Nursing Commons^™

Hospital Assessment And Response To Environmental Pollution As A Population Health Need: Identifying Prevalence And Predictors In Community Benefit Practices, Sarah Valentine

Doctoral Dissertations

Hospitals have a growing role in improving population health. Environmental pollution is an important determinant of health with disproportionate effects on Communities of Color. This warrants hospital action. To advance such action, it is important to take stock of current hospital engagement with environmental pollution and to identify factors associated with such engagement. I investigated the following. To what extent do New York State (NYS) non-profit hospitals assess, identify, and respond to environmental pollutants as part of community benefit practices? Do factors previously reported as associated with hospital engagement of social determinants predict engagement with environmental pollution as a community …

Geographical Disparity Of Adverse Childhood Experiences And Chronic Diseases In Saudi Arabia, Fahad Alhowaymel

Doctoral Dissertations

Background: Adverse childhood experiences (ACEs) have been linked to numerous negative physical and mental health outcomes and have been shown to increase risk for chronic diseases in adulthood. In Saudi Arabia, few studies have examined ACEs prevalence and their relation to chronic diseases across geographical settings. Purpose: The purpose of this study was to examine ACEs prevalence and association with chronic diseases across the provinces of Saudi Arabia, and to determine the moderating effect of geographical setting on the ACE-chronic disease relationship. Methods: A cross-sectional design was used with an existing Saudi national dataset from the National Family Safety Program …

School-Based Telemental Health And Family Psychoeducation: A Program Evaluation, Ainat Koren

Doctor of Nursing Practice (DNP) Projects

Background: Telemental Health has been established as an effective model of care in the adult population. There are few studies that addressed the effects of providing child and parent telehealth services in underserved communities where mental health services are sparse. Families who attend face to face mental health support report high levels of satisfaction, show increased knowledge about mental illness/treatment, and youth have a lower risk of relapse.

Purpose: The purpose of this DNP project was to evaluate an innovative Telemental Health model offering timely social/behavioral health support for children/families’ mental health services in rural Massachusetts.

Methods: Process …

Adolescent Mental Health Training For Middle School Educators, Sarah Minton

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Adolescent mental health disorders are an increasing concern in the United States. School systems, specifically educators, are in the unique role to aid in early identification of mental health disorders, as well to intervene in mental health distress. However, mental health training for educators is lacking, leaving educators unprepared to manage mental health concerns within their classroom.

Purpose: The purpose was to utilize an evidence-based training, the “Teacher Knowledge Update Guide” from TeenMentalHealth.org to train middle school educators on the signs and symptoms of mental health conditions in the adolescent population with the intent to increase awareness, knowledge, …

Food Safety And Risk Of Foodborne Illness At A Food Center Extension: Toolkit For Front-Line Volunteers, Sara Anderson

Doctor of Nursing Practice (DNP) Projects

Background: Foodborne illness is a serious public health issue. One in six Americans has an episode of foodborne illness each year and over 50,000 are hospitalized. Food distribution centers are instrumental in decreasing food insecurity, however, some of the food donated is expired or may be damaged leading to increased risk of foodborne illness.

Purpose: The purpose of this project was to educate front-line volunteers at a local food center regarding food safety.

Methods: A toolkit was developed to teach food safety to the front-line volunteers. Seven classes were given to front-line volunteers including a pre and post intervention …

The Impact Of Ptsd And History Of Involvement In The Criminal Justice System On Medication Treatment Success In Opioid Use Disorder, Kirk Sanger

Doctoral Dissertations

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4 …

Quality Improvement: Intimate Partner Violence Screen In Nurse Home Visit Program, Masayo Nishiyama

Doctor of Nursing Practice (DNP) Projects

Purpose: Women are disproportionately impacted from intimate partner violence (IPV). Their children also experience long-term adverse consequences. Effective IPV prevention and intervention efforts are vital. This quality improvement project addressed the lack of an evidence-based IPV training and protocol in a nurse home visit program.

Methods: Stakeholder engagement and an evidence-based practice intervention were implemented. Training effectiveness was examined by the pre-post-training assessments; completed by 17 nurses. To measure the IPV practice change, 196 pre- and 107 post-intervention charts were reviewed.

Results: The training significantly increased nurse knowledge and comfort (t=5.9, p< .001). Only 22% of those referred due to recent IPV history were screened before the intervention; 65% after the intervention. Multivariate analysis of screening rates was performed; predictors included county, mental health status, education, subprogram, and IPV referral reason. Due to low power, a one-tail test was employed. One county was 14 times less likely to screen than the other county (p= .023). 93% of those referred due to IPV history were enrolled in the crisis response subprogram, only offered by the other county. Those referred due to IPV history were three times more likely to be screened (p=.042) than those referred for other reasons. There was no significant change observed on IPV disclosure and intervention practice.

Conclusions: The adoption of an evidence-based IPV training …

Program Evaluation Of An Easy Access Clinic For Effective Contraception For U.S. Active Duty Women In Okinawa, Japan, Cynthia Kuehner

Doctor of Nursing Practice (DNP) Projects

Background: Unintended pregnancy in the United States (U.S.) is a significant health problem that takes on additional magnitude in the context of military service. Young, active duty women have higher unintended pregnancy rates compared to the general population, secondary to non-use of contraception or selection and use of the least effective methods (condoms and oral contraceptive pills). The literature validates the problem, identifies access barriers to highest-efficacy contraception options in primary care settings, and offers evidence-based, best practice opportunities to impact this public health challenge.

Purpose: The purpose of this project was to evaluate access, utilization, effectiveness, and patient satisfaction …

Measuring The Impact: A Re-Aim Framework For Evaluation Of A Needle Exchange Program, Lindsay Novacek

Doctor of Nursing Practice (DNP) Projects

Background: Needle exchange programs (NEPs) have been widely documented over the past three decades as an effective and economic approach to controlling human immunodeficiency virus (HIV). As of July 1st, 2016, these programs have been legalized in North Carolina. Purpose: To perform stage 1 of an evaluation of a needle exchange program in North Carolina by utilizing a public health framework: the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Methods: First, the RE-AIM framework was used to create a plan for a program evaluation of a local NEP. Then, the first stage of the evaluation was completed. NEP program participants …

Improving Blood Pressure Control Among Hispanic Patient Population By Enhancing Providers' Attention To Culturally Competent Solutions Aimed At Increasing Self-Care And Treatment Adherence At And Post Hospital Discharge: A Quality Improvement Project, Katarzyna Swistak

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Hypertension is a primary, preventable risk factor for coronary heart disease, heart failure, and stroke. However, despite advances in preventive care and treatment modalities related to blood pressure control, the prevalence of hypertension in the United States remains at an undesirable level and disproportionately affects Hispanic patients. Purpose: The purpose of this quality improvement (QI) project was to determine if a culturally sensitive, multifaceted intervention focused on promotion of hypertension awareness and self- management strategies increases treatment compliance and blood pressure control among Limited English Proficiency (LEP) Hispanics. Design/Methods: The DNP project included a QI …

Development And Evaluation Of An Emergency Department-Based Nurse Practitioner Care Delivery Model, Tiesha Johnson

Doctor of Nursing Practice (DNP) Projects

Background: Acute mental health care needs are not always optimally managed in the Emergency Department (ED) with the traditional approach to care and management. The ED encounter for psychiatric patients is lengthy, costly, fragmented, inefficient and often ineffective, contributing to poor outcomes.. Purpose: To introduce the evidence- based advanced nursing practice model to ED professionals and staff for feedback and evaluation of an ED-based Psychiatric Nurse Practitioner care delivery model for the acute care of psychiatric patients. Implementation: The care delivery model was created based on evidence and presented to professionals and staff at one medical center ED. A focus …

Center Based Help For Elder Depression And Emotional Reinforcement (Cheer), Jennifer Taylor

Doctor of Nursing Practice (DNP) Projects

Purpose.

The aim of this project was to decrease depression of those socially isolated, and/or homebound seniors, through behavioral activation by using CHEER and emotional support, along with bridging access to programs and the needs of seniors in the community.

Background.

As we age we face functional, medical, and social complexities that frequently become hard to manage. Depression is a problem that is present but often goes unrecognized in society. It is more prevalent in younger adults, however, depression has more acute affect in older persons. Depression can potentially be debilitating and increase adverse events with other health issues such …

Delivering Culturally Competent Care To The Lesbian, Gay, Bisexual, And Transgender (Lgbt) Population, Evan M. Mcewing

Doctor of Nursing Practice (DNP) Projects

Purpose: To this day, the lesbian, gay, bisexual, and transgender (LGBT) communities still experience negative health outcomes due to social stigma and discrimination. Additionally, nursing has lagged behind other health professions in the promotion of culturally competent care to members of this minority group. Several national authorities on LGBT health have proposed guidelines for providing such care to the LGBT population; however, many nursing schools are not integrating these recommendations into their curricula. Methods: Using these national guidelines, an educational program was developed for BSN students at a large south Florida university to improve competency in providing care for LGBT …

Improving Overall Health Outcomes Through Public Health Workforce Development, Zienna Blackwell

Doctor of Nursing Practice (DNP) Projects

Poor health outcomes among South Carolinians, indicated by an overall U.S. health ranking of 42 (America's Health Rankings, 2016) may be the result of an underdeveloped public health workforce. This can be mediated through a thorough assessment of the public health workforce followed by the implementation of a workforce development plan. The purpose of this quality improvement project was to assess the competency level of the South Carolina public health workforce and to develop, implement, and evaluate a workforce development plan to address the weaknesses identified through the assessment process. The Competency Assessment for Public Health Professionals developed by the …

Fluoride Varnish Application In The Pediatric Population, Ellen Gnaedinger

Doctor of Nursing Practice (DNP) Projects

Purpose: The United States (U.S.) has a persistent problem of dental caries in primary teeth with a greater prevalence of dental caries found in minority and poor children. The majority of children in the U.S. experience dental caries in their primary teeth by age eight. This problem could be addressed by primary care providers applying fluoride varnish (FV) to children's teeth starting at the age of primary tooth eruption. The causes of dental caries in children’s primary teeth are multifactorial and therefore require multiple interventions. Around the world providers are utilizing FV as an effective and easily administered strategy. This …

Pneumococcal Pneumonia In The Older Adult: Increasing Patient Education And Vaccination, Jessica E. Valletta

Doctor of Nursing Practice (DNP) Projects

Background:Pneumococcal disease is a transmitted infectious illness that results in serious complications and death every year in the United States. Given their increased susceptibility to the potential complications of this disease, patients aged 65 and older are considered to be high-risk, but vaccination compliance for this population remain well below state and national goals.

Purpose: The purpose of this project was to increase pneumococcal vaccination rates among adults aged 65 and older in a primary care clinic by increasing patient education.

Methods: An educational intervention was implemented within a large primary care practice located in Central Massachusetts. Educational …

Education Intervention Of Preconception Screening In Primary Care, Tracy Schuler

Doctor of Nursing Practice (DNP) Projects

Problem: The risk of a poor pregnancy outcome among women of reproductive age in Providence, Rhode Island is indicated by the high rates of unintended pregnancies, low multivitamin use prior to pregnancy, obesity, and smoking. Although recommended, health professionals often fail to routinely screen and educate women of reproductive age for preconception risk factors. Purpose: Evaluate the efficacy of an educational intervention on preconception risk factors, lifestyle modifications, and current screening recommendations; and introduce a preconception tool and education sheet among a population of health care providers. Method: Preconception health material and a modified preconception screening tool …

Improving Hpv Vaccination Initiation And Completion Rates: A Qi Project, Princy M. Varughese

Doctor of Nursing Practice (DNP) Projects

Human papillomavirus (HPV) is a common sexually transmitted infection in the United States and is the cause of most cervical cancers in women, as well as anogenital cancers, oropharyngeal cancer, and genital warts in both men and women (Centers for Disease Control [CDC], 2014b). The HPV vaccine is recommended for preteen girls and boys to protect against HPV infections (CDC, 2011). In line with the goal of Healthy People 2020, the purpose of this evidence-based quality improvement (QI) project was to implement a text message reminder system, and calculate the completion rate of the 3-dose HPV vaccination series among adolescents …

Perceived Family Support And Antiretroviral Adherence In Hiv-Positive Individuals: Results From A Community-Based Positive Living With Hiv Study, Krishna Poudel, David Buchanan, Rachel Amiya, Kalpana Poudel-Tandukar

Elaine Marieb College of Nursing Faculty Publication Series

The purpose of this study was to examine the association between perceived family support, either positive or negative, and adherence to antiretroviral medication regimens among HIV-positive individuals in the Kathmandu Valley, Nepal. We measured past 3-month antiretroviral adherence among 233 HIV-positive individuals, in relation to perceived family support, both positive (in terms of emotional and instrumental support) and negative (in the form of negative interactions), using the 10-item Nepali Family Support and Difficulty Scale. Medium and high levels of perceived emotional support from family were associated with reduced risk of antiretroviral nonadherence, compared with low levels of perceived emotional support …

Asthma Education And Care Coordination In The Medical Home, Veronica G. Mansfield

Doctor of Nursing Practice (DNP) Projects

Asthma is the most common chronic disease in childhood. In spite of the many advances in the medical management of asthma, families frequently seek treatment for acute exacerbations of asthma in the emergency department. The purpose of this project was to evaluate asthma care provided to pediatric patients at a community health center in New England through scheduled nursing visits for asthma education and care coordination. The asthma education and care coordination program was developed based on both the NHLBI, NAEPP, Expert Panel 3, 2007 guidelines and ANA White Paper and Agency for Health Care Quality (AHRQ) value of nursing …

Serum Zinc Concentration And C-Reactive Protein In Individuals With Human Immunodeficiency Virus Infection: The Positive Living With Hiv (Polh) Study, Krishna Poudel, Elizabeth Bertone-Johnson, Kalpana Poudel-Tandukar

Elaine Marieb College of Nursing Faculty Publication Series

Low zinc levels and chronic inflammation are common in individuals infected with human immunodeficiency virus (HIV). Zinc deficiency may promote systemic inflammation, but research on the role of zinc in inflammation among HIV-positive individuals taking account of antiretroviral therapy is lacking. We assessed the association between serum zinc and C-reactive protein (CRP) concentration in a cohort of HIV-positive individuals. A cross-sectional survey was conducted among 311 HIV-positive individuals (177 men and 134 women) aged 18–60 years residing in Kathmandu, Nepal. High-sensitive or regular serum CRP concentrations were measured by the latex agglutination nephelometry or turbidimetric method, and zinc concentrations were …

Parents' Gender Ideology And Gendered Behavior As Predictors Of Children's Gender-Role Attitudes: A Longitudinal Exploration, Hillary Paul Halpern

Masters Theses

This longitudinal study examined the association between parents’ early and concurrent gender ideology and gendered behaviors and their children’s gender-role attitudes at age six. Specifically, parents' global beliefs about women's and men's "rightful" roles in society, as well as their work preferences for mothers, were considered in relation to the gender-role attitudes held by their first-graders. In addition, parents’ gendered behaviors, including their division of household and childcare tasks, division of paid work hours, and job traditionality were examined as predictors of children’s gender-role attitudes. Based on previous research, it was hypothesized parents’ early and concurrent behavior and ideology would …

Copd Dyspnea Palliation Project: Dyspnea Palliation In End-Stage Copd Patients, Kaveri M. Roy

Doctor of Nursing Practice (DNP) Projects

Chronic Pulmonary Obstructive Disease (COPD) is a chronic and incurable disease that affects over 12 million Americans. The number of people with COPD is rising, and it is the third leading cause of death in the United States. Management and palliation of COPD symptoms has become a public health issue. The capstone project, the COPD Palliation Project, was a pilot study that combined nursing case management and patient education to provide optimal patient dyspnea palliation and self-efficacy of dyspnea management to end-stage COPD hospice patients. For the intervention, end-stage COPD patients were taught to use a dyspnea algorithm to palliate …

Perceived Family Support And Depression Among People Living With Hiv/Aids In The Kathmandu Valley, Nepal, Sadhana Shrestha, Krishna Poudel, Kalpana Poudel-Tandukar, Jun Kobayashi, Basu Dev Pandey, Junko Yasuoka, Keiko Otsuka, Masamine Jimba

Elaine Marieb College of Nursing Faculty Publication Series

Background: Depression is emerging as a highly prevalent psychiatric condition among people living with HIV/AIDS (PLWHA). Perceived family support (PFS) buffers depression among chronic disease patients. However, a similar relationship among PLWHA is unexplored. Objective: To examine the relationship between PFS and depression among PLWHA in the Kathmandu Valley, Nepal. Methods: In this cross-sectional study, depression was measured by Beck Depression Inventory Ia. Perceived family support was measured by Nepali Family Support and Difficulties Scale. The status of depression was compared between 208 PLWHA and 208 HIV-negative participants. The relationship between PFS and depression was examined only among PLWHA. Results: …

Smoking Cessation Increases Short-Term Risk Of Type 2 Diabetes Irrespective Of Weight Gain: The Japan Public Health Center-Based Prospective Study, Shino Oba, Mitsuhiko Noda, Kayo Waki, Akiko Nanri, Masayuki Kato, Yoshihiko Takahashi, Kalpana Poudel-Tandukar, Yumi Matsushita, Manami Inoue, Tetsuya Mizoue, Shoichiro Tsugane

Elaine Marieb College of Nursing Faculty Publication Series

Objective: The effect of smoking cessation on the risk of diabetes has been reported previously. However, it is unknown whether the association is influenced by weight gain and other potential risk factors. Methods: The Japan Public Health Center-Based Prospective Study established in 1990 for Cohort I and in 1993 for Cohort II provided data, and 25,875 men and 33,959 women were analyzed. The response rate to the baseline questionnaire was 80.9%, and 68.4% of the respondents participated both the 5- and 10-year follow-up surveys. Smoking cessation was noted during the initial five years and the development of diabetes was reported …

Heightening Mental Health Awareness On A Diverse, Urban Public University Campus Through A Media Outreach Campaign, Kathleen R. Golden Mcandrew

Doctor of Nursing Practice (DNP) Projects

Abstract

Mental health problems among students on college campuses have increased in severity over the last decade. On-campus health providers have reported seeing students with more complex problems such as depression, bipolar disorder, and mixed diagnoses that require frequent and regular follow-up and treatment. Students who require mental health services assistance from on-campus services need to be informed about what resources and services are available and how to access them. Since most on-campus counseling services are set up as short-term treatment models, providing students with community-based resource options is also important.

The purpose of this capstone project was to examine …

Using An Evidence Based Practice Informatics Guided Medication Safety Intervention To Improve Medication Safety Among Community Dwelling Older Adults, Raeann G. Leblanc

Doctor of Nursing Practice (DNP) Projects

Medication safety and prevention of medication related problems are important issues in promoting and maintaining health and safety in one’s home for community dwelling older adults. Assessment of medications and management of a medication schedule are essential elements of medication safety, medication review, and medication care coordination. The Framework for Geriatric Homecare Excellence (Collaboration for Home Care Advances and Practices, 2009) is used as the foundation of this project to improve medication management, and promote and maintain health and safety at home. An in-home medication assessment was completed, using a medication management software informatics system to review medications, identify medication …

Relationship Of Serum Fatty Acid Composition And Desaturase Activity To C-Reactive Protein In Japanese Men And Women, Kalpana Poudel-Tandukar, Masao Sato, Yuko Ejima, Akiko Nanri, Yumi Matsushita, Katsumi Imaizumi, Tetsuya Mizoue

Elaine Marieb College of Nursing Faculty Publication Series

Background: Although fatty acid composition in serum and desaturase activity, which alters serum fatty acid composition, has been associated with C-reactive protein (CRP) concentration in Western populations, no study has been carried out in non-Western populations. We examined the association of serum fatty acids and estimated desaturase activity with CRP concentrations in Japanese men and women. Methods: Subjects were 489 Japanese municipal employees aged 21–67 yearswhoparticipated in a survey at the time of a periodic health check-up. Serum high-sensitivity CRP concentrations were measured using the latex agglutination nephelometry method. Fatty acid composition was measured in serum cholesteryl esters and desaturase …

Social Support And Suicide In Japanese Men And Women E The Japan Public Health Center (Jphc)-Based Prospective Study, Kalpana Poudel-Tandukar, Akiko Nanri, Tetsuya Mizoue, Yumi Matsushita, Yoshihiko Takahashi, Mitsuhiko Noda, Manami Inoue, Shoichiro Tsugane

Elaine Marieb College of Nursing Faculty Publication Series

Although the important role of social support in mental health is acknowledged, no prospective study has yet examined the relation of social support to suicide. Here, we investigated the associationbetween social support and suicide in a cohort of Japanese men and women. A total of 26,672 men and 29,865 women aged 40e69 years enrolled in the Japan Public Health Center-based prospective study in1993e1994 completed a self-administered questionnaire which included four items of social support, and were followed for death through December 2005. Hazard ratios (HRs) and 95% confidence intervals (95% CI) of suicidal death by social support index were estimated …

Differences In Suicide Risk According To Living Arrangements In Japanese Men And Women – The Japan Public Health Center-Based (Jphc) Prospective Study, Kalpana Poudel-Tandukar, Akiko Nanri, Tetsyta Mizoue, Yumi Matsushita, Yoshihiko Takahashi, Mitsuhiko Noda, Manami Inoue, Shoichiro Tsugane

Elaine Marieb College of Nursing Faculty Publication Series

Background: Living alone has been suggested as a risk factor for suicide. However, the effect on suicide risk of living together with spouse, child(ren) and parent(s) is unclear. This study aims toexamine the association between living arrangements with spouse, child(ren), and parent(s) and suicide in a Japanese men and women.Methods: Altogether 104, 528 participants aged 40–69 years, who completed baseline questionnaire (1990–1994), were followed for death through December 2005. We used Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for suicide according to living arrangements.Results: During an average 13.2-year follow up, …