Peer Support To Enhance Safe Alcohol Use In University Students: A Quality Improvement Project, Kerri Reynolds

DNP Scholarly Projects

BACKGROUND: College is a period of transition to adulthood where many students experiment with alcohol consumption. Peer educators can bring access to evidence-based alcohol consumption education through student-centric strategies. This quality improvement project aimed to implement an evidence-based training program for college peer educators followed by the delivery of campus alcohol education in a six week period. Feasible ideas for sustainable college peer educator training were generated at this medium-sized public university. The impact of training on six peer educators’ self-reported professional leadership skills, knowledge, and confidence was measured.

METHODS: The Certified Peer Educator (CPE) training program (NASPA) was used …

Integrating Behavioral Health Into Family Medicine: Improving Access To Specialty Care Using A Collaborative Care Model, Christina Stephens

DNP Scholarly Projects

Primary care, an extensive of family medicine remains a key access point for patients entering the healthcare system. Accessing medical care and specialty psychiatric services is limited in rural communities. Patients often find exhaustive wait times, untimely referrals, and reliance on emergency services for crisis management. The primary care provider is able to help their community improve access to behavioral health care by using a collaborative approach. This quality improvement initiative used the framework produced by the AIMS Center at the University of Washington and adopted for use creating an 8-week intensive program in a family medical practice located in …

Evaluating The Impact Of Simulation On Perceived Knowledge And Confidence Of New Graduate Nurses (Ngns) In Maternal-Newborn Care, Disa Seymour

DNP Scholarly Projects

Abstract

Background: Nursing education worldwide varies in duration and training process, with nurses often facing rapid immersion into patient care complexities when entering the workforce. While new nurses contribute significantly to the nursing community with contemporary knowledge, their transition to practice can be daunting, necessitating support for both competence and retention. As specialty care settings integrate more new graduate nurses (NGNs) to address workforce shortages, collaboration between leaders and educators becomes crucial. Simulation emerges as a vital tool in building confidence while learning, offering a safe space for skill development and growth of confidence.

Purpose: This project’s objective was to …

Scares: A Clinician Guide To Spinal Cord Awareness, Response, And Emergency Support Creation And Implantation Of Scares Protocol Among Hospitalist Advanced Practice Providers, Brittany Biega

DNP Scholarly Projects

While they are more common in patients with oncological disease and trauma, SCE still exist among patients without these comorbidities. Less has been established regarding care protocols in this population. The absence of standardized procedures has been linked to preventable, adverse patient outcomes, including cases of permanent damage due to delayed treatment. This project employs Lean Six Sigma methodologies and Johns Hopkins Evidence- Based Practice to devise a robust SCE protocol, aimed at standardizing care and improving patient outcomes. A multidisciplinary team including general medicine, neurology, neurosurgery, and neuroradiology developed “Spinal Emergency Management Guidelines” protocol, which was implemented within the …

Non-Invasive Monitoring Device For Early Detection Of Breast Cancer Related Lymphedema, Amy Prendergast

Honors Theses and Capstones

Breast Cancer Related Lymphedema (BCRL) is a common co-morbidity in cancer survivors following neoadjuvant therapies such as chemotherapy, radiation, and/or surgery. It is brought about by the disruption in the lymphatic system (think lymph node biopsy) that leads to a buildup of lymphatic fluid in the arm. Current diagnostic strategies for this condition are merely retroactive, and fairly limited in the parameters that are examined to ensure patient well-being long term. We hypothesize that with an approach that mimics bioimpedance spectroscopy analysis, we will be able to provide a clinical support tool that would better determine early stages of lymphedema …

Optimizing The Assisted Living Experience: Integration Of Value-Based Care To Foster Augmented Resident-Centered Quality, Jennette Pietrzak

DNP Scholarly Projects

Background: Fee-for-Service models are quantity-focused reactive approaches and have historically been at the forefront of healthcare. Value-based models focus on proactive, resident-centered care that is aimed at quality care over quantity. Implementation of ValueBased Care models can positively impact healthcare and fiscal outcomes

Purpose: The quality improvement project aimed to develop, integrate, and implement a valuebased model in Memory Care as an alternative to traditional Fee-for-Service models. The project aimed to improve key performance indicators by reducing hospitalizations, emergency room visits, and falls following the implementation of Value-Based Care (VBC) models.

Method: Data metrics for hospitalizations, emergency room visits, and …

Empowering Nurse Leaders To Achieve Harmony: Fostering Work-Life Balance, Gilberto Gamba

DNP Scholarly Projects

BACKGROUND: Balancing professional and personal life demands has become a focal point in today’s healthcare organizational culture. Despite the technological advances in providing better and faster healthcare, team members often struggle to achieve work-life harmony while meeting the demands of a growing population of healthcare clients. The evidence highlights nurse leaders as one group for which the identification and implementation of work-life balance interventions is crucial.

METHODS: An original tool based on available evidence was developed and used with a group of nurse leaders participating in an educational activity to engage them in behaviors supporting work-life harmony. A post-educational survey …

The Expansion Of Language Interpretation Services Post-Executive Order 13166: Effects On Maternal And Fetal Outcomes Of Non-English-Speaking Patients, Lilly Annabelle Smith

Honors Theses and Capstones

Over 69 million people older than the age of 5 in the U.S. speak a language other than English at home (U.S. Census, 2022). Of this population, around 38% report speaking English less than "very well" or limited English proficiency, “LEP”. Research has shown patient-provider communication quality in healthcare settings to be directly linked to the provider's ability to deliver safe and suitable care for LEP patients (Au et al., 2009). Executive Order (EO) 13166, signed into law in 2000, requires all federal agencies to implement and document language interpretation services in their establishments (Basu et al., 2017). LEP mothers …

Distribution Of Tick Species On Free-Ranging Ungulates In Northern New England, Karisa Graham

Honors Theses and Capstones

In Northern New England, ungulates are often parasitized by ticks, which is one of the leading causes for the decline in population. Ungulates are a good host for ticks, specifically deer ticks and winter ticks, and these ticks cause many tick-borne diseases in humans as well. The purpose of this study was to assess passive sampling from harvested animals as a means of tick surveillance in Vermont and New Hampshire. Ticks were collected from deer and moose and mapped throughout the two states by ArcGIS to visualize the trends in distribution. Relative abundance was greater in southeastern Vermont, with no …

Nursing Education And Comfort Level In Caring For Patients With Eating Disorders, Jaylyn E. Jewell

Honors Theses and Capstones

Nurses are integral to providing care to patients with eating disorders, who often present to the generalized hospital setting related to physical complications from their disorder. Despite the vital role nurses play, a lack of education is cited. This project sought to assess knowledge on eating disorders of nurses at a local hospital through dissemination of a survey. A total of n=18 responses were gathered. Results supported the fact that many nurses have received inadequate education on eating disorders, and consequently have low knowledge and competency in the care of these patients. This project seeks to identify this lack of …

Exploring Lexical Stress Perception: An Investigation Across Varied Listener Experience With Prosody, Olivia J. Pride

Honors Theses and Capstones

Prosody is a characteristic of speech that allows others to understand emotion, emphasis, and meaning of language more deeply. Perceptual accuracy by speech-language pathologists is critical to diagnosing speech disorders. This study examined perceptual abilities of three different groups in identifying lexical stress across groups. Four SLPs, 6 SLP graduate students, and 6 untrained listeners listened to 396 audio files elicited in a prior study using the lexical stress tasks from the Prosodic Profiling Elements of Prosody in Speech-Communication (PEPS-C) and the naturalistic lexical stress (NLS) tasks. Listeners were asked if syllable stress was on the first syllable, second syllable, …

Inclusivity Of In Vitro Fertilization Clinic Websites, Erin Donahue

Honors Theses and Capstones

In the world, many people cannot naturally conceive children. They may be infertile, lack an intimate partner, or be in a same-sex relationship. Artificial reproductive technologies (ARTs) are catered to the aforementioned population. ARTs are fertility treatments that assist people with the fertilization of gametes and/or implantation of embryos. One of the most popular ARTs is in-vitro fertilization (IVF). IVF is a medical procedure in which an egg is fertilized by sperm in a lab so it can develop into an embryo. That embryo can then be implanted directly into the uterus. This quality improvement project aims to determine the …

Student Perspectives On The Adequacy Of Mental Health Curriculum Within The College Of Health And Human Services At Unh, Brianna Lee Meyer

Honors Theses and Capstones

This study aims to understand the confidence students in future healthcare oriented majors feel in regards to treating or interacting with individuals with mental health conditions. It also aims to understand the effect of students' in-major education, outside-major education, and lived experience on this confidence level. Students within the College of Health and Human Services at UNH were the participants who completed a short Qualtrics survey online. The survey collected data from Likert scales and short-answer questions. The Likert scales were then analyzed with a regression and descriptive statistics, while the short-answer questions were analyzed with thematic analysis. The study …

Investigation Of The Causative Agent Of Canine Leproid Granuloma Infection Cases In The Northeastern United States, Nicole J. Marcotte

Honors Theses and Capstones

Canine leproid granuloma syndrome (CLGS) is a form of disease in dogs of many breeds that is characterized by a skin infection in the subcutis and/or dermis. The granulomas that form as a result of infection are typically non pruritic, alopecic, raised, and firm. These mass-like granulomas can ulcerate, causing further infection beneath the skin surface, and are present in areas of the body such as the ears, head, neck, and extremities. CLGS has been known to infect dogs of different breeds and ages, but has most commonly been reported to infect shorthaired, large sized breeds. This disease is suspected …

Increasing Education And Staff Knowledge Of Delirium Care: An Evidence-Based Quality Improvement Project, Serena Martinath

Master's Theses and Capstones

Introduction At a small, community hospital in Massachusetts a gap analysis was conducted leading to a quality improvement project to increase staff education and knowledge regarding delirium and evidence-based best practices for delirium care. Delirium is a growing, often under recognized medical condition that occurs in hospitalized patients (Loftus & Wiesenfeld, 2017). Delirium is characterized by acute changes in congnition, level of consciousness, and attention (Loftus & Wiesenfeld, 2017). A better understanding of this condition is expected to result in improved patient care.

Methods The clinical microsystem studied in this gap analysis project was assessed by using the AHRQ Gap …

Heparin Vs. Saline: Evaluating Evidence-Based Best Practice For Maintaining Patency Of Implanted Ports, Shannon D. Murdock

Master's Theses and Capstones

Background Implanted ports are frequently used for central venous access in the adult oncology population. Maintaining patency of these ports is important for continuing uninterrupted treatment and supportive care for oncologic patients. Historically, heparin solution has been used as a locking solution for implanted ports to prevent occlusion. However, evidence shows that 0.9% sodium chloride (normal saline or NS) as a lock solution is equally effective as heparin solution at maintaining implanted port patency and poses less risk to patients.

Local Problem In an ambulatory adult oncology clinic serving Seacoast New Hampshire, a gap was identified between clinical practice where …

Implementing Change: The Use Of Minocycline-Rifampin Impregnated Central Venous Catheters In Central Line Associated Blood Stream Infection Prevention In Critically Ill Patients, Shawn B. Murray

Master's Theses and Capstones

Introduction: At a large academic healthcare facility in the northeast a Gap Analysis was conducted finding quality improvement opportunities for central line associated blood stream (CLABSI) prevention in critically ill patients. Review of literature reveals the use of minocycline-rifampin impregnated (MNRI) central venous catheters (CVCs) as being an effective intervention in CLABSI prevention.

Methods: Several assessments were conducted regarding the implications of updating the facilities practice to reflect this evidence including AHRQ Gap Analysis Tool, a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Stakeholder Feedback, and Resource Allocation.

Results: Facilitators and barriers were identified in implementing this …

Streamlining The Postpartum Educational Process For Safe And Equitable Patient Care: A Quality Improvement Initiative, Shea N. Cook

Master's Theses and Capstones

Abstract

BACKGROUND:

Postpartum discharge education is essential in the care of mothers, newborns, and their families as they transition from the hospital setting to home. The U.S Department of Health and Human Services has identified postpartum discharge education content as a public health priority to reduce physical and mood-related postpartum complications. Over half of all serious morbidity and mortality complications occur after a postpartum patient leaves the hospital. It is essential that hospitals utilize the best evidence-based practices to maximize the impact of patient education during maternity care in the hospital.

LOCAL PROBLEM:

Within the given microsystem there is a …

Enhancing Nurses' Self-Efficacy In Smoking Cessation Counseling To Improve Patient- Centered Care At A Federally Funded Urgent Care Center: A Quality Improvement Initiative, Adam N. Waller Ii

Master's Theses and Capstones

Background: It is well documented that there is a high prevalence of Veteran tobacco use in the United States. Additionally, providing smoking cessation counseling in an emergency setting is beneficial. The broader Veteran Affairs (VA) macrosystem has a plethora of smoking cessation resources available for Veterans. Within a VA Urgent Care Center (UCC) a quality improvement initiative was conducted that focused on increasing registered nurses (RNs) self-efficacy in providing smoking cessation counseling. Prior to this quality improvement (QI) project, smoking cessation did not occur in this UCC. If RNs have higher self-efficacy more smoking cessation counseling will occur.

Methods …

Utilization Of The Broset Violence Checklist For Early Identification Of Aggressive And Violent Behavior To Improve Unit Safety: A Quality Improvement Initiative, Emily Sharretts

Master's Theses and Capstones

BACKGROUND: There continues to be an increase in workplace violence nationally in the healthcare setting which jeopardizes patient and staff safety. Liu et al. (2019) found about 59% of health care workers experience workplace violence. Kafle et al. (2022) emphasizes the link between workplace violence and increased levels of nurse burnout and therefore decreased job satisfaction.

LOCAL PROBLEM: The microsystem assessment revealed that there was no risk assessment tool to identifying early aggressive or violent patient behavior.

METHODS: The Plan-Do-Study-Act (PDSA) framework was used for this quality improvement project to reduce workplace violence on this unit.

INTERVENTIONS:After completion …

Promoting Safety Of Medication Administration And Reducing Medication Errors Using Photographic Patient Identification In An Inpatient Psychiatric Setting: A Quality Improvement Initiative, Kyla Kelly

Master's Theses and Capstones

Abstract

Background: Medication errors pertaining to patient wristband workarounds in a behavioral and mental health inpatient unit can affect patient outcomes, safety and can even be fatal. The proper verification of the five rights of medication administration, patient acuity, diagnosis, and unit staffing can impact the need for patient wristband workarounds to occur. Improving staff and patient education and reducing the need for wristband workarounds through the utilization of patient photographic identification significantly reduces the number of medication errors relating to wristband workarounds during the medication administration process. Additionally, a significant reduction in the time it takes to administer medications …

Implementation Of A Multipronged Approach To Improve Pre-Operative Efficiency And First Case On Time Start Performance, Melyssa A. Stokes

Master's Theses and Capstones

Background: Surgical services are an important source of revenue and important economic driver of hospital systems. Surgical services account for approximately 42% of a hospital’s annual revenue, however, it also constitutes 40% of facility operating costs (Gupta, et al., 2022 & Morel & Gomez, 2021). Despite the high costs associated with surgical services delays remain a significant issue across the nation. On-time starts for the first surgical cases of the day is a key performance metric tracked by surgical facilities to determine efficiency. Currently, 50 – 90% of first surgical cases are delayed throughout the United States and the most …

Using Education To Improve Nurse Perceptions On Rounding To Increase Patient Safety And Efficiency Of Care On A Behavioral Health Unit: A Quality Improvement Project, Shannon Alty

Master's Theses and Capstones

Abstract

Background: Hourly rounding completed by nursing staff are routinely completed on most inpatient hospital units. Evidence suggests that hourly rounding can improve patient outcomes, patient satisfaction rates, communication, minimize patient requests and improve the nurse patient relationship (Halm, 2009). Additional evidence suggests that inpatient psychiatric patients often feel disconnected from their nurse and hourly rounding is recommended to build the nurse-patient relationship (DaSilva, 2017). However, for successful implementation, nurse perceptions of rounding must be obtained.

Local Problem: Hourly rounding is a standard of practice, however, was not being consistently completed. Assessing the nurse perceptions regarding rounding, was imperative understand …

Assessing And Improving Pediatric Nurses' Documentation Of Childhood Immunization Status Using The Electronic Health Record, Katherine Engalichev

Master's Theses and Capstones

BACKGROUND: Adherence to the standardized childhood immunization schedule put forth by the American Academy of Pediatrics is the gold standard for decreasing vaccine-preventable disease morbidity. The first step to improving adherence with the recommended immunization schedule is identifying children who are under-immunized. The inpatient setting offers an opportunity to screen pediatric patients for immunization status. A survey was administered to nurses working on an inpatient pediatric unit to gauge nurse self-report of Cerner™ Electronic Health Record (EHR) use for immunization documentation, their perceptions regarding EHR ease of use for documenting pediatric immunization status, attitudes towards documenting immunization status, and perceived …

Using Education To Promote Waste Segregation And Waste Reduction In The Operating Room: A Quality Improvement Initiative, Sarah E. Landgraf

Master's Theses and Capstones

Background: The operating room (OR) is known to be one of the largest producers of medical waste and of the surgical specialties, orthopedic surgery tends to the largest portion of this. Waste from the OR can be mitigated by recycling non-contaminated materials. This reduces the number of raw materials needed to create new products, decreases landfill use, and lowers hospital costs.

Local Problem: It was observed that a gap in knowledge existed related to recyclables in the OR of a large medical center in New England. Also, it was observed that there was potential for waste and recycling to be …

Improving Communication Between The Emergency Department And Prehospital Emergency Medical Services Through The Use Of A Secure Messaging Application: A Quality Improvement Project, Jacob G. Petlon

Master's Theses and Capstones

Background: Communication between emergency medical services (EMS) and the emergency department (ED) is a key part of treating patients being transported by ambulance. This communication is moving away from traditional radio and cell phone calls to the use of secure text-based apps. These apps can generate metrics and provide real time location information that is not available using traditional methods. Increased use of these apps can improve communication between EMS and receiving EDs.

Local Problem: Wildcat hospital introduced the EMS communication app Twiage in May of 2023. There is low utilization of the app and some EMS and ED …

Implementing Education For Maternity Nurses To Improve Nurses’ Knowledge, Attitudes, And Practices Regarding Postpartum Depression: A Quality Improvement Initiative, Haley Merrill

Master's Theses and Capstones

BACKGROUND: Postpartum depression (PPD) is the most common complication of childbirth, but often goes undiagnosed. Adequate patient education on PPD increases the patient’s knowledge and supports enhanced communication between patients and provider. Maternity nurses have continued interaction with new mothers and are in a vital position to educate patients regarding PPD. However, maternity nurses may lack confidence in delivering the appropriate education and resources for PPD to postpartum women.

LOCAL PROBLEM: Within the given microsystem, there was currently a gap that existed between PPD education for nurses and the delivery of PPD patient education.

METHODS: Utilizing the Plan-Do-Study-Act model, a …

Enhancing Education To Mitigate Workplace Violence To Increase Staff Safety In A High Acuity Setting: A Quality Improvement Project, Michelle Crowley

Master's Theses and Capstones

Background: The current microsystem is a critical access 8 bed Emergency Department with 3 hallway beds. On average it can see anywhere from 30-50 patients in a 24 hour period. Due to the nature of the microsystem, staff are at high risk for experiencing workplace violence (WPV). Within this microsystem staff do not have a readily available communication device on their person in case of an adverse event leaving them susceptible to patient to staff WPV. Staff within this microsystem are Management of Aggressive Behavior (MOAB) 1 and 2 trained, however this does not provide education on risk factors for …

Incorporating Non-Pharmacological Labor Coping Methods To Improve Nursing Care And Reduce Primary Cesarean Section Rates: A Quality Improvement Project, Cait Maccabe

Master's Theses and Capstones

Abstract

BACKGROUND: Cesarean sections (c-sections), while life-saving in some circumstances, carry a significantly higher risk of morbidity and mortality than vaginal birth for birthing patients and neonates alike. Despite this, rates of c-section have continued to rise in the US and around the world. As primary cesarean births are highly likely to lead to repeat cesarean births, concerted efforts are being made to reduce them both broadly and within the setting of this quality improvement (QI) project: a labor and delivery unit located within a Level II trauma center in New Hampshire. A literature review provided evidence supporting the use …

Giving Effective And Timely Hospice Education To Lessen Participant Stress (Get Helps), Caroline Rose Carter

Master's Theses and Capstones

In 2022, 1.72 million people chose to use hospice as their end-of life care. This is a 6.8% increase from 2019, and the number of patients who choose to use hospice is increasing (Summers, 2022). The aim of this quality improvement (QI) study was to decrease levels of stress reported by the patient and informal caretakers by combining the information from the hospice program’s admission packet and other approved handouts, while standardizing the verbiage through a Flesch-Kincaid readability scale to an eighth-grade reading level. Pre-survey perceived stress scores averaged 22.97 on a modified Perceived-Stress Scale, and the mean of the …