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- All Subjects: Quality Improvement
- All Subjects: Patient education
- Creators: Arizona State University. College of Nursing & Healthcare Innovation
- Creators: Enz, Billie
Description
This study investigated the effects of different types of play-embedded instruction on preschoolers' vocabulary learning during a vocabulary intervention known as Say-Tell-Do-Play (STDP). The goal of this study was to determine whether or not two types of play - Story Drama and a Vocabulary Matching Game - enhanced the effectiveness of the STDP strategy. To investigate this goal, the researcher implemented the STDP instructional routine for 17 children with three different picture books and their corresponding play activities and a control condition (Drawing) in a counterbalanced order. Descriptive statistics were utilized to understand the effects of these different play activities on the children's receptive and expressive vocabulary learning. Findings showed that the STDP vocabulary instructional strategy had a much larger impact on children's receptive vocabulary than on expressive vocabulary learning. The play activities did not seem to make much difference in the learning of receptive and expressive vocabulary. The results indicated that the STDP strategy is an effective way to teach receptive vocabulary. There was a lack of evidence that the different types of play significantly affected children's vocabulary learning.
ContributorsSong, Mi-Jung (Author) / Christie, James (Thesis advisor) / Enz, Billie (Committee member) / Blanchard, Jay (Committee member) / Arizona State University (Publisher)
Created2012
Description
Abstract
Objective: The purpose of this literature review is to examine the most psychometrically sound (e.g., valid and reliable) instruments measuring physical activity (PA) so that reflection of preschool children’s activity and documentation of intervention effects on preschool child PA is accurate.
Methods: Rigorous validation and calibration studies and those studies designed to test the psychometric properties of PA measurement instruments were specifically sought out to include in this review. Articles were excluded if they did not include specific information about the validity and reliability of the PA measures used with preschool children.
Discussion: Of the six articles reviewed, the systematic review used the most rigorous protocols to conduct its review, yielding the highest level of evidence appraising several validation studies. Because Pfeiffer et al. (2006) utilized the most valid and reliable criterion measure (Cosmed® portable metabolic system), the validation study this research team conducted is deemed to have identified the most valid and reliable cut points to utilize when reducing accelerometry data.
Conclusion: Current cut-points vary widely and greatly affect the reported results of a study. Therefore, it is critical that authors reference validation studies used to support the cut-points that were employed in the data-reduction phase. Currently, validation methods have been identified using high quality criterion measures in rigorous validation studies and thus it is strongly recommended that those cut points be used in data reduction processes.
Objective: The purpose of this literature review is to examine the most psychometrically sound (e.g., valid and reliable) instruments measuring physical activity (PA) so that reflection of preschool children’s activity and documentation of intervention effects on preschool child PA is accurate.
Methods: Rigorous validation and calibration studies and those studies designed to test the psychometric properties of PA measurement instruments were specifically sought out to include in this review. Articles were excluded if they did not include specific information about the validity and reliability of the PA measures used with preschool children.
Discussion: Of the six articles reviewed, the systematic review used the most rigorous protocols to conduct its review, yielding the highest level of evidence appraising several validation studies. Because Pfeiffer et al. (2006) utilized the most valid and reliable criterion measure (Cosmed® portable metabolic system), the validation study this research team conducted is deemed to have identified the most valid and reliable cut points to utilize when reducing accelerometry data.
Conclusion: Current cut-points vary widely and greatly affect the reported results of a study. Therefore, it is critical that authors reference validation studies used to support the cut-points that were employed in the data-reduction phase. Currently, validation methods have been identified using high quality criterion measures in rigorous validation studies and thus it is strongly recommended that those cut points be used in data reduction processes.
ContributorsAcuna, Kelsey Manique (Author) / Jacobson, Diana (Thesis director) / Small, Leigh (Committee member) / Barrett, The Honors College (Contributor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / W. P. Carey School of Business (Contributor)
Created2014-05
Description
Atrial fibrillation, also known as Afib or AF, is the most common irregular heart rhythm among the United States adult population. Atrial fibrillation is characterized by an abnormal fibrillation of the upper chambers of the heart, known as the atria. When left chronically untreated, this condition may lead to insufficient systemic blood flow or the formation of blood clots. Atrial fibrillation has many modifiable risk factors, meaning contributing habits and practices within the patient's control that may worsen the condition. Communication of these modifiable risk factors to patients with atrial fibrillation is important in improving patient quality of life and for reduction of disease symptoms. The motivation for this study was to convey the potential of improved disease process by lifestyle modification to patients with atrial fibrillation.
ContributorsLehman, Jessica Lynn (Author) / Ross, Heather (Thesis director) / Kelly, Lesly (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2017-12
Description
Background: Advance Care Planning (ACP) conversations are discussions between patients, providers, and loved ones addressing key care decisions in the event of incapacity. Nearly twothirds of US adults have not completed an Advance Directive (AD), yet ACP conversations rarely occur in practice. The objective of this quality improvement project was to implement workflow changes with a reminder system to facilitate ACP conversations during Medicare Wellness Visits (MWV).
Method: Social Cognitive Theory describes the complex relationship between variables that can influence an individual’s decision to address ACP. Providers in a primary care office in the Southwestern United States participated in an ACP education session and confidence survey. Patients presenting for the MWV were screened for ACP, and visual reminders were attached outside the exam room for provider review. Aggregate data were used to evaluate provider surveys. Descriptive statistics were used to evaluate patient characteristics and the Chi-square Test of Independence, and Fisher’s test was used to compare the pre-and post-intervention advance directive documentation.
Results: Qualitative feedback from the survey indicates reminders and easily accessible resources may help facilitate ACP conversations. Of the 251 MWVs, 21 (8%) had an AD documented, significantly less than the nationally reported rate of 37.7% (p < 0.05, z = -2.39).
Conclusions: Healthcare providers face multiple barriers preventing or delaying ACP conversations in practice. System-level changes and provider education can improve the rate of ACP conversations and impact patients’ care at the end of life.
ContributorsSmith, E. Elizabeth (Author) / Reifsnider, Elizabeth (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Medicare implemented a yearly Annual Wellness Visit (AWV) to improve quality patient care through early detection of declining health. However, there has been only partial provider participation since its inception, which potentially delays treatment and negatively impacts patient outcomes. The aim of this quality improvement project was to assess the feasibility of implementing a standardized electronic AWV template into private primary care practices to improve the consistency of delivery and documentation. The project designer utilized the theory of transitions (TOT) to facilitate the project execution. An electronic Excel-based template was designed to capture and calculate all aspects of the AWV, including billing codes, to allow for ease and consistency of use within a small primary care practice over two weeks. A provider performed the AWVs using the electronic template after completing a hands-on tutorial and reviewing an educational handout. Data were retrieved from a 7-question, 5-point Likert scale questionnaire given to the provider to assess the effectiveness of the electronic template versus a paper assessment. The results of this study indicated overall satisfaction with using leveraged technology to provide consistency of AWVs to improve patient outcomes, provider satisfaction, and increase revenue through uniform charting and billing. The outcomes of this project provide a basis of existing evidence for using standardized methods to perform and track Medicare AWVs.
ContributorsHill, L. Michelle (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Background: An evidence-based project was performed to train and increase skills among healthcare providers to perform advance care planning. Training decreases barriers and improves attitudes and confidence to perform advance care planning. Advance care planning can include the Physician Order for Life-sustaining Treatment, an out-of-hospital order that directs emergency medical services of a patient’s wishes. Internal evidence found that many providers are unfamiliar with the Physician Order for Life-Sustaining Treatment form. The Theory of Planned Behavior was used to guide the project.
Objectives: To improve advanced care planning processes in a healthcare organization.
Design: A quality improvement project was performed at a medical center with outpatient provider groups. Virtual training was provided by the Arizona Hospital and Healthcare Association on the Physician Order for Life-Sustaining Treatment. Participants completed a three-part survey to measure skills for advance care planning after a training event.
Setting/Subjects: Five (n=5) American palliative and primary care providers at a medical center.
Measurements: The East Midlands Evaluation Toolkit is a validated survey tool that measures confidence and competence in advance care planning after training.
Results: Descriptive statistics, Friedman’s test, and the Kruskal-Wallis test were used for data analysis. Results provided evidence to the healthcare facility that there is a significant need to train their healthcare professionals on advance care planning.
Conclusions: Recommendations are made to focus research on larger studies looking at the types of advance care planning, and differences in disciplines and specialties.
ContributorsPate, A. Shurine (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Background: This quality improvement project examined the effect an educational intervention focused on the psychosocial needs of cancer patients had on knowledge, attitudes, and behaviors (KAB) of a group of nurses. While nurses understand the physical toll of cancer, they may forget the impact cancer has on mental health. The project was guided by the Health Belief Model.
Methods: Consent was obtained from 15 participants working as nurse advocates for a large insurance company. Nurse advocates are tasked with improving the health of patients and connecting them to additional resources. A twenty-minute educational intervention focused on the impact cancer has on mental health and the benefit of multiple psychosocial supportive resources was delivered to the participants. Education included a comprehensive review of the resources available for cancer patients at the project site. Participants were then given 10 minutes to complete a retrospective post-then-pre survey, based on a Likert Scale.
Results: Statistically significant improvements in survey scores were observed in each of the three KAB domains. Statistical analysis confirmed improvements in survey scores were significant and not likely due to random variation. Participants also referred more patients into a cancer support program following the intervention.
Conclusion: A brief educational intervention was able to improve KAB scores among nurses. There was also an increase in the number of patients these nurses referred into a psychosocial supportive program. Nurses that better understand the mental health needs of cancer patients are more likely to connect them with psychosocial resources. This intervention will become part of standard training for new nurse advocates at the project site.
ContributorsLeyba, S. Edward (Author) / Harrell, Liz (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-05-02
Description
Falls in hospitalized patients are a widespread occurrence in the United States, resulting in unfavorable outcomes amongst patients, healthcare providers, and hospital organizations. Current fall prevention efforts have failed to adequately reduce patient fall rates. Nursing peer review (NPR) seeks to refine the quality and safety of patient care, making its use applicable in post-fall reviews. This evidenced-based quality improvement project implements a post-fall NPR program to examine patient falls in an inpatient setting, in addition to the facilitation of patient safety culture education. The Hospital Survey on Patient Safety Culture was used to assess nurses’ perceptions of their units’ patient safety culture. The pre- and post-survey results were analyzed using a two-tailed Mann-Whitney U test, determining significant differences in event (U=2033, z=-2.81, p=.005) and learning (U=1196, z=-2.52, p=.012). No significant differences were noted in support (U=1587, z=-0.05, p=.959), prevent (U=1369, z=-0.70, p=.485), and rate (U=1355.5, z=-0.34, p=.737). Post-fall NPR participation survey results were analyzed using descriptive statistics, showing that it improved patient safety culture (n=10, 91%), reduced “blame & shame” culture (n=9, 82%), and was a non-punitive learning method (n=10, 91%). Reviewing falls through NPR and educating nurses on patient safety culture can create a positive environment to learn from falls. Additional research is needed to determine the impact on patient fall rates.
ContributorsBlythe, M. Lindsay (Author) / Morgan, Michelle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-28
Description
Successful management of pediatric procedures is challenging. Many procedures have a detailed list of pre-procedural requirements and post-procedural pain control regimens. Patients and families often get lost in the many requirements needed before scheduling the procedure and often delay intervention. This delay can cost both the families and facility time and money but often leave the patient needlessly suffering. Inadequate pain control results in emergency room (ER) visits or hospital admissions for acute postoperative pain management. The opioid epidemic has significantly impacted postoperative opioid prescriptions at discharge. The limited prescriptions available after discharge, paired with inadequate understanding and support of discharge postoperative instructions by the family, result in increased acute postoperative pain management admissions. Postoperative pain is the leading cause of hospital readmissions within 48 hours of discharge. These ER visits are typically for issues that are easily addressed at home. Teach-back methods have shown to be the cornerstone of education, resulting in knowledge gained and increased pain regimen adherence. A literature review exploring current evidence regarding postoperative pain control and interventions coupled with teach-back was conducted to address this concern, and an evidenced-based intervention is proposed.
ContributorsBarrante, Adrianne (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-20
Description
Introduction: Drowning is the leading cause of death in children between 1 and 4 years of age; in Arizona drownings are double the national average for this age group. The goal of this Doctor of Nursing project was to educate and empower pediatric providers to give quality drowning prevention (DP) anticipatory guidance (AG) to caregivers of children between 1 and 4 years of age at every well exam.
Method: This quality improvement (QI) project included 32 providers from six pediatric clinics in Arizona. A one-hour education session focused on drowning prevention followed one month later by a a thirty-minute follow-up feedback session were conducted. Pre- and post- education surveys were administered at the first session to measure perceived previous and future intended DP AG practice. An additional follow-up survey was administered at the second session to evaluate perceived change. In addition, caregivers were contacted and surveyed one to three months post initial education to assess provider delivery of AG. Likert-scales and descriptive statistics were used to evaluate data sets.
Results: Post-educational intervention, providers reported increased intention (p = 0.027) to provide water safety AG, and increased intention (p < 0.001) to connect water AG to developmental milestones. Post-intervention follow-up indicated an increased provision of developmentally specific water safety AG to caregivers (p < 0.001) and increased connection of developmental milestones in AG (p = 0.016). Barriers that prevent water safety AG were reported as time constraints and other perceived AG of higher priority.
Implications: This QI project adds to the literature and demonstrates the benefit of education to invigorate and empower increased provision of quality DP AG from providers.
ContributorsDiMiceli, Carolyn (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-22