Medicine and Health Sciences Commons^™

Naloxone Administration By Law Enforcement: Policy And Public Health Nursing Implications, Thomas Stegnicki

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Opioid overdose has become a public health epidemic, and the use of naloxone by law enforcement personnel has recently become a controversial policy issue. This pilot research project addresses the question of attitudes regarding addiction, overdose, naloxone administration training, and the expanding role of law enforcement in naloxone administration by law enforcement personnel who have been trained in the administration of naloxone to those experiencing an opioid overdose. A comprehensive literature review was conducted relating to the topic of opioid use and overdose and the use of naloxone by law enforcement. The Theory of Planned Behavior was the theoretical framework …

Intra-Operative Iv Fluid Management: Goal Directed Therapy With Esophageal Doppler Monitoring Vs. Standard Weight Based Fluid Therapy, Amanda K. Krueger

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Intravenous fluid management in the peri-operative period continues to be a debate in the anesthesia literature in terms of which fluid type is best along with how much fluid should be given. The majority of post-operative complications in colo-rectal surgery can be traced back to the amount of IV fluids patients receive. Most recently the term Goal- directed therapy (GDT) states that a more individualized approach to fluid management is not only safer but necessary. The Esophageal Doppler, a technology analyzing stroke volume and cardiac output intra-operative, may prove to be a safe way to provide GDT and decrease complications …

Effects Of Hyperglycemia On Adults Hospitalized With Sepsis, Katie Cardoso

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Infectious sepsis (IS) is the result of a complex infection that is difficult to identify, diagnosis and treat. The gold standard for treatment of IS is early identification and intervention. There is a rise in patients with IS along with a concurrent rise of adults with Diabetes Mellitus (DM). Adults with DM are more susceptible to acute illness due to the multiple body systems affected by DM. Acute illness in adults with DM leads to increased blood glucose levels that become difficult to treat. Extreme elevations of blood glucose are linked to longer lengths of stay and higher mortality rates …

Identifying Beliefs About Smoking In Patients With Peripheral Vascular Disease, Elizabeth Lopes-Costa

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Peripheral vascular disease (PVD) is a chronic disabling illness that frequently results in the occlusion of arteries in lower limbs and may cause ischemia, gangrene, or infection. The single most significant factor contributing to both the onset and progression of PVD is smoking, which has addictive properties. Once smoking becomes a habitual behavior, combined with the atherosclerotic process, a disastrous pathway ensues. The aim of this project was to gain an understanding of the beliefs of patients with PVD who smoked. Data were obtained from a sample of participants with a known history of PVD who have had a previous …

Decreasing Stress In The Master's Level Nursing Student: A Stress Management Education Session, Krystal Hilton

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Stress in the nursing professional and in nursing students is well documented in the literature. However, the extent to which it occurs and the means of coping with stress vary. Family responsibilities, finances, and academia have been identified as main stressors for graduate school nurses. It is important to establish coping mechanisms that address the two hemispheres of stress, due to the physiological and psychological effects on the body. The purpose of this study was to develop a stress management education session for Master of Science in Nursing (MSN) students enrolled in their initial clinical rotation at Rhode Island College …

Computed Tomographic Scans On Patients With Repeat Renal Calculi: A Pilot Study, Kayla Reposa

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Patients at risk for repeat renal calculi presenting to the ED with symptoms similar to their previous episodes, are likely to be over-exposed to computed tomographic (CT) scans. With recurrence at fifty percent minimizing CT use in this population is imperative (Goertz & Lotterman, 2010). Studies indicate using urinalysis and alternative imaging methods are necessary to prevent increases in radiation exposure, cost and ED visit time. The purpose of the project was to decrease CT use by providing current evidence-based research to ED providers on the overuse of CT scans for patients with a history of renal calculi who present …

Measuring Nurse Satisfaction With The Chest Pain Protocol, Ashley D. St. Amand

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Approximately 380,000 lives are claimed annually from coronary heart disease. Early identification and prompt action is crucial to preventing mortality. Nurses are the frontline defense to rapidly assessing and intervening to prevent further cardiac damage and alleviate chest pain symptoms. A local community hospital implemented a chest pain protocol for nurses to utilize on the Medical-Surgical units. The chest pain protocol outlines the use of specific medications, including Nitroglycerin sublingually and Morphine intravenously, as well as obtaining an EKG and notifying the provider. The purpose of this project was to measure satisfaction among registered nurses on medical-surgical units at a …

Comparison Of Outcomes Of Combined Thoracic Epidural Anesthesia With General Anesthesia Versus General Anesthesia During Coronary Artery Bypass Graft Surgery, Lana Keker

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Coronary artery bypass graft (CABG) surgery is the most common type of heart surgery in the United States. The main benefit of CABG surgery is a significant decrease in myocardial infarction rate, while the most common complications of CABG are myocardial damage and atrial fibrillation. The incorporation of epidural anesthesia occurred in order to decrease sympathetic nervous system response during CABG but has not been extensively studied. A systematic review was conducted to compare the cardiovascular outcomes of the addition of thoracic epidural anesthesia to the anesthetic plan versus general anesthesia as a solo technique during coronary artery bypass grafting …

Educating Oncology Nurses With Simulation: A Chemotherapy Spill, Sherry Ann Demacedo

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

The purpose of the QI project was to determine if the use of a simulated chemotherapy spill increased the competencies and confidence of oncology nurses employed on an inpatient chemotherapy unit. An educational QI design was utilized including a confidential voluntary pre and post intervention survey. The simulations were held on a 25 bed oncology unit. Twenty-nine RNs participated. The simulation objective was to locate and follow the current hospital policy, the MSDS for the particular drug and clean up the simulated spill based on the current policy. Twelve simulations were conducted. Only 20.6% of RNs had been previously exposed …

Understanding The Role And Training Of Interdisciplinary Professions: Emergency Medical Technicians, Jason Morin

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Understanding the role and training of all healthcare professionals is essential for RNs who are responsible for delegating, receiving, and transferring patient care too. An educational program which educates nursing students about the role, and training of EMTs was designed in an attempt to enhance interprofessional collaboration, communication, and the safe transfer of patients across the two professions. EMTs were selected as a profession of interest related to the acute, and often frantic environment in which RNs and EMTs interact. The purpose of the educational program was to educate program participants related to the role, and training of the varying …

Exploring Nurses' Attitudes About The Value Of A Hospital Based Medical Futility Policy, Christie M. Bowser

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Nurses are responsible for providing care for patients and following through with a physician’s orders, however, it is not always easy to do. Certain cases are more difficult than others, especially those involving end-of-life care versus continuing with life-sustaining measures. It is not an easy decision for families or patients to make, but sometimes these life-sustaining interventions can do more harm than good, causing much distress among caregivers (Burns & Truog, 2007). Some cases have become hallmark cases like that of Terri Schiavo, a woman who was in a persistent vegetative state from 1990 to 2005 while her parents and …

Nurse Perceptions Of Electronic Handoff, Ashlee Viveiros

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Nursing handoff is the important exchange of pertinent information between nurses that is critical to patient safety. The purpose of this quality improvement project was to explore progressive care nurses' perceptions of usefulness of a new electronic SBAR handoff tool on an inpatient adult acute care setting at an academic medical center. A 10 question survey including eight Likert response and two open-ended response questions was created from content areas of a survey designed to measure nurses' perceptions of usefulness of a computerized tool for shift handover report writing. The anonymous survey was completed by 16 of 24 eligible participants. …

Does The Use Of Positive End Expiratory Pressure (Peep) During Surgery Decrease Respiratory Complications Twenty-Four Hours Post Operative?, Malgorzata Majewski

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

General anesthesia can lead to pulmonary compromise during surgery. Nurse anesthetists in the operating room are responsible for minimizing pulmonary complications while managing ventilation through mechanical ventilation. Positive end-expiratory pressure (PEEP) can be used to improve oxygenation, prevent airway collapse and facilitate expansion of alveoli during each breath. Yet the use of PEEP varies among clinicians, as supported by the literature. The goal of this systematic review was to evaluate the impact of PEEP intra-operatively on selected respiratory outcomes. The research question was: Does the use of positive end expiratory pressure (PEEP) during surgery decrease respiratory complications 24 hours post-operative? …

Nurse Anesthesia Program Directors: Applicant Selection, Attitudes, And Admission Criteria, Griffin Stewart

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

The field of nurse anesthesia is an evolving and demanding one, requiring challenging schooling and training. The application and selection process of nurse anesthesia students remains imperfect. The purpose of this study was to examine nurse anesthesia program directors’ attitudes about the perceived importance of admission criteria and attributes in relation to success in the program. A retrospective non-experimental/ descriptive survey, with mixed method qualitative and quantitative data, was used. A convenience sample of 17 program and assistant program directors completed the researcher developed survey. Data were evaluated using descriptive statistics. Nurse anesthesia program directors’ attitudes about perceived importance of …

Exploring The Presence Of Moral Distress In Critical Care Nurses, Justina Gonzalez

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

With healthcare moving toward greater outpatient and preventative approaches, hospitalizations are increasingly intended for those who are critically ill. Frequently this requires the need for highly specialized nursing as well as resource utilization. Technological advances have aided in providing this type of intensive care but they have also compelled practitioners to make treatment decisions that did not previously exist. The conflict of maintaining one’s life without ascertaining whether there will be quality of life is just one example of a difficult situation that can lead to moral distress. The purpose of this study was to explore the effects of moral …

Decision-Making Of Crnas Related To Use Of Laryngeal Mask Airways, Salvador Guerrero

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Improper airway management is a major concern in anesthesia care. Today the laryngeal mask airway (LMA) has a well-established role in anesthesia practice. It is widely used, but there are certain situations where anesthesia providers are hesitant to use the LMA. The purpose of this study was to evaluate the factors that influence the decision-making process of CRNAs regarding the use of an LMA versus an endotracheal tube. The design of this exploratory study was qualitative and 11 CRNAs participated in semi-structured interviews. Results showed that all participants received formal training with an LMA and were most likely to be …

Does Prophylactic Antibiotic Administration Time Effect Surgical Site Infection Rates In Colorectal Surgery?, Ashley E. Desjardins

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Colorectal surgery is known for having a high risk of surgical site infection (SSI). Prior research has suggested that administering prophylactic antibiotics prior to colorectal surgery may prevent SSI. This led to the question: In adult surgical patients having colorectal surgeries, does prophylactic antibiotic administration time effect surgical site infection rates within 30 days of surgery? A comprehensive literature review was completed followed by a detailed screening for inclusion and exclusion criteria, resulting in a final total of nine studies. Detailed data were collected for each study, followed by completion of critical appraisal checklists appropriate to the study design. Quality …

Increasing Staff Nurse Knowledge Related To Organ And Tissue Donation: A Quality Improvement Project, Carly G. Shields-Pirri

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Initially viewed as doubtful and plagued with uncertainty, the process of organ/tissue transplantation has proved to be one of the most successful medical breakthroughs of modern medicine. From the initial documented success of organ/tissue donation and subsequent transplantation, the need for organ/tissue donation exceeds the available resources. Many individuals are aware of the need for organ/tissue donation for life-saving transplantation but do not take the necessary steps to become a donor or share that desire with family and/or loved ones. There are no national programs or efforts in place for standardized nursing education about organ/tissue donation and transplantation. The purpose …

Hyperphosphatemia In Hemodialysis Patients: Can An Educational Intervention Make A Difference?, Mofoluso Oluyemisi Agbelese

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Adherence to the treatment regimen, including proper phosphate binder use and the monitoring of dietary phosphorus intake, is crucial to optimal health outcomes in hemodialysis patients. Hyperphosphatemia remains a significant health problem in hemodialysis patients since excessive serum phosphate is associated with increased morbidity and mortality rates in this patient population. Hyperphosphatemia can occur due to lack of knowledge. The purpose of this program is to determine the effect of an educational intervention on phosphorus knowledge in hemodialysis patients.

Participants consisted of a convenience sample of 12 hemodialysis patients. The teaching intervention utilized a pre and posttest design. The difference …

Improvement Of Patient Satisfaction Through Enhancement Of Rn Communication Skills: A Quality Improvement Project, Pamela A. Kusiak

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Studies have shown that people with low health literacy understand health information less well, obtain preventative healthcare such as screenings for cancer less frequently and use expensive resources such as emergency rooms more often. The Agency for Healthcare Research and Quality (AHRQ), with guidance from Institute of Medicine (IOM) reports, developed quality indicators for individual institutions to demonstrate improvement. The Health Resources and Services Administration (HRSA, 2012) constructed online communication education modules for healthcare professionals including health literacy tools developed by the AHRQ. The purpose of this project was to examine the impact of RN communication education on patient satisfaction. …

Oral Chemotherapy, A Tough Pill To Swallow: A Systematic Review, Jessica Corrente

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

As patients begin to receive more oral chemotherapies in the place of the traditional parenteral therapies, the responsibility for treatment falls on the shoulders of patients and their caregivers. The responsibility for the “five rights” of medication administration, which include the- right drug, right dose, right time, right route, and right patient are being transferred to patients and care givers. This places patients at risk for medications errors. Patients and care providers assume responsibility for medication administration, often with little or no healthcare education. As the number of patients being prescribed chemotherapies continues to increase, an emphasis on education as …

The Use Of Probiotics In The Prevention Of Clostridium Difficile Infection, Lindsay F. Mook

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Despite advances in the diagnosis and treatment of Clostridium difficile infection (CDI), the prevention of CDI, particularly in the inpatient hospital setting, remains a challenge. Clostridium difficile now rivals methicillin-resistant staphylococcus aureus (MRSA) as the most common pathogen to cause hospital acquired infections (HAI) in the United States. Hospitalized patients are considered to be especially high risk for CDI, and among inpatient cases, antibiotic treatment, especially with Fluoroquinolones has been an almost universal factor in the development of CDIs. One preventative measure that is incontinently used in the prevention of CDI is oral probiotics. Probiotic consumption is reported to exert …

Propofol And Emergence Agitation In The Pediatric Population: A Systematic Review, Bevin Doyle

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Emergence agitation (EA) is common among pediatric patients undergoing general anesthesia. Sevoflurane is a volatile anesthetic that is associated with an increased incidence of EA of as high as 80% in children undergoing surgery. Emergence agitation can cause increased stress in the patient, nurses and caregivers. Agitation experienced by the patient can also increase the risk of self harm, delay medical treatments, damage equipment and ultimately increase the length of stay in the hospital. Current studies lack a consistent method of quantifying and recognizing EA in a standardized manner. The development of the Pediatric Anesthesia Emergence Delirium (PAED) scale provided …

Assessing Knowledge And Attitudes Toward Spirituality And Spiritual Care In Aprn Students, Beth Susan Perry

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Research has revealed patients’ spiritual care needs are rarely addressed by both Registered Nurses and Advanced Practice Registered Nurses. The purpose of this project was to assess the attitudes and knowledge of APRN students toward spirituality and the provision of spiritual care. Graduate students (N=51) at a suburban institution in Rhode Island were surveyed using the Spirituality and Spiritual Care Rating Scale (SSCRS). The results revealed that although these participants had encountered patients with spiritual needs, 40 of the 51 surveyed (78%) believed they had received inadequate training in the spiritual dimension of nursing care. Recommendations were made to improve …