Nursing Commons^™

Prophylactic Phenylephrine Infusion To Mitigate Intraoperative Hypotension After Spinal Anesthesia Among Orthopedic Patients, David Nelson, Braden Hemingway, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background

Intraoperative Hypotension (IOH) is common after spinal anesthesia (SA) and is associated with an increased risk of end organ damage.1 2 3 The treatment regimen for IOH after SA varies in the orthopedic population. However, the current research literature suggests that a prophylactic infusion of phenylephrine significantly reduces the number of episodes and duration of hypotension.1 This EBP project aims to report the proportion of patients receiving prophylactic phenylephrine infusions and the incidence of hypotension following SA among orthopedic surgery patients at Providence Sacred Heart Medical Center (PSHMC) in Spokane, WA.

Methods

• A retrospective, observational EBP project was …

Chronic Pain, Sleep Disruption, And Work Performance In The Military, Jeffrey Ransom

Dissertations

Abstract

Background and Significance: Managing pain is a challenge for many organizations, including the U.S. military. The added complication of managing sleep disruption compounds the issue. Examining pain and sleep disruption in the context of work performance within the military is critical to understanding the impact of these conditions on our nation’s fighting forces.

Purpose: Examine the associations of chronic pain and sleep disruption in the context of work performance among active duty military service members.

Research Aims: 1) Describe sociodemographic characteristics, military service characteristics, clinical characteristics, and work performance of active duty service members, 2) Examine relationships between these …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

Video Education For Improved Education Of Newly Diagnosed Multiple Sclerosis Patients, Theresa Mccrumb

Doctoral Projects

Anxiety and depression are prevalent in multiple sclerosis (MS) patients, especially those newly diagnosed. Receiving a diagnosis of MS can be overwhelming and impact patients in multiple areas including physical issues, cognitive changes and anxiety and depression (Kantor, Bright & Burtchell, 2017). This anxiety and depression can cause patients to be less engaged in their plan of care and thereby reduce their quality of life (Rieckmann, et al., 2015). According to the Multiple Sclerosis Association of America (MSAA), four of 10 MS patients are diagnosed with depression and anxiety, with the highest incidence at diagnosis (Multiple Sclerosis Association of America, …

Trust In Primary Care Providers: Perspectives From Deaf People., Greir Ander Huck Flynn

Electronic Theses and Dissertations

Trust is an integral part of the patient-provider relationship, responsible for influencing several key aspects of healthcare behaviors and patient perceptions of health outcomes. Though the topic has previously been discussed by scholars, little evidence exists to support the application of our understanding of trust in culturally Deaf populations. As such, this dissertation seeks to lay the necessary groundwork for further investigations on the topic by first understanding the nature of trust in patient-provider relationships from the perspectives of culturally Deaf people. The dissertation is comprised of five chapters. The first chapter provides an introduction to salient terms and concepts …

Qualifications Of Executive Nurses For Service On Hospital Boards, Michelle Lee Foxx

Electronic Theses and Dissertations

Abstract Healthcare governing boards have responsibility for the legal and financial stability of the organization. They are assuming more responsibility for quality care and outcomes. Nurse leaders have valuable insights into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight. Yet, only 5% of the 3.2 million nurses in the U.S. health workforce hold a seat on hospital governing boards in the United States. The purpose of this study was to explore how nurses with executive experience perceive their own leadership qualities in the context of established requirements for executive hospital boards. Fifty …

Moral Distress And Moral Residue Among Nurses Working In The Surgical Intensive Care Unit: A Descriptive Qualitative Approach., Adam Tyler Booth

Electronic Theses and Dissertations

Introduction: Approximately one in five Americans will die in the intensive care unit (ICU). Nurses spend more time with chronically ill and end-of-life patients than any other healthcare professional, and may perceive some actions in the ICU as immoral. Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints. Development of the Moral Distress Scale-Revised revealed that 31% of ICU nurses left a prior position or considered leaving their current nursing job because of moral distress. The purpose of this descriptive qualitative study is to explore surgical ICU (SICU) nurses’ perceptions …

Calmodulin Hvcam1 Negatively Regulates Salt Tolerance Via Modulation Of Hvhkt1s And Hvcamta4, Qiufang Shen, Liangbo Fu, Tingting Su, Lingzhen Ye, Lu Huang, Liuhui Kuang, Liyuan Wu, Dezhi Wu, Zhong-Hua Chen, Guoping Zhang

Publications

Calcium (Ca) signaling modulates sodium (Na) transport in plants; however, the role of the Ca sensor calmodulin (CaM) in salt tolerance is elusive. We previously identified a salt-responsive calmodulin (HvCaM1) in a proteome study of barley (Hordeum vulgare) roots. Here, we employed bioinformatic, physiological, molecular, and biochemical approaches to determine the role of HvCaM1 in barley salt tolerance. CaM1s are highly conserved in green plants and probably originated from ancestors of green algae of the Chlamydomonadales order. HvCaM1 was mainly expressed in roots and was significantly up-regulated in response to long-term salt stress. Localization analyses revealed that HvCaM1 is an …

Preceptor Education And Structured Onboarding Process, Charles Morato

Master's Projects and Capstones

Problem: Staff nurse retention is an ongoing problem for this intensive care unit (ICU). Through exit interviews from staff who left, inadequate onboarding and education made them feel unprepared for their job and not part of the team. The preceptors on the unit have never been trained on the roles and responsibilities of being a preceptor. The current onboarding process consists of pairing new hires with a preceptor who either happens to be willing to do it that day or someone who has been there the longest. There is no consistency or personalizing the orientation information to the new hire. …

Child Body Fat And Body Mass Index: Which Determinants Are Most Important?, Marilyn Frenn, Astrida S. Kaugars, Juanita Terrie Garcia, Mauricio Garnier-Villarreal

College of Nursing Faculty Research and Publications

The purpose of this study was to examine child and parent determinants of children’s body fat percentage (BF%) along with their body mass index percentile (BMIp). Children’s BF% and BMIp auger lifelong health risks when elevated, and one in five children are affected. Participants (N = 135) included 62% female children; 50.7% Caucasian, 31.7% Hispanic, and 8.5% African American. Children were aged 9–15 years (2% underweight, 47.9% normal weight, 19.7% overweight, and 24.6% obese). Parent BMI average was 30.67 (1.4% underweight, 20.4% normal weight, 23.9% overweight, 40% obese, and 7% extreme obesity); 77.5% of the participating parents were mothers. …

Systematic Review Of Psychometric Properties Of Instruments Measuring Patient Preferences For Engagement In Health Care, Teresa Jerofke-Owen, Mauricio Garnier-Villarreal, Alissa Fial, Georgia Tobiano

College of Nursing Faculty Research and Publications

Aim

To identify, critically appraise, and summarize instruments that measure patients’ preferences for engagement in health care.

Design

Psychometric systematic literature review.

Data sources

PubMed, Embase, CINAHL, and PsycINFO were searched from inception to March 2019.

Review methods

Three reviewers independently evaluated the ‘methodological quality’ and the ‘measurement properties’ of the included instruments using the Consensus‐based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. Each instrument was given a Grading of Recommendations Assessment, Development and Evaluation (GRADE) score. The review was registered at PROSPERO (registry number CRD42018109253).

Results

A total of 16 studies evaluating …

Correlates Of Access To Hand Hygiene Resources In Ghanaian Households: An Exploratory Analysis Of The 2014 Demographic And Health Survey, Paul Lawer Kenney, Herman Nuake Kofi Agboh, Florence Akosua Agyemang, Seth Sylvester Dadzie, Henry Ofori Duah, Pascal Agbadi

College of Nursing Faculty Research and Publications

Objectives

Handwashing with soap and water remains the most effective public health measure to reduce the risk of infectious diseases, which kill over 2.5 million people annually, mostly children in developing countries. The absence of hand hygiene resources in homes put many at risk of these infectious diseases. In the wake of the outbreak of the COVID-19 pandemic, the World Health Organization (WHO) and governments around the world have stressed the importance of regular handwashing to prevent the spread of the virus. This suggests that research on water, sanitation, and hygiene issues deserve continuous scholarly attention. In Ghana, studies on …

Neostigmine Versus Sugammadex And The Relationship To Reintubation Rates In The Pacu, Delanie Urrutia, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Findings Discussion Reintubation in the post-anesthesia care unit (PACU) is a complication that may be related to residual neuromuscular blockade. Neostigmine and sugammadex have different pharmacokinetics that effect speed and completeness of reversal of paralysis. According to Tillquist et al. (2016) reintubation following general anesthesia in the PACU is associated with a 50% increased risk of mortality. Few studies have investigated the incidence rate of PACU reintubation and its possible relationship and choice of reversal medication.

Methods • Retrospective Observational Research Study. • This project was approved by the PSHMC Clinical Innovation and Research Council and deemed human subjects …

Postoperative Nausea And Vomiting With Low-Dose Propofol Infusions In Patients Undergoing Gynecological Surgeries With Volatile Anesthetics At Providence Sacred Heart Medical Center And Providence Holy Family Hospital, Adrianna Silva, Braden Hemingway, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative nausea and vomiting (PONV) is a common complication following surgery. It remains the most important determinant of length of stay and leading cause of dissatisfaction in anesthesia.4 Females undergoing gynecological laparoscopic surgery have the highest rates.8 Apfel’s baseline risk factors for PONV include female gender, history of motion sickness and/or PONV, non-smoking status and administration of postoperative opioids.1 Propofol has antiemetic properties and Gan’s evidence supports the use of an intraoperative low-dose infusion to reduce baseline risk factors for PONV.6 This project aims to describe the rates of intraoperative low-dose propofol infusions in female patients undergoing gynecological surgery …

Improving Survival Rates In Patients Suffering Cardiac Arrest With Specialized Resuscitation Teams: An Integrative Review, John Campbell Holcomb

Doctoral Dissertations and Projects

Over 300,000 hospitalized patients suffer a cardiac arrest requiring a Code Blue activation each year in the United States. These patients have an extremely high mortality rate. These rates are not uniform across all hospitals and facilities that employ specialize Code Blue resuscitation teams have a higher percentage of patients that survive resuscitation events. This Integrative Review shows that these teams are essential to patient survival but are prone to barriers that must be overcome to provide effective teamwork. Quality improvement projects centered around Code Blue teams can be created at the local level and have been found to be …

Improving Identification Of High-Risk Obstructive Sleep Apnea Patients In Primary Care: An Integrative Review, Lauren Ashley Paulson

Doctoral Dissertations and Projects

Obstructive sleep apnea continues to be an area that is underdiagnosed and therefore undertreated. Left untreated, the condition is associated with increased morbidity and mortality as it can amplify the risk of multiple health conditions. Due to the negative impact of obstructive sleep apnea it is necessary for healthcare providers to provide timely detection. Primary care providers are in a position to identify high-risk individuals and refer them for further follow up testing. High-risk identification can be accomplished by integrating validated screening tools into patient assessments. This integrative review provides an overview of current screening tools for use in the …

Preventing Polypharmacy Amongst The Elderly In An Acute Care Setting Through The Integration Of The Deprescribing Tools Start, Stopp, And Beers Criteria, Samantha Bonita Wilkins-Copeland

Doctoral Dissertations and Projects

A significant percentage of medications prescribed in the United States are prescribed to elderly adults, which is due to the increase in chronic illness as Americans age. This increase in the use of medications amongst the elderly population has led to the issue of polypharmacy, which can lead to negative patient outcomes. An evidence-based practice pilot project was performed at a large tertiary care facility in Virginia. The aim of the scholarly project was to integrate three deprescribing tools into the everyday practice of pharmacists at the facility. Three outcomes were achieved: (1) Pharmacists understood how to accurately utilize the …

Ask, Advise, Assist And Follow: An Evidence Based Project To Address Unhealthy Alcohol Use In A Free Clinic Setting, Lisa K. Floyd

Doctoral Dissertations and Projects

Preventative care in free clinic settings aims to mitigate health risks for vulnerable populations. Heavy alcohol intake is a major threat to physical and mental health. Wellness care for free clinic patients must include regular screening for alcohol use in accordance with national guidelines. The purpose of this project was to implement and evaluate an evidence- based practice change to improve alcohol screening and intervention in a free clinic setting. The NIH/NIAAA screening, brief intervention, and referral for treatment (SBiRT) process was implemented. A convenience sample of de-identified patient charts was reviewed to assess alcohol screening before (n = 38 …

Increasing New Orienting Emergency Department Nurses' Awareness Of Mass Casualty Incident Emergency Preparedness And Disaster Response Core Competencies To Improve Mass Casualty Incident Response, Christopher C. Deramo Ii

Doctoral Dissertations and Projects

Mass casualty incidents (MCI) impose a substantial threat to healthcare. Despite the increasing frequency of MCIs many healthcare organizations and nursing programs do not adequately prepare nurses to be effective responders during an MCI. This evidence-based practice pilot project was purposed to increase new orienting emergency department nurses’ confidence and ability to effectively respond to an MCI. This project involved implementing an MCI educational program consisting of a disaster nursing framework to educate new orienting emergency department nurses on emergency preparedness and disaster response core competencies. The project leader utilized a quasi-experimental design to collect data pre- and post-intervention utilizing …

Identification Of Human Trafficking Victims In The Health Care Setting: An Integrative Review, Jami Leigh Castellucci

Doctoral Dissertations and Projects

Most victims who have escaped trafficking report that during their captivity they were taken to health care facilities. Though health care–based trafficking reporting has increased over the last few years, studies show that private practices and most hospitals within the country do not have a human trafficking protocol, policy, nor educational intervention for their frontline staff to be able to identify and refer victims for short- and long-term support. The United States health care system is poised to play a large role in the fight against human trafficking. This integrative review describes the current status of human trafficking victim identification …

Walking Through Smoke: Implementation Of The 5a'S For Smoking Cessation Counseling In Rural Virginia, Cristina Maria Minotti

Doctoral Dissertations and Projects

Tobacco use represents a significant cause of morbidity and mortality in the U.S. and is a contributing risk factor for multiple pulmonary, cardiovascular, and oncologic diseases. Despite documented evidence of these health hazards, use of tobacco products remains high, particularly in rural America. While providers may frequently question patients regarding tobacco use and inform patients of associated health hazards, a standardized, structured process for delivering smoking cessation counseling (SCC) is rarely established in practice settings. One such method for standardization of SCC is the 5A’s (Ask, Advise, Assess, Assist, Arrange) model which has a robust body of evidence to support …

Nighttime Quiet In The Intensive Care Unit: An Integrative Review, Heather Rae Smith

Doctoral Dissertations and Projects

Excessive environmental noise in the ICU often negatively impacts patient sleep. The World Health Organization (WHO) and Environmental Protection Agency (EPA) have published recommendations for hospital decibel levels, but the literature indicates that noise levels in the ICU often exceed these values. Patients experience disturbed sleep and rarely enter into N3 and REM sleep. The integrative review examined both the patients’ and healthcare workers’ perception of noise in the ICU environment to identify contributors and suggested interventions to mitigate these occurrences. In addition, this study evaluated objective measurements of patient sleep to further determine how well patients were sleeping in …

Diabetes Health Literacy In The Rural Community: An Integrative Review, Shannon M. Elrod

Doctoral Dissertations and Projects

Health literacy is paramount for successful management of health and prevention of disease. Yet a majority of adults have low health literacy. The impact of low health literacy on chronic disease management effects health outcomes and health care costs. With six out of 10 adults in the US diagnosed with a chronic disease such as diabetes, health literacy is a serious concern. Diabetes impacts over 30.3 million Americans. Since diabetes is one of the most common chronic diseases in the country, it is imperative that health literacy be addressed as part of this population’s health management. Diabetes health literacy plays …

Intratracheal Lidocaine And Postoperative Sore Throat At Providence Sacred Heart Medical Center And Providence Holy Family Hospital, Jennifer Cowgill, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative sore throat (POST) is a common side effect from general anesthesia (GA) and has a prevalence of 14.4-50%.1 The experience of POST contributes to patient discomfort during recovery from surgery. The etiology of this is thought to be from tracheal mucosal erosion from the cuff of the endotracheal tube (ETT), trauma from intubation, coughing and bucking, and friction between the ETT and the tracheal mucosa during general anesthesia.2 Risk factors shown to contribute to the development of POST include, but are not limited to, elderly age, smoking history, patient positioning, ETT cuff pressure, and movement of ETT during …

The Long-Term Multidimensional Impact Of Persistent Multisite Pain On Physical And Psychological Disability, And Mortality In Community-Dwelling Older Adults, Saurja Thapa

Graduate Doctoral Dissertations

Persistent multisite pain is highly prevalent, affecting 25-43% of community-dwelling older adults. Although existing evidence suggests that persistent multisite pain is associated with physical and psychological disability, studies use a cross-sectional assessment approach that overlooks pain duration or persistence. This study aimed to estimate the persistence of multisite pain and the proportion of incident multisite pain and examine the association between persistent multisite pain and physical (ADL and IADL) and psychological disability (depression and anxiety) at 18 months and six years. Also, the association between baseline persistent multisite pain and mortality was assessed.

Secondary data analysis of the MOBILIZE Boston …

Opioid Consumption After Scheduled Cesarean Delivery Following Implementation Of Enhanced Recovery After Surgery, Mindy Woodruff, Emily L. Mcquaid-Hanson, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background With 47,600 opioid overdose related deaths in the U.S. in 2017, the opioid crisis is of national concern.1 Cesarean delivery is the most common surgery worldwide, with over 1.2 million in the U.S. in 2018 alone.2,3 As cesarean delivery is a highly prevalent surgery it has a large capacity to influence the opioid epidemic. Literature is showing that Enhanced Recovery after Surgery (ERAS) and multimodal analgesia are effective means of managing postoperative pain while minimizing opioid use.4,5,6,7,8 This project aims to help discover if introduction of ERAS, and more specifically it’s multimodal analgesia aspect, has helped decrease oral morphine …

Rates Of Ondansetron Administration Prior To Spinal Anesthesia: Evaluating The Practice Of Prophylactic Attenuation Of Spinal-Induced Hypotension And Bradycardia, Clare Santana, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Hypotension and bradycardia are common complications of spinal anesthesia. Intraoperative hypotension and bradycardia may lead to complications that require additional treatment and increase cost. The literature identifies intervention strategies to attenuate spinalinduced hypotension (SIH) and bradycardia.1 Prophylactic administration of ondansetron, a serotonin 5-hydroxytryptamine receptor antagonist, prior to spinal anesthesia is associated with reduced SIH and bradycardia.1,2,3,4,6 The objective of this scholarly project was to report the practice of ondansetron prophylaxis for SIH and bradycardia and the rate of rescue interventions in patients who received ondansetron prior to spinal anesthesia.

Methods Retrospective, multi-center observational evidence-based practice project conducted at Providence …

Intraoperative Hypotension And Acute Kidney Injury In Non-Cardiac Surgery At Providence Sacred Heart Medical Center, Elizabeth Davison, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Acute kidney injury (AKI) is a serious postoperative complication that increases a patient’s risk for both long and short-term morbidity and mortality.¹ Intraoperative hypotension (IOH) is an independent risk factor for AKI,^2-5 which can be readily modified by anesthesia providers. This project aims to describe the risk factors and rates of AKI following IOH at various absolute mean arterial blood pressure (MAP) thresholds for specified durations of time among adults undergoing non-cardiac surgery at Providence Sacred Heart Medical Center (PSHMC).

Methods PSHMC approved this retrospective, observational evidence-based project and deemed the project exempt by the Institutional Review …

Employed Mothers’ Satisfaction With The Breastfeeding Provisions In The Patient Protection And Affordable Care Act, Rebecca A. Penders

Graduate Doctoral Dissertations

Objective: Guided by the Conceptual Model for Nursing and Health Policy (CMNHP), the purpose of this study was to determine the extent to which employed mothers perceived satisfaction in their breastfeeding experiences after enactment of the Patient Protection and Affordable Care Act (PPACA) breastfeeding provisions. Methods: The participants (N=507) were employed mothers who returned to work after the birth of their infants and reported hourly pay. Convenience sampling was used to recruit women via La Leche USA Facebook account (LLL USA). Participants completed the Penders Breastfeeding Survey in Research Electronic Data Capture (REDCap). The survey consisted of 39-items; including five …

Correlation Of Ondansetron Timing In Postoperative Nausea And Vomiting: A Retrospective Evaluation Amongst Adult Patients Receiving General Anesthesia, Jeff Tanguay, Braden Hemingway, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Addressed as a national quality initiative by the Centers for Medicare and Medicaid Services (CMS), postoperative nausea and vomiting (PONV) is a vexing complication requiring further attention by anesthesia providers.3 Medication optimization is an area of focus to address this complication.4 Ondansetron, a selective 5- hydroxytryptophan subtype 3 (5-HT3 ) receptor antagonist, is effective and considered the “gold standard” in the prevention of PONV.4 GlaxoSmithKline™ suggests administering Zofran® (ondansetron) before the induction of anesthesia.5 These directions are in contrast to the synthesis of the research evidence, which supports increased effectiveness of ondansetron when administered 30 minutes before emergence from …