Partnering with Hospital Providers to Facilitate Handoff for Persons with Dementia in the Acute Care Setting

Practice Problem: Individuals with Alzheimer's disease and related dementias cannot verbalize their care needs during transitions of care (TOC) and rely on their home caregivers (HCs) for advocacy. The lack of communication between clinicians in one setting and HCs can lead to detrimental health outcomes for the length of stay. PICOT: The PICOT question that guided this project was: With the assistance of family nurse consultants (P), how does the implementation of standardized care needs communication tool for support persons of persons with dementia (I) vs. no standardized process (C) enhance the ability for the support person to communicate care needs during TOC (O) within 5 weeks (T)? Evidence: The review of high-quality studies reveals evidence that supports clinician-home caregiver communication as an approach to bridge gaps for the person with dementia (PWD) across health care settings. Intervention: The clinician-home caregiver communication checklist was used as an evidence-based tool to enhance the HC’s ability to communicate care needs for the PWD during care transitions. Outcome: There was a clinically significant improvement with the family nurse consultants’ utilization of the tool, and HCs who were offered the tool benefited from that time of preparation for their loved ones. There was a statistically significant improvement in family nurse consultants’ perception of the value and usefulness of the tool after they were introduced to it. Conclusion: The project findings revealed that using the standardized care needs communication tool, HCs can be crucial members to strengthen TOC for the cognitively impaired individual.

Implementing Geriatric Frailty Screening in Acute Care

Practice Problem: Frailty is a syndrome of age-related physiologic decline characterized by an increased burden of symptoms and higher susceptibility to adverse health, including higher functional decline rates, pressure ulcers, falls, and delirium. In the general medicine unit of this project, geriatric patients were not screened for frailty. PICOT: The PICOT question that guided this project was: In hospitalized patients 65-years-of-age and older (P), how does implementing a geriatric frailty screening tool (I), compared to standard assessments (C), influence frailty identification and personalized plans of care (O) over eight weeks (T)? Evidence: Literature supports screening for frailty in the hospitalized geriatric population. Intervention: For eight weeks, a group of four RN clinicians piloted the CFS and collected data on patient appropriateness for screening, completion of screening, CFS scores, and influence of CFS scoring on personalized patient care plans. Outcome: Statistical analysis results suggest that completing the CFS and adjusting the individualized plan of care were related to one another. Conclusion: Applying best practices to identify frailty during hospitalization demonstrated a measurable influence on health promotion in acutely ill geriatric patients.

Development and Implementation of an Opioid Risk-Reduction Strategy

Practice Problem: Accidental overdose is a continued concern for those who are prescribed opioids, and it is essential that healthcare members intensify prevention and response measures in order to prevent death or misuse from this medication. PICOT: The PICOT question that guided this project was: “In adult patients at an outpatient chronic pain management clinic (P), how does development and implementation of a safe opioid risk-reduction office policy (I), compared to usual practice (C), improve patient rates of naloxone availability and health literacy (O) over eight weeks (T)?” Evidence: The CDC’s Guideline for Prescribing Opioids for Chronic Pain, the Surgeon General’s Advisory on Naloxone and Opioid Overdose, and the U.S Department of Health and Human Services website were used to gather evidence-based components for information and practice changes. Intervention: This project created a safe opioid risk-reduction strategy in the form of a new office protocol that ensured naloxone was received with instruction on what to do in the event of an overdose or life-threatening respiratory reaction to opioids and other safety information. The providers assessed the change in knowledge by using the teach back method. Outcome: The results showed improvement in the availability of naloxone as a reversal agent as well as increased understanding of safe opioid storage, disposal, and drug interactions. Conclusion: The manuscript reports barriers, successes, and challenges discovered during the project. The recommendations can be applied to other outpatient clinic sites to enhance the safety of all patients who manage their chronic pain with the use of prescription opioids.

Preventing Falls in Long-Term Care Using Patient-Centered Fall Interventions

Practice Problem: The practice problem identified within the Community Living Center included continuous falls, despite using current fall prevention strategies and provider-driven interventions. Baseline data reflected a fall rate of 4.2 in the long-term care areas despite improving the fall prevention program. PICOT: The PICOT question that guided this project was: In older adult residents (P), what is the effect of a standing operating procedure (SOP) using patient-centered interventions (I) compared to physician-driven fall interventions (C) on decreasing falls and falls with injuries (O) within one month (T)? Evidence: In twelve high-quality articles that fit the eligibility criteria and contained EBP literature, the overwhelming evidence revealed that an SOP encompassing patient-centered fall interventions could decrease LTC falls and falls within injury rates. Outcome: Observations reflected the nursing staff utilized the SOP and patient-centered fall interventions in practice; however, fall rates on both LTC #1 and LTC #2 increased from baseline, but the falls with injury rates remained zero. Patient satisfaction measured a weighted mean score of 4.7 of 5 points, representing satisfaction with the patient-centered interventions and nurses as a whole. Conclusion: The EBP project did not result in an overall reduction in the fall rates; however, falls with injury rates remained at zero. Furthermore, the patient's overall satisfaction with the nurses and patient-centered fall prevention program was favorable. It is essential to note that due to COVID-19 related events, the project halted after 30 days, and the results might have been different if implemented 90 days as initially projected.

Using Problem-based Tasks to Promote Higher-order Thinking Skills for TESOL MA Students in Vietnam

This paper denotes the findings from an action research project, which applied problem-based learning (PBL) in linguistics courses in an MA TESOL program in Vietnam. The project aimed to study the extent to which the use of problem-based tasks in semantic courses could promote students’ employment of higher-order thinking skills in their learning. It was found that the PBL approach was specifically appropriate in promoting higher-order thinking skills for students with passive learning habits in such Confucian heritage cultures as Vietnam. With well-designed problem-based tasks and adequate tutoring, students learned how to use higher-order thinking skills to facilitate their learning; how to stay more focused on the completion process of problem-based tasks; and how to be motivated to engage in learning activities. In addition, some students were encouraged to follow the same PBL approach in their own teaching practice. Problem-based tasks which took place at a fixed time during class seemed to cause students to lose interest. In addition, a lack of adequate job experience might also have limited the effectiveness and overall success of the problem-based tasks.

Improving Mammography Rates Among the Hispanic Population: An Evidence-Based Project Utilizing a Promotora Intervention

Practice Problem: Breast cancer is the leading cause of death in Hispanic women in the U.S., with mammography being the most effective means of reducing breast cancer mortality. Promotoras have been shown to improve health promotion, including mammography, among the Hispanic population. PICOT: The PICOT question that guided this project was: In Hispanic women 40 years or older (P), how does the use of a promotora intervention (I), compared to no promotora intervention (C), affect mammography rates (O) within an 8-week period (T)? Evidence: Twenty-one studies that met the inclusion criteria supported the use of promotoras to improve mammography rates. Interventions included education and counseling, navigation assistance, providing a link to resources, and facilitating interaction with providers. Intervention: A promotora was assigned to contact patients with a mammogram order to provide education, counseling, and other assistance needed. Outcome: The intervention improved compliance with mammography rates by 37% over baseline. The results are clinically significant as the cost of the promotora intervention is minimal compared to the benefits of an early-stage diagnosis. Conclusion: The implementation of this project was consistent with the research evidence supporting a promotora intervention to improve mammography rates in the Hispanic population.

Mindfulness-based Intervention and Relapse Rates in Adults with a History of Substance Use Disorder

Practice Problem: Substance abuse disorder (SUD) has become an increasingly prevalent community health problem worldwide, affecting individuals in all geographical regions regardless of age, race, sex, and socioeconomic status, despite decades of efforts to find a solution (Bowen et al., 2014). A lack of treatment engagement and substance‐misuse crisis calls attention to the effectiveness of relapse‐sensitive care and treatments. PICOT: The question addressed in this evidence-based project was “ In adults over 18 years of age with substance use disorder (P), how does the effect of mindfulness-based treatment (I), compared with no mindfulness-based treatment (C), reduce the risk of relapse (O), in 3 months (T)?” Evidence: Evidence exists to support that Mindfulness-based intervention (MBI) significantly reduced the incidence of relapse in adult patients with a history of SUD by decreasing symptoms related to substance abuse craving or use. Intervention: Mindfulness-based practice consisting of meditation and mindful breathing exercises, motivational interviewing and relapse prevention cognitive therapy was implemented to reduce incidence of relapse in adults with a history of SUD. Outcome: Findings revealed a less than 15% reduction in incidence after three months of MBI implementation. Conclusion: The results indicate that the reduction in the risk of relapse in adult patients with a history of SUD post implementation was not significantly significant. The reduction also indicated a clinically significant improvement in relapse outcomes two months after implementing MBI.

The Development of E-Book Based on Project Based Learning on the Plant Anatomy Structure Material

Problem solving skills are needed by students to solve problems that arise in everyday life. Innovation in learning is needed so that students can achieve the basic competencies and apply 21st-century skills, in the form of interactive, collaborative learning models. One of the innovations is using the Project-Based Learning learning model with the E-book of plant anatomy structures. This study aims to develop an E-book of PjBL-based plant anatomy structures to practice problem-solving skills which are declared valid in terms of theoretical and empirical aspects. The theoretical aspect is viewed from the results of the validity. Empirical aspects in terms of learning outcomes, student responses, and readability. The development model used is 4D. The research was carried out at the UNESA Postgraduate Program in June-August 2020. The target of this research was an online E-book on the structure of plant anatomy based on Project Based Learning which was tested on ten students of Muhammadiyah 1 Gresik senior high school in February 2021. The instruments used were validation sheets, student response sheets, and fry chart sheets. The data were analyzed descriptively quantitatively. The results showed that the PjBL-based E-book of plant anatomical structures was theoretically feasible based on the validation results obtained an categories very valid and empirically feasible based on student learning outcomes (N-gain of moderate categories). Based on this description, a PjBL E-book of plant anatomy structures to train students' problem-solving skills is feasible theoretically and empirically.

Face-to-Face Nursing Promotion of Cardiac Rehabilitation

Practice Problem: The burden of cardiovascular disease is rising at global and national levels, and cardiac rehabilitation is recognized as one of the most beneficial and cost-effective strategies to manage it. One significant problem globally, nationally, and locally is the low numbers of eligible patients who enroll in cardiac rehabilitation. PICOT: In patients with isolated coronary artery bypass graft (CABG) (P), how does face-to-face nursing promotion of cardiac rehabilitation (I) compared to the patients who do not have face-to-face nursing promotion (C), affect the percentage of patients enrolling in cardiac rehabilitation after discharge (O) within 8 weeks (T)? Evidence: The evidence used to guide this project included the need for a healthcare organization to have a systematic process for cardiac rehabilitation enrollment, face-to-face nursing promotion, improvement of the healthcare team’s knowledge about cardiac rehabilitation, and identification of patient barriers that hinder cardiac rehabilitation enrollment. Intervention: A systematic approach for cardiac rehabilitation was developed using the interprofessional team. After the healthcare team received standardized education, nurses in various roles provided face-to-face promotion, the ARNPs endorsed cardiac rehabilitation, and the care managers addressed barriers. Outcome: The cardiac rehabilitation enrollment rate increased by 16% among all patients admitted with an isolated CABG on the pilot unit. Conclusion: Implementation of face-to-face nursing promotion, ARNP endorsement, and reducing barriers were clinically significant in increasing the cardiac rehabilitation enrollment rate.

Wound Care Management and Documentation Non-Compliance in Prevention and Care of Wounds

The incidence of non-compliance and adherence to best practices wound care competence continues to be an issue among the clinical staff of the Veterans Affairs Medical Center (VA). At the VA, there is a practice problem of non-compliance and adherence to best practices wound care competency as evidenced in the electronic medical record (EMR) documentation among the clinical staff. A PICOT question was developed to explore if the establishment of a staff best practices wound care policy focusing on EMR documentation will improve proper wound care management among the clinical staff. The clinical site is a hospital consisting of 40 acute care beds. A new policy adjusted documentation with the use of the Braden scale and the spinal cord impairment monitoring (SCI-PUMT) tools and documentation in the EMR at appropriate times was implemented. A pretest and posttest were conducted to determine the significance of the total documentation using the Braden or SCI-PUMT tools, total accurate documentation using the wound care tools, and the number of multidisciplinary team contacts using the EMR. The results showed no statistically significant improvement with t =1.66, p =.107, t =1.03, p = .310, and t = -0.31, p = .775, respectively. Although the above results did not show any statistical significance after two months of the project implementation, a re-implementation of the project is recommended with the elimination of the barriers encountered during the project implementation