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Articles 1 - 30 of 56
Full-Text Articles in Medicine and Health Sciences
Effects Of Resilience Coaching On Behavioral Health Nurse Burnout, Dalila Franklin
Effects Of Resilience Coaching On Behavioral Health Nurse Burnout, Dalila Franklin
Dissertations
Abstract
Background: Inpatient, staff nurse burnout negatively impacts nurses’ mental and physical health, hospital nurse retention and turnover, and patient care. The Stress First Aid for Health Workers program attempts to bolster resilience and subsequently reduce burnout among mental health nurses in this project.
Method: This quality improvement (QI) project was an observational pre-post survey design and was conducted on a cohort sample of inpatient, behavioral health nurses at an urban, mid-sized, Midwestern hospital psychiatric unit to assess personal, work-related, client-related, and overall burnout utilizing the Copenhagen Burnout Inventory (CBI) tool to quantitatively measure burnout pre- and three months post-implementation …
Palliative Care Services On An Adult Inpatient Oncology Unit, Heather E. Barger
Palliative Care Services On An Adult Inpatient Oncology Unit, Heather E. Barger
Dissertations
Abstract
Problem: Palliative care (PC) services are widely underutilized for patients with cancer, partly due to the shortage of PC specialists. Additionally, many Americans have not filled out advance directive (AD) paperwork which is commonly addressed in PC. In the absence of an AD, cancer patients are at risk of receiving undesired aggressive treatments in the event they are unable to make decisions independently.
Methods: This quality improvement pilot initiative utilized a descriptive observational design to evaluate the number of ADs documented in the electronic health record (EHR) on an inpatient oncology unit. A retrospective EHR review was used to …
Fall Prevention Among Older Adult Behavioral Health Patients, Jodie Shipley
Fall Prevention Among Older Adult Behavioral Health Patients, Jodie Shipley
Dissertations
Abstract
Problem: Inpatient falls are a major patient safety issue. Behavioral health units experience higher rates of falls among elderly patients with between 13.1 to 25 falls per 1,000 occupied bed days (OBD). The risk of falls for the aged population is increased on a psychiatric unit due to a myriad of issues including psychotropic medications, over-activity on the unit, and confusion (Wong & Pang, 2019).
Methods: This QI project is an observational descriptive pilot intervention evaluation of a redesigned fall prevention program with the aim to reduce falls on a midsized suburban Midwestern inpatient geriatric behavior health …
Evaluating Sbirt In A Behavioral Health Urgent Care, Christina L. Williams
Evaluating Sbirt In A Behavioral Health Urgent Care, Christina L. Williams
Dissertations
Background: Adolescent substance use (SU) is a major health concern. Most youth who engage in alcohol and other SU do not meet criteria for SU disorder (SUD). Nonetheless, evidence shows SU during adolescence impacts cognitive, social, and emotional development, increases risk of physical injury, and may progress to SUD in adulthood. Only half of clinicians properly screen adolescents for SU; those identified with SUD often receive no intervention. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention to address this problem. The purpose of this project was to evaluate implementation of SBIRT using CRAFFT 2.1+N, a SU …
Multi-Method Approach To Examining Psychosocial Responses And Reactions To Covid-19 In The Us And China, Fan Li
Dissertations
Objective
The purpose is to examine health care providers’ psychosocial responses to COVID-19 in China and the US via exploring relationships among psychological responses and describing experiences of working at the epicenter during the pandemic.
Methods
In manuscript one, a cross-sectional study was conducted in nurse and physician volunteers who provided direct care to COVID-19 patients in Wuhan (volunteers) and those with no COVID-19 contact outside of Wuhan (non-volunteers). A path analysis theoretical model was developed to illustrate the relationships among psychosocial variables and was separately applied to volunteer and non-volunteer groups.
In manuscript two, a cross-sectional study was conducted …
Evaluation Of An Education Program Implementation For Adults With Stage 4 And 5 Chronic Kidney Disease, Dana Marie Carter
Evaluation Of An Education Program Implementation For Adults With Stage 4 And 5 Chronic Kidney Disease, Dana Marie Carter
Dissertations
Abstract
Problem: Patients with long-term medical conditions represent a significant public health issue. Therefore, patients diagnosed with a chronic illness must have a high level of health literacy (HL) to manage their condition effectively. This Quality Improvement (QI) project evaluated the impact of an existing education-based program for stage 4 and 5 chronic kidney disease (CKD) patients and its effect on laboratory values compared before and after an NP-led education program that included vascular access, and modality choices.
Methods: A retrospective chart review was completed on 20 patients with an inclusive diagnosis of CKD stage 4 or 5 from …
Implementation Of An Evaluation Of Davita Clabsi Protocol To Reduce Bloodstream Infections In Acute Hemodialysis Patients, Emmy Le
Dissertations
Abstract
Problem: Central line-associated bloodstream infection (CLABSI) is the primary cause of morbidity and mortality in End-Stage Renal Disease (ESRD) patients on hemodialysis. It is associated with severe medical conditions, prolonged hospitalization, and financial burden. Despite its convenience and simple operation, central venous catheter (CVC) account for 70% of all CLABSI occurrence and increase the risk for septicemia and death.
Methods: This quality improvement (QI) project utilized a descriptive observational pilot design to identify the effect of DaVita CLABSI Protocol on CLABSI occurrence rate. Quantitative data was collected retrospectively and prospectively via electronic medical record (EMR) review before and …
Reducing Pediatric Morbidity Through Development Of A Clinical Practice Guideline, Deanna Kroh
Reducing Pediatric Morbidity Through Development Of A Clinical Practice Guideline, Deanna Kroh
Dissertations
Peripheral intravenous therapy is a commonly utilized treatment modality for the care of acutely ill pediatric patients. Two risk factors include infiltration and extravasation injuries. These injuries, peripheral intravenous infiltration or extravasation injuries (PIVIEs), can vary in their clinical manifestations from minor discomfort to harm as severe as loss of limb or disfigurement. Clinicians caring for patients at risk of developing PIVIEs need to be able to act quickly to reduce potential morbidity. The purpose of this project was to create a clinical practice guideline (CPG) that would guide staff intervention if a PIVIE occurs, with the ultimate goal of …
Implementing A D/Deaf Educational Module For Graduate Nursing Students, Brenda J. Pauley
Implementing A D/Deaf Educational Module For Graduate Nursing Students, Brenda J. Pauley
Dissertations
Problem: Nurse practitioners lack knowledge and skills to effectively communicate with D/deaf individuals which potentiates risk for health disparities and gaps in care. Graduate nursing programs rarely incorporate D/deaf-focused education in their curriculums.
Methods: This descriptive quality improvement project implemented the first D/deaf-focused educational online module at a Midwestern university’s College of Nursing. A purposive sample of 38 BSN-DNP students enrolled in the Spring Intensive completed a pre- and post-education survey. Both surveys assessed students’ D/deaf perceptions through Lewis and Keele’s (2020) D/deaf and Hard of Hearing Interaction Beliefs Scale for Registered Nurses (DdHH-IBS/RN) and evaluated students’ knowledge through a …
Visualizing Depressive Symptom Improvement: Implementing The 17-Item Hamilton Depression Rating Scale, Briana Raterman
Visualizing Depressive Symptom Improvement: Implementing The 17-Item Hamilton Depression Rating Scale, Briana Raterman
Dissertations
Visualizing Depressive Symptom Improvement: Implementing the 17-Item Hamilton Depression Rating Scale
Abstract
Problem
Depression, a mental health diagnosis, has affected about 18.5% of adults (Villarroel & Terlizzi, 2020). Ketamine, a medication initially used as an anesthetic, has improved depressive symptoms in individuals struggling with treatment-resistant depression.
Method
This quality improvement (QI) project used the 17-item Hamilton Depression Rating Scale questionnaire to assess depressive symptom changes in patients receiving intramuscular ketamine for treatment-resistant depression. The questionnaire was administered to patients pre-and post-intramuscular ketamine administration. The data was collected on injections one, three, and six on each participant’s set schedule of injections …
Education To Improve Long-Acting Injectable Antipsychotic Use, Travis Donald Wolfangel
Education To Improve Long-Acting Injectable Antipsychotic Use, Travis Donald Wolfangel
Dissertations
Purpose: Long-acting injectable (LAI) antipsychotics are underutilized as an evidence-based treatment for schizophrenia and schizoaffective disorder. The purpose of this quality improvement project was to determine if a web-based LAI education module changed advance practice prescribers’ knowledge, attitudes, and practice behaviors regarding LAI antipsychotics one month after receiving LAI education at a community-based mental health organization.
Methods: This QI project was an observational pre- post-educational design. The 20-item Knowledge, Attitudes, and Practices (KAP) questionnaire was used to assess advanced practice providers’ knowledge retention, attitude changes, and practice modifications regarding LAI antipsychotics and prospective patient chart reviews were performed. …
An Evaluation Of Mindstrong™ Implementation With Graduate Nursing Students, Angela B. Sabblut
An Evaluation Of Mindstrong™ Implementation With Graduate Nursing Students, Angela B. Sabblut
Dissertations
Problem: Nursing graduate students are at increased risk of greater stress, anxiety, and depression (Hoying, 2020; Melnyk et al., 2020). Cognitive Behavioral Therapy is the gold standard in the treatment of anxiety and depression (Hoying et al., 2020; Melnyk et al., 2015; Melnyk et al., 2020). MINDSTRONG™, a CBT-based training program, has been proven in many studies to be effective in helping individuals prevent or cope with these issues (The Ohio State University College of Nursing, 2020).
Methods: This Quality Improvement (QI) project was a descriptive-observational, pre-post design. Sample and setting were nursing graduate students from a Midwestern, middle-sized urban, …
Evaluating Mindfulness On Loneliness In An Older Adult Population, Jessica Tieskoetter
Evaluating Mindfulness On Loneliness In An Older Adult Population, Jessica Tieskoetter
Dissertations
Problem: Loneliness is a widespread public health concern and has negatively impacted mortality and health outcomes among older adults. This quality improvement project’s purpose was to evaluate mindfulness on loneliness and quality of life among adults aged 65 years and older, participating in a weekly befriending socialization program.
Methods: A descriptive cohort design was utilized to assess loneliness pre-and post-implementation of a mindfulness telephone line over three months. A convenience sample of 22 older adults enrolled in a befriending socialization program was used. The Iowa Model of Evidence-Based Practice framework was applied to guide the implementation of a practice change …
Implementation Of A Protocol Nurse In The Emergency Department, Marissa Kramer
Implementation Of A Protocol Nurse In The Emergency Department, Marissa Kramer
Dissertations
Abstract
Problem: Increased wait times and extended length of stay (LOS) of patients in the Emergency Department (ED) are contributing to overcrowding, burdening EDs worldwide. A nurse can initiate patient care using protocol order sets while a patient is in the waiting room; however, triage nurses are often too busy to complete these orders. Scheduling a nurse to complete these protocol order sets could reduce ED overcrowding and patient LOS.
Method: A convenience sample was used to retrospectively chart review and collect data utilizing an excel spreadsheet with patients 40 years of age and older with a chief complaint of …
Screening For Social Determinants Of Health In A Comprehensive Pediatric Sickle Cell Disease Clinic, Marie Turner
Screening For Social Determinants Of Health In A Comprehensive Pediatric Sickle Cell Disease Clinic, Marie Turner
Dissertations
Problem: Social determinants of health (SDOH) affect health outcomes across the lifespan. The American Academy of Pediatrics recommends routine screening for SDOH. Poverty is a SDOH affecting health outcomes in children, especially in children with a chronic disease such as sickle cell disease (SCD). Children with sickle cell disease have a high burden of SDOH. This project sought to describe the SDOH barriers experienced by pediatric patients with SCD.
Methods: A descriptive survey/observational design, using a convenience sample of pediatric patients ages 0-19 years old in a comprehensive SCD clinic at a large, urban, Midwestern academic medical center was utilized …
Implementation Of A Critical Event Debriefing Tool In The Pediatric Intensive Care Unit, Tara Fiala
Implementation Of A Critical Event Debriefing Tool In The Pediatric Intensive Care Unit, Tara Fiala
Dissertations
Problem: Working in the Pediatric Intensive Care Unit (PICU), staff encounter critical patient events without warning. Debriefing after adverse patient events has been shown to give staff the opportunity to process these events in an open, honest, and judgement-free environment. Debriefing has been recognized as a tool for detecting medical errors, improving team communication, providing emotional support, and analyzing team performance.
Methods: A descriptive, observational pilot study was used to implement the DISCERN tool into a large, midwestern, urban PICU. The aim of the quality improvement project was to achieve a debriefing tool completion rate of 20% over a one-month …
Life Matters, Marina Fischer
Life Matters, Marina Fischer
Dissertations
Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.
Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …
Implicit Bias Training For Perinatal Nursing, Racheal Lakine-Harden
Implicit Bias Training For Perinatal Nursing, Racheal Lakine-Harden
Dissertations
Problem: Maternal and fetal morbidity and mortality is a rising health care crisis in the United States. Black women are disproportionately affected. Clinician implicit bias and medical racism have been named as factors in this crisis. Recommendations to address this public health peril include; educating and raising awareness among front-line perinatal nursing staff on implicit bias and its consequences for Black women. The purpose of this project is to evaluate the impact of implicit bias training on nurses’ awareness of implicit bias, attitudes, and beliefs about disparities, and the likelihood to engage in behaviors to reduce or address racial bias …
Implementing Patient Acuity Scale On A Medical-Surgical Unit, Coreen Ladd
Implementing Patient Acuity Scale On A Medical-Surgical Unit, Coreen Ladd
Dissertations
Problem: Nurses commonly report dissatisfaction with their workload levels due to inequity of shift assignments. Imbalanced workload distribution has been shown to lead to missing or delayed care. Increased nursing workload has been linked to increased fall rates, healthcare associated infections, and avoidable deaths. Research has shown that patient classification is more accurate when an instrument is used. The purpose of this quality improvement project was to implement a patient acuity tool to aid nurse-patient shift assignments on a medical-surgical unit. The project aimed to provide a standardized and objective method of measuring patient acuity.
Methods: The project took place …
Initiation Of Procalcitonin Screening As A Marker In Antibiotic Therapy De-Escalation, Briana Kile
Initiation Of Procalcitonin Screening As A Marker In Antibiotic Therapy De-Escalation, Briana Kile
Dissertations
Problem: The overuse of antibiotics has created antimicrobial resistance (AMR)
resulting in treatment failure for bacterial infections. To combat AMR, clinicians should
only prescribe antibiotic therapy when clinically warranted. It is easy to misdiagnose a
viral infection. However, any delay in the initiation of antibiotic therapy in a bacterial
infection may lead to increased morbidity and mortality. These patients with non-specific
clinical symptoms may be misdiagnosed without a rapid and definitive diagnostic test.
Methods: This quality improvement (QI) initiative utilized an evidence-based clinical
guideline for procalcitonin (PCT) levels for antibiotic therapy de-escalation. WBC counts
were collected two-days and one-day before …
Implementing A Standardized Nursing Communication Tool To Improve Inpatient Nursing Communication, Ashley D. Nator
Implementing A Standardized Nursing Communication Tool To Improve Inpatient Nursing Communication, Ashley D. Nator
Dissertations
Implementing a Standardized Nursing Communication Tool to Improve Inpatient Nursing Communication
Ashley D. Nator
B.S. Nursing, University of Missouri-St. Louis, 2018
A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree
Doctor of Nursing Practice with an emphasis in Family Nurse Practitioner
August 2022
Advisory Committee
Cathy Koetting, PhD, DNP, APRN, CPNP, PMHS, FNP-C
Chairperson
Sarah Jackson, DNP, APRN, FNP-C
Amy Terbrock, MSN, PCCN, SCRN, RN
Copyright, Ashley D. Nator, 2021
Original: 08/2021 Revised: 09/2021, 10/2021, 04/2022
Abstract
Problem: Patient handovers occur among nurses more than 4,000 times …
Effect Of A Trauma Informed Care Tool In A Pediatric Cardiac Intensive Care Unit, Taylor Park
Effect Of A Trauma Informed Care Tool In A Pediatric Cardiac Intensive Care Unit, Taylor Park
Dissertations
Problem: Parents of infants less than one-year-old with complex congenital heart disease (CCHD) experience significant stress while their child is admitted to the pediatric cardiac intensive care unit (PCICU), often resulting in trauma to parents and their families. Trauma informed care (TIC) seeks to minimize the impact of emotional trauma and it acknowledges previous trauma an individual may have experienced.
Methods: The purpose of this quality improvement (QI) project was to assess the thrive guide’s ability to decrease parental stress in the pediatric cardiac intensive care unit (PCICU). The aim was to decrease parental Perceived Stress Scale (PSS) scores by …
Healthcare-Associated Pressure Injury Prevention In The Intensive Care Unit, Ross Quinton
Healthcare-Associated Pressure Injury Prevention In The Intensive Care Unit, Ross Quinton
Dissertations
Problem: Healthcare-associated pressure injuries (HAPIs) occur when prolonged pressure is on the sacrum, coccyx, elbows, and heels, during a hospital stay. HAPIs can result in increased morbidity and mortality, and prolonged hospital stays, which consequently requires excess expenditure on treatment. Early specialty mattress placement can prevent HAPI acquirement.
Methods: This quality improvement (QI) pilot project aimed to increase specialty prevention mattress usage in the intensive care unit (ICU). A sleep surface decision tree was implemented into the admission process in a 30-bed ICU. A retrospective record review was used to examine demographics, comorbidities, HAPI risk, length of stay, and when …
Doubling Down On Sepsis: A Quality Improvement Project To Improve Sepsis Bundle Compliance On An Inpatient Oncology Unit, Kayla Slay
Dissertations
Problem: Sepsis is a leading cause of death worldwide, and the second most common cause of death in cancer patients. Early management of sepsis through use of sepsis bundles have been shown to improve patient outcomes, yet bundle adherence is unfortunately inconsistent.
Methods: A two-nurse team, called the Sepsis Sidekicks, was a process improvement initiative to increase compliance with the center for Medicare and Medicaid Services (CMS) sepsis bundle and improve patient outcomes related to sepsis. The observational quality improvement project utilized a Plan-Do-Study-Act (PDSA) model over a six-week period where quantitative data was collected using a retrospective chart review. …
Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith
Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith
Dissertations
Problem: CAUTIs (catheter-associated urinary tract infections) are a common hospital-acquired condition (HAC) that increase length of hospital stays, hospital costs, and risk for patient mortality. CAUTI rates in a PICU increased in 2021 from the year 2020. A rapid cycle PDSA revealed nurses were not using soap and water for foley catheter care, which is the recommended cleanser by the Centers for Disease Control and Prevention (CDC).
Methods: An observational descriptive design was used to evaluate foley catheter cleaning and CAUTI rates. PICU nurses completed behavior surveys regarding foley catheter cleaning practices. An education intervention occurred when nurses answered anything …
Evaluating The Effectiveness Of Implementing Depression Screenings With Uninsured African American Adults, Pamela Talley
Evaluating The Effectiveness Of Implementing Depression Screenings With Uninsured African American Adults, Pamela Talley
Dissertations
Problem: Uninsured African Americans are underdiagnosed and often untreated for depression. Individuals usually do not present to their primary care provider with a complaint of depressed mood, however, may report symptoms such as decreased energy, general body aches, digestive concerns, somatic complaints, or older adults' memory or cognitive problems. The purpose of this quality improvement pilot project was to examine the results of the implementation of a depression screening (PHQ-9) in a primary care setting for uninsured adults for detection, diagnosis, and treatment of depression in African American clients.
Results: The PHQ-9 screening questionnaire was given to 100% (N …
Effect Of A Turn Clock On Hospital-Acquired Pressure Injury Incidence, Sydney Warren
Effect Of A Turn Clock On Hospital-Acquired Pressure Injury Incidence, Sydney Warren
Dissertations
Problem: Hospital-Acquired Pressure Injuries (HAPIs) are the only quality metric increasing in incidence and are preventable. HAPIs are wounds to bony prominences during a hospitalization and can increase hospital costs, morbidity, and mortality. HAPIs could be prevented through interventions, including repositioning patients every 2 hours and using a turn clock method. The aim of this quality improvement (QI) pilot project was to decrease HAPI incidence.
Methods: A turn clock method was implemented on a general medicine floor at a mid-sized, suburban medical center utilizing a descriptive retrospective observational design. Data was collected for the pre-intervention timeframe from June through August …
Readmit Clinical Risk Index: Identifying Risk Factors To Reduce 30-Day Psychiatric Readmissions, Victoria Faulkner
Readmit Clinical Risk Index: Identifying Risk Factors To Reduce 30-Day Psychiatric Readmissions, Victoria Faulkner
Dissertations
Abstract
Problem: There has been a growing concern in the past decades over the increase in community-based adults who require readmission to psychiatric care shortly after discharge. It is estimated that nearly half of discharged psychiatric patients will be readmitted within twelve months after discharge. This has been primarily attributed to the absence of screening tools and resources to assists behavioral healthcare providers in identifying socio-demographic factors contributing to readmissions. Screening tools like the READMIT Clinical Risk Index identify patients at risk for psychiatric readmission. This quality improvement project aims to identify socio-demographic factors that lead to 30-day readmission …
Left Ventricular Assist Device (Lvad) Driveline Infection Rates Between Two Different Dressing Methods, Gretchen Compton
Left Ventricular Assist Device (Lvad) Driveline Infection Rates Between Two Different Dressing Methods, Gretchen Compton
Dissertations
Problem: Heart failure has a growing impact on Americans, and this contributes to an increased number of patients requiring treatment for advanced heart failure. Typical treatment options may include cardiac transplant or the implantation of a left ventricular assist device (LVAD). The use of an LVAD requires sterile management of an external driveline site. Driveline infections are a common complication in this patient population and can lead to chronic complications. There are no published guidelines on the management of the driveline site. This project aimed to provide evidence that can be used in the establishment of standardized guidelines for driveline …
Implementing A Child Friendly Menu Guide In A Pediatric Unit: Promoting Healthful Choices, Lauren Hull
Implementing A Child Friendly Menu Guide In A Pediatric Unit: Promoting Healthful Choices, Lauren Hull
Dissertations
Problem: Over 1/3 of children in the United States are overweight or obese and children’s nutritional status while hospitalized worsens rather than improves. Hospital meals have too many calories, too much sugar, and too few nutrients compared to recommended guidelines for children. The primary purpose of this quality improvement project is to increase the amount of healthy foods ordered by children in a southeastern pediatric hospital unit through implementation of a menu guide.
Methods: A quality improvement pre-post interventional pilot study was done through implementation of a child friendly menu guide promoting healthful eating. Data was collected by retrospective and …