Medical Specialties Commons^™

Improving Communication Of Asthma Related Care Between Pediatric Primary Care Providers And Schools, Jessica N. Heichel

Doctoral Projects

Introduction: Asthma is a life-altering chronic disease that affects many children throughout the state of Michigan. Evidence-based guidelines recommend a written asthma action plan (AAP) be given to all caregivers of children with asthma. This would include schools, but the plans are not making it there. This project focused on collecting school asthma data and designing a process change at a local clinic to send the plans directly to the schools.

Objectives: The goal of this project was to improve communication between healthcare providers and schools for children with asthma. The objectives were to increase the percentage of children with …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Developing An Evidence-Based Supportive Services Program For Cancer Survivors In A Private Oncology Practice, Joseph Ellul

Doctoral Projects

Improvements in cancer treatment have led to a rapidly increasing survivor population. In response, multiple side effects of cancer and cancer treatment as well as the various wellness needs of survivors have been recognized. Survivorship programs have been developed to care for survivors with residual effects of cancer and the side effects of treatment; however, additional support is needed. The purpose of the project was to highlight the need for a comprehensive supportive services program for the cancer survivor population and describe the steps that were required to successfully develop the program. The clinical question addressed by the project was: …

Improving Advance Care Planning Documentation In A Home Based Primary Care Program, Emily Radtke

Doctoral Projects

Advance care planning (ACP) is an importance process of reflection and communication regarding one’s preferences for future health care (Hagen et al., 2015). Findings from research indicate that advance care planning supports patient autonomy, improves quality of end-of-life, and increases patient and provider satisfaction (Bischoff at al., 2013; Brinkman-Stoppelenburg et al., 2014). To promote advance care planning discussion, the Centers for Medicare and Medicare Services (2016) made a decision to compensate health care providers for face-to-face conversations regarding future treatment associated with serious illness, offering two new current procedural terminology billing codes for ACP. The Plan-Do-Study-Act model (AHRQ, 2018) was …

Management Of Distress In Adult Oncology Patients, Lauren Jongsma

Doctoral Projects

Cancer related distress has the potential to negatively impact the health of the patient and their treatment outcome (Grassi, Spiegel, & Riba, 2017). As identification and treatment of distress has a positive impact on patient outcomes; the Commission on Cancer (2016) required distress screening for accreditation. Key stakeholders within a Midwest hospital system expressed a desire for the improvement in the current state of the distress screening. Thus, the scholarly paper describes the key attributes of the organizational assessment, a literature review on evidence-based distress screening tool and a quality improvement project. The Promoting Action on Research Implementation in Health …

Nurse Care Manager Impact On Type 2 Diabetes Mellitus At A Rural Primary Care Practice, Patrick Joswick

Doctoral Projects

Background: Type 2 Diabetes Mellitus is a common diagnosis managed in the primary care setting. Patients with an uncontrolled state of the condition are most vulnerable to develop complications from the disease. Consequently, type 2 diabetes remains as the leading cause of end stage renal disease and nontraumatic limb amputations.

Objectives: To improve type 2 diabetes quality measures, improve documentation of quality measures, increase the continuity of care, and create a streamlined workflow and communication within an interdisciplinary team.

Methods: Quality improvement project to establish multifaceted management of type 2 diabetes. Data on the management of care was gathered pre-/post-implementation …

Implementation Of An Evidence Based Screening Protocol To Improve The Diagnosis Of Dementia In A Home-Based Primary Care Setting, Lauren Liesbeth Sutton

Doctoral Projects

Dementia is a major public health concern that is both debilitating and deleterious to those afflicted with its various forms. The number of those living with dementia is increasing exponentially as the population continues to rise, with 46.8 million people worldwide currently afflicted with dementia (Chow et al., 2018). Dementia causes cognitive impairment that is severe enough to affect everyday function (Chow et al., 2018). The impairment and disability resulting from dementia indicates a significant health problem in primary care. Findings from research studies indicate that prophylactic and periodic screening for dementia can heighten provider suspicion and translate into earlier …

Preoperative Anemia Management In Adult Outpatient Coronary Artery Bypass Graft Surgical Patients To Improve Treatment Of Preoperative Anemia, Katherine Mills

Doctoral Projects

The transfusion of blood products can lead to life-threatening complications after surgery. In addition, blood products are a scarce and expensive resource. Even though anemia in coronary artery bypass surgery patients is currently undertreated, research has shown that the intravenous infusion of iron products, as well as a single dose of erythropoietin-alpha prior to surgery, decreases the amount of blood products used in the perioperative setting. The goal of this pilot project was to increase the number of patients screened for anemia, and if necessary, treated prior to coronary artery bypass graft surgery.

Methods: This was a practice improvement, pilot …

Final Defense: Sepsis Screening Tool Assessment At A Freestanding Children’S Hospital In The Midwest, Cassandra Cummings

Doctoral Projects

Pediatric sepsis is a major contributor to childhood morbidity and mortality. Tools for predicting sepsis in pediatric patients have had poor predictive ability nor been validated. Risk assessment screening tools are effective at earlier detection of sepsis. The implementation of an evidence-based pediatric sepsis screening tool could reduce time to detect and diagnose severe sepsis so that patient treatment could occur earlier. This was a quality improvement project that evaluated a sepsis screening tool predictive validity at a children’s hospital.

Evidence-Based Intervention To Improve Assessment Of Headache Pain And Its Functional Capacity, Mavjuda Saydazamova

Doctoral Projects

Introduction: Headache is a chronic pain that is challenging to properly assess in clinical practice, as it is based almost entirely on the ability of the clinician and patient to communicate. This communication is based on pain scale tools. To assess patients’ disability and pain intensity, the selected organization uses the Migraine Disability Assessment (MIDAS) screening tool. Pain intensity is measured with a Numeric Pain Scale within the MIDAS. Measuring chronic headache pain accurately, while using a very subjective and inadequate pain scale to measure chronic pain was an issue. The literature review supported replacing the Numeric Pain Scale with …

Using The Qsat To Generate Multi-Source Feedback On An In-Situ Pediatric Simulation Case, Michael C. Nguyen Md, Nicole Elliott Do, Michael R. Jong Md, Msc, Suzanne S. Puentes Bsn, Ccrn, Rn, Diane Begany Md, Matthew D. Cook Do, Louis Morolla Do, Zachary Matuzsan Do, Jennifer E. Macfarlan Mph, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Acquiring Blood Pressures On High Risk Sepsis Patients In The Ed, Mckenna Scharlau, Jacob Schneider

Nurse Presentations

Describes a project to improve use of the Sepsis Tool in the Emergency Department and to improve documentation of blood pressure measurements in high risk sepsis patients under three years of age.

Prehospital Troponin Testing Protocol For Accelerated Diagnosis And Early Intervention In Chest Pain Patients, Ronald D. Meador

DNP Final Reports

Non-ST elevation acute coronary syndromes (NSTE-ACS) have significant morbidity and mortality rates despite the progress made in diagnosis and management and represent a significant public health burden in the United States. Lengthy diagnostic algorithms contribute to emergency department over-crowding, increased health care costs, and adverse patient outcomes. A troponin assay instituted earlier in the diagnostic pathway of patients with chest pain suspected of NSTE-ACS will reduce time to definitive diagnosis and medical intervention. This will improve patient outcomes, decrease emergency department crowding through improved ED workflow, and reduce the economic burden. The Star Model of Knowledge Transformation was used to …

The Influence Of Stressful Life Events On The Development Of Type 2 Diabetes, Joshua Minks

Dissertations

This study examined the relationship between distress and the development of Type 2 diabetes mellitus (T2DM) in the presence of established risk factors. Distress secondary to mental health disparities, stressful life events, and work conditions has been shown to promote insulin resistance and the development of T2DM.

Subjects (N=79) diagnosed with T2DM within the previous six months were recruited from SSM Health Centers and VA Medical Centers in the greater St. Louis area. They completed the Recent Life Changes Questionnaire, ENRICHD Social Support Instrument, and a demographic survey and analyses were conducted to determine differences between the veteran …

Watchful Waiting And Antibiotic Stewardship: A Quality Improvement Project, Rebecca Couper

Seton Hall University DNP Final Projects

Antibiotic misuse and overuse are major contributors to antibiotic resistance which is responsible for the death of 23,000 American’s annually. There is a growing body of evidence that antibiotic stewardship programs are successful in reducing antibiotic prescribing rates while maintaining safe patient care. Research supports a multifaceted approach with an ongoing commitment to antibiotic stewardship. This quality improvement project aimed to reduce the overuse of antibiotics in pediatric acute respiratory tract infections (ARTIs), improve the percentage of children who received laboratory confirmation for the diagnosis and treatment of streptococcal pharyngitis, and to implement and measure the efficacy of watchful waiting …

An Exploration Of Why Healthcare Professionals Under-Report Observed Patient Aggression, Sydney Bonta

UNO Student Research and Creative Activity Fair

An Exploration of Why Healthcare Professionals Under-Report Observed Patient Aggression

Authors: Sydney Bonta & Lisa L. Scherer, Ph.D.

Advisor: Lisa L. Scherer, Ph.D.

According to the 2011 US Bureau of Justice Statistics report, medical professionals experienced the third highest proportion of workplace violence (WPV), with violence primarily emanating from patient. In a national survey of nurses employed in hospitals, 76% stated that they had encountered some sort of violence in their workplace (Speroni, Fitch, Dawson, Dugan, Atherton, & Leesburg, 2014). Similarly, patient aggression against physicians has long been a problem (Morrison, Lantos, Levinson, 1998). Despite this widespread exposure to WPV …

Nonalcoholic Fatty Liver Disease And The Pnpla3 Gene, Lori Houghton-Rahrig, Debra Schutte, Jenifer I. Fenton, Jennifer Awad

Peer Reviewed Articles

Nonalcoholic fatty liver disease (NAFLD) is a rapidly emerging worldwide public health concern strongly associated with obesity, insulin resistance/diabetes type 2, and the metabolic syndrome (Younossi et al., 2011). It is the most common cause of liver disease in the world (World Gastro - enterology Organisation [WGO], 2012). Defined as a total liver weight comprised of more than 5% fat, NAFLD can progress from simple fatty liver disease to nonalcoholic steatohepatitis with or without fibrosis, liver cirrhosis, liver cancer, or liver failure resulting in premature death (Levene & Goldin, 2012). The development and progression of NAFLD is influenced by genetic …

Exploring Lived Experiences Of Married Pakistani Women Post-Mastectomy, Laila Hussain, Zeenatkhanu Kanji, Sharifa Bashir Lalani, Shabnam Moledina, Abida K. Sattar

School of Nursing & Midwifery

Objective: This qualitative descriptive exploratory study aimed to explore the lived experiences of married Pakistani women, 2 years post-mastectomy.
Methods: Twelve participants were recruited through purposive sampling from outpatient oncology clinic from a tertiary care hospital in Pakistan. Interviews were audio-taped and transcribed, and then themes and sub-themes were identified.
Results: Women verbalized a range of their experiences throughout the span from diagnosis to mastectomy. One over arching theme, quality of life and four main themes and their subthemes emerged from the data. Following are the themes; from history to diagnosis, worries, coping strategies, and recommendations.
Conclusions: The study findings …

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

A Nurse Navigator-Driven Program To Increase Palliative Care Referrals For Advanced Heart Failure Patients, Margaret Richter, Linda Desitter, Adam Mizgajski, Deborah Strohecker

Articles, Abstracts, and Reports

No abstract provided.

Managing Severe Tbi In The Icu Setting Using A Three Tier Approach, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Assess the effects of injury to the brain in the neurologic injured patient and implement a tiered approach to manage severe TBI
• Evaluate TBI patients using multimodality monitoring
• Apply interventions to manage brain injury & integrate the complex multi-system issues and manage these patients using an actual case study.

Temperature Management: All Shook Up! Managing Shivering In Normothermia, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Identify key factors related to maintaining normothermia
• Describe the use of the Bedside Shivering Assessment Scale
• Provide interventions to manage shivering in the Neuro patient population

Fast And Furious: Stroke Update 2019, Mary Kay Bader

Books, Presentations, Posters, Etc.

This lecture focuses on the AHA guidelines and how the Acute Stroke Team focuses the efforts in the first few hours after presentation. Audience will be made up of physicians, nurses and EMT/EMS personnel. The aims of the event include providing a couple ‘cutting edge’ key note speakers with varying expertise from different parts of the acute stroke care continuum.

Rapid 5 Lb Weight Gain Is Not Associated With Readmission In Patients With Heart Failure, Jill Howie-Esquivel, Kathleen Dracup, Mary A. Whooley, Charles Mcculloch, Chengshi Jin, Debra K. Moser, Robyn A. Clark, Michele M. Pelter, Martha J. Biddle, Linda G. Park

Nursing Faculty Publications

Aims Heart failure (HF) patients are taught to identify a rapid 5 lb body‐weight gain for early detection of cardiac decompensation. Few data support this common advice. The study aim was to determine whether a 5 lb weight gain in 1 week and signs and symptoms of HF increased risk for unplanned physician or emergency department (ED) visits or hospital admission in rural HF patients.

Methods and results This was a secondary analysis of a randomized trial. Patients tracked body weight and HF symptoms using diaries. We included patients adherent to daily diaries > 50% over 24 months (N = …

What? Not Another Fall!: Reducing Falls In The Neuroscience Patient Population, Elizabeth Plante

Nursing Posters

The purpose of this evidence-based practice project is to reduce the fall rate from 5.52 to less than 4.80 on a Neuroscience/Spine Unit through increasing staff and patient awareness of fall risk and application of evidence-based fall prevention practices of communication, patient involvement and bedside report.

Reducing Falls In The Neuroscience Patient Population, Elizabeth Plante

Nursing Posters

Purpose Statement:

The purpose of this evidence-based practice project is to reduce the fall rate from 5.52 to less than 4.80 on a Neuroscience/Spine Unit through increasing staff and patient awareness of fall risk and application of evidence-based fall prevention practices of communication, patient involvement and bedside report.

Pathophysiology Of Osteoarthritis, Lara Stover

Nursing Student Class Projects (Formerly MSN)

Osteoarthritis (OA) is one of the most common joint diseases worldwide, and especially in the United States. This disease can cause chronic pain and disability, and can impair a patient’s quality of life and ability to perform activities of daily living. There are many different factors that can contribute to the development, progression, and severity of OA. Chronic inflammation and the inflammatory response is the primary pathological process that contributes to the development of OA. With the number of cases of OA expected to increase in the United States, it is important that primary care providers have an understanding of …

Ua66/13/2 Ogden College Of Science & Engineering Public Health Centers, Wku Archives

WKU Archives Collection Inventories

Records related to Public Health Centers.

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

Effects Of A Plant-Based Vegan Diet On The Risk Of Cancer: An Integrative Review Of The Literature, Chelsie M. Silavent

Honors Undergraduate Theses

Cancer, an aggressive chronic disease, impacts the lives of millions of people every day. There are numerous proposed triggers related to the diagnosis and much remains to be learned about the causes. Associated with this disease's variability is the challenge to identify a single causative agent that lead to its prevention. Specific topics that need additional evidence relate to environmental factors and lifestyle behaviors in the development, treatment and, in some instances, even suppression of disease progression. Specifically, a diet that excludes animal-based products but consists of a variety of fruits and vegetables (i.e., plant-based vegan diet) is reported to …