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Depression Screening and Breastfeeding Support in a Community Breastfeeding Clinic

Description

Purpose: Implementation of a postpartum depression (PPD) screening while using evidence-based interventions to improve depressive symptoms, enhance breastfeeding (BF) self-efficacy, and strengthen the mother-infant dyad (MID).

Background and Significance: PPD is highly prevalent among women living in the United States and

Purpose: Implementation of a postpartum depression (PPD) screening while using evidence-based interventions to improve depressive symptoms, enhance breastfeeding (BF) self-efficacy, and strengthen the mother-infant dyad (MID).

Background and Significance: PPD is highly prevalent among women living in the United States and threatens the physical and psychological health of MIDs. Many of these women go undiagnosed and without treatment, further worsening symptoms and outcomes. This has inspired world healthcare leaders and organizations to address maternal mental health among postpartum women.

Methods: A 12-week evidenced-based project consisted of two-sets of participants including mothers and staff. A comprehensive maternal support program guided by an informational pamphlet (IP) and implementation of PPD screening using the Edinburgh Postnatal Depression Scale served as the two-part intervention for this project. Goals were to decrease PPD, enhance BF satisfaction, and strengthen the MID. Comprehensive maternal support encompasses interventions proven to meet the project goals and includes tailored BF education and care to maternal needs, social support by peer/family involvement, skin-to-skin contact during BF, emotion-regulation strategies, and availability of community resources.

Outcomes: The BSES-SF scores did result in statistical significance based on an alpha value of 0.10, t(3) = -2.98, p = .059, proving a positive effect was seen in breastfeeding self-efficacy post intervention. The results did not show statistical significance (t(3) = 0.60, p = .591) in regard to pre and post-depression scores. However, the mean pre-score (M =3.50, SD 3.11) did decrease post-intervention (M =2.75, SD 1.26) and exemplifies clinical significance.

Conclusion: The outcomes of this Quality-Improvement project showed improved scores for depression and BF self-efficacy post-intervention. This demonstrates the value in screening for PPD using a validated screening tool and instituting comprehensive maternal support guided by evidence-based practice in a community setting.

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Date Created
2020-04-25

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Infection Control Driven Antibiotic Stewardship in a Long-Term Care Facility

Description

Antibiotics have contributed to the decline in mortality and morbidity caused by infections, but overuse may weaken effectiveness resulting in a worldwide threat. Antibiotic overuse is correlated with adverse events like Clostridium difficile infection, antimicrobial resistance, unnecessary healthcare utilization and

Antibiotics have contributed to the decline in mortality and morbidity caused by infections, but overuse may weaken effectiveness resulting in a worldwide threat. Antibiotic overuse is correlated with adverse events like Clostridium difficile infection, antimicrobial resistance, unnecessary healthcare utilization and poor health outcomes. Long term care facility (LTCF) residents are vulnerable targets for this phenomenon as antibiotics are one of the most commonly prescribed medications in this setting. Consequently, multiple organizations mandate strategies to promote antibiotic stewardship in all healthcare sites particularly LTCFs.

To address this global issue, this doctoral project utilized the Outcomes-Focused Knowledge Translation intervention framework to provide sepsis education, promoted use of an established clinical algorithm, and engaged a communication tool for nurses and the certified nursing assistants (CNAs) thus, improving antibiotic stewardship. The project was conducted in a 5-star Medicare-rated LTCF in Mesa, AZ with a convenience sample of 22 participants. The participants received a knowledge questionnaire and Work Relationship Scale pre- and post- intervention to determine improvement.

The results show that the education provided did not improve their knowledge with a p = 0.317 for nurses while p = 0.863 for CNAs over 8 weeks. Lastly, education provided did not improve the nurses’ Work Relationship p = 0.230 or for the CNAs p = 0.689. Though not statistically significant, the intervention tools are clinically significant. Additional research is needed to identify ways to determine barriers in implementing an antibiotic stewardship program.

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Date Created
2020-05-08

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Advance Care Planning in Community-Dwelling Adults

Description

Advance care planning is a process that allows for patient autonomy at the end of life. Yet, less than 30% of Americans over the age of 65 have an advance care plan. Advance care planning has positive effects on patients,

Advance care planning is a process that allows for patient autonomy at the end of life. Yet, less than 30% of Americans over the age of 65 have an advance care plan. Advance care planning has positive effects on patients, families and healthcare systems. However, both patients and healthcare providers report barriers to completing and discussing advance care planning. Many different interventions have been studied to increase advance care planning rates. Engaging patients and providers electronically before or during appointments in outpatient clinics and community settings has shown marked improvement in advance care plan discussions and documentation rates. To address this complex issue, two community-based seminars with electronic pre-engagement for adults has been proposed to improve advance care planning completion rates.

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2020-04-24

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Motivational Interviewing Impact on Cardiovascular Disease

Description

Harm reduction in cardiovascular disease is a significant problem worldwide. Providers, families, and healthcare agencies are feeling the burdens imparted by these diseases. Not to mention missed days of work and caregiver strain, the losses are insurmountable. Motivational interviewing (MI)

Harm reduction in cardiovascular disease is a significant problem worldwide. Providers, families, and healthcare agencies are feeling the burdens imparted by these diseases. Not to mention missed days of work and caregiver strain, the losses are insurmountable. Motivational interviewing (MI) is gaining momentum as a method of stimulating change through intrinsic motivation by resolving ambivalence toward change (Ma, Zhou, Zhou, & Huang, 2014).

If practitioners can find methods of educating the public in a culturally-appropriate and sensitive manner, and if they can work with community stakeholders to organize our resources to make them more accessible to the people, we may find that simple lifestyle changes can lead to risk reduction of cardiovascular diseases. By working with our community leaders and identifying barriers unique to each population, we can make positive impacts on a wide range of issues that markedly impact our healthcare systems.

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Date Created
2020-04-28

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Aging out of Pediatrics: Preparing Adolescents for Health Care Transition Using Illustration-based Anticipatory Guidance

Description

Objective
Health care transition (HCT) for adolescents without special health care needs in the primary care setting has received inadequate attention, as represented by national surveys, when compared to adolescents with special health care needs. Barriers to transition such as

Objective
Health care transition (HCT) for adolescents without special health care needs in the primary care setting has received inadequate attention, as represented by national surveys, when compared to adolescents with special health care needs. Barriers to transition such as lack of knowledge and preparation have been known to hinder HCT despite the knowledge gap and weak evidence related to non-special needs adolescent transition. Application of anticipatory guidance education related to care transition may improve transition readiness scores of adolescents without special health care needs.
Methods
Utilizing Meleis’ transition theory with the Plan-Do-Study-Act framework, a quasi-experimental study was conducted comparing transition readiness scores between baseline and intervention groups of adolescents 14 years or older attending their well checks at a small pediatric primary care site. The intervention consisted of two videos developed from Got TransitionTM's (n.d.) Six Core Elements for specific adolescent age ranges.
Results
Statistical analysis reveals that the subgroup and overall transition readiness scores for both age groups, 14-15 and 16-18 years of age, when comparing the baseline groups to the intervention groups, have mixed significance (p = .419, p = .074, respectively). However, when asking the respondents about their understanding of the transition process and their role in that process, 75% and 62.5%, respectively, at minimum agreed the intervention was helpful.
Conclusion
The findings were mixed, indicating the educational videos did have a short-term impact on adolescent transition readiness scores for the 16-18 years old group only. Future focus on long-term follow up throughout the adolescent period may yield better data.

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Date Created
2021-04-28

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Adolescent Hemorrhage Control Training

Description

Preventing deaths from uncontrolled bleeding remains a national priority, as mass causality events in communities and schools continue to rise. National initiatives have been set in motion by the Department of Homeland Security, to teach laypersons hemorrhage control techniques while

Preventing deaths from uncontrolled bleeding remains a national priority, as mass causality events in communities and schools continue to rise. National initiatives have been set in motion by the Department of Homeland Security, to teach laypersons hemorrhage control techniques while waiting for emergency personnel to arrive. A full and growing body of evidence supports the use of hemorrhage control training classes among adult laypeople and is growing steadily in the adolescent population. With the majority of shooting events occurring at high schools, the implementation of a hemorrhage control training curriculum can increase survival rates among high school students in the event of an active shooter. The purpose of this paper is to investigate current knowledge and hemorrhage control practices among high school students and the implication of implementing a hemorrhage control educational intervention by evaluating current knowledge of hemorrhage control as well as their willingness, confidence, and perceived value in hemorrhage control education. This evidenced-based assessment is proposed utilizing the Social Learning Theory and Rosswurm and Larrabee’s implementation framework.

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Date Created
2021-05-03

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Addressing Obesity in Hispanic Families Through a Family Centered Approach: An Educational Intervention for Providers

Description

Current obesity statistics exceed national goals with Hispanics disproportionately affected. Evidence suggests a family centered methodology focusing on culture can positively improve weight loss, client satisfaction and participation. This project will evaluate use of culturally tailored resources for primary care

Current obesity statistics exceed national goals with Hispanics disproportionately affected. Evidence suggests a family centered methodology focusing on culture can positively improve weight loss, client satisfaction and participation. This project will evaluate use of culturally tailored resources for primary care providers to educate Hispanics on weight loss. Eight providers in a small practice in the Southwestern US were recruited to complete a pre- and postEBPAS tool after an educational session. A BMI form tracked provider use of the fotonovela intervention against preferred methods.

Feedback on time spent educating and overall perception were collected. Four providers completed the pre-EBPAS, three completed the post-, one participated in the intervention, and six contributed project feedback. Descriptive statistics revealed an aggregate provider decrease of five-points post-educational session for attitude toward adopting EBP. The BMI documentation form demonstrated a 53% (n = 8) use of the fotonovela. However, there were five undocumented fotonovelas taken/given out postintervention. Key themes noted by providers included poor timing of the project, satisfaction with workflow and resources, and overall discontent for the fotonovela. Future implications include re-evaluating the project in a practice not undergoing significant changes with specific focus on timing of the intervention.

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Date Created
2018-04-30

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Advanced Practice Registered Nurse Led Transitional Care Program in an Accountable Care Organization

Description

Purpose: Reduce or prevent readmissions among heart failure (HF) patients and increase quality of life (QOL), self-care behavior (SCB) and satisfaction through an advanced practice registered nurse (APRN) led transitional care program (TCP) in collaboration with an Accountable Care Organization

Purpose: Reduce or prevent readmissions among heart failure (HF) patients and increase quality of life (QOL), self-care behavior (SCB) and satisfaction through an advanced practice registered nurse (APRN) led transitional care program (TCP) in collaboration with an Accountable Care Organization (ACO).

Background: Hospital readmissions place a heavy financial burden on patients, families, and health care systems. Readmissions can be reduced or prevented by providing a safe transition through care coordination and enhanced communication. Research demonstrates implementation of APRN led home visits (HV) along with telephonic follow-up are cost effective and can be utilized for reducing readmissions among HF patients.

Methods: A program was designed with an ACO and carried out in a family practice clinic with a group of seven HF patients older than 50 years who were at risk of readmission. Interventions included weekly HV with supplemental telephonic calls by the APRN student along with a physician assistant for 12 weeks. Readmission data was collected. QOL and SCB were measured using “Minnesota Living with Heart Failure Questionnaire” (MLHFQ) and “European Heart Failure Self-Care Behavior Scale” respectively. Data was analyzed using descriptive statistics and the Friedman Test.

Outcomes: There were no hospital readmissions at 30 days and the interventions demonstrated a positive effect on QOL, self-care management and satisfaction (χ2 = 30.35, p=.000). The intervention had a large effect on the outcome variables resulting in an increase in QOL and SCB scores post-intervention (ES= -1.4 and -2 respectively).

Conclusions: TCP designed with an ACO, carried out in a primary care setting has a positive effect on reducing hospital readmissions and improving QOL, SCBs, and patient satisfaction among HF patients. TCPs are not revenue generating at outset due to reimbursement issues, however future considerations of a multidisciplinary team approach with convenient workflow may be explored for long-term feasibility and sustainability.

Funding Source: American Association of Colleges of Nursing and the Centers for Disease Control and Prevention with support of the Academic Partners to Improve Health.

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2017-05-02

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Caring for the Caregiver

Description

Background: As the nation’s population ages and the prevalence of chronic diseases, like dementia, increases, informal caregivers will play an increasingly important role in maintaining independence for the elderly. Informal caregivers provide most long-term care for the elderly in this

Background: As the nation’s population ages and the prevalence of chronic diseases, like dementia, increases, informal caregivers will play an increasingly important role in maintaining independence for the elderly. Informal caregivers provide most long-term care for the elderly in this country and save hundreds of billions of dollars in healthcare costs annually. However, most informal caregivers experience burden secondary to caregiving that adversely impacts their physical, social, and/or psychological health. Caregiver burden threatens caregiver health and contributes to institutionalization of care recipients. Since the program of all-inclusive care for the elderly (PACE) model of care delivery relies heavily on informal caregivers to maintain independent aging, understanding and meeting the needs of caregivers is essential to the sustainability and success of PACE programs.

Purpose: This evidence-based practice (EBP) project was a gap analysis that surveyed 156 caregivers at an urban PACE program in the Midwest to examine caregiver demographics, caregiver burden, caregiver interest in support services, and the relationship between these variables to guide the development of caregiver programs.

Methods: Caregiver Assessments were administered to 156 caregivers via telephone or in person. The assessment included caregiver demographics, interest in caregiver services, and the 12-item Zarit Burden Interview (ZBI-12) to assess caregiver burden. The ZBI-12 has good reliability and validity as indicated by a Cronbach’s alpha of 0.88 and a correlation with the full version ZBI scores of 0.95. Results were analyzed using descriptive statistics, the Pearson r correlation test, the Wilcoxon signed rank test, and the Mann-Whitney U test on SPSS version 25. This project was approved by the Arizona State University IRB.

Results/Outcomes: Of 171 eligible informal caregivers of program participants living outside of an institution, 156 completed the survey, 3 refused, and 12 were unreachable. Most informal caregivers surveyed were Caucasian (69.5%) females (66%), children of the care recipients (45.5%), caring for people with dementia (40.6%), with some college education (37.2%), who earned $10,000-$25,000 annually (38.7%), provided over 30 hours of care per week (55.8%), and averaged 61.4 years old (SD=7.7). The average ZBI-12 score was 12.15 (SD=9.04), indicating a moderate level of burden. The most common stressors indicated by caregivers were activities of daily living (ADL) assistance (63.5%) and the time commitment involved in caregiving (57.7%). Correlates to high burden score included: limited time, aggressive behavior, financial stress, grief, assistance with ADLs, wandering behavior, toileting assistance/incontinence, and lack of sleep. Respite care was identified by 42.9% of those surveyed as the most helpful resource provided by PACE. 55.1% and 50.6% of caregivers indicated an interest in educational sessions and support groups respectively, if these services were offered in the future.

Conclusion: Through the exploration of caregiver demographics, factors correlated to increased burden, and caregiver interest in support services, the results from this EBP project provide guidance to programs, particularly other PACE programs, seeking to proactively mitigate caregiver burden through support services. The results indicate that respite care, educational sessions, and support groups should be prioritized when developing informal caregiver support services.

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Created

Date Created
2019-04-30

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Advance Care Planning in a Primary Care Setting

Description

Purpose: Advance care planning (ACP) allows an individual to discuss and document their personal preferences at end-of-life. ACP has been shown to improve communication and reduce discomfort for patients and their families. The literature supports utilizing formalized, multimodality training programs

Purpose: Advance care planning (ACP) allows an individual to discuss and document their personal preferences at end-of-life. ACP has been shown to improve communication and reduce discomfort for patients and their families. The literature supports utilizing formalized, multimodality training programs for healthcare providers in order to increase their confidence in initiating ACP discussions. These findings led to the initiation of an evidence-based practice project in a primary care setting with the purpose of increasing advance care planning discussions between providers and patients with the use of a standardized education tool.

Background and Significance: National regulations mandate that patients are provided information about advance directives in the healthcare setting, but completion rates are not monitored and continue to be low. ACP is now a billable service for healthcare providers, but it has not provided enough incentive to increase completion rates. Barriers for healthcare providers in the outpatient setting include lack of time, protocols, and lack of education on how to initiate and foster advance care planning discussions.

Methods: Healthcare providers in a primary care office attended a 15-minute structured educational session with and a toolkit was provided on the importance of ACP, how to initiate conversations with patients, and bill for the service. Participants completed a portion of the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD) survey assessing their confidence in ACP before and three months post intervention. Participant confidence (N = 6) in ACP was analyzed using the Wilcoxin test and descriptive statistics. The number of billed ACP services for the office was collected for four months post intervention and compared to the previous four months. Outcomes: A significant increase in provider confidence after participating in a multimodality education program was found in the results (Z = -2.21, p = .03). There was a 42.1% increase in the number of billed ACP discussions for the office in the four months post intervention.

Conclusion: The future desired state is that ACP discussions become standard practice in primary care leading to the completion of advance directives. This can be accomplished through formalized education sessions and resources for providers in order to increase their confidence in initiating ACP discussions with patients. The ultimate goal is to decrease unnecessary spending at end-of-life while improving patient and family satisfaction with the quality of care received at end-of-life.

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2018-04-30