Digital Commons Network^™

Strategies Ambulatory Practice Leaders Use In Optimizing Electronic Medical Record Systems, Jeffrey L. Brown

All Theses And Dissertations

Electronic medical record systems (EMRs) were quickly adopted by ambulatory care practices due to federal government programs encouraging their rapid adoption and implementation. The accelerated implementation and adoption of these digital care systems introduced new forms of administrative burdens that have become negatively associated with the practice of medicine. Research regarding the challenges related to implementing and adopting EMR systems has been abundant. However, there is little research on EMR optimization strategies within ambulatory practice settings. This qualitative phenomenological study explored the lived experiences of ambulatory practice leaders and the strategies they used to optimize EMR systems. The data collected …

Stakeholder Engagement In Adoption, Implementation, And Sustainment Of An Evidence-Based Intervention To Increase Mammography Adherence Among Low-Income Women, Jennifer Holcomb, Gayla M Ferguson, Jiali Sun, Gretchen H Walton, Linda Highfield

Faculty, Staff and Student Publications

Multi-level organizational stakeholder engagement plays an important role across the research process in a clinical setting. Stakeholders provide organizational specific adaptions in evidence-based interventions to ensure effective adoption, implementation, and sustainability. Stakeholder engagement strategies involve building mutual trust, providing clear communication, and seeking feedback. Using constructs from the Consolidated Framework for Implementation Research and The International Association for Public Participation spectrum, a conceptual framework was created to guide stakeholder engagement in an evidence-based intervention to increase mammography appointment adherence in underserved and low-income women. A document review was used to explore the alignment of the conceptual framework with intervention activities …

Inspiring Excellence In Doctoral Nursing Education Through Partnership: Incorporating An Innovative Change Model To Improve Dnp Project Outcomes, Melanie Brewer, Debbie Conner, Transition Management Partners, Llc

All Faculty and Staff Scholarship

Background/Introduction

Franklin University, a leader in educating working adults, formed an academic practice partnership with OhioHealth. Integrating the OhioHealth Change Management Model (CM) into the Doctor of Nursing Practice (DNP) program marks a deviation from a theory-based project to a more theory-to-practice model for managing organizational change. The CM provides leadership-driven DNP students with access to an innovative, real-world approach to prepare to transform organizations, systems, and healthcare through evidence-based interventions.

Purpose

The CM is a novel, goals-focused, data-driven approach used to manage people while implementing evidence-based practice, policy, or business change in an organization. The model includes Identifying executive …

Assessing The Testability Of The Multi-Theory Model (Mtm) In Predicting Vaping Quitting Behavior Among Young Adults In The United States: A Cross-Sectional Survey, Manoj Sharma, Kavita Batra, Ravi Batra, Chia-Liang Dai, Traci Hayes, Melinda J. Ickes, Tejinder Pal Singh

Social and Behavioral Health Faculty Research

Purpose: Given the increased exposure to e-cigarettes and nicotine among young adults, difficulty in quitting vaping is likely, which supports the need for effective behavioral interventions. Therefore, this cross-sectional study aims to assess the testability of the contemporary multi-theory model of health behavior change in predicting the vaping quitting behavior among young adults in the United States. Methods: A nationally representative sample of 619 young adults engaged in vaping behavior and aged 18–24 years was recruited to complete a 49-item web-based survey. A structural equation model was used to test relationships between MTM constructs. Hierarchical multiple regression was utilized to …

Positive Patient Postoperative Outcomes With Pharmacotherapy: A Narrative Review Including Perioperative-Specialty Pharmacist Interviews., Richard H Parrish, Heather Monk Bodenstab, Dustin Carneal, Ryan M Cassity, William E Dager, Sara J Hyland, Jenna K Lovely, Alyssa Pollock, Tracy M Sparkes, Siu-Fun Wong

Pharmacy Articles

The influence of pharmacotherapy regimens on surgical patient outcomes is increasingly appreciated in the era of enhanced recovery protocols and institutional focus on reducing postoperative complications. Specifics related to medication selection, dosing, frequency of administration, and duration of therapy are evolving to optimize pharmacotherapeutic regimens for many enhanced recovery protocolized elements. This review provides a summary of recent pharmacotherapeutic strategies, including those configured within electronic health record (EHR) applications and functionalities, that are associated with the minimization of the frequency and severity of postoperative complications (POCs), shortened hospital length of stay (LOS), reduced readmission rates, and cost or revenue impacts. …

Workforce Diversity And Health Equity: The Role Of Schools Of Public Health, Adashima Oyo

Dissertations, Theses, and Capstone Projects

The goal to eliminate health disparities and achieve health equity has remained a consistent public health and social welfare challenge for the United States. Schools of public health, despite being disproportionately White, are charged with the important task of training a diverse workforce of master and doctoral-level public health students to protect and promote the overall health of the nation with research, policy, and practice. Experiences and practices related to the recruitment, admission, enrollment, and graduation of students of color, specifically Blacks and Latinx, warrant further research. Positive deviance theory, critical race theory, and organizational culture theory informed this research. …

Improved Data Communication With Frontline Staff, David Sprecher

Master's Projects and Capstones

Problem: Frequently, communication from the Quality Department (QD) needs to be filtered through several organizational layers without first-hand knowledge of what message was given to frontline staff. Current mechanisms of communication between the QD and front-line microsystem teams have barriers preventing them from being consistent and reliable.

Context: Research has found that collaborating with and supporting frontline staff was key to establishing a culture that supports change and a focus on safety. Establishing open communication and effective teamwork with individuals on the frontline leads to shared values within a team and better collaboration which drives performance improvement.

Interventions: For trended …

Instituting A Preceptor Program In Home Health, Abbi Arnold

Master's Projects and Capstones

Problem: Staff being unfamiliar with the role of being a preceptor impacts their ability to perform the job well. Insufficient understanding of a new role creates stress and uncertainty which can lead to poor employee retention or high job dissatisfaction.

Context: The setting for this project is a large hospital-based home health agency that has an average daily census of 375 patients. The project was a collaboration between home health management and the quality department.

Measures: A measurement strategy was developed to meet the outcome measure, process measure, and balancing measure. The outcome measure was increasing the nurses’ understanding of …

Improving The Delivery Of Discharge Instructions On The Postpartum Unit By Increasing The Nurses' Knowledge, Judy Anne Settles

Master's Projects and Capstones

Abstract

The field of nursing prides itself on two critical functions: safety and patient education. One of the mechanisms for both education and safety is the discharge process. Improvements in the discharge process have been shown to increase patient comprehension and safety. This study is grounded in the (Barach & Johnson, 2006) healthcare organizational framework called the 5 Ps microsystems assessment to explore the impacts and improvements in the discharge instruction process on a postpartum unit in a large organization. It was found that HCAHPS scores regarding discharge instructions were 55-60%, which is below what is considered satisfactory. Utilizing the …

A Delphi Study Of The Skills Necessary For A Speech-Language Pathologist Or Occupational Therapist To Be Successful In A Leadership Position, Jessica Miller

Dissertations

Purpose: The purpose of this Delphi study was to identify the skills necessary for a speech-language pathologist or occupational therapist to be successful in a leadership position using an expert panel. In addition, the purpose was to rate the identified skills based on importance and lastly to determine the activities experts recommend to acquire the top-rated skills. Methodology: This study used a three-round Delphi method to collect data from expert leaders in speech-language pathology and occupational therapy. In Round 1, the expert panel was asked to identify the skills necessary to transition from a speech-language pathologist or occupational therapist to …

Quantification Of Obstetric Hemorrhage, Alma Garcia

Student Scholarly Projects

Practice Problem: The practice problem identified involved the inconsistent measurement of blood loss during the postpartum period due to the standard practice of estimating blood loss. Estimates are subjective measures that can have variable results based on interpretation and thus provide minimal meaningful data.

PICOT: The question that guided this project was structured in the following PICOT format. In postpartum women (P), how does the implementation of quantitative blood loss measurements (I), compared to estimated blood loss measurement (C), affect the early identification of severe hemorrhage (O), during the recovery period (T)?

Evidence: Obstetric hemorrhage is a preventable event that …

Understanding Modern Drivers Of The Employee Experience In Healthcare, Antonio Pangallo, Tim Atwell, Kristi Roe, Adrienne Boissy

Patient Experience Journal

Employee engagement has been considered the guiding metric to convey the health, loyalty, and performance of the healthcare workforce. However, the pandemic created new challenges and stimulated deeper conversations around remote work, systemic racism, inclusivity, trust, well-being, and mental illness, which calls into question whether engagement alone is enough. Using an employee experience model deployed in other industries, we identified key drivers of six employee experience (EX) outcomes. We conducted a panel study with close to 5,000 nurses and physicians to identify and prioritize current key drivers specific to the healthcare employee experience. Relative weights analyses suggest that being treated …

Addressing Anxiety In Hospitalized Adults Using A Music Intervention, Raina M. Rochon

Student Scholarly Projects

Practice Problem: The practice problem is anxiety related to hospitalization among adults in an acute care setting. Increased anxiety can lead to other issues while hospitalized including disruptive behaviors.

PICOT: The PICOT question that guided this project was: In hospitalized medical-surgical adults (P), how does the implementation of a music intervention as an adjunct to standard distraction techniques (I) compared to standard care (C) affect symptoms of anxiety as observed by the rate of behavior de-escalation team calls (O) within eight weeks (T)?

Evidence: There were five systematic reviews, four systematic reviews with meta-analysis with high level of …

Implementing A Diabetes Risk Screening Protocol In The Primary Care Setting., Anna Marks

Doctor of Nursing Practice Papers

Abstract

Background: Over one-third of the United States population, approximately 86 million individuals, are estimated to have prediabetes (CDC, 2021a). If left untreated, prediabetes will progress to type II diabetes mellitus (T2DM) in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop T2DM within their lifetime (Hostalek, 2019).

Purpose:The purpose of this quality improvement project was to implement and evaluate the American Diabetes Association MyChart Diabetes Risk Assessment tool in a primary care clinic to optimize the early identification of prediabetes and T2DM in non-pregnant adults ages 18 to 70 …

Reducing The No-Show Rate At A Community Mental Health Organization., Philip E. Pippen

Doctor of Nursing Practice Papers

Relative to other outpatient healthcare specialties, appointment nonattendance (no-shows) is most prevalent in psychiatric settings. Upon meeting with a community-based mental health organization in Louisville, KY (LCMHO), referral no-shows for intake appointments were identified as a significant issue. LCMHO’s intake appointment no-show rate, estimated at 25 – 40%, exceeded nonattendance trends in the literature. The purpose of this evidence-based practice (EBP) project was to develop and implement a referral engagement reminder intervention for improving intake appointment attendance. A systematic approach guided by the Model for Improvement was applied to foster this evidence-supported practice change. The project’s findings included a 16% …

Evaluation Of The Time To Ask Program At St. Croix Regional Family Health Center, Mary Lindsey Smith Phd, Evelyn Ali Bs, Tyler Egeland Ba

Substance Use Research & Evaluation

The goals of the Time to Ask (TTA) education and quality improvement program are to increase the capacity of the interprofessional care team to effectively, efficiently and compassionately discuss alcohol use with their patients through screening, brief intervention, and referral (SBIRT) as well as to expand regular screening and monitoring of unhealthy alcohol use at the practices. This infographic is a summary of a participant feedback following the TTA program at St. Croix Regional Family Health Center. For more information, please contact Lindsey Smith at [email protected]

Overview Of Transition Care Clinics And Patient No-Shows, Manul Awasthi

Electronic Theses and Dissertations

Introduction

Transition care clinics (TCCs) have proven to be effective in meeting the time-sensitive needs of patients in the post-discharge period and ensuring smooth transitions of patients from hospital to home. These clinics have led to lower readmissions, lower emergency department visits, cost savings, and lower rates of other adverse events following discharge. However, TCCs, including the East Tennessee State University Family Medicine (ETSU-FM) TCC have been facing high rates of patient no-shows.

Aim

The aim of this dissertation is to identify the different components and outcomes of TCC based on the literature. We further aim to analyze the TCC …

A Feasibility Study To Identify If The Induction Of The Relationship Based Care Program Enhance The Caring Skills Of Registered Nurses?, Jennifer Millet

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this Doctor of Nursing Practice project was to educate the Registered Nurses (RNs) to implement the Relationship Based Care (RBC) model and Jean Watson’s Theory of Human Caring principles into their practice. The model and principles were put into practice by the RNs, followed by examining the RNs perception and practices of caring and confidence skills had improved after the intervention. The mission of this project was to promote quality outcomes and patient satisfaction through caring relationships. Strengthening these relationships will help the caregiver experience the essence of care and be able to better connect to another …

Reducing Falls Related To Toileting, Brian Locastro

Student Scholarly Projects

Practice Problem: The practice problem for the medical-surgical unit is a high rate of falls associated with toileting activities, despite universal fall precautions for all patients. The current fall rate is an average rate of 4 falls per 1,000 patient days.

PICOT: The PICOT question that guided this project was: Among adult patients in the inpatient medical-surgical unit (P), what is the effect of adding a toileting care plan (I) to the current practice of universal fall precautions (C) to reduce the severity and incidence of falls (O) within an 8-week period (T)?

Evidence: Nine high-quality articles supported a toileting …

The Effect Of Transfer Of Care Protocol On The Rehospitalization Rates In Psychiatric Patients, Fernando Guillen Msn, Cnp, Pmhnp-Bc

Student Scholarly Projects

Practice Problem: The problem involved the transition of psychiatric care from long psychiatric hospitalizations to community-based psychiatric treatment which has developed into shorter inpatient psychiatric hospitalizations, which in turn has developed into a significantly higher number of individuals being readmitted within one year of inpatient discharge.

PICOT: In adult patients undergoing inpatient acute psychiatric care (P), how does the use of a transfer of care protocol (I), compared to current transfer of care practice (C), affect the rate of readmission within 30 days for inpatient acute psychiatric care (O), in 10 weeks?

Evidence: The evidence from an extensive literature review …

A Commentary On The Healthy Community Stores Case Study Project: Implications For Retailers, Policy, And Future Research, Samantha M. Sundermeir, Megan R. Winkler, Sara John, Uriyoán Colón-Ramos, Ravneet Kuar, Ashley Hickson, Rachael D. Dombrowski, Alex B. Hill, Bree Bode, Julia Deangelo, Joel Gittelsohn

Urban Studies and Planning Faculty Research Publications

In the United States, low-income, underserved rural and urban settings experience poor access to healthy, affordable food. Introducing new food outlets in these locations has shown mixed results for improving healthy food consumption. The Healthy Community Stores Case Study Project (HCSCSP) explored an alternative strategy: supporting mission-driven, locally owned, healthy community food stores to improve healthy food access. The HCSCSP used a multiple case study approach, and conducted a cross-case analysis of seven urban healthy food stores across the United States. The main purpose of this commentary paper is to summarize the main practice strategies for stores as well as …

Nurse-Led Intervention: Implementing Early Mobilization Of Patients In The Intensive Care Unit, Lou A. Hill

Student Scholarly Projects

Practice Problem: Immobility of patients in the hospital intensive care unit can cause longer stays in the intensive care unit and the hospital. Evidence-based early mobilization of patients helps to reduce length of stay (LOS) and avoid many detrimental sequelae, leading to short and long-term debilitation.

PICOT: The PICOT question that guided this project was: In the adult medical and surgical intensive care units (P), how does implementation of a nurse-driven protocol for early mobility (I), affect the LOS in the intensive care units and the LOS in the hospital (O), as opposed to not using a protocol for early …

Developing Standards For Cultural Competency Training For Health Care Providers To Care For Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, And Asexual Persons: Consensus Recommendations From A National Panel, Mandi L. Pratt-Chapman, Kristen Eckstrand, Amorie Robinson, Lauren B. Beach, Charles Kamen, Alex S. Keuroghlian, Scott Cook, Asa Radix, Markus P. Bidell, Daniel Bruner, Liz Margolies

Publications and Research

Purpose: Lesbian, gay, bisexual, transgender, queer, intersex, and/or asexual and other sexual and gender diverse persons (LGBTQIA + or SGD persons) experience barriers to equitable health care. The purpose of this article is to describe a collaborative process that resulted in core cultural competency recommendations addressing training for those who provide health care and/or social services to LGBTQIA + patients.

Methods: In 2018 and 2019, Whitman-Walker Health, a Federally Qualified Community Health Center in Washing- ton, DC, and the National LGBT Cancer Network purposively selected leaders of community clinics and community-based organizations, cultural competency trainers, and clinicians and researchers with …

Predictors Of Engagement In Nursing Professional Practice: Transforming Organizational Culture In The Post-Covid Healthcare Environment, Jennifer Garnand

Dissertations

Cultivating the shared belief that individuals matter within an organization enhances the empowerment of staff and supports enthusiastic engagement in organizational efforts aimed toward a common mission, vision, and goals (McShane & Von Glinow, 2019). The nursing profession has been plagued by an unprecedented decrease in engagement and diminished job satisfaction, particularly following the prolonged tenure of the COVID-19 pandemic, leading to subsequent attrition amidst a staffing crisis. This quantitative predictive correlational study seeks to determine whether proactive and persevering characteristics, professional identity, and passion of nurses are predictors of engagement in a post-COVID healthcare environment. The research was based …

A Nursing-Driven Delirium Protocol, Alexandria Gray Bridges

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Delirium is a common, often preventable, condition in hospitalized patients and is associated with increased complications, worse outcomes, increased risk of death, and increased health care costs. Purpose: The purpose of this project was to determine if, utilizing a nursing-driven, non-pharmacological intervention, based on the NICE Guidelines, can decrease the incidence of delirium. Methods: Using the Iowa Model of Evidenced Based Practice to Promote Quality Care (Iowa Model), an EBP project was implemented. Patients were identified as being at risk of delirium using The Confusion Assessment Method (CAM) and these patients received the non-pharmacologic intervention as part of …

Assessing The Readiness Of Chf Patients To Use The Medisafe App To Increase Medication Adherence, Janet Lynn Kubas

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Heart failure (HF) is a complex cardiovascular disease that affects 6.2 million Americans and is associated with high morbidity and mortality, with almost 400,000 deaths annually. Medication adherence in HF can lower the risk of death and rehospitalization. As many as 46% of heart failure patients have medication nonadherence. The 2021 Update to the 2017 American College of Cardiology Expert Consensus Decision Pathway for Optimization of Heart Failure Guidelines recommends smartphones or other mobile health (mHealth) applications (apps) for medication adherence tracking. Purpose: This evidence-based practice project aimed to assess the readiness of HF patients admitted to an …

The Use Of A Clinical Pathway To Increase Child Abuse Screenings Of Young Children With Fractures, Stephanie Li Schaller

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Nationally, infants and young children who present to emergency departments with fractures are not being screened adequately for possible physical abuse with a skeletal survey (Paine & Wood, 2018; Shelmerdine et al., 2014; Wood et al., 2019). Without universal screenings, implicit bias along racial and socioeconomic lines becomes a factor in deciding which children with fractures get screened, resulting in either under-or over-utilization of skeletal survey screenings (Kim et al., 2017; Paine & Wood, 2018). When child abuse is not diagnosed correctly, further abusive injuries or death can occur (Ravischandiran et al., 2010). Purpose: This evidence-based practice project …

Addressing Polypharmacy: Implementing The Medication Appropriateness Index Clinical Tool To Increase Deprescribing By Healthcare Providers, Lori Floyd

Doctor of Nursing Practice Projects

Background: Polypharmacy is a national and local issue of concern within healthcare. Deprescribing medications has been identified as a plausible solution for patients experiencing polypharmacy. However, many healthcare providers are unaware of the practice of deprescribing and, if aware, may not be implementing clinical tools for deprescribing effectively. The family medicine clinical site supplies an opportunity for healthcare providers to utilize an evidence-based clinical tool to review medications, identify if inappropriate, and deprescribe if indicated.

Purpose: The purposes of the Doctor of Nursing Practice (DNP) project were to increase deprescribing activity among prescribing healthcare providers and to increase prescribing healthcare …

Evaluation Of The Implementation Of The Munro Pressure Ulcer Risk Assessment Scale To Mitigate Pressure Ulcers In The Perioperative Setting, Sherry Lynn Grandison

Doctor of Nursing Practice Projects

Background: The process of implementing appropriate skin assessment and documentation throughout the patient’s operative experience assists in the early detection of pressure ulcers.

Purpose: This Doctor of Nursing Practice (DNP) project had two goals. The first was to determine a practical tool that would ensure that surgical nurses demonstrate competence and comply with the process of identifying compromised skin integrity, and the second goal was to effectively communicate the findings with other clinical team members.

Methods: The DNP project focused on the use of the Munro Pressure Ulcer Risk Scale Assessment Tool to identify pressure ulcers and to promote collaboration …

Reducing Inpatient Falls And Falls With Injury, Constance Leigh Cannon

Electronic Theses and Dissertations

Patient falls are a costly problem for many inpatient hospitals and are exacerbated by poor training of nursing and ancillary staff. The researcher sought to determine if there was a difference in inpatient falls and falls with injury after a hospital facility in the Southwestern United States revised its fall prevention policy, reorganized its fall prevention committee, and provided new interventions for nurses assessing patients for fall risk. In this quantitative, retrospective, comparative project, the researcher reviewed data from 2017–2020 related to the facility’s fall prevention program, including its new interventions and efforts to involve patients in their safety and …