Changing Osteoporosis Knowledge and Behaviors Through Structured Education.

Osteoporosis is a silent disease that is associated with enormous cost and can lead to disability and death. We identified that individuals who have sustained a fracture from a fall are often unaware of osteoporosis risk factors and have a knowledge deficit regarding osteoporosis. Therefore, they do not receive the proper treatment. An evidence-based practice project was completed using "pre-post" intervention tools with an educational intervention to measure osteoporosis knowledge and self-efficacy in individuals hospitalized with a fragility fracture. A convenience sample of 25 participants 50 years and older, who were admitted with a fragility fracture, received targeted education. Descriptive and comparative statistics were used for comparison of pre- and postintervention data. Hospitalized osteoporotic individuals have a gap in knowledge regarding the existence of osteoporosis. Healthcare workers can improve knowledge and self-efficacy by offering osteoporosis education for these individuals.

Implementing the evidence: Routine screening for depression and anxiety in primary care.

Background: Primary care providers are qualified to treat, diagnose, and manage common mental health issues like anxiety and depression. Anxiety and depression are common among college age students, with the average age of onset occurring in one's late teens to early 20s. Screening tools are commonly used to recognize patients who may be at risk for anxiety and depression. Purpose: The purpose of this evidence-based practice project was to (a) implement evidence-based guidelines for screening and management of college-aged patients with anxiety and/or depression and (b) to develop an algorithm that describes evidence-based management to guide providers at two student health centers. Methods: All patients who registered for a sick visit or other appointment at the project site were screened for anxiety and depression using two validated tools. An algorithm to help healthcare providers properly assess and better treat anxiety and depression was developed and implemented for this project. Results: A total of 366 patients were screened for depression and anxiety over a 3-month period. Using the created algorithm, patients received education on anxiety and/or depression and a counseling referral. If warranted, patients were prescribed medication therapy for depression and/or anxiety. Conclusion: Screening for anxiety and depression has become the standard of care in primary care clinics. Routine screening tools help healthcare providers identify patients with anxiety and depression. Early identification and diagnosis of anxiety and depression leads to better outcomes in treatment.

Implementing a Resilience Bundle for Emergency Nurses: An Evidence-Based Practice Project.

INTRODUCTION: Resilience bundles are designed to work within and enhance existing routines. In the wake of COVID-19, nurses are reporting high levels of burnout and are leaving the field at an alarming rate. Hospital system leaders across the country are working to develop wellness programs to improve nurse morale, decrease burnout, and enhance resilience. Resilience can help mitigate nurse burnout, and using a bundle of tools to help nurses develop resilience is more effective than a single strategy. METHODS: Using the Connor-Davidson Resilience Scale-10 and the Perceived Stress Scale 4, emergency nurses were surveyed to measure resilience and stress before and after implementation of a 3-strategy resilience bundle. We surveyed at baseline, phase 1 (6 weeks after implementation), and phase 2 (15 weeks after implementation). RESULTS: A statistically significant increase in the Connor-Davidson Resilience Scale-10 scores was identified between the baseline and phase 1 surveys. A measurable decrease in the Perceived Stress Scale 4 was found between the baseline survey and the phase 1 and phase 2 postintervention surveys. DISCUSSION: Although evidence suggests a multifocal approach to improving resilience, use of resilience bundles is new. To enhance nurse resilience and mitigate burnout, nurse leaders may consider resilience bundles to prioritize the mental health and wellness of their staff.

Touchpoints: A Business Strategy to Retain New Graduate Nurses.

OBJECTIVE: The aim of this study was to reduce the turnover of new RNs (NRNs) completing a 1-year nurse residency program. BACKGROUND: Businesses use touchpoints to retain both internal and external customers, yet no evidence was found in retaining NRNs. Touchpoints, distinct points in the company-customer experience, play a vital role in the customer's experience with the company. Employees are one of a company's many customer types. METHODS: This quality-improvement project implemented touchpoints to improve NRN retention rates. RESULTS: Retention rates and job-satisfaction scores were significantly higher among the touchpoint-intervention cohort compared with the nonintervention cohort. Implementation costs were far less than those associated with NRN turnover. CONCLUSIONS: Touchpoints are a practical management approach for NRN retention.

Measuring health professionals' beliefs about skin-to-skin care during a cesarean.

Women and their newborns are at risk of delayed or withheld skin-to-skin care (SSC) during a caesarean, which is about one-third of births, worldwide. To date, no instrument exists to assess health professionals' (HPs) beliefs, and potential barriers and strategies for implementing SSC during a cesarean. The study aims were to (1) develop an instrument, Health Professionals' Beliefs about Skin-to-Skin Care During a Cesarean (SSCB ), (2) establish its validity and reliability and (3) describe HPs' beliefs about SSC during a caesarean. Quantitative and qualitative analyses were used to test the SSCB and describe HPs' beliefs. SSCB analysis yielded a content validity of 0.83 and reliability of α = 0.9. We grouped all practice roles as either nurses or physicians. The mean rank score for nurses (n = 120, M = 90) was significantly higher (p = 0.001) than physicians (n = 46, M = 79). Despite this difference, scores for both roles reflected support for SSC. Participants identified hospital readiness to implement SSC and maintaining maternal and newborn safety as major issues. SSCB is a valid, reliable instrument to measure HPs' beliefs about SSC during a caesarean birth. HPs can use the SSCB during quality improvement initiatives to improve access to immediate SSC for women who have a caesarean birth. Improved access can enhance breastfeeding outcomes and promote optimal maternal and child health.

The effect of PARO robotic seals for hospitalized patients with dementia: A feasibility study.

Robotic seals have been studied in long-term care settings; though, no studies of patients with dementia in the acute care setting have been reported. The purpose of this study was to evaluate the feasibility of PARO interventions for hospitalized patients with dementia, determine physiological effects and describe social-affective interactions. Using a prospective descriptive design with pre-post PARO intervention physiological measurements, we studied 55 participants who received up to five 15-min PARO interventions. The PARO was favorably accepted for 212 (95%) of the 223 PARO interventions. Differences in pre- and post-physiological measures for mean arterial pressure, pulse, respiration, oxygenation, stress, and pain levels were evaluated using Wilcoxon Signed Rank test with statistically significant pre and post differences (p=<0.05); however, the differences were not clinically significant. Participants (95%) demonstrated beneficial PARO interactions with the most frequent interactions being speaking and petting. The PARO shows promise for enhancing social and affective responses for hospitalized patients with dementia.

The Risk of Infection and Indication of Systemic Antibiotics in Chronic Wounds.

BACKGROUND: No definitive guidelines exist to assist clinicians in determining when a chronic wound is infected or at risk for infection, nor do guidelines exist to aid in determining the indication or duration of systemic antibiotics. The lack of widely accepted guidelines can lead to excessive and improper use of systemic antibiotics, which can contribute to adverse drug events and the rise of multidrug-resistant organisms. Implementing a simple tool to measure the risk of infection in patients with chronic wounds could help clinicians determine the indication and appropriate use of systemic antibiotics as well as potentially reduce the use of systemic antibiotics. OBJECTIVE: This evidence-based practice project aims to identify both chronic wounds at risk for infection and the risk factors associated with chronic wound infection, evaluate the use of systemic antibiotics in patients with chronic wounds, and reduce the use of systemic antibiotics in chronic wounds that are not infected or at risk for infection by implementing a Wounds at Risk (WAR) score for all patients admitted with chronic wounds. MATERIALS AND METHODS: In this pre- and post-observational study, a convenience sample of all patients admitted with chronic wounds over a 6-week period were given a WAR score based on electronic medical record observations. Data were collected on the use and indication of systemic antibiotics and were compared with the same data of a control group of patients admitted with chronic wounds during a 6-week period before project implementation. Other clinical, microbiological, and demographic data also were collected and compared between the 2 groups. RESULTS: Though not significant, the overall use of systemic antibiotics was decreased in the post-intervention group. A significant reduction was seen in wound-related indications for antibiotics, most notably in the "infected ulcer" category. Diabetic foot ulcers were at highest risk for infection, and pathogen or microbiological burden did not play a significant role in infection risk. CONCLUSIONS: The WAR score can help guide clinicians in determining the need for antibiotics, thus helping to reduce unnecessary antibiotic exposure, which can reduce the incidence of adverse drug events and multidrug-resistant organisms.

Effects of Skin-to-Skin Care During Cesareans: A Quasiexperimental Feasibility/Pilot Study.

Introduction: Our aim was to describe feasibility and outcomes of skin-to-skin care (SSC) that began during cesarean surgery and continued, uninterrupted, for about 5 hours. We described maternal/newborn measures of physiologic stability and stress; maternal measures of comfort; maternal satisfaction with surgery and SSC; and exclusive breast milk feeding at discharge. Materials and Methods: We used a quasiexperimental, time-interrupted design and randomly assigned women to receive SSC that began during surgery (Group 1, intervention; n = 20) or after surgery, before transfer to recovery (Group 2, standard care; n = 20). We analyzed differences across time and for five observations: before transfer to the operating room (OR); in the OR, about 20 minutes after birth; in the recovery room, about 1 hour after admission; in the New Family Center (NFC), about 1 hour after admission; and in the NFC, about 2 hours after admission. Results: Group 1 began SSC an average of 0.89 minutes after birth and continued an average of 300 minutes and Group 2 began an average of 46 minutes after birth and continued an average of 126 minutes. Women who began SSC during surgery were more satisfied with the experience (p = 0.015) and had lower levels of salivary cortisol across time (p = 0.003). We found no negative effects on maternal or newborn measures of physiologic stability and no difference in exclusive breast milk feeding rates at discharge. Conclusion: Immediate and uninterrupted SSC during medically uncomplicated cesarean surgery is a feasible, low-cost intervention that can safely begin during surgery and continue, uninterrupted, for extended durations.

Comparison of the Nephrotoxicity of Vancomycin in Combination With Cefepime, Meropenem, or Piperacillin/Tazobactam: A Prospective, Multicenter Study.

BACKGROUND: Patients often receive broad-spectrum antibiotics for nosocomial infections commonly with activity against Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Previous retrospective and/or single-center studies have suggested that the combination of vancomycin and piperacillin/tazobactam might be associated with an increased risk of acute kidney injury. OBJECTIVES: To compare the incidence of nephrotoxicity in patients receiving intravenous vancomycin in combination with cefepime, meropenem, or piperacillin/tazobactam. METHODS: This was a prospective, multicenter observational study of patients receiving vancomycin in combination with piperacillin/tazobactam versus cefepime or meropenem. Adult patients 18 years of age or older who were hospitalized and received 72 or more hours of intravenous vancomycin and 72 hours or more of cefepime, meropenem, or piperacillin/tazobactam were eligible. Patient and medication characteristics were examined for the 242 patients included. RESULTS: The incidence of acute kidney injury for patients treated with vancomycin and piperacillin/tazobactam was significantly higher than for those treated with vancomycin and cefepime or meropenem, 29.8% versus 8.8%, respectively, P < 0.001. Binary logistic regression demonstrated that patients receiving vancomycin and piperacillin/tazobactam were 6.7 times more likely to develop acute kidney injury compared with the other cohort. CONCLUSIONS: The combination of vancomycin with piperacillin/tazobactam significantly increases the risk of acute kidney injury compared with other broad-spectrum antibiotic combinations. Clinicians should be vigilant when employing this regimen.

Improving Adherence to Atypical Antipsychotic Agent Screening Guidelines in Pediatric Patients: A Quality Improvement Project Within an Integrated Community Mental Health Setting.

BACKGROUND: Approximately 14% to 20% of children and adolescents have a mental health problem. Atypical antipsychotic agents are used to treat behavioral, emotional, and mental health problems in children and adolescents. A discrepancy between best practices and actual practices exists. OBJECTIVE: The purpose of this quality improvement project was to increase adherence above baseline, through implementation of a checklist, to recommended screening guidelines in children, ages 4 to 18, prescribed atypical antipsychotic agents over 12 weeks. Design/Results: Aggregate comparison of the mean ranks of scores were tested with the Mann-Whitney U test, U = 1,087.5, n1 = n2 = 70, total N =140, p < .001. Variables of body mass index, blood pressure, waist circumference, fasting glucose, fasting lipids, personal history, and family history were observed and tested using the chi-square with Fisher's exact tests and are significant at or above 99% confidence level ( p < .01). CONCLUSION: Educating mental health providers, child and adolescent psychiatrists, and psychiatric mental health nurse practitioners on recommended screening guidelines and implementing a checklist had a measurable effect on increasing adherence to the recommended screening guidelines in a community mental health setting.

Collaborative Effort to Manage Childhood Obesity: Parental Employer, Health Insurance, and Employee Health Clinic.

BACKGROUND: Childhood obesity is an epidemic in the United States affecting 12.7 million children (Centers for Disease Control and Prevention, 2015a), and costing the United States $14.1 billion every year (Cawley, 2010). It also costs corporate America about $9 billion in direct costs (Adeagbo, 2015) and $4.3 billion in indirect costs for health-care expenditures (Cawley, 2010). Studies suggest interventions implemented by employers involving the whole family are twice as effective as interventions with employees alone (Adeagbo, 2015). METHODS: This quality improvement pilot study used a quasi-experimental pretest and posttest design in an outpatient employee health clinic to evaluate a coaching method for empowering parents to manage childhood obesity. A convenience sample of 10 employed parents who had children between the ages of 2 and 19 years who were overweight or obese and met study criteria, were enrolled. Three coaching sessions lasting 20-30 minutes were provided before administering the posttest questionnaire. RESULTS: The Mann-Whitney U test showed a measurable positive difference after coaching on healthy behaviors and was statistically and clinically significant (Mann-Whitney U = 80, Wilcoxon W = 125, standard error = 12.26 and p = .003). CONCLUSION: Findings indicate management of childhood obesity through parental education, coaching, and family-based interventions can promote healthy lifestyle changes among children.

Influence of Immediate Skin-to-Skin Contact During Cesarean Surgery on Rate of Transfer of Newborns to NICU for Observation.

We conducted an evidence-based practice project to determine if skin-to-skin contact immediately after cesarean birth influenced the rate of transfer of newborns to the NICU for observation. We analyzed data for 5 years (2011 through 2015) and compared the rates for the period before implementation of skin-to-skin contact with rates for the period after. The proportion of newborns transferred to the NICU for observation was significantly different and lower after implementing skin-to-skin contact immediately after cesarean birth (Pearson's χ2 = 32.004, df = 1, p < .001). These results add to the growing body of literature supporting immediate, uninterrupted skin-to-skin contact for all mother-newborn pairs, regardless of birth mode.

Public Health Nursing Practice in the Affordable Care Act Era: A National Survey.

OBJECTIVES: To explore public health nurses' knowledge, perceptions, and practices under the Affordable Care Act (ACA). DESIGN AND SAMPLE: A cross-sectional, web-based survey was completed by a sample of 1,143 public health nurses (PHNs) in the United States. MEASURES: Descriptive statistics were analyzed for variables related to general knowledge and perception of the ACA and for the extent of involvement in activities related to the implementation of the ACA. Qualitative analysis was conducted on free text comments to two open-ended questions about current and future PHNs involvement in the ACA. RESULTS: Approximately 45% of PHNs reported changes in their daily work due to the ACA. PHNs reported being very or somewhat involved in these activities of the ACA: integration of primary care and public health (62%), provision of clinical preventive services (60.3%), care coordination (55.4%), patient navigation (55.3%), establishment of private-public partnerships (55.3%), population health strategies (53.6%), population health data assessment and analysis (53.8%), community health assessments (49%), involvement in medical homes (37.8%), provision of maternal and child health home visiting services (32.1%), and involvement in Accountable Care Organizations (29.2%). CONCLUSION: PHNs are making substantial contributions to implementation of the ACA.

Content analysis of continuing education for cervical cytology.

AIM: The purpose of this project was to assess free and low-cost web-based continuing education activities to determine if they reflect updated national guidelines for cervical cancer screening. METHODS: A qualitative design and descriptive statistics were used to conduct a content analysis. An abstraction tool was used to evaluate 15 continuing education activities. Data collection was conducted between January and February 2013 by two registered nurses. The results were recorded independently and compared for agreement between data collectors, as well as inter-rater reliability of the data collectors, and the abstraction tool was used to collect data for the analysis. RESULTS: The majority of the continuing education activities included the updated guidelines for screening intervals, the age to begin screening and when to discontinue screening. Most of the activities also indicated that human papillomavirus (HPV) DNA testing is not recommended for younger women. Very few of the continuing education activities included tips for providers to use when counselling patients. CONCLUSIONS: The correct information on age-appropriate screening intervals and HPV co-testing was included in the continuing education activities reviewed. The areas that were largely underrepresented in the continuing education activities were the risk factors, prevention measures for transmission of HPV, patient counselling about HPV and the appropriate screening practices.

Use of a video-ethnographic intervention (PRECESS Immersion Method) to improve skin-to-skin care and breastfeeding rates.

PURPOSES: Skin-to-skin care after birth often is absent, interrupted, or delayed for routine procedures. The purposes of this project were to improve skin-to-skin care and exclusive breastfeeding at hospital discharge. METHODS: For Part 1, we used a descriptive observational design, with video-ethnography and interaction analysis (PRECESS-Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success), during a 5-day quality improvement pilot study in a U.S. hospital (August 13-17, 2010). For Part 2, we used electronic health record review to test for differences in monthly rates of skin-to-skin care and exclusive breastmilk feeding (baseline, July 2010; post-intervention, August-December 2010). RESULTS: In Part 1, 11 mothers and babies participated: 10 (91%) received immediate skin-to-skin care, eight (73%) received uninterrupted skin-to-skin care, nine (82%) planned to breastfeed, six (67%) of these babies were exclusively breastfeeding at hospital discharge, and five (83%) of the six babies who completed all nine instinctive stages during skin-to-skin care were exclusively breastfeeding at hospital discharge. In our subsequent review (Part 2), we found a significant improvement (25% above baseline) in the overall rate of skin-to-skin care across post-intervention months (Pearson χ(2)=23.798, df=5, p<0.000), predominantly from improvements in the cesarean section population. The rates of exclusive breastfeeding showed no significant change. CONCLUSIONS: The PRECESS immersion method may help to rapidly improve skin-to-skin care. Babies who undergo all nine stages during skin-to-skin care may be more likely to exclusively breastfeed. Mothers need support during skin-to-skin care to recognize their baby's readiness to breastfeed. Skin-to-skin care during cesarean surgery may reduce maternal stress and improve satisfaction with the surgical experience.