Reducing Coercive Measures to Improve Patient and Staff Safety by Increasing the Frequency of Risk Assessment

Violence is a critical issue in Healthcare. Inpatient psychiatric nurses are the healthcare professionals most affected by this problem. Structured risk assessment tools can predict imminent aggression, prompt interventions, mitigate the advent of aggressive behaviors and staff and patient injuries, and reduce restrictive aggression management methods. This quasi-mixed methods project instructed registered nurses in an acute inpatient psychiatric unit to implement the Dynamic Appraisal of Situational Aggression (DASA: IV) more frequently to determine the impact on aggressive behaviors, the use of coercive techniques to manage aggression, and to assess nurses\u27 perception of the tool. Twenty-five registered nurses screened 447 patients over 28 days using the DASA: IV tool. Pre-implementation and implementation data were collected and analyzed with the statistical methods of percentage change, 2-tailed t-test, and ANOV A. The results indicated a 58.55% reduction in overall assault rates and a 20% reduction in the use of seclusions and restraints (S&R). A majority of participants had positive attitudes toward implementing the tool. Implementation of a DASA: IV protocol is feasible and may improve safety in adult inpatient acute psychiatric units

Therapeutic Inertia in the Pharmacologic Treatment of Type 2 Diabetes Mellitus: Investigation of Causes and Recommendations for Change

Diabetes mellitus (DM) is a pervasive chronic condition and a serious global health issue. Type 2 diabetes mellitus (T2DM) comprises approximately 90-95% of all DM cases (Centers for Disease Control and Prevention [CDC], 2022). The prevalence of T2DM has risen rapidly over time; in fact, the number of adults diagnosed with T2DM over the past 20 years has more than doubled (CDC, 2022). T2DM currently affects an estimated 462 million people globally (equal to 6.28% of the world’s population), including more than one out of every 10 Americans (American Diabetes Association [ADA], 2018; CDC, 2022; Khan et al., 2020). In Washington state specifically, DM is the seventh leading cause of death (Washington State Department of Health [WADOH], 2018). As of 2018, one out of every 11 Washington adults have DM, and an estimated 33.7% of Washington\u27s adult population have prediabetes (CDC, 2018; WADOH, 2018)

Seattle University-Seattle Police Department Research Collaborations: Student Research Analyst Positions

https://scholarworks.seattleu.edu/lightning-apr2023/1001/thumbnail.jp

Education Program on Safe Medication Administration for Nursing Assistants

Background: Facility-based long-term care provide a variety of health care services, including medication management. However, medication errors are common and such errors contribute to disability and mortality. Due to an inadequate number of nurses, Washington State passed the Medication Assistant Endorsement law, allowing certified nursing assistants (CNAs) with specialized training as medication assistants (MAs) to administer certain medications under a register nurse’s supervision in assisted living facilities and nursing homes. However, initial medication assistant training is limited. Providing continuing education for CNAs can address gaps in knowledge and skills needed for safe medication administration and help enhance patient safety. Furthermore, training CNAs as MAs allocates more time for licensed nurses to perform roles that require clinical judgment, reduces costs, and offers additional resources to MAs for career advancement. Purpose: The purpose of this project was to develop an education program for certified nursing assistants to improve confidence in knowledge of medication management and skills in safe medication administration at an assisted living facility. Methods: Based on research and staff input, an educational program was developed and disseminated to nursing assistants through an in-person presentation. Quasi-experimental preand post-test measured perception and confidence with a survey questionnaire, and skills related to safe medication administration via observation of nursing assistants at an assisted living facility in Washington State. Descriptive statistics and thematic analysis were conducted to analyze the data. Results: 12 CNAs participated in the study. 11 themes were identified in perceptions on barriers to safe medication administration, with all participants reporting a lack of understanding in administering different forms of medications as a barrier. Statistically significant improvement was found in confidence on knowledge of medication management. Participants also showed increased skills for safe medication administration after education intervention. Conclusion: Addressing medication management challenges in assisted living facilities requires collaboration between nurses and certified nursing assistants. With continuing education and training, a culture of patient safety can be established, resulting in improved safe medication administration practices by certified nursing assistants

Sacred Lives: A Study on the Spiritual Needs of LGBTQ+ Students and Possible Responses by Catholic High Schools

In this project, I examined the spiritual care offerings available to LGBTQ+ students in Catholic high schools in the state of Washington and potential best practices. Through a convergent mixed methods approach to gathering information on spiritual care, both public and clandestine, I sourced several methods of inquiry to analyze data and make recommendations. Using a survey of all fifteen Category I and Category II Catholic high schools in Washington, I collected data from administrators, counselors, campus ministers, and diversity equity inclusion (DEI) directors about spiritual care efforts in catholic high schools. Concurrently, two listening sessions were held with six LGBTQ+ alumni about their personal spiritual journeys as students who attended a Catholic high school. With a liberative lens and as a practical theologian, I dialogue with Catholic social teaching, Catholic doctrine and social sciences, and other Christian theologians who speak to LGBTQ+ spiritual care experiences

Curricular Innovations to Promote Systems Thinking in a General Chemistry Laboratory Course

Systems thinking is a perspective and set of skills used to examine the dynamic complexities of an entire system and to make predictions about system behavior. Systems thinking is of interest to educators because of its unique potential to enhance students’ critical thinking and problem-solving skills, therefore developing scientists who are capable of addressing many of the complex problems facing our world today. Utilizing previously published pedagogical tools, revisions and additions that promote systems thinking were made to a general chemistry laboratory unit. Through these curricular innovations, students defined systems thinking and employed many systems thinking skills throughout the laboratory unit. Students were surveyed after completing the laboratory unit, and their responses were analyzed to assess the utility of the curriculum revisions and inform subsequent revisions

How Leaders are Shaped for Transitional Ministry: An Exploration of Pastoral Formation Among U.S. Presbyterian Short-Term Transitional Pastors

This study focused on practical issues of pastoral formation among practitioners who lead short-term transitional ministry today. It utilized a survey tool and interviews to enhance the understanding of how the training and post-training practices of these pastors shaped their vocational ministry. Findings in this research aimed to report what draws, sustains, and supports pastors in this work. This study listened to pastors with transitional ministry experience by inviting them to share feedback about their formation through training to discover what forms of support are most beneficial. From them this study aimed to uncover what might be helpful or encourage vocational sustainability. Five research questions guided this study: (1) How likely are pastors with transitional ministry experience to seek calls as transitional pastors? (2) What draws leaders to transitional ministry in congregations? (3) How satisfied are they with the transitional ministry training? (4) What, if anything, would they change about training? (5) Which type of post-training support is most beneficial and what forms of support are difficult to find? These questions are not easily answered. But church leaders want to know about pastors’ lived experience because the church needs transitional pastors, and pastors with this specialization are increasingly hard to find. Nearly 90 clergy from various Protestant traditions participated in the study. Two thirds were Presbyterian pastors. Feedback about transitional ministry training was generally positive. If one change were made it would be to include time during training to discuss with faculty points of practical application unique to the pastors’ particular contexts. Findings on how to support pastors in this work focused on the impact of transitional ministry training; informal relationships with mentors, peers and friends; formal relationships with helping professionals such as leadership coaches; spiritual directors and facilitated peer groups; and the support desired from mid councils and national offices of the church. The researcher’s work with the data gathered from the survey and follow up interviews informed a storyline of short-term transitional ministry practice. It revealed that pastors come to transitional ministry for a variety of reasons, but they stay because of a sense of calling and a community of colleagues that support them in this work. They can feel like second-class citizens, especially when there is a gap in employment. New models of support are needed and should be explored

Nurse-Provided Foot Care for Populations with Severe Mental Illness: A Phenomenological and Swanson’s Theory of Caring Approach

Foot care is an essential element of health care for populations with, or at high risk for chronic diseases and foot abnormalities. However, nursing research regarding foot care specifically for patients with severe mental illness (a category which includes bipolar disorder, schizophrenia, and schizoaffective disorder) is sparse. This mixed methodology phenomenological study seeks to provide a further understanding of how nurse-provided foot care and its implicit “caring” ethos impact this patient population, and what might this imply about creating models and educational protocols for the delivery of future evidence-based care. Methodology: Participants at a low-barrier day center for populations who self-identified as female, unhoused, and diagnosed with severe mental illness were treated with nurse-provided foot care. Data was collected from a five-question semi-structured interview, focused on the participant’s experience of foot care and then thematically coded. Results: Six participants fulfilled eligibility requirements, provided informed consent, and completed the semi-structured interviews. Five main themes emerged from data analysis: 1) apprehension to enjoyment, 2) self-criticism, 3) importance of hygiene, 4) inclusion of anecdotal experience, and 5) attitude of the practitioner. Conclusion: This research project called attention to the need for increased access and provision of hygiene supplies and the relevance of incorporating relationship-based therapeutic foot care. The process of addressing these issues will require focusing on these needs in the development of models for hygiene access provision as well as incorporating the importance of a Swanson’s Theory of Caring derived education protocol

The Impact of Mobile Integrated Healthcare on 911 Use and Patient Activation

Background: Emergency Medical Services (EMS) and Emergency Departments (EDs) are experiencing an increase in low-acuity and high frequency patients. Treating non-emergent patients with emergency resources drives up healthcare costs, leads to delays in care for all patients, and increases strain on emergency resources. To address the increase in low-acuity and high-frequency patients within the 911 system and emergency departments, mobile integrated healthcare (MIH) has emerged as an EMS-based intervention to connect patients with community resources and reduce non-emergent transports and ED visits. This program evaluation examines the impact of nurse-social worker teams in a fire-based MIH program by measuring 911 and ED use and patient activation before and after MIH interventions. Methods: Participants were enrolled in the program evaluation by the MIH field teams. Participants were either new or existing MIH patients and enrollment occurred over a 2-month period. Participants completed the patient activation questionnaire (PAM-13) at the time of enrollment and again between 8 and 12 weeks later. The number of 911 calls, transports, and ED visits for each participant was extracted from Julota and EPIC for a period of 12 weeks prior to and after the date of enrollment. The pre and post data and PAM-13 scores were compared using Wilcoxon Signed Ranks Test of Significance. The mean pre and post PAM-13 scores were also compared to evaluate the difference. Results: 19 participants were enrolled in the study. One participant died during the follow-up period. Of the remaining 18 participants, 4 completed the second PAM-13 questionnaire. There was a statistically significant reduction in 911 calls (p=0.015), transports (p=0.021), and ED visits (p=0.006) following MIH intervention (n=19). The change in PAM-13 scores (n=4) was not significant (p=0.655). The difference in the means of the pre and post PAM-13 questionnaires was an increase of 1.75. Conclusions: MIH intervention reduced 911 calls, transports, and ED visits in this program evaluation. The effect on patient activation as measured by the PAM-13 questionnaire was not significant. Given the statistical significance in reducing use of emergency services for this small sample, a longer evaluation with more participants is needed to determine if fire-based MIH using a nurse and social worker is effective in reducing emergency resource use