Medical Education Commons^™

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 …

Implementation Of An Education Program To Decrease Inpatient Falls, Elizabeth M. Carpenter, Jewyl Gibson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Inpatient falls are affecting 1 million patients across the United States every year with 25% of fall resulting in injury. Approximately 25% of falls are preventable with accurate assessment and appropriate fall precaution interventions. According to the literature, obtaining an accurate fall risk assessment is the first step in inpatient fall prevention.

LOCAL PROBLEM: Patient falls increased on 2 cardiac stepdown units in a level III trauma center in Knoxville, Tennessee. From 2020- 2022, the combined units experienced a 48% increase in patient falls. Nursing leadership identified staff knowledge deficits and inaccurate scoring of fall assessments as primary contributors …

Initiating Culturally-Directed Education For Hispanic Adults With Type 2 Diabetes Mellitus, Marie Davis, Jennifer Smith, Mandy Horner

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND:

The U.S. Hispanic population has the highest rate of Type 2 diabetes mellitus (T2DM), which is influenced by socio-economic status and language barriers. Current evidence suggests that the delivery of culturally-directed Diabetes Self-Management Education (DSME) with the use of an interpreter can reduce diabetes-associated complications.

LOCAL PROBLEM:

The project took place at a free clinic in North Carolina. The purposes of this project was to create a culturally-directed DSME bundle for Hispanic adults with the use of a Spanish interpreter to improve understanding of T2DM management.

METHODS:

The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was …

Working Under Pressure: Evidence-Based Risk Assessment And Pressure Injury Prevention In The Pediatric Intensive Care Unit, James A. Hutcheson Iv, Allyson M. Neal

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: The hospital-acquired pressure injury (HAPI) can have physiologic, psychologic, and financial sequelae. Children are at increased risk secondary to immature physiology, developmental differences, and severity of illness. Evidence suggests presence of medical devices exponentiates HAPI risk.

Local Problem: Upward trends in HAPIs revealed nearly 50% are device related in the project setting, an urban Pediatric Intensive Care Unit. The Braden QD Scale was identified as best evidence for HAPI risk assessment. This initiative aimed to observe the ability of the Braden QD Scale as a predictor of HAPI risk as compared to current practice utilizing the Braden Q …

Improving Outcomes For Persons With Opioid Use Disorder By Introducing Buprenorphine In The Emergency Department, Emily Caroline Wegenka, Mary Johnson, Thomas Vajen

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Opioid related death is the leading cause of accidental death in adults younger than 50 years old in the United States (US) with approximately 130 opioid related deaths daily. Emergency department (ED) visits for a non-fatal overdose, the one-year mortality is 4.7-5.5%. Studies show increased access to medications for opioid use disorder (MOUD) decrease morbidity and mortality related to OUD. Additionally, there is evidence that initiating MOUD in the ED increases engagement in outpatient follow up, also reducing morbidity and mortality associated with OUD.

LOCAL PROBLEM: The setting for this practice improvement project was a non-profit, rural …

Antibiotic Stewardship In Patients With Viral Upper Respiratory Illness: Improving Quality Measures In Retail Health, Meredith A. Nolan, Robin Harris, Clay Smith

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Millions of people will die from antibiotic-resistant bacterial infections in the next 30 years. Retail health providers are pivotal in this global epidemiological problem.

LOCAL PROBLEM: Setting included 15 retail health clinics operated by Vanderbilt University Medical Center in Middle Tennessee. Project examined provider education, patient engagement, and commitment to antibiotic stewardship, components of the CDC's Core Elements of Outpatient Antibiotic Stewardship framework. Specific aims were that providers would have a significant reduction in the percentage of antibiotics prescribed for viral illness over the study period.

METHODS: Using the Evidence-Based Practice Improvement Model, a Quality Improvement …

Reducing Copd Readmissions Through The Implementation Of A Guideline-Based Clinical Pathway: An Evidence-Based Practice Improvement Project, Hannah F. Hall, Allyson Neal, Samantha Bauer

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is characterized by airway inflammation and damage that inhibits appropriate airflow. Exacerbations of COPD (ECOPD) hasten disease progression and have profound impacts on the patients.

Local Problem: East Tennesseans experience higher rates of COPD than the rest of the state. Community members at the project site identified that the inpatient management of ECOPD is inconsistent and discordant with the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The purpose of this project was to reduce readmissions and increase guideline concordance by developing an algorithm …

Health Professional Students Receiving Osteopathic Manipulative Treatment: An Interdisciplinary And Interprofessional Activity To Improve Attitudes Towards Osteopathic Medicine And Interprofessional Collaboration, Nicole Neiman, Justinas Joksas, Erica Sickel, Anne Marie Zeller

Research Day

No abstract provided.

How Soon Is Too Soon? A Quality Improvement Approach To Postoperative Length Of Stay Following Transcatheter Aortic Valve Replacement, David Brian Jones, Robin Harris, Paul N. Fiorilli Md, Allyson Neal

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Heart valve disease prevalence is expected to rapidly increase over the next twenty years. Aortic stenosis, the most common valvular disorder, is a significant cause of heart failure hospital admissions and high mortality if left untreated. Treatment options include surgical aortic valve replacement (SAVR) and the more popular transcatheter aortic valve replacement (TAVR). The rapid increase of TAVR procedures generates hospital bed capacity issues, and there is no recommendation defining the minimum length of stay (LOS) following TAVR.

LOCAL PROBLEM: The setting was a 1,100-bed academic medical center in southeastern Pennsylvania with an average annual TAVR volume …

Assessment Of Breastfeeding Education In Medical Training, Saranya Madan, Abigail Kuplicki

Medical Student Research Symposium

In 2019, the Academy of Breastfeeding Medicine issued a revised set of educational objectives for medical trainees at various stages of education. In this statement, objectives for medical school were broken down into preclinical and clinical training objectives. In this project, our goal is to assess the degree to which medical training at Wayne State University School of Medicine is addressing these aims.

The assessment of breastfeeding education is accomplished by surveying medical students at various stages of training (M1-M4) and eliciting their level of confidence in and understanding of the topics outlined in the objectives by the Academy of …

Creating An Interactive Guide To Support Health Disparities Competency, Lauren E. Robinson, Stephanie Henderson, Cayla M. Robinson, Rebecca J. Morgan, Beth Reeder

2024 R&I Day

Authors share their educational resource developed for the health sciences, that guides users in awareness of health disparities, vulnerable populations, and social determinants of health, directing them to specific guidance and resources available through the library.

The Clinical Judgment Measurement Model And Improving Student Clinical Judgment, Sara E. Carr

Non-Thesis Student Work

Nurses provide care to clients in complex situations. Nurses entering practice need greater confidence and skills to make sound clinical judgment decisions when caring for clients. A question arises: Do structured clinical judgment activities based on the Clinical Judgment Measurement Model (CJMM) improve students’ clinical judgment skills throughout a semester simulation and clinical rotation? A literature search of EBSCOhost, CINAHL, Next Generation: NCLEX News, and article reference lists were used. Peer-reviewed articles published from 2018-2023 were reviewed, resulting in 13 articles being selected. The literature demonstrated that nursing schools work to prepare nurses for entry-level practice by designing a curriculum …

Describing The Evidence Linking Interprofessional Education Interventions To Improving The Delivery Of Safe And Effective Patient Care: A Scoping Review, Tamara Cadet, Joseph Cusimano, Shelley Mckearney, Julie Honaker, Cynthia O'Neal, Reza Taheri, Virginia Uhley, Yingting Zhang, Margaret Dreker, Judith S. Cohn

Pharmacy Faculty Articles and Research

Empirical evidence indicates that collaborative interprofessional practice leads to positive health outcomes. Further, there is an abundance of evidence examining student and/or faculty perceptions of learning or satisfaction about the interprofessional education (IPE) learning experience. However, there is a dearth of research linking IPE interventions to patient outcomes. The objective of this scoping review was to describe and summarize the evidence linking IPE interventions to the delivery of effective patient care. A three-step search strategy was utilized for this review with articles that met the following criteria: publications dated 2015–2020 using qualitative, quantitative or mixed methods; the inclusion of healthcare …

Is Racial Diversity Important When Applying To Jmu Pa Program?, Gaelyn E Young, Deonte J. Hope

Physician Assistant Capstones, 2020-current

The Physician Assistant profession is predominantly female and Caucasian. In order to increase the diversity of the profession at the level of the workforce, it is necessary to examine PA programs' role as the entryway into the profession. To that end, this evaluation aimed at surveying current and future PA students at James Madison University to understand whether racial diversity of both the program's cohort and/or its faculty was a factor in their decision to apply and/or attend the school.

Ultrasound-Guided Intravenous Access As A First-Line Approach By Nurses: A Quality Improvement Project, James Austin Burkhart, Pamela Hardesty, Melissa Mcdonald

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Up to 9% of patients admitted to EDs (Emergency Departments) have difficult intravenous insertion access issues (DIVA). This creates delays in patient care that includes interruptions for physicians providing medical emergency care. Often the utilization of RNs to perform US (ultrasound) IV insertions is limited related to lack of training and supportive policies.

Local Problem: The site for this project was an ED Level 1 Trauma Center associated with a large teaching hospital located in the southeastern U.S. Prior to the implementation of the process improvement project, there was no formal education of RNs in the use of US …

An Exploratory Investigation Of Longitudinal Interprofessional Education Attitudes At The Team Level, Tina Patel Gunaldo, Colette Baudoin, Sharon Duffy, Harun Mazumder, Scott Edwards

Center for Interprofessional Education and Collaborative Practice Papers

Introduction: Although interprofessional education (IPE) experiences inherently include students from different academic programs working together, most quantitative IPE longitudinal research is analyzed at the all-student level or academic program level. There is a need to assess IPE outcomes at the team level.

Methods: Pre-licensure students participating in a two-year IPE curriculum were randomly assigned to 60 teams. Each student completed the Student Perceptions of Interprofessional Clinical Education Revised instrument, version 2 (SPICE-R2) using a retrospective pre/post-test design at the end of the first and second year. Boxplots of score changes for each of the teams were constructed. Differences in SPICE-R2 …

Implementation Of Standardized Handoff Report In The Post Anesthesia Care Unit, Christie Faye Cox, Godsy Raju, Alyssa Garcia, Nicole Odom, Jennifer Patrick

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Handoff communication is a critical event as it involves the transfer of patient details, authority, and responsibility from one clinician to another. The variations in handoff can lead to increased opportunities for clinician error due to the distinct possibility of the anesthesia providers omitting critical patient information.

LOCAL PROBLEM: The site for this quality improvement project is an academic medical center in the Southeastern region. The purpose of this quality improvement project was to implement a standardized anesthesia handoff tool for anesthesia providers. The aim of this project was after one month of implementation, the mean anesthesia …

Making Decisions "In The Dark": Learning Through Uncertainty In Clinical Practice During Covid-19, Urvashi Vaid, Henriette Lundgren, Karen E. Watkins, Deborah Ziring, Grace A. Alcid, Victoria J. Marsick, Dimitrios Papanagnou

Division of Pulmonary and Critical Care Medicine Faculty Papers

PURPOSE: The purpose of this study was to explore how decision making and informal and incidental learning (IIL) emerged in the clinical learning environment (CLE) during the height of the Covid-19 pandemic. The authors' specific interest was to better understand the IIL that took place among frontline physicians who had to navigate a CLE replete with uncertainty and complexity with the future goal of creating experiences for medical students that would simulate IIL and use uncertainty as a catalyst for learning.

METHOD: Using a modified constructivist, grounded theory approach, we describe physicians' IIL while working during times of heightened uncertainty. …

Implementation Of An Evidence-Base Hospital Acquired Pressure Injury Prevention Program, Brenda Miner

MSN Capstone Projects

Covid-19 hindered many quality improvement projects. As the stressors from the pandemic began to disappear the healthcare industry was struck with new struggles. These new struggles were ensuring quality care was being provided to all patients. The decline in quality care also led to a decline in reimbursement from payor sources, such as Medicare. During the pandemic the healthcare industry was at their most vulnerable state and now that the dust is settling the ramifications of just surviving are staring the industry right in the eyes. Change is difficult, but it is even more difficult following traumatic events such as …

Playing Well With Others: Evaluating An Intervention To Prepare Students For Interprofessional Collaborative Learning, Kelli S. Fox

Social Work Faculty Publications

National trends in health care delivery focus on quality team-based care, patient safety, reducing costs and improving practitioner satisfaction (Interprofessional Education Collaborative, 2016). Health profession students, including social workers, are expected to be workforce ready for a complex interprofessional work environment. Educators are charged with developing effective ways to teach collaborative team skills as part of the curriculum (Rubin et al., 2018; Thistlethwaite et al., 2014). Educators across health professions recognize the importance of providing opportunities to immerse students in experiential, person-centered interprofessional teamwork to adequately prepare them for the workforce. (Cohen Konrad et al., 2017; Mokler, 2020). Planned interprofessional …

Prenatal Care: Improved Attendance Through Text Messaging, Samareea Saunders

Master of Science in Nursing Family Nurse Practitioner

No abstract provided.

Implementation Of A Virtual Interprofessional Icu Learning Collaborative: Successes, Challenges, And Initial Reactions From The Structured Team- Based Optimal Patient-Centered Care For Virus Covid-19 Collaborators, Simon Zec, Nika Zorko Garbajs, Yue Dong, Ognjen Gajic, Christina Kordik, Lori Harmon, Marija Bogojevic, Romil Singh, Yuqiang Sun, Vikas Bansal, Linh Vu, Kelly Cawcutt, John M. Litell, Sarah Redmond, Elly Fitzpatrick, Kirstin J. Kooda, Michelle Biehl, Neha S. Dangayach, Viren Kaul, June M. Chae, Aaron Leppin, Mathew Siuba, Rahul Kashyap, Allan J. Walkey, Alexander S. Niven

Jefferson Hospital Staff Papers and Presentations

IMPORTANCE: Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes. OBJECTIVES: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices. DESIGN, SETTING, AND PARTICIPANTS: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method …

Benefits Of Using An Upright Laboring Position As Compared To Supine In The Second Stage Of Labor And The Impact On The Use Of Assisted Devices, Chelsey Cook

Master of Science in Nursing Family Nurse Practitioner

Abstract: This paper explores the conclusion that women and their infants are at an increased risk for harm when assisted devices are used during the second stage of labor. Traditional practices involving a supine position during pushing have been associated with an elevated likelihood of assisted delivery, necessitating interventions such as forceps, vacuum extraction, or episiotomy. However, emerging evidence suggests that adopting an upright position during labor may help decrease the need for these interventions and positively impact maternal and fetal outcomes.

Although comprehensive research on this topic is limited, the available evidence supports the benefits of an upright position …

Introduction Of Hiv Point-Of-Care Testing In Adolescent Primary Care: A Quality Improvement Project, Jennifer Quinn Belfry

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: HIV, first identified in 1981, remains a persistent public health problem affecting 1.1 million Americans today. Detection is a critical first step to ending the HIV epidemic and the CDC recommends universal HIV screening for all patients 13-64 years of age regardless of risk factors. HIV screening rates are suboptimal especially in adolescent and young adult populations who face unique barriers to screening. The aim of this project was to improve HIV screening rates in adolescent and young adult patients at a large, urban FQHC.

LOCAL PROBLEM: In the state of Rhode Island, 1 in 10 persons living with …

Addressing Adolescent Sexual Health Through An Educational Toolkit For Providers In Rural Alaska, Anna M. Martin, Tracy L. Brewer, Hannah E. Warren

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Introduction. Adequately addressing an adolescent’s sexual health is essential during the child’s development yet, 33% of adolescents have health visits with no mention of sexual health. On average, primary care providers spend approximately thirty-six seconds discussing sexual health topics with adolescents despite recommendations for comprehensive education. Alaska Native youth face significant disparities regarding sexual and reproductive health care. Implementation and evaluation of a comprehensive educational toolkit regarding various sexual health topics for rural healthcare providers in Alaska revealed positive outcomes in discussing sexual health with an adolescent.

Methods. Larrabee's Model for Evidence-based Practice Change guided the development, implementation, and …

Reducing Occupational Stress And Improving Coping Strategies Among Nursing Home Nurses: Implementation Of The Breathe Web-Based Program., Nicole N. Nde, Allyson Neal

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Objective: The purpose of this quality improvement evidence-based project is to determine the effect of a web-based stress management program called BREATHE on reducing occupational stress and improving coping strategies. This evidence-based web-based program was made available to nurses in a nursing home (NH) in the Southeastern United States who have not participated in any stress management program before.

Method: The project provided a web-based stress management educational program to the participants. The program consists of six modules that give nurses an in-depth understanding of stress, how to manage it, and develop coping strategies. The project was carried out in …

Journey To A Heart Safe Community, Mary Mccormack Dnp, Aprn, Fnp-C, Carole Zarcone Dnp, Aprn, Anp-C, Kendra Hoepper Dnp, Pnp-Bc, Elizabeth Cotter Ph.D, R.N., Geraldine Ann Moore Edd, Rn, Bc, Ae-C

Faculty Works: NUR (2010-2023)

Riding the Wave of Wellness Conference a UNC-Wilmington from the Building Healthy Academic Communities organization

Instituting An Educational Module To Improve Knowledge Of Local Anesthetic Systemic Toxicity Among Anesthesia Providers, Alisha Marie Linehan, Chad Andrew Mcclure, Steven Taylor Moon, Shukhratilla Ibragimov Shamshitdinov, Julie Newton Bonom, Jason Michael Buehler

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Local anesthetic use in the perioperative period is increasing in the United States as healthcare providers seek alternatives to opioid-based pain management. While increased use of local anesthetics has many benefits, their use also increases the risk of Local Anesthetic Systemic Toxicity (LAST), which is a serious and potentially life-threatening complication. A search of the literature indicates there is a considerable gap in knowledge of LAST among healthcare providers, including Certified Registered Nurse Anesthetists (CRNAs) and anesthesia residents. This knowledge gap is combined with a lack of standardized approaches to identifying and treating this complication. Identifying and treating LAST is …

Coh 1700: Health Care Coordination Syllabus, Sasha Harry

Open Educational Resources

This is the syllabus for a Health Care Coordination course.

The goal of health care coordination is to improve patient outcomes with better health care services. Care coordinators play a critical role in improving patient care. Students will learn how to effectively advocate for patients and interact with members of the healthcare team in finding solutions to provide high quality, value-based, and efficient care. Effective communication styles, assessing patient’s needs and goals, and helping with patients’ transitions of care are among many topics covered in this course. Upon course completion, students will have acquired basic knowledge and skills to educate, …

Bundle Up To Improve Cauti, Jennifer Anderson, Valorie Dearmon

DNP Manuscripts

Catheter Associated Urinary Tract Infections (CAUTIs) are a leading cause of healthcare acquired infections. Strong evidence for CAUTI best practices exists, however, the struggle to translate best practice evidence into everyday practice remains a challenge. Catheter associated urinary tract infection rates continue to be a problem despite organizational efforts to implement best practice guidelines; the challenge is to effectively translate and embed best practices into everyday practice. The Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for expenses associated with hospital acquired CAUTI; moreover, hospitals are subject to penalties for high rates of hospital acquired CAUTIs. …