Ensuring the safety and welfare of children has a lasting effect on society. As we progress to a more inclusive concept of what constitutes a family, the effect of same sex parenting (SSP) must be considered. Health related outcomes describing the advantages, disadvantages and unique challenges experienced by this population is surprisingly robust.

No description available.

Purpose: Quality improvement project to improve diabetic retinopathy education and screening in a rural primary care clinic to meet the standard of care. Aims: To improve the delinquency rate of diabetic retinopathy screening. Processes: Participants included those with type 1 and type 2 diabetes ages 18 and up in the rural health clinic. Diabetic retinopathy screening importance education was displayed in the clinic and provided to each applicable patient in the form of a handout. A diabetic eye camera was brought to the rural health primary care clinic to offer more convenient access and free eye exams to clinic patients with diabetes. The project was deemed quality improvement by the IRB. Results: (To be determined after project implementation – results anticipated to be excellent based on the number of patients who are signed up to participate in this day.) There are 486 patients with a diagnosis of diabetes in the clinic. ___ were delinquent in eye exam prior to implementation and ___ were delinquent after. Limitations: Project performed in only one clinic; project leader is employed at the clinic in this study. Conclusions: Implementation of the eye exam day improved the delinquency rate of diabetic retinopathy screening in the clinic and proved to be a valuable means of enhancing patient compliance and satisfaction of routine eye health monitoring in patients with diabetes.

Abstract Purpose: Mental illness in the United States is a well-documented prevalent health concern. Mental health conditions are extensive and subject to mental illness stigma that negatively impacts client care. Aims: This quality improvement project aims to implement the NAMI In Our Own Voices presentation in conjunction with a ninety-minute anti-stigma educational session to reduce mental illness stigma among nursing students. Methods: This quality improvement project utilizes a pretest-posttest study design to evaluate the implementation of the National Alliance on Mental Illness In Our Own Voices presentation in conjunction with a ninety-minute anti-stigma educational session’s impact on mental illness stigma reduction. The Open Minds Stigma Scale for Health Care providers will be used to determine the level of stigma reduction in undergraduate baccalaureate nursing students. Results: Results are pending project implementation approval from the National Alliance on Mental Illness. Conclusion: No conclusion can be determined at this time as study results are pending.

Implementation of provider-made follow-up appointments for depression in primary care Rebecca Vaughn College of Nursing, East Tennessee State University; Whitson Hester School of Nursing, Tennessee Technological University Author Note Rebecca Vaughn https://orcid.org/0009-0007-0731-3316 College of Nursing, East Tennessee State University There are no conflicts of interest to disclose. Corresponding concerning this manuscript should be addressed to Rebecca Vaughn 108 Reed Mill Lane Monroe TN 38573 Zrev2@etsu.edu Abstract Depression is a common condition diagnosed and managed in primary care. Follow-up is inconsistent and low in these settings, creating a gap in care that impacts management, adherence to treatment, and patient outcomes. The purpose of this quality improvement project was to implement in-room scheduling of follow-- up appointments by providers of newly diagnosed depression patients. The project aimed to improve follow-up of newly diagnosed depression patients and adherence to treatment in primary care. The setting of the project was a primary care clinic care located in North-East Tennessee. The IRB determined that no approval was needed. A 12-week retrospective chart review was conducted to determine baseline rates and demographics for the project. During the six-week project , providers scheduled follow-up appointments and documented them on the data collection form. Providers were given a pre/post-test before and after implementation to measure providers confidence levels. While the study is ongoing , and results are pending, the expected outcomes include improved follow-up rates and improved adherence to treatment which will lead to improved outcomes in depression. Keywords: depression, primary care, follow-up, adherence

Purpose: To determine if a quality improvement project involving individualized, one-on-one Diabetes education will improve health literacy and Diabetes outcomes in adults with Type 2 Diabetes in a rural primary care clinic. Diabetes is a chronic condition affecting the United States with 9.6% of Virginia’s population living with Diabetes. Aims: To improve patient’s Diabetes literacy scores, BMI, and Hemoglobin A1c levels through Diabetes education. Processes: There are pre- and post-education phases. Data to be collected at the end of both phases consist of DNT15 scores, BMI, and A1c. In the pre-education phase, BMI was obtained, DNT15 was administered, and Diabetes education was provided. Then, A1c was obtained, and patients were scheduled to return in the month of May. Post-education phase starts at the follow-up where participants retake DNT15 and BMI and A1c will be obtained. Results: Only pre-education data has been collected from the participants. Post-education data will be collected throughout the month of May during 3-month follow-up appointments. Expected results include 10% improvement of BMI, A1C, and Diabetes literacy scores. Limitations: Increased use of GLP1 prescriptions in clinic could affect results. Some patients were sent to the ED after being seen requiring prompt follow-ups while others obtain A1c results from other disciplines and may not have results sent to this clinic by the end of the data collection period. There have also been several no shows. Patients and staff have been receptive to the quality improvement initiative. Conclusion: Education has been provided to 25 patients. Follow-ups are scheduled for post-education data collection in May.

Bakgrund: I dagens läge finns det kunskapsluckor om hur den perioperativa omvårdnadsprocessen uppfattas ur operationssjuksköterskans synvinkel. För att operationssjuksköterskan ska kunna ge god vård till patienten utifrån dennes önskningar och behov är det viktigt att operationssjuksköterskan får en bra kontakt med patienten. Får operationssjuksköterskan dela patientens värld d.v.s. om patienten både vill och är förmögen till att dela med sig av sina tankar och önskemål, då blir det lättare att ge en personcentrerad vård. Syfte: Syftet med föreliggande litteraturstudien är att undersöka hur operationssjuksköterskan uppfattar den vårdande relationen ur ett perioperativt synsätt. Metod: Det är en litteraturstudie med elva artiklar som har en kvalitativ ansats och en artikel som har en kvantitativ ansats. Föreliggande studien har en kvalitativ ansats då fokus är att beskriva och tolka operationssjuksköterskans upplevelser av omvårdnadsprocessen. Resultat: Generellt sett hade operationssjuksköterskorna en positiv inställning till den perioperativa processen. Operationssjuksköterskorna upplevde att den perioperativa processen  bidrog till ökad kontinuitet och ökad trygghet hos patienterna men framförallt också hos dem själva. Operationssjuksköterskorna utvecklades i sin yrkesroll men också som individer. De kände att deras arbete var meningsfullt och att det fanns en vårdande relation mellan patienten och operationssjuksköterskan. Slutsats: Föreliggande studie lyfter fram att arbetet för operationssjuksköterskor skulle bli effektivare, säkrare vård, få mer kontinuitet och gynna både sjuksköterskorna och patienterna om den perioperativa processen användes i större utsträckning. Det skulle bli lättare att uppnå välmående och god omvårdnad i slutändan. / Background: At present, there are gaps in the knowledge of how the perioperative process is seen from the point of view of the operating room nurse. When it comes to the operating theater nurse to provide quality care to the patient, it is important that the operating theater nurse gets a good contact with the patient. The operating room nurse has to share the patients’ world. Then, it will be easier to give a patient-centered care. Aim: The purpose of this study is to investigate how the operating theater nurse experienced the perioperative process from her/his point of view. Method: This study is a literature review of eleven articles that have a qualitative approach and one article which has a quantitative approach. This study has a more qualitative approach. Its focus is describing and interpreting the surgery nurses’ experience of the perioperative process. Result: The surgical nurses had, to a large extent, a favorable attitude to the perioperative process. Surgical nurses felt that the perioperative process contributed to increased continuity and increased safety for patients, but above all for themselves. Surgical nurses developed professionally, but also as individuals, they felt that their work was meaningful and that there was a caring relationship between the patient and the surgical nurse. Conclusion: This paper emphasizes that if the perioperative process would be used on a larger scale, the work for operative nurses would be more efficient, provide a more secure care, give more continuity and be very favourable to nurses as well as patients. The result for the patients would be a good care and well-being.

Information technology is ubiquitous in society and industry; however, healthcare is just beginning to explore how health information technology (HIT) can be optimized to support quality care. HIT can assist with standardizing care delivery, increasing access to evidence-based medicine, improving accuracy and ease of documentation, and assisting with patient education. Advanced Practice Registered Nurses (APRNs), specifically nurse practitioners (NPs) and certified nurse midwives (CNMs), play a pivotal role in the healthcare delivery system. To be effective practitioners, providers must manage, integrate, and assimilate a multitude of knowledge with each patient encounter. HIT can serve as the channel through which the NP and CNM provides cost-effective, efficient, and quality care. However, healthcare providers have been slow to adopt and implement HIT resources. We know that adoption of HIT by healthcare providers is varied among provider and practice settings. However, few studies have examined the impact on and utilization of information technology by APRNs, specifically nurse practitioners and certified nurse midwives.The purpose of this research was to investigate the utilization and influence of HIT on the clinical decision making of Kentucky nurse practitioners and nurse midwives (Kentucky APRNs). A descriptive cross-sectional design using survey methodology and convenience sampling was employed. Participants were asked to complete an author-modified, web-based survey tool that was based on current research. The 40-question tool was designed to explore providers' attitudes and perceptions of technology, determine their knowledge and utilization of various electronic and traditional print medical resources, and assess the penetration of and daily usage of HIT in practice.This study revealed information related to Kentucky APRN's utilization and influence of HIT on clinical decision making. Establishing exploratory Kentucky APRN findings will assist in evaluating further HIT utilization in Kentucky. Findings suggested that APRNs in Kentucky are beginning to explore the benefits of HIT; however, additional research will be required to identify the true penetration and utilization of technology in Kentucky. Although additional research is needed, HIT appears to be having an overall impact on the clinical practice of Kentucky APRNs.

One out of 2 women and 1 out of 5 men over age 50 will sustain a fragility fracture (FF) in their lifetime. The risk of a 2nd FF increases dramatically after the 1st fracture and can lead to pain, disability, and mortality. Despite the evidence that secondary prevention programs are effective, the local facility did not have a formal mechanism to address this need. The purpose of this project was to design a program for secondary prevention of FFs and to address the need for a program for secondary FF prevention that was sustainable locally. The program was designed for facility patients age 50 or older who sustained a wrist fragility fracture within 6 months. The reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework was used to guide the project and program evaluation. A needs assessment was conducted prior to developing the program and included secondary data from the facility's provider survey. The 'Own the Bone' program, a nationally recognized program, was chosen as the intervention model. The 'Own the Bone' program provided a registry data for performance measures which assisted in the development of the program. The program included a short survey for providers to assess satisfaction with the referral process, and a telephone survey to referred patients who chose not to attend. Patient satisfaction with the program incorporated the Standardized Clinician Group Consumer Assessment of Healthcare Providers and Systems survey. Data collection and analysis plans were provided to the site with recommendations for implementation. This program was the 1st step in closing the local research-practice gap of secondary fragility fracture prevention. The project offers an opportunity to promote positive social change through the prevention of FF in a setting that had not previously addressed the problem.

In 1978, Primary Health Care (PHC) was formally recognised, in the Declaration of Alma-Ata, as the key to achieving the World Health Organisation's goal of 'Health For All by the Year 2000' (HFA). PHC was seen as the solution to the inadequate illness management systems that had developed throughout the world. It was hoped that PHC would address some of the major inequalities in health observed both within and between countries by its balanced system of treatment and disease prevention. The WHO envisaged that PHC would take place as close as possible to where people live and work and be the first element of a continuing health care process. Additionally, health service collaboration and multi-professional partnerships were expected to replace professional boundaries and competition. Shortly after the Declaration of Alma-Ata, the World Health Organisation, supported by national and international nursing bodies, proposed that nurses would be the driving force behind the HFA movement as active partners in inter-professional teams, leaders in health care and resources to people rather than resources to other health professionals. In the ensuing years, although community health nurses were acknowledged by the government and the nursing profession as key players in PHC in Australia, practice nurses (nurses who are employed in general medical practices) were not identified within this group. Hence, it appeared as though these practice nurses were 'invisible', not considered important to PHC in Australia, or simply overlooked as a major influence on population health. The purpose of this study was to describe the current role of these nurses and to identify and analyse the factors that influenced their scope of practice and hence their contribution to PHC. The research was conducted as a case study of practice nurses in one Division of General Practice in southeast Queensland. The study was influenced by the constructivist paradigm of inquiry and utilised a complementary sequence of quantitative methods followed by qualitative investigation. The first stage of the study comprised a telephone followed by mail survey of general practitioners and practice nurses employed within the Division. This was followed by a second stage, which involved group and individual interviews of key informants and was supported by document review and observation. The study revealed that the practice nurse role is essentially one of assistant to the general practitioner wherein the nurse undertakes basic assessment procedures to aid the medical diagnosis, carries out delegated therapeutic procedures, and contributes to the administrative functioning of the practice. Autonomous nursing initiatives, which appear to be largely opportunistic and incidental to delegated activities, include physical and emotional support of patients, clarification and reinforcement of medical instructions, and the provision of health education. The practice nurse's role, and hence contribution to PHC, was found to be constrained by a number of factors. These factors include the current funding arrangements for general practice, the view that practice nurses are an option rather than a necessity, the general practitioners' control of the practice setting, the appropriation of nursing work to medical receptionists, the lack of professional development opportunities, and the practice nurses' passive acceptance of their circumstances. However, both general practitioners and practice nurses appreciate the value of nursing services in general practice and GPs would sanction the employment of more nurses, if given financial incentives, especially for the purpose of preventive care. The majority of practice nurses believe their role should be expanded to include autonomous functioning while most of the GPs were amenable to some extension of nursing practice but reticent or opposed to any independent interventions. There appears a need in Queensland for courses to prepare practice nurses for advanced practice if they want to expand their role in PHC beyond that of assistants to GPs. It would also seem to be in the nurses' interests to initiate a professional association of practice nurses as a vehicle to explore other issues relevant to their professional development. In addition, if PNs want to expand their role they will need to demonstrate improved patient outcomes and cost effectiveness.