Medicine and Health Sciences Commons^™

Evidence Based Protocol: Improving Nutrition Monitoring In Hospitalized Adults, Philip W. Jackson

Master's Projects

Malnutrition affects a large number of adult inpatients. For these patients, the implications of the high rate of malnutrition include impaired wound healing, higher rates of infection, and an increased risk of death. These complications contribute to increased healthcare costs and longer lengths of stay. The level of monitoring and documentation of patients’ meal consumption was acknowledged to be below expectations in an acuity-adaptable neurosciences unit situated in a downtown hospital located in the Midwestern United States. The define-measure-analyze-improve-control (DMAIC) quality improvement framework guided the quality improvement team to develop a standard process for meal related activities. The rate of …

An Evaluation Of A Care Conference Model And Improvement In The Transition Process For Medically Complex Pediatric Patients Between Inpatient And Outpatient Care, Tamara Van Kampen

Doctoral Projects

Medically complex and/or fragile pediatric patients are high utilizers of health care dollars. This population represents less than one percent of the general pediatric population, yet they account for more than 30% of pediatric healthcare costs. These patients tend to have longer lengths of stay in the hospital, high readmission rates, and lower healthcare satisfaction scores. They also have multiple transitions between inpatient and outpatient care which increases the opportunity for medical errors. Research has shown that care conferences attended by key stakeholders tend to reduce readmissions and healthcare utilization while improving satisfaction rates and patient outcomes. Research also shows …

The Effect Of Dietary Specialism And Generalism On Evolutionary Longevity In An Early Paleogene Mammalian Community, Samantha Glonek

Masters Theses

This study examines the relationship between relief index (RFI) on first and second mandibular molars and longevity of the genus. The molars were extracted from small-bodied, arboreal mammals during the late-Paleocene, early-Eocene in the Bighorn Basin in Wyoming. This study site is a well-known location to research and study fossil mammals of this time period. The study was conducted and analyzed at the genus level due to the relatively small number of specimens available and identifiable at the species level. Dietary breadth, or how broad or narrow a dietary preference is for a mammal, is an area of concentration within …

Role Of Race/Ethniciy, Pre-Pregnancy Bmi, And Socioeconomic Status On Risk For Large-For-Gestational (Lga) Infants Born To Women With Gestational Diabetes Mellitus (Gdm), Anna M. Kiefer

Masters Theses

Background Fetal macrosomia occurs in approximately 10% of all pregnancies taking place in the United States. Babies born LGA are placed at a greater risk for shoulder dystocia, perinatal trauma, cesarean section, jaundice, hypoglycemia, and neonatal intensive care admission. Even more, the long-term impacts are severe and include increased risk of becoming overweight or obese and developing type 2 diabetes later in life. Women with gestational diabetes mellitus (GDM) have higher rates of delivering macrosomic offspring due to insulin resistance taking place beyond what is normal during a pregnancy. Additionally, maternal obesity, socioeconomic status, and race/ethnicity have been associated with …

Program Evaluation Of A Bundled Educational Intervention To Enhance Implementation Of Professional Exchange Report, Luanne M. Shaw

Doctoral Projects

Communication handover is a source of potential error and risk to patient safety. Electronic-based tools may reduce errors and mitigate risks to patient safety. Electronic tools have been successfully implemented using multiple methods of education and training. Electronic tools vary in functionality and integration with the electronic health record (EHR). A large West Michigan Regional Health System (RHS) implemented a new EHR containing an embedded tool for communication handover called Professional Exchange Report (PER). There was inconsistency in the practice of bedside report by nurses. The RHS planned to use a bundled approach of educational interventions to implement the new …

Lessons Learned From The Quality Improvement Process In A Community Based Hospital: The Dissection Of Implementation Failure Of Use Of The Prism Mortality Risk Tool And Standardization Of Case Management To Reduce Readmissions In High Risk Patients, Mary K. Ziomkowski

Doctoral Projects

Hospital readmission, particularly within 30 days of discharge, is a wicked problem. Effective case management is an imperative component of high quality healthcare for the successful transition of patients across acute and post-acute settings. Patients with complex care needs endure an increased risk for negative outcomes, mortality, and hospital readmission. A small body of evidence suggests that early, targeted interventions aimed at high risk patients can mitigate complications and poor transitions. Patient complexity is an important consideration when establishing a comprehensive care management plan. Risk prediction tools are valuable for ensuring that high risk patients receive appropriate resource allocation. Case …

Implementation Of A Patient-Centered Communication Model In The Emergency Department, Carrie Mull

Doctoral Projects

The objective of this scholarly project is to determine the impact of patient-centered communication education in an emergency department (ED) on the perception of workplace safety. The ED is a vulnerable setting and susceptible to workplace violence (WPV) due in part to increasing numbers of patients presenting to EDs with primary psychiatric complaints. High-quality patient-staff interactions correlate positively with better treatment outcomes. Patient-centered communication skills can be taught, and patients have similar expectations of what patient-centered communication means no matter their diagnoses. The purpose of this quality improvement project was to conduct patient-centered communication education with nurses, nursing assistants, and …

Implementation And Evaluation Of A Preceptor/Mentorship Program During Orientation In A Long Term Care Facility: A Strategy To Increase Nursing Employee Satisfaction, Maria A. Painter

Doctoral Projects

High nursing turnover in long-term care (LTC) facilities is a significant problem that results in additional expenses, lower quality of patient care, increased adverse patient events, and decreased patient and nursing satisfaction. A structured orientation and supportive preceptors are protective factors in retaining nurses as well as increasing nursing job satisfaction and improving patient outcomes. The goal of this pilot project was to implement an evidence-based preceptor program for staff registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs) in an LTC facility to develop preceptors’ skills and preceptees’ orientation satisfaction. The preceptor development project facilitated by …

Perceived Barriers To The Pre-Transplant Evaluation: A Patient Perspective, Linda K. Buck

Doctoral Dissertations

Patients who are afforded the opportunity for a kidney transplant tend to have better short and long-term outcomes, including improved physical health, quality of life, and long-term survival over those who are treated with prolonged dialysis (Landreneau, Lee, & Landreneau, 2010; Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients (OPTN/SRTR), 2014; Wolfe et al., 1999). At the end of 2012, 402,514 people were being treated with hemodialysis while 40,605 were receiving peritoneal dialysis (USRDS, 2014). At this same time, only 92,885 people were listed on the OPTN national waitlist for kidney transplantation. The aim of this project …

Influence Of Socioeconomic Status On Event-Free Survival In Children Diagnosed With Acute Lymphoblastic Leukemia, Jordan L. Chester

Masters Theses

Acute lymphoblastic leukemia (ALL) is the most common type of cancer diagnosed in children. However, little is known about how socioeconomic status (SES) influences the outcomes of children diagnosed with ALL. The goal of the research study was to understand how SES impacted the outcomes of children diagnosed with ALL, with a particular interest in children living in West Michigan. Children ages 0-14 years who received treatment for ALL at Spectrum Health’s Helen DeVos Children’s Hospital’s Pediatric Hematology and Oncology program between the years 2002-2011 were considered for this study. Eligible participant’s zip codes and dates of relapse/death were obtained …

Early Progressive Mobility In The Intensive Care Unit Adult Patient Population, Kimberly Henry

Master's Projects

No abstract provided.

Evidence-Based Protocol: Decreasing Falls And Falls With Injury In A Nsdu, Jennifer J. Komm

Master's Projects

Patient falls in acute care tend to be the most common adverse events reported. The Centers for Medicare and Medicaid Services report that fall-related injuries are classified as hospital-acquired conditions and no longer reimburses for the diagnosis and treatment of injuries incurred from falls during hospitalization. Falls are decreasing at too slow a rate even with a variety of fall prevention guidelines being available. Falls are a complex problem within hospitals and the prevention of falls is challenging. Literature supports the individualization of fall prevention interventions based on the risk factors exhibited by a patient. Tailoring interventions to specific fall …

The Role Of Affective Forecasting And The Impact Bias In Nutritional Health Behaviors, Matthew D. Fallon

Masters Theses

Previous literature on affective forecasting has studied its role in health decisions, but there is little research investigating affective forecasting in diet choices and eating behaviors. The present study collected affective forecasts from 43 college participants before eating an indulgent snack and then observed emotions immediately after eating the snack. We predicted that emotion predictions would be significantly stronger than observed emotions, in support of previous literature on the impact bias. We also predicted that optimism would predict a stronger impact bias and that extraversion and neuroticism would have a role in forecasts and observed emotions. Contrary to our hypothesis, …

Cesarean Section Surgical Site Infection Prevention Evidence-Based Practices And Implementation Plan, Amanda K. Smith

Master's Projects

The Cesarean section (C-section) surgical site infection prevention implementation plan has been designed as a quality improvement project. The project included a microsystem assessment, identifying the problem, literature review, application of a nursing theory and conceptual model, and development of an implementation plan. The microsystem assessment involved a Labor and Delivery Unit who had initiated a new surgical site infection (SSI) prevention bundle developed by an interprofessional team utilizing evidence-based practices and other hospitals protocols. The problem defined was the elevated rates of SSIs due to gaps in the SSI bundle risking the sustainability of the bundle. A literature review …

Assessing The Potential Benefits Of Recreational Therapy On Functioning Outcomes, Samantha R. Lamkin

Masters Theses

Background: The aim of recreational therapy, like all rehabilitation therapies, is to promote the functionality and well-being of a person with disability. However, unlike other forms of therapy, recreational therapy utilizes a unique approach to rehabilitation by incorporating meaningful daily life activities into the patient’s individualized rehabilitation plan. Gains in functionality can be quantified using a Likert scale measurement Functional Independence Measures (FIM®). Previously conducted research shows a positive association between recreational therapy services and functionality gains in specific populations of persons with disability with stroke, traumatic brain injury, and spinal cord injury being most heavily represented. Problem: Research gaps …

Effects Of Aging And Dietary Phytoestrogens On Sperm Production In Sprague Dawley Rats, Brian Cutler

Masters Theses

Estrogens, in addition to testosterone, are physiologically relevant to normal sperm production in the testis and sperm maturation in the epididymis. Previous studies from our lab demonstrated that daily sperm production declines from 15 to 18 months of age in Sprague Dawley rats, and treatment with estrogen during this period attenuated the age-associated decline. Phytoestrogens are present in standard rodent diets at high levels (350-650 mg/kg) and may be potential endocrine disruptors. The purpose of this study was to investigate the effect of removing dietary phytoestrogens during aging on sperm production. Retired breeder Sprague Dawley rats were obtained at 9 …

Early Ambulation For Colorectal Enhanced Recovery Patients In A Surgical Specialties Unit, Jessica P. Pelletier

Master's Projects

Early ambulation is a key concept in surgical recovery and overall improvement of medical conditions. The initiation of Enhanced Recovery programs (ERP) for surgical procedures have used evidence-based research to bundle best practices for a quicker and more effective recovery.

The author evaluated the consistency of early ambulation on a surgical specialties unit using the ERP method. Through process improvement methods, data and practice were evaluated to show inconsistencies in documentation, data report abstraction, and understanding of complete collaborative bundle components.

Impacting Adherence To Infant Safe Sleep Practice, Danielle M. Hartig

Master's Projects

This paper provides a complete microsystem assessment of a pediatric unit. The assessment includes identification of a process problem with infant safe sleep practice in the hospital setting. The paper explores six different published articles regarding clinical practice guidelines, best practices, and evidence-based interventions. The literature review indicates agreement amongst various authors following infant safe sleep guidelines in the hospital setting. The literature review also indicates that caregiver role modeling while in the hospital setting is the most influential component that affects parents’ practices upon return to the home setting. The clinical project will include baseline needs assessments of both …

Identifying Themes When Using A Community-Based Participatory Research (Cbpr) Approach With Men Living In Abstinence-Based Recovery Housing, Rachel Morrison, Jade Sharrer, Jason Clements

Mental Health

This abstract will be available for download after an embargo period

Improving The Supply Process In An Interventional Procedures Unit, Megan M. Rose

Master's Projects

In the combined cardiac catheterization and interventional radiology unit of an urban Midwestern hospital, having supplies when and where they are needed is necessary for efficiently and safely completing a wide variety of procedures. Due to the complexity of the supply chain process in this setting, baseline data collection revealed many missing supplies, overnight shipments, and expired items. In this project, the MSN student sought to determine whether a Clinical Nurse Leader driven Lean Six Sigma based approach to supply chain interventions in the interventional procedures setting would improve outcomes and lead to financial savings by decreasing waste and variation. …

Evidence-Based Protocol: Standardizing Handoffs To Improve Outcomes, Melissa L. Rykse

Master's Projects

Nurse to nurse handoffs were identified as an area for improvement in an acuity-adaptable, progressive care (AAPC) unit in a Midwestern hospital. By using the Plan, Do, Study, and Act (PDSA) quality improvement framework, the content of handoffs was standardized by the creation and use of a handoff tool, organized in a Situation, Background, Assessment, Recommendation (SBAR) manner. Outcomes of nursing satisfaction and incidental overtime were improved after the implementation of the handoff tool. This cost neutral project has a cost savings potential of $2000/year with the reduction of incidental overtime.

Evaluation Of A Pilot Multidisciplinary Debriefing Program: Promoting Pediatric Provider Emotional, Social, And Spiritual Wellbeing, Allison E. Reynolds

Doctoral Projects

Regular exposure to trauma, such as the act of bearing witness to intense suffering and pain of pediatric patients and families, has a significant effect on healthcare professionals. Despite the fact that traumatic situations in pediatrics are a reality, there is little education and few interventions focused on how to prepare and support healthcare providers to care for dying children and families or for other clinically challenging situations. Pediatric residency program directors within a large, freestanding children’s hospital identified a subjective need for support for their pediatric residents in dealing with clinically challenging situations faced during residency, motivating residency program …

Development Of A Patient-Centered Medical Home Toolkit At An Integrated Primary Care Clinic, Lyndsay A. Randall

Doctoral Projects

Health care spending in the United States far exceeds that of other high-income countries (Squires & Anderson, 2015). In 2013, the U.S. spent 17.1 percent of its gross domestic product (GDP) on healthcare, which was almost 50 percent more than the next highest spender noted as France (Squires & Anderson, 2015). While the U.S. spends more on healthcare than other countries, multiple other health outcome measures are worse including life expectancy, heart disease, diabetes, and chronic respiratory illnesses (Squires & Anderson, 2015). Today’s healthcare system is highly fragmented, lacking the necessary coordination within the primary care setting. Better care coordination …

Improving Care Of Behavioral Health Patients In A Rural Emergency Department: A Needs Assessment, Margaret Perec

Doctoral Projects

Leadership and staff at a rural Critical Access Hospital (CAH)have identified the need for interventions to address the specific care issue of behavioral health patients presenting to the emergency department (ED). The ED has experienced a higher than expected number of visits, which has presented the department with challenges, especially in finding placements for patients who need inpatient treatment. ED management and staff have reported many patients have experienced long lengths of stay in the ED while waiting for beds.

A needs assessment attempts to identify characteristics of patients who remain in the ED for extended lengths of time, and …

Implementing Clinical Practice Guideline Recommendations To Address Prenatal Smoking: A Practice Change In A Community Health Department, Rachel L. Danks

Doctoral Projects

According to the authors of current literature, pregnant women who smoke may be more resistant to change, and may not fully understand the harmful effects of smoking. Therefore, there is agreement among researchers that the use of psychosocial interventions for smoking cessation can be effective. At the time of this project many settings, including clinics, health departments, and providers, were implementing the 5As which guide healthcare and community workers to ask, advise, and assess the smoking status of pregnant women at every health visit, and then assist and arrange smoking cessation interventions if applicable. Despite these efforts, pregnant women are …

Creative Movement Dance Class For Adolescents With Autism Spectrum Disorder, Zoe N. Brennan, Abigail L. Koning, April L. Miller

Pediatrics

Objective: The objective of this phenomenological study was to identify how an occupational therapy developed Creative Movement Dance Class (CMDC) addresses social interaction skills in adolescents with Autism Spectrum Disorder (ASD).

Method: Interviews were conducted with a Certified Occupational Therapist Assistant (COTA), Occupational Therapist (OT), ballet instructor, student intern, teacher, and an aide that were directly involved with the CMDC.

Results: Three themes were identified. The first theme, structure of the class, consisted of eight sub-themes including opportunity to practice, fulfilling sensory needs, the Just Right Challenge, classroom support, classroom expectations, interprofessional collaboration, themes, and format of the class. The …

Female Veterans: Satisfying Patterns Of Daily Activities As Defined By The Life Balance Model, Chloe Hillpot, Kerry A. Macdonald, Laura A. Rohr

Mental Health

This phenomenological case study explored the occupational needs and life satisfaction of one female veteran upon reintegration into civilian life. One female veteran, with 23 years of military service, participated in a semi-structured telephone interview. Results demonstrated that military service negatively impacted the participant’s social interactions, physical and mental wellbeing, and ability to cope with stressors, indicating military service posed difficulties for the participant to engage in meaningful occupations upon reintegration. Recommendations included development of occupation-based interventions using the Person Environment and Occupation framework, and further research to identify appropriate services to facilitate successful reintegration into society for female veterans.

Identifying Themes When Using A Community-Based Participatory Research (Cbpr) Approach With Men Living In Abstinence-Based Recovery Housing, Rachel Morrison, Jade Sharrer, Jason Clements

Community Based

This abstract will be available for download after an embargo period

The Effect Of Occupational Therapy Play-Based Interventions On Cooperative Behavior In Elementary School Aged Children With Autism Spectrum Disorder, Shaunna Kelder, Jennifer E. Langill, Carol A. Reiss, Nicole F. Socia

Pediatrics

The purpose of this study was to explore the perceptions of occupational therapy practitioners regarding the effect play-based interventions have on cooperative behaviors in elementary school aged children with autism spectrum disorder (ASD). While occupational therapy practitioners use a variety of interventions involving play to enhance skills related to social, self-regulation and communication, the concept of how play affects cooperative behavior, specifically in children with ASD, has not been readily identified. This qualitative research project utilized an anonymous survey to collect the perceptions of occupational therapists (OT) and certified occupational therapy assistants (COTA). The intent of the survey was to …

The Use Of Sensory Spaces In Schools, Syeda S. Mahmood, Erin E. Mallekoote, Ashley Rister

Pediatrics

Objective: This mixed methods continuing line of inquiry was conducted in order to identify how occupational therapists (OTs) report that sensory spaces are being used in Michigan public school settings. This includes who uses the spaces, what purpose the space serves, and the training that individuals utilizing the spaces have received.

Methods: A link to a survey, which was adapted from Abbot, Wills, and Hanert (2015), was posted on the Michigan Alliance of School Physical and Occupational Therapists’ (MASPOT) listServ and Michigan Occupational Therapy Association’s (MiOTA) facebook page in June of 2016 in order to recruit participations. The …