Medicine and Health Sciences Commons^™

Evaluation Of The Associations Between Unplanned Readmissions And The Lace Index And Other Variables, Cathy Stankiewicz, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: Unplanned readmissions, within 30 days following an inpatient hospital admission, are common and costly. Research has identified factors that predict readmissions, and predictive algorithms, such as the LACE index, have been studied and widely adopted by hospitals despite demonstrated variability in predictive ability.

Objectives: To examine the associations between unplanned readmissions and the LACE index, and other variables that reflect patient- and encounter-level factors not currently incorporated in the LACE index.

Methods: A retrospective analysis was conducted utilizing data from electronic health records of inpatients discharged from a large quaternary hospital located in the southeastern United States between January …

Assessing Employee Needs To Enhance A Workplace Wellness Program, Paige Herschend, Dnp, Msn, Bsn, Ba

Doctor of Nursing Practice Projects

Background: Workplace wellness programs are increasingly prevalent, but their designs vary dramatically. While successful programs differ, those that are coordinated, comprehensive, and planned intentionally to address specific workplace needs have been found most beneficial.

Objective: This project assessed the perceived health status and wellness needs of employees at one company to determine whether its workplace wellness program could be enhanced.

Methods: This project focused on one site of a large, multi-state company. A retrospective review of data from an employees’ health and wellness survey was performed. Univariate and bivariate statistics were used to analyze the relationships among …

Measuring Nursing Students’ Perceptions Of Teamwork In A Multiple Patient Simulation, Christine Seaton, Dnp, Msn

Doctor of Nursing Practice Projects

Background: Simulation based education offers safe, reflective learning opportunities. However, data had not been obtained of nursing students’ perceptions of teamwork performed during Virtual Hospital (VH), a multiple patient simulation.

Objectives: This evaluation gap was addressed using the Agency for Healthcare Research and Quality’s (AHRQ) TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ). The validated survey measures self-reported perceptions of teamwork in communication, mutual support, and situational awareness on a Likert scale from 1 to 5 (AHRQ, 2014).

Methods: A pre-and post, one group design was used to measure perceptions of teamwork. Twenty participants were recruited from students, enrolled in a second-degree undergraduate …

Evaluating Patient Outcomes When Adding Licensed Practical Nurses To The Staffing Mix, Isabel C.M. Shephard, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: An incorporation of licensed practical nurses (LPNs) in the RN staffing mix was made in a small community hospital. Research shows that RNs at the bedside equates to less adverse patient outcomes such as falls, pressure ulcers and an increase on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Objectives: To evaluate the effects of incorporating LPNs in the staffing mix on the number of patient falls, pressure ulcers and HCAHPS survey results.

Methods: A Pre and Post study design was used to compare baseline data obtained four months prior to implementing and four months during …

A Retrospective Study: Diagnosis And Treatment Of Depression In Breast Cancer Patients, Cheryl Ann Thaxton, Dnp

Doctor of Nursing Practice Projects

Background: One issue related to breast cancer diagnosis and treatment is the risk of depression.

Objectives: The purpose of this study is to examine ethnic differences and commonalties in the method of diagnosis and treatment of depression for female breast cancer patients.

Specific Aims: The study aims to examine the method of diagnosis and treatment of depression in Caucasian, Latino, and African American breast cancer patients.

Questions/Hypothesis: 1. Does the method of diagnosis and treatment of depression differ based on ethnicity? Hypothesis: Method of diagnosis and treatment will differ for Minorities as compared to Caucasians; 2. What percentage of patients …

Shelburne And Clark’S Harbour Quit Smoking: A Community-Based Smoking Cessation Initiative Process Evaluation, Georgeann Lois Macdonald Mn: Dnp, Anp, Rn, Accn, Np

Doctor of Nursing Practice Projects

Background: The prevalence of Canadian smokers is 14.6%. Clark’s Harbour and Shelburne’s rate of smoking increased from 15.6% in 2012 to 19.4% in 2015 (Propel Centre for Population Health Impact, 2015). It was imperative that innovative ways be found to reduce the smoking prevalence.

Objectives: 1) Identify a difference in the participants’ Stages of Change before and after completing the smoking cessation program. 2) Determine whether the participants quit smoking 3) Assess whether there was satisfaction with the program.

Methods: In this one group pre and post-test design, the participants completed a series of pre and post program questionnaires. The …

Educating Oncology Nurse Practitioners To Provide Basic Palliative Care, Lynn Adams, Dnp, Ms, Anp-Bc, Aocn

Doctor of Nursing Practice Projects

Background: Approximately 1.66 million Americans are diagnosed with cancer each year and another 589,430 die from the disease. As treatment options have expanded, many cancer patients are living longer with worsening symptoms and disabilities and an increased illness burden. These patients are ideal candidates for palliative care. Palliative care involves care delivered by a team of clinicians with specialty training and a focus on improving the quality of life for patients with serious illnesses. A number of major organizations have made formal recommendations regarding the integration of palliative care into comprehensive cancer care including the American Society of Clinical Oncology …

Variables Related To Colon Cancer Screening Rates Among Male Veterans, Patricia D. Dotson, Dnp, Msn, Aprn

Doctor of Nursing Practice Projects

Background/Problem: The Center for Disease Control & Prevention (CDC) recommends colon cancer screening colonoscopy beginning at age 50 years and every 10 years thereafter. The purpose of this study was to compare differences in meeting the colorectal cancer (CRC) screening recommendations between male Veterans and non-Veterans and identifying any association among Veterans social economic status (SES).

Methods: A descriptive-comparative design was used to address the study question, aims and hypotheses, using the 2014 Behavioral Risk Factor Surveillance System (BRFSS) data. A national representative sample of 20,360 Veterans and 36,183 non-Veterans between 50-74 years, were included in analysis. The associations between …

Referral Patterns From Long-Term Care Services To Palliative Care: Perceptions Of Directors Of Nursing, Karen S. Sharrah, Dnp, Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: Palliative care referrals are important in long-term care facilities because they are the first step in generating the services that the patient may need. This study looked at the phenomena of how Directors of Nursing in long-term care facilities that had access to palliative care services determined if a referral was needed.

Objectives: The purpose of this study was to gain a deeper understanding of the decision- making process used by Directors of Nursing for referrals. The study’s aims were to determine what factors prompt a referral in long-term care settings. The primary research question was: How …

Proposal Defense: Improving Patient Portal Adoption In Primary Care, Melissa Wagner

Doctoral Projects

Introduction: Stage three of Meaningful Use (MU) is currently underway and is focused on promoting patient portal use. If the electronic medical record patient portal use is less than 25%, primary care providers face reductions in value-based reimbursements. National adoption rates from portal use remain under 27% with some providers averaging well below the needed 25%. The following practice question is proposed, “In a low-income urban adult clinic, how does an interactive electronic education intervention compared to no education intervention affect patient portal adoption rates?”

Objectives: The purpose of this project is to identify whether an electronic patient educational video …

Use Of The Montreal Cognitive Assessment As An Early Indicator Of Tumor Progression In Patient With Stage Iii And Iv Gliomas, Eric David Laney

Masters Theses

Patients diagnosed with high grade glioma have a short life expectancy due to rapid progression of disease following and/or during treatment. Magnetic resonance imaging (MRI) is the primary method of surveying tumor progression, but is costly, lengthy in duration and often uncomfortable for the patient. An alternative to MRI that is cost efficient and patient friendly is of great interest to the medical community. If this alternative could also provide advanced notification of disease progression, then this patient population would have the opportunity for earlier treatment and the potential for greater efficacy. To pursue this concept, we assessed whether the …

Effects Of Chronic Atrazine Exposure On Male Reproductive Function In Sprague Dawley Rats, Josh Quinn

Masters Theses

Estrogens, in addition to testosterone, are much more physiologically relevant to normal sperm production in the testis and overall male fertility than previously thought. Current use herbicides, such as atrazine, are known endocrine disruptors and have been suggested to disrupt male reproductive health. The purpose of this study was to investigate the effect of chronic atrazine exposure on male reproductive function in Sprague Dawley rats. Three groups of rats were treated until 7 months of age. The first group was the control vehicle and given only water. The second group was given a low dose of atrazine (0.1 mg/kg) and …

Structure, Process, And Outcomes: The Foundation For Continuous Quality Improvement In Primary Care, Mark A. Contreras

Doctoral Projects

Healthcare within the United States is notoriously fragmented and inefficient. Contemporary innovations for policy, reimbursement, and care delivery are consistently directed towards the promotion of value based care (Bates, 2010). These initiatives routinely coalesce around the promising potential of a robust primary care system. The Patient-Centered Medical Home (PCMH) model is increasingly becoming the standard of quality care and use of this model by healthcare providers is poised to bring about a paradigm shift towards value-based care (Henderson, Princell & Martin, 2012).

This scholarly project incorporated an evidence based approach to establishing continuous quality improvement in a primary care office …

Implementation Of Evidence-Based Culturally Adapted Interventions, Collaborative Care, And Change Management For Improved Mental Health Outcomes In A Community-Based Safety-Net Clinic, Laura E. Hall

Doctoral Projects

Mental health disorders are prominent and devastating in the United States. They are more prevalent in low-socioeconomic and minority groups with lower rates of diagnosis and treatment in these populations. Primary care settings are the foremost location for screening, diagnosis, and treatment for common mental health disorders but do not always provide adequate care due to limitations of time, knowledge, and resources. Evidence has shown that collaborative care models can provide more effective treatment for behavioral health services through a team-based approach to holistic patient care. This project focused on implementing culturally adapted, collaborative care models to improve mental health …

Improving The Patient Handoff From Or To Picu In Children Who Have Undergone Cardiac Surgery Using A Standardized Handoff Tool, Amanda Taylor

Doctoral Projects

Inpatient hospitalizations for children are often costly. Children often transition from one setting to the next while hospitalized, therefore their provision of care is also transferred from one care team to the next. This transition presents a vital time for the child, that may be associated with adverse events and medical error. Adverse events can lead to poor outcomes for the child. Despite efforts to improve patient handoffs, communication failures are still abundant in healthcare. Research indicates that the use of a standardized handoff tool from one setting to the next is an effective method for improving the patient’s transition. …

Effect On Opioid Use Following The Implementation Of Evidence-Based Pain Management, Kathryn L. Ellens

Doctoral Projects

Pain is the most common reason people seek healthcare. Initiatives to prevent the undertreatment of pain have resulted in overreliance on opioids to treat pain. Despite significant increases in opioid use, pain is more prevalent than ever. Additionally, devastating consequences from opioid use have resulted, such as dependence, addiction, and increasing opioid-related deaths. Research demonstrates multimodal analgesic therapy is an effective alternative to the overreliance on opioids to treat pain. Multimodal analgesia is the synergistic use of two or more analgesics with different mechanisms of action. Multimodal analgesia produces significantly more effective and efficient pain management than opioid-only therapy. This …

An Event- And Network-Level Analysis Of College Students’ Maximum Drinking Day, Matthew K. Meisel, Angelo M. Dibello, Sara G. Balestrieri, Miles Q. Ott, Graham T. Diguiseppi, Melissa A. Clark, Nancy P. Barnett

Statistical and Data Sciences: Faculty Publications

Background—Heavy episodic drinking is common among college students and remains a serious public health issue. Previous event-level research among college students has examined behaviors and individual-level characteristics that drive consumption and related consequences but often ignores the social network of people with whom these heavy drinking episodes occur. The main aim of the current study was to investigate the network of social connections between drinkers on their heaviest drinking occasions.

Methods—Sociocentric network methods were used to collect information from individuals in the first-year class (N=1342) at one university. Past-month drinkers (N=972) reported on the characteristics of their heaviest drinking occasion …

Extracellular Vesicles Released By Cardiomyocytes In A Doxorubicin-Induced Cardiac Injury Mouse Model Contain Protein Biomarkers Of Early Cardiac Injury, Chontida Yarana, Dustin W. Carroll, Jing Chen, Luksana Chaiswing, Yanming Zhao, Teresa Noel, Michael Alstott, Younsoo Bae, Emily V. Dressler, Jeffrey A. Moscow, D. Allan Butterfield, Haining Zhu, Daret K. St. Clair

Toxicology and Cancer Biology Faculty Publications

Purpose—Cardiac injury is a major cause of death in cancer survivors, and biomarkers for it are detectable only after tissue injury has occurred. Extracellular vesicles (EV) remove toxic biomolecules from tissues and can be detected in the blood. Here, we evaluate the potential of using circulating EVs as early diagnostic markers for long-term cardiac injury.

Experimental Design—Using a mouse model of doxorubicin (DOX)-induced cardiac injury, we quantified serum EVs, analyzed proteomes, measured oxidized protein levels in serum EVs released after DOX treatment, and investigated the alteration of EV content.

Results—Treatment with DOX caused a significant increase in …

In Vitro Assay Development As An Alternative To The Use Of Laboratory Animals For Measuring Clostridium Perfingens Type C Toxoid, Lauren M. Wilmes

School of Veterinary and Biomedical Sciences: Dissertations, Theses, and Student Research

Clostridium perfringens type C produces beta toxin, which is a primary virulence determinate that can cause necrotic enteritis in neonatal animals. Vaccines directed against C. perfringens toxins have shown to be efficacious in preventing disease. However, the production of a commercial vaccine requires not only an efficacious antigen, but also testing methods for quantifying antigens and potency on final product. This research was undertaken to fulfill a need for the reduction in small animal usage to produce and deliver vaccines. The current testing methods are performed in vivo according to the Code of Federal Regulations number 9 (9CFR) United …

Champs: Child Health And Methods Of Parenting Study, Megan Fletcher

Department of Nutrition and Health Sciences: Dissertations, Theses, and Student Research

The range of different contexts in which children learn and develop dietary and physical activity habits varies greatly, yet there is limited research on the role of the family structure and parenting style in the development of childhood obesity. CHAMPS (Child Health and Methods of Parenting Study), was designed to explore the relationships between parenting style, family structure, and child health status through a new lens and novel application of the Unified Theory of Behavior model. Surveys were administered to families at two partner locations to examine these relationships. 51 parents/legal guardians and 57 children completed the survey. Results were …

The Write Stuff - Spring 2018 (Vol. 15, No. 2), Research Medical Library

Write Stuff 2018

• What is a PMCID and how do I get one?
• Updates to ClinicalTrials.gov
• EndNote Manuscript Matcher helps authors identify journals
• NIH grant applications: Where should the preliminary data go?
• Unusual terms used in scientific writing and publishing: h-index

Partidarios De La Vida: Resiliencia En Los Afectados Directos De La Dictadura En Arica, Chile / Supporters Of Life: Resilience In The Direct Victims Of The Dictatorship In Arica, Chile, Danielle Levinson

Independent Study Project (ISP) Collection

The present study is a qualitative analysis of resilience mechanisms in inhabitants of the city of Arica, Chile who participated actively in the resistance against the Pinochet dictatorship. Through one-on-one interviews with members of this population and the coordinator/social assistant of the Arican branch of the Chilean government’s reparation program (PRAIS), this project was able to corroborate the existence of the following four categories of resilience mechanisms, which are identified in a technical standard published by the Chilean Under-Secretariat of Health: individual, family, social network, and values and ideology. However, it was revealed that this model should be adapted to …

Neutrophils From Both Susceptible And Resistant Mice Efficiently Kill Opsonized Listeria Monocytogenes, Michelle G. Pitts, Travis A. Combs, Sarah E. F. D'Orazio

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Inbred mouse strains differ in their susceptibility to infection with the facultative intracellular bacterium Listeria monocytogenes, largely due to delayed or deficient innate immune responses. Previous antibody depletion studies suggested that neutrophils (polymorphonuclear leukocytes [PMN]) were particularly important for clearance in the liver, but the ability of PMN from susceptible and resistant mice to directly kill L. monocytogenes has not been examined. In this study, we showed that PMN infiltrated the livers of BALB/c/By/J (BALB/c) and C57BL/6 (B6) mice in similar numbers and that both cell types readily migrated toward leukotriene B4 in an in vitro chemotaxis assay. However, …

Poster: Nursing Knowledge And Attitudes Toward Trans* And Gender-Nonconforming Patients, Christine Humphrey

Doctor of Nursing Practice Scholarly Projects

This project aims to impact nursing knowledge and attitudes toward trans* and gender-nonconforming patients. The term transgender, synonymous with the term trans*, is utilized by individuals whose gender and designated sex at birth differ from one another, compared to cisgender persons whose gender and assigned sex are aligned (Erickson-Schroth, 2014).

The trans* population remains underserved. Nurses conscious and unconscious biases impede the advancement of knowledge and attitudes needed to promote best outcomes for trans* patients. Trans* patients have many of the same healthcare concerns as cisgender individuals. However, unique needs for this population arise from compounded issues of prejudice and …

Differences In The Rothman Index Score In Evolving Emergent Events In Medical-Surgical Patients, Deborah Cardenas, Dnp, Msn, Rn, Paralegal

Doctor of Nursing Practice Projects

Background: The Rothman Index (RI), an early warning system using software integrated with the electronic medical record provides scores monitoring patient conditions. Minimal findings exist regarding RI scores in medical-surgical patients.

Objectives: Explore differences in the RI scores in medical-surgical patients who suffered rapid response, cardiopulmonary resuscitation or death events.

Methods: A retrospective comparative design of 75 subjects with a rapid response or cardiopulmonary resuscitation event on medical-surgical units over 12-months at an academic medical center using RI scores at admission, 48- and 24-hours before and at time of event. Deaths were identified immediately following the emergent events.

Results: The …

Transitioning Experienced General Care Float Pool Nurses To A Critical Care Float Pool, Troy T. Betts, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: A nationwide nursing shortage has resulted in a significant reduction in the number of qualified nurse applicants for critical care positions. Additional recruitment solutions for critical care staffing needed to be explored.

Purpose: The purpose of this project was to evaluate the effectiveness of an orientation program designed to transition experienced general care trained float pool nurses to a critical care float pool.

Methods: This descriptive study measured participants’ pre and post critical care orientation knowledge, and completion of core computerized competencies. Critical thinking questions, unit-based competencies, and measurement of participants’ individual perception of competence were also completed. Pre …

Differences In Preventable Cardiovascular-Related Versus Unavoidable Occupational Causes Of Firefighter Fatalities On Duty, Amy Goad, Dnp, Ms, Np-C

Doctor of Nursing Practice Projects

Background: Firefighters across the United States face high fatality rates in the line of duty of which many are likely related to preventable cardiovascular risk factors.

Objectives: To assess differences in firefighter cardiovascular-related versus unavoidable occupational-related fatalities by career status, age, smoking, obesity, and hypertension.

Methods: We used an exploratory, comparative secondary data analysis design. We extracted data from a national database of deceased firefighters over 14 years. Variables extracted were career status, age, smoking, obesity, and hypertension as well as the reason for death while on duty (i.e., cardiovascular-related or unavoidable occupational-related death). Data were analyzed using Chi-Square to …

The Impact Of Digital Education Delivery On Postoperative Pain Outcomes, Amber Stitz, Dnp, Ms, Aprn, Acns-Bc, Ocns-C

Doctor of Nursing Practice Projects

Background. Advances in technology and communication tools offer new, innovative methodologies for delivering information to patients. Research is needed to understand the clinical effectiveness of different education delivery methods on outcomes and comprehension.

Purpose. Compare the effects of digital education with conventional, written and verbal instructions on patients’ pain outcomes, knowledge attainment, and treatment participation.

Methods. A quasi-experimental design evaluated outcomes in 133 patients undergoing major hip (n=73) and knee (n=60) arthroplasty who received point-of-care pain education delivered via a dynamic mobile-computing (iPad) platform (n=65) or by conventional education (n=68). The significance level was set at 0.05. Person’s r and …

Identification Of Risk Factors Associated With Falls In The Long Term Care Setting, Jacqueline L. Patel, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Falls threaten the safety of older adults in long term care (LTC).

Objectives: To assess environmental, clinical and pharmacological causes of falls as well as compare Fall Risk Assessment Score, Brief Interview of Mental Status (BIMS) score, Activities of Daily Living (ADL) scores, age and gender of residents with one fall, recurrent falls, and no falls.

Methods: Using a descriptive-comparative design, we included a convenience sample of 290 adults ≥50 years old at our LTC facility. Fall and recurrent fall groups were matched to those with no falls. We assessed environmental, clinical and pharmacological variables, Fall Risk Assessment Scores, …

The Effect Of Palliative Care Nursing Education To Improve Knowledge In Palliative Care Of Hospital-Based Nurses Caring For Patients With Chronic, Serious Illness, Madelyn Rose Balicas, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Palliative care nursing provides care for the relief of pain and suffering throughout the course of a patient’s chronic, serious illness. Hospital-based nurses need to be equipped with palliative care nursing knowledge to provide optimal care for patients and their families to improve the quality of life. Lack of education in pain and symptom management and communication about goals of care can result in a suboptimal and high cost of care.

Objectives: To determine if a brief palliative care nursing education can improve the knowledge of hospital-based nurses about palliative care nursing.

Methods: A cross-sectional quantitative pre-posttest design used …