104 A Quality Improvement Project to Reduce Orthoses Complications

Introduction Anatomical structures of the hand are complex and delicate making hand burns particularly challenging to manage. Orthoses are a cornerstone treatment modality and unsuccessful therapeutic interventions can result in hand contracture and deformities, which can result in up to 95% impairment in upper extremity function. Therapists at our burn center have varying degrees of education and credentials, and we had noticed increased incidence of orthotic induced complications in the hand. The purpose of this QI project was to implement a formal protocol that provided guidelines around fabricating and fitting hand orthoses. Methods The protocol mandated that custom fabricated resting hand orthoses should be fabricated by a single CHT or co-fabricated by two (non-CHT) therapists. Orthoses were fabricated as indicated. Orthosis modifications and orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) were documented. For the purposes of our study, breakdown was limited to the index finger. These modifications and complication totals were compared to pre-implementation data. Any patient with missing data points was excluded. Results Seventy-seven patient hands were examined from 2016–2019. Prior to implementation of the protocol, erythema occurred with 23.4% (n=18) of orthoses and orthosis induced partial thickness injury was found in 11.7% (n=9) of cases. Post protocol implementation involved examination of 51 hands. Erythema occurred in just 2.0% of cases (n=1) and partial thickness injury in 3.9% of cases (n=2) This represents a decrease of 94.4% and 77.7%, respectively. Number of modifications was reduced by 40.9%, from 22 to 13. Conclusions Orthosis fabrication is a specialized therapy skill, requiring hands-on training and advanced anatomical knowledge. While orthotic fabrication is part of general therapy education, the depth and breadth of this education is limited by the clinical opportunities presented to each therapist. CHT’s have undergone rigorous study and testing to make them experts in orthosis management and can bolster skills in a burn therapy department. For therapists without this specialty certification, co-fabrication can also lead to improved outcomes, through real time peer review. Data from this QI project showed a statistically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses.

MANAGEMENT OF INSTITUTIONAL AND PREVENTIVE ACTIVITIES IN THE PUBLIC HEALTH SYSTEM OF UKRAINE

The aim: Scientific justification of the public health management methods and instruments for improvement of its effectiveness. Materials and methods: The authors conducted a complex research of the public health of Ukraine personnel resources development during the system establishment and building. Conclusions: The paper justifies the competence-based model of a specialist (the postgraduate educational level) as well as the university educational standards of the first (bachelor) and second (master) levels of specialty 229 “Public health”, knowledge branch 22 “Healthcare”. The authors have established insufficient level of the youth motivation for obtaining the specialty certification and described disadvantages of both advocacy program within the public health system and its leadership within the preventive system component. The authors emphasize the necessity of an integrated preventive program maintaining and strengthening the population health, using the advocacy component and available information resources of the public health.

The Influence of Education and Specialty Certification on Nurses' Intent to Support Breastfeeding Post-Birth

Breastfeeding is something that many new mothers aspire to do, but also something that many struggle with in the days following birth. Nursing support in the hospital can make a huge difference in the success of this endeavor for many patients. It is important for nurse educators that work with the obstetric population, and the nurses that care for them, to understand what drives nurses to be supportive of patients who have recently given birth in their breastfeeding efforts. This will allow for appropriate interventions to be implemented to increase the level of support. This study seeks to determine if a relationship exists between nurses' level of education and specialty certification, and their intent to provide support to new mothers in their efforts to breastfeed their babies.

The Effects of Nurse Specialty Certification and Medical Treatments on Glycemic Control Outcomes: A Retrospective Study

AIMSTo describe and explore the impact of the presence of specialty certified nurses on the unit on glycemic control among non-critically ill hospitalized patients with Diabetes mellitus.BACKGROUNDPoor glycemic control during hospitalization has been associated adverse patient outcomes. Staff nurses administer much of the diabetes-specific care delivered to patients during hospitalization. Nurse specialty certification is a recognized indicator of nursing care quality.METHODSA retrospective sample of medical records data was analyzed to describe and explore the impact of specialty certified nurses on glycemic control among a group of 293 non-critically ill hospitalized patients with Diabetes mellitus. Regression analysis was performed to assess the impact of the percentage of certified nurses on the unit as a mediator or moderator of the relationship between medical treatments and glycemic control outcomes.RESULTSIncreases in the percentage of specialty certified nurses on the unit were associated with significant decreases in mean blood glucose levels among patients who received a basal-bolus insulin regimen or enteral nutritional feedings.CONCLUSIONSPatients who received specific medical treatments during hospitalization had superior outcomes when nursing care was delivered during times in which the relative proportion of certified nurses on the unit were higher.