Medicine and Health Sciences Commons^™

Optimizing The Implementation And Dissemination Of The Recovery Model Approach, Lani Schofield

Master's Projects and Capstones

For a period of nine months spanning 2018 and 2019, monthly patient satisfaction survey scores in a 22-bed sub-acute inpatient psychiatry unit at a safety-net hospital in California decreased significantly, which revealed that patients felt they were not receiving satisfactory care and which warranted calls for innovative approaches to improve care delivery. The patient experience of care affects recovery and length of stay. Because prolonged hospital stays result in increased costs and increased use of healthcare resources in hospital units, including sub-acute psychiatric microsystems, it benefits hospitals to improve the quality of patient care. In an effort to improve quality …

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 …

An Evidence-Based Intervention To Reduce The Use Of Physical Restraints In A Female Adolescent Population At An Inpatient Psychiatric Unit, Mambo Ndingwan

Doctor of Nursing Practice

The use of physical restraints within psychiatric units is problematic since it raises a range of legal, ethical, and clinical questions (American Psychiatric Nurses Association, 2014). The use of physical restraint has become a common practice in many psychiatric units despite the negative effects associated with its use. Selecting strategies such as verbal de-escalation to manage aggressive psychiatric inpatients shows promise with patients when used by providers and staff in mental health facilities. The purpose of this evidence-based project was to introduce and train staff to utilize the Modified Overt Aggression Scale (MOAS) and verbal de-escalation in psychiatric units in …

Program Evaluation Of An Aprn-Led Home-Based Psychiatric Care (Hbpc) Program For Vulnerable Geriatric Patients, Stacey A. Poole

Doctor of Nursing Practice

Background: Mental illness remains under-treated in older adults, especially those that are home-bound. In response to access to care gaps, an innovative advanced practice registered nurse led Home-Based Psychiatric Care program was developed as an adjunct to an established home-based counseling agency. The program involves the research supported provision of home-based psychiatric evaluations and medication management by the agency’s PMHNP. Purpose/Objectives: To evaluate the HBPC Program’s effectiveness at increasing access to timely and effective psychopharmacological treatment and management as evidenced by: (a) an increased percentage of referred patients who are being managed by the agency’s PMHNP, (b) a decrease in …

Implementing A Cognitive Impairment Care Planning Toolkit To Enhance Dementia Care: A Quality Improvement Project, Raquel Garcia-Priestly

Doctor of Nursing Practice

Background: Alzheimer’s is the most expensive disease in the United States with costs reaching $277 billion a year and affecting 5.7 million Americans. By 2050, 14 million Americans will have Alzheimer’s disease and related dementias (ADRD). This burdensome disease not only affects the individual, but also those who are responsible for their care, making it extremely complex to manage. Purpose: To systematically integrate the Alzheimer’s Association’s Cognitive Impairment Care Planning Toolkit in an outpatient mental health clinic to enhance care by effectively addressing the needs of patients with ADRD and of their caregivers. Objectives: Increase the number of patients with …

Improving Provider Adherence To Guidelines And Screening For Adult Depression In Primary Care, Amber Crenshaw

Doctor of Nursing Practice

The purpose of this QI project was to improve provider adherence to the Institute for Clinical Systems Improvement (ICSI) Guidelines for Adult Depression in Primary Care to enhance the screening, diagnosis, treatment, and management of adult major depressive disorder (MDD). MDD is a widespread, disabling, and treatable psychiatric disorder that is primarily treated and managed by primary care providers (PCPs). Untreated depression is prone to become chronic and can lead to pain, suffering, disability, increased morbidity and mortality, and premature death, with serious repercussions for the individual and society. Universal and routine screening in primary care for depression in adults, …

A Quality Improvement Initiative To Improve Depression Screening In Prenatal And Postpartum Mothers, Britanni Greene

Doctor of Nursing Practice

Screening for depression during the prenatal and postpartum period is essential. The United States has the highest mortality rate in the developed world, with mental health complications being 1 of the top 5 reasons women expire within the 1st year of childbirth. The purpose of this quality improvement project was to increase depression screening during the gestational and postpartum periods in an obstetric and gynecological clinic. An administration schedule was created to administer the Edinburgh Postnatal Depression Scale (EPDS). The EPDS was administered during the initial prenatal, 32-weeks prenatal, and 6-week postpartum appointments. Women scoring 10 or higher on the …

The Usage And Impact Of Outpatient Commitment Orders On Suicide And Suicide Attempt Rates In Mississippi, Sam Mauldin

Dissertations

Rates of self-harm and suicide in the United States have not decreased since 1980 and remained relatively constant through the start of the 21^st Century. The most recent data indicate that suicide rates in the United States have risen by about 2% a year from 2006 through 2016, although suicide rates have decreased in other countries during the same timeframe. Finding a viable intervention to slow rates of self-harm and suicide is needed in the United States. The need for closer patient observation has been cited as an underutilized intervention for the reduction of attempts of self-harm and suicide. …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

The Nurse As The Facilitator Of Patients' Narration: An Educational Intervention, Petra Stockman

Electronic Theses and Dissertations

More than one million resident patients live and receive care at certified long-term facilities in the United States, many of whom suffer from depressive symptoms and anxiety. Prior research recommended storytelling as a vibrant nursing intervention to assist long-term care residents in overcoming challenges and emotional pain. However, nurses frequently lack knowledge of successful planning and implementation of narrative reminiscence. This scholarly project was designed to increase nursing competence and confidence in using storytelling as a clinical tool to improve mental health in long-term care, using a quasi-experimental, nonrandomized pretest, intervention, and posttest study design. A convenience sample of 10 …

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 …

Treating Substance Use Disorders: Enhancing Attendance At The Weekly Inpatient Medication Assisted Treatment Group, Devon Gillis, Jayne Weisberg, Dena Whitesell, Amy Mcauliffe, Amy Sparks, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Operations Transformation

At a large academic tertiary medical center, an Integrated Medication Assisted Treatment (IMAT) program has been established for those medically stable inpatients with an addiction diagnosis. Over a four month period, this program had experienced a decline in attendance and a quality improvement project was initiated is to better understand the barriers to attendance and institute a process that would reverse the decline.

A goal was established to improve attendance by medically stable patients that have consented to participate to a minimum of 50%.

A root cause analysis outlined numerous causes for low attendance and several countermeasures were established to …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

The Effectiveness Of Psychotherapy In The Treatment Of Postpartum Depression, Elisa De Feo

Grace Peterson Nursing Research Colloquium

ABSTRACT

Background: Suicide is the second leading cause of death in postpartum women making it a major health priority. Lack of diagnosis, recognition of symptoms, and proactive treatment of postpartum depression (PPD) can lead to devastating effects on the mother and child such as harm or death. The intervention of psychotherapy is recommended as a first line treatment for PPD and is a means by which PPD can be reduced or avoided altogether. This integrative literature review seeks to discover if there is an opportune time in which to initiate psychotherapy interventions in order to reduce or prevent PPD development …

Interventions In Hospice Caregivers’ Coping Mechanisms, Ollie Urbanski

Grace Peterson Nursing Research Colloquium

Abstract

Background: There is an increasing awareness, and need for, hospice services in the United States. While some may choose to receive their care in an inpatient setting, many prefer the comforts of home. When they receive their care at home, their loved ones end up shouldering many of the burdens of that care. There is a noticeable lack in support for this specific population of caregivers.

Objectives: The purpose of this integrative literature review is to investigate current best practices in regards to coping mechanisms for informal hospice caregivers and to analyze potential areas for development of research in …

Prison And Its Effects On The Health Outcomes Of Hiv Positive Black Men Post Incarceration, Samuel Gaines

Grace Peterson Nursing Research Colloquium

Prison and its Effects on the Health Outcomes of HIV Positive Black Men Post Incarceration

Samuel T. Gaines

Faculty Sponsor: Young-Me Lee, PhD, RN

Background: With an estimation that one in three Black men will be incarcerated in their lifetime and that incarcerated Black men are five times more likely to be diagnosed with HIV than their white counterparts, there is little information as to what factors affect their health outcomes post-incarceration.

Objectives: The purpose of this literature review is to use current research to explore the factors affecting the negative health outcomes of HIV positive African American men post-incarceration. …

Emergency Department Nursing Psychological Care (Early Crisis Intervention) For Adult Victims Of Violent Crime: A Quantitative Study, Barbara Conn

Electronic Theses and Dissertations

Recognition of the significance of early interventions and the importance of addressing psychological trauma for the victim of violence is of utmost importance for quality of life and the victim’s future. The serious impact of psychological trauma on victims of violent crime supports further study to determine whether Emergency Department (ED) nurses assess this trauma and initiate early interventions and referral for ongoing psychological care. Nursing care, assessment and early intervention with victims of violent crime was the focus of this dissertation study.

A quantitative study, with a non-experimental, descriptive design employed retrospective chart reviews to determine whether ED nurses …

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 …

The Link Between Genetics And Depression, Rachel Shirey

Nursing Student Class Projects (Formerly MSN)

This paper examines the link between genetics and depression. Information was gathered and reviewed from multiple studies. Signs and symptoms of depression, the pathophysiology of environmental and genetic factors, and the significance of the pathophysiology were explained. Additionally, nursing implications regarding genetics and depression are discussed.

Exploring The Mental Health Care Experiences Of Youth Transitioning From Paediatric To Adult Psychiatric Services Using The Photovoice Method: A Participatory Analysis Of The Photostream Project, Brianna Jackson

Electronic Thesis and Dissertation Repository

The transition from adolescence to adulthood brings with it many new challenges and stressors that may negatively impact psychosocial wellbeing. Unfortunately, the disjointed progression from paediatric to adult psychiatric services leaves transitional-aged youth (TAY) vulnerable to its deleterious sequelae, including social isolation, self-harm, substance use, and suicidal ideation. As devised, the Canadian mental health sector is ill-equipped to meet the care demands of emerging adults, resulting in undue suffering. Current evidence validates the need for clinical practice reform and policy revision to address this issue, yet the perspectives of young people are consistently underrepresented in conversations regarding youth-oriented psychiatric program …

Barriers To Mental Health Treatment In Patients Referred By Primary Care, Rebecca Palmer

Dissertations

Problem: Limited access to mental health treatment is one of many potential barriers to treating mental illness in the United States. Where resources are readily available, reportedly high no-show rates for established mental health appointments suggests further investigation is necessary to identify frequent barriers within that population. This was a quality improvement project to identify common themes in patient-reported barriers to care.

Methods: A 4-question phone survey was offered to individuals that did not appear at their mental health appointment. Data was analyzed to identify the most commonly reported barriers to mental health treatment. Additional data collected includes reported history …

Depression Screening In Antepartum Females, Michelle Burk

Dissertations

Problem: Perinatal mood disorders, including depression, affects one in five pregnant or postpartum females. The American College of Obstetricians and Gynecologists (ACOG) and the US Preventative Task Force (USPTF) recommended screening for depression at least once during the antepartum and postpartum periods. The purpose of this quality improvement initiative was to introduce depression screening using the patient health questionnaire (PHQ) in antepartum women in a Midwestern private OB-GYN practice.

Methods: An observational, descriptive, cohort design utilizing a retrospective record review was used to evaluate for PHQ depression screening. A convenience sample of antepartum patients at/or around 36-weeks gestation was studied. …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Understanding The Impact Of A Perinatal Mood And Anxiety Disorders Phone Support Line, Diana Nguyen, Semira Semino-Asaro

Doctor of Nursing Practice Final Manuscripts

Postpartum depression affects one in every seven women and anxiety is estimated to range from 13-21% in new mothers. Risk factors include prior diagnosis of depression, family history of depression, having medical complications during childbirth including a premature baby and a lack of social, emotional support. The purpose of this evidence-based practice project was to increase the amount of data gathered by a local perinatal support organization by analyzing the callers’ demographics through phoneline surveys and use the information to expand resources and access to care for mothers with perinatal mood and anxiety disorders (PMADs). The project was guided by …

Comprehensive Sleep Apnea Screening In Veterans With Posttraumatic Stress Disorder, Richard W. Schulz

Doctor of Nursing Practice Final Manuscripts

Objectives: Recent studies have shown a higher prevalence of sleep apnea in veterans with Posttraumatic Stress Disorder (PTSD). It is estimated that 69 to 83% of veterans have Obstructive Sleep Apnea (OSA) while 80 to 90% are undiagnosed or untreated. Untreated OSA can lead to severe chronic medical conditions as well as impairment of neurocognitive and fear extinction processing potentially decreasing responsiveness to trauma focused therapy. Despite the widespread dissemination of knowledge regarding the negative effects of OSA, many veterans are not screened. The goal of this project is to increase the rate of identifying veterans who are high-risk for …

Do Not Miss Your Shot: Improving Follow-Up In Patients Receiving Long-Acting Injectable Medications, Mary O'Hara

Doctor of Nursing Practice Final Manuscripts

Background: Serious mental illness including schizophrenia and bipolar disorder affects 1 in 24 adults in California. These chronic disorders are difficult to treat and often sabotaged by medication nonadherence. Long-acting injectable (LAI) medications are one strategy to combat medication nonadherence. Effectively providing treatment with LAI medications can be challenging at the clinic level.

Objectives: Reduce the number of days without medication by reducing the number of days between injection due date and injection administration for patients receiving LAI medications.

Design: Establish appointments for all injection visits. Standardize visit protocol for injection encounters to optimize provider time. Arrange immediate follow-up and …

Perinatal Mood And Anxiety Disorders, Stigma, And Social Support Among Postpartum Women, Ellen K. Fleischman

Dissertations

Purpose/Aims: The purpose of this descriptive, correlational, cross-sectional study was to examine the relationships among perinatal mood and anxiety disorder (PMAD) symptomatology, select demographics, stigma of mental illness, and social support, among inpatient postpartum women. Rationale: PMADs affect as many as 21% of childbearing women, yet these disorders are identified and treated less than half the time. There is a gap in the literature regarding the relationships among stigma, social support, and PMADs in postpartum women.

Conceptual Basis/Background: Despite recommendations from professional organizations, screening for PMADs is not consistently completed using a valid, reliable instrument. Stigma contributes to the low …

Exploring Help-Seeking Intentions Of Homeless Veterans Attending A Stand Down Event, Tara Vaughn

Nursing Theses and Dissertations

Lack of help-seeking behavior among homeless veterans results in higher burden of disease and lower quality of life. No studies have been conducted involving help- seeking intentions of homeless veterans within the veteran stand down population. Pender’s Revised Health Promotion Model was used to guide this descriptive correlational study with the aim of exploring the extent selected personal characteristics and experiences and behavior-specific factors affect help-seeking intentions among homeless veterans attending a stand down event.

A convenience sample of 86 homeless veterans (mean age 56) was recruited from a 3-day veteran stand down event in Northern California. Each participant was …

The Effects Of Learning Mindfulness Based Stress Reduction On Psychosocial Variables And Hba1c In Adolescents With Type 1 Diabetes, Denise Van Sant - Smith

Electronic Theses and Dissertations

ABSTRACT

THE PHYSIOLOGICAL AND PSYCHOSOCIAL EFFECTS OF AN ONLINE MINDFULNESS BASED STRESS REDUCTION INTERVENTION ON ADOLESCENTS WITH TYPE 1 DIABETES

By

Denise E. Van Sant – Smith

Date: 4-5-2019

Dissertation Supervised by Linda Goodfellow, PhD, RN, FAAN

Background: Stress has been shown to increase glucose levels through a sympathetic physiological response resulting in a release of chemicals such as adrenalin and cortisol, a response which results in an even greater need for insulin. Adolescents with Type 1 Diabetes may not be able to change or decrease the amount of stress in their lives but they may be able to …

Nurses' Attitudes And Understanding Of The Suicidal Patient, Cheryl Lemmon

Doctor of Nursing Practice Scholarly Project

Motivation / Problem statement: While not all suicides are predictable, there are reasonable guidelines for identifying those individuals at risk and reducing risk for high-risk individuals. There is, however, an apparent gap in best practice as there is a continual climb in suicide statistics. The aim of this project is to survey emergency department nurses to discover their attitudes and understanding of suicide. The purpose is to better understand the phenomenon, and guide education initiatives, as nurse professionals are in a key position of prevention when working with these patients.

Methods / Procedure / Approach: A non-probability, purposive and voluntary …