Medicine and Health Sciences Commons^™

Reducing Intraoperative Hypothermia In Adults 18-60 Undergoing Primary Elective Unilateral Total Knee Replacement With General Anesthesia, Carrigan Collinsworth

Doctor of Nursing Practice Final Project Abstract

Reducing Intraoperative Hypothermia in Adults 18-60 Undergoing Primary Elective Unilateral Total Knee Replacement with General Anesthesia

Background

Intraoperative hypothermia (core temperature < 36°C) is associated with increased surgical site infections, blood loss, prolonged recovery, and longer hospital stays. Because forced-air warming devices are restricted during total joint arthroplasty at the project site due to infection concerns, patients relied on passive warming, resulting in a baseline hypothermia rate of 63.3%

Purpose

The purpose of this quality improvement project was to reduce the incidence of intraoperative hypothermia among adults aged 18-60 undergoing primary elective unilateral total knee arthroplasty with general anesthesia by implementing a conductive warming device in the operating room of a large level 1 trauma hospital

Methodology

This evidence-based quality improvement project implemented a conductive warming blanket following staff education. Data was collected through the electronic health record. Primary outcomes included hypothermia incidence and average intraoperative temperature. Secondary …

Nurturing The Nurturers: Caritas Literacy Wellness Program, Pakeeza Ali

Doctoral Projects

Burnout, compassion fatigue, and emotional exhaustion remain significant concerns among oncology staff in high-demand ambulatory settings. This quality improvement project implemented the Caritas Literacy and Resilience Training Program (CLARITY), a microlearning-based intervention grounded in Watson’s Caring Science Theory, to support self-caring behaviors and emotional resilience among oncology staff in an ambulatory cancer center. A quasi-experimental, mixed-methods design was used, incorporating pre- and post-intervention survey data and qualitative focus group feedback. Quantitative outcomes were assessed using the Watson Caritas Self-Rating Score (WCSR) and post-intervention ratings of perceived effectiveness of the microlearning format. Wilcoxon signed-rank tests were used to examine pre-post change …

Evidence-Based Clinical Practice Guidelines For Postspinal Hypotension In Pregnant Women, Grace Mackey

Doctor of Nursing Practice Scholarly Projects

Abstract

Postspinal hypotension (PSH) in pregnant women undergoing a cesarean delivery is a common yet significant problem for the safety of the mother and fetus. The physiological effects of a spinal injection may compromise uteroplacental flow, predisposing the fetus to hypoxia and acidosis. Maternal consequences of prolonged hypotension include unstable hemodynamics, loss of consciousness, and nausea. Historically, healthcare providers have used crystalloid preloads and reactive phenylephrine boluses to correct hypotension. However, recent evidence suggests that these interventions have limited effectiveness. Thorough research led to the development of clinical guidelines that propose providing a 500 mL 6% hydroxyethyl starch preload or …

Evidence-Based Practice Guidelines For The Risk Stratification And Anesthetic Management Of Geriatric Surgery Patients At High Risk For Postoperative Cognitive Dysfunction Undergoing Non-Cardiac Surgery, Patrick M. Garvey

Doctor of Nursing Practice Scholarly Projects

As the global geriatric surgical population rapidly expands, managing complications like postoperative cognitive dysfunction is increasingly essential, given its adverse impacts on recovery, quality of life, and healthcare costs. Postoperative cognitive dysfunction can lead to extended hospital stays, delayed recovery, and significant cognitive decline, particularly among elderly patients exposed to general anesthesia. This quality improvement final scholarly project develops and hypothetically implements evidence-based practice guidelines for anesthetic management in geriatric patients at high risk for postoperative cognitive dysfunction undergoing non-cardiac surgery. This Doctor of Nursing Practice (DNP) project uses preoperative cognitive assessments, such as the Mini-Cog tool, to identify patients …

Practice Considerations For Perioperative Ondansetron Use In Parturients Undergoing Cesarean Sections With Spinal Anesthesia, Mackenzie Glaros

Doctor of Nursing Practice Scholarly Projects

Elective cesarean sections are often performed with spinal anesthesia, a form of neuraxial anesthesia that offers superior pain relief and reduces the risks associated with general anesthesia. However, over 50% of parturients experience side effects from spinal anesthesia, including shivering, hypotension, nausea, and vomiting, which can cause both physiological and psychological issues for the laboring mother and be detrimental to the fetus. Preventing these side effects is vital for improving safety, patient satisfaction, and minimizing complications. While various interventions and medications have been explored to manage these effects, no standardized guidelines exist for their prevention. A review of existing literature …

Evidence-Based Practice Guidelines For Lung Protective Ventilation In Adult Patients Undergoing Abdominal Laparoscopic Surgery, Marco A. Spada

Doctor of Nursing Practice Scholarly Projects

The rise in abdominal laparoscopic surgeries has underscored the need for improved ventilation strategies to reduce postoperative pulmonary complications, such as atelectasis, ventilator-induced lung injury, and pneumonia. These complications can increase hospital stays, healthcare costs, and mortality. This final scholarly project investigates the impact of lung protective ventilation in adult patients undergoing abdominal laparoscopic procedures and proposes guidelines for implementation. Lung protective ventilation strategies, including low tidal volume ventilation, individualized positive end-expiratory pressure, and recruitment maneuvers. Current research shows potential in mitigating postoperative pulmonary complications by improving intraoperative oxygenation and lung compliance. Using the Johns Hopkins Evidence-Based Practice model, this …

Evidence-Based Guidelines For Intraoperative Quantitative Neuromuscular Monitoring, Noah Graham

Doctor of Nursing Practice Scholarly Projects

Nondepolarizing neuromuscular blocking agents are routinely used medications vital to anesthetic care. When administering neuromuscular blocking agents, monitoring neuromuscular blockade depth and degree of recovery is a standard of nurse anesthesia practice to facilitate adequate recovery. If not adequately reversed, postoperative residual neuromuscular blockade can cause severe complications. Traditional qualitative neuromuscular monitoring practices largely contribute to the continuing high incidence of postoperative residual neuromuscular blockade, as supported by research that qualitative monitoring methods are insensitive to the depth of blockade and clinical situations, providing unreliable physiologic information. As recommended in practice guidelines by the American Society of Anesthesiologists, quantitative neuromuscular …

Implementation Of Evidenced Based Practice Guidelines For Reducing Emergence Delirium In Elderly Patients Undergoing A Total Hip Replacement, Luke D. Kleinfelder

Doctor of Nursing Practice Scholarly Projects

A total hip replacement is a common surgery for the elderly population, as it is a successful treatment option for hip fractures and end-stage osteoarthritis, a common condition associated with aging. Recovery from surgery is critical, and any postoperative complication can delay recovery, increase cost, lengthen hospital stay, and lead to a poorer long-term surgical outcome. One of the most common and severe postoperative complications for elderly patients following general anesthesia is emergence delirium. Traditional practice focuses on treating the symptoms of emergence delirium reactively instead of proactively and lacks standardized guidelines. Recent literature found a promising decrease in the …

Proposed Evidence-Based Practice Guidelines For Using Esmolol To Blunt The Sympathetic Stress Response To Laryngoscopy And Intubation, Maya Kurdi

Doctor of Nursing Practice Scholarly Projects

Direct laryngoscopy (DL) and endotracheal intubation (ETI) are standard procedures performed during general anesthetic induction, which provoke a sympathetic stress response that can result in intraoperative hemodynamic instability. Traditional agents like lidocaine and fentanyl, commonly used to mitigate the stress response, have limitations and can lead to adverse effects. Recent literature suggests that esmolol, an ultra-short-acting, cardio-selective beta-1 adrenergic receptor antagonist, may be an effective alternative due to its rapid onset, short duration, and minimal side effects. This final scholarly project (FSP) aims to develop evidence-based practice guidelines for using esmolol as an adjunctive induction agent. A systematic literature review …

Heads Up! Designing A Nursing Assessment Tool For Early Recognition Of Intracranial Hypertension Post Head Injury, Sergio A. Dondiego

Honors Capstones

This meta-analysis identifies noninvasive clinical predictors of intracranial hypertension (IH) post head trauma to develop a multi-criteria IH screening tool designed for nurses to wear on their badge reels. High-sensitivity predictors were prioritized to assist in early IH suspicion. Findings suggest that radiographic-measured abnormalities including an optic nerve sheath diameter (ONSD) 5.6 mm and signs of significant head trauma via computed tomography (CT) were highly effective for predicting IH and were therefore defined as major criteria for the assessment tool. Other significant examination findings include a Glasgow Coma Scale (GCS) score 8 and atypical pupillary reactivity. While age showed conflicting …

Evaluating The Impact Of Glp-1 Receptor Agonists On Perioperative Aspiration Risk: The Role Of Preoperative Fasting Duration, Caitlin Maureen Carter Bsn, Rn, Adam Wade Johnson Bsn, Rn, Allison Whitney Jones Bsn, Rn, Joseph Kaesberg Bsn, Rn, Kelly Maura Watson Bsn, Rn, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for diabetes and obesity due to their metabolic benefits; however, these medications delay gastric emptying, raising concern for increased residual content (RGC) and aspiration risk during anesthesia. Current perioperative fasting and medication management guidelines for patients taking GLP-1 RAs remain inconsistent, creating uncertainty for anesthesia providers. This scoping review aimed to synthesize current evidence on the relationship between GLP-1 RA use and perioperative gastric safety, with particular focus on fasting duration and aspiration risk.

Methods

A scoping review was conducted in accordance with PRISMA-ScR guidelines. Searches were performed using the …

Enhancing The Diversity And Number Of Certified Registered Nurse Anesthetists: A Proposed Pipeline Program For Underrepresented Students, Alexis Lamoreaux

Doctor of Nursing Practice Scholarly Projects

The underrepresentation of minority groups in the Certified Registered Nurse Anesthetist (CRNA) profession impacts healthcare providers’ diversity and cultural competence. This Final Scholarly Project (FSP) proposes a pipeline program to increase diversity within the CRNA field by providing academic support, mentorship, and clinical exposure to students from underrepresented backgrounds. Given the shortage of anesthesia providers, especially in underserved areas, improving access to the CRNA profession for minority students is critical for enhancing patient outcomes. This FSP suggests establishing mentorship and skill development concepts through a 12-month structured program that targets minorities, first-generation college students, or those from rural backgrounds. The …

Empowering Voices: A Qualitative Exploration Of Shared Governance Among Healthcare Workers In Clinical Practice, Ayman Alhazaymeh

Doctoral Projects

This project intervention evaluated the implementation of shared governance (SG), focused on partnership council activities and staff perception. The shared governance framework has several pillars, such as Partnership, Equity, Ownership, Accountability, and Shared Decision-Making, to support the design of healthcare organizations for excellent patient care (Porter-O’Grady, 2009). To effectively evaluate the SG implementation and ensure the ongoing success of the SG process, the author investigated staff contributions and actively sought feedback. He provided templates and guidelines for the partnership council and collected staff feedback. Murray et al. (2016) stated that the partnership council reported empowering staff to implement innovative solutions …

Evaluating The Impact Of A Meaningful Recognition Bundle On The Health Of The Emergency Department Work Environment And Emergency Nurse Burnout, Sean Truesdell

Doctoral Projects

Background: The health of the work environment significantly influences emergency nurse practice. The Emergency Nurses Association and the American Association of Critical-Care Nurses have called for the establishment of a healthy work environment (HWE) to improve outcomes, reduce burnout and turnover, and increase job satisfaction. Meaningful recognition is consistently among the lowest-performing HWE standards. Purpose: To implement a bundle of meaningful recognition elements in the Emergency Department (ED) and evaluate the outcomes. Methods: A quality improvement project was conducted in the ED of a non-profit community health system in Northern California. The Healthy Work Environment Assessment Tool (HWEAT) and Oldenburg …

Advancing Equitable Nurse Assignments Through Nursing Workload Score Categorization In An Adaptable Acuity Unit At An Academic Health Center, Moses Albaniel

Doctoral Projects

Inpatient nursing shift assignments often rely on clinical judgment, which can lead to inequitable workload distribution on mixed‑acuity units. This quality improvement project evaluated assignment equity using the coefficient of variation (CV) of nursing workload acuity scores and examined the relationship between workload balance and perceived assignment burden. A single‑group pretest–posttest design was implemented on a cardiac adaptable acuity unit at Stanford Health Care over a 12‑week period, encompassing 168 shifts from December 14, 2025, to March 7, 2026. The intervention, implemented with 11 charge nurses, combined structured charge nurse education with an optimized Epic Reporting Workbench tool incorporating dynamic …

Evidenced-Based Practice Guideline Development: The Addition Of Adjunctive Dexmedetomidine In Brachial Plexus Blocks For Upper Arthroscopic Surgery, Mylene Louail

Doctor of Nursing Practice Scholarly Projects

Dexmedetomidine (DEX) is an alpha-2 adrenergic agonist increasingly studied as an adjunct in brachial plexus blocks (BPBs) to enhance postoperative pain management. This project examines the efficacy of DEX as an adjunct in BPBs for upper extremity arthroscopic surgeries, focusing on its ability to extend analgesia duration, reduce opioid use, and enhance patient satisfaction. With analgesic and sedative properties, DEX can improve postoperative pain management with minimal side effects, providing shortened hospital stays, decreased costs, and better patient outcomes. Using the Iowa Model for evidence-based practice, baseline data on postoperative pain, analgesia duration, and opioid use will be collected from …

Nurse-Driven Palliative Care Screening Tools In The Icu, Olivia Sarkis Bsn, Rn, Fiona Hill Bsn, Rn, Isak Madden Bsn, Rn

Nurse Residency

PICOT Question: In adult ICU patients, how does implementing a nurse-driven palliative care screening tool, compared to provider-discretion palliative care consultation, affect rates of palliative care consultation in the ICU?

Safety Practices Regarding Oral Nimodipine Administration, Hannah Linsky Bsn, Rn, Nathan Mendoza-Connell Bsn, Rn, Perla Moguel Bsn, Rn, Andrew Vachon Bsn, Rn

Nurse Residency

PICOT Question: In adult patients with subarachnoid hemorrhage who are unable to swallow, does pharmacy prepared nimodipine oral solution administered via EnFit syringes, compared with bedside aspiration of nimodipine capsule solution using a blunt needle into syringes, reduce medication administration errors during hospitalization?

Remimazolam As A Sedative For Endoscopic Procedures: A Scoping Review, Hamzha Aysheh, Megan Henderson, Megan Hinkle, Sara Holton, Spencer Turner, Dwayne Accardo Dnp, Ccrn, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Propofol is commonly used for procedural sedation during endoscopic procedures because of its rapid onset and short duration; however, its use is frequently associated with adverse effects such as hypotension, hypoxemia, respiratory depression, bradycardia, and injection site pain. As diagnostic endoscopic procedures continue to increase, particularly among older and medically complex patients, there is a growing need for sedative agents that provide effective sedation while minimizing perioperative risk. Remimazolam, a novel ultra–short-acting benzodiazepine metabolized by tissue esterases, has demonstrated favorable hemodynamic stability and a reduced adverse effect profile in recent literature. The purpose of this evidence-based quality improvement project …

Discharge Education Bundles And Evaluating The Effect On Readmission And Satisfaction Rates: A Scoping Review, Jane Campo Bsn, Rn, Charlotte Edwards Bsn, Rn, Mary Catherine Hall Bsn, Rn, Sarah Moore Bsn, Rn, Allison Walker Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Transitioning children with a chronic medical condition from hospital to home is a critical and difficult process, leaving many families feeling anxious and unprepared. Nationally, 1 in 7 pediatric patients are readmitted within thirty days, making readmission rates an important quality indicator with both clinical and financial implications. To address these challenges, multiple discharge bundles have been developed; however, their effectiveness has not been consistently evaluated. The aim of this project is to summarize the current literature and highlight its positive outcomes, with the intention of promoting further research, reducing 30-day readmission rates, and increasing parental satisfaction (Shermont et …

Impact Of Nitrous Oxide Analgesia On Labor Experience, Kierra Jones Rn, Bsn, Elyzabeth Morales Rn, Bsn, Lanitra Ray Rn, Bsn, Rhonda Johnson Dnp, Cne, Cnm, Facnm

Doctor of Nursing Practice Projects

Purpose/Background

Nitrous oxide (N₂O) has re-emerged in the United States as a labor analgesia option that supports mobility, autonomy, and patient-centered care. As nurses increasingly support low-intervention and physiologic birth approaches, understanding the effectiveness and safety of nitrous oxide for low-risk laboring individuals is essential. This scoping review examines current evidence on nitrous oxide use during labor, focusing on maternal pain management, satisfaction, and neonatal outcomes to inform evidence-based nursing and midwifery practice.

Methods

A scoping review was conducted using PubMed, CINAHL Complete, and the Cochrane Library between September and October 2023. Inclusion criteria consisted of English-language studies published within …

A Program Evaluation Of A Family-Based Healthy Weight Program For Overweight And Obese Children And Their Families, Ashley Heimbouch, Margaret Platel, Kelly Betts

Doctor of Nursing Practice Projects: College of Nursing

This project’s purpose was to complete a program evaluation of the Building Healthy Families (BHF) program to determine its effect on children and their families’ health outcomes. The specific aims of success were 1) an improved perception of health-related quality of life for children and parents and 2) decreased body mass index (BMI) percentiles for age and sex in children from baseline measurements and scores compared to measurements and scores at 3 months and 6 months of program completion. The project was completed in a community setting on the University of Nebraska Medical Center’s Western Nebraska campus, and the population …

How Employment-Based Clinical Experience During Undergraduate Education Influences Transition To Practice: A Qualitative Systematic Review, Seung A. Park, Marion Eckert, Rebecca Sharp, Belinda Clark, Micah D.J. Peters

Research outputs 2022 to 2026

Aim: To synthesize qualitative evidence on the experiences of undergraduate nursing students and new graduate nurses engaged in formal paid employment models or health-related work during their undergraduate studies, to examine how these employment-based clinical experiences influence their transition to nursing practice, and to identify elements that facilitate or hinder this transition. Design: Qualitative systematic review. Methods: Searches were conducted in MEDLINE, Embase, Emcare (Ovid), CINAHL Complete (EBSCOhost), ERIC (ProQuest), and gray literature sources, including ProQuest Dissertations and Theses and Google Scholar. No date or country limits were applied, although only English-language studies were included. The review followed JBI methodology …

Exploring Policy Change To Support Early Diagnosis Of Congenital Heart Defects (Chd) In New Mexico, Kelsey Carson Leibenhaut

Doctor of Nursing Practice Scholarly Projects

Congenital heart disease (CHD) is not a new or rare problem; it has likely always been a leading cause of childhood morbidity and mortality and clocks in today as the most frequently occurring birth defect, affecting an estimated 1 in 100 newborns (CDC, 2025). Prior to the middle of the 20th century, there was little to be done about CHD, as no treatments existed. Everything changed with the advancement of options for surgical repair of CHDs, significantly prolonging lifespans and improving quality of life for affected individuals. Despite these incredible advancements, babies are born with CHD every day, leading to …

Navigating The Nicu Without Words: A Case Study Of A Spanish-Speaking Mother’S Healthcare Experience, Emma Norris

Poster Presentations

Research on NICU experiences largely focuses on majority-language families; non-English-speaking families are understudied (Cleveland, 2008). The Family Integrated Care model promotes parent-infant connection and shared decision-making to improve outcomes (Wreesmann et al., 2020). Language barriers impede parent-provider communication, increasing miscommunication and parental anxiety (Kynoe et al., 2020; Ardal et al., 2011). The purpose of this research is to explore communication experiences and barriers between English-speaking and bilingual NICU nurses and a Spanish-speaking NICU mother.

Exploring Student Feelings, Knowledge Related To Menstruation And Menstrual Education: A Cross-Sectional Survey, Ella A. Handel

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Menstrual, reproductive, and sexual health education in the United States remains inconsistent in both content and delivery. This inconsistency often leaves adolescents underprepared for developmental milestones such as menarche and contributes to ongoing stigma and discomfort surrounding menstruation. This study examined participants’ feelings and perceptions related to menstruation and menstrual education. Using a cross-sectional descriptive survey design, a mixed-methods approach was employed to collect data from 29 college students aged 18 to 19 years at a large public university in Arkansas. Quantitative data from Likert-scale items were analyzed using descriptive statistics, while qualitative open-ended responses were reviewed and organized into …

The Relationship Between Mc1r Gene Variants For Red Hair And Clinical Responses To Anesthesia, Analgesia, And Pain: A Systematic Review Of The Literature, Mary Clark Allen

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: Genetic variations of the melanocortin-1 receptor (MC1R) are commonly associated with red hair and pale skin. Research has linked MC1R variants with alterations in anesthetic response, pain perception, opioid sensitivity, and pain-related fear. Existing literature presents inconclusive findings, highlighting the need for further investigation.

Purpose: This review aims to synthesize current evidence concerning the role of MC1R variants in altering physiologic responses.

Methods: A systematic literature review was conducted by accessing CINAHL, MEDLINE, and PubMed through the University of Arkansas Libraries OneSearch platform. After applying inclusion and exclusion criteria, a total of 20 peer-reviewed articles were extracted for review. …

The Prevalence Of Stress Fractures In Relation To Red-S Syndrome Among Various Sports In Collegiate Female Athletes, Lilianna G. Couch, Marilou D. Shreve

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: RED-S is a risk factor for bone stress injuries in female athletes. Athletes that compete in sports that involve repetitive movements of impact are prone to stress injuries. The treatment of stress fractures requires addressing all potential causes of the injury to accelerate healing and prevent reinjury. Since RED-S is a well-established risk factor for stress injuries, early detection of RED-S is crucial to prevent long term negative health consequences in athletes including the development of stress fractures. It is also confirmed that certain sports have a higher prevalence of reported stress fractures in female athletes such as cross …

The Effects Of Sugammadex Vs. Neostigmine On Intraoperative Heart Rate In Pediatric Patients Under Two Years: A Scoping Review, Saumel Abston, Jackson Cobb, Elle Dean, Tanner Dillard, Pauline Dinh, Dwayne Accardo Dnp, Crna, Faana, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Neuromuscular blockade (NMB) reversal is a critical component of anesthesia care, particularly in infants under two years of age who have immature autonomic regulation and heightened vagal tone, predisposing them to bradycardia. Neostigmine, the traditional reversal agent, is associated with parasympathomimetic effects such as bradycardia, requiring anticholinergic co- administration. Sugammadex, a selective relaxant binding agent, offers rapid and predictable reversal of aminosteroidal neuromuscular blocking agents with less cholinergic side effects. Although the safety profile of sugammadex is well established in older pediatric populations, limited evidence exists regarding its cardiovascular effects in infants under two years of age.

Methods

A …

Improving Access And Early Identification Of Anxiety Disorders Through Annual Gad-7 Screening In High Schools: A Scoping Review, Joshua Richard Yumul Bsn, Rn, Cindy Thao Msn, Rn, Justin Doyle Borden Bsn, Rn, Rebecca Lizette Johnston Bsn, Rn, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Background: Anxiety disorders affect nearly one-third of adolescents in the United States, yet many cases remain undiagnosed due to inconsistent screening and limited access to school-based mental health services. The Generalized Anxiety Disorder 7-item (GAD-7) questionnaire is a validated screening tool, but its routine use in high school settings is not well established.

Purpose: This scoping review aimed to synthesize current evidence on the use of the GAD-7 in high schools to support early identification of anxiety disorders and improve access to mental health care.

Methods: A comprehensive literature search was conducted using PsycINFO, ERIC, PubMed, CINAHL, and Google Scholar. …