Medicine and Health Sciences Commons^™

The Crossroads Of Wellness And Second Victim Syndrome: Identifying Factors That Alter The Pathway Of Caregiver Recovery Following An Unanticipated Adverse Patient Outcome, Kimia Zarabian, A. Katharine Hindle, Ivy Benjenk, Anita Vincent, Jamil M. Kazma, Benjamin Shambon, Raymond Pla, Eric Heinz

Journal of Wellness

Introduction: Second Victim Syndrome (SVS) describes the phenomenon in which a caregiver experiences a traumatic psychological and emotional response to an adverse patient event or medical error. Using quantitative survey analysis, we aim to better understand the personal factors that affect SVS development and recovery.

Methods: Caregivers at a small urban academic medical center who had experienced an adverse patient event in the past six months were invited to take part in this institution-wide, voluntary, quantitative, cross-sectional study. Three surveys were administered; the Holmes-Rahe Life Stress Inventory (HRLSI) was used as a surrogate to measure stressful life events. The …

Resilience, Moral Distress, And Workplace Engagement In Emergency Department Nurses, Paul Clark, Timothy Crawford, Brandonn Hulse, Barbara Polivka

Faculty Scholarship

This cross-sectional, correlational study’s purpose was to evaluate the effects of resilience and moral distress on workplace engagement in emergency department nurses providing direct patient care. Data were collected from 175 emergency department nurses using a Web-based survey. The higher the nurses’ resilience and the lower their moral distress, the greater their workplace engagement. Resilience and moral distress were not correlated; furthermore, moral distress did not mediate a relationship between resilience and workplace engagement. Resilience was higher with greater job satisfaction, increased age, and longer tenure as a nurse. Workplace engagement increased with higher job satisfaction and less time seeking …

Implementing A Standardized Pediatric Bone Marrow Transplant Orientation., Erika L. Shell

Doctor of Nursing Practice Papers

Nurse orientation programs focus on establishing a nurse’s ability to perform skills necessary in the organization’s setting. The purpose of this project was to develop a unit-specific orientation program for the experienced registered nurse transitioning into providing care for pediatric bone marrow transplant (BMT) patients at a local children’s hospital to enhance nurse knowledge and satisfaction. Melnyk and Fineout-Overholt’s rating system for the hierarchy of evidence was used in the selection of articles with high levels of evidence for the critical appraisal of the supporting literature for the program development. The best practices for orientation content provide constructive effects on …

Moral Distress And Moral Residue Among Nurses Working In The Surgical Intensive Care Unit: A Descriptive Qualitative Approach., Adam Tyler Booth

Electronic Theses and Dissertations

Introduction: Approximately one in five Americans will die in the intensive care unit (ICU). Nurses spend more time with chronically ill and end-of-life patients than any other healthcare professional, and may perceive some actions in the ICU as immoral. Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints. Development of the Moral Distress Scale-Revised revealed that 31% of ICU nurses left a prior position or considered leaving their current nursing job because of moral distress. The purpose of this descriptive qualitative study is to explore surgical ICU (SICU) nurses’ perceptions …

Trust In Primary Care Providers: Perspectives From Deaf People., Greir Ander Huck Flynn

Electronic Theses and Dissertations

Trust is an integral part of the patient-provider relationship, responsible for influencing several key aspects of healthcare behaviors and patient perceptions of health outcomes. Though the topic has previously been discussed by scholars, little evidence exists to support the application of our understanding of trust in culturally Deaf populations. As such, this dissertation seeks to lay the necessary groundwork for further investigations on the topic by first understanding the nature of trust in patient-provider relationships from the perspectives of culturally Deaf people. The dissertation is comprised of five chapters. The first chapter provides an introduction to salient terms and concepts …

Evaluating Family Satisfaction On An Advanced Certification Palliative Care Unit., Ruby Aebersold

Doctor of Nursing Practice Papers

Inpatient palliative care programs with The Joint Commission (TJC) Advanced Certification for Palliative Care are accountable for evaluating multiple health outcomes, including family satisfaction. A midwestern urban hospital’s palliative care unit received certification in January 2019. To comply with TJC standards, a clear data management and evaluation plan for family satisfaction data was needed. Investigation of the previous family satisfaction measure processes revealed areas in need of improvement in the satisfaction survey distribution, data collection, and evaluation processes. Satisfaction surveys were often unable to be distributed to families of deceased patients because the documented mailing address was a nursing facility. …

Nursing And Caregiver Satisfaction And The Implementation Of A Discharge Education Roadmap For Newly Diagnosed Pediatric Oncology Patients., Sable Iglesias

Doctor of Nursing Practice Papers

The initial diagnosis of a pediatric cancer is a stressful and overwhelming experience. During this time, distressed caregivers are expected to learn about the diagnosis, treatment plan, and how to care for their child at home. Simultaneously, parental reactions to a new cancer diagnosis often make learning a difficult process. The discharge education process is often a responsibility of the nursing staff. However, there are currently no evidence-based, systematic guidelines to direct the discharge education process of newly diagnosed pediatric oncology patients. Consequently, there is a lack of standardization across institutions, resulting in considerable variability in content provided in teaching …

Alcohol Misuse And Abuse Among College Students: An Implementation Of A Screening Program., Tiffany Slaughter Newcomb

Doctor of Nursing Practice Papers

Excessive alcohol use in the United States creates serious economic, health, and mortality problems (CountyHealthRankings, 2018). College students experience high rates of use, binge drinking, and 20% of college students meet the criteria for alcohol use disorder [AUD] (NIH, 2014). Screening by healthcare providers (HCPs) in the student health setting is critical and a recommended strategy for reducing negative consequences of alcohol use experienced by college students (US Preventive Services Task Force, 2018).

Aims: The objective of this project was to implement an alcohol screening program among college-age undergraduate students in a university student health center.

Methods: HCPs …

Optimist Prime- Emergency Medicine Residents Are An Optimistic Group, Nicole Battaglioli, Sarah Mott, Tim P. Moran, Simiao Li-Sauerwine, Matt Melamed

Journal of Wellness

Introduction: No study before has been conducted looking at the level of optimism and pessimism in emergency medicine residents and how it may be linked to resident burnout. This is the first national- level assessment of these personality factors.

Methods: This was a prospective survey study leveraging data obtained through the 2017 National Emergency Medicine Resident Wellness Survey, which included the Life Orientation Test-Revised (LOT-R). The Life Orientation Test-Revised (LOT-R) is a 10-item tool that measures levels of optimism versus pessimism.

Results: We found that the majority of our resident respondents scored in the moderate category of the LOT-R. Additionally, …

Implementation Of A Central Line Bundle As A Quality Improvement Priority., H. Anthony Flood

Doctor of Nursing Practice Papers

Background: Central-line associated blood stream infections (CLABSI) are a major threat to patient morbidity and mortality. Kentucky Continue Care Hospital (KCCH), a long-term acute care hospital, experienced a significant increase in CLABSI in 2018; therefore, implementation of a central-line bundle to reduce CLABSI was identified as a quality improvement priority. Methods: This author used the Quality Improvement Model to plan, study, and evaluate the implementation of a central line bundle in KCCH following University of Louisville Institutional Review Board (ULIRB) approval, staff were educated on the new process and the audit tool using a self-study module over a 2-week period …

Feasibility Of Implementation Of An Evidence-Based Trained Service Dog Provider Assessment Guide., Cassandra Lee

Doctor of Nursing Practice Papers

American healthcare is costing more, and patients are living with more complex chronic conditions. For many, alternative therapies such as trained service dogs provide a valuable complement to standard treatments. Many providers are unaware of the role a service dog can play in healthcare outside of visual impairment, as well as contraindications and concerns their use may bring. The use of service dogs is still considered by some to be complementary and alternative medicine (CAM) since it is not a part of usual medical practice and is not commonly taught within conventional medical education. The purpose of this project was …

Reducing Nurse Burnout In The Acute Care Setting., Christopher Reynolds

Doctor of Nursing Practice Papers

This paper examines nurse burnout in intensive care unit (ICU) nurses. The quality improvement (QI) project was conducted at the University of Louisville Hospital (ULH) in a ten bed medical intensive care unit (MICU) over the course of one month. The Maslach Burnout Inventory (MBI) survey and a demographic questionnaire were administered to nurses pre and post intervention. The intervention consisted of a uninterrupted, 30 minute work break during a nurse’s twelve hour work shift. The MBI survey was used to determine nurses’ level of burnout using three subscales; emotional exhaustion, depersonalization, and personal accomplishment. A paired t-test was used …

Breastfeeding Education In The Postpartum Period., Kiersten Proctor

Doctor of Nursing Practice Papers

Breastmilk is the best source of nutrients for an infant, yet many mother-infant dyads do not sustain breastfeeding past initiation. Breastfeeding education and support offered to the motherinfant dyad in the postpartum period have the potential to increase maternal breastfeeding selfefficacy, and attribute to a longer duration of breastfeeding. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to implement breastfeeding education and support in the postpartum period to mothers who have initiated and maintained breastfeeding by the time of the newborn well-child check, occurring at two to eight days postpartum. This project aimed to increase …

Breathing Easier: Indoor Air Quality Education Program., Sarah Kuner

Doctor of Nursing Practice Papers

Background: Exposure to indoor air pollutants increases the risk for poor health outcomes and health disparities among vulnerable groups such as children. The purpose of this evidence-based project was to implement an indoor air quality program that would: 1) improve caregiver awareness of indoor and outdoor environmental health exposures and 2) increase the intention to reduce exposures to indoor household pollutants. The target population included caregivers of preschool children, ages 3 to 5 years, who currently attend the Ohio Valley Education Cooperative. Methods: This project used a pre and post test study design that included two, virtual-learning modules that reviewed …

Early Initiation Of Therapeutic Hypothermia In The Emergency Department., Taylor Purnsley

Doctor of Nursing Practice Papers

Therapeutic hypothermia (TH) is a treatment initiated by critical care providers for the management of cardiac arrest. It has been shown to lower the body temperature, reduce the inflammatory response, and suppress many of the pathways leading to delayed cell death. The American Heart Association (AHA) has strongly recommended to initiate cooling within 4-6 hours after return of spontaneous circulation (ROSC); however, despite the recommendation, the use of TH in emergency departments (ED) is not routine and it is commonly delayed. The purpose of this project was to evaluate the impact of an educational intervention on the timing of initiation …

Improving The Rates Of Smoking History Documentation In The Electronic Medical Record., Megan Mccleese Vitellaro

Doctor of Nursing Practice Papers

Lung cancer is the leading cause of cancer related deaths in the United States, and Kentucky leads the nation in lung cancer deaths. Lung cancer care also contributes billions of dollars a year to the cost of health care in this country. The U.S. Preventive Services Task Force (USPSTF) recommends low-dose computed tomography (LDCT) for lung cancer screening with a grade B recommendation, which is a covered service under the Centers for Medicare and Medicaid Services (CMS) guidelines. In order to qualify, patients must have an appropriately documented smoking history. A primary care office was identified within a major healthcare …

Strategies To Increase Hpv Vaccine Uptake In Primary Care., Katelyn Brandel

Doctor of Nursing Practice Papers

Purpose: The purpose of this project was to increase HPV vaccination initiation rates in a primary care setting. This was accomplished through evidence-based provider and parental education using presumptive language and distribution of a customized toolkit. Design: The project protocol was designed using a theoretical approach about chosen health behaviors from the Health Belief Model. Outcomes included initiation rates, efficacy of a toolkit intervention, efficacy of a recall system, and provider satisfaction. Methods: A two-sided Fisher’s Exact Test was performed. Primary outcome results indicated a non-significant increase in vaccination rates. Of the 24 patients who received the toolkit, 25% chose …

The Impact Of Estimated Weight Versus Accurate Weight On Ischemic Stroke Patients With Tpa., Vanessa Johnson

Doctor of Nursing Practice Papers

Purpose: The gold standard of treatment for an ischemic stroke is the administration of weight based tPA within 4.5 hours of patient last neurological known well. The aim of this project was to improve accuracy of tPA dosing and decrease complications, improving outcomes for the stroke patient population. Method: This project implemented a new system, allowing every stroke patient to be accurately weighed when arriving to the hospital. AIS patients from a historical group were compared to patients receiving tPA within the first 3 months following an in-service, evaluating prospectively to determine if estimated or measured weights were used for …

Education And Implementation Of The Clinical Opiate Withdrawal Scale (Cows) In The Acute Care Setting For Care Providers., Rachel Schollaert-Culwell

Doctor of Nursing Practice Papers

The opioid epidemic is a growing crisis, the US consumes a majority of the worlds opioid supply. There are an estimated 100,000,000 opioid dependent persons and according to the National Institute of Health (NIH) over 7 million of those individuals also have an overlapping mental illness which further complicates treatment for this population. In the inpatient setting there is a great need to assess the opioid dependent patient and identify withdrawal signs and symptoms. There are many challenges especially within the ICU when recognizing these patients. Patients can require mechanical ventilation and intravenous sedation and pain medication which consist of …

A Needs Assessment & Implementation Strategy Of The Emergency Nurse Practitioner Post-Graduate Certificate., Nancy Wilding

Doctor of Nursing Practice Papers

Nurse Practitioners have been utilized to meet the growing needs of emergency departments during the shortage of Emergency Medicine-trained physicians. Stakeholders have recognized the benefits that Nurse Practitioners (NP) bring to Emergency Departments (ED) in providing quality, evidence-based, cost-effective quality care. However, there is a confusion of the emergency nurse practitioner (ENP) role and scope of practice by facilities, physicians, state boards of nursing, credentialing bodies, and patients that limit the ENP from practicing at their full scope of practice. To establish the role and expand the NPs' knowledge and skills to meet the needs of the ED setting, a …

Improving Peripheral Intravenous Maintenance Compliance To Decrease Intravenous Infiltration In A Pediatric Icu., Miranda Jones

Doctor of Nursing Practice Papers

Purpose: Intravenous (IV) infiltration is recognized as the most frequent complication of IV therapy (Thigpen, 2007). Pediatric patients are at an increased risk due to small and weaker blood vessels, immature skin, lack of subdermal fat, and constant movement (Odom & Lowe, 2018). In 2018, the pediatric intensive care unit (PICU) in a Kentucky children’s hospital reported 229 IV infiltrations, that which included over 10% of the PICU population. As a result, a quality improvement (QI) project was developed to identify and correct barriers to compliance, knowledge gaps, and target specific behaviors that may contribute to IV infiltration in the …

Education Module For Serotonin Syndrome With 24-Hour Dose Monitoring Intervention., Jonathon Blake Hicks

Doctor of Nursing Practice Papers

Background: Serotonin Syndrome (SS) is recognized by a combination of mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity (Volpi-Abadie, Kaye, & Kaye, 2013). Despite the severity and commonality of SS, it is an under reported and an under treated condition (Boyer, 2018). The purpose of this project was to 1) implement an education module on SS using a pretest and posttest design to increase LTC staff knowledge, and 2) evaluate the effectiveness (e.g., confidence level, satisfaction) of the intervention among nursing staff. Method: An education module was implemented focusing on recognizing and treating SS in aging adults. A pretest-posttest design …

Evaluation Of A Blood Pressure Education Program On Knowledge And Self-Efficacy In Patient Care Associates ., Casey Prestigiacomo

Doctor of Nursing Practice Papers

The American College of Cardiology (ACC) and American Heart Association (AHA) revealed common errors made by healthcare professionals when measuring blood pressure (BP) in adult inpatients. These errors include using incorrectly sized cuffs, improper cuff placement, and inappropriate patient positioning. Inconsistent cuff sizes and position lead to underestimated and overestimated results, directly impacting patient care and outcomes. Additionally, the ACC/AHA identified patient position and talking during assessments as factors that directly impact the accuracy of the results. At Norton Healthcare facilities, a majority of BPs are obtained by patient care associates (PCAs). The purpose of this quality improvement project was …

Preoperative Opioid Education: Total Knee And Total Hip Arthroplasty., Brittany Durbin

Doctor of Nursing Practice Papers

Opioids are commonly prescribed for the treatment of acute pain symptoms such as surgical pain. The United States is struggling to deal with abuse, misuse, and accidental death associated with prescription opioids. Lack of knowledge regarding safe opioid use is partly to blame for this crisis. The purpose of this evidence-based quality improvement project is to implement a dual-modality (written and spoken) opioid educational intervention to both health care providers and patients. Intended outcomes include increased opioid knowledge for providers yielding more effective opioid education to patients. A pre- and post-test design was used to evaluate provider knowledge and intent …

Hiv/Hcv Screening Protocols In The Emergency Department., Adrianne Warren Johnson

Doctor of Nursing Practice Papers

Background: The United States is experiencing an epidemic of opioid drug use that has increased the number of people who inject drugs (PWID). This has resulted in an increase in the risk of transmission of blood-borne pathogens including human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among this population. Although injection drug use has surpassed sexual transmission as the leading risk factor for HIV, PWID have the least access to HIV prevention, testing, treatment, and healthcare. Current guidelines recommend testing individuals from high-risk populations for HIV/HCV every six months. Offering routine, opt-out, targeted, bundled HIV/HCV testing in an emergency …

Expansion Of A Food Insecurity Scale In Primary Care., Andrea Gibson

Doctor of Nursing Practice Papers

As a household-level economic and social condition defined by limited or uncertain access to inadequate food, food insecurity serves as a health threat. Food security impacts health by increasing the risk of cardiovascular disease, type 2 diabetes, stroke, and several cancers (WHO, 2005). Expansion of the two-item food insecurity screening to a six-item short-form (USDA 6- SF) screening in primary care has the potential to identify and categorize households into three categories of food security, high/marginal, low, or very low. By differentiating food insecurity categories, clients received more appropriate referrals to services aimed at improving food security. During a recent …

Modifying The Open Visitation Policy In The Adult Intensive Care Unit To Improve Patient, Family, And Nurse Satisfaction., Elizabeth Blandford

Doctor of Nursing Practice Papers

Background: Open visitation within adult intensive care units (ICUs) has recently replaced restricted visitation to further support patient and family centered care (PFCC) and improve satisfaction. The involvement of the patient or designated person in healthcare decisions and activities, decreases patient anxiety and stress, and can improve recovery. However, with the initiation of open visitation, many ICU patients, families and nursing staff are feeling overwhelmed and frustrated with the new issues that are arising. Decreased productive sleep, increased incidences of delirium, and constant overstimulation can cause patients and families to feel like recovery is unattainable. Nursing workflow is becoming dysfunctional, …

The Implementation Of An Evidence Based Decision Aid To Improve Self-Efficacy Of Critical Care Nurses In The Recognition Of Need For Palliative Care In Icu Patients., Abigail Southall

Doctor of Nursing Practice Papers

BACKGROUND: Internal and external evidence demonstrates a poor understanding of the definition and scope of palliative care for ICU patients by nurses. Palliative care and hospice care are often viewed as mutually exclusive rather than complimentary. This knowledge gap causes delayed palliative care consultation for ICU patients which has been shown to increase length of stay and cost of care while decreasing patient/family satisfaction. SETTING: The project took in a 36-bed Intensive Care-Open Heart Unit (ICU-OHU) in an urban hospital in the Midwest United States. PURPOSE: The purpose of the quality improvement project was to address misconceptions regarding palliative care …

Improving Delirium Management And Compliance On A Trauma/Surgical Universal Unit., Ardis Roederer

Doctor of Nursing Practice Papers

Background: Delirium is an acute, reversible syndrome that may cause cognitive impairment, disorientation, perceptual disturbances, attention discrepancies, and fluctuating psychomotor activities. Health professionals may not recognize, treat, or prevent delirium. More than seven million hospitalized adults, with an estimated cost of $164 billion annually, suffer from delirium each year. Consequently, delirium commonly affects 15 to 37% of the older adult population, yet less than 5% of delirium cases are documented in the electronic medical records of older adult patients. Early detection, intervention, and compliance with best practices are critical for the reduction of hospitalized delirium incidence. Aim: This project aimed …

Family Presence During Resuscitation: Nurses’ Perceptions Of Their Self-Confidence., Jessica Duffy

Doctor of Nursing Practice Papers

Family presence during resuscitation (FPDR) remains a controversial topic among healthcare providers. Nurses’ lack of self-confidence has repeatedly been identified as one of the barriers as to why families are not being offered the option to be present during resuscitation of their loved ones. The purpose of this quality improvement project is (1) to explore whether nurses’ selfconfidence perception when experiencing FPDR is greater after an educational intervention; and (2) to further explore nurses’ perceived benefits and risks related to FPDR. This prospective project gained a baseline knowledge of the perception of self-confidence, benefits, and risks in regard to FPDR …