Medicine and Health Sciences Commons^™

Caring For The Adult Patient With Autism: Development Of Staff Education And An Online Toolkit For Healthcare Providers, Kristen Conkle

Doctor of Nursing Practice Projects

There are disparities in knowledge among healthcare workers when caring for adult patients with autism spectrum disorder (ASD). Lack of knowledge about the characteristics of this population and strategies to enhance care pose a barrier to treatment during hospitalization. A computer based educational module was developed and assigned to staff at a community hospital. An online toolkit for healthcare providers was developed to aid staff in recognition of triggers and supplied adjunct methods for communication. A pre and posttest of healthcare provider knowledge and stigma regarding autism was performed. Achievement of the training was robust among staff; of the one …

Utilizing The Anatomage Virtual Dissection Table For Learning Neuroanatomical Structures In Nurse Anesthesia Programs, Domenica Camaci-Douleh, Nicole Gorris

Doctor of Nursing Practice Projects

Certified registered nurse anesthetists are responsible for developing expertise in neuraxial anesthesia. A thorough understanding of anatomy and physiology is essential in the performance of subarachnoid and epidural blocks. Although cadaveric dissection is considered the gold standard for learning anatomy, student use of cadavers can become limited due to supervisory, ethical, accessibility, and financial constraints (Periya and Moro, 2019). In recent years, the evolution of technology has produced a virtual option for cadaver dissection (Washmuth et al., 2020). The anatomage virtual dissection table is a tool that could be used to increase knowledge of neuroanatomical structures and their spatial relationships …

Developing An Advocacy Campaign To Minimize Barriers To Srna Political Awareness, Alejandra Villescas

Doctor of Nursing Practice Projects

Continuous advocacy and political participation have secured better working conditions and recognition of certified registered nurse anesthetists (CRNAs), translating into better patient care. This project aimed to launch an advocacy campaign targeting student registered nurse anesthetists (SRNAs). A pre-lesson survey was designed to identify SRNAs’ political participation barriers and assess their political literacy. Additionally, a lesson was developed to help SRNAs’ understand CRNA advocacy. To evaluate the educational tool, a post-lesson survey was created. These materials were distributed via email to all SRNAs (n=320) enrolled in a CRNA program in Illinois. Only 51 students completed the pre-lesson survey, and 39 …

Second-Victimhood Among Anesthesia Providers & The Effects On Patient Outcomes, Erika Aitken

Doctor of Nursing Practice Projects

Anesthesia providers work in environments promoting productivity with tremendous pressure to begin the next case regardless of any recent adverse events that may have occurred (Wands, 2021). Certified nurse anesthesiologists (CRNAs) potentially struggle with a lack of recognition, a high number of hours, inadequate work-life balance, and limited professional advancement, which all contribute to high stress levels within the field (Andrade & Dantas, 2015). A healthcare professional involved in an unexpected adverse event, medical error, or patient-related injury is labeled as a second victim. Thirty anesthesia providers from a central Illinois hospital viewed a PowerPoint presentation, completed a survey, and …

Improving Pulmonary Rehabilitation Referral And Uptake For Chronic Obstructive Pulmonary Disorder, Amanda Frassato

Doctor of Nursing Practice Projects

Abstract

Participation in pulmonary rehabilitation (PR) for patients with Chronic Obstructive Pulmonary Disease (COPD) improves exercise capacity and quality of life and reduces readmissions and mortality. Despite its benefits, PR is underutilized in the treatment of COPD. Referral to PR is impacted by provider knowledge of who and how to refer, the burden of making a referral, the provider’s positive or negative influence and accessibility to a PR program. In contrast uptake of PR by patients is impacted by patient knowledge of what PR entails and how it will help their health. This project aimed to increase referrals to PR …

Cbt Technology Implementation With Pediatric And Adolescent Populations, Tracey W. Kreipe, Heath Gage, Sandra Obiebi

Doctor of Nursing Practice Projects

Abstract

Digital therapy is a growing healthcare intervention improving limited access to specialty care for specific populations and geographic areas. Cognitive Behavioral Therapy (CBT) applications focus on treating anxiety and depression and assist pediatric and adolescent patients in learning behavioral techniques as they wait for 3-6 months or longer to see a mental health provider. Such delays are attributed to the national shortage of mental health practitioners and the further scarcity of fewer psychiatric providers in rural areas, causing the potential for adverse patient outcomes. The setting for this 8-week quality improvement project was a pediatric care clinic that sees …

Short Term Medical Mission Gerd And Ulcer Treatment Guideline, Robin Risky

Doctor of Nursing Practice Projects

The United States conducts over 6,000 international medical mission trips each year. The short-term nature of these trips, unfamiliarity with the patient population, language barriers, limited resources, and inadequate staff training are just some of the factors that make it challenging to provide quality care. One way to avoid doing harm is to follow evidence-based guidelines when treating common conditions. This quality improvement project sought to provide an evidence-based protocol for short-term medical missions (STMMs), guiding providers and pharmacy staff on the treatment of GERD and peptic ulcer. This project was implemented in a rural health clinic at the Land …

Improving Depression Remission Screening Compliance, Crystal Wingerter

Doctor of Nursing Practice Projects

Depressive disorders are widespread in the United States and are diagnosed and treated in the primary care setting. In 2019, there were an estimated 19.4 million adults that had at least one major depressive episode. The purpose of this project was to improve follow up and depression remission assessment for patients with a diagnosis of depression at a metropolitan family care practice clinic. The Patient Health Questionnaire (PHQ–9) was utilized for remission assessment. Front desk staff and providers were trained and granted access to the quality information system (QIS) in the electronic medical records (EMR) system which allowed easy identification …

Compassion Fatigue And Burnout In Mission Trip Providers, Camille Roland

Doctor of Nursing Practice Projects

Compassion fatigue (CF), burnout (BO), lack of compassion satisfaction, and impaired mental health have had catastrophic effects on nurses, providers, and support staff in the past few years due to COVID-19, labor shortage, an influx of critically ill patients, and long hours. Compassion fatigue was coined by Figley as a state of exhaustion and dysfunction biologically, psychologically, and socially because of prolonged exposure to compassion stress. Related concepts identified as burnout and secondary traumatic stress (STS) play an inclusive role in one’s ability to cope with daily environmental stressors causing physical, emotional, and mental breakdown. The link between …

Sti Education For Adolescents, Maryann Van Ryn, Lucy Nyrongo

Doctor of Nursing Practice Projects

Adolescents make up the majority of STI cases in the United States; however, most STI education has not targeted them and their unique needs. This quality improvement project aimed to create an evidence-based educational tool for sexually transmitted diseases (STIs) for adolescents in a pediatric clinic. Next, we created a dynamic QR code to access the flyer digitally on a patient's mobile device. The QR code was printed and placed in an accessible location in the office. The dynamic QR code allowed us to capture data on the total number of scans and provided the demographics of the scanners and …

Increasing Education And Awareness Of Patients Who Identify As Transgender In Primary Care​, Cindy Wallace

Doctor of Nursing Practice Projects

Background. Lesbian, gay, bisexual, and individuals who identify as transgender and queer (LGBTQ) often experience negative healthcare encounters (Parameshwaran et al., 2017). According to the Williams Institute of Law (2022), there are 1.3 million adults who self-identify as transgender. This education project utilized a pre/post-test design to explore attitudes, practices, and knowledge of primary care providers when interfacing with individuals who identify as transgender in primary health care settings.

Theoretical Framework. This project was guided by Lewin’s Change Theory.

Methods. Primary care providers in an urban community health clinic received a pre and post-education survey. A teaching session was delivered …

Introduction Of A Spinal Care Pathway Triage Protocol In The Secondary Care Setting, Tonicia I. Boston

Doctor of Nursing Practice Projects

Background: Back pain is considered the leading cause of disability worldwide. Providing effective multidisciplinary care for clients with chronic back pain (CBP) has been an ongoing issue globally. Improper care management of CBP creates personal, economic, and societal burdens that significantly affect patients, their families, and the healthcare system. Purpose: This quality improvement project aimed to successfully integrate a spinal care pathway (SCP) electronic decision support tool (e-tool) into a multidisciplinary spinal care program, to improve providers’ satisfaction with care delivery and their satisfaction with CBP patient outcomes. Methods: This DNP project used an evidence-based quality improvement (EBQI) design to …

Utilizing Gastric Point-Of-Care Ultrasound Assessment For Patients With Questionable Npo Status, Carolina Botero

Doctor of Nursing Practice Projects

Perioperative aspiration is a rare but serious complication with high morbidity and mortality for patients. This event often occurs from anesthetic depression of protective airway reflexes. NPO guidelines are implemented before anesthesia to eliminate the presence of any gastric contents. However, patients with certain comorbidities may still persist with a full stomach before an anesthetic. Patients may complicate matters further by not following NPO instructions, the patient’s NPO status may be unknown, or the timing of surgery may prevent adequate NPO times. In these situations, the anesthesia provider is faced with the difficult decision to alter, delay or potentially cancel …

Foley Catheter Algorithm, Chary Mathew

Doctor of Nursing Practice Projects

Urinary catheterization, indwelling and intermittent are simple and common procedures performed in hospitals, emergency rooms, nursing homes, and clinics to ensure adequate urinary output in patients who cannot void efficiently or closely monitor fluid intake and output. Though simple and straightforward in most cases, catheterization can become a challenging procedure with complications in the absence of a standardized protocol for difficult catheterization (Ghaffary et al., 2013). This Quality Improvement Project aimed to develop a standardized Foley catheter algorithm/ flow chart available in our institution's intranet and laminated charts in nursing stations and procedure rooms with Foley catheter insertion indications, types, …

Advanced Care Planning In Primary Care, Kaylee Beals, Amanda Merriman

Doctor of Nursing Practice Projects

In Illinois, the do-not-resuscitate (DNR) form that is legally binding in all healthcare facilities is known as the Practitioner Orders for Life-Sustaining Treatment (POLST) form. The Patient Self-Determination Act (PSDA) of 1991 mandates only certain facilities to discuss advanced care planning (ACP). Primary care offices are not included in this mandate. Therefore, no structured process exists for primary care providers to identify patients who may benefit from ACP discussions. The purpose of this Doctor of Nursing Practice (DNP) project was to initiate conversations about ACP with patients 55 years and older in a primary care office and complete POLST forms …

Active Learning Techniques To Improve Emotional Intelligence Among Student Registered Nurse Anesthetists, Sydney Bontz

Doctor of Nursing Practice Projects

Students enrolled in nurse anesthesia programs are challenged to meet rigorous and lengthy clinical and didactic requirements throughout doctoral-level curriculums. Historically, admission into nurse anesthesia programs has been based on categories such as academic performance, intensive care nursing experience, and the curriculum vitae. However, emerging research has exhibited emotional intelligence as an essential skill for varying situations that may be encountered. Additionally, training can be utilized to increase emotional intelligence levels (Lolaty et al., 2012).

The goal of this doctoral project was to provide emotional intelligence training for first-year student registered nurse anesthetists (SRNAs) at a mid-size University in the …

Remifentanil In Labor Analgesia, Courtney Silberberg

Doctor of Nursing Practice Projects

Labor has the potential to be the most excruciating and intense physical pain a woman experiences in her life. Neuraxial anesthesia, which includes epidural, spinal, or combined spinal-epidural technique, is the gold standard for pain control in laboring patients (Lee et al., 2017). Seemingly forgotten, a subset of parturients cannot experience the benefits of neuraxial anesthesia due to several absolute and relative contraindications. These women rely on other options for labor pain control. Remifentanil has emerged as a preferred opioid option for labor and delivery due to its rapid onset (peak effect in 1.1 minutes) and rapid metabolism by non-specific …

Expansion Of Heart Failure Education From Hospital To Clinic, Abigail M. Fischer

Doctor of Nursing Practice Projects

Heart failure education is vital to the long-term management of this condition. Education recommendations for heart failure are given by the American Heart Association (AHA) and the American College of Cardiology (ACC). Recommendations include verbal instruction and written materials regarding the patient’s medication plan, recognition of symptoms, what to do when symptoms occur, and the importance of daily weights.

This project aimed to provide outpatient clinic providers and staff with resources and education necessary to educate heart failure patients. The project expanded use of an inpatient heart failure education packet for outpatient use. This was accomplished by conducting educational sessions …

A Comparison Of Erector Spinae Plane Block And Epidural Analgesia For Major Abdominal Surgery, Charles Serrano

Doctor of Nursing Practice Projects

A large tertiary care center in central Illinois saw an increase in erector spinae plane (ESP) block administration for abdominal surgery patients, but many anesthesia providers at the facility were not acquainted with the ESP block. This project aimed to develop a comprehensive educational program concerning the ESP block compared to thoracic epidural analgesia for major abdominal surgery patients and ultimately improve patient care. The program introduced the relevant anatomy, indications, technique, advantages, and disadvantages of ESP block and epidural analgesia. Additionally, the risks, benefits, and costs of both adjunctive therapies were compared. The current literature shows that the thoracic …

Tranexamic Acid Protocol For Lower Extremity Total Joint Arthroplasties, Autumn Cullison

Doctor of Nursing Practice Projects

Abstract

Bleeding is a risk associated with surgery, and complications, such as hypotension, anemia, and decreased oxygen-carrying capacity, can occur. Blood transfusions have been the mainstay treatment for excessive surgical blood loss; however, transfusion has associated risks including infection, volume overload, immunological reactions, and increased morbidity and mortality (Sahu et al., 2014). Interventions to decrease surgical blood loss are essential components to improving surgical outcomes. The antithrombolytic, tranexamic acid (TXA), decreases surgical blood loss and blood transfusion requirements, thereby decreasing transfusion-related complications (Gausden et al., 2017). Despite frequent use, variance exists surrounding the administration of TXA. Current evidence and guidelines …

Management Of Ineffective Epidural For Cesarean Section, Miriam Ndenecho

Doctor of Nursing Practice Projects

In the United States, epidural anesthesia is used for approximately 29-44% of cesarean sections (Carvalho, 2012). A failed or inadequate labor epidural is challenging to manage, especially when a cesarean section is imminent. A failed labor epidural is defined as insufficient pain relief within 45 min after placement, accidental dural puncture, re-siting or abandoning the procedure, and patient dissatisfaction at follow-up (Ismail et al., 2021). This project examined established best practices for managing a parturient with an ineffective labor epidural that requires a cesarean section. The literature review provided zero practice guidelines for the management of failed epidural for cesarean …

Establishing A Diabetes Self-Management Resource For The Self-Pay Client In A Rural Clinic, Emily Birkhead

Doctor of Nursing Practice Projects

Self-management of type 2 diabetes mellitus remains a prominent health concern across the United States. Adherence to treatment plans, medication, and glucose monitoring are often limited by out-of-pocket costs for the client. Diabetes Self-Management Education (DSME) is a set of domains that includes: medication adherence, glucose monitoring, nutrition, exercise, and effective coping mechanisms. DSME programs are provided across the United States helping those with Type 2 diabetes mellitus on their daily habits and management of the condition. DSME programs are largely unavailable to rural communities due to cost and distance barriers, resulting in diabetes education not being readily available in …

Hyperoxemia Education To Nurses To Increase The Adherence To Oxygen Weaning Goals In Inpatient Copd Patients., Katherine Ellingson

Doctor of Nursing Practice Projects

Hyperoxemia in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are at risk for increased hospital stay, mechanical ventilation, and increased risk of death. Literature supports that establishing increased education to nursing staff on the risks of hypoxemia to increase adherence to oxygen weaning protocols has the potential to improve future practice. Oxygen weaning protocols are often not followed for concern of patient care. Nurses may believe to be helping patients when increasing oxygen, when they could actually be potentially harming them. Increased education on hypoxemia in COPD patients for the nursing staff will assist them to feeling …

Development Of Neuraxial Anesthesia Educational Videos For Nurse Anesthesia Students, Mackenzie Schutt, Kaylie Lajeunesse

Doctor of Nursing Practice Projects

Development of Neuraxial Anesthesia Educational Videos for Nurse Anesthesia Students

Kaylie LaJeunesse, BSN, RN, SRNA & Mackenzie Schutt, BSN, RN, SRNA

Performance and evaluation of anesthetic procedures, specifically neuraxial anesthesia, are core components of nurse anesthesia curriculums. Teaching methods must provide nurse anesthesia students with the proper tools and knowledge to perform skills confidently and proficiently. Traditional teaching methods have fallen short of providing the necessary instruction for optimal student success. Incorporating video-learning resources on neuraxial anesthesia into course curriculums can significantly improve nurse anesthesia practice by better-preparing students for the clinical setting. Video learning increases student engagement and facilitates …

Art As Experienced By A Female Combat Veteran Using The El Duende Process Painting., Bonita Owen

Art Therapy Counseling Final Research Projects

This single-participant phenomenological case study seeks to determine how a female combat veteran experiences art therapy. The case study participant is a female veteran who served in Iraqi Freedom and Enduring Freedom. While painting on a single canvas, the participant followed Miller’s El Duende process painting procedure (2012) and kept a written and pictorial journal of the experience. The research involved five sessions during which the participant annotated her thoughts and feelings on the experiential expressions chart for each session. These charts were analyzed to identify the mechanism of change in art therapy for the participant. The participant’s journals indicated …

Adverse Effects Of Early Exposure To Pornography And The Utilization Of Art Therapy, Meghan Potts

Art Therapy Counseling Final Research Projects

Pornography is not a new phenomenon in our culture or world. With the expansion of the affordability, accessibility, and anonymity of pornography, demand and consumption rates have also escalated, along with the adverse impact associated with this growth (Coopersmith, 2006 as cited by Dines, 2017). This two-year grant proposal seeks to focus its efforts on serving children, the population being exposed to this widespread phenomenon (Wright, Paul, et al., 2021). The full-time art therapist will carry out trauma-informed prevention and intervention methods to advocate for the mental and physical health of children in individual, relational, and community contexts. This will …

Art Therapy: Mechanisms Of Change And Identity: A Heuristic Study, Kirsten O'Loughlin

Art Therapy Counseling Final Research Projects

The aim of this arts based heuristic study was to uncover emergent themes through an intensive immersion in clay work to deepen my own embodiment and understanding of my identity as an art therapist in training and artist. As I moved through the immersion process, I experienced several mechanisms of change often theorized as reasons why art therapy works. By experiencing these mechanisms of change on a personal level, I have strengthened my ability to understand how these mechanisms work and their potential effects on clients. This has led to a better understanding and acceptance of my identity and the …

Trends In Resources For Neonatal Intensive Care At Delivery Hospitals For Infants Born Younger Than 30 Weeks' Gestation, 2009-2020, Nansi S. Boghossian, Marco Geraci, Ciaran S. Phibbs, Scott A. Lorch, Erika M. Edwards, Jeffrey D. Horbar

Faculty Publications

Importance: In an ideal regionalized system, all infants born very preterm would be delivered at a large tertiary hospital capable of providing all necessary care. Objective: To examine whether the distribution of extremely preterm births changed between 2009 and 2020 based on neonatal intensive care resources at the delivery hospital. Design, Setting, and Participants: This retrospective cohort study was conducted at 822 Vermont Oxford Network (VON) centers in the US between 2009 and 2020. Participants included infants born at 22 to 29 weeks' gestation, delivered at or transferred to centers participating in the VON. Data were analyzed from February to …

Gold 2023 Update: Implications For Clinical Practice, Diana R. Tamondong-Lachica, Neil Skolnik, John R. Hurst, Nathaniel Marchetti, Adrian Paul J. Rabe, Maria Montes De Oca, Bartolome R. Celli

Abington Jefferson Health Papers

In 2022, over 3 million people died of chronic obstructive pulmonary disease (COPD) and the global burden of the disease is expected to increase over the coming decades. Recommendations for the treatment and management of patients with COPD are published by the Global Initiative for Chronic Obstructive Lung Disease, and updated annually with scientific evidence-based recommendations. The 2023 updates, published in November 2022, contain key changes to recommendations for diagnosis and treatment of COPD that are anticipated to have a significant impact on clinical practice for patients with COPD. Updates to how COPD is defined and diagnosed, including the expansion …

Species Differences In Platelet Protease-Activated Receptors, Stephanie A Renna, Steven E. Mckenzie, James V. Michael

Cardeza Foundation for Hematologic Research

Protease-activated receptors (PARs) are a class of integral membrane proteins that are cleaved by a variety of proteases, most notably thrombin, to reveal a tethered ligand and promote activation. PARs are critical mediators of platelet function in hemostasis and thrombosis, and therefore are attractive targets for anti-platelet therapies. Animal models studying platelet PAR physiology have relied heavily on genetically modified mouse strains, which have provided ample insight but have some inherent limitations. The current review aims to summarize the notable PAR expression and functional differences between the mouse and human, in addition to highlighting some recently developed tools to further …