Protocol to Increase Administration of Herpes Zoster Vaccine in a Long-Term Care Facility

Although the herpes zoster (HZ) vaccine to decrease the incidence of Shingles was licensed for use in 2008, little coverage for HZ vaccination has occurred and stands nationally at 16%. At a targeted nursing home and assisted living facility, a protocol for including HZ along with state-mandated vaccinations was devised and used in screening incoming residents. Baseline data from chart reviews (n=122) showed that despite treatments given for the infection in the preceding 12 months, no vaccinations had occurred. During a 6-month implementation period, all new residents meeting eligibility criteria were offered the HZ vaccination. In this period, four residents agreed to the vaccination. In a pre to post implementation survey, all clinical providers (n = 9) indicated they had been (1) or would (8) would recommend the HZ vaccination

Quantification of the oxygen uptake rate in a dissolved oxygen controlled oscillating jet-driven microbioreactor

BACKGROUND: Microbioreactors have emerged as a new tool for early bioprocess development. The technology has advanced rapidly in the last decade and obtaining real-time quantitative data of process variables is nowadays state of the art. In addition, control over process variables has also been achieved. The aim of this study was to build a microbioreactor capable of controlling dissolved oxygen (DO) concentrations and to determine oxygen uptake rate in real time. RESULTS: An oscillating jet driven, membrane-aerated microbioreactor was developed without comprising any moving parts. Mixing times of ∼7 s, and kLa values of ∼170 h−1 were achieved. DO control was achieved by varying the duty cycle of a solenoid microvalve, which changed the gas mixture in the reactor incubator chamber. The microbioreactor supported Saccharomyces cerevisiae growth over 30 h and cell densities of 6.7 gdcw L−1. Oxygen uptake rates of ∼34 mmol L−1 h−1 were achieved. CONCLUSION: The results highlight the potential of DO-controlled microbioreactors to obtain real-time information on oxygen uptake rate, and by extension on cellular metabolism for a variety of cell types over a broad range of processing conditions. © 2015 The Authors. Journal of Chemical Technology & Biotechnology published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry

Improving Fragmentation in Healthcare Delivery through Strengthening Interprofessional Communication

a. To train advanced health professions students on methods for modifying patient behavior for persons with multiple chronic conditions by enhancing interpersonal communication skills during patient assessment. b. Narrative as a diagnostic tool provides a nuanced view focused on patients’ stories that are context bound. Thus attention to narrative informs care decisions. Through an Advanced Education Program grant the advanced nursing curriculum is being expanded through improving interpersonal communication and ethical decision making in caring for persons with multiple chronic conditions (MCC) for a medically underserved patient population. Project participants include graduate nursing, dentistry, pharmacy, and social work students who learn and work together as interprofessional clinical (IPC) teams for assessing, evaluating, and developing patient-centered care plans. c. Taking an innovative approach to IPE, methods grounded in the humanities and behavioral health are being utilized and implemented in a clinical setting which include narrative and reflective practice, interpersonal and interprofessional communication, and motivational interviewing strategies. This training allows the IPC teams to be more fully present through intentionality and non-judgmental response and for their patients to fully tell their story. Two goals inform the project: improved patient and team communication; reduced fragmentation in healthcare delivery. d. Student and patient experiences were analyzed using a series of pre- and post-surveys along with focus groups that were analyzed qualitatively for key themes. Preliminary results suggest that students begin with high levels of readiness for IPCP and that following a semester-long experience, the students reported high levels of IP collaboration along with increased skills for teamwork. e. Cohorts of graduate students in nursing, dentistry, pharmacy, and social work are trained together and work as IP clinical teams in an urban clinic. f. Focused-immersion sessions followed by clinical practicum experiences as IP clinical teams can serve to improve communication and patient-provider interactions. g. Apply interpersonal communication and motivational interviewing strategies in developing IP clinical teams; Identify methods for using narrative and reflective practice in Advanced Nursing curricula; Value the importance of the patient’s story as part of health assessment

Uninformed Consent

Patients seek the advice of health care providers regarding treatment options and protocols. When there is a condition with several treatment alternatives, patients generally rely on their health care providers to explore all the options available and guide them on the evidence-based treatment that would ensure the best outcome. This simple premise is complicated by the fact that there are often not one, but a range of treatments with differing interpretations of the best outcome. In addition, failure to ensure that patients have adequate comprehension of treatment options and complications often result in negative treatment outcomes. Cases where the treatment causes more harm than the disease generally lead to debates of whether observation without intervention is the optimal course. This article discusses a patient’s total reliance on the advice of the attending physician, who apparently failed to ensure that the patient had adequate comprehension of the long-term implications and complications resulting from a recommended surgical procedure. The ethical dilemma that emerged is analyzed, with emphasis on the concept of informed consent, by reviewing the patient’s surgical outcome and roles of the surgeon and primary care provider. The paper concludes by providing recommendations to ensure that patients are sufficiently informed before consenting

Effect of a Quality Improvement Initiative on Procedural Abortion Pain and Anxiety Using a Standardized Patient-Focused Sedation Options Counseling Guide

Sedation decreases the discomfort of pain and anxiety during a procedure. Our quality improvement initiative using a standardized sedation options counseling guide to provide patient-focused counseling decreased pain, but not anxiety, during abortion procedures. This adjunct to established pain management options is a simple improvement on current practice.https://knowledgeconnection.mainehealth.org/nnectr/1005/thumbnail.jp

Application of Systems Engineering Science to the Healthcare Environment

This Doctoral dissertation consists of a research portfolio examining the application of systems engineering techniques to the healthcare environment. The portfolio consists of three final publishable articles submitted to meet the program requirements for the, Doctor of Philosophy in Nursing degree from the University of San Diego, Hahn school of Nursing and Health Sciences. Article one is titled; Use of a bed projection tool to predict ICU bed needs. This article describes the dissertation research study in which a bed projection tool was piloted on an ICU unit to determine the tool\u27s ability to predict inpatient bed requirements. Article 2 is titled; Reducing Disruptive Communication in the Health Care Setting: Use of the Crew Resource Model (CRM). Crew resource is a human factor-engineering model that creates uniform team roles and communication structure. This article advocates the use of this model to assist in dealing with disruptive behaviors by healthcare team professionals. The article advocates the use of the CRM model for meeting the Joint Commission on Hospital Accreditation requirement for organization\u27s in which a plan is implemented for dealing with disruptive communication in the health care environment (by health care team professionals). Article 3 is titled; Application of systems engineering to the hospital environment; has the time for a Nurse Engineer role arrived? This article describes the evolution of systems engineering as a discipline and its historical application. The article stresses the need for Nurses to acquire an engineering skill set in order to participate in the redesign of clinical health systems, which will ensure efficiency and patient safety

Global IPE: Challenges and Opportunities

A description of global interprofessional education and practice, highlighting real world examples from the work of Partners In Health in West Africa and Haiti

Educating Oncology Nurse Practitioners to Provide Basic Palliative Care

Background: Approximately 1.66 million Americans are diagnosed with cancer each year and another 589,430 die from the disease. As treatment options have expanded, many cancer patients are living longer with worsening symptoms and disabilities and an increased illness burden. These patients are ideal candidates for palliative care. Palliative care involves care delivered by a team of clinicians with specialty training and a focus on improving the quality of life for patients with serious illnesses. A number of major organizations have made formal recommendations regarding the integration of palliative care into comprehensive cancer care including the American Society of Clinical Oncology and the National Comprehensive Cancer Network. With an advanced education and scope of practice, a holistic orientation, and an evidence-base that substantiates their provision of safe and effective care, nurse practitioners (NPs) are well positioned to improve access to palliative care; yet, many NPs lack basic knowledge of palliative care and do not have competencies to provide such care. Objectives: This project aimed to measure differences in NPs’ knowledge of basic palliative care concepts and their self-rated self-competence in the provision of its care before and after a formal education program. Methods: This study used a one-group pre-post test design and valid and reliable instruments to measure the effects of an education intervention on NPs’ knowledge of basic palliative care and self-reported self-competence. The content for the education intervention, which was drawn from the End of Life Nursing Education Consortium’s (ELNEC) Advanced Practice Registered Nurse (APRN) curriculum, was delivered in one 8-hour program. The sample included NPs who practiced in the regional network sites of a National Cancer Institute designated comprehensive cancer center. Statistical differences were tested using paired t-tests, and a Wilcoxon Signed Ranks test. Results: A total of 37 NPs participated in the program. Knowledge, as measured by the ELNEC KAT increased from a mean of 89.03 to a mean of 90.49. Paired samples t tests revealed a statistically significant difference between the mean pre and mean post-test scores (t =-2.165, df =36, p= .037). Self-reported self-competence as measured by the PCNSC increased from a mean of 3.21 to a mean of 4.10. Paired samples t tests revealed that the difference between the mean pre and mean post PCNSC score was statistically significant (t =-9.202, df =36, p= .001). Conclusion: A one-day course based upon the ELNEC APRN clinical modules was effective in improving both knowledge, and self-competence of basic palliative care among oncology NPs