Medicine and Health Sciences Commons^™

Improving Collection Of Second Blood Pressure For Patients In Primary Care Who Present With An Elevated Reading, Jordan Sieh, Elizabeth Sundberg, Tania Arreguin

Doctor of Nursing Practice Projects: College of Nursing

Purpose: Early diagnosis of hypertension is critical to prevent complications such as renal and cardiovascular diseases. Many healthcare facilities do not have a blood pressure training program educating appropriate staff on importance of accurate blood pressure readings and techniques. The purpose of this project is to improve the number of patients with elevated blood pressure reading at the OneWorld Quick Sick Clinic.

Methods: Health aides/Health Assistants/Medical assistants at OneWorld Quick Sick will receive blood pressure training to review proper techniques. During this training they will also be educated on appropriate follow-up blood pressure readings and a new technique to document …

Heart Failure Zone Tool: A Quality Improvement Project, Emily Scahill, Cindy Driggers, Angelica Marquez

Doctor of Nursing Practice Projects: College of Nursing

Purpose

Heart failure is the leading cause of hospital admissions among adults over 65 years old and lack of patient knowledge regarding the self-management of heart failure is a key factor in rising readmission rates. This project enhances inpatient heart failure education using a laminated heart failure zone tool handout to guide heart failure education. The intent was to increase patients’ confidence regarding heart failure self-management and positively impact patients’ knowledge regarding the management of heart failure.

Materials and Methods

The process included identifying hospitalized patients who had been flagged as a heart failure core measure or had been identified …

Development, Validation, And Diagnostic Performance Of A Novel Radiomic Model For Predicting Prostate Cancer Recurrence, Linda M. Huynh

Theses & Dissertations

Multi-parametric magnetic resonance imaging (MP-MRI)-derived radiomics have been shown to capture sub-visual patterns for the quantitative characterization of prostate cancer (PC) phenotypes. The present dissertation seeks to develop, evaluate, and compare the performance of an MRI-derived radiomic model for the prediction of PC recurrence following definitive treatment with radical prostatectomy (RP).

MP-MRI was obtained from 339 patients who had a minimum of 2 years follow-up following RP at three institutions. The prostate was manually delineated as the region of interest and 924 radiomic features were extracted. All features were evaluated for stability via intraclass correlation coefficient (ICC) and image normalization …

Multimodal Investigations For The Identification Of Surgically Relevant Brain Areas, Kevin Tyner

Theses & Dissertations

Epilepsy is a neurological disease leading to recurrent and unpredictable seizures. Patients can be diagnosed as focal onset, where the seizure focus resides in one hemisphere; generalized onset, where seizure foci reside in both hemispheres; or unknown onset. Anti-seizure medications are the first line of treatment, and those whose seizures cannot be controlled with medication are diagnosed with drug-resistant epilepsy (DRE). For patients diagnosed with focal onset epilepsy to achieve seizure freedom, surgical resection of the epileptogenic zone (EZ), the region of the brain that is both necessary and sufficient for initiating seizures, is required. The EZ is a theoretical …

Incorporating A High Fidelity Transgender Simulation Into Undergraduate Nursing Curriculum, Kacee Child, Jenniepearl Spencer

Doctor of Nursing Practice Projects: College of Nursing

Purpose

The purpose of this study was to evaluate the knowledge and attitudes of nursing students participating in a high-fidelity transgender patient simulation. The aims were to increase student knowledge and confidence to improve communication and provide more inclusive and equitable care.

Healthcare providers are not adequately prepared to manage the unique health needs of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Nurses are ideally positioned to address gaps in LGBTQ healthcare by providing culturally competent care. Yet, LGBTQ health education is lacking in most undergraduate nursing school curriculums.

Methods

62 undergraduate nursing students participated in a post-surgical …

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

A Literature Review Of Societal Obesity And Its Impact On United States Military Recruitment, Megan Thibodeaux

Capstone

In recent decades, obesity rates have increased in the United States, raising significant health and societal concerns, especially in terms of military readiness. The ever-rising rates of weight-related health obstacles present a critical national security issue as it impacts the effectiveness of recruitment. This literature review aims to analyze how obesity impacts military recruitment and readiness to serve while utilizing the socio-ecological model to help determine gaps in evidence. Data was drawn from Embase, PubMed, and PsychInfo. Inclusion criteria consisted of academic journals and reports from government and non-profit organizations written in English. They focused only on the United States …

Implementation Of A Doula-Supported Postpartum Wellness Toolkit In A Black Community-Based Maternal Wellness Program, Janice Luethje, Leslie Torres

Doctor of Nursing Practice Projects: College of Nursing

Objective: The objective of this project was to expand the areas of focus within a maternal wellness program at a Black community center and to evaluate the satisfaction levels of the doulas who utilized the material during postpartum home visits. The toolkit covers a range of postpartum topics in the areas of nutrition, exercise, sexual health, mindfulness, and social support as well as a postpartum mental health screening tool.

Design: This quality improvement project included three distinct phases: The pre-implementation phase, the implementation phase, and the post-implementation phase.

Setting: The project location was a Black community center in Lincoln, Nebraska. …

Implementing A Standardized Protocol For Early Detection Of Undiagnosed Hypertension Patients, Jenscena Hansen, Chris Bell

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Hypertension is a preventable disease that frequently goes unrecognized and undertreated. Early diagnosis can prevent further comorbidities such as heart disease, stroke, and chronic kidney disease. Implementation of this protocol aims to decrease the number of patients with undiagnosed hypertension and increase the identification of patients with elevated blood pressure who did not have a pre-existing diagnosis of hypertension. The goal of implementing a standardized protocol would help eliminate the number of patients who go undiagnosed.

Methods: This quality improvement design had clinical staff flag patients with elevated blood pressure. Identified patients without a diagnosis of hypertension were educated …

Effects Of An Educational Evidence-Based Website To Improve Breast Health Knowledge And Self-Efficacy Of Breast Self-Examination: Interim Analysis, Mackenzie Koch, Jennifer Cera, Brooke Hancock, Elizabeth Graham

Doctor of Nursing Practice Projects: College of Nursing

Purpose and Aims

Breast disease, whether benign or malignant, encompasses a wide array of diagnoses. Breast self- examination (BSE) is a simple screening assessment that improves early recognition and diagnosis. With changes in the 2021 ACOG practice guidelines from mandatory to optional provider-performed clinical breast examinations (CBE), it is imperative for patients to possess basic breast health knowledge and accurate BSE techniques. Current standard patient education is provided via brochures or pamphlets. An educational multimedia website was created using ACOG guidelines to impart knowledge and demonstrate proper BSE techniques. Aims were to evaluate changes in participant’s (1) breast health knowledge …

Reduction Of Hospital-Acquired Pressure Injuries In The Acute Care Setting, Bailey Rasmussen, Taylor Bacon, Andrew Gross

Doctor of Nursing Practice Projects: College of Nursing

Background: Hospital-acquired pressure injuries (HAPIs) have been a longstanding problem in hospitals nationwide. HAPIs cause significant financial strain to a healthcare system and complications can be devastating to the patient.

Purpose: The purpose of this project was to implement the Standard Pressure Injury Prevention Protocol (SPIPP) 2.0 Checklist for patients in the Intensive Care Unit (ICU). The primary aim of this study was to determine if implementing the checklist would reduce the number of HAPIs.

Methods: This project took place over a four-week period at a Midwest hospital in the ICU. Data were collected via patient chart …

Perceived Barriers Of Early Mobilization In The Intensive Care Unit, Melissa Sonderman, Emily Miles, Joshua Ferge

Doctor of Nursing Practice Projects: College of Nursing

Purpose

Early mobilization of Intensive Care Unit (ICU) patients can improve patient outcomes but also includes barriers to implementation. Nebraska Medicine has continued to have ongoing quality improvement initiatives like the ABCDEF liberation bundles and early mobilization that have been attempted but have never fully come to fruition. This project surveys Nebraska Medicines ICUs staff to better understand attitudes, knowledge and behavior regarding early mobilization using a validated tool. The aim was to identify barriers, so the organization could better understand the needs of ICU staff for future implementations of early mobility and related assessment tools.

Materials and Methods

A …

How To Evacuate When Disaster Strikes: A Literature Review Of Hospital Evacuations, Grant Orr

Capstone Experience

Hospitals are an essential component of any community’s infrastructure, and due to the nature of their services they are vulnerable when a disaster strikes. If a disaster is severe enough to warrant a hospital evacuation, both hospital and community leaders must decide how to proceed with the resources at their disposal. Organizations such as the World Health Organization, the United Nations, and the United States Department of Health and Human Services offer general guidance, but specifics as to how a hospital should proceed with an evacuation are left to individual hospital leaders and emergency management teams. This capstone project will …

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

Physician Burnout In The United States: A Systematic Review Of Organizational And Systemic Approaches And Their Efficacies, 2014-2024, Nicole Butler

Capstone Experience

Physician burnout represents a critical public and clinical health concern in the United States. It compromises patient care and physician safety. Approaches to solve the issue are pervasive, with limited indication of effectiveness. Due to the essential job functions of physicians, the practice of medicine is inherently stressful. However, the introduction of new, more complex stressors, including those exacerbated by the COVID-19 pandemic, and the increase in chronic healthcare conditions have made burnout an unfortunate staple of physician life, with an estimated prevalence of up to 60%. Burnout involves three factors: emotional stress, depersonalization, and reduced job satisfaction. The consequences …

Identifying Barriers To Healthcare Access And Utilization Experienced By Lgbtq+ Adults With Chronic Diseases Through The Lens Of The Social Ecological Model, Devin Mottier

Capstone Experience

The purpose of this literature review is to comprehensively examine and synthesize existing research on present barriers to health access and utilization that contribute to the disparities in chronic disease prevalence within the adult LGBTQ+ population. In the context of this review, the social-ecological model (SEM) was used to describe the nuanced and multifaceted nature of healthcare access and utilization. This literature review was based upon the following question: ‘Using the social-ecological model, what are the barriers to health access and utilization that contribute to high rates of chronic disease in LGBTQ+ adults?’ Outcome measures of interest included the following …

Examining The Impact Of Racial And Ethnic Disparities In Colorectal Cancer Screening Compliance In The United States And The Potential Of Targeted Interventions., Jessica Ware

Capstone Experience

Objectives:

Examine Colorectal cancer (CRC) screening compliance among racial and ethnic groups in the United States (US) based on the US Preventive Services Task Force (USPSTF) recommendations.

Identify targeted interventions to promote screening compliance, early diagnosis, and CRC survivorship.

Methods: This cross-sectional study utilized 165,878 selected participant responses from the 2022 Behavioral Risk Factor Surveillance System. We modeled and investigated CRC screening compliance based on the USPSTF recommendations as inclusion criteria between racial/ethnic groups in the US while adjusting for covariates using a weighted logistic regression.

Results: With covariates adjustment, Hispanics (POR 1.16 95%CI 1.04-1.29), Asian American …

Addressing Equitable Access In A Safety-Net Hospital System: An Implementation Framework, Hillary Alycon

Dissertations: Doctor of Public Health

Acute care organizations face a significant challenge in effectively implementing health equity programs, particularly in rural areas where guidance is often lacking. Despite abundant literature focusing on health outcomes, there remains a noticeable dearth of published data on implementing health equity initiatives. In response to this gap, I present a comprehensive analysis that utilizes readily available, open-sourced data to address this critical issue.

A thorough assessment of the demographic characteristics of acute care facilities within the catchment regions was conducted based on data from reputable sources such as the US Census Bureau, the American Community Survey, and the County Health …

Disabilities And Snap Work Requirements: A Scoping Review, Jacquelyn Platt

Capstone Experience

This scoping review aims to assess if the criteria to determine Supplemental Nutrition Assistance Program (SNAP) work requirement exemptions provide equal access to individuals with disabilities (IWDs) using a modified PRISMA analysis framework. IWDs applying for SNAP must meet at least one of three requirements to be exempt from work requirements, but these requirements may be disproportionately burdensome for them. SNAP has a long history of expanding food security throughout the U.S., benefiting millions of families. Almost two-thirds of SNAP participants are children, older adults, or IWDs. Children and older adults are exempt from work requirements and IWDs may be …

Optimizing Malaria Control In Nigeria: A Comprehensive Review Of Llin Effectiveness And Policy Frameworks, Jash Mehta

Capstone Experience

This comprehensive literature review examines the effectiveness of Long-Lasting Insecticidal Nets (LLINs) and the policy frameworks governing their use in Nigeria, with the goal of optimizing malaria control strategies in the country. The review explores the scientific underpinnings of LLINs, evaluates their effect on malaria incidence, and examines the operational, sociocultural, and economic aspects that affect their use. It also examines Nigeria's policy environment, assessing the creation, application, and efficacy of policies pertaining to LLIN. The summary of research results from several studies emphasizes the importance of LLINs in preventing malaria and the challenges associated with implementing policies in different …

Development Of A National Core Indicators Dashboard Of Long-Term Services And Supports Outcomes For Individuals With Intellectual And Developmental Disabilities, Rhonda Haitz

Capstone Experience

The National Core Indicators (NCI) surveys are conducted annually across the United States, including Nebraska. Individuals with intellectual and developmental disabilities and/or their guardians are surveyed to learn more about their experiences and the quality of their services and lives (National Core Indicators- IDD, 2023). However, the data is only useful when understood and applied to make informed decisions to improve the lives of those with intellectual and developmental disabilities (McDonald et al., 2013). This project designed and developed two data dashboards for the state of Nebraska that publicly track, analyze and display the NCI survey results. The In-Person Survey …

Improving Intimate Partner Violence Screening In A Women’S Health Practice Through Implementation Of An Evidence-Based Screening Tool, Jasmine Weber

Doctor of Nursing Practice Projects: College of Nursing

The purpose of this quality improvement project was to implement intimate partner violence screening in an outpatient women’s health clinic with no prior screening process in place. Current recommendations are to screen all reproductive age women for intimate partner violence 6 . During a three-month period 170 patients out of 260 eligible patients were screened using the HARK screening tool, 7 of those patients screened positive and were offered referrals to social work. While universal IPV screening was not achieved, a screening rate of 64% is a remarkable improvement from an apparent absence of screening prior to project implementation.

Substance Use Patterns Among High School Students - A Replication Study Of The 2020 Youth Risk Behavior Survey, Haley Irons

Capstone Experience

The study selected for replication is “Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students” by Christopher Jones and colleagues published in the Morbidity and Mortality Weekly Report Supplement in August 2020. The original report used data from the Centers for Disease Control’s 2009-2019 Youth Risk Behavior Survey (YRBS), which is a cross-sectional survey administered every two years to a sample of public- and private-school students in 9th–12th grade in the United States. Researchers from the original report aimed to use the 2009-2019 YRBS data to examine substance use among high school students, characterize the …

Exploring The Mental Health Experience Of Perinatal Military Spouses Based In Sigonella, Italy, Lyndsey Dannenberg

Capstone Experience

The perinatal period can have a profound impact on the mental health of women, their infants, and their families, especially when it comes to depression and anxiety disorders. This study aims to delve into the experiences of perinatal mental health among military spouses stationed overseas, on Naval Air Station Sigonella, Italy, and contribute to the limited research on active-duty military spouses and their perinatal mental health while stationed overseas. The research uses a qualitative phenomenological approach, seeking to provide valuable insights into the lived experiences of military spouses and their perinatal mental health. Risk factors associated with perinatal mental illness …

Associations Between Self-Reported Cognitive Decline And Chronic Diseases: A Cross-Sectional Analysis Of Behavioral Risk Factor Surveillance System (Brfss) 2022, Hailey Child

Capstone Experience

Objective: This study seeks to capture how self-reports measure cognitive decline. The association between chronic conditions and cognition with age consideration in individuals aged 45 and older is investigated.

Methods: Univariate analysis generates frequencies and weighted percentages of 2022 BRFSS data. Chi-square tests and polytomous regressions generate odds ratios for bivariate analyses. A weighted multiple logistic regression model stratified by age group analyzes self-reported cognitive decline.

Results: Respondents ages 45 to 54 with three or more chronic diseases have the highest odds (OR = 6.81; 95% CI = 4.42, 10.48) of cognitive decline. Respondents 75 and older …

Ordinal Logistic Regression Analysis Of The Frequency Of Marijuana Use Among Adult Informal Caregivers In 20 U.S. States, Behavioral Risk Factor Surveillance System (Brfss) 2021, Athena Plichta

Capstone Experience

Objectives. To examine the association between frequency of marijuana use among informal caregivers of persons with dementia (PWD) and other health conditions compared to non-caregivers in 20 U.S. states.

Methods. We used complex survey data from the optional modules Caregiver and Marijuana Use of the 2021 BRFSS survey. Univariate and bivariate analyses were performed to determine the frequency and distribution of sample population characteristics and calculate crude relationships. Ordinal logistic regression modelled the relationship between the three-level outcome and covariates.

Results. Frequency of marijuana use and caregiver status were not associated. There was no difference in increased use among individuals …

Evaluating Lack Of Access To Secondary Prevention-Based Healthcare Services Between Racial/Ethnic Groups In The United States: A Logistic Regression Analysis Using 2022 Brfss Cross-Sectional Data, Samuel Ortiz Severiano

Capstone Experience

Objective: To determine whether racial/ethnic minorities have reduced access to preventive healthcare services in the United States, with participation in routine checkups serving as the metric for access. Methods: Performing logistic regression analysis comparing the length of time since the last routine checkup between different racial/ethnic groups in the study population. Those who haven’t had a routine checkup in at least 12 months served as the comparison group. Results: Black populations were 66% less likely to not have access to preventive care compared to White populations, while Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander populations were 8.5% more likely …

Examining The Relationship Between Adverse Childhood Experiences And Covid-19 Vaccine Status Using 2022 Brfss Data: A Cross-Sectional Study, Cristhian A. Chau-Valdivia

Capstone Experience

Abstract:

Objective.To determine the association between adverse childhood experiences (ACEs) scores with COVID-19 vaccination outcomes before and after adjusting for demographic variables.

Methods. Data were from 2022 Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding 13 categories of ACEs, COVID-19 vaccination, and demographic variables. Data was weight adjusted for survey respondent data. This complex design combined the core and optional modules. Participants who received at least one dose of the COVID-19 vaccine were categorized as vaccinated. The sample size is 12,514.

Results. Participants who were female (OR=1.35, 95% CI: [1.19,1.52]), greater than or equal to 65 years old (OR=4.76, 95% …

Mental Health Perceptions Among Us Veterans And Non-Veterans: 2022 Behavioral Risk Factor Surveillance System, Nicole Frederickson

Capstone Experience

Objective. To determine the association between veteran status and perceived mental health in US adults.

Methods. 2022 Behavioral Risk Factor Surveillance System cross-sectional telephone survey data were used. Analyses were adjusted for confounding sociodemographic and health-related characteristics. Weighted multinomial logistic regression was used to determine the association between veteran status and reporting 0, 1-13, or 14+ poor mental health days.

Results. A total of 430,653 individuals were included in this analysis. Veteran status was associated with decreased odds of reporting 1-13 poor mental health days than nonveterans (OR=0.81; 95% CI 0.77, 0.86) but greater odds of reporting 14+ poor mental …

Association Between Frequent Mental Distress And Insurance Status Using The 2022 Brfss, Christina Clayson

Capstone Experience

Objectives

Determine if there is a direct relationship between frequent mental distress and health insurance coverage.

Methods

Data from the 2022 BRFSS was used to calculate adjusted percentages. Crude odds ratios for both mental distress and insurance coverage. Multivariate analysis calculated crude and adjusted odds ratios for frequent mental distress by insurance coverage with income as a covariate.

Results

Individuals reporting frequent mental distress had lower income, less education, and were younger. Individuals without health insurance were more likely to be younger, Hispanic, and not have graduated high school. There was no significant association between frequent mental distress and not …