Medicine and Health Sciences Commons^™

Utilizing Decision Tree Implementation And Provider Education To Improve Colorectal Cancer Screening Orders: A Quality Improvement Project, Alicia Kollar

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths (Jain, et al., 2022). Healthy People 2030 objectives include reducing the CRC death rate and increasing the proportion of adults who get screened (Healthy People 2030, n.d.). According to 2021 data, only 58.7% of adults are screened with a Healthy People target of 68.3%. Healthy People states that there are effective screening tools to detect colorectal cancer early, and people are more likely to survive it (Healthy People 2030, n.d.). Purpose: This quality improvement (QI) project aims to implement an …

Strokes Of Excellence And Opportunity: A Program Evaluation Analyzing Emergency Department Stroke Care In A Newly Formed Five-Hospital Health System, Joshua Adams

Doctor of Nursing Practice (DNP) Manuscripts

Stroke is a significant public health problem in the United States and globally. For patients experiencing an acute ischemic stroke, also known as “infarct” or “brain attack,” the effectiveness of treatment is extremely time dependent. This DNP Project presents a program evaluation of stroke care delivered in five emergency departments (EDs) in community hospitals in a health system newly formed through the merger of two smaller organizations. This evaluation focused on assessing the five programs’ effectiveness in delivering timely and effective care to stroke patients with the standardized performance measure door-to-needle (DTN). The evaluation also included a review of factors …

Integrating Health-Related Quality Of Life And Evidence-Based Polycystic Ovarian Syndrome Management: A Quality Improvement Initiative, Kami Beveridge Wast

Doctor of Nursing Practice (DNP) Manuscripts

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder affecting approximately 10% of women of reproductive age, characterized by symptoms such as irregular menstrual cycles, infertility, and metabolic issues (Fatemeh et al., 2021). Despite its prevalence, the management of PCOS remains challenging due to its manifestations and impact on quality of life. Current treatment paradigms often fail to adequately address the comprehensive needs of this patient population, highlighting a substantial gap in care.

Utilizing the Plan-Do-Study-Act (PDSA) methodology, this quality improvement (QI) project aimed to enhance the management of PCOS and improve the quality of life for patients in a …

The Impact Of Sitting And Crawling On The Acquisition Of Object Permanence In Infants With Motor Delays And Infants With Typical Development, Karl Jancart

Electronic Theses and Dissertations

Object permanence (OP) is the ability to understand that objects continue to exist even when they cannot be perceived. During play, infants with an understanding of OP will continue searching for toys when the toys have been obscured by other items. Searching requires movement. The theory of embodied cognition maintains that the form and function of an organism’s body influence how the organism learns; Therefore, if a child has difficulties with movement, as demonstrated by children with motor delays, they will likely have difficulty engaging in play, the modality by which children learn about their world. The current research is …

Modified Early Warning Score In Detecting Clinical Deterioration: A Continuous Quality Improvement Initiative, Robin Daller

Doctor of Nursing Practice (DNP) Manuscripts

Despite considerable emphasis on patient safety and high-quality care in U.S. hospitals for the past two decades, significant challenges remain in the early detection and treatment of clinical deterioration in adult medical-surgical patients contributing to poor patient outcomes, increased resource utilization and increased costs. Modified early warning scoring (MEWS) systems have been used to identify patients at risk of deterioration. The Modified Early Warning System (MEWS) is effective in supporting the early detection and prevention of clinical deterioration of at-risk patients earlier in their hospitalization and potentially save lives (Institute for Healthcare Improvement, 2017). This project implemented MEWs on medical …

Implementation And Evaluation Of Abcdef Bundle In The Surgical Intensive Care Unit (Sicu): A Quality Improvement Project, Carrie Blasko

Doctor of Nursing Practice (DNP) Manuscripts

Intensive Care Unit (ICU) delirium is highly prevalent in this patient population; however, it is a potentially avoidable hospital complication (Vasilevski et al., 2018). The Confusion Assessment Method (CAM) has been used as a tool to measure delirium in the SICU since 2014 (AHN, 2023). The SICU clinicians deliberated if a better assessment and management bundle is available to better identify and manage delirium as a concerning volume of patients continue to experience ICU delirium even with the current delirium assessment tool in place. Upon reflection, SICU clinicians acknowledge a gap in nurses’ knowledge in connection with identifying signs, symptoms, …

Evaluation Of Effectiveness Of Cultural Competence Program Implemented As Standard Practice To Improve Nurses’ Cultural Competency (Cultural Awareness, Cultural Cultural Knowledge, Cultural Skill), Improving Patient Care In A Community Hospital, Kendra Elam

Doctor of Nursing Practice (DNP) Manuscripts

The need for a culturally competent healthcare workforce is increasing as diversity increases in the United States’ patient population. Cultural competence is necessary because it helps the healthcare provider to offer the best care to every patient while considering and incorporating their cultural diversity and the patient holistically. Healthcare providers should be culturally competent to provide compassionate, caring, patient-centered care that promotes safety and quality in healthcare, reducing healthcare disparities. Culturally competent care supports social justice and health equity; it encourages health care as a human right. There is evidence that cultural competence and humility in professional development improve providers' …

Implementation Of A Self-Care Management Program Utilizing Telehealth In Adults With Hypertension, Diann Schmitt

Doctor of Nursing Practice (DNP) Manuscripts

Hypertension (HTN) can lead to heart disease which is the leading cause of death in the United States for men, women, and most racial and ethnic groups. Evidence-based practice supports early recognition of available self-care management (SCM) modalities to impact hypertension improvement and medication adherence. Best practices for heart disease prevention and management include lifestyle modification, reducing out-of-pocket costs, self-management support and education, and self-measured blood pressure monitoring. Successful evidence-based approaches within literature have addressed the modalities and successful outcomes.

The Plan-Do-Study-Act (PDSA) is a quality standard of The Institute of Health Improvement (IHI) was used to conduct this project …

Isolation And Total Synthesis Of Sigma-2 Ligands From Marine Cyanobacteria, Andrea Hough

Electronic Theses and Dissertations

Cyanobacteria have been studied for over 50 years as a source of new antibiotics, antiviral, and anticancer drugs. The research described in this dissertation investigates marine cyanobacteria as a source of natural products with activity within the central nervous system and with cytotoxicity against breast cancer cells. Barbamide (1) is a known cyanobacterial metabolite that has been re-isolated from a variety of species and collection sites suggesting broad utility as a signaling molecule. Utilizing the psychoactive drug screening program, we screened barbamide for CNS activity and found that barbamide exhibited affinity for the kappa opioid receptor (KOR) and …

Analyzing Pseudomonas Aeruginosa With Bacteriophage Tags Using Photoacoustic Flow Cytometry, Jennifer C. Schinke

Electronic Theses and Dissertations

The number of daily bacterial infections is climbing and the CDC explains that this is due to the antibiotic-resistant threat in the United States. Finding a faster way of bacterial identification is necessary as it currently takes 1-4 days for a medical lab to culture and identify bacteria. Photoacoustic flow cytometry (PAFC) can be used as an alternative method resulting in swift identification within an hour (Edgar, 2019). Pseudomonas aeruginosa, cell line PA01, will be coated in up to a few hundred red dyed phages making it detectible by the photoacoustic flow cytometry system. Bacteriophages (phages) are viruses that …

"Reducing Heart Failure Readmission Rates Through Implementation Of Heart Failure Diuretic", Caley Tatrn, Yvonne Weideman, Venkatraman Srinivasan

Doctor of Nursing Practice (DNP) Manuscripts

Background and significance: heart disease was the number one cause of death in the United States in 2021, with 696, 962 deaths (Leading Causes of Death, 2022). There are about 6.2 million individuals in the U.S. total with heart failure (Kilgore et al., 2017). About one-quarter of patients with heart failure are readmitted within thirty days of discharge, while one-quarter of hospital readmissions are preventable. Between 2010-2017, over seven million patients were admitted for heart failure in the United States. Eighteen percent had a readmission within thirty days and thirty-one percent had a readmission within ninety days (Khan et …

“One University’S Covid-19 Pandemic Mitigation Response And Anxiety Construct: A Summative Program Evaluation”, Ann Hodgin

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

The effects of the COVID-19 pandemic continue to ripple through everyday life. In December 2019, an outbreak occurred in China. Subsequently, the World Health Organization identified SARS-CoV-2 as a new type of coronavirus that quickly spread around the globe (Nazario, 2022). As of May 31, 2023, there were 6,938,353 confirmed deaths worldwide from COVID-19 (WHO, 2023).

A needs assessment completed by the University identified that a program evaluation of the university’s COVID-19 response was warranted. Therefore, this program evaluation was conducted to assess the effectiveness of the policies and protocols implemented at a Catholic University in Southwestern Pennsylvania to …

Effectiveness Of A New Graduate Nurse Residency Program: A Program Evaluation, Christine Meyer

Doctor of Nursing Practice (DNP) Manuscripts

Healthcare organizations continue to face challenges in the retention of new graduate registered nurses (NGRNs) within the first year of hire. Accredited nurse residency programs are designed to provide support to NGRNs and help make the transition from student to graduate nurse by developing their knowledge and skills. This project evaluates a nurse residency program at a rural, community hospital. The project aims to analyze both qualitative and quantitative data to evaluate the program outcomes as it relates to nurse retention, turnover, and job satisfaction. The sample includes 94 new graduate registered nurses that were part of the yearlong residency …

Improving Ostomy Patient’S Self-Efficacy And Quality Of Living Through Prehabilitation And Prevention Of Complications Using Telehealth Visits: A Quality Improvement Project, Shabnam Pratik Bagh

Doctor of Nursing Practice (DNP) Manuscripts

Due to the rise in colorectal cancer and diverticular diseases in the United States, approximately 100,000 to 150,000 intestinal stomas (fecal diversions) are created annually. With approximately 80% of readmissions experiencing post-discharge complications (Agri et al., 2020), quality improvement (QI) initiatives to increase ostomy patient’s self-efficacy and quality of living (QOL) are needed. The purpose of this QI project was to enhance the current continuum of care for ostomy patients by adding a Prehabilitation Session prior to surgery followed up with 24-hour Telehealth visits after discharge from the hospital to support their living with an ostomy. The resulting Comprehensive Ostomy …

Evaluating Outcomes Of An Integrated Medical Care Model In An Acute Care Hospital: A Program Evaluation, Erin Flanagan

Doctor of Nursing Practice (DNP) Manuscripts

Background: Increased awareness of disparities for people with co-occurring medical and behavioral health disorders identified a gap in their individualized health care plan. This gap provides opportunities for hospitals and acute care centers to evaluate current care models for this specific patient population. Problem: Hospitals are challenged to meet the growing needs of patients while working to decrease operational costs. Patients with behavioral health disorders also have significantly greater spending for general medical conditions than patients without a behavioral health disorder (Chu et al., 2019). Methods: Hospitals are attempting to address this gap in care through interdisciplinary or collaborative care …

Improving Nursing Provision Of Patient Care In High Acuity Medical Units And Fostering Their Wellbeing By Providing Education On End-Of-Life Care And Finding Joy And Meaning In Work: A Quality Improvement Project, Donna Durant

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Palliative care employs a multidisciplinary approach focusing on the quality of life for patients and their families experiencing the complexity of serious illness (Nelson, 2021). Due to shortages of palliative care specialists and a lack of nurse proficiency in caring for people with serious illnesses, integrating a palliative care approach is an ethical obligation for nursing (Parekh de Campos, 2022). Gaps in palliative care and end-of-life education for new nurses coming to the acute care setting in a large tertiary hospital in Southwestern Pennsylvania were identified.

Evidence-based education was delivered by advanced practice providers trained in this content area. …

International Strategies For Addressing The Needs Of Children With Disabilities: Comparing Pediatric Therapy Services In Italy And The United States, Cassidy Hearn, Lillian Hsiao, Lavinia Fanelli, Regina Harbourne

Physical Therapy Projects

This paper introduces and compares the professions of Neuro and Psychomotor Therapist of Developmental Age and pediatric physical therapy. Although pediatric physical therapy practice is prevalent in the United States, Italy utilizes another profession which encompasses many features of physical therapy, but also incorporates neuropsychological factors, specifically for children.

School Psychologists’ Knowledge And Perceived Competence Regarding Concussion Management In Schools, Braelyn Tracy

Electronic Theses and Dissertations

A concussion is a type of traumatic brain injury that can have a serious effect on a young, developing brain. Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Schools may be the ideal setting to address some of the problems children experience as schools employ some personnel with expertise and experience in assessment and intervention. If return to learn is put to the side, students experiencing concussion signs and symptoms could potentially have long-term cognitive problems. School psychologists play a key role in the prevention and assessment of, and intervention for …

Tabletop Role-Playing Games As Autism Psychotherapy: A Video-Cued Multivocal Clinical Ethnography, Adina Rubin-Budick

Electronic Theses and Dissertations

This qualitative study is a video-cued multivocal ethnography that analyzed the clinical reasoning and perspectives of psychotherapists using Tabletop Role-Playing Games (TRPG) as a therapeutic treatment for children and adolescents diagnosed with Autism Spectrum conditions. With a growing number of TRPG therapists nationwide using this modality in their clinical practices, this study aimed to develop a clearer understanding of the ways in which their therapeutic orientation, gaming practices, and knowledge of Autism Spectrum Conditions informs their use of TRPG psychotherapy with Autistic clients.

Research that focuses on clinical decision-making and the knowledge that informs clinical interventions and technique generally refers …

Culture Care Values And Beliefs Of Puerto Rican Adults Related To Suicide: An Ethnonursing Study, Griselle Estrada

Electronic Theses and Dissertations

BACKGROUND: Suicide is a public health issue among the growing U.S. Latinx population; however, Latinx subgroups are diverse and represent different cultural backgrounds. Puerto Ricans are the second largest Latinx subgroup in the nation. Although research points to possible mental health vulnerabilities among Puerto Ricans when compared to other Latinx subgroups, there is a dearth of research exploring cultural influences that can impact suicide prevention efforts for Puerto Ricans living in the U.S. mainland. AIMS: This study aimed to explore the culture care values, beliefs, and needs of Puerto Rican adults pertaining to suicide and its prevention. METHODS: The …

The Health And Health Care Needs And Experiences Of Mexican Heritage Individuals In A Nonmetro Location: An Ethnonursing Study, Karla Adu

Electronic Theses and Dissertations

Introduction: The population of Mexican heritage individuals has grown significantly in nonmetro, emerging communities. The purpose of this study was to explore the health and health care needs and experiences of this population in the Midwest. Methods: Leininger’s Culture Care Theory and Ethnonursing Research Methods were used as the guiding theory and methodology for the qualitative study. Interviews were conducted with 27 informants. Recordings were transcribed and analyzed according to Leininger’s phases of data analysis. Results: Three themes emerged from the data: 1. living a better life in a nonmetro community with and for family, 2. barriers to understanding …

Speciated Isotope Dilution Mass Spectrometry In Combination With Thor’S Hammer Metaspike Technology For The Assessment Of Low-Level Biomarkers For Human Health Evaluation, Ashley Ebert

Electronic Theses and Dissertations

Our research team has been focused on quantifying important biological analytes in human blood samples to delineate the biochemical processes underlying certain states of dysfunction and evaluate treatment efficacy. These efforts have been guided by laboratory measurements with the input of medical experts. Speciated isotope dilution mass spectrometry (SIDMS) explained in detail in EPA Method 6800 has been successfully applied in the quantification of an important biomarker analyte for immune function and detoxification processes: glutathione. Past research has proven the molecule a biomarker for autism spectrum disorder (ASD) in the form of the reduced/oxidized glutathione (GSH/GSSG) ratio, and literature has …

Empowering Lung Cancer Survivors In Post-Treatment Survivorship Care Using Participatory Action Research, Kelly Filchner

Electronic Theses and Dissertations

Purpose: To explore the experiences of lung cancer survivors (LCS) and their informal and professional caregivers with post-treatment care and to empower them to implement action-based study findings.

Participants & Setting: Participants were recruited using purposeful and snowball sampling from an NCI-designated cancer center in Northeastern US.

Methodological Approach: This study used a participatory action research (PAR) four-phase design. Phase one was a focused ethnography; phase two utilized a core group of participants to decide an action to be implemented in phase three; and phase four evaluated the action for the completion of one PAR cycle.

Findings: Twenty-eight categories, eight …

The Relationship Between Urban Green Space Perception And Use Within The Adolescent Population: A Focused Ethnography, Rachel Lyons

Electronic Theses and Dissertations

Introduction: Greenspace is beneficial for improving adolescent mental health, yet we still do not understand the connection between the built environment and subjective mental wellbeing. We also lack understanding of how this population uses greenspace and how they feel when in it. Purpose: The purpose of this qualitative study was threefold: to understand why adolescents use greenspace, to identify how they use greenspace, and to explore how they feel when they are in greenspace. Methods: participated in a focused ethnography that utilized auto photography for photo elicitation. Braun and Clark's (2006), six phases of thematic analysis were used to guide …

The Ethical Imperative Of Inclusion In Healthcare Innovation: Scaling And Sustaining Digital Health Equity, Lukas E. Chandler

Electronic Theses and Dissertations

The COVID-19 pandemic revealed the harm of digital health exclusion. Excluded groups could not benefit from virtual care due to device access gaps, broadband connectivity, and digital and language literacy levels. A lack of engagement with historically excluded populations in digital health innovation is an ethical harm and a maleficent form of social exclusion. Digital tools in healthcare delivery represent more than just a strategy for promoting health equity; they signify an opportunity to address health inequities in the health technology design process.

The historical focus of healthcare ethics on bedside decision-making issues largely explains why the field lacks concerted …

A Process Evaluation On The Health Care Transition Process For Youth With Osteogenesis Imperfecta With Special Health Care Needs, Janet Amirkhanian

Doctor of Nursing Practice (DNP) Manuscripts

With medical, surgical, and technological advances, children with childhood diseases with special health care needs (SHCNs) are surviving and living into adulthood (Cohen et al., 2014). Health care transition (HCT) should be a process through which youth are expected to achieve the skills necessary to manage their health as adults (Sawicki et al., 2017). HCT should be a purposeful, organized, and coordinated process involving the youth, family, and health care team (Stringer et al., 2015; Gabriel et al., 2017; White et al., 2018). Evidence supports that adolescents and young adults with SHCNs are often unprepared for transition (Jensen et al., …

Decreasing Intent To Leave In Nurse Residents (Nr) With The Addition Of Wellness Interventions: A Quality Improvement Project, Susan Eckman

Doctor of Nursing Practice (DNP) Manuscripts

The US nursing workforce decreased 1.8 percent between 2019 and 2021, marking the largest drop seen in four decades. New nurses or nurse residents NRs) are included in this loss. Many nurses, but particularly new nurses, experience burnout. If workplace stress is not managed, it can become chronic. The first year of employment as a nurse has been shown to be a very vulnerable time. Within the first 2 years of nurses’ employment, there is a reduction in commitment along with increased stress. New graduate nurses’ lack of life experiences, along with the recent pandemic have contributed to more than …

Reducing Risk Factors Of Diabetes Mellitus Type Ii Development In Veterans Post Military Discharge Through The Patient Aligned Care Team Model And The Utilization Of Preventive Programs Involving Lifestyle Changes., Jeni Grundy

Doctor of Nursing Practice (DNP) Manuscripts

Diabetes Type II (T2DM) prevalence is rising in America, becoming a focus for disease prevention. The American Diabetes Association (ADA) has highlighted the need to tackle the increased T2DM precursor, prediabetes, which ultimately leads to T2DM if risk factors remain unaddressed. One group of the American population with a high rate of prediabetes is the 9/11 Veteran cohort. The Veterans Affairs (VA) system has numerous health promotion missions. This system has highlighted its initiatives to address the development of T2DM. Specific to the 9/11 group, their primary T2DM contributory risk factor is obesity paired with the low utilization of already …

Trends In Health Outcomes Before And After Long Term Care Federal Regulations Limited Antipsychotic Medication Use: A Secondary Data Analysis, Karen Robson

Electronic Theses and Dissertations

Trends in resident falls did not significantly change, although trends in serious injury from falls declined ten years after regulations restricted antipsychotic medications in long-term care facilities. Trends in functional and continence status worsened after the regulations were implemented.

Is Trauma Informed Care Practiced In Public Std Clinics In New York State, Antonia Brewer

Electronic Theses and Dissertations

Introduction: Sexually transmitted diseases (STDs) are increasing in the United States and often result in long-term adverse health outcomes. New York State (NYS) local health departments (LHDs) provide public STD clinics for high risk populations also found to have high rates of violence. This study examined if/how trauma informed care (TIC) is implemented in these settings. The study sample were LHD STD Program Directors in NYS.

Method: A convergent parallel mixed methods study design was used which included an online survey and follow up interviews. Survey data were analyzed using univariate statistics and conventional content analysis was used to analyze …