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Please reply with 100-150 each DQ

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Please reply with 100-150 each DQ. Thank you

Casey:

Falls in the elderly are a common occurrence for chief complaints of this population upon presentation to the emergency department. Furthermore, falls in the elderly are an often occurrence during their visit to the emergency department. These issues combined, place them at an increased risk of mortality and adverse events s/p their ED visit. Additionally, especially with the pandemic, emergency departments are overwhelmed and inundated, therefore, any chance to decrease the number of potential ED visits, can be appreciated. In my PICOT statement, I seek to find if adding tools during triage in the emergency room could potentially alert the staff that certain patients are at an increased risk. This would be in addition to the current standards. There have been several tools used to identify patients who are at risk for falls/frailty, however, none were developed specific to the emergency department (Galvin, et al, 2017, pg. 180). The ISAR (Identification of Seniors at Risk) was developed to assist in identifying the risk of elderly patients (greater than or age of 65) who could be subject to, “future adverse outcomes including functional decline, unplanned hospitalization or ED visit (Galvin, et al., 2017, pg. 180). As a nurse manager, it is my responsibility to ensure the tools that are needed for the frontline staff to identify this population and place the proper precautions to prevent falls. A lot of factors come into play from an administration standpoint. Patient safety, quality improvement, and risk management, just to name a few. It is my hope that using the ISAR tool will improve the identification of this vulnerable population and thereby increase the resources needed upon initial presentation to the emergency department.

PICOT: In geriatric adult patients who present to the ED with a chief complaint of falls or injury related to falls (P) does implementing the ISAR (Identification of Seniors at Risk) screening tool (I) when added to the current fall risk standards (C) indicate a higher level of fall risk, thus subsequent emergency department visits, or further injuries (O) for a period of 30 days(T)?

References:

Galvin, R., Gilleit, Y., Wallace, E., Cousins, G., Bolmer, M., Rainer, T., Smith, S. M., & Fahey, T. (2017). Adverse outcomes in older adults attending emergency departments: a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool. Age and Ageing, 46(2), 179.

Devin:

PICOT: In adult smokers with MI (P), does the use of mHealth technologies for smoking cessation, in addition to standard treatment (I), compared to standard treatment alone (C), lead to increased quit attempts and abstinence rates and reduced number of cigarettes per day (O) in 6 to 12 months (T)?

Rates of cigarette smoking in the United States have reduced dramatically over the past several decades, to about 14% in 2019 (Cornelius, et al., 2020); despite this fact, more preventable disease and death in the United States is attributable to cigarette smoking than to any other cause, with a mortality rate of about 448,865 in 2014 (Ma, et al., 2018). Additionally, smoking rates among certain populations, namely, those with mental illness (MI), have been largely resistant to the same decline, with disproportionately higher rates of tobacco use compared to the general population (Lipari & Van Horn, 2017). Despite the desire of adult smokers with MI to quit (Tulloch, et al., 2016), they have a lower likelihood of cessation compared to those without MI (Lipari & Van Horn, 2017), even with the availability of standard evidence based treatments for smoking cessation (e.g., varenicline or bupropion, nicotine replacement therapy, behavioral support/counseling). In the digital age, mobile health (mHealth) technologies for smoking cessation may help achieve improved smoking cessation rates, including higher quit and abstinence rates and lower rates of cigarettes per day (CPD), among adult smokers with MI. The dramatic decline in tobacco use is considered one of the greatest public health achievements of the twentieth century (Centers for Disease Control and Prevention, 1999). However, vulnerable and overlooked populations, such as those with MI, need continued research, attention, and more targeted interventions to enjoy the same success. As a future advanced public health nurse, I will undoubtedly be involved in community outreach and prevention programs, likely including tobacco cessation, particularly for those most vulnerable to tobacco-related disparities. The proposal supports those with MI by zeroing in on the needs of this specific population, including social support, distraction from cravings, and self-esteem building, to boost smoking cessation rates in this vulnerable population (Gowarty, et al., 2020; Klein, et al., 2019). Additionally, the selected problem is amenable to a research-based intervention due to the desire of smokers with MI to quit smoking and their need for further assistance in doing so beyond standard treatment (Tulloch, et al., 2016), as well as the acceptability, usability, and feasibility of mHealth interventions for smoking cessation among smokers with MI, and their generally positive attitudes toward such interventions (Klein, et al., 2019; Gowarty, et al., 2020). Not only is the proposal amenable to research, but further research is also vital to determine which design features and styles within an mHealth intervention would be most useful for the population in question, in order to provide the greatest benefit.

References:

Cornelius, M.E., Wang, T.W., Jamal, A., Loretan, C.G., & Neff, L.J. (2020, November 19). Tobacco product use among adults — United States, 2019. Morbidity and Mortality Weekly Report, 69, 1736–1742. Centers for Disease Control and Prevention. http://dx.doi.org/10.15585/mmwr.mm6946a4

Centers for Disease Control and Prevention. (1999). Ten great public health achievements - United States, 1900-1999. Morbidity and Mortality Weekly Report, 48, 12, 241-243. https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm

Isabel:

In adult patients with diabetes (P) does provide support such as a personalized health coach program (I) when compared to other interventions (C), lead to improved HbA1C levels (O) over the course of one year (T)?

The intervention I am proposing is one that adds to the current standard of care for diabetes self-management education programs in which a peer, registered nurse, or trained person in the field of diabetes coaches the patient in education, health diet choices and medication adherence. The anticipated outcomes would be to see a decrease in HbA1c over a course of time with an increase in self-managing their chronic condition such as diabetes.

The intervention supports the diabetic population in that it is attempting new interventions to help Americans control their diabetes. The American Diabetes Association reports that just over 1 in 10 Americas have diabetes– approximately 34.2 million people. Also, that new diabetes cases were higher among non-Hispanic blacks and people of Hispanic origin than non-Hispanic Asians and non-Hispanic whites (Centers for Disease Control and Prevention, 2020). The setting I work within is a busy inpatient hospital that serves a metropolitan community of approx. 350,000. The role I currently occupy is one of a staff nurse and provide beside patient care within the Emergency Department. In the E.R. there are several times where we must assume care for admitted patients and serve as a “floor nurse” as well. IN summary, very fluid-like in the ER as far as a role is assumed, but will always involve providing excellent care to our patients.

In adult patients with Diabetes, does providing support such as a personalized health coach program, when compared to other interventions, lead to improved HbA1C levels over the course of one year? A recent study done by Pirbaglou et al. (2018), evaluated the impact of Personal Health Coach (PHC) programs on glycemic management and related psychological outcomes. Randomized controlled trials (RCT) published between January 1990 and September 2017 focused on the effectiveness of PHC interventions in adults with T2DM. Pirbaglou et al. found that relevant study information from individual trials (eg, design, sample characteristics, intervention structure, control group characteristics, disease management outcomes) were extracted and assessed by three reviewers’ using a prespecified format. Meta-analyses of 22 selected publications showed PHC interventions favorably impact HbA1c levels in studies with follow-ups. It is important to note that pharmaceutical, lifestyle-based, and psychoeducational approaches are not mutually exclusive. All can be, theoretically, combined in optimal proportions. It does not seem productive to further assess them competitively, as it is appropriate now to attempt, document, and compare optimal integrations. Certainly, PHC would seem to be an important component of optimally integrated approaches as seen in the study where PHC was offered in combination with a structured dietary program (ie, protein-rich meal replacement). In summary, this study provided useful data but note that PHC will be better served in combination with other structured dietary programs.

References

Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/...

Pirbaglou, M., Katz, J., Motamed, M., Pludwinsk, I. S., Walker, K., & Ritvo, P. (2018). Personal Health Coaching as a Type 2 Diabetes Mellitus Self-Management Strategy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. American Journal of Health Promotion, 32(7), 1613-1626. doi:10.1177/0890117118758234