Digital Commons Network^™

The Evolution Of Aces As A Mitigating Factor In Criminal Cases, Tamara Olson

Master's Theses and Capstones

The present study looked into how adverse childhood experiences (ACEs) affect childhood development and lead to potential criminal behavior. It also looked into how this psychological theory can be used as a legal defense. By examining previous research on the topic and studying criminal cases in which ACEs were used as a mitigating factor in the criminal act, the study attempted to investigate the connection between this psychological theory and its being used as a mitigating factor in criminal defense. The research questions for this study are: (1) to what degree are ACEs successful, (2) what are the qualities of …

A Novel ‘Adjacent Mycorrhizal Symbiosis’ In Invasive Garlic Mustard, Joshua A. Trombley

Master's Theses and Capstones

Invasion of temperate forests by Alliaria petiolata (garlic mustard) may be affected by interactions with arbuscular mycorrhizal fungi (AMF). Although AMF are generally mutualists of land plants, they suppress the growth of close relatives of garlic mustard1–3. Garlic mustard produces indolic glucosinolates, a class of organic compounds known to suppress AMF4,5 and which may protect the plant from AMF antagonism. We would therefore expect a negative interaction between these organisms. Contrary to this expectation, we show that AMF inoculation promotes garlic mustard growth, and this effect is influenced by investments in plant defense. AMF inoculation and subsequent colonization increased plant …

Assessing Visitor Preferences For Reservation Systems In Parks And Protected Areas: Insights From The Green Mountain National Forest, Ridgley Jordan Ward

Master's Theses and Capstones

The use of reservation systems in parks and protected areas has recently increased across the United States, influenced by factors such as carrying capacity and social distancing measures during COVID-19. This study employs stated choice modeling to examine visitor preferences for reservation systems at the Green Mountain National Forest in Vermont, USA, using a combined mail-back and online survey approach (n=629) during the summer of 2023. Our analysis focused on several key factors: ecological integrity, permit acquisition, crowding, parking wait times, and price. Findings reveal that ecological impacts, such as visible signs of litter or vegetative damage, significantly influenced visitor …

The Influence Of Lake Productivity On Methane Production And Ebullition From Temperate And Arctic Lake Sediments, Megan Wimsatt

Master's Theses and Capstones

Northern freshwater lakes (> 40°N) are an increasingly recognized major contributor of methane (CH4), a potent greenhouse gas, to the atmosphere. Climate warming and eutrophication acceleration threaten to increase CH4 emissions from these lake ecosystems, particularly in littoral (shallow lake edge) zones where ebullition (bubbling) is often a dominant flux pathway. Few studies have investigated the impacts of lake productivity on limnological CH4 cycling for a range of trophic classes and provided a comparison between different latitudes. Here, we analyzed chlorophyll α (chlα; proxy for lake productivity), other water quality parameters, sediment CH4 production rates, and ebullition rates at nine …

Magnetic Properties Of Manganese-Bismuth (Mnbi) Using Dft Calculations, James Wirth

Master's Theses and Capstones

Permanent magnets are in electronic or other systems that are necessary in daily life. Rare earth metals are the common base elements for permanent magnets, but their availability on the global stage is unstable. MnBi is one material being considered to replace rare earth materials due to its high electron mobility and strong conductivity. A literature review on the topic revealed that MnBi has a large energy product, high Curie temperature, promising band structure, and other beneficial features. This review was based on experimental data and theoretical calculations that used a variety of approximations. It was determined that MnBi could …

Enhancing Chest Pain And Oxygen Supplementation Protocol Adherence Through Nurse Education In The Emergency Department For Patients With Acute Coronary Syndrome And Unspecified Chest Pain: A Quality Improvement Project, Leah Gamble

Master's Theses and Capstones

Abstract Background: Acute Coronary Syndrome (ACS) and unspecified chest pain are common presentations in the Emergency Department (ED). Proper management, including appropriate oxygen supplementation, is crucial for optimal patient outcomes. However, discrepancies between current practice and evidence-based guidelines have been identified, highlighting a need for targeted educational interventions.

Local Problem: In the ED, knowledge gaps among nurses regarding the correct administration of supplemental oxygen for patients with ACS and unspecified chest pain have been observed. This inconsistency with the American Heart Association (AHA) and American College of Cardiology (ACC) guidelines may lead to poor patient outcomes.

Methods: The Plan-Do-Study-Act (PDSA) …

Using The Stop5 Debriefing Model To Increase Utilization Of Debriefing Practice In The Emergency Department: A Quality Improvement Project, Hallie Chancey

Master's Theses and Capstones

Abstract Background: The practice of debriefing has been an important process in critical care settings to promote team unity as well as best care practices. Literature has shown that debriefing can not only influence quality care and improved operations, but the process can also influence the emotional support staff receive. These implications are particularly important for nurses that work in critical care settings as the job can often be stressful and lead to moral distress as well as the need for evidence-based care practices is crucial when a patient’s life is on the line. Literature supports that any form of …

Acuity-Based Models Of Care: Improving Wait Times And Efficiency In An Outpatient Infusion Center, Jordan Lavallee

Master's Theses and Capstones

Background: Timeliness is a crucial aspect of high-quality care, yet remains a common issue faced by many outpatient infusion settings leading to patient dissatisfaction and potential negative outcomes.

Local Problem: At a 28-chair community infusion center, results from patient satisfaction surveys as well as chart audits highlighted suboptimal wait times and efficiency. 32% of patients were dissatisfied with wait times ranging from 23 to 40 minutes based on the therapy received.

Methods: A quality improvement project was conducted aiming to decrease the average wait time of patients receiving short therapies while increasing patient satisfaction. After a thorough review of the …

Re-Educating Proper Blood Culture Collection With Emphasis On Initial Blood Waste To Decrease Contamination Rates: A Quality Improvement Project, Samantha A. Dickinson

Master's Theses and Capstones

Background: A critical access hospital in New England experienced an increase in blood culture contamination rates within the Emergency Department (ED). There was a disconnect between the current standardized collection protocol within the ED and the action of staff collecting which has led to an increase of blood contamination (BCC) rates.

Local Problem: The disconnect between the current collection standard and staff collecting caused the Emergency Department to rise above 3.0% in blood cultures contaminations. This rise in contamination rates contributes to longer patients stays and unnecessary treatments.

Methods: Using the Plan-Do-Study-Act model, an educational flyer was implemented to remind …

Enhancing Communication Efficiency In An Emergency Department By Employing A Visual Communication System For Lab Results Tracking: A Quality Improvement Project, Julie Burr

Master's Theses and Capstones

Abstract

Background: A Critical Access Hospital in New England faces communication challenges in its Emergency Department, impacting patient flow and safety. The current paper charting system leads to delays and inefficiencies.

Local Problem: The communication gap between ordering laboratory tests and providers reviewing results at the patient’s bedside averages 130 minutes, contributing to delays and potential patient safety issues.

Methods: Using the Plan-Do-Study-Act model, a visual communication system was implemented. Laminated labels indicating pending lab, CT, and radiology reports were affixed to patient folders. Data was collected pre- and post-intervention to measure time from lab order to provider review.

Interventions: …

Improving Patient Safety And Continuity Of Care By Educating Nurses About Standardized Handoffs In The Post-Anesthesia Care Unit: A Quality Improvement Project, Remi Dos Santos

Master's Theses and Capstones

Background: Effective communication during patient handoffs is crucial for ensuring patient safety and continuity of care. The I-PASS handoff tool has been identified as an effective method to standardize communication and reduce errors during these critical transitions.

Local Problem: In the Post-Anesthesia Care Unit (PACU) of a hospital in New England, the lack of standardized procedures for nurse handoffs posed a risk to patient safety and care quality.

Methods: A quality improvement project was conducted using the Plan-Do-Study-Act (PDSA) cycle to implement and evaluate an educational intervention aimed at improving PACU nurses' proficiency with the I-PASS handoff tool. Pre- and …

Incorporating Educational Interventions To Improve Nursing Adoption Of Electronic Medical Record Technology: A Quality Improvement Project, Andrew Oratovsky

Master's Theses and Capstones

Background: Use of Electronic Medical Records (EMRs) has become the standard for medical information management and exchange amongst acute care hospitals in the United States. The Epic® electronic medical record has been identified as a popular EMR software for adoption by many healthcare organizations. Associated with the adoption of this technology is a large investment in training medical professionals on its specific processes.

Local Problem: In the outpatient, primary care setting of a hospital in New England, the adoption of Epic® has come with much fear and resistance regarding the ability of nursing staff to efficiently learn and …

Implementing Change: Training For Adult Emergency Assessment, Recognition, And Stabilization For Novice And Non-Critical Care Nurses, Shannon C. Clancy-Burgess

Master's Theses and Capstones

Abstract

Background At a macrosystem in New England hospital nurses are requesting more training for better preparedness in situations of clinical deterioration in the patient. Current education offerings were focused on cardiac and respiratory arrest situations. Review of the literature reveals the need for training in recognition and response to clinical deterioration. Simulation training can be a useful training tool.

Methods Several assessments were conducted to determine the need for a new course that focuses on recognition and response for stabilization. These assessments included an AHRQ Gap Analysis, a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis, Stakeholder feedback using Qualtricsä, …

Increasing Pediatric Vaccination Rates Through Parental Education At A Federally Qualified Community Health Center: An Evidence-Based Quality Improvement Project, Dayna Dicola

Master's Theses and Capstones

Background: Childhood immunization rates for children aged 2 years and under at a community health center were assessed and determined to be below optimal levels. Immunizations protect against preventable diseases (Hill, 2023). The project assessed the microsystem to understand low immunization rates and to guide strategies for improvement.

Methods: The Plan-Do-Study-Act (PDSA) model was used. In the planning phase, key stakeholders were consulted to assess current rates and barriers contributing to immunization rates. The chosen intervention was placed simplified immunization schedules in pediatric exam rooms to educate parents and promote adherence.

Intervention: A visual guide detailing the recommended vaccination schedule …

A Quality Improvement Initiative To Redefine The Process Of Instrument Decontamination From The Surgical Field In The Operating Room To The Sterile Processing Department., Nicole Dannett Denton

Master's Theses and Capstones

Background: The Operating Room (OR) faces a significant challenge with the increasing presence of bioburdens on instruments. Research-based on evidence has demonstrated the critical role of precleaning at the point of care with sterile water in reducing bioburden incidence. While current practices recommend the use of an enzymatic solution post-procedure to spray instruments, it is clear that a more comprehensive approach is needed to effectively manage bioburdens and reduce the risk of Surgical Site Infections (SSI).

Methods: Utilizing the Plan-Do-Study-Act (PDSA) model to create a Quality Improvement (QI) solution, the project leader recommended using sterile water at the point of …

Sensory Modulation Training To Reduce Restrictive Interventions On An Acute Inpatient Psychiatric Unit At A Secure Psychiatric State Hospital: A Clinical Nurse Leader Quality Improvement Project, Fionna Norman

Master's Theses and Capstones

Abstract

Background: Symptoms of severe mental illnesses can result in Personal Safety Emergencies (PSE’s) in the acute in-patient psychiatric setting. As part of treatment of PSE’s, restrictive interventions such as seclusion are utilized in current practice to maintain the safety of the patient, peers, staff, and the environment. Evidence-based research has shown restrictive interventions can cause physical and psychological harm to both patients and staff. Reducing restrictive interventions continues to be a priority to create the most therapeutic environment possible. Evidence-based research has shown that sensory modulation is a non-restrictive intervention that can reduce the use of restrictive interventions, decrease …

Increasing Patient Awareness About Fall Risk Through Patient Education Pamphlets On A Medical-Surgical Floor: A Quality Improvement Project, Nicole Madden

Master's Theses and Capstones

Introduction At a nonprofit hospital located in New Hampshire, a thorough 5P Assessment was executed to identify the root cause behind an increase in falls occurring on a medical-surgical floor. Subsequently, a comprehensive quality improvement initiative was launched with the dual goals of minimizing falls and enhancing patients' awareness regarding their susceptibility to experiencing a fall during their length of stay. Patient falls are the most common adverse events reported in hospitals and are considered a sentinel event (LeLaurin & Shorr, 2019). Hospitals need to adopt a multifaceted approach to minimize the risk of patients experiencing falls during their inpatient …

Implementing Of An Informative Poster To Improve Nurse Job Satisfaction In A Medical Surgical Microsystem: A Quality Improvement Project, Stephanie E. Mahoney

Master's Theses and Capstones

Abstract

Background: Nurse job satisfaction is important since the quality of patient care directly depends on the staff and their willingness to continue working. Traditional approaches used in yearly surveys may cover only some aspects that upset nurses, such as workload and training. This project was designed to overcome these limitations by presenting a more extensive and often-used procedure to assess and solve issues regarding the satisfaction level of registered nurses.

Method: In the quality improvement project, data on job satisfaction using the Acute Care Nurses Job Satisfaction Scale (ACNJSS) was collected on job interest, colleague support, recognition, …

Improving Quality Of Documentation In Perianesthesia Care Units To Increase Nurse Satisfaction And Patient Safety: A Quality Improvement Project, Anja Novcic

Master's Theses and Capstones

Abstract

Background: Quality documentation in healthcare settings is essential to ensure nurse satisfaction and patient safety. Documentation templates for patient charting should be in a format that follows best practice nursing care and captures all necessary assessments and interventions ordered by providers for patient care. A quality improvement was conducted in a PACU to evaluate the nurse satisfaction with the use of a new and revised documentation template for pain block procedures.

Local Problem: Within the perianesthesia care unit (PACU) of a Same Day Surgery center, a problem was identified regarding the nurse dissatisfaction with the template in place for …

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 …

Enhancing Inpatient Sleep Quality In Patients On An Intermediate Care Unit Through Healthcare Staff Education: A Quality Improvement Project, Avery B. Drouin

Master's Theses and Capstones

Background

In the Intermediate Care Unit (IMCU), patients often suffer from poor sleep quality due to continuous overnight care and inherent hospital environment noise. Poor sleep can adversely affect recovery, especially for cardiac patients, who constitute a significant portion of the IMCU population. Improving sleep quality in these patients is essential for their recovery and overall well-being.

Local Problem

Despite the importance of adequate sleep, only 47% of patients in the hospital that houses the microsystem reported a quiet environment at night using the Hospital Compare online survey platform. Disruptions from alarms, phones, and care activities significantly impact sleep quality, …

Using Education To Confidently Identify And Report Concerns Of Child Abuse And Neglect: A Qualitative Improvement Initiative Through Staff Development, Sarah E. Neilson

Master's Theses and Capstones

BACKGROUND: Pre-licensure education on child abuse and neglect is crucial for nurses in the healthcare field. It helps to equip them with the knowledge and skills necessary to effectively identify, report, and intervene in cases of child abuse and neglect. Having this education available and understanding the signs and effects of child abuse and neglect, empowers nurses to take quick and decisive action in early intervention and prevention. Within the microsystem of a local Operating Room (OR), this quality improvement (QI) project will determine the muchneeded addition to the healthcare curriculum.

METHODS: The Plan, Do, Study, Act (PDSA) framework was …

Enhancing Postpartum Depression Screening Tools To Improve Maternal Mental Health Outcomes: A Quality Improvement Initiative, Jillian Squires

Master's Theses and Capstones

Abstract

BACKGROUND:

Postpartum depression (PPD) is a prevalent and serious condition affecting new mothers, often underdiagnosed due to challenges in traditional screening methods. Early detection and intervention are crucial for improving maternal and infant health outcomes.

LOCAL PROBLEM:

On the maternity unit, existing PPD screening processes were insufficient, with significant barriers including patient reluctance to disclose mental health concerns, leading to missed or inadequately addressed PPD cases.

METHODS:

This quality improvement (QI) project utilized the Plan-Do-Study-Act (PDSA) framework. Pre-intervention surveys were conducted to identify current challenges and perceptions. An at-home PPD screening tool using the Edinburgh Postnatal Depression Scale (EPDS) …

Improving Discharge Education Quality In Urgent Care Settings: A Quality Improvement Project, Brielle N. Patscheider

Master's Theses and Capstones

BACKGROUND:

Effective discharge education is vital for improving patient care by enhancing health outcomes and reducing hospital readmission. When patients receive thorough and personalized discharge instructions, they are better able to manage their health, follow treatment plans, and identify symptoms needing further attention. This not only boosts patient satisfaction and safety but also reduces the strain on healthcare systems by decreasing preventable readmissions.

LOCAL PROBLEM:

Urgent care facilities serve diverse populations with a range of common, non-emergency ailments. The rapid service and walk-in availability often lead to a high volume of patients with diverse and complex medical needs. To eliminate …

Improving Postpartum Depression Education Within The Microsystem, Mackenzie A. Sturdevant

Master's Theses and Capstones

BACKGROUND: Postpartum depression (PPD) is a significant mental health issue affecting a substantial percentage of new mothers, ranging from "baby blues" to severe forms like postpartum psychosis. Maternity nurses play a crucial role in early detection and education due to the gap in postpartum care follow-up appointments, which can delay necessary interventions.

LOCAL PROBLEM: Despite the critical role of maternity nurses, there is variability in their preparedness to educate and support patients regarding PPD during the immediate postpartum period. This study aims to enhance maternity nurses' knowledge and confidence in providing PPD education through a quality improvement (QI) project within …

Improving Patient Handoff In The Emergency Department Microsystem, Alahna V. Kinney-Sandefur

Master's Theses and Capstones

Abstract

Background: Gaps in communication in the patient handoff process have been directly linked to patient safety errors and unwanted patient outcomes. The reviewed literature highlights multiple factors impacting the handoff process and unanimously conclude that a standardized handoff process is necessary in maintaining a high standard of patient safety and a minimization of safety errors.

Methods: This intervention took place in an 86-bed, acute care facility, a level III trauma center macrosystem with implementation of this project taking place in the emergency department and medical/surgical microsystems. Utilizing the Plan, Do, Study, Act framework over a total of eight weeks, …

Improving The Postpartum Depression Discharge Education To Increase Quality And Safety Of Care: A Quality Improvement Initiative, Amanda Lucia

Master's Theses and Capstones

Background: Postpartum depression (PPD) is the most prevalent psychological condition to affect mothers following childbirth which can have detrimental consequences on the physical and mental health of the mother, child, and spouse (Wang et al., 2021). Globally, postpartum depression affects 17.2% of the world population, and in the United States 1 in 8 women who recently gave birth reported symptoms of PPD, and 1 in 10 women reported experiencing a major depressive episode within a year following delivery (CDC, 2023). Patients’ spouses and family members are in a unique position to identify early manifestations of PPD which can lead to …

Sepsis Screening And Bundle Adherence: Staff Education As An Intervention To Increase Knowledge In A Medical Surgical Clinical Microsystem, Nicole Elise Maheu

Master's Theses and Capstones

Background: Sepsis-related deaths outnumber those caused by opioids, breast cancer, and prostate cancer combined (Nguyen, 2020). Sepsis places a significant health burden and cost burden on both an individual and a systemic level, emphasizing the need for proper care of the sepsis patient in all inpatient settings.

Local Problem: Within a medical-surgical microsystem, it was found that care of the sepsis patient was inadequate. A pre-intervention survey was conducted which demonstrated a lack in knowledge of the inpatient sepsis workflow, including use of the sepsis best practice advisory (BPA) within EPIC® and the sepsis bundle of care. Additionally, according to …

Improve Dysphagia Screening In Patients With Neurological Conditions Through Education: A Quality Improvement Project, Kendra Mcintosh

Master's Theses and Capstones

Background: A macrosystem in Southern Massachusetts faces challenges in patients with neurological conditions recieveing a dysphagia screening prior to anything enter the patients mouth in the Emergency Room.

Local Problem: The educational gap identified in Registered Nurses regarding the frequency of screening being completed and the knowledge of the indications for a dysphagia screening.

Methods: Using the Plan-Do-Study-Act model, an educational intervention was implemented. An educational poster was displayed in the microsystem. Data was collected pre-and post-intervention through a survey to measure change.

Interventions: The educational poster was displayed in high-traffic areas of the microsystem. This educational poster included …

Using Education To Improve Glycemic Management Within An Emergency Department, Rebecca Olson

Master's Theses and Capstones

Background: Patients with diabetes mellitus (DM) frequently visit acute care facilities for a variety of reasons. Proper management of this comorbidity increases patient safety, satisfaction, and quality care. Patients with persistent dysglycemic events in acute care facilities have an increased risk of complications and death during their stay. Lack of education can contribute to gaps in proper management within this population and therefore must be improved for better patient outcomes.

Methods: The Plan-Do-Check-Act design from the A3 Problem Solving model was used to guide a quality improvement project which focused on improving staff education and confidence surrounding glycemic management. The …