- Attitudes of Primary Care Providers in South Central Pennsylvania Towards Complementary and Alternative Therapies in Migraine Treatment
- Migraines are a common and debilitating medical issue. Many patients are turning to complementary and alternative medicine to either augment or replace conventional medical treatment for this. However, it is unclear what their primary care providers’ attitudes are toward the use of CAM and the PCP’s knowledge base in this area. This study was designed to determine PCPs’ attitudes towards CAM and if a brief educational presentation regarding CAM modalities frequently used for migraines had any impact on their attitude towards CAM. There was a pre survey, a Power Point presentation discussing common CAM used for migraines, and a post survey. This was a small study, with 13 participants completing the pre survey and 10 completing the post survey. There was no significant difference between the pre and post intervention groups (p=0.46, significance level of <0.05). However, both groups had a mostly favorable attitude towards CAM. Gender, work setting, and credentials did not impact attitudes towards CAM. Acupuncture, relaxation therapy, massage, and chiropractic care were the CAM modalities that the providers felt the most comfortable discussing. The findings from this study can be used as a guide for future educational offerings and CAM services in the area. Suggestions for future research include offering a continuing medical education credit to boost participation., Copyrights are retained by Stephanie Boyer. Contact Stephanie for further use of this material.
- Collaborative Telehealth Approach Where Traditional Care Fails: Diabetes Care Network
- Clinical inertia is the failure to initiate or intensify treatment in a timely manner in people with type-2 diabetes mellitus (T2DM) in primary care (PC) where collaborative care can be an approach to overcome inertia. Diabetes care network (DCN) is a telehealth based collaborative care model to address clinical inertia in the PC environment. In DCN, initial care was delivered via E-Consult by hub diabetes team for Veterans with A1c of 9% or higher and the longitudinal collaborative care delivered by PC liaison with weekly team huddle. To study the difference in the clinical outcomes with DCN vs PC practices, we compared the DCN cohort (97.7% male, 90.8% white, with a mean age 67.2 (8.9), with a PC cohort (100% male, 94.9% white, mean age: 68 year (10.5), with A1C >9%). Methods: Means (SD), frequencies. and percentages were presented. The DCN cohort had a significant decline in the baseline A1C of 10.2% (1.4), to 8.1% (0.99), 7.6% (0.96), 7.5 % (0.86) at 3, 6, and 12 months while A1c in PC cohort stayed poor with baseline A1C of 10.1% (0.89), to 10.2% (1.69), 9.7% (1.74) and, 9.5% (1.83) at 3, 6, and 12 months. Patients who achieved A1c less than 8% in DCN cohort were 38 (43.6%), 56 (64%), and 56 (64%) at 3, 6, and 12 months and were 1(1.7%), 5(8.5%), and 6(10.2%) at 3, 6, and 12 months in PC cohort. An A1c of less than 7% was achieved in DCN cohort in 10 (11.4%), 21 (24.1%), and 23 (26.4%) patients at 3, 6, and 12 months and only 1(1.7%), 0(0%), and 0(0%) patients achieved A1c less than 7% at 3, 6, and 12 months in PC cohort. Our study shows participation in the DCN telehealth program for 1 year was associated with significant improvement in A1c. This improvement was not seen within the PC with traditional care practices. Thus, addressing clinical inertia in PC will need a paradigm shift in current practices. The proposed collaborative approach of DCN can overcome clinical inertia in PC and improve care for people with T2D by supporting PC access to specialty care expertise, decreasing the burden of diabetes care for patients and PC providers.
- Delayed Prescribing: Promoting Antibiotic Stewardship in an Urgent Care Setting
- According to the Centers for Disease Control, (CDC, 2018) at least thirty percent of outpatient antibiotics are unnecessary. A retrospective 2018 study by Incze, M.A. Redberg, R.F. and Katz M. found forty nine percent of antibiotic prescriptions in the urgent care setting were for inappropriate diagnosis. The aim of this study was to educate providers on one method of reducing antibiotic prescriptions and incorporate new patient instructions into the electronic health record. Participants included physicians associates and nurse practitioners.
- Effect of Peer Support on Treatment Engagement in Clients with Opioid Use Disorder
- Opioid misuse has been a growing concern that has escalated to a public health emergency. Despite substance use programs that offer assistance in the treatment of opioid use disorder (OUD), keeping the client engaged in recovery treatment can be very challenging. Relapse prevention is a priority concern due to the higher risk of overdose following a period of sobriety. The use of Certified Peer Specialists to facilitate client engagement in treatment programs has proven to be beneficial and their role in helping individuals remain in recovery treatment is explored using the theoretical framework of Modeling and Role-modeling. The purpose of this research is to establish whether a peer support program provided by an outpatient facility was effective in achieving client engagement in recovery treatment. Data collected by the facility on client treatment encounters spanning six months was analyzed. Data sets related to individuals enrolled in a certified recovery services (CRS) program versus individuals engaged in treatment as usual were compared. Statistical analysis using the t test revealed greater engagement in recovery services among those enrolled in the CRS program. The findings support the benefit of a peer recovery service program as an option to encourage treatment engagement in clients with OUD. This research will be of value in the design and development of future program policy and treatment guidelines.
- Evaluating an Educational Intervention's Effectiveness in Reducing Stigma and Negative Attitudes of Registered Nurses Toward Persons with Alcohol Use Disorder
- The purpose of this study was to identify the presence of stigma and perceived negative attitudes of nurses working with patients diagnosed with AUD [alcohol use disorder) in all areas of practice, with the aim of decreasing stigma and enhancing positive attitudes in nurses caring for patients with AUD through an educational intervention. The literature is well established that nurses feel unprepared educationally to care for patients with AUD, and also hold negative attitudes and perceptions of working with patients with AUD (Haskins, et. al, 2014). This research will conduct a pre-and post-survey of registered nurses' attitudes and perceived stigma followed by an educational intervention to evaluate whether the education is a positive critical element that can help to reduce stigma and improve negative attitudes nurses may hold toward caring for patients with AUD. This research is a quality improvement project to collect and use data that is meant to drive change that has practice and policy changing implications. The Seaman-Mannello Survey was used as a pre-and post-survey to measure the efficacy of the interventional education video. A convenience sampling of 76 registered nurses from three Northwestern Pennsylvania hospitals was used. The goal of this research study was to investigate the effectiveness of an educational intervention that, if significantly effective, can be used on a larger scale to decrease stigma and improve attitudes of nurses toward patients with AUD. The results found no significant relationship between the provided educational intervention and reduced stigma or improved attitudes of nurses while working with patients with AUD. Although a positive relationship could not be established, it was inferred from the pre-and post-survey scores, ongoing education is still needed and may impact the care of individuals with AUD.
- Interventions Used by Nurse Practitioners to Decrease Polypharmacy in the Older Adult: A Systematic Review
- This systematic literature review was conducted to ascertain what interventions NPs are using to combat polypharmacy among older adult patients. Nine articles were examined to better understand the polypharmacy interventions used by or recommended for NPs working with older adults. Four main types of interventions emerged from the review, including identification interventions, deprescribing interventions, educational interventions, and medication management protocols. Overall, the body of research on polypharmacy protocols employed by NPs is small and heterogenous, indicating many opportunities for future research. Practical implications and opportunities for future research emerged from this systematic review.
- Laying the Foundation - Determining Health Care Knowledge of Parishioners of the Purpose and Functions of a Faith Community Ministry
- The focus of this DNP project was a descriptive approach in gathering data related to participants' understanding of what a faith community health ministry is and how it can be valuable in promoting body, mind, and spirit wellness. The objectives for this project were to lay a foundation in initiating a faith community health ministry within a rural Christian parish; establish basic knowledge detailing the role of a faith-based nurse, and what benefits a faith community ministry can provide. The researcher assessed a priority of topics related to health promotion and prevention measures based on the parishioners' interests. The questions purported were: What is the effect of an on-line educational program on parishioners' knowledge of a Faith Community Nursing ministry? What health topics are of interest to a parish community?
- LGBTQIA+ Inclusive Healthcare Versus Traditional: Comparing Patient Satisfaction
- Study Aim: The aim of this study was to evaluate the difference in patient satisfaction scores between lesbian, gay, bisexual, transgender, questioning or queer, intersex, and asexual (LGBTQIA+) individuals who receive healthcare from LGBTQIA+ inclusion clinics and LGBTQIA+ individuals who receive healthcare from traditional clinics. Background: LGBTQIA+ individuals have unique healthcare needs and require safe, affirming, culturally competent, and inclusive healthcare environments that will meet these unique needs, eliminate health disparities and inequities, and improve patient reported outcomes such as patient satisfaction. Theoretical Framework: This study was guided by the Health Equity Framework, centered on three foundational concepts: equity at the core of health outcomes; multiple, interacting spheres of influence; and a historical and life-course perspective. Methodology: Study protocol review and approval were obtained from Edinboro University’s Institutional Review Board. This study was an on-line questionnaire study and was conducted using a nonexperimental, nonrandom, cross-sectional study adhering to a quantitative methodology. A nonrandom convenience sample of LGBTQIA+ individuals (n=56) was selected, and study participants were invited to participate in this study via an on-line survey link by way of Qualtrics. Data were collected using the Short-Form Patient Satisfaction Questionnaire (PSQ-18). Results: To test for differences in patient satisfaction between groups, the independent samples t-test statistical method was utilized. There was not a statistically significant difference in mean values between groups. Due to assumption violations, the Communication sub-scale was tested using the independent samples Mann-Whitney U test to determine if the distributions in the two groups were significantly different from each other. It was found that the distributions in the two groups significantly differed. Conclusions: LGBTQIA+ inclusion health plays a critical role in improving patient satisfaction and the health and well-being of LGBTQIA+ individuals. Implications for Nursing Practice: Nursing professionals play an integral role in transforming healthcare for LGBTQIA+ individuals and must align their practices with their professional duty of delivering equitable and culturally competent and sensitive care to LGBTQIA+ individuals. Recommendations: Further research is needed with larger sample sizes to investigate the relationship between receiving healthcare from LGBTQIA+ inclusion clinics and improved patient satisfaction and whether there is a difference in patient satisfaction between those who receive healthcare from LGBTQIA+ inclusion clinics and those who do not. Because study respondents who went to LGBTQIA+ inclusion clinics had significantly higher communication satisfaction than those who did not go to inclusion clinics, the impact of culturally competent communication on improved patient satisfaction should also be investigated further in future research.
- A Retrospective Chart Review of a Nasal Decolonization Program to Decrease Surgical Site Infections at a Community Based Medical Center
- Background: Surgical site infections (SSI’s) are a major concern for patients, providers, and healthcare organizations worldwide. SSI’s remain the costliest and most common of all hospital-acquired infections (HAI’s) (Septimus, 2019). It is estimated that SSI’s occur in 2 percent to 5 percent of all patients undergoing surgery, translating to 160,000 to 300,000 people annually at a cost of $3.5 to $10 billion (Ban et al., 2017). An SSI substantially increases morbidity and mortality as patients are twice as likely to die, are 60% more likely to be admitted to the intensive care unit (ICU), and the readmission rate is five times higher than patients who do not have a hospital-acquired SSI (Darouiche, 2019). Research Question: Did the intervention of preoperative nasal decolonization using the Profend Nasal Decolonization Kit, 10% povidone-iodine (PVP-I), reduce surgical site infections in patients undergoing an orthopedic surgery with implantation, to include total joint arthroplasty (TJA) and an orthopedic fracture repair, in a 12-month period preintervention compared to a 12-month period post-intervention? Objective: The objective of this DNP project was to evaluate the effectiveness of using a 10% PVP-I Nasal Decolonization Kits in the prevention of SSI’s in patients undergoing an orthopedic surgery for a TJA or fracture repair at the medical center. Methods: This DNP project used a retrospective data review from data points previously collected as part of standard work performed in the EMR. All patient information was blinded when the information was displayed. A standard report from the EMR was run to collect all data. Results: The preintervention group was composed of 431 patients and the postintervention group contained 365 patients. The preintervention group had eight postoperative infections for an infection rate of 1.86%. The postintervention group had an infection rate of 0.27%. This resulted in a p-value of 0.0367 using a two proportions z-score, showing a statistical improvement in SSI’s. Conclusion: The facility successfully implemented a nasal decolonization program with 10% PVP-I that decreased the number of infections, had a higher compliance rate for PVP-I nasal swab over the national average for mupirocin, and showed potential cost savings for the medical center.