Digital Commons Network^™

Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Beyond The Physical Wounds: A Proactive Approach To Mental Health Recovery After A Traumatic Injury, Christine Mcgahey

Doctor of Nursing Practice (DNP) Projects

Beyond the Physical Wounds: A Proactive Approach to Mental Health Recovery After a Traumatic Injury

Background: Every year, millions of Americans incur a life-threatening traumatic event and are admitted to trauma centers to treat their acute physical injuries. While traumatic injury is closely associated with developing post-traumatic stress disorder (PTSD), patients are rarely evaluated for PTSD risk or educated about long-term psychological sequelae.

Local Problem: The predictive value of early screening to quantify PTSD risk in trauma patients is well documented in the literature. However, in a 241-bed Level II Trauma acute care hospital, there was no protocol to evaluate …

Mental Health Screening After Trauma: A Concise Review, Christine Mcgahey

DNP Qualifying Manuscripts

OBJECTIVE: To gain a better understanding of the value of mental health screening for PTSD risk in hospitalized trauma survivors.

DATA SOURCES: Studies were pooled from a literature search performed on the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and the Cochrane Database of Systematic Reviews.

STUDY SELECTION: Relevant studies published between 2015 and 2022 in English, excluding traumatic injuries incurred during combat.

DATA EXTRACTION: Ten articles were selected for inclusion in this review.

DATA SYNTHESIS: There is a significant and widespread mental health burden following traumatic injury. Early screening to quantify the risk for PTSD can …

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 …

Addressing Perceived Barriers To Screening For Adverse Childhood Experiences In Primary Care, Trenton Conway

Dissertations

Problem: Inconsistent screening for Adverse Childhood Experiences (ACEs) in primary care settings leads to fewer appropriate behavioral health (BH) referrals and may increase risk for and incidence of chronic health conditions.

Methods: This quality improvement (QI) project used a descriptive observational design with prospective and retrospective data collection. The CDC’s ACE screening tool was administered to patients 18 years and older presenting to primary care. Data collection included number of ACE screenings completed and the number of BH referrals made following the screening. In additional, information was collected from medical assistants (MAs) and providers about the ACE screening process.

Results: …

Trauma-Informed Care In The Emergency Department, Kayla Kvell, Kristin Oscarson

Nursing DNP Projects

Introduction: This project aims to analyze the effectiveness of trauma-informed care (TIC) education on attitudes of registered nurses (RNs) and psychiatric associates (PAs) towards TIC. The purpose of this project was to educate ED (emergency department) RNs and PAs on the effects of trauma and increase attitudes towards implementing a TIC approach to care for mental health (MH) patients in the ED.

Method: This project followed a pre–post-survey design with quantitative data. Participants included RNs and PAs newly hired to the ED, and/or if they had no previous TIC education. Data were collected utilizing a 10-question Likert scale survey.

Results: …

Organizational Implementation Of Trauma And Violence Informed Care, Tanaz Javan

Electronic Thesis and Dissertation Repository

For the past several decades, social and health services have increased their efforts to enhance service delivery and close the ‘science-to-service’ (or ‘evidence-to-practice’) gap by implementing effective interventions. At the same time, there has been growing recognition of the prevalence of trauma and violence in the lives of those served and those providing care and the impact of these experiences on service needs and interactions. This study explored the implementation of trauma- and violence-informed care (TVIC), a complex intervention focused on providing safety and choice for service users in the context of their life experiences and conditions, exploring factors that …

Focused Surrogate Decision-Maker Identification In The Traumatically Injured Adult, Kelly Ann Evans

Walden Dissertations and Doctoral Studies

AbstractPatients in the trauma care setting are often dependent on their families and physicians to decide medical treatments when they cannot participate in the process.But in up to one-third of cases, the surrogate decision-maker (SDM)selected by the patient is not the emergency contact listed in the electronic medical record (EMR).SDM identification and documentation will ensure that the patient is best represented by someone who knows their values and goals if they become incapacitated.Nurses can facilitate identifying a patient’s SDM and document this choice in the EMR.The purpose of this study was a staff education program to improve intensive care unit …

A Call To Create: Poetry As Healing And One Nurse’S Self-Discovery, Kim Cornett Henry, Kim Cornett Henry

English Theses

Florence Nightingale’s vision for nursing has changed greatly in the past one hundred and fifty years, with nursing’s identity replaced with an emphasis on science over caring. The fast-paced, technologically sophisticated environments, designed to meet the declining health of an American public, have resulted in nurses who are being pulled away from nurse-to-patient caring acts and the reasons they felt called to become nurses. These changes have had detrimental psychological and emotional effects on nurses and are especially evident in Intensive Care nurses. Expressive writing as poetry, autoethnography, and participation in vibrant writing communities offer nurses experiences for healing, voice, …

Peer-To-Peer Emotional Support For Second Victims Of Hospital Adverse Events, Jessica L. Van Leuven

Master's Projects and Capstones

Abstract

Problem: Psychological impact of trauma on healthcare workers is profound, and if left unaddressed can debilitate its victims, depress morale, and undermine safety culture. When adverse events occur and focus is placed on providing care and support to patients and their families, the emotional support needs of healthcare workers must also be acknowledged.

Context: Frontline workers in the oncology unit of the medical center that is the setting for this project experience emotional distress as “second victims” of adverse patient events. Close relationships develop between providers and patients during long-term treatments. When unanticipated or adverse patient events there can …

Introducing Trauma-And Resiliency-Informed Care In A Residential Treatment Setting, Connie Quach

Doctor of Nursing Practice Final Manuscripts

Background: The link between trauma exposure and substance use is well established. Seventy-five percent of individuals in substance use treatment report histories of abuse and trauma. Early traumatic experiences or repetitive trauma exposure disrupts a person’s ability to self-regulate which may demonstrate as disruptive behavior or present as physiological symptoms.

Purpose: The purpose of this project was to introduce and increase awareness of trauma and resiliency informed definitions, techniques, and provide resources for staff in a residential treatment setting.

Evidence-based Intervention and Methods: Participating nurses and resident assistants received a one hour presentation on trauma, resiliency, and its associated interventions. …

Educating Providers To Screen For Post-Traumatic Stress Disorder, Alyssa Fraino

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this evidence-based change in practice is to increase the knowledge base of psychiatric providers in outpatient psychiatric settings, by educating clinicians regarding the significance of implementing a post-traumatic stress disorder (PTSD) screening tool during the initial evaluation of patients. This can help to identify patients with PTSD that may not have been identified on initial visit, and may otherwise go unrecognized or untreated for PTSD, without the inclusion of a PTSD screening tool.

Problem: Evidence suggests that PTSD is underreported and overlooked in most populations. However, there is no standardized practice surrounding the routine use of …

A Tailored Multicomponent Intervention In Primary Care For Survivors Of Adverse Childhood Experiences (Aces), Rebecca L. Peterson

Evidence-Based Practice Project Reports

Adverse childhood experiences (ACEs) include 10 traumatic events of abuse, neglect, and household dysfunction that occur before 18 years of age. Adverse childhood experiences affect greater than 60% of the population, and approximately one in six individuals affirm that they have experienced four or more types of ACEs. They are associated with negative, long-term health outcomes in adults, including 9 out of the 10 leading causes of death in the United States (Centers for Disease Control and Prevention, n.d.; Felitti et al., 1998). The purpose of this evidence-based practice project was to implement a tailored, multicomponent intervention to mitigate the …

Integrating The Concept Of Trauma Into An Undergraduate Nursing Curriculum, Jacey Walker

DNP Scholarly Projects

Adverse childhood experiences, or ACEs, are early childhood traumas such as abuse, neglect or household dysfunction that can cause chronic physical and mental health problems across the lifespan. Approximately 61% of the adults in the United States have experienced ACEs. The prevalence of ACEs among nurses is at least comparable to population prevalence, and rates may be higher in subpopulations of individuals who work in helping professions. The stressful and highly interpersonal nature of nursing work may exacerbate and compound the health impacts of a nurse’s underlying ACEs, affecting not only the nurse’s health, but also his or her work …

Syrian Refugee Women's Experiences With The Ontario Health Care System: A Critical Ethnography Study, Areej Al-Hamad

Electronic Thesis and Dissertation Repository

There has been growing interest in migration and refugee research; the vulnerability of Syrian refugee women and how they adapt to their host communities. However, there is limited evidence regarding the pre- and post-migration trauma and its impacts on the health of Syrian refugee women in the Canadian context. The purposes of this critical ethnography using intersectional perspectives were: (1) to explore and describe Syrian refugee women’s experiences and meanings of pre- and post-migration trauma and its impact on their health in the context of repeated displacement and migration from their homes and families; (2) to critically examine how the …

Improving Psychological Trauma Awareness For Culturally Responsive Care: A Dnp Project, Jose M. Cruz

Doctor of Nursing Practice Projects

Racism and racial discrimination occur in a variety of forms (Kendi, 2017). Both can contribute to poor mental health outcomes in the United States (Alvarez, Liang, & Neville, 2016; Comas-Diaz, Hall, & Neville, 2019; Levy, 2019; Malott & Schaefle, 2015; Williams, Lawrence, Davis, & Vu, 2019). These social conditions have been identified as chronic stressors that can illicit trauma symptoms, result in post-traumatic stress disorder (PTSD), and contribute to increased suicidality (French et al., 2020). Providers should understand the ramifications of the psychological trauma that can occur and endeavor to deliver evidence-based solutions. This doctoral project was designed to develop, …

Nurse Perspectives Of Trauma-Informed Care, Lee Ann Blazejewski

Walden Dissertations and Doctoral Studies

There is growing interest in trauma-informed nursing methods to better respond to the needs of patients with histories of adverse childhood experiences and other traumatic events. Recent advances in the understanding of how trauma can negatively affect long-term health outcomes have fostered a shift towards trauma-informed care as a method to decrease patient retraumatization in nursing practice. With the implementation of trauma-informed care in many areas of healthcare and public health, several challenges have been exposed. The purpose of this study was to examine nurses’ lived experience of implementing trauma-informed care into nursing practice for the care of patients with …

The Effect Of An Acuity Adaptable Unit On Efficiency In Non-Critical Trauma Patients, Rebecca Charles

DNP Projects

Problem Statement: It was observed a large academic medical center is experiencing impeding congestion of non-critical care patients due to challenges with bed availability and high patient volumes. Delays in transferring patients to an appropriate level of care can impose safety risks and prolong length of stay. Implementation of an acuity adaptable unit may be a cost-effective approach to a growing problem.

Background: A fixed bed model limits the acuity of patients admitted to a specific space. Using the Iowa Model of Evidence Based Practice as the framework for design, moving to an acuity adaptable unit could facilitate patient …

Care Coordination Of The Geriatric Traumatic Fracture Patient: A Multimodal Approach To Pain Management, Alexandra Keough

DNP Projects

Introduction: Traumatic fractures are increasing in incidence across the country, particularly in the aging population. Geriatric patients who are admitted to the acute care setting for traumatic fractures are a unique population that require acute pain management, while also managing other comorbidities. While there are several guidelines on pain management for patients who are admitted to the acute care setting, there are no specific guidelines on the best practices to manage acute pain in the geriatric traumatic fracture population. Evidence supports a multimodal pain management strategy using pharmacologic and non-pharmacologic means as the best way to care for this population. …

A Descriptive Study Of Male Victims Of Sexual Assault Seen For A Sexual Assault Forensic Medical Examination, Madeleine Prince

Undergraduate Honors Theses

Ten percent of all victims who report a sexual assault (SA) are male (Department of Justice, 2013), yet there has been little research on their experiences. Further study on the unique characteristics of male SA victims is warranted. The purpose of this study is to explore, identify, and analyze variables of male SA victims who received a SA forensic medical examination (SAFME), and identify implications and areas for future research. Data from the SAFME charts were entered into the Statistical Package for the Social Sciences (SPSS) version 25. Male victims were compared to female victims from the same data set. …

Trauma Informed Care (Tic): Caring For Victims Of Trauma, Deanna Smith

Nursing Student Class Projects (Formerly MSN)

This poster discusses the use of trauma-informed care (TIC) in care settings to address health needs of patients who have experienced traumatic events. Complex trauma, childhood trauma, and post-traumatic stress disorder (PTSD) can cause long term impacts on health of patients including physical, behavioral, and cognitive manifestations. This poster explores health implications of trauma, how they can present in healthcare settings, and how the use of trauma-informed care can alleviate the burden on healthcare settings and improve patient outcomes by preventing further re-traumatization. The use of the TIC approach is applicable to all care modalities and settings, including primary and …

Implementation Of A Wellness Program For Emergency Department Medical Professionals., Madeleine Chesney

Doctor of Nursing Practice Papers

Background: Current data from the ANA HealthyNurse Survey 2018-2019 states that 70 percent of nurses that were surveyed report putting the health, safety, and wellness of their patients before their own. Additionally, in a study conducted between 2011 and 2017 of over 5,000 physicians less than 50 percent stated that they had enough time for their personal and family life. This data supports the urgent need to focus on the promotion of self-care and wellness for medical professionals. Objective: The purpose of this quality improvement project was to provide an opportunity for emergency department medical professionals to work toward improving …

The Relationship Between Stress, Anxiety, Depression, Coping And Satisfaction With Care Among Family Of Adult Acute Care Trauma Patients, Ashalata Ann Pereira

Theses and Dissertations

Background: Surprisingly few studies have considered the impact of trauma on adult family members of those admitted to the acute care, rather than ICU. Throughout the course of hospitalization, as patients move through different levels of care, family members must learn to adapt to, and cope with changes in care delivery. Purpose: To explore the literature to understand the state of the science, to assess the psychosocial and functional impact on family of adult trauma in acute care, and to identify predictors of coping and satisfaction with care provided to meet their needs. Design: The Lazarus & Folkman (1984) Stress, …

Essential Trauma Care Documentation: Redesigning A Community Hospital’S Trauma Flow Sheet, Murphy Neenan

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Poor trauma documentation has negative consequences on continuity of care, results in errors related to treatment, and yields increased time to order completion^{2, 3}. Nursing staff at a community hospital emergency department (ED) expressed frustration when utilizing the existing trauma flow sheet. The purpose of this project was to redesign and implement an evidence-supported emergency department trauma flow sheet for efficient and comprehensive documentation of trauma encounters.

Methods: A new trauma flow sheet was developed through a focus group session and semi-structured interviews. A PDSA model for improvement was introduced to facilitate future initiatives to improve trauma …

Trauma-Induced Coagulopathy, Zachary Wise

Nursing Student Class Projects (Formerly MSN)

Trauma-induced coagulopathy (TIC) is a medical emergency requiring effective correction of pathophysiological issues. TIC is antagonized by a lethal triad of factors including hypothermia, acidosis, and coagulopathy. This triad is a vicious cycle that is not seen in every patient that has experienced a physical trauma. However, if it is present, mortality rates quadruple(Phillips, Mohorn, Bookstaver, Ezekiel, & Watson, 2017). Effective correction of this triad can be successfully obtained with the utilization of thromboelastography (TEG). Appropriate usage of TEG promotes patient outcomes while reducing days in the ICU and overall length of stay(Pigna, Lippi, Saronni, & Cervellin, 2018).

The Impact Of Ptsd And History Of Involvement In The Criminal Justice System On Medication Treatment Success In Opioid Use Disorder, Kirk Sanger

Doctoral Dissertations

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4 …

Identifying Gaps In Care In The Geriatric Trauma Patient With Rib Fractures, Kathy A. Crystal

Doctoral Projects

Introduction: Rib fractures in the geriatric patient can be life altering. Across the country trauma centers are caring for an increased volume of geriatric patients aged 65 years and older (Ali-Osman et al., 2018). The geriatric patient with thoracic injury has the second highest mortality rate among the trauma population in the United States (Mentzer et al., 2017). The assessment of the patient is key to identify critical changes due to high risk of adverse events from rib fractures. Despite efforts to standardize the assessment and care provided to the patient with rib fractures, a lot of variation occurs. Research …

Association Of Skeletal Muscle And Psychological Responses To Immobility After Major Injury, Jacob T. Higgins

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and …

Moving On After Critical Incidents In Health Care. Second Victims: A Qualitative Study Of The Experiences Of Nurses And Midwives, Melanie Buhlmann

Theses: Doctorates and Masters

Aims: The aims of this study were to gain a deeper understanding of the experiences of nurses and midwives who have been involved in a critical incident in a non-critical care area and to explore how they have ‘moved-on’ from the event.

Background: It is irrefutable that health care is intrinsically risk-laden and perceived to be personally and professionally demanding for those who are employed within it. The term ‘second victim’ has been assigned to health care professionals who experienced emotional distress as a result of their involvement in critical incidents. Despite the recognition that critical incidents contribute to workrelated …

Probiotic Use In Trauma Patients: A Pathway To Determining The Standard Of Care To Improve Outcomes, Heather Vitko

Electronic Theses and Dissertations

The gut microbiome consists of normally non-pathogenic bacteria, viruses, and fungi. These friendly microbes serve to maintain GI barrier function and integrity, play a role in host nutrient and drug metabolism, immunomodulation, and prevent pathogenic bacteria from colonizing or causing disease. The importance of a healthy microbiome for the overall health of the host is just recently being appreciated within the medical and science communities. Disruption of the microbiome places one at greater risk for illness and infection. Patients who suffer a traumatic injury are among those at highest risk for complications associated with microbial imbalance, or dysbiosis. In addition …