Medicine and Health Sciences Commons^™

Chinese Immigrants With Non-Insulin-Dependent Diabetes Mellitus: Nutritional Self-Management Approach, Winnie Manlai Wong

Student Theses, Dissertations and Capstones

Background: Chinese immigrants (CIs) with non-insulin dependent diabetes mellitus (NIDDM) generally have poor control in their diet regimen. Due to the variation in body mass, physiology, and cultural differences as compare with the general American population, special attention must be conducted in treating diabetes in Cis, emphasizing culturally sensitive care and nutrition therapy that acknowledge the differences. Purpose: The purpose of this project was to assess cultural challenges in self-management for CIs living with non-insulin dependent diabetes mellitus and evaluate the effectiveness of a diabetic nutritional self-management guide tailored to this population. Theoretical Framework: Havelock’s theory of change is a …

Improving Wound Care Using The Time Framework, Pavel Kulikov

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and purpose:Although wound care guidelines are available for primary care providers, barriers to assessment and treatment remain. This paper examines current evidence, guidelines, and discusses the need for improved training, education, and a simplified approach to wound management in primary care. The goal of the project was to increase the provider’s comfort level in assessing and initiating wound care treatment in the clinical setting. Methods:An evidence-based wound treatment framework, identified as the TIME (tissue, infection, moisture, epithelial) framework, was selected for the project. The framework was tailored by subject matter experts to provide a distinctive approach …

Stroke Clinical Order Pathway Education (Scope) For Apns, Varsha Singh

Seton Hall University DNP Final Projects

More than 795,000 American adults have a stroke annually. About 610,000 are first or new strokes. Almost 140,000 Americans of all ages die of a stroke every year (Centers for Disease Control and Prevention [CDC], 2017). Stroke requires emergent treatment and an exact clinical order pathway to ensure better patient outcomes and compliance with the standards of care defined by regulatory bodies such as the Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS). While stroke management teams often include an Advanced Practice Nurse (APN), there is a lack of a standardized protocol across New Jersey (NJ) …

Access To Care And The Use Of Healthcare Services By Women In Rural Cameroon: A Participatory Action Research Study, Grace Tadzong-Awasum

Electronic Theses and Dissertations

Women in rural Cameroon do not access health care as timeously and as often as they should. They fail to get screened for common diseases, with the consequence that such diseases are often diagnosed at a very advanced stage. This accounts for the high morbidity and mortality rates as well as low life expectancy recorded among women. The purpose of this study was to explore and understand the health access experiences of women in rural Cameroon. Methodology: Participatory action research was used guided by a Focused ethnography in phase one. Twenty-five women aged 21-77 years were recruited through local the …

Probiotic Use In Trauma Patients: A Pathway To Determining The Standard Of Care To Improve Outcomes, Heather Vitko

Electronic Theses and Dissertations

The gut microbiome consists of normally non-pathogenic bacteria, viruses, and fungi. These friendly microbes serve to maintain GI barrier function and integrity, play a role in host nutrient and drug metabolism, immunomodulation, and prevent pathogenic bacteria from colonizing or causing disease. The importance of a healthy microbiome for the overall health of the host is just recently being appreciated within the medical and science communities. Disruption of the microbiome places one at greater risk for illness and infection. Patients who suffer a traumatic injury are among those at highest risk for complications associated with microbial imbalance, or dysbiosis. In addition …

Adaptations Made To Evidence-Based Public Health Programs In Low- To Middle- Income Countries: A Concept Mapping Analysis, Elizabeth Holguin

Nursing ETDs

One of the most challenging barriers to implementing successful and sustainable evidence-based programs in public health is the ability to remain faithful to original protocols grounded in scientific evidence while adapting programmatic components to reflect the reality of the communities they are meant to benefit. It is generally accepted that some degree of adaptation should occur in order to achieve positive, sustainable outcomes in public health programs. A concept mapping methodology was used to explore types of adaptation that occur during implementation of evidence-based global health programs in low- to middle-income countries (LMICs). Purposive and snowball sampling produced a sample …

The Role Of An Advanced Practice Provider (App) And Its Relation To Physician Shortages And Rural Healthcare Survival: A State-By-State Analysis, Allen Anderson

Dissertations, Theses, and Projects

The extent that Advanced Practice Providers (APPs) are able to practice independently with a full scope of practice varies state-by-state. The purpose of this paper was to review how APPs could help in a number of different areas of healthcare. This analysis examines the state of rural healthcare and reviews physician shortage statistics and hospital closures by state. In the examination, it also evaluates which states have full scope, reduced scope, and restricted scope of practice laws and cross-references that with states that have experienced a hospital closure. Through case studies, this research finds that APPs can be an alternative …

A Simulated Learning Experience In Advanced Care Planning Conversations, Brandy Ellis

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Background: The CDC (2012) reports that 1/3 of Americans have no advance care planning (ACP), which is essential for maintaining autonomy when people are no longer able to communicate wishes directly. IOM (2014) reports that providers have limited training in communication techniques and low confidence in holding advanced care planning conversations. Nursing simulation is an effective method of teaching clinical skills in a safe environment. The development of a high fidelity (HF) standardized patient simulation, using the Jeffries Simulation Framework, combined with evidence-based practice classroom curriculum, may increase knowledge and confidence in holding ACP conversations for nurse practitioner students.

Methods: …

The Effects Of Psychotropic Medications On Developing Brains, Abass Jafuneh

Nursing Capstones

No abstract provided.

Relationships Between Aprn State Practice Authority, Perceived Autonomy, Professionalism, And Interprofessional Team Function Among A National Sample Of Aprns In The U.S., Patricia Rae Gilman

Nursing ETDs

Healthcare that includes high performing interprofessional clinical teams (IPTs) is one recommended strategy to provide optimal quality and cost-effective care delivery. Highly functional IPTs are characterized by effective communication, trust, respect, collaboration, information-sharing, and conflict resolution and are more efficient than individual providers working alone. Internally, IPT members’ relationships and understanding of both one’s own professional identity and others’ role and responsibilities are crucial to team functionality and effectiveness. Externally, factors including regulatory practice environments might influence the effectiveness and performance of both individual team members and the team overall. Inconsistencies between states’ practice authority (SPA) for advanced practice nurses …

Reducing Polypharmacy, Gladys A. Ndege

Nursing Capstones

No abstract provided.

Evaluation Of The New Onset Diabetic Education Program For Navajo Adults, Denise S. Bartley

Nursing ETDs

The prevalence of diabetes mellitus (DM) is higher in American Indians/Alaska Natives (AI/AN) than in any other racial or ethnic group in the United States (U.S. Department of Health and Human Services [USDHHS] Centers for Disease Control and Prevention [CDC], 2018). In response to this escalating health issue, the U.S. government funded a number of DM education and treatment programs focusing on AI/AN populations. The purpose of this study was to evaluate the New Onset Diabetes Education Program (NODEP) based at Northern Navajo Medical Center (NNMC) in Shiprock, N.M.

The Navajo philosophy of learning was used as a guiding framework. …

Treatment Challenges Of Delusional Disorders, Amanda Mikhaeil

Nursing Capstones

No abstract provided.

The Role Of Interest Groups In Shaping U.S. Governmental Responses To Military Sexual Trauma, Patricia Ann Harnois-Church

Nursing ETDs

Military sexual trauma (MST) is a significant problem in U.S. military service branches, service academies, and National Guard units, with both immediate and longer term traumatic effects on survivors who are disproportionately female. MST includes sexual harassment or assault during military service and the ensuing consequences for physical health and psychosocial well-being of service members and veterans. The Department of Defense is committed to reducing the incidence of sexual assault and harassment among service members, encouraging victims to report, and mitigating the impact of MST. However, the estimated prevalence of sexual assault among active duty service members remains unacceptably high, …

Synthetic Cannabinoid-Induced Psychosis, Kenna Kennedy

Nursing Capstones

No abstract provided.

Psychostimulants And Psychosis, Cherri L. Runde

Nursing Capstones

No abstract provided.

The Effectiveness Of Bispectral Index Monitoring On Intraoperative Awareness In Adult Surgical Patients Undergoing General Anesthesia, Eugene D. Lee

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

Intraoperative awareness (IA), or the unexpected and explicit recall by patients of events that occurred intraoperatively, is a rare but serious event. Incidences of IA have been associated with extreme anxiety, physiologic stress, and the development of post-traumatic stress disorder. Anesthesia has debated the efficacy of brain monitoring devices, such as the Bispectral (BIS) index monitor, to reduce the incidence of IA. By analyzing EEG waves, these monitors can be used to alert the anesthesia provider when the patient may not be sufficiently anesthetized. An integrative review was conducted to evaluate the current evidence on the use of BIS monitoring …

Effects Of A Crisis Intervention Team Assessment Center On Emergency Department Length Of Stay, Carlissa Lam

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Introduction: Emergency departments are overburdened with mental health patients who lack adequate access to behavioral health resources. The influx of patients has led to an increased length of stay in the emergency department for patients who are being evaluated for mental health concerns. Overcrowding can lead to delays in treatment, undesirable medical events, and patient mortality. Crisis Intervention Team (CIT) models bring law enforcement, mental health providers, emergency departments, and individuals with mental illness together to improve care for patients in crisis. They have been instrumental in identifying patients in crisis and transporting them to a Crisis Intervention Team Assessment …

An Interdisciplinary Code Sepsis Team To Improve Sepsis Bundle Compliance In The Emergency Department, Jill M. Delawder

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Purpose: Sepsis is one of the leading causes of mortality with over 700,000 hospitalizations and 200,000 deaths annually. Various tools exist to aid in the early identification and treatment of sepsis including electronic alert systems, standardized order sets, nurse-initiated protocols and specialty trained teams. Despite available guidelines, mortality rates for severe sepsis and septic shock are near 50%.

Methods: The aims of this rapid cycle quality improvement project were 1) to develop and implement an interdisciplinary team to address early implementation of evidence-based sepsis bundles in the emergency department and 2) to compare sepsis bundle compliance three months pre-and three …

Improving Lead Screening In A Pediatric Practice: A Quality Improvement Project, Audrey Myers

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Background: Detectable lead levels in children’s blood have been associated with increased cognitive difficulties, attention deficits, and poorer academic performance. Children enrolled in Medicaid have higher rates of elevated blood lead levels, yet requirements to test all children at age 1 and 2 who are enrolled in Medicaid are not being met. Nationally, 34% of children enrolled in Medicaid do not undergo proper blood lead level screening. The aim of this project was to increase required blood lead level screening rates for children with Medicaid insurance at a private pediatric practice in the Shenandoah Valley in Virginia.

Methods: The …

Use Of Telemedicine To Improve Cpap Non-Adherence In Patients With Obstructive Sleep Apnea, A Pilot Study, Kristin L. Hanger

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

The aim of this project is to improve continuous positive airway pressure (CPAP) non-adherence in patients newly diagnosed with obstructive sleep apnea. Obstructive sleep apnea (OSA) is caused by recurrent collapse of the upper airway during sleep. Untreated, OSA is associated with co-morbidity and decreased quality of life. The standard for OSA treatment is CPAP. Adherence to CPAP is not optimal. Applying telemedicine technology to monitor adherence of CPAP treatment, allows for early intervention. Prior research has shown mixed results with use of telemedicine on non-adherence rates.

This is a pilot study using telemedicine to monitor adherence data to …

Video-Based Diabetes Education For A Culturally Diverse Population, Heather Harris

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Immigrants and refugees represent an underserved population in need of quality, accessible, and culturally appropriate healthcare and education. Diabetes is a chronic condition frequently seen in this population. The author utilized the Wagner Chronic Care Model (CCM) as a theoretical framework for planning diabetes education delivery in this diverse population. Studies report significant health disparities in diabetes care and subsequent poor diabetes quality indicators in refugees and immigrants. Research has found that culturally sensitive diabetes education can improve diabetes outcomes in ethnically diverse populations. The author implemented a translational project to develop and evaluate a video-based diabetes health education intervention …

Improving Infection Management Of The Institutionalized Elderly, Jovel Angela Viloria Broqueza

Doctor of Nursing Practice Projects

Abstract

As the elderly population rapidly grows in the United States, the burden of managing infection in long-term care facilities (LTCF) escalates. The use of evidence-based infection identification algorithms for early recognition and treatment of pneumonia, urinary tract infections (UTI) and skin and soft tissue infections (SSTI) was evaluated at a Midwest suburban 110-bed long-term care facility. Focus group sessions were conducted at the facility with four nurse practitioners, the medical director, eight nurses and certified nursing assistants (CNAs) prior to an educational in-service which was provided to all staff at the facility. As criteria of infection were reported, nurses …

An Analysis Of Interprofessional Rounds Effect On Readmission Rates And Patient Satisfaction, Cynthia Atkinson

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Evidence supports an interprofessional approach to patient care reduces readmissions, mortality, costs, and length of stay while simultaneously increasing communication, collaboration, and satisfaction of care providers and patients (Vazirani, S., et al, 2005). The health care team in an acute care setting, especially direct patient care providers such as nurses and ancillary disciplines must assess the discharge needs of patients from admission to the hospital until discharge disposition (Zakzesky, Klink, McAndrew, Schroeter, & Johnson, 2015). The purpose of this study was to determine if interprofessional rounds improved patient satisfaction and reduced readmission rates. The interprofessional team consisted of the hospitalists, …

Outcomes Of Implementing The Chronic Disease Self-Management Program (Cdsmp) In The Kurdish Community, Chinor Fattahi

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: The incidence of chronic diseases signifies a need to redesign the U.S. healthcare system to better support minority individuals. This project examined the impact of the chronic disease self-management program (CDSMP) workshop in the Kurdish community. The literature shows many positive outcomes of CDSMP workshops, including improvements in physical health, self-efficacy, depression, communication with providers, as well as reduced emergency department visits and hospitalizations. This results in healthcare cost savings for our local communities and our nation. The literature is limited on managing chronic diseases in the Kurdish population, a growing refugee population in the United States and central …

Healing Wounds Through Nutrition, Deanna Garza

Master's Projects and Capstones

Abstract

The role of nutrition in wound care is often overlooked. The main reasons why wounds fail to heal are malnutrition, infection, impaired organ function due to co-existing diseases such as diabetes, hypertension, renal disease, and peripheral vascular disease to name a few. These factors have contributed to poor patient outcomes and patient satisfaction, as well as an increase in hospital length of stay. To promote wound healing, fuel from macro and micronutrients are necessary to deliver oxygen and energy for cell regeneration. However, nurses must possess knowledge and understanding of these requirements and the effects of nutrition on wound …

Transitions Of Care: Implementing Early Follow-Up Appointment To Help Decrease Readmission Rate, Lualhati Espina Dursun

Master's Projects and Capstones

Abstract

Problem – The rate of readmission in the country is at a severe level. According to CMS, in 2017 the average national readmission rate was 18.4%(CMS, 2018). Hospitals are penalized for unnecessary readmissions (HRRP, 2018). In addition to the financial burden of readmissions, quality of life is decreased with readmission.

Context – Early or timely outpatient follow-up after hospitalization has been projected as a means of decreasing readmission rates.

Interventions – Integrating follow-up appointment to the current care transition - HUB process as a means in reducing readmission rates.

Measures & Results – Identified high-risk patients that need timely …

Improving Breastfeeding In Rural Tanzania Using Bardach’S Policy Analysis Methodology, Katherine Skiff

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Appropriate breastfeeding has the potential to have the broadest impact on childhood survival in children under five years (U5Y) compared to all other preventive interventions. The World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) recommend that all facilities providing maternal services and newborn care have a written policy addressing breastfeeding that is routinely disseminated to staff. Shirati hospital, in rural Tanzania, does not have a breastfeeding policy. Bardach’s 8-Fold Pathway for policy analysis methodology (adapted by Collins for health policy) was used to evaluate three promising breastfeeding policies to improve compliance with this recommendation. They include …

Can The Implementation Of Interprofessional Rounds Improve Hospital Throughput Efficiency?, Rebecca Howdyshell

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Efficient throughput processes are a vital part of providing cost effective, safe, quality patient care. Research has shown interprofessional rounds can have success at improving throughput processes. A rural, not-for-profit, 255 bed hospital in a Mid-Atlantic State was experiencing issues with throughput/patient flow. The aims of this quality improvement project were 1). to implement Interprofessional Rounds on the Progressive Care Unit (PCU); 2). To design and build a working Interprofessional Rounds template into meditech to guide Interprofessional Rounds and streamline discharge documentation; 3). to increase the amount of discharge orders entered between 0700 and 1300 by ten percent; and …

Implementing A Surgical Infection Prevention Practice In An Integrated Healthcare System, Tammy Peacock

Doctor of Nursing Practice (DNP) Projects

Problem: One of the most preventable health care associated infections (HAI) is surgical site infection (SSI). Approximately sixty percent of SSI’s could be prevented. The devastation of an SSI to the patient can be catastrophic. The cost to the health care system for treating SSI’s can be substantial (Ban et al., 2017).

Context: The rate of surgical site infections has been on the increase over the past three years. The concern for the amount of harm affecting our patients was worrisome. The cost of reputation and the bottom line to the organization was recognized by senior leadership. The support from …