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Purpose: This project sought to evaluate the gap that exists between best practice and current practice, for sepsis identification and EGDT implementation.
Methods: The project was completed over a four-month period with prior Institutional Review Board (IRB) approval and consisted of evaluation of sepsis knowledge and barriers to EGDT. Questionnaires included demographics, sepsis knowledge, barriers to EGDT and AHRQ quality indicators toolkit.
Results: Sample (N=16) included registered nurses (RN) and healthcare providers. Descriptive statistics were utilized for evaluation of questionnaires. Results indicate staff have sound understanding of signs and symptoms of sepsis, however application through case studies demonstrated lower performance. Overall system barriers were minimal, with greatest barriers in central line monitoring and staff shortages. High level unit teamwork exists within the ED, however collaboration is lacking between ED staff and upper management. Results demonstrate moderate disengagement between upper management and staff leading to miscommunication. Recommendations included increased, consistent sepsis education, utilization of Institution for Healthcare Improvement (IHI) triple aim framework for evaluating systems, implementing a closed loop approach to communication, and having a staff champion for sepsis be included in meetings with upper management.
Children often present to the emergency department (ED) for treatment of abuse-related injuries. ED healthcare providers (HCPs) do not consistently screen children for physical abuse, which may allow abuse to go undetected and increases the risk for re-injury and death. ED HCPs frequently cite lack of knowledge or confidence in screening for and detecting child physical abuse.
The purpose of this evidence-based quality improvement project was to implement a comprehensive screening program that included ED HCP education on child physical abuse, a systematic screening protocol, and use of the validated Escape Instrument. After a 20-minute educational session, there was a significant increase in ED HCP knowledge and confidence scores for child physical abuse screening and recognition (p < .001). There was no difference in diagnostic coding of child physical abuse by ED HCPs when evaluating a 30-day period before and after implementation of the screening protocol.
In a follow-up survey, the Escape Instrument and educational session were the most reported screening facilitators, while transition to a new electronic health system was the most reported barrier. The results of this project support comprehensive ED screening programs as a method of improving HCP knowledge and confidence in screening for and recognizing child physical abuse. Future research should focus on the impact of screening on the diagnosis and treatment of child physical abuse. Efforts should also be made to standardize child abuse screening programs throughout all EDs, with the potential for spread to other settings.
Suicide has become a national concern due to the increasing rates across the country. The 2012 National Strategy for Suicide Prevention aims to improve the area of clinical prevention. Emergency departments (ED) play a key role in addressing this effort as they have multiple opportunities to connect with patients who are at risk. There exists a high-risk period of time immediately following a patient’s discharge from emergency care. To address this period of concern, a review of the literature was conducted on the effectiveness of follow-up contacts as a means to prevent suicide and suicide related attempts in this at-risk population.
Based on this review, a follow-up intervention was proposed to increase patients’ social support and knowledge on suicide prevention through a safety plan and the use of caring postcards. The aim was to evaluate the degree to which implementation of a safety plan and follow-up using postcards reduces suicide risk in the ED. ED suicide prevention practices such as safety planning and caring contacts with postcards have shown to be feasible and cost-effective methods to reduce patients’ risk of suicide as they provide education and address the high-risk period of time after discharge.
Using a quasi-experimental pre and post-test design, English speaking adults 18 years of age and older, admitted to an ED in the Phoenix Metropolitan area with suicidal ideation, were voluntarily recruited for two weeks. The self-rated Suicidal Behaviors Questionnaire-Revised (SBQ-R) was used as a baseline assessment along with the introduction of a safety plan. Participants were then followed with the receipt of postcards with caring messages over a two-week period, and a final SBQ-R. The SBQ-R has shown beneficial reliability and validity measuring suicidality in the adult population. Data from the pre-SBQ-R was analyzed using descriptive statistics as no post-SBQ-Rs were received. Outcomes for this project included a reduction in suicidal ideation and suicide risk.
This project provides insight into the implementation of a safety plan and follow-up intervention in the ED and their attempts to reduce acute suicide risk as well as highlight the value that post-ED support provides.
Keywords: suicide, prevention, safety plan, caring messages, postcards, emergency department, follow-up, contacts, brief intervention
The demand for interdisciplinary and cross campus courses has increased substantially over the past few years resulting in increased program offerings and modifications to existing coursework in universities across the nation. This is very clearly evident in the arts realm. However, there is no clear agreement of knowledge, skills and abilities deemed important to the success of selfemployed artists and arts entrepreneurs. This essay presents qualitative data collected from personal conversations and other data collected over the past several years from students and faculty members engaged in lessons learned from The Coleman Foundation Faculty Fellows Program, a national initiative of The Coleman Foundation. Building upon the lessons learned from this initiative a framework is presented to embed entrepreneurship content across several arts subjects. Suggestions for conceiving and designing entrepreneurship course content are portrayed. The “modules” approach to the infusion of entrepreneurship within the arts and other disciplines are presented. Assessment methods to measure the impact of using such modules to infuse entrepreneurship are explained. Pedagogical constructs and pedagogical resources are presented. The implications for future research are postulated and suggested.
Frameworks for Educating the Artist of the Future: Teaching Habits of Mind for Arts Entrepreneurship
This essay looks at pedagogies that can be deployed to teach the habits of mind that support arts entrepreneurship through the lenses of frameworks developed by Gardner, Duening, and Costa & Kallick for conceptualizing ways of thinking. It draws a network of connections between these frameworks for ways of thinking on which are mapped various pedagogies for teaching arts entrepreneurs as employed in educational programs and as described in recent literature. After first briefly summarizing each of these frameworks, I graphically describe the ways these various frameworks may overlap and then offer examples of pedagogies that support the development of entrepreneurial habits of mind for artists and others.
In this essay, I investigate the relationship between local political context and entrepreneurship in the arts, specifically entrepreneurship by cultural institutions, which I refer to as “cultural entrepreneurship.” I look at cultural entrepreneurship as a discourse and discuss one locus in particular, the city of Utrecht in The Netherlands. The discourse on cultural entrepreneurship in the Dutch context is influenced by diminishing government responsibility for financial support of the arts. Entrepreneurship is seen in that context as finding new sources of income. Entrepreneurial values such as curiosity and experimentation are dominant in the routine relationship between cultural organizations and their subsidizing administrations but are not incorporated in the understanding of cultural entrepreneurship. After applying these considerations to the observation of the culture-political practice in the city of Utrecht, I suggest a framework that allows us to understand the discourse on the relationship between cultural entrepreneurship and political context along two axes. One axis moves between risk acceptance and aversion, and the other between the private and public interests.
This article argues that the current economic design of the US not-for-profit arts sector, specifically theatre, fails to support the long-term wellness of the cultural worker and the cultural commons. As a solution, we propose a global, commons-based alternative economy and complementary currency called Culture Coin that creates new wealth, abundance, and virtuous social behaviors by matching unmet needs with underutilized resources that our current economy fails to circulate. The current design of our arts economy results in generative artists being disproportionately poorer, unjust disparities in how resources are distributed, and social behaviors in the nonprofit sector that mimic for profit, commercial enterprises. The arts sector has an over-dependence on uncompensated or undercompensated “sweat equity” and volatile philanthropic funding. We detail the value and characteristics of a commons framework for entrepreneurial activity and describe internet-enabled peer production as a way to build cultural commons as well as the most effective way to collectively co-create and deploy the Culture Coin project.