Improving Discharge Teaching for Adult Patients with an Ileostomy

LOCAL PROBLEM

Discharge teaching is essential to the self-care and successful recovery of colorectal surgery patients, yet the trend toward shorter hospital stays for patients with new ileostomies limits opportunities for patient education. As a result, discharged patients at our institution are initiating calls to providers with questions that could have been addressed prior to discharge.

PURPOSE

The aim of this quality improvement (QI) project was to decrease patient-initiated postdischarge inquiries using a frequently asked questions (FAQs) handout at discharge.

METHODS

A retrospective chart review of inquiries to the outpatient clinic over the six-month period between July 2020 and January 2021 revealed common concerns, among them bowel movements, home health care, medications, wound care, stoma issues, pathology reports, diet, and activity-related issues. Based on these concerns, a FAQs handout was developed to review with patients prior to discharge. Data from three postdischarge time periods (0 to 72 hours, 72 hours to 21 days, and 0 to 21 days) in the three months from June to September 2021 were analyzed to determine the impact of the intervention on the frequency and content of the patient inquiries.

RESULTS

Use of the FAQs handout led to a decrease in total patient-initiated postdischarge inquiries from 46 in the preintervention period to five in the postintervention period, and fewer topics of concern prompted patients' postintervention inquiries. There was also a pre-to-postintervention reduction in the proportion of patients who made calls to the outpatient clinic in each of the three postdischarge time periods, the greatest of which-from 49% to 15% of patients-was significant and occurred in the 72-hour-to-21-day period.

CONCLUSION

This QI project demonstrated that a change in discharge teaching by adding a FAQs handout to the protocol could be effective.

Increasing Understanding and Perceived Confidence of Nurses Working in an Emergency Department in Assessing Patients at Risk of Violent Behavior

PURPOSE

The aims of this quality improvement project were to improve understanding and perceived confidence in using a tool that assesses patients at risk of violence.

PROJECT DESCRIPTION

The Brøset Violence Checklist is valid at assessing patients at risk of violence. Participants were given access to an e-learning module that demonstrated how to use the tool. Improvement in understanding and perceived confidence in using the tool were assessed preintervention and postintervention via an investigator-developed survey. Analysis of the data was conducted using descriptive statistics, and open-ended survey responses were analyzed using content analysis.

OUTCOME

Participants did not demonstrate an increase in understanding and perceived confidence after introduction of the e-learning module. Nurses reported that the Brøset Violence Checklist was easy to use, clear, reliable, and accurate and could be used to standardize assessments of at-risk patients.

CONCLUSION

Emergency department nursing staff were educated in use of a risk assessment tool for identifying patients at risk of violence. This supported the implementation and integration of the tool into emergency department workflow.

Supporting Role Knowledge and Role Transition in Neonatal APRN Students

Advanced practice registered nurses (APRNs) play a critical role in alleviating provider shortages and expanding access to health care services for medically underserved populations. To meet these shortages, the APRN workforce is growing faster than the average for all occupations. This creates a critical need for effective transitioning from the role of student to APRN provider. Unfortunately, transitioning to the APRN role is not seamless and role confusion or challenges in role exposition can contribute to job stress and even role exodus. A recent quality improvement project supported student understanding of APRN roles and anticipation of role transition challenges for neonatal students preparing for roles as nurse practitioner and clinical nurse specialist. This strategy has the potential to contribute to successful role transition of neonatal nurse practitioner and neonatal clinical nurse specialist students.

Using technology to enhance nurse practitioner student engagement

Active learning strategies applied to nursing education can enhance student understanding, stimulate inquiry, and encourage critical thinking. Effectively applied technology can facilitate active learning processes and engage learners in their process of learning. This article will describe some technology-based strategies to support engagement in nurse practitioner education.

Optimisation of the hydrogen peroxide pre-treatment of titanium: surface characterisation and protein adsorption

BACKGROUND

Researchers have attempted to enhance titanium osseointegration by modifying its surface properties, including via H(2)O(2) pre-treatment, with reported treatment regimes varying from minutes/hours, to weeks.

OBJECTIVE

This study examined the effects of various H(2)O(2) treatments on titanium surface topography/roughness, chemical composition/oxide thickness, hydrophilicity and plasma protein adsorption.

MATERIALS AND METHODS

Titanium discs were treated with 30% H(2)O(2) for 0-24 h or 1-4 weeks and subjected to atomic force microscopy (AFM), scanning electron microscopy (SEM), profilometry, X-ray photon spectroscopy and contact angle analysis. For protein adsorption, whole plasma and FITC-conjugated serum albumin were added to 0-24 h and 1-4 week H(2)O(2)-treated discs and examined by SEM and fluorescence microscopy, respectively.

RESULTS

AFM, SEM and profilometry demonstrated that 1-6 h H(2)O(2)-treated discs exhibited subtle alterations in surface topography/roughness at the nanometre scale, although 24 h and 1-4 week H(2)O(2)-treated discs exhibited much greater increases in surface roughness, in the micrometre range. Maximal increases in surface oxide thickness and chemical modification were identified between 1 h-4 weeks and 3 h-4 weeks, respectively, although no increases in oxygen/titanium (O1s : Ti2p) molar ratio or in hydrophilicity were evident. Plasma and serum albumin adsorption increased on 1-24 h H(2)O(2)-treated discs, with further increases on 1-4 week H(2)O(2)-treated discs.

CONCLUSIONS

Based upon the present data and previous findings, this study supports the concept that surface topography/roughness and oxide composition/thickness, are more significantly modified by H(2)O(2) treatment and more influential to protein adsorption than hydrophilicity. Additionally, it can be hypothesized that the 24 h H(2)O(2) treatment of titanium surfaces, which induced micrometre scale changes in roughness and protein adsorption, to those associated with enhanced osteoblast attachment/behaviour, mineralisation and subsequent implant osseointegration, would be most beneficial.

Anemia: when is it not iron deficiency?

Anemia presents a challenge both in determination of cause and appropriate management. Careful history taking and appropriate screening in keeping with AAP recommendations will aid in identifying cases of anemia. Judicious use of laboratory testing will assist in achieving accurate diagnosis. Finally, appropriately timed and monitored treatment strategies will offer the most optimal outcome.

Anemia: when is it iron deficiency?

Iron deficiency anemia, the most common of childhood anemias, presents many challenges to the practitioner. Careful history taking that includes nutritional assessment may uncover this frequently subtle condition. In keeping with AAP recommendations, screening will aid in diagnosing this condition in populations at risk. Prompt treatment and conscientious follow-up will afford the most optimal outcome.