Mental and Social Health Commons^™

The Usability And Feasibility Of A Nursing Evidence-Based Comorbidity Educational Website For An Urban Mental Health Assertive Community Treatment (Act) Program, Andrea Brudigan, Laurie Sewell-Muller, Kokuvi Sena Tsogbevi

Doctor of Nursing Practice Projects: College of Nursing

Objective: Serious mental illness (SMI) causes an increased risk for comorbidities like heart disease, obesity, metabolic syndrome, and diabetes. Many times, these comorbidities are due to side effects of antipsychotics and poor self-management from low insight and other symptoms of mental illness. This project aims to enhance client care enrolled in an Assertive Community Treatment (ACT) program by providing evidence-based resources tailored to clients with SMI, providing ACT team members with support to promote healthy behaviors in clients.

Methods: A website was developed that provides printable, easy-to-read, evidence-based resources that address physical comorbidities. The ACT team integrated these resources into …

Reducing Physical Restraints And Emergency Psychiatric Medications On An Inpatient Psychiatric Unit With The Broset Violence Checklist, Victoria Hernandez

Doctor of Nursing Practice

Background: Physical restraint and psychiatric emergency medication use, especially psychotropic medications, is problematic, negatively impacting patient safety on psychiatric units (Ambwani et al., 2021; Iuppa et al., 2013; Rahman, 2021). The Bröset Violence Checklist (Woods & Almvik, 2002), a short-term violence-predicting tool, has been used in the inpatient setting to predict violent outbursts and determine when high-level violence interventions are needed.

Purpose: The purpose of this project was to recognize signs and symptoms of aggression and agitation early and intervene to reduce the use of physical restraints and emergency restraint medications on an inpatient psychiatric unit, thereby improving patient safety. …

Implementing Evidence-Based Adult Psychiatric Inpatient Depression Assessment, Treatment, And Post-Hospitalization Referral, Lucy Flores

Doctor of Nursing Practice

Purpose: This project was designed to strengthen the quality of depression assessment with evidence-based depression assessment tools in inpatient psychiatric units.

Background: Missed diagnosis and treatment of depressive disorders contribute to the most severe outcome of depression: suicide. A crisis stabilization facility with inpatient psychiatric units had significant opportunities to improve clinical outcomes by screening for depression in adults and to monitor symptoms with evidence-based tools.

Methods: The 12-week quality improvement project included implementation of staff education sessions of evidence-based tools to screen, monitor, interpret scores, and detect risk modifiers. The design and build with Information …

Substance Use Among Nurses As A Result Of Covid-19, And The Impact Of Rehabilitative Programs On Nurses, Gerome Macaspac

Nursing | Senior Theses

Background: The incidence of substance use among nurses has been a persistent issue for decades. The effects associated with substance misuse depend on what is used, the amount, how often, and how they are taken. Regardless of the substance used, any nurse who enters the workplace using substances puts the lives of others at risk. Due to the widespread effects of the COVID-19 pandemic, there is a risk that the number of nurses resorting to the use of substances may have increased. Therefore, an investigation into drug use among nurses during the pandemic is particularly important.

Objective: To explore the …

Implementing The Depression Screening Tool Phq-9 In The Annual Wellness Exam Of Concierge Family Medicine, Eric Iglesias

Doctor of Nursing Practice

Abstract

Background: Depression has been one of the most common mental health disorders that our population fact but is underdiagnosed and undertreated. Primary care providers are often the first line of defense in detecting depression. Because of this, implementing a depression screening tool in a primary care setting will improve holistic management of care and improve quality of life.

Project Aim: The aim of this project was to increase the number of clients who are evaluated for depression by using the PHQ-9 screening tool during their annual wellness exam and initiate treatment according to the Veteran’s Affairs/Department of Defense Depression …

Tiny Tusks Breastfeeding And Infant Support: Breastfeeding's Effects On Maternal Mental Health, Anna Jacobs

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Breastfeeding has proven to be beneficial for infant health and maternal physical health, but there are variable outcomes for maternal mental health. This literature review explores the relationship between breastfeeding and maternal mental health, a topic that is often disregarded when discussing breastfeeding with mothers. After an internship with Tiny Tusks Breastfeeding and Infant Support, a program to make breastfeeding more accessible at Razorback Athletics events, maternal mental health related to breastfeeding was shown to be a topic in need of more current research. This objective of this literature review was to determine how breastfeeding can impact maternal mental health …

The Clinical Healthcare Provided To Homeless Communities Across The United States: A Literature Review, Saylor Sisemore

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Homelessness has become a global public health concern as it results in poorer physical and mental health than age-matched people living in permanent housing (Ortiz & Roser, 2017). The area that comprises Northwest Arkansas (NWA), like other areas of the United States experiencing rapid growth, has seen a marked increase in the number of people experiencing homelessness in recent years. The homeless population is one of the most vulnerable and underserved groups of individuals in NWA and beyond. Public health nursing as a discipline is dedicated to providing compassionate care and exceptional service for all members of communities, with special …

How Has The Pandemic Exacerbated Nurse Burnout, And What Can Be Done To Improve Their Psychological And Emotional Well-Being?, Lisette Diaz

Nursing | Senior Theses

Background: The COVID-19 pandemic has affected millions of people, both emotionally and physically. Nurses are among the people who are most affected. The nurses' quality of life and the way they provide care has been changed by the pandemic. Nurses are so focused on providing the best possible care for their patients that they neglect to look after themselves.

Objective: The purpose of this literature review is to identify and evaluate how the COVID-19 pandemic has affected nurses and their well-being. The significance of this research was to establish how the ongoing pandemic has impacted nurses’ performance and …

The Uncertainty And Psychological Health Of Family Caregivers Of Patients With Delirium In Intensive Care Units, Amal Shokri Haji Assa

Theses and Dissertations (ETD)

Each year, more than 5 million patients are admitted to an intensive care unit (ICU) in the United States, and up to 80 % of these patients develop delirium. Delirium is a common indicator of acute brain dysfunction in the ICU and a predictor of mortality, longer ICU/hospital stay, and long-term cognitive impairment. Family caregivers are a valuable resource in preventing, detecting, and managing delirium in the ICU. However, witnessing delirium episodes can generate adverse psychological symptoms in family caregivers that may compromise their health and well-being. Research in this area has demonstrated a gap in the literature regarding how …

Preventing And Reducing Nurse Burnout In An Outpatient Military Facility, Lisa Haik

Student Scholarly Projects

Practice Problem: Nurse burnout adversely affects nurses, patients, and healthcare organizations. Implementing changes to address key contributors to burnout can effectively reduce and prevent burnout.

PICOT: The PICOT question that guided this project was: In outpatient clinic nurses (P), how does implementing a bundled strategy (I) compared to not providing interventions (C) affect nurse burnout (O) within eight weeks (T)?

Evidence: Evidence from an extensive literature review showed that there is no single cause for burnout and therefore no single intervention to reduce or prevent it. The primary themes in the literature to address burnout include practicing mindfulness, …

Utilization Of A Multimodal De-Escalation Class To Improve Staff Confidence When Caring For Behaviorally Escalating Patients, Tara B. Neuner

Graduate Theses, Dissertations, and Capstones

Workplace violence is a common challenge seen in the healthcare settings across the world. This problem is steadily increasing in all types of hospitals, including a level one trauma center located in an urban area. There has been a steady rise in the number of assaults and workplace violence reported from bedside staff at this hospital. The leadership of the organization formed a work group to help combat the workplace violence and staff assaults that were occurring. In this process, a behavior response team was created to help nursing staff with escalating behavior in patients, and to help de-escalate the …

Implementation Of Nurse Navigators For Behavioral Health, Theresa Papagna

Seton Hall University Dissertations and Theses (ETDs)

Mental health patients have been notoriously non-adherent with diligent medication conformity, office visit fidelity, candor about side effects, use of illegal substances for self-medication, and truthfulness about co-occurring conditions. This non-adherence makes treatment difficult for psychiatric providers, and all those who participate in the care of patients with mental illness. Patient non-adherence can cause frustration and can lead to provider burnout, which affects patients as well as providers. Also, there are concerning financial implications of excessive time and resources needed to adequately monitor mental health patients. Implications regarding 30- day re-admissions are tantamount to consideration of financial strains put on …

Connecting And Communicating To Support Youth Mental Health, Michele Davide

Seton Hall University Dissertations and Theses (ETDs)

The nation is experiencing a pediatric mental health crisis amid a shortage of pediatric mental health care providers. The Connecting and Communicating project explores a strategy pediatric primary care practitioners can employ to bridge this gap and maximize their impact on supporting youth mental health in a community.

For this project, a pediatric primary care nurse practitioner created a pilot educational video with the dual purpose of educating parents and school staff on the importance of connecting with adolescents using the proven evidence supported communication technique of validating strong emotions without judgement, and partnering with pediatric health stakeholders by requesting …

Telehealth, During Covid-19 Pandemic Did It Increase Access To Care?, Annette Allegra

Seton Hall University Dissertations and Theses (ETDs)

Abstract

The purpose of this project was to implement an Advance Practice Nurse-led Quality Improvement (QI) initiative to assess telehealth intervention during the Covid-19 pandemic and determine if it increased access to healthcare. This Doctor of Nursing Practice (DNP) project used interventions noted in the literature review to assess effectiveness and acceptance of telehealth use with psychiatric patients to increase access to healthcare in the setting of a medical center. Psychiatric patients often have poor compliance with healthcare visits and treatment due to the challenges of an inability to afford medications, transportation to appointments, poor community support and stigma to …

Quality Improvement For Patients With Alcohol Withdrawal Syndrome Starts With An Evaluation Tool, Jessica Bass

Doctoral Projects

Patients with alcohol withdrawal syndrome (AWS) have adverse outcomes to the traditional methods of assessing for and treating withdrawal within the intensive care unit (ICU), which includes a standardized treatment plan. Some negative outcomes include acquiring costly and dangerous hospital-acquired infections, safety concerns, and traumatic experiences that deter further treatment. More individualized assessments and treatments are needed to prevent or decrease the severity of AWS from occurring in critical care settings, which will facilitate more positive outcomes and experiences for the staff and patients. The Minnesota detoxification scale has been shown to be a more appropriate tool for the critical …

Emergency Care For Youth Who Experience Suicidality And Identify As Lesbian Gay Bisexual Transgender Queer/Questioning (Lgbtq+): An Interpretive Phenomenology, Theresa Schultz

Electronic Theses and Dissertations

Purpose: Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of young adults who identify as LGBTQ+ and sought emergency care for suicidality when they were adolescents.

Methods: Heideggerian hermeneutics phenomenology is the research method used in this study. Youth, ages 18-25 years, who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents (13-17 years) were recruited to participate;fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described …

Enhancing Elementary School Educators And Staffs Behavioral Classroom Management Strategies To Support Children Affected By Trauma Through Utilization Of Trauma-Informed Care (Tic) And Social-Emotional Learning (Sel) Modalities: A Quality Improvement Project, Kerstin Burt

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Background: The fundamental ACE study asked more than 17,000 adults about their childhood trauma exposure and how it has impacted their health as an adult. The study found a link between ACE exposure and a higher likelihood of experiencing adverse emotional and physical outcomes (Felitti et al., 1998).

Problem: Educators and staff encounter children affected by trauma and are untrained in trauma-informed care approaches, known as the “Four R’s” (SAMHSA, 2014b).

Purpose: This quality improvement (Q.I.) project aimed to respond to the trauma-informed care (TIC) and social-emotional learning (SEL) gaps among educators and staff at a private elementary school …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Improving Trauma-Informed Education And Parenting For Resource Parents At A Foster Care Agency., Courtney Albers

Doctor of Nursing Practice Papers

675,000 children nationwide were involved with the foster care system in 2019, and nearly all children within the foster care system are actively suffering from the effects of trauma. Resource parent trauma-informed trainings, such as Resource Parenting Curriculum (RPC) developed by The National Child Traumatic Stress Network, are associated with improved parental perceptions towards trauma-informed care, improved child outcomes, and placement stability. Foster care agencies have trauma-informed state-based curriculum, but it does not meet the needs of resource parents, specifically those caring for children with developmental delays or disorders. The project was implemented at a therapeutic foster care agency for …

Associations Between Postpartum Depression And Child Overweight And Obesity: Mediating Effect Of Maternal Feeding Behaviors And Beliefs, Michelle Harrison

Theses and Dissertations (ETD)

Purpose. Postpartum depression (PPD) is a mental condition that significantly affects 10% to 25% of women within the first year after the birth of their child. The mother-infant relationship is key to child growth. Previous studies have shown that PPD has a detrimental effect on children’s physical and psychological well-being as it affects the child through the mother’s parenting behavior. Depressed mothers show a lack of engagement with their children, which could extend to feeding practices influencing weight gain. The prevalence and severity of childhood overweight and obesity is a global public health problem. An increase in weight gain in …

The Effect Of Transfer Of Care Protocol On The Rehospitalization Rates In Psychiatric Patients, Fernando Guillen Msn, Cnp, Pmhnp-Bc

Student Scholarly Projects

Practice Problem: The problem involved the transition of psychiatric care from long psychiatric hospitalizations to community-based psychiatric treatment which has developed into shorter inpatient psychiatric hospitalizations, which in turn has developed into a significantly higher number of individuals being readmitted within one year of inpatient discharge.

PICOT: In adult patients undergoing inpatient acute psychiatric care (P), how does the use of a transfer of care protocol (I), compared to current transfer of care practice (C), affect the rate of readmission within 30 days for inpatient acute psychiatric care (O), in 10 weeks?

Evidence: The evidence from an extensive literature review …

Evaluating Sbirt In A Behavioral Health Urgent Care, Christina L. Williams

Dissertations

Background: Adolescent substance use (SU) is a major health concern. Most youth who engage in alcohol and other SU do not meet criteria for SU disorder (SUD). Nonetheless, evidence shows SU during adolescence impacts cognitive, social, and emotional development, increases risk of physical injury, and may progress to SUD in adulthood. Only half of clinicians properly screen adolescents for SU; those identified with SUD often receive no intervention. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention to address this problem. The purpose of this project was to evaluate implementation of SBIRT using CRAFFT 2.1+N, a SU …

Visualizing Depressive Symptom Improvement: Implementing The 17-Item Hamilton Depression Rating Scale, Briana Raterman

Dissertations

Visualizing Depressive Symptom Improvement: Implementing the 17-Item Hamilton Depression Rating Scale

Abstract

Problem

Depression, a mental health diagnosis, has affected about 18.5% of adults (Villarroel & Terlizzi, 2020). Ketamine, a medication initially used as an anesthetic, has improved depressive symptoms in individuals struggling with treatment-resistant depression.

Method

This quality improvement (QI) project used the 17-item Hamilton Depression Rating Scale questionnaire to assess depressive symptom changes in patients receiving intramuscular ketamine for treatment-resistant depression. The questionnaire was administered to patients pre-and post-intramuscular ketamine administration. The data was collected on injections one, three, and six on each participant’s set schedule of injections …

An Evaluation Of Mindstrong™ Implementation With Graduate Nursing Students, Angela B. Sabblut

Dissertations

Problem: Nursing graduate students are at increased risk of greater stress, anxiety, and depression (Hoying, 2020; Melnyk et al., 2020). Cognitive Behavioral Therapy is the gold standard in the treatment of anxiety and depression (Hoying et al., 2020; Melnyk et al., 2015; Melnyk et al., 2020). MINDSTRONG™, a CBT-based training program, has been proven in many studies to be effective in helping individuals prevent or cope with these issues (The Ohio State University College of Nursing, 2020).

Methods: This Quality Improvement (QI) project was a descriptive-observational, pre-post design. Sample and setting were nursing graduate students from a Midwestern, middle-sized urban, …

Nursing Anxiety Self-Evaluation And Resiliency Methods, Dianne Deck

Dissertations

Abstract

Introduction: Nurses are stressed due to the demands of their job. This study aims to determine whether MICU nurses at a large Midwestern hospital would have reduced stress and anxiety after a 30-day meditation and exercise intervention.

Design and Methods: A quasi-experimental pre-post pilot study design was adopted. The convenience sample consisted of eight Medicine Intensive Care Unit (MICU) nurses in a large Midwestern urban tertiary medical center. Data collected included demographics, pre- post-Beck Anxiety Inventory Scale (BAIS), pre- and post-Single Item Stress Scale (SISS), and weekly diaries on exercise and meditation.

Results: The pre- post-SISS showed statistical significance …

Evaluating Patient Health Questionnaire-9 (Phq-9) Use In Burn Survivors, Chelsey Friend

Dissertations

Problem: A burn injury affects both psychological and physical health, resulting in a greater than 50% major depressive disorder morbidity. The purpose of this quality improvement (QI) project is to evaluate the use of the Patient Health Questionnaire-9 (PHQ-9) in adult burn survivors, with an aim to increase the use of the screening tool.

Methods: A mixed-methods pre/post-survey design with an educational component was utilized to assess nurse knowledge, confidence, willingness, and barriers to completion of the PHQ-9. Aggregate data were collected to determine PHQ-9 completion rates for patients admitted to and discharged from the unit during the two months …

Implementing Adverse Childhood Experience Screening In An Intensive Outpatient Mental Health Program, Bryan Amaro

Doctor of Nursing Practice Final Manuscripts

Adverse Childhood Experiences (ACES) are linked to damaging events which happen to people when we are young (0-18). ACEs are connected to a phenomenon known as the toxic stress response which can later become the root etiology for many mental health, substance abuse and chronic medical health complications our society faces. ACEs affect all populations and do not discriminate across socioeconomic, racial, ethnic, gender, or geographic lines. Roughly two thirds of Americans have experienced at least one ACE. This project seeks to perform ACE screening at an Intensive Outpatient behavioral health center by screening for ACEs upon all admissions into …

A Qualitative Study On Nurse Facilitators Of Mind-Body Skills Groups, Paula D. Blake-Beckford

Mindfulness Studies Theses

The Center for Mind-Body Medicine (CMBM), founded by Dr. James Gordon, provides communities with evidence-based Mind-Body Skills Groups (MBSGs) that foster self-care, self-awareness, and self-expression. MBSGs range from 8 to 12-week series on various mind-body practices wherein group members meet, practice, and reflect on the impact of mind-body skills in their lives. Research has demonstrated that participants in MBSGs have positive outcomes. Healthcare professionals (HCPs), especially nurses, gain resiliency from MBSGs. As facilitators of MBSGs, nurses develop essential skills transferable to clinical and educational settings. MBSGs are therapeutic for adult participants with chronic stress. Prior to this thesis, only one …

Development And Implementation Of A Standardized Protocol For Nurse Practitioners Working In An Aud Treatment Telehealth Program, Cj Dea

Doctor of Nursing Practice (DNP) Projects

Background

Alcohol Use Disorder (AUD) is a major public health concern in the United States. Ria Health is a growing telehealth provider delivering AUD treatment through pharmacotherapy combined with behavioral health counseling.

Local Problem

Ria Health employs six California licensed nurse practitioners, but two of them have not yet met all the California provisions to practice independently without protocols. Ria Health has not put any standardized protocols in place.

Methods

This DNP project involved the creation of an evidence-based standardized protocol for AUD. The Student Satisfaction and Self-Confidence in Learning questionnaire was disseminated to participating nurse practitioners to measure student …

The Outcome Of A Multidimensional Intervention Strategy For The Management Of Generalized Anxiety Disorder In An Internal Medicine Setting, Nicholas Davidson

Evidence-Based Practice Project Reports

Anxiety disorders are very prevalent in the United States. The most common type, Generalized Anxiety Disorder (GAD), affects 6.8 million adults every year. GAD can cause significant deficits in a person’s ability to function, decrease their quality of life and increases a person’s risk of attempting suicide. The purpose of this evidence-based practice (EBP) project was to improve the outcomes of adults diagnosed with GAD in an internal medicine setting by implementing a protocol composed of a combination of interventions. A thorough literature search was conducted to find the best available evidence to support the project. A total of 11 …