Medicine and Health Sciences Commons^™

Organizational Strategies To Promote Nurse Resilience In The Acute Care Hospital Inpatient Setting: An Integrative Review, Marcia A. Depolo

Doctoral Dissertations and Projects

Nurses practicing in acute care hospital environments are exposed to constant stressors from a variety of sources. Workplace stress can lead to unhealthy coping behaviors, illness, and burnout, with intent to leave the organization or the nursing profession altogether. Resilience-building strategies can be employed to foster coping, improve nurse wellbeing, increase job satisfaction, promote retention, and enhance quality patient outcomes. This integrative review provides a synthesis of scholarly publications on nursing resilience from January 2014 through October 2020. Themes to promote nursing resilience occurred at three levels: personal or individual, unit or group, and organizational. This paper will provide a …

Implementation Of A Fall Risk Assessment Tool In Primary Practice May Decrease Fall Frequency In The Aging Population, Regina M. White

Doctoral Dissertations and Projects

The purpose of this evidence-based project was to illustrate the benefits of utilizing a fall risk assessment tool during office visits for the aging population of a Midwestern U.S. primary care practice. Utilization of this tool helped minimize fall frequency, thus improved quality of health. The reduction in falls helped minimize unnecessary healthcare expenses. This manuscript identified a rationale for the project, specific tool utilization, outcome measures before and after implementation, limitations, and future application for practice. Provider compliance with tool utilization and frequency were measured. Multiple potential causes of falls and recommendations to minimize falls were identified with the …

Parenting A Child With Autism Spectrum Disorder: Perspective Of Jordanian Mothers, Khulood Kayed Shattnawi, Wafa'a M. Bani, Saeed, Ahlam Al-Natour, Mohammed M. Al-Hammouri, Manar Al-Azzam, Rachel Joseph

Faculty Publications and Presentations

Introduction: Parenting a child diagnosed with autism spectrum disorder (ASD) is challenging for mothers because of concerns related to behavior, difficulties in accessing specialized care, and lack of community acceptance, yet their stories in Jordanian context are still unknown. Common challenges in Jordan include financial burdens, lack of public awareness, and lack of specialized knowledge even among health care providers, which may lead to delays in obtaining the diagnosis and interventions for ASD.

Method: A phenomenological descriptive approach was used to explore and understand the mothers’ everyday lived experiences of raising a child with ASD. Semistructured interviews were conducted with …

A New Era: Utilizing Technology Tools To Enhance Elder Independence, April Lisa Phelps

Doctoral Dissertations and Projects

The goal of this integrative review was to examine the multitude of technology tools and the evidence which supports their use to enhance elders’ independence when residing at home. Multiple journal articles and books published between July 2015 and July 2020 were examined using the PRISMA model for evidence to support or oppose the use of technology to enhance the elders’s independence. A total of 27 articles were included in the final review. An exploration of gaps in knowledge related to the issue of elders using technology tools such as wearable sensors, artificial intelligence, home monitoring, robots, mHealth, Internet of …

Contraceptive Methods In The United States: The Question Of Abortive Mechanisms, Tara Ferenczy

Senior Honors Theses

This thesis reviews the many methods of contraception available in the United States. Although society’s understanding of women’s health has become a major topic, there is still a significant deficit of information regarding how the accessible methods affect women’s bodies, specifically reproductive tissue. The thesis analyzes numerous contraceptive options focusing specifically on the mechanisms of action to determine whether options have abortifacient properties so that readers may develop educated opinions regarding medical and ethical uses. Information involving strengths and limitations of each technique and the effects on both the female body and the reproductive material assist in understanding the process …

Determining The Effectiveness Of System-Based Solutions To Improve Fragmented Care For Oncology Patients Living In Rural And Remote Regions: An Integrative Review, Andrea Nicole Fulmer

Doctoral Dissertations and Projects

The purpose of this integrative review is to review, critique, and synthesize the current literature to determine the state of the science related to the established systems approach for improving healthcare management and care coordination of the oncology patient population in rural and remote regions. The oncology patient population with co-existing chronic disease living in rural and remote regions experience fragmented health care. New cancer diagnoses take precedence over other existing comorbidities and require focused and specialized care for lengthy periods of time. Research is significantly limited for the current state of science for the identified patient population living in …

Nurses' Knowledge And Practices Of Physical Restraints In Intensive Care Units: An Observational Study, Maysa H. Almomani, Wejdan A. Khater, Baha'a Aldin Abdel-Latif Qasem, Rachel Joseph

Faculty Publications and Presentations

Aim

To investigate the knowledge and practice of physical restraints (PR) among Jordanian intensive care unit (ICU) nurses.

Design

A descriptive, observational design was used.

Methods

A convenience sampling was used to recruit participants. We examined the knowledge of PR in 301 nurses (knowledge check) and the real‐time practice of PR in 81 nurses (direct observation) in ICU. A knowledge questionnaire was used to collect data on knowledge about PR use, and data on their practice of PR were observed and documented using an observation checklist.

Results

The mean scores of nurses' knowledge and practices were 61.5 (SD = …

Self-Management Education For Prevention, Early Detection, And Treatment Of Hypoglycemia: An Integrative Review, Chinedum Rosemary Ikwueme

Doctoral Dissertations and Projects

Hypoglycemia is a major complication from poor diabetic care management. Available literature indicates that it is the underlying cause of mortality in over 258,000 deaths reported in 2017. That notwithstanding, it remains a phenomenon that is given less attention than it deserves, particularly in adults with type 2 diabetes. Aside from the huge annual financial costs to the health care system (about $327 billion) in 2017, patients with hypoglycemia complications risk many cardiovascular and neurological complications, including skipped time from work in middle aged adults, dementia, falls, hospitalization and death. The purpose of this integrative review is to educate nurses …

Use Of Delirium Protocols In Decreasing Falls Among Adults In Acute Care: An Integrative Review, Shelly Steverson Thornton

Doctoral Dissertations and Projects

Delirium in elderly hospitalized adults continues to be a common and costly issue in health care today. Various delirium protocols and strategies are available to reduce negative outcomes of delirium such as falls, increased length of stay, pressure ulcers, hospital readmissions, the need for transferal to long-term care, and mortality rates. However, many hospitals have still not implemented routine delirium protocols. Because falls in older hospitalized adults are often linked to delirium, this integrative review was undertaken to examine delirium protocols and approaches that specifically decrease falls among older adults in acute care settings. Several multicomponent, multidisciplinary delirium protocols were …

Addressing Prescription Opioid Misuse Through The Increased Reporting Of Prescription Monitoring Program (Pdmp) Data: An Integrative Review, Claudia Hannah Georgestone

Doctoral Dissertations and Projects

Opioid misuse relating to prescription pain killers have claimed the lives of many Americans, posing an escalating nationwide public health crisis. Prescription opioid overdose and death can impair an individual’s functionality, destabilizes family, and impose a significant financial burden. In 2014, the U.S. had an estimated 36 million people ages 12 years and older who had used prescription opioids for non-medical reasons. In that same year, there were “28,647” (61%) of 47,055 prescription and non-prescription opioid overdose deaths, indicating an increase from previous years (Center for Disease Control (CDC, 2020). Several measures to address the opioid crisis have been implemented, …

Cdsss For Cvd Risk Management: An Integrative Review, Elisabeth Mary Campbell

Doctoral Dissertations and Projects

Cardiovascular disease (CVD) is a preventable disease affecting almost half of adults in the United States (U.S.) and can have significant negative outcomes such as stroke and myocardial infarction, which can be fatal. Utilizing clinical decision support systems (CDSSs) in the primary care and community health setting can improve primary prevention of CVD by supporting evidence-based decision making at the point of care. This integrative review synthesizes the most up-to-date literature on the use of clinical decision support (CDS) tools to support guideline-based management of CVD risk. Using Whittemore and Knafl’s framework for integrative reviews, a systematic search of CINAHL, …

Preventing Polypharmacy Amongst The Elderly In An Acute Care Setting Through The Integration Of The Deprescribing Tools Start, Stopp, And Beers Criteria, Samantha Bonita Wilkins-Copeland

Doctoral Dissertations and Projects

A significant percentage of medications prescribed in the United States are prescribed to elderly adults, which is due to the increase in chronic illness as Americans age. This increase in the use of medications amongst the elderly population has led to the issue of polypharmacy, which can lead to negative patient outcomes. An evidence-based practice pilot project was performed at a large tertiary care facility in Virginia. The aim of the scholarly project was to integrate three deprescribing tools into the everyday practice of pharmacists at the facility. Three outcomes were achieved: (1) Pharmacists understood how to accurately utilize the …

Improving Survival Rates In Patients Suffering Cardiac Arrest With Specialized Resuscitation Teams: An Integrative Review, John Campbell Holcomb

Doctoral Dissertations and Projects

Over 300,000 hospitalized patients suffer a cardiac arrest requiring a Code Blue activation each year in the United States. These patients have an extremely high mortality rate. These rates are not uniform across all hospitals and facilities that employ specialize Code Blue resuscitation teams have a higher percentage of patients that survive resuscitation events. This Integrative Review shows that these teams are essential to patient survival but are prone to barriers that must be overcome to provide effective teamwork. Quality improvement projects centered around Code Blue teams can be created at the local level and have been found to be …

Increasing New Orienting Emergency Department Nurses' Awareness Of Mass Casualty Incident Emergency Preparedness And Disaster Response Core Competencies To Improve Mass Casualty Incident Response, Christopher C. Deramo Ii

Doctoral Dissertations and Projects

Mass casualty incidents (MCI) impose a substantial threat to healthcare. Despite the increasing frequency of MCIs many healthcare organizations and nursing programs do not adequately prepare nurses to be effective responders during an MCI. This evidence-based practice pilot project was purposed to increase new orienting emergency department nurses’ confidence and ability to effectively respond to an MCI. This project involved implementing an MCI educational program consisting of a disaster nursing framework to educate new orienting emergency department nurses on emergency preparedness and disaster response core competencies. The project leader utilized a quasi-experimental design to collect data pre- and post-intervention utilizing …

Walking Through Smoke: Implementation Of The 5a'S For Smoking Cessation Counseling In Rural Virginia, Cristina Maria Minotti

Doctoral Dissertations and Projects

Tobacco use represents a significant cause of morbidity and mortality in the U.S. and is a contributing risk factor for multiple pulmonary, cardiovascular, and oncologic diseases. Despite documented evidence of these health hazards, use of tobacco products remains high, particularly in rural America. While providers may frequently question patients regarding tobacco use and inform patients of associated health hazards, a standardized, structured process for delivering smoking cessation counseling (SCC) is rarely established in practice settings. One such method for standardization of SCC is the 5A’s (Ask, Advise, Assess, Assist, Arrange) model which has a robust body of evidence to support …

Nighttime Quiet In The Intensive Care Unit: An Integrative Review, Heather Rae Smith

Doctoral Dissertations and Projects

Excessive environmental noise in the ICU often negatively impacts patient sleep. The World Health Organization (WHO) and Environmental Protection Agency (EPA) have published recommendations for hospital decibel levels, but the literature indicates that noise levels in the ICU often exceed these values. Patients experience disturbed sleep and rarely enter into N3 and REM sleep. The integrative review examined both the patients’ and healthcare workers’ perception of noise in the ICU environment to identify contributors and suggested interventions to mitigate these occurrences. In addition, this study evaluated objective measurements of patient sleep to further determine how well patients were sleeping in …

Improving Identification Of High-Risk Obstructive Sleep Apnea Patients In Primary Care: An Integrative Review, Lauren Ashley Paulson

Doctoral Dissertations and Projects

Obstructive sleep apnea continues to be an area that is underdiagnosed and therefore undertreated. Left untreated, the condition is associated with increased morbidity and mortality as it can amplify the risk of multiple health conditions. Due to the negative impact of obstructive sleep apnea it is necessary for healthcare providers to provide timely detection. Primary care providers are in a position to identify high-risk individuals and refer them for further follow up testing. High-risk identification can be accomplished by integrating validated screening tools into patient assessments. This integrative review provides an overview of current screening tools for use in the …

Ask, Advise, Assist And Follow: An Evidence Based Project To Address Unhealthy Alcohol Use In A Free Clinic Setting, Lisa K. Floyd

Doctoral Dissertations and Projects

Preventative care in free clinic settings aims to mitigate health risks for vulnerable populations. Heavy alcohol intake is a major threat to physical and mental health. Wellness care for free clinic patients must include regular screening for alcohol use in accordance with national guidelines. The purpose of this project was to implement and evaluate an evidence- based practice change to improve alcohol screening and intervention in a free clinic setting. The NIH/NIAAA screening, brief intervention, and referral for treatment (SBiRT) process was implemented. A convenience sample of de-identified patient charts was reviewed to assess alcohol screening before (n = 38 …

Identification Of Human Trafficking Victims In The Health Care Setting: An Integrative Review, Jami Leigh Castellucci

Doctoral Dissertations and Projects

Most victims who have escaped trafficking report that during their captivity they were taken to health care facilities. Though health care–based trafficking reporting has increased over the last few years, studies show that private practices and most hospitals within the country do not have a human trafficking protocol, policy, nor educational intervention for their frontline staff to be able to identify and refer victims for short- and long-term support. The United States health care system is poised to play a large role in the fight against human trafficking. This integrative review describes the current status of human trafficking victim identification …

Diabetes Health Literacy In The Rural Community: An Integrative Review, Shannon M. Elrod

Doctoral Dissertations and Projects

Health literacy is paramount for successful management of health and prevention of disease. Yet a majority of adults have low health literacy. The impact of low health literacy on chronic disease management effects health outcomes and health care costs. With six out of 10 adults in the US diagnosed with a chronic disease such as diabetes, health literacy is a serious concern. Diabetes impacts over 30.3 million Americans. Since diabetes is one of the most common chronic diseases in the country, it is imperative that health literacy be addressed as part of this population’s health management. Diabetes health literacy plays …

Low Health Literacy Impact On Heart Failure Patients' Readmissions: An Integrative Review, Melissa S. Goodwin

Doctoral Dissertations and Projects

Heart failure is a common chronic disease that affects numerous people throughout the world. Low health literacy plays a critical role in heart failure mismanagement. The purpose of this systematic review was to summarize what is known about the impact of health literacy of heart failure patients’ readmissions. MEDLINE, CINAHL, PSYCHINFO, and PUBMED databases were searched for the years 2010-2020 and for English language articles. The findings indicated that low health literacy has a significant impact on heart failure patients’ unplanned readmissions. Interventions for low health literacy also affect outcomes for heart failure patients; for example, reduce unplanned hospital readmissions. …

Evaluating The Utilization Of A Combination Therapy To Improve Self-Efficacy And Glycemic Control In Patients With Type Two Diabetes Mellitus And Low Health Literacy, Crystal Manus Masling

Doctoral Dissertations and Projects

Type 2 diabetes mellitus is a significant health issue, as it requires patients to perform daily self-management activities. One in every three Americans with Type 2 diabetes has limited or low health literacy skills. Limited or low health literacy skills can impact a patient’s overall health outcome; therefore, a critical element for disease management and patient adherence is health literacy. The purpose of this three-month scholarly project was to determine if the utilization of an educational intervention specific to one’s level of health literacy, combined with a short message service reinforcement tool, could improve glycemic control and self-efficacy in Type …

Improving Newborn Outcomes Through Implementation Of Delayed Bathing: An Integrative Review, Tennille Ideen O'Connor

Doctoral Dissertations and Projects

Evidence-based practice is foundational to ensuring patient safety and quality of care. Implementing evidence-based practice is the responsibility of all care providers. The completion of an in-depth integrative review provides a project leader the opportunity to explore the benefits of delayed bathing of the newborn and impact of the practice on newborn outcomes. The goal of this integrative review is to identify the benefits of delayed bathing and ways to implement this practice in the clinical setting. This integrative review seeks to present care providers with the most recent research and guidelines as it relates to the practice of delayed …

Wellness And Coping Of Residents In A Skilled Nursing Facility, Christine M. Larson

Doctoral Dissertations and Projects

Depression is common among older adults in long-term care (LTC) facilities. As many as 50%-80% of residents will experience depressive symptoms or have a diagnosis of depression. Depression increases the risk of poor health-related outcomes in older adults. A review of the literature suggests that early intervention using movement-based techniques decreases the risk for depression and improves depressive symptoms. This scholarly project aimed to reduce the risk of depression of residents in an LTC located in a suburban area in Midwestern United States. The LTC facility and a Doctor of Nursing Practice (DNP) student implemented the Chair One Fitness program …

Increasing Knowledge Of Abdominal Aortic Aneurysm Screening Criteria And Introduction Of A Screening Tool To Improve Aaa Screening In A Family Practice Clinic: An Evidence-Based Practice Project, Jennifer Elizabeth Rank

Doctoral Dissertations and Projects

Abdominal aortic aneurysms (AAA) are diagnosed most frequently in male patients of advanced age with a current or past smoking history. Screening for AAA by ultrasonography is effective at detecting clinically significant aneurysms and reduces AAA-associated and all-cause mortality at short-term and long-term follow-up. The criteria for screening include male gender, age 65 to 75, and a current or past smoking status. Additional criteria that may be considered include family history of AAA in a first-degree relative and/or a personal history of hypertension or atherosclerotic cardiovascular disease. Based on review of the evidence, the project leader designed an evidence-based practice …

Implementation Of An Independent, Unit Specific Lgbt Cultural Competency Training, Kristen Nicole Kaiafas

Doctoral Dissertations and Projects

This paper describes the methodology of the implementation of an educational intervention in the emergency department (ED) setting seeking to improve the provision of culturally competent care for the Lesbian-Gay-Bisexual-Transgender (LGBT) population. The intent of the project was to improve the knowledge and skills, openness and support, and oppression awareness of ED nurses when providing care to the LGBT population. The scholarly project included an evidence-based, unit specific education intervention to improve these measurement outcomes. Analysis utilizing descriptive statistics demonstrated an increase in the mean knowledge and skills and openness and support following the education intervention. The results illustrated an …

Implementation Of Post Forms Upon Hospice Admission: An Evidence-Based Practice Intervention To Reduce Hospice Revocations, Joanna Grace Asselin

Doctoral Dissertations and Projects

Background and Purpose: Reduction of live hospice discharges in the form of revocations is necessitated in order to maintain regulatory compliance and meet quality measures. Upon admission to hospice services, many have not considered personal desire regarding further intervention beyond Do Not Resuscitate (DNR) status. Evidence-based practice has revealed Physician Order for Scope of Treatment (POST) forms as effective in enhancing translation of patient desires related to care and interventions at end-of-life. The clinical question of this scholarly project asked if implementation of POST forms upon admission to hospice services would result in decreased revocations with related emergency department (ED) …

Decreasing Psychiatric Readmissions In A Nonprofit Behavioral Health Hospital, John Schreiber

Doctoral Dissertations and Projects

This scholarly project aimed to decrease adult readmission rates of psychiatric patients in a Nonprofit Behavioral Health Hospital (NBHH). The project aims to decrease the number of readmissions to an NBHH by 25% using specific interventions that have been revealed through a literature review of evidence-based practices (EBPs). A literature review revealed focused EBP interventions that could decrease readmissions. The PICOT question for this project was, "In adult mentally ill patients who are in an NBHH, what is the effect of focused interventions compared with usual care on readmission rates in 2 months?" Reducing the number of psychiatric readmissions is …

Strength In Community: A Community-Based Health Program To Improve Weight Loss And Blood Pressure Within An African American Faith-Based Organization, Leonna Sylvitrice Ameduite

Doctoral Dissertations and Projects

In general, conventional health promotion strategies have not successfully mitigated health inequality and health disparities in African American communities. Health disparities among African Americans continue to persist. Obesity and hypertension are more prevalent in African Americans and are well-known precursors to chronic illness such as cardiovascular disease, diabetes, and stroke. A wholistic solution to health disparities is complex and multifaceted. However, community-based programs such as faith-based health promotion programs can be an integral part of the solution. The purpose of this project was to provide a community faith-based weight loss program for African Americans to help guide weight loss and …

A Nursing Education Intervention In An Adult Inpatient Setting For Decreasing Hypoglycemia Incidence, Meredith Lynn Camilleri

Doctoral Dissertations and Projects

Hypoglycemia can cause an array of outcomes including increased morbidity, mortality, and hospital length of stay. The literature revealed specific educational methods effective in decreasing hypoglycemia including case-based learning tutorials and unit-based lectures. Focused nursing education regarding the cause of hypoglycemia and understanding the importance of provider notification of hypoglycemia was also shown in the literature to reduce rates of hypoglycemia. The purpose of this project was to decrease inpatient hypoglycemia incidence utilizing a unit-based educational seminar as an intervention on a diabetic renal unit within a hospital. While anticipating a decreased hypoglycemia incidence after the educational seminar, an increased …