Medicine and Health Sciences Commons^™

The Social Process Of Dying In The Hospital: A Grounded Theory Study, Alyson Prokop

Doctoral Dissertations

The majority of deaths in the United States occur in the hospital (Xu, Kochanek, Murphy, & Tejada-Vera, 2010). Because there is little understanding of the meaning behind this delicate social process for the patient, the purpose of this study was to develop a theory that describes the social processes one undergoes during the in-hospital end-of-life phase. Grounded theory methodology was chosen to understand this phenomenon and then explain it theoretically (Charmaz, 1990). The data used to develop the theoretical model was previously collected by StoryCorps and therefore components of secondary analysis were taken into consideration. Stories that are housed at …

Making The Invisible Visible: Adolescent Caregiver Experiences In Multiple Sclerosis, Renee Crizer

Doctoral Dissertations

Multiple Sclerosis, a chronic, debilitating neurological disease is typically diagnosed during the child bearing and child rearing ages of 20-50. Therefore, many people diagnosed with Multiple Sclerosis have children and adolescents living at home. With approximately 400,000 people in the United States currently diagnosed with multiple sclerosis and 10,000 new cases each year, a group of caregivers have emerged that are often unrecognized and potentially at risk: a group of young caregivers. The aim of this study was to explore the lived experience of individuals who provided care for a family member with Multiple Sclerosis during their adolescence. This qualitative, …

Cultural And Family Challenges In Type Two Diabetes Self-Care For Puerto Rican Identified Hispanic Adults, Jalil Johnson

Doctoral Dissertations

ABSTRACT CULTURAL CHALLENGES IN TYPE TWO DIABETES SELF-CARE FOR PUERTO RICAN IDENTIFIED HISPANIC ADULTS FEBRUARY 2019 JALIL A. JOHNSON, B.S.N., MIDDLE TENNESSEE STATE UNIVERSITY M.S., UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL, WORCESTER Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Dean Stephen Cavanagh Background: Puerto Rican identified Hispanics are disproportionately affected by type 2 diabetes and co-morbid conditions compared to their white counterparts. Culturally tailored interventions improve self-care for Hispanic populations. Interventions should be tailored to the targeted Hispanic subgroup. The intersection of Familism in Puerto Rican culture as it influences type 2 diabetes self-care is not well understood. Research Aims: The …

The Impact Of Ptsd And History Of Involvement In The Criminal Justice System On Medication Treatment Success In Opioid Use Disorder, Kirk Sanger

Doctoral Dissertations

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4 …

Social Factors That Exacerbate Features Of Borderline Personality Disorder In Young Adult Women Between 25 And 35 Years Of Age Living In The Commonwealth Of Puerto Rico, Erika M. Carrasquillo

Doctoral Dissertations

The high prevalence of BPD hospitalizations, unsuccessful treatments, poor social awareness, suicide attempts and complete suicides were motivating forces for this research study. The aim was to uncover pertinent social factors that exacerbate BPD in the lives of individuals with this affliction and therefore find ways to combat this disease. Since most of the individuals affected by this disease are female, the present research was focused on uncovering factors that increased the likelihood of BPD factors in women between the ages of 25-35 years. Borderline personality disorder is often viewed as difficult to treat. However, recent research shows that BPD …

Use Of A Checklist To Facilitate The Recognition Of A Transfusion Associated Adverse Event, Susan Scott

Doctoral Dissertations

Transfusions are the most common procedure that hospitalized patients undergo. One of the risks associated with a transfusion is a transfusion related adverse event (TAAE). Transfusion associated adverse events can occur in any patient receiving a transfusion. Some patients are at risk of certain TAAEs (e.g., heart failure patients at risk of transfusion associated circulatory overload) while other events (e.g., allergic reactions) cannot always be anticipated. The severity of a TAAE can range from mildly uncomfortable to life threatening. Nurses need to be able to identify the signs and symptoms of a possible TAAE and intervene immediately by stopping the …

Suicide Education To Support Caregivers In Their Abilities To Care For Suicidal Individuals, Cassandra Lipa

Doctor of Nursing Practice (DNP) Projects

Purpose: Suicide is a preventable act of lethality yet still remains a public health concern. Suicide can affect individuals from a variety of backgrounds and does not discriminate against age, gender, ethnicity, income, or occupation. Efforts to prevent suicide often focus on supporting the suicidal individual however there is a lack of available resources that focus on supporting those closest such as caregivers. Caregivers can play a pivotal role in their loved one’s trajectory towards recovery. The purpose of this project was to provide caregivers with a suicide toolkit that encompasses basic education, approaches to supporting a loved one who …

Reducing 30-Day Heart Failure Readmission Among Elderly Population In Long-Term Care, Nkechi Ukomadu

Doctor of Nursing Practice (DNP) Projects

Background: Heart failure is the leading cause of hospitalization in the United States and accounts for more than one million hospitalizations every year. Readmission within 30 days of discharge is an indicator used for measuring the quality of care for heart failure patient. Methods: The goal of this quality improvement project is to reduce the 30-day readmission rate of heart failure patients 60 years and older in a long-term care setting in Texas by using an evidence-based transitional readiness discharge checklist for heart failure. Interventions included staff education on the key components and on the checklist. A pre- and post-test …

Stress Relieving Lavender Aromatherapy For Inpatient Nurses, Kaneisha Deburgo

Doctor of Nursing Practice (DNP) Projects

Lavender essential oil as a form of aromatherapy is proven to be an effective way to relieve occupational stress among nurses, providing them with a healthy self-care outlet. The purpose of this DNP project was to decrease the stress levels of inpatient nurses by implementing lavender essential oil aromatherapy as a self-care initiative. Willing inpatient Registered Nurses within a fast-paced inpatient telemetry unit were given a vial that contained three drops of Young Living lavender essential oil enclosed within at the beginning of their shifts. The nurses were asked to carry it with them during their eight-hour shifts for three …

Increasing Staff Knowledge And Screening Practices For Adverse Childhood Experiences In Primary Care, Angela Mcgraw

Doctor of Nursing Practice (DNP) Projects

Adverse childhood experiences (ACE) are important to future health outcomes. Many health care providers lack the knowledge or training to assess for ACE. Purpose. The purpose of this quality improvement project is to increase the identification of ACE among adult clients in a primary care clinic in Saint John New Brunswick Canada, through the delivery of an education session for the health care team members and patient screening for ACE. Methods. Staff at one clinic attended an educational program about ACE. Staff completed a pre and post education survey questionnaire (N = 8). Additionally, clinic patients (N= 32) were screened …

Human Trafficking Recognition And Response Training For Sexual Assault Nurse Examiners In New Hampshire Emergency Departments, Carolyn L. Noyes

Doctor of Nursing Practice (DNP) Projects

Human trafficking is a pervasive yet under-recognized public health epidemic. Traffickers use various forms of manipulation to control their victims for the benefit of the trafficker with little regard for the victims’ well-being. This leads to victims of human trafficking suffering short- and long-term health problems. Trafficking victims may subsequently access healthcare during their time in captivity as a result of a direct harm caused to them due to their victimization from neglect, injury or disease. Unfortunately, victims often do not see themselves as victims or are too afraid to let their healthcare provider know that they need help. Warning …

Prevention And Management Of Gastroesophageal Reflux Diseases (Gerd) And Peptic Ulcer Diseases (Pud’S) Among Bhutanese Refugees Utilizing Personalize Patient Education, Sharada Paudel

Doctor of Nursing Practice (DNP) Projects

Background: Bhutanese refugees in the United States frequently suffer from gastrointestinal diseases especially gastroesophageal reflux disease (GERD)and peptic ulcer disease (PUD) which may impact on their quality of life. Purpose: This DNP Project utilized individualized patient education to help improve knowledge on prevention and management of GERD to decrease exacerbations. Methods: Three sessions of individualized live patient education with 15 Bhutanese refugee patients living in Western Massachusetts were provided. Pre and post intervention surveys on patient's symptoms, quality of life, degree of patient knowledge about disease and self-care management and number of ambulatory care visits utilizing the GERD …

Utilizing Motivational Interviewing To Encourage Weight Loss In Primary Care, Wendy Sergeant

Doctor of Nursing Practice (DNP) Projects

Purpose and Background: The purpose of this project was to educate nurse practitioners (NPs) and nurses (RNs) to promote healthy changes in obese individuals using the principles of Motivational interviewing (MI). Obesity is a growing epidemic in the United States with two out of every three adults considered overweight or obese. Their health problems become costly and deadly. Ideally, RNs and NPs are the front line providers in this struggle of obesity because of their philosophy of health promotion. RNs and NPs can screen and address obesity through lifestyle counseling. Motivational interviewing, a proven and effective counseling method, is useful …

The Implementation Of A Faith-Based Heart Healthy Education Program For Latinos In Miami, Florida, Cassandra Zacke

Doctor of Nursing Practice (DNP) Projects

Background: Cardiovascular disease (CVD) has been identified as a leading cause of mortality in the Latino population in the United States. Studies conducted in faith-based settings demonstrate effectiveness in improving the promotion of lifestyle changes.

Methods: This project was a four-week faith-based educational intervention for Latinos meeting weekly at a faith-based organization in Miami-Dade Florida. Classes focused on cardiovascular disease prevention and risk reduction and included PowerPoint presentations, fotonovellas, and interactive activities offered in English and Spanish. Participants were asked to complete cardiovascular disease knowledge questionnaire before and after the educational classes based on the National Institute of Health’s …

Incorporating Complementary Alternative Methods In The Management Of Chronic Pain Into A Primary Care Practice In New York, Vladimir Sher

Doctor of Nursing Practice (DNP) Projects

Background: Pain is a physical, emotional, and psychological symptom that causes discomfort and leads to physiological consequences that can damage tissue, alter neurological pathways, and cause severe psychological distress. The combined use of complementary and alternative medicine (CAM) therapies can reduce pain and lead to an improvement in patient health. Purpose: The purpose of this quality improvement project/evidence-based practice intervention was to review concepts related to pain and analyze the current use of music and massage CAM therapies in a primary care setting.

Methods: The Gate Control Theory was used in this project describing pain as "a category of …

Reduction In Postoperative Infections Using Surgical Care Improvement Project (Scip) Guidelines: A Quality Improvement Project, Irene Smith

Doctor of Nursing Practice (DNP) Projects

Optimal methods for measuring and reporting quality surgical care have predominantly been based on process measures, rather than outcome measures. Efforts to reduce adverse outcomes and increase quality perioperative care, were instituted with the introduction of the Surgical Care Improvement Project (SCIP). These measures were created to reduce postsurgical complications as they have been associated with substantial increase in costs, length of stay and most importantly, patient quality of life and mortality. This quality improvement project focused on four SCIP measures and their effectiveness in reducing post operative infections in lower extremity total joint surgery. Educational sessions regarding infection/complication rates …

Improving Mental Healthcare For Older Adults: Community Based Screening For Social And Emotional Loneliness And Major Depressive Disorder, Eunice Kowalczyk

Doctor of Nursing Practice (DNP) Projects

Abstract

Purpose: Major depressive disorder (MDD) is a devastating mental health disorder affecting older adults that is often misdiagnosed or untreated due to a lack of screening and the stigma that MDD symptoms are a normal and expected part of aging. The goal of this quality improvement (QI) project was to implement a community-based screening intervention to identify community-dwelling older adults at risk for or suffering from MDD, and facilitate further evaluation and care.

Methods: Participants were community dwelling older adults, age 56 and older, in Massachusetts. Two screening tools were administered in two sites that screened for social and …

Timely Transitioning To Hospice: A Needs Assessment With A Pace Program To Improve End Of Life Care, Kristina Kelley

Doctor of Nursing Practice (DNP) Projects

Background: Hospice care has been proven to improve patient outcomes at the end of life. However, patients frequently die without receiving hospice benefits. The challenge of transitioning patients from care with a life prolonging intent to a comfort focused approach can partly be attributed to poor prognostication or misconceptions about hospice. A Program for All Inclusive Care of Elders (PACE) in Massachusetts identified transitioning to hospice as an area for improvement. Purpose: To perform a needs assessment to gain understanding of the barriers to effective transitions to hospice and to provide education aimed at addressing those barriers. Methods: Subjects included …

Reducing 30-Day Heart Failure Readmission Among Elderly Population In Long-Term Care, Nkechi Ukomadu

Doctor of Nursing Practice (DNP) Projects

Background: Heart failure is the leading cause of hospitalization in the United States and accounts for more than one million hospitalizations every year. Readmission within 30 days of discharge is an indicator used for measuring the quality of care for heart failure patients.

Methods: The goal of this quality improvement project was to reduce the 30-day readmission rate of heart failure patients 60 years and older in a long-term care setting in Texas by using an evidence-based transitional readiness discharge checklist for heart failure. Interventions included staff education on the key components and on the checklist. A pre- and …

Quality Improvement: Intimate Partner Violence Screen In Nurse Home Visit Program, Masayo Nishiyama

Doctor of Nursing Practice (DNP) Projects

Purpose: Women are disproportionately impacted from intimate partner violence (IPV). Their children also experience long-term adverse consequences. Effective IPV prevention and intervention efforts are vital. This quality improvement project addressed the lack of an evidence-based IPV training and protocol in a nurse home visit program.

Methods: Stakeholder engagement and an evidence-based practice intervention were implemented. Training effectiveness was examined by the pre-post-training assessments; completed by 17 nurses. To measure the IPV practice change, 196 pre- and 107 post-intervention charts were reviewed.

Results: The training significantly increased nurse knowledge and comfort (t=5.9, p< .001). Only 22% of those referred due to recent IPV history were screened before the intervention; 65% after the intervention. Multivariate analysis of screening rates was performed; predictors included county, mental health status, education, subprogram, and IPV referral reason. Due to low power, a one-tail test was employed. One county was 14 times less likely to screen than the other county (p= .023). 93% of those referred due to IPV history were enrolled in the crisis response subprogram, only offered by the other county. Those referred due to IPV history were three times more likely to be screened (p=.042) than those referred for other reasons. There was no significant change observed on IPV disclosure and intervention practice.

Conclusions: The adoption of an evidence-based IPV training …

Simulation-Based Mental Health Nursing Education, Deanna Dubay

Doctor of Nursing Practice (DNP) Projects

• DNP Project Goal: Provide a simulation-based mental health nursing education experience to pre-licensure nursing students prior to participating in a mental health clinical rotation to reduce anxiety and increase confidence in therapeutic communication and care of the patient with mental health needs.
• Background and Review of Literature: Research suggests nursing students feel anxious about participating in mental health clinical rotation and have decreased confidence in treatment and communication with patients.
• Methods: A quality improvement project was conducted utilizing seven nursing students from a BSN program. The participants engaged in a simulation-based mental health nursing education experience, which …

De Novo Cancer Monitoring For Adult Heart Transplant Patients To Improve Early Detection And Intervention, Angelo C. Mabasa

Doctor of Nursing Practice (DNP) Projects

“De Novo Cancer Monitoring for Adult Heart Transplant Patients to Improve Early

Detection and Intervention”

Abstract

Background. The surgical advancements in orthotopic heart transplantation along with improvements in immunosuppressive drugs increase the survival rate and quality of life of heart transplant recipients. However, the prolonged use of immunosuppressive medications increases the risk of infection and related cancer. Solid organ transplant recipients have approximately two to three-fold higher risk of developing de novo cancers. Thus, modulation of immunosuppression regimen and cancer screening appear as key factors in preventing and treating de novo cancer among solid organ transplant recipients.

Purpose: The purpose …

Screening For Trauma In The Foster Care Community, Catrina Graham

Doctor of Nursing Practice (DNP) Projects

Children within the foster care community experience health disparities on a variety of levels, from physical and mental health conditions, developmental delay, and impaired social interactions. Many of these conditions can stem from the experience of trauma or adverse childhood events that color each component of their lives. For healthcare providers to be successful in the assessment and treatment of this community, an understanding of traumatic events and the delivery of trauma-informed care is essential. The complex needs of this community are such that the provision of healthcare must be specialized, multidimensional, and organized. The purpose of this project is …

Mitigating Prescription Opioid Risk: Prescription Drug Monitoring Programs, Brenda Vigue

Doctor of Nursing Practice (DNP) Projects

Background: Opioid-related morbidity and mortality is a serious public health issue in the United States. Prescription Drug Monitoring Program (PDMP) review prior to prescribing opioids has consistently been recommended as best practices for risk mitigation, however, access/utilization of this monitoring program remains low.

Methods: This quality improvement (QI) project for improved PDMP utilization employed a pre-post survey design in a random sample of Advanced Practice Registered Nurses in Arizona. Quantitative measures included online surveys with close-ended responses to salient items from the review of literature and best practices. A follow-up survey was requested of the participants who provided their …

Implementing A Protocol To Monitor Cardiometabolic Syndrome In Patients Prescribed Atypical Antipsychotics, Svetlana Valkovska

Doctor of Nursing Practice (DNP) Projects

Atypical or second-generation antipsychotics (SGAs) are a vital part of the management of many psychotic disorders, as well as behavioral and psychological symptoms. However, these medications have serious cardiometabolic complications, such as an increase in obesity, glucose intolerance, dyslipidemia, and hypertension, and can place the patient at serious risk for cardiovascular disease. The American Diabetes Association (ADA) and the American Psychiatric Association (APA) recommend clinical guidelines for metabolic screening, which requires the regular monitoring of patients treated with SGAs (ADA, 2004). The goal of this quality improvement project was to 1) implement a metabolic screening protocol based on ADA and …

Self-Management Of Dyspnea In Chronic Obstructive Pulmonary Disease Patients., Juliet Marcia Farrell

Doctor of Nursing Practice (DNP) Projects

Background: Patients with chronic obstructive pulmonary disease (COPD) exacerbation are reported to have a decreased quality of life relating to their health. In 2015 it was reported that over three million COPD patients died as a result of their disease. Although COPD patients are receiving medication, they still struggle with dyspnea as they carry out their daily activities.

Purpose: To implement an evidence-based educational program to assist COPD patients in self-management of dyspnea.

Methods: The DNP student obtained consent from prospective participants and assigned a unique identifier, which included his or her first and last initial and three digits. …

Hiv Education And Empowerment A Program For The Women Of Kiryabicooli, Uganda, Emily Rymland

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: HIV continues to be a serious health, social and economic burden in Uganda. Early in the epidemic, the government’s rapid response brought the HIV infection rates from 30% in the 1990s to 4% by 2000, however rates are rising with some district’s reporting the HIV rate rising up to 7.8%. Myths surrounding transmission, disease progression and treatment compound the country’s vulnerability. The goal of this Quality Improvement project is to educate women with children under 13 years old about the facts of HIV, in the hopes that with that knowledge they can take action to decrease their own …

A Public Health Initiative To Support The Development Of A Trauma Informed Care Culture In A Community Organization That Provides Services To Individuals With Developmental And Intellectual Disabilities, Lisa Coenen

Doctor of Nursing Practice (DNP) Projects

Background: Trauma informed care (TIC) is a socio-ecological theoretical approach for universal practice focus to improve HRQOL and wellbeing outcomes. There is a gap in TIC system implementation for vulnerable populations, including the ID/DD population.

Purpose: The purpose of this project was to transfer knowledge to a newly created TIC work group on the use of an existing TIC system implementation tool to plan, develop, and measure the level of TIC systems culture in their community organization.

Methods: Knowledge transference through the utilization of a TIC systems implementation process map, TIC education, and the facilitation of a …

Using Mobile Health To Improve Mild Depression Outcomes In Adult Primary Care, Michele Marek

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Mild depression is a common patient complaint in primary care, potentially impairing role function in multiple dimensions, with risk for escalation to severe Major Depressive Disorder (MDD), a chronic, recurring illness with multiple comorbidities at high emotional and economic cost to individuals, families, and society. Barriers to care include lack of access to Mental Health Specialists, financial constraints and stigma, all of which can cause escalation of symptoms to the point of disability and are magnified in underserved populations.

Purpose: The primary goal of this quality improvement (QI) project was to improve depression symptoms using the evidence-based mobile …

Program Evaluation Of An Easy Access Clinic For Effective Contraception For U.S. Active Duty Women In Okinawa, Japan, Cynthia Kuehner

Doctor of Nursing Practice (DNP) Projects

Background: Unintended pregnancy in the United States (U.S.) is a significant health problem that takes on additional magnitude in the context of military service. Young, active duty women have higher unintended pregnancy rates compared to the general population, secondary to non-use of contraception or selection and use of the least effective methods (condoms and oral contraceptive pills). The literature validates the problem, identifies access barriers to highest-efficacy contraception options in primary care settings, and offers evidence-based, best practice opportunities to impact this public health challenge.

Purpose: The purpose of this project was to evaluate access, utilization, effectiveness, and patient satisfaction …