Improving Chlamydia Treatment in Adolescent Partnersby Ashley Renee Plummer Doctor of Nursing Practice University of California, Irvine, 2021

Untreated or recurrent sexually transmitted infections (STIs) cause considerable long-term morbidity, including chronic pelvic pain, ectopic pregnancy and infertility. Successful partner notification and proper treatment for STIs is essential to prevent reinfection and curtail further transmission. The practice of expedited partner therapy (EPT), which allows a clinician to treat an infected partner without a medical exam or history, can improve treatment rate among the partners of adolescents with STIs. The purpose of this quality improvement project at a Title X-supported family planning clinic was to implement a new program utilizing EPT. Without a health assessment or physical examination, the partners of adolescents with a diagnosis of chlamydia were treated with a single dose of Azithromycin, 1gram, if the patients expressed the need for treatment of their partner. The patient’s preferred method of receiving the treatment was utilized with one of the two new implementations: the ability to mail treatment to both the patient and their partner, or allowing the patient to pick up treatment for their partner when they picked up theirs at the study site. All these options were free of cost to the patients due to a grant received by the study site in March 2020. The patients then received a follow up phone call two weeks after treatment was provided to confirm compliance for both them and their partner, and to discuss after care if necessary. The phone call was a uniform questionnaire that was used by all investigators participating in this project. The feasibility of this program was evaluated in April, 2020, using data from June 1, 2019 to December 31, 2019 to ensure a similar time span for comparison. The primary unexpected variable that played a role in this project was the onset of the COVID 19 pandemic in March of 2020. Numerous attempts were made to address this in order to keep the project in a controlled setting, and are noted throughout this manuscript.

ABSTRACT

Implementation of an Acuity-adaptable Staffing Model in a Cardiovascular Surgical Unit: A Retrospectivve Review by Kathryn Kay Anotado Lopez Doctor of Nursing Practice, Post- Masters in Nursing Science University of California, Irvine, 2022 Dr. Nicole Martinez, Chair Improvement in the hospital patient experience is at the forefront of health system leadership throughout the country. Acuity-adaptable units allow patients to stay in the same hospital room from the time of admission to the time of discharge, regardless of their change in acuity, thereby improving workflow, patient comfort, and the overall patient experience (Shiva Kumar, Somu & Arun, 2017; Kitchens et al., 2018; Caroll & Frey-Moylan, 2020). Cardiac surgery patients have a specific recovery clinical pathway that allows nurses to identify deviations from the path. Registered nurses (RN) and physician teams trained in cardiac surgery care for the open-heart patient from admission to discharge. This relationship creates continuity of care, active communication, and trusting relationships. The team is knowledgeable and adept with a skillset to provide exceptional care while anticipating any complications (Chindhy et al., 2014; Kitchens et al., 2018; Bonuel, 2017; Costello et al., 2017). The quality of nursing care and anticipation of complications results in best patient outcomes and a high-quality patient experience. A retrospective review was completed on the implementation of an acuity-adaptable cardiovascular surgical unit (CVSU). CVSU outcomes were compared to cardiovascular surgery patients recovered in a traditional staffing model. In the CVSU, having the shared mental model of adaptability and flexibility and a structured orientation with knowledge sharing increased engagement and retention of newly hired staff (Clipper & Cherry, 2015). The cardiovascular surgery acuity-adaptable unit improved both patient outcomes with decreased failure-to-rescue rates (2.9%), decreased lengths of stay in the ICU (3.92 days), and decreased hospital lengths of stay (12.5 days); and improved staff engagement with 4.4 staff engagement mean and minimal turnover (4.9%). With the improvements in patient outcomes and staff engagement in this acuity-adaptable staffing model, the overall patient experience and operational budget can improve for the organization.

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Conclusions

Hispanic children have greater mental health challenges but fewer received mental health services than other ethnic groups. A classroom-based Emotional Health Curriculum (EHC) was developed to address mental health disparities in an underserved Hispanic community.

A quasi-experimental design with one group pre- and post-intervention was used to test the feasibility of an 8-week EHC for one hundred 3rd and 4th grade children in a dual-immersion Spanish-English elementary school. Limited efficacy was measured by changes in depression and anxiety scores reported by children and teachers. Acceptance was evaluated by a child-reported satisfaction survey and a focus group in which the four teachers shared their experiences. Implementation was measured by participation, retention, and fidelity rates.

The child-reported depression and anxiety and teacher-reported depression were significantly decreased in at-risk children with the effect size ranging from 0.60 to 1.16 (ps < 0.05). The majority of children (89.7%) enjoyed the EHC and teachers observed that children had acquired skills to manage their emotional distress. The participation, retention, and fidelity rates were 98%, 94%, and 99.13%, respectively.

The results provide promising evidence that the EHC has the potential to improve depression and anxiety symptoms in at-risk children.