Nursing (Doctor of Nursing Practice)

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.

Clostridium difficile is a microbe that may cause a severe intestinal infection in vulnerable individuals such as those who are ill and taking antibiotics, or the elderly living in skilled care facilities. Use of probiotic supplements have shown in some studies to decrease the incidence of Clostridium difficile infection (CDI). Does the use of probiotic supplements in residents of a skilled nursing facility in western Pennsylvania receiving antibiotic therapy reduce the incidence of CDI? This retrospective study reviewed electronic medical records of 164 residents in a skilled nursing facility, including residents receiving antibiotics, and those receiving antibiotics and probiotics. Limitations included the size of the study sample, the age and condition of the patient including possible previous CDI history, and the time frame of transposition of laboratory analysis results to the electronic medical record. Results revealed a statistically significant difference in the rate of antibiotic-related diarrhea between patients receiving antibiotics and those receiving antibiotic therapy with probiotic supplements. In this study, no patients receiving probiotics and antibiotics were positively diagnosed by laboratory analysis with CDI. This study indicates the need for further studies related to use of probiotic supplements in patients receiving antibiotic therapy.

This study was a non-experimental, cross-sectional design with retrospective electronic medical data review to assess the effectiveness of an EMR intervention in Hepatitis C Virus (HCV) screening for those born between 1945-1965 birth cohort. The study measures three months pre-EMR provider prompt and three months post-EMR provider prompt. Screening, statistically the patients who met HCV screening criteria increased from 27.9% to 72.1% post-EMR provider prompt screen. With the increase in screening, the study showed an increase overall HCV testing from 5.6% to 37.6% post-EMR provider prompt screen. This increase in both screening and testing for HCV, allows the possibility to capture those undiagnosed Hepatitis C patients and provide the patient with appropriate linkage to care to decrease overall morbidity and mortality within the given birth cohort. The success of utilizing an EMR prompting system, will allow the opportunity for further research in other aspects of health maintenance.

There is existing research noting a possible correlation between vitamin D insufficiency and irritable bowel syndrome. The etiology of irritable bowel syndrome is unknown with the goal of the health care provider being symptom control. There are studies suggesting insufficient vitamin D levels may cause an inflammatory response in the gut leading to symptoms of irritable bowel syndrome. Out of 118 patients in a private gastroenterology practice in rural Western Pennsylvania, 62 individuals with the diagnosis of irritable bowel syndrome had vitamin D blood levels drawn within the last 5 years. The diagnosis of irritable bowel syndrome was broken down into IBS/ diarrhea, IBS/ constipation, and IBS/mixed. The expected value from the Chi-Square test as derived from a proportional analysis of low vitamin D levels in the general population of the United States is 19.8. The observed value from this study is 30, a 10.2 value higher than the expected value. The Chi-square test indicated significance, thereby the (30) IBS patients (48.3%) the total patients with low levels of vitamin D as compared (32) IBS patients (51.1%) of the total patients with normal levels of Vitamin D, where Chi-square (1, n = 62) = 7.6, p < .006. The study showed a possible correlation between insufficient vitamin D levels and irritable bowel syndrome in a small rural gastroenterology practice in Western Pennsylvania. Further investigation into a possible correlation between vitamin D insufficiency and symptoms of irritable bowel syndrome in the adult patient would be a positive step towards this challenging functional bowel disorder.

The aim of this study was to evaluate the difference in patient satisfaction scores between lesbian, gay, bisexual, transgender, questioning or queer, intersex, and asexual (LGBTQIA+) individuals who receive healthcare from LGBTQIA+ inclusion clinics and LGBTQIA+ individuals who receive healthcare from traditional clinics. LGBTQIA+ individuals have unique healthcare needs and require safe, affirming, culturally competent, and inclusive healthcare environments that will meet these unique needs, eliminate health disparities and inequities, and improve patient reported outcomes such as patient satisfaction.