Medicine and Health Sciences Commons^™

Evaluation Of Provider Adherence To An Intraoperative Glucose Monitoring Guideline At A Midwestern Academic Hospital, Lauren Schoolfield, Taylor Crittenden

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Patients with diabetes (PWD) are at higher risk of requiring surgery and developing complications in the perioperative period making euglycemia an important component of intraoperative care. There is an association between dysglycemias and adverse perioperative outcomes. Implementation science evidence indicates that education with audit feedback strategies towards barrier identification to clinical practice guideline (CPG) uptake will improve implementation success.

Purpose: The purpose of this quality improvement project was to evaluate and improve adherence to intraoperative glucose monitoring outlined by the current intraoperative glucose management guideline at a midwestern academic hospital through barrier identification with tailored …

Promoting Personal Agency In Nursing Students' Ability To Evaluate Evidence, Kaitlyn Kelly

AI Assignment Library

In NURS450: Transition to Practice Seminar, the senior capstone for graduating nursing students and an essential studies class focused on information literacy, we examine research studies with a CASP Programme checklist, which helps students understand the validity and applicability of published research to their patient populations. In this assignment AI, specifically ChatGPT, is used to generate a fictional randomized controlled trial. Students are guided through the checklist and a group discussion on whether that study meets the requirements to be considered valid and applicable to a local population (with the assumption that the study was real). The purpose is to …

Leadership Paper, Raquel Zeidlik

AI Assignment Library

The purpose of this formal paper is to explore effective nursing leadership characteristics. This essay will examine the leadership role of a nurse. Using evidence and supporting literature, the student will demonstrate their understanding of nursing leadership characteristics and skills and how they apply to clinical practice.

Education Aimed To Increase Train-Of-Four Ratio Use, Frank Bougher

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: The current state of practice surrounding non-depolarizing neuromuscular blocking drug monitoring is variable among practitioners and poses a safety risk to patients who may subsequently experience residual neuromuscular blockade and complications. The literature supports that train-of-four ratio monitoring, with an emphasis on use prior to extubation, is superior to other techniques and reduces the occurrence of complications related to residual neuromuscular blockade, improving patient safety and outcomes.

Purpose: The purpose of the project was to determine if an education intervention founded on evidence-based neuromuscular monitoring leads to increased use of train-of-four ratio in practitioner …

Addressing The Gaps: Pain Management, Multimodal Analgesia, And Crna Education, Hunter Niemeyer

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Opioid consumption, addiction, and narcotic-related deaths are a prevalent public health issue in the United States. Opioids are often administered throughout the perioperative period, and their utilization can lead to unwanted side effects and negative patient outcomes. Certified Registered Nurse Anesthetists (CRNAs) are strategically placed in hospital systems; these clinicians may advocate for the responsible administration of opioids and utilize multimodal pain strategies.

Purpose: This project assessed the knowledge and attitudes of CRNAs before and after the implementation of an educational program based on the prevention of operative pain, multimodal approaches, and the perioperative use …

Anesthesia Provider’S Use And Perception Of Emergency Cognitive Aids, Katie Mette

Doctor of Nursing Practice (DNP) Student Projects

Cognitive aids have been shown to increase proper use of evidence-based practice treatment strategies in emergent scenarios. These treatment strategies can be unfamiliar to the provider as emergencies are rare, and when coupled with a heightened stress level and sense of urgency, relying on memory alone can be challenging. The purpose of this project was to implement a set of emergency-use cognitive aids developed by Stanford University known as the Stanford Emergency Manual into a set of operating rooms and measure the anesthesia providers use and perception of the cognitive aid via pre-implementation and post-implementation e-mailed surveys.

Efficacy Of A Mixed Methods Training Program For Transthoracic Echocardiography, Britni Tharp

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Currently, there is a knowledge gap in CRNA education. As anesthesia providers, CRNAs are licensed to perform cardiac diagnostic imaging such as TTE during surgery, yet it is often missing from CRNA school curriculum. Other studies have shown that simulation is an effective way of teaching this crucial skill.

Purpose: The project’s goal was to establish the efficacy of using a mixed model computerized and in-person simulation program for training CRNAs in the use of TTE during non-cardiac surgery.

Methods: A training program was created that uses a computerized training session along with a …

Standardizing Intraoperative Handoffs Amongst Certified Registered Nurse Anesthetists, Mallory Light

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Communication errors are a leading cause of preventable medical errors and inadequate handoffs have been linked to sentinel events. Research has shown that standardizing handoff processes can reduce errors, improving patient safety, and resulting in other positive outcomes including increased staff satisfaction, without impacting handoff duration.

Purpose: The purpose of this project was to determine how the implementation of a standardized handoff tool would impact perceptions of handoff communications, retention of important patient information relayed during handoffs, staff satisfaction, and handoff duration.

Implementation Plan and Methods: Information regarding use of the tool was sent to …

Gastric Point-Of-Care Ultrasound Education For Certified Registered Nurse Anesthetists, Robert Graham

Doctor of Nursing Practice (DNP) Student Projects

Background: Pulmonary aspiration is a significant risk of general anesthesia and is related to increased perioperative morbidity and mortality. Gastric point-of-care ultrasound (POCUS) has been shown to be a reliable indicator of gastric contents and volume, and it can be used in the perioperative setting to detect gastric contents and make informed clinical decisions to prevent aspiration events.

Purpose: This project aimed to educate Certified Registered Nurse Anesthetists (CRNAs) at Washington University in the use of point-of-care ultrasound to assess gastric contents prior to surgery with the overall goal of improving knowledge, skills, and attitudes towards this practice …

Anesthesia Provider Education On The Adherence To The Fourth Consensus Guidelines For The Management Of Postoperative Nausea And Vomiting, Christine Johnson

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: The occurrence of postoperative nausea and vomiting (PONV) has been linked to unplanned admissions, longer post-anesthesia care recovery units (PACU) times, and decreased patient satisfaction. The Fourth Consensus Guidelines for the Management of PONV released new guidelines in 2020 outlining evidence-based practice to manage PONV. A literature review was conducted on a total of 10 studies. The findings support the methods these guidelines employ.

Purpose: This quality improvement (QI) project aims to provide education for anesthesia providers on the fourth consensus guidelines and improve provider adherence.

Methods: A six-minute educational video, post-education quiz, provider …

Educating Perioperative Nurses On Preventing Hypothermia In Surgical Patients, Bethany Geisler

Doctor of Nursing Practice (DNP) Student Projects

Perioperative hypothermia (PH) is a preventable complication of surgical procedures that has been linked to postoperative conditions such as coagulopathies, increased cardiac morbidity, surgical site infection, increased incidence of pressure ulcers, increased length of hospital stay, and increased financial expense. Anesthetic agents given to patients during surgery directly contribute to PH and associated complications.

Background: Perioperative is a time frame involving the three stages of surgery (preoperative, intraoperative, and postoperative). Hypothermia is defined as body core temperature below 36 degrees Celsius. The incidence of PH ranges from 11% to 90% depending on the anesthesia administered, type of surgery, length of …

Improving Small-Volume Antibiotic Administration For Surgical Prophylaxis, Benjamin Thomas

Doctor of Nursing Practice (DNP) Student Projects

Background: Small-volume IV antibiotics are commonly administered for surgical prophylaxis, but no clear policy on administration method exists, leading to wide variation in anesthesia provider practice at a large academic medical center. Administration via a secondary tubing set is the recommended practice to minimize significant medication losses which could lead to poor patient outcomes. This large academic medical center performed below the national benchmark for one of these outcomes–surgical site infections.

Goals and Objectives: Objectives of this project included eliminating a potential systematic shortcoming in the administration of prophylactic antibiotics. The goal was to increase the use of …

Utilizing The Phq9 Survey To Improve Depressive Symptoms In Opioid Dependent Adults: A Quality Improvement Project, Taylor Fuhr

DNP Projects

Significance and Background: Opioid dependence continues to be a fighting battle in our country. While many individuals do well on maintenance therapy such as suboxone, they often are faced with comorbid challenges including depression and anxiety. Research shows that the risk for depressive symptoms in opioid dependent adults increases along with the duration of use and increase of dosage (Semenkovich et al., 2014). There is no consistency among depression screening for opioid dependent adults despite the research that suggests the two often coincide with one another. The goal of this quality improvement project was to implement routine depression screening using …

Pediatric Preoperative Fasting Guidelines Update And Education: A Quality Improvement Project, Brooklyn Mickolyzck

DNP Projects

Significance and Background:

Longer preprocedural fasting times in the pediatric population causes distress among children and their families and potentiates postoperative complications. Allowing children to consume clear liquids up to two hours prior to surgery improves satisfaction and decreases overall fasting durations. Current guidelines from the American Society of Anesthesiologists (ASA) allow preoperative consumption of clear liquids up to two hours prior to arrival time. However, preoperative nursing staff at an ambulatory surgery center in Northern, CT are educating patients parents and guardians to keep their children from having “nothing to eat or drink after midnight”.

Purpose: Develop a standardized …

Nutrition-Related Experiences Of Women With Perinatal Depression During The Covid-19 Pandemic: A Qualitative Study, Dahlia Stott, Cynthia Klobodu, Lisa A. Chiarello, Bobbie Posmontier, Mona Egohail, Pamela A. Geller, June Andrews Horowitz, Brandy-Joe Milliron

College of Nursing Faculty Papers & Presentations

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to …

Educational Intervention On Pediatric Concussions For Providers, Melissa Callaway, Robert Cornette

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

The purpose of this project was to find a gap in care within my community and fill the need with evidence-based practice. The process of evidence-based practice requires systematically searching and grading existing literature and basing a recommended practice change based on what is discovered. The recommendation is then applied translated to clinical practice. For the purposes of this project, the community which I am a part of needed improvement on the education of healthcare providers regarding post- concussive care in the pediatric population. Regardless of the explosion of research in concussions- translation to practice remains deficient. Concussions remain a …

A Clinical Classification Framework For Identifying Persons With High Social And Medical Needs: The Complexedex-Social Determinants Of Health (Sdh), Suzanne S. Sullivan, Kathryn M. Ledwin, Sharon Hewner

Nursing Faculty/Staff Publications

Background

First-generation algorithms resulted in high-cost features as a representation of need but unintentionally introduced systemic bias based on prior ability to access care. Improved precision health approaches are needed to reduce bias and improve health equity.

Purpose

To integrate nursing expertise into a clinical definition of high-need cases and develop a clinical classification algorithm for implementing nursing interventions.

Methods

Two-phase retrospective, descriptive cohort study using 2019 data to build the algorithm (n = 19,20,848) and 2021 data to test it in adults ≥18 years old (n = 15,99,176).

Discussion

The COMPLEXedex-SDH algorithm identified the following populations: cross-cohort …

Burnout And Its Impact On Nurses And Doctors, Zahra Tharani, Abeer Musaddique, Syeda Humera Qutb

School of Nursing & Midwifery

No abstract provided.

Seeds Of Trust Ripe As Luscious Fruits: Faculty Mentorship Forum At Aga Khan University Medical College, Rehana Rehman, Rahila Ali, Saira Khalid, Tazeen Saeed Ali

Department of Biological & Biomedical Sciences

Background & objective: Faculty members require mentoring in all stages of their professional development. Aga Khan University (AKU) has initiated mentorship programs for students and faculty at AKU Medical College (AKU- MC) and AKU School of Nursing and Midwifery (AKU-SONAM). This study aimed to explore perceptions of mentors, mentees, administrators (chairs, co-chairs, founder members and coordinators of the mentoring program) and leadership and further investigate the strengths and challenges faced by 'Faculty Mentorship Program' at AKU- MC.
Methods: We conducted a qualitative exploratory study from February till December 2021 after approval from AKU using purposive criterion sampling. Mentors, mentees, administrators …

Stop-Bang Questionnaire For Screening Obstructive Sleep Apnea Syndrome Among Hypertensive Patients In Kenya, Salim Abdallah, Jasmit Shah, Jumaa Bwika, Sayed Karar

Internal Medicine, East Africa

Introduction: Obstructive sleep apnea (OSA) is a type of breathing problem during sleep caused by the blockage of the upper airway, which can cause cessation of airflow. There is limited research on the prevalence of OSA in hypertensive patients in sub-Saharan Africa (SSA). The study aimed to describe the prevalence and clinical characteristics of OSA among hypertensive patients at a tertiary hospital in Nairobi, Kenya.

Methods: This cross-sectional study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. Two hundred and fifty-one hypertensive patients were screened for OSA risk using the STOP-Bang questionnaire (SBQ). Patients with a SBQ …

Treatment Of Seizures In The Neonate: Guidelines And Consensus-Based Recommendations—Special Report From The Ilae Task Force On Neonatal Seizures, Ronit Pressler, Nicholas Abend, Stéphan Auvin, Geraldine Boylan, Francesco Brigo, Maria Roberta Cilio, Linda De Vries, Maurizio Elia, Pauline Samia

Paediatrics and Child Health, East Africa

Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence-based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta-analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non-randomised studies - of interventions (ROBINS-I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). …

Interventions Co-Designed By Healthcare Providers And Clients For Improving Therapeutic Relationships In Maternal And Child Healthcare: A Pilot Study Using Human Centered Design In Rural Tanzania, Kahabi Isangula, Eunice Pallangyo, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Background

Research shows that poor provider–client interactions in maternity and child health (MCH) continue to affect health outcomes, service uptake, continuity of care, and trust in formal healthcare systems.

Objective The study’s objective was to jointly create a prototype intervention package for enhancing nurse-client relationships using human centered design (HCD) approach.

Methods A five-step HCD methodology was used: (1) Community-driven discovery through qualitative descriptive research methods using 9 focus groups with nurses and clients and 12 key informant interviews with MCH administrators; (2) consultative ideation and co-creation meetings with 10 nurses, 10 clients, and 10 administrators to co-design a rough …

Affective Domain Development In Virtual Education: Visual Thinking Strategies And Art Pedagogy, Jayne Josephsen

Nursing Faculty Publications and Presentations

Development of the affective domain is linked to increasing self-awareness of internal dialogue, such as biases and assumptions, which can affect the ability of nurses to engage in person-centered care and meet the identified patient outcomes. Through visual thinking strategies (VTS) paired with art-based pedagogy to examine grief, loss, and bereavement concepts in a hospice and palliative care nursing virtual education course, affective domain development was advanced. Foundational to this virtual educational intervention was using the VTS framework of questions and pairing them with art-based pedagogy promoting open-ended interpretation and response to the art presented. This assisted the students in …

A Socioecological Description Of The Influencing Factors To Midwives’ Management Of Preeclampsia In A Ghanaian Tertiary Hospital, Isabella Garti, Michelle Gray, Angela Bromley, Benjamin Tan

Research outputs 2022 to 2026

Introduction: In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives’ practice and the complex factors that influence the delivery of maternal healthcare. Aim: This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives’ provision of preeclampsia care using a socioecological model. Methods: Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) …

Doctor Of Nursing Practice Transformative Leadership Ai Assignment, Elizabeth Gotay

AI Assignment Library

Assignment Overview: In this assignment, students will delve into the complex realm of transformative leadership in nursing practice through a comprehensive case study analysis. Students will examine real-world scenarios and apply their knowledge of leadership theories, ethical considerations, and advanced nursing concepts to critically analyze the role of transformative leadership in achieving positive patient outcomes and fostering organizational change.

How Nurses Perceive Their Task Load When Caring For Behavioral Mental Health Patients In The Pediatric Emergency Department, Emily Cameron, Robert Cornette

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

Abstract

Introduction: Pediatric behavioral mental health patients are being seen more frequently in the emergency department setting. With this ever-growing number of cases comes the need for trained staff, including registered nurses, to care for these children during a mental health crisis. With this increase comes increased stress of nurses’ workload. The purpose of this project was to identify nurses’ perceptions of their workload when completing three identified tasks: communication, procedures, and initial intakes. Methods: The National Aeronautics and Space Administration (NASA) Task Load Index tool was used to measure nurses’ perceptions of how difficult each task was to complete. …

Complementary And Integrative Therapies Available For Treating Veterans With Ptsd: An Integrative Review, Kelly Ann Greene

Doctoral Dissertations and Projects

PTSD is described as the resulting from exposure to threatened or real injury, death, or sexual violence. Its symptoms have four different clusters: avoidance, re-experiencing, hyperarousal, and negative alterations in mood. PTSD is a widespread diagnosis among U.S. military veterans. This is a way of daily life for many veterans, and not all therapy is successful. The Veterans Health Administration (VA) recognizes that conventional therapy is not always appropriate for each veteran with PTSD. The VA has developed the Whole Health approach, which represents a move toward more person-driven health care, which the VA characterizes as proactive, patient driven, and …

Association Between Chronic Disease And Substance Use Among Older Adults In Tennessee, Manik Ahuja, Jessica Stamey, Johanna Cimilluca, Kawther Al Skir, Mary K. Herndon, Kathleen Baggett, Thiveya Sathiyasaleen, Praveen Fernandopulle

ETSU Faculty Works

Background:

Design and methods:

The Importance Of Family Presence At The Bedside Of Critically Ill Patients, Brenda K. Ramsey

MSN Capstone Projects

The purpose of this paper is to discuss the visitor restrictions on patients and their families during the COVID-19 pandemic. At the beginning of the pandemic, visitation was highly restricted with only telecommunication as a means of “visiting” with your loved one who were hospitalized, especially in the ICU settings. During my research of keeper studies for my capstone project, the articles discussed different forms of communication. The articles discussed interventions such as electronic (e-visits) for physician offices and diaries kept in the ICU for communication between family and staff. Some discussed the effects of visitor restrictions and how it …

Impact Of Strokes: The Burden Of Care, Post-Cva Fatigue & Caregiver Role Strain, Tanya G. Schlemmer

Nursing Faculty Publications and Presentations

Strokes and cerebral vascular accidents (CVAs) and related disease events are an unfortunate circumstance that inflicts individuals around the world and impacts people every day as individuals and their caregivers. The consequences of these strokes or CVA events are life-changing for all those involved. As a result of long-term disability related to strokes, the caregiver may undergo many emotional, psychological, and physical factors that impact their daily lives. There is a relatively short period of time to react to the necessary change and as a result there may be differences in coping associated with these unexpected health circumstances. Many stoke …