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The purpose of this project is to create an educational activity book for Spanish-speaking children that face a language barrier when seeking care in the Emergency Room. In order to effectively develop relationships and provide exceptional healthcare for clients, nurses must understand how to effectively communicate (Escarce & Kapur, 2006).

The purpose of this project is to create an educational activity book for Spanish-speaking children that face a language barrier when seeking care in the Emergency Room. In order to effectively develop relationships and provide exceptional healthcare for clients, nurses must understand how to effectively communicate (Escarce & Kapur, 2006). Current research reports that clients with Spanish as their primary language were more likely to have a poor experience when seeking health care assistance (Hispanic Health Disparities and Communication Barriers, 2016). Additionally, they were more likely not to seek care at all due to little or no communication capabilities with healthcare staff (Hispanic Health Disparities and Communication Barriers, 2016). The language barrier present and the lack of resources available to address the issue have created a disparity in the quality of healthcare for Spanish-speaking clients (Juckett, 2013). The book was made with the intention of being distributed to Spanish-speaking children and/or children with Spanish-speaking guardians, upon arrival to the Emergency Department. This educational activity book is to be used by the child, their guardians, and their involved health care staff to more comfortably navigate their way through the Emergency Room process.
ContributorsBurkey, Lindsey (Co-author) / Streecter, Angela (Co-author) / Stevens, Carol (Thesis director) / Murphy, Ana Orrantia (Committee member) / Sutter, Kimberlee (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
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This long form creative nonfiction essay gives insider details on working in an emergency room as a medical scribe. The most pertinent topic is death and how the author copes with seeing patients die on a regular basis. Other topics are emergency room procedures, specific diagnoses and treatments, as well

This long form creative nonfiction essay gives insider details on working in an emergency room as a medical scribe. The most pertinent topic is death and how the author copes with seeing patients die on a regular basis. Other topics are emergency room procedures, specific diagnoses and treatments, as well information on the other personnel in an emergency room.
ContributorsFeller, Aaron Lee (Author) / Gutkind, Lee (Thesis director) / Robert, Jason (Committee member) / Rowe, Todd (Committee member) / Barrett, The Honors College (Contributor) / Department of Chemistry and Biochemistry (Contributor) / Department of English (Contributor)
Created2013-05
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Description

Adverse childhood experiences (ACEs) are traumatic events experienced during childhood that have negative effects starting as a child and extending into adulthood. The presence of multiple ACEs increases negative mental, physical, and behavioral health outcomes. Children of parents who have experienced ACEs are at a higher risk of experiencing ACEs

Adverse childhood experiences (ACEs) are traumatic events experienced during childhood that have negative effects starting as a child and extending into adulthood. The presence of multiple ACEs increases negative mental, physical, and behavioral health outcomes. Children of parents who have experienced ACEs are at a higher risk of experiencing ACEs themselves, creating an intergenerational cycle of trauma between parents and their children. Evidence suggests that parenting education can reduce the impact of ACEs and potentially eliminate poor health outcomes. The literature revealed that parenting education was found to increase parenting competency, which will in turn reduce the impact of ACEs on children.

The purpose of this evidence-based project is to evaluate parenting competency and parenting self-efficacy after implementing six parenting workshops. The workshop topics consist of: (a) stress management, (b) understanding trauma, (c) positive parenting, (d) positive discipline, (e) play, and (f) learning development and support. The workshops were delivered at a community residential facility for women seeking recovery from abuse, incarceration, chemical dependency and other life-controlling problems. Participants included 10 female residents.

Demographics, ACE scores, pre and post Parenting Sense of Competency Scale, and a post intervention satisfaction questionnaire and discussion were used to collect data from the participants. Mothers’ ACE scores ranged from 2-9. The parenting self-efficacy score increased in the subgroup that attended all six workshops. All of the mothers agreed that the workshops would help with parenting their children. The findings suggest that parenting education increases parenting knowledge and self-efficacy, and may reduce the impact of ACEs on children.

ContributorsGohlke, Melissa (Author) / Thrall, Charlotte (Thesis advisor)
Created2020-05-04
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Description
Declaration of Conflicts: This project has no conflicts of interest to declare.

Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab

Declaration of Conflicts: This project has no conflicts of interest to declare.

Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.

Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.

Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.

Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.

Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (<0.52%), with an increase in revenue by 41%. Additionally, a statistically significant increase in patient, provider and staff satisfaction was also noted when compared to the old scheduling system, as >68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.

Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.

Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.

Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.

Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.

Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 2017
ContributorsPatel, Dimple (Author) / Thrall, Charlotte (Thesis advisor) / Glover, Johannah-Uriri (Thesis advisor)
Created2018-05-02
Description

“Man, the bravest animal and most prone to suffer, does not deny suffering as such: he wills it, he even seeks it out, provided he is shown a meaning for it, a purpose of suffering.” -Friedrich Wilhelm Nietzsche Juvenile justice reform is a complex and contentious topic. Despite the increased

“Man, the bravest animal and most prone to suffer, does not deny suffering as such: he wills it, he even seeks it out, provided he is shown a meaning for it, a purpose of suffering.” -Friedrich Wilhelm Nietzsche Juvenile justice reform is a complex and contentious topic. Despite the increased attention and focus throughout the years of looking for more effective ways of dealing with youthful offenders, America is still one of the most punitive countries regarding juvenile crime – averaging nearly 60,000 incarcerated youth daily. In recent years, there has been a trend toward reforming the juvenile justice system to prioritize rehabilitation over exclusion and punishment, with a preference for restorative approaches and strategies instead of traditional exclusionary and punitive responses. However, continued high incarceration rates combined with almost 90 percent recidivism rates suggest these approaches are ineffective and lack the necessary elements to address the underlying causes of juvenile crime or help position our youth for successful reentry or participation in society. As we learn more about adverse childhood experiences (ACEs) and the devastating long-term effects on a child’s development, we recognize a connection between ACEs, toxic stress, and juvenile crime. ACEs refer to adverse or traumatic events that occur during childhood, such as physical, emotional, or sexual abuse, neglect, or household dysfunction. These experiences can pose significant risks to children’s physical and mental health. Toxic stress refers to the chronic exposure to the body’s stress response systems reacting to severe and prolonged adversity, such as child abuse or neglect. Developmental changes in the body and brain due to toxic stress can increase the risk of physical and mental health problems, including anxiety, depression, and substance abuse, and lead to increased negative behaviors and criminal activity. This paper argues that a trauma-informed approach to reform juvenile justice is needed to help survivors of ACEs and toxic stress repurpose their adversity into a tool of opportunity and empowerment. This trauma-informed approach will, in turn, help trauma survivors find purpose in life, alter their perspective of their world, and perform actions and behaviors in service of their goals. Only by including an individualized trauma-informed approach will we finally realize collective juvenile justice reform.

ContributorsCollins, Rahman (Author) / Niebuhr, Robert (Thesis director) / Dietrich, John (Committee member) / Barrett, The Honors College (Contributor) / Historical, Philosophical & Religious Studies, Sch (Contributor) / School of Social and Behavioral Sciences (Contributor)
Created2023-05