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Thoughts From The Frontline - July 2024, Tennessee Center For Nursing Advancement, East Tennessee State University

Thoughts from the Frontline Newsletter

No abstract provided.

Addressing Caregiver Burden Among Oncology Caregivers: An Educational Intervention., Alexandria Salois

Doctor of Nursing Practice Papers

The incidence of cancer is on the rise, the number of cancer diagnoses are increasing at an alarming rate with advanced technologies and available evidence. Cancer care has also shifted from the inpatient setting to mostly outpatient. With this, a large portion of the responsibility has been transferred to the caregiver of that patient (Kent et al., 2019). Historically, caregivers have not been at the forefront of research, however, the concept of caregiver burden is beginning to emerge. A gap exists in addressing the needs of caregivers in both evidence-based data and with the local community cancer support group, Gilda’s …

Evaluation And Implementation Of Mindfulness Module To Reduce Burnout Among Emergency Department Nurses: A Quality Improvement Project, Katie Waltrip

Doctor of Nursing Practice Papers

BACKGROUND: Nurses working in the ED experience higher burnout rates than those working in other healthcare settings. Defined as emotional exhaustion, depersonalization, and a low sense of personal accomplishment, burnout is associated with increased work absences and turnover and decreased patient satisfaction and quality care. Burnout must be examined and addressed for emergency nurses to continue providing quality care.

PURPOSE: This quality improvement project aimed to evaluate burnout among nurses working in the ED prior to and immediately following a 9-week mindfulness-based intervention.

METHODS: A Plan-Do-Study-Act model was utilized along with application of supporting evidence from the literature and an …

Promoting Healthy Habits Among Children In A Residential Facility., Tiffany Jones

Doctor of Nursing Practice Papers

Background: Childhood obesity has been a significant public health concern in the United States. The prevalence of obesity among children and adolescents has increased over the past few decades. There are serious implications for immediate and long-term health. It poses serious health risks and economic challenges.

Setting: This quality improvement project will take place at a residential psychiatric treatment facility and therapeutic foster care program for children and adolescents with mental health or behavioral issues. This facility is in the suburbs of Louisville, Kentucky.

Purpose: The purpose of this project is to boost physical activity and improve knowledge about nutrition …

Improving Transitions In Care Through Early Discharge Planning: A Quality Improvement Initiative., Sarah Markgraf

Doctor of Nursing Practice Papers

Background: A substantial body of evidence has shown transitions in care are one of the weakest links in healthcare networks, especially for older adults with complex comorbidities. Residents receiving short-term rehabilitation (i.e., rehab) transitioning to home from a skilled nursing facility (SNF) are the most vulnerable in the first 30 days post-discharge for adverse resident events, including avoidable rehospitalization. Avoidable rehospitalizations cost Medicare billions of dollars annually and lead to poor resident outcomes. Early discharge planning in SNFs for short-term stay rehabilitation has decreased rates of avoidable rehospitalizations, improved quality of life in geriatric residents, and improved care partners' perceived …

A Parenting-Skills Intervention To Mitigate Adverse Childhood Experiences For Children Of Parents In Substance Use Disorder Recovery., Makayla S. Haas

Doctor of Nursing Practice Papers

Abstract

Background: Parents recovering from substance use disorder (SUD) are prone to neurobiological alterations that affect parental emotional regulation, increasing occurrence of harsh parenting, heightened stress, and relapse. Children with parents who suffer from SUD experience adverse childhood experiences (ACE), predisposing them to negative health and lifestyle risks. Implementing a parenting-skills intervention for parents in recovery can promote positive-parenting, reduce parenting stress, improve the parent-child relationship, and mitigate the effects of ACEs.

Setting: ChooseWell Communities (CWC), a sober-living community, in Louisville, KY served as the project site. Participants at CWC are sober parents with primarily young children under 5 years …

Improving Treatment And Follow-Up Care For Patients Who Screen Positive For Depression In Family Practice: A Quality Improvement Project., Jennifer D. Hooper

Doctor of Nursing Practice Papers

Background: Depression is a prevalent condition requiring systematic approaches for effective treatment and follow-up in primary care. This quality improvement project aimed to enhance care for patients screening positive for depression at an academic family practice with a diverse patient population and a comprehensive electronic health record (EHR) system.

Purpose: The primary objective was to assess whether a provider educational session and the implementation of an optional depression treatment and follow-up algorithm could improve timely and appropriate care for patients with positive PHQ-9 screenings.

Setting: The project was conducted at an academic family practice office.

Methods/Procedures: The intervention included a …

Improving Pressure Injury Nurse Awareness And Decision-Making In The Cardiac Intensive Care Unit: A Quality Improvement Project., Sarah G. Moreno

Doctor of Nursing Practice Papers

Abstract

Background/Significance: Hospitalized patients with pressure injuries have 5 times greater death compared to a patient without a pressure injury. A needs assessment identified the problem of pressure injuries in the CVICU with the goal to improve nurse awareness and decision-making to decrease pressure injuries in the CVICU.

Purpose: The purpose of this project was to increase nurse awareness of pressure injury prevention via an education workshop and evidence-based pressure injury decision tree in the Cardiovascular ICU.

Methods: A MeSH search was conducted to identify pressure injury interventions and nurse awareness of pressure injuries which resulted in 17 …

Reducing Stress And Improving Mindfulness Practices Among Mental Health Professionals Through Guided Meditation., Liara G. Patton

Doctor of Nursing Practice Papers

Abstract

Background: Chronic exposure to psychological stress places mental health providers in a vulnerable position when coping skills are not learned or available. Mental health providers are at risk for both mental and physical illness due to the empathetic demands of their client’s stressors. The deficit in adequate coping skills can cause provider-client relationships to suffer and create an undesirable work environment.

Setting: This project took place in Somerset, KY, at a mental health company called A New Beginnings Achievement Center (ANBAC). Twenty-six employees work at ANBAC, all of whom are involved in providing mental health services to developmentally delayed …

Focused Interventions To Decrease Inpatient Falls, Alyssa Nicole Watchmaker Smith

Doctor of Nursing Practice Papers

Background: Falls are the most commonly reported safety incidence in the hospital setting (Morris R. et al., 2017). Because falls may be a result of many factors, evidence shows that multicomponent fall interventions best reduce fall rates (Bargmann et al., 2020; Dykes et al., 2010; Dykes et al., 2020; Strini et al., 2021). In this project, a needs assessment identified a need for fall prevention strategies to reduce fall rates on inpatient units.

Setting: A step-down/telemetry Cardiovascular Intervention Unit (CVI) (15 beds) and Cardiovascular Unit (CVU) (12 beds) in a suburban private hospital.

Purpose: The purpose of this evidence-based project …

Improving The Integration Of Whole Health Into A Veterans Affairs Outpatient Primary Care Clinic., Diana Lynn Blair

Doctor of Nursing Practice Papers

Abstract

The annual $4.1 trillion price tag for healthcare with a simultaneous decline in patient health outcomes is the catalyst to change the current healthcare culture from disease-focused to a Whole Health wellness and prevention model. Transforming to preventative care would remedy the current costly healthcare system, thus Veterans Health Administration (VHA) set forth a mandate to implement Whole Health (WH) system wide. The purpose of this project was to provide a training program that facilitated the implementation of WH and improve the documentation of WH in the electronic health record (EHR). A needs assessment provided to the Fort Knox …

Help Programs Impact On Delirium, Abigail Holt

Nurse Residency

Background: Delirium is a condition that affects 1/3 of patients in the hospital. It is a condition that is preventable and reversible.

The Comparison Between Chlorhexidine And Povidone-Iodine Antiseptics In The Operating Room To Prevent Surgical Site Infections, Eleanor Decarolis

Nurse Residency

Background: Surgical site infections (SSI's) are one of the most common and costly complications from surgery. Chlorhexidine gluconate (CHG) and Povidione-Iodine (PVI) are the most common antiseptics used in surgery. The efficacy and uses of these surgical preps have been studied to determine the most effective in preventing surgical site infections.

How Environment Of Care Standards Impact Patient Satisfaction, Taylor Tantingco, Raeven Bilugan

Nurse Residency

Background: Environment of Care (EOC) are standards of care that revolve around the safety and well-being of both the staff and the patient.

EOC takes into account variables such as a clean environment, basic standards of care (ADLs), and access to resources/materials.

Evidence-Based Diabetes Exercise Intervention, Laura Smith

Nurse Residency

Type 2 diabetes mellitus is a chronic, noninfectious disease that affects a large population of adults in the world. Typically, it is associated with obesity, a sedentary lifestyle, and the consumption of undesirable meals (Nakrani et al., 2020/2023). Even with various treatments available for type 2 diabetes, most patients find it challenging to maintain a steady blood glucose level.

The Benefits Of Simulation-Based Training, Brooke Taylor

Nurse Residency

Background: Due to COVID-19, many hospitals shut down their in-person classes and simulated trainings. This has had a negative impact on the education of our new graduate nurses.

Purewick Versus Foley Catheters, Ashleigh Lunt, Grace Tibbetts, Tia Hufstader

Nurse Residency

Background: A Foley catheter is an indwelling urinary drainage device that is placed in a patient's urethra and remains in their bladder, continuously draining urine into a bag. In hospital settings, there are many indications for indwelling catheters such as strict I&O monitoring, incontinence, retention, end of life comfort, surgery, and immobility.

E-Gaming: An Active Learning Pedagogy For Engaging Learners In A Private University In Karachi, Pakistan, Laila Akber Cassum, Syeda Sadia Fatima

School of Nursing & Midwifery

There is a radical shift in teaching and learning pedagogies to engage the learners in healthcare profession. It was a tough challenge for Pakistani educators of an esteemed university to motivate and assess the learners for concept absorption and critical reasoning using creative approaches. Teaching and learning styles have changed fundamentally from conventional teacher centred to inquiry-based student-centred approach. Classroom teaching in recognised nursing and medical institutes in Pakistan have transformed to blended and entirely online methodologies with the integration of diverse active learning strategies. The educators grapple to engage the millennials and to encounter this, gaming technological platform was …

Stress And Its Associated Factors In Mothers With Preterm Infants In A Private Tertiary Care Hospital Of Karachi, Pakistan, Salima Akbar, Yasmin Parpio, Sumia Andleeb Abbasi, Tazeen S. Ali

Journal of Asian Midwives (JAM)

Background: Preterm births are the leading cause of death worldwide. Preterm births not only have devastating effects on the newborn, but they also have psychological effects on the mothers. Identifying stress related to preterm births, and the factors associated with the stress among mothers with preterm infants is of great importance, for providing sound care to the newborns and their mothers. The aim of this protocol paper outlines an extensive approach to assess the level of stress and its associated factors among mothers with preterm infants.
Methods: An analytical cross sectional study design will be used to achieve the study …

Exploring Maternal Perspectives On Human Milk Banks In Pakistan And Identifying Barriers And Enablers For Establishment, Hina Baba Jan, Naghma Rizvi, Kiran Mubeen, Marina Baig

Journal of Asian Midwives (JAM)

Background: Low-and middle-income countries including Pakistan still have low breastfeeding rates and infant feeding remains a concern. Human milk banks (HMBs) play a crucial role in neonatal and infant health by providing safe, pasteurized donor human milk to infants who do not have access to their mother's own milk, particularly preterm and low-birth-weight infants. The perception regarding the concept and use of HMBs has yet to be explored in several contexts, especially in the low-and middle-income countries including Pakistan.
Aim: To explore the perceptions of mothers regarding human milk banks in Pakistan, focusing on the barriers and enablers to …

Assessing Association Between Socio-Demographic Variables And Contraceptive Usage In Married Men Residing In Korangi District, Karachi, Pakistan, Fahmida Khawaja, Gloria Noble Khan, Alia Nasir, Kiran Khowaja

Journal of Asian Midwives (JAM)

Background: Population growth remains an alarming concern for Pakistan as it not only exhausts scarce resources but further impedes socioeconomic development. One potential solution is to advance modern Family Planning (FP), which in the Pakistani context requires specific and rigorous attention towards male contraception in conjunction with female family planning usage. This study aims to determine the association between socio demographic factors and contraceptive use in married men of squatter settlement of Korangi Karachi.
Methods and Materials: A cross-sectional study was carried out from March, 2017 to June 2017, using a non-probability convenience sampling technique to select married men …

Balancing Life After Spousal Loss: A Cross-Sectional Study Investigating The Mental Well-Being And Life Satisfaction Of Martyrs’ Wives, Mehreen Aslam, Ambreen Tharani, Yasmin Parpio, Rafat Jan

Journal of Asian Midwives (JAM)

Background: The wives who have lost their spouses in conflict zones are known as martyrs’ wives. After sacrificing the martyrs’ lives, their wives not only face the traumatic experience of losing their loved ones, but this loss may substantially affect their physical, socioeconomic, and emotional health. It may serve as a "vulnerability factor," raising the risk of depression.
Objective: To assess the levels of life satisfaction and mental well-being within the wives of martyrs residing in Karachi, Pakistan.
Methodology: A descriptive cross-sectional study was conducted to assess the mental well-being and life satisfaction of martyrs’ wives living in Karachi Pakistan. …

The Effectiveness Of Nurse Assistants Training Programme On Safe Motherhood: A Study On Bhutanese Nurse Assistants, Jureerat Kijsomporn, Nualyai Pitsachart, Phayong Thepaksorn, Ling Shing Wong, Vinodhkumar Ramalingam, Voon Wan Niu

Journal of Asian Midwives (JAM)

Background: This study aims to investigate the ability of nurse assistants in midwifery care in Bhutan to apply their knowledge and skills after attending the training programme.
Methods: A qualitative methodology was utilized in this study, in-depth interviews using a semi-structured interview guide questionnaire with five nurse assistants, three district health officers, and two medical doctors from hospitals. The interviews (n=10) were conducted on-site at basic health units in URA and Tang, Bhutan.
Results: The data analysis of their perceptions yielded three major categories: (1) Confirmability, the Quality of knowledge and skills of the program; (2) Credibility, Effectiveness, and comprehensiveness …

Determinants Of Underutilization Of Maternal Health Services In Anc Clinics In Lmics: A Narrative Review, Jonathan Johnson, Rubeka Mansha, Abeer Musaddique

Journal of Asian Midwives (JAM)

Background: Antenatal care (ANC) is critical for achieving Sustainable Development Goals (SDG) 3.1 and 3.2, aiming to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, and to decrease neonatal and under-5 mortality rates. Despite its importance, approximately 830 women die daily from preventable pregnancy and childbirth causes, predominantly in low-resource settings.
Methods: The study conducted a comprehensive literature search from January 1, 2009, to December 30, 2020, focusing on delayed initiation of ANC in low- and middle-income countries (LMICs). The search used multiple databases and included observational research and Demographic …

Decreasing Overall Breast Cancer Risk Through Assessment, Treatment, And Prevention Of Vitamin D Deficiency In The Adult Population, Rachel Jamison

Doctor of Nursing Practice Scholarly Project

The primary objective of this study is to examine the effectiveness of an educational initiative aimed at enhancing nurse practitioners' understanding and recognition of vitamin D deficiency. The purpose of this program is to equip them with the skills to screen, diagnose, and manage this condition to mitigate the overall risk of breast cancer in patients. Vitamin D deficiency is a prevalent global health issue that affects over one billion people, and it can manifest at any stage of life without showing any symptoms, making it challenging for healthcare providers to detect. However, even mild or prolonged deficiencies can lead …

Role Of Hospital Leadership In Pandemic Preparedness: Experience At A Tertiary Hospital In Kenya During The Covid-19 Pandemic, Lucy Wangari, William Macharia, Benjamin Wachira, Jemimah Kimeu, Boniface Mativa, Lukoye Atwoli

Emergency Medicine, East Africa

Introduction Pandemic preparedness refers to being ready for, responding to and recovering from public health crises, and is integral for health security. Hospital leadership is a critical building block of an effective healthcare system, providing policy, accountability and stewardship in a health crisis.

Objectives and methods We aimed to describe the leadership and governance structures put in place at the Aga Khan University Hospital, Nairobi, a private not-for-profit tertiary healthcare facility, following the COVID-19 pandemic. We reviewed over 200 hospital documents archived in the COVID-19 repository including those received from the Kenya Ministry of Health, emails, memos, bulletins, meeting minutes, …

Communication, Electrodes, Appropriateness Setup, And Education (Cease) Bundle Implementation In The Surgical Intensive Care Unit, Tina J. Garcia Miller

All Doctor of Nursing Practice (DNP) Scholarly Projects

An estimated 85-99% of alarms in the intensive care unit (ICU) do not require nursing intervention. This overabundance of non-actionable alarms can contribute to sensory overload and is a significant factor in alarm-related safety events. The aim of this project was to reduce the prevalence of non-actionable alarms through the implementation of an evidence-based alarm management bundle. The CEASE Bundle, a comprehensive five-step protocol encompassing Communication, Electrodes, Appropriateness, Setup, and Education, was implemented in an 11-bed surgical intensive care unit. Continuous alarm data was collected for 12 weeks before and 12 weeks after the implementation of the bundle for comparative …

Implementing The Fall Tips Tool To Reduce Falls In Older Adults, Ruth C. Santiago

Master's Projects and Capstones

Problem: In many organizations, falls and associated major injuries create a large barrier to maintaining patient safety. Patient falls impact quality of care and create financial difficulty for all parties involved. It is important that prevention measures are effective and individualized.

Context: A significant increase in falls and major injuries have been documented in unit F1 of Facility A in Northern California. Current strategies to prevent falls have not been successful in reducing fall rates over the past year.

Interventions: The intervention to decrease falls on this unit is the Fall Tailoring Interventions for Patient Safety (TIPS) tool. The tool …

Improving Nurse-Provider Communication, Caitlin Martel-Harrington, Martha Mary Lane

Nurse Residency

Background: Ineffective communication among healthcare staff has been shown to cause an increase in errors and decrease in patient satisfaction.

Fall Rates In Patient Populations With Remote Video Monitoring Compared To Companions, Alexandra Volpe, Catherine Close

Nurse Residency

Background: Healthcare facilities are constantly searching for new and improved interventions to minimize injury and fall rates within their units. 1:1 companions, or ‘sitters’, have been used to provide the patient with close monitoring in order to accomplish these goals. However, companions are not always a liable option for facilities due to poor staffing and increased expense in order to staff a ratio of 1 companion to 1 patient. Research has started to develop on the benefits of remote video monitoring, or ‘telesitting’, as an intervention to minimize fall risk and injury.