Digital Commons Network^™

Evaluating Adherence To The Sepsis Bundle And The Effectiveness Of Best Practice Alerts, Kate M. Burnett

DNP Projects

PURPOSE: To evaluate the adherence to the CMS sepsis recommendations and sepsis bundle used by the study health system before and after the implementation of Best Practice Alerts (BPAs) and assessing the effect of these alerts on patient outcomes.

METHODS: The study was a single-center, process evaluation through a retrospective chart review within a southwest healthcare system. The sample consisted of 73 patients for the pre-implementation period (May 1, 2016-September 7, 2016) and 75 patients for the post-implementation period (September 8, 2016-April 30, 2017).

RESULTS: No major differences were found between the two groups with regard to patient age, ethnicity, …

The Effect Of A Patient And Provider Education Program On Antibiotic Overuse In Respiratory Tract Infections In A Rural Primary Care Population, Erin Chiswell

DNP Projects

Objective: In the “walk-in” portion of the Jessamine Medical and Diagnostic Center (JMC) primary care (PC) practice in Jessamine County, Kentucky, a combination patient and provider education program was implemented to assess its effects on antibiotic prescribing in respiratory tract infections (RTIs). The goal was to conduct an evaluation of the patient and provider education program at JMC, by specifically examining changes in immediate antibiotic prescribing in RTI (i.e., prescription given during visit to start taking immediately) one-year after implementation of the education program (March 1, 2015- February 28, 2016).

Methods: Utilizing a quasi-experimental pretest-posttest design, a retrospective electronic medical …

Short Message Service (Sms) Appointment Reminder Project, Kathryn Wermers

Doctor of Nursing Practice (DNP) Practice Innovation Projects

The purpose of this quality improvement project was to decrease the appointment no-show rate at a mid-western primary care clinic by implementing short message service (SMS) appointment reminders. The project director analyzed the cost of the SMS appointment reminders and patient satisfaction with the intervention via telephone participant opinion surveys. The guiding theoretical framework was Nola Pender’s Health Promotion model (HPM). The subjects involved were the primary care patients who had access to cellular phones with SMS capability. The project assistant received verbal consent to send the SMS appointment reminder for a participant. Then the participant’s cellular phone number was …

A Comparative Study Of Cde Utilization Rates And Hospital Admissions For Foot Ulcerations Between Two Hospitals, Amber Toombs

Doctor of Nursing Practice Projects

One of the nine standards of diabetes self-management education declares that education should be performed by an instructor with expertise in diabetes education and management or a certified diabetes educator (CDE). The purpose of the study is to measure the prevalence of referrals to CDEs upon discharge for patients admitted with diabetic foot ulcers compared between two hospital populations, Baptist Hospital in Memphis, TN and NEA Baptist in Jonesboro, AR. Data was collected and reviewed to identify the number of patients who received a referral upon discharge and readmissions rates for these patients. Eighty-six patients were included in the study. …

Best Practice For Screening Adult Patients With Psoriasis For Polyautoimmunity: Celiac Disease, Rheumatoid Arthritis And Crohn’S Disease, Susan Danielle Ashbaugh

Theses and Dissertations

The purpose of this quality improvement project was to determine if screening primary care patients with psoriasis will improve early detection of celiac disease (CD), rheumatoid arthritis, and Crohn’s disease (CrD). The aim of this project is to assess the utility of early screening in patients with psoriasis in order to facilitate earlier diagnosis of CD, RA and CrD, which would consequently initiate earlier treatment and improve long-term patient outcomes. Genetic and population-based studies suggest that individuals with psoriasis have a greater risk of also having CrD, CD or RA, than do individuals without psoriasis. The literature also suggests that …

A Quality Improvement Project To Reduce The Incidence Of Clostridium Difficile Infection Through Implementation Of Evidence-Based Terminal Clean Procedures, Tamara Cook

Theses and Dissertations

Hospital-acquired infections (HAIs) are a huge economic burden and threat to patient health and outcomes. Clostridium difficile is the most common HAI. Effective hand hygiene and proper environmental cleaning procedures are significant to preventing the spread of C. difficile infections. The research question used to guide this project is: Does the use of a monitoring system for post C. difficile isolation terminal clean procedure reduce the rate of hospital-acquired C. difficile in the acute care population? A thorough organizational assessment was performed and directed this project to identify causes that may contribute to the recurrences of C. difficile infections. The …

Social Determinants Of Health And Disparities In Outcomes Related To Cardiovascular Health In Vulnerable Populations, Jennifer L. Miller

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the mechanism of association between social determinants of health (SDH), particularly limited health literacy, and disparate outcomes related to cardiovascular disease in vulnerable populations. Specific aims were to 1) compare quality of life (QOL), anxiety, and depressive symptoms between genders in implantable cardioverter defibrillator (ICD) recipients; 2) examine the association between multi-morbidity burden and QOL; 3) determine whether health literacy levels independently predict CVD risk in the male prison population; 4) examine the relationship between health literacy and decisiveness regarding end of life (EOL) choices, and 5) examine SDH as predictors of …

Parents Of Children Who Had Hypoxic-Ischemic Encephalopathy: A Mixed-Methods, Exploratory Study, Natalene Kramer

Electronic Theses and Dissertations

Background: There is scant literature addressing the parents of children who had hypoxic-ischemic encephalopathy (HIE). therefore only inferences may be made as to issues of that experience affecting parents.

Purpose: The purposes of this study was to uncover the lived experiences of parents of children who had HIE, evaluate issues of stress, depression, coping, and impact of neurologic disability in order to better care for them and thus their families

Methods: A parallel, convergent mixed-methods design was used to explore experiences and perceptions of these parents regarding their experiences and life changes. The quantitative strand addressed four research questions which …

Barriers And Facilitators Of Linkage To Hiv Care Among Hiv-Infected Young Chinese Men Who Have Sex With Men: A Qualitative Study, Haochu Li, Chongyi Wei, Joseph Tucker, Dianmin Kang, Meizhen Liao, Eleanor Holroyd, Jietao Zheng, Qian Qi, Wei Ma

School of Nursing & Midwifery, East Africa

Background: The Four Free and One Care Policy (HIV/AIDS-related free services) has been in place in China since 2004. However, linkage to human immunodeficiency virus (HIV) care is not yet achieved very well among people living with HIV. We conducted a qualitative study to explore individual and contextual factors that may influence a linkage to HIV care from the perspective of young HIV-infected men who have sex with men (MSM) in a highly centralized HIV care context of China.

Methods: Purposive sampling was used to recruit 21 HIV-infected MSM in Shandong Province, with in-depth interviews conducted between March and July …

Global Perinatal Nursing Research: Sustainable Development Goals Update, Lynn Clark Callister, Cheryl A. Corbett

Faculty Publications

Global health experts suggest that there is an urgent need for research supporting healthcare for childbearing women that is both respectful and evidence-based beyond “too little, too late and too much too soon.” The purpose of this editorial is to describe global perinatal research priorities, provide examples of global collaborative networking and research, identify global perinatal nursing research priorities, and describe exemplary global maternal health nursing research.

College Health Clinic Population Health Improvement Plan Project, Kathryn M. Flynn

Walden Dissertations and Doctoral Studies

A college community health improvement plan (CHIP) focusing on the indicators of nutrition and weight status, and physical activity and fitness is designed with the goal of reducing obesity risk, improving health, and preventing chronic disease. The precede proceed model, logic model, innovative care for chronic conditions model, self-care theory, and Bandura's social cognitive learning theory were used as a research design framework for assessing, planning, and managing sustainability through a two-year college health clinic. The research questions were: what are the current health promotion inputs and activities in terms of environment, ecology, education, and policy and what could be …

Role Of Midline Catheters In Patient Care, Tina K. Schlegel

Walden Dissertations and Doctoral Studies

Central line-associated bloodstream infections (CLABSIs) are responsible for 100,000 patient deaths per year, creating a critical need for prevention of these deadly infections that occur with central venous lines (CVLs). Alternative forms of IV access such as midline catheters (MLCs) may offer lower rates of infection than those seen with CVLs. MLCs were implemented at the practice setting in 2016; however, no evaluation of their effectiveness had been conducted. The purpose of this project was to evaluate the effectiveness of MLCs using a retrospective, pre- post- comparison of CLABSI rates and device utilization rates (DUR) obtained from the practice setting …

Correlation Of The Boost Risk Stratification Tool As A Predictor Of Unplanned 30-Day Readmission In Elderly Patients, Carol K. Sieck

Dissertations

Carol K. Sieck

Loyola University Chicago

CORRELATION OF THE BOOST RISK STRATIFICATION TOOL AS A PREDICTOR OF UNPLANNED 30-DAY REAMDISSION IN ELDERLY PATIENTS

Risk stratification tools can identify patients at risk for 30-day readmission but available tools lack predictive strength. While physical, functional and social determinants of health have demonstrated an association with readmission, available risk stratification tools have been inconsistent in their use of variables to predict readmission. The Better Outcomes by Optimizing Safe Transitions (BOOST) 8 P's tool is a risk stratification tool developed by the Society of Hospital Medicine but has no published validation studies. The theoretical …

Dna Methylation Patterns In Cord Blood Of Neonates Across Gestational Age Association With Cell-Type Proportions, Susan M. Braid, Kwame Okrah, Amol Shetty, Hector Corrada Bravo

Ellmer School of Nursing Faculty Publications

Background: A statistical methodology is available to estimate the proportion of cell types (cellular heterogeneity) in adult whole blood specimens used in epigenome-wide association studies (EWAS). However, there is no methodology to estimate the proportion of cell types in umbilical cord blood (also a heterogeneous tissue) used in EWAS.

Objectives: The objectives of this study were to determine whether differences in DNA methylation (DNAm) patterns in umbilical cord blood are the result of blood cell type proportion changes that typically occur across gestational age and to demonstrate the effect of cell type proportion confounding by comparing preterm infants exposed and …

Opioid Abuse In Pregnancy: A Systematic Review, Emily Sebunia, Colleen Fearon

Williams Honors College, Honors Research Projects

Prenatal opioid abuse is a serious public health concern and linked with numerous health consequences for both mothers and children. Despite research describing negative outcomes of drug use during pregnancy, it is still a prevalent problem in the United States, with researchers finding that women are at highest risk for substance abuse during their reproductive years. Opioid abuse during pregnancy is common, including opioids such as hydrocodone, oxycodone, morphine, and heroin. Use of these drugs results in both short and long term side effects for the mother and child. Therefore, the prevalence of this problem should not be underestimated. …

Role Of The Nurse During Disaster Preparedness: A Systematic Literature Review And Application To Public Health Nurses, Elizabeth Rivera-Rodriguez

Walden Dissertations and Doctoral Studies

After the 2001 attacks on the World Trade Center, public health garnered more attention. This event forced public health nurses to acquire new roles needed to respond to disasters. The purpose of this project was to synthesize the current evidence related to the role of nurses during disaster preparedness and apply that evidence to public health nurses. The practice question focused on the role of nurses during disasters which were not a part of their normal daily activity. The Fineout-Overholt, Melnyk, Stillwell, and Williamson hierarchy for grading evidence was the theoretical framework used. A systematic literature review was conducted to …

Women’S Narratives Of Living In Polygamous Marriages: Rural Malawian Experience Distilled And Preserved In Poetic Constructions, April Yerges, Patricia E. Stevens, Lucy Mkandawire-Valhmu, Wendy S. Bauer, Thokozani Mwenyekonde, Lance Weinhardt, Loren W. Galvao

College of Nursing Faculty Research and Publications

Polygamy in sub-Saharan Africa has been linked to poverty, infant mortality, and HIV; however, it is unknown how interpersonal dynamics within polygamous households may influence population health outcomes. Findings from this postcolonial feminist study derive from interview data in a larger mixed-methods study in rural Malawi. We used thematic narrative analysis to probe 25 women's stories and applied an arts-based research technique, poetic construction, to present the results. Participants' evocative expressions, distilled and preserved in poetic form, illustrate themes of perseverance, grief, agency, and reflection. We discuss how gender relations, childrearing, tradition, economics, and health intersect in polygamous households.

The Effect Of Continuing Professional Development From The Perspective Of Nurses And Midwives Who Participated In Continuing Education Programs Offered By Global Health Alliance Western Australia: A Mixed-Method Study, Yan Ing (Jenni) Ng

Theses

Continuing professional development (CPD) opportunities for nurses and midwives are central to improving knowledge, broadening skills and maintaining competencies to provide best practice and clinical care. This is gained through participating in continuing education (CE). CPD is readily accessible and a mandatory requirement for nurses and midwives in developed nations, such as Australia. However, in developing countries, such as Tanzania, while CPD is promoted, it has limited availability. As such, the Global Health Alliance Western Australia (GHAWA), an international health development program, seeks to provide further sustainable CPD opportunities for nurses and midwives in Tanzania.

The purpose of this research …

Improving Seasonal Influenza Vaccine Uptake Among Health Care Workers, Debra Gray

Walden Dissertations and Doctoral Studies

Yearly influenza (flu) immunization rates for hospital healthcare workers (HCW) continue to be lower than those suggested by the Centers for Disease Control and the World Health Organization. Vaccination is considered a valuable step in the process to protect patients against influenza infection. The goal of Healthy People 2020, and most hospital administrators, is that 90% of HCWs are being immunized. The objectives for this systematic literature review were to identify best practice recommendations for improving the vaccine rate among HCWs. The Cochrane methodology framed this systematic review, and Fineout-Overholt's and Melnyk's levels of evidence were used to evaluate the …

The Impact Of Nursing Staff Adherence With Chlorhexidine Gluconate Bathing On Intensive Care Unit Patient Outcomes, Tara M. Jones

DNP Projects

Purpose: The purpose of this study is to evaluate nursing staff adherence to a chlorhexidine gluconate (CHG) bathing protocol in the intensive care unit at Norton Brownsboro Hospital.

Methods: This study utilized a single-site, quasi-experimental, retrospective electronic medical record review format. The sample consisted of 200 patient records post CHG bathing protocol initiation from the Norton Brownsboro Hospital Intensive Care Unit during the period of March, 2015 to May, 2017.

Results: The sample was divided into adherent and non-adherent groups. No significant differences in age, sex, race, ICU length of stay (LOS), BMI, or mortality scores, presence of indwelling medical …

A Gap Analysis On Vaccine Administration For Average And High-Risk Adults, Whitney Pack Metcalfe

DNP Projects

Background: Nationally adult immunization rates continue to fall below the current benchmark goals. It is estimated adult vaccinations range from 20 to 60 percent, depending on the vaccine. There are different vaccine schedules for those of average-risk compared to those with high-risk conditions. Providers are being encouraged to explore their administration of vaccines as preventable, communicable diseases continue to be seen. Objectives: In a primary care clinic, a gap analysis was conducted to: 1.) Determine adult immunization rates, 2.) Compare vaccine administration rates of the Tdap, PCV13, PPSV23, and influenza vaccines between average and high-risk adults, 3.) Determine if specific …

An Evaluation Of Provider Adherence To Adult Sinusitis Quality Measures And Guideline, Caitlin A. Davidson

DNP Projects

Purpose

The purpose of this project is to evaluate adherence to Physician Quality Reporting System (PQRS) Measures #331 (delaying antibiotic treatment until at least seven days of symptoms) and #332 (prescribing amoxicillin or amoxicillin/clavulanate) on adult sinusitis treatment. Data was collected from patient encounters at the University of Kentucky College of Nursing Community Health Center (UKCONCHC) in Wilmore, Kentucky. To adhere to these quality measures would foster antibiotic stewardship. Further statistical analysis was completed to determine if gender or age bias was present in prescribing practices.

Methods

A retrospective chart audit was conducted to determine adherence to the quality measures. …

Adult Acute Sinusitis Antimicrobial Stewardship Program In A Primary Care Setting, Katelyn M. Hellman

DNP Projects

BACKGROUND: Inappropriate antibiotic prescribing is a well-documented global health crisis (Centers for Disease Control, CDC, 2013). Antimicrobial stewardship (AS) is the purposeful selection of the correct drug, dose, route and duration of antimicrobial treatment to decrease microbial resistance, adverse drug effects and cost while improving patient outcomes (Dellit et al., 2007; CDC, 2016). Antimicrobial Stewardship Programs (ASP) are multidisciplinary programs designed to improve AS.

PURPOSE: To describe baseline prescribing patterns and evaluate the effect of an antimicrobial stewardship program (ASP) for adult acute sinusitis on provider knowledge and antibiotic prescribing practice. among primary care providers in an internal medicine clinic …

Development And Evaluation Of An Evidence-Based Educational Process To Reduce Post-Transplant Infections, Erica Vanessa Henderson

Walden Dissertations and Doctoral Studies

The targeted transplant center's abdominal organ transplant unit had difficulty providing

adequate education to patients prior to discharge, which had resulted in a 24% readmission rate within 30 days due to infections. Patients and caregivers were unavailable to receive education despite multiple attempts, which made it challenging for health care providers to complete this aspect of their job, resulting in a negative impact on patients' long-term outcomes. A more structured educational environment was needed to provide appropriate and effective patient and caregiver education to increase adherence and positive outcomes. The health promotion model served as a foundation for the development …

Body Piercing And Health Complications Among College Students In Puerto Rico, Elsie Goicochea

Walden Dissertations and Doctoral Studies

The incidence and prevalence of body piercing health complications among students is a public health matter that has not been researched in Puerto Rico. College students are the most consistent participants in body piercing activities and have reported health complications resulting in visits to medical offices and emergency rooms. Based on the health belief model, which is used to explain and predict health attitudes, the purpose of this quantitative nonexperimental study was to analyze the health risks and possible complications occurring after body piercing and to investigate the association between sex and age and medical complications. Data were collected from …

Tuberculosis Screening In New Healthcare Employees: A Comparison Of Quantiferon®-Tb Gold In-Tube Test And Tuberculin Skin Test, Mary C. Giovannetti

Theses and Dissertations

Background: Streamlining onboarding processes for new hires to maximize efficiency and reduce costs while meeting regulatory requirements is a constant challenge for healthcare systems’ Employee Health staff. Health screening is a required step and includes obtaining a detailed health history, tuberculosis screening, drug screens, immunizations, fit for duty examinations, obtaining medical records, clarification of disability accommodations, pre-work screens, and other tests which are time consuming and result in delays in hire dates. Faced with a high volume of potential new employee hires a major southeast healthcare system was concerned about delays in new hire start dates. The two-step tuberculin skin …

Surgical Plume And Its Implications: A Review Of The Risk And Barriers To A Safe Work Place, E. Tan, K. Russell

Nursing Papers and Journal Articles

Every year thousands of health care professionals worldwide are exposed to surgical smoke. There is evidence that this smoke consists of toxic gases, pathogens and particulate matter that is a hazard for patients and the perioperative team. Past research indicates that perioperative staff inconsistently comply with smoke evacuation recommendations. The aim of this study was to identify, review and discuss the issues related to surgical plume and its implications for patients and perioperative staff. The findings of this review relate to: surgical smoke content, its risks to the health of the perioperative staff, preventative measures, infection control measures, compliance with …

Designing And Evaluating An Educational Initiative Promoting Condom Use Among Hiv+ Hispanic Men, Gilberto Andino

Walden Dissertations and Doctoral Studies

In 2013, the Centers for Disease Control and Prevention estimated that between 252,000 and 312,000 Hispanic men and women in the United States were unaware of their risk for transmitting HV/AIDS. Guided by the logic model and Leininger's theory, the purpose of this project was to design a culturally sensitive HIV/AIDS educational program for HIV+ Hispanic males and to evaluate the program content with the staff at a medical center in South Florida, with the goal of implementing the program at that center. The educational program content focused on increasing the knowledge of Hispanic HIV+ men on the effectiveness of …

Professional Development And Self-Efficacy Of Nurses Who Care For Patients Requiring Biocontainment, Denise Occhiuzzo

Walden Dissertations and Doctoral Studies

Increasing global occurrences of highly infectious, easily transmissible diseases unfamiliar to nurses affect the learning environment and the required skill set for professional nurses. The global threat of Ebola Virus Disease and other high-risk diseases requiring biocontainment necessitates competency in the management of complex patient needs, while ensuring safety measures that prevent spread of the potentially fatal disease. Guided by Bandura's social cognitive theory, this quantitative correlational study addressed the relationships between nurses' professional characteristics and their perceived self-efficacy when providing care to highly infectious patients requiring biocontainment. A full census of 92 nurses was used to recruit participants from …

Increasing Chlorhexidine (Chg) Daily Bathing Compliance, Jonathan Lee

Master's Projects and Capstones

Chlorhexidine gluconate (CHG) daily bathing in hospitalized patients in the intensive care setting is one of many interventions implemented by institutions to reduce and prevent central line associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs). These hospital-acquired infections (HAIs) plague and complicate treatments for critically ill patients in the acute care setting. CLABSIs and CAUTIs increase patient morbidity and mortality as well as place a financial burden with increased costs and hospital lengths of stay. The decrease of CHG compliance in our ICU unit can be associated with an elevated CLABSI rates. The focus of this CNL …