Medicine and Health Sciences Commons^™

Translating Evidence-Based Guidelines Into Practice—Are We Getting It Right? A Multi-Centre Prospective International Audit Of Nutrition Care In Patients With Foregut Tumors (Inform), Merran Findlay, Judith D. Bauer, Rupinder Dhaliwal, Marian De Van Der Schueren, Alessandro Laviano, Adrianne Widaman, Lisa Martin, Andrew G. Day, Leah M. Gramlich

Faculty Research, Scholarly, and Creative Activity

Malnutrition is highly prevalent in patients with foregut tumors comprising head and neck (HNC) and esophageal (EC) cancers, negatively impacting outcomes. International evidence-based guidelines (EBGs) for nutrition care exist; however, translation of research evidence into practice commonly presents considerable challenges and consequently lags. This study aimed to describe and evaluate current international nutrition care practices compared with the best-available evidence for patients with foregut tumors who are at high risk of malnutrition. A multi-centre prospective cohort study enrolled 170 patients commencing treatment of curative intent for HNC (n = 119) or EC (n = 51) in 11 cancer …

Medication Error Prevention Strategies, Shana L. Brown

MSN Capstone Projects

The fundamental purpose of every healthcare organization is to enhance patient quality of life through the provision of superior healthcare to produce the best patient outcomes. In the pre-hospital practice setting of helicopter emergency medical service (HEMS) the desire of system leaders and medical staff is to be primarily patient-centered, focused on the safety and wellbeing of patients while at the same time managing the business finances and budget of the organization. Maintaining a healthy environment with safe patient practices is the responsibility of organization administrators, physicians, nurses, paramedics, and all healthcare providers.

One of the primary duties that healthcare …

A Multimodal Analgesic Virtual Reality Program To Reduce Opioid Exposure, Jessica Hovland

Student Scholarly Projects

The opioid crisis continues to be a public health concern. Traditionally, an opioid-centric approach treats postoperative pain.

The following PICOT question guided this project: Will initiating a multimodal analgesic virtual reality quality improvement program (I) compared to current practice (C) decrease opioid requirements (O) in robotic hysterectomy patients (P) during the postoperative period (T)? Several articles promote non-opioid analgesia and non-pharmacological interventions, such as multimodal analgesia and virtual reality (VR) for pain management.

This project reviewed pre- and post-implementation data after implementing new evidence-based multimodal analgesia and VR protocols. The project captured a total of 64 patients in the pre-implementation …

Sustainability Of An Outpatient Antibiotic Stewardship Program, Kristin Smith

Dissertations

Abstract

Problem: Antibiotic stewardship is an effort to evaluate and improve the use of antibiotics by providers and patients. Antibiotic stewardship programs (ASPs) promote the appropriate use of antibiotics. There is increasing evidence that supports the use of antibiotic stewardship programs in reducing antibiotic prescribing rates while continuing to maintain safe patient care. Research supports approaches with multiple interventions and ongoing commitment to antibiotic stewardship. However, information regarding long-term sustainability of antibiotic stewardship programs is lacking. The purpose of this quality assurance project was to assess long-term sustainability of a previously implemented ASP promoting appropriate prescribing of antibiotics for the …

Orofacial Myofunctional Therapy With Children Ages 0-4 And Individuals With Special Needs, Robyn Merkel-Walsh

International Journal of Orofacial Myology and Myofunctional Therapy

Purpose: The purposes of this paper are to 1) define variations in terminology and treatment methodology for orofacial myofunctional disorders (OMDs) in children 0-4 years of age and in special populations, and 2) compare and contrast service delivery models for children ages 0-4 and individuals with special needs versus older children and children who are neurotypical. Method: A literature review of scholarly articles, professional presentations, poster presentations, blogs, and social media were analyzed using three tiers of evidence-based practice to include: 1) clinical expertise/expert opinion; 2) external and internal evidence and 3) client/patient/caregiver perspectives. Results: Professional texts and publications used …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

Qualifications Of Executive Nurses For Service On Hospital Boards, Michelle Lee Foxx

Electronic Theses and Dissertations

Abstract Healthcare governing boards have responsibility for the legal and financial stability of the organization. They are assuming more responsibility for quality care and outcomes. Nurse leaders have valuable insights into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight. Yet, only 5% of the 3.2 million nurses in the U.S. health workforce hold a seat on hospital governing boards in the United States. The purpose of this study was to explore how nurses with executive experience perceive their own leadership qualities in the context of established requirements for executive hospital boards. Fifty …

Applying Knowledge Translation In Rehabilitation: An Exploration Of What It Means To Change Clinical Practice, Stacey D. Guy

Electronic Thesis and Dissertation Repository

Health care providers are often required to implement evidence-based recommendations into the care they deliver. Resources that support health care providers’ efforts are a useful knowledge translation strategy. This thesis describes the development and usability evaluation of an evidence-informed clinical practice implementation toolkit to support implementation efforts. Two studies were undertaken to provide insight into what was needed to support health care providers, and to inform the development of the toolkit. A retrospective evaluation analyzed the performance of a team implementing a pressure ulcer risk assessment for patients with spinal cord injury. The rates of adherence to the risk assessment …

Purposeful Hourly Rounding And Reduction Of Patient Falls, Iesha S. Bell

Doctor of Nursing Practice Projects

Falls are a pervasive and persistent problem in all healthcare settings, with adverse clinical, social, and economic outcomes for patients, staff, and institutions involved. The systematic process of purposeful rounding is an intentional act conducted with a clear purpose for the patient's benefit. Prevention of inpatient falls remains a challenge for nurses. Despite fall prevention efforts by nurses, the rate of patient falls in the acute care setting is a major safety concern. A Doctor of Nursing Practice project was crafted and implemented to educate nursing staff on purposeful hourly rounding and apply the 4 P's (pain, positioning, possessions, and …

Early Covid-19 Interventions Failed To Replicate St. Louis Vs. Philadelphia Outcomes In The United States, Aliea M. Jalali, Brent M. Peterson, Thushara Galbadage

Faculty Articles & Research

The Coronavirus disease 2019 (COVID-19) pandemic has elicited an abrupt pause in the United States in multiple sectors of commerce and social activity. As the US faces this health crisis, the magnitude, and rigor of their initial public health response was unprecedented. As a response, the entire nation shutdown at the state-level for the duration of approximately one to three months. These public health interventions, however, were not arbitrarily decided, but rather, implemented as a result of evidence-based practices. These practices were a result of lessons learned during the 1918 influenza pandemic and the city-level non-pharmaceutical interventions (NPIs) taken across …

Engagement Of Community Stakeholders To Develop A Framework To Guide Research Dissemination To Communities, Jennifer Cunningham-Erves, Tilicia Mayo-Gamble, Yolanda Vaughn, Jim Hawk, Mike Helms, Claudia Barajas, Yvonne Joosten

Department of Health Policy and Community Health Faculty Publications

Background: Dissemination of research findings to past study participants and the community-at-large is important. Yet, a standardized process for research dissemination is needed to report results to the community. Objective: We developed a framework and strategies to guide community-academic partnerships in community-targeted, dissemination efforts.

Methods: From 2017 to 2019, a community-academic partnership was formed in Nashville, Tennessee, and iteratively developed a framework and strategies for research dissemination using cognitive interviews. A deductive, constant comparative analysis was conducted on interview responses to examine framework and strategy content. Feedback was used to finalize the framework and strategies for the evaluation. …

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and represents a …

A Positive Framed Message To Improve Cpap Compliance For Patients With Osa, Frances Clark

Evidence-Based Practice Project Reports

Obstructive sleep apnea (OSA) affects 24% of the US population (DiNapoli, 2014). Untreated OSA causes many diseases, affects one’s quality of life, and increases mortality (Pengo et al., 2018). Continuous positive airway pressure (CPAP) is the lifelong treatment for OSA; yet 30%-80% of OSA patients are CPAP noncompliant within one year. The purpose of this EBP project was to determine if implementing a positive frame message intervention would improve CPAP compliance for newly diagnosed OSA patients. Based on the evidence, implementation of behavioral interventions, such as a positive framed message, was effective in improving CPAP compliance (Pengo et al., 2018). …

Mass Matters: Increasing Mammography Rates To Underserved Women, Ingrid N. Cooper

Evidence-Based Practice Project Reports

Breast cancer is the most frequently diagnosed cancer among women in Indiana and the United States (Indiana Cancer Organization, 2019). An estimated 268,000 new cases of invasive breast cancer were diagnosed and 41,760 women died due to breast cancer in 2019 (ACS, 2019). Substantial breast cancer-related morbidity and mortality disparities persist among the underserved. Disparities in breast cancer outcomes are due to lower mammography screening rates, lack of timely follow-up of abnormal results, and lack of timely treatment initiation among women with breast cancer (Highfield et al., 2015). The purpose of this evidence-based practice project was to address low mammography …

Effect Of Lifestyle Modifications On Blood Pressure And Bmi In Overweight Or Obese Adults With Primary Hypertension, Mariska Vandenbergh

Evidence-Based Practice Project Reports

Hypertension (HTN) and obesity contribute to poor cardiovascular outcomes which can be managed with diet and exercise lifestyle changes. In addition, self-awareness (SA) of eating patterns can be a useful tool to promote adherence to lifestyle changes. The purpose of this project was to determine the effect of lifestyle education, the DASH diet, and tools to increase SA for adult clinic patients who were overweight with hypertension. The REAP and PIH tools were utilized to increase patients’ SA of their diagnosis and current dietary habits. A literature search over five databases was conducted and analyzed thoroughly. National guidelines strongly recommend …

Healthcare Provider Overlap On Evidenced-Based Practice In Intubated Patients Using The Theoretical Domain Framework: A Case Study, Katie Bull

CUP Ed.D. Dissertations

Intubation by endotracheal or tracheostomy means is a common life-saving intervention bearing significant, yet preventable risk. Evidence-based practice (EBP), intended to mitigate risk, is often inconsistently adhered to by healthcare providers (HCPs) due to a variety of factors, leaving patients vulnerable to adverse outcomes such as ventilator-associated pneumonia or tracheostomy-related stenosis. A review of the literature identified socially related barriers resulting from overlapping roles and expectations of primary HCPs. Little research has been conducted to understand the impact of overlap on EBP adherence. Using the Theoretical Domains Framework (TDF), this case study explored HCP overlap in one critical care unit …

Increasing Chlamydia Trachomatis And Neisseria Gonorrhea Screening Among Women 15 To 24 Years Old Using A Multifaceted Approach, Mackenzie Shireman

Evidence-Based Practice Project Reports

The Centers for Disease Control and Prevention (CDC) (2017a) estimates that one-quarter of sexually active people are between 15 and 24 years old, but account for half of 20 million sexually transmitted diseases (STD) reported annually in the United States. Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) are the most common reportable STDs (CDC, 2018). The purpose of this project was to increase CT/NG screening rates among sexually active, nonpregnant women 15 to 24 years old within the primary care setting through colleague education, routine sexual history taking, and indicated testing. A 30-minute colleague in-service was provided to educate clinical …

Creating Evidence-Based Practitioners: Bridging The Gap Between The Classroom And Clinic, Carolyn J. Murphy, Patti T. Calk

Journal of Interprofessional Practice and Collaboration

Occupational therapy (OT) academia is responsible for educating students about evidence-based practice (EBP). Unfortunately, students rarely see the connection between academic assignments related to research and application in clinical practice. Academicians need to explore instructional methods to help students bridge the gap between the classroom and being able to apply them in a clinical setting. Stube and Jedlicka (2007) noted that teaching strategies and methods that incorporate what students perceive as being clinically relevant promotes learning and utilization of evidence into practice. The purpose of this paper is to report the outcomes related to combining the concepts of problem-based learning …

Mapping Occupational Therapy Practice With Postsecondary Students: A Scoping Review, Karen M. Keptner, Karen Mccarthy

The Open Journal of Occupational Therapy

Background: Legislation supports a role for occupational therapy in postsecondary settings, but this area is not a common practice area and the practice area is not well understood. This scoping review maps current literature of occupational therapists working with students in postsecondary settings in order to inform future research and practice.

Method: After identifying included articles, a narrative description of the quantitative studies along with a concept map were completed. A qualitative thematic analysis of the articles was also conducted.

Results: Twenty-five articles met the inclusion criteria. Quantitative results describe occupational therapy services as both a direct …

From Evidence To Practice: Promoting Continued And Exclusive Breastfeeding In Rural Eastern Uganda, Katherine Judge

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Malnutrition is responsible for about one third of deaths globally among children under age five. Over 65% of these deaths, often associated with inappropriate feeding practices, occur during the first year of life and disproportionately affect those living in resource poor countries. Breastfeeding has been established as uniquely effective in providing infants with nutrients for healthy growth and development. Ugandan demographic surveys (2016) indicate less than 43% of infants age 4-5 months are breastfed.

Methods: The objective was to equip Community Health Educators (CHEs) with evidence-based practice guidelines for promoting continued exclusive breastfeeding to postpartum women. This project was …

Financial Impact Associated With Implementation Of The Low Back Pain Clinical Practice Guideline In Outpatient Physical Therapist Practice, Heidi Kosakowski

Department of Physical Therapy Student Theses, Dissertations and Capstones

Dysfunction and disability arising from low back pain (LBP) affects more people than any other condition globally, and results in changes to the quality of life for many individuals. The financial burden of managing low back pain is among the highest both in the United States and globally. Clinical practice guidelines (CPGs) provide recommendations on patient management strategies and have the potential to simultaneously improve patient outcomes and lower health care costs. Limited evidence exists on the impact of CPG implementation on downstream medical costs that are incurred after physical therapist care. A retrospective observational study was conducted that examined …

Implementation Of An Educational “Boot Camp” To Increase Nurses’ Confidence, Knowledge And Use Of Evidence-Based Practice In A Veterans Affairs Medical Center, Anita S. Dahl

Doctor of Nursing Practice Projects

Evidence-based practice (EBP) can be used to promote quality patient care, improve population health, decrease healthcare costs, improve work-life balance of health care professionals, increase job satisfaction, and decrease staff turnover. Barriers to implementing EBP include perceived lack of autonomy and authority to change patient care processes; and knowledge deficits related to EBP implementation. Limited access to research materials and inadequate leadership support also stifles implementation of EBP. The purpose of this project was to increase confidence, knowledge, and use of EBP by nurses through implementation of an intense, structured educational “Boot Camp”. A convenience sample of 27 nurses participated …

Providing Evidence-Based Education About Caring For Patients With Atrial Fibrillation, Rose M. Happy

Walden Dissertations and Doctoral Studies

Abstract In a multidisciplinary health care team, nurses are often the initial contact when patients present for clinical evaluation. Thus, it is of great importance that these nurses provide education to patients that is current and evidence-based. The target population of this project was nurses who care for patients with atrial fibrillation (A-Fib). The practice problem was the knowledge gap related to A-Fib. The purpose of the project was to provide an evidence-based, nursing education intervention to increase their knowledge. The practice-focused question sought to determine whether participation in the evidence-based education intervention increased nurses’ knowledge scores about providing care …

Survey Of Attitudes, Knowledge, And Barriers To Evidence-Based Practice Among Thai Physical Therapists, Mantana Vongsirinavarat, Witaya Mathiyakom, Warin Krityakiarana, Ninwisan Hengsomboon, Ratchanok Kraiwong

Internet Journal of Allied Health Sciences and Practice

Purpose: Healthcare professionals are encouraged to use evidence-based practice (EBP) to improve the quality of care and the patient’s quality of life. Knowledge and skill set specific to EBP, critical resources such as time and accessibility to databases, and clinician’s attitude toward EBP are needed for successful implementation of EBP. However, little is currently known about these factors among Thai Physical Therapists (PTs). This study aimed to explore the patterns of attitudes, perceived knowledge, and barriers toward EBP in Thai PTs. Method: An online questionnaire was used to obtain information regarding attitudes, knowledge, and barriers from Thai PTs. Descriptive statistics …

Adults On The Autism Spectrum: A Quality Improvement Project To Develop A Patient-Centered Nursing Care Guideline For The Acute Care Setting, Elizabeth Cirelli

DNP Scholarly Projects

Abstract

Background: Incidence of autism spectrum disorder is increasing. Current prevalence rate is 1 in 59 people, which translates to roughly 1% of the U.S. population. These adults have higher rates of epilepsy, gastrointestinal disorders, obesity, cardiac dysfunction, and mental health disorders. Healthcare system utilization is resultantly greater than their neurotypical counterparts, coupled with longer lengths of stay and decreased patient satisfaction reports.

Purpose: Most nurses report little to no formal training about the disorder or how to develop interventions sensitive to the needs of this population yet are crucial care givers to ensure patient-centeredness. A guideline to …

Mapping Occupational Therapy Practice With Postsecondary Students: A Scoping Review, Karen Keptner, Karen Mccarthy

Occupational Therapy | Faculty Scholarship

Background: Legislation supports a role for occupational therapy in postsecondary settings, but this area is not a common practice area and the practice area is not well understood. This scoping review maps current literature of occupational therapists working with students in postsecondary settings in order to inform future research and practice.

Method: After identifying included articles, a narrative description of the quantitative studies along with a concept map were completed. A qualitative thematic analysis of the articles was also conducted.

Results: Twenty-five articles met the inclusion criteria. Quantitative results describe occupational therapy services as both a direct and indirect service …

Increasing Adherence To A Light Sedation Protocol By Increasing Nurses’ Knowledge And Confidence, Katie Rust

DNP Projects

Abstract

BACKGROUND: Oversedation in the mechanically ventilated patient can cause long- and short-term adverse side effects. Light sedation practices provide patients with relief from agitation and pain and still allows them to actively participate in care. A light sedation protocol was introduced to bedside ICU registered nurses (RNs) at the University of Kentucky Medical Center (UKMC), but deep sedation is still commonplace. Reeducating bedside RNs and increasing their knowledge and confidence is a proposed strategy for increasing adherence to light sedation protocols.

PURPOSE: The purpose of this quality improvement project was to gain understanding of bedside RNs knowledge and perceived …

Are Current Clinical Guidelines On The Use Of Peripheral Intravenous Cannula For Blood Draws Supported By Evidence? An Organizational Case Study, Alycia Jacob, Linda Coventry, Hugh Davies, Elisabeth Jacob

Research outputs 2014 to 2021

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd Aim: To examine the quality of evidence used to inform health policies. Policies on peripheral intravenous cannulas were used as exemplars. Design: An organizational case study design was used, using the STROBE reporting guidelines. Methods: Policy guidelines were sourced between June and September 2018 from health departments in Australia. Seven documents were compared regarding intravenous cannula dwell times and blood collection use. Evidence used in the documents was critiqued using assessment guideline from the Oxford Centre for Evidence Based Medicine. Results: Large variations exist between policies regarding …

The Use Of An Embedded Librarian To Enhance Student Information Literacy Skills: A Pilot Study, Elaina J. Dalomba, Elizabeth Kavanaugh, Kaitlin Manbeck, Samantha O'Neill, Kyle Soldevilla, Melanie Watson, Ellen Mclaughlin

Journal of Occupational Therapy Education

This pilot study explored an embedded librarian (EL) intervention to enhance occupational therapy student information literacy skills development. The EL provided computer laboratory and in-class instruction, online presence in the classroom website, and extensive office hours to assist students in the identification of information needed, determination of how and where to find scholarly information needed, and assessment and utilization of information retrieved to meet assignment requirements. Participants were 46 third-year (junior) occupational therapy students. Three tools were used to assess skills pre and post intervention: the Student Assessment of Information Literacy Skills, the Student Perception of Literacy Skills-Q (SPIL-Q), and …

Community Teaching Experience: A Description Of The Development And Design Of A Unique Teaching Experience For Occupational Therapy Doctoral Students, Laura E. Landon, Christine Berg, Sara S. Ulfers

Journal of Occupational Therapy Education

Entry-level occupational therapy doctorate (OTD) students receive education and training to interpret and disseminate evidenced-based literature. However, these students are often missing the clinical experience to identify clinically relevant questions that impact occupational outcomes. Conversely, occupational therapy practitioners have the clinical experience to determine clinically appropriate questions but often encounter time, budget, and setting constraints on researching and learning up-to-date evidence-based practice assessment and intervention techniques. The purpose of this paper is to describe the development and design of an exploratory educational project in which OTD students utilized clinically relevant questions identified by local occupational therapy practitioners to disseminate evidence-based …