Nursing Commons^™

Health Outcomes Of Adolescents And Young Adults After Traumatic Injury: The Role Of Stress Resilience And Social Support, Belanie Peavy

Dissertations and Theses (Open Access)

Background: Traumatic injury is a major health problem and has been linked to mental and physical disability following injury. Although it is the leading cause of disability in the United States (US) for adolescents and young adults, there is a paucity of evidence in the literature regarding association(s) of perceived stress on the outcomes of anxiety and depressive symptoms and the moderating role of resilience and social support in which to develop prevention and treatment interventions for this patient population.

Purpose: The purpose of this study was to examine the effect of perceived stress on anxiety and depressive symptoms …

Scientific Proceedings Of The Texas Children’S Hospital’S 17th Session Of The Advanced Quality Improvement And Patient Safety Program, Arjun M. Dangre Bds Mph, Kelly Wallin Ms Rn Chse, Gertrude A. Leidich Mba, Rn, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety (AQI) Program is a six month mixed didactic and experiential learning experience designed to improve patient care, lower costs, change the culture, and develop quality leaders. As a part of AQI program participants are grouped into teams and each team completes a healthcare related Quality Improvement (QI) project. Each project demonstrates use of various QI tools including process maps, fishbone diagrams, and key driver diagrams. The projects use ‘Model for Improvement’ as the primary QI methodology to achieve their aim. Three or more Plan-do-study-act (PDSA) cycles are required for each …

Scientific Proceedings Of The Texas Children’S Hospital’S 16th Session Of The Advanced Quality Improvement And Patient Safety Program, Arjun M. Dangre Bds, Mph, Kelly Wallin Ms, Rn, Chse, Gertrude A. Leidich Mba, Rn, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety (AQI) Program is a six month mixed didactic and experiential learning experience designed to improve patient care, lower costs, change the culture, and develop quality leaders. As a part of AQI program participants are grouped into teams and each team completes a healthcare related Quality Improvement (QI) project. Each project demonstrates use of various QI tools including process maps, fishbone diagrams, and key driver diagrams. The projects use the IHI ‘Model for Improvement’ as the primary QI methodology to achieve their aim. Three or more Plan-do-study-act (PDSA) cycles are required …

Evidence-Based Skin Champion Program Reduces Pressure Injuries In A Pediatric Hospital, Alexandra Luton Mn, Rn, Ncns-Bc, Mary D. Gordon Phd, Rn, Cns-Bc, Megnon Stewart Msn, Rn, Ellena Steward-Scott Msn, Rn, Joellan Mullen Msn, Rn, Ccrn-K, Angela Jones Mn, Rn, Ne-Bc, Joseph Hagan Scd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Prevention of pressure injuries (PIs) in pediatric patients is an important nurse-sensitive quality goal. The PI rate at a large urban pediatric hospital triggered a call to action by the Chief Nursing Officer to establish a Hospital Acquired PI (HAPI) Task Force which identified the Skin Champion program as a key improvement strategy. The goals of the Skin Champion program are to lower the rate of HAPIs, empower front line care providers to implement evidence-based care bundles, achieve consistency of practice, and provide resource availability at the point of care. The implementation of the Skin Champion quality improvement program achieved …

Exome Sequencing Identifies Gene Variants And Networks Associated With Extreme Respiratory Outcomes Following Preterm Birth, Aaron Hamvas, Rui Feng, Yingtao Bi, Fan Wang, Soumyaroop Bhattacharya, Jared Mereness, Madhurima Kaushal, C Michael Cotten, Philip L Ballard, Thomas J Mariani

Faculty, Staff and Student Publications

BACKGROUND: Previous studies have identified genetic variants associated with bronchopulmonary dysplasia (BPD) in extremely preterm infants. However, findings with genome-wide significance have been rare, and not replicated. We hypothesized that whole exome sequencing (WES) of premature subjects with extremely divergent phenotypic outcomes could facilitate the identification of genetic variants or gene networks contributing disease risk.

RESULTS: The Prematurity and Respiratory Outcomes Program (PROP) recruited a cohort of > 765 extremely preterm infants for the identification of markers of respiratory morbidity. We completed WES on 146 PROP subjects (85 affected, 61 unaffected) representing extreme phenotypes of early respiratory morbidity. We tested for …

2018 Dnp Graduate Project Abstracts, Uthealth Cizik School Of Nursing

Doctor of Nursing Practice Projects 2018-2023

The UTHealth Cizik School of Nursing proudly presents the DNP Project abstracts for the 2018 Class of DNP Graduates.

Associations Between Physical Activity, Health-Related Quality Of Life, Regimen Adherence, And Glycemic Control In Jordanian Adolescents With Type 1 Diabetes, Yousef Aljawarneh

Dissertations and Theses (Open Access)

Background: Adolescents with Type 1 Diabetes (T1D) display a greater than two-fold higher risk of developing microvascular and macrovascular complications compared with the non-diabetic population and the risk increases markedly as glycated hemoglobin (HbA1c) increases. The majority of the findings on the associated factors with improved glycemic control are geared toward Western population with a clear lack of studies on Middle Eastern populations.

Purpose: This study aimed to examine the effect of Physical Activity (PA), Health-Related Quality of Life (HRQoL), and regimen adherence on glycemic control in Jordanian adolescents with T1D.

Methods: The study utilized a cross-sectional design. Jordanian adolescents …

Factors Influencing Physical Activity Among Immigrants From South India: A Qualitative Descriptive Study, Jaya Abraham

Dissertations and Theses (Open Access)

Background: In the United States (U.S), the percentage of diabetes and coronary artery diseases is higher among Asian Indian immigrants compared to other ethnic groups. Although research has been useful in describing patterns of physical activity among South Asian groups, very little is known about the factors influencing physical activity among Asian South Indian (ASI) immigrants. There is very limited research performed on the individual, social, cultural and environmental factors influencing physical activity among ASI immigrants.

Purpose: The study purpose was to explore the factors influencing physical activity with the following primary and secondary aims: The primary aim …

Relationships Of Moral Distress Among Interprofessional Icu Teams, Heather Vincent

Dissertations and Theses (Open Access)

Background: Moral distress is the psychological response to knowing the right action required by a healthcare professional but being unable to act upon the right course of action due to internal, external, and institutional constraints.

Purpose: The study investigated: 1. the level of moral distress among interprofessional healthcare providers working in four ICUs of a single academic hospital as measured by the 21-item Moral Distress Scale-Revised (MDS-R), 2. the differences in moral distress among interprofessional healthcare providers based on demographic characteristics and rankings of clinical scenario on the MDS-R.

Method: Descriptive, cross-sectional design using survey methodology.

Outcomes: Significant differences in …

Bridging The Gap Between Food Insecurity And Subsequent Child Body Mass: Mediating Effects Of Dietary Quality And Feeding Styles In Low-Income Hispanic Preschoolers, Nipa Kamdar

Dissertations and Theses (Open Access)

Background: Low-income Hispanic preschoolers face disproportionately high prevalence of food insecurity (FI) and obesity. Consumption of low-cost, energy-dense foods to compensate for FI leads to excess body-mass. FI parents may adopt feeding styles that contribute to decline in children’s dietary quality. Feeding style describes the amount of demandingness (i.e., control of children’s eating) and responsiveness (i.e., warmth used to express demandingness). FI may indirectly contribute to obesity through dietary quality and feeding style.

Purpose: This study investigated: 1. if dietary quality mediated the relationship between food security status (FSS) at Time 1 (T1) and child body-mass at Time 2 (T2), …

Uncertainty In Illness And Health Literacy In Pancreatic Cancer Patients, Rae Reynolds

Dissertations and Theses (Open Access)

Background: Despite a shared link to cognitive processing of health information suggested by their definitions, information on the association between uncertainty and health literacy is scarce. Their relationship has not been studied in pancreatic cancer patients.

Aims: To evaluate uncertainty and health literacy in pancreatic cancer patients, examine their bivariate correlation, and determine significant predictors.

Methods: This descriptive, cross-sectional study was conducted in a comprehensive cancer center. Uncertainty was measured using the Mishel Uncertainty in Illness Scale -Community and health literacy was measured using the Cancer Health Literacy Test 30. Spearman’s rho tested correlation and linear regression models were …

Meta-Analysis Of The Effects Of Exercise Interventions On Obese Adolescents, Brandy E. Strahan Phd, Rn, Hyochol Ahn Phd, Ms-Ece, Ms-Cts, Aprn, Anp-Bc, Jonathan Shuster M.Sc., Ph.D.

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A meta-analysis of 10 randomized control studies published in 2003-2013 was conducted to provide a summary of the effects of exercise interventions on obese adolescents. Outcomes of the reviewed trials included body mass index, weight, glucose, and triglycerides. Data were combined using an inverse variance weighted random effects model. The effect size estimate for BMI was 1.354 kg/m² (p < 0.001, SE 0.321), indicating that the BMI of individuals in treatment groups improved, as compared to control groups. A statistically significant reduction in weight was greater in the intervention groups than the control groups by 3.815 kg (p = 0.001, SE 1.101). The findings of this meta-analysis show that exercise interventions may improve control of weight and BMI and in turn be a factor in decreasing obesity.

Understanding The Experience Of Interprofessional Team Members After Participating In Comprehensive Obstetric Hemorrhage Training, Frances Kelly

Dissertations and Theses (Open Access)

Purpose: The obstetric hemorrhage rate has risen steadily in the U.S. accounting for 11.4% of maternal deaths between 2011 and 2013, and remains a leading cause of maternal morbidity. Improving the quality and safety of care could prevent much of the morbidity and potential mortality associated with obstetric hemorrhages. An interprofessional obstetric team developed, tested, and implemented obstetric hemorrhage and massive transfusion protocols. Multi-modal team training occurred before service-wide implementation of the protocols, including didactic, skills stations, on-line educational modules, and in situ simulation team training. Early quantitative results were promising.

Methods: To augment understanding of the quantitative results and …

Comparing The Effectiveness Of The Video Laryngoscope With The Direct Laryngoscope In The Emergency Department: A Meta-Analysis Of The Published Literature, D. Sean Degarmo

Dissertations and Theses (Open Access)

Purpose: Rapid intubation is essential for the critically ill patient in the emergency department in order to ensure adequate oxygenation. Regardless of presenting illness or injury, the first pass success rate (FPSR) can impact patient morbidity and mortality. The study aim was to evaluate the FPSR of direct laryngoscopy (DL) compared with video laryngoscopy (VL) in adult patients intubated in the emergency department.

Methods: Ovid Medline, Cochrane Library database, Embase, and Google Scholar were searched for peer-reviewed articles of studies of human subjects reporting a comparison of FPSR between VL and DL in adult patients who were orotracheally intubated in …

Optimizing Emergency Department Throughput Using Best Practices To Improve Patient Flow, Puneet Freibott Dnp, Rn, Nea-Bc, Ccrn-K'S

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Emergency Department (ED) crowding and bottle necks are the reality of hospitals across the country. Patients seeking care and needing inpatient beds via the emergency rooms are facing delays with attaining the right level of care. Orchestrating a patient through an ED admission requires a multidisciplinary effort to provide safe, effective and efficient care. This quality improvement project conducted in a tertiary acute care hospital focused on Centers for Medicare and Medicaid metrics to measure Emergency Department (ED) throughput. This multidisciplinary initiative focused on reducing time stamps for patient arrival to the ED through departure to hospital or home. Outcomes …

Reducing Antibiotic Use In Pediatric Upper Respiratory Infection: A Multifaceted Parent-Clinician Approach, Sydnee H. Lucas Dnp, Aprn, Sydney Thompson Dnp, Arnp, Fnp-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The goal of this QI initiative was to decrease inappropriate antibiotic for the treatment of pediatric upper respiratory infection (URI) in the retail clinic setting. The approach included the use of a protocol to treat viral upper respiratory illness, a visual aid decision-making tool for guideline adherence, prescription pad for nonprescription remedies, and shared decision-making techniques for providers to involve patients and parents in management plans regarding nonprescription remedies, supportive treatment, and signs and symptoms that would warrant a return visit. An improvement trend during the first 3 months of the initiative showed a shift in antibiotic avoidance from a …

Reducing Medication Errors Through Workflow Redesign, Rosslyn W. Blake Dnp, Aprn, Gnp

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Lack of medication reconciliation at the point of transitions between skilled nursing facilities/nursing homes (SNF/NHs) and acute care hospitals (ACHs) is a common point of origin for medical errors that cause harm to patients. The goal of this quality improvement initiative was to improve medication reconciliation at the point of transition from the SNF/NH to the ACH which in turn would reduce medication errors, adverse drug events, and medication-induced injury to the vulnerable elderly population. We implemented a workflow redesign process to reconcile the accuracy of residents’ medications at the time of transfer from the SNF/NH to the ACH. After …

Using Business Modeling To Streamline Cost Of Anesthesia In A Cardiopulmonary Laboratory, Johnny Dang Dnp, Crna, Kristen Starnes-Ott Phd, Crna

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Time Driven Activity Based Costing (TDABC) measurement system, a model used in the business arena, can capture clinical processes and costs that other costing models often overlook. Use of this system permitted tying costs to time and resources and identified areas of inefficiency such as depleted supplies and health care and emergency supplies placed inconveniently. A multidisciplinary team developed an anesthesia checklist for use in a remote cardiopulmonary laboratory. The compliance rate for checklist completion was approximately 85%. Checklist implementation translated to a decrease in case delays and time expenditure in patient care by 58% with a cost savings …

Education Program Using Non-Pharmacologic Support During Benzodiazepine Reduction In Patients With Anxiety Disorders, Kelly D. Kearney Dnp, Rn, Pmhnp-Bc, Diane Wardell Phd, Whnp-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A private mental health clinic developed an initiative to aid patients with anxiety disorders to taper their use of benzodiazepines. Based on best practices, a treatment protocol was developed in which patients attended 4 sessions (1 per month) in which they combined instruction in non-pharmaceutical anti-anxiety techniques (guided imagery, mindfulness meditation, deep breathing, progressive muscle relaxation, exercise, emotional freedom) with cognitive behavioral therapy and use of selective serotonin re uptake inhibitors. Participants experienced a reduction in benzodiazepine use. This small scale initiative showed that the holistic approach to anxiety management was an effective plan to decrease the use of benzodiazepines …

Factors Influencing Attendance, Postpartum Follow-Up, And Contraceptive Usage Among Teenage Centeringpregnancy® Participants, Latia Hickerson

Dissertations and Theses (Open Access)

Background: Teenage mothers are less likely to obtain postpartum examinations and contraception, increasing risks for negative social and health outcomes. The CenteringPregnancy® prenatal care model has been found to improve outcomes. However, little is known about factors influencing CenteringPregnancy® attendance or how this attendance impacts future pregnancy rates among teenagers.

Aim: The purpose of this study was to explore the association between CenteringPregnancy® attendance, postpartum return, contraception initiation and method selection. Additionally, the Group Care and Perinatal Behaviors Framework was used to assess the association between food insecurity, housing insecurity, intimate partner violence relationship status, partner group attendance and total …

Associations Among Meaning Of Illness, Quality Of Life, Symptom Burden And Depression In Patients With Leptomeningeal Metastasis, Julie Walker

Dissertations and Theses (Open Access)

Background Patients with leptomeningeal metastasis (LM) have symptoms related to disease within the neuroaxis, cancer sites outside the neuroaxis and treatment toxicities. Furthermore, the meaning ascribed to advanced cancer, such as LM, may impact the perceived severity, frequency and distress of symptoms as well as quality of life (QoL) and depression. Our aim was to explore and describe relationships among meaning of illness (MoI), depression, QoL and symptom burden in LM patients and to explore whether adding spine-related items from the MD Anderson Symptom Inventory-Spine (MDASI-SP) to the MDASI-Brain Tumor (BT) enhanced understanding of symptom burden in this population.

Methods …

Caring Minds, Uthealth Cizik School Of Nursing

Caring Minds

No abstract provided.

Protocol To Increase Administration Of Herpes Zoster Vaccine In A Long-Term Care Facility, Stephen Mbola Dnp, Rn, Anp-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Although the herpes zoster (HZ) vaccine to decrease the incidence of Shingles was licensed for use in 2008, little coverage for HZ vaccination has occurred and stands nationally at 16%. At a targeted nursing home and assisted living facility, a protocol for including HZ along with state-mandated vaccinations was devised and used in screening incoming residents. Baseline data from chart reviews (n=122) showed that despite treatments given for the infection in the preceding 12 months, no vaccinations had occurred. During a 6-month implementation period, all new residents meeting eligibility criteria were offered the HZ vaccination. In this period, four residents …

Quality Improvement And Safety In Healthcare: Reflections On Essential Frameworks To Guide Applied Scholarship That Promotes Transformation And Innovation, Angelo P. Giardino Md, Phd, Mph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The publication of the inaugural issue of the Journal of Nursing and Interprofessional Leadership in Quality and Safety (JONILQS) is a unique milestone that is the culmination of visionary leadership, scholarly effort, and keen attention to the many tasks necessary to launch a journal. The University of Texas Health Science Center at Houston’s School of Nursing launches this journal to address the focus on quality and safety initiatives and research that helps to make the health care we provide safer and better. This journal seeks to highlight practical work from the field that will change things for the better for …

Developing The Improving Post-Event Analysis And Communication Together (Impact) Tool To Involve Patients And Families In Post-Event Analysis, Madelene J. Ottosen Phd, Rn, Emily W. Sedlock Mph, Aitebureme O. Aigbe Drph, Jason M. Etchegaray Phd, Sigall K. Bell Md, Thomas H. Gallagher Md, Eric J. Thomas Md, Mph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The analysis of harmful errors is typically led by a team within the hospital and includes clinicians and staff who were involved at the time of the event. However, the patient and family are often left out of this process and are not asked to participate in the investigation. Because little guidance is available for facilitating patient input, an interprofessional team convened to develop a semi-structured tool to be used in eliciting patient feedback. Some 72 persons who had experienced adverse events were interviewed. Using a thematic analysis approach, the team learned that 51% of the interviewees preferred to participate …

An Assessment Of The Human Papillomavirus Immunization Knowledge, Practices, And Prevention Among A Cohort Of Urban College Students, Nancy H. Busen Phd, Fnp-Bc, Aprn, Robert G. Hanks Phd, Rn, Fnp, Aprn, Eileen R. Giardino Phd, Rn, Aprn, Fnp, Stanley Cron Msph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Human papillomavirus (HPV) is the most common sexually transmitted disease, yet little is known about the college-age knowledge and prevention practices related to HPV. Although sample vaccination rates mirrored national known vaccination rates, a majority of participants did not complete the three dose vaccine schedule. HPV knowledge was similar between males and females while males were more likely to engage in preventative practices. This information can help healthcare providers reinforce vaccination schedule and prevention practices.

From The Editors-In-Chief, Joanne V. Hickey Phd, Rn, Acnp, Faan, Fccm, Eileen R. Giardino Phd, Rn, Aprn, Fnp

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Co-editors in chief welcome The Journal of Nursing & Interprofessional Leadership in Quality and Safety to state what the purpose of the journal is and why it is important for this journal to start.

Implementation Of A Comprehensive Clinical Toolkit For Postpartum Depression Screening: Breaking Barriers In Women's Health Care, Liza C. Rivera Dnp, Msn, Aprn, Whnp-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A quality improvement initiative to increase screening of postpartum women to detect depression and appropriately refer women screening positive for follow-up care was implemented in an obstetrics and gynecology practice. Physicians in the practice (n = 13) completed an educational module on use and benefits of a toolkit and showed a significant post test increase. Review of patient medical charts found a significant increase in screening rate in an 8-week intervention cycle. Through means of establishing a protocol for appropriate referral for follow-up, the goal of referring 50% of women who screened positive was exceeded.

The Future Of Healthcare Delivery: Ipe/Ipp Audiology And Nursing Student/Faculty Collaboration To Deliver Hearing Aids To Vulnerable Adults Via Telehealth, Robert E. Novak Ph.D, Asha Fellow, Adelita Gonzales Cantu Phd., Rn, Amanda Zappler Aud, Laura Coco Aud, Craig A. Champlin Phd, Asha Fellow, Julie C. Novak Dnsc, Rn, Faanp, Faan

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A multi-departmental, two-city initiative to provide hearing aid service via a telepractice approach was developed whereby nursing and auditory students with supervisory faculty used AV conferencing for training and interaction with referred patients. Located in two cities, 21 nursing and 15 doctoral level audiology students met virtually, and students received teleaudiology education and practicum with interprofessional education and practice components. Nursing students in one city and a supervising faculty in another city could interact with providers and patients in both cities to provide hearing care. The teleaudiology project delivered hearing health care services, including fitting of digital mini hearing aids, …

The Power Of Reasoning: How Student Nurses Develop Confidence In Reasoning, Michael F. Brown

Dissertations and Theses (Open Access)

Background

Clinical Reasoning (CR) is the intellectual capacity to understand the value of patient data related to current knowledge, skills, and experiences within a dynamic domain of patient care with reflective analysis relating the new experience and understanding into new knowledge to be applied in future clinical situations. Poorly developed CR skills inhibit effective problem-solving abilities of nursing students producing levels of unexpected confusion and loss of confidence impeding their adaptability and effectiveness in dynamic healthcare environments. This study explored the effectiveness of human patient simulation (HPS) as an innovative method to facilitate the development of CR in undergraduate nursing …