Medicine and Health Sciences Commons^™

Increasing Hpv Vaccination Rates Using Social Marketing Strategies, Sharon Wilson Catledge

Doctoral Projects

The human papillomavirus (HPV) is the most common sexually-transmitted infection (STI). Approximately 20 million Americans between the ages of 15 and 49 years currently have HPV with > 6.2 million new HPV infections estimated to occur each year. Yet, HPV vaccination rates remain relatively low. More than 40 strains of HPV are transmitted through genital contact during vaginal, anal, or oral sex and can infect males and females. In addition to causing genital warts, HPV is associated with cervical, vulvar, vaginal, anus, penile, and oropharyngeal cancers. In women, the most prominent type of cancer is cervical with > 12,000 diagnoses each year …

Evaluating The Perceptions Of Quality Of Life In Informal Caregivers Caring For Hospice Patients, Rashandra Fisher Laws

Doctoral Projects

Maintaining or improving quality of life for informal caregivers is important as they endure the burden of providing care to terminally ill loved ones on a daily basis. Caregivers are at a greater risk for depression, deteriorating physical health, financial difficulties, and premature death than demographically similar non-caregivers (Demiris et al., 2010). The goal of this capstone project was to determine the effectiveness of the creativity, optimism, planning, and expert information (COPE) intervention, which address specific needs of the family and caregiver.

Twenty informal caregivers completed the Quality of Life (QoL) Index tool, which measured their perceptions of five different …

An Evaluation Of Fall Prevention Interventions Among Older Adults In A Long Term Care Facility, Courtney Anita Bennett

Doctoral Projects

Falls are serious unwanted events that are a common occurrence among older adults in long term care facilities (LTC). Fall prevention in LTC facilities requires the efforts of an interprofessional team that promotes safety within an organization. The purpose of this capstone project is to implement and evaluate evidence-based fall prevention interventions at a LTC facility. Specific objectives of the project include: (a) providing education to healthcare professionals on evidence-based practices to recognize, assess, and prevent falls among older adults in a long term care facility and (b) replacing the existing fall prevention policy and program with a falls and …

Psychiatric Mental Health Nurse Practitioner Workforce Development In Behavioral Healthcare Settings In Rural Mississippi, Arlen Davis Cooper

Doctoral Projects

Description and Significance of the Problem: The United States is facing a significant rural mental healthcare workforce shortage and an uneven distribution of mental healthcare professionals. The psychiatric mental health nurse practitioner (PMHNP) may increase access to mental healthcare in rural underserved regions (NRHA, 2012). However, little is known regarding their distribution. The lack of uniform and consistent data collection methods regarding the number and the geographic distribution of PMHNPs in rural areas, specifically in rural Mississippi, exists. The importance of better data collection and improving infrastructure through collaboration with state licensing boards and state nursing workforce centers is …

Integrating A System Approach To Identify And Manage Aggressive Behaviors In Adult Males With Severe Mental Illness In A Psychiatric Hospital, Mitzie Alford-Jenkins

Doctoral Projects

Aggressive behaviors exhibited by patients with a serious mental illness (SMI) hospitalized in inpatient psychiatric hospitals are a challenging safety problem. Early identification of aggressive behaviors is vital to helping nursing staff develop proactive interventions that focus on prevention. Structured risk assessments identify the level of risk and allow for early interventions.

The purpose of the doctoral capstone project was to: (a) provide education to nursing staff on implementing a structured risk assessment tool in order to identify risk for imminent aggression, manage risk for imminent aggression, and record aggressive behaviors among adult males with severe mental illness (SMI); (b) …

Re-Engineered Discharge Planning In A Rural Mississippi Hospital To Reduce 30 Day Readmission Rates Among Heart Failure Patients, Roxie Mae Hogan

Doctoral Projects

The hospital discharge is a complex process that involves interdisciplinary efforts to avoid readmissions and decrease health care costs. The purpose of this capstone project was to take a leadership role in translating evidence into practice by successfully preparing NWMRMC discharge planning stakeholders to adapt Project RED for use with HF patients admitted to NWMRMC.

A comprehensive systematic improvement plan, Project RED is designed to improve the work flow process through the use of timelines and strategies. Project RED supports discharge planning, helps to prevent readmission, and facilitates knowledge transfer that promotes sustainable changes. Re-Engineered Discharge Planning (RED), 6 step …

Nurses' Perceptions Of Structural Empowerment: A Practice Review Process Pilot, Andrea M. Lee-Riggins

Doctoral Projects

Nurses are professionally and morally obliged to monitor and evaluate nursing practice via active participation in review mechanisms that are designed to promote patient safety and care delivery, thereby improving patient care quality (American Nurses Association [ANA], 1988, 2001, 2004; O'Rourke, 2006). The purpose of this Doctor of Nursing Practice (DNP) project was to develop, pilot, and evaluate a nurse practice review process with frontline nurses within Fresno Heart & Surgical Hospital (FHSH), a small specialty hospital, affiliated with Community Medical Centers (CMC) in Fresno, California. A nurse practice algorithm was subsequently developed and structural empowerment was assessed with the …

A Novel Method For Assessing Medication-Related Adverse Outcomes In A Community Hospital, Christopher M. Patty

Doctoral Projects

The use of medications for hospitalized patients is universal, and unfortunately medication-related adverse outcomes are common. The accurate assessment of medication-related harm in hospitalized patients is foundational to the development of an effective hospital medication safety program. Every hospital has its own unique "fingerprint" of harm, accurate determination of the nature of medication-related harm specific to each hospital is necessary to facilitate prevention of that harm with specific and effective interventions. This project has provided a community hospital with its first systematic methodology for assessing medication-related harm. The methodology is adapted from that used in a recent national-level study.

Several …

Promoting Behavior Changes In Patients With Type 2 Diabetes Through Shared Medical Appointments, Shonda Lanette Williams

Doctoral Projects

Diabetes Mellitus (DM) is a chronic disease that affects many individuals in the United States. It was reported that a total of $245 billion is spent annually on both direct and indirect health care costs associated with the treatment of diabetes and diabetic related complications. Diabetes related complications can be prevented or delayed if proper education is done and individuals are willing to practice positive behavior changes and self-manage their disease. The purpose of this doctoral capstone project was to promote behavior changes in patients with diabetes through diabetes self-management education (DSME) in shared medical appointments (SMAs).

This project was …

Bridging The Gap: Understanding, Anticipating, And Responding To The Needs Of Student Veterans In A Bachelor Of Science In Nursing Program, Larry Michael Stowers

Doctoral Projects

The passage of the Americans with Disabilities Act Amendment Act (ADAAA) of 2008 and the Post-9/11 Veterans Assistance Act of 2008 have afforded veterans the opportunity to pursue post-secondary education. Since October 2001, over 2 million American men and women in uniform have deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). While thousands of returning combat veterans take advantage of recent legislation that helps pay for their education, they face new challenges in the classroom. This nation’s veterans represent a group of diverse individuals who bring different experiences, thus different perspectives than traditional college-aged students. …

An Evaluation Of The Effectiveness Of Providing Foot Care Education In A Rural Clinic Setting, Gloria Green-Morris

Doctoral Projects

Diabetes is one of the most frequently diagnosed metabolic disorders and is currently at pandemic magnitude. Approximately 1.4 million adults are diagnosed with diabetes each year. According to the American Diabetes Association (2011), the numbers of diagnoses will more than double by 2030. Because of the high prevalence of diabetes, the perceptions of risk factors and healthy behaviors are important. A good understanding of written and verbal healthcare instructions, healthcare accessibility, and socio-economic status have a direct effect on patient health outcomes and the overall health of the population (Jovic-Vranes, Bjegovic-Marinkovic & Marinkovic, 2009).

Diabetic foot complications are common concerns …

Electronic Medical Record In The Simulation Hospital: Does It Improve Accuracy In Charting Vital Signs, Intake, And Output?, Carel M. Mountain

Doctoral Projects

The introduction of electronic health records has created a shift in the way nursing care is delivered (McBride, Delaney, & Tietze, 2012; Furukawa, Raghu, & Shao, 2010). A factor which heavily influences a nurse’s ability to navigate and utilize EMR is adequate education in the use of computerized documentation (McBride, et al., 2012). There is an increased risk for error at the bedside without the correct knowledge and skills regarding EMR documentation (Kelly, Brandon, & Docherty, 2011). This skill should be introduced during the pre-licensure education of the nurse.

Two groups of associate degree nursing students attending a small community …

Chronic Non-Cancer Pain In The Ed: Are Nurses Sbirt-Ready?, Dorothy James Moore

Doctoral Projects

Emergency department (ED) Registered Nurse (RN) understanding of chronic pain management is critically important. By some estimates, 30% of all opioid pain medications in the United States (US) are prescribed from EDs. At the same time, prescription drug abuse is America’s fastest growing drug problem. While RNs have significant contact time with chronic pain patients who may also be drug abusers, RNs often use the stigmatizing label, “drug-seeking” for certain key patient behaviors and may not feel confident intervening constructively with these patients. This project reviews literature pertaining to SBIRT use for substance abuse in the ED and surveys ED …

Reducing "Failure To Rescue" Occurrences: A Pilot Project Incorporating High-Fidelity Simulation During Mock Codes, To Enhance Pediatric Nurses' Clinical Knowledge And Skills, Denise Dawkins

Doctoral Projects

Thanks to advances in technology, the survival rate of infants and children with critical illnesses has improved. One consequence has been an increase in the acuity levels of hospitalized pediatric patients, which may heighten the risk of in-hospital cardiopulmonary arrest. Patient safety can be compromised by nurses who do not detect subtle clinical changes in a patient's condition, do not perform accurate interventions, or do not apply critical thinking (failure to rescue). The Institute of Medicine (10M) in 1999 estimated that approximately 100,000 people died each year as the result of poor care.

Patients and families place great trust in …

Long-Acting Reversible Contraceptive Methods, Same-Day Initiation And Early Removal, Sandra Mary Loehner

Doctoral Projects

Objective: The study was conducted to identify the early removal rate of Long-Acting Reversible Contraceptive (LARC) methods and factors associated with early removal.

Study Design: A non-experimental descriptive design based upon retrospective chart review of electronic medical records (EMR) was used. There was a total of 96 subjects, ages 15-47 years who had a LARC method inserted within a 12-month time period and subsequent removal within 6-months of insertion date. Subjects were grouped according to same-day insertion versus non-same-day insertion.

Results: Seventy percent of study subjects with early removal had their LARC method inserted under a same-day protocol. Most subjects …

The Experience Of Latino Parents Of Hospitalized Children During Family Centered Rounds, Lisa Ann Walker-Vischer

Doctoral Projects

Problem: Hospitalization of a child is stressful. The parental role is altered and parents have a primary need to receive timely information. Family centered rounds (FCR) provide a mechanism to exchange information and facilitates shared decision making with the medical team while parents advocate for their child's needs. FCR has been linked to increased satisfaction and improved outcomes. A recent study suggests that Latino parents have a suboptimal experience related to language barriers and a lack of empowerment. The purpose of this study is to describe the experience of Latino parents of hospitalized children during FCR in a public safety …

Self-Reported Neurogenic Bowel And Bladder Management In Acute Hospitalized Chronic Spinal Cord Injured Patients: Its Role In Clinical Practice, Mary Lupe Jimenez

Doctoral Projects

Patients with spinal cord injuries and disorders (SCI/D) are at risk for mismanaged bowel care during acute hospitalization, which can lead to numerous medical complications ranging from loss of personal dignity and privacy to many serious medical conditions, some of which are life threatening. Additionally, mismanagement of bowel care during acute hospitalization may lead to costly extended hospital stays. The project was to describe bowel and bladder care for SCI/D patients during acute hospitalization using a self-reported questionnaire submitted by approximately 46.6% of SCI/D patients from the Veterans' Affairs Central California Health Care System. The self-report questionnaire was designed by …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

Impact Of Cue-Based Feeding Protocol On Premature Infants' Outcomes And Hospital Length Of Stay, Diana Michele Easley Cormier

Doctoral Projects

The project was an oral feeding practice change from traditional, gestational-age/volume-driven feeding progression to developmentally-based, infant-driven feeding progression. The infant-driven (cue-based) feeding protocol was implemented with goals to improve premature infants' feeding outcomes, and decreased the infant's length of hospitalization. The project was designed to implement a cue-based feeding protocol for oral feeding initiation and progression, within the neonatal intensive care unit (NICU) at Community Regional Medical Center (CRMC), and then retrospectively evaluate the impact of the cue-based feeding protocol on feeding outcomes. In order to realize full implementation of a NICU feeding practice change, multiple components, such as electronic …