Medicine and Health Sciences Commons^™

The Effect Of Head Inclination On Intraocular Pressure In The Prone Position, Vanessa Marzilli

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

Patient safety relies on effective and efficient communication among healthcare providers. Tools, such as standardized checklists, ensure information sharing in a consistent, predictable format. In the perioperative setting, where handoffs occur at several points and among various disciplines, high reliability is essential. This systematic review focused on the impact of standardized communication practices on perioperative staff satisfaction as it relates to sustainability of the new practice. The electronic databases PubMed and Google Scholar were used. Six articles met inclusion for the systematic review and of these six, four were determined to be of high quality through the application of The …

Perceived Barriers To Contraceptive Use: An Exploratory Study Of Women Living In Rural Haiti, Jocelyne De Gouvenain

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

Maternal health is defined by the World Health Organization (WHO) as the health of women during pregnancy, childbirth, and the postpartum period (WHO, 2016). Maternal health is a very important determinant of Haiti’s familial, educational, economic, and environmental development. One key to maternal health is family planning which can empower women to fulfill their familial and community roles. Family planning through contraception offers women the opportunity to gain time between child births by deciding when to get pregnant in relation to their other life obligations. Having fewer children and longer spacing between births provides women and children a better quality …

Evaluation Of A Diabetes Management Program For Persons With Serious And Persistent Mental Illness, Peris W. Mwangi

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

Clinical Practice Recommendations and Evidence-Based Guidelines for Integrated Care were used to evaluate a diabetes management program for persons with serious and persistent mental illness in an integrated primary and behavioral health care center in New England. A simple random method was used to select a sample of 25 medical records of patients with diabetes and at least one mental illness. Data on seven diabetes content areas offered to patients and biophysical measures of weight, body mass index (BMI) and Hemoglobin A1C were collected via retrospective electronic chart reviews. Results showed the center focused on nutrition and exercise education, offered …

Improving Nurse Knowledge And Attitudes Of Early Mobilization Of The Postoperative Patient, Laurie Chatterley

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

Mobilization plays an important role in the outcomes of postoperative patients. Early mobilization as an intervention is the most significant general nursing measure in the prevention of complications. Current research demonstrates a decrease in complication rates, reported pain and length of stay when early ambulation is initiated. Despite this evidence, early mobilization as a best practice standard is implemented inconsistently on the women’s health unit of a community hospital. The purpose of this project was to improve nurses’ knowledge and attitudes of early mobilization of postoperative patients. The quality improvement project utilized a pre-survey, educational intervention, post-survey design. Twenty-five nurses …

Nurses' Knowledge Of Hypoglycemia And Treatment In The Adult Hospitalized Patient With Diabetes: A Quality Improvement Project, Brittney O'Neale

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

There are currently more than 29 million people in the United States with diabetes. With increasing numbers of diabetic patients across the nation, it is imperative that health care professionals receive the knowledge and skills required to manage them in the acute care setting. Hypoglycemia is the most common side effect of diabetes treatment (Borzi et al., 2016) and is defined by the American Diabetes Association (ADA) as a condition that occurs when one's blood glucose is lower than normal, usually less than 70 mg/dl. Nurses’ knowledge of hypoglycemia and their adherence to hospital protocols are essential to achieving positive …

Comparing The Canadian Cervical Spine Rule And Radiology Confirmed Cervical Spine Injury In The Emergency Department, Ashley Claire Arnold

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

In the United States and Canada, more than 13 million trauma patients are at risk for cervical spine injury (CSI). To date, providers use computerized tomography (CT) to rule out CSI in these patients. Cervical spine immobilization with the use of rigid cervical collars can be uncomfortable, delays hospital transport, and has a modest morbidity. The Canadian Cervical Spine Rule (CCR) is a screening tool used in emergency departments (ED) as a screening tool to rule out CSI to avoid unnecessary CTs. The purpose of this project is to complete a retrospective chart review to evaluate if emergency departments can …

Nurse Practitioner Perspectives On The Barriers And Facilitators Of Advance Care Planning, Cherish Dellava

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

Every year, thousands of residents in the United States die while receiving end of life (EOL) care that is inconsistent with their wishes. Research evidence has shown that advance care planning (ACP) improves congruity between patients’ preference and actual care received at EOL. Despite medical guidelines supporting ACP, these discussions rarely occur. The purpose of this study was to explore the perspectives of nurse practitioners (NPs) on the barriers and facilitators of ACP. The web-based ACP survey was distributed to the members of the New Hampshire Nurse Practitioner Association (NHNPA). The participants (n = 65) were mostly women (96.9%), had …

Feasibility Of Remote Management Of Uncomplicated Urinary Tract Infection: A Quality Improvement Project, Scott A. Clement

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

Uncomplicated cystitis is a common condition that many women encounter in their lifetimes. The subjective symptoms that patients provide to their clinician are a critical component in the providers’ diagnosis. Traditionally, uncomplicated cystitis is diagnosed and treated during a face-to-face consultation in primary care offices, urgent care centers and emergency departments. Quite often, clinicians treat their patients based upon their initial presenting symptoms, regardless of the point of care testing and before urine culture results are available. The purpose of this project was to determine how often subjective symptoms of uncomplicated urinary tract infections (UTIs) are associated with treatment sensitive …

Nurses Perceptions' Of Bedside Reporting On An Intensive Care Unit Following Implementation, Christine Mcginn

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

Shift handoffs were included in The Joint Commission's 2009 National Patient Safety Goals, which requires that shift hand-offs must include up-to-date information about the care, treatment, current condition, and recent or anticipated changes with the patient. Bedside reporting addresses The Joint Commission's Goal 13, a safety strategy that encourages the patient's active involvement in care. The demand for quality care while caring for the sick population with multisystem complex diagnoses calls healthcare provides to look at ways to provide more efficient care while improving patient safety and outcomes.

Bedside reporting is one nursing intervention which can be implemented to improve …

Does Early Mobility Lead To Decreased Ventilator Days?, Nicole Halton

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

It is well documented that bedrest has adverse outcomes for hospitalized patients. This is especially true for critically ill patients due to life support measures, invasive catheters, and mechanical ventilation. Consequences associated with bedrest in critical care patients include venous thromboembolism, ventilator associated pneumonia, pressure ulcer development, and muscle weakness. Respiratory muscle weakness is associated with prolonged ventilator support and delayed extubation. The Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle uses evidence based practice to prevent and treat ICU acquired delirium and weakness. The bundle aims to do this by standardizing care processes in …

Interprofessional Simulation: Students' Perceptions, Elizabeth Katherine Welch

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

An alarming number of errors occur in the healthcare system. The Institute of Medicine (IOM) responded to the error rate by encouraging changes in professional education and recommending interdisciplinary team training. A variety of professions, including aviation and the military, have utilized simulation in their education and training for mastering skills and also to assist with respect and appreciation of other professional roles on the healthcare team. The purpose of this study was to examine undergraduate nursing students, graduate social work students, and APRN students’ perceptions of one another as healthcare professionals using interdisciplinary simulation. The research study was a …

Perceived Barriers To End-Of-Life Care Discussions In Cancer Patients From The Perspective Of Ambulatory Oncology Nurses, Susan K. Hobin

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

With the advancing age of the population, the increasing incidence of cancer, and all of the advances in cancer therapy, comes the ability to prolong life in cancer patients well beyond what was possible even ten years ago. Along with the progress of advanced surgical and radiation techniques, there is now an ever-expanding array of chemotherapy, biotherapy, and immunotherapy being used on patients in all age groups and in all stages of cancer. These advances have thrilled researchers and physicians, as they now have a multitude of options to offer cancer patients, perhaps even as late as third or fourth …

Nurse Telephone Follow-Up Post Initial Chemotherapy: A Quality Improvement Project, Katie Cherenzia

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

With the evolution of cancer care and chemotherapy agents over the last 15 years there has been an evident shift in care from the inpatient to the ambulatory setting. There is a growing need for cancer care, particularly in the ambulatory (outpatient) setting. Patients receiving chemotherapy in the outpatient setting return home immediately after completing treatment and do not have direct medical and nursing supervision to monitor for and address side effects or adverse reactions of treatment in a hospital inpatient setting. Nurse telephone follow-up post initial chemotherapy allows for assessment and timely management of potential side effects experienced after …

A Computer-Based Stroke Education Orientation Program For Nurses On A Designated Stroke Unit: A Program Development, Quality Improvement Project, Melanie Marco

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

Evidence of improved outcomes for patients admitted to a dedicated stroke unit supports the need for specialized stroke education and protocols. The Joint Commission now requires all stroke patients be admitted to a PSC and receive care on a designated stroke unit. Care on the stroke unit is focused on preventing further debilitation, deterioration and reducing medical complications. Nurses working at a primary stroke center are required by TJC to have initial orientation stroke education and annual competency review to ensure stroke patients receive high quality, current care. The Joint Commission also requires core stroke team members receive at least …

Concussion: Improving Nurses' Knowledge In The Emergency Department, Danielle Marsden

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

Patients presenting to the emergency department (ED) after trauma from a fall, motor vehicle collision, or assault frequently develop a mild traumatic brain injury (MTBI) also called concussion. There is no specific treatment for concussion, therefore, the focus shifts to managing symptoms. Countless EDs experience overcrowding leading to time and resource constraints, therefore nursing discharge education is brief and may only review symptoms which require immediate medical attention. This ED discharge practice leaves the patient on their own to manage symptoms and if the patient is unaware, they may perform activities that exacerbate their condition. The purpose of this project …

Compassion Fatigue In Hospice Nursing: A Program Development, David E. Carroll

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

Hospice nursing is an important aspect of health care. Hospice nursing is a specialized field in which patients are cared for at the end of life and an important aspect of healthcare. Because the care hospice nurses provide comes at the end of life, they are continuously exposed to death, dying, pain and suffering. Numerous studies have documented that continuous exposure to trauma, death and dying may result in compassion fatigue (CF). Compassion fatigue can lead to a physical and emotional toll on nurses resulting in low staff satisfaction , high turnover rates, and reduced quality of care. The 1 …

Neck Circumference And Mallampati Classification, Patrick B. Brennan

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

Difficult and failed intubations contribute to morbidly and mortality in anesthesia practice. Mallampati is one of the most widely used airway assessments but research shows it is highly variable in its ability to predict difficult intubation. Neck circumference is an objective assessment not commonly used, but has been shown to assess the degree of difficulty with intubation. Following Institutional Review Board (IRB) approval from both Charter Care and Rhode Island College, utilizing a descriptive design, 23 subjects had their neck circumference measured and Mallampati class assessed. The results revealed a relationship between increased neck circumference and Mallampati classification. The average …

A Systematic Review Comparing Ephedrine Versus Phenylephrine During Spinal Anesthesia For Cesarean Delivery, Shelby Sullivan

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

This systematic review compared the efficacy and safety of ephedrine with phenylephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery. Hypotension during cesarean section delivery can have detrimental effects on both the mother and the neonate. Some vasoactive medications such as ephedrine and phenylephrine have been found to be detrimental to the neonate and divert fetal blood flow. After a systematic search of the electronic database PubMed, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart was used to identify appropriate research. Studies were illustrated in a table to identify key variables and were then …

The Impact Of Smoke Free Housing On Sick Visits And Hospitalization For Respiratory Illness In Children Ages 0-12, Gail Davis

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

This project analyzes the impact of smoke-free family public housing on the respiratory health of children ages 0 – 12. The purpose of this pilot correlational study was to examine the relationship between the initiation of smoke-free policies in family public housing units and health outcomes in children 0 - 12 years. A comprehensive literature review of environmental tobacco health risks and tobacco-free public housing policy is presented. Two theoretical frameworks which guided the project, the Social Ecological Model and the Health Impact Pyramid, are described with an emphasis on health policy as a significant catalyst for positive health outcomes. …

What Are The Factors Contributing To The Delay In Hip Fracture Repair?, Karen Padraic

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

Hip fracture injuries are identified as one of the most serious healthcare problems affecting older adults (CDC). The prognosis after hip fracture is unfavorable and approximately 25% of elderly patients will die within one year after the event. Surgical repair is a critical element in the management of a hip fracture. Delay of surgery prolongs hospital stay and increases the risk of medical complications. Despite evidence showing early time to surgery reduces morbidity and mortality for patients with hip fractures, time delays to surgery still exist. The purpose of this quality improvement project was to explore patient- and hospital-specific barriers …

Standardized Communication And Perioperative Staff Satisfaction, Jessica Claire Mancini

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

Patient safety relies on effective and efficient communication among healthcare providers. Tools, such as standardized checklists, ensure information sharing in a consistent, predictable format. In the perioperative setting, where handoffs occur at several points and among various disciplines, high reliability is essential. This systematic review focused on the impact of standardized communication practices on perioperative staff satisfaction as it relates to sustainability of the new practice. The electronic databases PubMed and Google Scholar were used. Six articles met inclusion for the systematic review and of these six, four were determined to be of high quality through the application of The …

Ventilator-Associated Pneumonia And The Effectiveness Of Endotracheal Tubes Coated With Silver Sulfadiazine, Nathaniel Van Hueveln

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

Ventilator-associated pneumonia (VAP) is a consequence of intubation and mechanical ventilation. Bacteria colonize the inner-lumen of endotracheal tubes (ETT) and develop into a biofilm. One method to reduce/eliminate the develop of biofilms within the ETT is lining the inner-lumen with silver-sulfadiazine. A systematic review was conducted to evaluate the effectiveness of silver-coated ETTs for patients that develop VAP. Multiple databases were searched to identify key literature related to silver-coated ETTs and VAP. Inclusion and exclusion criteria were identified to finalize the studies that were included in this systematic review. Five key studies were included in this review. Studies were further …

Nurses' Perception Of Mobile Communication In An Acute Care Setting, David Allen Gardner

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

Communication is at the center of providing health with care. Good communication between nurses, patients, and among members of the health care team is paramount in delivering patient-centered care. The literature has demonstrated that mobile communication devices can improve quality and efficiency of communication among clinicians, mobilize information, improve clinical workflow, improve response time, and provide cost savings. The research has also revealed unintended consequences such as interruptions in care, increase in errors, caregiver distractions, and reductions in workflow processes. There is currently limited evidence in the literature regarding the perceptions of nurses regarding the use and satisfaction of mobile …

Preoperative Forced-Air Warming Of Patients To Minimize Inadvertent Perioperative Hypothermia: A Systematic Review, Devin Sadlers

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

Inadvertent perioperative hypothermia (IPH) occurs in many patients during surgery and can potentially carry serious complications, including cardiac arrhythmia, myocardial infarction, increased bleeding, impaired drug metabolism, impaired wound healing and increased risk of wound infection. There are many different techniques to minimize hypothermia during the perioperative period, but forced-air warming is used for many surgical patients. Forced-air warming has been shown to be effective during the intraoperative period; however, many institutions do not utilize this therapy in the preoperative setting. A systematic review was conducted to assess the use of preoperative forced-air warming and its’ effects on minimizing IPH. Databases …

Debriefing In The Emergency Department, Faithe Weathers

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

Workplace stress is a common hazard in many occupations, especially in healthcare. Workplace stress has physical and psychological impacts and can lead to burnout. Nurses exhibit high levels of stress and burnout, especially those working in the emergency department (ED). Strategies to combat stress and burnout are vital to preserve the overall heath and retention of staff in the workplace. One strategy is to incorporate debriefing sessions following traumatic events. The purpose of this study was to explore ED nurses’ opinions of debriefing sessions in the ED. The design was a qualitative survey. The study site was in the emergency …

Patient Attitudes About Patient Portal Functions, Tamara A. Sequeira

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

As part the U.S. government’s ongoing efforts to improve health care quality, the Electronic Health Records (EHR) Incentive Program from the Centers for Medicare and Medicaid (CMS) offers financial incentives to eligible health care providers (EP) who adopt, implement, improve, and demonstrate meaningful use of EHR. Beginning 2014, the Stage 2 Meaningful Use core objectives included the ability of patients to use online patient portals to view, download and transmit their health information. As a result, many EP offer a patient portal and encourage sign up, yet not all patients have done so. How patients perceive the patient portal, whether …

An Exploration Of Potential Gender Differences In The Discipline Of Nurse Anesthetists, Jedidiah F. Kane

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

Great diversity exists in the US population, therefore the US Department of Health and Human Services [HHS] has called for increased diversity among healthcare professionals as a means of improving public health outcomes. Males are consistently a minority group within the nursing profession and are disproportionately disciplined. The disproportionate discipline of male nurses and the loss of licensure often resulting from censure may have an impact on efforts to diversify the nursing sector of healthcare. Among certified registered nurse anesthetists [CRNAs], the ratio of males to females is more equal and little data exists examining the characteristics of disciplined CRNAs. …