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A Systematic Review of Racial Disparities in Emergency Department Pain Evaluation and Treatment in the United States
Background: Providers working in emergency departments (ED) must balance the need to relieve patients’ pain with the dangers of overprescribing opioids. Lack of standardization of pain evaluation and treatment may contribute to inequities in the management of pain in emergency departments. Evaluating differences in how different populations receive care in emergency departments can help to identify problems and areas where improvements need to occur.
Purpose: The purpose of this literature review is to evaluate what current research states about the prevalence and causes of racial disparities in pain evaluation and treatment in United States emergency departments and determine what gaps in knowledge are a priority for future research.
Methods: A literature review was conducted using the Augsburg University library search engine and PubMed. Exclusion criteria were any articles published prior to 2020, any articles discussing hospitals outside the United States, systematic reviews, and articles which did not discuss racial disparities in pain evaluation or treatment.
Conclusions: Many patient populations, such as Black, Hispanic and Native American patients, experience lowered rates of opioid prescription for pain in emergency departments across the United States. Racial disparities in the evaluation and treatment of chest pain are also widespread. Pediatric patients presenting with pain also experience racial disparities in rates of opioid prescription and imaging studies ordered. More research needs to be done into the efficacy of trainings and policy implementation to reduce these inequities
Impact of Race on the Relationship Between Adverse Childhood Experience and Mental Health in the Minnesota Homeless Population
It is well established that the homeless population endorses more adverse childhood experiences (ACEs) than the general population and is also more susceptible to mental health and substance use disorders. Of note, individuals who identify as Black, Indigenous, and People of Color (BIPOC) are disproportionally affected by homelessness compared to their White counterparts. Little is known about the relationships between ACEs, mental health, and substance use in the homeless community. The present study examined the relationship between ACEs and a number of psychosocial outcomes, including mental health diagnoses, current substance use, and long-term substance use in an adult homeless population (N = 412) located in Minnesota. The impact of participant race and ethnicity as a moderator on the relationship between ACEs and various psychosocial outcomes was also explored. The study utilized archival data from the Minnesota Homeless Study (Wilder Research, 2018), which focuses on capturing the experience of the homeless population in Minnesota. Results showed that as the number of ACEs increased among the sample, so did the likelihood of a mental health disorder. Additionally, the number of ACEs reported was significantly associated with long-term substance use, indicating that as the number of ACEs increased, so did the likelihood of long-term substance use. ACEs were not associated with current substance. However, when the homeless population was considered as a whole. When separated by racial/ethnic identity, only White participants were more likely to endorse current substance use as ACEs increased. Directions for future research (short versus long-term substance use) and clinical implications, such as ACE-specific interventions, are discussed
This is a Call To Action for All Primary Care Providers: Do Better for Your Transgender Patients
Background: Patients of all ages benefit from primary care. However, not everyone has equal access to primary care. Transgender patients often face a multitude of barriers to receiving basic healthcare.
Purpose: Improve health outcomes for transgender patients, enlighten providers on significant disparities, and offer solutions to these disparities faced by transgender community in the healthcare setting and when receiving cancer screening.
Methods: Literature review comprising results from Augsburg University Lindell Library databases, American Journal of Medicine, and Google Scholar.
Conclusions: Everyone can do better for their transgender patients, but primary care providers should take extra care cultivating relationships with these patients. More research needs to be conducted collecting patient data, specifically sexual orientation and gender identity. Guidelines are not specific or not clear for cancer screening recommendations for transgender patients
An Examination of the Big Five, Mental Illness Stigma, and Crisis Intervention Training
The number of individuals incarcerated with mental illness continues to grow, and correctional officers may play a critical role in rehabilitation. A correlation analysis was conducted between Big Five personality traits and mental illness stigma to determine whether there is a significant relationship in a sample of state correctional officers who participated in Crisis Intervention Training. A mixed model ANOVA was also conducted to assess whether personality traits impacted levels of mental illness stigma following completion of the training. A moderate negative correlation was found between agreeableness and mental illness stigma. All other findings were not clinically significant, potentially due to the study’s limitations. Future research is necessary to continue to address the gap in the research regarding personality and mental illness stigma amongst correctional officers
Pathway to Freedom: A Community Health Center Protocol for Guiding Human Trafficking Survivors to Safety
Human trafficking is a significant public health issue that intersects with social drivers of health, making community health centers (CHCs) uniquely positioned to address this problem. This project developed a comprehensive protocol for a Midwestern CHC to identify and support human trafficking survivors while contributing to prevention efforts. The protocol focuses on four key components: establishing partnerships with local agencies, training the health care team, implementing a universal education approach, and creating trauma-informed referral processes. Grounded in Madeleine Leininger\u27s Culture Care Theory, the protocol emphasizes culturally safe, survivor-centered, trauma-informed care. Evaluation methods include pre and post training assessments and ongoing quality improvement measures. The project highlights the critical role of CHCs in combating human trafficking and emphasizes the importance of interdisciplinary collaboration and community partnerships. Future directions include expanding the protocol to address related forms of exploitation and strengthening community partnerships. This work represents a significant step towards creating healthier, more equitable communities by enhancing health care accessibility for vulnerable populations and fostering a collaborative, trauma-informed approach to care
The Effects of Health Coaching on Stress Levels in College Students
Although a majority of mental health problems, including stress, emerge by early adulthood, few young adults can get the support they need. College students are at the forefront of this health concern due to the various stressors during this period of life. Health coaching is a holistic method used to improve health outcomes and lower costs through a supportive partnership between a coach and a client. The purpose of this scholarly project was to determine if access to a health coach could facilitate healthy habits to support students in achieving their health-related goal of decreasing stress. A thorough literature review was completed prior to the implementation of this scholarly project which included stress with college students, health coaching, self-efficacy, and the transpersonal caring relationship. Watson’s Theory of Human Caring was used as a theoretical framework to guide the project. The patient population for implementation of the project included college students in the Minneapolis/St. Paul region who were attending undergraduate or graduate school and were experiencing stress. Ten students were selected and completed the health coaching sessions. Health coaching included two 20–30 minute coaching sessions held via zoom over a three-to-four-week period. The PSS and Wellness Wheel were used as tools to measure health coaching results and guide the coaching sessions. The overall average PSS score decreased by 2.3 points before and after coaching sessions and all students gave positive feedback about the benefits of coaching. Health coaching has the potential to benefit the overall health and wellness of college students who are stressed and can be expanded to other patient populations and health conditions. Therefore, this scholarly project is significant to the future practice of advanced nurse practitioners
Nurse Closure Visits in Consultative Medicine
The Consultative Medicine practice at a major Midwestern teaching hospital specializes in diagnosing and developing care plans for adults across the United States who have struggled to receive accurate diagnoses for their complex or rare conditions. Recognizing that patients often face challenges implementing these care plans upon returning to their local healthcare settings, the health care team within the Consultative Medicine practice developed Nurse Closure Visits based on Margaret Newman’s theory of Health as Expanding Consciousness. The Nurse Closure Visits consist of two sessions: an in-person meeting immediately following the physician’s consultation and a virtual follow-up within one to two weeks. These visits aim to reinforce diagnoses, address patient concerns, and proactively identify and resolve any barriers to implementing the care plan locally, ultimately empowering patients to manage their health and follow-up care effectively. The project will be deemed effective by seeing a decrease in patients’ electronic messages after receiving a 30-day closure of care letter and an increase in patient satisfaction scores
Antibiotic Resistance in Livestock: A Literature Review of Its Consequences and International Effort on Human Antimicrobial Agents Resistant Crisis
Background: Despite their benefits, the overuse of antibiotics in livestock has resulted in negative consequences to human health and the augmenting of an antibiotic-resistant crisis. Countries worldwide have conducted analyses and confirmed the growth of bacterial strains immune to most antibiotics. The widespread use of antibiotics is shown in various sectors, including human medicine and agriculture, leading to the emergence of antibiotic-resistant bacterial strains.
Purpose: This comprehensive literature review focuses on finding the connection between the usage of antibiotics in livestock, the transfer of antibiotic resistance to humans through consumption and exposure, and international efforts to find solutions to antimicrobial alternatives.
Methods: A review of literature on Antibiotic resistance in livestock was conducted using the NIH and Google Scholar databases to identify relevant peer-reviewed articles and reports on antimicrobial use and resistance. Inclusion criteria were studies showing how antibiotic use in livestock impacts human health through meat consumption and farming exposure, and exclusion criteria were analysis of environmental contamination issues.
Conclusion: Antibiotic usage in livestock causes the development of antibiotic resistance in bacteria, which harms humans and wildlife populations. Therefore, limitations and regulations on the use of antibiotics are set to avoid drug-resistant evolution. In addition, some alternatives to antibiotics include pre-and-probiotics, vaccines, and essential oils to protect livestock against common diseases. Other alternatives to antibiotics may be more cost-efficient and may not be therapeutically effective as a lifelong course of antibiotics. However, it is an entirely separate problem to develop a feasible program for the subsidization of non-antibiotic treatment by the agricultural industry
Development of a Simulation Based on Lived Experiences of Health Care Barriers and Bias for Nursing
Barriers to health care and social determinants of health result in harmful and preventable health outcomes. Gaps in health outcomes and disequilibrium of occurrence of diseases and illness are a result of physical barriers of health, and bias and racism in health care. At an urban hospital in the Midwest, simulation is currently used for exploring and learning about various nursing skills, hospital protocols, practices, and policies. Using Madeline Leininger’s Culture Care Theory, a simulation based on people’s lived experiences highlighting health care barriers and subsequent inequities was developed to educate and expand nurses’ knowledge and understanding of caring for marginalized populations. Literature reviewing simulation in nursing, racism in health care and social determinants of health, the phenomenology of lived experiences, and the concept of culture care describes the possible successes of using simulation as a space for exploring diversity, equity, and inclusion and bias in health care and the importance of incorporating lived experiences into the learning. Nurses have the capability to either contribute to or dismantle health care bias and barriers experienced by patients through the care they provide. The project aims to educate nurses by enhancing awareness and ability to combat bias and barriers. Implications for future nursing practice and projects to ensure fair, equitable, and respectful health care for all resulted in the eye-opening learning of the importance of community and hospital partnership which is essential to mitigating barriers to health care
The Efficacy of Common Prosthetic Joint Infection Prevention Strategies: A Systematic Review
Thousands of total hip and knee arthroplasty patients suffer from prosthetic joint infections every year, making them a leading cause of arthroplasty failure. As the number of these procedures continues to grow, so will the healthcare and socio-economic burden of prosthetic joint infections. A comprehensive search for up-to-date literature was completed via the PubMed database, identifying eighteen retrospective and prospective cohort studies that focused on the four prosthetic joint infection prevention methods of interest. Tobacco use cessation of all forms is an efficacious prosthetic joint infection prevention strategy. The common practices of withholding intra-articular injections prior to surgery, using prophylactic single dose cephalosporins, and using the glycemic marker of HbA1c were found to be partially efficacious but require further considerations. Surgeons should be aware of the various considerations involved in validating or discrediting their preferred prevention strategies in order to prevent prosthetic joint infection