Asthma is the most common chronic illness in children. Preschool children (age 0 to 5) in particular experience a disproportionate disease burden compared to all other age groups. Part of the puzzle is the diagnostic challenge presented in this age group, and another is the difficulties in the care and management of asthma. Compounding the issue are the well-documented racial disparities experienced by minorities. This paper reviews the literature documenting the difficulties and disparities facing minority preschoolers with respect to providing and receiving care for asthma and qualitative improvement strategies targeting healthcare. Due to the complexity of the disease, more research on evidence based strategies targeting this age group is needed as well as better documentation of implementation processes.

Enduring cardiac surgery can result in physical pain and feelings of anxiety during the recovery period. Although pharmaceutical interventions exist to help alleviate these symptoms, complimentary therapies are seldom encountered in hospital settings. Listening to calming music has been shown to improve the patient experience and can be a safe adjunct to standard pharmaceutical management of pain and anxiety. The aim of this project was to implement music as a nursing intervention for open-heart patients and to evaluate both nurse attitudes and trends in use and patient experiences of pain, anxiety, and satisfaction. A descriptive, quality improvement project following the Plan-Do-Study-Act format for healthcare improvement was conducted on a cardiac telemetry unit at a suburban hospital in Arizona. Thirty percent of staff nurses provided feedback. The majority of participating nurses had a bachelor’s degree (58%) and less than 10 years of nursing experience (79%). Of the participating nurses, 79% recommended the intervention, with two fully providing the intervention to the patient when requested. Patient surveys were completed by 13% of potential patient participants, though only two surveys were suitable for analysis. Patients (n=2) reported improvements in satisfaction levels and would recommend the intervention for others. One reported an improvement in pain and the other patient reported an improvement in anxiety. Overall, music was viewed favorably by nurses and patients as a complementary therapy, but because of the short study period and limited nurse and patient feedback, more quality improvement projects are needed to determine its direct effects on patients. Engaging and recruiting frontline staff in the design of the project and enlisting more financial support from the organization would be advised.

Class of 2005 Abstract / Objectives: To determine the level of patient satisfaction regarding counseling services provided at a local community pharmacy. Methods: 100 questionnaires were handed out randomly to pharmacy customers who received counseling services on new prescription medication(s). The questionnaires contained multiple criteria/statements regarding the provision of counseling services. Customers were also asked to select from a list of potential additional categories of information that they would like to receive during counseling. Results: 48 of 100 questionnaires were received at the time this report was written. Customers strongly agreed that the criteria regarding the content of the counseling services were met: (name/strength/dose, and with all of the statements regarding the pharmacist's professional attributes and the counseling environment except one regarding privacy involved with counseling). Suprisingly, only 20% of customers would feel more comfortable being counseled in a more private area such as a separate room or walled off area. Implications: This study provided important feedback to the community pharmacy as well as the pharmacists working there in regards to the evaluation of counseling services provided to their valued customers. Customers have the opportunity to provide their input in regard to their satisfaction level of the quality of counseling services they receive at this community pharmacy (in the form of a questionnaire). Customers, through the completion of the questionnaire, may realize the value of this questionnaire and its use as a tool to improve the areas of the counseling services that customers agree need improvement as well as the opportunity to realize that this community pharmacy does care and value it’s customers and their level of satisfaction in the counseling services provided. This questionnaire may be used as a tool by the community pharmacy in the future to re-assess these criteria of counseling services in the overall purpose of improving the quality of counseling services provided by this community pharmacy.

Postpartum hemorrhage is a leading cause of maternal death, yet many deaths related to hemorrhage might be prevented with early recognition and intervention. The birthing unit of a U.S. community hospital formed an interprofessional task force to plan and implement a postpartum hemorrhage protocol that would provide the obstetric team with the knowledge, skills, and tools needed for early identification and quick action when hemorrhage occurred. Lewin's model of change provided a framework for protocol implementation. The purpose of this doctoral project was to evaluate this quality improvement project. Secondary data internal to the organization were collected and analyzed to answer the practice-focused question, Is there a relationship between implementation of a postpartum hemorrhage protocol and the incidence of postpartum hemorrhage? To determine the incidence of postpartum hemorrhage, the number of hemorrhages with and without blood transfusion was divided by the number of deliveries and recorded monthly. The chi-square test was used to analyze the rates of hemorrhage pre- and post-implementation. A statistically significant decrease in hemorrhage was noted post-implementation, suggesting that there was a relationship between implementation of a protocol and the incidence of postpartum hemorrhage. This project supported the Walden University mission by working towards optimal health outcomes for women. Eliminating preventable harm related to hemorrhage benefits women, families, and communities. Lessons learned from the implementation and evaluation of this quality improvement project are expected to be utilized by nursing leaders to address other challenges identified in the obstetric setting.

East Tennessee State University implemented quality improvement (QI) training for second-year family medicine residents in 2009. Results in 2011 indicated training increased scores in QI skill assessments as well as self-efficacy in QI. With residents who completed the training now in practice, does the increase in knowledge and skill translate to increased QI in practice? A survey of graduates compares frequency of QI cycles and self-assessment of QI skills among graduating classes, those receiving QI training and those graduating before training began. Residents that completed the QI curriculum rated their training higher; however residents that did not receive training were more involved in QI in practice. We suggest that this is due to QI involvement increasing with practice. Results will guide curriculum improvements to strengthen future resident training.

BACKGROUND: Pregnant and parenting women consistently show low rates of engagement and retention in substance use disorder (SUD) treatment. While pregnancy enhances motivation and commitment to treatment, this population faces unique barriers to accessing care. Co-design is an approach that proactively engages service users to create a care system shaped to meet their needs. This study evaluated an adapted experience-based co-design (EBCD) process involving SUD treatment staff and parenting women with SUD (WWLE). METHODS: Semi-structured interviews with WWLE and SUD treatment staff were conducted to develop content for the co-design process and identify barriers and facilitators to treatment. These data were analyzed using the principles of Trauma Informed Care (TIC). Multiple data sources were utilized to evaluate the co-design implementation, including semi-structured interviews, ethnographic observation, and discussion transcripts of EBCD launch events. The Integrated Promoting Action on Research in Health Services (i-PARIHS) framework informed tool development and data analysis of the co-design implementation. RESULTS: The full sample across all stages of the EBCD implementation totaled 34 individuals (WWLE =13 and SUD staff = 21). Findings highlighted the importance of TIC in small pivotal moments that either enhance or diminish treatment engagement and retention. For the evaluation, WWLE reported having a valued voice in the co-design process and attributed their comfort level to small, equally represented workgroups, skilled facilitation and pre-existing, respectful relationships with staff. Professionals expressed commitment to the concept of co-design, but displayed mixed perspectives about the value of EBCD. Complex regulations, limited funding, and uncertainties during start-up presented challenges to the co-design process. Use of a remote platform created accessibility for participants, but presented challenges to communication and relationship building. CONCLUSION: This research demonstrates how the core components of EBCD foster meaningful engagement of WWLE and can effectively create a collaborative co-design process that manages inherent power disparities between WWLW and treatment staff. The TIC analysis provides insight into aspects of care that encourage or deter women from treatment. This research illuminates the importance of integrating a TIC approach throughout a co-design initiative. Co-design presents an opportunity to create women-centered care and health equity in SUD treatment. / 2024-11-08T00:00:00Z

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Medical errors are a continuing issue for healthcare organizations and can lead to patient harm or death. To bring about organizational learning and therefore reduce medical errors, information must successfully flow through an organization. Nurse managers play an essential role as the conduit of information between frontline staff and the organization. The primary purpose of this study is to describe the decision-making process of how nurse managers actively select and transmit information on patient safety concerns. A qualitative constructivist grounded theory approach was used. Nineteen unit-level nurse managers, working full-time in an acute care hospital with a minimum of one-year experience were recruited through professional nursing organizations and snowball recruitment. Semi-structured, conversational, one-on-one interviews were conducted via Zoom or phone call, per the participant's preference. An initial interview guide based on the STOPS framework was used. Participants reported that after they acquired patient safety information, they quickly assessed whether or not the issue was severe and relevant. Then they prioritized the information based on the degree of the severity and relevance, the information source and type, and whether they needed feedback, guidance, or support. The prioritization step determined what mode and how frequently the message was forwarded. Although severity was a consistent consideration on whether to forward information, nurse managers struggled to define the concept. This study suggests that when a patient safety issue is on the extremes of the severity and relevance spectrum the decision-making process is clear. Whether to forward the information that was not on the extremes is less clear and more varied among nurse managers. This part of the decision-making process was inconsistent among nurse managers and has the potential for information to get lost. At the time of the interviews, COVID-19 had created an influx of patients into hospitals, which strained healthcare systems and providers. Nurse managers are in a position where they have insight on how COVID-19 has affected patient safety and can communicate that to their staff and into the organization. Therefore, a secondary thematic analysis of the data was conducted concerning the effects of COVID-19 on patient safety. Nurse managers identified several risks to patient safety that were exacerbated and created by COVID-19. Worsening staffing shortages have negatively affected staff psychological well-being, compelled nurses to work beyond their skill set, and necessitated providing only the mere essentials of nursing care. Burnout and patient isolation have also compounded patient safety concerns. But in the chaos and confusion, nurse managers were able to see some positives that resulted from the pandemic, such as improved teamwork, vigilance, and learning new skills, which can be used to better weather the next pandemic.

Yes / In relation to wrist imaging, the accepted requirement is two orthogonal projections obtained at 90°, each with the wrist in neutral position. However, the literature and anecdotal experience suggests that this principle is not universally applied. Method: This multiphase study was undertaken across eight different hospitals sites. Compliance with standard UK technique was confirmed if there was a change in ulna orientation between the dorsi-palmar (DP) and lateral wrist projections. A baseline evaluation for three days was randomly identified from the preceding three months. An educational intervention was implemented using a poster to demonstrate standard positioning. To measure the impact of the intervention, further evaluation took place at two weeks (early) and three months (late). Results: Across the study phases, only a minority of radiographs demonstrated compliance with the standard technique, with an identical anatomical appearance of the distal ulna across the projections. Initial compliance was 16.8% (n = 40/238), and this improved to 47.8% (n = 77/161) post-intervention, but declined to 32.8% (n = 41/125) within three months. The presence of pathology appeared to influence practice, with a greater proportion of those with an abnormal radiographic examination demonstrating a change in ulna appearances in the baseline cohort (p