Medicine and Health Sciences Commons^™

An Evidence-Based Strategy For The Use Of Simulation To Assess Situation Awareness In Applicants To Nurse Anesthesia Programs, Angela Lee

Doctor of Nursing Practice Scholarly Projects

Medical errors are considered one of the top causes of patient death. Closed claims analysis reveals an estimated 50% of claims are associated with preventable events by the anesthesia provider. Errors in anesthesia leading to critical incidents are associated with errors in situation awareness (SA). Identification of human factor variables, such as SA, provides an analysis of observable behavior and intuition necessary to guide crisis management, maintain clinical performance, and mitigate errors in patient safety. The human factor components of human error and SA play critical roles in patient safety and overall clinical anesthesia practice. The viability of simulation assessment …

Evidence Based Practice Guidelines For The Pediatric Autistic Spectrum Disorder Population, Calvin Sparks

Doctor of Nursing Practice Scholarly Projects

Children with autism spectrum disorder (ASD), as well as caregivers, experience significant challenges in their interactions with healthcare providers in a clinical setting. This is primarily due to their issues with communication, social interaction, and sensory sensitivities to anesthetic treatment during premedication or preoperative environments. Due to these characteristics, it is important to maintain and update the current standards of care for children with ASD while utilizing evidence-guided strategies to provide a pre-operative assessment effectively. The pre-operative assessment is a critical component that renders impact throughout the surgical experience with the purpose of risk stratification, preparation of altering the normal …

Development And Implementation Of An Evidence Based Practice Guideline Related To The Management Of Adult Angioedema, Megan Przybysz

Doctor of Nursing Practice Scholarly Projects

Angioedema (AE) is a potentially life-threatening medical condition that occurs with a higher frequency than medical providers may expect, with the emergency department (ED) serving as the usual first point of medical contact for patients. Any hesitation in recognizing AE or inconsideration of the disease process in differential diagnoses may lead to a dangerous delay of care. Due to the potential rapid progression of airway obstruction in AE, inexperienced providers should not attempt intubation, instead deferring to providers experienced in alternative airway techniques (i.e., anesthesia providers). The primary goal of this project is to develop an evidencebased practice guideline for …

Cat Color Theory: Can Cat Color Being Accurately Used To Predict Behavior, Emily Mears

Honors Theses

Is there scientific backing for "Tortie-tude" or "Orange Cat Behavior"? Many cat owners swear by these claims. Can coat color predict cat personality? If coat color is an accurate way to predict personality, the cat adoption process could be smoother. Also, veterinarians can be better prepared to avoid cat scratches and bites if they know a color is more likely aggressive. We made and distributed two surveys to determine the perception of personality by color and the actual personalities of cats. The first survey, "Cat Perception," was given to people who work with cats and, therefore, have interacted with a …

General Anesthesia Clinical Practice Guidelines For Patients With Posttraumatic Stress Disorder, Bradley Closson

Doctor of Nursing Practice Scholarly Projects

General anesthesia is an induced state of unconsciousness administered by anesthesia providers to obtain patient amnesia, analgesia, and akinesia. Adult patients with posttraumatic stress disorder (PTSD) are at risk for general anesthesia-related complications throughout the perioperative setting. Emergence delirium is a clinically significant postoperative complication that patients with PTSD have an increased risk of developing. Postoperative complications of emergence delirium include patient or medical staff injury, surgical site damage, prolonged postanesthesia care unit (PACU) stay, and increased medical care costs. Evidence demonstrates that implementing preventive interventions decreases the incidence of emergence delirium. There are no standardized, evidence-based general anesthesia guidelines …

Preprocedural Ultrasound For Labor Neuraxial Anesthesia: Evidence-Based Practice Recommendations, Nicholas Anderson

Doctor of Nursing Practice Scholarly Projects

Central neuraxial blockade (CNB) is the most widely used method of anesthesia provided to laboring patients and includes epidural, spinal, combined spinal-epidural, and caudal techniques. Studies have shown that using preprocedural ultrasound is a safe and effective tool to facilitate the placement of neuraxial needles, especially in patients with predicted difficulty. With the prevalence of obesity increasing, laboring patients with predicted difficulty of neuraxial needle placement is increasing as well. In addition, the traditional method of palpation and visualization of anatomical landmarks to place neuraxial needles can produce inaccurate results due to inconsistencies between patients. Use of preprocedural ultrasound to …

Development Of An Evidence-Based Crna Preceptor Training Program, Emmanuel Mensah

Doctor of Nursing Practice Scholarly Projects

A preceptor is an experienced clinician who is expected to facilitate a student's learning experience. Preceptorship is the relationship between a staff nurse and student, focusing on the development of clinical skills and knowledge. Initially introduced by Florence Nightingale in the 1800s, the concept was quickly adopted by nurse anesthetists and is a staple of the anesthesia practice today. As it stands, many Certified Registered Nurse Anesthetists (CRNA) preceptors do not receive formal training in their role, which may lead to a decrease in teaching ability and confidence to face broad teaching-learning issues. A lack of preparation hinders preceptor outcomes …

Incorporation Of Mindfulness Application Use In Doctoral Nurse Anesthesia Curricula For Mitigation Of Stress And Anxiety In Student Registered Nurse Anesthetists, Kerrie Rodgers

Doctor of Nursing Practice Scholarly Projects

The nurse anesthesia specialty is highly stressful, with educational training being no exception. High didactic demands and intensive clinical experiences are placed on student registered nurse anesthetists (SRNAs), increasing stress and anxiety in their personal and professional lives. High levels of psychological distress can lead to inadvertent consequences in students’ mental, emotional, and physical health and can contribute to illness, burnout, substance use, and compromise in patient safety. Some degree of stress is necessary for motivation to succeed and perform at high levels, and encountering stress while enrolled in a doctoral nurse anesthesia program is expected and unavoidable. A search …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Evaluating Nurses’ Turnover Intention And Organizational Commitment Following Stroke Unit Staffing Changes: An Evidence-Based Quality Initiative, Heather Tatusko

Doctor of Nursing Practice Scholarly Projects

Nurses are known to be overworked, overwhelmed, undervalued, and understaffed at dangerous levels throughout various inpatient hospital units across the United States (U.S.). Hospital registered nurse (RN) turnover is a significant issue that has accelerated since the COVID-19 pandemic, resulting in economic impacts and other burdens for organizations, individuals, and communities. Evidence suggests that evaluating Registered Nurses’ Turnover intention (NTI) and Organizational Commitment (OC) can help maintain a ready and capable team of skilled RNs; however, most healthcare organizations (HCOs) do not collect or analyze NTI and OC data and focus on staffing numbers and monetary incentives to get adequate …

Development Of Evidence-Based Practice Anesthesia Guidelines For Brain-Dead Organ Donors, Kelly Dzialowski

Doctor of Nursing Practice Scholarly Projects

Organ donation is a gift of life for both donors and recipients that can come from living donors, donors after cardiac death, or brain-dead donors (BDDs). Treating the donors with optimal care throughout the entire donation process is crucial due to organ supply shortages. Organs from BDDs are a large contributor to the number of organs donated each year and require critical care from the time of admission, declaration of brain death, and throughout the organ procurement surgery. Although each BDD requires meticulous care for successful retrieval and donation, there is a lack of evidence-based practice (EBP) guidelines for anesthesia …

Viscoelastic Monitoring In Major Hepatic Surgery: An Evidence-Based Practice Project, Randy Kinietz

Doctor of Nursing Practice Scholarly Projects

Patients undergoing major hepatic surgery are at high risk for intraoperative transfusion of allogenic blood products. These patients are at increased risk due to pre-existing hepatic pathology, surgical stress, and the complexity of surgical procedures. While blood product transfusion may be necessary to support hemostasis and hemodynamics, it is not without risk. Current literature states that viscoelastic monitoring is superior to traditional laboratory values when guiding transfusion during major hepatic surgery. Viscoelastic monitoring is a term used to describe the measurement of change in viscoelastic properties of whole blood during clot formation. There are two readily available point-of-care types – …

Routine Evaluation With Gastric Ultrasound To Reduce Gastric Aspiration (Regurga), Joel Jackson

Doctor of Nursing Practice Scholarly Projects

When a patient undergoes anesthesia, there are inherent risks that the providers should protect the patient from. Despite adherence to fasting guidelines established by the American Society of Anesthesiologists (ASA), patients undergoing anesthesia continue to experience intrapulmonary aspiration of gastric contents. There are several factors that delay gastric emptying, including coexisting disease, trauma, pain, and opioid use. Gastric ultrasound assessment of the gastric antrum is a relatively new technology in anesthesia and can be used to assess the gastric antrum and provide information to anesthesia providers regarding the risk of aspiration in the perioperative period. The primary aim of this …

Recommending An Eras Guideline For Patients Undergoing Total Joint Arthroplasty, Kahl Knapke

Doctor of Nursing Practice Scholarly Projects

Enhanced recovery after surgery (ERAS) is a comprehensive guideline that guides patients' care throughout their surgical journey. ERAS is intended to reduce the body’s response to the many stressors of surgery. ERAS is proven effective in various specialty surgical areas, including orthopedics. Orthopedic surgery rates increase parallel with the patient population ages, indicating a need for more joint replacements. Implementing an ERAS guideline reduces healthcare costs to the patient and hospital facility by reducing the length of stay (LOS) and complications postoperatively. The investigation revealed a lack of consistent direction of care, and the developed approach for patients undergoing joint …

Guidelines For The Optimal Assessment Of Airway To Predict Difficult Intubation, Morgan Kleinfelder

Doctor of Nursing Practice Scholarly Projects

Managing the airway is the cornerstone of anesthesia care. However, difficult airway or intubation is not clearly defined. A major complication with a difficult airway is a cannot intubate, cannot ventilate (CICV) situation, which is reported to be as high as 10%. In addition, according to the American Society of Anesthesiologists (ASA) Closed Claim Study, "Adverse respiratory events are the most common type of injury, with difficult intubation [DI] and ventilation contributing to most of the cases. Twenty-eight percent of all anesthesia deaths are related to a CICV situation. As anesthesia evolves, basic airway assessments were developed and include mallampati …

Evaluating Nurses’ Turnover Intention And Organizational Commitment Following Stroke Unit Staffing Changes: An Evidence-Based Quality Initiative, Heather M. Tatusko Phiri

Doctor of Nursing Practice Scholarly Projects

Nurses are known to be overworked, overwhelmed, undervalued, and understaffed at dangerous levels throughout various inpatient hospital units across the United States (U.S.). Hospital registered nurse (RN) turnover is a significant issue that has accelerated since the COVID-19 pandemic, resulting in economic impacts and other burdens for organizations, individuals, and communities. Evidence suggests that evaluating Registered Nurses’ Turnover intention (NTI) and Organizational Commitment (OC) can help maintain a ready and capable team of skilled RNs; however, most healthcare organizations (HCOs) do not collect or analyze NTI and OC data and focus on staffing numbers and monetary incentives to get adequate …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Development Of A Rotem-Guided Transfusion Algorithm In Cardiothoracic Surgery Patients, Kourtney Jane Snyder

Doctor of Nursing Practice Scholarly Projects

Abstract

Cardiothoracic surgical patients are at an increased risk for bleeding complications for various reasons, including induction of hypothermia, initiation of the coagulation cascade, degradation of the coagulation factors, mechanical destruction of platelets, and a systemic inflammatory response due to cardiopulmonary bypass (CPB). The American Society of Anesthesiologists recommends rotational thromboelastometry (ROTEM)-guided transfusion algorithms for perioperative blood management; however, there remains a heavy reliance on conventional coagulation laboratory values. Utilization of the following PICOT question will guide this project: In cardiothoracic surgical patients, how does the use of ROTEM versus traditional coagulation laboratory tests (PT, INR, aPTT, ACT, platelet count, …

Development Of Evidence-Based Clinical Practice Guidelines For The Prevention Of Peripheral Neurological Injury During Robotic-Assisted Prostatectomies For Patients In The Steep Trendelenburg Position, Tyler Wolpert

Doctor of Nursing Practice Scholarly Projects

Robotic-assisted surgery (RAS) is becoming more prevalent in modern surgical practice and is currently being utilized in a range of surgical specialties from colorectal and gynecological procedures to bariatrics and orthopedics. Every surgical procedure has potential risk to patients, however robotic-assisted laparoscopic prostatectomies (RALP) in the steep Trendelenburg (ST) position poses unique risk for peripheral nerve injury (PNI). Despite attempts to reduce the incidence rate of PNI during RALP, injuries are still occurring to patients causing patient harm and anesthesia provider litigation. The implementation of a CRNA based safety checklist may reduce the incidence rate of PNI and provider litigation …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Education Of The Effects Of Obesity Medications And A Stepwise Approach To Mitigate Prevalence And Encourage Lifestyle Medicine For Primary Care Physicians, Kiely M. Curran

Department of Nutrition Student Projects

My Capstone project is an Educational Manual that emphasizes a healthcare team approach to the treatment and management of obesity. The Educational Manual consists of a standardized protocol in management of obesity in patients and a document with summarized references for primary care providers; and a simplified document for patient education. There is a growing interest in the usage of obesity medications. The purpose of my Capstone project is to provide a simplified manual for the primary care provider to reference to make knowledgeable and patient-centered decisions in the prescription of obesity medications and decisions in weight-management. My methodology included …

Evaluating The Effectiveness Of Sglt2i Or Glp1ra Vs. Sulfonylurea Initiation After Hospital Admission For Congestive Heart Failure And Type Ii Diabetes Mellitus: A Scoping Review, Alyssa Ptacek Bsn, Rn, Amber Majors Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Carrie Harvey Phd, Aprn-Bc, Acnp, Chfn

Doctor of Nursing Practice Projects

Purpose/Background

The need for effective pharmacological management in patients with congestive heart failure (CHF) and type II diabetes mellitus (T2DM) is an ever-growing task for healthcare providers, especially in the primary care setting. Patients with multiple comorbidities are less likely to adhere to required rigorous medication schedules and lifestyle modifications, resulting in accelerated disease progression and defeated efforts of healthcare providers. Traditionally, sulfonylureas have been the medication management of choice by healthcare providers due to their affordability compared to modern medication. Current guidelines recommend that individuals with poor glycemic control could benefit significantly from using older sulfonylureas with other antidiabetic …

Sequence Learning In A 6-Ohda Mouse Model Of Parkinson’S Disease, Ani Gribbin

Neuroscience Honors Projects

Parkinson’s disease (PD), a neurodegenerative disorder originating in the dopaminergic cells of the basal ganglia, is characterized by severe motor impairments such as tremors, bradykinesia, and postural instability. However, non-motor symptoms impacting sensory systems and cognition are consistently pointed to as more greatly affecting quality of life for PD patients. Cognitive impairments in PD can include changes in reward processing, depression, apathy, and increases in risk-taking behavior. Additionally, learning and memory deficits are seen in PD, specifically in motor sequence learning. Often, the neural correlates of sequence learning impairments are traced to the substantia nigra. However, there is some evidence …

Decreasing Re-Intubation Rates In Mechanically Ventilated Adult Patients: A Scoping Review, Anne J. Shearin Bsn, Rn, Wesley Gray Bsn, Rn, Philip Habegger Msn, Aprn, Fnp-C, Evan Gregory Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Donna Lynch-Smith Dnp, Aprn, Acnp-Bc, Ne-Bc, Cnl

Doctor of Nursing Practice Projects

Decreasing Re-Intubation Rates in Mechanically Ventilated Adult Patients: A Scoping Review

Purpose/Background

Critically ill patients often require mechanical ventilation to support respiratory function. Prolonging mechanical ventilation can increase adverse outcomes. Weaning patients from the ventilator as soon as clinically appropriate can decrease adverse outcomes. The decision to wean mechanical ventilation lacks a standardized approach. This scoping review will evaluate the literature about the effectiveness of a standardized weaning protocol in decreasing the number of reintubations within 72 hours of extubation.

Methods

We conducted a literature search on PubMed, CINAHL, Scopus, and Medline between November 2020 and November 2023 using key …

Evidence-Based Practice Guidelines For The Surgical Patient With Obstructive Sleep Apnea, Aaron Mcneilan

Doctor of Nursing Practice Scholarly Projects

Obstructive Sleep Apnea (OSA) is a medical condition which many people may be affected by but may be unaware of the presence of the condition. The incidence of OSA has increased in direct correlation with the rising rate of obesity in the general population. While chronic conditions may arise if OSA goes untreated, patients with OSA also have an increased risk for acute complications following surgical procedures such as airway obstruction, hypoxia, brain damage, and death. Many anesthetic medications administered during surgery exacerbate the pathological consequences of OSA, predisposing patients to adverse respiratory events during the recovery period following a …

Cognitive Behavioral Therapy To Prevent Nurse Burnout In Sub-Saharan Africa, Anna C. Johnson

MSN Capstone Projects

Overall, burnout prevention has been shown to foster nurse resilience, ability to cope with stressors, teamwork, and improving the personal value of “doing good” and “being good”; the effects have been shown to last between 6 months and one year. The current evidence is strong enough to recommend a change to current nursing practice via annual Cognitive Behavioral Therapy (CBT) trainings to strengthen nurse resilience.

This researcher proposes to implement a CBT-based burnout prevention program in Ghana’s capital of Accra in sub-Saharan West Africa. There is ample evidence that African nurses face many of the same burnout issues that nurses …

Role Of Neurocellular Endoplasmic Reticulum Stress Response In Alzheimer’S Disease And Related Dementias Risk, Miriam Aceves, Jose C. Granados, Ana C. Leandro, Juan M. Peralta, David C. Glahn, Sarah Williams-Blangero, Joanne E. Curran, John Blangero, Satish Kumar

School of Medicine Publications

Currently, more than 55 million people around the world suffer from dementia, and Alzheimer’s Disease and Related Dementias (ADRD) accounts for nearly 60–70% of all those cases. The spread of Alzheimer’s Disease (AD) pathology and progressive neurodegeneration in the hippocampus and cerebral cortex is strongly correlated with cognitive decline in AD patients; however, the molecular underpinning of ADRD’s causality is still unclear. Studies of postmortem AD brains and animal models of AD suggest that elevated endoplasmic reticulum (ER) stress may have a role in ADRD pathology through altered neurocellular homeostasis in brain regions associated with learning and memory. To study …

Continuous Glucose Monitoring For Glycaemic Control And Cardiovascular Risk Reduction In Patients With Type 2 Diabetes Not On Insulin Therapy: A Clinical Trial, Joseph Reed, Tony Dong, Sanjay Rajagopalan, Ian J. Neeland

Faculty Scholarship

Aim: To evaluate the impact of the Dexcom G6 continuous glucose monitoring (CGM) device on glycaemic control and cardiometabolic risk in patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk who are not on insulin therapy. Materials and Methods: Adults with T2DM with glycated haemoglobin (HbA1c) >7% and body mass index (BMI) ≥30 kg/m2 not using insulin were enrolled in a two-phase cross-over study. In phase 1, CGM data were blinded, and participants performed standard glucose self-monitoring. In phase 2, the CGM data were unblinded, and CGM, demographic and cardiovascular risk factor data were collected through 90 days …

Aso Author Reflections: Outcomes Of Hepatic Artery-Based Therapies And Systemic Multiagent Chemotherapy In Unresectable Colorectal Liver Metastases: A Systematic Review And Meta-Analysis, Lee M. Ocuin

Faculty Scholarship

No abstract provided.

The Heavy Mark Of Ptsd The Justice System Leaves On The People Going Through It., Ezavier Miller, Angel Emetuche, Sakina Ahmed

ENGL 1102 Showcase

This is a paper about how the justice system in it's many forms can cause PTSD. Not only to the criminals that go through it but also the children, victims. With many process having extensive repercussion causing PSTD to take hold of the many people that seek the justice system for help or judgement.