Browsing by Author "Thornett, Tracy"

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    A Transcultural Nursing Approach to Secondary Prevention of Pressure-Related Foot Injury in Micronesian Migrants in Hawai’i with Type 2 Diabetes Mellitus
    (2019-08-21) Norris-Taylor, Joyce; Thornett, Tracy; Davis, Alice
    The newest members of the State of Hawai’i come from Micronesia under provisions of The Compacts of Free Association (COFA). In Micronesia, COFA citizens face unique challenges as a result of their association with the United States including the legacy of nuclear testing along with ongoing damage as a result of rising sea levels with saline leaching making land uninhabitable as the total land mass is diminishing. COFA citizens have the legal right to come to the United States and they are coming for educational opportunities, employment opportunities, and for health care. In Hawai’i, the Micronesian population has been met with prejudice, injustice and neglect. The health care issues of Micronesia include both the communicable diseases of a developing area as well as the noncommunicable diseases of a developed region including type 2 diabetes mellitus. Poverty, lack of natural resources, poor nutrition, and a sedentary lifestyle promote both communicable and noncommunicable diseases in this vulnerable population. Migration to Hawai’i provides opportunities to receive education, employment, and health care not available in native lands. The high prevalence of type 2 diabetes in COFA migrants presents many opportunities to pursue secondary prevention measures in this population. In the Micronesian population traditionally, as is common in tropical climates, footwear is minimal or nonexistent leaving feet exposed to injury. The overarching goal of this project was to address one aspect of secondary prevention in the Micronesian migrant population residing in East Hawai’i, preventative foot care in the diabetic. With the aid of a cultural interpreter a pilot study was conducted with participants surveyed as to footwear preferences. With the expert advice of a podiatrist and the guidance of the cultural interpreter, prototype safer alternatives to commonly worn footwear were developed. The prototypes were trialed over a one-week period after which a secondary survey was performed. Of the prototype trial participants, 100% liked the shoes, wore the shoes, and desired to keep the shoes. Cultural adaptations are required for successful promotion of self-management of chronic conditions including obesity and diabetes. Collaboration with COFA stakeholders will afford better outcomes for Micronesian citizens. To date, the healthcare community has failed to engage this population largely due to Western medicine ethnocentrism and paternalism. This pilot study demonstrated the willingness of the Micronesian migrant community to partner with healthcare providers for rational lifestyle changes to improve overall health.
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    Antipsychotic Medication-Associated Weight Gain: Development of an Evidence-Based Management Algorithm and Practice Guideline for Primary Care Providers
    (2016-11-30) Thornett, Tracy; Davis, Alice
    Obesity is a growing public health concern. Although people from all walks of life are affected by obesity, rates of this chronic disease are especially high among individuals with mental illness. Of particular concern are patients who take antipsychotic medications, as weight gain is a well-established side effect of many of these drugs. This practice inquiry project investigated the problem of antipsychotic medication-associated weight gain by applying the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to develop a preliminary evidence-based practice guideline and algorithm for use by primary care providers. As part of the project, an interdisciplinary panel of key stakeholders evaluated the proposed guideline for both quality and applicability. The results of this evaluation are discussed with future revision and expansion of the guideline in mind. Additionally, implications for advanced nursing practice are examined and strategies for promoting safe, effective, patient-centered, and equitable health care are suggested.
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    The Effectiveness of Action Plan Implementation by Primary Care Providers on the Frequency of Preventable Acute Care Visits for Adults with COPD
    (2018-09-12) Fried, D. Michiko; Davis, Alice; Thornett, Tracy; Van Hoose, Diane
    COPD is the 3rd leading cause of death in the U.S. and 4th in the world. The economic burden of COPD in the U.S. in 2010 was almost $50 billion, which included almost $30 billion in direct healthcare costs due primarily to hospitalizations following exacerbations. Selfmanagement skills fostered in a patient-centered primary care setting are essential for symptom control and the prevention or early detection of the exacerbations and complications that lead to healthcare utilization. However, adequate self-management is difficult due to the complex heterogeneity of COPD. Poor symptom control results in more frequent but preventable hospital visits and an accelerated functional decline. Patients with COPD often have increased health risks due to chronic co-morbid conditions and wide variations in clinical, functional, and behavioral patient presentations that challenge practitioners to develop, modify, and reinforce components of effective care plans whose success depends upon patient self-management. This paper describes the design and implementation of BREATHE for a Better Life, a primary care pilot program for adults focused on self-management. As a practice inquiry project (PIP), BREATHE sought to demonstrate the effectiveness of an action plan on controlling the symptoms of COPD or COPD with asthma to optimize daily function and quality of life. Quality measures included the frequency of acute medical visits for respiratory complaints, spirometry values, and COPD Assessment Test (CAT) scores tracked over a two-month implementation period. Despite the brief nature of the intervention, results revealed gaps in care, provided opportunities for workflow improvements, and substantiated the need to evaluate and incorporate patients’ self-perceptions of health into a comprehensive care plan. The PIP’s supervising physician committed to continuing BREATHE for a minimum of one year and will continue to collect data in anticipation of significant results to support its value and sustainability.