<p>Abstract Behavioral and mental health issues contribute to the needs of many patients presenting to emergency departments, and yet these needs often go unrecognized. Patient processing procedures in emergency departments may not include mechanisms to consistently identify and triage patients whose care is complicated by behavioral illness. The purpose of this project was to plan a program to improve early identification and management of behavioral health patients presenting to the emergency department. The objective of this project was to develop a rapid mental health screening tool and policies guiding use of the tool in the emergency department. A multi-disciplinary team of emergency department providers cooperated in the selection and evaluation of available screening tools. A literature search was done with the inclusion criterion of behavioral screening tools to be used at time of triage, and results were brought to the team for further consideration. The HEADS-ED pediatric screening tool was chosen through the expert opinions of the team members. The team evaluated and approved adaptations to the tool for its use in adults. Policies were developed to guide the future implementation of the screening tool in the emergency department. A plan for process and outcome evaluation was included in the developed program. Process will be evaluated by monitoring provider use of the screening tool, and patient length of stay in the emergency department will serve as the outcome measure. The program may contribute to social change through improved emergency department care of patients with behavioral illnesses.

<p> New nurses do not possess the clinical skills necessary to thrive in a fast-paced, rapidly changing telemetry unit. The study explores the idea that nurses with less than two years&rsquo; experience may not have the self-confidence or experience to begin a career on a telemetry unit. A search of the literature was performed to identify the skills needed to be successful in a critical care telemetry unit. Established orientation programs, nurse internships, and nursing experience were the keywords researched. Patricia Benner&rsquo;s Theory: From Novice to Expert Excellence and Power in Clinical Nursing Practice (1984) serves as the foundation for this investigation. The theory views nursing competency as a continuing learning experience based on individual experiences, exposures, and cumulative time in practice. The design is descriptive using qualitative, narrative analysis on focus group data. Two focus groups of five nurse participants were purposely selected for the study. One group represented novice nurses, and the other represented expert nurses. Novice nurses placed importance on completing the task list, keeping the patient safe, and receiving positive feedback from co-workers and management. Anticipation, symptomology, and intervention were demonstrated in the expert nurses in this study. Preceptorships, internships, and simulator science may assist in orienting novice nurses new to telemetry to critical thinking and time management skills, and for expert nurses learning a new cardiac skill-set for telemetry care and acting as resource personnel for less experienced colleagues.</p>

Emergency departments (ED) are exceeding the Centers for Medicare and Medicaid Services and The Joint Commission's recommended 4-hour door-to-admission and 2-hour door-to-discharge for patients. The purpose of this project was to look for factors that decrease door-to-admission and door-to-discharge times and offer recommendations to the Patient Flow Committee (PFC) at the health care facility that may reduce overcrowding, diversion, and patient boarding. The 7-step Iowa model of evidence-based practice (EBP) was used to concentrate on problem-focused triggers that initiate the need for change. The project focused on decreasing door-to-admission and door-to discharge times: by opening an observation unit run by the ED to decrease door-to-admission and door-to-discharge times, increasing point-of-care testing (POCT) within the ED to decrease patients' door-to-admission and door-to-discharge times, and placing a provider in triage to decrease the number of non-urgent patients seen in the ED. A systematic literature review was conducted to gather evidence-based practices other organizations have implemented to decrease the ED patients' length of stay. Article inclusion was based on those strategies that would best fit the milieu of the ED and would be sustainable. Four themes including guidelines, algorithms, expanded services, and modified processes were identified through comprehensive analysis of pertinent literature. A presentation to the 20 member multidisciplinary PFC team presented changes to the current system that may meet goals of reducing overcrowding, diversion, and patient boarding. Since door-to-admission and door-to-discharge times are reported quarterly to the PFC, members will be able to see the impact of the changes and on decreased times for ED patients.

<p> This thesis summarizes research and draws overall conclusions from the body of literature on fall prevention interventions to provide hospitals with a basis for developing evidence-based fall prevention programs in the hospital setting. Data was obtained from published studies. Articles were retrieved that focused on fall interventions in the hospital setting. An analysis was performed based on levels of evidence using an integrative review process. Multifactorial fall prevention intervention programs included fall-risk assessments, fall-risk alerts, environmental and equipment modifications, staff and patient safety education, medication management targeted to specific types, and additional assistance with transfers in both falls and fall injuries in hospitalized patients. Hospitals need to reduce falls by using multifactorial fall prevention programs using evidence-based interventions to reduce falls and injuries. </p>

The purpose of this paper is to propose an evidence-based intervention guideline to increase effective coping and positive adaptation in families with a preschool age child who has epilepsy. This population was chosen because there is a lack of research regarding interventions for families of preschool age children with epilepsy. Relevant literature was reviewed to summarize the effects of childhood epilepsy on families, and to assess the effectiveness of interventions to improve coping and adaptation in these families. The main stressors caused by epilepsy are knowledge deficits about epilepsy, knowledge deficits about treatments for epilepsy, increased seizure frequency, and emotional disturbances caused by epilepsy. Prior interventions for families of children with epilepsy included psychoeducational programs, support groups, education programs, family counseling groups, and therapeutic alliance. All interventions in the studies reviewed had positive outcomes for families of children with epilepsy. However, psychoeducational programs tended to address all of the common stressors, whereas other interventions did not. This paper provides an evidence-based intervention guideline for families affected by epilepsy. The significance and limitations of the program are discussed, and recommendations for future research in this area are presented.

Studies show that palliative care APRNs are effective in mitigating patient symptoms and improving quality of life (QOL). Unfortunately, there are no theory-driven models that guide and evaluate the role of an APRN embedded in an outpatient oncology setting. Purpose. The primary purpose of this study is to evaluate the feasibility and effectiveness of a palliative care theory-driven APRN intervention using the newly developed Hanna QOL-Symptom Control Model © on the following patient-, provider-, and financial related outcomes: symptom control, QOL, patient satisfaction; time in and location of APRN follow up; provider satisfaction, number and timing of referrals; and Emergency Room visits and hospital, versus home versus hospice deaths. Methods: Design. Longitudinal, quasi-experimental pre-posttest feasibility study. Sample/Setting. All oncology patients referred to the Palliative Care APRN over one year at St. Jude Heritage Healthcare, Orange County, CA. Intervention: APRN practice translation of National Comprehensive Cancer Network (NCCN) evidence-based symptom management guidelines. Instruments. St. Jude Electronic Medical Record Demographic and Medical Record Data; Patient and Provider Satisfaction Surveys; Quality Oncology Practice Initiative Data (ASCO-QOPI); The Edmonton Symptom Assessment System (ESAS) and single item validated QOL scale, Data Analysis. Descriptive and Inferential Statistics. Limitations. Non-randomized study evaluating the role of a single Palliative Care APRN provider in one clinical setting with a primarily Caucasian sample will affect the study’s generalizability. Implications. Study results will be used to revise the intervention and Hanna QOL-Symptom Control Model© and to disseminate results to St Jude Stakeholders and others via presentations and publications. A future comparative effectiveness study is planned using these findings as baseline data.

The purpose of the study was to evaluate the feasibility of utilizing an existing web based weight loss program and the effectiveness of the program in increasing self efficacy and motivation for weight loss among obese women with PCOS. There is consensus among many infertility experts that weight loss should be the first line of therapy for infertility and PCOS among obese women desiring pregnancy. Web based interventions have been effective in other areas of health behavior change. However, there have been no studies to evaluate use of a web-based weight loss program with the targeted population. Bandura's Social Cognitive Theory provides the basis for the contention that self efficacy is a major factor in self regulation. Another factor is motivation, which enhances self efficacy, thus creating behavior change. A sample of nine women participated in the one group pretest/posttest study measuring self efficacy, motivation and web site visits. BMI was calculated based on self-reported height and weight at baseline and after four weeks as a secondary outcome. There were significant increases in both self-efficacy and motivation for weight loss. Feasibility measures were not met at 90%. Eight of nine participants decreased their BMI. These results support utilization of currently available, free, online weight loss programs for this population.

The purpose of the study was to evaluate the effect of an educational intervention, aimed at nurse practitioners, on increasing knowledge and decreasing prescribing habits of antibiotics in upper respiratory tract infections. The Centers for Disease Control and Prevention currently estimates that nearly fifty percent of antibiotics prescribed in the outpatient setting are unnecessary. The world health organization states that antibiotic overuse is becoming a growing problem worldwide. Numerous studies have been completed targeting physicians and patients, but no long term decrease in antibiotic prescribing has been seen. As the number and role of nurse practitioners increase, this intervention was aimed to target a specially this specially educated group. Research has shown that nurse practitioners have equal outcomes and equal to higher patient satisfaction ratings when compared to physician counterparts. Thus, this group may help to decrease antibiotic overuse. Lewin's three step change theory served as the conceptual framework. The theory uses initial unfreezing, then finding a new equilibrium and finally refreezing, thus creating a new baseline for participants. A sample of fifty one nurse practitioners participated in the one group pretest/posttest/4-week posttest measuring knowledge and intention. Knowledge was measure using the questionnaire results; intention was measured by reviewing Likert-type rankings. Change in knowledge was found to be statistically significant, demonstrating that education will affect knowledge. However, intention was not found to be statistically significant. Intention did increase during the study, but not enough to show that there was an overall statistically significant effect.

Foster children represent a vulnerable pediatric population with complex health needs including both acute and chronic conditions that require comprehensive health care management. However, years of research has continually demonstrated a poor provision of health care services to this at risk population including gaps in preventative care and poor follow-up with specialty services. Current literature reveals that the health care management for foster children continues to be fragmented and subpar. Several health care delivery models, standards of care, and interventions have been recommended in an effort to improve the outcomes among foster children. However the perspective of foster parents, key caregivers, has been missing in current evidence. This investigation serves as a descriptive study utilizing grounded theory methodology to explore health care management from the Hawaii foster parent's perspective. The purpose of the investigation was two-fold: 1) to describe foster parents' experience obtaining health care for their foster children and 2) to elicit foster parents' opinions about whether or not a health education program designed for foster parents would be helpful. After completing seven individual interviews, which were analyzed using constant comparative analysis, 19 categories were developed describing the foster parent experience related to policy and services, social environment, physical environment, biology, and behavior. The concept of a medical home model was identified as unfeasible for Hawaii foster families, and large variations in health education preparation among foster parents was observed while a significant interest in further education on health-related topics was identified as a necessity. Implications for practice and recommendations for further research were also generated.

<p> There is a demand for nursing leadership to create a healthy work environment for nursing practice, which is crucial for maintaining an adequate workforce (Shirey, 2006). Rother and Lavizzo-Mourey (2009) predicted that by 2025 the nursing shortage may reach as high as 500,000 U.S. nursing vacancies. The purpose of this study was to examine the relationship between servant leadership (SL) characteristics of nurse leaders and the perceptions of empowerment among their followers. Servant leadership has emerged as an effective leadership style that prioritizes developing the full potential of followers (Liden, 2013). Current research suggests an empirical link exists between servant leadership and empowerment (Liden, Panaccio, Meuser, Hu, &amp; Wayne, 2011; Van Dierendonck, 2011). An empowered workforce is able to handle unstable environments (Liden, 2013) such as the nursing shortage. </p><p> In 2015, 51 nurse leaders and 237 direct-reports from workplace units in a multifacility health system completed the Servant Leadership Scale (SLS) and a demographic questionnaire. In addition, the direct-reports completed the Psychological Empowerment Inventory (PEI). A convenience sampling technique was utilized to assist in obtaining participants for this quantitative study. An independent samples t-test was used to analyze the data. It was found that a relationship existed between nurse leaders that were rated as servant-leaders by their direct-reports, and the direct-reports&rsquo; perception of empowerment. However, it was found that no relationship existed between the nurse leaders&rsquo; self-evaluation on the SLS and the direct-reports&rsquo; evaluation of their nurse leaders on the SLS.</p>