Medicine and Health Sciences Commons^™

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Psychological Distress During The Covid-19 Pandemic In Nursing Students: A Mixed Methods Study, Mayantoinette Watson

Dissertations

During such an unprecedented time of the largest public health crisis, the COVID-19 pandemic, nursing students are of the utmost concern regarding their psychological and physical well-being. Questions are emerging and circulating about what will happen to the nursing students and the long-term effects of the pandemic, especially now that hospitals are being overwhelmed with COVID-19 cases and patients as well as a significant need for nursing staff (Jividen, 2020). Expectations, demands, change, and the fear of the unknown during this unprecedented time can only contribute to the many stressors that accompany nursing students through laborious clinical and didactic courses …

Change Project Using A Fall Prevention Action Program To Decrease Falls On A Behavioral Health Unit, Amy Shuptrine

Student Scholarly Projects

Practice Problem: Fall rates are increasing in the behavioral health units of the East Texas hospital. Due to the worldwide COVID-19 pandemic, the units are short-staffed, which further supports the urgent need for a targeted intervention to reduce fall risk.

PICOT: The PICOT question that guided this project was: “In adult behavioral health patients (P), what is the effect of the Edmonson Psychiatric Fall Risk Assessment Tool (I), compared with previous use of the Morse Fall Risk tool (C), on the fall rate (O), in 8 weeks (T)?”

Evidence: Falls are the most reported incidents in acute care hospitals and …

Providing Resources To Caregivers Of Pediatric Mentally Ill Clients And Assessing For Caregiver Burden, Stacy Dee

Doctor of Nursing Practice

Background. Provision of educational and supportive resources to the caregivers of children with mental illness can help create an environment of advocacy and understanding between the child, caregiver, and provider. In depth and comprehensive learning about their child’s mental illness cannot be accomplished in a one-hour new patient appointment or established patient appointment of 20 minutes. Purpose. The purpose of this practice improvement project was to facilitate educational and community support for caregivers of pediatric clients with mental illness and evaluate if caregivers require additional support due to burden. Objectives. (a) 100% of caregivers of pediatric clients who have appointments …

Depression Screening Upon Admission At An Addiction Facility: A Quality Improvement Project, Eric Aniekwena

Doctor of Nursing Practice

More than one in six Americans will have a diagnosis of a substance use disorder at some time in their life. According to the National Institute on Drug Abuse (2020), those with a substance use disorder will have an increased rate of having a comorbidity of depression or depression symptoms during treatment, leading to poorer outcomes. The purpose of this quality improvement project was to increase provider and staff adherence to the treatment standards outlined in the Veteran’s Affair/Department of Defense Clinical Practice Guideline for the Management of Major Depressive Disorder (Veteran’s Affairs/Department of Defense, 2016). During this 10-week process, …

Implementation Of An Interprofessional Fall Prevention Program To Reduce Falls On An Older Adult Inpatient Psychiatric Unit, Teresa Woodson

Doctor of Nursing Practice

Background. Falls are the most reported incidents in the hospital setting, especially among older adults. According to the National Database of Nursing Quality Indicators (NDNQI), the number of falls in inpatient psychiatric units is 13-25 per 1,000 patient days, compared to 4 per 1,000 days for medical-surgical units. This DNP project aims to implement an interprofessional fall risk team to reduce falls in an older adult inpatient psychiatric unit. Problem. The psychiatric inpatient units had a total of 31 falls, with 13 (40%) occurring on the older adult unit. Interventions. Education of nursing staff, providers, and physical therapy (PT) …

Implementing Evidence-Based Treatment Of Patients With Opioid Use Disorder In An Inpatient Addiction Treatment Center, Emily Ashley

Doctor of Nursing Practice

Patients with opioid use disorder are at increased risk for overdose and death should they relapse due to reduced opioid tolerance after a period of abstinence. A retrospective chart review was performed at an inpatient drug and alcohol treatment center to identify areas in need of improvement. The global aim of this project was to promote patient adherence to treatment, as well as increase the prevention of patient overdose and death after inpatient treatment. Project objectives include improving provider management of opioid use disorder through standardizing patient education, increasing prescription of relapse prevention medication, initiating prescription of naloxone at discharge …

Implementing An Evidence-Based Practice Change For Alcohol Withdrawal In An Acute Care Hospital, Theresa Carroll

Student Scholarly Projects

Practice Problem: Alcohol Use Disorders (AUD) affects a significant portion of the population in the United States. When AUD is either unrecognized or inadequately treated in the acute care setting it can lead to medical complications, increased length or stay (LOS), increased healthcare expense, and increased patient mortality.

PICOT: In a population of adult patients admitted to an acute care hospital progressive care unit (P), how does applying an initial evidence-based screening tool to detect risk for moderate to severe alcohol withdrawal, the PAWSS (I), compare to no standard screening or assessment for potential alcohol withdrawal symptoms (C) affect the …

Reducing The Potential For Physical Harm In Student Nurses Caring For Clients Who Are Under The Influence, Hunter William Halford

Electronic Theses and Dissertations

This DNP project was conducted to identify gaps in knowledge and adequate preparation of nursing students in safely caring for a client who is behaving violently and is under the influence of illicit drugs. Student nurses are trained using a generalist approach, meaning they are taught the essentials of a variety of topics. It is not until these students enter the workforce that they are trained specifically for a certain position. Currently, the curriculum does not address specific measures to maintain client and personal safety. It is an almost unavoidable fact that a nurse will encounter a violent client or …

Benzodiazepine Reduction Program In A Psychiatric Mental Health Setting, Tracy Pacini

Dissertations

Benzodiazepine Reduction Program in a Psychiatric Mental Health Setting

The purpose of this pilot project was to reduce side effects and adverse effects of long-term benzodiazepines (BZDs) use in a non-profit community health center. This was a quality improvement project. The evidence-based practice (EBP) framework identified for the project was from the Institute for Healthcare Improvement (IHI) Plan-Do-Study-Act (PDSA) framework to decrease BZD use in a non-profit community health center. This model is focused on four stages: 1) gathering a proactive healthcare team to examine and identify solutions to reduce BZD usage, 2) testing the pilot program that the team …

Social Anxiety Screening And Associated Factors Among University Students, Kathleen Prendergast

Seton Hall University Dissertations and Theses (ETDs)

Social anxiety is a type of anxiety triggered by social situations whereby the individual feels scrutinized by others, and which may contribute to avoidance of certain situations. This avoidance can interfere with personal, academic, and career endeavors. Cognitive behavioral therapy can help manage social anxiety. However, social anxiety is often underrecognized and
under treated. A survey with the Liebowitz Social Anxiety Scale (LSAS) was disseminated to identify and address this need among students in a large Northeastern university in the United States. The study is valuable as a pilot study. There was a small response rate for participation in the …

The Effect Of Postpartum Depression Screening Education For Postpartum Nurses, Shecarra S. Cook

Electronic Theses and Dissertations

Depression affects about 13% of pregnant women and about 10% of women after childbirth. Some cases are so severe, the mother may even commit suicide. If left untreated, postpartum depression (PPD) affects both the mother’s and the infant’s health as well as their quality of life. The gap in clinical practice is that currently, patients only complete a postpartum depression screening tool during their 6-week follow-up appointment with their OB/GYN, leaving a gap in PPD detection and care during the immediate postpartum period. Postpartum nurses are not usually given specialized training in postpartum depression. The purpose of this study was …

The Discursive Construction Of Substance Use And Harm Reduction In Canadian Health Policy, Sibel Kusdemir

Electronic Thesis and Dissertation Repository

Harm reduction as a philosophy has been widely recognized by healthcare professionals in Canada, yet the topic remains controversial in both political and public discourses. Understanding these discourses will allow health care providers to better respond to political and public concerns, as well as ensuring that services are aligned well with public health needs. This study explored the discursive use of the term “harm reduction” in Canadian health care and nursing policy documents’ contexts by using a Foucauldian framework and Bacchi’s ‘what’s the problem represented to be?’ approach. I propose three discursive themes: self-responsible citizen, evidenced-based practice, and what nurses …

Mindfulness-Based Cognitive Therapy Staff Training Program To Tackle Postpartum Depression, Helen Xumin Chen

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Women in the process of childbirth go through significant physical and psychological changes. The internal changes along with other external factors can be overwhelming. There is a high rate of new mothers suffering from postpartum depression (PPD) as a result. Problem: High prevalence of PPD is a public health crisis. The condition has a negative impact on the mother-baby unit and the wellbeing of the whole family. Aside from the implications on the health of new mothers and babies, PPD is also costly to the economy. Methods: Mindfulness-Based Cognitive Therapy (MBCT) is a common and effective intervention for …

Distress Evaluation During Chemotherapy: The Real-Time Assessment Strategies For Oncology Nurses Among Asian Population In Outpatient Clinics, Ying Huang

DNP Qualifying Manuscripts

Background: Routine oncology visits failed to identify 50-94% of patient’s distress, which creates a considerable burden, impairs emotional well-being and reduces patients’ quality of life. Limited in-person visits during the COVID-19 pandemic have reduced access to care for many patients, further adding to their emotional distress. Untreated distress also leads to elevated stress levels, systemic inflammation, non-compliance with treatment, and higher mortality rates. Early distress screening and multidisciplinary care are recommended to reduce the impacts of distress.

Objectives: To identify the best outpatient practices to address newly diagnosed cancer patients’ unique needs due to distress.

Methods: Databases searched including CINAHL® …

Delirium, Angela Lee

Nursing Student Class Projects (Formerly MSN)

Delirium is a severe neurocognitive syndrome characterized by acute changes in consciousness and cognition (American Psychiatric Association, 2013; Wilson et al., 2020). The syndrome is found to be prevalent within the adult intensive care population resulting from various triggers and stressors in the critical care setting (Wilson et al., 2020). On average, the prevalence of delirium is 23%, but the incidence significantly increases to 50-70% in mechanically ventilated patients (Wilson et al., 2020). As a result of the extension of cognitive deficits, if left untreated, delirium may lead to long-term impairments in cognitive disfunction (Wilson et al., 2020). Current studies …

"Program Evaluation On The Use Of The Screening, Brief Intervention And Referral To Treatment (Sbirt) Process In Primary Care Physician Offices", Lisa Sanchez-Navarro

Doctor of Nursing Practice (DNP) Manuscripts

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an early screening intervention tool for individuals with non-dependent substance use, which is employed to identify and provide care before a patient needs extensive specialized treatment. SBIRT can be used in primary care settings, to methodically screen individuals who might not seek help for a substance use issue (Centers for Medicare & Medicaid Services, [CMS], 2020). Gaps in using the SBIRT screening process were identified within the insurance organization’s PCP practices, therefore, a program evaluation was completed to: (a) determine whether Primary Care Physicians (PCPs) were using the SBIRT process, (b) …

Reducing The Incidence Of Compassion Fatigue In Obstetrical Nurses, Naveen Samuel

Student Scholarly Projects

Practice Problem: Compassion fatigue is a growing problem that can affect 21% to 39% of nurses who work in hospital settings (Berger et al., 2015). Compassion fatigue has been further exacerbated due to the COVID-19 pandemic. Compassion fatigue negatively impacts the nurses in profound physical and emotional ways.

PICOT: The PICOT question that guided this project was: For obstetrical nurses working in a nonprofit organization, what is the effect of a compassion fatigue program, compared with no program, on nurses in reducing compassion fatigue after two months?

Evidence: Current evidence shows that mindfulness decreases compassion fatigue and increases compassion …

Impact Of Social Isolation In Hiv-Positive Individuals During A Pandemic, Corina Jane Bakoylis

Dissertations

Problem: The global pandemic of COVID-19 caused concern for immunocompromised individuals. The purpose of this quality improvement initiative was to assess the impact of social isolation on feelings of loneliness, depression, and social isolation experiences in HIV-positive individuals residing in a long-term care facility.

Methods: A mixed-method convergent design with a purposeful sample of HIV-positive adult residents residing in a long-term care facility was utilized. An evaluation of loneliness using the University of California Los Angeles (UCLA) Loneliness Scale (Version 3) and depression using the Patient Health Questionnaire-8 (PHQ-8) were completed. Personal experiences were also assessed with five predetermined open-ended …

Evaluation Of Depression, Anxiety And Stress In Graduate Nursing Students, Rachel Dunston

Dissertations

Mental health issues are growing in the United States. Postgraduate school is widely known to increase the level of psychological difficulties (Dyrbye et al., 2006) experienced by students. There is a need to address mental health care in graduate nursing students. This project was a descriptive observational comparison pre-post-intervention design used to see if online modes of delivery would aid in decreasing mental health issues for nursing graduate students. Participants were provided with access to three podcasts and encouraged to use the Sanvello mobile application provided to all students at this university. The first podcast focused on using the Sanvello …

Identification Of Veterans Experiencing Symptoms Of Mental Illness For The First Time After Covid-19 Diagnosis, Brittania Phillips

Dissertations

There has been a general increase in psychiatric symptoms since the COVID-19 pandemic began. Literature that has been published since the start of the pandemic has indicated there is an increased risk of depression, insomnia, altered mental status, new-onset psychosis, neurocognitive syndrome, and anxiety. The military veteran population is at higher risk for psychiatric illness than the general population, and should be screened accordingly. This quality improvement project was developed in collaboration with the mental health clinic at urban medical center in the Midwest to identify new symptoms of mental illness after COVID-19 diagnosis utilizing the PDSA model and descriptive …

Evaluation Of A Dirfloortime® Program For Autism Spectrum Disorder, Jennifer L. Pipitone

Dissertations

Problem. Parents with children who have neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) experience high levels of parenting stress. The prevalence of ASD is on the rise in the United States. As a result, there has been an increase in the use of treatment modalities, in effort to better understand which modalities have the most positive impact on children and their parents. DIRFloortime® is a developmental treatment modality used to help strengthen the parent-child bond and used to decrease parental-child stress. The Autism Parenting Stress Index (APSI) measures the impact of an intervention …

Intimate Partner Violence Education For High School Students, Morgan Foster

Dissertations

Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.

Methods An educational lesson plan for IPV was created for high school teachers.

Results …

Improving Suicide Risk Assessment Through Educational Program Implementation, Timothy Booth

Doctor of Nursing Practice Projects

Background: Unsustainable behavioral health education focused on comprehensive suicide risk assessment performance contributes to decreased registered nurses’ perceived self-efficacy in assessing and caring for suicidal patients.

Purpose: To educate medical-surgical and progressive care registered nurses in assessing patients for suicide risk factors and warning signs comprehensively.

Design Method: A quasi-experimental designed quality improvement project with evidence-based suicide educational program implementation. Project results yielded a 56.7% increase in registered nurses’ perceived self-efficacy in assessing and caring for suicidal patients. Future DNP work will focus on sampling a larger population (N) to decrease opportunities for the skewness of project results …

Balancing Provider Stress And Resilience In The Time Of Covid, Zachary Love

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project is to improve secondary traumatic stress (STS), compassion satisfaction, and burnout amongst providers—physicians, residents, and nurse practitioners—within the acute psychiatry units of the La Jolla Veterans Health Administration (VHA) through a one-time educational training session.

Background: Mental health providers at the VHA acute psychiatry units experience one of the highest risks for the development of STS, CF, and burnout amongst all professions due to a number of individual and institutional factors. STS is characterized by secondhand traumatization with symptoms similar to that of Post-Traumatic Stress Disorder—difficulty sleeping, mood changes, upsetting images appearing …

Developing A Culturally Relevant Mental Health Assessment For Persons Of African Descent, Roberta Iyamu

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Persons of African descent have lower access to mental health care, are less likely to receive needed care, and are more likely to be misdiagnosed, experience severe disease, and to receive mental health care through primary care than non-Hispanic Whites. Context: Cultural norms related to mental health as well as the lack of culturally congruent health care delivery contribute to lower mental health care access and uptake among persons of African descent. Interventions: Campinha-Bacote’s cultural competence model and the BATHE technique provided the theoretical framework for the development and implementation of a nurse practitioner (NP) (n = 4) …

Neonatal Abstinence Syndrome Nonpharmacological Intervention Education For Healthcare Professionals Caring For Newborns, Darby Harvey

Doctor of Nursing Practice Scholarly Project

Neonatal abstinence syndrome has increased significantly in the United States over the past few decades due to the increase of maternal substance abuse. The overall goal of caring for these infants is effective management of the withdrawal symptoms, including both pharmacological and nonpharmacological interventions. However, nonpharmacological interventions have been shown to improve infant outcomes and reduce length of hospitalization. This project sought to increase healthcare professionals’ knowledge and confidence regarding neonatal abstinence syndrome and the utilization of nonpharmacological interventions when caring for infants diagnosed with neonatal abstinence syndrome through the provision of an educational presentation. This study utilized a one-group …

Caring Calls: A Weekly Phone Call Intervention And The Correlation With Loneliness In Rural Dwelling Adults, Abigail Jumbeck, Jennifer Timm, Mieca Valen, Chris Malone

Nursing DNP Projects

Purpose: This pilot study’s aim was to examine the impact of weekly phone calls from interprofessional students on loneliness in rural dwelling adults.

Design: A pretest and posttest quasi-experimental design was utilized.

Setting: The intervention was based in southeastern Minnesota, although the participants could have lived anywhere. Zoom for Healthcare © was utilized, and students were able to make the phone calls from their homes, therefore, no travel was necessary.

Subjects: The subjects were rural dwelling adults (over the age 18 years old).

Intervention: Interprofessional students made weekly social phone calls to rural dwelling adults over ten weeks.

Measures: The …