Programs and Communities

Vicarious exposure to traumatic events is correlated with: mental health problems, a higher prevalence of posttraumatic stress disorder, employee attrition, and higher mortality rates for Law Enforcement Officers when compared to the general population. The purpose of this evidence-based project was to determine if a resiliency training improved resiliency and resiliency knowledge in law enforcement officers in a rural law enforcement agency in the southwestern United States. Six participants completed a demographic survey, Response to Stressful Experience Scale and a resiliency knowledge measure. A Wilcoxon signed-rank test was conducted to compare pre- and post- training resiliency and resiliency knowledge scores.

The post-test overall resiliency scores (Mdn = 59.50) were not significantly higher than pre-test overall resiliency scores (Mdn = 54.50), Z = -1.47, p = .141. Post-test resiliency knowledge scores (Mdn = 9.00) were not significantly higher than pre-test resiliency knowledge scores (Mdn = 8.00), Z = -1.63, p = .102. In this group of law enforcement officers, the resiliency training did not have an effect on resiliency or resiliency knowledge. These outcomes could be potentially explained by the limited sample size (N = 6), and possibly small effect size. Recommendations for improving the current study include conducting the resiliency training with a larger sample size of at least 30, and including additional relevant questions in the resiliency knowledge measure.

There is an estimated 6.2 million people Americans over the age of 20 suffering from Heart Failure (HF) (Bejamin et. al., 2019). It is essential that HF patients have sufficient knowledge about the disease and self-management (Abbasi, Ghezeljeh, & Farahani, 2018; Dinh, Bonner, Ramsbotham & Clark, 2018). Lack of self-management is largely to blame for many HF exacerbations. Current evidence supports utilizing both verbal and written education with an emphasis on self-care and education delivered in a group setting or individual setting showed equal impact on self-care and HF knowledge ( Hoover, et. al., 2017; Ross et. al., 2015; Tawalbeh, 2018).

An outpatient VA clinic located in a suburb of the large metropolitan identified there was no consistency on how a HF patient was educated, managed, or tracked and the registered nurses (RNs) lacked knowledge of HF. As a results of these findings this Evidence Based Project (EBP) was implemented. RNs were educated on HF and completed a self-assessment questionnaire evaluating their knowledge pre and post education. The RNs, as part of a multidisciplinary team, educated HF patients on signs and symptoms of HF as well as on how to manage the disease. Patients completed, the Kansas City Cardiomyopathy Questionnaire (KCCQ) to assess quality of life and the Self Care Heart Failure Index (SCHFI) to assess knowledge of HF and self-management skills.

These questionnaires were completed initially and at 30 and 60 day intervals. The RNs self-assessment of their knowledge and ability to educate patients increased in all areas. The patient’s KCCQ and SCHFI score improved at 30 days and 60 days when compared to their initial score. Larger EBPs are needed over a longer period of time to assess the impact on hospital readmissions and same day clinic visits for HF exhibitions.

Ineffective transitional care programs for ensuring the continuation of care from acute settings to the home settings post discharge can result in rehospitalization of elderly patients with chronic diseases. Usually, transitional care should be time-sensitive, patient-centered services intended to ensure continuity of care and an efficient transition between health care settings or home. A patient centered transitional care program was implemented at an outpatient primary care facility to reduce readmission rates. Institutional Review Board approval was obtained.

Twenty adult patients with chronic diseases discharged from an acute setting were identified. A follow up phone call and/or a home visit within 24-72 hours post discharge was employed. The Care Transitions Measure (CTM®) and Medication Discrepancy Tool (MDT®) were utilized to identify quality of care of transition and medication discrepancies. A chart audit collected data on the age of participant, diagnosis for initial hospitalization, CTM score, home visit, and ED visits or re-hospitalizations after 30 days of discharge. The outcome indicated that transitional care within primary care utilizing evidence-based practices is beneficial in reducing readmission rates. A logistic regression showed model significance, p = .002, suggesting that the CTM score was effective for both telephone support (TS) and home visit (HV).

A correlation analysis showed that as age of participants increased, the CTM score decreased, indicating that older adults required more support. A significance p <.001, of a proportional test indicated that readmission rates after the intervention was lower. It is evident that providing a timely and effective transitional care intervention in a primary care setting can reduce hospital readmissions, improve symptom management and quality of life of adult patients with chronic diseases.

Low back pain is a worldwide health problem. Preoperative education is essential to provide patients with information across the continuum of care. Gaps exist among healthcare organizations regarding deficiencies in properly educating patients about their surgical experience. The lack of proper preoperative education can negatively impact reimbursement for healthcare systems, providers, and patient outcomes. In a large metropolitan tertiary care center providing spine surgery, an evidence-based project was implemented. A self-developed pre and post intervention surveys was given assessing patients’ knowledge and surgical expectations after surgery. A tri-fold education pamphlet was given to the participants with information that included detailed information regarding expectations before and after surgery.

Descriptive statistics were used to describe the sample and outcome variable. An increase in knowledge in expectations after surgery was noted from pre-intervention (mean 1.83, SD .408) to post-intervention (mean 1.67, SD .816) with a Cohen’s D of 0.248 although this was not statistically significant. However, the change in average length of stay (LOS) was significant. The average LOS for the project participants dropped from 4.54 days to 2.833 days which is within the Centers for Medicare and Medicaid Services (CMS) guidelines of 2.92 days for this surgical population. In conclusion, an increased in patients’ knowledge regarding expectations following surgery and decreased LOS was seen for the project participants.

As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental illness and substance abuse, alienation from potential healthcare proxies, and specific fears related to dying. Completion of an advance directive (AD) would address many of these barriers, as well as national goals of reducing medical costs associated with end of life care. A review of the literature indicates that homeless individuals, once educated on the purpose and significance of ADs, complete them at a higher rate than non-homeless people. Further, racial and ethnic disparities in document completion are minimized with educational interventions about an AD’s purpose.

King’s Theory of Goal Attainment provides the theoretical basis for the application of such an intervention in the setting of a medical respite center and a day resource center that both serve the homeless. Thirty-seven clients of the two sites and 14 staff members were administered a pre-and post-test measuring attitudes and knowledge relating to ADs on a Likert scale, resulting in an increase in knowledge about one of the two documents that traditionally comprise an AD, while not significantly affecting attitudes. Implications for practice include an inexpensive intervention that does not require a medically trained individual to deliver, enabling a broad application to a variety of settings with the goal of empowering a traditionally disenfranchised population to make health decisions related to the most vulnerable of life passages.