<p> Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient&rsquo;s other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS.</p>

<p> This study explores the pervasiveness of job fatigue in Emergency Room nurses. It identifies factors that contribute to nurse burnout, including job dissatisfaction and workplace bullying, and explores strategies for assessing and reducing fatigue syndrome. As the literature suggests, there is a link between nurse burnout and patient safety. These findings are expected to help organizations develop strategies to reduce stress in the workplace and develop wellness programs. Upon using an interviewing process, the study found several themes that pointed to the key factors of increased ER nurse burnout, and provided several implications as to the changes that need to be made to improve the ER department environment. Some of the key findings included the need to hire more staff, make supervisors and management more approachable and available, and increasing support to ER nurses. Doing so will clearly help mitigate the problem of high stress levels among ER nurses and help to prevent the likelihood of burnout.</p>

No description available.

<p> US asthma prevalence increased by five million in the last decade and health care spending for the disease increased from $53 billion to $56 billion. Children are more likely than adults to have an asthma attack and its estimated that 1-in-10 youth has asthma. Despite initiatives to promote adherence to practice guidelines, childhood asthma emergency room) visits, and hospitalizations remain steady while the number of asthma deaths have increased over a 17-year period. Preliminary studies find the majority of adolescents prefer smartphones as a means of education and guidance. A modified Technology Acceptance Model (TAM) survey was comprised of 15 statements that explored providers&rsquo; acceptance of smartphone applications (apps) as an adjunct strategy for management of asthma among adolescents in the outpatient setting. Current insight in adolescent asthma demonstrates multifaceted disparities in care stemming from biological and developmental transitions unique to adolescents. The quantitative, descriptive design of the project assessed two factors integral to the TAM related to provider acceptance and perception: 1) Perceived use (PU), and 2) Perceived ease of use (PEU). The survey sample consisted of 18 providers. Overwhelmingly, the majority of providers surveyed favored use of a smartphone app for adolescent asthma and believed apps had the potential to improve the quality of adolescent asthma management. Most participants agreed; smartphone apps might help accomplish benchmarks for adolescent asthma management. Numerous studies demonstrate adolescents&rsquo; preference for technological interventions for self-management of their asthma symptoms. The survey results reinforce the willingness of providers to accept asthma smartphone apps as a potential adjunct management strategy for adolescent asthma. Additional studies involving providers are required to further explore provider attitudes of acceptance and rejection relating to smartphone apps for chronic health conditions. </p>

<p> Death from medical error at time of writing is the third leading cause of the death in the United States. Creating a world where patients and those who care for them are free from harm is the priority in the patient safety movement. A strong culture of prioritizing safe practices is the foundation for safe patient care; this culture can be developed and maintained by the implementation of daily safety huddles. By engaging the team in safety behaviors to achieve the goal of reducing preventable patient harm, daily safety huddles have the potential to impact the safety culture at both the unit and organizational level. Daily safety huddles are deliberate, intentional, purposed conversations in a non-punitive environment from the leader with their team about safety events, concerns, and needs so that situational awareness is created, the team has a shared mental model, and resources can be assigned to reduce the risk of potential events of harm to patients, families, and the health care team. This change project evaluated the impact of daily safety huddles on unit-level safety culture as measured by the Safety Organizing Scale (SOS) survey which is based on the principles of high reliability utilizing a pre-posttest quantitative design. Descriptive statistics were used to describe the characteristics of the inclusive of gender, race, age, experience level, and educational level. Results indicated an overall increase in mean scores from the pre-test to the post-test for all behavioral indices of safety culture with the exception of one question describing handoff communication. A statistically significant positive difference was noted between groups with p = .03 for the SOS question on discussion of mistakes and how to learn from them as a result of huddle implementation. Thus, the implementation of huddles demonstrated a clinically significant improvement in unit level safety culture and a statistically significant improvement in one domain.</p>

<p> The national nursing shortage and high nurse turnover rates in the United States have been negatively affecting the quality of health care services since providing optimal patient care requires fulfilling necessary standards including nurse-to-patient ratios. The failure to maintain the mandated nurse-to-patient ratio not only will cause a penalty for a health care facility, but also will compromise the quality of health care service to the patients. Amerindo, an international nurse recruitment agency, intends to address these challenges by supplying qualified internationally educated nurses to the U.S. Amerindo will provide three levels of nursing vocations from Certified Nurse Assistants, Licensed Practical Nurses, and Registered Nurses, for all nursing domains including pediatric nursing, geriatric nursing, medical surgical nursing, maternity nursing, and psychiatric nursing. </p><p> Amerindo&rsquo;s mission is to be a trusted connector between internationally educated nurses and health care facilities in Southern California, by supplying qualified nurses with two years of initial employment contract. With the unique initial employment contract and several additional qualities, Amerindo distinguishes itself from other health care recruitment agencies. Moreover, Amerindo helps the health care facilities maintaining their nurse-to-patient ratio, and reducing the nurse turnover rate. Thus, in general, Amerindo helps improving health care access and quality.</p>

<p> Medical error, patient safety and nurses&rsquo; performance are some of the critical concerns within healthcare systems. Several factors contribute to nurses&rsquo; performance and patient safety including fatigue, sleepiness and work system parameters.</p><p> Furthermore, because of a shortage of nurses, working nurses are often experiencing high workloads. They often work in 12- hour shifts and/or consecutive night shifts without receiving enough sleep or recovery. Thus, they frequently are fatigued and suffer from sleep deprivation, which again is negatively associated with patient safety. Therefore, health care researchers and decision makers are interested in developing policies and tools that help decrease nurses&rsquo; errors and increase their performance.</p><p> Thus, there is a need for a promising approach to understanding nurse fatigue and its causes and consequences that is able to capture dynamic nature of the problem. This study aimed to address this need. In the first step, data were collected from a private hospital. Next, a data mining technique was applied to uncover the patterns and associations among contributing factors that affect performance and patient safety. Finally, a model was developed to measure nurses&rsquo; responses to different work system parameters and stressors.</p>

<p> Heart failure readmissions place a significant financial burden on the healthcare system. Stakeholders of this system have utilized many approaches to reduce the number and costs of heart failure readmissions, without significant improvement. The purpose of this practice improvement project was to determine whether education on the financial impact associated with readmissions improved a patient&rsquo;s measured quality of life, encouraged adherence to a therapeutic regimen, and thereby reduced readmission rates in Medicare and Medicaid patients diagnosed with heart failure. Theoretical support is derived from the theory of self-care of chronic illness, which recognizes the complex self-care processes a patient with chronic illness negotiates. The project used a quantitative methodology with a pre-test/post-test design. A convenience sample was enrolled of 10 Medicare and Medicaid patients who had recurrent heart failure readmissions. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to collect pre/ post-intervention data which was then analyzed by two-tailed paired t-test. There was no statistically significant difference from the intervention to determine any impact on the participant&rsquo;s measured quality of life (<i>p</i> = .953; &alpha; = .05). However, none of the participants were readmitted during the 30 day period of this project. The findings indicate heart failure patients acknowledge their financial constraints but quality of life is not as impacted by finances as anticipated. Polypharmacy and uncertainty with managing daily regimens during symptom exacerbation were the greatest concerns. It is recommended that heart failure patient education should be persistent and individualized to address the patient&rsquo;s unique needs. </p><p>

<p> <b>Purpose:</b> The purpose of this DNP quality improvement project was to increase primary care provider knowledge about indications for adolescent depression screening. </p><p> <b>Background:</b> Approximately 13.3% of adolescents experienced depression in the past year. In Oklahoma alone, rates are increasing, with depression totaling 60% of all mental health illness among adolescents. Primary care providers see approximately 75% of adolescents; however, mental health conditions are missed 84% of the time. Current clinical guidelines recommend screening for adolescent depression during wellness visits or when risk factors are present. </p><p> <b>Methods:</b> The providers of interest were nurse practitioners, physicians, and physician assistants providing primary care to children between the ages of 12 and 17 in a private pediatric practice group consisting of three clinics. The Model for Improvement guided the process of developing, implementing, and evaluating an educational intervention through use of a pre-test/post-test quantitative design. An email invited participants to complete an anonymous pre-test survey to evaluate knowledge and beliefs surrounding adolescent depression, then view an educational presentation on adolescent depression and screening guidelines, then complete a post-survey to evaluate any changes in knowledge and intention to screen. Results were shared with clinic representatives to help refine the education for future testing cycles and other clinic sites. </p><p> <b>Results:</b> Data collection took place over one week. Five providers completed both the pre-test and post-test surveys. Provider knowledge scores significantly increased 29% after participating in the education and self-reported knowledge on screening increased. </p><p> <b>Conclusions:</b> DNP quality improvement projects like this help develop strategies to increase best practices, leading to improved patient outcomes. Nurse-led improvement programs like this contribute to healthcare literature and the advancement of the nursing profession by developing patient-centered interventions applicable to a wide variety of providers. Results may be used to develop strategies to increase and align provider practices with best standards to help promote early identification and treatment of adolescents with depression. </p><p>

<p> Stress in the Intensive Care Unit (ICU) and the leadership style of the nurse manager are predictors of job satisfaction, which is linked to intent-to-leave and increased turnover rates among ICU registered nurses. This quantitative correlational study determined that authentic leadership behaviors of transparency, self-awareness, balanced processing, and internalized moral perspective of the nurse manager significantly correlated with job satisfaction and predictor of stress among ICU RNs. A Pearson correlation was used to analyze the data from a stratified random sampling of ICU RNs from the four different not-for-profit hospitals in the northwestern United States. The positive relationship between the nurse authentic leadership behaviors of transparency, self-awareness, balanced-processing, and ethical/moral behaviors and job satisfaction and stress among ICU registered nurses recommends for the nursing leaders to have an authentic leadership training. The information gathered through this study provided the nursing leaders a better understanding of authentic leadership theory to promote a healthy work environment. Thus, a satisfying leadership behavior fosters trust, enhance job satisfaction, and supports a less stressful working situation for the ICU staff nurses.</p><p>