Medicine and Health Sciences Commons^™

Addressing Breast Health Disparities Among Recent, Established African-Born Immigrant Women And Second-Generation Americans In Prince George County, Maryland, Omolola Okunromade

College of Graduate Studies: Theses & Dissertations

Background: Breast health disparities and underutilization of screening methods are major concerns in the United States (US), particularly affecting Black women who experience lower survival rates and advanced diagnoses. Despite the rapid growth of the African-born immigrant population, breast health among this group in the US is notably under-examined. This study aims to investigate the breast health knowledge and practices of first-generation African-born immigrants and second-generation immigrant women of African descent, aiming to understand the distinctive attributes of this group and the impact of acculturation on this public health issue.

Methods: Interviews were conducted among First Generation African immigrants and …

Streamlining Process To Improve Opioid Disposal For Surgical Patients, Kathy R. Tussey

Doctor of Nursing Practice Projects

Every day in the United States 130 people die from an opioid overdose. Healthcare facilities have a responsibility to do all they can to promote safety. Patients must understand the risk of opioids, how to store the medication in their homes, and how to dispose of unused opioid medications. Studies have shown that providing a comprehensive education plan along with an opioid disposal kit to patients after surgery could improve unused opioid disposal. The healthcare team must provide education and resources to patients at key points throughout their visit to make an impact in removing unused opioids out of the …

Promoting Positive Patient Outcomes Through A Standardized Handoff Communication Process, Elizabeth Morgan Rowland

Doctor of Nursing Practice Projects

Abstract

The lack of proper handoff communication between frontline staff has prohibited a true alignment of a partnership of care, which has the potential to affect the safe quality of care. In 2016, The Joint Commission showed that over a five-year span, communication failures led to thirty percent of malpractice claims, 1,744 deaths, and $1.7 billion dollars in malpractice costs (The Joint Commission, 2017). To improve team performance and teamwork between the nurses and the nursing assistants, the implementation of an evidence-based handoff communication SBAR format and process will allow for essential information to be shared that promotes quality, safety, …

School Nurse Perceptions Toward Peers With Substance Use Disorder And Knowledge Of Alternative-To-Discipline Programs, Patricia L. Howard-Chittams

Doctor of Nursing Practice Projects

Title of DNP Project: School Nurse Perceptions Toward Peers with Substance Use Disorder and Knowledge of Alternative-to-Discipline Programs

Student Name & Full Credentials: Patricia L. Howard-Chittams, MSN, FCN, AGNP-BC

Abstract

This pilot project addresses existing barriers to the use of alternative-to-discipline programs for individuals with substance use disorder. It aims to identify and dispel these barriers through an educational program. The focus includes assessing knowledge, confidence, and perceptions of school nurses about their peers with substance use disorder and alternative-to-discipline programs. Given the rise in substance use disorder since the pandemic, the pilot project’s goals is to enhance understanding, increase …

Pressure Injury Education & Staging Decision Tree To Mitigate Pressure Injuries, Grace C. Dengler

Doctor of Nursing Practice Projects

Abstract

Pressure Injuries (PI) are a major safety concern with a potential for immobility, grief, shame, fluid leakage, feeling of isolation and yet 95% of them are avoidable. Clinical team members are responsible for caring for patients to ensure that those admitted with pressure injuries are improving and not worsening. The cost per day to treat PIs is higher than for prevention. In the United States, 60,000 people die each year because of PI complications. The purpose of this project is to: 1) implement evidence-based PI education 2) increase skin assessment and documentation on the avatar within the electronic medical …

Improving Provider Confidence On Hiv Screening And Testing, Missy Stipp

Doctor of Nursing Practice Projects

HIV is a preventable disease when steps are taking to decrease transmission. Health care providers are on the forefront of curving the HIV epidemic. Provider confidence related to HIV screening and testing can increase with proper intervention and education. The Check List screening tool is a tool that providers can use in practice to screen those patients who might be at risk for acquiring HIV even if they have already been screened once in their lifetime. The goal of the DNP project was to increase the confidence and practice of the health care providers at the White House Clinics through …

Identity Formation And Role Expansion For Nurse Practitioner Residency Preceptors: A Qualitative Thematic Analysis, Angel Chen Kuo

Doctoral Dissertations

Employer-based nurse practitioner residency programs have been implemented to address the significant shortage of primary care providers in the community clinic settings. However, there continues to be a shortage of clinicians who serve as preceptors to nurse practitioner residents and students. Preceptors, also referred to as clinician educators, are essential in the training of learners and their socialization into the profession. Just as there is a shortage of clinicians of diverse backgrounds to reflect the population served in the community, there is also a significant shortage of preceptors of color to train learners from diverse backgrounds. The purpose of this …

Benefits And Drawbacks Of Pre-Licensure Clinical Jobs In Undergraduate Nursing Students, Rachael Muhlenkamp, Rebecca Trzecki, Jason Grassie

Williams Honors College, Honors Research Projects

This research study aims to identify the benefits and drawbacks of pre-licensure clinical jobs in undergraduate nursing students. Many nursing students are encouraged to have a job in clinical settings in order to gain more experience. Many undergraduate nursing students here at the University of Akron currently have jobs in the clinical setting and these are the student's who we plan to use as our sample for this study. This study will be completed by spring of 2023, before graduation.

Access To Prenatal Care And Mental Health In Pregnant Women During Covid-19: A Systematic Review, Chloe Feezel, Marin Kahoun, Kaija Kunttu

Williams Honors College, Honors Research Projects

COVID-19 affected the world in many ways. Pregnant women were greatly impacted by a change in their access to prenatal care, from in-person care to telehealth methods, and social support being limited by social isolation. Compared with prevalence of anxiety and depression in pregnant women pre-COVID-19, pregnant women during COVID-19 reported higher levels of anxiety and depression symptoms due to the stress of circumstantial changes. The purpose of this systematic review is to review and critically appraise the evidence about access to prenatal care and mental health in pregnant women during the COVID-19 pandemic. The following PICOT formatted question will …

Establishing A Benchmark For Opioid Consumption After Cesarean Birth, Laura Senn

Faculty Research, Scholarly, and Creative Activity

No abstract provided.

Increasing Self-Awareness In Nursing, Adrienne Irene Abbot

Walden Dissertations and Doctoral Studies

Nursing self-awareness is essential for nurses to develop relationships with co-workers and patients. In the local organization, the practice problem for this doctoral project is a perceived low level of self-awareness in nursing. This Doctor of Nursing project aimed to determine if an educational intervention focused on self-awareness and the benefit of self-awareness increased knowledge among nurses working on a medical-surgical unit. A comprehensive literature review of peer-reviewed evidence provided evidence to support this project. A total of 26 individuals (N = 26) participated in the educational intervention. Eighty-nine percent (89%) of the participants (n = 23) were female, and …

Improving The Care Of Neonates With Hyperbilirubinemia, Kellie Busse Kainer

Walden Dissertations and Doctoral Studies

AbstractProviders at a community-based pediatric hospital in the southern region of the United States have traditionally transferred otherwise healthy neonates with hyperbilirubinemia requiring inpatient treatment to a tertiary care facility. The question addressed was whether the implementation of an evidence-based, organizational protocol increases the quality and decreases the cost of caring for neonates with hyperbilirubinemia in the community-based, pediatric acute care hospital. The main goal of the organization’s quality improvement (QI) project was to facilitate the provision of high-quality, cost-effective care to neonates with hyperbilirubinemia using an evidence-based approach as evidenced by a reduction in the number of neonates with …

Lived Experiences Of American Adults Who Survive Covid-19: Implications For Physical Activity And Interpersonal Stress, Linda B. Piacentine, Hannah C. Barbosa, Kristin Haglund, Lauren Opielinski, Sandra K. Hunter, Paula E. Papanek, Marie K. Hoeger Bement, Norah L. Johnson

College of Nursing Faculty Research and Publications

Introduction: The cumulative number of COVID-19 cases has surpassed 579 million globally. Symptoms during and after COVID-19 infection vary from mild cold symptoms to severe multisystem illness. Given the wide range of symptom presentations and complications post COVID-19, the purpose of this study was to describe the lived experience of American adults surviving COVID-19.

Method: This study employed an exploratory qualitative description design. Semi-structured interviews were conducted with a sample of 35 individuals, [white (94%), female (71%), mean age = 43.7 years], with proximity to a university in an urban Midwest American city. Interviews occurred between May and …

Discharge Education Protocol To Improve Patient Satisfaction, Courtney Banzon

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Discharge education that is patient-centered and started in a timely manner provides patients with the knowledge to care for themselves in the home setting and prevent adverse outcomes from occurring.
Methods: A discharge education protocol was implemented on a cardiology inpatient unit. The registered nurses were given a discharge checklist that focused on education and discharge planning with the patient within 24 hours of admission. Patients completed a survey that measured satisfaction of staff education. Surveys were collected for 10 weeks pre-intervention and compared with surveys 10 weeks post-intervention. Data was collected on the time of discharge with the …

The Implementation Of A Palliative Needs Screening Intervention In A Neuro Critical Care Unit:, Marcus Goodfellow

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Purpose: Palliative care (PC) is an important and yet underutilized discipline in neuro critical care units (NCCUs). The purpose of this project was to integrate and improve PC in a NCCU by implementing a Palliative Needs Screening Intervention (PNSI). A PNSI consists of a list of criteria used to screen patients to identify family and patient PC needs.
Methods: A quality improvement project using a PNSI was implemented in a NCCU. Nurses completed 2 hours of pre-implementation PC education and a palliative perceived self-efficacy scale pre/post-implementation. A PNSI was developed and integrated into the NCCU’s daily rounding process.
Results: PNSI …

The Effects Of Positive Behavioral Interventions And Supports On Emotional Regulation In Preschool Children, Alyssa Richardson

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Purpose: Positive Behavioral Interventions and Support (PBIS) is an evidence-based three-tiered framework that supports children and their behavioral needs including emotional behaviors. Emotional behavioral problems (EBP) seen at an early age have a major connection to their preschool setting and a significant effect on future long-term mental and physical health outcomes. 11
Methods: Preintervention, teachers completed PBIS and Teacher Observations of Classroom Adaptation-Checklist (TOCA-C) training. The teachers evaluated and assigned each student to a PBIS tier group using TOCA-C. Tier appropriate interventions were then implemented. TOCA-C was used 3 months post intervention to reevaluate each months post intervention to …

Implementation Of A Suicide Prevention Program In A Rural School, Mackenzie Wieser

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Introduction: Suicide is a leading cause of death among today's youth. One in six youth have seriously considered attempting suicide, and one in 13 have attempted suicide at least once. Timely identification of those at risk and connection with appropriate help are critical. Elementary, middle, and high school teachers are ideally positioned to act as gatekeepers through early recognition of students in psychological distress and timely response and referral when appropriate.
Evidence Summary: Teachers report a sense of responsibility for providing indirect mental health services to youth but have a lack of sufficient training and preparedness. Kognito online simulations have …

Improving Unlicensed Staff And Nurses’ Knowledge, Attitudes, And Practices Associated With Fluid Status Monitoring By The Utilization Of A Fluid Status Monitoring Protocol, Brittni Roberts

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Monitoring fluid status may prevent adverse patient outcomes. Nurses and unlicensed staff are responsible for inpatient fluid status monitoring and documentation.
Methods: Registered nurses and unlicensed staff completed a pre-intervention questionnaire measuring their knowledge, attitudes, and practices related to fluid status monitoring. They then completed an education session on fluid status monitoring and the new protocol. This protocol includes use of a fluid balance chart, a standardized daily weight process, and allowed patient participation. The protocol was implemented for 2 months, and the questionnaire was completed again post implementation.
Results: The results were analyzed using a Wilcoxon signed-rank test …

Chronic Pain Assessment And Documentation Protocol Implementation In Home Health Care, Lannese Purtell

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background/Purpose: Chronic pain management protocols are necessary in all aspects of health care to reduce negative perceptions and improve knowledge and comfort when caring for patients with chronic pain.
Methods: A pre-implementation Simplified Knowledge and Attitude Survey Regarding Pain (KASRP) and Comfort Survey were administered to rural Midwest home health nursing staff followed by implementation of a chronic pain management protocol. The protocol included an educational session on understanding and managing chronic pain, the use of the OPQRST handout to guide proper documentation, Pain Risk Factors Assessment Form, and a Managing Chronic Pain handout. The Simplified KASRP and Comfort Surveys …

Impact Of A Respiratory Health Program On Attitudes, Knowledge, And Behaviors Related To Respirator Use In Farmers And Ranchers, Rebecca White

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Studies show an association between agricultural occupational hazards and respiratory illnesses. Personal protective equipment (PPE) has protective effects, but limited education and inadequate respiratory protection are common among agricultural workers.
Methods: A demographic questionnaire and two pre-intervention surveys were initially administered to farmers and ranchers. The surveys measured attitude, knowledge, and behaviors related to respiratory safety and PPE practices. Pulmonary function testing, educational handouts, and respirator fit testing was provided in a variety of settings, and one N95 mask was given to each participant. Two surveys were distributed 3 months post-intervention.
Results: The pre- and post-intervention surveys were matched …

Clinical Care Protocol For Enhanced Nurse Competency In Caring For The Patient With An External Ventricular Drainage (Evd) Device, Lauren Orson

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: The focus of this Doctor of Nursing Practice Project surrounds the need for an evidence-based clinical nursing protocol to augment nurse competency and therefore streamline care to patients with an external ventricular drain (EVD).
Methods: A clinical protocol alongside tailored education was used to promote nurse competency for EVD management. A pre-implementation survey was completed evaluating the nurses’ baseline competency when managing an EVD. The nursing protocol was then implemented for bedside use. After 2 months, the survey was completed once again and paired for statistical analysis.
Results: Statistical analysis using the Wilcoxon signed-rank nonparametric test with dependent matched …

Sick Day Plans For Pediatric Home Health To Reduce Unplanned Hospitalizations:, Katie Anderson

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background/Purpose: Pediatric home health patients with chronic respiratory conditions often have a higher risk of developing respiratory tract infections leading to emergency room (ER) visits and unplanned hospitalizations. A sick day plan (SDP) can help nurses recognize signs of illness early and prompt them to intervene with supportive respiratory care, thus preventing worsening illness and hospitalization.
Methods: A SDP respiratory assessment and intervention tool was implemented in a pediatric home health organization. The number of pre and post intervention ER visits and unplanned hospitalizations were compared.
Results: The total mean ER rates over 1 year before project implementation was found …

Implementing A Walking Program For Sedentary Patients In A Weight Management Clinic, Bailey Tetrault

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Promoting physical activity in weight management patients promotes better patient outcomes.
Methods: Weight management clinic patients were enrolled in the 6-week Walk with Ease (WWE) program. At the first session, each participant’s walking distance was measured over a 20-minute timeframe using pedometers. WWE group met 3 times weekly for six weeks for walking activities and with education on movement, mobility, and strength. At each session, the walking distance of participants was measured over 20 minutes. Race, gender and age descriptive were also collected.
Results: Statistical tests included the Friedman Test, ANOVA, and linear regression were calculated at the 5% …

Implementation Of A Venous Thromboembolism Protocol And Its Impact On Nurses’ Attitudes And Knowledge, Mikelle Eliason

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Venous thromboembolism (VTE) is a leading cause of preventable death following a surgical procedure in the United States. To reduce this risk, it is crucial that nurses are able to recognize VTE risks, perform a VTE risk assessment, and follow appropriate prophylactic recommendations.
Methods: Nurses received VTE education and the Caprini risk assessment model (RAM) was initiated at a rural outpatient surgery center. A pre- and postquestionnaire approach was utilized to evaluate nurses’ attitudes and knowledge on VTE risk assessment. Utilization of the Caprini RAM was tracked. Results: There were 8 nurse participants. At a 5% level of significance, …

Strengthening New Hampshire’S Primary Care Workforce Pipeline: Utilization Of Alternative Scheduling Models, Elizabeth Harrison

DNP Scholarly Projects

Abstract

BACKGROUND: Traditional clinical scheduling coupled with the current reimbursement system have created systematic barriers leading to decreased clinical education opportunities. Alternative scheduling models such as longitudinal integrated clerkships, one preceptor to two students and wave scheduling have the potential to eliminate these barriers and provide financial gains and increased access to care.

INTERVENTION: Interventions to meet this quality improvement project's objectives included (1) pre-intervention planning (2) focus groups, (3) video presentations and (4) a pilot program of alternative scheduling models in clinical practice.

RESULTS: A pilot program utilizing the alternative scheduling models increased the relative value units (RVU) of …

A Comparison Of Outcomes For Lipid Emulsions In Total Parenteral Nutrition Among Home Infusion Patients, Gregory W. Wesley-Lynch

DNP Scholarly Projects

This quality improvement project aimed to compare the outcomes of lipid emulsions used in total parenteral nutrition among home infusion patients. The quality improvement project included 45 patients who received four weeks or more of either Intralipid or SMOFlipid. Paired t-tests were used to compare SMOFlipid and Intralipid regarding three liver function test (LFTs) values; (Alkaline Phosphate (ALP), Aspartate transaminase (AST,) and Alanine transaminase (ALT). Results demonstrated that SMOFlipid was superior to Intralipid, resulting in lower LFTs for ALP, AST, and ALT. This study provides evidence to support the use of SMOFlipid over Intralipid in total parenteral nutrition for home …

Decreasing Post-Operative Ventilator Time In The Cardiovascular Surgical Patient: A Nursing Education Quality Initiative, Amanda J. Bruno Roberts

DNP Scholarly Projects

Extended mechanical ventilation times after open heart surgery can contribute to complications prolonging recovery and length of stay, as well as increasing mortality. Standardized staff education of immediate post-open-heart recovery and ventilator weaning protocols, combined with the use of ABCDE and VAP bundles can reduce these complications. At Hospital X during summer of 2022, the average length of time patients remained mechanically ventilated after open heart surgery increased. After an initial needs survey was distributed to nursing staff, a set of novel QR codes was created to simplify and centralize training for staff in the ICU to facilitate early extubation …

Implementation Of Point-Of-Care Tick-Borne Disease Powerplan™ And Algorithm For Early Detection And Treatment Of Tick-Borne Diseases, Ashley Pinkham

DNP Scholarly Projects

Abstract

Local Problem: The Concord Hospital system, serving 30+ communities, is situated in the heart of New Hampshire surrounded by densely wooded forests, lakes, and mountains and is a mecca for camping, vacationing, and sightseeing, doubling its population of 1.6 million residents during spring, summer, and fall months. Despite the serenity, there is a predator that lingers among the hiking trails and lake shorelines. From January 2021 through August 2022 there were a total of 41 hospitalizations from tick-borne diseases, some with life threatening symptoms. Unfortunately, nearly half (43%) of patients presented to their primary care provider first where the …

A Quality Improvement Initiative: Addressing Workplace Violence Toward Nurses To Promote A Culture Of Safety In An Inpatient Psychiatric Facility, Ernestina Danso

DNP Scholarly Projects

This quality improvement initiative aimed to address workplace violence against nurses in inpatient psychiatric facilities and promote a culture of safety. The QI project involved 27 participants, including inpatient psychiatric nurses and mental health counselors from Cahill 4 and 7 West units at the Cambridge Campus. The primary objective was to identify challenges that hindered the effective utilization of the Broset Violence Checklist (BVC) tool for referring patients to sensory modulation rooms.

Pre- and post-intervention surveys were conducted to assess participants' self-reported knowledge and barriers to BVC and sensory room utilization. Educational sessions covering workplace violence, debriefing techniques, and the …

Exploring & Mitigating Workplace Incivility At A Rural Community Hospital, Jacquelyn Ethier

DNP Scholarly Projects

Workplace Incivility (WI) is a well-known challenge in healthcare, with decades of mounting evidence showing the effects on workplace culture, healthcare worker retention and patient safety. The nursing workforce has become increasingly vulnerable to all stressful elements of the work environment. Organizational leadership must develop and deploy mitigation strategies to minimize the negative consequences of these behaviors for nurses, and the entire healthcare team. The purpose of this quality improvement project is to assess the current state of nurse perceptions of WI at a rural community hospital and deploy evidence-based education on strategies to address and mitigate WI. The method …