Restorative Streetscapes: Promoting Positive Mental Health Outcomes Through Urban Landscape Design In Winooski, Vermont, Sean R. Fitzsimmons

Landscape Architecture & Regional Planning Studio and Student Research and Creative Activity

The global health burden of mental health disorders is immense. The World Health Organization ranks depression as the single largest contributor to global disability; anxiety disorders alone rank sixth. One in four people will have a diagnosable mental illness in their lifetime and mental health conditions are increasing worldwide, rising 13% in the last decade. The economic implications are also immense, costing the global economy US $1 trillion each year. Mental health is more than the absence of disorders or disabilities, however. It is defined by the WHO as “a state of well-being in which an individual realizes his or …

The Massachusetts Public Health Data Warehouse And The Opioid Epidemic: A Qualitative Study Of Perceived Strengths And Limitations For Advancing Research, Elizabeth A. Evans, Elizabeth Delorme, Karl D. Cyr, Kimberly H. Geissler

Health Promotion and Policy Faculty Publication Series

Due to the opioid overdose epidemic, Massachusetts created a Public Health Data Warehouse, encompassing individually-linked administrative data on most of the population as provided by more than 20 systems. As others seek to assemble and mine big data on opioid use, there is a need to consider its research utility. To identify perceived strengths and limitations of administrative big data, we collected qualitative data in 2019 from 39 stakeholders with knowledge of the Massachusetts Public Health Data Warehouse. Perceived strengths included the ability to: (1) detect new and clinically significant relationships; (2) observe treatments and services across institutional boundaries, broadening …

Transitions In Health Insurance During The Perinatal Period Among Patients With Continuous Insurance Coverage, Chanup Jeung, Laura B. Attansio, Kimberly H. Geissler

Health Promotion and Policy Faculty Publication Series

Importance Although health insurance continuity is important during the perinatal period to improve birth outcomes and reduce maternal morbidity and mortality, insurance disruptions are common. However, little is known about insurance transitions among insurance types for individuals who remained insured during the perinatal period.

Objective To examine insurance transitions for birthing individuals with continuous insurance, including those with Medicaid and Medicaid managed care coverage, before, during, and after pregnancy.

Design, Setting, and Participants This cohort study used January 1, 2014 to December 31, 2018 data from the Massachusetts All-Payer Claims Database. The sample included deliveries from January 1, 2015, to …

Simple Method For Cutoff Point Identification In Descriptive High-Throughput Biological Studies, Alexander Suvorov

Environmental Health Sciences Faculty Publication Series

Background

Rapid development of high-throughput omics technologies generates an increasing interest in algorithms for cutoff point identification. Existing cutoff methods and tools identify cutoff points based on an association of continuous variables with another variable, such as phenotype, disease state, or treatment group. These approaches are not applicable for descriptive studies in which continuous variables are reported without known association with any biologically meaningful variables.

Results

The most common shape of the ranked distribution of continuous variables in high-throughput descriptive studies corresponds to a biphasic curve, where the first phase includes a big number of variables with values slowly growing …

Improving Dementia Caregiver Competency In Nursing Home, Disha Bhattacharya

Doctor of Nursing Practice (DNP) Projects

Background: Inadequate training of dementia care providers in nursing homes lead to adverse health outcomes in patients with dementia.

Purpose: To educate and train dementia caregivers in a nursing home to improve dementia care.

Methods: A Quality Improvement Project (QIP) was implemented in a nursing home with nine nurses engaged in two virtual education group sessions led by the DNP student over an eight- week timeframe. Topics discussed included education on the nature and progress of dementia, building trust with dementia patients, managing their behavior, communication strategies, and self-care. Pre-training and post-training surveys were completed prior to …

Postpartum Hemorrhage: Improving Patient Outcomes With Improved Communication And Post-Drill Debriefing, Sheila L. Lafortune

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: A woman is at risk of dying from postpartum hemorrhage every four minutes. Maternal hemorrhage is found to be the direct cause of maternal mortality, overall accounting for 27% to 75% of maternal deaths worldwide. In the United States, 54% to 93% of maternal mortality could have been prevented. Postpartum hemorrhage remains among the top causes of pregnancy-related deaths worldwide. The purpose of this project is to educate providers of obstetrical care regarding best practices for effective communication during a postpartum hemorrhage by implementing a debriefing educational tool during postpartum hemorrhage mock code drills. Methods: The postpartum …

Acute Care Nursing Education To Enhance Aggression Management Skills, Marybeth Hayes

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Workplace Violence (WPV) in healthcare settings is pervasive. Acute care nursing staff experience higher rates of aggression from patients. These experiences may cause physical and psychological injury to caregivers and stress healthcare systems.

Purpose: The purpose of this quality improvement (QI) project was to strengthen understanding of evidence-based principles for management of aggressive patients on acute care medical units. Education enhances nursing staff sense of self-efficacy and clinical reasoning skills and is associated with effective management of aggression. Ultimately, improved management of aggression may lead to lower rates of patient assault towards staff members.

Methods: A pre and …

Use Of Public Health Detailing To Improve Provider Practice In The Clinical Management Of Syphilis, Tessa A. Robinson

Doctor of Nursing Practice (DNP) Projects

Background: Throughout history, syphilis has been a challenge to manage and control until the invention of penicillin in 1943 was available. Even with effective treatment, the diagnosis and clinical management of syphilis remains a challenge for providers. Purpose: The purpose of this project was to increase provider knowledge of evidence-based practice in the clinical management of syphilis, using public health detailing, to decrease inadequate and delayed identification and treatment of syphilis. Methods: Providers from a federally qualified health center (FQHC) participated in one public health detailing visit during March of 2021. Each provider completed a Provider Practice …

Standardizing Behavioral Health Triage: Using The Heads-Ed Tool, Sarah K. Peifer

Doctor of Nursing Practice (DNP) Projects

Background: In the past two years emergency departments across the country have experienced an increase in pediatric patients requiring behavioral health care. It is essential to provide efficient, early intervention to these vulnerable patients. The use of a standardized tool can improve management of pediatric patients and allow access to resources in a timely manner.

Purpose: To evaluate the implementation of the HEADS-ED in a community hospital ED, to provide rapid behavioral health assessment.

Methods: Education for staff was provided through various platforms and involved regular support for staff throughout the intervention. It was hypothesized that implementation of …

Transition Readiness Tools To Improve Health Care Transitions Among Adolescents With Inflammatory Bowel Disease, Meagan Moffett

Doctor of Nursing Practice (DNP) Projects

Inflammatory bowel disease is associated with severe disease in pediatric patients often requires treatment through adulthood. Collaborative efforts of patients, families, and health providers are needed to foster a smooth transition of care from pediatric to adult health care.

The purpose of this quality improvement project was to establish a baseline understanding of transition readiness among adolescents at one gastroenterology clinic to improve transition to adult care. A cross-sectional design was used to assess adolescents’ readiness for transition of care over a three-month period. Transitioning Readiness Assessment Questionnaire (TRAQ) was administered followed by individualized education on topics covered in the …

Promoting Exclusive Breastfeeding Among Racing/Ethnic Minority Women For The First Six Months, Linda A. Boateng

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Breastfeeding is the recommended way of feeding infants due to the numerous health benefits. However, racial/ethnic minority women in the United States are less likely to initiate and maintain breastfeeding for the recommended six months compared to white women. This has resulted in higher health issues such as obesity, diabetes type I, allergic sensitivity, acute otitis media, and gastrointestinal problems among racial /ethnic minority children. Purpose: The purpose of this Quality Improvement Project was to promote exclusive breastfeeding among racial/ethnic minority postpartum mothers for the first six months. This was done by providing breastfeeding education to postpartum nurses …

Perceptions Of The Flu Vaccine In The Setting Of Covid-19, Lauren A. Vogel-Hanley

Doctor of Nursing Practice (DNP) Projects

Background: Vaccination is a key component to public and personal preventative health. The COVID-19 pandemic has illuminated the need for further research into how best to encourage vaccination, especially in harder to reach or vulnerable populations.

Purpose: This project sought to evaluate beliefs and perceptions of the flu vaccine in the context of the COVID-19 pandemic and to explore the views of the project site’s population in order to develop more targeted educational programs for increasing flu vaccination. The project focused on the ambulatory population of the emergency department.

Methods: The survey tool administered was based on the National Flu …

Addressing Implicit Bias To Improve The Engagement And Retention Rate Of The Under-Represented Minorities In Substance Use Treatment., Adekemi Victoria Adeleye

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Racial and ethnic minorities' care for substance use disorder is negatively affected by biases, prejudices, and stereotypes in healthcare. This has created a general mistrust of the healthcare system and has constituted a barrier preventing minority patients from seeking care. Implicit biases are harmful, and this project aimed to bring awareness to this issue through educational activities to empower nurses in recognizing the problem.

Methods: Twelve nurse-care managers in an outpatient addictions treatment clinic volunteered to participate in an educational session on implicit bias and its impact on the healthcare environment. The training involved an interactive presentation …

Fall Prevention Program For Adults With Intellectual Disabilities, Marie Ambroise

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and Review of Literature: Adults with intellectual disabilities are vulnerable to falls. Proper intervention results in enhanced health outcomes. Implementing Otago Exercise Program (OEP), an evidence-based exercise intervention, has been shown to reduce fall rates among adults with ID.

Purpose: To use evidence-based preventive measures for reducing falls among intellectually disabled mental health facility residents over the age of 55.

Methods: An OEP was provided to adults with Intellectual Disabilities aged 50 and above at a chronic mental health facility for eight weeks. The implementation involved four phases. Phase one included organizing meetings with stakeholders and gathering …

Enhancing Preventative Health Care For Latino Migrant Dairy Farm Workers In Addison County, Vermont, Elizabeth A. Douglas

Doctor of Nursing Practice (DNP) Projects

Background: Latino dairy farmworkers, mainly from Mexico and Guatemala, help produce over 50% of Vermont’s milk. Latino dairy farmworkers may not seek health care for many reasons, including fear of immigration/law enforcement, language barriers, lack of transportation, and cost of care. Purpose: The purpose of this DNP project was to increase the utilization of health care services, including immunizations, of migrant farmers by educating and providing information about preventative, curative, and support services available in southern Vermont (VT). Methods: The intervention, one 60-minute educational program session took place at a local church service for migrant farmers, and an informational pamphlet …

Improvement Of Overweight And Obesity Screening And Intervention In Primary Care, Catherine Lehtinen

Doctor of Nursing Practice (DNP) Projects

Background: Obesity is a chronic health condition, resulting in significant morbidity and mortality, and is inadequately managed and treated in primary care. The Obesity Pathway is an organization-specific algorithm for providers to treat patients with obesity.

Purpose: To improve provider use of an Obesity Pathway in a primary care clinic and to increase the screening and intervention of all adult patients with overweight or obese status.

Methods: The Obesity Pathway was reviewed with primary care providers as well as best practices for weight management, obesity bias and stigma. The NEW Attitudes Scale and satisfaction surveys were completed by providers before …

Implementing Intimate Partner Violence Screening In The Primary Care Setting, Deirdre F. Howard

Doctor of Nursing Practice (DNP) Projects

Background. Intimate partner violence is a highly prevalent problem in the United States and leads to serious negative physical and psychological health outcomes, including death. There are screening tools that can detect IPV, yet screening rates in healthcare settings remain low, due to a variety of barriers, including lack of time, confidence, screening policies, and resources. Purpose. The purpose of this DNP project was to increase IPV screening rates within a primary care clinic.Methods. To accomplish the purpose of the project, an education intervention on IPV and available resources was provided to clinicians and staff. This was followed by …

Improving Telehealth Knowledge And Comfort In An Older Adult Population, Carolyn J. Jones

Doctor of Nursing Practice (DNP) Projects

Background: Telehealth usage is increasing a means of providing healthcare in a more efficient and cost-effective way. Older adults have been left behind from the telehealth movement and this can negatively impact their access to the healthcare system.

Purpose: An educational workshop was offered in a local older adult community with the goal of increasing their knowledge, literacy, motivation, and usage of telehealth.

Methods: The participants completed a pre-assessment survey to determine their baseline knowledge, experience, and perceptions about telehealth. They then participated in an educational workshop, which consisted of a 45-minute presentation given via Zoom with a 15-minute …

Building Resilience In Undergraduate Nursing Students: Evaluation Of Changing Minds, Changing Lives, Rebecca Liljestrand

Doctor of Nursing Practice (DNP) Projects

Background: Undergraduate nursing students report experiencing high levels of stress, which may negatively affect academic, personal, and professional outcomes. Resilience has been found to mitigate the effects of high, prolonged stress. Specifically, nursing students who engaged in a program to enhance resilience had positive outcomes related to themselves, others, and their nursing program.

Purpose: The purpose of this project was to implement and evaluate the feasibility, acceptability, and value of an evidence-based resilience program, Changing Minds, Changing Lives, designed to reduce nursing student stress levels by building resilience and increasing use of positive coping strategies.

Methods: Junior baccalaureate nursing …

Initiating Standardized And Structured Handoff For Nurses In The Outpatient Setting, Keri Wagner

Doctor of Nursing Practice (DNP) Projects

Background: Handoff is the transfer and acceptance of patient care responsibility achieved through effective communication. Patient-specific information moves from one caregiver to another, to ensure continuity and safety. Ineffective handoffs negatively impact patient safety, patient and staff satisfaction, adverse events, missed care, and treatment delays.

Purpose: To decrease adverse events associated with ineffective handoff and improve nurse satisfaction by implementing a structured, electronic handoff process, inclusive of a standardized handoff report in an outpatient setting.

Methods: This quality improvement project implemented an evidence-based, electronic, structured, handoff process, utilizing situation-background-assessment-recommendation (SBAR). A pre-implementation survey was created to identify intra-organization patient …

Utilizing A Toolkit With Individualized Food Label Education For Healthy Food Choices To Reduce The Burden Of Chronic Disease Among Black Americans, Johanna M. Kasidi

Doctor of Nursing Practice (DNP) Projects

Background/Purpose: Black Americans are disproportionately affected by chronic diseases related to diet including hypertension, diabetes, obesity, and stroke when they lack healthy food options and healthy living environments. The purpose of this project was to implement and evaluate the feasibility and effectiveness of a toolkit that primary care providers could use to educate and support Black adults in adopting healthy diet habits to improve overall outcomes and work towards decreasing this disparity.

Methods: This quality improvement project took place at a Community Health Clinic in an urban neighborhood. Participants received nutrition education utilizing a graphic titled “Your Nutrition Facts” …

Evaluating The Implementation Of A Wellness Initiative In An Independent Living Community, Pamela L. Hannon

Doctor of Nursing Practice (DNP) Projects

Background: An independent living community in New England is transforming their philosophical approach to wellness by implementing a new wellness initiative based on the Eight Dimensions of Wellness framework. Purpose: Using implementation science, we evaluated the process of implementing the Eight Dimensions of Wellness. Methods: A Pre-Implementation Survey was given to residents prior to the implementation and Post-Intervention Interviews of residents and staff was planned post-implementation. The post-intervention phase was not completed due to the delay in implementation at the site related to COVID-19. The data analysis of the of the Pre-Implementation Surveys included Kendall’s tau and Kruskal-Wallis tests. …

Changing Minds, Changing Lives: Increasing Resilience In Undergraduate Nursing Students Through The Implementation Of A Resilience Educational Intervention Program, Jennifer Rivera-Perez

Doctor of Nursing Practice (DNP) Projects

Background: Nursing students suffer from high levels of stress and psychological distress, especially those with histories of childhood adversity. The COVID-19 pandemic has been an additional source of stress on students. Students who suffer from psychological distress are at greater risk of engaging in maladaptive behaviors that may lead to physical and psychological conditions. Despite this data, college campuses lack resilience intervention programs, which have been shown to reduce psychological distress, perceived stress, and increase resilience. Purpose: The purpose of this Quality Improvement project was to implement a well-established evidence-based resilience program for nursing students, and to evaluate the feasibility …

Deprescribing Medications At The End Of Life At A Community Hospice Setting, Shannon Dickson

Doctor of Nursing Practice (DNP) Projects

Background: Polypharmacy can yield various adverse outcomes for patients over the age of 65. The lack of a standardized process and education for hospice nurses to implement into their clinical practice can increase polypharmacy, which burdens patients and families at the end of life.

Purpose: This quality improvement project aimed to increase hospice nurses' knowledge and confidence to initiate deprescribing for non-essential or inappropriate medications with hospice patients.

Methods: A multimodal educational program that incorporated evidenced-based resources composed of STOPP Frail Criteria, Garfinkel algorithm, and the BUILD model was presented at a community hospice agency. Pre- and post-intervention questionnaires were …

Development Of A Standardized Transfer Acceptance Bundle To Improve Team Collaboration During The Transfer From The Pediatric Intensive Care Unit To The Surgical Unit, Pamela Morrison

Doctor of Nursing Practice (DNP) Projects

Background/Significance: The project site utilizes a high reliability framework to support safety and quality improvement. Although the infant-toddler surgical unit frequently accepts transfers of surgical patients from the ICU, there was no standardized process in place.

Purpose: The purpose of this project was to develop and implement a standardized transfer acceptance process bundle for patients transferring from the ICU to the inpatient surgical unit.

Methods: This Quality Improvement project utilized a Plan-Do-Study-Act model to guide the project implementation. The standardized transfer acceptance process bundle included APRN use of the I-PASS hand-off tool, an RN and APRN bedside huddle at the …

Reducing The Risk Of Fentanyl Related Overdose In Medication Assisted Treatment Programs Based On Principles Of Motivational Interviewing, Anna B. Snow, Chelsea Betsold

Doctor of Nursing Practice (DNP) Projects

Background: The increase in fentanyl exposure by individuals who use illicit drugs has risen causing a significant increase in the number of overdoses and overdose-related deaths. Drug checking for the presence of fentanyl can allow drug users to make more informed decisions especially when combined with motivational interviewing.

Purpose: The purpose of this project was to assess the effectiveness of an educational program for clinical staff regarding the use of fentanyl test strips based on the principles of motivational interviewing.

Methods: The project was completed at a Medication Assisted Treatment (MAT) program in an outpatient behavioral health facility in New …

Improving Cultural Competency Among Rn Case Managers Serving Hispanic Adult Patients In Western Massachusetts, Victor O. Boadu

Doctor of Nursing Practice (DNP) Projects

Background: Hispanics are the largest minority group in the United States and account for an increasing number of poor health outcomes in treating and managing mental illnesses. The barriers to care include low socioeconomic status, lack of health insurance, clinician bias, low health literacy, and lack of effort around cultural care. A literature review was conducted to synthesize the effectiveness of cultural competency training supporting clinical practice and to evaluate areas that needs improvement. Purpose: To increase RN case managers’ cultural competency levels by completing an educational intervention based on a specific cultural competency model to improve quality of …

Using The Re-Aim Framework To Evaluate The Programmatic Management Of Latent Tuberculosis Infection In Maine, Jovin M. Bayingana

Doctor of Nursing Practice (DNP) Projects

Background: Treating Latent tuberculosis infection (LTBI) which is asymptomatic and a reservoir for TB disease is essential to end tuberculosis. This project focused on identifying gaps in programmatic management of LTBI in the state of Maine and the creation of minimum data metrics to serve as a framework for potential quality improvement initiatives.

Methods: Participants included Maine Medical Center/TB Clinic, referring primary care sites, their staff, and the Public Health Nursing Central Referral Office. The number of referrals to TB Clinic, number of attendances, number of individuals diagnosed and prescribed with LTBI treatment, number of treatment initiations, number of treatment …

Improving Lgbtq Provider Competency In The Emergency Department: Guided By Leininger’S Theory Of Transcultural Nursing, Kandyce Casey

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The lesbian, gay, bisexual, transgender, queer (LGBTQ) population have poorer health outcomes and health disparities due to stigma and discrimination when compared to the general population. The LGBTQ population represents many ethnicities, races, religions, social classes which creates an additional barrier to care. The LGBTQ person has higher rates of being uninsured and therefore healthcare is often delayed, or medical attention is sought in the emergency department (ED) for nonurgent issues.

Purpose: To increase competency of ED providers when caring for the LGBTQ population in the ED by implementing an evidence-based educational program.

Methods: The quality improvement …

Diabetes Footcare In A Rural Community: Footcare Education And Outreach, Dyanne Rodriguez

Doctor of Nursing Practice (DNP) Projects

Background: Foot care self-management is critical in continuity of care and in prevention of foot complications associated with diabetes. The purpose of this project was to help residents in a rural Canadian community gain a better understanding foot care self-management.

Methods: This project aimed to implement and evaluate evidence-based education in self-foot care among adults in with diabetes or pre-diabetes who live in Vegreville. Educational sessions were held in person based on the framework of the Social Cognitive Theory. Recruitment occurred over five months in collaboration with community housing centers. The goals focused on evidenced based education in daily foot …