Medicine and Health Sciences Commons^™

Ontrack: A Program Evaluation, Justin Mynatt

Doctoral Projects

OnTrack is a program that provides coordinated specialty care (CSC) services for patients who have experienced their first episode of psychosis (FEP). Appropriately identifying and aggressively treating this vulnerable population, while providing support to both them and their families is critical for improved outcomes. Appropriate treatment of FEP patients can improve their quality of life, preserve brain matter, improve overall functioning, and lessen the burden of the clients’ family who may be involved in their care, such as caregiver strain or financial hardship. The purpose of this project is to evaluate the success of OnTrack, a FEP program, at improving …

Comparison Of A Self-Audit Tool To Accrediting Health Care Agencies’ Standards Of Care In A Corrections Setting, Matthew C. Widerman

Doctoral Projects

Millions of individuals enter correctional facilities each year and require health services. Inmates are bound to a set of rules, wherein they are thought of as objects of surveillance, punishment, or rehabilitation, rather than as patients. In addition to standards of care defined by national accrediting bodies and state boards of practice, correctional facilities also have state laws that define expected health services for incarcerated persons. All health care providers have a responsibility to provide the highest quality care, but in prisons, patients are still inmates bound to correctional rules. Policies and procedures guide health care practices in correctional facilities, …

A Quality Improvement Project To Determine The Incidence And Prevalence Of Obstructive Sleep Apnea, Best Practice Anesthesia Guidelines, And The Incidence Of Perioperative Cardiac And Respiratory Complications After The Implementation Of The Stop-Bang Questionnaire, Bradly Diamond, Gregory Guerrier, Cody Holliman, Robert Marrero, Tyler Nelson

Doctoral Projects

Patients with obstructive sleep apnea (OSA) are at risk for perioperative respiratory and cardiovascular compromise (Opperer et al., 2016). Unfortunately, almost 90% of patients with moderate-to-severe OSA are not diagnosed and unaware of their disorder; however, they remain at increased perioperative risks (Singh et al., 2015). The STOP-BANG questionnaire was developed to meet the need for a reliable, concise, and efficient screening tool for OSA risk. The facility at which this project was conducted did not utilize a prescreening OSA risk tool. The facility not using a prescreening OSA risk tool is especially important because the State of Mississippi currently …

Opioid Abuse Among Student Registered Nurse Anesthetists In The United States: A Policy Change Proposal, Ifeoma P. Anakor

Doctoral Projects

Opioid abuse among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) is an epidemic that is growing in numbers yearly. The number of deaths from opioid abuse is also increasing. The specialty of anesthesia primarily has increased instances of opioid abuse cases (Wright et al., 2012). The reason for the increase in opioid abuse occurrences is because anesthesia providers regularly administer opioids in patient care. Opioid abuse commonly results in injury or death. While abusing, anesthesia providers are not only putting their lives in jeopardy but also the lives of their patients.

The project observed the opioid …

Implementation Of A Self-Care And Wellness Educational Program Addressing Job Stress Among Child Protective Service Workers, Natonya Murray

Doctoral Projects

Job stress attributed to secondary exposure to trauma and the high work demands put child protective service workers at high risk of developing physical and psychological health problems. The purpose of the project was to develop and implement a self-care and wellness educational program addressing job stress among child protective service workers (CPS) guided by Substance Abuse and Mental Health Science Administration’s (SAMSHA, n.d.b) educational toolkit, Promoting Staff Wellness and Preventing Vicarious Trauma and other Work Force Concerns, the Centers for Disease Control and Prevention’s (CDC, 2019c) section on Adverse Childhood Experiences, and the National Council for Community Behavioral …

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

Increasing Patient Satisfaction Survey Response Rate At An Ambulatory Surgery Center, Carlee Nicholson

Doctoral Projects

In an effort to increase distribution rate and response rate of the patient satisfaction survey at this ASC, adjustments were made to current processes. These interventions included accentuating the option of a paper or emailed survey, providing pre-operative and post-operative response prompts, as well as adding a cover letter to the existing survey. The purpose of these interventions was to ensure a 100% distribution rate of the survey as well as to increase the response rate by 20%.

Results were obtained by collecting forms to monitor distribution of the survey. The response rate was calculated by the number of responses …

Implementing Screening To Assess Readiness To Change In Overweight And Obese Patients At A Patient-Centered Medical Home, Jarrod Gant

Doctoral Projects

Obesity is at epidemic levels within the United States (U.S.), but the Southern U.S. has some of the most obese states. Mississippi (MS) is the most obese state in the country (Robert Wood Johnson Foundation, 2018). Factors such as diet, sedentary lifestyle, cultural influences, and socioeconomic status contribute to the state’s citizens being overweight and obese.

Contributing to the state’s obesity is the fact that MS has more people living in poverty than any other state (Center for American Progress [CAP], 2018). Lacking the ability to afford healthy foods and the ability to afford quality healthcare adds to the state’s …

Developing A Local Anesthetic Systemic Toxicity Protocol In A Mississippi Hospital, James Dearman, Terry J. Tieman

Doctoral Projects

Local anesthetic systemic toxicity (LAST) is a rare complication of administering local anesthetic medications. However, this complication is potentially deadly, especially without prompt and correct treatment. Due to the rarity of LAST and the fact that its treatment differs from the conventional treatment of cardiac arrest, the authors sought a best practice recommendation to guide its treatment. While the most effective treatment for LAST has been well established, a thorough review of literature and survey of clinical preceptors demonstrated that most providers have not encountered LAST in clinical practice. Additionally, lipid emulsion therapy is a somewhat controversial treatment among some …

A Market Analysis Of Pay Rates For New Graduate Certified Registered Nurse Anesthetists, Zachary Halliwell

Doctoral Projects

The profession of Certified Registered Nurse Anesthetists (CRNA) is a thriving occupation. In their national Occupational Outlook Handbook, the Bureau of Labor Statistics (U.S. Department of Labor, 2018), reported the national market for CRNAs is predicted to continue its steady growth through 2026. The Bureau of Labor Statistics (BLS) provides numerous statistics, as previously mentioned, on their website. However, the stats available include CRNAs of varying experience levels. The Mississippi Department of Employment Security (MDES) has a few statistics, online, regarding the market for CRNAs. The data provided by MDES, while appreciated, is lacking in numerical significance, given the minuscule …

Evidence-Based Best Practice Policy Recommendation For Postoperative Sore Throat, Corey Gambrell

Doctoral Projects

Airway management is a fundamental aspect of patient care when general anesthesia is being administered. Unfortunately, tracheal intubation can lead to the development of postoperative sore throat (POST) in the recovery room. POST is a minor yet preventable consequence of manipulation and injury of the airway mucosa. POST is routinely considered a minor postoperative complication; however, the occurrence of POST can have a negative influence on patient satisfaction as well as their perception of the perioperative experience. The etiology of POST is multifactorial, but evidence indicates that prevention is possible when evidenced-based practices are employed by anesthesia providers. A targeted …

Introduction Of Auricular Acupuncture, Monica Lyons

Doctoral Projects

The overall purpose of this quality improvement project was to assess if there was an interest to add auricular acupuncture to a substance abuse program. The two guiding questions of the Doctor of Nursing Project were (a) how can auricular acupuncture be helpful when treating patients with substance abuse in a selected organization? (b) what information is needed for both staff and patients to make an informed decision regarding auricular acupuncture? The Promoting Action on Research Implementation in Health Services (PARiHS) framework was used as the theory framework for implementation of evidence-based research into an organization. The facilitator in the …

Evidence-Based Cardiac Monitoring: A Practice Change, Joseph Paul Urbanski

Doctoral Projects

Background: Overuse of cardiac monitoring (CM) in acute care settings contributes to increased healthcare spending and cost of services for patients. Additionally, inappropriate use of CM can contribute to wastefulness of healthcare resources, increases in hospital staff workloads, and can be improved with best evidence-based practice recommendations. A Midwest acute care hospital lacked an evidence-based, systematic method to define care for patients requiring CM.

Objective: The purpose of the project was to pilot an evidence-based CM change initiative, determine feasibility for sustainment, and propose next steps for adoption of the change initiative across non-emergency department, non-intensive care inpatient CM units …

Optimizing Clinical Processes Using The Electronic Health Record To Improve Patient Outcomes In Primary Care, Alex Jubril

Doctoral Projects

Background: The EHR has been used to leverage clinical processes for the improvement of patient outcomes. The average users of EHR limit its uses to the minimum level required to complete the daily tasks needed, regardless of the existence of features within the EHR that are readily available to optimize clinical processes for efficiency and effectiveness.

Objectives: The objective of this project was to improve the documentation in a nurse-managed health clinic related to the patient-centered medical home (PCMH) core criteria through enhancing the EHR to foster the quality improvement metrics and reporting.

Methods: This was a quality improvement project …

Prior Authorizations And Continued Treatment In Addiction Medicine, Wendy Hunting

Doctoral Projects

Introduction: Patients that require medication assisted treatment for opioid addiction can have their treatment delayed through the prior authorization process. A prior authorization is required by many insurance companies and can cause lengthy delays before the drug is approved. The two drugs that were considered for this project were Suboxone® (buprenorphine/naloxone) and Sublocade® (buprenorphine). These drugs are used for the treatment of opiate addiction. The proposed solution to the problem was to use quality improvement methods to implement a tracking and tickler system to improve the approval time from the insurance company.

Objectives: The project goal was to decrease the …

Comparing Two Surgical Outcomes: Minithoracotomy Or Full Sternotomy In Coronary Artery Bypass Grafting Surgery, Shirin Badrkhani

Doctoral Projects

Cardiovascular diseases and heart-related conditions can be life-threatening; however, some cardiovascular conditions can be managed with open heart surgery. Coronary artery bypass grafting (CABG) is the most common type of heart surgery performed on adults. There are two different surgical procedures to correct cardiac defects: mini-thoracotomy and full sternotomy. Mini thoracotomy approach has been shown to reduce complications, such as pneumonia, excessive blood loss, and infection in mitral valve repair surgeries. However, little research has been done to compare these two surgical approaches performed for patients undergoing coronary artery bypass grafting (CABG).

Specifically, there is inadequate data to compare these …

Barriers In Hypertension Management Among Culturally Diverse Patients In An Urban Urgent Care Setting, Navpreet Kaur

Doctoral Projects

Hypertension is the leading cause of deaths related to cardiovascular disease conditions. A vast number of patients are not taking their medications as prescribed by the physicians. This non-adherence to hypertensive treatment plans results in increased numbers of cases of unstable blood pressure. Medication adherence will help to manage the controllable cardiovascular diseases and will automatically decrease the incidences of emergent cases in hospitals and urgent care clinics. It will further decrease the costs of diagnostic evaluations used during the emergent visits. This decreased patient load in the emergency rooms will improve quality patient care. The study timeframe of data …

Understanding The Skills Necessary For Advanced Practice Nurses In Oncology To Deliver Bad News To Patients With Cancer: The Results Of A Delphi Analysis, Matthew Michael Burke

Doctoral Projects

Overcoming the dichotomy of providing bad news in a compassionate, empathetic manner that strengthens dialogue and enhances a caring environment is the ultimate challenge advanced practice nurses (APN) face in oncology. This study aims to understand the skills necessary for APNs in oncology to deliver bad news to patients with cancer.

Using a Delphi analysis, an established method of developing a consensus, a novel, patient-centered survey tool has been developed designed to extract as much information as possible about the present issue from an expert panel. Oncology APNs were recruited via Facebook. The survey tool was administered using a web-based …

Comparison Of A Numeric And A Descriptive Pain Scale In The Occupational Medicine Setting, George Francis Mcmahon Iii

Doctoral Projects

Pain is a universal phenomenon. The assessment of a patient’s pain is difficult to objectively obtain because the perception of the pain by the patient is influenced by many subjective perception variables. These variables can inflate or deflate the patient’s self-reported pain level which can adversely affect the medical provider’s ability to accurately create a treatment plan for the patient. This study compared the patient’s response to a self-rating of their pain on a numeric pain scale with the response given by the patient on the Mankoski pain scale. Comparison of the numeric pain scale to the Mankoski pain scale …

Surgical First Assist: An Educational Program For Advanced Practice Providers, Sandra Walton Mobley

Doctoral Projects

As the number of surgical procedures increase, many Advanced Practice Providers (APPs) are being required to scrub in as a First Assist (FA). Unfortunately, many APPs lack any formal surgical training. The Association of perioperative Registered Nurses (AORN) now requires that all advanced practice providers in the perioperative environment to complete a course that complies with Registered Nurse First Assist (RNFA) standards. The purpose of this project was to evaluate knowledge acquisition of APPs participating in a surgical FA educational program. A surgical FA course was comprised of five days of didactic learning, which included lecture, small groups, skills lab, …

The Effect Of Basal Bolus Insulin Administration Vs. Sliding Scale Insulin On Glycemic Control In Patients With Type 2 Diabetes Mellitus At A Community Hospital, Meriam Signo

Doctoral Projects

Evidence of effective insulin delivery by nurses can help prevent fluctuating plasma glucose levels of Type 2 diabetes mellitus (T2DM) in the hospital setting. Information leading to better diabetes care using either basal bolus insulin administration (BBI) or sliding scale insulin (SSI) is essential for safe blood sugar values. The purpose of this project was to measure patient glycemic control after the implementation of BBI vs. SSI during a patients’ stay in the hospital. This study was a quantitative, retrospective exploratory chart review of T2DM in medical-surgical units at a Northern California community hospital. The data were collected from routine …

Identifying Perceived Barriers To Primary Health Care Access In Rural, Medically Underserved Areas, Suzanne Hewitt

Doctoral Projects

Persons living in rural areas designated as having primary care provider shortages often lack access to timely and appropriate levels of care, frequently forcing them to forego care, delay treatment, or seek care in an emergency department for non-urgent complaints. This qualitative study reviewed evidence-based research and data generated from two focus groups sessions to generate a body of distinctive knowledge of the barriers to primary healthcare access as perceived by members of this rural, medically-underserved area of northern California. The theme that was identified, through conventional qualitative content analysis, as most prevalent among subjects was the inability to schedule …

Exploring Ways To Improve Healthcare Access For The Homeless Population In Merced County, Stella Nwasoka Adesokan

Doctoral Projects

Homelessness is a societal dilemma that affects people in the United States and around the globe. Homelessness relates to poor health conditions that affect the living conditions of individuals (Institute for Urban Initiatives, 2018). Chronic and acute illnesses are rampant in this group, most of these illnesses are treatable but accessing healthcare poses a challenge for this vulnerable population. Homeless persons are often unable to access healthcare due to fear and denial of ill health, difficulty in communicating health needs, and low self-esteem (Lamb & Joels, 2014).

In the study, questionnaires were administered to 25 homeless individuals through random sampling. …

Human Papillomavirus Vaccine Program, Magdalena Ruiz

Doctoral Projects

Pediatric primary care focuses on maintaining patients’ health, preventing diseases, and assessing children’s developmental milestones. Vaccine administration and disease prevention are key components of a well-child exam for pediatric patients; however, vaccine refusal is an important complication of pediatric patient care. Of particular interest to this researcher is the HPV vaccine which was approved by the Federal Drug Administration and is currently recommended by the Centers for Disease Control and Prevention (2016) for both males and females, beginning at 11 or 12 years of age through age 26 years. The HPV vaccine protects against diseases and cancers caused by the …

Barriers In Health Care In Hmong Men And Women With Cardiac Diseases, Ying Thao

Doctoral Projects

Lauver’s theory of care seeking behaviors is applied to identify perceived barriers to accessing healthcare in Hmong men and women that may influence care seeking behaviors. The purpose of this study is to identify barriers in accessing health care among Hmong men and women ages 50 to 80 with cardiovascular heart disease (CHD) and risk factors for CHD (e.g., diabetes, hyperlipidemia, and hypertension). A quantitative descriptive analysis was used to look at demographic characteristics while a multiple regression analysis was used to statistically compare correlations between barriers to care, risk factors for CHD, sex, and access to health care. The …

A Retrospective Chart Review Pilot Study Of Fall Prevention Through A New And Innovative Care Model, Lydia Smith

Doctoral Projects

According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury-related mortality in the geriatric population, and they are the most common cause of brain injury and hip fracture. The prevalence for falls is 30% in patients over 65 in the United States who experience a fall annually, and the prevalence in dementia patients can be up to 80% annually; the consequences of falls can include injury, reduction in mobility, depression and decreased socialization with peers (CDC, 2015). The purpose of this retrospective chart review pilot study is to examine the number of falls …

Nurses’ Perception Of Discharging The Medically Complex Pediatric Patient, Stacie Camille Licon

Doctoral Projects

The purpose of this study is to query the nurses for their perceptions of the barriers and facilitators of discharging medically complex pediatric patients from a freestanding children’s hospital in central California. Using a mixed methods research design via an online survey, 90 nurses identified 3 distinct themes that act as barriers. Those barriers include: 1) knowing the plan of care, 2) time, and 3) disposition of the family. Several implications for improving the discharge process for medically complex patients and overcoming the identified barriers include strategies to improve multidisciplinary communication, implementation of a Family Learning Center, use of video …

Advanced Informatics Competencies Of Nurses At Sutter Maternity And Surgery, Jessica Liston

Doctoral Projects

Today, the profession of nursing requires the integration of many sciences and skill sets in order to care for the increasing acute and chronic illness in our patient populations. In order for nurses to safely care for patients in highly technological environments, they must integrate knowledge from Nursing Informatics (NI), to advance the profession, deliver safe high-quality patient care and effective documentation that drives improvement in patient outcomes. When nurses have an understanding of advanced NI skills, they are better equipped to become super users that train and lead teams in optimization of electronic health records (EHRs) to support them …

Identifying Predictors Of Airway Complications In Conscious Sedation Procedures, Rosemary Bray

Doctoral Projects

Problem: Conscious sedation procedures are complicated by unanticipated airway compromise and obstruction. The STOP-Bang questionnaire (University of Toronto, 2012) is a validated obstructive sleep apnea (OSA) screening questionnaire used as a pre-procedure evaluation tool to assess a patient’s risk for OSA. There are four verifiable, objective questions and four subjective questions. This study examines to what extent the STOP-Bang score question variables reliably predict airway complications during conscious sedation procedures.

Method: The method was a retrospective review of data from the electronic medical record (EMR) of patients who had conscious sedation for endoscopy procedures. The individual questions of the STOP-Bang …

Pilot Study: Program Evaluation Of Peanut Oral Immunotherapy In A Private Clinic, Kinga Olson

Doctoral Projects

The privilege of providing a therapy perceived by patients and families as “life changing” has seasoned physicians describing food oral immunotherapy (OIT) as one of “the most impactful and rewarding thing that they have done in medicine” (Wasserman, Jones, & Windom, 2018). OIT is a medical treatment that allows the immune system to become desensitized to a food to which it may otherwise be allergic. This is not a cure for food allergies but a way to decrease the incidence of anaphylaxis due to accidental ingestion. Living with food allergies can be distressing due to the daily fear of exposures. …