Ethical Decision Making in Online Graduate Nursing Education and Implications for Professional Practice

Academic dishonesty is an issue in academic institutions, which is escalating due to digital cheating. Cheating in online courses is a challenge in health science disciplines where high ethical standards are expected in professional practice. Unethical behaviors may begin in the academic career and persist into the professional career. The purposes of this article are to examine academic dishonesty within the online learning environment, transference of unethical behavior into professional practice, and strategies to reduce academic dishonesty in online graduate nursing education. In order to maintain high academic and professional standards, the individual must feel a moral obligation to engage in ethical behaviors in academia using online instructional technologies and in professional practice. Educators that teach in online courses are obligated to develop pedagogical and instructional designs that discourage dishonesty and encourage ethical decision making in the academic and professional setting. This article provides a glimpse of online cheating in academia and its implications for graduate nursing education and professional practice

“Implementation of an Outpatient Iron Infusion Clinic: Alternative Approach to Treat Iron Deficiency Anemia in Pregnancy”

Abstract Iron deficiency anemia in pregnancy is a common and treatable condition that can potentially affect pregnant women and their unborn fetus. In pregnant women, iron deficiency anemia can lead to complications such as preterm labor, preeclampsia, and even sepsis. In children, iron deficiency anemia could affect the neurodevelopment of the fetus. This could potentially result in poor school performance, behavioral problems, or cognitive deficits. In addition, iron deficiency anemia in pregnancy could lead to intrauterine growth disturbances and potential fetal loss. In order to address this problem, an outpatient intravenous iron infusion clinic has been implemented at a Women’s Hospital to allow for access to an alternative approach to treatment. Oral iron supplementation, the traditional treatment of iron deficiency anemia, is most often poorly tolerated by patients. As a result, many patients exhibit poor compliance with treatment for iron deficiency anemia. The goal of this quality improvement project is to provide patients and providers with an effective and efficient outpatient alternative approach to treat iron deficiency anemia in pregnancy. Keywords: iron deficiency anemia, pregnancy, fetus, intravenous, iron infusio

Effectiveness of EHR-Depression Screening Among Adult Diabetics in an Urban Primary Care Clinic

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR). Methods We conducted a retrospective chart review on patients aged 18 years and above with a diagnosis of DM2 and no initial diagnosis of depression or other mental illnesses. Chart reviews included those from 2018 or prior for before integration data and 2020 to present for after integration. Sixty subjects were randomly selected from a pool of 33,695 patients in the clinic with DM2 from the year 2013-2021. Thirty of the patients were prior to the integration of depression screening tools PHQ2 and PHQ9 into the EHR, while the other half were post-integration. The study population ranged from 18-83 years old. Results All subjects (100%) were screened using PHQ2 before integration and after integration. Twenty percent of patients screened had a positive PHQ2 among subjects before integration, while 10% had a positive PHQ2 after integration. Twenty percent of patients were screened with a PHQ9 pre-integration which accounted for 100% of those subjects with a positive PHQ2. However, of the 10% of patients with a positive PHQ2 post-integration, only 6.7 % of subjects were screened, which means not all patients with a positive PHQ2 were adequately screened post-integration. Interestingly, 10% of patients were treated with antidepressants before integration, while none were treated with medications in the post-integration group. There were no referrals made to the behavior team in either group. Conclusion There is no difference between the prevalence of depression screening before or after integration of depression screening tools in the EHR. The study noted that there is a decrease in the treatment using antidepressants after integration. However, other undetermined conditions could have influenced this. Furthermore, not all patients with positive PHQ2 in the after-integration group were screened with PHQ9. The authors are unsure if the integration of the depression screens influenced this change. In both groups, there is no difference between referrals to the behavior team. Implications to Nursing Practice This quality improvement study shows that providers are good at screening their DM2 patients for depression whether the screening tools were incorporated in the EHR or not. However, future studies regarding providers, support staff, and patient convenience relating to accessibility and availability of the tool should be made. Additional issues to consider are documentation reliability, hours of work to scan documents in the chart, risk of documentation getting lost, and the use of paper that requires shredding to comply with privacy

Prevalence of Binge Eating Disorder in an Insurance-Based Weight Management Center

Purpose: This project was anticipated to demonstrate an increase in the number of those diagnosed with BED according to Diagnostic and Statistical Manual (DSM) 5 criteria, diagnosed with ICD-10 code F50.8 or R63.2 and treated according to best practice guidelines. Background: Binge eating disorder (BED) is the most common eating disorder in the United States, more than both anorexia and bulimia combined. It affects 3.5 percent of women, 2 percent of men and 30 percent of those seeking weight management. Design: This evidenced-based project consisted of a retrospective analysis of 150 patients seen in a weight management clinic setting since implementing the ICD-10 coding system 02/09/16. Findings: Results demonstrated the prevalence of BED in this weight management center was 27.5%, 44% were diagnosed with an ICD 10 code, and approximately 20% were provided with evidence based treatments. Clinical Implications: Understanding the prevalence of BED demonstrates the need for increased screening methods to optimize the likelihood patients obtain empirically supported treatment

Establishing a Nurse Practitioner Residency Program in a Rural Federally Qualified Health Center: A Feasibility Analysis and Pilot Study

Abstract Rural communities are disproportionately underserved and have been identified as a priority population to improve health outcomes and access to care (Agency for Healthcare Research and Quality [AHRQ], 2015). National organizations have recognized a deficit in primary care providers, recommended nurse practitioners (NPs) as a solution, and supported NP residency programs as a means to prepare and recruit qualified practitioners into communities (Institute of Medicine [IOM], 2010; The Patient Protection and Affordable Care Act [PPACA], 2010). However, there are only three primary care NP residency programs in rural California (National Nurse Practitioner Residency and Fellowship Training Consortium [NNPRFTC], 2015). A pilot NP residency program and feasibility analysis was designed to evaluate current program structures and funding sources while promoting the development and implementation of NP residency programs within rural Federally Qualified Health Centers (FQHCs). Evaluation metrics included competency self-assessments, content-based evaluations of a web-based didactic module, and qualitative program evaluations. The results of this pilot study showed an increase in self-reported clinical competence as well as knowledge acquisition with the didactic module. An opportunity exists to model new NP residency programs off the pilot activities and structures identified in this project within rural FQHCs

Increasing Adult Influenza Vaccination Rates in the Primary Care Setting

Background: Provision of vaccinations is one of the most basic interventions aimed at health promotion and disease prevention in the primary care setting. Despite increased public awareness and improved access to vaccinations through minute-clinic settings, health fairs, and employer-offered vaccination clinics, adults in the United States continue to fall short of national goals. Literature demonstrates vaccination rates among adults vary widely and may be affected by a multitude of factors, however vaccination rates may be greatly improved with increased provider engagement. Objectives: The purpose of this project was to develop, implement, and evaluate a program to improve immunization rates in an ambulatory family practice setting. The primary aim of this study was to implement and assess the efficacy of a multi-pronged provider and staff engagement intervention targeted at increasing influenza vaccination of adults ≥18 years of age in the outpatient setting. The primary outcome measured was practice vaccination rates for the influenza vaccine among adult patients seen between October 1, 2019-November 30, 2019. Methods: This project followed a pre-post-test design, tracking practice influenza vaccination rates among adult patients, following a comprehensive practice intervention to improve provider engagement, tracking of influenza vaccinations, and patient understanding of vaccinations through increased patient education efforts. Results: During the two-month intervention period, 171 adult patients were evaluated. Data analysis revealed a 12.3% increase in vaccination rates (from 15.2% to 27.5%). A statistically significant improvement in vaccination rates among adult patients was noted following the intervention (t (170) = 3.470, p = 0.001). Pre- and post-test surveys were completed by staff members and analyzed before and after staff training. Analysis of staff surveys revealed no statistically significant changes among any of the survey items. Additionally, a total of 25 patient surveys were completed to assess reasons for vaccine refusal, revealing the primary reason for vaccine refusal was dislike of needles. Conclusions: Current data demonstrates an overall increase of 12.3% in vaccination rates among patients seen during the intervention period. Additionally, improved vaccination rates were noted in each of the specific demographic categories

PrEP Education Intervention

Background: The nation’s HIV infection rate is alarming, yet only a small percentage of eligible individuals are prescribed pre-exposure prophylaxis (PrEP). This sluggish PrEP uptake may be related to lack of knowledge among non-HIV specialist providers. Thus, interventions toexpand providers’ use of PrEP as an HIV prevention strategy are needed. Objectives: The project aim was to develop an intervention to improve retail nurse practitioners’ (NP) knowledge for PrEP clinical practice, comfort screening for “at-risk HIV” patients, confidence prescribing PrEP, and likeliness to prescribe PrEP in the next six months. Methodology: An online PrEP tutorial was implemented for retail clinic NPs. There were three phases: pre-survey, post-survey, and 30-day retention survey. Paired t-tests for differences between the pre- and post-surveys were performed. ANOVA was conducted to test differences between pre-, post-, and 30-day retention surveys. Results: Paired t-tests revealed significant differences between pre- and post-surveys for knowledge, comfort, confidence, and likeliness to prescribe (p \u3c.05). Similarly, the repeated measures ANOVA revealed a significant main effect of the intervention on all constructs (p \u3c.05). Post-hoc analysis showed all constructs, except for comfort, increased betweenthe preand post-surveys and all constructs increased between pre- and retention surveys. There were no differences between post- and retention surveys for any constructs. Conclusion: By increasing knowledge related to PrEP, online education can improve NPs consultation and prescribing practices to help confront the HIV epidemic

The development, implementation and evaluation of an Evidence-Based Biohazard Training Program within a Pediatric Ambulatory Practice

Background: Communicable disease(s) such as Ebola or Coronavirus can cause a catastrophic health crisis within the United States healthcare system, especially among the pediatric and elderly population. Lack of knowledge, skills and confidence among health care professionals in the pediatric setting regarding these infectious organisms can affect early identification, proper isolation, early treatment, and increased risk of a possible pandemic and/or fatalities. Aims/Objectives: The aim of this study was to develop, implement and evaluate an evidence-based biohazard training program-using the Identify, Isolate and Inform (3I) tool within a pediatric urgent care center to increase the staff’s knowledge, skills and confidence in managing these high-risk patients. Methods: This quality improvement project involved sixteen pediatric urgent care center staff members who took part in the biohazard-training program utilizing a pre and posttest via a modified Knowledge, Skills, Attitude (KAP) survey. Results: A 70% knowledge (K) score, 96.9% attitude (A) score and 87.5% practice (P) score including a total KAP score of 84.8% were obtained at baseline with 56.2% self-report confidence. After the completion of the evidencebased biohazard-training program, a 10% increase in the categories of knowledge, attitude and practice was found and maintained for 60-days post training with an increased confidence level of 74.5%. Conclusion: An evidence-based biohazard-training program using the 3I tool is useful in the identification and management of communicable disease(s). The training program may be an effective preventative measure to minimize infection and prevent the spread of a contagion. Therefore, more research is needed with a larger sample size to determine its usefulness within a clinical setting

Reducing Antibiotic Use in Pediatric Upper Respiratory Infection: A Multifaceted Parent-Clinician Approach

The goal of this QI initiative was to decrease inappropriate antibiotic for the treatment of pediatric upper respiratory infection (URI) in the retail clinic setting. The approach included the use of a protocol to treat viral upper respiratory illness, a visual aid decision-making tool for guideline adherence, prescription pad for nonprescription remedies, and shared decision-making techniques for providers to involve patients and parents in management plans regarding nonprescription remedies, supportive treatment, and signs and symptoms that would warrant a return visit. An improvement trend during the first 3 months of the initiative showed a shift in antibiotic avoidance from a baseline avoidance rate of 66% to a post intervention rate of 82%. The antibiotic avoidance initiative proved to be an effective approach in reducing the rate of inappropriate antibiotic treatment for pediatric viral upper respiratory conditions

Caregivers of underserved minority populations: views and opinions of the role of schools in BMI screening, education and communication

A pilot study exploring caregiver views of the role of schools in students’ health. Abstract To date, 20 states in theUnited Statesrequire school-based body mass index (BMI) screening for school-aged populations and for some the requirements include caregiver notification of the findings. Few studies have provided empirical data indicating whether or not caregivers accept or act on BMI communication from schools. Therefore, an exploratory pilot study was conducted in a culturally diverse urban school district to determine how a required (BMI) screening and notification were viewed by caregivers. Most caregivers reported that they felt schools did not have a role in the evaluation of their child’s BMI or interventions and did not find the letter an acceptable means of communication regarding their child’s weight status. This was especially true for Hispanic cultures. Implications for service delivery include more culturally sensitive communication and individualized communication especially for overweight and obese children. Health disparities can be reduced by tailoring communication to different racial and ethnic groups to meet their cultural expectations and beliefs