Delaware journal of public health最新文献

The nursing profession is deeply rooted in the life and behavioral sciences, having evolved from the historical image of white dresses and caps to modern scrubs and lab coats. Despite its strong foundation in scientific processes, nursing is not yet recognized as a STEM profession. Nurses trained in research and PhD-prepared nurse scientists are paving the way for academia and healthcare to acknowledge the contributions of nursing to science through research, promotion of evidence-based practice, and dissemination of curated knowledge. Nurse scientists play a crucial role in involving more clinical nurses in research efforts. However, clinical nurses face several challenges in participating in research. To address these challenges, ChristianaCare launched the Nursing Fellowship in Robotics and Innovation in 2024. This fellowship provides clinical nurses with research opportunities and mentorship from nurse scientists. It successfully bridges the gap between clinical practice and research, fostering a future where nurses are integral contributors to scientific advancement.

The Delaware Division of Public Health, Office of Emergency Medical Services (EMS) implemented the first statewide program enabling paramedics throughout the state to initiate buprenorphine treatment for opioid use disorder (OUD) in the prehospital setting. Building on a model from Camden, New Jersey, this protocol was approved in 2022 in response to rising overdose deaths and was fully implemented across Delaware's advanced life support (ALS) EMS agencies in April 2023. Eligible patients-those 18 years or older, resuscitated with naloxone, and able to consent-received up to 24 mg of sublingual buprenorphine along with ondansetron for nausea. Between April 2023 and May 2025, paramedics administered 118 buprenorphine doses to 105 patients, with improvement in withdrawal symptoms reported after 63.6% of doses. Despite a rise in patient ineligibility due to altered mental status-likely linked to sedating adulterants,such as xylazine and medetomidine,in regional street drugs-paramedics increased the percentage of eligible patients accepting offered buprenorphine from 19.0% to 22.8% between the first and second year of the program. This protocol not only addresses acute overdose management in the field but also connects patients to ongoing care, aiming to reduce mortality and expand access to medications for opioid use disorder.

This paper offers a clear, evidence-based look at how we can reduce opioid use after knee replacement surgery without sacrificing pain relief. This review focuses specifically on total knee arthroplasty (TKA)-one of the most commonly performed and most painful surgeries-and asks whether opioids are truly necessary. By analyzing results from 21 clinical trials, the paper shows that non-opioid medications like NSAIDs and gabapentinoids can provide similar pain control with fewer side effects, such as nausea, dizziness, constipation, and sedation. Lower risk of long-term use is an added benefit. A recent RCT found that after knee/shoulder arthroscopy, 72% of patients in an opioid-sparing protocol remained opioid-free over six weeks-compared to just 5.4% in the traditional opioid group.⁸ Given how many people receive their first opioid prescription after surgery, the findings have major public health implications. They highlight a growing opportunity for clinicians and hospitals to shift away from default opioid prescribing toward safer, evidence-based pain management protocols. This transition is not only clinically feasible, but also urgently needed to reduce unnecessary opioid exposure, prevent avoidable side effects, and lower the risk of long-term use or diversion. With the right combination of education, clinical tools, and system-level support, many surgical patients may recover successfully with minimal or no opioid use when supported by effective multimodal protocols.

Objective: To explore how the experiences of recovering professionals reveal insights that improve and influence the goals and outcomes of clients in substance use treatment.

Methods: In the Summer of 2024, a qualitative study investigated the observations and experiences of six recovering Delaware residents working in the field of addiction treatment. Semi-structured interviews conducted over Zoom discussed treatment experiences, with subsequent coding focused on the domains of experience, practice, and challenges.

Results: Coding of the interviews revealed four themes: relationships, levels of care, and understanding, which aid in clinical understanding of client motivations, plus systemic issues. Stronger relationships increased client commitment, functioning as a form of mentorship that reinforced the client's willingness to trust and build confidence. Levels of care that solved real-life problems were deemed very effective but faced funding challenges. Self-determination was paramount, with the clients willing to participate, but sometimes in a manner that permits them to maintain control. Finally, treatment failure may be a systemic flaw preventing clients from accessing essential resources necessary to gain recovery.

Conclusion: Recovering professionals reported on the use of personal skills to enhance therapeutic relationships with clients and inform their clinical practice by facilitating and executing discussions and goals. This study expounded on the numerous ways in which professionals recognize encoded information within client interactions, such as willingness and self-determination, and tailor treatment decisions to enhance client engagement. It is essential that the skills and power of the therapeutic relationship be maximized to make treatment as effective as possible.

Policy implications: This study provides additional evidence of missed opportunities to address the needs of individuals lacking essential services, such as transportation or housing. Furthermore, reserving resources to protect agency interests damages the client's prognosis for continued treatment.

Workplace violence in healthcare settings is a growing concern, with healthcare workers facing significantly higher risks of physical and verbal assaults compared to other professions. Despite the prevalence and severity of these incidents, there remains a critical lack of standardized policies across institutions and jurisdictions to address and mitigate workplace violence. This inconsistency contributes to underreporting, inadequate preventive measures, and insufficient support for affected staff. This article highlights the urgent need for comprehensive, evidence-based national standards and policy frameworks to ensure the safety and wellbeing of healthcare workers, improve reporting mechanisms, and foster a culture of zero tolerance for violence in healthcare environments.