Examining A Fatigue Management Model That Identifies Risk Factors And Consequences Of Fatigue In Older Individuals, Maral Torossian

Doctoral Dissertations

Fatigue is experienced by 40-74% of older individuals living with a chronic disease. Despite advances in scientific knowledge around risk factors and consequences associated with fatigue, a comprehensive model that can serve as a guide for healthcare providers caring for older individuals with fatigue is lacking. Thus, the purpose of this study was to examine a fatigue model based on the Theory of Unpleasant Symptoms (TUS). The model included psychological, physiological, and situational risk factors of fatigue, as well as fatigue outcomes, such as physical, social, and cognitive performances, perceived health, and quality of life (QOL). This was a secondary …

A Cloud Infrastructure For Large Scale Health Monitoring In Older Adult Care Facilities, Uchechukwu Gabriel David

Masters Theses

Technology development in the sub-field of older adult care has always been on the back-burner compared to other healthcare areas. But with increasing life expectancy, this is poised to change. With the increasing older adult population, the current older adult care facilities and personnel are struggling to keep up with demand. Research conducted in the Netherlands [1] found 33,000 older adults were awaiting admission into a home for the elderly showing that demand far exceeds availability. This huge demand for older adult care has resulted in a decrease in the quality of care being provided. A recent study involving older …

Perseverance: A Focused Ethnographic Study Of The Emergency Triage Nurse, Ellen C. Smithline

Doctoral Dissertations

Introduction: The emergency triage process is not meeting the needs of the patient or the healthcare team. Current and past research has focused primarily on the emergency triage nurse’s ability to accurately designate the triage acuity score, while largely ignoring the impacts of the complex and dynamic environment in which they are immersed. Therefore, the purpose of this study was to describe the factors that influence the decision-making process of the emergency triage nurse (ETN). Method: This was a focused ethnographic study that included four phases. Phase 1 was the grand tour of the emergency triage and waiting room area. …

Nurse-Delivered Shoe-Lacing Intervention: Effect On Comfort And Toe Pressures For Active Community-Dwelling Adults (Age 65+), Mary C. Clayton-Jones

Doctoral Dissertations

Significance: Problems with shoe fit are endemic, affect gait and balance and lead to falls. Falls are physically, emotionally, and economically costly. Low-cost, easily implemented interventions, that reduce pain and improve balance meet the “triple aim” of the Institute for Healthcare Improvement. Purpose: Evaluate the impact on community-dwelling adults (65+) of two nursing interventions involving foot repositioning and shoe relacing. Outcome measures: Toe pressures, experiences of pain and comfort. Method: Repeated-measures, mixed-methods lab-based study. Walk #1 Control. Intervention #1, participant’s heel secured to back of shoe, the participant’s chosen lacing pattern snugged. Intervention #2, heel secured to back of …

Hospital Assessment And Response To Environmental Pollution As A Population Health Need: Identifying Prevalence And Predictors In Community Benefit Practices, Sarah Valentine

Doctoral Dissertations

Hospitals have a growing role in improving population health. Environmental pollution is an important determinant of health with disproportionate effects on Communities of Color. This warrants hospital action. To advance such action, it is important to take stock of current hospital engagement with environmental pollution and to identify factors associated with such engagement. I investigated the following. To what extent do New York State (NYS) non-profit hospitals assess, identify, and respond to environmental pollutants as part of community benefit practices? Do factors previously reported as associated with hospital engagement of social determinants predict engagement with environmental pollution as a community …

Implementation Of An Evidence-Based Screening Tool For Children For Detection Of Developmental, Behavioral And Family Issues, Lyndsay Goss

Doctor of Nursing Practice (DNP) Projects

Background: Children are a vulnerable population who are at risk for a variety of developmental, behavioral and family concerns. Early intervention leads to improved outcomes. By implementing the comprehensive evidence-based screening tool the Survey of Well-being for Young Children (SWYC), within a Federally Qualified Health Center (FQHC), outcomes for these children may be improved through early intervention.

Methods: The SWYC survey was provided to parents and guardians of children ages zero to five years at one pilot site at a FQHC in New England during well child visits (WCV) over a 6-week period. Implementation success was measured through review …

Robot Pets In Dementia Care: An Educational Intervention, Laura Bradford

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Dementia is a progressive disease of memory and functioning that affects almost six million people in the United States. Elders with dementia often experience depression, as well as behaviors such as agitation or wandering. Antipsychotic medications have been used to manage behaviors in dementia, but these medications can have serious side effects. There is data on effective non-pharmaceutical approaches to behavior management in dementia, but these techniques are not always used. The use of robot pets is a potential intervention, but there are currently no programs that include training about robot pets in dementia care. …

Evaluating The Impact Of An Educational Program On The Healthcare Providers Knowledge On Depression And Screening Among Adolescents And Young Adults, Albert Peprah

Doctor of Nursing Practice (DNP) Projects

No abstract provided.

Enabling Patients In Opioid Detox To Pursue Long-Term Recovery, Duny Damas

Doctor of Nursing Practice (DNP) Projects

Background/Purpose: High readmission rates of individuals in need of opioid detoxification demonstrate that opioid detoxification alone may be insufficient to promote changes in behavior and prevent relapse. There is a critical need for improvement in treatment approaches along with efforts from healthcare professionals to lead opioid-dependent patients toward long-term recovery. Such a care improvement is feasible through the delivery of adequate education to providers regarding patients suffering from opioid addiction to facilitate a change in attitude and more effective treatment. Methods: Data collected through a pre-test survey assessed provider’s knowledge about opioid use disorder, the availability of screening …

A Quality Improvement Project For Opioid Use Disorder At A Psychiatric Hospital In Western Massachusetts, Pauline T. Eteng

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Opioid abuse is a challenging health care concern, and has been identified as a national public health issue. The prevalence of illicit fentanyl and prescription pain medication in our society are related to a multitude of factors which have impacted many lives and triggered a national epidemic despite experts' preventative measures and treatment recommendations. Purpose: A quality improvement (QI) project was designed to enhance the assessment of patients suffering from opioid use disorder (OUD) with evidence-based screening tools to prevent opioid abuse among adult patients in a chronic care psychiatric hospital. Methods: The QI project integrated …

Improving The Frequency And Efficacy Of Advance Care Planning In Primary Care, Katherine Farrell

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a process to support patients in understanding and expressing their future medical wishes. Despite evidence supporting the benefits of ACP there remain a number of barriers limiting uptake of this important practice. Absence of advance care planning places patients at risk of receiving care misaligned with their values, goals, and preferences as well as increased patient and family distress at end-of-life. Purpose: This quality improvement (QI) project addressed provider knowledge, and patient awareness and level of engagement in the advance care planning process in an effort to increase the frequency and efficacy of ACP …

A Toolkit To Assist Child And Adolescent Providers In Assessing Problematic Internet Use And Cyberbullying In An Outpatient Psychiatry Clinic, Collin J. Mcgrath

Doctor of Nursing Practice (DNP) Projects

Social media has become a transformational part of daily life in the United States. Currently, there are few assessment tools and no standard of care when it comes to assessing internet use, social media, and cyberbullying among child and adolescent patients. Problematic internet use (PIU) and cyberbullying can both significantly and negatively impact the mental health of children and adolescents. The purpose of this project is to evaluate the effectiveness of an online toolkit implementation for a Southwest Florida (SWFL) outpatient psychiatry office. A pre/post one group design was used. A convenience sample of 13 healthcare providers was recruited from …

Evidence-Based Strategies For The Prevention Of Workplace Violence Against Health Care Workers: Creating An Educational Toolkit, Chibuzor Anyanwu

Doctor of Nursing Practice (DNP) Projects

Background: Violence in healthcare is a growing problem. Health care workers are being physically and psychologically assaulted by patients and their families. This is particularly a problem in emergency departments, psychiatric units, waiting rooms and geriatric facilities.

Purpose: This project focused on the creation of an educational toolkit for the prevention of violence against healthcare workers.

Methods: This quality improvement project used Kotter’s 8-step change model to guide the evaluation of a toolkit incorporating evidence-based nonviolent crisis prevention strategies with Crisis Prevention Institute’s top 10 de-escalation tips. The project was implemented at a psychiatric hospital in Illinois. Healthcare workers reviewed …

Increasing Knowledge And Awareness Of Expedited Partner Therapy Among Providers, Angeline K. Motari Mokaya

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: In the past six years, there has been a steady rise in the number of reported cases of chlamydia and gonorrhea in the United States. Expedited partner therapy (EPT) refers to the practice of treating partners of patients diagnosed with specific treatable sexually transmitted infections without first evaluating them. This treatment was recommended by the Centers for Disease Control and Prevention in 2006 and it is currently legalized in 45 states and the District of Columbia. However, many health care providers (HCPs) do not have knowledge of EPT therefore do not make use of it.

Purpose: This quality …

Enhancing Therapeutic Alliances In Neonatal Care: Parents With Substance Use Disorders, Shannon A. Starkey

Doctor of Nursing Practice (DNP) Projects

Background: The number of newborns exposed to opiates quadrupled in the United States from 1999 to 2014, from 1.5 per 1,000 hospital deliveries to 6.5 per 1,000. Many of these babies are admitted to the neonatal intensive care unit for neonatal abstinence withdrawal syndrome. While neonatal nurses are trained to care for babies exposed to substances in utero, they often struggle to meet the unique psychosocial needs of the babies’ parents. Negative attitudes and strained interactions between neonatal nurses and families with substance use disorders (SUDs) result in subtherapeutic alliances and suboptimal outcomes in neonatal nurseries. Purpose: Educational …

Implementing An Interactive Educational Intervention To Increase Knowledge On Phosphorus Diet And Binder Adherence In Patients Receiving Hemodialysis, Rene Chagnon

Doctor of Nursing Practice (DNP) Projects

Background: Maintaining low serum phosphorus (PO4) levels is recommended in patients receiving hemodialysis through a low phosphorus diet and binder medication compliance, however this remains a struggle for many patients. The literature shows that educational interventions focused on phosphate management can increase patients’ knowledge and improve patient outcomes.

Purpose: To implement an educational intervention focused on low phosphorus diet and adherence to binder regimen to increase patients’ knowledge base, receiving hemodialysis at an outpatient unit at a Veterans Affairs (VA) Hospital.

Methods: An interactive educational intervention involving two 30-minute, one-to-one counseling sessions with educational materials including short videos and a …

Psychoeducation Intervention For Stress Management In Adolescents, Gold E. Okoeka

Doctor of Nursing Practice (DNP) Projects

Background: Stress reduction techniques (SRT) such as yoga, exercise, deep breathing, positive self-talk, sleep hygiene among others, have shown to be effective in stress reduction in adolescents. SRTs are effective in lowering stress levels, improving mood, reducing anxiety levels as well as promoting overall health.

Purpose: This DNP project aimed to implement a psychoeducation intervention using e-brochures to reduce stress levels among adolescent’s ages 16-18 years old.

Methods: A total of 15 adolescents who agreed to participate in the program received a psychoeducation intervention using e-brochures on the impact of stress on their mental health and a few SRTs including …

Identification Of Post-Intensive Care Syndrome (Pics) In Primary Care, Danielle L. Riggi

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Post-intensive care syndrome (PICS) occurs in approximately 50% of ICU survivors and increases risk of mortality and hospital readmission while decreasing quality of life. There were no national guidelines for diagnosis or treatment of PICS at the time of the completion of this project.

Purpose: The purpose of this project was to increase identification of PICS in the primary care setting by providers. This was accomplished by implementing an educational toolkit and algorithm to better identify patients with PICS and to evaluate the incidence of PICS.

Methods: An educational presentation and a survey were presented to the providers …

Elearning Module For Nursing Students To Improve Delirium Identification, Prevention, And Management, Shannon Baker

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Delirium is a serious, acute alteration in cognition and consciousness, which is common amongst older hospitalized patients and has an overwhelmingly negative impact on patient outcomes. Under-recognition by healthcare providers poses a barrier and contributes to poor patient outcomes, including increased morbidity and mortality.

Purpose: To reduce the incidence of delirium amongst acutely ill patients via internet-based education for student nurses on delirium prevention, assessment, and management.

Methods: An eLearning intervention consisting of a virtual lecture with an unfolding case study for undergraduate nursing students. This project utilized the Nurses’ Delirium Knowledge Assessment (NDKA) …

Massage Therapy For Anxiety And Depression, R. Maryam Lempke

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Massage therapy is a proven method for reducing symptoms of anxiety and depression as evidenced through literature review. However, the practice of complementary and integrative modalities (CIM), such as massage, is uncommon within psychiatric care. This leaves a gap in practice in the psychiatric setting. Purpose: The capstone quality improvement project addressed the identified gap by providing education on massage therapy to mental health providers and clients, and by increasing massage accessibility and use in the outpatient psychiatric setting by providing education on performing self-massage. Methods: The education was provided via pre-recorded video. Clients/providers completed pre and post-assessments …

A Quality Improvement Project To Assess The Value Of Pharmacogenomic Testing In Adults Diagnosed With Major Depression, Ileana Miranda Velazquez

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Treatment of major depression follows the guidelines from evidence-based medicine established algorithms; however, 50% of patients diagnosed with major depressive disorder do not respond to their first medication trial, and 70% may go through four treatment attempts before achieving remission.

Purpose: To demonstrate the value of pharmacogenomic testing as a treatment-guidance technology in patients with resistant depression and assess healthcare providers' motivation to adopt the technology.

Methods: A retrospective chart review of (N = 73) patients' treatment response measured by the pre-post PHQ-9 depression scale after pharmacogenomic guided medication intervention with descriptive statistics and paired t-test. The …

An Educational Toolkit For Providers On A Plant-Based Diet And Cardiovascular Disease Prevention, Alexandra Collette

Doctor of Nursing Practice (DNP) Projects

Background: Cardiovascular disease is the leading cause of death globally with risk factors that can be prevented through healthy behavioral and lifestyle habits, such as a diet that is high in healthy plant-based foods. Despite current guideline-based recommendations and evidence that supports a plant-based diet for cardiovascular health, there is a lack of understanding amongst healthcare providers regarding diet as a core aspect of primary and secondary prevention of cardiovascular risk factors.

Purpose: Implementation of an educational toolkit with resources on a plant-based diet and its benefits for cardiovascular health.

Methods: Physicians, nurse practitioners, physician assistants, and registered nurses, located …

Educating Nurse Practitioners On Aces And The Hope Model To Improve Awareness And Acceptability Of Trauma-Informed Care, Emily T. Gardner

Doctor of Nursing Practice (DNP) Projects

Background: Adverse childhood experiences (ACEs) continue to demonstrate negative effects on children and adults’ health. A dose-response relationship exists between the number of adverse experiences a person faces during childhood, and the extent and severity of chronic illnesses developed in adulthood, including early death. Identifying patients who have ACEs is key to managing their health care. Trauma-informed care provides a clinical framework in which patients with a history of ACEs receive optimal health care to prevent and manage the health influences of ACEs.

Purpose: The purpose of this Quality Improvement (QI) project was to increase nurse practitioner (NP) knowledge about …

Alcohol Screening In A Pain Clinic To Reduce The Risk Of Overdose And Improve Patient Care And Compliance With Prescription Opioids, Alicia Ellis

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The nationwide opioid crisis is having a significant impact on the U.S. population. Patients may turn to alcohol and opioids for pain relief, which can lead to cancer, alcoholic liver disease, and heart disease. Providers can improve outcomes by screening patients for alcohol use prior to getting an opioid prescription using the Audit-C screening tool.

Purpose: This DNP Project started formal screening for alcohol abuse in a small rural pain clinic with five hundred patients per month.

Methods: During the first visit, patients were triaged by the nurse and screened using the AUDIT-C tool and had a urine …

Implementing Second Person Reporting In Nurse Practitioner Curricula: A Practical Approach To Person-Centered Care, Collette Tattman-Melo

Doctor of Nursing Practice (DNP) Projects

Background: Nurse handover report inclusive of patient participation has been shown to promote a patient-centered approach to care resulting in increased satisfaction, safety and efficacy. However, a review of the literature suggests the pedagogy of handover report is mainly provided within the “hidden curriculum” of practice, rather than within formal nursing programs. As a result, what constitutes person-centeredness in a handover report is subject to individual interpretation and therefore, practiced inconsistently. Purpose: The project goal was for nurse practitioner students to connect theories of person-centered care (PCC) with practice, specifically by using a tripartite, second-person report (SPR) style. …

Increasing Enrollment Of Cardiac Rehabilitation For Eligible Patients In The Outpatient Setting: A Toolkit, Staci M. Grothues

Doctor of Nursing Practice (DNP) Projects

Background: Heart disease is the leading cause of death worldwide. It is responsible for serious cardiac events that can be fatal. When a patient experiences one cardiac event, they are more likely to have a second event. Therefore, secondary prevention programs such as cardiac rehabilitation (CR) have been proven to reduce mortality in these patients and enhance quality of life; however, they are severely underutilized. Purpose: The purpose of this integrative review and DNP project was to educate outpatient providers about the immense value of cardiac rehabilitation to eligible patients and develop a toolkit targeted to help providers recognize eligible …

Improving Diabetes In The Latino Population: A Culturally Sensitive Approach, Veronica M. Green

Doctor of Nursing Practice (DNP) Projects

Background: Latinos in the United States suffer higher rates of type 2 diabetes (T2D) and need culturally sensitive approaches to diabetes self-management education (DSME).

Purpose: To implement a culturally sensitive DSME program to Latino adults by integrating a community health worker, clinic support, and digital technology.

Methods: This project was implemented over 8 weeks in an internal medicine clinic in El Paso, Texas. It included online DSME group sessions delivered by a community health worker, with primary care support, and key topic reinforcement through text messaging. Concluding hemoglobin A1c levels were drawn and compared with the patient’s baseline hemoglobin A1C …

Educating Primary Care Providers In Dual Diagnosis Disorders Of Mental Health And Substance Use, Sarah Stout

Doctor of Nursing Practice (DNP) Projects

Abstract

Purpose: Many adults in the United States suffer from mental health and substance use disorders. Due to personal and structural barriers, care is not always received by those who suffer with a dual diagnosis. Lack of education among primary care healthcare providers is a barrier to dual diagnosis treatment. The aim of this project was to present and summarize evidence to increase the providers knowledge, assessment, and confidence levels in treatment of these disorders. Methods: This project was designed using a quality improvement (QI) approach to increase the knowledge, and confidence of primary care healthcare providers through an educational …

Telehealth Coaching To Improve Exercise Self-Efficacy In Diabetics, Oby C. Ikoro

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and Review of Literature: Exercise is essential to the self-management of Type 2 Diabetes Mellitus (T2DM). The literature reveals that many patients with difficulty in the self-management of exercise improve with coaching. The literature also reveals that an adequate exercise routine results in improved blood glucose control and the prevention of complications.

Purpose: This DNP project aims to demonstrate the positive effect of low-cost telehealth coaching to improve self-efficacy in an exercise regimen for T2DM patients.

Methods: A one-group pretest-posttest design was used in this project. Telephone calls and text messaging were used to coach patients to improve …

Noteaid: A Comprehension Tool To Improve Patient Understanding, Harriette F. Green

Doctor of Nursing Practice (DNP) Projects

Background: Meaningful use mandates allow patients access to provider notes, however, there remain many barriers including the inability of the patient to understand the notes.

This project surveyed clinicians on the informatics committee of a large tertiary care facility about their thoughts regarding the Noteaid translation system after presenting examples of translated patient notes and education about the meaningful use mandate.

Methods: An online PowerPoint presentation and preintervention survey was distributed, followed by a live educational intervention. The members were emailed a post intervention survey about the effectiveness, likeability, usability, and practicality of the Noteaid software tool to translate …