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In today’s healthcare environment, there is ample evidence to support early identification of disease and implementation of effective treatment to improve patient outcomes. The objectives of this clinical intervention were twofold; the implementation of an innovative change within an organization, allowing for systematic screening through incorporation of the Mood Disorder Questionnaire (MDQ), and evaluation of mental health provider’s willingness to incorporate practice change.
A pre- and post-quasi-experimental design evaluated the attitude of providers regarding practice change using the Evidence-Based Practice Attitude Scale and the utilization of the MDQ following educational intervention. Parametric testing was used to explore the relationship between education specific to practice change and the provider's attitude through the use of the paired t test. The Chi-square test evaluated the use of the MDQ by clinic healthcare providers in relation to an innovative practice change.
Results of this study illustrate enhanced provider willingness to adopt innovation and increased MDQ use following the intervention. Ensuring provider access to screening tools and education during the process of practice change provides a strategy for early intervention enhanced willingness to support practice evolution.
Children often present to the emergency department (ED) for treatment of abuse-related injuries. ED healthcare providers (HCPs) do not consistently screen children for physical abuse, which may allow abuse to go undetected and increases the risk for re-injury and death. ED HCPs frequently cite lack of knowledge or confidence in screening for and detecting child physical abuse.
The purpose of this evidence-based quality improvement project was to implement a comprehensive screening program that included ED HCP education on child physical abuse, a systematic screening protocol, and use of the validated Escape Instrument. After a 20-minute educational session, there was a significant increase in ED HCP knowledge and confidence scores for child physical abuse screening and recognition (p < .001). There was no difference in diagnostic coding of child physical abuse by ED HCPs when evaluating a 30-day period before and after implementation of the screening protocol.
In a follow-up survey, the Escape Instrument and educational session were the most reported screening facilitators, while transition to a new electronic health system was the most reported barrier. The results of this project support comprehensive ED screening programs as a method of improving HCP knowledge and confidence in screening for and recognizing child physical abuse. Future research should focus on the impact of screening on the diagnosis and treatment of child physical abuse. Efforts should also be made to standardize child abuse screening programs throughout all EDs, with the potential for spread to other settings.
Background and Significance: NIRS data can be used in conjunction with standard vital sign monitoring to help clinicians understand blood flow and metabolic demands of organ systems, particularly cerebral, renal, and mesenteric blood flow patterns. A NICU unit in the northwestern US adopted NIRS use on their patients in 2008, however, NIRS monitoring usage decreased over the past 5 years, citing a lack of continued education and comfort interpreting and managing NIRS monitored patients. One patient was monitored with NIRS in the year prior to the QI project.
Methods: A 5 point Likert-Type survey was designed to examine provider comfort and confidence using and interpreting NIRS on NICU patients. No Croanbach’s alpha value exists for the survey as it was purposefully designed for the QI project. An educational presentation on the use and interpretation of NIRS on NICU patients was created and delivered during a formal provider staff meeting. Pre and Post education surveys were distributed electronically to participants and were presented 1 week prior to educational session and 1 month after educational session. IBM SPSS version 23 was used for descriptive statistics, paired t tests, and Wilcoxon test. Significance set to p<0.05.
Results: In total, 18 providers (N=18) were surveyed, and 13 paired survey results (n=13) were received (8 MD and 5 NNP). Paired-samples t tests were calculated to compare the mean total score (TS) for pre/post comfort and pre/post confidence. This was a significant improvement for both comfort (t(11) = -3.13, p=0.010) and confidence (t(11) = -3.37, p=0.006). Wilcoxon test showed a significant increase in the times a provider managed a patient with NIRS (z=-2.762, p=0.006). The number NIRS monitored patients increased from one in the previous year to 15 patients in the 5 months of data tracking, a clinically significant increase.
Conclusions: Providing educational session on previously utilized clinical applications can improve providers comfort and confidence and influence their usage in clinical practice. Future continuing education sessions could be designed for different clinical applications in order to keep clinicians abreast of the current evidenced based applications of advanced clinical monitors.
Methods: This quasi-experimental pre/post design project was guided by the ACE Star Model and Leininger’s Theory of Cultural Care. The affiliated University’s IRB approved this project. The Diabetes Empowerment Education Program (DEEP) was implemented in a free, community clinic in a medically underserved area. Spanish speaking patients (n = 15) with A1C levels
> 8mg/dl were recruited to participate in a 6-week group educational program facilitated by community health workers. Outcomes included A1C levels, weight, and two surveys from the Michigan Diabetes Research Center - DM knowledge test and the DM empowerment scale.
Results: Paired sample t-tests were used to analyze the outcomes. The participants had an average pre-A1C of 8.82 mg/dl with post-A1C of 8.01 mg/dl (p = .028). Pre-knowledge test scores averaged 9.40 with post-test average of 12.07 (p < .001). Empowerment scores increased from 4.09 to 4.63 (p = .001). The reduction between the average pre-and post-weight measures were not statistically significant (p = .681).
Discussion: The implementation of a culturally-tailored DM educational program in a medically underserved community had a significant impact on reducing A1C levels, improving DM knowledge, and enhancing empowerment levels. Although the sample size was small and limited to one clinic, applying these programs can have a measurable clinical impact in the treatment of Hispanic DM patients. Future research can further exam how to duplicate this project on a larger scale and over a sustained period.
Introduction and Background: Drowning is the leading cause of preventable injury death in Arizona for children under five years old. Tailored education has demonstrated efficacy in behavior change and knowledge retention. The purpose of this evidence-based project was to evaluate if tailored education improved knowledge and self-reported behaviors related to pediatric drowning. The Elaboration Likelihood Model provided the framework for this project.
Methods/Experimental Approach: The prospective pilot project was conducted using the Iowa Model of Evidence Based Practice. Parents with children under five years, presenting with low acuity complaints in a pediatric emergency department were approached. A baseline assessment identified high-risk behaviors and a custom education plan was delivered to parents. Outcome variables were measured at baseline and three weeks after initial assessment.
Results: The average parent age was 29 (M = 28.5; SD = 6.35) years. Participant (n=29) responses were analyzed using descriptive statistics. Participants (n = 27, 93%) reported likelihood to change behaviors and 29 (100%) perceived the tailored intervention as relevant. Secondary outcome variables were not measured at three weeks due to a lack of survey response.
Conclusions: Parents reported a high likelihood of behavior change when water safety education was tailored and relevant to their child. The tailored intervention evoked positive interaction and receptivity from parents and suggested a high motivation to make a behavior change. The effect of the intervention could not be tested due to the lack of follow-up and post data collection. The design of this evidence-based project is quantifiable and replicable in a low-acuity setting, which allows for future evaluations of self-reported behavior change and knowledge improvement.
Funding: No sponsorship or financial conflict of interest.
Study Design: Ten health care providers from Vaccines for Children (VFC) clinics in New Mexico were included in this pretest/posttest study. Providers were given a questionnaire adapted from the Determinants of Intent to Vaccinate (DIVA) questionnaire. Only two subscales were utilized for this project (total of 10 items): Adaptation to the Patient’s Profile and General Practitioner’s Commitment to the Vaccine Approach. Martinez et al. (2016) suggest that PCP’s commitment to the vaccination approach” can be used as a stand-alone tool with a Cronbach’s alpha > .70. Following the pretest, which served as consent, providers viewed a short, four video series addressing common barriers to the HPV vaccine, followed by the same questionnaire. First and second dose rates of the HPV vaccine were measured prior to the intervention and three months post intervention using the New Mexico Immunization Information System (NMSIIS).
Results: A Wilcoxon Ranks test was used for statistical analysis of the survey responses. Alpha was set at ≤ .10. Four of the 10 questions were statistically significant for increasing provider intent to vaccinate. HPV first dose rates increased in all three clinics and second dose rates increased in two out of the three clinics.
Conclusions: Web-based education is a successful intervention for increasing
provider intent to vaccinate and first and second dose HPV administration rates. Not only can the intervention be used for the HPV vaccine, but to help increase administration rates of all other vaccines.
Aim: To determine the change in provider’s compassion fatigue after implementing an education-based intervention in behavioral health.
Materials and Methods: A four-part education-based intervention for compassion fatigue was implemented over the course of 16 weeks. The Professional Quality of Life instrument was used to measure compassion fatigue and compassion satisfaction.
Results: Although not statistically significant, mean compassion fatigue scores decreased in the sample.
Conclusion: Based on these results, further exploration into the causative factors of compassion fatigue in behavioral health are recommended.
Background and Significance: Evidence shows primary care providers (PCPs) are not adhering to the GOLD Guidelines for COPD screening.
Methods: Guideline education with pre/post-intervention survey and percent of eligible participants screened.
Results: Pre-intervention surveys (n=10) and post-intervention surveys (n=8) completed. Significant increase in knowledge regarding the CAT score (M score = 11.50, U = 24.000, p<.05). Part 2) 24% (n=6) of participants were screened with the CAT questionnaire.
Conclusions: PCPs are aware of the GOLD Guidelines, but do not always adhere to its recommendations. Future research should concentrate on effective ways to implement the GOLD Guidelines screening recommendations in primary care clinics.
