Digital Commons Network^™

Establishing A Protocol To Address Workplace Violence And Increase The Perceptions Of Safety Among Emergency Department Nurses: A Quality Improvement Initiative, Devan M. Robidoux

Master's Theses and Capstones

Background: Violence against emergency department nurses has become a widespread phenomenon that can greatly impact a nurse's job satisfaction and performance. Research has been scarce in examining the relationship between workplace violence and its underlying consequences. There remains a disconnect between precursors of violence against nurses perpetrated by patients and the cultural expectation that violence is a part of the nurses job and, subsequently, what they signed up for when going into the field. Nurses learn that having a greater understanding of the value in the lived experience of their patients leads to better quality delivery of care. However, culturally …

Evaluating A Rapid Response Team Performance To Implement Best Practice In Rapid Response Team Protocol, Pansy Samuel

Doctor of Nursing Practice Projects

Background

Rapid Response Teams (RRT) provide clinical resources to improve patient safety outcomes at healthcare institutions. This team promptly responds to deteriorating patient conditions to prevent further deterioration and reduce mortality rates. Rapid response teams do not always perform optimally. Reasons for this performance failure include breakdowns in communication, team dynamics, or other variables that can often be adjusted when the team members understand the role these variables play in undermining the performance of the RRT. An understanding of the perceptions of the RRT members regarding their roles and potential areas of improvement did provide valuable data that was utilized …

Organization Of Sensorimotor Activity In Anterior Cruciate Ligament Reconstructed Individuals: An Fmri Conjunction Analysis., Amber J Schnittjer, Howon Kim, Adam S Lepley, James A Onate, Cody R Criss, Janet E Simon, Dustin R Grooms

Neuroscience Articles

INTRODUCTION: Anterior cruciate ligament reconstruction (ACLR) is characterized by persistent involved limb functional deficits that persist for years despite rehabilitation. Previous research provides evidence of both peripheral and central nervous system adaptations following ACLR. However, no study has compared functional organization of the brain for involved limb motor control relative to the uninvolved limb and healthy controls. The purpose of this study was to examine sensorimotor cortex and cerebellar functional activity overlap and non-overlap during a knee motor control task between groups (ACLR and control), and to determine cortical organization of involved and uninvolved limb movement between groups.

METHODS: Eighteen …

Peripherally-Induced Movement Disorders: An Update, Abhishek Lenka, Joseph Jankovic

Faculty, Staff and Students Publications

BACKGROUND: Peripherally-induced movement disorders (PIMD) should be considered when involuntary or abnormal movements emerge shortly after an injury to a body part. A close topographic and temporal association between peripheral injury and onset of the movement disorders is crucial to diagnosing PIMD. PIMD is under-recognized and often misdiagnosed as functional movement disorder, although both may co-exist. Given the considerable diagnostic, therapeutic, and psychosocial-legal challenges associated with PIMD, it is crucial to update the clinical and scientific information about this important movement disorder.

METHODS: A comprehensive PubMed search through a broad range of keywords and combinations was performed in February 2023 …

Women's Power In Hospital-Based Nursing: A Critical Qualitative Study, Kaitlyn C. George, Bret Lyman, Andy Pilarte Alcantara, Maya Stephenson

Faculty Publications

Aim: To understand the factors that affect power in hospital-based nursing and reveal how the female gender affects an individual's ability to feel empowered.

Design: Critical qualitative research design.

Method: Semi-structured interviews were conducted with nurses working in inpatient hospital settings in Utah and New Mexico. Data were collected from February to March 2022. Interviews were analysed using thematic analysis.

Results: Sixteen participants were interviewed. Six themes were identified from the data, four of which related to nurses' power at work, and two of which specifically related to how gender affects a nurse's ability to use power and feel empowered. …

Best Strategies To Address Burnout Among Healthcare Professionals: An Integrative Review, Kimberly Ann Delbo

Doctoral Dissertations and Projects

The purpose of this integrative literature review (ILR) is to provide a comprehensive summary and analysis of past empirical and theoretical literature related to the phenomenon of burnout while sharing a synthesis of literature. This ILR explores, critiques, summarizes, and analyzes best practices and interventions to address burnout and promote engagement and well-being among health care workers within acute care hospitals. The scientific basis for this ILR was the premise that a relationship exists between burnout interventions and organizational cultures which can be positively influenced by relational and social leadership styles that reduce work-related stressors and create positive, professional, healthy …

Implementation Of A Medical Emergency Chain Of Command Protocol In The School Setting, Vikki Shannon Brannon

Doctoral Dissertations and Projects

Medical emergencies occur every day in school settings across America. School nurses have a vital role in providing care for individuals experiencing a medical emergency and leading a multidisciplinary team during a medical emergency event. Since incidences of medical emergencies are commonplace, it is standard to have protocols and guidelines for these events. To address this concern, an evidence-based practice project was implemented in a rural school district in North Georgia. The pilot project was developed and implemented to assess the effectiveness of implementing a “Medical Emergency Chain of Command Protocol.” The protocol was developed to improve the effectiveness and …

Improving Access For Medicare Inpatient Psychiatric Patients: A Health Policy Analysis, Malinda B. Whitfield

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The Medicare Inpatient Psychiatric Services (IPS) policy, originally developed in the 1960s and without any significant or meaningful updates since the 1980’s, is physician specific, does not reflect the current model of care for psychiatric inpatients, and is restrictive for psychiatric mental health nurse practitioner (PMHNP) practice. The policy is complex, consists of outdated regulations, and results in millions of dollars in compliance costs for Inpatient Psychiatric Facilities (IPFs) annually (NABH, 2019). Although clearly an important part of the inpatient psychiatric services team, PMHNPs are not identified or defined in the policy (Center for Medicare and Medicaid Services [CMS], 2019). …

Developing A Quality Improvement Process: Impacting Patient Outcomes And Achieving Ambulatory Accreditation, Colleen E. Nappi

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Colon cancer is the second leading cause of cancer deaths in the United States (US) and colonoscopy is the best method for screening and detecting cancer before symptoms are present. A colonoscopies' ability to detect precancerous lesions or identify colorectal cancer (CRC) relies on patients having a high-quality bowel preparation. The US Multi Society Task Force (USMSTF) on colorectal cancer set quality standards for colonoscopy including bowel preparation quality, adenoma detection, and cecal intubation times. As a private gastroenterology practice in Northern Virginia was preparing for re-accreditation with the Accreditation Association for Ambulatory Health Care (AAAHC) it was determined that …

Decreasing Seclusion And Restraint Events Among Clients Within An Inpatient And Crisis Stabilization Behavioral Health Facility, Karen Lee Richards

Doctor of Nursing Practice (DNP) Projects

Background: Despite global shifts in behavioral health treatment, changes regarding use of seclusion and restraint (S/R) continues to be extremely slow. Local Problem: Increasing S/R events and subsequent staff injuries and financial burden. Methods: A quality improvement project providing education in trauma-informed care (TIC), sensory modulation (SM), and S/R debriefing (S/RD). Interventions: Education and training for S/RD, TIC, and SM using a variety of materials and methods over a 6 to 12-month period was provided to staff within a 16-bed inpatient adult psychiatric health facility (PHF) and a crisis stabilization unit (CSU). Because of positively affecting the use of S/R, …

Mental Health Promotion, Early Identification & Treatment Services And Supports In Public K-12 School Districts: Three Case Studies To Explore Available Resources, Interventions, And Community Partnerships, Keenan Krick

Theses & Dissertations

Objective: This study: 1) identifies the multi-tiered efforts public K-12 school districts in a large Midwestern metropolitan area use to support mental health promotion activities and comprehensive mental health services, and 2) compares district efforts to domains defined by the National Center for School Mental Health (NCSMH). Participants: A sample of public K-12 school districts (n=12) in a large Midwestern metropolitan area participated in this study from August 2021 to October 2022. Methods: Using the Multi-Tiered Systems of Support (MTSS) intervention framework, a series of three case studies identify the resources public K-12 school districts utilize to support mental health …

Depression And Parenting: A Mixed Method Analysis Of Some Protective Factors For Depression Among African American Fathers Using A Community-Based Participatory Research Approach, Tatiana Tchouankam

Theses & Dissertations

In the United States (US), African American (AA) men often face oppression, discrimination, negative interactions with the justice system, and significant economic, neighborhood, and social hardships over their life course. These challenges increase the risk of chronic exposure to stressful events with negative mental health outcomes, such as depression. Most of the research on parenting and parental depression has focused on mothers based on the premise that women are more often primary caregivers for their children, especially during early childhood. However, a growing number of fathers take on childcare responsibilities. Despite dealing with different life stressors and negative circumstances, AA …

Reducing The Risk Of Central Line Associated Blood Stream Infection With Chlorhexidine Gluconate Education, Scarlett Ocon

Master's Projects and Capstones

Problem: A nosocomial central line-associated bloodstream infection is a preventable infection that is costly and potentially fatal. In order to combat bloodstream infections chlorhexidine gluconate wipes have been used as antiseptic. Medical surgical units do not have accessible CHG for bathing purposes. In addition, the staff lacks knowledge of how to use CHG wipes. The current standard bathing practice on this unit consists of using soap and water or disposable washcloths spontaneously without a predetermined time. The aim of this quality improvement project is to educate the registered nurses (RNs) and certified nurse assistants (CNAs) on the benefits of daily …

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 …

Study Of The Impact Of Working At Home And The Fears Of Returning To Work Among Managers And Professionals Who Are In Virtual Congruent Jobs And Who Are High Growth/Achievement Oriented, Carmine Gibaldi, Gerald Cusack, Niall Hegarty

Journal of Vincentian Social Action

Using two surveys, this article examines employee opinions on working from home during the Covid-19 pandemic. In March 2020 we chronicled the experience and reactions of 478 managers and professionals to the mandate they work at home. We found that a large portion of the respondents felt no significant loss in productivity and no reduction in job satisfaction. Most of the challenges they faced had involved efforts required to establish a facilitating home working environment and disruptions in the ease of collaboration with others. The opportunities overwhelmingly focused on the benefits of having more time to rebalance their work and …

Increasing Equitable Access To Care: Implementation Of Universal Palliative Care Screening In The Intensive Care Unit, Sarah Weaver

Student Scholarly Projects

Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations.

PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame?"

Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance …

Retrospective Evaluation Of Depression Screening Process Among Older Adult Patients In Primary Care For Quality Improvement., Ashley Dru Larson

Doctor of Nursing Practice Papers

Background: Depression is not a normal process of aging; it is a diagnosable and treatable medical condition. The US Preventive Services Task Force (USPSTF) recommends that older adults be screened for depression annually.

Aim: The purpose of this evidence-based practice (EBP) project was to evaluate the depression screening process for older adults (age 65+) in a primary health care setting and provide recommendations to the primary health care clinic for improving it.

Methods: This EBP project involved collecting retrospective data from August to October 2022, including aggregate data (demographics), from all older adults who were seen in …

Therapists’ Demonstrated Multicultural Competence In Treating Latinx Immigrants, Dulce Diaz Benitez

Graduate Theses and Dissertations

Studies suggest that health disparities occur when people from marginalized communities receive care that is inadequate based on their cultural needs (USDHHS, 2011). Multicultural competence (MCC) models have been proposed to provide a framework of the competencies that therapists should develop to work with multicultural populations (Sue et al., 1992). Researchers have questioned the validity of measures, which are mostly based on therapist self-report (Cartwright, 2008). The multicultural case conceptualization ability task has been used in previous studies as a measure of demonstrated cultural competence using a vignette to assess case conceptualization abilities (Ladany et al., 1997). However, it has …

Iris Nursing Strong Program: Benchmark Study, Sonia Bunyard, Keviesha Lacy

MSN Capstone Projects

The change project we are presenting is the IRIS-Nursing Strong program. IRIS stands for: Increasing, Reason & Relaxation, Implementation, Strategies all aimed to prevent nursing burnout. The Iris flower symbolizes hope and strength as nurses are healthcare providers who constantly provide that hope and strength to their patients. We plan to develop this program in the workplace to infuse that hope and strength back into the nurses who spend so much time taking care of others. The goal is to offer a non-judgmental environment, recognize early signs of distress in ourselves and our peers, provide …

Expanding The Focus Of Occupational Safety And Health: Lessons From A Series Of Linked Scientific Meetings, Paul A Schulte, George L Delclos, Sarah A Felknor, Jessica M K Streit, Michelle Mcdaniel, L Casey Chosewood, Lee S Newman, Faiyaz A Bhojani, Rene Pana-Cryan, Naomi G Swanson

Faculty, Staff and Student Publications

There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s total Worker Health

A Tale Of Two Migrations: A Medical Library Case Report, Lisa Palmer, Tess Grynoch, Sally Gore

Medical Institutional Repositories in Libraries (MIRL)

Launched in 2006, the eScholarship@UMassChan institutional repository has been an important digital platform at UMass Chan Medical School, hosting faculty research, student research, and unique original publications and scholarship. In June 2021, UMass Chan’s Lamar Soutter Library decided to migrate eScholarship@UMassChan from the bepress Digital Commons platform to two separate hosted platforms. Most content – over 25,000 items representing faculty and staff publications, theses and dissertations, conference proceedings, and departmental and project collections – moved to Open Repository, a DSpace repository platform hosted by Atmire. The Janeway publishing platform became the new home for the open access, peer-reviewed journals and …

Development And Use Of A Survey Tool To Prioritize And Catalyze Change Surrounding Faculty Wellness In A Department Of Pediatrics, Sarah Rhoads, Alison Riese, Mohammed Faizan, Lloyd Feit, Shuba Kamath, Albert Ross, Katherine Mason

Journal of Wellness

Introduction: Physician wellness is an important factor in the delivery of safe, effective and humanistic patient care. There is compelling data describing the widespread prevalence of physician burnout and its subsequent adverse impact on patient care, healthcare costs, and relationships. Initiatives to improve wellness are necessary to maintain the healthcare work force as well as to ensure high-quality care. This project investigated faculty physicians’ attitudes and priorities regarding physician wellness within the department of Pediatrics at a single-center academic institution.

Methods: A survey was created and distributed via e-mail to all faculty physicians employed within the Department of Pediatrics in …

The Correlation Between Transformational Leadership And Mental Health Clinician Burnout, Rebekah E. Shutter

Electronic Theses and Dissertations

Mental health clinicians working in a hospital setting are at a high risk of experiencing burnout due to the stressful demands of their caseloads, compassion fatigue, limited resources, and unsupportive leadership. While there is ample research regarding the cause and effect of burnout on clinicians there is a gap in the literature when it comes to the impact leadership has on mental heath clinician burnout. The purpose of this quantitative, correlational study is to determine if and to what extent there is a correlation between Transformational Leadership and mental health clinician burnout. Participants for this study consisted of 200 mental …

Key Healthcare Providers’ Perspectives On The Implementation Of Senior-Friendly Emergency Department Care In Quebec, Deniz Cetin-Sahin, Francine Ducharme, Jane Mccusker, Mona Magalhaes, Nathalie Veillette, Paul-André Lachance, Sylvie Cossette, Alain Vadeboncoeur, Rick Mah, T.T. Minh Vu, Simon Berthelot

Journal of Geriatric Emergency Medicine

Background: Senior-friendly emergency department (ED) care is emerging to address large numbers of older adults in healthcare and implementation is variable.

Objectives: We aimed to explore key healthcare providers’ perspectives on factors affecting implementation of senior-friendly ED care during the first five years of the Senior-Friendly Hospital Initiative in the Province of Quebec, Canada.

Methods: We conducted a descriptive qualitative study of four urban EDs. Key healthcare providers involved in care within the ED or after discharge to the community were purposefully selected. Semi-structured telephone interviews were conducted in participants’ preferred language, English or French. Recorded interviews were transcribed. A …

Professional Misfits: “You’Re Having To Perform . . . All Week Long”, Brenda L. Beagan, Kaitlin R. Sibbald, Tara M. Pride, Stephanie R. Bizzeth

The Open Journal of Occupational Therapy

Background: Occupational therapy professes commitment to equity and justice, and research is growing concerning the experiences of clients from marginalized groups. To date, almost no research explores the professional experiences of therapists from marginalized groups. This qualitative study explores how exclusion operates in the profession among colleagues.

Method: Grounded in critical phenomenology, semi-structured in-depth interviews were conducted with 20 occupational therapists who self-identified as racialized, disabled, ethnic minority, minority sexual/gender identity (LGBTQ+), and/or from working-class backgrounds. Iterative analysis was conducted using constant comparison and employing ATLAS.ti for team coding.

Results: Across identity groups, four processes of exclusion …

Client-Centered Practice When Professional And Social Power Are Uncoupled: The Experiences Of Therapists From Marginalized Groups, Brenda L. Beagan, Kaitlin R. Sibbald, Tara M. Pride, Stephanie R. Bizzeth

The Open Journal of Occupational Therapy

Background: Client-centeredness is foundational to occupational therapy, yet virtually no research has examined this aspect of practice as experienced by therapists from marginalized groups. The discourse of client-centeredness implicitly assumes a “dominant-group” therapist. Professional power is assumed to be accompanied by social power and privilege. Here, we explore what happens when professional and social power are uncoupled.

Method: In-depth interviews grounded in critical phenomenology were conducted with Canadian therapists (n = 20) who self-identified as disabled, minority sexual/gender identity (LGBTQ+), racialized, ethnic minority, and/or from working-class backgrounds. Iterative thematic analysis employed constant comparison using ATLAS.ti for team coding. …

Impacting Nurse Job Satisfaction And Engagement Through Shared Governance, Meghan K. Douglas

Doctor of Nursing Practice Scholarly Projects

Problem: Shared governance (SG) has been identified as an effective process to promote shared decision-making between direct care nurses and nursing leadership. However, barriers were identified at a large hospital system in the Southeastern United States (US) that postponed the full implementation of SG. This prevented nurses from having input on policies and actions that directly affected their work. Purpose: The purpose of this evidence-based project (EBP) was to determine if unit-based SG improved job satisfaction and engagement for nurses on inpatient medical-surgical units at a large hospital system in the Southeastern US. Method: Five medical-surgical units were identified to …

Organizational Readiness For Implementing A Postpartum Depression Screening Protocol In The Nicu, Deanna L. Suber

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Postpartum depression (PPD) is a major depressive disorder that is the most common complication following childbirth, occurring in about 16% of new mothers (Berns et al., 2021). Mothers with infants in the Neonatal Intensive Care Unit (NICU) are 40% more likely to develop PPD but are not typically screened for this complication (Berns et al., 2021; Cherry et al., 2016; Garfield et al., 2021). Implementing a PPD screening protocol in the NICU could help increase the detection of PPD in this population but would first require an evaluation of organizational readiness to ensure sustainability. Purpose: The purpose of …

Implementing The Use Of The Emergency Severity Index Triage Tool In Urgent Care, Sakeena Spencer

Doctor of Nursing Practice Projects

Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has …

Implementation Of Routine Screening To Detect Early Cases Of Depression And Anxiety In Hispanic Adolescents In The Primary Care Setting, Latoya Hayward

Doctor of Nursing Practice Projects

Depression and anxiety are among the leading causes of illness and disability in adolescents and are two of the most prevalent mental health conditions in Latino youth. If left unrecognized and untreated, these conditions can lead to decreased quality of life and increased rates of suicide. Researchers recommend early mental health screening to occur in the primary care setting. Through routine screening using evidence-based screening tools (PHQ-9 and GAD-7), the primary goal of this quality improvement project was to increase early detection of depression and anxiety in primary care and initiate early treatment. Project methods included implementation of new workflow, …