Digital Commons Network^™

Nutrition And Neurosurgery: Designing A Perioperative Pathway For Elective Spine Fusion Patients, Abigail J. Mckay

Doctoral Projects

Each additional hospital day related to a surgical complication costs an estimated $1,000 (Grusky et al., 2015). Due to the rising costs of healthcare, European professors designed Enhanced Recovery After Surgery pathways to mitigate potential adverse surgical outcomes and associated costs. A primary focus of these pathways emphasizes the importance of pre-procedure nutritional optimization. Literature increasingly supports malnutrition as an independent predictor of postoperative complications and increased length of stay (LOS) (Adogwa et al., 2014). The neurosurgical population has a wide variety of comorbidities that place them at increased risk for nutritional compromise. Thus, a perioperative nutrition pathway was implemented …

Implementation Of The Vaccines For Children Program In A Midwest, Urban Clinic Dedicated To The Underserved Population, Akmal Saydazamov

Doctoral Projects

Background: Low immunization rates weaken herd immunity and endanger children. The Safety Net Health Clinic (SNHC) study site serves an underprivileged and refugee population with significantly lower than ideal coverage. Series completion disparities persisted after control for demographic, access-to-care, poverty and language effects (Varan et al, 2016).

Objectives: SNHC implemented the Vaccines for Children (VFC) program in order to increase the vaccination rates among the underserved population.

Methods: As an efficacy study, the project focused on three major areas in the VFC implementation – cost, staff preparedness and patient need. Cost was determined by utilizing electronic medical records (EMR) and …

Using Technology-Driven Patient Communication Appointment Reminders To Improve Uniform Data System Measures In A Federally Qualified Health Center, Ana Torres

Doctoral Projects

Background: Process of meeting Uniform Data System (UDS) measures in a west Michigan Federally Qualified Health Center (FQHC) has several components with different team members sharing responsibility in the process and workflow to document preventative screenings. An evidence-based technology-enhanced patient communication intervention was developed to meet benchmarks for the FQHCs UDS reporting metrics. The purpose of this quality improvement project was to answer the clinical question: Will technology-enhanced communication appointment reminders using automated telephone communication increase rates of screening follow-up visits to improve data reported to UDS at a west Michigan FQHC organization?

Objectives: Increase percentage of screening visits after …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Self-Efficacy In Emerging Nurse Leaders: The Effects Of A Virtual Community Of Practice On Nurse Educators In A New Practice Role, Kevin Daugherty Hook Msn, Ma, Ms, Agpcnp-Bc, Crnp

Doctor of Nursing Practice Projects

Background: Clinical nurse educators in long-term and skilled nursing facilities have an opportunity to exercise new leadership skills in bridging the gap between education and practice.

Objective: To assess the effects of a virtual Community of Practice (CoP) on the self-efficacy of clinical nurse educators who work in newly developing leadership roles in a large long-term and skilled nursing organization operating in multiple sites across the United States.

Methodology: The exploratory pilot study used a one group pre-test/posttest method. A convenience sample was used to enroll participants with newly created roles in clinical education. The Leader Efficacy Questionnaire (LEQ) was …

Overcoming Barriers To Adopting And Implementing Pharmacotherapy: The Medication Research Partnership, Raina Croff, Kim Hoffman, Kelly Alanis-Hirsch, Jay Ford, Dennis Mccarty, Laura Schmidt

OHSU-PSU School of Public Health Faculty Publications and Presentations

Pharmacotherapy includes a growing number of clinically effective medications for substance use disorder, yet there are significant barriers to its adoption and implementation in routine clinical practice. The Medication Research Partnership (MRP) was a successful effort to promote adoption of pharmacotherapy for opioid and alcohol use disorders in nine substance abuse treatment centers and a commercial health plan. This qualitative analysis of interviews (n = 39) conducted with change leaders at baseline and at the end/beginning of 6-month change cycles explains how treatment centers overcame obstacles to the adoption, implementation, and sustainability of pharmacotherapy. Results show that barriers to …

Systems Thinking In The Healthcare Professions: A Guide For Educators And Clinicians, Margaret M. Plack, Pt, Dpt, Edd, Ellen F. Goldman, Edd, Mba,, Andrea Richards Scott, Edd, Mba, Shelley B. Brundage, Phd, Ccc-Slp

Guides

No abstract provided.

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

An Evaluation Of A Nerve Block Protocol In Patients With Hip Fractures, Jenna Buchman

Doctoral Projects

BACKGROUND/PURPOSE: Pain management for hip fracture patients in the time before surgery is crucial. Literature highlights the success of local, single injection nerve blocks to aid in preoperative pain management. A local hospital implemented a preoperative, single injection nerve block protocol in March 2018. This quality improvement project investigated: (1) organization protocol compliance, and (2) if the preoperative single injection nerve block protocol reduces hip fracture pain, use of systemic opioid analgesics, decreases incidence of adverse opioid effects, and reduces cost of care.

SUBJECTS: Patients ages 18 and older admitted with the primary diagnosis of an operable isolated hip fracture …

Network Analysis Approaches To Collaborative Information Seeking In Inter-Professional Health Care Teams, J. David Johnson

Communication Faculty Publications

Introduction: It is widely believed that interprofessional health care teams can improve patient care and increase safety; however, intra-team communication has often proven to be problematic. One particularly important aspect of this problem is how teams collaborate to seek the information needed to address the issues they are confronting. Network analysis offers a rich set of concepts for tackling this problem.

Method: Review essay.

Analysis and results: Network analysis approaches offer the promise of more nuanced approaches and diagnostic tools that could address these issues by focusing on its elements: reciprocity, centrality, density, fault lines, multi-team systems, …

Engaging Older Adults With Parkinson’S Disease In Physical Activity Using Technology: A Feasibility Study, Melinda Hermanns, Barbara K. Haas

Nursing Faculty Publications and Presentations

Parkinson’s disease (PD), a progressive neurodegenerative disorder, presents unique and daily challenges. Living with PD may limit one’s physical activity and negatively affect quality of life (QOL). No studies were identified that utilized online technology to promote health in this population. The purposes of this study were to (a) assess the feasibility of an intervention that requires wearing a physical activity tracker and participating in an online support group, and (b) examine the effect of this intervention on the self-efficacy for physical activity and QOL of older adults with PD. A 12-week longitudinal pretest/posttest design was used to assess physical …

Addressing Health Literacy And Collaboration In Mobile Clinics Utilizing Teach-Back Methodology And Healthcare Provider Training, Mark Robert Drye

Doctoral Dissertations and Projects

Focused healthcare provider teaching was used to increase health literacy sensitive care and to improve interdisciplinary collaboration between providers in a mobile clinic setting that serves significantly underserved and socioeconomically challenged populations. The teach-back method was selected as one of the tools to help providers help their patients overcome health literacy challenges by increasing compliance and helping providers engage their patients in collaborative care. Multidisciplinary providers working in a large university clinic system in the southern United States (N = 20) were surveyed, provided focused training, and resurveyed to determine if provider practices addressing health literacy and interdisciplinary collaboration could …

Increase In Pneumococcal Immunization In Adults Over 65 Years Of Age In A Federally Qualified Health Center, Mara J. Dominguez

Doctoral Dissertations and Projects

Pneumococcal disease is a healthcare concern with increasing financial and societal burden for adults over the age of 65 years and their caretakers. The Center for Disease Control and Prevention (CDC) recommends the use of pneumococcal vaccines in this population as a preventive measure helping minimize the mortality and morbidity. This project aimed at increasing the rate of pneumococcal vaccines in a Federally Qualified Health Center (FQHC). The interventions implemented included the use of audit, feedback and provider educational intervention aimed at increasing the knowledge and the intent to change and improve their practice. The key results indicated an increase …

The Population Health Template: A Roadmap For Successful Health Improvement Initiatives, Michael Kobernick, Md, Ms-Hsa, Ms-Poph, Faafp

Population Health Leadership Series: PopTalk Webinars

Learning Objectives

• Describe the population health template as a tool to achieve and report on Quintuple Aim objectives of health improvement initiatives
• Identify gaps in current health initiatives illustrating the needs for the template's more organized approach
• Apply the template to health improvement opportunities in health improvement initiatives
• Understand the role of social determinants of health in health improvement initiatives

Presentation: 50:31

High Medicaid Nursing Homes: Organizational And Market Factors Associated With Financial Performance, Robert Weech-Maldonado, Justin Lord, Rohit Pradhan, Ganisher Davlyatov, Neeraj Dayama, Shivani Gupta, Larry Hearld

Faculty Publications

High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services’ (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities …

A Roadmap To Competitive Integrated Employment: Strategies For Provider Transformation, Esther Kamau, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Competitive integrated employment is defined within the Workforce Innovation and Opportunity Act (WIOA, 2014) as full-time or part-time work at minimum wage or higher, with wages and benefits similar to those without disabilities performing the same work, and fully integrated with coworkers without disabilities. The Act requires that states ensure employment is offered as a priority outcome for people with intellectual and developmental disabilities (IDD). As a result, providers who offer employment support to people with IDD have been working to phase out sheltered workshops and transform to offer competitive integrated employment.

Journey Of Change: A Summative Assessment Transformation, Karen A. Fallon, Diana C. Emanuel

Teaching and Learning in Communication Sciences & Disorders

Abstract

Program review indicated the need for substantive change in a summative assessment process for a speech-language pathology graduate program. A group dynamics approach was used to facilitate change that involved an emphasis on quality culture and faculty input. The result was a productive and collaborative journey of transformation resulting in a more time-efficient and valid summative evaluation of student knowledge and skills.

A Scoping Review Of Challenges And The Adaptation Process In Academia: Implications For Occupational Therapy Educators, Maria Concepcion C. Cabatan, Lenin C. Grajo, Erlyn A. Sana

The Open Journal of Occupational Therapy

The fulfillment of role expectations and responsibilities as one builds an academic career can be challenging. Increased demand for occupational therapy faculty merits examination of academic experiences from the literature. This study describes the experiences of educators using adaptation models (Savickas & Porfeli, 2012; Schkade & Schultz, 2003) as a theoretical lens. Arksey and O’Malley’s Scoping Study Framework (2005) was used in the study. Researchers reviewed literature from 2005-2017 from four databases. Researchers analyzed 28 articles from higher education and the health professions using quantitative and qualitative methods. Twenty-two of the 28 articles were published from 2010-2017. The studies analyzed …

Enhancing The Effectiveness Of Special Olympics Minnesota’S Health Promotion Programming, Avery R. Bajema, Laura Marie Hayes, Kelsey B. Kostreba, Shelly Winslow

All Electronic Theses and Dissertations

Nearly 3% of the world’s population have an intellectual disability. A link exists between intellectual disability and higher rates of chronic and preventable diseases, which is partially attributed to lack of health education geared toward individuals with intellectual disability. Health promotion programs can provide health-related resources and education. Health promotion programs are often standardized, making it challenging to meet the various learning needs of individuals with intellectual disability. Special Olympics is the largest organization that provides health-related programming for those with intellectual disability. In Minnesota, the Special Olympics branch known as Health Promotion has reported difficulty with meeting the goal …

How To Address Tobacco Use In Minnesota's Mental Health And Substance Use Disorder Services: Tips From The Field, Meghan Bown, Jamie Andycha, Sophie Burnevik, Ruth Tripp, American Lung Association, Blue Cross Blue Shield, Leadership Academy Collaborative

Articles

The American Lung Association, Upper Midwest Region, developed and facilitates the Leadership Academy Collaborative, bringing together various health care stakeholders in Minnesota to collaborate on a shared vision to reduce commercial tobacco use among people living with mental illness and/or substance use disorders. The following areas were identified as strategies that would benefit from further collective action: social norms, delivery, policy

Increasing Hospice Nurses’ Knowledge And Improving Attitudes On Pain Assessment In Dementia Patients, Lyn Marie Peugeot

Student Theses, Dissertations and Capstones

Background: Patients with dementia have difficulty articulating pain due to cognitive deficits incommunication, sensation, and overall physical decline due to the aging and disease process. Patients who have dementia are considered at-risk for uncontrolled pain due to under-assessment, under-treatment, or untreated pain. Current research notes gaps exist in pain assessment among nurses’ due to knowledgedeficits and attitudes on pain assessment for dementia patients. Barriers regarding the utilization of evidence-based behavioral pain assessment tools are related to nurses’ knowledge deficit and skills competency.

Purpose: The purpose of this evidence-based practice (EBP) project was to increase hospice nurses’ knowledge and improve attitudes …

Care Team Perspectives And Acceptance Of Telehealth In Scaling A Home-Based Primary Care Program: Qualitative Study, A. Kozikowski, J. Shotwell, E. Wool, J. C. Slaboda, K. A. Abrashkin, K. Rhodes, K. L. Smith, R. Pekmezaris, G. J. Norman

Journal Articles

No abstract provided.

Improving Nurse-To-Nurse Handoff Communication At The Bedside Through Simulation-Based, Lisa Thornsberry Mrs.

Doctor of Nursing Practice Projects

Communication among nursing staff is crucial to the outcome of patient care. Poor handoff and communication among professionals can have a negative impact on the safety of patients. The systemic nature of the problem with miscommunication among healthcare clinicians supports the necessity of standardization of communication among nursing as a handoff of care.

Change of shift report, or nurse-to-nurse report ensures the transfer of critical information to promote patient safety and best practices. Transferring and communicating pertinent information from one shift to the next is one factor in providing continuity of care. Bedside Shift Report (BSR) is an opportunity to …

Staff Nurses’ Perception Of Standardized Bedside Shift Report And Safety Assessment, Lara Scarborough

Nursing Theses and Capstone Projects

This study was conducted to explore a group of Medical-Surgical staff nurses’ perception of a unit-based procedure change, which included implementation of a standardized bedside shift report with a comprehensive safety assessment. The goal was to gain insight from the staff nurses via a qualitative survey to provide data for nurse leaders to examine common perception themes associated with implementation of bedside shift report with a standardized safety assessment. Themes derived from data analysis indicated that nurses perceived bedside shift report to increase patient safety but felt that some nurses were not willingly participating in bedside shift report. Staff nurses …

Basic Organizational Skills And Structure For New Nurses: The Boss Method. Using Simulation To Teach Management And Organizational Skills, Kathy W. Locklear

Nursing Theses and Capstone Projects

The Bachelor of Science in Nursing (BSN) program had a deficiency in teaching graduating senior nursing students in the areas of managing and organizing care for an assigned group of patients. By the last semester of the senior year, most of the senior nursing students had no exposure to caring for more than one patient during clinical rotations. In 2017, the senior nursing students’ performance in Team Nursing and Focused Care experiences, which occur during the last semester of the graduating year, demonstrated a lack of ability to care for more than one patient at a time. In 2018, there …

The Education And Social Reform Of Al-Azhar University: A Short Historical Commentary, Basil H. Aboul-Enein

Health & Wellness Department Faculty Publications and Research

The concept of the university is perhaps one of the oldest social institutions in the world and plays an intricate and pivotal role in societies in various cultures. Every university has a unique story in its history, growth, controversies, and its on-going survival. The role of each respective university's faculty and academic leadership has a certain level of professional interaction in terms of their role and contract with society. This paper examines the historical evolution, challenges, reforms, and proposed prediction of the renowned Al-Azhar University of Cairo, Egypt.

Improving Staffing At A Southern Virginia Hospital Using Bardach’S Policy Analysis And The Ihi Triple Aim Framework, Caitlin Crowder

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Nurse staffing is a major concern for healthcare organizations. Ensuring adequate staffing is crucial to providing quality, patient-centered care. The purpose of this project was to explore staffing policy options at a Southern Virginia Hospital using Bardach’s policy analysis and the IHI Triple Aim as frameworks. This policy analysis was conducted to offer a solution for staffing. The current staffing model at this rural Southern Virginia hospital resulted in ongoing, escalating costs that cannot be sustained over time. The three staffing options reviewed included: allowing the current staffing plan to stay in place, implementing a staffing committee, and implementing a …

Reducing Inpatient Falls On A Cardiovascular Progressive Care Unit: A Quality Improvement Study To Implement Interprofessional Intentional Rounding, Deidra Pennington

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Patient falls remain a significant concern for hospitals despite years of focus and research on the topic. Most hospitals have robust fall prevention policies in place containing numerous interventions, yet few demonstrate evidence of long-term sustainability in fall reduction. Patient falls impact overall health outcomes and result in higher costs for the patient and facility due to increased lengths of stay and more medical tests. The location for this study was the cardiovascular progressive care unit (CVPCU) at a Level 1 Trauma Center and academic hospital. This unit underwent a relocation and merger of two nursing units in the fall …

Partner Build Grow: Resources To Sustain Partnerships And Advance Prevention Initiatives, Evelyn Frankford, Rachel Sadlon, Olga Acosta Price, Linda Sheriff

Prevention and Community Health Faculty Publications

Alignment of programs, practices, and policies by practitioners at the state and local levels can create health-promoting environments for all children. Such alignment, guided by principles of prevention science and public health, can enhance school–community partnerships involved with the mental, emotional, and behavioral well-being and positive development of children and youth. The key to success of such prevention approaches is sustaining the work over time. Partner Build Grow, an online Action Guide, supports sustainability through cross-sector collaborations and systems change to create school– community environments that promote equity. Informed by local and national experts along with field experience and application …

The Tailoring Of National Guidelines For Upper Extremity Post-Stroke Rehabilitation: A Concept In Use., Salem F. Alatawi

Internet Journal of Allied Health Sciences and Practice

Background: In Saudi Arabia, national evidence-based clinical guidelines (NCG) were created based for healthcare interventions. However, clinicians appear to be slow to incorporate the evidence into practice. As a result, there exists a time-gap between the gathering and presentation of evidence for best practice and the use of that evidence by clinicians. It becomes, therefore, imperative to investigate the gap between the research evidence and clinical practice. The knowledge to action (KTA) framework is available to facilitate the implementation of research evidence. This framework incorporates the theory of tailoring, a concept that is intended to create a fit between …