Medicine and Health Sciences Commons^™

A Multiple Comparison Study That Test The Validity Of Varian’S Rapidplan For Prostate Cancer Cases Based On Models Built From Outside Institution., La'rone Reid

Culminating Experience Projects

In radiation oncology treatment planning techniques and outcomes can differ from one institution to the next. With knowledge-based planning (KBP) the experience of larger institutions could help smaller institutions who may not have the opportunity to encounter certain types of cancer cases. However, this scenario is only true if the KBP software is consistent with its algorithmic output. Varian's KBP software called Rapid Plan (RP) will be analyzed for algorithmic consistency. This study investigates the validity and consistency of RP models from two different radiation oncology institutions, and compare data to determine RP quality, and consistency when planning prostate cancer …

Comparison Of A Self-Audit Tool To Accrediting Health Care Agencies’ Standards Of Care In A Corrections Setting, Matthew C. Widerman

Doctoral Projects

Millions of individuals enter correctional facilities each year and require health services. Inmates are bound to a set of rules, wherein they are thought of as objects of surveillance, punishment, or rehabilitation, rather than as patients. In addition to standards of care defined by national accrediting bodies and state boards of practice, correctional facilities also have state laws that define expected health services for incarcerated persons. All health care providers have a responsibility to provide the highest quality care, but in prisons, patients are still inmates bound to correctional rules. Policies and procedures guide health care practices in correctional facilities, …

Exploring Neighborhood Level Variation In Incidence And Secondary Transmission Of Seasonal Influenza, Melissa Freeland

Masters Theses

Influenza epidemics in the United States, are major causes of morbidity and mortality, and cause serious economic disruption on an annual basis. Evidence has begun to accumulate linking neighborhood-level socioeconomic disadvantage to higher rates of hospitalization and mortality related to influenza (Cordoba & Aiello, 2016; Jung, Lin, & Viswanath, 2013). Some studies suggest that this may be due to lower rates of vaccination, higher rates of comorbidities in socioeconomically disadvantaged communities (Cordoba & Aiello, 2016; Jung, Lin, & Viswanath, 2013; Ross & Mirowsky, 2001). However, few studies have evaluated the effects of neighborhood level socioeconomic disadvantage and structural features on …

Developing An Evidence-Based Discharge Process For Patients On A Cardiac/Renal Acuity-Adaptable Inpatient Unit, Tami Gallagher

Master's Projects

Introduction: Readmissions continue to negatively impact patient outcomes and create a significant financial burden. Regardless of efforts to reduce readmission rates, the cost of readmission continues to increase.

Clinical Problem: All-cause, 30-day readmission rates on a cardiac/renal acuity-adaptable inpatient nursing unit ranged from 11% to 33% from July to December 2018 for patients diagnosed with COPD, AMI, HF, and sepsis. The readmission rate for the organization was 16.2% in September 2018 with a target goal of 14.8%.

Project Aim: To use quality improvement tools and an interdisciplinary team to implement the teach-back method during discharge education and a discharge preparedness …

A Quality Improvement Project To Enact Evidence-Based Guidelines To Improve Documentation Of Hemoglobin A1c For Inpatient Diabetes Populations, Karyn C. Kinney

Master's Projects

The purpose of this paper is to describe a quality improvement project aimed to improve the documentation of hemoglobin A1c in the discharge instructions for patients with a diagnosis of diabetes prior to a transition from the acute care setting. Clinical practice guidelines from the American Diabetes Association and patient education recommendations from The Joint Commission are the impetus for this process improvement. The Plan-Do-Study-Act (PDSA) model was utilized to identify, design, and implement the process change in collaboration with an interprofessional team. The documentation rate of hemoglobin A1c was measured on two medical-surgical inpatient hospital units both pre- and …

Introduction Of Auricular Acupuncture, Monica Lyons

Doctoral Projects

The overall purpose of this quality improvement project was to assess if there was an interest to add auricular acupuncture to a substance abuse program. The two guiding questions of the Doctor of Nursing Project were (a) how can auricular acupuncture be helpful when treating patients with substance abuse in a selected organization? (b) what information is needed for both staff and patients to make an informed decision regarding auricular acupuncture? The Promoting Action on Research Implementation in Health Services (PARiHS) framework was used as the theory framework for implementation of evidence-based research into an organization. The facilitator in the …

Program Evaluation Of The Impact Of Sensory Room Activities On Student Readiness In Muskegon County, Mary C. Spyhalski

Education

There is a lack of research regarding the effect of sensory room interventions and equipment on student’s school readiness, as well as a lack of research regarding documentation and monitoring the effectiveness of sensory rooms. This is a problem for occupational therapists and teachers implementing sensory interventions that are not backed by research (Stephenson & Carter, 2011). Occupational therapists in Muskegon County Northern Service Unit (NSU) have determined a need to collect data on the impact of sensory room interventions on student readiness for school-day activities within their district. Program evaluations are needed in order to gather data that discusses …

Optimizing Clinical Processes Using The Electronic Health Record To Improve Patient Outcomes In Primary Care, Alex Jubril

Doctoral Projects

Background: The EHR has been used to leverage clinical processes for the improvement of patient outcomes. The average users of EHR limit its uses to the minimum level required to complete the daily tasks needed, regardless of the existence of features within the EHR that are readily available to optimize clinical processes for efficiency and effectiveness.

Objectives: The objective of this project was to improve the documentation in a nurse-managed health clinic related to the patient-centered medical home (PCMH) core criteria through enhancing the EHR to foster the quality improvement metrics and reporting.

Methods: This was a quality improvement project …

Occupational Therapy In Prisons, Amber Carmean, Amanda Boman, Katie Kowalski, Joselyn Walsworth

Community Based

This study investigates the needs of incarcerated individuals upon reintegration into the community. In this article, we use thematic analysis to dissect two prison documentaries in order to best assess the needs of these individuals to inform occupational therapy intervention. Occupational therapy seeks to empower individuals while analyzing needs and how the individuals can be best supported. Our analysis shows that there are many needs that go unaddressed prior to community reintegration leading to a higher chance of recidivism recurring. Through better understanding the needs of individuals, occupational therapy can become better informed on how intervention can benefit this specific …

Advocacy-Related Occupations Among People With Disabilities: Assessing Program Outcomes Of An Advocacy Workshop, Audrey Tarbutton, Stefanie Austin, Rachel Bendewald, Hayley Monforte

Community Based

An emerging area of occupational therapy (OT) practice includes program development for persons with disabilities (PWD). These programs are designed to train PWD how to identify issues and advocate for inclusion and accessibility (Umeda et al., 2017). Among the available literature on community-based advocacy programs, results show positive social outcomes including increased self-advocacy knowledge and related behaviors (i.e. Kramer, 2015; Mishna et al., 2011). Regarding the present study, an advocacy training program titled “Community Organizing Advocacy Skills Training” (COAST) was developed using the Midwest Academy Training Manual for the Advocate. The purpose of this study was to pilot a tool …

A Family's Perception Of Occupation-Based Activity Sessions During Their Transition To Permanent Housing, Laura Opie, Lauren Goldstein, Ashton Roth, Ella Savalox

Community Based

This study aimed to evaluate families' perceptions of occupation-based activity sessions during their transition from homelessness to permanent housing. A phenomenological design was selected to identify families' perceptions. Results identified potential benefits of providing occupation-based activity sessions to families in transition and indicated the importance of empowering families to enact their own sense of agency to successfully resolve their transition to permanent housing.

Global Occupational Therapists’ Health And Wellness Interventions With Community-Dwelling Older Adults, Catherine Keegin, Lyndsey Lehman, Hannah Meier, Megan Weinberg

Older Adult

Rationale: The profession of occupational therapy (OT) has an opportunity to positively impact health and wellness for community-dwelling older adults with the approaching global increase of the aging population (He, Goodkind, & Kowal, 2016). Objective: The purpose of this study was to explore occupational therapists’ use of health promotion and wellness approaches to facilitate healthy aging with community-dwelling older adults in a global context. Results: Four qualitative themes were uncovered: perceptions of older adults, safety, the role of OT, and preventive versus reactive care. Participants with 10 or more years of experience addressed spirituality in practice more often than those …

Exploring The Connections Between The Presence Of Developmental Trauma And Clinical Reasoning: The Lived Experience Of Pediatric Occupational Therapists, Gwendolyn R. Blake, Briar E. Plantinga, Julie Shafer

Pediatrics

Background: Developmental trauma is a current issue facing the nation. It adversely affects participation in occupations across the lifespan. This paper examines how the clinical reasoning of practicing pediatric occupational therapists changes when treating clients who have experienced developmental trauma.

Methods: A phenomenological approach was applied using multiple cases. Four individuals, who identified as working with clients with developmental trauma, were interviewed using a series of semi-structured and open-ended questions on their experience treating these clients.

Results: Narrative transcripts were reviewed by the authors and organized into themes of performance patterns of the therapist and the context of developmental trauma …

Program Evaluation Of The Impact Of Sensory Room Interventions On Student Readiness In Muskegon County, Emilie Brzak, Olivia Deweerd, Erica Roll

Pediatrics

Aim: This study is a program evaluation of four different sensory rooms in the schools within Muskegon County Northern Service Unit (NSU) to uncover the benefits of sensory interventions on students’ school readiness.

Methods: Grand Valley State University occupational therapy students analyzed data from the school occupational therapists to promote evidence based practice of this program.

Results: Within this program, sensory interventions increased students’ school readiness.

Conclusion: Outcomes indicate that the primary means of increasing students’ school readiness include transitioning to an active activity following sensory interventions and participating in multiple stations. Results are not generalizable to other programs.

Evidence-Based Cardiac Monitoring: A Practice Change, Joseph Paul Urbanski

Doctoral Projects

Background: Overuse of cardiac monitoring (CM) in acute care settings contributes to increased healthcare spending and cost of services for patients. Additionally, inappropriate use of CM can contribute to wastefulness of healthcare resources, increases in hospital staff workloads, and can be improved with best evidence-based practice recommendations. A Midwest acute care hospital lacked an evidence-based, systematic method to define care for patients requiring CM.

Objective: The purpose of the project was to pilot an evidence-based CM change initiative, determine feasibility for sustainment, and propose next steps for adoption of the change initiative across non-emergency department, non-intensive care inpatient CM units …

Prior Authorizations And Continued Treatment In Addiction Medicine, Wendy Hunting

Doctoral Projects

Introduction: Patients that require medication assisted treatment for opioid addiction can have their treatment delayed through the prior authorization process. A prior authorization is required by many insurance companies and can cause lengthy delays before the drug is approved. The two drugs that were considered for this project were Suboxone® (buprenorphine/naloxone) and Sublocade® (buprenorphine). These drugs are used for the treatment of opiate addiction. The proposed solution to the problem was to use quality improvement methods to implement a tracking and tickler system to improve the approval time from the insurance company.

Objectives: The project goal was to decrease the …

The Acute Effects Of Melatonin On Striatal Dopamine Release: Progressive Electrochemical Analysis In An Ex Vivo Mouse Model Utilizing Fast Scan Cyclic Voltammetry, Kevin D. Hughes

Masters Theses

The caudate putamen is a sub region of the basal ganglia, containing neural tracts important for cognition, reward learning, and voluntary motor function. Dopamine (DA) signaling received from the dopaminergic neurons of the substantia nigra pars compacta mediate locomotion, degradation of which is the characteristic neuropathology for Parkinson’s disease (PD). PD is an initially neurovegetative motor disorder but can progress to include cognitive impairments as well. Sundowner’s syndrome (SS) has been observed in patient populations with neurodegenerative diseases, characterized by the decline of cognition into evening hours. Due to the circadian influence which the hormone melatonin has on the sleep-wake …

Women & Adhd Functional Impairments: Beyond The Obvious, Noelle Marita Lynn

Masters Theses

Women with Attention Deficit Hyperactivity Disorder are an understudied and underserved population. Research on women with ADHD has shown that they are significantly impaired by ADHD and its functional impairments. It also shows that women often internalize their symptoms and impairments. However, no research was found that explores what this internalization does to the women. The researcher chose to begin to address this gap in the literature through this qualitative phenomenological study. The purpose of this study is to explore the impact of functional impairments caused by ADHD on the internal lived experiences of women.

The researcher conducted fourteen interviews …

Implementation Of Evidence-Based Chronic Non-Malignant Pain Management Protocol For Primary Care, Jenny E. Kipp

Doctoral Projects

Chronic pain is the most prevalent health condition in the United States and is the most common reason people seek healthcare (Chang, Daubresse, Kruszewski & Alexander, 2014). In 2012, health care providers wrote 259 million prescriptions for opioid pain medications despite little change in self-reported pain prevalence (Centers for Disease Control and Prevention (CDC) 2016; Chang et al., 2014). Initiatives to prevent the under treatment of pain have resulted in overreliance on opioids to treat pain. As a consequence of opioid centric prescribing, an opioid epidemic has evolved with devastating consequences such as dependence, addiction and overdose deaths related to …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Evaluating The Effectiveness Of Diabetes Class: A Project To Improve Quality Metric Measures, Miriam O. Russell

Doctoral Projects

Background: Diabetes is a significant health issue worldwide. Its increasing prevalence globally and regionally has been documented. Consequently, complications have resulted in higher morbidity and mortality in patients with diabetes (Martin & Lipman, 2013). The lack of education on self-managing diabetes can lead to serious complications. An effective approach, including evaluating and enhancing diabetes education, is necessary to improve diabetes self-management (Johnson & Raterink, 2009).

Objectives: To provide evaluation of a diabetes education class through quality measures and create a toolkit that will enhance the impact on the current diabetes education class.

Methods: A retrospective chart review that analyzes five …

Final Defense: Sepsis Screening Tool Assessment At A Freestanding Children’S Hospital In The Midwest, Cassandra Cummings

Doctoral Projects

Pediatric sepsis is a major contributor to childhood morbidity and mortality. Tools for predicting sepsis in pediatric patients have had poor predictive ability nor been validated. Risk assessment screening tools are effective at earlier detection of sepsis. The implementation of an evidence-based pediatric sepsis screening tool could reduce time to detect and diagnose severe sepsis so that patient treatment could occur earlier. This was a quality improvement project that evaluated a sepsis screening tool predictive validity at a children’s hospital.

Pathways To A Sustainable Community Health Worker Program In A Rural Native American Community, Hannah R. Duby

Doctoral Projects

Introduction: American Indian/Alaska Native (AI/AN) people have some of the greatest health disparities of any other citizen group in the U.S. (National Indian Health Board [NIHB], 2018). As liaisons between community members and health services, community health workers (CHWs) play an important role in reducing disparities in AI/AN communities (Indian Health Service [IHS], 2018). CHWs in the organization of interest are not being used to their full potential as the documentation of their care is not accessible to the primary care providers (PCPs) for care coordination and the program is threatened by issues related to sustainability.

Objectives: The purpose of …

Evidence-Based Toolkit To Evaluate Telemedicine Delivery Of Palliative Care, Aubrey E. Dwyer

Doctoral Projects

Advances in healthcare have led to many individuals with cancer to live longer, however the quality of life of these individuals has decreased. Palliative care is a medical sub-specialty that can assist to care for individuals with a life-limiting illness such as cancer. However, the access to palliative care services in rural communities is limited. According to the Institute of Medicine (IOM) report Dying in America, increasing access to palliative care will not only enhance the quality of life for patients with a life-limiting illness, but also contribute to a more sustainable healthcare system. The key stakeholders within a Midwest …

Factors Associated With Rapid Repeat Pregnancy Among Women In A Healthy Start Program In Kent County, Michigan, Sarah Jane Schmidt

Masters Theses

Strong Beginnings (SB) is a federal Healthy Start Program aiming to improve the health and well-being of black and Hispanic families by promoting racial equity and eliminating racial disparities in birth outcomes, including rapid repeat pregnancy (secondary pregnancy within 18 months of index birth). To better prevent the occurrence of rapid repeat pregnancy (RRP), this study explores individual, social, and environmental factors associated with RRP. De-identified data for this study included information from SB, the Maternal Infant Health Program, Medicaid claims, and birth certificates. The sample includes women enrolled in SB with an index birth between 2013 and 2015. Chi-square …

Adult Attention Deficit/Hyperactivity Disorder Quality Improvement Project, Danielle Miller

Doctoral Projects

Adults with Attention Deficit Hyperactivity Disorder (ADHD) vary widely in their symptom presentation and functional deficits, which can make management in the primary care setting challenging for providers (Morstedt, Corbisiero, Bitto, & Stieglitz, 2015). Measurement-based care is common in the management of medical disease, however is rarely used as standard practice in treatment of psychiatric disorders (Waldrop & McGuinness, 2017). As a result, treatment for psychiatric conditions, such as ADHD, may vary widely among clinicians and may result suboptimal treatment and patient outcomes (Waldrop & McGuinness, 2017). The proposed solution was to introduce the use of a standardized measurement tool …

Increasing Screening And Education For Human Trafficking In The Obstetric Department, Chibwe Caroline Powell

Doctoral Projects

Background: Human Trafficking, is a human rights violation with global public health implications. HT is associated with multiple health problems. Healthcare providers working in obstetrics departments are in a unique position to interact with trafficked persons. Lack of specific HT screening tools, training and education have been identified as barriers to recognizing HT victims.

Objectives: The purpose of this quality improvement project was to increase victim identification and referrals by improving screening through implementation of an interdisciplinary screening tool into the EHR workflow and providing HT education.

Methods: This project examined the impact of implementing a HT screening tool and …

Improving Heart Failure Care Plan Coordination Across The Health Care Continuum, Amy Veltkamp

Doctoral Projects

Heart failure costs the United States 31 billion dollars each year, with much of those costs attributed to hospital admissions. Coordinating care across the health care continuum is a critical factor in improving heart failure care and reducing readmissions. An organizational assessment was conducted using the Burke and Litwin Causal Model of Organizational Performance and Change. The quality improvement project implemented a longitudinal plan of care (LPOC) across 10 hospitals and numerous ambulatory care sites at a large Midwestern health organization. Nurse care managers (NCMs) were the focus of this project due to their high-level of involvement in care coordination. …

Interprofessional Collaboration To Improve Discharge Planning, Erica L. Spalding

Doctoral Projects

Historically, health care professionals collaborated solely with other professionals within the same discipline. However, evidence shows collaboration between all disciplines involved in patient care leads to improved patient outcomes. Interprofessional collaboration can reduce costs and improve patient care, yet is used inconsistently in health care systems. Interprofessional collaboration was not fully used on two medical-surgical units in a large health system in the Midwest, particularly during the discharge planning process. This project aimed to standardize rounds on two units as part of a larger initiative to standardize rounds across all units within the system. The clinical question to be answered …

Developing An Evidence-Based Supportive Services Program For Cancer Survivors In A Private Oncology Practice, Joseph Ellul

Doctoral Projects

Improvements in cancer treatment have led to a rapidly increasing survivor population. In response, multiple side effects of cancer and cancer treatment as well as the various wellness needs of survivors have been recognized. Survivorship programs have been developed to care for survivors with residual effects of cancer and the side effects of treatment; however, additional support is needed. The purpose of the project was to highlight the need for a comprehensive supportive services program for the cancer survivor population and describe the steps that were required to successfully develop the program. The clinical question addressed by the project was: …