Nursing (Doctor of Nursing Practice)

A social-learning group was used to train caregivers of school-age augmentative and alternative communication (AAC) users. Training was aimed at the caregiver of emergent AAC users and occurred in the home and community settings using a modeling strategy. Instruction was primarily delivered in three 15-minute training sessions using Facebook. In addition to social media instruction, the caregiver-child teams met with other participants to practice and implement newly learned skills during community activities. Meetings were approximately 1-hour in length and included coaching and feedback. A single subject AB design was used to evaluate the effects of community instruction on caregiver AAC modeling. Frequency of caregiver modeling is the dependent variable measured by direct observation. Module development utilized behavior skills training techniques consisting of (a) instruction (b) modeling (c) practice (d) feedback and coaching in the community setting.

Cardiovascular disease (CVD) is the number one killer of women. Surprisingly, only about half of women are aware of this risk. Statistically, heart disease kills about 1 in 5 African American and Caucasian women. Lifestyle behavior choices such as obesity, lack of exercise, consuming an unhealthy highly processed diet, smoking, and an intake of greater than 1 drink per day of alcohol increases a women’s risk for CVD. These risk factors are avoidable. These lifestyle behavior choices are modifiable and with improvements to each behavior they will decrease the women’s risk. Health and Wellness Coaching is a proven intervention to improve lifestyle behaviors that negatively impact chronic medical conditions. The development of a tailored lifestyle self-management intervention by a Nurse Practitioner in a Nurse Practitioner Wellness Clinic will address each of the lifestyle behavior choices to ultimately decrease the risk of cardiovascular disease and provide education that allows these changes to be enduring.

Background: Substance use disorders have increased in the U.S. in the past 20 years, with opioid abuse causing over 70,000 deaths from 1999 to 2019. The growing public health problem necessitates developing a patient-centered educational toolkit. Patients on benzodiazepines who are at increased risk of morbidity and mortality are not engaged in their benzodiazepine management and need a specific educational tool to provide the necessary knowledge for medication management. In addition, there is currently no patient education to improve benzodiazepine safety or evidence-based program to enhance the partnership between the prescriber and the patient in many offices. Method/Design: The investigator developed an evidence-based patient education toolkit to enhance patients' knowledge about the safe use of Benzodiazepines and the risks of chronic Benzodiazepine use. Forty-one participants completed a voluntary pre, and post-survey focused on benzodiazepine-related knowledge and willingness to decrease or cease use. This improvement project aimed to (i) educate and improve the patients' understanding of safe Benzodiazepine use. (ii) Increase patient's readiness to decrease or ease long-term Benzodiazepine use. Participants: A convenient sample of 41 patients prescribed benzodiazepines at the behavioral health clinic was selected. Results: Results of linear regression indicated that patients improved their knowledge regarding safe benzodiazepine use after using the patient-centered toolkit. However, no statistically significant changes were observed in patient willingness to decrease or cease benzodiazepine use. Conclusion: The patient-centered toolkit is useful in improving patient knowledge regarding safe usage of benzodiazepines. However, the toolkit was not beneficial in changing the patients’ willingness to cease or decrease benzodiazepine usage. Nevertheless, findings are helpful in nursing practice and should be used to inform current practice. Future investigators should improve the toolkit by completing projects focused on how the toolkit can be made more effective or used in more focused interventions.

This researcher described the current Fee for Service (FPS) Model to gain information regarding Nurse Practitioner Service awareness in Pennsylvania and introduced the practice model of Direct Primary Care (DPC). The respondents provided information related to the research question of: What are community members' knowledge of alternative pay models for primary care services provided by a Nurse Practitioner? What are community members' willingness to participate in alternative pay models for primary care services rendered by a Nurse Practitioner? The research showed access problems as >70% of respondents indicated difficulty to scheduling an appointment taking more than 24 hours. It was determined that >28% of respondents found the DPC model more attractive than their current care model, an example of perceived value. This research showed scalability potential meaning other Nurse Practitioners who wish to pursue the DPC practice model in their geographical area could reproduce similar data collection efforts to learn the perception in their state or locality. It is believed that burnout associated with healthcare providers is high and DPC provides an alternative practice model to curb burnout, engage patients and heighten health outcomes while focusing efforts on a smaller practice size., Copyrights are retained by the author. Please contact Neal Garverick for further use of this material.

Can seniors learn what is included in an AWV through an educational presentation, thus leading to an increase in participation and possible improving of overall health? This study aims to investigate if an educational presentation will be effective in increasing the knowledge of an AWV for senior citizens through a pre and post-test. The pre- test and post test will assess their level of knowledge. It will be a quantitative study using a 10 question survey. The seniors will take the survey once before the presentation and then again after the presentation. The participants will be using a Likert scale to rate the importance of a variety of questions that are included in an AWV. Participants over the age of 65 will be eligible for the study, regardless of sex, gender, religious affiliation, or cultural background.

Breast cancer affects people all ages, genders, and races. The ways in which providers prevent and detect breast cancer have change significantly over the years. Healthcare providers have a number of resources to utilize to screen patients for breast cancer appropriately. However, providers do not always follow the guidelines that are recommended likely due to lack of knowledge. The purpose of this evidence-based quality improvement project was to increase healthcare provider knowledge about current breast cancer screening guidelines and recommendations. In August of 2024 over a two-week period, healthcare providers at a federally qualified health center look-alike were asked to participate in an evidence-based quality improvement project concerning breast cancer screening guidelines. Participants completed a pretest and posttest questionnaire to measure if there was an increase in knowledge after completing the presentation. Fifteen participants completed both the pretest and posttest. A paired-samples t-test was utilized to analyze data which resulted in a statistically significant finding. These results conclude that a breast cancer screening guidelines presentation helps to increase provider knowledge.

Cardiac arrest is a global issue. Research has been done over the years to create the golden standard within the American Heart Association (AHA) that chest compressions matter. The research now is advancing beyond just the quality aspect. The new knowledge of the quality has led more researchers into the specific timing which is known as the ratio of chest compression fraction (CCF) time. The initiative behind the implementation of this project was to address the problem that the institution did not have any means of measuring either the quality of manual compressions or the CCF. CCF is the time doing compressions divided by the overall time of the cardiopulmonary resuscitation event.

Education was provided to staff on ways to reduce interruption: pre-charge defibrillator, establish pulse prior to holding compression and hoover over the chest for next compressor on the opposite side of the patient. In addition to education on current protocols, a manual compression feedback device was used to monitor real-time feedback. Quality improvement implementation of the measurement of CCF. Data was collected by using a manual feedback device. Reviewing the quality % of compressions. Data was collected for baseline, then post-implementation of education regarding the importance of measuring CCF.

Data were compared for pre and post-intervention, by reviewing overall patient outcomes and looking at the 30-day post resuscitation mark. The post-intervention data included 10 patients. Six of the patients had CCF greater than 80%, Four events used the manual compression feedback device, and two with the mechanical compression device. Four patients had a return of spontaneous circulation at the time of the resuscitation event. However, there were zero survival patients at the 30-day post-resuscitation mark. The data had no difference between the pre and post-interventions for the 30-day survival rate.

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.

Compassion fatigue, also known as secondary traumatic stress disorder, results from repeated exposure to the suffering of others, eventually exhausting his or her ability to show compassion. Self-care has been suggested as a potential preventative or treatment strategy in compassion fatigue however there has been limited documentation to validate this relationship. This study utilized a non-experimental, descriptive correlational design in order to determine if EMS professionals in Northwestern Pennsylvania, who practice self-care, experience less compassion fatigue than those who do not. A survey which was comprised of The Professional Quality of Life (ProQOL) scale, a validated tool for assessing compassion fatigue by evaluating secondary traumatic stress, burnout, and compassion satisfaction, as well as the Health Promotion Lifestyle Profile (HPLP) II, a tool to evaluate health promotion/self-care, was completed by 164 EMS professionals in Northwestern Pennsylvania. Spearman’s rank correlation coefficient was utilized to determine the relationship between self-care and compassion fatigue. The results demonstrated a negative correlation between self-care and burnout (p<.000), a negative correlation between self-care and secondary traumatic stress (p<.000), and a positive correlation between self-care and compassion satisfaction (p<.000), suggesting lower levels of compassion fatigue in those who practice self-care. These findings suggest that the implementation of self-care may result in decreased compassion fatigue, improving the EMS professional’s quality of life as well as patient outcomes.

During the COVID-19 outbreak in the spring of 2020, the nursing department responsible for facility-wide heart failure (HF) interdisciplinary communication was disbanded and redirected to other hospital needs. With that change and the subsequent lack of cohesive educational efforts, the hospital readmission rate climbed to 29.85%. This hospital system has consistently had readmission rates greater than the Centers for Medicare & Medicaid Services (CMS) national benchmark of 21.9%, which is both detrimental to our patients and the hospital to incur readmission penalties yearly. Before this program began there was no process to transition care from inpatient to outpatient for the HF population; key members that touched HF patients operated in silos. Based on consistently high readmission rates and the need for improved outcomes, a comprehensive HF discharge program was designed and implemented house-wide. Transitional care coordination includes providing education, scheduling post-discharge follow-up appointments, and providing HF toolkits. There was a retrospective analysis of data three months after the implementation of QI initiatives. Our facility’s all-cause 30-day readmission rate has progressively declined by 7.63% since the HF transitional program’s implementation (Study period 25.37% down to 17.74%). Readmission average rate for 2019 was 24.9% (n=241) (July 6-September 30, 2019) and compared to after implementation in 2020 was 22.56% (n=195) (July 6-September 30, 2020). Overall, we have found having an advanced practice provider (APP) led multi-disciplinary program to be the best practice for the HF population while improving outcomes and the ability for self-care while decreasing 30-day readmission.

Urinary tract infections (UTIs) are the most commonly treated infection among nursing home residents; patients are commonly treated even in the absence of signs or symptoms of a UTI being present. This research study’s objective is to reduce the amount of unnecessary antibiotic prescribing and assess the impact of educational interventions in nursing home residents that have asymptomatic bacteriuria (ASB). The design of this research study is quasi-experimental. The setting is Butler Memorial Hospital, a non-profit organization and an independent community hospital with 296 beds located in rural Pennsylvania. Population of interest includes nursing home residents that present to Butler Memorial Hospital’s Emergency Department with consecutive positive urine cultures. A multifaceted educational intervention will be provided to Emergency Department staff to reduce the number of unnecessary antibiotic prescribing in ASB cases. There were 105 in the sample population that resided in an institutional facility for the elderly that were seen in Butler Health System’s Emergency Department. Out of the DEFERRING ANTIBIOTIC PRESCRIBING IN NURSING HOME RESIDENTS WITH ASYMPTOMATIC BACTERIURIA 4 105-sample population, 73 were encountered before educational intervention. Twelve out of the 73 pre-educational sample population met the study’s inclusion criteria. Out of the 105 sample population, 32 were encountered after educational intervention. 4 out of the 32 post-educational sample population met the study’s inclusion criteria. In conclusion, this pilot study showed that there was a 3.9 percent overall reduction in nursing home residents that were being inappropriately diagnosed with a UTI and placed on unnecessary antibiotics when in fact they had ASB and met the criteria to defer prescription. While this was a small change the potential for changing prescribing habits with educational programs is encouraging and more studies should be done with larger samples sizes.

Background: 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.
Methods: The Quality improvement approach of Plan Do Study Act was utilized for this project. A literature review was completed to study methods of antibiotic stewardship. The electronic health record system was queried for delayed prescribing discharge instructions. Informal discussions among providers revealed absence of a cohesive approach to reducing unnecessary prescriptions for antibiotics.

Interventions: A PowerPoint was emailed to all providers on the use of delayed prescribing for antibiotics along with a Likert-Scale survey on provider perceptions of implementation. New instructions for patients on delayed prescribing of antibiotics was added to the existing electronic health record system. For a period of 30 days the number of times delayed prescribing instructions sheets were printed for patients was monitored along with the number of patients seen at each location. The provider survey was also reviewed.

Results: Provider survey demonstrated favorable attitudes toward antibiotic stewardship. The delayed prescribing instruction set was utilized twenty-seven times over the thirty-day period. There were 2,579 patient encounters during the study for a 0.9% utilization rate.

Conclusions: This was a new process in the clinic where the study was completed and though the utilization was low there was favorable consensus among providers on the value of antibiotic stewardship. There are many opportunities going forward including tracking diagnosis codes along with antibiotic prescriptions and following up to determine how many delayed prescriptions were filled. This research can provide a starting point for any outpatient facility looking to decrease rates of antibiotic prescribing.

Long-acting injectable antipsychotics (LAIs) are underutilized pharmacological treatment options for those with schizophrenia. Research examining psychiatric prescribers' relationship with LAIs hypothesized that their knowledge deficits, uninformed attitudes, and poor prescribing practices contribute to the underutilization of LAIs in clinical practice. There is a gap in the literature regarding educational interventions to address psychiatric prescribers' knowledge deficits, uninformed attitudes, and poor prescribing practices. The purpose of this Doctor of Nursing Practice (DNP) research project, based on the Knowledge to Action Framework, was to develop and evaluate the impact of a web-based educational toolkit on the knowledge, attitudes, and practices of psychiatric prescribers. A seven-part web-based module that included a presentation of the created educational toolkit regarding LAIs and a before and after knowledge, attitudes, and practices questionnaire was hosted on an online-open source learning management system and disseminated to psychiatric prescribers. Findings indicated that the web-based educational toolkit slightly improved the knowledge, attitudes, and practices of psychiatric prescribers regarding LAIs. It also revealed a relationship between a positive change in attitudes and psychiatric prescribers practicing in a hospital setting. This DNP research project reflects the essentials of the DNP degree. It contributes to the body of knowledge of psychiatric nursing, created a lasting reference tool for prescribing LAIs, filled gaps in the literature regarding LAIs, supports the use of continuing web-based education and toolkits, and serves as a catalyst for other studies regarding LAIs.

Patients who are receiving comfort-directed care at the end of their lives will be cared for by nurses throughout their hospital stay. Providing bedside end-of-life care requires specialty assessment, communication, and intervention skills. Nurses who provide bedside end-of-life care in the acute care setting may not receive specialty palliative care training as part of their undergraduate education. To address this an educational curriculum was designed by members of the Palliative Care team and a Palliative Superuser training program was developed. Guided by the Comfort ALways Matters (CALM) framework the course focused on specialized assessment and symptom management, holistic approaches to patients and their caregivers, and communication instruction. Course description is a four-hour workshop presented by certified registered nurse practitioners from the inpatient palliative care team. Nurses who complete the superuser training will act as mentors to their peers and will continue to receive educational updates every two months. A goal of training ten percent of nurses in the acute hospital setting was set. Individual class size is limited to 10 attendees to facilitate small group discussion. Program availability was advertised by email and flyer to the managers of all inpatient units. Nurses who expressed interest and volunteered to attend were chosen by their managers and enrolled in the class. Pre- and post- testing of nurses who volunteered for the training revealed improvement in knowledge, confidence, and comfort in providing end of life care after completing the initial training session. Early positive results of the QI initiative suggested that ongoing training will be valuable to the institution and the patients.

Background: The problem of interest is focusing on an increase for education within the forensic interviewing process for individuals within the multidisciplinary team and community stakeholders. The PICO question is: Does the development of an assessment tool kit for the child forensic interviewing process increase knowledge of qualified observations evidence by the multidisciplinary team and stakeholders. The Theoretical foundation for this research will aim to develop and present a toolkit that will enhance and positively affect the knowledge and practices of the forensic interview, based on the Iowa Method of Evidence-Based Practice and a Knowledge-to-Action structure.

Methods: Methods utilized a pre-survey, presentation, and post-survey; which entailed an example of setting the stage introduction, rapport, encouraged narrative, facilitators, interview instructions, narrative practices, and follow-up questioning. The analysis of the forensic interview consisted of a model structure in which the multidisciplinary team was given a pre-survey questioning acquired knowledge from previous education, a presentation entailing a structured conversation with a child intended to elicit detailed information about a possible event or events that the child has experienced or witnessed, and a post-survey that measured knowledge gained.

Results, conclusion, implications, and recommendations: The scholarly project gathered information through the pre/post surveys focusing on assessing the information interviewers typically review prior to conducting the forensic interview. The surveys revealed a lack of uniformity within the protocols and the preparation practice, as well as the observational viewers. Summary of data collected, there were limitations to the results which stemmed from a lag in the post survey sent out, as well as a decrease in response from the attendees. In conclusion, there was evidence of learning, which was observed through the results obtained.

The Pearson correlation was used with the result sought after to determine if there was a linear relationship between two quantitative variables, whether a positive or negative correlation. In this scholarly study, the variables were the pre and post survey measuring gain of knowledge by participants. Each question results were reviewed as data to the survey response, with a total of ten questions; both pre and post survey. The pre-survey there were 19 responses. The post-survey resulted in nine out of nineteen responses. Four questions had no statistical significance, however, the remaining questions relating to rapport with the child, impartial attitude, ground rules of the interview, appropriate process, open-ended questioning, and a value with discoverable evidence demonstrated a statistical significance.

This study evaluates the impact of training on providers’ confidence about using the MinuteClinic (MC) hypertension (HTN) guideline to conduct HTN management visits in MC. MC providers who participated or did not participate in the training/webex education sessions provided prior to the commencement of HTN chronic care services were surveyed and their confidence scores measured. T-test analysis did not show any statistically significant difference between the Trained group and the Non-Trained group. Factors enabling the lack of significant difference between the two groups and suggestions for further studies are discussed.

Nurse residency programs (NRPs) have been instrumental in assisting to bridge the theory-to-practice gap commonly experienced by new graduate nurses (NGNs). NRPs have also proven useful in improving retention, work satisfaction, confidence, and competence (Spector, et al., 2017; Ulrich, et al., 2010; Rosenfeld, & Glassman, 2016). Despite the overwhelming literature to support implementation of NRPs in all hospitals, to date, in the United States, only 31 hospital sponsored NRPs are accredited by the Commission on Collegiate Education in Nursing (CCNE) (AACN, 2019). Currently, public documentation on the number of NRPs accredited by the American Nurses Credentialing Center (ANCC) are unavailable. Additionally, in Pennsylvania, only 2 hospital sponsored NRPs have obtained national accreditation. NRP accreditation holds health care organizations accountable and proves these programs have demonstrated quality. For an organization to undergo a significant change initiative, such as accreditation, a state of readiness must be present or created (Franquiz & Seckman, 2015).

Background: Hypertension, or high blood pressure, is a chronic medical condition characterized by elevated blood pressure levels persistently exceeding the normal range. Hypertension is a crucial public concern and the leading cause of kidney disease and cardiovascular diseases, including heart attacks and strokes, and is the most frequent diagnosis seen in medical treatment in the US and worldwide. Adequate education, lifestyle modifications including physical activity, heart-healthy diets, and medication adherence are essential for patients with high blood pressure to be able to manage their disease and live with the best quality of life. Many studies have indicated the effectiveness of educational programs in reducing blood pressure and improving the health status of patients with hypertension.

Aims and Objectives: The purpose of this evaluation is to determine whether a formal single hypertension educational program will improve knowledge of management, increase motivation to change health behavior, and improve and promote medication adherence among the senior population.

Design: A pre-test and post-test study were conducted.

Methods: In this evidence-based education program, 33 older adult patients were recruited from the senior citizen community-based center in Philadelphia, PA. The intervention included education focused on improving knowledge of blood pressure, lifestyle changes, medication adherence, and motivation for behavior change. Outcomes were measured utilizing The Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB-Scale) and Hypertension Knowledge Test (HKT), a 12-item National Heart Lung & Blood Institute questionnaire.

Results: The program showed promising results that have positive implications for future practice and research. Of the participants that completed the study (N=33) of African descent, 27.7% were of Caucasian descent, 72.3%, 60.61 % were women, and 39.39% were men. The data collected reflected the participants' intentions regarding disease knowledge, medication adherence, and behaviors pre- and post-intervention. Findings suggest that community-based tailored education programs can successfully produce better HTN management by increasing hypertension knowledge, improving adherence to treatment regimens, and encouraging lifestyle changes among senior adult populations.

Conclusion: This educational intervention successfully identified improvement in senior adults' knowledge and increased motivation to change their blood pressure management health behaviors, leading to improved blood pressure control. It is hoped these results will be more widely used. Further investigation and future research would be more effective in meeting these goals in later programs to gain a more in-depth understanding of managing hypertension among senior adult communities.

Research has supported health literacy as one of the determinants in diabetes management (Fang et al., 2020; Kim & Utz, 2019; Robatsarpooshi et al., 2020; Van der Heide et al., 2014). Low health literacy has led to poor health outcomes in diabetes management (Poureslami et al., 2017; Van der Heide et al., 2014; Wang et al. et al., 2016). Research lacks interventions aimed at improving diabetes self-management for individuals with low health literacy (Jiang et al., 2019; Kim & Utz, 2019; Vandenbosch et al., 2018). This doctoral quality improvement project aims to evaluate the relationship between health literacy and diabetes self-management skills after participation in a web-based educational pilot program for adult patients with Type 2 diabetes in a rural community in Western Pennsylvania.

In hospitalized patients, the transition from hospital to home can lead to adverse events, negative outcomes, ER visits, and hospital readmissions (Backman et al., 2021). A poor transition of care can also be reflected in low Care Transition scores in HCAHPS surveys. The Care Transition questions reflect how well the patient felt prepared to manage their own care at home.

This quality improvement initiative answered the following research question: “In hospitalized adult patients, how does collaborative care transition planning compared with traditional discharge planning affect Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores one month after implementation”?

The theoretical framework is Larrabee’s model of Evidence-Based Practice. Methods include comparing the Care Transitions scores the month prior to implementation to those from the month following implementation.

There was a decrease in scores the month during implementation, but then increased in the month after. While not a part of the initial data collection, there was also an improvement in patients’ average length of stay. It can be concluded that the increase in communication amongst the healthcare team during the huddle did play a part in the efficiency of managing patients’ plan of care.

The nursing implications include the need for increased communication. When the healthcare team works together, it improves the patients’ transition from hospital to home. Future research may focus on length of stay as an important variable. A limitation of this study was a lack of consistency in collaborative rounding. Additional research in this area is needed.

A lack of support and understanding by healthcare professionals can contribute to cascading events in the quality of their patients, newborns, and communities’ lives from experiencing birth trauma. Women who experience a traumatic birthing experience without support can hinder their feelings of having more children, create relationship problems, negatively affect the bonding with their newborn, and they may avoid medical interventions that are like their birthing experience such as pap smears (Birth Trauma Association, 2018). This project aims to answer, “Does implementing trauma-informed care practices education to perinatal nurses increase their knowledge, attitudes, and practices of trauma-informed care after educational implementation?” Trauma-informed care (TIC) is a concept that is grounded in a set of four assumptions and six principles. A trauma-informed approach to nursing care is inclusive of trauma-specific interventions; whether it includes assessment, treatment, or recovery supports, it also incorporates key trauma principles into the targeted organizational culture. The results of the project noted a positive Pearson correlation from p= 0.1 to 0.6 in all areas of the nurse’s knowledge, attitude, and practices (KAP) from pre- to post-survey results. These results conclude that educating perinatal nurses does positively impact their KAP and is beneficial to implementation. This implementation impacts future perinatal nursing and maternal newborn dyads for generations. The ability to change cultural thinking from “What is wrong with you?” to “What happened to you”? This demonstrates an improvement in care and is the first step in healing for all past and future trauma survivors.

Background: Alcohol use disorder (AUD) has among been reported in 10-32% of hospitalized patients. The evidence suggests the need for screening and early management of alcohol withdrawal syndrome (AWS). Methods: This project included 2 phases - retrospective and prospective chart reviews. Demographic variables (age, gender, race) and length of stay were examined. Statistical tests were conducted to compare data from the phases. The outcome variables examined were the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale. Results: Of 61 patients in phase 1, most (72.5%) were males, had an average age of 47.1 years, and a length of stay of 8.1 days. Most (96.7%) of the patients were placed on CIWA at admission. In one patient, there was not a prompt initiation of the CIWA protocol and alcohol withdrawal treatment, which may have resulted in a reduced incidence of delirium and a shorter hospital stay. Of the 16 patients in phase 2, most (81.3%) were males, Caucasians (62.5%), with an average age of 49.3 years and a mean length of stay of 5.5 days. There were no significant differences at p<.05 between characteristics in the two phases of the study. In phase 2, 7 of 16 patients (43.8%) had a PAWSS score >=4, indicating that these patients were at high risk. 5 of these 7 patients experienced severe withdrawal symptoms making this a true positive PAWSS score. The PAWSS scores were not recorded for 9 patients in this study phase, and 7 of these patients had CIWA score >=16, indicating that the patients may experience severe withdrawal symptoms. Conclusion: As the problem of AUD continues to exist, more detailed information about the use of PAWSS and CIWA to assess alcohol withdrawal is needed. Improving strategies to evaluate the effect CIWA management may be warranted.

Problem Statement: According to the U. S. Preventive Services Task Force (2018), Falls are the leading cause of injury that are related to morbidity and mortality among older adults in the United States. In 2014, about 28.7% of adults aged 65 years or older had a history of fall resulting in 29 million falls in which about 37.5% required medical treatment or encountered restricted activity for a day or more while an estimated 33 000 resulted in death in 2015 (USPSTF, 2018). This is estimated to increase to seven falls per day by 2030 which makes it an important topic to address (CDC, 2021).
Objectives: The purpose of this project was to improve safety by conducting a retrospective review of a Quality improvement (QI) measures of an evidence-based fall prevention program in Assisted Living. PICO research question was identified as P- Older adult residents, I- Evidence Based Fall Prevention Guideline C- Comparing before and after fall prevention programs, O- Decrease in falls.
Methods: This research was completed in Southern New Jersey, United States. Participants were required to be at least 65 years of age and older. The squire guideline 2.0 was well used in this QI article. This study evaluated a QI fall prevention protocol of Physical Therapy (PT) that was instituted in the Assisted Living Facility (ALF). Data were obtained from EHR and paper records. For the purpose of this study, fall was defined as an inpatient’s unknowing, sudden drop to the floor with or without injury, regardless of height of drop, whether assisted or unassisted to the floor (NDNQI, 2020). A weekly number of falls were retrieved 6 weeks before intervention and 6 weeks after. Data was analyzed using t-test to compare outcomes and propose policy change.
Intervention: The IOWA model was used to do a retrospective review of the success of the program. It was used at the beginning of the QI project as a foundation for the project. The Iowa Model helped direct decision-making and EBP process from both the clinician and system’s point of view (Iowa Model Collaborative, 2017). This 12-week fall prevention program focused on falls before and after physical therapy for individuals 65 years and above. The EBP fall prevention program of PT was instituted during week 7 and monitored by all team members.
Result and Conclusion: Using the paired t-test analysis, findings revealed a significant difference in pre and post intervention of p< 0.05. There was a decrease in the number of falls post intervention when compared to pre-intervention data. All data are presented in graphs, charts and tables for description. This paper has about 51 pages including references and appendix with tables and graphs of statistical importance. All tables and graphs are original work of the authors. The pages can be reduced as the reference pages currently list all tables, graphs and figures already used in the body of the article. Given the large audience to your publication, this article will be very valuable to your professionals. It will help educate them or reinforce knowledge on how to reduce injury and high cost of care that are incurred from falls, and improve overall safety.

The purpose of this evidence-based practice project is to evaluate the effectiveness of a pilot mental health knowledge questionnaire tool used to assess for change in knowledge. Currently, there are limited tools being used to assess mental health and depression knowledge in vulnerable communities. This study’s objective and goal is to improve the current practice for community mental health education in vulnerable communities with the intent to increase awareness and dispel cultural misconception of mental health. A self-reported pre-test was administered to assess baseline knowledge of mental health and depression followed by the educational program on mental health and depression. The data was analyzed utilizing the Statistical Package for the Social Sciences (SPSS) 23 for descriptive and inferential statistics. The scores from a paired t-test were compared to determine the effectiveness of the educational intervention. This study sought participants aged 18 and older, fluent in speaking, reading, and understanding English. The findings reflect a positive improvement in knowledge recorded on the post-test responses. Results also showed an increase in correct responses on the post-test after the implementation of the mental health depression educational program. Finally, the promotion of educational programs on mental health and depression in vulnerable communities are beneficial in bring awareness of mental illness.

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.

Overweight and Obesity is defined, according to the CDC, as a weight higher than what is considered healthy for a given height (CDC, 2021). This is calculated using a screening tool for overweight and obesity. Overweight is regarded as a BMI of 25-30, and obesity is greater than 30. The latest data shows that adult overweight and obesity is increasing and has become a major global epidemic. Overweight and Obesity is a very complex health issue that has resulted from a combination of factors, including behaviors. This includes poor dietary patterns and inactivity. Lack of education in healthy nutrition is one of the issues contributing to overweight and obese adults. Other reasons can be psychosocial barriers that can include fear of judgment and uncertainty about the process of seeking help if one is obese. Other obstacles can consist of time commitment and the cost of programs. Being overweight and obese can lead to increased health risks like diabetes, heart disease, stroke, and certain cancers. According to the CDC, obesity is also associated with the leading causes of death in the United States (CDC, 2021). With this comes a significant economic impact as well. This small pilot study used participants in a brief online asynchronous. The criteria were people ages 18-65. Each volunteer participant gave written consent to participate and be evaluated during the program. Each volunteer participant answered the preprogram questionnaire, watched the virtually based PowerPoint presentation linked under YouTube, and then answered the same questionnaire to assess their new knowledge and willingness to change to a healthier lifestyle. The General Nutrition Knowledge Questionnaire was the tool used for evaluation. This questionnaire is a valid measure of nutrition knowledge that is consistent and reliable.

The virus responsible for Covid-19, acknowledged as a public health threat, has been causing global disease since it was first discovered in December 2019 in China. The CDC (2021) issued a call for action through its Science Agenda for Covid-19 to identify evidence-based interventions for interrupting disease progression in vulnerable populations such as those in emergency shelter settings.

This project focused on Covid-19 and its impact on the homeless population in northwestern Pennsylvania. The theoretical framework was the John Hopkins Evidence-Based Practice Model (JHEBP). A survey collected self-reported data on the practice and barriers to using personal non-pharmaceutical interventions (NPIs). Participants were adults ages 18 and over in one of two emergency shelters on the data collection date.

Sepsis is a clinical condition that requires early identification and initiation of evidence based interventions to improve mortality and outcomes. A quality concern that has been
identified is that the emergency department at the practice site is not actively screening for sepsis patients. This has resulted in difficulty meeting three-and six-hour sepsis
bundle metrics. The purpose of this quality improvement project is to implement a sepsis screening methodology to correct this gap in practice. The door to lactic acid collection metric will be used to determine if any statistical improvement was made after the implementation of a sepsis screening tool. The screening tool selected for the project will be the qSOFA tool as this is one of the easiest tools to use and implement. The quality improvement project used a quantitative methodology with quasi-experimental design. The results demonstrated a statistically significant improvement in the collection times of lactic acid post-implementation. The results further support the use of sepsis screening in the emergency department setting for rapid identification and treatment of sepsis conditions. Emergency nursing plays a pivotal role in the identification and treatment of this condition as nurses are often the first healthcare professional a septic patient will encounter.

Atrial fibrillation is the most common dysrhythmia and has significantly impacted healthcare staff and systems. Catheter ablations remain the most effective tool in the treatment of
atrial fibrillation, and yet these have often contributed to hospital admissions and costs. Sameday discharges are a safe and cost-saving method being used more in this patient population. This study was completed to evaluate and compare same-day discharge versus admission following catheter ablation.

In the study, there were 321 patients who underwent catheter ablation for atrial fibrillation over 12 months from July 2021 to July 2022. Of these 321 patients, there were 74 same-day discharges. 30-day readmission rates for both samples were similar, with 4 (4%) patients readmitted following same-day release and 3 (2%) patients readmitted following observation or inpatient admission. 90-day readmission rates for both samples were also similar at 2.7% for same-day discharges and 1.2% for observation/inpatient admissions. There was a cost savings of at least $37,000 using same-day discharge versus at least $123,000 in costs for admission for observation or inpatient. Based on this study, the use of same-day discharge in catheter ablation for atrial fibrillation is reaffirmed as safe and cost-effective and should be considered in routine practice.