Medicine and Health Sciences Commons^™

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Implementing A Standardized Protocol For Early Detection Of Undiagnosed Hypertension Patients, Jenscena Hansen, Chris Bell

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Hypertension is a preventable disease that frequently goes unrecognized and undertreated. Early diagnosis can prevent further comorbidities such as heart disease, stroke, and chronic kidney disease. Implementation of this protocol aims to decrease the number of patients with undiagnosed hypertension and increase the identification of patients with elevated blood pressure who did not have a pre-existing diagnosis of hypertension. The goal of implementing a standardized protocol would help eliminate the number of patients who go undiagnosed.

Methods: This quality improvement design had clinical staff flag patients with elevated blood pressure. Identified patients without a diagnosis of hypertension were educated …

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

Evaluating Nurses’ Turnover Intention And Organizational Commitment Following Stroke Unit Staffing Changes: An Evidence-Based Quality Initiative, Heather Tatusko

Doctor of Nursing Practice Scholarly Projects

Nurses are known to be overworked, overwhelmed, undervalued, and understaffed at dangerous levels throughout various inpatient hospital units across the United States (U.S.). Hospital registered nurse (RN) turnover is a significant issue that has accelerated since the COVID-19 pandemic, resulting in economic impacts and other burdens for organizations, individuals, and communities. Evidence suggests that evaluating Registered Nurses’ Turnover intention (NTI) and Organizational Commitment (OC) can help maintain a ready and capable team of skilled RNs; however, most healthcare organizations (HCOs) do not collect or analyze NTI and OC data and focus on staffing numbers and monetary incentives to get adequate …

A Conceptual Model Of Organizational Compassion In Healthcare, Rachel Thienprayoon, Eli Awtrey, Teresa Pestian, Beth A. Lown, Naomi Winick, Jason Kanov

Journal of Wellness

Introduction: In healthcare, while the suffering of patients is often evident, the suffering of clinicians receives less focus. Some sources of clinician distress are directly related to constant exposure to patient suffering, but others are caused by the health care system, and thus potentially preventable. Looking at clinician suffering through the lens of compassion fosters a new paradigm of individual, team, and organizational capabilities, and moves the responsibility to alleviate this suffering from the individual onto the organization and team. Yet research into the impact of organizational compassion in healthcare has been extremely limited.

Approach: Our conceptual model of organizational …

Evidence-Based Practice Education For Nurses Caring For Oncology Patients With Chemotherapy-Induced Peripheral Neuropathy: A Quality Improvement Project., Natalie N. Ellis, Pamela Hardesty

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Nurses are one of the primary sources of information for patients during their healthcare journey. Patient education can mean the difference between a positive and negative outcome. Oncology patients undergoing chemotherapy are an especially vulnerable population and education and preparation for potential side-effects related to chemotherapy is important. There are several ways to control chemotherapy-induced side effects (CISE). One of the debilitating side effects can be chemotherapy-induced peripheral neuropathy (CIPN). While difficult to manage, the support of nursing staff to encourage patients to take an active role in their care could help decrease the risk of CIPN and improve …

Evaluating The Efficacy Of Universal Depression Screenings In The High School Setting, Telisha Anthony Msn, Fnp-Bc, Jennifer Thorsen Bsn, Rn, Jackie Sharp Dnp, Pmhnp-Bc, Sharon Little Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Depression in adolescents is rising each year. Early detection of depression has been shown to result in better health outcomes and success in school. This scoping review aims to evaluate the implementation of universal depression screenings in the high school setting and how this detection of depression and initiation of treatment.

Methods

From August 2022 to November 2023, we used the Medline, PubMed, Elsevier, Google Scholar, and PsycINFO databases, using specific keywords related to depression in adolescents. Of the 38 articles found, 10 were chosen after extensive article critique. The publication dates ranged from 2014-2023, were full-text, and from …

The Impact Of Social Determinants Of Health On Adherence To Urinary Tract Infection Treatment: A Scoping Review, Barrett S. Patel, Ms, Bsn, Rn, Emily A. Gentry, Bsn, Rn, Sally Humphrey Dnp, Aprn, Cpnp-Pc, Bobby Bellflower Dnsc, Nnp-Bc, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

Urinary tract infections (UTIs) are a common diagnosis among children. Patients must fully comply with treatment regimens to reduce the risk of recurring UTIs and prevent long-term complications. This scoping review aims to evaluate the literature and examine the association between screening for social determinants of health (SDH) and adherence to UTI treatment.

Methods

A thorough literature search via PubMed, Cochrane Library, Elsevier Clinical Key, CINAHL, and JAMA was conducted with the following keywords: Pediatric UTI, Adherence to Treatment Plans, Social Determinants of Health, Social Needs Screening, and others. Ten articles were appraised for their evidence and quality. The …

Patient Throughput In The Emergency Department, Daniel Alanis

MSN Capstone Projects

In response to ongoing overcrowding in emergency departments, it is imperative to explore effective strategies for mitigating the capacity crises. The purpose of this project is to investigate and implement throughput strategies for a large level 1 trauma emergency department in Houston’s Texas Medical Center. The proposal involves launching a process improvement project to identify opportunity potential for two main interventions: 1. Patient classification for split clinical pathways 2. Dedicated liaison role for throughput responsibilities. The review aims to answer the question: In emergency department patients, how does the implementation of a dedicated throughput liaison compared to a split flow …

Reducing Central Line-Associated Bloodstream Infections (Clabsi) With Chlorhexidine-Impregnated Dressings, Sara Garcia

MSN Capstone Projects

Mitigating and eradicating central line-associated bloodstream infections (CLABSI) is a vital patient safety priority. These healthcare-associated infections lead to patient fatalities and incur costly, preventable expenses. Therefore, it is imperative to assess central venous catheter (CVC) maintenance protocols to mitigate the likelihood of infection. Federal guidelines advocate using chlorhexidine (CHG) dressings to lower this risk (Centers for Disease Control and Prevention, 2017). A comprehensive central line maintenance bundle includes incorporating a CHG dressing as a critical measure in reducing the risk of CLABSI (Buetti et al., 2022). Consequently, the escalating infection rates underscore the necessity for implementing CHG dressings (Buetti …

Evidenced-Based Strategies To Increase Cervical Cancer Screening Rates, Tuong Cat Vo Bsn-Rn, Nada Salloukh Bsn-Rn, Tatiana Elena Swanson Bsn-Rn, Xiao Mie Cindy Zhu Bsn-Rn, Laura Taylor Reed Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Cervical cancer is the fourth leading cause of cancer affecting women worldwide (Staley et al., 2021). With cervical cancer being a preventable disease, an effective method of reducing healthcare costs and mortality is primary prevention, such as screenings. Financial burdens and barriers to accessing medical care may result due to the lack of proper cervical cancer screenings. Detecting cervical cancer includes screening women 21 to 65 years old with a Papanicolaou (PAP) test every three years. Women aged 30 to 65 years old can extend the screening of cervical cancer by having a Human Papillomavirus (HPV) test along with …

Lai Antipsychotics Vs. Oral Antipsychotics: Treatment Adherence, Relapses, And Readmissions, Natalie N. Lewis Bsn, Rn, Mallory F. Johnson Bsn, Rn-Bc, Tyler N. Halle-Todd Bsn, Rn, Natalie N. Ragland Bsn, Rn, Sharon H. Little Dnp, Aprn, Fnp-Bc, Jacqueline Sharp Dnp, Aprn,Pmhnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Schizophrenia is a lifelong illness with recurrent and often debilitating symptoms that may impair daily functioning, cognition, behaviors, socialization, emotions, and expression. It is recognized as a global mental health burden that affects the individual, their family, and society. Medication nonadherence and resulting relapse detrimentally affect the patient’s physical and mental health and quality of life. They are associated with increased hospitalization and emergency room visits, substance use, suicide, and homelessness. Current guidelines endorse second-generation antipsychotics such as Risperidone and Aripiprazole as the first-line treatment for most cases of psychosis. However, long-acting injectable (LAIs) atypical antipsychotics are a promising …

Effects Of A Compassion Fatigue Workshop On Psychiatric Mental Health Nurses, Johnnie Elizabeth Bower Bsn, Mary Johnson Dnp

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Compassion fatigue (CF) is a collection of symptoms associated with exposure to traumas experienced by other people. Nursing is one of the professions that experiences CF from recurrent exposure to patient and family distress and from potential acts of abuse at work. Nurses working in behavioral health are one of the highest at risk for CF. Of newly graduated behavioral health nurses, 17.5% leave the field after one year and 33.5% leave after two. Signs of CF include hopelessness, feelings of inadequacy, anxiety, depression, fatigue, and increased absenteeism. Training in self-care techniques and mindfulness builds nurse resilience and …

Assessment Of Condylar Morphology In Various Facial Types-Cbct Study, Dr.Shruti Patil

Annual Research Symposium

Mandibular condyle being part of the TMJ complex, its volume and shape play a pivotal role in treatment stability and outcomes in orthodontic and orthognathic patients over long term periods. Different loading patterns would result in different morphology of the TMJ. The association with different facial types and understanding the relationship between condylar position, morphology and jaw base divergence is limited. This study’s objective is to assess the condylar structure which includes condylar height, width and height of the fossa in different jaw base divergences.

A cross-sectional study was conducted in which 90 patients undergoing Orthodontic treatment were selected and …

The Impact Of Patient And Provider Education On Statin Therapy Initiation And Adherence In Type Ii Diabetics, Jane Harlan Bsn-Rn, Lindsey Jacobsen Bsn-Rn, Emily Easterly Bsn-Rn, Mitch King Bsn-Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

Type 2 diabetes mellitus (T2DM) is a common, chronic disease that increases the risk of coronary artery disease and stroke fourfold, which makes protecting cardiac function a priority. The American Diabetes Association (ADA) and American Heart Association (AHA) recommend the prescription of statins to reduce cardiovascular complications. Unfortunately, provider and patient adherence to this recommendation is poor.This study aimed to determine if shared-decision making and patient follow-up within a 6 month period of being newly diagnosed with T2D has an effect on the initiation rate of statin therapy.

Methods

In this retrospective study we requested data from the University …

Initiating Culturally-Directed Education For Hispanic Adults With Type 2 Diabetes Mellitus, Marie Davis, Jennifer Smith, Mandy Horner

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND:

The U.S. Hispanic population has the highest rate of Type 2 diabetes mellitus (T2DM), which is influenced by socio-economic status and language barriers. Current evidence suggests that the delivery of culturally-directed Diabetes Self-Management Education (DSME) with the use of an interpreter can reduce diabetes-associated complications.

LOCAL PROBLEM:

The project took place at a free clinic in North Carolina. The purposes of this project was to create a culturally-directed DSME bundle for Hispanic adults with the use of a Spanish interpreter to improve understanding of T2DM management.

METHODS:

The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was …

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Scholarly Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …

Improving Outcomes For Persons With Opioid Use Disorder By Introducing Buprenorphine In The Emergency Department, Emily Caroline Wegenka, Mary Johnson, Thomas Vajen

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Opioid related death is the leading cause of accidental death in adults younger than 50 years old in the United States (US) with approximately 130 opioid related deaths daily. Emergency department (ED) visits for a non-fatal overdose, the one-year mortality is 4.7-5.5%. Studies show increased access to medications for opioid use disorder (MOUD) decrease morbidity and mortality related to OUD. Additionally, there is evidence that initiating MOUD in the ED increases engagement in outpatient follow up, also reducing morbidity and mortality associated with OUD.

LOCAL PROBLEM: The setting for this practice improvement project was a non-profit, rural …

Optimizing A Clostridium Difficile Screen For Intensive Care Unit Admissions, Mary Katherine V. Natour, Jennifer Smith

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Clostridium difficile infection is one of the most common healthcare-associated infections. Careful screening upon hospital admission enables clinicians to mitigate the spread and sequelae of this illness through early intervention and isolation but this screening must be accurate and highly sensitive to maximize benefit.

Local problem: The site for this project, an ICU in Tennessee, currently employs a highly sensitive but nonspecific tool to detect CDI. This has resulted in low accuracy, low staff compliance, low patient morale, and unnecessarily high personal protective equipment (PPE) costs.

Methods: Levin’s evidence-based practice improvement model was chosen to guide this project from …

Antibiotic Stewardship In Patients With Viral Upper Respiratory Illness: Improving Quality Measures In Retail Health, Meredith A. Nolan, Robin Harris, Clay Smith

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Millions of people will die from antibiotic-resistant bacterial infections in the next 30 years. Retail health providers are pivotal in this global epidemiological problem.

LOCAL PROBLEM: Setting included 15 retail health clinics operated by Vanderbilt University Medical Center in Middle Tennessee. Project examined provider education, patient engagement, and commitment to antibiotic stewardship, components of the CDC's Core Elements of Outpatient Antibiotic Stewardship framework. Specific aims were that providers would have a significant reduction in the percentage of antibiotics prescribed for viral illness over the study period.

METHODS: Using the Evidence-Based Practice Improvement Model, a Quality Improvement …

Reducing Copd Readmissions Through The Implementation Of A Guideline-Based Clinical Pathway: An Evidence-Based Practice Improvement Project, Hannah F. Hall, Allyson Neal, Samantha Bauer

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is characterized by airway inflammation and damage that inhibits appropriate airflow. Exacerbations of COPD (ECOPD) hasten disease progression and have profound impacts on the patients.

Local Problem: East Tennesseans experience higher rates of COPD than the rest of the state. Community members at the project site identified that the inpatient management of ECOPD is inconsistent and discordant with the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The purpose of this project was to reduce readmissions and increase guideline concordance by developing an algorithm …

Effect Of Certified Diabetes Clinical Education Specialists On Adults With Type 2 Diabetes, Rachel Faller, Tracy Gregory, Michelle Jones, Peyton Barnett, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

Type 2 diabetes mellitus affects 13.1% of adults living in Shelby County and over 30 million adults in the United States. This chronic disease creates a higher risk of macrovascular and microvascular complications for this population resulting in poor outcomes if not properly managed. Improving glycemic control can help to improve the quality of life for people living with diabetes and reduce healthcare costs. Currently 20% of funds spent in the United States on healthcare is utilized for diabetic care. Certified Diabetes Care and Education Specialists (CDCES) primarily educate patients about managing their diabetes, including health promotion that can …

Working Under Pressure: Evidence-Based Risk Assessment And Pressure Injury Prevention In The Pediatric Intensive Care Unit, James A. Hutcheson Iv, Allyson M. Neal

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: The hospital-acquired pressure injury (HAPI) can have physiologic, psychologic, and financial sequelae. Children are at increased risk secondary to immature physiology, developmental differences, and severity of illness. Evidence suggests presence of medical devices exponentiates HAPI risk.

Local Problem: Upward trends in HAPIs revealed nearly 50% are device related in the project setting, an urban Pediatric Intensive Care Unit. The Braden QD Scale was identified as best evidence for HAPI risk assessment. This initiative aimed to observe the ability of the Braden QD Scale as a predictor of HAPI risk as compared to current practice utilizing the Braden Q …

Police Versus Non-Police Response To 988 Crisis Calls, Miriam A. Maloney-Mattheisen Bsn, Rn, Latrina N. Blakemore Msn, Fnp-Bc, Janelle M. Scullark Msn, Fnp-C, Jacqueline Sharp Dnp, Pmhnp-Bc, Sharon Little Dnp, Fnp-Bc, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background

The 988 Suicide & Crisis Lifeline is a mental health-specific emergency line that became nationally available in July of 2022. This resource allows callers in crisis to connect with trained mental health professionals. Despite the initiation of this new dispatching service, there is still a significant shortage of trained mental health professionals to respond to these calls when they require emergency intervention. The present scoping review aims to determine whether non-police crisis responses correlate to improved outcomes when compared to police response as evidenced by reduced inpatient admissions, reduced arrests, and decreased presence of intrusive traumatic symptoms following intervention. …

The Financial Impact Of Correct Status Within Health Systems, Davin Evanson, Arveen Asghar, Eugene York, Michael S. Weingarten, Walter Bohnenblust

Tower Health Research Day

No abstract provided.

How Soon Is Too Soon? A Quality Improvement Approach To Postoperative Length Of Stay Following Transcatheter Aortic Valve Replacement, David Brian Jones, Robin Harris, Paul N. Fiorilli Md, Allyson Neal

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Heart valve disease prevalence is expected to rapidly increase over the next twenty years. Aortic stenosis, the most common valvular disorder, is a significant cause of heart failure hospital admissions and high mortality if left untreated. Treatment options include surgical aortic valve replacement (SAVR) and the more popular transcatheter aortic valve replacement (TAVR). The rapid increase of TAVR procedures generates hospital bed capacity issues, and there is no recommendation defining the minimum length of stay (LOS) following TAVR.

LOCAL PROBLEM: The setting was a 1,100-bed academic medical center in southeastern Pennsylvania with an average annual TAVR volume …

5.2.24 Hsc Committee Meeting Notice, Helen Maestas

HSC Committee (A subcommittee of the UNM Board of Regents)

5.2.24 HSC Committee Meeting Notice

A Systematic Review: Mirror Neurons & Schizophrenia, Yashesvi Sharma, Surajit Dey

Annual Research Symposium

This research project establishes a link between Mirror Neuron System (MNS) activity and this information's implications in treating and understanding schizophrenia, specifically, schizophrenic patients with negative symptoms.

J Mich Dent Assoc April 2024

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association provides news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. It stands as the primary publication reaching Michigan dentists.

In the April 2024 issue, the Journal focuses on the landscape of practicing in rural settings. Original content includes:

• A cover story highlighting Michigan’s Donated Dental Service Program
• A feature on Michigan’s Revised Kindergarten Oral Health Assessment Law
• A feature article on the origins, future, and use of the CDT Code
• Profiles of the 2024-25 MDA Officer, Trustee and ADA Delegation candidate
• An …

Agents Of Change: Which One Are You?, Michelle C. Dziurgot Dds

The Journal of the Michigan Dental Association

In her editorial, Michelle C. Dziurgot, DDS, explores various roles dentists play as agents of change, including catalysts for urgency, collaborators with specialists, diligent workers for accuracy, risk-taking entrepreneurs, charismatic leaders, and peacemakers who resolve conflicts within their practices.