Medicine and Health Sciences Commons^™

Overdose Education And Naloxone Distribution: Implementation In The Acute Care Setting, Emily A. Daniell

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

The number of opioid related overdose deaths has increased significantly over the past ten years. In order to combat this problem, many drug treatment programs have implemented Overdose Education and Naloxone Distribution programs as a harm reduction technique. While these programs are fairly new, initial research demonstrated effective reduction in the number of opioid overdose related deaths. The risk of overdose deaths increases when an opioid addicted person is abstinent for a period of time and loses tolerance. Individuals who have been incarcerated, completed inpatient detoxification, or who have been admitted into an acute care setting face the risk of …

Hypertension Management Among Cambodian-Americans In Rhode Island, Rathana Long

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Hypertension is a major risk factor for heart disease and stroke and the focus of much study in the US. However, there is limited transfer of this knowledge in terms of hypertension management in certain recent immigrant groups such as the Cambodian-­‐Americans. Cambodian-­‐Americans are often included among the Asian/Pacific Islanders and are one of the fasting growing populations in the US. The purpose of this study was to explore how Cambodians in Rhode Island manage hypertension. This study used a survey design with a convenience sample of 30 participants who could read, write, and understand English. It was conducted at …

Preventing Ventilator-Associated Pneumonia: Educating Emergency Room Nurses, Dana M. Ferrazzano

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Ventilator-associated pneumonia (VAP) is the second most common hospital acquired infection and is primarily found in the intensive care units. The presence of an endotracheal tube is the primary risk factor for developing VAP. Many times the process of intubation occurs pre-hospital, in the emergency room (ER) or in the operating room. Ventilator associated pneumonia is associated with increased hospital stay and costs. Evidence-based guidelines have been developed to decrease the occurrence of VAP and decrease patient mortality. Preventative measures are initiated on the intensive care unit once the patient is transferred. The purpose of this study was to evaluate …

Intravenous Acetaminophen Use In Postoperative Pain Management, Selvi K. Kumar

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Surgery is a most common source of acute pain and effective postoperative pain management is crucial for wound healing and recovery. Opiods are the mainstay for acute pain management but have various adverse effects including death. The multimodal approach involves the use of multiple drugs with varying mechanism of action to achieve optimal pain relief with less adverse effects. Intravenous acetaminophen (IVAPAP) is a new addition to the multimodal approach that appears to afford effective pain relief with a low risk profile. The purpose of this research study was to examine the impact of IVAPAP use in multimodal pain management …

Development Of A Community-Based Lactation Support Program, Susan D. Bryant

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Background. Despite the recommendations from leading health organizations and the documented health benefits for both mother and infant, breastfeeding success rates continue to be suboptimal.

Design. A program development design was used for this Community-Based Lactation Support Program. This pilot was the first step in accomplishing the long term goal of expansion of the program to the entire community of Scituate and the state of Rhode Island.

Objectives. The objectives of this program were to increase exclusive and sustained breastfeeding rates in the town of Scituate through education and support and to ensure a positive breastfeeding experience for the …

A Nurse-Driven, Exercise-Based Intervention For Patients With Cancer-Related Fatigue When Severe Fatigue Interferes With Daily Activity, Nancy B. Opaluch-Bushy

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Cancer affects more than 1 million people each year. Of all of the symptoms related to cancer, the most frequently experienced is fatigue. Cancer-related fatigue (CRF) is an extreme tiredness that contributes to morbidity and mortality due to resulting inactivity. Extreme inactivity related to CRF may cause severe complications affecting multiple body systems. The Oncology Nursing Society (ONS) recommends exercise as the only evidence-based intervention shown to be significant for CRF. The purpose of this project was to provide a nurse-driven, exercise-based intervention to combat severe CRF. The site was an oncology out-patient clinic of a 247 bed Magnet hospital …

Timelines Of Oral Care And Early-Onset Ventilator Associated Pneumonia Prevention, Kristen M. Francoeur

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Hospital-acquired infections, including ventilator associated pneumonia (VAP), are a significant cause of morbidity and mortality and associated with increased costs and length of stay (Chastre & Fagon, 2002; NNIS, 2004). Ventilator associated pneumonia is believed to primarily result from aspiration of oropharyngeal secretions around the endotracheal tube cuff into the lungs (Grap, Munro, Unoki, Hamilton, & Ward, 2012). A randomized control trial tested early application of oral chlorhexidine (CHG) on oral microbial flora and VAP in trauma patients and suggested that early (within 12 hours of intubation) application may reduce VAP rates in trauma patients (Grap, Munro, Hamilton, Elswick, Sessler …

Nurses Perceptions Of Family Presence During Resuscitation In The Emergency Department, Jennifer L. Jennings

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Family presence during resuscitation has been a controversial and much debated topic for many years. In the past decade, the movement toward family presence has steadily grown. The Emergency Nurses Association (ENA) and the American Heart Association (AHA) have endorsed family presence and incorporated guidelines for its implementation. Although becoming more accepted in practice, there are still many hospitals without family presence policies, and some nurses and other health care providers continue to identify concerns about its’ use. The purpose of this project was to survey nurses’ perceptions of family presence during resuscitation in the Emergency Department. A researcher developed …

Exploring Nurses' Knowledge About Heart Failure Before And After The Implementation Of A Heart Failure Education Program, Suzanne H. Richmond

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Heart failure (HF) has become a national epidemic, with 5.7 million Americans currently living with HF. Although HF is incurable, it is manageable if health care professionals apply current practice guidelines to patient teaching. Nurses are charged with providing comprehensive education about HF self-­‐management and it is imperative they stay abreast of evidence-­‐based guidelines. The purpose of this project was to explore the current HF knowledge of Home Based Primary Care (HBPC) registered nurse Care Managers employed at the Providence Veterans Administration Medical Center (PVAMC). The logic model and Knowles andragogy theory assisted this researcher in the creation of a …

Nurses' Knowledge Related To Heart Failure Essentials, Ann Mary Garris

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Heart Failure is a complex syndrome which continues to be a major health issue in the United States and worldwide. Strategies and educational interventions implemented by hospitals to reduce hospital admissions and readmissions for this costly chronic disease have not been consistently successful. Patient education is an important strategy for the management of HF to improve quality of life, optimize patient outcomes, and reduce the use of healthcare resources by reducing readmissions. The purpose of this program development was to increase nurses’ knowledge regarding HF education to be provided to HF patients prior to discharge from the acute care setting. …

Surgical Skills For The Aprn Student: A Low-Fidelity Simulation Experience, Jason C. Heath

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

There are many contemporary areas of practice available to the ACNP to date that encompass a surgical component of practice. Surgical specialty settings require a practitioner to be competent in a specialized base of knowledge as well as possess a fundamental set of psychomotor skills to practice competently. Unlike the training of the PA, ACNP programs do not typically address surgical theory or skills. The purpose of the program was to increase graduate nursing student confidence in basic surgical skills. The review of the literature examined the differences between the educational preparation of the PA and the NP, expansion of …

The Dnp: A Descriptive Study Of Student Experiences And Factors Contributing To Pursuing This Degree, Daniel J. Neilson

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Since 2004 discourse pertaining to a terminal clinical degree in nursing has increased nationally, however few articles were found that discussed why advanced practice registered nurses (APRNs) were choosing to pursue this degree, and their lived experiences while doing so. This descriptive, qualitative research study aimed to identify contributing factors in the decision to pursue the DNP degree, and to explore the experiences of DNP student experiences. Rogers’ theory of diffusion of innovations (2003) guided the study. Snowball recruitment led to seven participants from who data was collected using email conversations. Five major themes were identified: (1) personal development, (2) …

Educational Innovation Brief: Educating Graduate Nursing Students On Value Based Purchasing, Kristen M. Farrell

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

The Patient Protection and Affordable Care Act implemented value-based purchasing to raise the bar on quality care and patient satisfaction in healthcare facilities. The time has come to educate graduate nursing students on the reality of quality indicators and the impact that advanced practice nurses will have on these initiatives. This educational brief describes implementation of an educational session developed for graduate nursing students on VBP and the APN role. The content for the education was derived from an extensive literature review, The Essentials of Master’s Education in Nursing, and the clinical experience of the author. The education was …

Nurses' Perceptions Of Nurse Staffing And The Impact On Patient Falls, Kristin J. Henry

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Patient falls contribute to unnecessary injury and incapacitation for patients and are also a major source of stress for the nurses caring for patients who fall. Hospitals are no longer being reimbursed for extended hospital stays related to injuries caused by patient falls and action is needed to decrease such events. Nurse staffing has been shown to play a critical role in determining the incidence of patient falls, with better nurse staffing decreasing the likelihood of a patient falling. The purpose of this study was to determine nurses’ perceptions of nurse staffing and its impact on the incidence of patient …

Examining Chronic Stress In Spouses Of Active Duty Military Members, Cristina L. Joseph

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Even in the absence of wartime stressors, the military lifestyle is characterized by frequent challenges that affect not only the military member, but also his or her spouse and children. Due to frequent relocations and deployments, military spouses are often relied upon to become the primary child-rearers, make occupational sacrifices, deal with financial concerns independently, organize relocations, and cope with lack of social support. These multiple responsibilities can create a myriad of stressors, which over time lend themselves to the formation of chronic stress. The purpose of this exploratory study is to determine if spouses of active duty military members …

Alarm Fatigue: A Technology Hazard, Iracena Santos Lopes

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

This research project sought to investigate the impact of alarm fatigue on nurses in an inpatient adult acute care setting at an academic and magnet medical center in the Northeast. The project methodology included a 12-question survey containing 9- likert and 3 open ended questions, designed by the student researcher. The survey was administered to 48 registered nurses on two telemetry-monitoring units. The survey explored whether nurses are aware of alarm fatigue, and also how their daily workflow was impacted by alarm fatigue. Surveys were anonymous and confidential. Descriptive statistics were performed on the study variables, and responses from three …

An Exploration Of The Barriers To Diabetes Management Among West African Immigrants In The United States, Oluseyi Grace Abioye-Akanji

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Purpose: To explore the barriers to diabetes management among West African immigrants living in Rhode Island. Study Design and Methods: Semi-structured interviews with adults (N=5); men (n=2), women (n=3), Nigerian (n=3), Liberian (n=1), and Ghanaian (n=1) ages ≥18 with Type 1 or Type 2 diabetes, living in Rhode Island. Demographic information of the participants was obtained using a questionnaire. Interviews were conducted by the researcher and lasted approximately 50 minutes, and were scheduled to accommodate participants’ needs. Interviews were audio-taped and statements of the study participants were recorded. Subjects were redirected to clarify responses when necessary. Content analysis and coding, …

Alarm Fatigue: A Risk Assessment, Erica Baillargeon

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Alarm fatigue is the phenomenon which occurs when nurses become overwhelmed by the high number of alarms in the clinical environment. This is a significant patient safety issue as delayed or inappropriate responses can and have resulted in patient harm. The purpose of the observational study was to conduct a risk assessment of alarm fatigue at an acute care teaching hospital in Providence, RI. Observations of telemetry alarms and response were conducted, utilizing a standardized tool on two medical surgical units over a six week time period. Participants were 36 nurses working on the two units at time of observations. …

Mandatory Influenza Vaccination For Healthcare Workers: Do Nurses Agree?, Meghan Leah Nightingale

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Influenza is a significant cause of morbidity and mortality among hospitalized patients. Health care workers are considered a high-risk group for influenza, and annual vaccination is the most effective way to prevent getting influenza. Increasing concern about inadequate levels of healthcare work vaccination has led many groups to recommend mandatory vaccination for healthcare workers. The state of Rhode Island was considering mandatory vaccination in 2012 for all healthcare workers, with only medical exemption, but this movement was halted. Research focused on the perception of nursing personnel toward mandatory influenza vaccination is lacking, and considering that registered nurses are one of …

Prevention Management Of Postoperative Nausea And Vomiting In Ambulatory Setting: How Well Are We Identifying Patients With Motion Sickness?, Sheila A. Capasso

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) continue to be a serious problem in the ambulatory setting. These symptoms are among the most undesired complications following surgery and can adversely affect the quality of recovery for many patients. Previous research has concluded that the identification of risk factors for PONV/PDNV is a first step in developing effective prevention strategies. The purpose of this study was to examine the incidence of PONV/ PDNV in the ambulatory setting in female clients who were treated with transdermal scopolamine (TDS) for motion sickness as compared to those patients who were …

Improving Nurse Satisfaction And Knowledge Of Therapeutic Hypothermia Using A Staff Education Program And Evidence-Based Protocol, Laura Anne Cresap Goldstein

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Mild Therapeutic Hypothermia (TH) or Targeted Temperature Management (Nunnally et al., 2011) is defined as an intentional reduction of a patient’s core temperature to 32°C–34°C (89.6- 93.2° F) following ventricular fibrillation (V-Fib) sudden cardiac arrest (SCA) with return of spontaneous circula-tion (ROSC), and who remain unconscious, for the purposes of limiting neurologic reperfusion injury (Polderman, & Herold, 2009). Mild TH is a highly valuable post cardiac arrest procedure that can result in preservation of neurologic function and reduction of the inflammatory effects of neurologic reperfusion syndrome following cardiac arrest. This procedure requires specific educational preparation in order to perform the …

Online Learning Modules And Nursing Students' Knowledge Of Tuberculosis, Monica L. Kunkel

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Tuberculosis is identified as a major global health issue. Recommendations for increased training for health professionals from both the Institute of Medicine and the National Institutes of Health have been outlined. Nursing curriculum tools developed by the National Tuberculosis Consortium and presented through online learning modules were utilized in an experimental study of baccalaureate nursing students. Knowles’ Theory of Adult Learning provided the theoretical framework for the study. The test scores on a thirty question multiple-choice exam of students who participated in the intervention are compared to those of students who only participated in the regular course content. Although the …

Contributing Factors To Hospital Readmissions, Susan M. Amalfitano

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Aims and objectives. To investigate the elderly patient’s perspective about the reasons for discharge to home being unsuccessful, resulting in rehospitalization. Background. Elderly patients have a high rate of readmission to the hospital within 30 days of discharge. Starting in October of 2013, hospitals having a high rate of readmission of patients with heart failure (HF), myocardial infarction (MI), and pneumonia (PNA) will face financial penalties. Evidence indicated that by utilizing risk prediction tools and incorporating transition interventions the risk of a hospital readmission may be reduced. Design. A qualitative, descriptive design was used. Methods. In 2013, a student investigator …

Intra-Femoral Sheath Time: Does It Increase A Patient's Risk For Developing A Hematoma?, Colleen O'Brien Planchon

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Despite advancements in technology and medication therapy, coronary artery disease continues to remain the number one cause of death. Treatment for coronary artery disease requires life style modifications, medication therapy, percutaneous coronary interventions, and sometimes coronary artery bypass surgery. Though percutaneous coronary interventions are considered safe and are commonly occurring procedures, there are still risks for complications. One of the most frequently occurring complications is hematoma of the femoral artery site. The purpose of this study was to determine if there was an increased incidence of hematomas in individuals undergoing percutaneous coronary intervention with associated sheath times of less than …

A Palliative Care Program Evaluation, Kathleen M. Robinson

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Palliative care is a growing field in response to the healthcare needs of people suffering with the consequences of serious health issues. As an evolving specialty, palliative care needed criteria to denote and measure quality. National leading specialist in palliative care have developed and promoted standards for care and excellence in this field, however, it is critical for palliative care programs to evaluate the manner and extent to which these standards are incorporated into their care. A program evaluation of an existing Palliative Care Program at a VA hospital was undertaken. National guidelines and standards, that specify preferred structures and …

Booking The Appointment: A Strategy To Reduce Readmissions In Heart Failure Patients, Lindsey Moran

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Heart failure (HF) is a chronic condition that is the cause for many hospitalizations in the United States. Hospital readmission is a common problem in many chronic conditions, especially heart failure. The purpose of this research was to determine if scheduling a follow-up appointment with a primary care provider (PCP) or cardiologist prior to hospital discharge decreases 30-day readmission rates in patients with a primary diagnosis of HF. A quasi-experimental, two-group study was performed at The Miriam Hospital, a 247-bed acute care hospital, with a sample of 60 patients. A retrospective chart audit was performed to determine if 30-day readmission …

Implementation Of A Nurse-Driven Mobility Protocol In Critical Care, Kim M. Uustal

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Prolonged immobilization plays an important role in negative outcomes of critically ill patients. Immobility is widely documented in the literature as a cause of increased mortality and complications. Despite the growing evidence in support of early mobility, many ICUs are unable to effectively integrate early/progressive mobility into their daily practice. Literature supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes. A progressive mobility tool may help to force a daily structured assessment of current mobility status, which supports the critical thinking process by the nurse and team to …

Development Of An Ambulation Program At Kent Hospital, Joseph L. Rocheleau

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

An important aspect of nursing care in a hospital setting is mobilizing patients. Numerous studies have documented that prolonged bed rest is associated with negative patient outcomes. An ambulation program can assist patients to maintain functional status during the hospital stay in preparation for discharge. Nurses are the member of the health care team with responsibility for mobilizing patients. In order to do this successfully, nurses require updated knowledge related to implementing an ambulation program. Several factors facilitate ambulating patients on a regular basis, including adequate staffing, appropriate equipment, and availability of a mobility protocol. The purpose of the project …

An Exploration Of The Barriers In The Prevention And Control Of High Blood Pressure Among West African Immigrants In Rhode Island, Ntaobasi Patrick Udeh

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

This is a report of a pilot study to explore the barriers to the prevention and control of high blood pressure by West African immigrants in Rhode Island. The incidence of high blood pressure is high in African Americans with many possible contributory factors documented. However, little is known about possible barriers to the control of high blood pressure among specific black ethnic populations such as West African immigrants living in Rhode Island. A qualitative research design employing a semi-structured interview was utilize to explore the issue. The barriers to high blood pressure management reported by these West Africans immigrants …

Nurses' Attitudes Towards Drug-Seekers In The Emergency Room, Megan E. Gernt

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Emergency department patients often present with a chief complaint of pain. There is a unique population of patients who present with this chief complaint in an effort to obtain narcotics for non-medical use. This population is often referred to as drug-seekers and there is little information available to define what exactly nurses mean when they use this term. This study utilized a descriptive survey design to gain a better understanding of nurses’ use of the term drug-seeker. Respondents agreed on a variety of behaviors that lead them to identify patients as drug-seeking and expressed a frustration with this population of …