Medicine and Health Sciences Commons^™

Implementation Of A Human Trafficking Screening Tool In An Immigrant Services Organization, Cassandra Cooper

DNP Projects

Background

Human trafficking (HT) is a public health problem that advances the spread of disease and mental health issues and affects vulnerable populations including immigrants. HT screening tools are more reliable than clinical judgment in identifying HT victims, as even victims themselves are sometimes unaware of their own victimhood. To reduce the instances of victims being missed, HT screening tools have been validated to identify victims without the influence of personal bias.

Project Goals

1. Choose and implement a HT education module for staff.

2. Implement the AHTST for all new arrivals and from the months of November 2023 through …

Loma Linda Nurse - Vol. 31, Loma Linda University School Of Nursing

Loma Linda Nurse

FEATURES

4 | The Next Chapter for LLUSN

8 | 50 Years of West Hall

10 | Dr. Shawn Collins Named New Dean

12 | Dr. Gloria Huerta Named New Associate Dean

14 | Adventist Nursing Theory with Dr. Patricia Jones

LLUSN HIGHLIGHTS

16-23 | ALUMNI NEWS

24-27 | ACADEMICS

28-32 | HOMECOMING

33-35 | FACULTY UPDATES

Use Of A Shared Decision-Making Approach To Improve Blood Pressure Readings In A Hispanic Population With Hypertension, Narayani Koirala

Doctor of Nursing Practice Final Project Abstract

Background: Hypertension is a major risk factor for cardiovascular disease morbidity and mortality with over half of all cardiovascular deaths attributed to it (CDC, 2022). “It is estimated that one-third of adults are hypertensive worldwide. Predictions indicate that one billion individuals will be hypertensive by 2025” (Eghbali et al., 2022). Non-adherence to prescription medication and lifestyle changes is a significant problem and prevalent in the Hispanic population due to various factors related to social determinants of health.

Aim: This project aimed to increase patient adherence to hypertension treatment therapy in Hispanic adults with hypertension for improved blood pressure control and …

Situation Awareness Preparation And Prebriefing: Fostering The Cognitive Processes Of Thinking Like A Nurse In Simulation, Amanda Lynn Potter

Dissertations (1934 -)

Situation awareness (SA) is linked with actionable decision-making and clinical judgment in nursing practice. The cognitive processes used in developing SA, outlined in Endsley’s (1995) model, is the framework underpinning this study and are interwoven into the National Council of State Boards of Nursing Clinical Judgment Measurement Model (NCJMM). Cultivating these cognitive processes through prebriefing and simulation designed to intentionally develop SA, is a recommended practice currently seen in aviation and military training. There is a lack of vigorous research testing whether a specific intervention during clinical simulation can develop SA in nursing students. In addition, fostering SA in the …

Learning Circles: Promoting Inclusive Care Starting In The Classroom, April Graham, Kindsey Gattman, Tobias Johnson

Articles, Abstracts, and Reports

No abstract provided.

Prenatal And Postnatal Disparities In Very-Preterm Infants In A Study Of Infections Between 2018–2023 In Southeastern Us, Robin B. Dail Phd, Rn, Faan, Kayla C. Everhart Phd, Rn, Victor N. Iskersky, Weili Chang, Kimberley Fisher, Karen Warren Phd, Rn, Heidi J. Steflik, James W. Hardin Ph.D.

Publications

Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. Methods: 367 preterms born at < 32 weeks gestational age (GA) between 2019–2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics. Results: The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). Conclusions: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

Co-Occurrence Of Mental Illness And Substance Use Among Us Pregnant Individuals, 2012-2021, Zhong Li, Curisa M. Tucker Phd, Rn, Cassie L. Odahowski Phd, Mph, Kacey Y. Eichelberger, Jiajia Zhang Ph.D., Peiyin Hung Ph.D

Publications

Aim: Substance use disorders are increasingly prevalent among pregnant individuals, with evident risks of adverse perinatal outcomes. This study examines substance use (tobacco, alcohol and marijuana) among pregnant individuals with mental illness. Methods: A national representative sample of pregnant individuals were derived from 2012 to 2021 National Survey of Drug Use and Health data. Associations of past-year mental illness with past-month polysubstance use and each substance use were analyzed by logistic regression models, with complex sampling weights and survey year. Results: Among 6801 pregnant individuals, 16.4% reported having any mental illness (AMI) in 2012 and 2013, increasing to 23.8% in …

Recommendations For Sugammadex Administration In Standard And Special Populations, Kristen E. Mattson, Alexa Brummund

Doctor of Nursing Practice Projects

The purpose of this project was to collect evidence-based information regarding sugammadex administration in both standard and selected special populations. Special populations included renal failure, breastfeeding, pregnancy, and pediatrics. The objectives of the project were to collect and present current research to the host facility, define barriers to the use of sugammadex, and assess the participants’ knowledge of sugammadex use in special populations. A guideline for sugammdex administration was created and presented to the host facility through a poster presentation and quick reference guide. A voluntary post-implementation survey was implemented, and the results were recorded, analyzed, and displayed in the …

Shivering In Postpartum Women: Development Of A Perioperative Protocol For Women Undergoing Cesarean Section, Lindsay Dawson, Kara Peters

Doctor of Nursing Practice Projects

In obstetric patients undergoing a cesarean section, a spinal anesthetic is the most common form of anesthesia (Hannallah, 2016). An intrathecal (or spinal) block is not benign. Postpartum shivering is a potential risk with any neuraxial procedure, with an incidence of 40-80% specifically following a spinal anesthetic (Feng et al., 2021). Patients who experience shivering are at a greater risk for postoperative complications, impaired mother-newborn bonding, and decreased patient satisfaction. Both nonpharmacological and pharmacological treatment options exist for prevention and treatment of postpartum shivering. The objective of this project was to introduce a standardized, evidence-based protocol to decrease the incidence …

Anesthesia Management For The Preeclampsia Or Hypertensive Parturient, Britanie Sumpter

Doctor of Nursing Practice Projects

Preeclampsia is a placental disease characterized by abnormal maternoplacental blood vessels and placental dysfunction resulting in fetoplacental hypoperfusion and maternal multi-system organ dysfunction (Wang et al., 2019). Expectant management of a hypertensive or preeclamptic parturient includes antihypertensive medications, magnesium sulfate for seizure prophylaxis, and early delivery of the fetus (ACOG, 2020). Neuraxial anesthetic-induced sympathectomy combined with circulating antihypertensives, magnesium sulfate therapy, and intravascular volume depletion in preeclampsia is thought to contribute to exaggerated hypotension.

Persistent refractory hypotension after neuraxial anesthesia in parturients with preeclampsia or hypertension has been an ongoing issue affecting obstetric providers at the host facility. This project …

Diversity, Equity, & Inclusion In Nurse Anesthesia: Bridging The Gap, Aminat Yusuff-Akinbo

Doctor of Nursing Practice Projects

The nurse anesthetist plays a crucial role in the healthcare system. Through intensive training, they provide safe and effective anesthesia care to patients across various healthcare settings. Currently, the nurse anesthesia field lacks diversity, with underrepresentation of minority groups such as Black, Hispanic, and Indigenous individuals. The United States Census revealed that there are more than 325 million residents. Yet only 10.9% of nurse anesthetists are of diverse racial backgrounds. This lack of diversity limits the cultural perspectives and experiences brought to patient care and perpetuates disparities in healthcare outcomes. An increase in diversity can improve care for individuals and …

Integrating Psychotherapy In A Psychiatric Outpatient Clinic, Ayesha Baluch

Doctor of Nursing Practice Projects

Mental illness is common in the United States, affecting millions of people. Although there are effective medications for mental illness, psychotherapy in addition to pharmacotherapy provides the best outcomes. This project aimed to improve providers' psychotherapy screening and education of patients about psychotherapy utilization. A pre-implementation survey was conducted to evaluate psychotherapy screening and the barriers faced by providers to utilize psychotherapy screening. An education session was provided to the providers about the importance of psychotherapy screening and education. Data showed that the providers discussed psychotherapy with eight patients (40%) and educated four patients (20%) pre-implementation. Data showed that the …

Improving Depression Screening In Primary Care, Grace Wilson, Annmarie O'Connor

Doctor of Nursing Practice Projects

Depression remains an increasingly prevalent and underdiagnosed disorder affecting approximately 21 million adults in the United States with only 66% seeking treatment (NIMH, 2022). Untreated depression can lead to worsening mental and physical health which negatively impacts a person’s quality of life. The implementation of routine depression screening in primary care is recommended by the US Preventive Services Task Force (USPSTF) to improve early detection leading to improved outcomes (USPSTF, 2023). Despite increased depression prevalence and USPSTF recommendation, there remained an absence of routine depression screening in a primary care practice in Midwest Illinois which led to the development of …

Nurses' Experience Implementating Weighted Blankets In Inpatient Psychiatric Unit, Michael Ragen

Doctor of Nursing Practice Projects

The complexity of treating sleep difficulties in patients with concurrent psychiatric disorders continues to be a struggle for the medical community. The mechanism that causes psychiatric disorders can induce insomnia or hypersomnia (Khurshid, 2018). There is also a growing interest in disturbed sleep ability to induce psychiatric episodes (Verkhratsky et al., 2020). This classic “Chicken or Egg Scenario” meets the modern focus on creating the best outcome for patients with the least medication, spurring interest in the holistic management of sleep disorders. The literature has little information on the use of weighted modalities for sleep management and anxiety in an …

Lung Cancer Screening In A Primary Care Clinic For Coal Mine, Glenda Mills, Sarah Cobb

Doctor of Nursing Practice Projects

Lung cancer is the leading cause of mortality for both men and women in the United States. Guidelines are set by the American Cancer Society for annual screenings of at-risk patients. Early identification of lung cancer risk and screening with low-dose CT scans can increase detection and treatment thereby reducing risk of death or disability. Coal miners are exposed to numerous cancer-causing agents, such as toxic chemicals, dust pollution from coal, and diesel exhaust fumes. However, primary care clinics serving coal miners lack lung cancer screenings despite the increased risk miners face. Patients were screened using criteria set forth by …

Establishing Routine Multiple Micronutrient Supplementation During Pregnancy In An Impoverished Guatemalan Community, Marissa Schuette, Erin Brueggemann

Doctor of Nursing Practice Projects

Pregnant and breastfeeding women in impoverished settings face heightened nutritional demands, placing them and their children at increased risk of inadequate nutrition's detrimental effects. Existing literature suggests that supplementing with multiple micronutrients (MMS) may offer superior protection against morbidity and mortality compared to traditional iron and folic acid (IFA) formulations. This research is set in the Land of Hope (LOH) clinic, located in Escuintla, Guatemala, a community served by the non-profit organization ER Abroad. The study aims to assess the feasibility of standardizing MMS provision to pregnant women at LOH, coupled with supplementary education on pregnancy and nutrition. The team …

Enhanced Recovery After Surgery (Eras) Protocol For Bariatric Surgery, Krista Bunch

Doctor of Nursing Practice Projects

Bariatric surgery has been utilized in treating severe obesity and offers several benefits, such as sustainable weight loss, treatment of various metabolic comorbidities, and improved life expectancy (Sundbom et al., 2017). With these benefits and procedural improvements, there has been a marked increase in the demand for bariatric surgery and increased interest in shifting some of these procedures to an ambulatory care setting (Stenberg et al., 2022). However, postoperative complications such as pain, nausea, and inability to tolerate oral intake can cause patients to experience an increased length of stay in the hospital and suboptimal outcomes (King et al., 2018). …

Improvement In Patient Compliance For Gynecological Care, Tracee Williams

Doctor of Nursing Practice Projects

This quality improvement project implemented the patient-initiated follow-up (PIFU) pathway in a gynecology clinic setting. PIFU has potential to lead to decreased no-show appointments and increased patient autonomy in outpatient healthcare practices. Barriers that influence compliance with plans of care include lower socioeconomic status, racial and ethnic minorities, and unmet social needs such as food insecurity, healthcare travel and cost, and child/adult care needs. In addition to higher rates of no-show appointments, individuals facing these barriers have increased comorbidities. Prior to implementing the PIFU model, patients between the ages of 18 and 42 completed a patient satisfaction survey to better …

Preparing Nursing Students To Manage Acculturative Stress Experienced During Study Abroad Experiences: Novel Use Of Immersive Simulation And Cognitive Behavioral Strategies, Theresa Schnable, Christine A. Schindler, Jeffrey D. Roche, Karli Webster, Christopher E. Larkee, Maharaj Singh, John F. Ladisa

College of Nursing Faculty Research and Publications

This pilot study adds to the understanding of interventions to manage acculturative stress experienced during undergraduate study abroad programs. It was designed to evaluate the impact of cognitive behavioral strategy training combined with intentional practice during mixed reality (MR) simulations on acculturative stress. Participants included a convenience sample of undergraduate nursing students enrolled in a faculty-led study abroad course. Students participated in two MR simulations within a virtual environment over back-to-back days. Simulations were written by nursing faculty experts to reproduce realistic clinical situations students may encounter while studying in Peru. The Generalized Self-Efficacy Scale, State-Trait Anxiety Inventory, and Slater-Usoh-Steed …

Psychometric Evaluation Of The “Providing Validation” Measure In Vascular Anomalies, Bryan A. Sisk, Anna M. Kerr, Amy R. Newman, Dandan Chen, Jennifer W. Mack, Bryce B. Reeve

College of Nursing Faculty Research and Publications

We assessed the psychometric properties of the “providing validation” subscale of PedCOM measures for parents of children with vascular anomalies and adult patients. A total of 139 adult patients and 78 parents completed surveys. The mean score for patients was 3.7 (standard deviation 1.0), and for parents was 4.0 (standard deviation 0.9). “Providing validation” measures demonstrated high internal consistency and good model fit to a unidimensional model for both patients and parents using confirmatory factor analysis. The measures also demonstrated convergent validity with co-administered measures. This study demonstrated the validity of “providing validation” measures for parents and adult patients with …

Reducing Hemoglobin A1c Using Diabetes Self-Management Education And Support (Dsmes) For Hispanic Adults In A Primary Care Setting, Gita Gyawali Sedai

Doctor of Nursing Practice Final Project Abstract

Background: Members of the Hispanic population have a 50% or higher chance of developing diabetes and often do so at a younger age than other adults in the United States (CDC, 2022a). Diabetes complications also impact the Hispanic population harder, with higher rates of kidney failure caused by diabetes, along with diabetes-related vision loss and blindness (CDC, 2022a). DSMES programs have shown significant improvements in A1C and blood sugar control in different settings (Powers et al., 2020). However, it has not been implemented in many primary care settings.

Purpose: The purpose of this project was to implement and evaluate …

Nursing Care Regarding Social Determinants Of Health For Breastfeeding In Mothers And Infants, Natalie Jefson

Senior Honors Theses

Breastfeeding is incredibly important to the health and well-being of the mother-infant dyad. Because of this, there are both world-wide and national recommendations and guidelines for breastfeeding in the United States. Although many women choose to initiate breastfeeding, the percentage of women who continue breastfeeding for the recommended duration does not meet the Healthy People goal for the United States. Many factors influence this early breastfeeding cessation, including physical and socioeconomic barriers. Certain populations face increased barriers to reaching these goals related to social determinants of health which can and should be addressed by nurses through preventive measures and education.

Clinical Experiences Of Rn To Bscn Nursing Students In Kenyan Universities, Gladys Mbuthia, Gisela Rensburg Rensburg, Sheila Shaibu

School of Nursing & Midwifery, East Africa

Introduction and objective: Clinical learning environments play a great role in nursing training as they allow nursing students to develop their clinical skills by combining cognitive, psychomotor and affective skills. Consequently, clinical learning environments enable nursing students to bridge the theory-practice gap. Fewer studies have examined the clinical experiences of RN to BScN students in Kenya. This paper is part of analytical memo of a larger PhD study that sought to explore and describe the support needs of RN to BScN students in Kenyan universities. The paper focuses on clinical experiences of RN to BScN students.

Methods: Using a qualitative …

I Changed My Mind After My Placement: The Influence Of Clinical Placement Environment On Career Choices Of Final-Year Pre-Registration Nurses, Edah Anyango, Irene [email protected] Ngune, Janie Brown, Esther Adama

Research outputs 2022 to 2026

Background: Clinical placements (CPs) in the final year of nursing education largely impact nursing students’ professional development by exposing them to nursing realities. Nursing students also use placement exposure to identify suitable career opportunities for their upcoming professional life. However, there is limited evidence on how final-year CPs may attract pre-registration nursing students into different nursing specialties, including hospital and non-hospital settings. Aim: To explore the influence of CPs in the final year of nursing education on pre-registration student nurses’ career decisions. Method: A narrative inquiry approach was utilised. A purposeful sample of 12 final-year students from two Western Australian …

Maternal Prebiotic Supplementation During Pregnancy And Lactation Modifies The Microbiome And Short Chain Fatty Acid Profile Of Both Mother And Infant, Jacquelyn M. Jones, Stacey N. Reinke, Mahsa Mousavi-Derazmahalleh, Johan Garssen, Maria C. Jenmalm, Ravisha Srinivasjois, Desiree Silva, Jeffrey Keelan, Susan L. Prescott, Debra J. Palmer, Claus T. Christophersen

Research outputs 2022 to 2026

Background & aims: Improving maternal gut health in pregnancy and lactation is a potential strategy to improve immune and metabolic health in offspring and curtail the rising rates of inflammatory diseases linked to alterations in gut microbiota. Here, we investigate the effects of a maternal prebiotic supplement (galacto-oligosaccharides and fructo-oligosaccharides), ingested daily from < 21 weeks' gestation to six months’ post-partum, in a double-blinded, randomised placebo-controlled trial. Methods: Stool samples were collected at multiple timepoints from 74 mother–infant pairs as part of a larger, double-blinded, randomised controlled allergy intervention trial. The participants were randomised to one of two groups; with one group receiving 14.2 g per day of prebiotic powder (galacto-oligosaccharides GOS and fructo-oligosaccharides FOS in ratio 9:1), and the other receiving a placebo powder consisting of 8.7 g per day of maltodextrin. The faecal microbiota of both mother and infants were assessed based on the analysis of bacterial 16S rRNA gene (V4 region) sequences, and short chain fatty acid (SCFA) concentrations in stool. Results: Significant differences in the maternal microbiota profiles between baseline and either 28-weeks’ or 36-weeks’ gestation were found in the prebiotic supplemented women. Infant microbial beta-diversity also significantly differed between prebiotic and placebo groups at 12-months of age. Supplementation was associated with increased abundance of commensal Bifidobacteria in the maternal microbiota, and a reduction in the abundance of Negativicutes in both maternal and infant microbiota. There were also changes in SCFA concentrations with maternal prebiotics supplementation, including significant differences in acetic acid concentration between intervention and control groups from 20 to 28-weeks’ gestation. Conclusion: Maternal prebiotic supplementation of 14.2 g per day GOS/FOS was found to favourably modify both the maternal and the developing infant gut microbiome. These results build on our understanding of the importance of maternal diet during pregnancy, and indicate that it is possible to intervene and modify the development of the infant microbiome by dietary modulation of the maternal gut microbiome.

The Correlational Effects Of Academic And Demographic Factors On Nursing Students’ Attrition, Progression, And Completion At A University College Of Nursing, Adebusola A. Obafemi

Electronic Theses and Dissertations

High United States nursing student attrition rates have attracted political, organizational, and social interest for numerous reasons. This attrition places financial burdens on the students, results in revenue loss for the college, and exacerbates the existing nursing shortage. Students' success in a nursing program is crucial for nurses to practice nursing. The purpose of this retrospective study was to explore the effects of academic performance and demographic/categorical factors on nursing students' progression and completion at a University College of Nursing in the Southern United States. The target population consisted of students enrolled at the University College of Nursing from January …

Diabetic Coaching Program To Improve African American Patients Glycemic Control, Shonda Moore

Student Scholarly Projects

Practice Problem: The purpose of the practice problem was to find out if, among African Americans with type II diabetes who are over 18, adopting a diabetic coaching program that emphasizes diet management can result in better glycemic control over 10 weeks than for those who do not receive coaching.

PICOT: In African Americans with type II diabetes over 18 years of age (P), does a diabetic coaching program on diet management (I), compared to no coaching program (C), improve glycemic control (O) over 10 weeks (T)?

Evidence: The evidence used to guide this project came from databases, including PubMed, …

Heavy Burdens Of Family Caregivers Caring For Persons With Severe Mental Disorders, Kissa Bahari, Arief Bachtia, Gracia Herni Pertiwi, Ahmad Syahlani

Jurnal Keperawatan Indonesia

Family caregivers who live with and care for individuals with severe mental disorders face serious issues. This study aimed to investigate the burdens of these family caregivers. This descriptive phenomenological study involved 15 family caregivers who looked after persons with mental disorders in Malang City, Indonesia; the participants were selected using a purposive sampling technique. Data were gathered using individual in-depth interviews and observations, and then analyzed inductively. Based on the findings, the burdens of family caregivers can be grouped into four main themes: 1) families encountered challenges and stigma in caring for persons with severe mental disorders, 2) there …

Efficacy Of Programs Designed To Reduce The Incidence Of Premarital Sexual Behavior Among Adolescents: A Systematic Review, Desy Ayu Wardani, Siti Khuzaimah Ahmad Sharoni, Endang Triyanto

Jurnal Keperawatan Indonesia

The incidence of premarital sexual behavior worldwide is increasing despite the fact that it is known that it may cause health and psychological problems. Hence, interventions are needed to reduce the incidence of premarital sexual behavior. The aim of this study was to provide an overview of the reported interventions used to reduce the incidence of premarital sexual behavior in adolescents and identify the implications for nursing practice. A systematic review was conducted using The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The Scopus, Science Direct, Web of Science, and ProQuest databases were searched using the keywords …

Nurses’ Job Satisfaction Regarding The Use Of Health Technology: A Survey Study, Diah Arruum, Setyowati Setyowati, Hanny Handiyani, Raldi Artono Koestoer

Jurnal Keperawatan Indonesia

The development of innovative health technology is continuously needed by health workers, including nurses in hospitals. Nurses need to adapt and are required to be able to use various current technological innovations. However, the demand for quality care in maintaining patient safety through the use of technology is still an issue, thereby affecting the achievement of nurse job satisfaction. This study aims to describe the job satisfaction of nurses regarding the use of health technology. It is a descriptive study with a cross-sectional design that included 172 hospital nurses. The sample was selected using the purposive sampling method, and the …