Digital Commons Network^™

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …

Implementation Of Home Blood Pressure Monitoring, Sarah Gutzke

Dissertations

Approximately 48.1% of adults in the United States have high blood pressure. Providers may encourage patients to monitor and log their blood pressure at home. Still, patients often fail to bring this information to appointments, leading to reliance on less comprehensive in-office measurements. This quality improvement project aimed to increase adherence to home blood pressure logs using a Blood Pressure Toolkit. A descriptive, observational design was utilized to record patient adherence of taking home blood pressure measurements and increase the number of patients who brought their blood pressure logs to their healthcare provider visits over two months. A convenience sample …

Bridging The Gap: Psychopharmacologic Education And Side Effect Screening For Non-Prescribing Mental Health Professionals, Elaine Fitzgerald

Dissertations

Abstract

Problem: The United States is experiencing a growing demand for pediatric mental health support. Surges in mental health diagnoses and psychotropic medication prescriptions have occurred, compounded by a shortage of psychiatric providers. Non-prescribing mental health professionals are well-positioned to recognize psychotropic medication side effects. However, psychologists and counselors lack formal pharmacology education.

Methods: The quality improvement (QI) initiative was guided by the Plan-Do-Study-Act (PDSA) model. The evidence-based psychopharmacologic education for non-prescribers utilized a quasi-experimental pre- and post- test design. Data collected from clinicians included knowledge, confidence, and skill concerning psychotropic medications. The Psychotropic Medication Monitoring Checklist (PMMC) screen clients …

A Guideline-Based Approach To Increase Early Mobilization In The Pediatric Patient Following Cardiothoracic Surgery, Kayla Keeven

Dissertations

A Guideline-Based Approach to Increase Early Mobilization in the Pediatric Patient Following Cardiothoracic Surgery

Problem: Prolonged bedrest during the post-operative period contributes to complications that lengthen hospital stay and increase mortality and medical costs. Early mobilization is recognized as safe and feasible in critically ill children. However, there is no standardized procedure nor method of identifying patients who are safe to mobilize in a pediatric cardiac intensive care unit (ICU).

Method: The quality improvement (QI) project employed a descriptive observational design utilizing a retrospective-prospective method to assess the effects of implementing an early mobilization guideline in a pediatric cardiac ICU. …

Implementation Of A Vestibular Disorder Screening Tool In An Urgent Care, Kathleen A. Probst

Dissertations

Implementation of a Vestibular Disorder Screening Tool in an Urgent Care

Kathleen A. Probst

M.S.N., University of Missouri-Columbia, 2007

B.S.N., University of Missouri-Columbia, 2004

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice

August 2023

Advisory Committee

Susan Dean-Baar, PhD, RN, CENP, FAAN

Chairperson

Jennifer Vines, DNP, MSN, RN

Troy Dinkel, MD

Copyright, Kathleen A. Probst, 2023

Abstract

Problem: Vestibular disorders disrupt everyday living and can cause reduced quality of life. Guidelines developed to screen for vestibular disorders are not efficient to use …

Evaluation Of Dirfloortime® On Mother’S Depression, Anxiety, And Stress, Hailey Vanderleest

Dissertations

This paper reports the results of a retrospective record review and qualitative questionnaires of mothers of children with neurocognitive disorders such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The aim was to examine the relationship between DIRFloortime® use in children with ASD and ADHD and PHQ-8 scores for depression, GAD-7 scores for anxiety, and PSS-10 scores for perceived stress among the children’s mothers. The results showed no statistical significance between DIRFloortime® use in children and PHQ-8, GAD-7, and PSS-10 scores for mothers. Qualitative questionnaires did report improvements in quality of life. Implications for the need of evidence-based developmental …

Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs

Dissertations

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …

Implementing Obesity Management Guidelines In Rural Primary Care, Taylor Bell

Dissertations

Abstract

Problem: In the United States, obesity is one of the leading causes of death among Americans and rates of obesity continue to rise. Geographic location significantly affects the number of obesity cases, with rural areas being affected more than other locations. Despite this, obesity continues to be undertreated by rural primary care providers.

Method: This quality improvement (QI) pilot project utilized a descriptive, observational design to evaluate the implementation of an evidence-based clinical practice guideline algorithm for obesity management in a rural primary care clinic. An algorithm was implemented on patients aged 18-60 years and with a BMI of …

Improving Postpartum Depression Screening Practices In The Postpartum Setting, Courtney Lynn Cole

Dissertations

Abstract

Problem: Postpartum Depression (PPD) is frequently undetected in women due to barriers that limit effective recognition and diagnosis. Depression screenings and treatment referrals improve outcomes in the immediate postpartum period. Follow-up methods for positive depression screens are often missed by postpartum care teams.

Methods: A descriptive, observational design was used for this quality improvement project. A formalized depression screening protocol was created to help guide nursing staff on a Postpartum Unit when detecting a positive depression screen. Convenience sampling was utilized and the sample included patients aged 18-45. Data collected throughout this quality improvement project included Edinburgh Postnatal Depression …

Screening For Food Insecurity In A Suburban Pediatric Urgent Care, Rachel Foutz

Dissertations

Problem: Screening for Social Determinants of Health (SDOH), including food insecurity (FI) should be done on a regular basis at a child’s pediatrician. Many children in the state of Missouri do not have a pediatrician or do not regularly see their pediatrician and are therefore never being screened for FI.

Methods: This observational descriptive quality improvement (QI) project utilized a prospective observational analysis to implement a voluntary FI screening tool in a pediatric only urgent care. The project sampled pediatric patients aged two days to 21 years of life. All participants were given local resources after completing the screening. The …

Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke

Dissertations

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …

Acute Agitation Intervention Tool For Reduction Of Polypharmacy, Brooks J. Propst

Dissertations

Introduction: Patients with behavioral health diagnoses are among the highest risk for
aggression. For pediatric patients with behavioral health needs, urgent treatment is
needed for aggressive behavior, due to the potential unwanted outcomes. The purpose of this Quality Improvement (QI) pilot project was to implement an Acute Agitation Intervention Tool that uses the Broset Violence Checklist (BVC) to guide
pharmacological intervention for mild and moderate to severe agitation in pediatric
patients with behavioral health needs ages 8 to 18 to decrease the number of medications that patients are getting per agitation event over a 12-week period.

Methods: This QI included …

Evaluation Of An Education Program Implementation For Adults With Stage 4 And 5 Chronic Kidney Disease, Dana Marie Carter

Dissertations

Abstract

Problem: Patients with long-term medical conditions represent a significant public health issue. Therefore, patients diagnosed with a chronic illness must have a high level of health literacy (HL) to manage their condition effectively. This Quality Improvement (QI) project evaluated the impact of an existing education-based program for stage 4 and 5 chronic kidney disease (CKD) patients and its effect on laboratory values compared before and after an NP-led education program that included vascular access, and modality choices.

Methods: A retrospective chart review was completed on 20 patients with an inclusive diagnosis of CKD stage 4 or 5 from …

Reducing Pediatric Morbidity Through Development Of A Clinical Practice Guideline, Deanna Kroh

Dissertations

Peripheral intravenous therapy is a commonly utilized treatment modality for the care of acutely ill pediatric patients. Two risk factors include infiltration and extravasation injuries. These injuries, peripheral intravenous infiltration or extravasation injuries (PIVIEs), can vary in their clinical manifestations from minor discomfort to harm as severe as loss of limb or disfigurement. Clinicians caring for patients at risk of developing PIVIEs need to be able to act quickly to reduce potential morbidity. The purpose of this project was to create a clinical practice guideline (CPG) that would guide staff intervention if a PIVIE occurs, with the ultimate goal of …

Visualizing Depressive Symptom Improvement: Implementing The 17-Item Hamilton Depression Rating Scale, Briana Raterman

Dissertations

Visualizing Depressive Symptom Improvement: Implementing the 17-Item Hamilton Depression Rating Scale

Abstract

Problem

Depression, a mental health diagnosis, has affected about 18.5% of adults (Villarroel & Terlizzi, 2020). Ketamine, a medication initially used as an anesthetic, has improved depressive symptoms in individuals struggling with treatment-resistant depression.

Method

This quality improvement (QI) project used the 17-item Hamilton Depression Rating Scale questionnaire to assess depressive symptom changes in patients receiving intramuscular ketamine for treatment-resistant depression. The questionnaire was administered to patients pre-and post-intramuscular ketamine administration. The data was collected on injections one, three, and six on each participant’s set schedule of injections …

An Evaluation Of A Multidisciplinary Implementation Of Evidence Based Practice In Prediabetes, Emily Sisco

Dissertations

Abstract

Problem Over 70% of prediabetic patients progress to full diabetes. There are over 80 million American adults who are diabetic. Diabetes is the costliest chronic disease that often leads to many other health issues.

Methods This QI project utilized a descriptive observational design. Quantitative data was collected via retrospective chart review. Primary data collected was documentation of a patient visit to the registered dietician and the hemoglobin A1c (HbA1c) of patients who followed up in the office after the referral.

Results Eight patients followed up to the office for a second visit (n=8). Four patients did see the registered …

An Evaluation Of Mindstrong™ Implementation With Graduate Nursing Students, Angela B. Sabblut

Dissertations

Problem: Nursing graduate students are at increased risk of greater stress, anxiety, and depression (Hoying, 2020; Melnyk et al., 2020). Cognitive Behavioral Therapy is the gold standard in the treatment of anxiety and depression (Hoying et al., 2020; Melnyk et al., 2015; Melnyk et al., 2020). MINDSTRONG™, a CBT-based training program, has been proven in many studies to be effective in helping individuals prevent or cope with these issues (The Ohio State University College of Nursing, 2020).

Methods: This Quality Improvement (QI) project was a descriptive-observational, pre-post design. Sample and setting were nursing graduate students from a Midwestern, middle-sized urban, …

Life Matters, Marina Fischer

Dissertations

Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.

Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …

Effect Of A Trauma Informed Care Tool In A Pediatric Cardiac Intensive Care Unit, Taylor Park

Dissertations

Problem: Parents of infants less than one-year-old with complex congenital heart disease (CCHD) experience significant stress while their child is admitted to the pediatric cardiac intensive care unit (PCICU), often resulting in trauma to parents and their families. Trauma informed care (TIC) seeks to minimize the impact of emotional trauma and it acknowledges previous trauma an individual may have experienced.

Methods: The purpose of this quality improvement (QI) project was to assess the thrive guide’s ability to decrease parental stress in the pediatric cardiac intensive care unit (PCICU). The aim was to decrease parental Perceived Stress Scale (PSS) scores by …

Doubling Down On Sepsis: A Quality Improvement Project To Improve Sepsis Bundle Compliance On An Inpatient Oncology Unit, Kayla Slay

Dissertations

Problem: Sepsis is a leading cause of death worldwide, and the second most common cause of death in cancer patients. Early management of sepsis through use of sepsis bundles have been shown to improve patient outcomes, yet bundle adherence is unfortunately inconsistent.

Methods: A two-nurse team, called the Sepsis Sidekicks, was a process improvement initiative to increase compliance with the center for Medicare and Medicaid Services (CMS) sepsis bundle and improve patient outcomes related to sepsis. The observational quality improvement project utilized a Plan-Do-Study-Act (PDSA) model over a six-week period where quantitative data was collected using a retrospective chart review. …

Eye Care Protocol In Critically Ill Pediatric Patients On Neuromuscular Blockage, Jinnie Tkach

Dissertations

Abstract

Problem: Patients admitted to the pediatric intensive care unit (PICU) are at increased risk for the development of ocular surface disease (OSD) due to impaired ocular mechanisms while intubated, sedated, and on continuous neuromuscular blockade. The purpose of this project is to prevent OSD and vision impairments by increasing the frequency of eye care in accordance with a PICU eye care protocol.

Methods: An observational descriptive study was conducted utilizing retrospective and prospective chart review. Comparisons were drawn between the 2021 pre intervention group and the 2022 post intervention group regarding the impact of linking lubricating eye ointment orders …

Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen

Dissertations

Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost

Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …

Decreasing Central Venous Catheter Usage For The Hemodialysis Patient, Antionette Jordan

Dissertations

Abstract

Problem: The central venous catheter (CVC) usage rate in a large urban dialysis clinic was 34.5% and the Centers for Medicaid and Medicare Services (CMS) goal is 10.7%. CVC usage is a quality metric monitored by CMS to assess whether dialysis facilities are providing quality services which can impact reimbursement for the clinic. Failure to meet this metric can result in a penalty of up to 2% in reimbursement. The purpose of this quality improvement project was to determine if an interdisciplinary team (IDT) approach to vascular access planning and care influenced the CVC usage rate by 10% …

Improving Postpartum Hypertension Discharge Education: A Pilot Project, Kathryn Barth

Dissertations

Problem: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity, mortality, and postpartum readmission. Several evidence-based algorithms and protocols have been implemented in the inpatient setting to treat severe blood pressure and prevent complications. However, there remains an opportunity to improve the postpartum care transition and discharge education for patients with these conditions in an attempt to decrease 30-day postpartum hypertension readmissions.

Methods: This pilot project utilized a descriptive design and took place on a postpartum unit at a Midwest metropolitan high-risk obstetrical teaching hospital. Interventions included patient-specific discharge education, distribution of a home blood pressure …

Impact Of Social Isolation In Hiv-Positive Individuals During A Pandemic, Corina Jane Bakoylis

Dissertations

Problem: The global pandemic of COVID-19 caused concern for immunocompromised individuals. The purpose of this quality improvement initiative was to assess the impact of social isolation on feelings of loneliness, depression, and social isolation experiences in HIV-positive individuals residing in a long-term care facility.

Methods: A mixed-method convergent design with a purposeful sample of HIV-positive adult residents residing in a long-term care facility was utilized. An evaluation of loneliness using the University of California Los Angeles (UCLA) Loneliness Scale (Version 3) and depression using the Patient Health Questionnaire-8 (PHQ-8) were completed. Personal experiences were also assessed with five predetermined open-ended …

Preventing Ocular Surface Disease In The Pediatric Intensive Care Unit, Emily Mallette

Dissertations

Preventing Ocular Surface Disease in the Pediatric Intensive Care Unit

Problem: Ocular surface disease in the Pediatric Intensive Care Unit is a significant problem in intubated patients due to altered eye protective mechanics, leading to exposure of the eye surface and dry eye. The purpose of this quality improvement project was to evaluate how an eye care protocol affected the frequency of artificial tear ointment administration.

Method: A descriptive, cohort design utilizing a retrospective chart review with convenience sampling of intubated children in the PICU from two cohorts was used. Comparisons were made between the preintervention cohort in 2020 and …

A Telehealth Palliative Care Objective Structured Clinical Examination, Lindsey Q. Mcintyre

Dissertations

Problem: Palliative care is a service focused on symptom management and improved quality of life for persons with serious or chronic illnesses and is widely underutilized. Although advanced practice registered nurses (APRNs) possess a unique skillset to contribute to palliative care, there is minimal reporting on palliative care training for this professional group. The purpose of this clinical scholarship project was to implement the End-of-Life Nursing Education Consortium (ELNEC) online training program for APRN students in the BSN-DNP program and evaluate its effect on student performance during a telehealth objective structured clinical examination (OSCE).

Methods: An observational, descriptive …

A Descriptive Study Of Health-Related Risks And Outcome Differences By Loneliness Status In A Sample Of Older Veterans, Rachael Beard

Dissertations

There is a need to understand the influences and outcomes related to loneliness in veterans living with complex illness. Patients require self-care to manage complications and exacerbations associated with complex illness. Deficits in self-care result in negative health outcomes and drive resource utilization upward. The identification of potential factors related to self-care is important. Loneliness may be one factor that influences patients’ ability and desire to care for themselves. Descriptive correlational design was used to evaluate loneliness both as a predictor and outcome in veterans admitted to the hospital for three complex respiratory illnesses (heart failure, chronic obstructive pulmonary disease, …

Screening And Referring For Postpartum Depression In Pediatric Primary Care, Melissa Harkins

Dissertations

Problem

Postpartum depression (PPD) can lead to increased risk of child abuse, delays in infant development, and increased medical costs (Earls et al., 2019). The American Academy of Pediatrics (AAP) recommends all mothers of infants 0-6 months be screened for PPD during well-child visits. Despite these recommendations, many pediatric offices have no PPD screening process.

Methods

This quality improvement project utilized a standardized tool to screen mothers of infants 0-6 months for PPD during their infants’ well-child visits. Mothers who screened positive for PPD were offered referrals to treatment resources and given the opportunity to participate in two follow-up telephone …

Missed Appointment Rates And The Implication On Primary Care Practice, Kelly Martin

Dissertations

Problem: Missed appointments cost primary care facilities money and resources through lack of utilization. When patients fail to attend their scheduled appointment the providers are non-productive when they could be seeing other patients that are potentially moved to other days, sending patients to other providers, or worse sending patients to the prompt care or the Emergency Department for care. The missed appointment rate at Office A Primary Care is approximately ten percent, while Office B has a nearly 11% missed appointment rate. Both facilities make reminder calls to patients the day before their appointments to remind them of their appointment …