Medicine and Health Sciences Commons^™

Implementation Of A Screening, Brief Intervention, And Referral To Treatment Protocol For Treatment Of Opioid Use Disorder In Post-Carceral Populations, Adaora Ede, Mary Johnson

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

BACKGROUND: Opioid use disorder (OUD) is a pressing public health issue in the US affecting marginalized populations the most. Within the correctional setting, 65% of inmates are affected with OUD, worsening health outcomes when untreated.

LOCAL PROBLEM: This evidence-based practice (EBP) project targeted justice-involved individuals with co-occurring OUD at a behavioral health clinic in Johnson City, Tennessee. This project aimed to improve outcomes related to recidivism and relapse through clinician education and the implementation of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol.

METHODS: Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was the guiding EBP model for the …

Mindfulness-Based Educational Module For Nurses Caring For Pediatric Mental Health Patients, Brianna Mai Desjardins, Katherine Marie Newnam

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

BACKGROUND: Emergency pediatric nurses have the added stress of not only caring for medical patients but must also care for patients experiencing mental health issues. Many nurses feel unprepared to care for this specialized patient population. To bridge this gap, mindfulness-based interventions (MBIs) have been shown to provide nurses with the skills needed to care for mental health patients. This same concept can be applied to pediatric patients. Pediatric-focused mindfulness-based techniques can be used to help pediatric patients manage their symptoms.

LOCAL PROBLEM: The setting for this project was an urban pediatric emergency department in East Tennessee. At the state …

The Implementation Of Nurse Practitioner Residency Programs To Increase The Employment Retention Of New Graduates, Roni-Jo Panganiban

Master of Science in Nursing Family Nurse Practitioner

This review explores the effectiveness of Nurse Practitioner (NP) residency programs in addressing role strain, burnout, and retaining new graduates. It emphasizes the factors contributing to NP resignations and proposes formal residency programs to improve job satisfaction and retention rates. Research highlights benefits such as enhanced preparedness, credibility, and better patient care, advocating for increased program accessibility and funding. Additionally, the application of the theory of planned behavior underscores compliance with regulations, evidence-based practice, and environmental influences for patient safety in advanced practice registered nursing. The literature review on NP residency programs draws from six empirical articles, focusing on job …

Identifying Risk And Improving Outcomes: Application Of The Gad-7 Screening Tool Used Among Patients With Chronic Pain In An Outpatient Setting, Connor J. Cochran

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

Background: It is estimated that chronic pain affects one in every five adults and that one in every three adults will be diagnosed with an anxiety disorder within their lifetime, indicating an overlap in both chronic pain and anxiety. Early identification of anxiety in the outpatient setting has the potential to increase identification and referral rates to specialized care.

Local Problem: An outpatient primary care facility that treats patients with chronic pain located in Philadelphia, Pennsylvania was the project setting. Prior to implementation, there was no standard process for identifying anxiety in patients.

Methods: The Iowa model of Evidence-Based Practice …

The Effect Of Focused Client Education On Case Management & Readmission Rates In Homeless Individuals With Co-Occurring Disorders Admitted To A Jail Diversion Program, Pallavi Rao, Mary Johnson

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

Background: Individuals with both mental illness(es) (MI) and substance use disorder (SUD) occurring simultaneously are known as having co-occurring disorders (COD). The rates of COD found among homeless individuals (H-COD) are higher than in the general population. The presence of both conditions prevents H-COD individuals from overcoming their hardships and places them at a higher risk of being involved in the criminal justice system.

Local Problem: Jail diversion programs (JDPs) admit a high rate of H-COD clients nationally and locally at the project site in Knoxville (JDP-K). The Office on Homelessness reported about 80% of those admitted to JDP-K are …

The Effects Of Non-Pharmacological Interventions For Behavior And Psychological Symptoms Of Dementia: A Benchmark Study, Rachel R. Williams

MSN Capstone Projects

The management of behavioral and psychological symptoms of dementia (BPSD) in patients who reside in nursing homes can be challenging. These neuropsychiatric behaviors can include but are not limited to aggression, agitation, delirium, depression, and psychosis (Cloak & Al Khalili, 2022). Patients with BPSD often have difficulty expressing their needs due to the disease process, resulting in further complexity when managing behaviors. There are no psychotropic medications to treat BPSD specifically, but many are often prescribed to treat the symptoms or behaviors exhibited by patients. The use of psychotropics, especially long-term can cause a myriad of adverse effects and should …

Life Experiences Of First-Year College Students Who Resided With A Parent Experiencing Depression, Jasmine Olshin

Honors College

Depression is one of the most prevalent mental illnesses in the United States (US), and a significant number of depressed adults are parents to children who depend on them for care and nurturing. Research on parental depression (PD) focuses predominantly on its impacts on children and adolescents and has shown many negative outcomes as well as a predisposition to developing depression themselves. The literature on the impact of parental depression on young adults and college students is scant. Young adults (ages 18- 25) experience the highest rates of depression, and many of these individuals enter college where they are continuing …

Implementation Of A Protocol To Improve The Intake Assessment And Treatment With Suboxone Among Patients’ Dependent On Opioids On Two Mental Health Crisis Units, Maeghan Dillon

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: In 2021,106,699 people died from a drug overdose and of these deaths, over 75% were related to illicit or prescription opioids (Centers for Disease Control, 2023). At two in-patient community crisis stabilization units for psychiatric care, many patients have a comorbid diagnosis of a substance use disorder and another mental illness. Treatment with Buprenorphine/naloxone (Suboxone) is associated with decreased opioid overdoses and related deaths; however, Suboxone inductions have not been a part of admission treatment.

Methods: This quality improvement (QI) project initiated a Suboxone protocol for eligible patients on two crisis in-patient stabilization units. The outcomes …

Body Dysmorphia Screening Tool For Aesthetic Treatments, Brandi Harper

MSN Capstone Projects

This evidence-based project includes a discussion of Body Dysmorphic Disorder (BDD) or body image disturbance as part of pre-treatment screening in medical facilities providing appearance-altering procedures and aesthetic treatments to adult patients. The information provided serves as the foundation for endorsing the adoption of a BDD screening tool into clinical practice to increase the identification of body dysmorphia, thereby facilitating proper referral, diagnosis, and treatment to aid in patient safety and satisfaction and limit medico-legal imputations. The discussion presented here is supported by evidence-based research. It focuses on BDD prevalence and significance amongst adult patients and highlights validated screening tools …

Medication-Assisted Therapy And First Episode Psychosis: Evaluating Treatment And Readmission Rates: A Scoping Review, Whitney Nichole Trotter Ms, Bsn, Rdn/Ldn, Rn, Margaret Carrie Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background:

There is limited research aimed at addressing the reoccurrence of admission rates for first-episode psychosis. Research shows that early interventions for first-episode psychosis lead to remissions and prevention of relapses. Research also estimates that approximately one-half of first-episode clients have a history of cannabis abuse or dependence and one-third have a current cannabis use disorder (Wisdom et al., 2011). This study looks to determine whether Medication-assisted therapy (MAT) impacts readmission rates for patients who have substance use disorder and first-episode psychosis within six months of discharge.

Methods:

A comprehensive literature search was conducted using several electronic databases, including PubMed, …

Stop-Bang Questionnaire For Screening Obstructive Sleep Apnea Syndrome Among Hypertensive Patients In Kenya, Salim Abdallah, Jasmit Shah, Jumaa Bwika, Sayed Karar

Internal Medicine, East Africa

Introduction: Obstructive sleep apnea (OSA) is a type of breathing problem during sleep caused by the blockage of the upper airway, which can cause cessation of airflow. There is limited research on the prevalence of OSA in hypertensive patients in sub-Saharan Africa (SSA). The study aimed to describe the prevalence and clinical characteristics of OSA among hypertensive patients at a tertiary hospital in Nairobi, Kenya.

Methods: This cross-sectional study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. Two hundred and fifty-one hypertensive patients were screened for OSA risk using the STOP-Bang questionnaire (SBQ). Patients with a SBQ …

How Nurses Perceive Their Task Load When Caring For Behavioral Mental Health Patients In The Pediatric Emergency Department, Emily Cameron, Robert Cornette

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

Abstract

Introduction: Pediatric behavioral mental health patients are being seen more frequently in the emergency department setting. With this ever-growing number of cases comes the need for trained staff, including registered nurses, to care for these children during a mental health crisis. With this increase comes increased stress of nurses’ workload. The purpose of this project was to identify nurses’ perceptions of their workload when completing three identified tasks: communication, procedures, and initial intakes. Methods: The National Aeronautics and Space Administration (NASA) Task Load Index tool was used to measure nurses’ perceptions of how difficult each task was to complete. …

Effectiveness Of An Evidenced-Based Cognitive Behavioral Therapy Intervention For Adolescents In A School Setting, Sarah Ellen Gray, Kimberly Michaela Carter, Amanda Harper

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

Abstract

The adolescent years are a formative time when rapid hormonal and physical changes stimulate the developing mind. Exposure to poverty, abuse, violence, and lack of peer and social support causes an increase in vulnerability to the development of mental health problems. The COVID-19 pandemic has also exacerbated symptoms of depression and anxiety. Regardless of the risk factors, anxiety and depression continue to be significant health problems, affecting thousands of adolescents yearly in the United States. The first-line treatment recommendation for managing anxiety and depression symptoms is cognitive behavioral therapy (CBT). However, access to a provider for CBT treatment is …

Implementation Of A Peer Mentoring-Network Initiative In Outpatient Psychiatry To Improve Psychiatric Advanced Practice Nurses' Job Satisfaction, Maria Romanoff Rand

Doctor of Nursing Practice Scholarly Projects

Background: Post-pandemic rates of mental illness have increased, resulting in a rise in demand for psychiatric services. At the same time, a growing shortage of psychiatric providers is occurring. This combination has given rise to an expanding mental health crisis where strengthening and stabilizing the psychiatric workforce is paramount. Psychiatric Advanced Practice Nurses are uniquely qualified to staff this shortage. Therefore, positive job satisfaction for Psychiatric Advanced Practice Nurses is vital to increase and retain psychiatric healthcare providers available to address this critical need for mental health services.

Methods: At the project site, the shift to telehealth, changing leadership, and …

Bi-Weekly Follow-Up Of Adult Patients Diagnosed With Schizophrenia To Increase Treatment Adherence: A Scoping Review, Garrett L. Seaton, Bsn, Rn, Michelle A. Conteh, Bsn, Rn, Shelia L. Jackson, Msn, Bsn, Rn, Sharon H. Little, Dnp, Fnp-Bc, Aprn

Doctor of Nursing Practice Projects

Purpose/Background

Schizophrenia is a complex psychiatric disorder that can significantly affect a patient’s psychological state. Because of this, medication nonadherence is reported as one of the most common causes of relapse and rehospitalization in patients diagnosed with schizophrenia. Although long-acting injectable (LAI) antipsychotics can help provide more continuous treatment, they do not address other factors that affect treatment adherence. This scoping review will evaluate existing literature to assess if a multimodal approach, such as increased patient follow-ups in addition to scheduled, current-practice LAI treatment and management, may increase treatment adherence in adult patients diagnosed with schizophrenia.

Methods

A database search …

Suicide Screening Among Adolescents With A History Of Mental Or Physical Abuse- Evaluating The Effectiveness Of Suicide Screening: A Scoping Review, Tiffany Nicole Jackson Bsn, Rn, Cody Tyler Cottrell Bsn, Rn, Allison Tucker Mcculley Bsn, Rn, Cen, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose The purpose of this scoping review is to gather evidence on best practice for the administration of pediatric suicide screening in a variety of healthcare settings.

Long-Acting Injectable Antipsychotics Vs. Oral Antipsychotics In Treatment Adherence: Efficacy And Equity Of Care, Jason P. Peter Msn, Aprn, Fnp-Bc, Ashley F. Walker Bsn, Rn, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Summary

Background: Compliance with oral antipsychotic medications (OAP) in the treatment of patients with schizophrenia has been a challenge. Challenges to OAP include medication side effects, lack of ability to obtain medications, and missing doses, among other factors. As a result of this non-compliance, those taking oral antipsychotic medication are at greater risk for exacerbation of their illness. The consequence of relapse carries considerable risks with each psychotic event. The study aims to compare if medication treatment adherence is greater in clients with schizophrenia using oral antipsychotics (OAPs) vs. long-acting injectable (LAI) antipsychotic medications.

Methods: In this scoping review, 15 …

Telehealth By Certified Psychiatric Providers Compared To Emergency Department Healthcare Providers On Psychiatric Patient Outcomes: A Scoping Review, Lekisha C. Pride, Taylor B. Bradley, Michelle R. Porter, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Emergency department visits for mental health disorders have increased over the years due to insufficient mental health resources. The number of ED visits for mental health disorders rose from 1.4 to 2.5 million per year in the US. Therefore, mental health patients being seen by ED physicians are more likely to have longer lengths of stay, an increase in hospital admission, and high recidivism rates. Purpose: In this scoping review, we wanted to determine the role of telehealth on ED mental health patients. outcomes regarding how telehealth can reduce the number of admissions, length of stay in the ED, …

Creation And Implementation Of A Trauma-Informed Care Safety Tool In An Inpatient Mental Health Unit, Katie Rhea, Jeremy Williams, Teresa Rangel

Articles, Abstracts, and Reports

No abstract provided.

Evaluating The Efficacy Of Medication-Assisted Treatment For First Episode Psychosis: A Scoping Review, Chanel Thomas Msn, Aprn, Fnp-Bc, Rn-Bc, Alexandra Wittenberg Bsn, Rn-Bc, Anttrenika Anderson Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that individuals with substance use disorder (SUD) receive medicated-assisted treatment (MAT), as a complete approach to substance use treatment (SAMHSA, 2019). However, treatment measures using combination treatment for SUD in individuals experiencing first episode psychosis (FEP) are seldom used. This scoping review assesses the efficacy of MAT in conjunction with antipsychotics compared to the use of antipsychotic monotherapy for FEP individuals on hospital readmission rates.

Methods

The authors conducted a literature review utilizing PubMed, EBSCO, Elsevier, Google Scholar, PsychINFO, and Medline from August 2020 to November 2022. Key phrases …

Child Abuse From A Nursing Perspective: Assessment And Implications, Ashtyn Spring

Senior Honors Theses

Nurses experience the relationship dynamics between pediatric patients and their families firsthand. Being informed by the goals of holistic care, nurses should be assessing for unhealthy dynamics among pediatric patients and their caregivers so they can respond appropriately when a potential for abuse is present. Healthcare workers have the duty to provide safety and healing to their patients. Through the unique contact nurses have with patients, their training for accurate assessment skills, and their responsibility as healthcare workers, nurses are placed with the opportunity to help children out of abusive situations. Prompt identification of the potential for abuse can prevent …

Nursing Care Of Family Caregivers: Interventions And Considerations Regarding Current Issues Facing Family Caregivers Of Persons With Dementia Relevant To Nursing Practice, Alayna Kent

Senior Honors Theses

There are an estimated 6.5 million Americans age 65 and older who are currently living with Alzheimer’s dementia. A large majority of these individuals receive care from a nonprofessional family caregiver, typically in the home setting. It is well documented that family caregivers of dementia patients experience many unique challenges. These challenges provide valuable opportunities for nurses to provide helpful interventions to aid this vulnerable population. An integrated review of the recent literature was conducted, and articles were chosen by a method modeled after the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowsheet. The research was then analyzed …

Dnp Final Report: Conquering Rn Turnover: Implementing Flexible Scheduling To Improve Job Satisfaction, Camille Y. Parsee

DNP Final Reports

Nurse turnover is a complex problem for the nursing profession, especially in the behavioral health setting, where turnover rates are higher than the overall RN national average. The consequences of high nurse turnover include increased health costs, low-quality patient care, and staffing constraints. The association between nurse turnover and job satisfaction is profound because of their reciprocal relationship; therefore, implementing an intervention to help mitigate nurse dissatisfaction is essential to overcoming nurse turnover. Flexible scheduling is an intervention that gives nurses independence with their schedule which improves work-life balance and promotes nurse retention (Wright, 2017). The following PICOT question was …

Effects Of Emotional Support Animals On Adults With Depression And/Or Anxiety, Ileana Adams, Victoria Cline, Breanne Oakes, John M. White

Non-Thesis Student Work

Through understanding the role of emotional support animals and the effect their utilization has on mental health outcomes, a review of the literature was used to explore the following evidence-based PICOT question: In adults diagnosed with anxiety and depression, what effects do emotional support animals have on symptoms compared to individuals without emotional support animals? Although mental health disorders and their clinical manifestations are largely controlled by medication, non-pharmacological therapies are often used in cohesion. Emotional support animals offer a more holistic approach to symptom management and provide companionship to those suffering from symptoms of anxiety and depression. We performed …

Bibliography, Kim Link

Faculty/Staff Personal Papers

Bibliography of publications by Kim Link.

Covid-19 And Eating Disorders: How Covid-19 Increased The Prevalence And Severity Of Eating Disorders, And The Lasting Implications, Lucy Rogers

Mahurin Honors College Capstone Experience/Thesis Projects

COVID-19 brought on a whirlwind of changes that were impossible to have foreseen. The impacts on individuals have left lasting impressions, the natures of which continue to be unearthed even now- 4 years later. This thesis will outline the impacts of COVID-19 on those suffering from eating disorders and disordered eating habits, as well as ideas for how to support and care for these individuals through their continued hardships which have been set in motion by the pandemic.

The research conducted on this topic utilized peer reviewed articles found through databases such as CINAHL, PubMed, and Cochrane Library. The findings …

A Lifestyle Management Coaching Intervention For Fear Of Cancer Recurrence In Young Breast Cancer Survivors, Lisa R. Murphy

DNP Research Projects

Abstract

Objective: A significant challenge facing young breast cancer (BC) survivors is learning how to manage fear of cancer recurrence (FCR) during survivorship. Limited tailored FCR interventions and age-appropriate support exist. This Doctor of Nursing (DNP) project, based upon best practice guidelines, aimed to evaluate how a Lifestyle Management Coaching Intervention (LMCI) could help young female BC survivors learn how to decrease and manage their FCR more effectively and experience improved health outcomes.

Method: Eligible participants were female BC survivors aged 18-59 with Stage I-III BC demonstrating elevated baseline FCR screening scores during the extended survival period recruited from the …

Effectiveness Of Non-Pharmacological Interventions In Managing Inpatient Dementia, Jester West, Maddie Faulkner

Non-Thesis Student Work

When caring for dementia patients as inpatients at the hospital, the methods by which you treat the patient and manage their symptoms are varied. Often there are two methods of treating exacerbations and agitation: pharmacological and non-pharmacological. This literature review sought to examine the effect of including supplemental non-pharmacological techniques in managing inpatient dementia related behaviors. A literature search was conducted using CINAHL and NRCP using the following terms: inpait*, dement*, alzehei*, nonpharm*, interventions. Initial results resulted in 15 articles. After review, results were filtered to be within the past six years and a total of 12 articles met inclusion …