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Postpartum Support: Application of a Local Peer Support, Community Care Model
Get PDFThe postpartum period is one of the most influential developmental stages of a women’s life and represents a time of heightened risk for mental health decline. Perinatal mood and anxiety disorders have been implicated as a key influence of negative parenting experiences, poor newborn psychological outcomes, delayed newborn development, and inadequately adaptive family development behaviors. Integrating established resiliency components against mental illness, such as social support, into a postpartum care model can benefit postpartum women and secondarily positively impact the aforementioned outcomes. A community care model highlighting social support for postpartum mothers was integrated into a rural Minnesota region and was found to positively impact maternal experiences according to the 14 participants. Identified outcomes included improved perception of role identity, increased awareness of maternal self-care value, and enhanced peer relationships around a shared developmental experience. Future implications for nurse practitioner care include a recommendation to integrate group community care into postpartum wellness with facilitation by an experienced perinatal health provider knowledgeable in community resources. It is imperative that nurse practitioners caring for postpartum women validate dependent care agency, encourage and aid in facilitating support mobilization, and collaborate with women throughout the postpartum time
Opium use in Hmong Patients: a Drug Screening Tool and an Opium use Resource for Providers
No full textWhen working with a population such as the Hmong, attention to their cultural health practices is essential to provide the best care possible. As Hmong patients are reluctant to seek medical care from Western medicine, when they present to primary care, gathering the most accurate health assessment is necessary to implement culture-specific care. The role of primary care providers, such as family nurse practitioners, is to address patients’ healthcare needs from all cultural backgrounds. As health care becomes increasingly diverse, it is crucial for family nurse practitioners to have the appropriate tools and skills to perform their job well. Through an in-depth literature search, a gap of a culturally appropriate drug screening tool was identified in primary care to serve the Hmong patients. To address the gap, the scholarly project developed a pamphlet with an appropriate drug screening tool and an opium use resource for providers to use in primary care settings. This educational pamphlet was introduced to two clinics in St. Paul that serve Hmong patients. Eighteen primary care providers were given the pamphlet and 9 of them participated in a short survey. The survey revealed many primary care providers found the pamphlet to be useful in their practice. As family nurse practitioners adopt the tool, it has the potential to improve the health and wellbeing of the patients they serve
Holistic Admissions
Get PDFAs patient populations of Minnesota and the nation become more diverse there is much work to do in preparing a nursing workforce that has the experiences and attributes to provide holistic and culturally congruent care. The process of holistic admissions admits the most qualified applicants into schools of nursing who bring with them life experiences and crucial attributes. These holistic aspects of the applicants support both academic success and promote quality nursing practice. Holistic review aims to align the mission and vision of academic institutions with the admissions process ensuring that both the applicant and organization are clear in their commitment to a holistic nursing practice. This project created and implemented a holistic review process in a consortium made up of eight schools of nursing. Using a developmental evaluation model, ongoing assessment, and readjustments allowed for the formation of a process that considers applicants holistically, while maintaining a manageable workflow for involved institutions. This project also considered the importance of sustainability, while caring out translational research by documenting the process clearly so it can be followed each admission cycle. The commitment to holism extends beyond admissions to include education and ultimately nursing practice to ensure culturally responsive care for all patients and a nursing workforce that can meet the demands of a rapidly changing population
The Process to Implement a Discharge Safety Plan Interverntion in a Large Midwestern Hospital Emergency Department
No full textThe Emergency Department has been identified as a critical setting in which to identify people at risk of suicide and provide support. The period following emergency room discharge has been established as being a time of high risk for patients seen for suicidal thoughts and or behaviors. Given the inconsistency of suicidal patient\u27s seen in the ED to follow up with recommended outpatient mental health treatment, brief ED interventions to reduce suicide risk has been found to be especially useful. An innovative and brief intervention, A Safety Plan Intervention (SPI), will be described. The SPI involves a clinician, working collaboratively with a patient to build a documented personalized safety plan that includes identification of warning signs identification and personalized strategies to de-escalate a suicide. The basic steps of a SPI include (a) recognizing the warning signs of a suicidal crisis or thinking about self-harm; (b) using coping strategies that a person already knows; (c) contacting others as a way of distraction from suicidal thoughts; (d) reaching out to family members or friends who may be able to help the person get through the crisis; (e) contacting a suicide helpline, mental health professional or crisis line (f) reducing the availability of lethal means to complete a suicide. Following discharge patients that completed the SPI will receive a follow-up phone call by a clinician who will express concern and care for the patient’s wellbeing and a desire to stay in touch without setting any expectations for patients to provide anything in return
What is the Effect of Physical Activity on the Reduction of Macrovascular Complications in Patients Diagnosed with Type 2 Diabetes Mellitus?
Get PDFThe increasing prevalence and healthcare burden of type 2 diabetes is a worldwide concern. It is the seventh leading cause of mortality and a significant cause of morbidity. While both the macrovascular and microvascular complications of diabetes can have a profound impact on overall health and quality of life, cardiovascular events are the leading cause of mortality in patients with type 2 diabetes. Adults with diabetes have a two to four-fold increased risk of cerebrovascular events and myocardial infarctions. Oral medications combat insulin resistance and aid in the control of hemoglobin A1c, blood pressure, and cholesterol, therefore, contributing to a decrease in potential complications of diabetes. However, these medications may be costly and unobtainable for those who are uninsured or face barriers in accessing healthcare. The foundation of diabetes management and prevention is rooted in lifestyle modifications, including physical activity. Physical activity has been shown to decrease the risk factors associated with macrovascular complications in adults with type 2 diabetes. Through the optimization and implementation of physical activity into diabetes management, patients with type 2 diabetes can reduce the risk of mortality associated with coronary heart disease, cerebrovascular disease, and peripheral artery disease
An Overview of Individualized Management of Neuropsychiatric Symptoms in Dementia
Get PDFBackground: It is estimated that about 11% of adults 65 and older have dementia in the United States. Neuropsychiatric symptoms are common in the presentation of dementia. These symptoms often result in increased morbidity and mortality, negative patient outcomes, caregiver burden, institutionalized care, and diminished quality of life. The focus of this paper is to analyze the therapeutic effectiveness of nonpharmacologic interventions in the management of neuropsychiatric symptoms of dementia.
Methods: A literature review was conducted to critique current evidence on the use of nonpharmacologic interventions in managing neuropsychiatric symptoms in older adults with dementia. Searches were performed using PubMed, UpToDate, and Google Scholar.
Results: Pharmacotherapy should be cautiously considered in treating neuropsychiatric symptoms of dementia due to adverse effects and black box warnings. Although further studies are needed, music therapy, tailored bathing routines, bright light therapy, multisensory stimulation, and eliminating the use of elderspeak language are nonpharmacologic interventions that contain some evidence in improving quality of life in dementia. The validation technique is still an ethically controversial approach to communication. As a result of the COVID-19 pandemic, social isolation has worsened in people with dementia.
Conclusion: Dementia is a disease that requires multifactorial care in approaching management. Nonpharmacologic interventions are the first-line plan of treatment in managing neuropsychiatric symptoms of dementia and present with fewer side effects and are person-centered in implementing. Future research in developing measures for quality of life is needed to study effectiveness of nonpharmacologic therapy
Occupational Factors and Risk for Preterm Birth
Get PDFIntroduction: Preterm birth (PTB) is a leading contributor to infant death globally and in the United States. The biological mechanisms and etiologies for PTB are not well understood making prevention challenging. The correlation between increased number of women in the workforce and increased incidence of PTB in the U.S. inspired a thorough review of occupational risk factors that may contribute to shortened gestational length.
Background: The studies reviewed assessed the following occupational factors and their association with PTB: physical job demands, exposure to whole-body vibration and noise, shift work, long working hours, and psychosocial job strain.
Methods: A systematic search using Augsburg University’s Lindell Library, PubMed, and ScienceDirect databases was conducted to find peer-reviewed studies that examined maternal occupational factors and birth outcomes.
Discussion: PTB was most associated with physically demanding jobs, long working hours, and prolonged exposure to whole-body vibration. However, more research is needed to further clarify at what exposure level and stage of the pregnancy exposures have the most impact. Additionally, more studies that control for confounding variables and address the role of maternal race and socioeconomic status are needed.
Conclusion: There is not sufficient evidence to support the implementation of workplace policies that limit job duties or working hours for women during pregnancy. However, it may be prudent for clinicians to educate pregnant patients that heavy lifting, prolonged standing and bending at the trunk, working long hours, and having a full-time job with exposure to whole- body vibration has been associated with early parturition
A Missed Opportunity: The Underutilization of Preexposure Prophylaxis
No full textThe emphasis on adherence for those taking PrEP is paramount to prevent the seroconversion of HIV for those at risk in the community. The link between PrEP adherence, maintenance, burdensome visits requiring the need for quarterly visits and labs, the burdensome nature of navigating healthcare systems, and stigma surrounding taking PrEP will be discussed along with recent solutions being implemented to tackle these disparities
Maximizing Black applicant matriculation in U.S. PA programs: associations between the number of submitted applications and likelihood of matriculation
Get PDFBackground: Physician Assistants (PA) are important members of the medical team, and increasing diversity in healthcare professionals has been consistently associated with improved health outcomes for underrepresented minority patients. In this study of a national cohort of PA program applicants, we investigated whether the number of programs a student applied to (Application Number, AN) was significantly associated with increased likelihood of matriculation into a PA program. Methods: We examined all applications (n = 27,282) to the 2017–2018 admissions cycle of the Central Application Service for Physician Assistants, which is utilized by over 90% of accredited PA programs in the US. As we a priori hypothesized that associations would be non-linear, we used natural cubic splines to estimate the associations between matriculation and AN, controlling for multiple metrics of academic achievement, experience, and applicant demographics. We subsequently used segmented regression analyses (modified poisson regression with robust error variance) to investigate log-linear associations above and below inflection points identified in the spline analyses. Additionally, we explored for effect modification by race/ethnicity. Results: The strongest associations were observed between application number 2–7, and a threshold effect was observed at \u3e 16 applications, beyond which there was no significant, incremental benefit in matriculation likelihood. Associations differed by race, particularly for application number 2–7, wherein the incremental benefit from each additional application was highest for Black applicants (Likelihood Ratio [LR]: 1.243, 95% CI: 1.136 to 1.360) vs non-Latinx White (LR: 1.098, 95% CI: 1.072 to 1.125), with no additional, incremental benefit beyond 7 program applications. For all other races, significant increased likelihoods of matriculation were observed until 16 program applications. Conclusions: These findings can help guide pre-PA advisors and PA programs, providing recommended thresholds to applicants on the most cost effective ways to increase their likelihood of admissions, and the PA profession as a whole by providing actionable information that can potentially increase Race/Ethnic diversity in the PA profession and, by extension, medical teams
Determining EMIC Wave Vector Properties Through Multi-Point Measurements: The Wave Curl Analysis
Get PDFElectromagnetic ion cyclotron (EMIC) waves play important roles in particle loss processes in the magnetosphere. Determining the evolution of EMIC waves as they propagate and how this evolution affects wave-particle interactions requires accurate knowledge of the wave vector, k. We present a technique using the curl of the wave magnetic field to determine k observationally, enabled by the unique configuration and instrumentation of the Magnetospheric MultiScale (MMS) spacecraft. The wave curl analysis is demonstrated for synthetic arbitrary electromagnetic waves with varying properties typical of observed EMIC waves. The method is also applied to an EMIC wave interval observed by MMS on October 28, 2015. The derived wave properties and k from the wave curl analysis for the observed EMIC wave are compared with the Waves in Homogenous, Anisotropic, Multi-component Plasma (WHAMP) wave dispersion solution and with results from other single- and multi-spacecraft techniques. We find good agreement between k from the wave curl analysis, k determined from other observational techniques, and k determined from WHAMP. Additionally, the variation of k due to the time and frequency intervals used in the wave curl analysis is explored. This exploration demonstrates that the method is robust when applied to a wave containing at least 3–4 wave periods and over a rather wide frequency range encompassing the peak wave emission. These results provide confidence that we are able to directly determine the wave vector properties using this multi-spacecraft method implementation, enabling systematic studies of EMIC wave k properties with MMS