Clinical Management of Postpartum Hemorrhage in Community Birthing Hospitals in Vermont: A Gap Analysis to Promote Best Practice

Purpose: Despite advances in research and medical technology, the rates of postpartum hemorrhage (PPH) continue to rise. Annually, these preventable events are the cause of one-fourth of maternal deaths worldwide. In order to reduce maternal mortality and morbidity rates, the effective application of evidence-based interventions is required. The purpose of this DNP project was to conduct a gap analysis in community birthing hospitals in Vermont to examine the existing clinical management of PPH. Methods: Registered nurses at three hospitals were surveyed to assess current policies/protocols pertaining to the management of PPH in five categories: 1) systems level readiness, 2) patient level readiness, 3) recognition and prevention, 4) response, and 5) reporting and systems learning. Quality improvement recommendations targeting PPH management were made based upon the gap analysis. Results: A total of thirty-seven surveys were completed. Several evidence-based best practice recommendations were inconsistently done, not done, or unknown. Nurses would feel more prepared to manage a postpartum hemorrhage with more simulation drills and mock codes, a walk-through of mass transfusion protocols, easy access to hemorrhage medications, a PPH risk assessment done on all laboring mothers upon admission, and education about identification of PPH. Conclusions: Areas for improvement were identified across all five categories. A systematic approach to evaluation of current practice protocols and identification of improvement targets with implementation strategies using the California Maternal Quality Care Collaborative (CMQCC) OB Hemorrhage Toolkit V2.0 may enhance clinical management of PPH and maternity outcomes

Developing an Online Health Community for Autoimmune Disease Patients Through Self-Managed Diet

Part I, Autoimmune Disease Management and the Need for Intervention, discusses current and standard Autoimmune Disease- (AI/AID) management and the shortcomings within. Typical AID-management led by healthcare professionals lacks a holistic, symptom-based approach, thus further contributing to the daily chronic pain of the afflicted. This analysis indicates the need to connect those suffering with AID’s to scientific research that has determined strict dieting can significantly reduce symptoms associated with AID’s. Part II, Synthesizing A Model For Online Health Community Engagement, examines the website prototype of Greenebean, which is an online community developed via user-centric design, in a theoretical, physical, and creative sense. The intention of Greenebean is to educate and empower those with AID’s to adopt a self-managed healthcare approach through diet. The presentation and delivery of the prototype material is formulated based on how people learn online, the AID community specifically, and what has to exist for learning to occur. Additionally, the website design and content developed is intent on reducing or eliminating the most-common barriers associated with participating in online communities of this nature. By providing Autoimmune Disease patients with proper educational resources, concise and knowledgeable direction, as well as an emotional support community based on shared experiences, the patients will be more inclined and empowered to adapt to self-managed health through dietary changes. By participating in a supportive community where users are validated and connected to others in similar circumstances, Autoimmune Disease patients gain a better understanding of their health and perceive to have more control over their health. The importance of prototyping in web development is evaluated and how the creation of products through the lens of the user is an effective way to develop and maintain a thriving, interactive community. Since user experiences will significantly vary, the prototype reflects different user-journey designs, including individual and community interactions. Educational resources and emotional support elements must be flexible to achieve inclusivity and to appeal to varying levels of experience and knowledge. Inter-personal channels and the leveraging of personal experience are effective methods of influencing and empowering others to adopt new behaviors, even when skeptical

Mental Health Group for Elementary-Aged Children

Children learn many skills during their time in elementary school. One important area that is not sufficiently addressed in curricula is student mental health. Allowing students to address their mental health needs in the classroom improves their overall outcomes. This intervention is a short weekly group completed within the classroom by the classroom teacher and the school’s counselor. Implementing this low-cost, short mental health group in classrooms can help to address this gap in student learning. In this group, the children will have the opportunity to gain a stronger relationship with an adult and learn to cope with loss. The group will also teach students to express their emotions appropriately to their peers and to adults. This mental health group provides social support and mental health skills to students so that they are less likely to commit school shootings

The Puppy and the Snapping Turtle

On March 8, 2018, an abandoned, terminally ill puppy was brought into the classroom of Idaho high school science teacher Robert Crosland. Crosland, known for taking in sick animals, could tell that the puppy was beyond saving. After school, in front of a handful of his students, Crosland placed the sick puppy inside the tank of his snapping turtle. It drowned and was then eaten by the turtle. Crosland was reported for animal cruelty. The snapping turtle, a member of an invasive species, was confiscated and euthanized by the Department of Agriculture

Re-Thinking the Nature of Bodies.

Human beings are constantly growing and shedding cells. This means that very few of the cells that any person has as an adult were the cells that they had as an infant. Over the years, as we’ve learned more about cell growth and death, we’ve learned that our bodies aren’t fixed objects that simply change shape over time. Bodies are ever-shifting collections of physical stuff. To co-opt a phrase from Heraclitus, no one occupies the same body twice

Zoning Out Muslims?

As part of a legal settlement, Bernards Township, a small, affluent town in central New Jersey, will pay a 3.25-million-dollar settlement to a local Islamic group. The Justice Department filed suit. Together with the Islamic group, the department alleged that the township had changed their zoning laws to prevent a mosque from being built to service the area’s Muslim population

California Debates Parole for a Member of the Manson Family

On the night of August 9, 1969, several young people crept into the Los Angeles home of Leno and Rosemary LaBianca. At the behest of cult leader Charles Manson, they stabbed the couple to death. Cult member Leslie Van Houten stabbed Rosemary LaBianca fourteen times. The group wrote messages on the wall in the victims’ blood. After she played her part in the murder, Van Houten took a shower, put on one of Rosemary LaBianca’s dresses, and ate some food from the refrigerator

A Trump Administration Press Secretary Walks Into a Restaurant

On Friday, June 22nd, the Trump Administration’s Press Secretary, Sarah Huckabee Sanders, arrived and was seated at the Red Hen restaurant in Lexington, Virginia. Sanders was one guest in a party arriving for a reservation for eight, booked in her husband’s name. When the wait staff realized that Sanders was with the party, they called the owner of the restaurant, Stephanie Wilkinson. Wilkinson dropped everything and rushed to the restaurant. She allowed her employees to vote on a course of action. They voted to ask Sanders to leave. Wilkinson approached Sanders and said, “I’m the owner. I’d like you to come out on the patio with me for a word.” Once they were out of earshot of other customers, Wilkinson explained that the values that Sanders publicly espouses and defends were not consistent with her own and that, as a result, Wilkinson must ask her to leave. Sanders complied with the request. The other guests in the party were invited to stay, but, unsurprisingly, they declined the offer. They had already been served appetizers, and Wilkinson insisted that their bill was on the house

The Shifting Ethical Landscape of Online Shopping

Throughout the course of 2017, after a disappointing bottom line during the 2016 holiday season, Macy’s department store closed 100 of its locations nationwide. Gap Inc. announced last year that it would close 200 underperforming Gap and Banana Republic locations, with an eye toward shifting greater focus to online sales. Shopping malls across the country resemble ghost towns—lined with the empty façades of the retail giants that once were

When is Comedy Over the Line? The Departure of Shane Gillis from SNL.

Earlier this month, the famous sketch comedy program Saturday Night Live announced that Shane Gillis would be joining the troupe. The comedian was allegedly cast in an attempt to appeal to more conservative potential viewers. In recent years, the show has been perceived by many to have a liberal bias, and its creators wanted to draw more politically diverse viewership. Several days later, however, SNL announced that Gillis would not be joining the cast after all. The show’s representatives acknowledged that they cast Gillis on the basis of the strength of his audition, but failed to adequately vet him before offering him the job. In the days immediately following the casting announcement, comedic material surfaced that many found appalling. A good number of the offensive remarks came from a podcast co-hosted by Gillis in which he makes unambiguously racist, sexist, homophobic, and transphobic remarks. There are also recordings of Gillis making rape jokes and mocking people with disabilities