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Teach-Back Method; Improvement of Patient Comprehension of Nuss Procedure

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…

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
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Reducing Polypharmacy with Mobile Apps Among Mental Health Patients

Description

Polypharmacy among psychiatric patients is a concerning trend. From 2007-2010, 58.2% of women and 41.8% of men reported taking five or more prescription drugs within the last 30 days (CDC, 2014). Negative outcomes include prescription drug abuse, side effects, interactions, treatment failure, patient dissatisfaction, and lack of treatment control. The…

Polypharmacy among psychiatric patients is a concerning trend. From 2007-2010, 58.2% of women and 41.8% of men reported taking five or more prescription drugs within the last 30 days (CDC, 2014). Negative outcomes include prescription drug abuse, side effects, interactions, treatment failure, patient dissatisfaction, and lack of treatment control. The associated practice challenges have led to the following PICOT question. In persons with mental health issues receiving care at an outpatient mental health clinic, does engaging in mindfulness practice versus no mindfulness practice change polypharmacy use over a 3-month period?

The project purpose was to evaluate the effectiveness of Insight Timer mobile mindfulness app at helping patients self-manage distressing symptoms and reduce polypharmacy. Over three weeks, mental health clinic nurse practitioners (NPs) voluntarily recruited patients (n=12) over age 18 using as needed prescriptions (PRNs), and agreed to use Insight Timer mobile mindfulness app for adjunct symptom management. Consenting participants downloaded the mobile app, and completed a brief questionnaire measuring PRN use at the start of app use, and PRN use at their next visit. A Wilcoxon signed-rank test indicated a 10-week mindfulness app trial did not significantly lower total PRN doses compared with pre-app dosing (Z = -.534, p = .593). Paired t-tests revealed no significant change in pre (M = 65.17, SD = 28.64) versus post (M = 67.75, SD = 20.22) OQ45 life functionality results (t(11) = -.420, p = .683) (d = .121) as a result of app use.

Clinically relevant results illustrated 83.33% of participants taking greater than nine PRN doses over the study period used the app six times or more in place of medication. High PRN users employed the app frequently in place of medication regardless of total PRN doses taken. Practice implications and sustainability recommendations include incorporating mobile app use in treatment plans for high PRN users and educating NP’s on the tangible benefits of mindfulness apps in reducing polypharmacy and easing symptom distress on an ongoing basis.
Keywords: mindfulness, mhealth, mobile apps, mobile smart phone, online, RCT, behavior change, polypharmacy.
ContributorsPierce, Albert (Author) / Guthery, Ann (Thesis advisor)
Created2019-04-29