Medicine and Health Sciences Commons^™

Meta-Analysis Of Herbal Cannabis Therapy For Chronic Pain, Michael J. Seneca

UNF Graduate Theses and Dissertations

Since the first so-called “medical marijuana” legislation was passed in California in 1996, a total of twenty states and the District of Columbia have passed laws permitting limited use of cannabis. Despite the changes in state laws, cannabis remains illegal for any purpose under federal law. Changes in state laws have coincided with a renewed interest in the substance for the treatment of a variety of conditions. There has been a significant increase in published data over the past twenty years examining the efficacy of cannabis as an appetite stimulant, antiemetic agent, and analgesic adjuvant. The purpose of this meta-analysis …

Improving Anesthesia Professional Adherence To Hand Hygiene, Martha E. Seneca

UNF Graduate Theses and Dissertations

Performance of hand hygiene is among the most effective means of preventing healthcare associated infections (HAI) among patients. Deaths resulting from HAIs are one of the top ten leading causes of death in the United States. Any improvement in the frequency of hand hygiene among healthcare professionals may have a direct impact on patient mortality and associated costs. While anesthesia professionals have been found to have low rates of hand hygiene adherence, few targeted studies seeking to improve hand hygiene adherence among this group exist. Studies conducted to improve hand hygiene among health care professionals have reported limited improvement, with …

Evaluating The Effects Of An Educational Lifestyle Modification Intervention On Blood Pressure In Adults With Prehypertension, Andrea M. Patterson

UNF Graduate Theses and Dissertations

The purpose of this project was to evaluate the effectiveness of an educational lifestyle modification (LM) intervention on blood pressure (BP) among adults with prehypertension. Prehypertension is a precursor to hypertension (HTN) and is a public epidemic in the United States. Approximately 68 million (31%) U.S. adult’s aged ≥18 years have hypertension. Hypertension can cause significant target organ damage, lead to coronary heart disease, heart failure, stroke, and kidney failure. Early identification and the primary treatment of persons with prehypertension with LM have the potential to minimize the progression and delay the onset of comorbidities associated with hypertension. This quality …

Novel Oral Anticoagulants: Bedrest And Bleeding In Patients Undergoing Atrial Fibrillation Catheter Ablation, Lynn Mcwhirter

UNF Graduate Theses and Dissertations

Atrial fibrillation (AF), the most common cardiac arrhythmia in persons over age 65, is associated with an increased stroke risk necessitating the need for long-term oral anticoagulation for risk reduction. With the introduction of direct thrombin and factor Xa inhibitors in the US since 2010, these novel oral anticoagulants (NOACs) are increasingly being prescribed, replacing the use of warfarin, a vitamin K antagonist. AF catheter ablation (CA), an elective procedure requiring femoral vascular access is a treatment for drug refractory and persistent AF. Bedrest, limb immobilization, and limited head of bed elevation are nursing measures utilized following femoral venous, and …

Quality Improvement Measures For Cervical Screening Guidelines In A Clinic For Uninsured Adults, Julie Ann Baker-Townsend

UNF Graduate Theses and Dissertations

Cervical cancer, a completely curable disease with early detection and management, is an international concern. Early identification allows for treatment of the disease, which prevents or slows progression, ultimately reducing morbidity and mortality. Due to the regressive nature of most cervical lesions, the duration between cervical cytology has been lengthened to prevent over diagnosis and treatment. This was reflected in the 2012 United States Preventative Services Task Force (USPSTF) clinical practice guideline for cervical cancer screening.

The purpose of this project was to determine the effectiveness of a quality improvement initiative to increase adherence to the 2012 USPSTF guideline at …

Increasing Physical Activity In Post Liver Transplant Patients, Jennifer Lynn Serotta

UNF Graduate Theses and Dissertations

The purpose of this quality improvement project was to increase physical activity among postoperative adult liver transplant patients, improve documentation of daily activity, and ultimately influence quality of life (QOL). Quality of life has been shown to improve dramatically after liver transplant, as patients enter transplant severely debilitated with limitations on their physical activity which carry over following transplant. The literature supports that liver transplant patients should engage in physical activity which may improve QOL. Thirteen liver transplant patients were recruited within the seven days of their post-operative hospitalization. Twelve patients consented, were educated about the benefits of walking, given …

Midline Catheter Use In The Newborn Intensive Care Unit, Tricia L. Romesberg

UNF Graduate Theses and Dissertations

Ongoing evaluation of current practice and incorporation of evidence based research into guidelines and protocols is a requirement for the provision of high quality, cost efficient care. Despite some literature describing observational data, midline catheters (MCs) are not an appropriate vascular access device for Newborn Intensive Care Unit (NICU) patients due to insufficient high level evidence demonstrating safety and efficacy. In addition, national guidelines for MC use in neonatal and infant patients lacks sufficient information for safe and effective use of MCs.

The results of this small, online survey indicate that while some neonatal nurses and Nurse Practitioners report the …

Increasing Practitioner Knowledge Of Ketamine As An Adjunct Analgesic For Postoperative Pain, Allison Goldfarb

UNF Graduate Theses and Dissertations

Postoperative pain is of serious concern to patients and anesthesia providers alike. Management of a patients’ pain is a central component of anesthesia care. Ketamine as an anesthetic agent has been available for 50 years. It has been utilized as a general anesthetic and selectively as an anesthetic agent for high-risk patients. Due to dysphoric side effects associated with the dosage required to render general anesthesia, anesthesia providers may be reluctant to utilize this medication to its full potential. Recently there has been a resurgence of interest in ketamine as an analgesic agent. The researcher for this project performed a …

Effect Of Blood Collection Practices On Emergency Department Blood Specimen Rejection Rates, Barbara K. Vernoski

UNF Graduate Theses and Dissertations

The practice of obtaining blood as part of the placement of a new peripheral venous access device (p-VAD) is a frequent practice in the emergency department (ED). Of the concerns related to this practice is the possibility of laboratory specimen rejection due to p-VAD catheter size, use of the wrong collection device, and the absence of a standardized collection process. The objective of this study, therefore, was to examine the effect of the use of evidence-based venipuncture and p-VAD blood collection protocols on the rejection rate of blood specimens drawn by staff in the adult areas of an urban academic …

Practitioners' Use Of Clinical Practice Guidelines: An Evidence-Based Approach, Sondra Michelle Phipps Santana

UNF Graduate Theses and Dissertations

Pre-diabetes is a serious health problem in the United States. Distinguished by plasma glucose levels that are above the normal threshold, patients with pre-diabetes are 10 times more likely to develop type 2 diabetes. Patients with pre-diabetes suffer the same complications as patients with diabetes including diabetic retinopathy, nephropathy, and microalbuminuria.

There is considerable evidence to support the idea that early identification and aggressive treatment of pre-diabetes has the potential to delay disease progression. The American Diabetes Association’s clinical practice guideline recommends management of with lifestyle modification and metformin for patients who are at risk for developing type 2 diabetes. …

The Impact Of The Clinical Nurse Leader/Navigator On Clinical Outcomes And Patient Satisfaction, Diane Smith Raines

UNF Graduate Theses and Dissertations

In an era of value based purchasing and healthcare reform, hospitals face the challenge of delivering high quality care in an environment of diminishing resources. This performance improvement project describes the use of master’s prepared nurses on medical surgical units to improve quality and patient satisfaction. The setting was five medical surgical units in a 200+ bed hospital in the southeastern United States. Declining resources necessitated an increase in the nurse to patient ratios on the units (from 5:1 to 6:1). The project involved the modification of the model of care through the change in nurse/patient ratios and the addition …

Outcome Comparison Of An Evidence-Based Nurse Residency Program To Other Orientation Models, Debra A. Harrison

UNF Graduate Theses and Dissertations

The purpose of this evidence-based project was to compare one-year outcomes for newly licensed Registered Nurses (NLRNs) in three organizations within the same healthcare system. All three have lower than nationally reported turnover and strategies for NLRN retention. Only one is using a Nurse Residency Program (NRP).

NRPs are recognized as an effective strategy to retain newly licensed registered nurses (NLRNs) in their first year of employment (Institute of Medicine [IOM], 2010; The Advisory Board, 2007; Spector, 2007). The Commission on Collegiate Nursing Education (CCNE) (2008) defines an NRP as a series of learning sessions and work experiences that occur …

Implementation Of A Beta Blocker Protocol, Jody L. Heriot

UNF Graduate Theses and Dissertations

Background: Beta blockers are recommended by the American College of Cardiology/American Heart Association Guidelines for high and intermediate-risk cardiac patients undergoing non-cardiac surgery. Beta blockers are a class of drugs that moderate the effects of increased catecholamine levels on the heart by selectively blocking beta receptors in the heart and blood vessels, resulting in a lower heart rate and blood pressure. Beta blocker use perioperatively has been shown to reduce the risk of ischemia and infarction.

Purpose: The purpose of this project is to address beta blocker use in a group of anesthesia providers who routinely attend to high-risk and …

Improving Quit Rates For Tobacco-Dependent Hospitalized Patients, Marion G. Mann

UNF Graduate Theses and Dissertations

Abstract

Purpose: The purpose of this project was to evaluate outcomes of an existing inpatient tobacco cessation counseling program with 30-day follow-up among recently admitted tobacco-dependent patients who were tobacco-dependent.

Background/Significance: Tobacco use is considered the number one most preventable cause of disease, disability, and death in the United States. Despite associated dangers, approximately 21% Americans currently smoke. This has led to increased hospital admissions and chronic disease management, costing the United States approximately $96 billion per year. Decades of research and evidence-based clinical practice guidelines substantiate that inpatient tobacco cessation counseling has the potential to improve quit rates post-hospital …

Emerging Evidence In Infection Control Effecting Change, Melissa Dawn Machan

UNF Graduate Theses and Dissertations

Current procedures for cleaning anesthesia airway equipment have been reported to be ineffective. The potential for cross-contamination from some airway equipment to a patient has been documented in several studies. In order to prevent potential infections, it should be ascertained as to why all anesthesia providers are not using disposable laryngoscope blades. The purpose of this evidence based project is to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade before and after an in-service program designed …

Use Of Simulation To Reinforce Evidence-Based Collection Processes, Deborah Christeleit

UNF Graduate Theses and Dissertations

Proper collection of blood cultures is needed to identify pathogens causing serious infections and direct appropriate antibiotic therapy. Blood culture contamination can lead to longer hospital stays, incorrect antibiotic treatment, additional testing, and overall increased costs for the patient and hospital. Blood culture collection technique is the most important factor affecting contamination rates.

The purpose of this project was to determine the effect of simulation reinforcement of blood culture collection processes on the rate of contamination of blood cultures drawn by nurses in a community medical center emergency department.

This one-group before-and-after cohort study utilized a convenience sample of 50 …

Impact Of Group Medical Visits For Adult Patients With Type 2 Diabetes Mellitus, Theresa Pye

UNF Graduate Theses and Dissertations

Diabetes is a condition that is primarily self-managed and lifestyle modifications such as diet, exercise, and weight management are necessary to reduce morbidity and mortality. Motivation to implement lifestyle modifications through self management is an integral part of disease management and studies have shown group medical visits are more effective than individual appointments in this patient population. The purpose of this project was to develop, implement and evaluate an evidencebased group medical visit program for up to a maximum of 8 adult patients with type 2 diabetes in a family practice setting for six months. Seven participants with abnormal A1C …

An Evidence Based Multi-Activity Handwashing Education Program In Children, Sandra M. Annesi

UNF Graduate Theses and Dissertations

Proper handwashing is one of the simplest, most affordable and effective means of stopping the spread of infection. Due to the close proximity of children in schools and child care settings, there is a high risk for the spread of infectious disease. The purpose of this project was to improve handwashing behaviors of three to six year old children in a community school setting by implementing an evidence based multi-activity handwashing education program. The objective was to increase understanding of the relationship between germs and handwashing, as well as increase the frequency and correct technique procedure of handwashing behavior in …

Dysrhythmia Monitoring Practices Of Nurses On A Telemetry Unit, Susan Jane Schultz

UNF Graduate Theses and Dissertations

Standards of practice for hospital electrocardiogram monitoring were recommended in 2004 by the American Heart Association; however they are not widely followed. Many nurses monitor in a single lead regardless of diagnosis and are unable to differentiate wide QRS complex tachycardias. The purpose of this project was to evaluate the effectiveness of an interactive web-based education program combined with unit-based collaborative learning activities on both telemetry staff nurses‘ knowledge of dysrhythmias and their monitoring practices for patients at risk for wide QRS complex tachycardias. This interventional, one group before-and-after cohort study design consisted of four components: interactive web-based educational program …

Effects Of An Educational Intervention On Hospital Acquired Urinary Tract Infection Rates, Sharon Lanier Smith

UNF Graduate Theses and Dissertations

In today's hospital environment, good care has become synonymous with positive patient outcomes. Marring this landscape is the alarming rate of hospital acquired (nosocomial) infections. Urinary tract infection (UTI) is one of the most common hospital acquired infections. The major cause associated with these infections is the use of indwelling urinary catheters. Bacteria invade the lower urinary tract by ascending through or around the catheter. Morbidity associated with urinary catheter-associated UTI can be minimized by prudent decisions concerning catheter usage and good catheter care. The principle route of dispersal of nosocomial infections is likely from patient-to-patient via transiently contaminated hands …

The Effect Of Leadership Skill-Building On Nurse Leader Behaviors, Barbara Drummond-Huth

UNF Graduate Theses and Dissertations

Patient outcome data are an important factor in healthcare. Reports by the Institute of Medicine between 1999 and 2001, as well as recent research by Linda Aiken and her colleagues have added more emphasis to measures that can be taken to improve patient outcomes. Because of the role they play in healthcare facilities, nurse leaders are in a position to take the lead in improving patient outcomes. There is evidence to suggest that nurse leaders' transformational leadership behaviors are associated with positive patient outcomes.

The purpose of this project was to identify the effect of transformational leadership skill-building training on …

New Nurse Residency - An Evidence Based Approach, Alice M. Nied

UNF Graduate Theses and Dissertations

Nurse educators believe that their graduates are well-prepared for entry level positions in nursing. In the acute healthcare setting, new graduates are placed on virtually every type of nursing unit, including critical care. Employers have developed formal orientations to familiarize new graduate nurses new with the institution and its policies and procedures and to teach the things employers believe new RNs need to know but do not, either because they were never taught the material or they have not retained it.

The purposes of this project were to (a) examine the evidence relative to a disconnect between nursing education and …

Effects Of Dietary And Exercise Interventions On The Incidence Of Metabolic Syndrome, Ricky Mccoy Kirby

UNF Graduate Theses and Dissertations

Metabolic syndrome is a serious health problem in the United States. The presence of metabolic syndrome significantly increases the risk of developing type II diabetes and cardiovascular disease by producing a prothrombic state. The prothrombic state that results from the clustering of several independent cardiovascular risk factors within one individual increases the risk of micro and macro vascular changes and eventually to end organ damage.

There is considerable evidence to support the serious nature of this medical condition. Medications used to treat the hypertension, diabetic, and dyslipidemia components of metabolic syndrome can be a significant drain on the monthly budget …

Dietary Interventions To Reduce Metabolic Syndrome In An Uninsured Population: An Evidence-Based Approach, Michele Smith Bednarzyk

UNF Graduate Theses and Dissertations

Recent studies show that more than one-third of U.S. adults (over 72 million people) were obese in 2005–2006. This includes 33.3% of men and 35.3% of women. Obesity is a primary factor in the development of metabolic syndrome, a condition that places individuals at high absolute risk of mortality and morbidity. The use of a nutritionally balanced diet aimed at weight reduction has the potential to decrease the prevalence of obesity, therefore reducing the incidence of metabolic syndrome and its consequences.

The purpose of this project was to investigate whether individual nutrition counseling would improve the outcomes of patients with …

Effects Of Community Of Practice And Knowledge Translation Strategies On Nurse Practitioners' Knowledge And Practice Behavior, Helen M. Holman

UNF Graduate Theses and Dissertations

Background: Emerging evidence suggests that interactive CE activities will have the most effect in terms of knowledge and practice. Using technology to provide interactivity via computer-based applications is as effective an educational strategy as traditional education formats.

Methods: A randomized controlled trial was conducted to test the effectiveness and satisfaction of educational activities provided within an online community of practice(CoP) on nurse practitioner (NP) knowledge and practice behavior. The online interactive website combined certified continuing education, professional forum, Ask-the-Experts, national guideline links, patient education tools, and professional resources. A Two-Group Control Group design was used. Study participants were assessed on …