Heart Failure Management in a Skilled Nursing Facility

Background: Reducing heart failure hospital readmissions remains a priority for health systems and is a marker of quality for the Center for Medicare and Medicaid Services (CMS). Heart Failure is the most common cause of U.S. hospital admissions and an effective management program in the nursing home setting is crucial for quality and outcomes. Purpose: The purpose of this project was to implement and evaluate a Nurse Practitioner/Physician supported heart failure management program in a skilled nursing facility that is able to be incorporated into facility staff workflow, enhances nursing staff knowledge of heart failure, improves identification of patients with a heart failure diagnosis, and reduces facility hospitalization rates over a three-month period of time. Methods: This was an evidence informed practice implementation and evaluation project that focused on all patients with a diagnosis of heart failure in a suburban skilled nursing facility. Quantitative data was obtained by using the Nurses Knowledge of Heart Failure survey and rehospitalization data was obtained from the practice site. Results: Eighteen patients were followed by the program. All had timely identification,16.66% experienced a change of condition that triggered medical provider follow up and none had a heart failure related hospitalization. Six nursing staff completed the pretest (mean, [SD], 78.33, [13.29]) and posttest (86.66, [10.80]) and demonstrated a positive relationship between program implementation and nurses’ knowledge. Conclusion: Implementation of a heart failure management program is associated with timely identification of patients, improved nursing knowledge, and timely intervention during changes in condition

Nurses\u27 Response to a Heart Failure Video to Teach Patients Self-Management

Numerous scholars have examined multiprocessors and techniques to decrease the heart failure readmission rate and to improve heart failure patient self-management. This project examined a new teaching method to create the experts\u27 awareness of possible solutions to improve heart failure education in a small community hospital. The purpose of this project was the assessment of a new iPad heart failure patient pre-discharge education program video HFPDEV). Pender\u27s health care model (PHM) served as a framework for this project. Five local nursing educator experts (master prepared) were asked to view a new iPad HFPDEV. After reviewing the 15-minute iPad HFPDEV, the local experts were asked to evaluate the video by completing a Likert-type survey, which evaluated the content, process, design, time, and functionality of the iPad HFPDEV along with a section for comments and recommendations. Descriptive analysis was used to analyze the survey results. Four of the experts defined the content, process, design, and functionality of the iPad HFPDEV as \u27excellent.\u27 One defined the content, process, design, and functionality of the iPad HFPDEV as \u27adequate.\u27 All experts expressed recommendations to improve the IPad HFPDEV by doubling the iPad size with an enlargement of print for easy reading and erecting all teaching iPads on mobile stands. A future pilot project will evaluate the relationship of HF readmission rate to the iPad HFPDEV. Social change will occur when the organization provides HF patients with iPad HFPDEV that will increase HF self-management skills and decrease HF readmissions

Campaigns from the Classroom to the Boardroom

“Don’t just sell yourself and your ideas; sell the concept of public relations as a top management function – then prove that it works.” This quote by John W. Felton, retired vice president for corporate communications at McCormick & Company, Inc, expresses the notion that organizations should not consider public relations an afterthought to management processes. Public relations should be an essential concern in all top-level management decisions. The Public Relations Society of America defines public relations as “a management function that involves counseling at the highest level and being involved in strategic planning for the organization.” Others define the field as reputation management. In short, public relations lies at the heart of any organization and serves as the foundation for the relationship between an organization and its publics. Organizations extend long-range investments in public relations campaigns and utilize such campaigns to propel them towards their overall business objectives and mission statements. Campaigns can address issues, seek solutions to problems, change behaviors, modify laws, or simply solidify an organization’s position in the marketplace. Public relations campaigns are vital to a successful organization yet they are complicated and demanding from a managerial standpoint. Given the complex dynamics of a campaign, it is necessary for students studying public relations to recognize the importance of strategic planning to ensure a meaningful result. As a result, Campaigns from the Classroom to the Boardroom was developed. The aim of Campaigns from the Classroom to the Boardroom was two-fold. First, the program gave students the opportunity to get real life experience working on a public relations campaign. Second, it provided local non-profit organizations the invaluable resource of student creativity and innovation. Campaigns from the Classroom to the Boardroom connected students currently majoring in public relations at URI with organizations belonging to the Central Rhode Island Chamber of Commerce. The students worked with their respective organizations to build a campaign for a real world situation. To ensure the success of this project I embarked on my own public relations campaign. This campaign attracted awareness to the Campaigns from the Classroom to the Boardroom program from both potential students and organization participants. Through my recruitment, eight non-profits and 24 students from a URI class were brought onto the project. These organizations were: A Wish Come True, Inc., Plan USA, the Kent County YMCA, the Rhode Island Center for Law and Public Policy, the Rhode Island Mentoring Partnership, Recycling for Rhode Island Education, VOWS Inc. (Volunteers of Warwick), and the J. Arthur Trudeau Memorial Center. After recruiting these organizations, I paired them with student groups. These students and organizations then met to conduct public relations audits. The students then built a campaign from the organizations’ ideas. The two parties remained in contact throughout the project and built business relationships. Once the students completed their plans, they pitched them to their organizations at an event where the students not only presented their work but networked with the other company representatives. Real life experiences are extremely valuable to a student’s education. Many classrooms lack the opportunity for hands-on projects. At the same time, small businesses and non-profit organizations often struggle to establish new, innovative, and creative ideas for reaching their publics. With the economy in its current recession, this program connected eager students with these organizations in a means that benefited both groups. Campaigns from the Classroom to the Boardroom not only gave students real life work experience and organizations free student help, but sparked business relationships between the students and non-profits that may prove beneficial in the future

Improving Heart Failure Education Prior to Discharge: An Emmi Implementation Project

Background: Heart failure is one of the leading causes of hospitalizations and increased health care costs in the United States. Many patients are readmitted within 30 days of discharge, resulting in increased costs. Purpose of Capstone Project: The purpose of this capstone project was to improve heart failure education for patients admitted with heart failure to Mercy Medical Center by utilizing Emmi educational videos in order to decrease the risk of hospital readmissions, improve quality of life, and decrease costs. Methods: The project focused on educating nurses about the importance of utilizing the video. It was asked of the nurses that each patient admitted with a diagnosis of heart failure have the opportunity to watch the educational video prior to discharge. The number of patients with heart failure that were given the opportunity to watch the Emmi educational video was collected. The evaluation of this project was a comparison of the number of Emmi educational videos utilized before the implementation of the Capstone Project to the numbers of videos utilized after the implementation. Results: When comparing the ordering of the Emmi videos after implementation to before the implementation, there was a noticeable increase in Emmi usage. This included the ordering for all categories of the heart failure Emmi and the general heart failure Emmi. Unfortunately, ordering the Emmi did not mean that the video was utilized. Recommendations: It was recommend that the utilization of Emmi videos be continued. Nurses need continued encouragement to utilize the video and not just order it. It was also recommended that APRNs and PAs focus on ordering and implementing the Emmi videos. Lastly, making Emmi utilization a function of case managers, cardiac rehab nurses, and discharge nurses was recommended

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

The influence of Instagram on exercise and eating behavior

The use of social media, specifically Instagram, of 305 Bryant University students ages 18-28 was investigated through student completion of an online survey to examine how following exercise and food related Instagram accounts impacts behavior. Both male and females use Instagram fairly equally, though males are more responsive to food Instagram accounts than females, who have no significant difference in behavior. Both males and females who follow exercise Instagram accounts are significantly more active than those who do not follow exercise Instagram accounts. Given the recent explosive use of Instagram in the population, the implications for this study are enormous, especially for organizations that want to reach this segment to influence exercise and eating behavior

Influence of alkali resistant (AR) glass in porcelain clay for vitrified clay pipes

The aimed of the present work is to produce porcelain clay reinforced with Alkali Resistant (AR) glass for vitrified clay pipes at minimum sintering temperature. In this study, AR fiberglass as a reinforcement was milled into an average particle size of 90 μm and mixed with porcelain in different weight percentage at 3 wt%, 6 wt%, 9 wt%, and 12 wt%. The sample was prepared by using powder compaction and then fired for 2 hours at 900°C, 1000°C 1100°C and 1200°C. Based on the chemical analysis, it was found that SiO2, Al2O3, Na2O and K2O is the significant element to produce the material. Result of thermal analysis shows that sintering start occurs at 900°C to 1300°C. The result of volume shrinkage, apparent porosity, water absorption, bulk density and flexural strength were recorded for each samples. Scanning electron microscope (SEM) was used to observe the microstructural morphology of samples. It was found that the addition of AR glass can dramatically lowering the apparent porosity as well as water absorption and increase the value of volume shrinkage, bulk density and flexural strength with the rising of sintering temperature. It can be seen that the volume shrinkage is satisfy the typical ceramic shrinkage where is quarter than original dimension which is 31.75%. Based on the result, the favorable properties of porcelain clay sintering were obtained at sintering temperature of 1100°C with addition of 3 wt% AR glass. Thus, the suitable value of apparent porosity, water absorption and density obtained was 0.41%, 6.27% and 2.29g/cm3 respectively. Meanwhile, the maximum value for flexural strength gained was 76.40MPa. Based on the microstructure image, it can be seen that the reduction of porosity and increasing of glassy phase was corresponded to the addition of AR glass and rising of sintering temperature. In conclusion, the objective of this study were achieve to satisfied the value of vitrified clay pipes standard based on EN 295

A Phenomenological Assessment of Factors that Affect Medication Adherence Among Hypertensive Nigerian Immigrants

This qualitative study explored the perceptions that affect medication adherence among hypertensive Nigerian immigrants in Sacramento, California. The research questions focused on factors that influenced the adherence to hypertension medication; specifically, how the sample population explained the cause of hypertension and whether culture and religion impacted the cause and management of hypertension. A phenomenological approach was used to understand perceptions about medication adherence. A predefined group of 9 acted as a purposive sample and was given semi-structured individual interviews. Qualitative data analysis of the interviews was performed using Colaizzi\u27s 7-step method. Results from the study found the cause of hypertension was believed to be genetics, stress, and diet. Education was strongly cited as the reason for dispelling cultural beliefs toward hypertension cause and management of the illness. Reasons for nonadherence were linked mostly to forgetfulness and side effects of hypertensive medication on sexual performance in males. Participants reported that prayer did not affect medication adherence, but was used for psychological healing. Living in the United States was viewed as a both a positive and negative influence on the management of hypertension

Avoidable Hospitalizations

Georgia Health Policy Center worked to improve health care in eight of the most rural, medically under served states in the country. The Center conducted research and provided strategic planning for eight Southern states: Alabama, Arkansas, Georgia, Louisiana, Mississippi, South Carolina, East Texas and West Virginia