Nursing Commons^™

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Implementation Of Cocare Help, Kara Marie Roman, Aaron Mestemaker

Masters Projects

Background: Delirium is a common disturbance in cognition among older adults in the hospital setting. It is associated with negative outcomes and high costs for patients, families, and hospital systems. Use of a reliable screening tool and evidence-based strategies such as CoCare: HELP demonstrates delirium prevention and functional decline in many geriatric hospitalized patients.

Objectives: This study examines the impact of implementing aspects of CoCare: HELP on two pilot units in an urban Midwestern hospital. Pre- and post-implementation measures of delirium rate, 30-day admission rate, length of stay, falls with injuries, safety attendant orders, restraint numbers, use of antipsychotics, and …

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Implementation Of Cocare Help, An Evidence-Based Intervention, Kara M. Roman, Aaron Mestemaker

Masters Projects

Background: Delirium is a common disturbance in cognition among older adults in the hospital setting. It is associated with negative outcomes and high costs for patients, families, and hospital systems. Use of a reliable screening tool and evidence-based strategies such as CoCare: HELP demonstrates delirium prevention and functional decline in many geriatric hospitalized patients.

Objectives: This study examines the impact of implementing aspects of CoCare: HELP on two pilot units in an urban Midwestern hospital. Pre- and post-implementation measures of delirium rate, 30-day admission rate, length of stay, falls with injuries, safety attendant orders, restraint numbers, use of antipsychotics, and …

Trauma And Resiliency, Madelyn Ferguson

Honors Projects

Life is a series of events, some overwhelmingly positive and others devastatingly negative. Because of the inevitability of adversity, one must learn to adapt to negative circumstances. However, people react to trauma in different ways with some seeking to take their own lives and others finding a healthy outlet. What causes such a difference in our reactions to trauma? Is it simply the power of thought or is there a genetic component? What can I do to build my own resilience and promote the resilience of others around me? The purpose of this paper is to explore the relationship between …

Interprofessional Education Lab Manual And Workbook, Geraldine Terry

Open Textbooks

This laboratory manual was designed to educate and develop integrated healthcare practices essential in delivering person-centered care. Participants will develop their ability to distinguish the role of their own profession and other healthcare professionals collaborating in the care coordination and case management of patients. The content and team-oriented activities in this manual provide guidance on advancing leadership and communication principles necessary for effective interprofessional communication and team collaboration. The well-researched material is tailored to build on the strengths of participants, while also identifying and encouraging areas for improvement.

Engaging Caregivers To Use An Evidence‑Based Intervention For Medicaid Benefciaries With Alzheimer’S Disease: A Pilot Study, Sandra Lee Spoelstra, Alla Sikorskii, Monica Schueller, Viktoria Basso, Autumn Baldwin

Peer Reviewed Articles

Background This pilot study aimed to adapt an intervention, engaging informal caregivers to help clinicians with providing care to improve (or maintain) physical function of individuals with Alzheimer’s Disease or other dementias. To the best of our knowledge, for the frst time, we report on use of the intervention in those with Alzheimer’s Disease or other dementias.

Methods This was a 5-month mixed methods cohort study in a convenience sample of clinicians, caregivers, and benefciaries at 3-Medicaid Home and Community-based Service sites in Michigan. Two content experts and 5 caregivers modifed the intervention. We trained 116 clinicians to engage caregivers …

Results Of A Multi-Site Pragmatic Hybrid Type 3 Cluster Randomized Trial Comparing Level Of Facilitation While Implementing An Intervention In Community-Dwelling Disabled And Older Adults In A Medicaid Waiver, Sandra Spoelstra, Monica Schueller, Viktoria Basso, Alla Sikorskii

Peer Reviewed Articles

Background: Evidence-based interventions that optimize physical function for disabled and older adults living in the community who have difficulty with daily living tasks are available. However, uptake has been limited, particularly in resource-constrained (Medicaid) settings. Facilitation may be an effective implementation strategy. This study’s aim was to compare internal facilitation (IF) versus IF and external facilitation (EF) on adoption and sustainability of an intervention in a Medicaid home and community-based waiver.

Methods: In a hybrid type 3 trial, waiver sites (N = 18) were randomly assigned to implement the intervention using a bundle of strategies with either IF or IF …

Formalized Diabetes Education In A Safety-Net Clinic, Haley N. Wanic

Doctoral Dissertations & Projects

Uncontrolled diabetes mellitus in a Hispanic population can be helped through a quality improvement project focused on progressive verbal and written diabetes self-management education (DSME) Purpose of this article is to review the background, an organizational assessment, a literature review, results of the quality improvement project that took place at a safety-net clinic in the Midwest. This project included four patients and data was analyzed through descriptive statistics. Results include improved hemoglobin (Hg) A1c, minimal workflow adjustments for providers, completed microalbumins, and written education given to patients. In conclusion, the quality improvement project showed positive trends in outcome measures over …

End The Stigma: Strategies To Improve Mental Health, Alexia M. Frantzeskakis

Honors Projects

The project discusses coping strategies that students can utilize to improve their mental health. A paper, along with five fliers that will be distributed to incoming freshmen were developed. Each flier discusses a different coping strategy on the following topics: physical activity, mindfulness, social media use, routines, and resources available to students in the community.

Know The Signs Of An Allergic Reaction: Anaphylaxis, Sarah R. Remillard

Honors Projects

The purpose of this project was to develop a food allergy informational poster for use in the classroom. The Center for Disease Control has estimated that an average of two children in each public school classroom in the United States struggled with a food allergy. Meanwhile, other researchers found that 25% of first-time anaphylaxis episodes occurred in classrooms. This Honors Project was developed to address the informational gap concerning anaphylaxis that occurs at schools. The methodology was literature review. The Honor Project's outcome was the informational poster, Know the Signs of an Allergic Reaction: Anaphylaxis, as well as the supplemental …

Improving Provider Adherence To Ada Clinical Practice Guidelines: A Qi Project In A Patient Centered Medical Home, David H. Kamp

Masters Projects

Background and purpose: Diabetes is the leading cause of kidney failure, lower limb amputations, and adult blindness. The American Diabetes Association recommends timely screenings to reduce complications. Flowsheets facilitate improved outcomes. The project implemented an electronic flowsheet to promote staff adherence to select screenings.

Methods: Screenings included foot exam, eye exam, glycohemoglobin, microalbumin creatinine ratio, lipid profile, and anti-hypertensive medication. Staff viewed the flowsheet to determine screening eligibility per ADA guidelines. Quantitative and qualitative data analyzed.

Results: Quantitative results: 40% improvement among medical assistants (MAs) completing foot exams and 75.53% improvement among providers ordering eye exams. No statistical significance among …

Nur 265: Introduction To Nursing Research And Evidence-Based Practice Oer Curation, Chealsye Bowley

Curated OER Collections

This OER curation is an annotated bibliography of prospective OER for the GVSU course NUR 265: Introduction to Nursing Research and Evidence-based Practice.

Nur 621: Clinical Pathophysiology Oer Curation, Chealsye Bowley

Curated OER Collections

This OER curation is an annotated bibliography of prospective OER for the GVSU course NUR 621: Clinical Pathophysiology, assembled by request from the instructor.

Development Of A Point-Of-Care Ultrasonography Workflow Within A Rural Clinic, Lauren Myers

Masters Projects

Abstract

Background and Objectives: Healthcare has revolutionized with advancements in ultrasound technology. Among these advancements and the increasing availability of imaging modalities is point-of-care ultrasonography (POCUS) technology.

Problem: While POCUS has gained considerable ground in primary care, infrastructure to support its utility is deficient. The purpose of this project was to design, pilot, and evaluate a POCUS workflow to facilitate technology utilization and increase access to care.

Methods: Program development and evaluation involves the design, implementation, and evaluation of an evidence-based workflow for POCUS technology. The project was intended to address the needs of individuals in a rural setting. Participants …

Improving Patient Portal Enrollment Through Education And Technology At Rural Family Practice, Kelsey Crampton

Doctoral Dissertations & Projects

Background: Patient portals are available through many healthcare offices. They offer the opportunity to improve patient engagement and quality of patient care, but few patients enroll. At a small rural primary care office, less than 20% of the patients were enrolled in the patient portal.

Objective: The purpose of this quality improvement project was to address the barriers reported by patients at this clinic and determine whether changes in portal enrollment volume occurred. Reported barriers included a lack of knowledge about the portal and difficulties with the sign-up process.

Methods: Over three months, strategies included the development of a …

Development Of A Care Management Program Within An Urban Health Center, April M. Butler

Masters Projects

Abstract

Care management (CM) services offered in primary care settings are used to increase patient engagement in self-care and improve communication between patients and health care providers. The aim of this article is to describe the creation of an evidenced-based toolkit within an urban health center that addresses the structures, processes, and outcome measures necessary for the development of a sustainable CM program. Based on the findings from an organizational assessment and comprehensive literature synthesis, several policies, procedures, and workflow diagrams of processes within the health center were created to guide the implementation of a CM program.

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Pre-Implementation Of Cocare Help, Thomas D. Finn, Autumn Baldwin, Elizabeth Hill

Doctoral Dissertations & Projects

Background: Delirium is a change in consciousness characterized by rapid onset and fluctuating attention, causing impairment in the ability to process and recall information, occurring in 30% of hospitalized older adults. Delirium can increase falls, length-of-stay, mortality, and cost. The CoCare Hospital Elder Life Program® (HELP) is an evidence-based bundle of interventions targeting cognitive impairment, sleep deprivation, immobility, visual/hearing impairment, and dehydration, embedding geriatric principles in care to prevent delirium.

Objectives: To further analyze the pre-implementation of the HELP in order to optimize success of program administration.

Methods: Mixed methods were used to collect retrospective/prospective data (interviews (N=25], surveys [N=25], …

Adverse Childhood Experiences: Effects Of Covid-19, Evan Guo

Honors Projects

The evaluation of an adult's health status consists of several entities. These factors can include physical, mental, and emotional health in an individual's history contributing to their overall health. When studying such factors, some researchers emphasize the importance of recognizing events experienced during a person's childhood that affect their development, and therefore, their adult health status. Today, as people continue adapting to the COVID-19 pandemic and changes in regulation of standards for socialization, it is becoming apparent to healthcare researchers how these new modifications are highly impactful to the development of children and adolescents. When studying the various factors that …

Evidence-Based Recommendations For Assistive Technologies For Safety In Dementia Care, Lee A. Diener

Masters Projects

A Quality Improvement (QI) project in a Midwestern Continuing Care Residential Community (CCRC) was designed to examine the evidence-base of four assistive technology platforms marketed as safety platforms as means to improve outcomes for older adults residing in memory care environments. Using the Evidence-Based Design Model Socio-Technical Systems Theory, survey data and observational data collected from the organization were considered with respect to the evidence-base supporting each technology. Ten organizational priorities derived from collected data were used to develop an Evidence-Based Assistive Technology Fitness score for each of the AT platforms reviewed. This methodology provides a means to evaluate planning …

Michigan Physician Orders For Scope Of Treatment: Development Of A Nationally Recognized Program, Megan Owens

Doctoral Projects

Background: Advance directives are well intentioned, but fail to promote patient autonomy in emergent situations.

Objective: To develop a sustainable portable medical order program consistent with national standards through an evidence-based toolkit.

Methods: A literature review and policy analysis were conducted to develop toolkit. Interviews were conducted with content experts to validate toolkit.

Results: The final toolkit consisted of five components: educational materials for healthcare providers, a policy brief, strategies for fund development, strategies for quality monitoring, and a cost savings exemplar.

Conclusions: An evidence-based toolkit tailored to state-specific barriers is critical to development of a portable medical order program.

Improving Adolescent Risk Assessment And Provider Follow-Up In Primary Care, Darby R. Disselkoen

Doctoral Projects

Purpose: The purpose of this quality improvement project was to improve preventive care for adolescent patients by implementing standardized, routine screening for risk-taking behaviors and improving provider response to identified risks using the Rapid Assessment for Adolescent Preventive Services tool and resources for providers to reference during discussions about risk.

Methods: Quality improvement methodology was utilized at a midwestern pediatric primary care office to implement a practice workflow for staff to follow during annual, adolescent wellchild exams beginning at age thirteen.

Results: Analysis of project results demonstrated a significant increase in routine screening for adolescent risk behaviors compared to the …

Evaluating The Impact Of Nurse Server Standardization On Patient Safety, Megan L. Priebe

Doctoral Projects

Aim: The aims of nurse server (supplies at bedside) standardization program evaluation were to: (1) examine supply costs; (2) identify staff efficiency; (3) evaluate patient safety; (4) identify staff satisfaction and acceptance.

Background: A healthcare facility in the Midwest implemented standardization of the nurse server. Standardization was done to improve patient safety and staff efficiency

Methods: The literature provided metrics for evaluating standardized nurse servers to determine the impact on patient safety. Specific measures used in this quality improvement project were: census data, costs analysis, supply room observations, semi-structured interviews, and data from the VOICE reporting system (system for adverse …

Evaluation Of A Chewing Gum Protocol For Postoperative Spinal Patients, Lauren E. Vachon

Doctoral Projects

Aims and objectives: The purpose of this project was to evaluate if the implementation of a chewing gum protocol improved bowel motility, decreased ileus rate, length of stay, bowel and pain medication use, and hospital costs in post-surgical spinal patients in a suburban hospital.

Background: Postoperative bowel dysfunction is a major source of health problems, including abdominal pain, ileus, increased length of stay, pain medication use, and healthcare costs.

Design: Retrospective cohort study with a focus on program evaluation of the previously implemented chewing gum protocol. An audit of the electronic health record compared outcomes in patients five months before …

A Program Evaluation To Assess Readiness For The National Committee For Quality Assurance’S Patient Centered Medical Home Model Application, Alida M. Semrinec

Doctoral Projects

The Patient Centered Medical Home Model is associated with enhanced patient experience and quality improvement outcomes. The Model has the capacity to guide primary care practices to enhance quality, provide more comprehensive, patient centered care, and increase practice revenue. An urban, nurse managed community health center that has recently implemented the nurse care manager role (a Model requirement) desires to apply for recognition. A program evaluation was conducted to assess current practice, policies, and procedures in place at a Community Health Center through the lens of the National Committee for Quality Assurance’s forty Patient Centered Medical Home Model core competencies. …

Utilization Of Home Blood Pressure Monitoring In Adult Patients With Hypertension, Justin R. Crow

Doctoral Projects

Hypertension is one of the most prevalent conditions in the United States, affecting roughly 45% of adults in the country (Centers for Disease Control and Prevention [CDC], 2020). The CDC (2020) reports that only an estimated 24% of patients have controlled blood pressure, which is defined as blood pressure less than 130/80 mm Hg. In 2017, the American Heart Association (AHA) and American College of Cardiology (ACC) released a comprehensive set of guidelines that aimed to assist providers with hypertension management. The Measure Accurately, Act Rapidly, and Partner with Patients (MAP) protocol was formulated as an evidence-based strategy to improve …

Enhancing Medication Adherence Behaviors Among Ambulatory Pediatric Hematology & Oncology Patients: A Quality Improvement Project, Desiree Palmer

Doctoral Projects

Introduction: Researchers have found that pediatric patients with acute lymphoblastic leukemia and adolescent patients with sickle cell disease struggle to adhere to medication treatment requirements. Because of this trend, there is a clear need to address medication adherence. The purpose of this quality improvement project was to enhance medication adherence behaviors among pediatric hematology and oncology patients and their families within an ambulatory hematology and oncology clinic.

Methods: The project included a systematic literature review to identify evidence-based interventions, an organizational assessment, and a three-phase multifaceted quality improvement process. To increase patients bringing medications to appointments, 32 medication transportation bags …

Faces Of Aces For Nursing Education, Kelsey Bredeweg, Angela Raterink

Honors Projects

Adverse childhood experiences (ACEs) are traumatic events that occur in childhood. They include children experiencing violence, abuse, neglect, or witnessing violence in the home. ACEs also incorporate environmental factors that threaten a child's stability and safety, such as having family members struggle with substance abuse, mental health, or instability due to parental separation or absent family members. There is significant evidence that ACEs are related to negative health outcomes in adulthood including chronic health problems, mental illness, and substance misuse. ACEs are common and experienced by many. According to the Centers for Disease Control and Prevention, 1 in 6 adults …

Registered Nurses’ Images Of Nursing During A Pandemic, Abigail Slaktowski

Honors Projects

The purpose of this research study was to discover any new or transformed images of nursing during the COVID-19 pandemic in the United States. The research question was “What are Registered Nurses’ images of nursing while working during a pandemic?” Registered nurses submitted an image and a brief narrative of the image through REDCap ©, a secure database, describing how the image and culture of nursing is impacted by the COVID-19 pandemic. Using Leininger’s Four Phases of Data Analysis (1991), the five submitted photos and narratives were analyzed. Data analysis revealed fourteen categories, then five patterns, then two final themes: …

Compassion Fatigue In Nursing: How Can It Be Prevented?, Megan J. Vlahos

Honors Projects

A literature review paper that discusses the prevalence of compassion fatigue among acute care nurses and interventions that can be implemented to prevent it from occurring.

Improving Handover Process For Stroke Patients Transferring From Emergency Department To Interventional Radiology: A Quality Improvement Project, Megan Buchman

Doctoral Projects

Background: A standardized handover process is needed for stroke patients transferring from the Emergency Department to Interventional Radiology.

Local Problem: Emergency Department and Interventional Radiology had different handover processes.

Methods: A quality improvement project was conducted in a large Magnet® designated midwestern health system. Participants included emergency department and interventional radiology nurses and stroke patients. Pre/post-quality and post implementation measures were obtained.

Interventions: The interventions included utilizing a standardized handover tool between departments, calling report prior to patient transfer, and turning in handover tool following stroke case to ensure compliance. Two cycles of the Plan-Do-Study-Act Cycle were completed.

Results: No …

“Warm Handoff” To Increase Enrollment In A Maternal Infant Health Program, Samantha Worthem

Doctoral Projects

Introduction: In a Midwest Health Department’s (HD) Maternal Infant Health Program (MIHP), infant death rate has been on a steady incline at 4.8 deaths per 1,000 in 2019 (Michigan Department of Community Health, 2020). Implementation of a “warm handoff” between the local HD and Michigan Department of Health and Human Services (MDHHS) was created to increase enrollment and visits. During warm handoffs, health care providers work together within the same setting to provide evaluation and care to patients and clients (Musselman et al., 2018).

Methods: This program evaluation reviewed data retrospectively from March 31 to September 30, for 2019 and …