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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).
Atherosclerotic cardiovascular disease (ASCVD) is a major contributor to nationwide morbidity, mortality, and healthcare costs in the United States. Over 92 million adults have at least one form of ASCVD, and annual costs for treatment are anticipated to surpass one trillion dollars within the next 15 years.
The objective of this study was to evaluate the medication therapy of a population of adults in comparison to the American College of Cardiology/American Heart Association (ACC/AHA) recommendations for statin therapy for ASCVD risk reduction.
The adult population receiving care from a group of hospital outpatient clinics was examined using a database query. Rates of ASCVD in a multicounty area were compared and provider adherence to current guidelines was assessed.
Rural counties showed higher rates of ASCVD. Rates of statin medication prescribing for patients of each ACC/AHA statin benefit group ranged from 66.2% to 74.8%.
Conclusions and Implications for Nurse Practitioners
Adherence to guidelines varied among counties and optimal adherence was not achieved. Providers were also more likely to prescribe statin medications to men than women within each group regardless of risk. These findings can assist nurse practitioners and other providers in addressing areas of nonadherence to guidelines.
- Go to article: Nationwide Doctor of Nursing Practice/Advanced Practice Registered Nurse Survey on Roles, Functions, and Competencies
Nationwide Doctor of Nursing Practice/Advanced Practice Registered Nurse Survey on Roles, Functions, and Competencies
Educational preparation for advanced practice registered nurses (APRNs) continues to shift from the master’s degree to the doctor of nursing practice (DNP). Previous analysis of the roles, functions, and competencies of APRNs by Honig, Smolowitz, and Smaldone (2011) identified differences in practice between Master’s of Science in Nursing (MSN)- and DNP-prepared APRNs. The aim of this study was to use the survey instrument created by Honig et al. to survey DNP/APRNs from across the nation and gain insight into their roles, competencies, and functions. A convenience sample was drawn from DNP graduates from the 13 schools provided by the American Board of Comprehensive Care (ABCC) as eligible to sit for the ABCC examination. A total of 375 individuals from 33 states who reported that they were in practice as a nurse practitioner (NP) completed the survey. Differences between the initial study and this study indicated that DNP NPs currently provide care across settings but with less inpatient care, less subacute care, and less palliative care than was reported in the initial analysis. Pregnancy-related care was the least common clinical service provided. Overall, this research indicates that DNP NPs prepared in comprehensive care are providing direct clinical care across settings to complex patients consistent with the comprehensive care domains for the ABCC certification examination (Honig et al., 2011).
Sudden sensorineural hearing loss (SSNHL) is a rare but emergent condition that afflicts approximately 4,000 Americans annually (Ciorba, Faita, Bianchini, Aimoni, & Scanelli, 2013; Scapa & Friedland, 2009; Stachler et al., 2012). It causes unilateral nerve loss of hearing that may not recover left untreated. Because SSNHL is uncommon, practitioners may be unaware of the urgency or the protocol for immediate testing and treatment. Aural fullness, a common presenting symptom of SSNHL, overlaps with more common outer and middle ear problems resulting in misdiagnosis and/or delayed diagnosis and treatment. This case study will lead practitioners through the necessary diagnostic reasoning process to identify, diagnose, treat, and refer SSNHL patients effectively.
- Go to article: Using Transcultural Nursing Education to Increase Cultural Sensitivity and Cultural Assessment Documentation by Staff in an In-Home Chronic Disease Self-Management Program
Using Transcultural Nursing Education to Increase Cultural Sensitivity and Cultural Assessment Documentation by Staff in an In-Home Chronic Disease Self-Management Program
Despite literature indicating that culturally sensitive care promotes a positive patient environment and may help improve outcomes, limited data exist on the documentation of patients' cultural concerns in electronic medical records (EMR).
The project's objective was to use an educational intervention to increase clinic staff's cultural sensitivity and cultural assessment documentation.
Researchers conducted this 3-month project at a Midwestern clinic's in-home, self-care chronic disease management program. The voluntary sample of clinical staff (n = 8) received an educational intervention on transcultural nursing practices. Researchers administered the Transcultural Self-Efficacy Tool for the Multidisciplinary Healthcare Provider (TSET-MHP) to participants before and after the intervention. A pre- and postintervention EMR audit was completed on 128 charts to evaluate cultural assessment documentation.
TSET-MHP cognitive and practical subscales scores increased postintervention. Affective subscales scores decreased slightly. Electronic cultural assessment documentation increased by 10%. An assessment questionnaire showed an increase in participants' cultural self-awareness and comfort with cultural assessment.
An educational intervention demonstrated an increase in providers' cultural awareness and cultural assessment documentation.
Implications for Nursing
Transcultural nursing education may help increase providers' perceived cultural self-efficacy, which may improve cultural assessments and culturally competent care.
- Go to article: Improving Structural Empowerment and Job Satisfaction Among State Health Facility Surveyors
State survey agencies are experiencing an increase in work requirements and surveyor staffing instability thereby compromising organizational performance. No information has been published about surveyor perceptions of the work environment and job satisfaction to inform management interventions for improvement.
The purposes of this study were to evaluate state health facility surveyor perceptions of the work environment and to formulate management recommendations for improving recruitment and retention.
The Theory of Structural Empowerment (SE) served as the framework for this study which employed a nonexperimental descriptive survey design. Data were obtained using the Conditions of Work Effectiveness Questionnaire-II, the Job Satisfaction Survey, and open-ended questions. Participants were surveyors employed by a state survey agency in northeast United States (N = 52).
Surveyors reported moderate and ambivalent overall SE and job satisfaction, respectively. Significant differences among bureaus, divisions, disciplines/backgrounds, and level of nursing education were identified.
Surveyor perceptions of SE and job satisfaction are suboptimal and could be improved with modifications to the work environment.
Implications for Nursing
Managers should assess how staff perceive the work environment and implement data-driven, evidence-based interventions that can reduce attrition and improve organizational efficiency and effectiveness.
- Go to article: Medication Adherence and Safety Program for Community-Dwelling Seniors With Chronic Conditions
Misuse and mismanagement of medical products (e.g., pharmaceuticals and medical devices) can significantly impact the quality of life of community-dwelling seniors aged 65 years and older with chronic health conditions. Medication therapy management is an ongoing concern among community-dwelling older adults. The increased use of both prescription and over-the-counter (OTC) pharmaceuticals and the lack of medication safety education drove the importance of this capstone project. To explore the problem, the researchers implemented a multifaceted educational intervention. The intervention format included seminars on medication adherence, safety, storage, and disposal for this target population and their caregivers residing in Broward County, Florida. This scholarly project was aligned with the national objectives addressed in Healthy People 2020 that promoted the need to ensure the safe use of medical products (U.S. Department of Health and Human Services [HHS], 2013). A pilot of the Medication Adherence and Safety Program (MASP) for Community-Dwelling Seniors with Chronic Conditions was conducted with a convenience sample of 31 community-dwelling older adults aged 65 years and older. The MASP educational intervention for these community-dwelling seniors with chronic conditions resulted in self-reported increased medication errors, storage, and disposal awareness. Recommendations for future studies include the use of a modified pre- and postintervention test, the addition of a medication take-back to the program, and the use of more novice health care professionals to educate and perform the Brown Bag medication reviews (BBMRs).
- Go to article: Change in Benzodiazepine Prescribing Practices of Mental Health Providers After Implementation of an Agency-Specific Protocol
Change in Benzodiazepine Prescribing Practices of Mental Health Providers After Implementation of an Agency-Specific Protocol
Purpose: As a class of drugs, benzodiazepines are highly effective in treating anxiety disorders. However, the use of benzodiazepines carries a risk for dependence with an increased incidence in individuals with cooccurring disorders. The project evaluated the impact of a benzodiazepine prescribing protocol on mental health providers’ prescribing practices. Methods: A retrospective chart review (N = 237) was conducted to assess changes in benzodiazepine prescribing patterns prior to and following the implementation of an agency-specific protocol. A convenience sample of 15 providers included nurse practitioners and psychiatrists from a regional mental health center in East Tennessee. For the diagnoses of anxiety disorders, the number of benzodiazepine prescriptions written, dose reduced or discontinued was determined along with concordance to current recommendations for benzodiazepine use. Results: No statistically significant differences were found in scores between study periods, even though there was a decrease in the number of prescriptions written between the pre- (n = 81) and postmeasures (n = 34). Conclusion: The implementation of a benzodiazepine protocol does not necessarily bring about significant changes in providers’ prescribing practices. Audit and feedback are an essential part of the intervention strategy and are often required to change performance-related outcomes.