Medicine and Health Sciences Commons^™

Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Development Of A Midwifery Student Peer Debriefing Tool: An Interpretive Descriptive Study, Kate Buchanan, Carolyn Ross, Dianne Bloxsome, Jen Hocking, Sara Bayes

Research outputs 2022 to 2026

Background: Psychosocial traumatisation associated with giving birth, can occur in those present with the woman giving birth, a phenomenon known as vicarious trauma. It has been identified that there are currently no interventions available for midwifery students who have experienced vicarious trauma following difficult birth experiences. Objective: To explore whether the counselling intervention developed by Gamble et al. (2005), can be adapted for midwifery students to be appropriately and feasibly used as a counselling intervention with peers who have experienced midwifery practice-related vicarious trauma. Design: Interpretive descriptive methodology. Setting: This study was set at two Australian universities from which pre-registration …

Beyond The Physical Wounds: A Proactive Approach To Mental Health Recovery After A Traumatic Injury, Christine Mcgahey

Doctor of Nursing Practice (DNP) Projects

Beyond the Physical Wounds: A Proactive Approach to Mental Health Recovery After a Traumatic Injury

Background: Every year, millions of Americans incur a life-threatening traumatic event and are admitted to trauma centers to treat their acute physical injuries. While traumatic injury is closely associated with developing post-traumatic stress disorder (PTSD), patients are rarely evaluated for PTSD risk or educated about long-term psychological sequelae.

Local Problem: The predictive value of early screening to quantify PTSD risk in trauma patients is well documented in the literature. However, in a 241-bed Level II Trauma acute care hospital, there was no protocol to evaluate …

Acute Stress Disorder And Post-Traumatic Stress Disorder Screening In Pediatric Trauma Patients, Samantha Irizarry, Marian Malone, Megan Waddell

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Two-thirds of U.S. children and adolescents report experiencing one or more potentially traumatic events by age seventeen. 13.4% of the North Carolina pediatric population ages 0-17 have undergone two or more traumatic adverse childhood experiences, compared to 14% of the U.S. population. Early identification reduces the by-products of underdiagnosis of ASD and PTSD, such as mental illness, developmental delays, poor academic performance, and challenges with social interactions.

LOCAL PROBLEM: The project site is a level-one pediatric trauma hospital in Charlotte, North Carolina, seeing more than 130,000 patients annually. Before project implementation, there was an absence of ASD …

Implementing An Acute Stress Disorder Screening Tool In The Trauma Intensive Care Unit Setting, Sierra Bridgers

Epsilon Sigma at-Large Research Conference

This is a quality improvement project that focuses on implementing screening for acute stress disorder using the Acute Stress Disorder Structured Interview–DSM-IV tool in a Trauma Intensive Care Unit (ICU) at a Level 2 Trauma Center in Nashville, TN. Currently, at this hospital there is not a screening process implemented for these patients. Every trauma patient meets the criteria for acute stress disorder. Starting the process early aims for patients to be properly educated about their trauma and gets them the resources they need to heal mentally from the trauma.

During the 6-week implementation period of this project, the trauma …

Trauma And Resiliency, Madelyn Ferguson

Honors Projects

Life is a series of events, some overwhelmingly positive and others devastatingly negative. Because of the inevitability of adversity, one must learn to adapt to negative circumstances. However, people react to trauma in different ways with some seeking to take their own lives and others finding a healthy outlet. What causes such a difference in our reactions to trauma? Is it simply the power of thought or is there a genetic component? What can I do to build my own resilience and promote the resilience of others around me? The purpose of this paper is to explore the relationship between …

Mental Health Screening After Trauma: A Concise Review, Christine Mcgahey

DNP Qualifying Manuscripts

OBJECTIVE: To gain a better understanding of the value of mental health screening for PTSD risk in hospitalized trauma survivors.

DATA SOURCES: Studies were pooled from a literature search performed on the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and the Cochrane Database of Systematic Reviews.

STUDY SELECTION: Relevant studies published between 2015 and 2022 in English, excluding traumatic injuries incurred during combat.

DATA EXTRACTION: Ten articles were selected for inclusion in this review.

DATA SYNTHESIS: There is a significant and widespread mental health burden following traumatic injury. Early screening to quantify the risk for PTSD can …

The Effect Of Trauma-Informed Care Education On Improving Knowledge And Confidence Of Clinicians Caring For Women In A Labor And Delivery Setting, Claire Annaliese Wycoff

Doctoral Dissertations and Projects

The birthing process can be profoundly emotionally, mentally, and physically strenuous for women. Many women feel a loss of sense of control during their labor and birth experience. While trauma during the birthing process can happen to anyone, women with a history of sexual trauma are more likely to experience retraumatization during birth. Health care workers have the ability to exacerbate the patient’s trauma or promote healing through the care they provide. The lack of provider and nurse education in trauma-informed care is related to women’s experiences of secondary trauma during labor and childbirth and can cause prolonged complications for …

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 …

Addressing Perceived Barriers To Screening For Adverse Childhood Experiences In Primary Care, Trenton Conway

Dissertations

Problem: Inconsistent screening for Adverse Childhood Experiences (ACEs) in primary care settings leads to fewer appropriate behavioral health (BH) referrals and may increase risk for and incidence of chronic health conditions.

Methods: This quality improvement (QI) project used a descriptive observational design with prospective and retrospective data collection. The CDC’s ACE screening tool was administered to patients 18 years and older presenting to primary care. Data collection included number of ACE screenings completed and the number of BH referrals made following the screening. In additional, information was collected from medical assistants (MAs) and providers about the ACE screening process.

Results: …

Moving On After Critical Incidents In Health Care: A Qualitative Study Of The Perspectives And Experiences Of Second Victims, Melanie Buhlmann, Beverley Ewens, Amineh Rashidi

Research outputs 2022 to 2026

Aims To gain a deeper understanding of nurses and midwives' experiences following involvement in a critical incident in a non-critical care area and to explore how they have 'moved-on' from the event. Design An interpretive descriptive design guided inductive inquiry to interpret the meaning of moving-on. Methods Purposive sampling recruited 10 nurses and midwives. Data collection comprised semi-structured interviews, memos and field notes. Data were concurrently collected and analysed during 2016–2017 with NVivo 11. The thematic analysis enabled a coherent analytical framework evolving emerging themes and transformation of the data into credible interpretive description findings, adhering to the COREQ reporting …

A Scoping Review: Trauma Informed Care For Justice Involved Youth To Decrease Recidivism, Tamika Beecham, Marissa Gray, Shelby Husband, Diana Dedmon Dnp, Fnp, Bc

Doctor of Nursing Practice Projects

Purpose The purpose of this scoping review was to address trauma-informed care, juvenile justice systems, and recidivism rates. The literature review conducted identified key research and analysis of effective trauma-informed treatment methodologies, referrals, and accessibility of care for justice-involved youth, and the rate change of recidivism related to trauma-informed treatment and interventions.

Background The high rates of recidivism in the juvenile court systems matched with the increased prevalence of psychological trauma in justice-involved youth represent the need for implementing trauma informed care. The scoping review analyzed the research implementing the intervention of trauma informed care to determine if it resulted …

Trauma-Informed Care In The Emergency Department, Kayla Kvell, Kristin Oscarson

Nursing DNP Projects

Introduction: This project aims to analyze the effectiveness of trauma-informed care (TIC) education on attitudes of registered nurses (RNs) and psychiatric associates (PAs) towards TIC. The purpose of this project was to educate ED (emergency department) RNs and PAs on the effects of trauma and increase attitudes towards implementing a TIC approach to care for mental health (MH) patients in the ED.

Method: This project followed a pre–post-survey design with quantitative data. Participants included RNs and PAs newly hired to the ED, and/or if they had no previous TIC education. Data were collected utilizing a 10-question Likert scale survey.

Results: …

Organizational Implementation Of Trauma And Violence Informed Care, Tanaz Javan

Electronic Thesis and Dissertation Repository

For the past several decades, social and health services have increased their efforts to enhance service delivery and close the ‘science-to-service’ (or ‘evidence-to-practice’) gap by implementing effective interventions. At the same time, there has been growing recognition of the prevalence of trauma and violence in the lives of those served and those providing care and the impact of these experiences on service needs and interactions. This study explored the implementation of trauma- and violence-informed care (TVIC), a complex intervention focused on providing safety and choice for service users in the context of their life experiences and conditions, exploring factors that …

Analysis Of Zero Balancing Case Studies Through An Occupational Therapy Lens, Deanna Waggy Otr, Msa, Czb, Csla

Journal of Transformative Touch

Does Zero Balancing positively impact occupational performance? This is a question many Occupational Therapists (OTs) ask when discerning if Zero Balancing (ZB) is an evidence-based treatment modality. Case studies from the book Experiencing the Power of Zero Balancing: Case Studies of Journeys to Health and Wholeness (Quarry & King, 2016) were reviewed and compared to the Occupational Therapy domain of practice to show clear evidence that each case study had a positive impact on occupational performance. A comparison chart shows a direct link between the occupational categories and documented evidence of improved occupational performance through practitioner observation and client feedback …

Focused Surrogate Decision-Maker Identification In The Traumatically Injured Adult, Kelly Ann Evans

Walden Dissertations and Doctoral Studies

AbstractPatients in the trauma care setting are often dependent on their families and physicians to decide medical treatments when they cannot participate in the process.But in up to one-third of cases, the surrogate decision-maker (SDM)selected by the patient is not the emergency contact listed in the electronic medical record (EMR).SDM identification and documentation will ensure that the patient is best represented by someone who knows their values and goals if they become incapacitated.Nurses can facilitate identifying a patient’s SDM and document this choice in the EMR.The purpose of this study was a staff education program to improve intensive care unit …

A Call To Create: Poetry As Healing And One Nurse’S Self-Discovery, Kim Cornett Henry, Kim Cornett Henry

English Theses

Florence Nightingale’s vision for nursing has changed greatly in the past one hundred and fifty years, with nursing’s identity replaced with an emphasis on science over caring. The fast-paced, technologically sophisticated environments, designed to meet the declining health of an American public, have resulted in nurses who are being pulled away from nurse-to-patient caring acts and the reasons they felt called to become nurses. These changes have had detrimental psychological and emotional effects on nurses and are especially evident in Intensive Care nurses. Expressive writing as poetry, autoethnography, and participation in vibrant writing communities offer nurses experiences for healing, voice, …

Adverse Childhood Experiences: Effects Of Covid-19, Evan Guo

Honors Projects

The evaluation of an adult's health status consists of several entities. These factors can include physical, mental, and emotional health in an individual's history contributing to their overall health. When studying such factors, some researchers emphasize the importance of recognizing events experienced during a person's childhood that affect their development, and therefore, their adult health status. Today, as people continue adapting to the COVID-19 pandemic and changes in regulation of standards for socialization, it is becoming apparent to healthcare researchers how these new modifications are highly impactful to the development of children and adolescents. When studying the various factors that …

Peer-To-Peer Emotional Support For Second Victims Of Hospital Adverse Events, Jessica L. Van Leuven

Master's Projects and Capstones

Abstract

Problem: Psychological impact of trauma on healthcare workers is profound, and if left unaddressed can debilitate its victims, depress morale, and undermine safety culture. When adverse events occur and focus is placed on providing care and support to patients and their families, the emotional support needs of healthcare workers must also be acknowledged.

Context: Frontline workers in the oncology unit of the medical center that is the setting for this project experience emotional distress as “second victims” of adverse patient events. Close relationships develop between providers and patients during long-term treatments. When unanticipated or adverse patient events there can …

Introducing Trauma-And Resiliency-Informed Care In A Residential Treatment Setting, Connie Quach

Doctor of Nursing Practice Final Manuscripts

Background: The link between trauma exposure and substance use is well established. Seventy-five percent of individuals in substance use treatment report histories of abuse and trauma. Early traumatic experiences or repetitive trauma exposure disrupts a person’s ability to self-regulate which may demonstrate as disruptive behavior or present as physiological symptoms.

Purpose: The purpose of this project was to introduce and increase awareness of trauma and resiliency informed definitions, techniques, and provide resources for staff in a residential treatment setting.

Evidence-based Intervention and Methods: Participating nurses and resident assistants received a one hour presentation on trauma, resiliency, and its associated interventions. …

Educating Providers To Screen For Post-Traumatic Stress Disorder, Alyssa Fraino

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this evidence-based change in practice is to increase the knowledge base of psychiatric providers in outpatient psychiatric settings, by educating clinicians regarding the significance of implementing a post-traumatic stress disorder (PTSD) screening tool during the initial evaluation of patients. This can help to identify patients with PTSD that may not have been identified on initial visit, and may otherwise go unrecognized or untreated for PTSD, without the inclusion of a PTSD screening tool.

Problem: Evidence suggests that PTSD is underreported and overlooked in most populations. However, there is no standardized practice surrounding the routine use of …

A Tailored Multicomponent Intervention In Primary Care For Survivors Of Adverse Childhood Experiences (Aces), Rebecca L. Peterson

Evidence-Based Practice Project Reports

Adverse childhood experiences (ACEs) include 10 traumatic events of abuse, neglect, and household dysfunction that occur before 18 years of age. Adverse childhood experiences affect greater than 60% of the population, and approximately one in six individuals affirm that they have experienced four or more types of ACEs. They are associated with negative, long-term health outcomes in adults, including 9 out of the 10 leading causes of death in the United States (Centers for Disease Control and Prevention, n.d.; Felitti et al., 1998). The purpose of this evidence-based practice project was to implement a tailored, multicomponent intervention to mitigate the …

Integrating The Concept Of Trauma Into An Undergraduate Nursing Curriculum, Jacey Walker

DNP Scholarly Projects

Adverse childhood experiences, or ACEs, are early childhood traumas such as abuse, neglect or household dysfunction that can cause chronic physical and mental health problems across the lifespan. Approximately 61% of the adults in the United States have experienced ACEs. The prevalence of ACEs among nurses is at least comparable to population prevalence, and rates may be higher in subpopulations of individuals who work in helping professions. The stressful and highly interpersonal nature of nursing work may exacerbate and compound the health impacts of a nurse’s underlying ACEs, affecting not only the nurse’s health, but also his or her work …

Syrian Refugee Women's Experiences With The Ontario Health Care System: A Critical Ethnography Study, Areej Al-Hamad

Electronic Thesis and Dissertation Repository

There has been growing interest in migration and refugee research; the vulnerability of Syrian refugee women and how they adapt to their host communities. However, there is limited evidence regarding the pre- and post-migration trauma and its impacts on the health of Syrian refugee women in the Canadian context. The purposes of this critical ethnography using intersectional perspectives were: (1) to explore and describe Syrian refugee women’s experiences and meanings of pre- and post-migration trauma and its impact on their health in the context of repeated displacement and migration from their homes and families; (2) to critically examine how the …

Cervical Collar Clearance: Using Ebp To Decrease Pressure Injuries, Christoph Lecznar

VCU Health Nursing

Purpose: The purpose of this evidence-based practice (EBP) project was to decrease medical device pressure injury (MDPI) related to Cervical Collar (C-collar) clearance in adult blunt trauma patients. PICO: In the adult obtunded blunt trauma patient, should a c-collar be cleared with a negative CT, compared to a negative CT with adjunct imaging to reduce adverse events such as MDRPI?

Background: Our unit observed an incidence in C-collar MDRPI of 3 in 2019 and 3 in 2020 based on the date of the survey. C-collar clearance in the blunt trauma patient is a crucial step to avoid MDRPI. There are …

Improving Psychological Trauma Awareness For Culturally Responsive Care: A Dnp Project, Jose M. Cruz

Doctor of Nursing Practice Projects

Racism and racial discrimination occur in a variety of forms (Kendi, 2017). Both can contribute to poor mental health outcomes in the United States (Alvarez, Liang, & Neville, 2016; Comas-Diaz, Hall, & Neville, 2019; Levy, 2019; Malott & Schaefle, 2015; Williams, Lawrence, Davis, & Vu, 2019). These social conditions have been identified as chronic stressors that can illicit trauma symptoms, result in post-traumatic stress disorder (PTSD), and contribute to increased suicidality (French et al., 2020). Providers should understand the ramifications of the psychological trauma that can occur and endeavor to deliver evidence-based solutions. This doctoral project was designed to develop, …

Nurse Perspectives Of Trauma-Informed Care, Lee Ann Blazejewski

Walden Dissertations and Doctoral Studies

There is growing interest in trauma-informed nursing methods to better respond to the needs of patients with histories of adverse childhood experiences and other traumatic events. Recent advances in the understanding of how trauma can negatively affect long-term health outcomes have fostered a shift towards trauma-informed care as a method to decrease patient retraumatization in nursing practice. With the implementation of trauma-informed care in many areas of healthcare and public health, several challenges have been exposed. The purpose of this study was to examine nurses’ lived experience of implementing trauma-informed care into nursing practice for the care of patients with …

The Effect Of An Acuity Adaptable Unit On Efficiency In Non-Critical Trauma Patients, Rebecca Charles

DNP Projects

Problem Statement: It was observed a large academic medical center is experiencing impeding congestion of non-critical care patients due to challenges with bed availability and high patient volumes. Delays in transferring patients to an appropriate level of care can impose safety risks and prolong length of stay. Implementation of an acuity adaptable unit may be a cost-effective approach to a growing problem.

Background: A fixed bed model limits the acuity of patients admitted to a specific space. Using the Iowa Model of Evidence Based Practice as the framework for design, moving to an acuity adaptable unit could facilitate patient …

Care Coordination Of The Geriatric Traumatic Fracture Patient: A Multimodal Approach To Pain Management, Alexandra Keough

DNP Projects

Introduction: Traumatic fractures are increasing in incidence across the country, particularly in the aging population. Geriatric patients who are admitted to the acute care setting for traumatic fractures are a unique population that require acute pain management, while also managing other comorbidities. While there are several guidelines on pain management for patients who are admitted to the acute care setting, there are no specific guidelines on the best practices to manage acute pain in the geriatric traumatic fracture population. Evidence supports a multimodal pain management strategy using pharmacologic and non-pharmacologic means as the best way to care for this population. …

A Descriptive Study Of Male Victims Of Sexual Assault Seen For A Sexual Assault Forensic Medical Examination, Madeleine Prince

Undergraduate Honors Theses

Ten percent of all victims who report a sexual assault (SA) are male (Department of Justice, 2013), yet there has been little research on their experiences. Further study on the unique characteristics of male SA victims is warranted. The purpose of this study is to explore, identify, and analyze variables of male SA victims who received a SA forensic medical examination (SAFME), and identify implications and areas for future research. Data from the SAFME charts were entered into the Statistical Package for the Social Sciences (SPSS) version 25. Male victims were compared to female victims from the same data set. …