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- Go to article: Standardized Follow-Ups Lower HbA1c in Adults With Type 2 Diabetes Living in a Rural Community: A Pilot Study
Standardized Follow-Ups Lower HbA1c in Adults With Type 2 Diabetes Living in a Rural Community: A Pilot Study
To implement and evaluate the use of a standardized process, which includes the teach-back method for follow-up among patients with type 2 diabetes in rural health care settings in order to reduce glycosylated hemoglobin A1c (HbA1c) in adults with diabetes.
It remains unclear whether or not controlled patient follow-up among patients with type 2 diabetes between office visits (at 3-month intervals) is effective in reducing their HbA1c.
This study recruited 12 participants from a rural health family practice in Northern Illinois to participate in a pretest–posttest study to evaluate if close patient follow-up with reinforced education was effective in helping patients reduce their HbA1c.
The preintervention for HbA1c and postintervention HbA1c mean difference was found to be statistically significant. The HbA1c level decreased from preintervention to postintervention (p < .05). Further, the mean and standard deviation from the preintervention for HbA1c and postintervention HbA1c were used to calculate an effect size using Cohen’s d found that there was a medium to large effect size d = .67. The change in HbA1c levels was of clinical significance as well as statistical significance.
The use of a standardized process for patient follow-up as part of routine management of type 2 diabetes appears to have had a clinically as well as statistically significant impact in reducing HbA1c levels.
Nurse practitioners at a primary care clinic established a weight loss program to address high obesity rates among their African American patients. Interviews and a retrospective chart review were used to evaluate the weight loss program. Number of appointments was the only significant predictor of weight loss, and there was a strong positive correlation between total number of appointments and weight loss. The overall view of the program was positive. This description and evaluation of the program may be useful to nurse practitioners seeking to develop an individualized effective weight loss intervention for African Americans within a primary care setting.
Nature and scope of the project: Patients with hemiplegia may develop pain, decreased strength, sensation, and tone impacting functional ability of the affected arm when patients are not positioned correctly. The purpose of this quality improvement (QI) project was to evaluate improvements in the function of patients with hemiplegia in a rehabilitation hospital after implementing a hemiparetic positioning program. Project implementation: Education on hemiparetic positioning developed by an interdisciplinary team was offered to all nursing and therapy staff over a 1-month with follow-up and written materials. Evaluation criteria: The outcome measures for this project were Functional Independence Measurement (FIM) scores. Changes in FIM scores of patients hospitalized 3 months before the project were compared with a sample hospitalized after the project to see if outcomes improved. Outcomes: The sample consisted of 91 (pre-QI = 27, post-QI = 64) hospitalized patients with hemiplegia. All patients had significant improvements in FIM scores from admission to discharge. There were no significant differences observed between the groups on FIM change scores using Mann–Whitney U test: transfers from bed/chair/wheelchair (z = −.822, p = .411), upper body dressing (z = −.104, p = .917), lower body dressing (z = −1.120, p = .263), and toileting (z = −1.259, p = .208).
- Go to article: Development and Evaluation of Preoperative Teaching Materials for CABG/Valve Surgery Patients
Patients often experience anxiety and feel overwhelmed by the prospect of undergoing open-heart surgery. Randomized controlled trials have found preoperative education materials and counseling to reduce levels of patient anxiety, depression, and perioperative complications following coronary artery bypass grafting (CABG)/valve surgery.
The purposes of this performance improvement project were to develop preoperative teaching materials for cardiac surgery inpatients and evaluate their usability.
Existing CABG/valve teaching materials were evaluated. A new booklet was developed through an iterative process. An expert panel reviewed the final draft using the patient education materials assessment tool for printable materials (PEMAT-P). Patients were surveyed for usability and usefulness.
Expert reviewer results for using the PEMAT-P tool for understandability and actionability were 99% and 100%. Of 62 teaching booklets and patient preparedness questionnaires distributed, N = 11 (17.7%) were returned. Nearly all respondents (90.9%) agreed or strongly agreed for questions related to how well the booklet prepared them for surgery. Likewise, 90.9% of respondents agreed or strongly agreed with statements about design and content of the booklet. The hospital consumer assessment of healthcare providers and systems performance reports from October 1, 2016 to December 31, 2016 showed improvement for discharge information (96.2% from 92.2%), symptom to look for (100% from 94.9%), and care transitions (66.2% from 54.3%).
The development and implementation of evidence-based preoperative teaching materials help patients and families prepare for open-heart surgery and self-care after discharge.
Implications for Nursing
Nurses' utilization of preoperative teaching materials improves patient satisfaction, preparedness, and usefulness.
Human papillomavirus (HPV) vaccines are available to prevent HPV-associated cancers. However, parents are reluctant to make the decision to immunize their children. Nationally, HPV vaccination rates remain low.
The objectives were to improve parents' attitudes and knowledge about HPV/HPV vaccine, increase parental intent to vaccinate, and increase HPV vaccination rates in a primary care office.
A one-group, pretest/posttest design was used to assess participants' attitude, knowledge, and intent to vaccinate before and after viewing an HPV educational video. Pre–post project HPV vaccination rates were compared.
Participants' attitudes toward HPV/HPV vaccine improved while knowledge increased. Intent to vaccine increased by 31% after viewing the HPV educational video. HPV vaccination rates increased 6% (females) and 9% (males).
Primary care providers (PCPs) should look for innovative ways to educate parents about HPV, help parents make informed decisions about the HPV vaccine, and work toward a common goal of preventing HPV-associated cancers.
Implications for Nursing
Implications are three-fold benefiting parents, PCPs, and society. Parents will be more knowledgeable, providers will understand they are an important key in the vaccine process, and society will benefit from a decrease in HPV-associated cancers.
- Go to article: National Clinical Graduate Nursing Faculty: Management of Multiple Chronic Conditions
The purpose of this project is to compare clinical graduate nursing faculty self-perceived knowledge with actual knowledge on the management of symptomatic multiple chronic conditions (MCCs) through a psychometrically reliable and valid 46-item objective examination. Methodology included three separate e-mail communications to more than 800 U.S.-based graduate nursing school or program chairs, deans, or directors encouraging faculty participation. One hundred and six respondents initiated the survey and over half of the participants withdrew from completing in its entirety, making it difficult to correlate self-perceived knowledge with actual knowledge. The results, however, show an overall mean score of below average pass rate. This study has been performed in undergraduate, graduate, and clinical graduate nursing faculty—suggesting a serious concern in clinical nursing education and clinical practice to meet the complex care needs of the largest, fastest-growing, and costliest U.S. patient population—those with MCCs.
- Go to article: Clinical Track Promotion Guideline Development for Nursing Faculty in a Traditional Research-Focused University
Clinical Track Promotion Guideline Development for Nursing Faculty in a Traditional Research-Focused University
Background: The clinical track is a newer concept for universities traditionally placing a hefty emphasis on research and funding. Objective: Guidelines should ensure equitable criteria for promotion of practicing faculty reflect teaching, scholarship, and academic outreach milestones. Methods: This article describes the process, challenges, and overall experience of developing clinical track promotion guidelines within a research-focused university setting. Results: The department’s outdated clinical track promotion guidelines were revised to reflect current roles of clinical faculty. Conclusions: As DNP and clinically focused advanced practice faculty flood into 4-year academic settings, universities must ensure that criteria for promotion reflects clear and equitable teaching, scholarship, and academic outreach milestones. Implications for Nursing: The recent influx of DNP clinical faculty and advanced nursing practice faculty roles requires an overhaul of outdated guidelines.
- Go to article: Implementing Sleep Apnea Screening Prior to Conscious Sedation Procedures in a Rural Hospital: A Quality Improvement Project
Implementing Sleep Apnea Screening Prior to Conscious Sedation Procedures in a Rural Hospital: A Quality Improvement Project
Screening patients for obstructive sleep apnea (OSA) risk factors is an effective method for helping reduce adverse outcomes in conscious sedation. Patients receiving conscious sedation for endoscopy were not being screened for OSA at a rural hospital.
The purpose of this quality improvement project was to implement a nurse education program to improve OSA screening of endoscopy patients, using an evidence-based screening tool, and to increase nurse OSA knowledge and patient education.
This study was conducted in the outpatient perioperative section of a small rural hospital in northern Michigan. Data were obtained from pre/post chart review and nurse knowledge assessment. Twenty-eight nurses participated in an educational session that included OSA education and instructions on using the STOP-Bang questionnaire for OSA screening.
Nurse OSA knowledge increased from 75% preeducation program to 89% posteducation program. Use of the STOP-Bang Questionnaire for patients presenting for outpatient endoscopy procedures requiring conscious sedation and patient OSA education increased from 43.5% to 81.2% pre- to posteducation program.
This study's educational session was successful in promoting use of the STOP-Bang questionnaire among perioperative nurses and increasing education for patients screened positive for OSA.
Implications for Nursing
Training nurses to use a brief OSA screening tool effectively improved the OSA screening of patients presenting for outpatient conscious sedation involving endoscopy.