Medicine and Health Sciences Commons^™

Staff Education To Reduce Medication Error In Psychiatric Intensive Care Unit, Christiana Omodugba-Udeh

Walden Dissertations and Doctoral Studies

Summary This staff education project was an initiative designed to address the practice problem of medication errors in the psychiatric intensive care unit (PICU). The project’s purpose was to improve the nursing staff’s knowledge regarding medication administration and documentation through a structured educational intervention. The practice-focused question was: Will staff education on medication administration and documentation in the electronic medical record (EMR) result in an increase in staff knowledge with an aim to promote a reduction in medication errors in the PICU? The education was delivered through in-person sessions during regularly scheduled staff meetings to ensure full participation without disrupting …

Vocal Toning Increasing The Parent-Child Bond In Neonatal Care: A Proposed Method, Mikki Mcintire

Expressive Therapies Theses

Vocal toning in the Neonatal Intensive Care Unit (NICU) is an innovative therapeutic method that greatly improves emotional connections between caregivers and fragile infants. This practice is more than just a new idea; it fosters the crucial relationships essential for developing newborns. Vocal toning also aids in stabilizing physiological responses and promoting emotional regulation in infants, who are often subjected to high-stress situations. Using structured vocalization techniques, caregivers can provide consistent auditory and vibrational cues that encourage relaxation and promote co-regulation with the infants in their care. This proposed approach examines the theoretical foundation, solid methodology, practical application, and anticipated …

Silent Sparks: Gaining Clinical Experience To Implement An Occupation-Based Program In A Birth-3 Group With Deaf/Hard-Of-Hearing Children, Sydney Patrow, Moses Ikiugu

Occupational Therapy Capstone Presentations

This capstone project aimed to develop clinical skills and implement an occupation-based program for Deaf and hard-of-hearing (D/HH) children at Metro Deaf School in Saint Paul, Minnesota. Guided by the Dynamic Family Systems Model, Lifespan Development, and Sensory Integration Theory, the project emphasized holistic, family-centered care, skill development, environmental modifications, and promotion of regulation and participation. Clinical skill development was assessed using the Theory Application Assessment Instrument (TAAI) and a site mentor survey. An 8-point improvement from pretest to posttest on the TAAI indicated enhanced theory use skills, and the mentor survey reflected high satisfaction. The program included a five-week …

Experience Of Coparents/Partners Of African American Mothers Participating In Breastfeeding Education, Samantha Hickson

Walden Dissertations and Doctoral Studies

Coparents and partners of African American mothers are critical in the initiation and continuation of breastfeeding and influence a woman’s decision to breastfeed. The purpose of this qualitative study was to explore the experience of coparents/partners of African American mothers participating in breastfeeding education and its impact on the support they provide. Bandura’s social cognitive theory provided the theoretical foundation for this study. Data were collected via semi-structured interviews with 11 participants. Data analysis followed the traditional seven steps of interpretative phenomenological analysis. Findings showed that while coparents and partners of African American breastfeeding mothers found breastfeeding education to be …

Novel Combination Therapies For Estrogen Receptor-Positive Breast Cancer Driven By Rational Molecular Mechanisms, Anneka Lila Johnson

Dartmouth College Ph.D Dissertations

Breast cancer (BC) is the most common non-keratinocyte cancer diagnosed in women in the United States with approximately 300,000 new cases diagnosed each year. Despite a myriad of treatment options, BC remains the second-most deadly cancer. Estrogen receptor-positive (ER+) BC comprises 60-70% of BC diagnoses and is treated with endocrine therapies that limit ER signaling. Despite endocrine therapy options, ~1/3 of patients experience recurrence within 10-20 years of diagnosis. Novel therapeutic strategies are required to limit BC recurrence-related morbidity and mortality.

Radiotherapy is used as an adjuvant treatment for ER+ BC patients prior to the use of endocrine therapy. Radiation …

Eos Wellness Center: Rethinking Inpatient Mental Health Facility Design, Emily Simms

Bachelor of Architecture Theses - 5th Year

The design of mental health facilities significantly impacts patient outcomes, especially for individuals with depression. Environmental factors such as lighting, thermal comfort, and access to nature influence mental health. This research explores how architectural design can reduce self-harm incidents and enhance recovery outcomes for patients with depression. The project hypothesizes that synchronizing light patterns and thermal comfort with patients’ circadian rhythms will reduce self-harm incidents and improve recovery. The problem established in the research is that disruptions to circadian rhythms increase the risk of depression, PTSD, and anxiety by 30% (Burns et al., 2022). Suicide is also the second leading …

Enhancing Nurse Competency: Proper Application Of Chlorhexidine Gluconate Dressings To Prevent Central Line Associated Bloodstream Infections, Joseph Earich

Doctor of Nursing Practice Scholarly Projects

Central line-associated bloodstream infections (CLABSIs) pose a significant risk to patient safety and healthcare outcomes. The proposed Doctor of Nursing Practice (DNP) project addresses the knowledge gap among nurses regarding the correct procedures for changing chlorhexidine gluconate (CHG) dressings on central lines. The goal is to enhance nurse education and adherence to best practices, thereby reducing the incidence of CLABSIs. The project employs a quasi-experimental design with a pre-test and post-test methodology. Nurses will complete a pre-test to assess their baseline knowledge of CHG dressing changes. The nurse will participate in a hands-on educational session to improve their understanding and …

A Multicomponent Quality Improvement Initiative For The Early Identification, Prevention, And Management Of Delirium In The Medical-Surgical Setting, Sarah K. West

Doctor of Nursing Practice Scholarly Projects

Hospital-acquired delirium affects older adult patients, across the healthcare continuum. The incidence in frail older adults is high, costly, and often deemed preventable. Hospital-acquired delirium is associated with a multitude of short- and long-term complications, resulting in an increased rate of morbidity and mortality. The challenges of early recognition and management are prevalent in healthcare literature. While published guidelines exist, hospital systems continue to struggle with the standardization of geriatric delirium care. Given medical-surgical nursing is the cornerstone of hospital care, it is imperative to establish a standardized delirium prevention and management guideline, at this level of care, to optimize …

Enhancing Advanced Practice Nursing: Implementing A Simulation-Based Point-Of-Care Ultrasound Training Program, Brandy Younge, John Chovan, Bonnie Fagan, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

Nurse practitioners (NPs) are advanced practice nurses entrusted with diagnosing and treating illnesses, managing acute and chronic diseases, and engaging in continuous education to remain knowledgeable of evidence-based advancements. NPs offer a comprehensive range of healthcare services, catering to patients from wellness check-ups to those requiring complex care, such as individuals hospitalized with sepsis. One technological advancement that can support NPs in delivering optimal patient care is point-of-care ultrasound (POCUS). In the United States, over 385,000 NPs practice in patient care settings that may use POCUS. Numerous medical societies have issued position statements supporting the use of POCUS in the …

Final Scholarly Project: Evidence-Based Practice Guidelines For The Perioperative Management Of Blood Glucose Levels In The Cardiac Surgery Patient, Chelsey Benner

Doctor of Nursing Practice Scholarly Projects

Cardiovascular disease is the leading cause of mortality worldwide, necessitating a high demand for cardiac surgery. A unique stressor for cardiac surgery is an increased surgical stress response involving hyperglycemia. Perioperative hyperglycemia contributes to adverse postoperative outcomes following cardiac surgery. Current evidence examines blood glucose control and its effect on adverse postoperative outcomes, including sternal wound infections, acute kidney injury, prolonged mechanical ventilation, and an increased length of stay in the intensive care unit. Despite the link between hyperglycemia and poor postoperative outcomes, most facilities lack standardized guidelines for the perioperative management of blood glucose levels in cardiac surgery patients. …

Final Scholarly Project: Development And Initial Validation Of An Evidence-Based Guideline For Presurgical Medication Hold Times, Alyscia Defrancisco

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Presurgical testing is a critical component for preventing surgery delays and postsurgical complications. A major focus of presurgical testing is educating patients on hold times of medications prior to surgery. Medication guidelines vary across ambulatory surgery centers.

Methods: Creating a standardized evidence-based medication guideline could improve some surgical complications. This project is the creation and pilot evaluation of an evidence-based medication guideline. After the development of the guideline participants attended an educational session. The evaluation of the effectiveness of the guideline, used a preintervention and postintervention questionnaire. The participants of the project are presurgical testing practitioners at …

Division Iii Soccer Athlete Ankle Stability In An Ankle Brace Compared To Ankle Tape During Functional Testing, Caitlin M. Craig

Masters Theses/Capstone Projects

Objective/ Context: A common injury to athletes and non-athletes is a lateral ankle sprain. There is a higher incidence of a lateral ankle sprain occurring during sports participation. Additionally, soccer athletes are at an increased risk for lateral ankle injuries due to the high impact of cutting and turning, which can lead to the mechanism of injury. As a means of injury prevention and ankle stability, ankle taping and ankle bracing provide athletes with similar support. There is an ongoing debate on whether one method is better at providing stability to at-risk populations; however, the answer is still being determined. …

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Final Scholarly Project: The Administration Of Transversus Abdominis Plane Blocks In Patients Undergoing Anesthesia For Open Ventral Hernia Repairs, Brennon Pinion

Doctor of Nursing Practice Scholarly Projects

Ventral hernia repairs are the only definitive treatment for umbilical or abdominal hernias. These procedures are prevalent and often lifesaving but also carry high risks of adverse effects. Some of the problems that follow include postoperative ileus, increased opioid use, and prolonged length of stay. Due to the rate of complications, there was a need to improve these outcomes. One way to improve outcomes is to implement superior anesthetic techniques. This Final Scholarly Project (FSP) followed the Plan-Do-Study-Act (PDSA) model to conduct evidence-based practice (EBP) and quality improvement (QI) sections. The plan phase included a thorough literature search and analysis …

Development Of Evidence-Based Clinical Practice Guidelines For Pediatric Preoperative Anxiety, Whitney R. Stant

Doctor of Nursing Practice Scholarly Projects

Preoperative anxiety is a problem that occurs frequently in pediatric patients. Preoperative anxiety creates physical and psychological changes that impact a child’s surgical experience. Pediatric patients who experience preoperative anxiety may also experience prolonged postoperative care, long-term psychological complications, and increased postoperative pain. Sedating medications are often administered to prevent and treat preoperative anxiety. Commonly, midazolam is administered intranasally to prevent preoperative anxiety. Midazolam increases the risk of cognitive impairment and respiratory depression. Dexmedetomidine is an effective alternative to midazolam. Dexmedetomidine is a highly selective alpha-2 agonist and provides arousable sedation without respiratory depression. Dexmedetomidine is safe and effective at …

Guidelines For Intraoperative Use Of Quantitative Neuromuscular Monitoring, Alex Thompson

Doctor of Nursing Practice Scholarly Projects

Chemical paralysis with neuromuscular blocking agents is common practice in anesthesia. Adequate reversal of these medications is essential for postoperative recovery and return to physiologic baseline. Inadequate reversal may lead to residual paralysis and respiratory complications such as hypoxemia, upper airway obstruction, atelectasis, and pneumonia. Quantitative neuromuscular monitoring was introduced as an objective measure of adequate recovery from neuromuscular blockade. The American Society of Anesthesiologists recommends utilizing quantitative neuromuscular monitoring before tracheal extubation in their 2023 practice guidelines, as the research involving quantitative neuromuscular monitoring shows a reduction in postoperative residual paralysis rates and adverse respiratory complications postoperatively. In this …

Diabetes Self-Management Education For Older Adults In Primary Care, Makilah Rae Furlan

Doctor of Nursing Practice Scholarly Projects

Type 2 Diabetes (T2DM) is a chronic disease that impacts 27.2 million seniors 65 and older. Evidence-based care for T2DM includes a combination of medication and disease-management behaviors. Access to education to teach patients healthy behaviors to manage their disease is limited and even less accessible to geriatric patients with aging learning needs. The scholarly project addresses this gap in patient education by implementing evidence-based diabetes self-management education for geriatric patients to increase patient knowledge and confidence in implementing self-management behaviors. The scholarly project aims to assess health behaviors in patients aged 65 and older with established type 2 diabetes …

Proposed Final Scholarly Project: Pediatric Provider Attitudes And Clinical Practices For Physical Activity Interventions In The Treatment Of Attention-Deficit/Hyperactivity Disorder, Andrea Zanders

Doctor of Nursing Practice Scholarly Projects

Attention-deficit hyperactivity disorder (ADHD) is one of the most common mental health conditions diagnosed in children and adolescents. First line treatments of psychopharmacology and psychotherapy can be ineffective, come with intolerable side effects, or not be available to all youth. Physical activity is among the most effective adjunctive interventions. However, many mental health providers report insufficient education or training on physical activity interventions as a barrier to implementing them into clinical practice. Using the transtheoretical model of behavior change principle of consciousness-raising, the proposed scholarly project aims to impact provider attitudes and knowledge about the use of evidence-based guidelines for …

Evidence-Based Practice Guidelines For Perioperative Use Of Dexmedetomidine In Pediatric Congenital Cardiac Surgery, Kayla Thomsen

Doctor of Nursing Practice Scholarly Projects

Tachyarrhythmias are common postoperatively in the congenital cardiac surgery population. About 1% of the population is born with congenital heart disease (CHD), with 50% of patients undergoing surgery for CHD experiencing arrhythmias. Complications can arise from postoperative arrhythmias, including hemodynamic instability and myocardial depression, having catastrophic health repercussions. Despite the high prevalence and complications, there is no standard practice for postoperative tachyarrhythmia prevention in the chosen population, and prevention is at the provider's discretion. However, literature exploring the effects of dexmedetomidine notes promising results for using the drug for postoperative tachyarrhythmia prevention. The project aims to address the lack of …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler

Doctor of Nursing Practice Scholarly Projects

A pancreaticoduodenectomy, or Whipple procedure, is the only curative option for pancreatic cancer. For those eligible for tumor resection, the Whipple procedure is a difficult surgery for both the patient and provider. Complications following pancreaticoduodenectomy are numerous and include infection, delayed gastric emptying, high hospital costs, and pancreatic fistulas. Enhanced Recovery After Surgery (ERAS) protocols exist to provide evidence supporting standardization of practices that lead to the improvement of these patient outcomes. An ERAS protocol for the pancreaticoduodenectomy, first established in 2012, is inconsistently implemented in healthcare facilities. Researchers collected data involving the use of the Whipple procedure ERAS guidelines …

Development Of Evidence-Based Practice Guidelines For Utilizing Erector Spinae Plane Blockade For Patients Undergoing Cardiac Surgery, Gabrielle Metoyer

Doctor of Nursing Practice Scholarly Projects

In the United States, the aging population and high rates of cardiovascular disease leads to increased cardiothoracic surgeries. Analgesia for cardiac surgeries often involves high-dose opioids. However, with an ever-increasing opioid epidemic and adverse effects on the postoperative healing process, recent literature seeks to decrease opioid consumption by utilizing alternative methods of analgesia. The American Association of Nurse Anesthetists recommends the use of regional anesthesia techniques to reduce the incidence of undertreated postoperative pain that can occur from opioid-sparing methods of analgesia. This project aims to create an evidence-based analgesia guideline for adult patients undergoing cardiac surgery. Interventions will include …

In A Healthy D-Iii Population, Is Blood Flow Restriction More Effective For Increasing Quadriceps Strength Compared To Concentric Resistance Training?, Conner R. Ruff

Masters Theses/Capstone Projects

Strength is an important factor in the prevention of injuries. However, strength can decrease for numerous reasons, such as age, chronic injuries, or acute injuries. In recent years, Blood flow restriction (BFR) has been used as a modality to increase a patient’s strength gain while utilizing a low load of weight. However, in most research, BFR has been used concurrently with conventional strength training or compared to concentric training in the treatment of an injured population. This study looked at the effect of BFR on a healthy Division III (DIII) collegiate student population and its effectiveness in increasing quadriceps strength …

A Proposal: Gap Analysis On Novice Advanced Practice Provider Role Transition Within The Inpatient Setting, Erin Cornelius

Doctor of Nursing Practice Scholarly Projects

Background: Healthcare specialties are an integral part of patient care yet are briefly discussed throughout the academic journey of the advanced practice provider (APP). Hiring departments or facilities must provide further education on complex specialties. Due to a decline in practicing physicians, APPs will provide more patient care within specialties by 2032.

Purpose: To emphasize the importance of a high-quality onboarding program for the success of the APP, the department, and the hiring facility.

Method: Proposed data collection involves a two-part survey using the Novice Nurse Practitioner Role Transition (NNPRT) scale and an onboarding experiences survey.

Results: A literature thematic …

An Educational Intervention: Knowledge Acquisition Of Perimenopausal Mental Health Symptoms And Treatment Options For Women Aged 35 Years Plus, Allison M. Hopps

Doctor of Nursing Practice Scholarly Projects

Perimenopause is a span of four to six years preceding menopause when estrogen levels decline. Up to 40% of women experience depression during the perimenopause transition. Hormone replacement therapy (HRT) can be an effective treatment for depressive symptoms during perimenopause, but many healthcare practitioners prescribe antidepressants instead of HRT for the management of mood-related symptoms. Perimenopausal depression is associated with the progression of chronic conditions such as cardiovascular disease, diabetes, and dyslipidemia. The general population, including women and healthcare providers, lacks the education and awareness surrounding perimenopause symptoms and treatment. This project educated women between ages 35 to 55 on …

Development Of An Evidence Based Orientation Model For The Newly Graduated Nurse, Sandra L. Takach

Doctor of Nursing Practice Scholarly Projects

Healthcare in the acute hospital setting experienced a significant increase in highly acute patients with multiple comorbidities requiring competent, experienced clinicians who can provide high quality, safe care. The nursing shortage paired with the post pandemic hospital environment has altered the landscape of nurses entering the workforce and created a gap in competency of the bedside nurse. A loss of tenured nurses who typically onboard and mentor the novice nurse coupled with less than adequate clinical preparation of those graduating college led to elevated levels of stress and staggering turnover rates for the newly graduated nurse. Research validates efficient orientation …

Quality Improvement Initiative: Implementing Wellness Visit (Wv) Education To Improve Staff Self-Efficacy, Preston T. Holifield

Doctor of Nursing Practice Projects

Preventive care delivery is a cornerstone of value-based primary care, yet non-provider staff often lack the confidence and training to engage patients in Medicare Annual Wellness Visits (AWVs). Non-provider staff included Registered Nurses (RN’s), Licensed Practical Nurses (LPN/LVN’s), Secretaries, Medical Aids (MA’s), and Practice Managers (PM’s). This quality improvement project aimed to evaluate whether a brief educational intervention could improve self-efficacy among non-provider staff related to AWV discussions and workflow. Conducted in two primary care clinics in Southeast Missouri, this one-group pretest-posttest study involved six participants and utilized the General Self-Efficacy Scale (GSES) and Learning Self-Efficacy Scale (LSES) to measure …

The Effectiveness Of Telehealth For The Management Of Chronic Disease, Mariam Odunewu-Smith

Honors Capstones

Telehealth made a wide appearance in the medical industry during the Covid-19 pandemic due to the necessary decrease of physical interaction. It has continued to thrive and populate more patients since then. The benefits of telemedicine include quick, reliable one-onone sessions with a healthcare provider virtually, and is overall less costly compared to in person visits. Seeing a medical provider online is helpful in aiding patient recovery and management of chronic diseases. It is used to significantly improve the quality of life in the patients seen today. A literature review was conducted using databases such as PubMed and ScienceDirect. Papers …

Development Of Clinical Practice Guidelines For Incorporating Paravertebral Blockade For Thoracic Surgery Adult Patients, India Hutchison

Doctor of Nursing Practice Scholarly Projects

Thoracic surgery is considered one of the most painful surgical procedures due to its severity and the duration of the procedure. Pain is detrimental to the patient experience, and poor patient satisfaction results in revenue loss for hospitals. Maintaining adequate pain control after surgery is crucial in preventing pulmonary complications such as atelectasis and respiratory failure that prolong patient recovery. It is the responsibility of the anesthesia provider to ensure adequate pain control throughout the perioperative experience. Although current evidence-based data shows that regional anesthesia provides superior thoracic postoperative pain control, the current practice continues to be the utilization of …

Enhancing Postoperative Care For Vascular Patients: Pre- And Post-Test Clinical Knowledge Acquisition Of Early Mobilization Education For Interventional Healthcare Providers, Jennifer Wenger

Doctor of Nursing Practice Scholarly Projects

Peripheral vascular disease (PVD) is a chronic, systemic condition that often requires surgical intervention, presenting significant postoperative risks, including complications like thromboembolisms, pneumonia, and delayed functional recovery. Evidence-based practices (EBP), particularly early mobilization guidelines, have proven to improve recovery outcomes but remain inconsistently applied among interventional healthcare providers. The project addresses this critical issue by evaluating the impact of structured educational sessions on interventional healthcare providers’ knowledge and application of mobilization guidelines in postoperative vascular care. Using the John Hopkins Model of Evidence-Based Practice, a quasi-experimental design was adopted to assess the impact of the education. The project includes pre- …