Medicine and Health Sciences Commons^™

Apneic Oxygenation: An Adjunctive Therapy For Laryngoscopy During Anesthesia Induction, Yaro Hoffman

Doctoral Projects

Endotracheal intubation is an essential component within the skill set of anesthesia providers. Rapid arterial desaturation remains a primary risk factor during laryngoscopy and intubation. The risk for hypoxemia exists because during endotracheal intubation, patients are apneic or hypo-ventilating (Wong et al., 2017). Apneic oxygenation (AO) has been advocated to attenuate hypoxemia during endotracheal intubation (Pavlov et al., 2017).

The aim of this project was to assess for any knowledge deficits regarding AO among anesthesia providers and assess the willingness of these providers to include AO into their current practice. The project investigator conducted an education session involving the …

Clinical Application: A Cost-Benefit Analysis Of Sugammadex Versus Neostigmine For A North Mississippi Delta Hospital, Donald Carver, Andrew Bundt

Doctoral Projects

As the cost of health care continues to rise and insurance reimbursements have decreased, organizations have to find avenues to cut costs and increase profits. A goal of this project is to help prepare anesthesia providers with the best evidence-based knowledge about sugammadex and neostigmine and allow providers to make a sound, cost-efficient decision when choosing a reversal method. A needs assessment was conducted with the chief certified registered nurse anesthetist (CRNA) at a north delta Mississippi facility. The needs assessment demonstrated that cost was the main concern and reason for choosing neostigmine over sugammadex. Further, providers at the chosen …

Using Collaborative Objective Simulation Clinical Evaluation With Undergraduate Nursing Students And Nurse Anesthesia Students Labor Epidural Placement In An Active Labor Patient, Chaka K. Jackson, Aisha Pierre

Doctoral Projects

Developing interdisciplinary teamwork and patient communication skills are essential for the student registered nurse anesthetist (SRNA) to provide quality patient care when administering epidural anesthesia. The synthesis of the evidence revealed limited available information on simulation use for SRNA epidural administration and collaboration. This doctoral project examined the effectiveness of learning through traditional simulation to enhance communication and collaboration between the Bachelor of Science in Nursing (BSN) and the Nurse Anesthesia Program (NAP) students. The BSN and NAP students were provided with a simulation environment to care for a laboring patient while improving patient safety and quality outcomes. The project …

Cultural Competence Objective Structured Clinical Examination For Student Nurse Anesthetists, Ashley Nicole Minor, Loryn Elise Jamison

Doctoral Projects

The landscape of ethnicity is growing increasingly diverse. In 2017, the U.S. Census Bureau estimated that by the time the 2020 Census is conducted, over half of the nation’s children will be of a minority group (U.S. Census Bureau, 2017). With this evolution in cultural variety comes a necessity to incorporate exposure and training of cultural competency into professional health programs. Student registered nurse anesthetists (SRNAs) are a key demographic to professional growth within the realms of cultural competence as related to the field of nurse anesthesia. Along with clinical skills and advanced knowledge, cultural competence should be equally developed. …

Uniform Clinical Evaluation For Video Laryngoscopy In Nurse Anesthesia Training: A Policy Proposal, Kristen Yelverton

Doctoral Projects

At The University of Southern Mississippi’s (USM) Nurse Anesthesia Program (NAP), no standardized clinical evaluation for video laryngoscopy (VL) use exists. To address the gap in standardized evaluation of VL, an evidence-based, objective structured clinical examination (OSCE) will be developed and proposed to the USM NAP. The intervention to this need is the evaluation of the OSCE and supporting documents by the panel of experts. The aim of the OSCE would be to teach SRNAs in a step-by-step process how to properly handle a video laryngoscope and the necessary techniques to ensure both patient and student safety (Wunder et al., …

Evaluating The Effectiveness Of Adverse Childhood Experiences And Trauma Informed Care Training For Mental Health Nurses, Felicia Gathings

Doctoral Projects

Adverse Childhood Experiences (ACEs) are traumatic events that happened to a person at a young age, and when untreated they have a higher risk of developing a mental illness. ACEs are associated with social problems, illnesses, and physiological issues. ACEs are related to increased health risks and an increase in high-risk behaviors. Despite increase evidence relating ACEs to physical and mental issues, nurses lack training in ACEs and trauma-informed care (TIC). The overall goal of this project was to increase knowledge of ACEs and TIC in mental health nurses when caring for mentally ill patients. Pre-test and Post-test surveys were …

A Best Practice Recommendation: Decreasing Perioperative Fentanyl Used Through The Utilization Of Dexmedetomidine Prior To Surgical Incision, Shelby Harriel, Amy Houck

Doctoral Projects

Upon anesthesia induction, patients often receive fentanyl, an opioid medication that is linked to addiction, dependence, morbidity, and mortality (Stanley, 2014). The goal of this practice recommendation was to propose an alternative way of managing pain and the increased sympathetic response in the perioperative setting, specifically during the induction phase, through evaluating published research. A possible substitute for fentanyl is a drug called dexmedetomidine (Precedex™). Through a comparison of pharmacology, indications, risks, and benefits, one can conclude that if Precedex™ is given prior to induction, in the place of large doses of fentanyl, it can potentially achieve a smoother intraoperative …

Improving Door To Transfer Times For St Segment Elevation Myocardial Infarction In Small Emergency Departments: A Quality Performance Improvement Project, Amber Ryals

Doctoral Projects

Heart disease is a leading cause of death in the United States (Centers for Disease Control [CDC], 2020). ST-elevation myocardial infarctions are around 38% of all coronary syndrome patients that present to the emergency department (Akbar et al., 2020). Smaller, outlying facilities can be at a disadvantage due to the lack of readily available specialties and services, such as a cardiac catheterization laboratory, which has the potential to cause a delay in inpatient care. With standardized cardiac protocols in place at many facilities, initial identification and treatment of myocardial infarctions are begun long before a patient enters a facility, often …

Evaluation Of An Intervention To Maintain Therapeutic Pressure Of The Endotracheal Tube Cuff During Intraoperative Surgery, Jamare Reed

Doctoral Projects

The current practice of intraoperatively assessing the cuff pressure of the endotracheal tube (ETT) is arbitrary and potentially leads to negative impacts on patients. This best practice project aimed to review and synthesize the existing evidence-based literature on measuring ETT cuff pressure and to establish a policy guideline for anesthesia providers to measure ETT cuff pressure in the intraoperative environment. Based on the star model of the knowledge transformation framework model provided by the Academic Center for Evidence-Based Practice (ACE), the creation of evidence-based policy on ETT cuff measurement is expected to potentially prevent poor patient outcomes, patient expenses, and …

Developing An Interdisciplinary Team Checklist To Assess Readiness For Appropriate Medical Removal Of Central Venous Catheter (Cvc), Miranda Harper

Doctoral Projects

Healthcare-associated infections are not a new concept in health care. Many different health-care-associated infections have been established over the years including but not limited to healthcare-associated pneumonia, catheter-associated urinary tract infection, and central line-associated bacterial infection. While these infections are common in healthcare facilities, the rates of these infections are still prevalent in hospitals across the United States. This DNP project focused on central line-associated bacterial infections.

An interdisciplinary team checklist to assess readiness for appropriate medical removal of central venous catheter (CVC) was developed to assess intensive care unit patients for early appropriate medical CVC removal. The interdisciplinary team …

Educating Student Registered Nurse Anesthetist On Malignant Hyperthermia Using An Objective Structured Clinical Examination, Ednita Street Fountain, Faith Sherman

Doctoral Projects

Malignant hyperthermia (MH) is a low-frequency, high-impact event that many student registered nurse anesthetists (SRNA) may be unprepared to manage due to limited exposure in clinical practice (Hackl et al., 1990). Lack of preparation for dealing with such low frequency, high impact events can lead to unfortunate adverse events resulting in death (Hackl et al., 1990). Thus, students should be are prepared to handle these situations if an event should occur.

An objective structured clinical examination (OSCE) is a structured method used to assess certain skills and underpinning knowledge required for practice (Harden & Gleeson, 1979). Students are allowed to …

Ultrasound-Guided Peripheral Venous Access: An Objective Structured Clinical Examination (Osce), Christopher Smith

Doctoral Projects

Intravenous (IV) access is essential to anesthetic practice as it allows the provider to administer fluids, sedative agents, and resuscitation medications. There is, however, a large subset of patients in which IV access can be difficult to obtain due to confounding factors such as preexisting disease, body habitus, and volume status (Sabado & Pittiruti, 2019). Bedside ultrasonography is an effective tool that can be used to gain IV access in these difficult patient populations. The downside to this technology is that there is a learning curve associated with its use, and proper training in ultrasound-guided venous access techniques is crucial …

Optimizing The Impact Of Quality Healthcare Improvements Within A Federally Qualified Health Clinic (Fqhc), Felicia Keys, Ladonna Phillips, Lashundra Speights

Doctoral Projects

This doctoral project’s purpose was geared toward strengthening quality healthcare outcomes documentation by constructing an updated policy and procedure manual specific to quality measures identified above, identifying attitudes and barriers to documenting, and assessing administration willingness to change. The project included a retrospective chart review of three populations and seven healthcare topics. Each diagnosis was researched utilizing specific ICD-10 (see Appendix A). A focus group/Pre-Implementation Questionnaire was administered to a panel of experts consisting of three nurse practitioners with one to nine years of experience employed at the FQHC. Afterward, a focus group was held to discuss barriers and attitudes …

Mindful Matters: Addressing Barriers To Classroom-Based Mindfulness, Kirsten Munk

Doctoral Projects

A growing body of research suggests that incorporating classroom-based mindfulness interventions in elementary schools is associated with improvements in student behavior, self-regulation, and measures of mental health. However, the adoption of teacher-led mindfulness programs in California’s public schools has not been widely embraced. This doctoral project explored the impact of an educational intervention on pre-service teachers’ perceptions, attitudes, and intentions to implement mindfulness interventions in their classrooms. A brief educational intervention and website resource were provided to multidisciplinary teaching credential students in a 2-year graduate credential program. Participants completed a pre- and post-intervention survey to evaluate their intentions to implement …

Video Education For Improved Education Of Newly Diagnosed Multiple Sclerosis Patients, Theresa Mccrumb

Doctoral Projects

Anxiety and depression are prevalent in multiple sclerosis (MS) patients, especially those newly diagnosed. Receiving a diagnosis of MS can be overwhelming and impact patients in multiple areas including physical issues, cognitive changes and anxiety and depression (Kantor, Bright & Burtchell, 2017). This anxiety and depression can cause patients to be less engaged in their plan of care and thereby reduce their quality of life (Rieckmann, et al., 2015). According to the Multiple Sclerosis Association of America (MSAA), four of 10 MS patients are diagnosed with depression and anxiety, with the highest incidence at diagnosis (Multiple Sclerosis Association of America, …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

Evaluating The Clinical Impact Of Providing Home Blood Pressure Monitors To Patients With Elevated Or High Blood Pressure, Theresa La Guardia Asmus

Doctoral Projects

Many clinicians continue to diagnose hypertension based on office-based readings, despite the 2015 United States Preventive Services Task Force recommendation for the use of home or ambulatory blood pressure monitoring to confirm the diagnosis of hypertension prior to initiating treatment. Without obtaining blood pressure readings outside of the clinic environment, it is impossible to correctly diagnose hypertension, particularly regarding masked hypertension and white coat hypertension.

Stanford Health Care implemented a quality improvement project that provided patients with a home blood pressure device to monitor out of clinic blood pressure readings. The purpose of the project was to improve clinical care …

Patient-Centered Emr Communication, Christi Lynn Camarena

Doctoral Projects

The electronic medical record (EMR) has become the standard in health care documentation. The EMR has been shown to improve the availability of medical records, provide tools to facilitate communication, and improve patient safety. Because of the absence of standardized training and EMR research, there is a gap in understanding the relationship between the EMR and the provider-patient relationship. The EMR requires the provider to use purposeful and deliberate patient-centered EMR communications behaviors to facilitate a meaningful, engaging, and educational dialogue with patients. These behaviors have been studied in physician populations and standardized tools have been developed to assist in …

Ntchs© Health Literacy Intervention Pilot Study, Genevieve Evenhouse

Doctoral Projects

This pilot study explored the effectiveness of a validated curriculum called, “Navigating the Health Care System” (NTHCSÓ) in improving the health literacy of high school-aged adolescents in response to the national call to promote knowledge and skills in all ages, and socio-economic and cultural groups to achieve healthier lives. Low health literacy has been shown to greatly affect the quality of lives, health outcomes, and health spending of individuals with and without health conditions across social demographics. High school-aged adolescents are the population of interest of this study due to their developmental milestones which allows for knowledge and skill building …

Respiratory Distress Observation Scale Implementation For Comfort Care Patients In The Acute Care Setting, Marianne Wachalovsky

Doctoral Projects

One of the most common symptoms at the end of life is respiratory distress. Respiratory distress or dyspnea is a subjective symptom and therefore challenging to assess, especially when the patient is unable to communicate. Controlling symptoms depend on the knowledge and assessment skills of the clinicians and their willingness to administer the necessary pharmacological intervention. Assessment and treatment of this symptom presented a gap in the quality of care for the patients in the hospital of the author. An exhaustive literature review established that this existed also in other clinical settings and led to the Respiratory Distress Observation Scale …

The Collaborative Health Objectives In Combatting The Effects Of Diabetic Peripheral Neuropathy (Choice): A Second Chance To Change Diabetic Destiny, Alishia A. Claibourn

Doctoral Projects

The Collaborative Health Objective in Combatting the Effects of Diabetic Peripheral Neuropathy (CHOICE); A Second Chance to Change Diabetic Destiny, is a research pilot study that will test the validity of The Diabetic Foot Book. Diabetic peripheral neuropathy (DPN) affects 60-70% of the diabetic population. The CHOICE project will use The Diabetic Foot Book, a patient education booklet, created explicitly for the DPN population. The goal of the pilot study is to evaluate the effectiveness of The Diabetic Foot Book to increase health literacy and affect behavior change in the DPN population.

Evidence-Based Policy And Procedure Review System, Meredith A. Stokes

Doctoral Projects

Policies and procedures guide practice and the care of patients in every field of healthcare. Incorporating best practice evidence into clinical practice is a critical step towards providing safer patient care and improved patient outcomes. The challenge has been finding a way to incorporate best practice evidence into policies and procedures. Accordingly, an evidence-based project to answer the following clinical practice question was proposed: What is an evidence-based strategy for reviewing, updating, and disseminating policies and procedures for office staff at a cancer treatment organization? Through the use of Donabedian’s Model for Quality Improvement, student created tools, and an evidence-based …

Nurse Practitioners’ Perceptions Of Telehealth Behaviors, Michelle Austin

Doctoral Projects

Problem: NP’s must be proficient in the behaviors that are required for a successful patient encounter to provide the full benefit of nurse practitioner (NP) telehealth. Consequently, it is imperative for NPs to understand telehealth etiquette behaviors which include the technical and non-technical skills that are necessary for an effective NP-patient patient telehealth encounter (Haney, Kott & Fowler, 2015). Telehealth has been incorporated into healthcare delivery and its use is expanding. In the United States, it is predicted to be used by seven million patients in 2020 (US Department of Health and Human Services, 2018). Appropriate access to health care …

Willingess To Use Telehealth For Diabetes Management In The Rural Healthcare Setting, Andrew Kim

Doctoral Projects

Diabetes is a disease that has far reaching physically and financially consequences. This disease has shown to increase morbidity and mortality, along with increasing overall healthcare costs. Optimal management of diabetes may require a multidisciplinary approach across the span of multiple encounters with the diabetic patient. Considering the nature of diabetes, integration of telehealth has the opportunity to improve diabetes management by improving healthcare outcomes, along with potential cost savings. However, the use of novel technology like telehealth is only as useful if patients are willing to use it. Thus, this survey aimed to determining whether patients within a rural …

Implementing A Practice Strategy In Primary Care Using An Assessment Tool To Screen For Depression, Donna Snow

Doctoral Projects

Increased efforts are being made to move individuals with co-morbid medical and psychiatric diagnoses toward integrated care. Lack of consistent screening in primary care has caused missed opportunities to identify depression during a routine healthcare provider visit. This project sought to implement a practice strategy in primary care using an assessment tool to screen for depression. Interviews were used to ask patients to answer two questions related to the frequency of depressed mood in the last two weeks. The project was seeking to show by screening patients in primary care for depression, the number of referrals to behavioral health would …

Improving Medication Adherence In African American Adult Females With Hypertension, Donald Welch

Doctoral Projects

The World Health Organization (WHO) reported that adherence among patients with chronic diseases averages nearly 50% in developed countries (Lam & Fresco, 2015). Medication non-adherence is recognized as a significant public health issue that leads to poor health outcomes and added healthcare costs. Multiple African American adult females with hypertension have a high prevalence of non-adhering to their treatment plan. Numerous factors lead to poor medication adherence, including socioeconomic factors, therapy-related factors, patients-related factors, condition-related factors, and health system/healthcare team-related factors (Lam & Fresco, 2015). Medication adherence can lead to a decreased risk of adverse outcomes such as stroke and …

Assessment Of Intrapartum Nurses' Beliefs Related To Birth Practices, Janice Scaggs

Doctoral Projects

Intrapartum nurses’ beliefs influence nursing behavior and nursing interventions during labor and birth. Assessing these beliefs in a regional hospital in the Southeastern United States was the focus of the doctoral project. Before the project, there was no objective data that assessed individual nurse’s beliefs and birth practices in the labor and delivery unit, or among the nursing staff as a whole. A knowledge gap existed in understanding if the nursing culture valued, promoted, and supported intended vaginal birth. Nursing leadership recognized that the overall cesarean birth rate and primary cesarean birth rate in the hospital were similar to State …

Learning Lean To Lead, Krystle Irene Guenther

Doctoral Projects

This project sought to see if training frontline nurses and physicians together in Lean methodology improved collaboration between the two disciplines while giving them the tools they need to lead change at the bedside and in their practice. A quasi-experimental pre- and post-intervention methodology was used. The intervention was six, four-hour in-person modules on performance improvement (PI). Respondents completed two surveys, the performance improvement instrument and the Professional Practice Environment Assessment Scale (PPEAS). Surveys were paired for analysis. There was a statistically significant median increase in participants confidence for all questions on the PI instrument post-intervention. Results for the PPEAS …

The Mental Health Experience Among Parents Of Children With Autism, Thao Tran

Doctoral Projects

Parents of children diagnosed with autism spectrum disorder (ASD) face challenges, stress, and mental health issues than parents of children without autism. Mental health experience of parents in underserved communities are not adequately studied. This qualitative study used a phenomenological approach to understand the mental health experience of eight parent caregivers residing in San Joaquin Valley, California. All parents reported the journey was stressful but not all parents described the point when they received the diagnosis as being more stressful than before and after the ASD diagnosis. Parents’ responses to the semi-structured interview that assesses for the degree of ambiguous …

Evaluating The Experience Of Patient And Provider Satisfaction In Participation In A Hybrid Virtual Perinatal Care Model In A Private Practice Setting, Gretchen Ann Delong Nelson

Doctoral Projects

Improving access to health care in general and to appropriate prenatal care specifically are two leading health indicators (LHI) as designated by Healthy People 2020 (U.S Department of Health and Human Services, 2010). The California Department of Public Health (CDPH) also prioritizes minimizing health disparities that prevent women from entering into prenatal health care (CDPH, 2019). In Fresno county, transportation to specialty care such as perinatal care has been identified as a barrier (CDPH, 2017). The American College of Obstetricians and Gynecologists (ACOG) and The American Academy of Pediatricians (AAP) have identified a standard of fourteen to sixteen visits for …