital readmissions. Heart failure affects 5.7 million people in the United States with 670,000 new patients diagnosed each year. Patients are most vulnerable during the transition from the acute care setting to home. Limited patient knowledge on symptom recognition leads to detrimental outcomes for the patients; therefore, discharge education is paramount for decreasing readmissions. The national benchmark for 30-day readmission is 27%. The purpose of this quality improvement project was to improve compliance with the 2013 American Heart Association guidelines through discharge education by Telemetry staff for heart failure patients age 55 years and older. The 30-day readmission rate was also assessed. A retrospective review of 70 charts resulted in finding that 32 patients met the inclusion criteria as patients discharged from the Telemetry Unit, a 350-bed military hospital located in South Texas. Licensed nursing staff implemented evidence-based heart failure discharge education using the teach-back methods before patients discharged to home. The average age of heart failure patients was 76 years. At 12 weeks after implementation, 91% (29 of 32) of patients received heart failure discharge education. Of the 32 patients that received heart failure discharge education, 2 patients were readmitted to the Telemetry Unit within 30 days, thus decreasing readmission rate to 6.25%. This evidence-based project is beneficial in standardizing the patient discharge education. The heart failure discharge education program has a significant implication for healthcare professionals uniquely designed to meet the learning needs of patients with heart failure
Increasing The Adherence to Updated Clinical Practice Guidelines for TB Screening Among HIV Patients Entering a Congregate Setting Utilizing a Clinical Reminder
Get PDFPurpose: The purpose of this Doctor of Nursing Practice project was to update an existing tuberculosis policy for screening HIV-positive individuals entering a south Texas jail to meet current evidence-based guidelines and increase the adherence of jail staff to the updated screening process.
Background and Significance: In 2015, over 700,000 people were jailed in the United States with over 20,000 being HIV-positive. Tuberculosis is highly contagious and spreads through the air. HIV is a virus that targets the immune system. HIV-positive people are 17-22 times more likely to contract tuberculosis. The current screening process at the jail showed a low adherence among staff for placing a purified protein derivative and performing a chest x-ray in the HIV population.
Method: A retrospective chart review of pre-intervention and post-intervention HIV-positive inmate charts was conducted. The implementation of an updated tuberculosis policy and staff education provided a new TB screening process. The addition of a clinical reminder sticker affixed to the computer monitors in the screening area was a component of the intervention.
Results: Results showed an increase in purified protein placement, chest x-rays and documentation post intervention with a significant correlation.
Conclusion: Policy revision and the use of a clinical reminder sticker can increase staff adherence to process change. Evidence supports that chest x-ray is a valuable adjunct when used with purified protein derivative to screen HIV-positive inmates for tuberculosis in a correctional facility. Strengthening the tuberculosis screening process to include both purified protein derivative and chest x-ray protects other inmates and the community. Jails are expected to provide care consistent with community standards and evidence-based practice
Added Sugar Consumption Among College Students
Get PDFAdded sugar consumption has been increasing in all age groups in the United States and worldwide, with the greatest increase in young adults. College-age years are a critical period in the young adult\u27s life where many habits develop, including nutrition and food choices. An understanding of college-age students’ attitudes and behaviors toward added sugar consumption might help predict added sugar consumption within this population. This was a quantitative study of traditional-aged college students\u27 added sugar consumption through a convenience sample at a private university in San Antonio, TX. A survey was administrated to undergraduate students at different classes. Subjects were 18 to 24 years old, 72% females and 27.7% males. Results indicated that most participating students consumed one sugar-sweetened beverage daily or at least several times per week. Moreover, most participating students rarely/never chose a product based on the type of sweetener used. Only 11% of participating students mentioned that they tried to limit and avoid added sugars, however, 61% of those considered limiting sugar-sweetened beverages to help maintain a healthy weight. Furthermore, 56.5% of participating student declared that they were not aware of the American Heart Association (AHA) added sugar recommendations. Over half, 54.4%, of participating student reported that they were not aware of the 2015-2020 Dietary Guidelines for Americans. Similarly, 58.3% declared that they were not aware of the WHO added sugar limit recommendations and the associated health benefits. In conclusion, many students were not aware of their added sugar intake, and only a small percentage were aware of the added sugar limit recommendations. Variables that influence excess sugar consumption include taste preference, stress, and cost. Most of the students who consider the sugar content of the foods and beverages they buy do so to help maintain a healthy weight
Increasing the Vaccination Rates of Adolescent Males 11 to 18 Years of Age in an Urban Pediatric Clinic: A Quality Improvement Project
Get PDFPurpose: The purpose of this quality improvement project was to determine if an evidence-based educational toolkit and an electronic reminder system would increase the rate of HPV vaccination among male adolescents, age 11-18 years old in an urban pediatric clinic. Background & Significance: HPV is one of the most commonly reported sexually transmitted infections in the United States. The safety and efficacy of the HPV vaccine have been established and approved for both males and females. Despite recommendations, vaccination rates among adolescent males remain lower compared to females. Methods: An evidenced-based educational toolkit from the CDC along with an electronic reminder that flags patients due for vaccines, prompting staff to make vaccine recommendations, was implemented. This QI project utilized a retrospective review of 100 male patient charts preand post-intervention. Results: A significant increase in provider’s knowledge and recommendations for HPV vaccination from 53% to 74.4%, and 66.7% to 100%, respectively, contributed to a 49% increase in HPV vaccination rates post-intervention. Conclusion: The study showed that an evidence-based educational brochure and reminder system was effective in increasing HPV vaccination rates among adolescent males at an urban pediatric practice
Dopamine Levels in the Brain of Rat Models of Human Rheumatoid Arthritis
Get PDFResearch Focus. Rheumatoid arthritis (RA) is a chronic, debilitating, autoimmune disease that causes the destruction of bone tissue and the articular structures of joints. At least 30% of RA patient populations have cognitive impairment. Acidic dopamine (DA) is the principal neuroimmunotransmitter that links the central nervous system and peripheral nervous system together. The aim of the present study was to determine the levels of DA and its two acidic metabolites: 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in arthritic induced rats, and whether their levels vary across four different parts of the brain: amygdala (AMG), front cerebral cortex (CX), hippocampus (HIP), and cerebellum (CBL). Brain protein was also assessed.
Materials and Methods. 3-month old male Lewis Rats (n=16) were randomized into either control (n=6) or treatment (n=10) groups. In the treatment group, arthritis was induced in the rats using Freund’s Adjuvant and all rats were sacrificed on day 28. Dopamine, DOPAC, and HVA levels were quantified using High Performance Liquid Chromatography technique while proteins were quantified using Bicinchroninic Acid (BCA) Protein Assay, in the four brain regions. Two-way ANOVA test was performed to determine whether brain regions, induce arthritis treatment or their interactions significantly influenced the levels of the analytes (at p\u3c0.05).
Research Results/Findings. Levels of brain protein (C-reactive protein) were elevated in arthritic rats across all brain regions (p\u3e0.05). Dopamine and DOPAC levels were lower in arthritic rats than controls (p\u3e0.05). HVA levels were higher in arthritic rats compared to non-arthritic controls.
Conclusions from Research. The present study has demonstrated that C-reactive protein, dopamine, DOPAC and HVA are involved in the neurophysiology of arthritis. RA patients can benefit from treatment with dopamine agonists. However, more studies are warranted to determine the effect of DOPAC and HVA levels in the brain on dopamine utilization in arthritis
Preliminary Examination of the Bacterial Diversity Harbored by the Pill Bug (Armadillidium Vulgare)
Get PDFPill bugs (Armadillidium vulgare) were examined at 4 time points during 2015- 2016. The time points corresponded to summer, fall, winter, and spring. At each time point, 2 to 10 pill bugs were collected from each of three sites. All sites were located in San Antonio, Texas. The first site was in central San Antonio, but due to difficulties in collecting specimens the first site was only utilized at the first time point. The remaining localities, Bonilla Science Hall on the campus of the University of the Incarnate Word and a private residence in northwest San Antonio, were utilized for the remaining three time points. After collection, pill bugs were washed. The recovered supernatant was serially diluted and plated on nutrient agar plates and incubated overnight at 37o C. After incubation, colonies were scored for morphological characteristics and subjected to a variety of biochemical tests. The results of these analyses revealed 65 unique isolates, four of which could not be sequenced. The 16s rRNA gene was sequenced for each of these isolates in order to classify each to genus and species. Based upon DNA analysis, 61 isolates generated DNA data that were found to represent 15 described genera of bacteria. These 61 isolates were further identified to 30 unique species of which 16 were described species. The most common bacterial genus identified was Bacillus. At least one species of Bacillus was identified at time points and in all localities. Overall, the most common species identified was B. cereus. This species was found at all localities and at all time points. There was no other genera or species identified at more than two localities or time points—although several were found at two time points or sites. In general, other than B. cereus, there was no genus or species consistently found at a single site. These data suggest that there is a unique bacterial fauna at each site and each time point—which could be correlated to climatological conditions, such as temperature, humidity and/or rainfall. These data reveal that there are pathogens associated with pill bugs at each site and during each season. The highest incidence of pathogenic bacteria occurs during time points associated with summer and spring. These are times of the year when mammals, particularly humans, could be in contact with pill bugs and suggest that there is the potential for pathogens to be transferred from pill bugs to humans. Overall, this study suggests that there is a diverse bacterial fauna associated with pill bugs
Improving Transitions of Care From Hospital to Community Provider for Patients with Type II Diabetes Mellitus
Get PDFPoorly coordinated care transitions result in nearly half of discharged patients’ experiencing at least 1 medication error and 1 in 5 Medicare beneficiaries readmitted within 30 days. Repercussions of suboptimal transitions of care greatly impact the nation’s economy costing between 44 billion annually. Ineffective handoffs between providers at hospital discharge contribute to suboptimal patient outcomes; therefore, strategies to improve transitions of care are necessary to provide quality care while decreasing health care expenditure. A quality improvement project was conducted on an inpatient surgical unit to decrease hospital readmissions and emergency department visits. Proposed interventions for patients with type II diabetes mellitus discharged home included (1) a follow-up appointment arranged with an outpatient provider prior to discharge and (2) receipt of a follow-up phone call within 48 to 72 hours. A process for providing discharge information to outpatient providers was assessed. A total of 58 patients met inclusion criteria: 91% patients received at least 1 intervention, 48.2% had a follow-up appointment arranged prior to discharge, and 29.3% received a discharge phone call within the proposed timeframe. There was a significant negative correlation with the number of interventions a patient received and decreased hospital readmissions (r = -.131). Health care in the United States has become increasingly fragmented and highly complex. Nurses have a pivotal role for ensuring patients’ experience a seamless transition throughout the continuum of care. In accordance with achieving a safe, timely, effective, efficient, equitable, patient-centered health care system a bundled intervention methodology may in fact serve to improve patient outcomes while decreasing health care expenditure
The Effect of Varying Environmental Conditions on the Growth of Stenotrophomonas Maltophilia
Get PDFStenotrophomonas maltophilia has emerged as an important opportunistic pathogen in the debilitated host. It possesses the ability to target and colonize respiratory-tract epithelial cells and grow on the surface of medical devices. It is associated with a significant case-fatality ratio in cystic fibrosis patients. S. maltophilia species have the ability to grow in bacterial biofilms, which further complicates these infections by providing the opportunity for acquisition of antibiotic resistant genes. This study investigated the effects on the growth of different strains of the same species of S. maltophilia, ATCC 51331 and 13637, when the selected environmental factors are varied. Factors studied were temperature and salt concentration in the medium, sodium chloride (NaCl) and ferric chloride (FeCl3). Further, minimal inhibitory concentrations (MICs), against a select panel of antibiotics were assessed for both strains when cultured in the different growth conditions proposed. The expectation of this study is that Ferric Chloride concentrations provided the most significant effects on S. maltophilia biofilm growth. Initially Luria Bertani (LB) media (with proper modification to salt content) were used to culture the organisms to visually assess colony growth under these conditions at the following temperatures: 40C, 200C, 370C, 550C and also to conduct MICs. The effects of various experimental conditions were also determined on S. maltophilia biofilms formed in the 96 well plate format. Viability of the biofilms have assessed using a previously published metabolic assay. Our data show that different environmental conditions affect S. maltophilia growth. For instance, when grown in different temperatures the morphology of S. maltophilia X51331 and X13637 varied during 3 days growth period and the S. maltophilia could not grow in the low and high temperatures of 40C and 550C. Furthermore, our data shows the effect of iron and sodium chloride with different concentrations of salt on the growth and metabolic activity of the biofilms of S. maltophilia X51331 and X13637 incubated at 300 C and 370 C, as well as S. maltophilia growth at varying FeCl3 and NaCl concentrations for 24, 48, and 72 hours. There was a significant increase in the average size of S. maltophila X51331 and X13637 colonies when grown in low concentrations of salt 0 μM and 1 μM, and growth was inhibited in the presence of concentrations ≥ 2% NaCl and FeCl3