Addressing Stroke Care Disparities Through Patient Education, Christina Annerino

Honors Capstones

It has been found across current studies and evaluations of stroke care and patient outcomes that there is a disparity in disability and mortality between male and female patients who have experienced stroke. The aforementioned studies did not identify the cause of this disparity, although a number of hypotheses for this phenomenon were provided. This study then conducted a preliminary survey of 130 participants, both men and women, aged 18-80 years old, to evaluate potential barriers to accessing stroke care and receiving treatment effectively. Preliminary survey data demonstrated consistent gaps in knowledge related to stroke risks, stroke symptoms, and when …

Telehealth Acceptance And Medical Mistrust Among The Elderly Of Rural Appalachia: A Correlational Study Using The Medical Mistrust Index And Technology Acceptance Model, Victoria Hood-Wells

Electronic Theses and Dissertations

Adults aged 65 years and above have grown substantially over with past decade. However, the chance of developing multiple comorbidities only increases with age. Because elderly residents of rural Appalachia often encounter barriers to healthcare, rural nurses, providers, and policy makers must overcome physical and structural barriers, but also gain a more in-depth understanding of the personal and cultural attitudes impacting the use of new and innovative forms of healthcare delivery. With a slow and variable uptake of telehealth adoption in rural Appalachia, and in the presence of well-documented medical mistrust, this study was designed to better understand the degree …

Implementing Universal Adult Depression Screening In A Rural Maine Free Medical Clinic, Karen Hussion

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Depression in adults is a leading cause of disability, morbidity and mortality worldwide with an estimated prevalence of 20% in the US population. Despite estimates that one out of every five Americans suffers from depression, less than 50% of adult primary care patients with depression are identified, and less than 5% of all adult primary care patients are screened. To increase early detection and management of depression, the United States Protective Service Task Force (USPSTF) recommends routine depression screening for adults older than 18 years in primary care settings.

LOCAL PROBLEM: This project site was a rural, free, …

Cultural Education Interventions Impact On Cultural Competence, Kaylie V. Griffin Ms

ONU Student Research Colloquium

Problem: In the United States, there is a substantial increase in diversity. This increase in diversity poses multiple challenges for healthcare workers and healthcare systems. Because nurses care for patients with various cultural backgrounds, health beliefs and practices, and languages, cultural competency plays a pivotal role in providing patient-centered care. There is a need to enhance cultural education for healthcare workers to ensure that healthcare workers have the skills and knowledge to effectively engage with all patient populations. Implementing cultural education interventions seeks to increase healthcare workers' competency, communication, and patient outcomes. Purpose: The purpose of this research question is …

A Global Perspective On Intersecting Social And Systemic Barriers Experienced By Grandparent-Caregivers: A Qualitative Systematic Review, Schola N. Matovu, Deborah M. Whitley, Heather M. Young

GrandFamilies: The Contemporary Journal of Research, Practice and Policy

Globally, many grandparents are taking on the caregiving role for their grandchildren without public or government interjection of support, particularly financial assistance for basic needs such as housing, health care and living expenses. This paper aimed to broaden understanding of social and systemic barriers experienced by grandparent-caregivers across the globe. Of the 2,828 relevant grandparent caregiving studies identified in the literature, 34 representing eight countries met our inclusion criteria to answer the research question and the focus of this paper: What are the social and systemic barriers experienced by grandparent-caregivers across the globe? We utilized Noblit’s and Hare’s (1988) meta-ethnography …

Attitudes Toward Caring For Older Adults Among Undergraduate Nursing Students At A Public University In Kuala Lumpur, Malaysia, Azera Hasra Ismail, Siti Zuhaida Hussein, Aslina Mohamed Yasi, Nurul Izzati Ishak, Nurul Nazira Mohd Yazar, Nur Syafiqah Sabri

Makara Journal of Health Research

Background: The growing number of elderly members of the population is expected to increase the demand for more dedicated nursing students committed to providing excellent care. This study aims to determine prevailing attitudes toward the care of older adults among undergraduate nursing students at a public university in Kuala Lumpur, Malaysia.

Methods: This is a quantitative cross-sectional survey of 107 undergraduate nursing students enrolled at a public university in Kuala Lumpur, Malaysia. The students were recruited using stratified random sampling. The respondents’ attitudes toward caring for older adults were measured using 14 items from the Geriatrics Attitudes Scale …

The Effect Of Obesity On Comorbidities: A Benchmark Study, Kaley Nolen

MSN Capstone Projects

Obesity is distinguished by a body mass index (BMI) greater than 30. Tremmel et al. (2017) reports obese individuals are at a greater risk for developing cardiovascular disease, diabetes, and cancer. In 2014, approximately 641 million adults were classified as obese (Zhang et al., 2018). This epidemic has drastically worsened over the last two decades resulting in obesity ranking as the fifth most common cause of death globally (Safaei et al., 2021). Okunogbe et al. (2021) states, slowing the incidence rate of obesity by 5% will save approximately $3.3 billion annually between 2020-2060. The pathophysiology and cause of obesity is …

Enhancing A Pressure Injury Prevention Bundle In A Skilled Nursing Facility, Lorillie Soleta

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: The purpose of the project was to address the increase in pressure injuries in a skilled nursing facility, which had risen from 6% to 10% despite the implementation of a prevention bundle. The project aimed to evaluate and enhance the effectiveness of existing interventions.

Aim of the Project: The aim was to add evidence-based interventions to the existing pressure injury prevention bundle. The desired outcome was to decrease the number of acquired pressure injuries.

Review of the Evidence: Research indicated that pressure injury prevention bundles were more successful when incorporating offloading interventions. These offloading measures, including frequent turning and …

About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski

Electronic Thesis and Dissertation Repository

This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …

Expanding The Volunteer Role To Include Advance Care Planning Knowledge, Andrea C. Leomo

Master's Projects and Capstones

Problem: Transition patients at the end-of-life are those patients who are not mentally ready or physically eligible for hospice thus not enrolled in a Palliative or Hospice Program. Only one-third of the Transition patient census had completed and filed advance care plans. Healthcare providers are obligated to perform life-saving measures unless documented otherwise. A lack of advance care planning can create complicated scenarios and cause discordant care incidents.

Context: End-of-life care is a delicate subject to navigate conversations with patients. With holistic care being a large component of hospice and palliative care, it is important to have updated and accurate …

Fall Risk Identification And Reduction Among The Gerontological Population At A Long-Term Care Facility, Esther A. Lowe, Breanna Cates, Lisa James, Ashley Samson, Jowel Ochoa, Matthew Ng

Master's Projects and Capstones

Abstract

Problem: Data obtained from the facility from February 2022 to July 2023 showed that there were a total of 110 falls at the facility with 51% resulting in injury. The facility also lacked a standardized fall assessment tool with minimal follow up after fall incidents.

Context: A microsystem assessment of the geriatric population at the long-term care facility indicated the need for a standardized fall risk screening tool to accurately assess patients.

Interventions: A staff presentation was created highlighting the high rate of falls at the facility as well as to educate on the implementation of the Morse Fall …

Reduce Extended Length Of Stay By Reducing In-Hospital Falls, Norberto Benitez

Master's Projects and Capstones

Abstract

Problem: Every year, there are many in-hospital falls (IHFs). Nationally there are between 700,000 to 1 million falls recorded each year. Hospital falls financially burden our healthcare industry, costing approximately 34 billion annually. Context: In a local hospital in Northern California, Marin County, the microsystem has had an extraordinary number of in-hospital falls (IHFs). To date (June 2023), 13 falls have been recorded thus far; the microsystem is on track to beat the previous year's record number of 21 falls in a calendar year. Interventions: The MSN–CNL student proposed re-educating staff, resetting expectations, and reestablishing workflow. We also sought …

Chronic Diseases And Inpatient Care Among The Middle-Aged And Elderly People In Indonesia, Ema Madyaningrum

Journal of Health Research

Background: The prevalence of chronic diseases contributes to an increase in healthcare utilization that results in increased vulnerability in middle and old age. This study aims to determine the factors that influence in-patient care among the middle-aged and elderly.

Methods: We conducted a repeated cross-sectional study using the Indonesia Family Life Survey 4 (IFLS 4) in 2007 (10,754 participants) and IFLS 5 in 2014 (12,058 participants). Chronic diseases include hypertension, diabetes mellitus, tuberculosis, asthma, coronary heart diseases, liver diseases, cancer, arthritis, gout, high cholesterol, prostate illness, kidney diseases, and digestive diseases. We used the frequency distribution, and logistic regression to …

Assuring A Continuum Of Care For Heart Failure Patients Through Post-Acute Care Collaboration, Purnima Krishna

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure (HF) patients have a high risk of rehospitalization after discharge from acute care. Post-discharge management of HF patients requires coordinating services outside the hospital, such as skilled nursing and home health care to address patients’ complex needs.

Local Problem. High HF readmission rates negatively impact a hospital’s efficiency and pose a risk of financial penalties. In the project setting, the HF patients discharged to skilled nursing facilities and home health agencies had a higher rate of 30-day readmission than patients discharged to home.

Methods: Fourteen post-acute care (PAC) facilities were selected for the interventions. The …

Do-Not-Hospitalize Orders In Assisted Living Facilities: Perspectives From Direct Care Workers, Alanna Kates Dancis Dr.

Doctor of Nursing Practice Scholarly Projects

Context: Do-not-hospitalize (DNH) orders in assisted living facilities (ALFs) are often misunderstood, ignored, or countermanded by direct care workers (DCWs), potentially leading to residents being sent to the hospital against their wishes.

Objectives: The primary purpose of this study was to gather sufficient qualitative data to create an intervention that would help prevent DCWs from sending residents with DNH orders to the hospital against their wishes. To accomplish this goal, the study centered on three research objectives: 1) to understand more fully how DCWs interpret DNH orders; 2) to determine if carrying out DNH orders causes moral distress for DCWs; …

Nursing Care Of Family Caregivers: Interventions And Considerations Regarding Current Issues Facing Family Caregivers Of Persons With Dementia Relevant To Nursing Practice, Alayna Kent

Senior Honors Theses

There are an estimated 6.5 million Americans age 65 and older who are currently living with Alzheimer’s dementia. A large majority of these individuals receive care from a nonprofessional family caregiver, typically in the home setting. It is well documented that family caregivers of dementia patients experience many unique challenges. These challenges provide valuable opportunities for nurses to provide helpful interventions to aid this vulnerable population. An integrated review of the recent literature was conducted, and articles were chosen by a method modeled after the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowsheet. The research was then analyzed …

Screening For Social Determinants Of Health In The Primary Care Setting: A Quality Improvement Project, Winifred Ann Shouse

Graduate Theses, Dissertations, and Capstones

Social determinants of health are the conditions in which individuals are born, age, work, and live that affect health status and outcomes (Rivich et al., 2019). These social and environmental factors can create barriers to patients being able to access and adhere to recommendations for chronic disease management (Gold, et al., 2019). Communication gaps between patients and primary care providers make it challenging for healthcare providers to be completely aware of the financial burdens their patients encounter (Patel et al., 2016). Research supports that identifying and addressing the barriers related to social determinants of health can improve the management of …

Family Caregivers Of Older Adults With Physical Disabilities In Rural Thailand, Denis Tuttle, Jiranan Griffiths, Anuchart Kaunnil

The Qualitative Report

Thailand is one of many countries experiencing changes in the demographics of its population. People are living longer and having fewer children resulting in an increasing percentage of older adults in the general population. This presents a challenge in providing care for older adults, especially in countries where there is a culture of family caregiving. This study aims to investigate the experience of family caregivers, exploring the problems of caring for older people with physical disabilities and the needs of family caregivers. This is done to better understand ways to support caregivers. Using a descriptive qualitative approach, 15 family caregivers …

The Use Of Paxlovid Amongst The Elderly & Reduced Hospital Stays, Maria M. Gichana, Kate Ames, Nicole Chandler, Madeline Gill

Non-Thesis Student Work

Coronaviruses are a large family of viruses infecting many species and cause a variety of illnesses. COVID-19 is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2). Understanding that COVID-19 can cause severe disease in vulnerable populations has launched the development of viral treatments. Nirmatrelvir-ritonavir (Paxlovid) is an oral antiviral treatment authorized for adults with mild to moderate symptoms who are at an increased risk for severe disease. These authors pose the question: For older adults over the age of 65 who have had COVID-19, does the use of Paxlovid reduce hospitalizations, compared to those not treated with Paxlovid? …

Polypharmacy: Increasing Medication Adherence, James C. Kelly

Nursing | Student Research Posters

Polypharmacy is a common problem among older adults where they take multiple medications concurrently, leading to negative health outcomes such as adverse drug reactions, drug-drug interactions, and non-adherence to medications. To address this issue, a randomized controlled trial (RCT) is proposed that will involve elderly patients (aged 65 years or older) who are taking five or more medications. Participants will be randomly assigned to either the intervention or control group, with the intervention group receiving nurse-led medication therapy management (MTM) and patient education to improve medication adherence. The Health Belief Model can be used to educate and empower older adults …

Addressing The Inpatient Penicillin Allergy And Antibiotic Stewardship: The Effect Of Education On Compliance Rates Of The Nurse Driven Penicillin Allergy Assessment Tool, Alexandria Bassler

DNP Projects

Background: Penicillin allergies are the most frequently reported drug allergy but less than 1% of the total population has a true immune-mediated allergy. Patients who are labeled as having a penicillin allergy may receive drugs that are less effective, more costly, and more toxic. The nurse driven penicillin allergy assessment tool strives to increase penicillin allergy de-labeling rates by pharmacists and providers.

Objective: The purposes of this study were to (1) perform a retrospective and prospective chart review to determine compliance rates with the nurse driven penicillin allergy assessment tool, (2) provide an education module on antibiotic stewardship …

Gender Differences In Administration Of Tpa In Treatment Of Ischemic Stroke, Christina Annerino

CURE Proceedings

As medicine and pharmacology advance through the years, new life-saving treatments are studied or discovered every day, and a medical emergency is no longer a death sentence. Even with conditions as serious as ischemic stroke, there is hope for survival and rehabilitation with the ‘clot-busting’ drug, tissue plasminogen activator, colloquially known as ‘tPA’. tPA is a thrombolytic agent, a substance that acts on fibrin in clots to dissolve them so they can no longer cause ischemia in blood vessels that results in a stroke. (Vega, 2022). tPA is an extremely effective treatment for ischemic stroke, demonstrated in 2013 by a …

Heart Smart Holidays: Coping With Stress, Staying Active, And Healthy Cooking Strategies For Seniors In Cleveland County, Lauren Ridgeway

Doctor of Nursing Practice Projects

This Doctor of Nursing Practice Project assessed whether attending community group meetings focusing on stress, staying active, and healthy eating during the holidays, could influence cardiovascular disease awareness, mental health awareness, and quality of life of senior citizens in Cleveland County. A convenience sample of 6 participants attended the Coping with Stress and Staying Active event while 10 participants attended the Healthy Cooking Strategies event. The objectives were measured using a pretest posttest design before and after the presentations. There was strong evidence (t(9) = -13.597, p < .05) that the group seminar on managing stress and staying active during the holiday season improved the mental health awareness of participants. Data also showed a significant increase in Cardiovascular Disease Awareness from pretest to posttest (t(5) = 3.246, p < .05) after the seminar on healthy cooking strategies. The project raised community awareness to the importance of managing stress, staying active, and making small nutritional changes to positively impact the cardiovascular health of Seniors.

Impact Of Montessori-Based Dementia Programming On Engagement And Affect Of Older Adults With Dementia, Meredith S. Sheppard

Master's Projects and Capstones

The COVID-19 pandemic has profoundly impacted the Adult Day Services program and Adult Day programs across the country. As the Adult Day Services program transitions to an in-person format, goals within the organization include developing appropriate programming, increasing group size, and keeping clients entertained. The framework guiding this quality improvement project is Montessori-Based Dementia Programming ® (MBDP). This project aims to increase client engagement, decrease client anxiety, and decrease staff workload. This will be measured by a self-developed staff workload survey, the Menorah-Park Engagement, and the Affect rating scale. Implementation of MBDP at the Adult Day Center did not meet …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Nurses Addressing The Knowledge Gap In Advance Care Planning, Stephanie Winkel, Elaine B. Harwood

International Journal of Faith Community Nursing

Background: Advance care planning allows people autonomy about values and preferences related to care at the EOL. Engaging in advance care planning enables one to consider decisions about medical treatment at the EOL and informing significant others, including health care providers, about preferences (National Institute on Aging [NIA], 2018).

Methods: In this QI project, the intervention will be a one-time ZOOM^® meeting between nurse leaders and participating church members. The nurse leader will present the 5 Wishes curriculum and lead a question-and-answer portion at the end of the ZOOM^® meeting. Participants will be asked to complete a short …

Advance Care Planning In Faith Communities: A Quality Improvement Project, Lorie Hacker, Jan Gaddis, Jessica Grimm, Catherine Chung

International Journal of Faith Community Nursing

This quality improvement project examined the impact of providing an advance care planning training tool to faith community nurses in the community setting on advance care planning knowledge, self-efficacy, and implementation of advance care planning outreach and advance directive completion. The pre- and post-intervention frequencies measure and paired-t test survey design resulted in clinically significant improvements in knowledge, and self-efficacy of advance care planning among faith community nurses. A fifty-fold increase was seen in advance care planning outreach activities among the group from pre- to post-intervention. The limitations of the project included small sample size and short implementation timing. However, …

The Effects Of Hospital Policy And Procedure On Cauti Occurrence, Kevin Kaga, Michaela Morrison, Daniel John

Symposium of Student Scholars

Abstract

Background: Clients that require indwelling catheterization often get bacterial infection causing catheter-associated urinary tract infections. These infections lead to longer hospital admissions and poorer outcomes for clients.

Objectives: To assess the effectiveness of the use of suggested hygiene methods from hospital policy/guidelines in preventing catheter-associated urinary tract infections.

Methods: Using the Kennesaw State Library search system, 10 articles were found to support that the use of consistent evidence based practices can prevent urinary tract infection occurrence.

Results: Our articles identified appropriate and inappropriate indications for catheterization and effective hygiene techniques used by nurses in the prevention of CAUTIs. These …

Physical Activity, Daily Step Counts And Functional Ability In Older Adults: Using Nhanes Database, Chunfang(Maggie) Chen

Doctoral Dissertations

Maintaining functional ability and independence are essential in the healthcare of older adults. Physical activity(PA) has been acknowledged as effective and economical health promotion strategies in older population. However, the amount of PA needed to maintain functional ability in older adults remains unclear. This investigation used PRISM Dose-response Curves Stimulation Variable slope model to explore the relationships between the amount of PA and functional ability in community-dwelling young-old, middle-old and old-old age group adults. ANOVA analysis was used to examine the relationship between functional ability and self-perceived active level changes compared to 10 years ago. NHANES 2005-2006 older participants datasets …

Improving Hypertension Self Management In African American Men, Elizabeth C. Felix

Electronic Theses and Dissertations

Hypertension is a cardiopulmonary condition linked to genetic, environmental, and social factors. Left untreated, it can lead to fatal conditions such as heart disease. In the United States, African Americans experience disproportionately high rates of hypertension, earlier onset of symptoms, greater severity, and higher related mortality rates. African Americans also statistically have more difficulty self-managing their hypertension than other demographics. The aim of this project was (a) to identify, define, and measure perceived barriers to self-management of hypertension among African American men and (b) to target these barriers and increase patient engagement through personalized intervention plans. The researcher recruited 24 …