Development Of An Endometriosis Toolkit To Support Clinicians In Providing Quality Care For Women, Rachel Hasbun

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Endometriosis is the abnormal growth of endometrium-like tissue outside the uterine cavity, affecting approximately 11% of women in the United States during their reproductive years. Diagnostic challenges stem from its varied clinical presentations, reliance on laparoscopy for definitive diagnosis, and limited awareness among practitioners and patients, potentially leading to diagnostic delays of up to 13 years.

Problem: The complexities of diagnosing endometriosis in primary care and specialty settings, combined with limited provider awareness and a lack of comprehensive resources, hinder timely and accurate identification. This leads to suboptimal treatment and care for women affected by the condition.

Methods: …

Bilateral Corneal Perforations Due To Elder Neglect, Jaclyn Jordan, Katherine Selman, Richard Byrne

Journal of Geriatric Emergency Medicine

Introduction: Atraumatic corneal melting and perforation is a rare etiology of eye pain and visual loss in the Emergency Department (ED), and xerophthalmia from vitamin A deficiency is primarily described as a cause of blindness in pediatric patients.

Case: A 68-year-old female presented to the ED with worsening eye pain and months of clouding and vision loss. History was limited by cognitive impairment and was provided by spouse. On exam, she was found to have a body mass index of 13.7 kg/m², dry mucous membranes, purulent discharge from both eyes, and opacification and erosion of both corneas. She …

Institutional Pilot Changes Lead To A Reduction In Emergency Department Boarding Patients, Rohan Akhouri, Jennifer Watts, Christopher S. Kennedy, Kelly A. Sinclair, Bethany Bolt, Ashley Daly

Research Days

Background: Crowding and boarding pediatric emergency departments (ED) is an ongoing problem associated with a mismatch in resources and patient care demands. ED boarding can be defined as a patient admitted to an inpatient unit who remains in the ED. ED boarding occurs when there is limited availability of inpatient bed space – either due to patient volume or decreased staffing. ED boarding is associated with adverse events, and increased mortality. Few studies address the impact of inpatient strategies on ED boarding. The objective of our study was to evaluate hospital-based strategies within a single institution and their effect on …

The Impact Of Electronic Health Record Unintended Consequences On Quality Of Care Within A High Complexity Healthcare Organization, Joetta Powell

ATU Theses and Dissertations 2021 - Present

“Unintended consequences are unexpected, and unwanted outcomes that can limit the value of EHR implementation and adversely affect quality of care and patient safety” (Lee & Kang, 2021, p. 898). Few organizations have redesigned the EHR to improve usability to mitigate potential patient safety concerns. This study aims to identify unintended consequences in patient care workflows and determine educational needs related to EHR usability. A mixed method approach was used to investigate unintended consequences in deidentified patient safety reports submitted Jan 1, 2020, through December 31, 2023. The data was analyzed to identify error types and educational deficits. The Acute …

An Examination Of Cardio-Vascular Patients’ Experiences In A Rural Food Prescription Program, Julia Hansen

Honors Theses

The burden of diet-related chronic diseases in rural communities has prompted the implementation of food prescription programs in rural areas to investigate the impact of more affordable and accessible fresh produce on these vulnerable populations. Because there is little research on the impact of food prescription programs on cardiovascular patients in rural areas, this study will focus on how food prescription programs can benefit this at-risk population. Another goal of this study is to receive feedback from participants to improve food prescription programs to better suit cardiovascular participant needs. To accomplish these goals, a series of questions were asked to …

Enhancing The Culture Of Safety Among Hospital Personnel By Implementing A Just Culture Program: A Quality Improvement Project, Lawson Stuart

Doctor of Nursing Practice (DNP) Manuscripts

Objectives

The purpose of this study was to assess employee perceptions of a healthcare organization’s existing climate of psychological safety regarding reporting patient care errors or near-miss events. Based on data obtained from the use of a valid and reliable survey tool, a plan was developed for the introduction and implementation of Just Culture throughout a large multi-hospital healthcare system.

Methods

Employee perceptions of the organization’s culture and current barriers to improving patient safety were identified by administering the JCAT survey to a population of 25,893 frontline staff, middle leaders, and senior leaders (clinical and non-clinical) at 26 separate hospitals …

Exploring The Cultural Influences On Sexual And Reproductive Health Behaviors: A Cross-Cultural Study Of Asian American And Caucasian Female College Students, Emilee Ly

Honors Theses

This capstone honors project aims to investigate the influence of cultural backgrounds on the healthcare behaviors of Asian American and Caucasian college students. The main research question of this focus group study is: “How do cultural backgrounds influence healthcare behaviors, including communication, seeking, and access to sexual and reproductive health, information, and services, among Asian American and Caucasian female college students?”

Drawing upon the World Health Organization’s 2003 Social Determinants of Health (SDOH) framework, this study explores how structural determinants, social networks, cultural backgrounds, and healthcare systems factors collectively influence the way female college students communicate, seek, and have access …

Dnp Final Report: Effects Of Open-Access Scheduling On Patient No-Show Rates In An Outpatient Clinic, Maria Aileen A. Wilkinson Msn, Mba, Rn

DNP Final Reports

No-show rates in a South Texas outpatient clinic have been as high as 16% to 20% which increases wait times to be seen in the clinic and decreases patient access to outpatient care. This no-show rate data has continued despite multiple interventions that have been implemented in an academic health science center. Physical, socio-economic, geographic, and health/lifestyle factors affecting no show or missed appointments are crucial to determining the most appropriate interventions to alleviate this issue. No-show rates are important metrics to improve because it directly affects the organization's revenue, access to care, and appointment wait times. Research evidence regarding …

Mortality In Medicine, Maren Dougherty

Honors Projects

Practitioners in the medical field attend to health issues across one’s lifespan from birth to death and everything in between. A common conflict in today’s practice of medicine is establishing the true function of medicine. The complete reliance on medicine to ward off death proliferates the biomedicalization of natural life processes, like death. Biomedicalization is the process in which medical authority and its accompanying technology begin to control other aspects of daily life. With medicine’s ultimate goal being to cure disease and fight death, it interferes with the inevitability of human mortality. End-of-life treatment can be taken too far without …

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Early Identification Of Hospitalized Patients Lacking Prescription Drug Insurance, Nicholas Macdonald, Md, Matthew Tucker, Md, Phoebe Chun, Md, Liam Heneghan, Md, Sawyer Kieffer, Md, Megana Murugesh, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

According to 2021 data from the US Department of Health and Human Services, 16% of persons in the United States under the age of 65 do not have prescription drug insurance.1Unsurprisingly, prior investigations have shown that the presence of prescription drug insurance is associated with reduced probability of hospital admission and length of stay for many common medical conditions.2A large majority of hospitalized patients are started on at least one new medication at the time of hospital discharge. Increasing the proportion of individuals with prescription drug insurance would have a substantial benefit on our population's health.

One care gap …

Evaluating The Effectiveness Of A School-Based Cognitive Behavioral Youth Depression Prevention Program In Improving Life Satisfaction, Roshani Patel, Steven M. Brunwasser, Alissa Hochman

Rowan-Virtua Research Day

Depression is the leading cause of disability worldwide, known as the global burden of disease. Incident cases from 1990 to 2017 have increased by 49.86%. Additionally, rates have been seen to dramatically rise in adolescents aged 18-25 (17%) compared to rates in individuals aged 10-14 (1.1%). This makes it beneficial to have prevention programs for middle school aged children. The Penn Resiliency Program (PRP) is a youth depression prevention program focused on cultivating healthy thinking styles and behavioral coping skills. In our study, we used archival data from a randomized control trial of PRP to evaluate whether the program led …

Case Report: A Case Of Ttp In The Ed, Brian F. Lim, Andrew Caravello, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 54-year-old female who presented with mild shortness of breath, lower chest discomfort, fatigue, and weakness ongoing for several days and was diagnosed with thrombotic thrombocytopenic purpura (TTP). TTP is characterized by microangiopathic hemolytic anemia and thrombocytopenia due to either an inherited or immune-mediated reduction in von Willebrand Factor (VWF) cleaving protease ADAMTS13.

Patients presenting with non-specific symptoms is becoming increasingly common and initial bias could be to attribute symptoms to viral syndrome or upper respiratory tract infection. However, the differential for non-specific complaints is extensive and thorough review of labs and re-evaluations of patients …

Lep Prevalence In Southern New Jersey And The Use Of Interpreting Services In Healthcare Settings, Katherine Chavarria, Ariana Blake, Marlyn Valentin

Rowan-Virtua Research Day

Language barriers pose a great challenge to populations of Limited English Proficiency (LEP) in understanding their health, diagnosis, and treatments in healthcare settings. Our research aimed to gain a better understanding of the language access needs in Southern New Jersey. We analyzed census data in order to determine the prevalence of LEP populations in Southern New Jersey, as well as the languages most spoken by LEP populations. Additionally, our research looked at the use of interpreting services in healthcare settings. In Camden county, specifically we found that the top 3 languages spoken by LEP populations were Spanish, Vietnamese, and Chinese. …

Management Strategies For Traumatic Injuries In Pregnant Women: A Comprehensive Literature Review, Jaylyn D. Thompson, Jenna Zappetti, Clarence Julian Clark Ii

Rowan-Virtua Research Day

Introduction: Traumatic injuries in pregnant women are the leading cause of non-obstetric death and affect 6% to 8% of all pregnancies. Therefore, it is imperative to maintain updated guidelines to construct a framework for the optimal management strategies for traumatic injuries in pregnant women, considering the perspectives of obstetrics/gynecology, emergency medicine, and orthopedics.

Methods: To conduct this study, research was done via a database search through the Rowan-Virtua School of Osteopathic Medicine’s research library. PubMed was the sole database used to review 8 peer-reviewed sources. Articles that were published within the last 10 years were chosen.

Results: Every woman with …

Cva In Patient With Systemic Sclerosis On Aspirin Therapy: A Case Report, Rahyan Mahmud, Bianna Koutsenko, Kenneth Goich, Usaid Hasan

Rowan-Virtua Research Day

Introduction

Systemic sclerosis is an autoimmune disorder characterized by microvascular damage and multiorgan fibrosis. These patients have a higher risk of cerebrovascular events, but it is difficult to develop strategies for prevention due to limited understanding of underlying pathophysiology.

Case Presentation

A 76-year-old female with a history of systemic sclerosis presented to the emergency department with acute onset slurred speech, facial droop, and left arm pain with a National Institutes of Health (NIH) Stroke Scale of 1. She was outside the thrombolytic window. Other history includes hypertension and hyperlipidemia; both were well controlled. MRI confirmed right frontal lobe ischemic stroke …

Utilization Of Depression Screening In Patients With Type 2 Diabetes Mellitus, John T. Norris Bsn, Rn, Dnp-Pmhnp Student, Robin Gordon Bsn, Rn, Dnp-Pmhnp Student, Margaret Harvey Phd, Aprn-Bc, Acnp, Chfn, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Type 2 diabetes is a chronic metabolic disorder affecting millions of individuals worldwide. Research has shown that individuals with diabetes are at a higher risk of developing depression in comparison to those of the general population. Depression affects the individual's emotional well-being and has a significant impact on the management and outcomes of diabetes (Mather, 2022). This research study aims to investigate the feasibility and effectiveness of implementing the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is one the most effective assessment tools available to identify symptoms of depression (Celik, 2020).

Methods

In this retrospective chart review, at least 50 …

Between Nsaids, Local Anesthetics, And Non-Medicinal Analgesics, Which Method Is The Most Effective At Providing Pain Relief During Iud Insertions For Nulliparous And Multiparous Women?, Natali Sharma

Rowan-Virtua Research Day

Objective: One major barrier for usage of intrauterine devices (IUD) includes a widespread sense of fear regarding pain during insertion of this contraception. By researching the most effective IUD insertion analgesics available and standardizing these pain management methods, women may be less fearful of obtaining IUDs.

Methods: A comprehensive literature review was conducted using Scopus, PubMed, Web of Science, EMBASE and Cochrane Library to compare methods of pain relief during IUD insertions. Outcomes measured include the pain management method used, the dosage administered, the pain experienced by patients evaluated using a Visual Analog Scale (VAS) prior to insertion …

Implementing A Standardized Protocol For Early Detection Of Undiagnosed Hypertension Patients, Jenscena Hansen, Chris Bell

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Hypertension is a preventable disease that frequently goes unrecognized and undertreated. Early diagnosis can prevent further comorbidities such as heart disease, stroke, and chronic kidney disease. Implementation of this protocol aims to decrease the number of patients with undiagnosed hypertension and increase the identification of patients with elevated blood pressure who did not have a pre-existing diagnosis of hypertension. The goal of implementing a standardized protocol would help eliminate the number of patients who go undiagnosed.

Methods: This quality improvement design had clinical staff flag patients with elevated blood pressure. Identified patients without a diagnosis of hypertension were educated …

Reduction Of The Length Of Stay At The Emergency Department Of The Audie L. Murphy Hospital, Arwa Al Shikrian

Theses

We implemented the DMAIC framework (Define, Measure, Analyze, Improve, and Control) and Lean Six Sigma methods to reduce the length of stay (LOS) in the Emergency Department (ED) at Audie L. Murphy VA Hospital, a crucial issue affecting operational efficiency and patient care quality. This project was conducted in conjunction with an internship at the Hospital; our efforts were an integral part of a Green Belt project being conducted by Mr. Roarke Verkaik-Bushby, Hospital Administration Service, to

whom this author reported.

We employed quantitative research design, meticulously observing, measuring, and analyzing ED processes. We tracked patient flow, identified bottlenecks, and …

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience: Master of Public Health

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

Risk Evaluation In Occupational Safety And Health Research: Results From A Benchmarking Exercise Of Federal And Academic Irbs, Sarah A Felknor, Jessica M K Streit, Angela M Morley, John D Piacentino

Faculty, Staff and Student Publications

OBJECTIVE: Research involving working populations can pose unique ethical and risk evaluation challenges. The purpose of this benchmarking project was to assess how federal agencies and academic institutions approach the interpretation and application of key risk evaluation concepts in research involving workers in their places of employment.

METHODS: Key informant interviews were conducted to ascertain current practices related to assessing soundness of research design, determining risk reasonableness and research relatedness of risks, and evaluating the risk of noninvasive clinical tests in occupational settings.

RESULTS: There were noteworthy commonalities among the approaches described to review and address critical aspects of risk …

Understanding Medical Students' Perceived Readiness To Serve As Culturally Competent Practitioners, Michel'le Janae Bryant

Seton Hall University Dissertations and Theses (ETDs)

Background: The US population is more culturally diverse than ever. Although advancements have been made in improving the nation’s overall health, health disparities continue among different racial and ethnic groups. To promote person-centered care practices, medical students must be ready to serve diverse patient populations and provide equitable care. Despite their training, some medical students report feeling unprepared to treat diverse patient populations, potentially impacting their clinical practice and patient care outcomes.

Purpose: This study’s purpose was to explore the perceived readiness of final-year medical students in the US to provide culturally competent care utilizing the Readiness Theory and The …

Addressing Equitable Access In A Safety-Net Hospital System: An Implementation Framework, Hillary Alycon

Dissertations: Doctor of Public Health

Acute care organizations face a significant challenge in effectively implementing health equity programs, particularly in rural areas where guidance is often lacking. Despite abundant literature focusing on health outcomes, there remains a noticeable dearth of published data on implementing health equity initiatives. In response to this gap, I present a comprehensive analysis that utilizes readily available, open-sourced data to address this critical issue.

A thorough assessment of the demographic characteristics of acute care facilities within the catchment regions was conducted based on data from reputable sources such as the US Census Bureau, the American Community Survey, and the County Health …

Perception Of Lean Adoption Among Emergency Department Personnel In Public Hospitals In Selangor, Malaysia, Azizul Rahman Mohamad Jamil, Mohd Rizal Abdul Manaf, Sharifa Ezat Wan Puteh, Kiran Ganesh Balakrishnan

Makara Journal of Health Research

Background: This research aims to assess the perceptions of the staff working in emergency departments in Selangor, Malaysia, regarding the adoption of lean management and identify the factors that affect their perceptions.

Methods: A cross-sectional study using the Lean in Healthcare Questionnaire was conducted with 251 respondents, which consisted of doctors, nurses and medical assistants employed in three selected hospitals.

Results: One-way analysis of variance (ANOVA) showed a significant difference in every domain score in accordance with the occupation category. For the domain process, a significant negative correlation was found between age and domain score (r = …

Healthcare Provider Engagement And Its Effects On Patient Rereferral: Insights From Indonesia, Felicia Setiawan

Makara Journal of Health Research

Background: In the highly competitive landscape of healthcare, nurturing strong relationships between referring healthcare providers and healthcare facilities is essential for maintaining patient loyalty. This study explores the factors influencing referring health care provider engagement and its subsequent impact on the willingness to rerefer to healthcare facilities.

Methods: A cross-sectional quantitative survey was conducted with 181 healthcare providers who regularly refer patients to a private hospital in Jakarta. Data were collected through an online structured questionnaire consisting of 29 questions. The following dimensions were covered: specialist characteristics, practice characteristics, healthcare provider–specialist interaction, patient–specialist interaction, returning referral, training opportunity, …

Barriers And Facilitators Of Pharmacists’ Roles During The Pandemic In Malaysia, Thanushiri Palani Velu, Farida Islahudin, Wei Wen Chong

Makara Journal of Health Research

Background: The coronavirus disease 2019 (COVID-19) left a devastating impact on healthcare systems worldwide. The crisis initially emerged as a supply disruption issue but eventually evolved into a myriad of additional challenges, which were attributed mainly to the extensive scale of the pandemic. This study aimed to explore the barriers to the role of hospital pharmacists and related facilitators encountered during the COVID-19 pandemic.

Methods: Pharmacists in Malaysia participated in a cross-sectional online questionnaire-based survey. The participants were recruited using convenient sampling. Cronbach alpha of the questionnaire was analyzed.

Results: The study successfully enrolled 367 pharmacists. The …

Patients’ Perceptions Of Interprofessional Collaboration: A Scoping Review, Robynne Gilchrist Miss, Aayesha Kholvadia Dr, William (Bill) Burdick Prof

Patient Experience Journal

Collaboration has emerged as a pivotal element within an intentional person-centred healthcare framework. However, there is a need for evaluative feedback from patients to enhance interprofessional collaboration and its outcomes. The objective of this review was to describe the state of knowledge on the perspectives of patients living with a chronic condition regarding their experiences of interprofessional collaboration. A scoping review across five online databases (EBSCOhost, Google Scholar, PubMed Central, ScienceDirect, and Taylor & Francis Online; February 2023) identified all peer-reviewed literature published in English between the years 2018 and 2023 that reported on patients’ perspectives of, and experiences with, …

Evaluation Of Online Patient Complaints Regarding City Hospitals In Türkiye During The Covid-19 Pandemic: A Content Analysis Study, Canan Çınar, Elif Erbay, Gökçen Çeliker, Ahmet Selçuk Yıldırım

Patient Experience Journal

The COVID-19 pandemic put tremendous pressure on healthcare systems worldwide, which led to heightened scrutiny of the medical services offered by hospitals. This article aims to evaluate complaints about city hospitals in Türkiye during the COVID-19 pandemic using the Healthcare Complaints Analysis Tool, which includes three main domains and seven problem categories. The complaints submitted by users on the site via “sikayetvar.com” were systematically collected. Document analysis was used as the data collection method, and 925 complaints were included in the analysis. The most common motive for complaining was “just to express” and problems occurred at the stage of admission, …

Healthcare Team Members’ Views On Social Determinants Of Health Screening And Referral Practices In A Pediatric Emergency Department, Jadelynn Nagy, Natalie J. Tedford, Sahlil Ahmed, Sofia Thoms, Akiko Kamimura, Maija Holsti

Patient Experience Journal

We aimed to explore the healthcare team members’ (HTMs) views on social determinants of health (SDH) screening and referral processes in a pediatric emergency department (PED). We conducted a cross-sectional, mixed-methods study to explore PED HTMs’ views on social care practices at a quaternary-level children’s hospital. The survey was created using a goal identification framework. The survey gathered quantitative and qualitative data by assessing SDH screening practices, comfort and personal habits in screening, prioritization of SDH domains, workflows to perform screening, and perceived barriers to screening. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis …