Honoring Veterans’ Wishes: Efficacy Of An Evidence-Based Shared Decision-Making Tool In Va Icu Goals-Of-Care Discussions, Stephanie Alexander, Anna Astashchanka Md, Venktesh Ramnath Md

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: This Doctor of Nursing Practice project aimed to enhance the knowledge and confidence of the San Diego Veterans Health Administration’s (VASD) Intensive Care Unit (ICU) medical providers in goals-of-care discussions (GOCD). Additionally, this project aimed to improve the documentation of these discussions.

Background: Delays in GOCD can lead to futile medical and surgical interventions, inappropriate antibiotic use, and higher rates of mental health conditions in patients and their loved ones. Earlier GOCD are associated with lower ventilation and resuscitation rates, earlier hospice enrollment, reduced ICU admissions, lower financial costs, and better patient and caregiver quality of life. However, …

Improving The Utilization Of Lunch Breaks For Nursing Staff, Norma Dawson, Kelsey Robinson, Bridget Miller, Deborah Monck, Beth Kessler

Operations Transformation

The Med-Surg Unit at LincolnHealth has a high number of nursing staff missing lunch breaks, despite encouragement and existing efforts to promote taking breaks. In addition, there are many instances where staff are not accounting for the breaks they have taken on their time sheets.

Mainehealth Cancer Care Network Ticket Intake Process, Lauren Couture, Brett Cropp, Gavin Carr, Ashok Kunche, Heather Boulier, Evelyn Taylor

Operations Transformation

The MaineHealth Cancer Care Network informatics team is manually submitting most reporting tickets for oncology customers. The current intake ticket process includes various communication channels to the business intelligence developers [BID] when a reporting need is identified resulting in workflow deficiencies and redundancies. As of FY23, MaineHealth has moved to a new ticket reporting system called ServiceHub which includes new customer self-service tools that have not yet been utilized.

Creating Capacity To Accommodate Additional Cardiac Catheterization Procedures, Kristin Anthony

Operations Transformation

Patient access to diagnostic outpatient (OP) cardiac catheterization is limited by a perceived lack of capacity. Outpatient cardiac cath pts flow through the ACU for pre/post procedure care. Current schedule limits pts that may be scheduled through the ACU to two OP procedures/day. Cardiologists request the ability to schedule beyond the two procedures/day allowed. Significant variation in pre/postoperative care orders exist amongst cardiologists resulting in variability in length of stay. Cardiac procedures are booked either as 60/90/120 minutes – Epic case averaging technology is not active in the cath lab. As a result, the case minutes in the cath lab …

Key Performance Indicator (Kpi) Development Pathway, Christopher Lloyd, Amy Giles, David Spaulding, Sarah Rines

Operations Transformation

In Q1 FY24 as more team members started to take Operational Excellence classes and subsequently become more engaged in quality improvement it was observed there was much enthusiasm but also some gaps in the understanding of available tools, resources, data collection strategies, and what elevates something to a KPI, etc. There is a need to create a guide that supported gaps, streamlined tracking process, and aligned teams in this new approach.

Enhancing Peripartum Care Through Standardized Nurse Knowledge Exchange, Gabriela Ochoa

Master's Projects and Capstones

Problem Inconsistent handoff practices during patient transfers can cause mistakes and adverse outcomes. Hospital A's peripartum unit has no set policy for Nurse Knowledge Exchange (NKE) during transfers. This project will introduce a standard handoff guide to enhance communication and prevent harmful results after patient transfers.

Context The quality improvement project was conducted in a peripartum mesosystem within an urban hospital in Northern California. This specific area of the hospital comprised 21 postpartum rooms and nine laboring rooms.

Intervention The project involved a methodical strategy that encompassed engaging stakeholders, conducting a literature review, and analyzing data to pinpoint areas for …

Implementation Of Lymphedema Education Toolkit For Nurse Coordinators, Heather Gee

Master's Projects and Capstones

Problem: Lymphedema is a chronic condition that develops secondary to cancer treatments such as chemotherapy, radiation, and surgical removal of affected lymph nodes. This swelling in patient’s limbs can cause discomfort and limit mobility, however lymphedema is often not detected until later stages, delaying treatment and patient education.

Context: This quality improvement project was conducted at Hospital S Women’s Cancer Center, an outpatient center specializing in advanced treatments for breast and gynecological cancers. This center has a multidisciplinary team focusing on both the medical and surgical aspects of oncology treatment.

Interventions: An evidence-based lymphedema education toolkit was created for nurse …

Approach To Pivie In Pediatrics: Standardization For Early Detection, Jamie Green, Jill Gregory, Elizabeth Murphy, Jessica Miller, Nicole Manchester, Frank Harris, Meaghan Wildes, Cecilia Inman, Jenn Paradis, Faye Weir

Operations Transformation

PIVIE (Peripheral Intravenous Infiltration & Extravasation) can have devastating effects, especially in the pediatric population. The condition may disrupt vasculature severe enough for permanent skin and tissue loss that can lead to impaired limb function due to severe scarring. Problem: No standardized process existed either to prevent or review these events at Barbara Bush Children’s Hospital at Maine Medical Center prior to the study. PIVIEs were measured through the event reporting platform and only severe PIVIEs were being documented in this report. All infiltrations (1-4 on the infiltration scale) should be measured for accurate benchmarking. Occurrences in the electronic medical …

Transition To Adult Care For Bleeding Disorders: Building A Multidisciplinary Tool, Leslie Larson, Ekaterina Funk, Dana Grass, Felicia Munster, Eric Larsen, Louise Baca, Glen Roy, Sara Artinyan

Operations Transformation

Youth with chronic illnesses often have poorer health outcomes after transitioning to adult care. Maine Health Bleeding Disorders is a Health Resources and Services Administration (HRSA) grant funded Hemophilia Treatment Center (HTC) that serves patients with congenital bleeding disorders. We provide multidisciplinary specialty care throughout the lifespan which includes pediatric and adult hematologists, family nurse practitioners, nurses, physical therapists, social worker, dietitian, genetic counselor, and research coordinator. In 2022, HRSA mandated all federally funded HTCs increase by 25 percent from baseline the number of individuals ages 12 to 26 years seen in a comprehensive clinic that have a health care …

Increasing Palliative Care Team Involvement In Pediatric Hematopoietic Stem Cell Transplant Patients, Meagan Vacek, Lisa Tarbell, Melissa List, Erin Hall, Jennifer Linebarger, Kelstan Ellis, Gina Jones, Joel Thompson

Research Days

Early implementation of palliative care in pediatric oncology is well established but its role in pediatric hematopoietic stem cell transplant (HSCT) patients is yet to be fully determined. Multiple organizations encourage palliative care involvement in HSCT patients. Our aim was to increase palliative care team consults for patients receiving HSCT for our targeted diagnosis. Though we did not achieve this aim, we were able to increase the palliative care team's involvement in the total cohort of patients undergoing HSCT.

Provider Use And Comfortability With Standardized Mental Health Screeners At The Center For The Urban Child, Elisa Vengalil, Yehudit Yuhjtman, Riley Weidle Babich, Shelby Shajimon, Jordan S. Wilson, Prayag Shah, Renee Moore, Noah Buboltz

St. Chris Research Day

No abstract provided.

Bilateral Corneal Perforations Due To Elder Neglect, Jaclyn Jordan, Katherine Selman, Richard Byrne

Journal of Geriatric Emergency Medicine

Introduction: Atraumatic corneal melting and perforation is a rare etiology of eye pain and visual loss in the Emergency Department (ED), and xerophthalmia from vitamin A deficiency is primarily described as a cause of blindness in pediatric patients.

Case: A 68-year-old female presented to the ED with worsening eye pain and months of clouding and vision loss. History was limited by cognitive impairment and was provided by spouse. On exam, she was found to have a body mass index of 13.7 kg/m², dry mucous membranes, purulent discharge from both eyes, and opacification and erosion of both corneas. She …

Institutional Pilot Changes Lead To A Reduction In Emergency Department Boarding Patients, Rohan Akhouri, Jennifer Watts, Christopher S. Kennedy, Kelly A. Sinclair, Bethany Bolt, Ashley Daly

Research Days

Background: Crowding and boarding pediatric emergency departments (ED) is an ongoing problem associated with a mismatch in resources and patient care demands. ED boarding can be defined as a patient admitted to an inpatient unit who remains in the ED. ED boarding occurs when there is limited availability of inpatient bed space – either due to patient volume or decreased staffing. ED boarding is associated with adverse events, and increased mortality. Few studies address the impact of inpatient strategies on ED boarding. The objective of our study was to evaluate hospital-based strategies within a single institution and their effect on …

Dnp Final Report: Effects Of Open-Access Scheduling On Patient No-Show Rates In An Outpatient Clinic, Maria Aileen A. Wilkinson Msn, Mba, Rn

DNP Final Reports

No-show rates in a South Texas outpatient clinic have been as high as 16% to 20% which increases wait times to be seen in the clinic and decreases patient access to outpatient care. This no-show rate data has continued despite multiple interventions that have been implemented in an academic health science center. Physical, socio-economic, geographic, and health/lifestyle factors affecting no show or missed appointments are crucial to determining the most appropriate interventions to alleviate this issue. No-show rates are important metrics to improve because it directly affects the organization's revenue, access to care, and appointment wait times. Research evidence regarding …

The Long And Winding Road: What Comes Next After Detox, Michelle Pryce, Karen Lasater

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

BACKGROUND: Detoxification centers are specialized facilities treating patients with substance use disorder (SUD). The detoxification process is a medically managed treatment where substances are slowly weaned from the body. This process lasts approximately 5-7 days. Most patients meet the criteria for SUD upon admission, but do not seek specialized post-discharge treatment, which has been found to increase long-term sobriety.

LOCAL PROBLEM: The site was a 16-bed adult detoxification center located in South Carolina. The operations manager identified there was no standardized discharge educational planning process to support long-term sobriety. This project’s aim was to increase the percentage of …

Mortality In Medicine, Maren Dougherty

Honors Projects

Practitioners in the medical field attend to health issues across one’s lifespan from birth to death and everything in between. A common conflict in today’s practice of medicine is establishing the true function of medicine. The complete reliance on medicine to ward off death proliferates the biomedicalization of natural life processes, like death. Biomedicalization is the process in which medical authority and its accompanying technology begin to control other aspects of daily life. With medicine’s ultimate goal being to cure disease and fight death, it interferes with the inevitability of human mortality. End-of-life treatment can be taken too far without …

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Cva In Patient With Systemic Sclerosis On Aspirin Therapy: A Case Report, Rahyan Mahmud, Bianna Koutsenko, Kenneth Goich, Usaid Hasan

Rowan-Virtua Research Day

Introduction

Systemic sclerosis is an autoimmune disorder characterized by microvascular damage and multiorgan fibrosis. These patients have a higher risk of cerebrovascular events, but it is difficult to develop strategies for prevention due to limited understanding of underlying pathophysiology.

Case Presentation

A 76-year-old female with a history of systemic sclerosis presented to the emergency department with acute onset slurred speech, facial droop, and left arm pain with a National Institutes of Health (NIH) Stroke Scale of 1. She was outside the thrombolytic window. Other history includes hypertension and hyperlipidemia; both were well controlled. MRI confirmed right frontal lobe ischemic stroke …

Between Nsaids, Local Anesthetics, And Non-Medicinal Analgesics, Which Method Is The Most Effective At Providing Pain Relief During Iud Insertions For Nulliparous And Multiparous Women?, Natali Sharma

Rowan-Virtua Research Day

Objective: One major barrier for usage of intrauterine devices (IUD) includes a widespread sense of fear regarding pain during insertion of this contraception. By researching the most effective IUD insertion analgesics available and standardizing these pain management methods, women may be less fearful of obtaining IUDs.

Methods: A comprehensive literature review was conducted using Scopus, PubMed, Web of Science, EMBASE and Cochrane Library to compare methods of pain relief during IUD insertions. Outcomes measured include the pain management method used, the dosage administered, the pain experienced by patients evaluated using a Visual Analog Scale (VAS) prior to insertion …

Lep Prevalence In Southern New Jersey And The Use Of Interpreting Services In Healthcare Settings, Katherine Chavarria, Ariana Blake, Marlyn Valentin

Rowan-Virtua Research Day

Language barriers pose a great challenge to populations of Limited English Proficiency (LEP) in understanding their health, diagnosis, and treatments in healthcare settings. Our research aimed to gain a better understanding of the language access needs in Southern New Jersey. We analyzed census data in order to determine the prevalence of LEP populations in Southern New Jersey, as well as the languages most spoken by LEP populations. Additionally, our research looked at the use of interpreting services in healthcare settings. In Camden county, specifically we found that the top 3 languages spoken by LEP populations were Spanish, Vietnamese, and Chinese. …

Evaluating The Effectiveness Of A School-Based Cognitive Behavioral Youth Depression Prevention Program In Improving Life Satisfaction, Roshani Patel, Steven M. Brunwasser, Alissa Hochman

Rowan-Virtua Research Day

Depression is the leading cause of disability worldwide, known as the global burden of disease. Incident cases from 1990 to 2017 have increased by 49.86%. Additionally, rates have been seen to dramatically rise in adolescents aged 18-25 (17%) compared to rates in individuals aged 10-14 (1.1%). This makes it beneficial to have prevention programs for middle school aged children. The Penn Resiliency Program (PRP) is a youth depression prevention program focused on cultivating healthy thinking styles and behavioral coping skills. In our study, we used archival data from a randomized control trial of PRP to evaluate whether the program led …

Case Report: A Case Of Ttp In The Ed, Brian F. Lim, Andrew Caravello, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 54-year-old female who presented with mild shortness of breath, lower chest discomfort, fatigue, and weakness ongoing for several days and was diagnosed with thrombotic thrombocytopenic purpura (TTP). TTP is characterized by microangiopathic hemolytic anemia and thrombocytopenia due to either an inherited or immune-mediated reduction in von Willebrand Factor (VWF) cleaving protease ADAMTS13.

Patients presenting with non-specific symptoms is becoming increasingly common and initial bias could be to attribute symptoms to viral syndrome or upper respiratory tract infection. However, the differential for non-specific complaints is extensive and thorough review of labs and re-evaluations of patients …

Management Strategies For Traumatic Injuries In Pregnant Women: A Comprehensive Literature Review, Jaylyn D. Thompson, Jenna Zappetti, Clarence Julian Clark Ii

Rowan-Virtua Research Day

Introduction: Traumatic injuries in pregnant women are the leading cause of non-obstetric death and affect 6% to 8% of all pregnancies. Therefore, it is imperative to maintain updated guidelines to construct a framework for the optimal management strategies for traumatic injuries in pregnant women, considering the perspectives of obstetrics/gynecology, emergency medicine, and orthopedics.

Methods: To conduct this study, research was done via a database search through the Rowan-Virtua School of Osteopathic Medicine’s research library. PubMed was the sole database used to review 8 peer-reviewed sources. Articles that were published within the last 10 years were chosen.

Results: Every woman with …

Utilization Of Depression Screening In Patients With Type 2 Diabetes Mellitus, John T. Norris Bsn, Rn, Dnp-Pmhnp Student, Robin Gordon Bsn, Rn, Dnp-Pmhnp Student, Margaret Harvey Phd, Aprn-Bc, Acnp, Chfn, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Type 2 diabetes is a chronic metabolic disorder affecting millions of individuals worldwide. Research has shown that individuals with diabetes are at a higher risk of developing depression in comparison to those of the general population. Depression affects the individual's emotional well-being and has a significant impact on the management and outcomes of diabetes (Mather, 2022). This research study aims to investigate the feasibility and effectiveness of implementing the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is one the most effective assessment tools available to identify symptoms of depression (Celik, 2020).

Methods

In this retrospective chart review, at least 50 …

Implementing A Standardized Protocol For Early Detection Of Undiagnosed Hypertension Patients, Jenscena Hansen, Chris Bell

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Hypertension is a preventable disease that frequently goes unrecognized and undertreated. Early diagnosis can prevent further comorbidities such as heart disease, stroke, and chronic kidney disease. Implementation of this protocol aims to decrease the number of patients with undiagnosed hypertension and increase the identification of patients with elevated blood pressure who did not have a pre-existing diagnosis of hypertension. The goal of implementing a standardized protocol would help eliminate the number of patients who go undiagnosed.

Methods: This quality improvement design had clinical staff flag patients with elevated blood pressure. Identified patients without a diagnosis of hypertension were educated …

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

Addressing Equitable Access In A Safety-Net Hospital System: An Implementation Framework, Hillary Alycon

Dissertations: Doctor of Public Health

Acute care organizations face a significant challenge in effectively implementing health equity programs, particularly in rural areas where guidance is often lacking. Despite abundant literature focusing on health outcomes, there remains a noticeable dearth of published data on implementing health equity initiatives. In response to this gap, I present a comprehensive analysis that utilizes readily available, open-sourced data to address this critical issue.

A thorough assessment of the demographic characteristics of acute care facilities within the catchment regions was conducted based on data from reputable sources such as the US Census Bureau, the American Community Survey, and the County Health …

Understanding Medical Students' Perceived Readiness To Serve As Culturally Competent Practitioners, Michel'le Janae Bryant

Seton Hall University Dissertations and Theses (ETDs)

Background: The US population is more culturally diverse than ever. Although advancements have been made in improving the nation’s overall health, health disparities continue among different racial and ethnic groups. To promote person-centered care practices, medical students must be ready to serve diverse patient populations and provide equitable care. Despite their training, some medical students report feeling unprepared to treat diverse patient populations, potentially impacting their clinical practice and patient care outcomes.

Purpose: This study’s purpose was to explore the perceived readiness of final-year medical students in the US to provide culturally competent care utilizing the Readiness Theory and The …

Implementation Of An Education Program To Decrease Inpatient Falls, Elizabeth M. Carpenter, Jewyl Gibson

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

BACKGROUND: Inpatient falls are affecting 1 million patients across the United States every year with 25% of fall resulting in injury. Approximately 25% of falls are preventable with accurate assessment and appropriate fall precaution interventions. According to the literature, obtaining an accurate fall risk assessment is the first step in inpatient fall prevention.

LOCAL PROBLEM: Patient falls increased on 2 cardiac stepdown units in a level III trauma center in Knoxville, Tennessee. From 2020- 2022, the combined units experienced a 48% increase in patient falls. Nursing leadership identified staff knowledge deficits and inaccurate scoring of fall assessments as primary contributors …

Patients’ Perceptions Of Interprofessional Collaboration: A Scoping Review, Robynne Gilchrist Miss, Aayesha Kholvadia Dr, William (Bill) Burdick Prof

Patient Experience Journal

Collaboration has emerged as a pivotal element within an intentional person-centred healthcare framework. However, there is a need for evaluative feedback from patients to enhance interprofessional collaboration and its outcomes. The objective of this review was to describe the state of knowledge on the perspectives of patients living with a chronic condition regarding their experiences of interprofessional collaboration. A scoping review across five online databases (EBSCOhost, Google Scholar, PubMed Central, ScienceDirect, and Taylor & Francis Online; February 2023) identified all peer-reviewed literature published in English between the years 2018 and 2023 that reported on patients’ perspectives of, and experiences with, …