Opioid-Crisis Intervention: A Pilot To Moderate Patient’s Use of Post-Operative Opioid Medications Using a Video-Based Perioperative Education Tool

Problem Description The opioid epidemic has been ravishing communities in the United States for nearly two decades, resulting in opioid misuse, dependence, and overdose-related deaths. Healthcare providers have inadvertently fueled the epidemic by overprescribing opioid medications contributing to 40% of the opioid overdose-related deaths. One in every 48 patients who receives an opioid medication for the first time will become a chronic user of these medications. Furthermore, 6% of all surgical patients will continue chronic use of opioid medications 90 days after their surgeries regardless of absence of pain. With over 50 million surgical cases performed each year in the United States, the number of surgical patients adds another 2 million potential chronic users of opioid medications. Educating surgical patients about pain management choices better prepares them for shared decision making. Setting The setting of this project is a major trauma medical center in the Pacific Northwest. The medical center’s perioperative clinicians continue to largely treat pain with opioid medications, especially in the post anesthesia care unit (PACU). Rationale Bandura’s self-efficacy theory provides the rationale for using patient-education as a tool in this project. The strength of people’s convictions in their own effectiveness will determine the level of coping with a given situation. Recognizing that pain is a temporary part of surgery that will subside, enables surgical patients to become self-sufficient in diverting their thoughts from sensing pain while focusing on other activities. This consequently helps them cope better with surgical pain. This leads to reduction in opioid consumption after surgery and improved outcomes. Specific Aims The project aimed to inform patients of opioid dangers, provide expectations of surgical pain, and describe alternative non-opioid therapies for pain management. There are many methods to convey the information, however, given the wide range of healthcare literacy between patients, audio, and visual aids -specifically cartoon animations- have been proven to enhance learning and engagement. The project focused on developing an animated educational video to enhance awareness of opioid dangers. Project Outcomes A six-minute-high quality educational video animation was developed by the project manager along with data collection, and post intervention assessment tools. All stakeholders were informed of the aims of the project and understood the intervention-related processes prior to implementation with every patient. Receiving and accessing the video animation were paramount to the success of the project. Thus, two outcomes for the project ensured focus on patients’ receiving and accessing the video animation. Outcomes related to level of anxiety and pain after watching the video animation allowed for assessment of the intervention’s potential influence on patients’ perception of both. Patients were further assessed in achieving three or more of five desired post-surgical outcomes that are known to be highly influenced by pain and opioid consumption. Stakeholders feedback on potential improvements to the project were sought after implementation. Implementation and Evaluation Plan 12 patients were individually invited for participation between June 2022 and August 2022. The video was shown to every patient prior to surgery by the project manager, ensuring access of all participants. Intervention’s influence on patients’ anxiety related to surgical-pain management was assessed by direct questioning of patients during hospitalization. Electronic health records were also reviewed for reports of anxiety, pain scores, and achieving three or more of the following outcomes: 1. Ambulated early (on day of surgery or the next morning), 2. Lacked complaints of nausea and vomiting, 3. Tolerated self-care activities. 4. Reported minimal or no drowsiness, and 5. Reported readiness for discharge to home. Aggregate data was tabulated, and descriptive statistics were used to quantify results in numbers and percentages. Results and Interpretation The initial aim was to assess the effectiveness of the educational tool exclusively on bariatric surgery patients. However, the departure of the project’s bariatric surgery champion at the host institution greatly minimized the ability to enroll bariatric surgery patients in the project. Consequently, the surgical patient pool had to be broadened to allow for sufficient number of enrollees. Other types of surgeries were chosen based on their potential to produce relatively similar pain burden postoperatively as bariatric surgeries. Of the 12 patients who participated in the project, five (41.5%) were female, five (41.5%) were male, and 2 (17 %) self-identified as transgender. Eleven patients (92%) did not require an anxiolytic before surgery and after viewing the video and the opportunity to ask follow-up questions. The presence of the project manager during viewing of video allowed patients and their families to have immediate access to further clarifications and answers to questions. Ten patients (83%) did not receive opioid medications during surgery and five (42 %) did not require any pain medications after surgery. 59% of patients found the intervention educational and helpful. 67% of patients reported their pain as mild after surgery. Conclusion Patient-focused education prior to surgery regarding surgical pain management could be a helpful tool in alleviating anxiety and reducing opioid consumption after surgery, especially using a multimedia tool such as video animation

Nursing Student Work-Study Internship: Partnering to Bridge the Education-to-Practice Gap

Abstract Discussed for decades, the need for transitional experiences bridging educational and practice settings gained momentum in the mid-1970s with the release of Kramer’s groundbreaking book Reality Shock: Why Nurses Leave Nursing. Nursing student internship programs were developed in the 1970s as one effort to address this issue. The Northern California Region of Kaiser Permanente partners with five universities to conduct the Nursing Student Work-Study Internship Program (WSP). The program provides senior level nursing students with a paid internship in clinical practice settings, working under the supervision of RN preceptors. The aim of the program is to improve the intern’s perception of readiness for practice as professional RNs. An evidence-based, change of practice, quality improvement project was conducted to improve the organization’s existing Nursing Student WSP. Interventions included an evaluation of the WSP structure, processes, and outcomes, and development of evidence-based resources to address identified gaps. The 2008 Casey Fink Readiness for Practice Survey© was administered to the 2016 cohort prior to and at the conclusion of the internship as a measure of the WSP impact on intern’s progression toward professional practice and demonstration of value to the organization. Quality improvement measures had a positive impact on nursing student interns and demonstrated program value to the organization

Emergency Room Nurses Knowledge of and Experience with Health Literacy and their Patient Teaching Methods

Health literacy (HL) is the ability one has to understand health information and navigate within the health system. Health literacy is linked to health knowledge and acute and chronic health outcomes. The conceptual model of health literacy outlines the contextual factors related to individual health literacy throughout the health system and the mitigating influence on outcomes. Education is a key factor to health knowledge and behavior changes. Nurses are the primary educators for providing patient teaching and yet research indicates nurses are lacking in knowledge regarding this. One area in the health system where health literacy has a strong effect on patient outcomes is the emergency department (ED). Identifying the association between emergency department nurses knowledge of, and experience with health literacy, and their use of patient education strategies is important for future patient outcomes. This descriptive, exploratory, correlational study examined the HL knowledge, experience and most frequently used teaching methods of ED nurses as well as relationships between and among emergency department nurses’ health literacy knowledge, health literacy experience and their patient teaching methods. Results of this study indicated that ED nurse participants knew less basic facts about HL than about evaluating HL interventions and the consequences associated with low HL. Overall the participants answered 62% of the knowledge questions correctly. There were correlations found between HL knowledge and age, years as a licensed registered nurse (RN) and years worked in the ED with the strongest predictor of HL knowledge being nurses level of education (β = .21, p = .012). A number of ED nurses (49.8%) indicated they never participated in HL strategies such as HL screening, evaluating reading level of written materials or illustrations and very few (4.6%) indicated they always participate. The participants indicated the most frequently used teaching methods in the ED were providing written materials, avoiding medical jargon and encouraging questions. Further research is needed to explore methods to increase health literacy knowledge of ED nurses and strategies to facilitate experiences with health literacy in the ED. Communication is an important component of the relationship between nurses and low health literate patients in the ED. Methods to enhance communication and facilitate patient understanding and retention of patient teaching should also be explored

An overview of the nature of the preparation of practice educators in five health care disciplines

Practice education is a core element of all educational programmes that prepare health care professionals for academic award and registration to practice. Ensuring quality and effectiveness involves partnership working between Higher Education Institutions (HEI’s) and health care providers, social care communities, voluntary and independent sectors offering client care throughout the United Kingdom and Republic of Ireland. Clearly practitioners who support, supervise and assess learners for entry to their respective professions need to be well prepared and supported in their roles as practice educators. However it would appear that the nature of this support and preparation varies across disciplines and that good practice is not easily shared. With this in mind, the Making Practice Based Learning Work (MPBLW) project aims to make practitioners more effective at supporting and supervising students in the workplace across a range of health care disciplines namely Dietetics, Nursing, Occupational Therapy, Physiotherapy and Radiology. The Department of Employment and Learning (Northern Ireland) and the Higher Education Funding Council for England has funded this collaborative project involving staff from Ulster, Northumbria and Bournemouth Universities. The outcomes for each phase of the project are: Phase One: • Identify and document good practice on how practitioners are prepared for their educational role. Phase Two: • Develop and evaluate learning materials for use by practitioners across five health care disciplines. • Make learning materials available in a number of efficient media, e.g. paper, electronic, CD-ROM and web-based. • Develop a programme applicable to interprofessional and uniprofessional contexts. • Widen access for a multicultural workforce. Phase Three: • Embed best educational practice through the establishment of an academicpractitioner network. • Disseminate a range of materials and processes across the wider academic and health and social care communities

Improving postoperative breast augmentation patient education delivery.

Background: Effective patient education promotes successful postoperative outcomes. Nurses in an outpatient surgery center lacked consistent patient education practices and materials. Purpose: The purpose of the project was to implement an evidence-based multimodal educational strategy for patients who undergo breast implant surgeries. Methods: At an outpatient plastic surgery center, pre- and post-intervention phone calls were tracked; post-intervention education, documentation, and patient satisfaction data were recorded. Nurses were educated on the new materials, delivery procedures, and electronic health record (EHR) documentation. All patients undergoing breast implant surgery received multimodal education at each postoperative appointment. Outcomes included (1) the number of patient phone calls for additional postoperative education; (2) EHR documentation; and (3) patient satisfaction with educational content and delivery (Quality of Discharge Teaching Scale). Intervention: At postoperative visits, nurses provided verbal and written education and QR code access to an online video and educational resources. Nurses documented the educational encounters in the newly established EHR patient education checklist. Results: Patient phone calls improved by 28%. On a scale of 1-10, patients reported high levels of satisfaction with educational content (8.86 ± 1.42) and delivery (9.48 ± 1.07). Nurses’ documentation of education provided improved by 178%. Discussion: Nurses educated nearly 100% of patients and had 100% EHF documentation. Patients demonstrated a greater understanding of their postoperative self-care and expectations, with fewer phone calls. Patients reported a high level of satisfaction with educational content and delivery. The patient teaching is now incorporated into all breast surgery postoperative care

Nurses' perception about the implementation of focused ante-natal care services in destrict health facilities of Dar Es Selaam

The purpose of this study was to explore and describe the perception of nurses about the implementation of focused ante-natal care services in nine district health facilities of Dar es Salaam. Quantitative, explorative and descriptive research was conducted to determine how the implementation of the focused ante-natal care guidelines was perceived by nurses who provided midwifery health care services. Data collection was done using a structured questionnaire. A simple random sampling method was used to select the respondents. The study sample comprised of nursing officers (n=50), nurse midwives (53) and public health nurses (40). The SAS/Basic and SAS/STAT version 11.1 was used to analyse data. Validity was ensured and the Cronbach’s coefficient reliability test was 0.86.The findings revealed that the greatest area of concern was the shortage of human and material resources for successful implementation of focused ante-natal care to pregnant women and unborn children.Health SciencesM.A. (Health Studies

Nursing Staff Optimizing Elder Care

Older adults, 65 years and older, make up more than 50% of the acute care patient population at a Southwest Michigan critical access hospital. This DNP capstone project was implemented for nursing staff members in a small rural hospital to assist with improving knowledge and perceptions of caring for older adults. Realized outcomes from this educational initiative were not meant to create new information but instead to focus on clinical issues and apply best practice for the purpose of determining evidence based solutions. The project’s design implemented to assess outcomes was a quantitative, descriptive, quasi-experimental, non-randomized approach. The plan included a pre and post intervention survey using the Geriatric Institutional Assessment Profile (GIAP) from the Nurses Improving Care for Healthsystem Elders (NICHE) Program. Education was provided after the pre intervention survey was completed via classroom presentations, hand-outs, and informational emails. The GIAP survey was repeated post educational intervention. Thirty nursing staff members participated in the pre intervention survey and seventeen completed the post intervention survey. Independent samples t-test on measures related to knowledge and attitudes revealed compelling percent changes representing statistical significance between pre and post GIAP survey responses with a p value of ˂ .05 in all areas measured

Professional and lay facilitators\u27 perceptions of roles, goals, and strategies to promote social support and self-management in face-to-face support groups for adults with multiple sclerosis and myotonic muscular dystrophy

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