Medicine and Health Sciences Commons^™

Optimizing A Clostridium Difficile Screen For Intensive Care Unit Admissions, Mary Katherine V. Natour, Jennifer Smith

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Clostridium difficile infection is one of the most common healthcare-associated infections. Careful screening upon hospital admission enables clinicians to mitigate the spread and sequelae of this illness through early intervention and isolation but this screening must be accurate and highly sensitive to maximize benefit.

Local problem: The site for this project, an ICU in Tennessee, currently employs a highly sensitive but nonspecific tool to detect CDI. This has resulted in low accuracy, low staff compliance, low patient morale, and unnecessarily high personal protective equipment (PPE) costs.

Methods: Levin’s evidence-based practice improvement model was chosen to guide this project from …

Acute Stress Disorder And Post-Traumatic Stress Disorder Screening In Pediatric Trauma Patients, Samantha Irizarry, Marian Malone, Megan Waddell

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Two-thirds of U.S. children and adolescents report experiencing one or more potentially traumatic events by age seventeen. 13.4% of the North Carolina pediatric population ages 0-17 have undergone two or more traumatic adverse childhood experiences, compared to 14% of the U.S. population. Early identification reduces the by-products of underdiagnosis of ASD and PTSD, such as mental illness, developmental delays, poor academic performance, and challenges with social interactions.

LOCAL PROBLEM: The project site is a level-one pediatric trauma hospital in Charlotte, North Carolina, seeing more than 130,000 patients annually. Before project implementation, there was an absence of ASD …

Reducing Iatrogenic Opiate Withdrawal In The Picu: An Evidence-Based Practice Improvement Project, Kaitlin Kirk Ogle, Marian Malone, Will Guider

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Current recommendations to reduce pain associated with mechanical ventilation is the administration of opiate and benzodiazepine infusions for Pediatric Intensive Care Unit (PICU) patients. If these infusions are weaned too quickly, iatrogenic withdrawal syndrome (IWS) often occurs. IWS symptoms include tachycardia, hypertension, diaphoresis, fever, irritability, tremors, clonus, hyperactive reflexes, vomiting, and diarrhea. Untreated IWS can lead to life-threatening complications.
LOCAL PROBLEM: The PICU at the project site contains fourteen beds and treats critically-ill pediatric patients. There was no standardized withdrawal assessment tool in practice. The purpose of this project was to implement the Withdrawal Assessment Tool-Version 1 …

Ultrasound-Guided Intravenous Access As A First-Line Approach By Nurses: A Quality Improvement Project, James Austin Burkhart, Pamela Hardesty, Melissa Mcdonald

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Up to 9% of patients admitted to EDs (Emergency Departments) have difficult intravenous insertion access issues (DIVA). This creates delays in patient care that includes interruptions for physicians providing medical emergency care. Often the utilization of RNs to perform US (ultrasound) IV insertions is limited related to lack of training and supportive policies.

Local Problem: The site for this project was an ED Level 1 Trauma Center associated with a large teaching hospital located in the southeastern U.S. Prior to the implementation of the process improvement project, there was no formal education of RNs in the use of US …

Implementing A Pressure Ulcer Bundle, Amy D. Johnson, Pamela Hardesty, Janice Zimmer, Patricia Moore

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: A quality improvement DNP project in a rural southern hospital was implemented to improve hospital-acquired pressure ulcers by implementing an evidence-based pressure ulcer prevention policy and education. Framework: The Evidence-Based Practice framework utilized in the project's development, implementation, and evaluation was the John Hopkins Evidence-based Practice Model. Local Problem: The hospital had no pressure ulcer bundle in place. Design: Quality improvement project utilizing the plan-do-study-act cycle. Methods: An educational presentation on pressure ulcers and the steps to implement a bundle. A pre-and post-test using Pieper's Pressure Ulcer Knowledge Test, modified from Agency for Healthcare Research and Quality (AHRQ) website. …

The Effects Of Bundle Adherence On Ventilator-Associated Pneumonia: A Quality Improvement Project, Sara Borges, Tracy L. Brewer, Donita Beard

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Ventilator-associated pneumonia (VAP) is a hospital-acquired infection that affects intubated patients on a ventilator. The risk of acquiring the infection increases the longer a patient stays on the ventilator. Complications from ventilator-associated pneumonia can impact the patient physically, financially, or emotionally. Evidence-based recommendations collectively implemented to prevent VAP are referred to as a care bundle. Despite rising VAP cases in a local hospital, adherence to all elements of the VAP prevention bundle remained low. Our quality improvement project aimed to provide training to staff to increase awareness and adherence to the VAP bundle and decrease the number of VAP …

Implementation Of An Educational Guide To Improve Icu Delirium Awareness And Detection, Samantha Payne, Samereh Abdoli

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Intensive care unit (ICU) delirium is a prevalent condition that can occur in up to 80% of critical care patients. It can increase hospital length of stay, morbidity rates, and recovery time. It can also demand higher costs for care and long-term effects on the patient. A good practice statement, issued by the Society of Critical Care Medicine, acknowledges the importance of delirium awareness (Devlin, 2018). For ICU nurses, educational approaches of ICU delirium have shown significant increases in delirium awareness and detection. The purpose of this project was to determine if an evidenced-based education program on delirium would improve …

The Need For A Sepsis Screening Tool In An Outpatient Facility, Michael C. Ciccarone, Terrica Durbin

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Sepsis is an exaggerated inflammatory response generated by the immune system secondary to the presence of septicemia, or pathogens within the bloodstream. An average of 270,000 individuals die from sepsis each year, while a total of 1.7 million cases occur annually. Research has shown that the early identification of sepsis prior to hospital admission is associated with decreased lengths of stay, hospital-associated costs, and overall mortality. To demonstrate this research, 26 healthcare staff members in an outpatient clinic were provided with a pre-survey, qSOFA sepsis screening tool, and a post survey to determine if these materials
increased participant confidence when …

Embodied Work: Insider Perspectives On The Work Of Hiv/Aids Peer Counselors, D.K. Messias, L Moneyham, M. Vyavaharkar, C. Murdaugh, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

Our aim in this study was to explore HIV/AIDS peer counseling from the perspective of women actively engaged in this work within the context of a community-based program in rural areas of the southeastern United States. Based on this research we suggest that the embodied work of HIV/AIDS peer counselors is constructed around their personal identities and experiences. This work involves gaining entry to other HIV-positive women’s lives, building relationships, drawing on personal experiences, facing issues of fear and stigma, tailoring peer counseling for diversity, balancing risks and benefits, and terminating relationships. Peer counselors recognize the personal and collective value …

Moderate Intensity Exercise Training Reverses Functional Aerobic Impairment In Hiv-Infected Individuals, Kenneth D. Phillips`

Faculty Publications and Other Works -- Nursing

No abstract provided.

A Look At Tuberculosis And Its Relationship To Hiv/Aids, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

No abstract provided.

Creativity In Older Adults: A Plethora Of Possibilities, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

No abstract provided.

Social Support, Coping, And Medication Adherence Among Hiv-Positive Women With Depression Living In Rural Areas Of The Southeastern United States, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

No abstract provided.

Counteracting Muscle Wasting In Hiv-Infected Individuals, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

No abstract provided.

Spiritual Well-Being, Sleep Disturbance And Mental And Physical Health Status In Hiv-Infected Individuals, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

No abstract provided.

Alcohol And Other Drug Disorders, Comorbidity And Violence In Rural African American Women, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

No abstract provided.

Predictors Of Quality Of Life In Hiv-Infected Rural Women: Psychometric Test Of The Chronic Illness Quality Of Life Ladder, C. Murdaugh, L. Moneyham, K. Jackson, Kenneth D. Phillips, A. Tavakoli

Faculty Publications and Other Works -- Nursing

The Chronic Illness Quality of Life Ladder (CIQOLL) underwent psychometric testing in a sample of 278 women with HIV disease. The CIQOLL, a self-anchoring striving scale based on Cantril’s Ladder, measures seven domains (physical , emotional, financial, family and friends, spiritual well-being, peace of mind, and overall life satisfaction) across four time periods (present, past, future, life without a diagnosis of HIV). The domains were derived from focus groups with persons with HIV disease. Women with a diagnosis of HIV Infection, age 18 or older, residing in rural areas in the southeastern United States, completed questionnaires that measured physical functioning, …

Patterns Of Risk Of Depressive Symptoms Among Hiv-Positive Women In The Southeastern United States, Linda Moneyham, Carolyn Murdaugh, Kenneth D. Phillips, Kirby Jackson, Abbas Tavakoli, Mary Boyd, Medha Vyavaharkar

Faculty Publications and Other Works -- Nursing

Depressive symptoms are a common response to HIV disease, and women appear to be at particularly high risk. The authors report results from a crosssectional analysis of data collected from 280 rural women with HIV/AIDS in the Southeastern United States aimed at identifying risk factors of depressive symptoms. Stress theory provided a framework for identification of potential risk factors. Descriptive statistics, measures of association, and regression analyses were used to systematically identify patterns of risk. The final regression model included 22 factors that accounted for 69% of the variance in depressive symptoms. The majority of variance in depressive symptoms was …

Stress Reduction As A Means To Enhance Oral Immunity In Hiv-Infected Individuals, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

No abstract provided.

Physical Activity And Immunity In Hiv-Infected Individuals, C.M. Bopp, Kenneth D. Phillips, L.J. Fulk, W.D. Dudgeon, R.L. Sowell

Faculty Publications and Other Works -- Nursing

The purpose of this study was to determine what relationship exists among physical activity levels and viral load and CD4+ cell count in HIV-infected individuals. Increased viral load is associated with disease progression and symptom severity. A convenience sample of 66 male and female subjects between the ages of 18 and 64 years of age (mean 399/8) was recruited from a hospital-based HIV/AIDS clinic. Components of PA were assessed for three continuous days using a mini-motion logger wrist actigraph. These components included mean PA level, and PA index and acceleration index. Pearson’s correlational analysis was used to test the strength …

Psychological And Physiological Correlates Of Sleep In Hiv Infection, Jennifer L. Robbins, Kenneth D. Phillips, Wesley D. Dudgeon, Gregory A. Hand

Faculty Publications and Other Works -- Nursing

Insomnia, a common problem associated with HIV disease, is most likely caused by a multitude of factors. This study investigated the correlations between a selected group of physiological and psychological factors and sleep quality in an HIV-infected population. A convenience sample of 79 ethnically diverse HIVpositive adults, ages 24 to 63, completed a number of questionnaires and released their laboratory records for CD4+ cell count and viral load information. Variables significantly related to sleep quality were HIV-related symptoms, total pain, fatigue, depression, state anxiety, and the number of adults in the household. Findings support the need for health care providers …

Physiological And Psychological Correlates Of Fatigue In Hiv/Aids, Kenneth D. Phillips, R.L. Sowell, M. Rojas, A. Tavakoli

Faculty Publications and Other Works -- Nursing

Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper’s integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. …

Physiological And Psychological Effects Of Exercise Interventions In Hiv Disease, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

No abstract provided.

Clinical Implications Of Therapeutic Exercise In Hiv/Aids, C. Bopp, Kenneth D. Phillips, L.J. Fulk, G.A. Hand

Faculty Publications and Other Works -- Nursing

No abstract provided.

Disclosure Of Hiv Infection: How Do Women Decide To Tell?, R.L. Sowell, B.F. Seals, Kenneth D. Phillips, C.H. Julious

Faculty Publications and Other Works -- Nursing

This descriptive study explores the phenomenon of disclosure of HIV infection by women. Specifically, we examined women’s level of disclosure to various groups and how these disclosure decisions are made. The sample consisted of 322 HIV-infected women residing in the southern US. Participants were predominantly African-American, single women of reproductive age with yearly incomes less than $10 000. Data were collected at the first interview of a longitudinal study of reproductive decision making. Findings showed that the majority of the women had disclosed to some sex partners, close family and friends, and health care professionals. However, for a group of …

Differentiation And Treatment Of Anemia In Hiv Disease, Kenneth D. Phillips, M Groer

Faculty Publications and Other Works -- Nursing

Anemia is a frequent complication of HIV disease that contributes to decreased quality of life and increased morbidity and mortality. The three major categories of anemia in HIV disease are anemia due to impaired red blood cell production, anemia due to increased red blood cell destruction, and anemia due to increased red blood cell loss. Although anemia of chronic illness is the most common type of anemia in HIV disease, other classifications of anemia may be encountered. Understanding the pathophysiology of anemia and laboratory tests that are frequently used to establish the differential diagnosis of anemia helps to ensure that …

Incidence And Correlates Of Violence Among Hiv-Infected Women At Risk For Pregnancy In The Southeastern United States, R.L. Sowell, Kenneth D. Phillips, B. Seals, C. Murdaugh, C. Rush

Faculty Publications and Other Works -- Nursing

To identify the incidence and correlates of physical and sexual violence among HIV-infected women at risk for pregnancy, a cross-sectional examination was conducted within a longitudinal study of reproductive decision making. Participants consisted of 275 HIVinfected women 17 to 49 years of age (mean = 30.1 years).Women were predominantly African American (87%) and single (82%), with annual incomes of $10,000 or less (66%). Overall, 68% of the women reported experiencing lifetime physical and/or sexual violence. Before becoming HIV infected, 65% of the women reported having been physically or sexually abused. After HIV diagnosis, 33% of the women reported experiencing physical …

Family Functioning And Motivation For Childbearing Among Hiv-Infected Women At Increased Risk For Pregnancy, B.C. Latham, R.L. Sowell, Kenneth D. Phillips

Faculty Publications and Other Works -- Nursing

This study examined family composition and functioning in a cohort of HIVinfected women of reproductive age living in the southern United States. Participants were predominantly single (82.2%), African American women (86.7%) with annual incomes of less than $10,000 (65.5%), with a mean age of 31.2 years. Using the Family Apgar Scale as a measure of perceived family functioning, women reported that their families functioned moderately well. Multiple regression analysis showed that level of education, life satisfaction, and coping through avoidance and coping by seeking social support were positively associated with family functioning. In contrast, a history of interpersonal verbal violence …

Psychosocial And Physiologic Correlates Of Perceived Health Among Hiv-Infected Women, Kenneth D. Phillips, R.L. Sowell, C.J. Rush, C.L. Murdaugh

Faculty Publications and Other Works -- Nursing

The purpose of this study was to identify factors related to perception of physical health in a cohort of HIV-infected women. A descriptive correlational design was used to identify factors influencing perceived physical health in a sample of 275 HIV-infected women in Georgia, South Carolina, and North Carolina. Participants were predominantly single African-American women with household incomes of less than $10,000 per year.

Using Spearman’s rho, statistically significant positive correlations (p < .05) were found between perceived physical health and T helper cell count, hope, present life satisfaction, education, and income. Statistically significant positive correlations (p <.05) were observed between perceived physical health and three HIV-specific active coping styles (managing the illness, focusing on others, and positive thinking). Inverse relationships were observed between perceived physical health and HIVrelated symptoms, stage of illness, depression, physical and sexual violence experienced since becoming HIV-infected, history of drug use since becoming HIV-infected, and age. Using backward stepwise selection, 9 of 14 variables were retained in the final model that explained 60% of the variance in physical health at the p < .10 level of significance (R2 = .60). Variables that demonstrated a significant relationship with perceived physical health were HIV-related symptoms, depression, present life satisfaction, age, education, coping by managing the illness, coping through positive thinking, and coping by focusing on the present. These findings support the need to address the psychosocial as well as the physiologic factors associated with HIV/AIDS in developing comprehensive plans of nursing care.

Effects Of Individualized Acupuncture On Sleep Quality In Hiv Disease, Kenneth D. Phillips, W.D. Skelton

Faculty Publications and Other Works -- Nursing

Although it may begin at any point, sleep disturbance often appears early in HIV disease and contributes to decreased quality of life during the course of the illness. Relatively few studies have explored the complex nature of poor sleep quality in HIV disease or tested interventions to improve sleep quality. The purpose of this study was threefold: explore the nature of sleep quality in HIV disease, test the relationship between pain and sleep quality, and test the effectiveness of acupuncture delivered in a group setting for improving sleep quality in those who are HIV infected. A pretest, post-test, pre-experimental design …