Ipmtc- An Emerging Nursing Theory On Transitioning Individuals With Traumatic Brain Injury From Long-Term Care Facilities To The Community Under Medicaid Waiver Programs, Sylvia Abbeyquaye

Doctoral Dissertations

This study aims to explore the process of transitioning individuals with traumatic brain injury (TBI) from long-term care settings to the community and develop a theory of transition. Also, it explores the definition of successful transitioning and the perceived role of the nurse in the transitioning process. A constructivist grounded theory method guided by symbolic interactionism was used in this study. The research sample was recruited throughout the Commonwealth of Massachusetts. The sample included individuals with TBI, family caregivers, professional caregivers, and community service providers involved with the Acquired Brain Injury and the Money Follows the Person waiver programs in …

The Lived Experience And Factors Affecting Disclosure Of Pregnant Victims Of Domestic Violence, Pedro Vargas Ortiz

Doctoral Dissertations

Domestic violence is defined as a pattern of assaultive and coercive behaviors that includes the threat or infliction of physical, sexual, or psychological abuse that is used by perpetrators for the purpose of intimidation and control over the victim. The lived experience and meaning of domestic violence in Puerto Rican pregnant women has not been well researched. This study described pregnant women’s lived experience of domestic violence and examined the factors influencing the process of disclosure of domestic violence among pregnant women in the southern region of Puerto Rico. A phenomenological method was used where women who have experienced domestic …

Using Motivational Interviewing To Increase Walking And Functional Ability In Older Adults: A Quasi-Experimental Study, Erin Lamoureux

Doctoral Dissertations

The purpose of this study was to determine if brief motivational interviewing (MI) sessions would increase daily steps and functional ability in older adults. Regular exercise in the older adult can slow the physical, psychological, and functional decline that is often associated with aging. However, only 25% of adults aged 65 and older meet the suggested physical activity recommendations of the American Heart Association and the National Institute of Health. Understanding what may contribute to the initiation and adherence of exercise within the older adult population might identify interventions that would successfully increase physical activity. This study focused specifically on …

Exploring How Nurse Beliefs And Attitudes Influence End-Of-Life-Care Practice, Cara Chandler

Doctoral Dissertations

Nurses are the cornerstones to provide safe patient care. Studies about nurses experiencing challenges while providing end-of-life care (EOLC) are limited. It is imperative to understand how nurses’ beliefs and attitudes influence their actions while providing EOLC. The aims of this study were to (a) explore the relationship of personal factors and nurse beliefs and attitudes on providing EOLC and (b) examine the relationship of nurse beliefs and attitudes on intention and performance to provide EOLC. These aims were explored in a convenience sample of nurses working in multiple adult patient settings. The Theory of Planned Behavior guided a cross-sectional …

The Effect Of Social Networks On Self-Care Behaviors And Health Outcomes Among Older People Living With Multiple Chronic Conditions, Raeann G. Leblanc

Doctoral Dissertations

Background: Older adults are the fastest growing segment of the population in the United States. By 2030, 72.1 million Americans will be over sixty-five years of age and many live with and manage multiple chronic conditions. Self-care behaviors are a priority to effectively manage chronic conditions, yet a gap exists in our understanding of how social networks influence the outcomes of self-care behavior and health within the context of aging and managing multiple chronic conditions. Objective: The aim of this study was to determine how social network features and functions influence self-care behaviors and health among community dwelling older adults …

Maternal Outcomes Of Women Who Prefer To Communicate In English Compared To Women Who Prefer To Communicate In A Language Other Than English In New England, Katharine Green

Doctoral Dissertations

Introduction: Language acquisition is the primary marker of acculturation to the dominant society in a receiving geographic area, and effective communication in English is a marker of acculturation in the United States. There is good evidence that women who receive midwifery care have improved maternal outcomes, and that women who are not well acculturated to the dominant culture in the United States have improved neonatal outcomes. However, the maternal outcomes of women who do not communicate in English are not well studied, nor is it known whether care during parturition by physicians when compared to nurse midwives makes a difference …

“Tell Me A Story®”: Promoting Resiliency In Military Children, Katherine-Marie Conover

Doctoral Dissertations

Multiple and lengthy deployments of military members are common and negatively impact children’s well-being. Programs seek to increase resiliency and reduce potential negative impact of parental deployment on children exist but lack empirical evidence to support their effectiveness. Increased parent engagement through reading and subsequent discussion with their children has positive psychology implications and potential to improve resilience. Thus, this study’s purpose was to examine the effectiveness of the intervention Tell Me A Story® (TMAS) in improving resiliency in school-age children (aged 6 to 10 years) of active duty military members. This study also aims to examine the impact of …

A Toolkit To Assist Massachusetts School Nurses Start Elementary School Substance Use Prevention Education Programs, Caitlin Pettengill

Doctor of Nursing Practice (DNP) Projects

Purpose: Massachusetts currently only mandates fifth-twelfth grade substance use prevention. Literature states it is counter productive to wait until the adolescent years to initiate substance use prevention due to the adolescent developmental stage of social conformity. Starting evidence-based substance use prevention education in early elementary school will arm children with the knowledge and confidence they need to make healthy choices and reduce future high school drug rates.

Methods: A toolkit was created to assist Massachusetts elementary school nurses to start a substance use prevention program in their schools/districts. The toolkit was presented and evaluated in January 2018 by the …

Evidence-Based Interventions: Improving Influenza Vaccination Rate Among Health Care Workers (Hcws) Targeting Direct Care-Givers, Jennelyn Fraser-Johnson

Doctor of Nursing Practice (DNP) Projects

Background: Influenza is a contagious disease affecting over three million people every year. It is associated with yearly seasonal outbreaks which increases the risk of mortality among immune-compromised, hospitalized clients, clients in long-term care facilities and also enhances the risk of infection in healthcare workers (HCWs). Nosocomial infections and employees’ absenteeism are often associated with the flu. A high influenza vaccination rate in health care professionals reduces the risk of influenza infection as well as being a cost- effective strategy to reduce lost work hours. A Joint Commission criterion for accreditation for healthcare facilities is to achieve a 90% …

Measuring The Impact: A Re-Aim Framework For Evaluation Of A Needle Exchange Program, Lindsay Novacek

Doctor of Nursing Practice (DNP) Projects

Background: Needle exchange programs (NEPs) have been widely documented over the past three decades as an effective and economic approach to controlling human immunodeficiency virus (HIV). As of July 1st, 2016, these programs have been legalized in North Carolina. Purpose: To perform stage 1 of an evaluation of a needle exchange program in North Carolina by utilizing a public health framework: the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Methods: First, the RE-AIM framework was used to create a plan for a program evaluation of a local NEP. Then, the first stage of the evaluation was completed. NEP program participants …

Screening For Traumatic Brain Injuries (Tbi) In Veterans: A Quality Improvement Project To Change The Identification And Referral Process In Primary Care Providers., Chiara Simonini

Doctor of Nursing Practice (DNP) Projects

Background: The incidence of traumatic brain injuries (TBI) among veterans has increased exponentially in those who served in Operation Enduring Freedom and Operation Iraqi Freedom. Identification and treatment for these injuries remains difficult due to variance in screening methods, interpretation of results, and barriers to access to care. Purpose: The goal of this quality improvement project is to improve TBI screening process offered to veterans by healthcare workers and providers in an outpatient VA clinic in the northeast. Methods: Current standards of practice and provider knowledge were assessed through focus groups, pre-intervention survey, followed by educational outreach to provide …

Using Cognitive Behavioral Therapy To Treat Insomnia In Adults, Alexandra Christodoulou

Doctor of Nursing Practice (DNP) Projects

Background: Insomnia is a physically, mentally, and psychologically complicated and distressing medical condition that can affect adults with or without comorbid conditions. Research indicates that cognitive behavioral therapy (CBT) is an underutilized, but extremely beneficial intervention that may support individuals in overcoming insomnia and other comorbid conditions, without ever ingesting a pill. Unfortunately, CBT is underutilized due to the patient educational time requirements; therefore, medication is often prescribed as a first line of treatment for insomnia. Adults suffering from insomnia with or without comorbid conditions such as psychiatric disorders or cancer have benefitted from CBT as opposed to oral …

Hypertensive Management For African American Patients, Aleksandrya Bracey-Asiedu

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The rates of angioedema amongst African American patients using angiotensin- converting- enzyme- inhibitors (ACE-I) are five times greater than non-African American counterparts (01.-07 percent vs. 0.5-3.5 percent). Although ACE-I agents are widely prescribed, they have less therapeutic control in hypertension amongst this group of patients and high incidences of life threating side effects.

Methods: The purpose of this quality improvement (QI) project was to assess provider knowledge related to established guidelines from the Joint National Committee (JNC) on hypertension management, as well as their knowledge of the side effects of ACE-I for African American patients. A pre …

Reducing Readmissions In Bipolar Patients With Discharge Interventions, Alexandra Steeves

Doctor of Nursing Practice (DNP) Projects

Purpose: The purpose of this DNP project was to evaluatea discharge protocol with interventions to improve the process of discharge from the in-patient setting and transition the patient into the community.

Methods: This program evaluation centered on evaluating a discharge protocol currently in place and adding revised interventions to strengthen the discharge planning process. De-identified data was viewed on readmission rates and interviews were conducted with stakeholders involved with the discharge process.

Results: There were a total of twelve participants in the evaluation period of pre and post evaluation interviews. Review of the interviews resulted in four themes relating to …

A Quality Improvement Project For Co-Occurring Disorders In Outpatient Behavioral Health, Erin Sheehan

Doctor of Nursing Practice (DNP) Projects

Purpose: Patients with mental health diagnoses often have co-occurring alcohol use disorders, which can exacerbate their psychiatric symptoms. A standardized assessment tool should be utilized for screening for alcohol use disorders in outpatient mental health programs so that interventions can be implemented when a co-occurring disorder is identified. The purpose of this project was to provide clinicians with education and to improve the process for screening patients with mental health disorders for problematic drinking behaviors to implement recommended interventions when appropriate to improve the overall quality of the patient’s care and increase the clinician’s knowledge and confidence in treating co-occurring …

A Quality Improvement Project To Improve Type 2 Diabetes Mellitus Screening In Asian Americans Using Body Mass Index Cut Point Of 23, Annie Samuel

Doctor of Nursing Practice (DNP) Projects

Background: Asian Americans are at a higher risk for Type II Diabetes than other groups and disproportionately develop Type II Diabetes Mellitus at younger ages, although having a lower Body Mass Index (BMI) compared to non-Hispanic whites.

Methods: A group of 22 Nurse Practitioners (NP) in New York were presented an evidence-based educational intervention along with a five-item pre-test and post-test to determine if they had acquired new knowledge on the issue. A follow-up survey was conducted to test if the intervention changed individual NP practice in screening Asian Americans in adult primary care clinics.

Results: The overall mean …

Stop The Stigma! Eliminating Implicit And Explicit Bias Toward Adult Obese Women Receiving Gynecological Care: A Quality Improvement Project To Cultivate Empathy And Increase Knowledge Of Best Practices, Mary Ellen Burke

Doctor of Nursing Practice (DNP) Projects

Background: Increased weight carries significant health risks, yet obese individuals face stigma, implicit and explicit bias by health care providers that affects quality of care and increases health care avoidance. Obese women may delay or avoid gynecological care due to fear of stigma, inadequate equipment and embarrassment about their weight. Review of Literature: In the United States, 70.7% of adults, almost three quarters of the adult population are overweight or obese. Purpose: The purpose of this quality improvement project was to improve the quality of care and empathy toward obese women by health care providers in an OB/GYN practice through …

Managing Patients At High-Risk For Breast Cancer: An Elearning Module For Primary Care Providers, Erin Chaney

Doctor of Nursing Practice (DNP) Projects

Women at high-risk of developing breast cancer must be screened appropriately and educated about breast cancer reduction strategies much earlier than those of average risk. The National Comprehensive Cancer Network (NCCN) (2017) has identified guidelines for the care of this group. This project focused on the development of education for providers, specifically an eLearning module, to help translate guidelines into practice. Providers of adult primary care (including internal medicine and family practice) from four clinics in Snohomish County, Washington, were asked to participate in an eLearning module regarding the care of patients at high-risk for breast cancer. Repeated measures surveys …

Screening Adults With Substance Use Disorder For Adverse Childhood Experiences, Teri Murtha

Doctor of Nursing Practice (DNP) Projects

Background and purpose-Exposure to adverse childhood experiences results in increased morbidity and mortality among individuals with substance use disorders. Screening for histories of childhood trauma, and integration of trauma-informed care is lacking among health care practitioners. Integrating screening for histories of childhood abuse in person’s seeking treatment for substance abuse disorders can facilitate identification of individuals interested in additional support and resources to support their recovery. The purpose of this study was to assess the effectiveness and feasibility of a screening interview protocol for ACEs and to determine the presence of ACEs among individuals with substance use disorder (SUD) …

Educating Health Care Professionals To Improve Communication In Advance Care Planning, Laura E. Clubb

Doctor of Nursing Practice (DNP) Projects

DNP Project Goal:The goal and expected outcome of this DNP project was to increase providers’ self-reported preparedness and comfort levels by 50% when discussing advance care planning (ACP) and end of life wishes with patients.

Background: The Institute of Medicine designed ACP as a national health priority. However, health care professionals often do not facilitate discussions of ACP with patients, even in patients with chronic or life-limiting illnesses. This occurs due to professionals’ lack of knowledge about ACP, lack of comfort when discussing the issue, and a misperception that the patient may be too young or not sick enough …

Improving Patient Discharge Satisfaction Scores By Implementing Teach-Back Instructions In A Community Hospital Emergency Department (Ed): A Quality Improvement Project, Kristen Burke

Doctor of Nursing Practice (DNP) Projects

Background: Health literacy and patient satisfaction play a role in healthcare today and it is the responsibility of all providers to ensure that patients are educated about the care they received in the ED and what they should be doing upon discharge. The teach-back method ensures patients have a complete understanding of their ED stay and discharge instructions.

Purpose: The purpose of this quality improvement project was to increase patient satisfaction scores by implementing the evidenced-based, patient-centered, teach-back method for all patient education opportunities.

Methods: The DNP student led the ED leadership team and staff nurses in a quality improvement …

Medication Reconciliation In An Ambulatory Care Community Mental Health Practice, Matthew Bock

Doctor of Nursing Practice (DNP) Projects

Purpose: To improve medication safety among behavioral health patients at a community-based outpatient psychiatric practice in Western Massachusetts through implementation of an evidence-based medication reconciliation protocol.

Methods: Gaps in the current medication reconciliation process were identified by reviewing the current process with outpatient supervisors in the practice. A sample of 25 patients, the majority with more complex comorbid medical conditions, were selected to participate in an evidence-based medication reconciliation process. Medications, both prescribed and over the counter, were reconciled either in office or in the home.

Results: There was a significant increase in the number of medications identified post-intervention. On …

Best Practice Medication Reconciliation In The Outpatient Setting, Meghan J. Hession

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Medication safety is a focus of the Joint Commission’s National Patient Safety Goals and research supports improved medication reconciliation as a strategy to reduce medication errors and adverse drug events. In a busy, outpatient specialty clinic where patients are routinely considered for high-risk pharmaceutical therapies, a consistent medication reconciliation process is essential for patient safety and positive health outcomes. Purpose: To improve consistency of medication reconciliation in this high-risk outpatient setting. Method: Based on a gap analysis between evidence-based and current practice, a quality improvement intervention was implemented to increase patient engagement in the medication reconciliation process. A …

Using A Professional Language Interpreter During Discharge To Promote Self-Care Management For Spanish-Speaking Patients With Congestive Heart Failure: A Quality Improvement Project, Lucy Ankrah

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and Review of Literature: The high rate of hospital readmissions has become a national issue after the Affordable Care Act began and was found to be related to lack of proper education and communication during discharge, coupled with medication nonadherence. Purposes/Goal: The overarching goal of this DNP project was to improve lifestyle management of Spanish-speaking congestive heart failure (CHF) patients and to reduce their 30-day readmission rate. The intent of the project was to improve patients’ understanding of CHF exacerbation, medications, and discharge instructions geared to increase home self-management and reduce recidivism. The specific aims were (a) to …

Introducing Screening For Family Risks In Young Children In Primary Care, Sarah Kells

Doctor of Nursing Practice (DNP) Projects

Background: One in four children in the United States under the age of five is at risk for developmental, behavioral or social delay. Genetics and environment, including exposure to adversity, play a major role in healthy neurological development. The Survey of Well-being of Young Children (SWYC) as a screening instrument was developed to address perceived barriers and standardize physiological, psychosocial and family risks screening in primary care to identify those who would benefit most from early intervention.

Methods: This quality improvement project involved an information session for providers and staff at a Federally-Qualified Health Center in Western Massachusetts to …

Reducing Delays In Sexually Transmitted Infections(Sti) Treatment: A Quality Improvement Project To Improve Timely Communication Among Providers And Patients, Kattie Khadar

Doctor of Nursing Practice (DNP) Projects

Abstract

Purpose: To use a nurse-communication intervention for timely provider notification of abnormal chlamydia, gonorrhea and syphilis infections, to reduce delays in treatment at a large Northeastern United States hospital. Methods: The hospital’s communicable disease report was reviewed daily, and treatment of all patients who were seen in the Infectious Disease clinic and diagnosed with chlamydia, gonorrhea and syphilis infections was monitored. Emails were sent to inform treating providers whenever a patient was not treated within 72 hours after diagnosis. Data from patients in the three months preceding was compared with data during the three months of nurse-communication intervention …

A Quality Improvement (Qi) Project To Reduce Emergency Department (Ed) Readmissions Among Patients With Limited English Proficiency (Lep) Through Utilization Of Interpretive Services By Healthcare Providers, Christine Ndissi

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Patients with Limited English Proficiency (LEP) are a vulnerable population with greater risk for poor health outcomes due to provider-to-patient communication barriers. Emergency Department (ED) health providers are routinely confronted with problems of ineffective communication thereby, leading to lack of patients’ knowledge of their diagnoses and medications, and subsequently lead to medication-related adverse events and ED readmissions. Purpose: The purpose of this DNP quality improvement (QI) project is to evaluate the standards of care and examine factors that contribute to underutilization of interpretive services for patients with LEP who seek care at the ED to …

Alzheimer’S Dementia Screening In Primary Care: Quality Improvement Project To Identify Those At Risk, Kirstin Drake

Doctor of Nursing Practice (DNP) Projects

Background: Identifying Mild Cognitive Impairment (MCI) and Alzheimer’s Dementia (AD) in the Primary Care Practice (PCP) setting can initiate intervention early, before negative consequences occur including decreased quality of life and caregiver burden.

Purpose: To identify individuals at risk for AD and initiate early treatment and intervention. Methods: The Montreal Cognitive Assessment (MoCA) and Functional Activities Questionnaire (FAQ) were used as screening tools; adults age 65 and older were participants.

Implementation Procedure: Within the Internal Medicine Clinic, the standard annual wellness visits include Registered Nurses that administer a Mini-Cog screening tool with the patients. The Mini-Cog is a brief …

The Implementation Of Mindfulness Training With Nursing Students To Decrease Stress And Improve Attentiveness And Awareness, Margaret Young

Doctor of Nursing Practice (DNP) Projects

Abstract

This project was the implementation of mindfulness training for undergraduate baccalaureate nursing students to decrease perceived stress and increase their awareness and attention though mindfulness. The literature supports the importance of stress reduction in regard to improving perceived well–being and consequently improving ability to learn. Mindfulness is identified as an important aspect of self-care that increases awareness and attention, while ultimately improving well-being, all of which leads to better knowledge acquisition and the ability to be empathetic. For nursing students this includes improved knowledge acquisition, technical skills, clinical knowledge and critical decision making. The literature clearly supports the tenet …

Analysis Of Consistency Of Transthoracic Bioimpedance Measurements Acquired With Dry Carbon Black Pdms Electrodes, Adhesive Electrodes, And Wet Textile Electrodes, Hugo F. Posada-Quintero, Natasa Reljin, Caitlin Eaton-Robb, Yeon Sik Noh, Jarno Riistama

Elaine Marieb College of Nursing Faculty Publication Series

The detection of intrathoracic volume retention could be crucial to the early detection of decompensated heart failure (HF). Transthoracic Bioimpedance (TBI) measurement is an indirect, promising approach to assessing intrathoracic fluid volume. Gel-based adhesive electrodes can produce skin irritation, as the patient needs to place them daily in the same spots. Textile electrodes can reduce skin irritation; however, they inconveniently require wetting before each use and provide poor adherence to the skin. Previously, we developed waterproof reusable dry carbon black polydimethylsiloxane (CB/PDMS) electrodes that exhibited a good response to motion artifacts. We examined whether these CB/PDMS electrodes were suitable sensing …