Policy and Public Engagement

Policy and public engagement can enhance the health and well-being of local, national and global populations. Through the dissemination of innovative and interdisciplinary research as well as the optimization of quality, safety and equity, affordable health care services can be obtained through collaboration, evidence and impactful partnerships with public and private entities.

A Preoperative Skin Assessment Tool to Improve Nurses Knowledge and Behavior on Identifying at-Risk Patients of Intraoperative Pressure Injury Development

Authors: Tracy Steffes
Poster number: 7
Presentation date: Monday, April 5, 9:40 a.m.

Pressure injuries (PI) that develop within the surgical setting have become a major concern that can lead to detrimental consequences. Utilizing a risk assessment tool allows nurses to be proactive and predict who is considered at risk while implementing necessary actions to prevent such injuries from occurring. The overall objective is to strengthen current PI prevention efforts through implementation of the Scott Triggers assessment tool within Michigan Medicine’s general surgery preoperative department. This quasi-experimental design utilizes implementing the Scott Triggers assessment tool into practice for a total of two weeks with staff completion of a pre- and post-implementation questionnaire. Comparison of questionnaire results allows for appropriate assessment of the nurse’s knowledge, skills and attitudes towards the tool and whether it’s deemed valuable in recognizing at-risk patients of PI development. Further consideration following these results may include adding the tool within MiChart as a standard assessment.

Implementing Standardized Goal-Oriented Templates in Multidisciplinary Pediatric Intensive Care Unit Weekly Meeting

Authors: Lauren Stensen, BSN, RN; Tonie Owens, MSN, RN, CNS-C; and Elizabeth Duffy, DNP, RN, CPNP
Poster number: 11
Presentation date: Monday, April 5, 9:50 a.m.

Effective and efficient multidisciplinary team communication is essential in caring for critically ill patients (Seigel et al., 2014). A standardized, structured approach to multidisciplinary teams has been shown to improve communication and collaboration in an intensive care unit setting (Bonds, 2018; O’Brien et al., 2018). The overarching goal of this project is to standardize and structure the multidisciplinary meeting to increase teamwork among team members. Problem statement: Within the pediatric intensive care unit, does the implementation of standardized templates during weekly multidisciplinary meetings facilitate teamwork? The two aims are the following: Implementation of standardized goal-oriented templates within PICU multidisciplinary meetings. Assess the usability of a standardized goal-oriented templates. Pre/post design of an unpaired convenience sample of individuals participating in the weekly meeting will use an anonymous Clinical Teamwork Scale survey to measure key factors in teamwork. The findings and meaning of this project will be completed by March 2021.

iSTAMP Study: Protocol to Test a Mail-Out HIV Testing Intervention to Improve Linkage to HIV Prevention and Care among Minority MSM in Eleven U.S. States

Authors: Stephen Sullivan, Rob Stephenson, Akshay Sharma, Ruth Dana, Patrick S. Sullivan, Lisa Hightow-Weidman, Pollyanna Chavez and Robin MacGowan
Poster number: 21
Presentation date: Monday, April 5, 10 a.m.

To help address the disproportionate impact of the HIV epidemic among Black and Hispanic/Latino men who have sex with men (BHMSM) in the U.S., the iSTAMP study will assess the effectiveness of mail-out rapid HIV self-tests and smartphone-based technologies in linking BHMSM to HIV/STI prevention or care services. Over 2,000 sexually active, adult BHMSM from 11 U.S. states who reported not living with HIV or using PrEP were recruited online. At baseline, all completed a survey and were mailed two rapid HIV self-tests. They were randomized into one of two arms: 1) An HIV prevention mobile app; and 2) Standard information about HIV prevention and care. After four months, all participants completed another survey and received a third rapid self-test and a dried blood spot collection kit for diagnostic and antiretroviral testing. Results will inform public health-relevant data and outcomes that can inform strategies to optimize screening and care among BHMSM.

At the intersection of masculinity and racism: An exploration of black trans masculine health behaviors

Authors: Renee Pitter, Kieran P. Todd, Sarah Thornburgh and Sarah Peitzmeier  
Poster number: 23
Presentation date: Monday, April 5, 10:10 a.m.

The purpose of this paper is to explore the ways in which Black trans men conceptualize their identity and the impact that the intersection of racism and masculinity has on their health behaviors. Little is known about masculinity and its effects on the health behaviors of masculine identifying people. Less still is known about its relationship to this subpopulation who experience health disparities based on racism. Twenty-four participants were invited to participate in the cross-sectional qualitative study using in-depth interviews as its primary data collection method. This paper centers the nine participants who identify as Black. Findings suggest that Black participants conceptualize their identities through a process of envisioning and adopting versions of masculinities that they encounter in their environments. Experiences with racism exacerbated by external fears around black manhood affect their health behaviors impacting stress, anxiety and physical activity.

Web and Venue-based Sampling for Substance-using GBMSM

Authors: Alexis Hunter, M.A.; Jayelin N. Parker, MPH; Jose A. Bauermeister, Ph.D.; Rob Stephenson, Ph.D.; Erin E. Bonar, Ph.D.; and Adam W. Carrico, Ph.D.
Poster number: 25
Presentation date: Monday, April 5, 10:20 a.m.

Critical to the development of interventions that address high levels of HIV and substance use among young men who have sex with men (YMSM) in the U.S is the ability to recruit and retain hardly reached populations. Using data from a randomized control trial, Project Swerve, an HIV and substance use intervention for YMSM ages 15-29 in Southeast Michigan (N=414), we examine demographic and behavioral characteristics associated with successful recruitment from a range of virtual and physical venues. Our goal is to understand the factors associated with successful recruitment that has the potential to inform effective and efficient strategies for HIV prevention research with YMSM. We found that paid, online advertising is more successful and cost-effective than venue-based recruitment. We hope to present our research to share best methods and challenges of online and venue-based recruitment methods for hardly reached populations.

Nurse-Driven Weaning of High-Flow Nasal Cannula in Pediatric Patients with Bronchiolitis

Authors: Jordan Shifman, BSN, RN; Denise Roberts, MSN, RN, CNS-C, CPN; and Elizabeth Duffy, DNP, RN, CPNP
Poster number: 38
Presentation date: Monday, April 5, 10:30 a.m.

In pediatric patients with bronchiolitis, the utilization of high-flow nasal cannula (HFNC) has been shown to lower rates of intubation and improve work of breathing. For patients with bronchiolitis, when weaning protocols are implemented it has been shown to be a safe and effective intervention to facilitate weaning off of HFNC. In order to reduce the length of time on HFNC, a respiratory protocol for pediatric patients with bronchiolitis at C.S. Mott Children’s Hospital was implemented in December 2020. The protocol allows nurses and respiratory therapy to partner to successfully wean HFNC. The pre/post-test design will include a non-paired convenience sample of pediatric patients with bronchiolitis admitted to the general care units that require HFNC. This is an ongoing project and results are not available at this time.

APRN Communication Skills Training in the Deaf and Hard of Hearing: An Immersive Experience using 360-degree Virtual Reality Simulation

Authors: Andrea Merlotti, BSN, RN, DNP student
Poster number: 39
Presentation date: Monday, April 5, 10:40 a.m.

Limited knowledge among Advance Practice Registered Nurses (APRNs) on effective communication techniques with the deaf and hard of hearing has contributed to health disparities and ineffective utilization of health promotion services. We utilized a previously grant-funded 360-degree virtual simulation to develop a communication skills training (CST) program (educational materials and an interactive training dynamic) designed to enhance APRN knowledge, perspectives (attitudes, beliefs) and confidence. A qualitative study using a pre- and post-test Likert scale survey was administered prior to and following simulation to assess APRN knowledge, attitudes and confidence. Evaluation will include in-depth analysis of each outcome measure and an aggregate of the outcomes for overall implementation effect. A positive shift in knowledge, attitudes and confidence is deemed successful. The aim of this evidenced-based intervention is to propose a CST program for health care practitioners through the design and development of a formal implementation blueprint for consideration in professional and/or academic settings.

Ethnic Discrimination, Sexual Orientation Discrimination, and DSM-5 Alcohol Use Disorder among U.S. Latinx/Hispanic Sexual Minority Adults

Authors: Luisa Kcomt, Ph.D.; Carol J. Boyd, Ph.D.; Rebecca J. Evans-Polce, Ph.D.; Phil Veliz, Ph.D.; Curtiss Engstrom, BS; Brady T. West, Ph.D.; Frances Dean, BSHP; and Sean Esteban McCabe, Ph.D.
Poster number: 40
Presentation date: Monday, April 5, 10:50 a.m.

Social forces such as discrimination can be a driver of alcohol use. Although there is documented evidence of the relationship between discrimination and alcohol-related outcomes among Latinx/Hispanic and sexual minorities, respectively, no studies have examined the influence of ethnic and sexual orientation discrimination on the risk for alcohol use disorder (AUD) and AUD severity among Latinx/Hispanic sexual minorities while accounting for acculturation factors. This cross-sectional study using data from the National Epidemiological Survey on Alcohol and Related Conditions-III (n=36,309 non-institutionalized U.S. adults) found that Latinx/Hispanic sexual minorities who experienced both ethnic and sexual orientation discrimination were more likely to meet criteria for past-year AUD (AOR=3.44) and past-year moderate-to-severe AUD (AOR=2.69) compared to those who did not experience discrimination. Latinx/Hispanic sexual minority adults experience distinct AUD risks associated with discrimination due to complex systems of disadvantage. Continued efforts are needed to eliminate discrimination in our social systems.

Reduction of Pain in an Inpatient Adult Medicine Unit

Authors: Stephanie Colton, BSN, RN, CEN, CCRN, TCRN, DNP student, and Katie Barwig MS, RN
Poster number: 41
Presentation date: Monday, April 5, 11 a.m.

Acute and chronic pain are significant health problems that can cause dependence on opioids, perceived poor health status and reduced quality of life (Dahlhamer et al., 2018; Nahin et al., 2019). The Movement is Medicine pilot on an adult inpatient medical unit will test the question of: In adult patients with pain, how does the implementation of movement as a nonpharmacological treatment modality allow for greater reduction in pain compared to pain reduction with opioid administration alone? There is substantial evidence that movement decreases pain in patients with chronic pain. The theory is that increasing movement in the adult inpatient medical-surgical population will decrease their pain, decrease the unit’s opioid consumption and improve secondary outcomes such as falls and pressure ulcers. Currently, the pilot is showing a decrease in patients’ pain and opioid consumption on unit 7A; 8B is currently in progress.

Facilitating Early Mobility in the PICU

Authors: Alexandra Longnecker, BSN, RN; Blythe Pollack MSN, CPNP-AC; and Elizabeth Duffy, DNP, RN, CPNP
Poster number: 44
Presentation date: Monday, April 5, 11:10 a.m.

The lack of mobility in the pediatric critically ill population can lead to an increase in complications, specifically central nervous system disturbances, organ failure, intensive care unit (ICU) acquired weakness, and death. Immobility associated muscle loss begins within 48 hours of critical illness, onset or injury, and is greatest during the first two to three weeks of an ICU stay. This quality improvement project focuses upon the reimplementation of an interdisciplinary early mobility program in order to both facilitate mobility within the first three days of admission as well as increase the incidence of mobility documentation in the pediatric intensive care unit at C.S. Mott Children’s Hospital. The project is ongoing, with completion in March 2021. Implications to practice and results related to patient outcomes will be discussed.

Quality Improvement Project for Evidence-Based Sexually Transmitted Infections Screening in the Urgent Care Setting

Authors: Shannetta Dixon, BSN, RN; Jessica Fakhoury, FNP, RN; and Elizabeth A. Duffy, DNP, RN, CPNP
Poster number: 45
Presentation date: Tuesday, April 6, 10:40 a.m.

Adolescents and young adults have the highest rate of sexually transmitted infections (STIs) and are the least likely to be screened due to various barriers. Utilizing the Centers for Disease Control and Prevention (CDC) recommendations and evidence-based guidelines to increase STI screening in the urgent care setting is essential and the goal of this quality improvement project. Implementing the CDC's five Ps as a screening tool for unrelated STI complaints, determining the tool's usability and assessing the intervention results are the specific aims. The project is underway. A comparison of retrospective and post-implementation screening and testing rates will be discussed.

Stopping Provider Burnout: Healthcare System Wellness

Authors: John Knight, DNP, RN, CSSMBB, and Barbara R. Medvec, DNP, RN, NEA-BC
Poster number: 47
Presentation date: Tuesday, April 6, 10:50 a.m.

Provider burnout is a complex problem impacting up to 75% of physicians, nurse practitioners and physician assistants. Nursing leaders can provide leadership in identifying the causes of burnout and developing evidence-based interventions. Are electronic health record systems (EHRs) the primary cause of provider burnout in mid-size community health care systems (CHCS)? This is important because CHCS providers often perform multiple roles and offer more personalized non-EHR support. Our results indicate that non-EHR factors — emotional exhaustion (p=.000), excessive workload (p=.000) and poor provider relationships with leadership (p=.000) — led to provider burnout. Nursing leaders developed system-wide and targeted interventions to address the true root causes. Nurse leaders can be the catalyst to overcoming burnout. As millennial generation providers become more engrained in the delivery of patient care, nurse leaders will need to address organizational culture changes to meet the needs of the provider workforce and mitigate burnout.

Interprofessional Communication: CAPABLE Program

Authors: Kelsey Postler, Michelle L. Munro-Kramer, Katherine E. Martin, Emily J. Smith and Susan D. Ernst
Poster number: 59
Presentation date: Tuesday, April 6, 11 a.m.

The Inappropriate, Disrespectful and Coercive (IDC) Healthcare Interactions study seeks to understand how college students describe and experience IDC behaviors in differing health care settings. Using a phased approach including focus group discussions and cognitive interviews, a survey was developed to measure experiences of IDC health care interactions among U-M Ann Arbor students. The qualitative data indicate that IDC health care interactions are related to poor nonverbal and verbal communication and a lack of patient empowerment. This survey is currently being distributed via the registrar with data collection occurring through REDCap. Preliminary findings are expected in March 2021. Study results will help us understand the prevalence and impact of IDC health care interactions and inform the development of better training and policies for health care providers to improve and target their care.

It's all in the family: Sexual identity differences in alcohol and other drug use history among offspring and other relatives

Authors: Sean Esteban McCabe, Tonda L. Hughes, Jessica N. Fish, Sebastian Hoak, Luisa Kcomt, Rebecca J. Evans-Polce, Curtiss Engstrom, Kate Leary, Phil T. Veliz, Brady T. West and Carol J. Boyd
Poster number: 61
Presentation date: Tuesday, April 6, 11:10 a.m.

There is limited evidence that family history of alcohol and other drug (AOD) related problems differs across sexual identity subgroups (i.e., lesbian, gay, bisexual, heterosexual). We assessed family history AOD positive (FH+) and negative (FH-) in first-degree and second-degree relatives across sexual identity subgroups, including potential differences among offspring. This nationally representative survey of non-institutionalized U.S. adults based on structured diagnostic face-to-face interviews (N=36,309 U.S. adults aged 18 and older) found that AOD FH+ in first-degree and second-degree relatives was most prevalent among bisexual females relative to all other sexual identity subgroups. There were no differences in AOD-related problems among offspring of gay/lesbian parents relative to heterosexual parents. The higher risk of FH+ among sexual minorities, especially bisexual females, should be considered by health professionals. The lack of differences in AOD-related problems among offspring of gay/lesbian and heterosexual parents has important clinical, legal and policy implications.

Standardizing Practice of CLABSI Prevention between the Inpatient Setting and Home Health Care

Authors: Abigail Allmacher; Nancy Tena, MSN, RN, CNS-BC, CPHON, BMTCN; and Elizabeth A. Duffy, DNP, RN, CPNP
Poster number: 63
Presentation date: Tuesday, April 6, 11:20 a.m.

Central line-associated bloodstream infections (CLABSI) is the cause of over 28,000 deaths in the United States each year. Pediatric oncology patients are at greater risk for CLABSI due to immunosuppression and the long-term use of a central venous catheter (CVC). Roughly 85% of pediatric oncology patients will have their CVC used for frequent blood draws and chemotherapy treatments. To prevent CLABSI, maintenance CVC care bundles are utilized as part of standard practice. The care bundle includes daily chlorhexidine baths, oral hygiene, daily assessment of the site, utilization of a Biopatch and dressing/cap changes using sterile technique. Although inpatient units strictly use the care bundle, they are not practiced consistently by home care agencies. The goal of this ongoing project is to gain a better understanding of the CLABSI prevention methods used by home care agencies in order to standardize practice between the inpatient setting and at the patient’s home.

Policy Analysis: Implementation of Asthma medications in public and charter Detroit Schools based on Michigan Law

Authors: Keara Marks, RN, BSN, DNP candidate 2021
Poster number: 67
Presentation date: Tuesday, April 6, 11:30 a.m.

The prevalence of asthma in Detroit is greater than Michigan as a whole by 29%, and hospitalization rates for people who live in Detroit are three times higher than hospitalization rates for the rest of Michigan (DeGuire et al., 2016). The State of Michigan’s Compiled Law (MCL) 380.1179 (2004) allows for self-carry and self-administration of asthma medications by students in Michigan schools. However, implementation of this policy may vary. In a Detroit-based asthma clinic, participants reported variation in the management of asthma in school, with some participants reporting an inability to self-carry and self-administer asthma medications in school. This study evaluates asthma management in charter and public Detroit middle schools and determined the need for refinement of current practices. A policy analysis was completed using interviews with asthma shareholders. Contributing factors to asthma management in schools were recognized, and recommendations will be made to the Michigan Department of Education.

Geographic Variation in Nurse Practitioners Who Treat Dementia

Authors: Kathryn Lee, BSN, RN, and Matthew A. Davis, MPH, Ph.D.
Poster number: 69
Presentation date: Tuesday, April 6, 11:40 a.m.

Currently, an estimated one in ten older adults have dementia, a debilitating, chronic disease that requires an increased dependency on others for care needs. We know the general increased supply of nurse practitioners accommodates overall population health needs, however we do not know to what extent for people with dementia. Using 2017 U.S. national data of health care providers and their respective patients’ comorbidities, we identified 23,881 nurse practitioners who had at least 25% of their patient panel with a dementia diagnosis (i.e., about 21% of all nurse practitioners). We found that most nurse practitioners practiced in urban settings. Additionally, the number of nurse practitioners positively correlated with the number of physicians in these regions. The findings suggest nurse practitioners assume a substantial role in the care and management of people with dementia. Geographic variations suggest nurse practitioners work on teams with other providers.