Medicine and Health Sciences Commons^™

Political Astuteness In Tn Nurse Practitioners: Strategies To Inform, Tracie Gooch, Tracie Herrell

Doctoral Projects

Abstract

Political astuteness among nurse practitioners practicing in states like Tennessee where their scope of practice is restricted needs evaluation to promote policy and scope of practice change to increase access to quality healthcare in rural and underserved areas to decrease healthcare disparities in vulnerable populations. There is a scant amount of literature that specifically addresses political astuteness in nurse practitioners. The purpose of this project is to assess and provide strategies to inform nurse practitioners on political astuteness and activity. A cross sectional survey included the administration of an online version of the Political Astuteness Inventory (PAI), compared results …

Student Registered Nurse Anesthetists’ Perception Of Simulation As A Positive Reinforcement To Classroom Lecture In Handling A Difficult Airway, Kayla Forbis

Doctoral Projects

The management of a difficult airway by anesthesia providers is a core component of providing safe care. Simulation provides an opportunity for the student to manage uncommon clinical scenarios without harm to an actual patient. This project aimed to determine if the use of simulation may be useful in training Student Registered Nurse Anesthetist in the management skills of a difficult airway. The proposed intervention of this project was the addition of simulation experience to didactic lecture covering difficult airway management techniques. As supported in the Adult Learning Principles of Medical Learners, by allowing the SRNA to actively participate in …

Elevating The Head Of Bed During Preoxygenation For Obese Patients Undergoing General Anesthesia: A Clinical Policy Proposal, Brian F. Seymour Jr.

Doctoral Projects

Preoxygenation plays a vital role in ensuring patient safety for all patient populations, especially those considered clinically obese. The negative pathophysiological effects obesity has related to body habitus and respiratory mechanics increases the risk of unexpected adverse events. Obese patients encounter a 50% decrease in functional residual capacity (FRC) when undergoing general anesthesia. Dixon et al., (2005) addressed the link between efficient oxygenation and improving oxygen storage by lessening atelectasis and intrapulmonary shunting via preoxygenation in a more upright position. Can standardizing preoxygenation techniques among anesthesia providers improve patient safety and decrease hospital system’s risk by implementing an evidence-based clinical …

Drug Diversion Reporting And Response: A Policy Analysis, Lauren Roberts

Doctoral Projects

Despite the significant improvements made to address addiction and drug diversion by healthcare personnel, the issue continues to be problematic for most healthcare facilities. Current literature suggests that healthcare institutions incorporate early drug diversion and addiction education, implementation of effective policies and procedures, and continuous drug screening will strongly aid in decreasing the prevalence of drug diversion by healthcare providers.

Among all the different types of healthcare providers, anesthesia providers continue to be at a disproportionately higher risk for addiction and drug diversion when compared to other providers (AANA, 2016). The stress of a demanding profession, personality, and easy access …

Tools To Increase Compliance And Decrease Mortality Due To Sepsis, Cody F. Carr

Doctoral Projects

Severe sepsis is a leading cause of death in the United States and is the most common cause of death among critically ill patients in non-coronary intensive care units (Mayr, Yende, & Angus, 2014). The incidence of severe sepsis is estimated to be 300 cases per 100,000 population and cost an estimated $14 billion in the United States (Mayr et al., 2014). This Doctor of Nursing Practice (DNP) project focused on identifying an early-assessment tool to identify sepsis and increase compliance when using the tool. Identifying sepsis early is important in starting a treatment plan to prevent morbidity and mortality. …

Best Practice Policy Recommendation For Neuraxial Anesthesia Skin Antiseptic Solutions, Kyle Adams

Doctoral Projects

A clinical affiliate hospital in Mississippi lacked a best practice clinical policy regarding the most appropriate skin preparation solution to use prior to neuraxial anesthesia. The evidence showed that alcoholic chlorhexidine is the optimal solution due to advanced characteristics which help reduce infection. Reducing infections can potentially reduce further complications for the patient, hospitalization length, and cost. Also, chlorhexidine was found safe to use for neuraxial anesthesia if cross-contamination is avoided and adequate drying time is allowed. Lastly, alcoholic povidone-iodine is an appropriate alternate if 0.5% chlorhexidine is unavailable.

A best practice clinical policy was formulated and presented to a …

Following Epidural Pca Use, Do Obstetric Patients Feel Satisfied With Their Pain Control, James Mcrae

Doctoral Projects

ABSTRACT

Pain is a source of anxiety for many patients, and uncontrolled pain can have deleterious effects on patient outcomes (Patak et al., 2014). Pain associated with labor is a particular concern of obstetric patients. Epidural analgesia is currently the frontline treatment for pain associated with labor, with epidural patient-controlled analgesia (PCA) often being utilized (Braveman, Scavone, Blessing, & Wong, 2013). Little evidence exists that details what factors of epidural PCA that patients considered important (Patak et al., 2014). In this project, a randomized questionnaire was administered to obstetric patients to assess satisfaction levels with their epidural PCA. The questionnaire …

Care Of Adult Cancer Survivors, Kelsey Kloosterman

Doctoral Projects

As innovative cancer treatments emerge, more people are surviving cancer. Cancer survivors have multiple and unique healthcare needs due to their cancer and cancer treatments. Communication among those treating the cancer, primary care providers, and cancer survivors is necessary to coordinate care once treatment is finished. The development of a survivorship care plan that is reviewed with the cancer survivor is intended to facilitate communication among all stakeholders. This quality improvement project examined current practice in a survivorship clinic in a Midwestern health system cancer center that cares for a variety of types of cancer patients. By reviewing evidence in …

Evaluation Of Short Term Cognitive Behavioral Therapy Intervention In A Primary Care Setting, Kevin Hengeveld

Doctoral Projects

Introduction: Depression and anxiety are chronic recurring medical conditions that impact all aspects of health. When depression and anxiety are present with other comorbid diseases, mortality and health care costs are higher. Children and young adults are particularly vulnerable to mental health issues. Suicide is the 2nd leading cause of death for this demographic. Depression is common in adolescents with an incidence of 8 to 20 percent. Primary care provides 70 percent of mental health care in the United States, and the primary intervention offered is pharmacological. Evidence suggests that a combination of medication and psychotherapy provide superior relief of …

Improving Adolescent Risk Behavior Screening: Implementation Of The I-Cloud Rapid Assessment Adolescent Preventive Screening (Raaps) Tool, Donna L. Rinker

Doctoral Projects

Adolescents are engaging in risky behaviors earlier contributing to 75% of adolescent morbidity and mortality with unintentional injuries listed as the most common cause of death among this population in the United States. It is reported that engaging in more than one risk behavior will lead to other risk behaviors resulting in the rise of indirect and direct costs in society today. The scholarly project was conducted in response to a midwestern Michigan primary care clinic need to improve the early identification and documentation of adolescent risk behaviors with evidence-based technology screening. The purpose of this quality improvement project was …

Developing Cultural Competency In Anesthesia Through Student Registered Nurse Anesthetists, Emma To

Doctoral Projects

Certified Registered Nurse Anesthetists (CRNAs) are the main anesthesia providers in over 70% of rural hospitals providing anesthesia. Each year, over 2,000 student registered nurse anesthetists (SRNAs) graduate and continue as licensed CRNAs. This Doctor of Nurse Practice (DNP) project emphasizes the importance of developing culturally competent providers in anesthesia by promoting early outreach in cultural competence education of SRNAs. Cultural competence is described as possessing characteristics of congruent attitudes, awareness, and conduct that provides and enables effective skills in cross-cultural encounters. Encompassing cultural competency education early in the SRNAs profession may provide valuable lifelong cultural skills that will benefit …

Analysis Of Current Practices For Measuring Endotracheal Cuff Pressures, Myisha Jessie Dixon

Doctoral Projects

The current practice for the measurement of endotracheal tube (ETT) cuff pressure intraoperatively is subjective, potentially leading to negative consequences for patients. The purpose of this best practice project was to examine and synthesize the current evidence-based literature on measuring ETT cuff pressure and developed a policy recommendation for measuring ETT cuff pressure in the intraoperative setting by anesthesia providers. The ACE star model of knowledge transformation guided this best practice project. An extensive literature review was performed to evaluate and synthesize the current evidence-based research that can be used to develop the policy on measuring endotracheal tube cuff pressure. …

An Evaluation Of Implementing Enhanced Recovery After Surgery Protocol Throughout The Perioperative Phase: A Quality Improvement Initiative To Enhance Patient Outcomes After Colorectal Surgery, Jerica Hill Dnp

Doctoral Projects

Abstract: The Enhanced Recovery After Surgery protocol (ERAS) is a multimodal collaborative approach implemented throughout the perioperative phase to enhance patient outcomes. The key mechanism for effectiveness in the ERAS protocol is the attenuation of the surgical stress response combined with treatments that support the return of functions that delay recovery in traditional methods. The purpose of this scholarly project was to evaluate the results of the ERAS Pilot program currently initiated at Baptist Memorial Hospital to improve patient outcomes undergoing major abdominal surgery. Prior to the implementation of the ERAS protocol there was no standardized method in place at …

Evaluation Of A Health System’S Community Targeted Program For Individual’S With Increased Risk For Cardiovascular Disease And Diabetes, Phallon Lovelady

Doctoral Projects

Introduction: Lack of a program evaluation plan for a community targeted primary prevention program poses a risk for undefined program effectiveness. Conducting a systemic program evaluation helps determine program effectiveness and value. The purpose of this paper is to discuss the process of implementing a program evaluation during a Doctorate of Nursing Practice (DNP) scholarly project.

Objectives: The objectives of this project were to apply a scholarly approach to program evaluation utilizing evidence-based practice tools, demonstrate DNP Essentials and health systems leader competencies, and describe the steps taken during the process.

Methods: The CDC Framework for Program Evaluation (2011) was …

Implementation Of A Multimodal Hand Hygiene Intervention At A Rural Critical Access Hospital, Amy J. Hopp

Doctoral Projects

Healthcare acquired infections are the most common complication of hospital care in the United States, with subsequent negative implications on the healthcare system. While hand hygiene has long been considered the single most important and cost-effective way of reducing healthcareacquired infections, compliance among healthcare professionals is low, and most efforts to improve it fail. When compared to single-component hand hygiene interventions, research demonstrates that tailored multimodal interventions are an effective way to improve compliance with hand hygiene practices among healthcare professionals. This Doctor of Nursing Practice project focused on implementing a multimodal hand hygiene intervention, tailored to fit the specific …

Evaluation Of Processes And Procedures For Care Of The Opioid Recipient Patient In The Primary Care Setting, Anne Sproat

Doctoral Projects

Introduction: Chronic non-cancer pain is far reaching, affecting over 100 million Americans (Zgierska et al., 2018). Opioids are commonly prescribed for chronic pain, with approximately 20% of patients presenting to primary care offices with symptoms of pain or pain-related diagnoses (Dowell, Haegerich, & Chou, 2016). As a result, opioid prescribing rates are increasing at a faster rate for primary care practice compared with other specialties (Dowell et al., 2016). Within the United States population, it is estimated that three percent to four percent of the adult population are prescribed long-term opioids for the treatment of chronic non-cancer pain (Dowell et …

Alveolar Recruitment Maneuvers And Noninvasive Positive Pressure Ventilation In Obese Patients: A Quality Improvement Project, Ryan Miles

Doctoral Projects

Obesity is considered a complex, and often difficult to manage the diseasethat develops due to many factors. Over one-third of the U.S. population is considered to be obese with Mississippi ranked as second highest in adult obesity (WHO, 2016). With the increasedprevalence of obese patients, it is inevitable that these patients will be presenting for surgical procedures. Obesity and its comorbidities can prove to be challenging for anesthesia providers. These patients often will have compromised respiratory function due to an accumulation of adipose tissue on the abdominal, thoracic, and diaphragmatic structures(Nagelhout, 2014). General anesthesia causes atelectasis and reductions in lung …

Laryngeal Mask Airway: A Postoperative Sore Throat Clinical Practice Guideline, Logan Williams

Doctoral Projects

One of the most common and preventable complications experienced by patients undergoing general anesthesia is a postoperative sore throat (POST). Up to 70% of patients who receive a laryngeal mask airway (LMA) during anesthesia suffer from POST. Despite its regular occurrence and designation as a minor complication, POST has proven to be a distressing complication for patients afflicted. Consequently, a perceived minor complication can, in fact, play a major role in a patient’s perception of their care, the skill of their anesthesia provider, and their overall satisfaction with their experience.

Evidence shows that inflation of LMA cuffs beyond the recommended …

Intraoperative Ketamine Administration: An Adjunctive Therapy That Reduces Postoperative Pain For Patients Undergoing Spinal Surgery, Brittany Pierce

Doctoral Projects

In 2017, the United States Department of Health and Human Services declared that the country was experiencing an opioid crisis (U.S. Department of Health and Human Services, 2018). As a result of this phenomenon, healthcare providers are examining how they are managing pain and researching new avenues for the treatment of pain. Anesthesia providers are in a unique position to help reduce postoperative pain and ultimately the development of chronic pain. This doctoral project was conducted in order to write an evidence-based policy that directs and educates anesthesia providers in the administration of intraoperative ketamine to reduce postoperative pain in …

Use Of A Vietnamese Pain Scale And Report Of Pain Or Discomfort In Vietnamese Patients With Limited English Proficiency During The Post-Operative Period, Kristine Ho

Doctoral Projects

Language and the ability to communicate with the patient are foundational for effective anesthesia/patient relationships (Rosse, Bruijne, Suurmond, Essink-Bot, &Wagner, 2015). The burgeoning population of Vietnamese people in the United States demands implementation of procedures to ensure adequate communication and safe care. The present project sought to determine if the Wong-BakerVietnamese Pain Rating® Scale assisted Vietnamese patients with limited English proficiency to adequately report pain or discomfort relief during the post-operative period. A convenience sample of adults (N = 25) that meet inclusion criteria constituted the sample. Inclusive criteria were patients who were Vietnamese, between the ages of 30 …

Utilizing The Stop-Bang Questionnaire As A Preoperative Assessment Tool In Patients Undergoing Endoscopic Procedures, Emily Randle

Doctoral Projects

In the world of anesthesia, obstructive sleep apnea (OSA) can cause a conglomeration of post-operative complications. One of the best ways to avoid these complications is to alter one’s anesthetic to accommodate the needs of a patient with OSA. The current issue with altering one’s anesthetic is that a majority of patients with OSA still remain undiagnosed. My project that will showcase just how many patients have undiagnosed OSA.

The goal of this project was to recognize how many patients were at moderate to high risk for OSA. I did this by providing an in-service on OSA and the STOP-Bang …

Referral Policy For Moderate To High-Risk Obstructive Sleep Apnea Patients Identified By The Stop-Bang Questionnaire: A Quality Improvement Project, Martha Kate Goforth, Price Roberts

Doctoral Projects

BACKGROUND: An increase in the prevalence of Obstructive Sleep Apnea is as high as 70% in the surgical population. OSA is associated with a higher incidence of complications in the perioperative setting showing the increased need for proper identification of moderate to high-riskpatients for referral to local sleep clinics. Identifying and treating OSA is an important step to improve managementof chronic diseases, decrease complications both inside and outside the perioperative setting, and reduce healthcare spending.

METHODS: The purpose of this project was to create an OSA referral program for patients undergoing general anesthesia at a hospital in Mississippi. The recommended …

Implementation Of A Sustainable Peer Mentor Program In Student Registered Nurse Anesthetists (Srnas)”, Kristin Cox

Doctoral Projects

Evidence has shown that Student Registered Nurse Anesthetist’s (SRNAs) stress is perceived as above average and is correlated with substandard patient care during clinical courses (Chipas et al., 2012). Some studies have indicated SRNAs experience low self-efficacy during clinical, which could lead to difficulty in thinking clearly or responding to clinical situations (Imus, Burns, & Weglarz, 2017). Peer mentoring has shown to result in stress reduction and improvement in self-efficacy in students (Barker et al., 2012; Giordana & Wedin, 2010). Despite the current evidence, a nurse anesthesia program in the southeastern United States did not have an organized peer mentor …

A Quality Improvement Project To Increase Hand Hygiene Opportunities For Anesthesia Providers, Brad Margherio

Doctoral Projects

Hand hygiene is considered to be the far more superior method for preventing the spread of bacteria from a patient care provider to the patient (Allegranzi & Pittet, 2009; Rowlands et al., 2014; Tartari & Mamo, 2011). The addition of easily accessible hand hygiene devices to the anesthesia carts in the operating room may help to improve the opportunities for the anesthesia providers to perform hand hygiene. Hand sanitizer devices were placed on each of the eight anesthesia carts located in the surgery department of a rural hospital in south Mississippi. The devices were measured weekly for a two-week period …

Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell

Doctoral Projects

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at …

Best Practice Policy: Utilizing A Standardized Handoff Tool Postoperatively In An Intensive Care Unit For Patients Undergoing Cardiac Surgery, Alexandra Bradley

Doctoral Projects

Communication is a key aspect of care in the health care setting. Handoff communication occurs between medical provider’s numerous times a day. Each patient handoff performed has the potential for ineffective communication, leading to poor patient outcomes. The Joint Commission has recognized handoff communication as one of the main causes of sentinel events, or unexpected events that results in patient harm or death, in the health care setting (Joint Commission on Accreditation of Health care Organizations [JCAHO], 2012). The Joint Commissions National Patient Safety Goal requires “a standardized approach” for provider handoffs. The introduction of a checklist or handoff tool …

A Quality Protocol For A Federally Qualified Health Center: A Pilot Project, John K. Dekock

Doctoral Projects

Federally Qualified Health Centers (FQHCs) have become a vital part of access to care for low socioeconomic status individuals. The federal government has allocated funds to be distributed to FQHCs via Medicare and Medicaid reimbursement based on insurance claims and through the Health Resources and Service Administration (HRSA) via grants and incentives based on Uniform Data System (UDS) reporting. Federally Qualified Health Centers must complete annual uniform data system (UDS) reporting on quality indicator metrics to receive grants and incentives from HRSA. The Health Resources and Service Administration (HRSA) funded health centers are expected to have ongoing quality assurance and …

Barriers To Providing Quality Care For Pediatric Patients With Autism Spectrum Disorder As Identified By Baccalaureate Prepared Registered Nurses: A Basis To Enhance Professional Practice, Ugo Ndubaku

Doctoral Projects

The increased prevalence of autism spectrum disorder (ASD) foretells that this sector of the population will be accessing health care services in greater numbers; thus, it behooves healthcare providers to prepare for their impending needs. This qualitative study describes the experiences of baccalaureate prepared registered nurses caring for children and adolescents with ASD in order to identify challenges that hinder providing comprehensive and individualized care. A purposive sample of 10 baccalaureate degreed registered nurses (RNs) who have worked or work in the pediatric unit was used to gather rich descriptive experiences. The qualitative data analyses were based on an interpretive …

Patient Perceptions Of Google Glass In The Outpatient Dermatology Setting, Sandra Odenheimer

Doctoral Projects

Background: The ubiquitous use of electronic health record (EHRs) during medical office visits using a computer monitor and keyboard can be distracting and disrupt patient-healthcare provider (HCP) non-verbal eye contact cues, which are integral to effective communication. Provider use of a remote medical scribe with face-mounted eyeglass technology, such as Google Glass (GG), may preserve patient-HCP communication in the healthcare setting by allowing providers to access other parts of the patient’s EHR (e.g. laboratory results, current medications, immunization records) all while maintaining direct eye contact with their patients. The medical scribe is able to chart patient encounters in real-time working …

The Effectiveness Of Insulin Pump Therapy After Transition From Multiple Daily Insulin Injections In Type 1 Diabetes, Sima Sapkota

Doctoral Projects

The population of patients who have been diagnosed with diabetes mellitus (Type 1 or Type 2) has been increasing in the United States. Patients with type 1 diabetes may receive insulin through delivery via insulin pump therapy (IPT) or multiple daily insulin injections (MDII). In addition to requiring insulin, other management regimens have included frequent blood glucose monitoring, checking laboratory values hemoglobin A1c (A1C), maintaining normal body mass index (BMI), keeping a balanced diet, carbohydrate counting, and exercise. The purpose of the study was to compare the retrospective data of A1C and BMI of patients with type 1 diabetes after …