Medicine and Health Sciences Commons^™

Designing Recommendation Systems For Identification And Reduction Of Unnecessary Blood Tests, Tongtong Huang

Dissertations and Theses (Open Access)

Blood testing is an indispensable tool to check the patient's health status. However, the overutilization of lab tests in healthcare settings is a prevalent issue that can lead to redundant information, increased patient risk, and financial strain on healthcare resources. This dissertation presents novel approaches to optimizing lab test utilization by applying deep learning models. The primary objective is to develop and validate methods that accurately predict and reduce unnecessary blood tests.

The study introduces a “selective” mechanism that quantifies the predictability of future lab tests, allowing for the selective reduction of unnecessary tests in the context of specific clinical …

The Blessed Assembly: Irreplaceable Physical Co-Presence In Worship And Healthy Hybridity Reimagined After The Pandemic In The Digital Age, Yvette, Ying Wai Lau

Doctor of Pastoral Music Projects and Theses

Because of the unprecedented and unexpected force of the pandemic since 2020, most churches around the world have experienced some online worship during the lockdown of their cities or the mandated closure of the church buildings. For many people, online worship seems to be an equivalent, if not better, alternative for gathering together—a physical co-presence in worship—even after the pandemic has ended. As necessary and vital as online worship experiences have been for Christians during the pandemic, the witness of the church from Pentecost throughout Christian history indicates that gathered worship in physical spaces is irreplaceable for faith formation and …

Evaluation Of A Team-Based Model Of Nursing Care In The Acute Care Setting, Vanetta W. White

Doctor of Nursing Practice Scholarly Projects

Problem: The current nursing shortage is much different than the ones we have experienced in previous years. It is predicted that it will have long-lasting effects. With this shortage of nurses, especially in the acute care setting, alternative methods to deliver patient care beyond the current use of primary care models need to be explored. These alternative models of care which include team-based nursing must maintain quality and safety for patients cared for.

Purpose: This project will evaluate the outcomes of returning to a team-based nursing model of care on a medical-surgical unit while continuing to provide safe, quality care …

Implementation And Evaluation Of A Neonatal Resucitation Program Protocol In Stand-Alone Emergency Department, Hannah Collins Walden

Doctor of Nursing Practice Scholarly Projects

Problem statement: Within nursing there are some skills that hold a significant amount of risk. This includes neonatal resuscitation within stand-alone emergency departments. Due to the low frequency of opportunities to practice neonatal resuscitation, nurses must utilize alternative methods to maintain current evidence-based practice. Purpose: The purpose of this project was to evaluate the effectiveness of a protocol incorporating Neonatal Resuscitation Program (NRP) preparedness and simulation to increase stand-alone emergency department nurses’ perceived clinical competence to performing neonatal resuscitation. Methods: The development and implementation of a protocol that defines and incorporates NRP roles, provides a maintenance checklist for …

Measurement-Based Mental Health In Adolescents, Ayzia Lynn Taylor

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adolescent mental health is a growing concern. Children and adolescents are commonly diagnosed with Attention Deficit Hyperactive Disorder (ADHD), anxiety, and depression. Some youth may also experience co-occurring symptoms that their primary healthcare provider must distinguish to appropriately diagnose and treat.

Purpose: The project aimed to implement measurement-based care for adolescents between the ages of 12 to 18 in a pediatric outpatient facility that is not currently utilizing post-assessment screening tools. The project seeks justification for treatment options utilizing pre-assessment screening tools and therapeutic relief with medication intervention determined by post-assessment screening results.

Methods: Adolescents between the ages …

Implementation Of Shared Decision Making To Impact Decisional Conflict In Advancing Chronic Kidney Disease, Margaret Mcannar Sorkin

Doctor of Nursing Practice Scholarly Projects

Problem Statement: A notable phenomenon in nephrology is indecision regarding treatment for End Stage Renal Disease (ESRD). Indecision regarding treatment for ESRD can lead to suboptimal dialysis starts, creating poorer health outcomes, decreased quality of life, and higher healthcare costs. Purpose: This project aimed to determine if participation in a shared decision-making (SDM) program decreases decisional conflict in patients with advancing renal disease deciding between ESRD treatment options. Methods: A pretest-posttest design was used. Participants were recruited from a private nephrology practice. Inclusion Criteria: English-speaking patients, over the age of 20, with Chronic Kidney Disease Stages 4 or 5 (estimated …

Implementing The 5a’S Of Obesity Management In Primary Care, Holly H. Rowell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The prevalence of obesity continues to increase globally, with greater prevalence in the southern United States, resulting in higher costs to the healthcare system and greater risks for the development of other chronic diseases. Purpose: Determine if implementing the 5A’s of Obesity Management among primary care providers in a rural, low-income healthcare setting will increase the diagnosis of obesity and result in a subsequent decrease in weight among patients who are obese. Methods: An educational session was held to familiarize providers with the 5A’s of Obesity Management and the importance of obtaining and documenting proper height …

Impact Of Hydrogen Peroxide Wipes Disinfecting Clostridioides Difficle On High-Touch Surfaces, Tyler Wolf Ramirez

Doctor of Nursing Practice Scholarly Projects

Clostridioides difficile is the leading cause of nosocomial diarrheas worldwide (Centers for Disease Prevention and Control [CDC], 2022). 15% of all hospitalized patients in the United States develop antibiotic-associated diarrhea (AAD), with 15-25% of cases caused by C. difficile (CDC, 2022). C. difficile costs the United States Healthcare system $5.4-6.3 billion annually (Balsells et al., 2019). The project’s purpose was to see if implementing hydrogen peroxide (H2O2) wipes using an interprofessional team leads to the following expected outcome(s): reduction in hospital-acquired C. difficile infections and comparable disinfection rates to sodium hypochlorite. An interprofessional team consisting of the primary lead, Clinical …

Human Papillomavirus Vaccination Rates Among Adolescents In South Carolina, Rebecca Jane Morrison

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Among adolescents 11-17 years of age in South Carolina, low rates of human papillomavirus (HPV) vaccination can negatively impact health outcomes through increased risk of acquiring HPV-associated cancers.

Purpose: To determine if the 4 Pillars™ Immunization Toolkit increased HPV vaccination rates among adolescent patients.

Methods: The 4 Pillars™ Immunization Toolkit was the framework for this bundled intervention. Pillar 1, convenience and easy access, included after-school HPV express clinics. Pillar 2, communication, utilized staff motivational interviewing skills, campaign promotion materials, documentation of declination, and second-dose callback appointments. Pillar 3, enhanced vaccination systems, was designed to use …

Impact Of The Blaylock Risk Assessment Screening Score On Inpatient Length Of Stay On Inpatient Psychiatric Units Within An Acute Care Hospital, Princess P. Minter

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Insufficient discharge planning at the time of patient admission can result in increased hospitalization length of stay and poor clinical outcomes, including a rapid deterioration of stabilized patients’ mental status while unnecessarily waiting for discharge arrangements to be put in place at the time of discharge. Purpose: To determine if completing the Blaylock Risk Assessment Screening Score (BRASS) index tool to identify barriers to discharge at the time of patient admission impacts the length of stay for patients admitted to general psychiatric inpatient units. Methods: Patient admission and discharge data collected using the BRASS index within 48 hours …

Assessing Readiness To Quit As An Intervention For Tobacco Cessation In Oncology Patients, Victoria Gabriela Maddox

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Smoking and tobacco use is the leading cause of preventable death in the United States. Twenty percent of all cancer diagnoses are directly linked to smoking, and tobacco-related diseases and cancers contribute to one in every five deaths annually in the United States. Less than one in ten smokers are successful at quitting. Smokers attempting to quit are more successful in cessation programs after evaluation of self-efficacy, such as the readiness to quit.

Purpose: This evidence-based practice project aimed to evaluate the impact of motivational interviewing with the 5A’s model on smoking cessation efforts in patients at an …

Use Of An Audit And Feedback Tool And Sglt-2 Inhibitors To Delay Progression Of Chronic Kidney Disease, Megan Elaine Lanpher

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adults with Type 2 diabetes mellitus and chronic kidney disease experience a higher risk for progression to end-stage kidney disease, which negatively impacts health, increases medical costs, and decreases quality of life. Purpose: Determine if an audit and feedback intervention in a local nephrology clinic can increase provider adherence to a clinical practice guideline that supports the prescription of sodium glucose cotransporter-2 (SGLT-2) inhibitors. Methods: A pretest-posttest design was used to determine if an audit and feedback tool delivered to providers at three-week intervals would increase prescription of SGLT-2 inhibitors in adults with Type 2 diabetes and chronic …

Appropriate Policies For Patients Utilizing Insulin Pumps With Continuous Glucose Monitoring During Hospital Admission, Mary Elizabeth Holiday

Doctor of Nursing Practice Scholarly Projects

Problem Statement: A growing number of patients with diabetes are using advanced diabetes management technology with an integrated insulin pump and continuous glucose monitor (CGM); however, multiple concerns surround their use during hospitalization, ranging from patient safety risks to nursing comfort in overseeing these devices.

Purpose: This project aimed to determine if an accurate, reformed inpatient policy supporting specific automated insulin pump use during admission maintained patient glucose control, improved patient satisfaction, and increased nursing comfort levels.

Methods: Pre- and post-policy nursing knowledge surveys, retrospective admission glucose metrics, and patient experience narratives were evaluated.

Inclusion Criteria: Patients and nurses were …

Reducing Wait Times For Psychiatric Intakes, Ryan Brad Carsten

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Early intervention for mental illness is vital to a swift recovery and extended wait times for mental health treatment have proven to be a barrier to early intervention. Purpose: The purpose of this quality improvement project was to determine if wait times for psychiatry intakes at the University of South Carolina (USC) Student Health Center Psychiatry Services can be reduced and kept under 1 week by utilizing the Specific Timely Appointments for Triage (STAT) model. This model consists of clinicians scheduling a specified number of intake appointments based on the typical demand for service. Students were booked in …

Using Visual Thinking Strategies To Increase Empathy Levels In Inpatient Psychiatric Nurses: A Quality Improvement Project, Katharine E. Harding

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Research indicates that empathy is declining in today’s behavioral health nursing workforce. Purpose: The aim of this quality improvement project was to apply an evidence-based Visual Thinking Strategies intervention to the clinical problem and increase empathy levels from pre-survey measurement among psychiatric nurses. Method: VTS methodology was employed through in-person interviews where participants viewed art-based images pertaining to mental health. Feedback from semi-structured questions was shared among participants. Pre and post-test interventional quantitative data via The Jefferson Scale of Empathy-Health Provider version (JSE-HP) and The Interpersonal Reactivity Index (IRI) instruments were collected. Inclusion Criteria: Participants were voluntarily recruited …

Examining Enrollment & Engagement In A Hospital-Based Violence Prevention Intervention Study At A Level 1 Trauma Center, Leigh Frederick

Electronic Theses and Dissertations

BACKGROUND: Violence is a significant healthcare issue that affects the health and well-being of individuals, families, and communities. Violence prevention and intervention programs are a powerful way to stop the revolving door of violent injury in our hospitals and communities. The Health Alliance for Violence Intervention (HAVI), develops and connects violence intervention programs, promotes equity for victims of violence globally, and is dedicated to engaging patients during the window of opportunity when they are recovering in the hospital after a violent injury to reduce the chance of retaliation (related to the injury) and recurrence. A small body of research shows …

Improving Distributed Health Information Technology Integration Through Enriched Context In Sociotechnical System Components, Jeritt Thayer

Dissertations and Theses (Open Access)

The design and architecture of health information technology (HIT) are in the process of a transformative shift. Monolithic code bases, which are several systems intertwined into a single program, are being split into multiple distributed programs that communicate across information networks. Thus far, only sparse knowledge exists about the challenges of distributed HIT, and the interaction of these architectures with other factors of the sociotechnical system, such as clinical content, is not well understood. Existing sociotechnical models describe the components within a healthcare system and the connections between components, but the types of relationships between each component are underspecified. Within …

Can Nutrition Education Reduce Division Iii Female Athlete's Risk Of Developing Low Energy Availability, Coby Stover

Masters Theses/Capstone Projects

Context: Low Energy availability (LEA) is widely acknowledged as a state in which an individual does not have sufficient energy to support normal functions within the body after energy has been expended through exercise. In sports environments, athletes can exhibit LEA for a variety of reasons. These reasons range from improper food intake to effectively fuel and re-fuel their body for the energy demands of their specific sport, to eating disorders (ED) and eating disorder behaviors. Access to appropriate nutrition knowledge is also a major factor that can place athletes at risk for developing LEA. Both males and females …

Exploring Prescribing Practitioners’ Experiences And Perceptions Associated With Opioid Clinical Practice Guidelines Adherence To Treat Older Adults For Chronic Pain In Primary Care Practice Settings In The United States, Dara D. Skinner

Seton Hall University Dissertations and Theses (ETDs)

Background: Chronic pain is a common complaint in older adults,’ and they often seek treatment from their primary care provider who may prescribe opioids to treat their chronic pain. Treating and managing an older adult chronic pain can be complex due to several factors such as the patient’s co-morbidities (other medical conditions), impaired cognition, and advanced age. Opioids have been used since the 1890s for treatment of pain (acute and chronic). Opioid use can cause fractures, falls, kidney failure, addiction, respiratory depression, and overdose in older adults. According to Tong et al. (2016) primary care providers were responsible for writing …

The Implementation Of Comfort Medication Kits In Hospice Patients’ Homes To Reduce Hospice Revocations, Brandi J. Parker

Doctor of Nursing Practice Projects

Background: When hospice patients experience a symptomatic crisis at the end of life, unmanaged symptoms can lead to unwanted hospitalizations and the revocation of their hospice benefits. Strategies to reduce the incidents of hospice revocation are needed to improve patient care and quality of life.

Purpose: The quality improvement project aimed to reduce hospice revocation rates by implementing comfort medication kits in eligible hospice patients’ homes.

Methods: The project’s intervention included identifying patients at high risk for revocation, patients with a cancer diagnosis, and patients with a prognosis of two weeks or less. Comfort medication kits were placed in the …

Implementing Delirium Prevention Strategies To Reduce The Need For 1:1 Observation In A Palliative Care Unit, Natalyn Finley

Doctor of Nursing Practice Projects

Background: Delirium is a common complication within the palliative care community that is preventable. Delirium is a condition characterized by confusion and disturbed thought processes. One to one observation was the facility’s intervention used to prevent delirium. The best intervention is non-pharmacological interventions.

Purpose: This quality improvement (QI) project aimed to reduce 1:1 observation hours without increasing patient safety issues.

Methods: The Doctor of Nursing Practice (DNP) student educated nursing staff about the American Nurses Association’s (ANA) evidence-based interventions to help decrease delirium. The staff received the ANA interventions form and the Confusion Assessment Method (CAM) tool. The DNP student …

Reducing The Incidence Of In-Hospital Cardiac Arrests (Ihca) By Utilizing Infographics, Alexis Morgan Pope

Doctor of Nursing Practice Projects

Background: In-hospital cardiac arrests (IHCA) have negative outcomes on patients and can prolong hospitalization or lead to death. The rate of IHCA has been increasing over the past few years in the United States. A medical intensive-care stepdown unit in a level three trauma center has an incidence of IHCA above the national average and a survival-to-discharge rate less than the national average.

Purpose: The project aimed to improve patient outcomes and reduce the rate of IHCA by placing infographics containing evidence-based practice in the unit with the highest incidence.

Methods: A pre-post implementation quality improvement design was used to …

Implementation Of Depression Screening For The Puerperal Woman During The Fourth Trimester, Ashley Tidwell Bowlin

Doctor of Nursing Practice Projects

Background: Postpartum depression is a mental illness that most commonly develops in the first twelve weeks postpartum, known as the “fourth trimester.” Nationally, one in five women suffers from postpartum depression, with 50 percent going undiagnosed and untreated due to fear of stigmatization and lack of consistent screenings among healthcare providers.

Purpose: The evidence-based Doctor of Nursing Practice quality improvement project included screening for postpartum depression between seven to 14 days postpartum to increase the identification of women likely to have postpartum depression before their scheduled postpartum visit over six weeks.

Methods: The project used a quantitative design as the …

Implementing Bedside Shift Reporting On An Adult Medical-Surgical Unit: An Evidence-Based Intervention For Inpatient Fall Reduction, Halie Blackerby

Doctor of Nursing Practice Projects

Background: Patient falls are a continuous issue in healthcare facilities because they increase patient length of stay and hospitals receive no reimbursement for these falls from insurance providers. Falls are a patient safety issue and can result in long-lasting damage for patients in the healthcare facility, including fear of ambulation. Falls in a facility can impact a facility’s ability to meet strategic planning goals and receive state and federal funding.

Purpose: The Doctor of Nursing Practice (DNP) quality improvement project aimed to reduce inpatient falls during shift change by implementing an evidence-based bedside shift reporting (BSR) protocol.

Methods: Quantitative data …

Strengthening Medication Adherence In African Americans Diagnosed With Hypertension, Daphne James

Doctor of Nursing Practice Projects

Background: African Americans have a high rate of hypertension, which varies by region. Additionally, African Americans struggle to understand the risks of uncontrolled high blood pressure and the necessity of medication adherence in lowering strokes, heart attacks, and quality of life.

Purpose: The project aims to implement a patient education program to improve medication adherence and blood pressure control for African American patients in a primary care setting.

Methods: Twenty African Americans ages 18–65 with hypertension (130/80 mm Hg or above) and six months of nonadherence participated in this project. The pre-, mid-, and post-questionnaires assessed medication adherence and blood …

Nutric: Enhancing Surgical Intensive Care Unit Patient Nutrition Consultations, Misty Armstrong

Doctor of Nursing Practice Projects

Background: Daily nutritional screenings in the critical care population can identify patients in need of nutritional modifications during hospital admission. Inadequate nutritional assessments of critically ill patients lead to poor outcomes. Daily nutritional assessments result in the early identification of patients at risk for nutritional compromise compared to weekly assessments.

Purpose: The purpose of this project was to incorporate a daily nutritional assessment using the Nutrition Risk in the Critically Ill (NUTRIC) scores for patients in a surgical intensive care unit to identify patients in need of a referral to a registered dietician.

Methods: The method for this project used …

Improving Early Detection And Treatment Of Chlamydia By Implementing A Routine Chlamydia Screening And Testing In Females Between The Ages Of 18–24, Isabelle Vikumitsi

Doctor of Nursing Practice Projects

Background: Chlamydia Trachomatis is the most frequently reported bacterial sexually transmitted infection in the United States. One in 20 sexually active females between the ages of 15 and 24 have chlamydia. Most people with the infection are asymptomatic and do not seek treatment. Chlamydial infections in women, especially if untreated, increase the risk of infertility and ectopic pregnancy, leading to higher medical costs.

Purpose: The project aimed to implement early screening for chlamydial infections in the young adult population to increase early detection of the disease.

Methods: A pre-post design was used for this project to compare chlamydia diagnosis rates …

Standardization Of Chlorhexidine Gluconate Bathing: A Quality Improvement Project In Central Line Bloodstream Infection Prevention, Faustina Muruako

Doctor of Nursing Practice Projects

Background: Central Line-Associated Bloodstream Infections (CLABSIs) are severe healthcare-related infections that can lead to sepsis, organ failure, and even death. Several healthcare agencies provide guidelines to prevent CLABSIs, with Chlorhexidine Gluconate Bathing (CHGB) as one of the preventive measures for individuals with central venous lines (CVL).

Purpose: The Doctor of Nursing Practice (DNP) project aims to standardize CHGB procedures for maintaining CVLs on a specific unit for CLABSI prevention through evidence-based practice.

Methods: A quality improvement project was implemented at a Central Alabama hospital to standardize CHGB procedures for CVL patients utilizing a CLABSI unit champion monitoring system to establish …

Ekg Is Key: A Quality Improvement Project To Decrease Door-To-Ekg Time In A Rural Emergency Department, Amanda Southwell

Doctor of Nursing Practice Projects

Background: Electrocardiograms (EKGs) are the priority when evaluating patients with chest pain who present to the Emergency Department (ED). The American Heart Association and other governing bodies suggest a 10-minute door-to-EKG (DTE) time. The target facility displayed a delay in DTE times.

Purpose: The Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to decrease the average DTE time for patients over 18 years old with chest pain who presented to the ED registration area.

Methods: The DNP project consisted of an EKG suite to perform EKGs near the ED registration/triage area. Registration and ED staff were educated on …

Increasing Lung Cancer Screenings In A Family Medicine Clinic, Ashley Williams

Doctor of Nursing Practice Projects

Background: Lung cancer is the leading cause of cancer-related deaths worldwide. Although lung cancer screening is an established guideline for intervention in primary care, eligible patients do not receive it. Patients at high risk of developing lung cancer are aged 50 to 80 and currently smoke or have quit smoking within the last 15 years. Obtaining an annual low-dose computed tomography for patients at high risk of developing lung cancer helps detect lung cancer earlier and, therefore, improves patient outcomes.

Purpose: The Doctor of Nursing (DNP) project aimed to increase lung cancer screenings in patients at high risk of developing …