Incorporation of Child & Adolescent Mental Health Standardized Patient Simulations to Provide Interprofessional Education for Graduate Students.

Substantial need exists to prepare healthcare professionals to manage the increasing prevalence of mental health conditions, specifically in the child and adolescent population. The primary purpose of this study was to enhance knowledge of health care professionals in the assessment and treatment of common mental health disorders in children and adolescents through the delivery of workshops that provided both didactic and simulation training. This study utilized a repeated measures, quasi-experimental design. A total of 131 students representing counseling, pharmacy, PMHNPs and FNPs participated in the four workshops. Positive changes in the perceptions of interdisciplinary teamwork importance were noted.

The Effect of Preoperative Education Prior to Hip or Knee Arthroplasty on Immediate Postoperative Outcomes.

There is ample research demonstrating improved patient outcomes when using an enhanced recovery program. However, the literature reporting the impact of preoperative education alone prior to hip and knee arthroplasty is conflicting. With the number of these surgical procedures expected to increase in the next few years, the identification of strategies that positively impact outcomes is important. The aim of this study was to evaluate immediate postoperative physical therapy (PT) performance following a total hip or knee arthroplasty in patients who attended a preoperative education class compared with those who did not. This study was a retrospective chart review of 707 hip and knee arthroplasty patients, comparing outcomes based on preoperative educational session attendance. Demographics, comorbidities, length of stay (LOS), discharge disposition, and PT performance were collected from the chart review. Patients who attended the preoperative education class had significantly greater ambulation distances (p < .001), greater degrees of knee flexion (p < .001), and greater degrees of hip flexion (p = .012) on postoperative Day 1. Both hip (p < .001) and knee (p < .001) patients who attended the class had a significantly shorter LOS. The cost benefit analysis indicated a savings of $921.57 in direct costs per knee arthroplasty in those who attended a class. Patients who received preoperative education had greater mobility in the immediate postoperative period and reduced LOS for both hip and knee arthroplasties. Based on this study's results, preoperative education is effective in improving outcomes and reducing the cost of hip and knee arthroplasties.

Evaluation of an Electronically Delivered Learning Module Intended for Continuing Education of Practicing Registered Nurses: A Pretest-Posttest Longitudinal Study.

BACKGROUND: A widely used method for distributing continuing education to health care professionals is via electronically delivered learning modules (EDLM). The purpose of this study is to determine if RNs retain and value education provided by an EDLM. METHOD: This is a one-group pretest-posttest and longitudinal study employing survey methodology. RNs completed an electronically delivered sepsis educational module, an immediate posttest, and then a posttest 4 weeks later. Additionally, the researchers measured participants' feelings and practices regarding EDLMs. RESULTS: The mean value for total knowledge scores increased immediately postintervention then decreased to near baseline after 1 month. Additionally, participants reported that EDLMs did not increase their knowledge, nor did they value EDLMs. CONCLUSION: Our findings suggest that didactic information received via EDLMs may have minimal sustained impact on nurses' knowledge. Participants' lack of knowledge retention may be affected by module and evaluation design. [J Contin Educ Nurs. 2019;50(7):331-336.].

Impact of a standardized patient simulation on undergraduate nursing student knowledge and perceived competency of the care of a patient diagnosed with schizophrenia.

BACKGROUND: Undergraduate nursing students may not have the opportunity to assess and intervene with a patient diagnosed with schizophrenia during their clinical rotation. Provision of a standardized patient simulation experience affords students this opportunity in a safe setting without risk to the patient or student. METHODS: A quasi-experimental design was utilized to explore the impact of the addition of a standardized patient simulation scenario depicting a patient with a diagnosis of schizophrenia on undergraduate nursing student knowledge and perceived competency. RESULTS: The mean values for perceived competence and knowledge increased significantly over the three time periods (p < 0.001). CONCLUSION: The results suggest that incorporating SP simulation into the undergraduate psychiatric mental health nursing course has the potential to enhance both knowledge and perceived competency of students in caring for patients diagnosed with schizophrenia and ultimately promote better healthcare outcomes.

Evaluation of a Standardized Patient Simulation on Undergraduate Nursing Students' Knowledge and Confidence Pertaining to Intimate Partner Violence.

INTRODUCTION: Intimate partner violence (IPV) is a serious and preventable public health problem. Nurses are at the front lines of assessing and intervening with patients subjected to IPV. Lack of training and confidence is cited as a major barrier to assessing for IPV. OBJECTIVE: The purpose of this study was to evaluate a standardized patient (SP) simulation experience depicting a victim of IPV on undergraduate nursing student knowledge and confidence in assessment and intervention of IPV. METHODS: The Physician Readiness to Manage Intimate Partner Violence Survey tool was adapted to measure confidence, and a 10-item multiple-choice test was developed to measure knowledge, completed pretest, postlecture, and post-SP simulation. RESULTS: There was a statistically significant increase in confidence from pretest to postlecture, 14.04 (SD = 3.01) to 20.61 (SD = 2.39), F(1, 56) = 345, p < 0.001, to postsimulation, 14.04-21.93 (SD = 2.18), F(1, 56) = 21.1, p < 0.001. Only statistically significant increases in knowledge occurred from pretest to postlecture, 6.96 (SD = 1.36) to 7.95 (SD = 1.47), F(1,56) = 29.84, p < 0.001. Increase in knowledge from postlecture to postsimulation was not found to be statistically significant, 7.95 (SD = 1.47) to 8.05 (SD = 1.27), F(1,56) = 0.632, p > 0.10. CONCLUSION: Healthcare professionals need to be adequately educated and trained to screen for IPV. This study provides preliminary evidence that the addition of an SP simulation appears to enhance nursing student confidence and knowledge of assessing and intervening with victims of IPV.

An Assessment of an Outpatient Antimicrobial Therapy Program in a Rural Medical Center : A Retrospective Chart Review.

Current literature supports outpatient parenteral antimicrobial therapy (OPAT). This article presents results from a research study that evaluated an OPAT program that treated community-acquired pneumonia. If patients had the opportunity to receive outpatient intravenous antibiotics for community-acquired pneumonia, would this prevent future hospitalization? Was there a decrease in hospital admissions? An informal cost-benefit analysis comparing OPAT with inpatient hospital admissions for the same disease was also reviewed to provide evidence whether there was a change. What was the overall health care cost savings? The medical charts of 50 patients with confirmed pneumonia who had received OPAT in a 3-month period were reviewed. A retrospective medical record review was performed. All patients were evaluated by the in-house OPAT team. The resulting analysis provided evidence that an estimated savings of approximately $2100 per day would be achieved by decreasing hospital readmissions for patient who had been treated with OPAT. The conclusion of this study provides evidence that the implement of an OPAT program was, and is, essential for patient care and evidence-based best practice adherence.

Evaluation of an Educational Video: What to Expect on the First Day of Chemotherapy.

According to the American Cancer Society, more than 1.6 million new cases of cancer were diagnosed in 2015. Anxiety levels in individuals diagnosed with cancer are high, with the highest levels occurring at the time of diagnosis. A cancer diagnosis and the associated chemotherapy are life-altering events for patients and their families. In addition to managing the devastating news about the disease, patients are tasked with learning to manage the impact of chemotherapy and its impact on their bodies and sense of well-being. These authors report the development of an education video aimed at addressing typical questions and concerns about treatment regimens. Results of their studies to determine the effectiveness of their video indicate significant value for the patient, especially anxiety reduction and enhanced ability to absorb new information and instructions from their caregiving team.

Effects of Multimethod Intervention on Bedside Report Compliance and Patient Satisfaction.

Miscommunication is a large contributing factor to hospital sentinel events. Communication with nurses is a component of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The HCAHPS survey not only assesses patient satisfaction but also impacts how hospitals are reimbursed. A literature review reveals that nursing bedside shift positively impacts patient satisfaction and nurse communication. There is limited research on how to implement bedside report as well as what to include during report. A pilot study evaluated an educational intervention and its impact on nurses' compliance with bedside report. The study also evaluated whether bedside report compliance affected HCAHPS scores. A test of independent proportions showed that overall compliance scores increased significantly from period 1 (46%) to period 3 (81%), z = 2.23, P = -.017, one-tailed. HCAHPS scores for nursing communication went from 69.9% in quarter 1 of 2015 to 73.8% in quarter 4 of 2016, but there was no statistically significant change.

Stress Reduction in Postcardiac Surgery Family Members: Implementation of a Postcardiac Surgery Tool Kit.

The intensive care unit (ICU) can be a place of stress, anxiety, and emotional instability for both patients and families. Medical and nursing care during this acute time is patient focused, and family members are often left in the dark. Unintentional exclusion from information results in high levels of stress, anxiety, and uncertainty for families. Due to the acuity of illness, family members of cardiac surgery patients experience the highest levels of stress. Spouses may experience intense psychosomatic symptoms such as depression, anxiety, and fear for several months after the surgery. The purpose of this study was aimed at decreasing those feelings of anxiety in family members with postcardiac surgery through the use of a cardiac surgery tool kit. The study was a quality improvement project utilizing a convenience sample of 83 participants 18 years and older. Participants were asked to use the State Trait Anxiety Inventory (STAI) Form Y-1 (state anxiety) to rate their anxiety level preintervention and then again postintervention. Data were collected over a 6-month period. Descriptive data including age, education level, ethnicity, relationship, experience in the ICU, and active diagnoses of mental disorders did not affect the changes in the pre- and posttest data. A paired t test was conducted on the sample to assess changes in state anxiety, using the STAI Form Y-1. The results were statistically significant (t = 11.97, df = 81, P < .001). Respondents' scores decreased significantly from pre intervention (mean = 53.01, standard deviation = 12.19) to postintervention (mean = 37.38, standard deviation = 10.94). The data suggest that the use of a postcardiac surgery tool kit is a low-risk measure that can decrease the anxiety in family members of postcardiac surgery patients.

Anxiety Management in Primary Care: Implementing the National Institute of Clinical Excellence Guidelines.

More than 40 million Americans suffer from anxiety disorders, ranking them as one of the most common mental health disorders in America. The purpose of this pilot study was to educate providers on the National Institute Clinical Excellence (NICE) anxiety guidelines and monitor providers' perceived competence in managing anxiety. Results showed perceived competence increased significantly pre-intervention to immediately post-intervention (p=0.001), and data revealed the scores did not change significantly immediately post-to six-weeks post (p=0.170). Providers who implemented the guidelines into practice had significantly higher scores (p=0.026) than those who did not implement the guidelines.

Effect of the dedicated education unit on nursing student self-efficacy: A quasi-experimental research study.

Although the Dedicated Education Unit (DEU) has shown initial promise related to satisfaction with the teaching/learning environment, few studies have examined student outcomes related to the use of the DEU as a clinical education model beyond student satisfaction. The purpose of this quantitative, quasi-experimental study was to compare student outcomes from the traditional clinical education (TCE) model with those from the DEU model. Participants were students enrolled in a four-year baccalaureate program in nursing (n = 193) who had clinical education activities in one of three clinical agencies. Participants were assigned to either the DEU or a TCE model. Pre-clinical and post-clinical self-efficacy scores were measured for each group using an adapted Generalized Self-Efficacy Scale (Schwarzer and Jerusalem, 1995). Both groups experienced a significant increase in self-efficacy scores post clinical education. The increase in self-efficacy for the DEU students was significantly greater than the increase in self-efficacy for the traditional students. Self-efficacy is considered an important outcome of nursing education because high self-efficacy has been linked to making an easier transition from student to nursing professional. This study supports the quality of the DEU as a clinical education model by examining student self-efficacy outcomes.

An Analysis of the Prevalence of Depression Post-Myocardial Infarction.

Coronary artery disease (CAD) is the leading cause of death in the United States. The World Bank and the World Health Organization predict that depression and coronary heart disease will be the largest causes of global health burden and disability by the year 2020. Studies have demonstrated that patients with CAD experience depression at a higher rate than the general population. Because of this connection, it is critical to recognize depression and manage depression effectively for people with CAD. Studies have also provided evidence that identifying and treating depression in patients early after a myocardial infarction improve clinical outcomes. In addition, a number of studies have discussed the negative effects that can occur from untreated depression in these patients. The cited negative effects include mortality, recurrent myocardial events, and a worse quality of life. This article discusses the results of a research that was completed at a cardiology office using a retroactive medical record review that focused on outpatients with cardiac diseases. The primary aim of the study was to collect data using the Patient Health Questionnaire-9 (PHQ-9), a public domain screening tool. This research was intended to provide evidence that would support using the PHQ-9 as a standard depression screening tool for patients post-myocardial infarction. By recognizing the symptoms of depression, the patient would then be treated accordingly.

Improving Clinical Outcomes for Patients With Class III Heart Failure.

Heart failure (HF) is a serious medical problem in the United States and is placing a financial strain on the health care system. It is the leading cause of mortality and as the overall incidence continues to increase, so does the economic impact on the health care system. Innovative treatment options, in the form of disease management programs and implantable cardiac devices, such as the CorVue capable implantable cardioverter defibrillator (ICD) pacemaker, offer the promise of an enhanced quality of life and reduced mortality. Even with these advances, HF continues to be a challenge. Studies reviewing HF management programs have shown promising results. However, more studies are needed to determine which combination of HF management interventions has the greatest financial impact and yields the best patient outcomes. The objective of the research study was to compare 30-day readmission rates of patients implanted with the CorVue capable ICD pacemaker with patients with congestive heart failure (CHF) with no implanted device. The aim of the research focused on the usefulness of intrathoracic impedance monitoring alerts in guiding empirical treatment of patients with CHF to prevent HF readmissions. Methodology included a retrospective medical chart review, comparing 30-day readmission events among patients with class III CHF who received home health intervention with similar patients implanted with the CorVue ICD.

The Cost-efficiency and Care Effectiveness of Probiotic Administration with Antibiotics to Prevent Hospital-Acquired Clostridium difficile Infection.

Health care facility-acquired Clostridium difficile infections (HCFA-CDI) have increased over the last several decades despite facilities developing protocols for prescribing probiotics with antibiotics to prevent HCFA-CDI. The literature does not consistently support this. A retrospective medical record review evaluated the care effectiveness of this practice. Care effectiveness was not found; patients receiving probiotics with antibiotics were twice as likely to develop HCFA-CDI (P = .004). Except with glycopeptides, patients were 1.88 times less likely to experience HCFA-CDI (P = .05).

Impact of Social Support on Symptoms of Depression and Loneliness in Survivors Bereaved by Suicide.

According to the latest statistics from the American Association of Suicidology, there were approximately 41,000 suicides in the United States, accounting for 112 suicides per day or one every 12.8minutes (Drapeau & McIntosh, 2015). Survivors bereaved by suicide often experience complicated grief and feelings of social isolation. The study was a secondary data analysis from a study which involved 44 participants over the age of 18 from Southwestern Pennsylvania. Symptoms of depression and loneliness were assessed in relation to reported social support available to participants. The findings support the notion that increased availability of support can decrease symptoms of depression.

Factors that affect nurse practitioners' implementation of evidence-based practice.

BACKGROUND AND PURPOSE: Evidence-based practice (EBP) is a key recommendation to improve patient care outcomes. Factors that influence nurse practitioners' (NPs) ability to implement EBP in the clinical setting have not been fully explored. The study sought to explore NPs' practice, professional, and personal variables with self-reported ability to implement EBP. METHODS: The study was a correlational, cross-sectional design with a survey data collection methodology. A survey was mailed to 1200 randomly selected clinically practicing NPs, which included the Evidence-Based Education Questionnaire (EBEQ). A total of 480 surveys were returned, which represented a 40% response rate. Statistical analyses were performed to explore relationships between NPs' demographics and EBEQ scores. CONCLUSIONS: The DNP appears to have additive benefit for self-perceived ability to implement EBP in the clinical setting when compared to the master's degree educated NP. NPs' gender, age, and number of hours worked weekly also correlated to EBEQ scores. NPs' practice settings, such as Magnet status designation and employment at an academic center also significantly correlated to EBEQ scores. Other practice setting variables, such as where the practice is located, did not significantly correlate to EBEQ scores. IMPLICATIONS FOR PRACTICE: The findings of this study provide foundational knowledge to enable increasing NPs' EBP in the clinical setting.

Evaluation of Physicians' and Nurses' Knowledge, Attitudes, and Compliance With Family Presence During Resuscitation in an Emergency Department Setting After an Educational Intervention.

Family presence during resuscitation (FPDR) has been an ongoing topic of discussion in many hospital emergency departments throughout the United States. With the current emphasis promoting patient- and family-centered care, families are now exercising their right to be present at the bedside during resuscitation. With or without a policy, there is continued resistance to allow families to remain with their loved ones during resuscitation. The purpose of this study was to evaluate if an evidence-based educational intervention would increase physicians' and nurses' knowledge, attitudes, and compliance with allowing FPDR. This quasi-experimental study evaluated 30 attending physicians' and 65 registered nurses' knowledge of an existing family presence policy and their attitudes toward family presence post-educational intervention in an emergency department setting. Compliance of family presence was observed for 2 months pre- and post-educational intervention. Results show that most physicians and nurses either were not sure or were not aware that there was an existing written policy. The study demonstrated that nurses agree more than physicians that the option of FPDR is a patient/family right. The results also showed that the educational intervention had no effect on the physicians and nurses attitudes for FPDR, but it did change behaviors. Of the events involving professionals who were exposed to the educational intervention, family members were present 87.5% of the time. In contrast, only 23% of the events involving professionals who did not receive the educational intervention had families present. Ongoing staff education will heighten awareness to FPDR, make the staff more comfortable with families being present, and will presumably continue to increase invitations for FPDR.

Web-Based Treatment for Women With Stress Urinary Incontinence.

This was a non-experimental, descriptive, correlational study designed to assess the feasibility and efficacy of an evidence-based online pelvic floor treatment program targeting stress urinary incontinence in adult women. The majority of the participants reported some level of improvement in their incontinence symptoms and overwhelmingly supported the web-based physical therapy program.

Drosophila switch gene Sex-lethal can bypass its switch-gene target transformer to regulate aspects of female behavior.

The switch gene Sex-lethal (Sxl) was thought to elicit all aspects of Drosophila female somatic differentiation other than size dimorphism by controlling only the switch gene transformer (tra). Here we show instead that Sxl controls an aspect of female sexual behavior by acting on a target other than or in addition to tra. We inferred the existence of this unknown Sxl target from the observation that a constitutively feminizing tra transgene that restores fertility to tra(-) females failed to restore fertility to Sxl-mutant females that were adult viable but functionally tra(-). The sterility of these mutant females was caused by an ovulation failure. Because tra expression is not sufficient to render these Sxl-mutant females fertile, we refer to this pathway as the tra-insufficient feminization (TIF) branch of the sex-determination regulatory pathway. Using a transgene that conditionally expresses two Sxl feminizing isoforms, we find that the TIF branch is required developmentally for neurons that also sex-specifically express fruitless, a tra gene target controlling sexual behavior. Thus, in a subset of fruitless neurons, targets of the TIF and tra pathways appear to collaborate to control ovulation. In most insects, Sxl has no sex-specific functions, and tra, rather than Sxl, is both the target of the primary sex signal and the gene that maintains the female developmental commitment via positive autoregulation. The TIF pathway may represent an ancestral female-specific function acquired by Sxl in an early evolutionary step toward its becoming the regulator of tra in Drosophila.