Medical Specialties Commons^™

A Telehealth Palliative Care Objective Structured Clinical Examination, Lindsey Q. Mcintyre

Dissertations

Problem: Palliative care is a service focused on symptom management and improved quality of life for persons with serious or chronic illnesses and is widely underutilized. Although advanced practice registered nurses (APRNs) possess a unique skillset to contribute to palliative care, there is minimal reporting on palliative care training for this professional group. The purpose of this clinical scholarship project was to implement the End-of-Life Nursing Education Consortium (ELNEC) online training program for APRN students in the BSN-DNP program and evaluate its effect on student performance during a telehealth objective structured clinical examination (OSCE).

Methods: An observational, descriptive …

Covid-19 And The Impact On Rural And Black Church Congregants: Results Of The C-M-C Project, Lovoria B. Williams, Anita F. Fernander, Tofial Azam, Maria L. Gomez, Junghee Kang, Cassidy L. Moody, Hannah Bowman, Nancy E. Schoenberg

Nursing Faculty Publications

The COVID-19 pandemic has had devastating effects on Black and rural populations with a mortality rate among Blacks three times that of Whites and both rural and Black populations experiencing limited access to COVID-19 resources. The primary purpose of this study was to explore the health, financial, and psychological impact of COVID-19 among rural White Appalachian and Black nonrural central Kentucky church congregants. Secondarily we sought to examine the association between sociodemographics and behaviors, attitudes, and beliefs regarding COVID-19 and intent to vaccinate. We used a cross sectional survey design developed with the constructs of the Health Belief and Theory …

Efficacy Of Programmed Intermittent Epidural Boluses For Labor Analgesia, Keisha Joyce

Nurse Anesthesia Student Research Posters

Programmed intermittent epidural bolus (PIEB) is an automated method of administering epidural local analgesia with or without opioids. Fixed boluses at scheduled intervals can be utilized as an alternative to a continuous epidural infusion (CEI) alone or as a background administration with a PCEA technique. The purpose of this research project is to provide education regarding PIEB and investigate the benefits and challenges of implementing this new technique into practice.

Excessive Oxygen Administration During General Anesthesia, Soleil Gibbs

Nurse Anesthesia Student Research Posters

Nearly all patients undergoing general anesthesia will be administered oxygen and 83% of patients will be exposed to potentially preventable hyperoxemia (Suzuki et al., 2018). Physiological changes occur within the body when exposed to supranormal oxygen levels. Nurse Anesthetists must evaluate the potential risk and benefit of oxygen therapy. A review of the literature was completed to provide evidence based practice guidance to Anesthesia Providers regarding the use of perioperative oxygen administration.

Implementing An Antibiotic Stewardship Education Program To Decrease Antibiotic Prescriptions In An Urgent Care Clinic, James Gramling

Doctor of Nursing Practice Projects

Antibiotics are often prescribed for respiratory infections. These infections often have a viral rather than a bacterial source. Overuse of antibiotics is associated with increased potential for adverse effects, increased healthcare costs, and increasing antibiotic resistance. The purpose of this DNP project was to determine if implementing an antibiotic stewardship program at an urgent care clinic would decrease the number of antibiotic prescriptions written for acute respiratory tract infections. An educational session consisting of didactic and PowerPoint presentations was provided to each provider at the urgent care clinic. Medical records were reviewed for four weeks after completion of the session …

Hypertension Education And Management Intervention (Hemi) In The Urgent Care Setting, Conrad L. Cash

Doctor of Nursing Practice Projects

Background: Hypertension, being a very prominent disease, is a common problem found during urgent care visits. By beginning in the urgent care setting, hypertension management can be started early; thereby preventing complications from uncontrolled hypertension.

Purpose: This DNP project aimed to improve patient knowledge of hypertension and overall blood pressure readings by providing one-to-one provider-patient education.

Design Method: This DNP quality improvement project was a pre- and post-test design using quantitative data. The goal was to access if there was a change in patient education pre, post, and three months follow-up along with a change in blood pressure.

Results: …

Increasing Staff Awareness And Screening Practices For Adverse Childhood Experiences At A Primary Care Clinic, Kayla Wright

Doctor of Nursing Practice Projects

Adverse childhood experiences (ACEs) are present in approximately 60% of the adult population in the United States. There is a correlation between adverse childhood experiences and chronic health conditions as adults. Despite the evidence showing this correlation, there is a lack of screening for ACEs in the primary care setting. Many primary care providers and staff are unaware of ACEs or the correlation with chronic health conditions and substance abuse and, therefore, do not understand how to or recognize the benefits of screening in primary care. With education for providers and staff, primary care is the ideal setting to perform …

Improving Patient Outcomes With Post-Op Education For Nurses Caring For Patients Undergoing Total Joint Replacement, Amanda Collier

Doctor of Nursing Practice Projects

Background: Surgical site infections (SSI) are the third most reported nosocomial infection causing an increased length of stay, increased healthcare cost, and a substantial increase in morbidity. A SSI is an infection developing within 30 days of surgery without using an implant and within one year of surgery utilizing any form of implant. Typically SSI occurs at the time of incision. However, poor postoperative wound care can lead to an SSI.

Purpose: This project aims to educate nursing staff on care of the total joint replacement (TJR) patient to reduce readmission rates for postoperative SSI.

Design Methods: This …

Compassionate Indifference, Judith Sullivan

Journal of Transformative Touch

ABSTRACT

How to turn a not-so-good treatment into an excellent treatment with presence, relaxation and compassionate indifference.

Evaluation Of The Feasibility Of The Fast-M Maternal Sepsis Intervention In Pakistan: A Protocol, Sheikh Irfan Ahmed, Raheel Sikandar, Rubina Barolia, Bakhtawar M H. Khowaja, Kashif Ali Memon, James Cheshire, Catherine Dunlop, Arri Coomarasamy, Lumaan Sheikh, David Lissauer

Department of Obstetrics & Gynaecology

Background: Maternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth, and the postpartum period. It is estimated to account for between one-tenth and half (4.7% to 13.7%) of all maternal deaths globally. An international stakeholder group, including the World Health Organization, developed a maternal sepsis management bundle called "FAST-M" for resource-limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the …

The Ways In Which Women’S Suffrage Affected Healthcare, Madison M. Weber

The Review: A Journal of Undergraduate Student Research

The 19th Amendment had and continues to have a major impact on women’s healthcare in the United States. Prior to suffrage, women had little to no ability to voice their thoughts on and change policies that regarded their own health. This essay addresses the way in which the vote both directly and indirectly impacted healthcare; including workplace conditions, maternal and reproductive rights, racial disparities, political advocacy and healthcare, the different waves of feminism, and how this has all affected modern healthcare for women. From progressive articles being published in women's magazines, to the establishment of marital rape, to the availability …

Pediatric Surgery Nurses Lead And Coordinate Covid-19 Recovery Efforts, Shelly Johnson, Alice E. Dupler

2021 Providence Nurse Research Conference

Background: In early 2020, the appearance of the novel COVID-19 virus became a global concern, infecting hundreds of thousands of people. To reduce the spread of the virus, the United States government instituted social distancing and required hospitals to take steps to create extra beds for patient with COVID. One method to increase hospital capacity was the cancellation of scheduled, elective surgeries. In one large pediatric hospital in the Pacific Northwest, there was no formal process in place for cancelling elective procedures or for prioritizing when or how to reschedule the case. Because nurses were being called on to provide …

Evaluation Of A Coronary Artery Bypass Graft Care Steps Program, Sheri Havel, Karen Colorafi, Mirjeta Beqiri

2021 Providence Nurse Research Conference

Background: Across the U.S., 20% of cardiothoracic surgery patients who are discharged to home experience unplanned readmission within 30 days of discharge. Readmissions and postsurgical complications are associated with poor patient outcomes, increased mortality rates, and increased cost of healthcare. Evidence-based recommendations for reducing preventable readmission are limited, although there is some indication that high quality pre-operative and discharge education can reduce this burden. Providing appropriate patient education at time of discharge from acute care to home regarding medication adherence, prescheduled follow-up appointments, wound management and monitoring, and symptom management education is theorized to have a significant positive impact on …

Improving Outcomes For Pregnant Women With Severe Hypertension, Danette Schloeder

2021 Providence Nurse Research Conference

Background: In 2019, a large hospital in Alaska joined the Alaska Perinatal Quality Collaborative (PQC). The first project was the AIM Hypertension Project. The goals of the project were to reduce severe maternal morbidity among preeclampsia cases by 20% and Increase the timely treatment of hypertension to 80%. Other process and structure measures included education, simulation, clinical debriefs, and follow-up visits.

Methods/Approach: The PQC used monthly educational sessions, data collection and review of every case with severe hypertension, and Plan-Do-Study-Act cycles. Data collection occurred over an 18-month period. Cases were identified by the Washington State Hospital Association database and reviewed …

Improving Primary Care Screening For Familial Hypercholesterolemia, Mary Nametka, Brenda Senger

2021 Providence Nurse Research Conference

Background: Familial Hypercholesterolemia (FH) is the most common genetic condition resulting in cardiovascular disease, a leading cause of death in the United States. FH is estimated to affect 1 in 250 individuals with elevated lipid levels present from birth. An estimated 90% of individuals with FH remain undiagnosed. '

Purpose: The purpose of this quality improvement project was to increase provider awareness and promote screening for FH among adults ages 20 years and older. '

Methods: This quality improvement project consisted of an online educational intervention for providers working at an outpatient clinic regarding FH. Outcomes included: 1) pre-intervention …

Pain Management Trends Among Adults Hospitalized With Cellulitis: An Evidence-Based Practice Project, Syndey Pham, Teresa Bigand, Brenda Senger, Kenn Daratha, Kris Daratha

2021 Providence Nurse Research Conference

Background: Cellulitis is an infection of the skin causing swelling and acute pain. Two and a half to three and a half million adults seek care in the emergency department annually for this condition. Opioid medications are commonly administered and prescribed for pain, especially following the Joint Commission’s campaign in 2001 characterizing “pain as the 5th vital sign”. An estimated 22% of older adults hospitalized with a painful medical condition receive a new prescription for an opioid medication. Evidence suggests that there is no difference in pain outcomes among adults prescribed opioid versus non-opioid medications for acute pain conditions in …

Development Of A Smartphrase In The Electronic Health Record To Promote Chemotherapy And Immunotherapy Safety, Mary Jo Sarver, Monica Mcmanus, Amy Allen, Bethany Johnson, Dennielle Padgett, Elizabeth Ser

2021 Providence Nurse Research Conference

Background: Chemotherapy-immunotherapies are high risk medications that can include multi-drug and multi-day regimens with narrow therapeutic indexes and high risk for toxicities. Susceptibility for errors exists if adherence to protocol is inconsistent or if pertinent patient specific information is omitted. Prior to the creation of the "SmartPhrase" in the Electronic HealthRecord (EHR) pre-administration safety checks were on paper, not included in the EHR, not standardized among clinicians, and not completed every time. Chart audits revealed a need for consistent, centralized documentation to enhance patient safety while minimizing professional liability. A trans-disciplinary team created a "SmartPhrase" template for streamlining relevant …

Blind Taste Testing: A Case Study Of An Emergency Room Rn With Covid-19 Anosmia & Hypogeusia (Loss Of Taste & Smell), Marietta Sperry, Kimberly Kohlieber

2021 Providence Nurse Research Conference

Background: Anosmia, or the loss of taste and smell, is an important symptom for nurses to screen for among patients, as this can result in a poor appetite which impairs healing. In the early stages of the COVID19 pandemic, anosmia was not a known symptom indicative of infection with the virus. Yet, one Registered Nurse who was working in an Emergency Room received a positive COVID test following a workplace exposure to the virus while wearing personal protective equipment, and began to complain of anosmia shortly thereafter. Because the anosmia persisted, his spouse conducted blind taste test on him …

Deprescribing In The Hospice Population, Who Is Eligible And Who Is Agreeable: A Quality Improvement Project, Ashlee Nicole Smith

Doctor of Nursing Practice Final Manuscripts

Current evidence recommends and supports deprescribing medications to reduce polypharmacy in the hospice population. The project aim was to determine accurate percentages of deprescribing at three time periods: before hospice admission, at hospice enrollment, and four weeks post hospice enrollment. This project was a retrospective review of the medication administration record (MAR) of patients admitted into Sharp Hospice from a Sharp Healthcare facility. Sharp Hospice, in California, USA, admitted 164 patients during August 2020. Of those, 34 patients were eligible for inclusion in this retrospective quality improvement review. Prior to discharge from a Sharp facility, the percentage of target medications …

Teachable Moments, John E. Franklin

Journal of Transformative Touch

A Veterinarian's Induction into the Feldenkrais Method and the Dynamic Systems Approach to the Development of Cognition and Action.

Postdischarge 24/7 Hotline Service For Neurology And Neurosurgery Patients And 1-Year Impact On Readmission Rates, Unplanned Emergency Department Visits, And Patient Satisfaction, Shafqat Bibi, Rida Mitha, Kiran Bano, Farida Datoo, Nadia Karim, Muhammad Shahzad Shamim

School of Nursing & Midwifery

Objective: Telephone triage is a system in which trained nurses use standardized protocols to evaluate symptoms over the phone and determine the appropriate course of action.
Materials and methods: We implemented a protocol for systematic follow up phone calls and telephonic triage to families of neurology and neurosurgery patients after discharge, primarily to improve care transition and to assess its impact on the ratio of visits in the emergency department, readmissions, and overall satisfaction of patients and families. The intervention comprised the implementation of nurse led telephone triage and postdischarge follow up phone calls. After implementing hotline services in mind …

Investigating The Effects Of Zero Balancing On The Physical, Mental, Emotional, And Spiritual Dimensions Of Wellness: A Phenomenological Mixed Methods Pilot Study, Misty L. Rhoads, Mary Murphy, Michele Doucette, Tom Gentile, Dylan Rhoads, Jacob Watson

Journal of Transformative Touch

Background: Today, the necessity for relieving undue stress on the physical, mental, emotional, and spiritual levels is evident at this time of concomitant global crises from the pandemic, societal inequity, and climatic challenges. Methods to restore and enhance human well-being are critically needed.The study of overall wellness has not yet included the role that skilled, conscious touch may play in supporting the dimensions of wellness, an awareness of which this study seeks to elevate by exploring the effects of receiving positive touch on the physical, mental, emotional, and spiritual dimensions of wellness.

Methods: The researchers chose to utilize a concurrent …

Sunscreen Use And Screening In College Athletes: An Evidence-Based Pilot Project, Nicole Brustkern Bsn, Rn, Cpn, Sharon Boothe-Kepple Phd, Msn, Fnp-C, Phn (Chickasaw)

Doctor of Nursing Practice Final Manuscripts

Background: Melanoma is the third most common cancer in individuals ages 15 – 29. The greatest risk for melanoma is ultraviolet (UV) radiation from the sun. Collegiate athletes are exposed to 1,000 more sun hours per year than the average adult, placing them at higher risk for melanoma. Evidence supports sunscreen education and screening to promote protective behaviors in young adults.

Objective: This evidence-based pilot project implements the standardized screening of sunscreen use and sun protective behaviors in women’s soccer players ages 18 to 21 years old at the University of San Diego.

Methods: The Sun Exposure and Protection Index …

Managing Pediatric Atopic Dermatitis In The Allergy Clinic: Use Of An Eczema Action Plan To Improve Caregiver Understanding And Self-Efficacy, A Pilot Study, Danielle Hubacek

Doctor of Nursing Practice Final Manuscripts

Eczema, or atopic dermatitis, is a complex and chronic condition that affects approximately 10% of children throughout the United States (Brown et al., 2018). The American Academy of Allergy Asthma & Immunology (AAAAI) (2017) estimates the average cost of eczema management for each patient is approximately $3,302 per year. The complex nature of atopic dermatitis indicates a need for individualized treatment plans. Research has shown that standardized patient teaching, written education materials, and Eczema Action Plans (EAP) reinforce patient teaching, parental understanding, and improve quality of life. This evidence-based practice (EBP) project introduces the use of a written Eczema Action …

Weight Reduction Motivation In Osteoarthritis Patients Through Nurse Practitioner Driven Education And Follow-Up: A Pilot Project, Caoilfhionn Mulvey, Martha Fuller Phd

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The ultimate goal of this short-term pilot project is for

overweight or obese osteoarthritis patients to increase their knowledge on the benefits of

weight loss and physical activity. Research shows that for every kilogram of weight lost,

2.2–4.0 kilograms of weight is taken off of the joint and could reduce joint pain up to

thirty to fifty percent and improve quality of life. Following education from the provider,

patients will understand the correlation of osteoarthritis symptom management with

weight loss.

EBP Model/Frameworks: This project utilizes the Iowa Model of Evidence-Based

Practice to Promote Quality Care. This addresses …

Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel

Doctor of Nursing Practice Final Manuscripts

Abstract

Background

Congenital heart disease (CHD) is the most common birth defect and affects almost 1% of all live births. Treatment anxiety is common among children with CHD who undergo multiple procedures early in their lifetime. Dramatically increased life spans for this cardiac population has led to a shift from focusing on survival to their long-term health outcomes.

Methods:

Administration of the Peds QL Cardiac Module 3.0 assesses health related quality of life (HRQOL) during annual visits to a Cardiac Neurodevelopmental (ND) Clinic by evaluating the level of Treatment Anxiety a patient experiences during healthcare appointments. The questionnaire scores are …

Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht

Doctor of Nursing Practice Final Manuscripts

Advanced Care Planning (ACP) is an essential part of providing adequate care in the primary care setting. Discussing end of life with patients can be a tedious and uncomfortable conversation for many providers, however, its continued avoidance contributes to the stigma of end of life care and may also result in significant healthcare cost expenditure with the use of unwanted invasive treatments. All providers should engage in consistent advanced care planning in order to improve patient and provider communication, improve patient satisfaction, increase advanced directives on file, reduce the stigma of the topic, and improve quality of life.

Improving Identification Of Seniors At Risk Tool Adherence To Identify Emergency Department Readmissions In Older Adults, Joy Gao

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project (EBP) is to improve the emergency department (E.D.) staff adherence in completing the Identifying Seniors at Risk (ISAR) screening tool. The specific aim is to improve electronic health record (EHR) data collection to enhance the identification of older adults that are frequent utilizers of the E.D. at a local community hospital in Southern California. Based upon the most recent National Hospital Ambulatory Medical Care Survey, patients ages 65 and older make up 32% of all E.D. admissions. These patients also represent 50% of the moderate to severely ill patients seen in the E.D. …

Efficacy Of Telehealth Modalities In Medication Adherence For Older Adults, Mitchell Adrian C. Siy

Doctor of Nursing Practice Final Manuscripts

About half of the geriatric population who take at least one medication find medication adherence challenging. Average adherence of an elderly patient taking one medication a day is about 80%. This adherence decreases to about 50% for patients taking medications four times a day. Nonadherence can lead to a myriad of preventable adverse effects that can reduce the quality of life and even result in death. In the United States, $100-300 billion could be saved in health care costs due to adverse effects of poor medication adherence. The purpose of this evidence-based project (EBP) is to improve medication adherence in …

Impact Of Psychotropic Medications On Electrical Cardiac Conduction In The Emergency Department: A Best Practice Review, Juliann Hatt

Doctor of Nursing Practice Final Manuscripts

Abstract Background: The effects of psychotropic drugs on cardiac repolarization have increasingly gained attention in research and clinical practice over the last 2 decades. The absolute risk of cardiac arrhythmia, such as the polymorphic ventricular tachycardia, Torsades de Pointes (TdP), is low (14 per 10,000 patients/year) and sudden cardiac death as a consequence of all cardiac arrhythmias is less frequent (Braillon et al., 2017). TdP can occur at therapeutic doses of second-generation antipsychotics and antidepressants and with a corrected Q-T (QTc) interval >500 ms. Many psychotropic medications can delay cardiac repolarization thereby producing prolonged QTc in the electrocardiogram (ECG). Emergency …