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Use Of Seaweeds, Direct-Fed Microbial, And Nitrate To Mitigate Enteric Methane Emissions And Improve Health And Performance Of Dairy Cows, Diana Carolina Reyes Gomez

Doctoral Dissertations

Enteric methane (CH4) emissions from ruminants contribute significantly to global warming and represent a loss of dietary energy for the animal. Dietary manipulation is a promising approach for CH4 mitigation. Nitrate can effectively reduce CH4, but it can also be toxic in non-adapted ruminants. Supplementing with Paenibacillus fortis, a denitrifying probiotic strain, is a potential strategy to prevent toxicity. The interest in using macroalgae to mitigate CH4 emissions while improving animal health and production in ruminants has increased in recent years. The overall objective of this dissertation is to investigate nutritional-based strategies to mitigate enteric methane emissions and improve the …

A Comparison Of Outcomes For Lipid Emulsions In Total Parenteral Nutrition Among Home Infusion Patients, Gregory W. Wesley-Lynch

DNP Scholarly Projects

This quality improvement project aimed to compare the outcomes of lipid emulsions used in total parenteral nutrition among home infusion patients. The quality improvement project included 45 patients who received four weeks or more of either Intralipid or SMOFlipid. Paired t-tests were used to compare SMOFlipid and Intralipid regarding three liver function test (LFTs) values; (Alkaline Phosphate (ALP), Aspartate transaminase (AST,) and Alanine transaminase (ALT). Results demonstrated that SMOFlipid was superior to Intralipid, resulting in lower LFTs for ALP, AST, and ALT. This study provides evidence to support the use of SMOFlipid over Intralipid in total parenteral nutrition for home …

Implementation Of A Standardized Process To Increase Promotion Of Family Presence During Resuscitation, Eileen Hollis

DNP Scholarly Projects

BACKGROUND: Family Presence During Resuscitation (FPDR), has been studied and recommended as an important and relevant practice for decades, yet it remains controversial with frequent barriers to implementation. The benefits of this practice are numerous; and to truly embrace shared decision making, nurses and providers must encourage patients and families to participate in all aspects of care, even during resuscitation events. As evidence supporting the emotional and psychological benefits of FPDR began to grow, however, a global pandemic brought family presence to an abrupt halt.

METHODS: This quality improvement project’s focus was to standardize a process for offering and allowing …

Utilizing Outpatient Telehealth As A Treatment Approach For Patients With Substance Use Disorder: A Quality Improvement Project, Veronica Kwegyir-Afful

DNP Scholarly Projects

Background: The issue of substance use disorder (SUD) has demonstrated a growing prevalence both in the United States (U.S.) and globally. Effective treatment modalities have been devised for individuals afflicted by SUD, thereby enabling their post-treatment prognosis to be parallel to that of patients with other chronic diseases, such as diabetes. However, several factors or barriers impede individuals with SUD from assessing treatment. These barriers encompass financial constraints stemming from inadequate insurance coverage and high cost, the stigma surrounding SUD, which results in patient's hesitancy to seek treatment treat, adverse societal attitudes, collateral social percussions like work hour losses and …

Implementation Of Virtual Reality For The Laboring Patient: A Quality Improvement Project, Chantal Cole

DNP Scholarly Projects

BACKGROUND: Having a baby can be one of the most challenging and painful experiences a woman has in their lifetime. Being able to choose between a variety of pharmacological and non-pharmacological pain-control methods is important to improve the patient experience and outcomes. This quality improvement project aimed to introduce a virtual reality device into the labor and delivery setting as a non-pharmacological pain control method. The goal was to decrease pain and anxiety levels, decrease the rate of epidural anesthesia use, and decrease the length of time epidural anesthesia medication was running before delivery.

METHODS: The four key components of …

Strengthening New Hampshire’S Primary Care Workforce Pipeline: Utilization Of Alternative Scheduling Models, Elizabeth Harrison

DNP Scholarly Projects

Abstract

BACKGROUND: Traditional clinical scheduling coupled with the current reimbursement system have created systematic barriers leading to decreased clinical education opportunities. Alternative scheduling models such as longitudinal integrated clerkships, one preceptor to two students and wave scheduling have the potential to eliminate these barriers and provide financial gains and increased access to care.

INTERVENTION: Interventions to meet this quality improvement project's objectives included (1) pre-intervention planning (2) focus groups, (3) video presentations and (4) a pilot program of alternative scheduling models in clinical practice.

RESULTS: A pilot program utilizing the alternative scheduling models increased the relative value units (RVU) of …

A Quality Improvement Initiative: Addressing Workplace Violence Toward Nurses To Promote A Culture Of Safety In An Inpatient Psychiatric Facility, Ernestina Danso

DNP Scholarly Projects

This quality improvement initiative aimed to address workplace violence against nurses in inpatient psychiatric facilities and promote a culture of safety. The QI project involved 27 participants, including inpatient psychiatric nurses and mental health counselors from Cahill 4 and 7 West units at the Cambridge Campus. The primary objective was to identify challenges that hindered the effective utilization of the Broset Violence Checklist (BVC) tool for referring patients to sensory modulation rooms.

Pre- and post-intervention surveys were conducted to assess participants' self-reported knowledge and barriers to BVC and sensory room utilization. Educational sessions covering workplace violence, debriefing techniques, and the …

A Quality Improvement Initiative To Improve Access And Patient Flow In A Non-Emergency Walk-In Care Clinic, Renee J. Broze

DNP Scholarly Projects

Background: A community-based non-emergency walk-in clinic in Southern New Hampshire experienced high volume and inefficient workflows during the pandemic, causing delays in care, long visit times, and low net promoter scores.

Purpose: Institute an evidence-based approach to improve work efficiency through innovative models of care.

Methods: A literature review on best practices for workflow redesign guided the project. The project instituted an on-demand telemedicine service and a clinic fast-track workflow. A mixed methods approach analyzed pre /post cycle times, net promoter scores, and themes from staff interviews. Pre/post cycle times analyzed 12,767 completed appointments.

Results: There was a statistically significant …

Exploring & Mitigating Workplace Incivility At A Rural Community Hospital, Jacquelyn Ethier

DNP Scholarly Projects

Workplace Incivility (WI) is a well-known challenge in healthcare, with decades of mounting evidence showing the effects on workplace culture, healthcare worker retention and patient safety. The nursing workforce has become increasingly vulnerable to all stressful elements of the work environment. Organizational leadership must develop and deploy mitigation strategies to minimize the negative consequences of these behaviors for nurses, and the entire healthcare team. The purpose of this quality improvement project is to assess the current state of nurse perceptions of WI at a rural community hospital and deploy evidence-based education on strategies to address and mitigate WI. The method …

Facilitating Palliative Care In A Critical Access Hospital System: Implementation Of Screening And Educational Interventions, Michele Lovell

DNP Scholarly Projects

BACKGROUND: The United States health care system faces the dual challenge of an aging population with a concomitant increase in the presence of chronic and serious illness, the care of which accounts for the nation’s largest expenditure of burgeoning healthcare costs. Palliative care is specialized care for people with serious illness aimed at reducing suffering, optimizing quality of life, and enhancing medical decision making. An ample evidence base demonstrates that palliative care increases both quality of care and patient and family satisfaction while also reducing associated costs. The aim of this quality improvement project was to facilitate palliative care services …

Improving Patient Safety And Emergency Department Staff Efficiency In Barcode Medication Administration By Using The Rover™ Mobile Application, Ian Kirit

DNP Scholarly Projects

BACKGROUND: The Emergency Department (ED) is one of the busiest areas in the hospital. Patients are often acute, and it can get chaotic at times. Such a complex environment requires an effective and efficient system to increase staff efficiency and elevate patient safety. Patient and medication scanning has been a continuing issue with the current barcoding process using the in-room scanners and workstations on wheels (WOWs). In reviewing the Barcode Medication Administration (BCMA) weekly audit report, scanner broken and scanner not available are the most frequently used reasons for not scanning patients and medications. Additionally, WOWs can be hard to …

Improving Patient Access To Gastroenterology Through A Nurse-Practitioner-Led Clinic: A Quality Improvement Project, Kayla Northam

DNP Scholarly Projects

The United States has a critical healthcare access issue for gastroenterology patients. Delays in treatment can lead to expensive complications, including emergency room visits, hospitalization, and surgery. Creating a rapid-access clinic (RAC) for gastroenterology so that patients can obtain a quick and efficient evaluation of their symptoms in a shorter appointment time can help decrease the delay in care and generate more revenue for the hospital. Over 8 weeks in 2023, Dartmouth Hitchcock Medical Center Department of Gastroenterology used a telemedicine-only RAC to see patients for 20 minutes rather than the traditional 60-minute period. As a result, the RAC saw …

Development Of An Evidence Based Surgical Site Infection Bundle In Patients Undergoing Colorectal Surgery: A Quality Improvement Initiative, Jessica Mcbee

DNP Scholarly Projects

BACKGROUND: Surgical site infections (SSI) are among the leading healthcare-acquired infections that negatively impact patient outcomes and increase total cost of healthcare and the patient’s length of stay. At a community hospital in West Virginia, trends in SSI rates and the standardized infection ratio (SIR) increased for patients undergoing colorectal surgery. The purpose of this quality improvement project was to identify and implement permanent evidence-based practice changes to reduce SSI rates in colon surgery patients.

METHODS: Baseline rates of SSI and the SIR for the facility was calculated from October 2021 to September 2022. Colon surgery SSI reduction …

Evidence-Based Suicide Assessment And Managment Training For Mental Health Professionals, Clara Abit

DNP Scholarly Projects

Background: Suicide is a significant public health concern both nationally and globally. While the suicide rate has been decreasing in recent years, evidence shows that the rate of suicide among teenagers and adolescents has been on the rise. Teenage suicide accounts for 14% of all deaths by suicide in the United States, calling for effective interventions in various settings. However, inadequate knowledge of the potential signs and risk factors of suicide hinders mental healthcare professionals' ability to recognize at-risk patients.

Purpose: The project's objective was to evaluate the effects of the intervention on mental health workers' knowledge, skills, and screening …

Improving Nurse Awareness And Knowledge Of Utilizing Effective Alternative Communication Methods With Mechanically Ventilated Patients: A Quality Improvement Initiative, Christine Mcgee

Master's Theses and Capstones

Abstract

Local Problem: Each day, almost half of patients in the hospital’s Intensive Care Unit (ICU) require mechanical ventilation through an endotracheal tube. This intervention is often essential for patient’s survival; however, it greatly obstructs the ability to communicate. The unit nurses’ report trialing pen and paper or whiteboards, but often find patients lack the motor control and strength to produce legible written script. The unit nurses also report relying on eye and hand gestures for communication, which are often found to be ineffective.

Background: With the current evidence and changing practice in the ICU of using less sedation and …

Implementation Of A Multipronged Approach To Improve Pre-Operative Efficiency And First Case On Time Start Performance, Melyssa A. Stokes

Master's Theses and Capstones

Background: Surgical services are an important source of revenue and important economic driver of hospital systems. Surgical services account for approximately 42% of a hospital’s annual revenue, however, it also constitutes 40% of facility operating costs (Gupta, et al., 2022 & Morel & Gomez, 2021). Despite the high costs associated with surgical services delays remain a significant issue across the nation. On-time starts for the first surgical cases of the day is a key performance metric tracked by surgical facilities to determine efficiency. Currently, 50 – 90% of first surgical cases are delayed throughout the United States and the most …

Multidisciplinary Workflow Implementation For Ctdna Kit Collection To Decrease Inefficiencies For Patients And Staff: A Quality Improvement Initiative, Ryan Montano

Master's Theses and Capstones

Background: Circulating tumor DNA testing in the oncologic clinic setting is used to detect residual disease and genetic mutations for targeted therapy options.

Local Problem: This quality initiative was developed to standardize circulating tumor DNA kit (ctDNA kit) collection in a rural academic medical cancer center. The use of third-party ctDNA testing kits within the clinic has increased in the last three years to detect genetic markers for targeted therapy.

Methods: The use of a plan-do-study-act framework was utilized to revise the workflow for the ctDNA kit collection process to decrease total collection time and increase staff satisfaction. Intervention: With …

Implementation Of Point-Of-Care Tick-Borne Disease Powerplan™ And Algorithm For Early Detection And Treatment Of Tick-Borne Diseases, Ashley Pinkham

DNP Scholarly Projects

Abstract

Local Problem: The Concord Hospital system, serving 30+ communities, is situated in the heart of New Hampshire surrounded by densely wooded forests, lakes, and mountains and is a mecca for camping, vacationing, and sightseeing, doubling its population of 1.6 million residents during spring, summer, and fall months. Despite the serenity, there is a predator that lingers among the hiking trails and lake shorelines. From January 2021 through August 2022 there were a total of 41 hospitalizations from tick-borne diseases, some with life threatening symptoms. Unfortunately, nearly half (43%) of patients presented to their primary care provider first where the …

Increasing Access And Adherence To Cognitive Behavioral Therapy For Insomnia (Cbti) For Adults: A Quality Improvement Project, Kristen Newell

DNP Scholarly Projects

BACKGROUND: Insomnia is a sleep disorder that is becoming more prevalent. It can significantly impact a person's quality of life and it contributes to a substantial economic financial burden. Cognitive behavioral therapy for insomnia (CBTi) is the primary treatment for insomnia, but patients are rarely referred for this treatment. This quality improvement project focused on implementing motivational interviewing to increase patient utilization of CBTi. It also encouraged utilization of CBTi Coach, a free phone application that has all of the CBTi components, a rigid sleep behavioral plan and frequent follow-up appointments to improve sleep quantity and quality.

INTERVENTION: Patients that …

Improving Provider Retention Through Addressing Burnout At A Federally Qualified Health Center: A Quality Improvement Initiative, Emily Grattan

DNP Scholarly Projects

Background: Primary care providers employed by federally qualified health centers (FQHC) working with underserved populations experience high levels of burnout as patients are often medically complex, face healthcare disparities and societal stigmas. The aim of the project was to alleviate burnout and improve provider retention through introduction of organizational support measures. Participants involved were healthcare providers, as well as nurse management and senior leadership.

Methods: The quality improvement approach for this project utilized the Plan-Do-Study-Act (PDSA) cycle and a driver diagram to guide the selected interventions. Interventions were based on categories from Mayo’s Clinic’s Nine Organizational Strategies to Promote Engagement …

Improving Emergency Department Patient Experience Through The Engagement Of A Patient And Family Advisory Council To Create And Implement A Patient Rounding Tool, Rosemary Ostendarp

DNP Scholarly Projects

BACKGROUND: Patient experience is an essential indicator of healthcare performance. Understanding and improving patient experience in an Emergency Department is a complex issue.

INTERVENTION: The goal of the quality improvement project was to improve the patient experience by engaging with a Patient and Family Advisory Council to create a Patient Rounding tool. The Patient Rounding tool was used to obtain patient feedback, identify concerns, enhance patient comfort, and provide an opportunity for positive staff recognition. Patient Experience Scores were measured via the Emergency Department Consumer Assessment of Healthcare Providers and Systems (ED CAHPS) survey.

RESULTS: Five hundred twenty rounding sessions …

Improving Mental Health Psychiatric Nurse Practitioners’ Knowledge And Confidence To Assess Decision-Making Capacity In Geriatric Psychiatric Patients In Acute Settings, Lolita Brown

DNP Scholarly Projects

Abstract

In this quality improvement project, I aim to enhance the knowledge and confidence of psychiatric mental health nurse practitioners (PMHNPs) in completing Decisional Capacity Mental Assessments (DMCAs). I use qualitative and quantitative methods to measure the intervention’s success, emphasizing PMHNPs’ role in ensuring ethical DMCAs while maintaining patient autonomy. The education-based intervention significantly improves PMHNPs’ knowledge and confidence levels following the pre-education survey. These findings highlight the significance of DMCA training for health-care professionals, underscoring the necessity of standardized assessments alongside improved dialogue during capacity evaluations. Limitations include limited sample sizes and dependence on self-reported measures, which may introduce …

Intervention To Improve Screening Mammograms In Clinical Practice., Saida Khamooshi

DNP Scholarly Projects

Abstract

Breast cancer remains a challenging health issue in the United States, representing the second leading cause of cancer deaths for women. The key approach to tackle this issue is the early detection of breast cancer through annual mammography screening in asymptomatic women. This quality improvement project sought to improve the proportion of breast cancer screening documentation in a private obstetrics and gynecology practice that serves primarily Black women. In addition, the project is thought to improve the current utilization of office mammogram services and its mammogram completion rate. Comprehensive interventions implemented included establishing clear guidelines, staff education, using paper …

Decreasing Post-Operative Ventilator Time In The Cardiovascular Surgical Patient: A Nursing Education Quality Initiative, Amanda J. Bruno Roberts

DNP Scholarly Projects

Extended mechanical ventilation times after open heart surgery can contribute to complications prolonging recovery and length of stay, as well as increasing mortality. Standardized staff education of immediate post-open-heart recovery and ventilator weaning protocols, combined with the use of ABCDE and VAP bundles can reduce these complications. At Hospital X during summer of 2022, the average length of time patients remained mechanically ventilated after open heart surgery increased. After an initial needs survey was distributed to nursing staff, a set of novel QR codes was created to simplify and centralize training for staff in the ICU to facilitate early extubation …

Nutritive Comparison Of Ruminant Feed, Integrating Crab And Lobster Meal, Kelsi L. Devolve

Honors Theses and Capstones

In attempts to increase livestock production and decrease waste products from the seafood industry, crab meal and lobster meal were tested as a potential cattle feed ingredient. Jonah crab waste, Atlantic Red crab waste, soybean meal, and blood meal were collected from various vendors and utilized in an in vitro study, an in situ study, and a nitrogen analyzer to determine crude protein in each feed. After allowing the samples to sit in a DAISY incubator for 48 h, mimicking a rumen environment, degradability for the soybean meal, blood meal, lobster meal, and crab meal were 100.13%, 76.36%, 43.77%, and …

Odd Bedfellows & Marriage Of Necessity: Public Health And Politics In American Federalism, Gabriella Victoria Chianese

Honors Theses and Capstones

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, while the public disagrees over mask mandates, required vaccinations, and social distancing, it seems like one common sentiment exists – a distaste for the odd bedfellows of politics and public health. There are those who cry for the compartmentalization of the science of public health and the art of politics to rectify this situation. In the wake of so much confusion and chaos, it is not unjustified to demand the depoliticization of public health; however, this response is unrealistic given the modern political climate, demonstrates a narrow understanding of the …

What Granite Staters Need To Know About Medicaid, New Hampshire Dhhs

All Materials

No abstract provided.

Dataset For Effects Of Single-Session Practice Structure On Motor Skill Acquisition And Alpha And Beta Eeg Oscillations, Audrey Porter, Ronald V. Croce, Wayne Smith

Faculty Publications

Although it is known that practicing a motor skill updates the associated internal model, it is still unclear as to how cortical oscillations linked with the motor skill change under differing practice schedules. The current study investigated α- and β-power changes associated with motor skill acquisition. Firstly, we investigated the behavioral effects of practice on motor learning and retention during repetitive (RP) and variable (VP) practice schedules on an anticipation timing task. Secondly, we investigated changes in cortical α (10-13 HZ) and β (15-30 Hz) event-related synchronization and dyssynchronization (ERS/ERD) under RP and VP during early (EP) and late …

Effective Leadership Styles To Ensure Organizational Success, Nicholas Collishaw

M.S. in Leadership

A look into the different leadership styles that can ensure organizational success within the law enforcement field. Each generation that comprises of the law enforcement field have different preferred leadership styles and traits that keep an organization running effectively. Finally, an analysis of the different theories revolving around leadership and the benefits of each theory if implemented effectively.

Town Of Lempster, New Hampshire Annual Reports For The Year Ending December 31, 2022., Lempster Town Representatives

Lempster, NH Annual Reports

This is an annual report containing vital statistics for a town/city in the state of New Hampshire.