Medicine and Health Sciences Commons^™

Reducing The Incidence Of Opioid-Induced Unintended Advanced Sedation And Respiratory Depression In Hospitalized Patients, Angel Elliott

Doctor of Nursing Practice Projects

Background: Opioids are commonly administered to hospitalized patients to treat acute pain and can cause serious adverse events such as unintended advanced sedation and respiratory depression, also known as opioid-induced respiratory depression (OIRD). Post-surgical patients are at increased risk of unintended advanced sedation and respiratory depression due to anesthesia and pre-and post-opioid administration. They have a greater risk because they have less monitoring than those in the intensive care unit because their care teams, typically nurses, have higher staff-to-patient ratios. The use of enhanced interventions, such as the use of sedation evaluation tools, can decrease the risk of OIRD.

Purpose: …

Use Of Evidence-Based Telehealth To Reduce Complications In Adults With Type 2 Diabetes In A Rural Health Facility, Joni Kelley

Doctor of Nursing Practice Projects

Background: Formal education for type 2 diabetes mellitus (T2DM) patients is essential, especially in rural areas where diabetes is approximately 17% higher than in urban areas (Bolin & Ferdinand, 2018). In 2019, diabetes was listed as the direct cause of 1.5 million deaths, and 48% of all deaths due to diabetes occurred before 70 years (American Diabetes Association, 2021). According to the American Diabetes Association (2021), approximately 550,149 people in Alabama, or 14.1% of adults, have been diagnosed with diabetes. An additional 119,000 people in Alabama have diabetes but are unaware, significantly increasing their risk of complications (American Diabetes Association, …

Implementation Of A Perinatal Depression Screening Protocol, Michele Fuller

Doctor of Nursing Practice Projects

Background: Perinatal depression (PD), leading to suicide, ranked as a high cause of maternal mortality and was found to affect one out of 7 women in 2018, according to the American College of Obstetrics and Gynecology (ACOG) (2018). PD screening at the start of pregnancy care aims to achieve early referral to behavioral health resources (ACOG, 2018).

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to implement an evidenced-based PD screening protocol by presenting the Edinburgh Postpartum Depression Scale (EPDS) to each initial prenatal visit patient (IPV).

Methods: Qualitative pre-data was collected, followed by qualitative post-data …

Implementing An Evidence-Based Pressure Injury Bundle To Reduce Acquired Pressure Injuries In A Long-Term Care Facility, Latecia Rhoden

Doctor of Nursing Practice Projects

Background: Pressure injuries in the United States affect between 1-3 million people. Of the percentage of patients affected by pressure injuries, a range from 2% to 28% of those patients are in long-term care facilities. In Alabama, the pressure injury rate in long-term care facilities ranges from 2.3% to 18.4%. According to this long-term care facility's November 2022 quality improvement report, the acquired pressure rate rose from 2.2% to 8.3% in a year. A total of nineteen newly acquired pressure injuries were reported. Eleven of the nineteen pressure injuries occurred in the long-term stay unit, accounting for almost 58% of …

Utilizing A Multidisciplinary Team Approach To Opioid Stewardship At An Interventional Pain Clinic, Georgemarie Garber

Doctor of Nursing Practice Projects

Background: The opioid epidemic is a preventable health threat that is a recognized national problem by the Centers for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS). The evidence-based Opioid Stewardship (OS) toolkit is essential in the opioid epidemic because it supports identifying patients at risk for opioid aberrancy. However, at the Interventional Pain Management Clinic (IPMC), a chart review on the completion rates of the OS toolkit components for new patients admitted in June 2022 revealed that providers were not consistently completing components of the OS toolkit such as Opioid Risk Tool (ORT), the Morphine …

Implementation Of A Postpartum Depression Screening Protocol, Samantha Abercrombie

Doctor of Nursing Practice Projects

Background: Postpartum depression (PPD) is a major depressive disorder that can occur after having a baby and anytime during the first year postpartum (Centers for Disease Control and Prevention [CDC], 2021). Symptoms of PPD may include anger, crying more than usual, withdrawing from family, inability to bond with the baby, feelings of anxiousness, or thoughts of the mother harming herself or the baby. PPD can yield many challenges and hinder daily living activities. Recent research by the CDC (2021) estimates that 1 in 8 women experience manifestations of PPD. Findings also suggest that 1 in 5 women were not …

Implementation Of A Patient Care Specialist Role To Enhance The Patient Experience In A Pediatric Emergency Department, Jillian Brodeur

Doctor of Nursing Practice Projects

Background: Patient-centered care (PCC) has been an emerging trend in healthcare for the past two decades (Walsh et al., 2022). PCC and the patient experience have become essential measures of the quality of care provided and are linked to reimbursement dollars and improved patient outcomes (Rapport et al., 2019).

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to improve the patient experience in the Emergency Department (ED) of a metropolitan hospital. The DNP project focused on the benefit of a patient advocate in the ED to improve the patient experience. The project sought to improve …

Reducing The Incidence Of Hospital Acquired Pressure Injuries With An Interprofessional Collaboration Using Range Of Motion Exercises, Angela Johnson

Doctor of Nursing Practice Projects

Background: Hospital - Acquired Pressure Injuries (HAPIs) are an enormous problem for healthcare institutions and patients. HAPIs are painful, can lead to additional infections, increase the length of stay, and even cause death. Hospitals around the country are experiencing increases in the number of HAPIs. This project was implemented in a medical-surgical unit of a local urban hospital in the southeastern United States. The medical-surgical unit reported an increase in the number of HAPIs that exceeded the national average of 3%.

Purpose: The purpose of this quality improvement project was to apply an interprofessional approach to reduce HAPIs using a …

Improving Influenza Vaccination Rates In A Primary Care Clinic: A Quality Improvement Crusade, Janet Lowe

Doctor of Nursing Practice Projects

Background: Research consistently shows that influenza vaccines prevent medical appointments, treatments, and disabilities. In the United States (U.S.), 25-49 million individuals contracted influenza from October 2022 through January 2023. However, despite a greater community consciousness regarding viral contagions and the improved availability of vaccinations through primary care settings, ambulatory clinics, and local pharmacies, adults in the U.S. continue to miss the national influenza vaccination goals of 70%.

Purpose: This Doctor of Nursing Practice (DNP) project aimed to boost influenza immunization rates and comprehension of vaccination benefits among patients in a primary care setting during the influenza season. The DNP student …

Improving Door-To-Balloon Times In Adult Patients With St-Elevation Myocardial Infarction By Utilizing A Stemi-Rn, Amanda Hunter

Doctor of Nursing Practice Projects

Background: Heart disease is the leading cause of death in Alabama. The national estimated annual incidence of myocardial infarction (MI) is 605,000 new and 200,000 recurrent attacks, of which approximately 170,000 are silent (Tsao et al., 2022). Roughly every 40 seconds, an American will have an MI (Tsao et al., 2022). An ST-elevation myocardial infarction (STEMI) occurs when one or more of the coronary arteries supplying the heart with blood occlude, leading to myocardial injury (Akbar et al., 2021). Clinical practice guidelines for STEMI recommend Door to Balloon (D2B) intervention in 90 minutes or less (O'Gara et al., 2013), while …

Utilization Of A Simulation Electronic Documentation Model For Healthcare Providers To Reduce Documentation Errors In A Hospital Setting, Icy Moton-Hale

Doctor of Nursing Practice Projects

Background: Electronic health records (EHRs) are commonly used within healthcare systems across the United States. Although EHRs were developed to provide safe delivery of care, poor documentation quality remains a problem. Poor HER documentation can negatively affect many patients’ health outcomes.

Purpose: The purpose of the DNP project was to determine the degree to which using a simulated electronic documentation model to train nurses in an acute care unit would decrease documentation errors and missed care and decrease missed opportunities for patient education in EHRs.

Methods: The theoretical framework was underpinned by the Donabedian model, positing that factors associated with …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

Promoting Wellness With Medical-Surgical Nurses In An Urban Medical Center Through Mindfulness-Based Stress Reduction, Shemeka Leonard

Doctor of Nursing Practice Projects

Background: Due to their position on the forefront lines of the healthcare system, nurses are more likely to experience stress at work. Job-related stress can cause increased anxiety, emotional turmoil, depression, and other mental issues. Nurses commonly deal with elevated distress due to workload demands such as passing medication, checking for errors, ensuring patient safety, and charting—mindfulness-based stress reduction (MBSR) is a useful means of reducing psychological distress.

Purpose: The DNP project objectives were to reduce stress, encourage well-being, and show how effective an MBSR program works in a hospital setting. The aim is to reduce stress/improve wellness.

Methods …

Improving Early Sepsis Recognition And Treatment By Utilizing The Surviving Sepsis Campaign In Emergency Department Patients, Rebecca Smith

Doctor of Nursing Practice Projects

Background: Sepsis is a physical reaction to infection that can cause bodily injury, organ deterioration, and death (Sepsis Alliance, 2022). Early sepsis identification and intervention requires staff engagement in quick recognition and implementation of care (Jorgensen, 2019). Septic patients require prompt initiation of intravenous fluids, hemodynamic observation, and appropriate laboratory testing (Evans & Rhodes, 2021). Rapid detection of sepsis can prevent patients from progressing to severe sepsis and septic shock, increasing the risk of mortality (Jorgensen, 2019). As a result of the high mortality rates and complications associated with this health disparity, evidenced-based care bundles were developed to improve care …

Using The 2as And R Method To Encourage Referral To Smoking Cessation Counseling In An Urban Pulmonary Clinic, Jennifer Holloway

Doctor of Nursing Practice Projects

Background: Smoking is a habit of millions of Americans despite the associated preventable health issues and death that it produces. Smoking cessation programs, particularly those using pharmacotherapy, are effective in increasing smoking cessation rates. However, smoking cessation programs remain underutilized.

Purpose: The purpose of the DNP project is to educate providers on using the 2As and R (ask, advise, and refer) of smoking cessation to assess a patient’s readiness to quit and refer to smoking cessation counseling. For providers working in an urban pulmonary clinic, does education regarding the use of the 2As and R method as a standardized intervention …

Evaluation Of A Peer Support Group Implementation To Reduce Burnout In Nursing Staff On An Acute Inpatient Mental Health Unit, Marilyn Scott

Doctor of Nursing Practice Projects

Background: Burnout is feeling emotionally overwhelmed and exhausted due to stress in the workplace. Caring for acute psychiatric patients can impact the mental health of nursing staff and contribute to high-stress levels. Nursing burnout contributes to staffing shortages and increased risk for adverse patient safety events in an acute inpatient mental health unit.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) Quality Improvement (QI) project was to evaluate the impact of a peer support group on burnout reduction in the nursing staff working in an acute inpatient mental health unit.

Methods: A peer support group was implemented …

Stress Reduction In Correctional Healthcare Workers: A Survey Of Healthcare Staff Stress Levels In A Tennessee Correctional Facility Using The Perceived Stress Scale, Lashelle Melton

Doctor of Nursing Practice Projects

Background: Correctional nurses’ function in a high-stress environment due to the nature of their clients and the importance of environmental security. Job stress and satisfaction are theorized relational concepts that influence intent to stay, and turnover as described in the anticipated turnover model. Acute stress can occur in correctional nurses when faced with unexpected or intense situations, such as a medical emergency, a violent incident, or a suicide attempt. Several factors can contribute to acute stress in correctional nurses, leading to overwhelming feelings and making it difficult for nurses to provide quality care.

Purpose: The DNP project aims …

Physical Exercise As A Lifestyle Modification To Lower Blood Pressure In Hypertensive Females With A Body Mass Index Greater Than 25, Kacee Pee

Doctor of Nursing Practice Projects

Background: Hypertension affects many Americans nationwide and, if untreated, can cause heart attack, stroke, and chronic kidney disease. Hypertension (HTN) accounts for about 1 in 5 deaths of U.S. women and is a greater burden for women than men (Wenger et al., 2018). Women who are overweight increase their risk of developing hypertension. Lifestyle modifications, such as diet and exercise, are the first-line treatment for hypertension. Physical exercise is a crucial component of lifestyle therapy for the primary prevention and treatment of hypertension. Several studies consistently demonstrate the beneficial effects of exercise on hypertension, with reductions in both systolic and …

The Quality Improvement Program For Sepsis Fallouts: Utilizing Education And An Order Set To Improve Compliance With Sep-1, Ryleigh Tibbitt

Doctor of Nursing Practice Projects

Background: Sepsis is a multisystem disease that occurs when the human body reacts to a severe infection in the body. Sepsis is a life-threatening response that can lead to multisystem organ failure and even death. Sepsis is the number one cost of hospitalization and is estimated to be $62 billion annually (Sepsis Alliance, 2022). This disease affects at least 1.7 million adults yearly in the United States, and nearly 270,000 die from it (National Institute of General Medical Statistics [NIGMS], 2021).

Purpose: This Doctor of Nursing Practice (DNP) project aimed to improve the compliance rate of the sepsis bundle with …

Utilizing The Cdc T-Dap Educational Material To Increase Parental Consent Of T-Dap Vaccination Rates Among Children 11-14 Years, Anita Pates

Doctor of Nursing Practice Projects

Background:The T-dap vaccine is vital to combating vaccine-preventable diseases. "T-dap vaccine can prevent tetanus, diphtheria, and pertussis" (Centers for Disease Control and Prevention [CDC], 2021). Therefore, providers must identify and educate parents whose child is unvaccinated with the T-dap vaccine. "If an increase in unvaccinated children continues to rise, there is risk for a resurgence of vaccine-preventable diseases and potential increase in deaths related to these infectious diseases" (Bowling, 2018, p. 128).

Purpose: The purpose of this DNP project was to implement an educational session targeting parents of children aged 11-14 in a pediatric clinic in an urban area …

Overuse Of Broad-Spectrum Antibiotics In The Acute Care Setting, Adaline Morris

Doctor of Nursing Practice Projects

Background: The identified problem discussed for the DNP project is antimicrobial resistance in acute care settings associated with the overuse of broad-spectrum antibiotics. Antibiotics are often started before obtaining cultures, thus skewing the results. The overuse of antibiotics can lead to almost complete resistance. In a study reviewed by Olesen, et al., performed in 2011, 34% of people received an antibiotic, and 10% of people received 57% of all antibiotic prescriptions (Olesen, et al., 2018). According to the World Health Organization (WHO), for example, a 92% resistance rate prescribing Ciprofloxacin for urinary tract infections with an E.Coli bacteria. (World Health …

Incorporating A Depression Screening Tool With A Music Strategy For Depression In Adults Aged 50 And Older In An Ltc Facility, Margaret L. Hill

Doctor of Nursing Practice Projects

Background: Depression is not a normal part of life or the aging process. Unfortunately, older adults are at an increased risk of experiencing depressive symptoms. The global prevalence of major depression in older adults at 13.3%, and adults (70 and above) have a higher risk of depression compared to other age groups.

Purpose: The purpose of the DNP project was to improve patient outcomes through the implementation of depression screening and an adjunctive music strategy in older adults with depressive symptoms.

Methods: A pre, mid, and post-intervention was conducted in a long-term care facility. This author conducted a …

Reducing Falls And Enhancing Patient Safety: The Role Of Purposeful Hourly Rounding In Rehab Units, Jeffrey Hughes

Doctor of Nursing Practice Projects

Background: This Doctor of Nursing Practice (DNP) project aims to evaluate the impact of purposeful hourly rounding (PHR) on fall rates and patient outcomes over eight weeks. Fall rates for the rehabilitation unit were examined at the facility, showing 5.19 falls per 1,000 patient days, while the national average is around 3.0 falls per 1,000 patient days. Falls in the hospital are often preventable events. Ensuring the staff in the rehab unit were adequately trained on the use of purposeful hourly rounding (PHR) offers an approach that may reduce the number of these largely preventable events.

Purpose: Purposeful …

Implementing An Emergency Severity Index (Esi) Triage Refresher Training To Decrease The Under-Triage Rate In The Emergency Department (Ed), Monique Wallace

Doctor of Nursing Practice Projects

Background: The Emergency Severity Index (ESI) is a triage tool used in most emergency departments in the United States (U.S.) that assesses acuity and resource allocation for emergency care patients. Registered nurses (RNs) must assign the appropriate triage category to ensure patients are seen in a proper time frame, have ideal patient outcomes, and have efficient patient throughput.

Purpose: This quality improvement project aims to decrease the under-triage rate of patients in the emergency department (ED) by implementing an Emergency Severity Index (ESI) triage refresher training.

Methods: This project used an A3 methodology. The triage specialist completed retrospective chart reviews …

Organisation, Staffing And Resources Of Critical Care Units In Kenya, Wambui Mwangi, Ronnie Kaddu, Carolyne Njoki Muiru, Nabukwangwa Simiyu, Vishal Patel, Demet Sulemanji, Dorothy Otieno, David Misango, Wangari Siika, Rashan Haniffa

Anaesthesiology, East Africa

Objective: To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors.

Materials and methods: An online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care.

Results: The survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A …

Empowering Patient Similarity Networks Through Innovative Data-Quality-Aware Federated Profiling, Alramzana Nujum Navaz, Mohamed Adel Serhani, Hadeel T. El Kassabi, Ikbal Taleb

All Works

Continuous monitoring of patients involves collecting and analyzing sensory data from a multitude of sources. To overcome communication overhead, ensure data privacy and security, reduce data loss, and maintain efficient resource usage, the processing and analytics are moved close to where the data are located (e.g., the edge). However, data quality (DQ) can be degraded because of imprecise or malfunctioning sensors, dynamic changes in the environment, transmission failures, or delays. Therefore, it is crucial to keep an eye on data quality and spot problems as quickly as possible, so that they do not mislead clinical judgments and lead to the …

Exploration Of The Association Between Obesogenic Environments And Childhood Overweight/Obesity Rates In Rural Counties In The United States, Kara Lea Ferguson Davis

Theses and Dissertations

Rising obesity rates, particularly among children, pose a significant public health concern. Of particular concern is the prevalence of childhood obesity in rural communities, with up to 38% of rural children classified as overweight or obese, compared to 30% of urban children. Rural communities often lack the typical built environment characteristics associated with increased physical activity rates and healthy eating behaviors. Further, research on obesogenic environments within rural areas is limited. This study aimed to address this research gap by examining the association between obesogenic environment features and childhood overweight/obesity rates across the urban-rural continuum.

Simple and multiple linear regression …

Cardiac Imaging In Mice With Micro-Computed Tomography: An Assessment, Kyle Porter Stegmann

Theses and Dissertations

While echocardiography continues to be a renowned imaging approach to study LV function and geometry in mice, contrast enhanced micro-CT has recently gained popularity because of the high-resolution three-dimensional images produced. However, comparative analyses between echocardiography and micro-CT are limited and conflicting. Therefore, to demonstrate the validity of micro-CT against echocardiography, this study aimed to compare identical measurements of LV function and geometry in wildtype and genetically modified mice in which confounding parameters such as time and anesthetic conditions were taken into consideration. Globally deleted FAP knockout mice (n=12) and age-matched wild type mice (n=14) were included in this study. …

Laboratory Management Models In Core Facilities, Karmen Michael Owen

Theses and Dissertations

Core biotechnology facilities are often defined as laboratories that house shared resources for research. These laboratories are of great importance to research communities because a large portion of scientific research data is generated at these facilities. Different investigators can use core facilities to help further their research. In a university setting, there are several management strategies from small cores that house a specific type of instrument, to large cores that house many different technologies. Funding strategies also differ significantly, from those that are funded by a small group of well-funded investigators, to cores managed by a specific department or school, …

A Genome-Wide Snp Investigation Of Chemical Intolerance, Raymond F. Palmer, Marcio Almeida, Roger B. Perales, Rudy Rincon

School of Medicine Publications

Background

Chemical Intolerance (CI) also known as Multiple Chemical Sensitivity (MCS) is characterized by multi-system symptoms initiated by exposures to environmental toxins. Symptoms include fatigue, headache, mood changes, musculoskeletal pain, gastro-intestinal issues, and difficulties with memory/concentration. With mixed results, researchers have targeted specific genes to understand the genetic pathways associated with CI. This study is the first to apply a genome-wide, untargeted exploratory method.

Methods

A high-density genotyping platform was used to perform a hypothesis-free search for genetic variants associated with CI in a set of 200 participants. Each CI patient was verified using a validated survey. The association between …