Medicine and Health Sciences Commons^™

Rural Adolescents Are More Likely Than Their Urban Peers To Abuse Prescription Painkillers, Shannon M. Monnat, Khary K. Rigg

Carsey School of Public Policy

In this fact sheet, authors Shannon Monnat and Khary Rigg examine prescription painkiller abuse for over 32,000 youth aged 12–17 using data from the National Survey on Drug Use and Health, an annual nationally representative survey of the non-institutionalized U.S. population. They report that over 1.1 million adolescents aged 12 to 17 (4.7 percent of this population) abused prescription painkillers in 2014. Prescription painkiller abuse was more common among rural than urban adolescents. In 2014, 8.6 percent of rural adolescents, 8.1 percent of adolescents in small urban areas, and 6.5 percent of adolescents in large urban areas reported ever abusing …

Oral Health Care Access In New Hampshire, Eleanor M. Jaffee, Joan Widmer, Lisa Speropolous

Carsey School of Public Policy

In this brief, authors Eleanor M. Jaffee, Joan Widmer, and Lisa I. Speropolous provide an overview of the current state of oral health care in New Hampshire. They report that although New Hampshire is rated above the national average on most measures of pediatric oral health, performance varies substantially by county and by region. Access to adequate oral health care for both children and adults is particularly challenging for low-income families in the sparsely populated northern region of the state. Programs that address oral health care access issues by bringing services to those with the greatest need, such as school-based …

A Gateway To Future Problems: Concerns About The State By-State Legalization Of Medical Marijuana, Paul Lewis

The University of New Hampshire Law Review

[Excerpt] “Before 2009, every American presidential administration had been uniform in its policy of consistently enforcing the nation’s drug laws. Pursuant to federal law, possession, use, or cultivation of any drug deemed illegal by Congress was, universally, a prosecutable offense. Notwithstanding this unwavering policy, throughout the 1990s and early 2000s, the marijuana industry continued to grow, and several states legalized medicinal marijuana despite the standing federal prohibition. Moreover, President Barrack Obama, shortly after taking office, broke precedent with his predecessors when he put forth a policy of non-enforcement through a publicly released memorandum authored by the then Deputy Attorney General, …

Student Health Benefits Plan Market Research And Analysis, Zachary William Doucette

Honors Theses and Capstones

The University of New Hampshire (UNH) in Durham, New Hampshire requires all full-time students to have health insurance meeting set requirements as a condition of enrollment. UNH offers its own health plan, entitled the Student Health Benefits Plan (SHBP) through its Health Services Center to students as a way to procure this insurance if they lack insurance, or if their current insurance is insufficient or does not meet the insurance requirements. Health Services at UNH is looking for market research on current attitudes, perceptions, and beliefs of both students at UNH, and the parents of students who currently have a …

Promoting Social Interaction Skills To Influence The Transition To Employment For Youth With Autism Spectrum Disorders, Jennifer Susan Lange

Honors Theses and Capstones

Autism Spectrum Disorders (ASD) affect one in 68 children in the United States and are characterized by deficits in social interaction. Decreased social interaction skills limit youth with ASDs’ ability to obtain and maintain a job. Acquisition of needed social interaction skills must occur during high school years as part of youths’ transition program. The Therefore, the purpose of this qualitative study was to consider ways to facilitate social interaction to influence the transition to employment. The specific aims of the study were to explore strategies currently used to facilitate social skills, identify social skills currently targeted, and identify other …

Criterion-Related Validity Of The Children's Occupational Performance Questionnaire, Kelsey Zukowski

Honors Theses and Capstones

This study examined concurrent, criterion-related validity of a new measure of occupational performance for children, the Children’s Occupational Performance Questionnaire (COP-Q). The COP-Q is completed by caregivers of children to measure performance in five areas of occupation: Activities of Daily Living, Instrumental Activities of Daily Living, Social Participation, Play/Leisure, and Education/Work. Scores from a sample of children ranging in age from birth to 18 years were correlated with scores from the Vineland Adaptive Behavior Scales-II (VABS), a well-established assessment tool of adaptive behavior that measures similar functional areas as the COP-Q. The results indicated that the COP-Q correlates highly and …

Inefficiency In The Post Anesthesia Care Unit: A Quality Improvement Initiative, Ashley St. Martin

Master's Theses and Capstones

Background: The post anesthesia care unit (PACU) is a busy environment in which nurses communicate with patients, family members, and a large team of perioperative professionals. PACU nurses were experiencing an unmanageable number of work interruptions due to a higher patient census which increased the daily surgical caseload.

Aim: The purpose of this project was to improve efficiency and nurses’ job satisfaction by making work interruptions manageable in the PACU.

Methods: Based on Kotter’s Change Theory, a quality improvement initiative was implemented using a change in the communication process. Qualitative and quantitative data was gathered in the PACU and on …

Reopening The Discussion Of The Loss Of Opportunity Doctrine In New Hampshire: A Look At Decisions Made In Light Of Current Times, Benjamin Lajoie

The University of New Hampshire Law Review

[Excerpt] “A close family member is diagnosed with late-stage breast cancer and now only has a fifteen percent chance of survival. She soon dies. Prior to her diagnosis, she had routine screenings every two years, but her previous doctor failed to detect the then existing cancer when she would have had a fifty percent chance of survival. In New Hampshire, from a legal standpoint, there has been no wrong.

This legal concept of negligent medical care that causes a patient to have a lower percentage of survival, or a less favorable outcome, is referred to as the “loss of opportunity” …

Dementia And Primary-Care Health Measures:Hearing, Gait, And Markers Of Inflammation, Elsa Lindgren

Honors Theses and Capstones

Dementia is a syndrome associated with declining cognitive function that has a variety of types and causes, and is encountered frequently in general medical practice. Researchers are actively exploring possible risk factors for dementia. The St. Louis University Mental Status (SLUMS) exam is a dementia-screening exam used in primary care visits to detect cognitive impairment that may be a sign of dementia. This study compared scores on the SLUMS exam to other measures recorded in a typical primary care visit in 86 patients of age 65 and older to look for correlations between indicators of health, such as physical examination …

Friendships For High School Students: With Autism Spectrum Disorder And Without, Alanna Young

Honors Theses and Capstones

People with Autism Spectrum Disorder (ASD) experience deficits in social communication, having difficulty with carrying on conversations, abiding by social norms, and feeling empathy towards others. As social skills are important for successful interactions, these deficiencies can decrease the number of friendships experienced by teenagers with ASD. However, it is also possible that other social barriers are involved, such as stigma, assumed by peers of teenagers with ASD. The influence of deficits in social interaction and stigma was examined through semi-structured interviews and focus groups, comprised of groups with teenagers with ASD and groups with typically developing teenagers. It was …

Navigating Independent Double Checks For Safer Care: A Nursing Perspective, Danielle D. Grant

Honors Theses and Capstones

Abstract

The purpose of this study was to explore registered nurses’ understanding and practice of “independent double-checks” prior to administration of high-alert medications. The study used a qualitative descriptive design for data collection and data analysis. It included thirteen participants from a hospital located in southern New Hampshire. Results of the study revealed a core theme of navigating independent double checks (IDC) for safer care. Two major themes stemming from the core theme were also uncovered. Navigating IDC through knowing and navigating IDC through nurse partnership both focused on the perception and practice on IDC prior to administration of high …

Gastrointestinal Nematodes Of Ovis Aries In Eastern Cape, South Africa And An Evaluation Of Current Anthelmintic Procedures, Melyssa Rowell

Honors Theses and Capstones

Humans have known about helminth infections since ancient times. Today half of the human population is plagued by a nematode infection. Nematodes are responsible for billions of dollars in global crop damage annually and have had devastating effects on the global livestock industry. Due to the lack of a vaccine, and only a handful of approved classes of anthelmintics, nematode resistance has become a serious global phenomenon, and the South African commercial sheep industry has been one of the worst affected worldwide. The current study used fecal float parasitology to determine the nematode species found on a commercial sheep farm …

Literacy Exposure In Public Preschools: The Effects On Language Acquisition, Chloe Hannah Robison

Honors Theses and Capstones

No abstract provided.

Patient Perceptions Of Bedpan Usage And Comfort Levels, Emily Kay Schlachter

Honors Theses and Capstones

While it may be seemingly obvious, there is very little data on patient perceptions of bedpan use. In order to create a better bedpan, there needs to be evidence as to why it is necessary. The objective of this study is to explore patient experiences of bedpan use in order to define their perceptions of comfort levels. The literature shows that patients are physically and emotionally uncomfortable when using the bedpan, find the device unpleasant, and are not receiving the necessary levels of education and compassion from their care staff. A mixed methods study using a descriptive quantitative design was …

Contributing To A “Culture Of Safety” By Increasing Usage Of The Drug Library On Smart Infusion Pumps: A Quality Improvement Project, Heidi Armstrong

Master's Theses and Capstones

Background: Computerized infusion devices called smart infusion pumps or smart pumps are clinical tools capable of decreasing IV medication infusion calculation errors through the use of embedded drug libraries. These devices are now important tools contributing to a “culture of safety” defined by the Joint Commission. Reports from April 2015 indicated a 22% occurrence rate in which the devices were not correctly programmed before infusion.

AIM Statement: The global aim of this quality improvement project was to improve usage of the IV pump drug library by ensuring medication is correctly labeled before infusion. The specific aim was to increase the …

A Culturally Appropriate Cognitive Assessment Screening For Bhutanese Refugees, Holly Milligan

Master's Theses and Capstones

Background: As the incidence of cognitive impairment continues to rise, timely and accuratediagnoses are essential. Aim: The aim of this quality improvement project was to evaluate the standard cognitiveassessment screening for Bhutanese refugees in a medical home, and compare an alternative,validated, and potentially more culturally appropriate tool. Also, an assessment of provider,nurse and interpreter satisfaction with the two tools was performed. Method: Mixed methods including qualitative observations and quantitative satisfaction surveysrelated to the implementation of a culturally appropriate cognitive assessment tool. Results: When assessed with the standard tool, all 10 people screened positive for cognitiveimpairment. However, when using the alternative …

Using Shock Index As A Predictor Of Icu Readmission: A Quality Iimprovement Project, Melissa Sykes

Master's Theses and Capstones

Background: Adverse events will occur in one-third of patients discharged from the intensivecare unit (ICU) and evidence shows that ICU readmissions increase a patient’s length of stay,
mortality, hospital costs, and nosocomial infections, as well as decrease long-term survival.Specific predictive factors that will accurately predict which patients are at risk of adverseevents requiring readmission are needed.Aim: The specific aim of this project was to identify if shock index (SI) values higher than 0.7at the time of transfer from the ICU are a useful predictor of ICU readmission.Methods: Using the Plan, Do, Study, Act (PDSA) framework, a retrospective chart review wasperformed …

Aldrete Discharge Scoring: Appropriate For Post Anesthesia Phase I Discharge?, Laura P. Dowling

Master's Theses and Capstones

Background: Advances in anesthesia and surgical techniques, along with an increase in managed care, have led to an increase in ambulatory surgeries. The post-anesthesia discharge criteria used for inpatient care may not be appropriate for ambulatory care patients

Aim: This quality improvement project was aimed at examining whether or not the patient length of stay (LOS) in Phase I of post anesthesia care was appropriate. The global aim was to right-size post anesthesia care Phase I length of stay for adult upper extremity surgical patients.The first step was to assess the effectiveness of the PACU discharge criteria. The specific aim …

An Updated Rounds Checklist To Increase Appropriate Use Of Telemetry Monitoring, Hattie Miller

Master's Theses and Capstones

Background: Telemetry monitoring is an essential tool to monitor cardiac electrical activity. Its overuse is costly in time and resources and leads to subsequent testing and treatments that are not necessary for the patient and, in addition, healthcare staff is burdened with work that is potentially not clinically useful.

Aim: The global aim of increasing efficiency in telemetry use starts with the local improvement to facilitate nurse-physician communication of telemetry patients during

Methods: This study with pre and post data collection looked at the results of quantitative data, collected in May-July 2015, on the number of patients with telemetry and …

Prevention Of Icu Delirium Through Implementation Of A Sleep Promotion Bundle, Victoria Bennett

Master's Theses and Capstones

Background: Intensive care unit (ICU) delirium is the prevalence of delirium in ICU patientswho do not have a history of drug/alcohol abuse, an admission for a mental status change, or anadmission to the ICU for less than 24 hours. Serious adverse outcomes have been linked to thepresence of ICU delirium resulting in overall longer hospital lengths of stay, longer duration ofmechanical ventilation, higher rates of mortality, and long-term neuropsychological deficits afterdischarge. At the site of this quality improvement project, the prevalence of ICU delirium was92.3% in a population determined to be high risk using the PRE-DELIRIC screening tool. Aim: The …

Be Seen And Heard Being Clean: A Patient-Centered Approach To Hand Hygiene At Concord Hospital, Ashley Pinkham

Master's Theses and Capstones

Background: Regular hand washing is recognized as the most effective means to combat the spread of infectious illness; however hand washing behavior amongst health care workers (HCW’s) is inconsistent. Furthermore, measurement of hand washing behavior is subject to bias.

Aim: This quality improvement project aimed to remove the Hawthorne effect and improve the behavior of HH at Concord Hospital.

Methods: A quasi-experimental, pre-posttest design was used to evaluate HH rates on a 32 bed med-surge unit at Concord Hospital. Baseline data was collected for 30 days by asking patients if they had seen or heard staff cleaning their hands. Using …

Implementing A Checklist & Hourly Huddles To Increase Situational Awareness During The Second Stage Of Labor-A Perinatal Quality Improvement Project, Kelly Knowles

Master's Theses and Capstones

Background: Current management of the second stage of labor often follows tradition-based routines rather than evidence-based practices. A lack of situational awareness and tunnel vision can limit medical decision-making. Northern New England Perinatal Quality Improvement Network (NNEPQIN) has listed Second Stage Situational Awareness as a priority initiative. Standardized checklists are useful for maintaining situational awareness. Regular debriefings using a standardized tool have been shown to improve communication and team based care, which generally leads to improved patient outcomes. Based on this evidence, developing a standardized checklist including regular hourly care team “huddles” is valuable and could result in improved birth …

Using Servqualto Identify Gaps In Quality Care For Patients With Cystic Fibrosis: A Hospital-Based Quality Improvement Project, Alisha M. Nadeau

Master's Theses and Capstones

Background: Cystic Fibrosis (CF) Care Centers were established to centralize and integrate the knowledge and skills of pulmonary medicine, nutrition, gastroenterology, nursing, respiratory therapy, social work, and genetics to efficiently provide care for people living with CF. The high quality, specialized care that is given at CF Care Centers has led to the improved length and quality of life for people living with CF.

Aim: The aim of this quality improvement project was to identify any gaps in providing effective, high quality care to patients with CF to reduce the variability in nursing practices and improve their quality …

Improving Emergency Response In The Outpatient Clinic Setting, Matte Horton

Master's Theses and Capstones

Background: Effective triage, assessment, and activation of necessary systems in emergent situations of clinical instability is vital in reducing morbidity and mortality of patients in any clinical setting. When medical emergencies occur outside of the hospital, organized and expedited transfer to a higher level of care reduces the potential for adverse events, lasting deficits, and patient death. Aim: The aim of this project was to identify weaknesses in the emergency response system in the community-based outpatient clinic setting and to propose solutions. Methods: The “Swiss Cheese” theoretical framework was used to do a root cause analysis of two clinical scenarios. …

Engaging Patients To Improve Documentation Of Oral Intake On A Cardiac Telemetry Unit: A Quality Improvement Initiative, Timiny A. Mosher

Master's Theses and Capstones

Background Information
It is important for patients with heart failure to have awareness of their intake & output to effectively manage their disease. There is evidence that tracking intake & output is a component of missed nursing care resulting in discrepancies between the actual patient intake and what is documented in the patient’s electronic health record (EHR).

Aim

The aim of this quality improvement project was to engage patients in monitoring their intake by using teach-back and patient engagement techniques to track their own oral fluid intake throughout the day.

Methods
The Plan-Do-Study-Act (PDSA) model was used as the framework …