Medicine and Health Sciences Commons^™

An Objective Structured Clinical Examination (Osce) For Pec-Ii And Intrapec Block For Breast Augmentation Surgery, Kaleb Smith

Doctoral Projects

Ultrasound-guided regional anesthesia techniques are valuable tools for anesthesia providers to learn and implement in their practice. Two specific blocks that student registered nurse anesthetists (SRNAs) need to utilize are PECS-II and the Intrapec block for reconstructive breast augmentation and mastectomies. Teaching these blocks to SRNAs in the clinical setting may be difficult as they will be under higher pressure to perform since they will be practicing on live patients. Understanding this stress led to a review of the current Nurse Anesthesia Program (NAP) curriculum at The University of Southern Mississippi (USM) and found a gap in the education, which …

Early Onset Hypertension Objective Structured Clinical Examinations, Katrina Morace

Doctoral Projects

Hypertension is known as a condition in which raised blood vessel pressure persists. On a normal day, the pressure can rise and fall causing damage to the heart. When the pressure stays at higher readings, damage can be caused to the heart and can also lead to additional health problems. Another word for high blood pressure is hypertension. The blood is carried to all body parts from the heart by the arteries. The harder the heart pumps the higher the blood pressure (Centers for Diseases Control and Prevention [CDC], 2020). When hypertension is not diagnosed and treated at an early …

Objective Structured Clinical Examination For Arterial Line Placement, Delorean Calloway

Doctoral Projects

The University of Southern Mississippi (USM) is lacking a uniform guideline for arterial line placement. This DNP project promotes the addition of an objective clinical structured examination into the nurse anesthesia curriculum for future student registered nurse anesthetists (SRNAs) to gain comprehension and clinical experience in a simulation lab prior to practicing on real patients. Peer-reviewed literature and evidence-based practices have been researched and organized into a learning tool and checklist to be used as a step-by-step guideline. Having a guideline such as an OSCE in place can increase student competency and foster a culture of safety leading to better …

Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach

Doctoral Projects

The lack of preoperative warming has a direct relationship to perioperative hypothermia complications which include, but are not limited to: increased infection rate, coagulopathies, and increased myocardial oxygen consumption; all contributing to poor patient and facility outcomes. Implementation of an evidence-based educational module with visual aid can potentially increase the utilization of active warming techniques in the preoperative setting by perioperative staff. The DNP Project investigated barriers to preoperative warming by perioperative staff at a large teaching hospital in the southeastern United States. Barriers were assessed by a voluntary survey sent to 87 perioperative staff members. Twenty-two surveys were completed …

Using Collaborative Objective Simulation Clinical Evaluation With Undergraduate Nursing Students And Nurse Anesthesia Students Labor Epidural Placement In An Active Labor Patient, Chaka K. Jackson, Aisha Pierre

Doctoral Projects

Developing interdisciplinary teamwork and patient communication skills are essential for the student registered nurse anesthetist (SRNA) to provide quality patient care when administering epidural anesthesia. The synthesis of the evidence revealed limited available information on simulation use for SRNA epidural administration and collaboration. This doctoral project examined the effectiveness of learning through traditional simulation to enhance communication and collaboration between the Bachelor of Science in Nursing (BSN) and the Nurse Anesthesia Program (NAP) students. The BSN and NAP students were provided with a simulation environment to care for a laboring patient while improving patient safety and quality outcomes. The project …

Evaluation Of An Intervention To Maintain Therapeutic Pressure Of The Endotracheal Tube Cuff During Intraoperative Surgery, Jamare Reed

Doctoral Projects

The current practice of intraoperatively assessing the cuff pressure of the endotracheal tube (ETT) is arbitrary and potentially leads to negative impacts on patients. This best practice project aimed to review and synthesize the existing evidence-based literature on measuring ETT cuff pressure and to establish a policy guideline for anesthesia providers to measure ETT cuff pressure in the intraoperative environment. Based on the star model of the knowledge transformation framework model provided by the Academic Center for Evidence-Based Practice (ACE), the creation of evidence-based policy on ETT cuff measurement is expected to potentially prevent poor patient outcomes, patient expenses, and …

Does The Use Of An On-Q Pump Improve Postsurgical Outcomes In Patients With Secondary Chronic Shoulder Pain?: A Retrospective Study, Deborah Thompson-Spencer

Doctoral Projects

Orthopedic shoulder surgery is a common therapy for many medical conditions, but the healing process for orthopedic shoulder surgery can be adversely impacted by chronic shoulder pain. Frequently, chronic pain is not adequately controlled by opioid analgesics provided to patients during the surgical healing process, resulting in greater pain and diminished postsurgical mobility. The focus of this Doctor of Nursing Practice project was to examine the question of whether, among male and female adult patients (40-64 years of age) with a history of secondary chronic shoulder pain lasting three or more months who have undergone orthopedic shoulder surgery, the use …

Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell

Doctoral Projects

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at …

Assessing Speech-Language Pathologists’ Knowledge And Use Of Language Acquisition Through Motor Planning, Mary Catherine Cazalas

Honors Theses

Many individuals who are nonverbal require augmentative and alternative communication devices to communicate. The purpose of this research was to assess speech-language pathologists’ knowledge of a particular method of implementing augmentative and alternative communication devices known as language acquisition through motor planning (LAMP). Further, this research was designed to determine the percentage of speech pathologists who have used LAMP during their careers as well as the perceived level of success speech pathologists have found with LAMP. Mississippi speech-language pathologists were used as the sample for this study. A survey was created electronically via the online survey development software, “Survey Monkey,” …

Increasing Student Registered Nurse Anesthetists Clinical Self-Efficacy Using Peer Mentoring, Megan Christine Bass

Doctoral Projects

The purpose of this project is to determine if clinical self-efficacy is increased in SRNAs at The University of Southern Mississippi after participation in the peer mentoring program. The project was a one-group pre and posttest design in a sample of SRNAs who received peer mentoring. To evaluate the students’ perceived clinical self-efficacy before and after the peer mentoring educational intervention, the Rowbotham and Schmitz Student Self-Efficacy scale (SSE) (2013) was adapted and administered to second-year SRNAs (N=17). Clinical performance, skill and knowledge development, social interaction with clinical faculty, and coping with clinical stress are the four areas evaluated by …

Implementing Computerized St-Segment Analysis Utilizing 5-Lead Ecg Cables During The Perioperative Period For Myocardial Ischemia Detection In Patients At Risk For Cardiovascular Disease, Lauren Robertson

Doctoral Projects

Cardiovascular disease (CVD) is one of the leading causes of death in the United States (U.S.) annually (Centers for Disease Control and Prevention, 2011). Mississippi has a disproportionately higher percentage of citizens likely to have CVD (Mississippi State Department of Health [MSDH], n.d.). The numerous stressors related to surgery are alone enough to increase the demand of the heart and lead to ischemia of the myocardium. Surgical stressors combined with preexisting CVD can exponentially increase the risk of ischemia. It is estimated that over a third of all surgical patients have ischemic heart disease. Puelacher et al. (2015) reported 40% …

Administering Dexamethasone Prior To Peripheral Nerve Blocks, Jacob Millwood

Doctoral Projects

Post-operative pain creates burdens for the patient and their family members while also drastically increasing the price of cost to the healthcare system. The Institute of Medicine Committee on Advancing Pain Research, Care, and Education states that the annual economic cost of chronic pain in adults is $560-630 billion (IOM, 2011). Regional anesthesia has been shown to provide potent analgesia that often times leads to a reduction in systemic analgesic requirements, opioid related side effects, general anesthesia requirements, and possibly the incidence of chronic post-operative pain. There are several adjunct medications that can be combined with peripheral nerve blocks to …

The Development Of A Wayfinding Smart Phone Application As A Large Healthcare Facility Investment Opportunity, Jessie Fortson Marshall

Doctoral Projects

Health care is a continually growing field. New hospitals are constantly being built, while older facilities are experiencing renovation and expansion. With this growth comes a set of difficulties for patients as they try to navigate through large, multi-building facilities. Most large facilities have multiple parking garages, numerous buildings, and medical towers with an unending number of floors. Patients are forced to rely on directional signage to find their destination that is often insufficient. Attempting to navigate through large facilities is often overwhelming for visitors leading to frustration and stress.

New technology has allowed a convenient solution to this problem …

Noise: Its Impact In The Operating Room, Brennon Wesley Sloan

Doctoral Projects

Orthopedic and neurologic cases routinely reach noise levels exceeding 120 decibels (Katz, 2014). Modern equipment and monitors used by anesthesia personnel only reach 85 decibels (Katz, 2014). These monitors can go undetected during peak noise levels creating a serious safety concern for patients that could lead to patient injury or death (Gawande, Zinner, Studdert, & Brennan, 2003). A clinical question was developed to determine if the education of noise levels in the operating room affects change in practice. For operating room managers and staff, does education of noise levels in the operating room compared to no education initiate a change …

Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon

Doctoral Projects

Research has shown that post-operative nausea and vomiting (PONV) is a significant contributing factor to extended recovery times and unwanted hospital admissions following ambulatory surgery. The purpose of this DNP project was to assess current practice regarding administration of dexamethasone for the prevention of PONV, provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care.

An electronic presentation and survey were emailed to …

Regional Anesthesia Introduced Into An Emergency/Trauma, Jennifer Bryant Covalt

Doctoral Projects

Emergency rooms across the United States have an incredibly large number of shoulder dislocations that need to be manipulated and reset on a daily basis. A cost-benefit analysis in this Doctor of Nursing Practice Project will demonstrate a new form of care for shoulder dislocations in the emergency room with certified registered nurse anesthetists (CRNA) providing regional anesthesia with local lidocaine injections into the shoulder joint. A level II trauma center in Mississippi with many shoulder dislocations was the location that was used to evaluate conscious sedation, length of procedure, and pain scores. A retrospective chart review was performed at …

A Comparison Of The Features And Functions Available In Electronic Health Records, Kathryn Marie Tetreault

Doctoral Projects

The Institute of Medicine (IOM) (2007) estimates that medical errors transpire at a rate of 1.5 million per year. The IOM (2000), approximates 7,000 deaths per year are related to preventable medication errors, which are the leading cause of medical errors. Adverse drug events (ADE) occur due to medication errors, which are 100% preventable. Annually, approximately $21 billion dollars are spent to care for patients’ who experience ADE due to medication errors (IOM, 2007).

This doctoral project evaluates the current features and available functions for pediatric medication administration within the electronic health record (EHR). This comparison explored the EHR functionalities …

Is Current Evidence That Avoidance Of Inhalation Agents And Opioids May Decrease Metastasis Strong Enough For Crnas To Show A Willingness To Change Practice?, Michael Wesley Tillman

Doctoral Projects

Metastasis following the surgical resection of primary site breast cancer is a medical issue, which plagues mastectomy patients. The intention of this project was to synthesize current literature in order to make a presentation and disseminate it to Certified Registered Nurse Anesthetists (CRNAs) in southern Mississippi and assess the providers' willingness to change practice. CRNAs took part in a Qualtrics survey after viewing a PowerPoint presentation of evidence regarding anesthesia and metastasis. The presentation illustrated the anesthetic techniques and pharmacological agents utilized, which either mitigate or potentiate a patient's risk for metastasis. The survey assessed for a willingness to change …

Cerebral Oximetry Readings In The Sitting Position Versus Supine Position For Patients Undergoing General Anesthesia, Christopher Turner

Doctoral Projects

Problem: Inadequate cerebral blood flow is a significant risk for patients undergoing surgery in the sitting position. Placing the patient in a sitting position may cause a drop in pressure at the level of the brain when compounded with induction and maintenance of general anesthesia. These changes may cause a decrease in cerebral blood flow and oxygenation. Inadequate perfusion for a prolonged period of time could produce negative neurological consequences in the short and long term postoperative period.

Purpose: The purpose of this project is to determine if there is a significant drop in cerebral oximetry, from baseline, when patients …

A Comparison Of Cyfra 21-1, Nse, And Cea For The Serodiagnosis Of Lung Cancer, A Alexandra Knopp

Honors Theses

There were 224,210 new cases of lung cancer in the US during 2014, and of those cases, there 159,260 that died from lung cancer during 2014. Since early diagnosis and treatment leads to a better prognosis, the medical community is actively looking for new, noninvasive tests for the disease. This includes the search for new and effective tumor markers. Tumor markers are used in combination with other tests to diagnose cancer. After the diagnosis, they are used to follow a patient’s case. The three tumor markers studied were neuron specific enolase (NSE), carcinoembryonic antigen (CEA), and CYFRA 21-1. In this …

Use Of Monoclonal ∆-9-Tetrahydrocannabinol Antibodies Chemically Bound To A Polystyrene Surface Using Glutaraldehyde For The Purpose Of Extracting ∆-9-Tetrahydrocannabinol And ∆-9-Tetrahydrocannabinol Carboxylic Acid From Postmortem Whole Blood Samples For Analysis By Gas Chromatography Mass Spectrometry, Thomas Sidney Pittman

Dissertations

Quantitations of drugs and their respective metabolites in postmortem blood samples using gas chromatographic instrumentation is a primary analytical practice used to determine if drugs played a role in or were the cause of a victim's death. Postmortem blood samples often prove difficult to work with due to interfering substances formed during the putrefaction process. Attempts to eliminate interfering substances with present day extraction methods can be time-consuming, costly and often ineffective when dealing with drugs that exhibit toxicity or impairment at very low concentrations. This study was conducted using monoclonal antibodies chemically bound to a polystyrene surface to extract …