Nursing Commons^™

Addressing Melanoma Risk In Families, Rebecca B. Roy, Deborah O. Himes

Student Works

Melanoma is one of the top 10 cancers in the United States. It is an aggressive and potentially fatal skin cancer. Up to 10% of all people diagnosed with melanoma have a positive family history of melanoma and a family history with a first degree relative can increase the risk for family members by 75%. Poor family communications often result in first degree relatives’ lack of knowledge about risk and prevention for melanoma. Considering this lack of knowledge, primary care providers have the opportunity to assess risk; teach and encourage prevention measures; teach and perform skin exams; and refer to …

Admissions Of Covid-Positive Patients To Us Nursing Homes With Personal Protective Equipment Or Staffing Shortages, Diane M. Gibson, Jessica Greene

Publications and Research

Background: US nursing homes are required to follow Centers for Disease Control guidance for COVID-19 transmission-based precautions (TBP) when admitting COVID-positive patients.

Objective: To assess how frequently nursing homes had shortages of personal protective equipment (PPE) or staffing in weeks when they admitted COVID-positive patients, which likely made it more difficult to follow TBP, and to compare facility characteristics by admissions practices.

Design and Setting: Facility-level data from the Nursing Home COVID-19 Public File for the period between June 7, 2020 and March 7, 2021 was combined with additional data. The percentages of nursing homes that admitted COVID-positive patients and …

Exploring The Effect Of Language Concordance Between Nurses And Limited English Proficient Patients On Their Health Outcomes., Elizabeth K. Moon, Sarah Miner

The Review: A Journal of Undergraduate Student Research

Communication is essential to the medical field. Approximately 350 different languages are spoken in the USA. The commonality of language discordance between patients and health care providers causes poor communication, limited understanding of their condition, and a decrease in the patient’s satisfaction with their care. This literature review explored the effect that a language concurrent healthcare provider has on the health outcomes of LEP patients. LEP is defined as limited English proficiency. METHODS: CINHAL and Pubmed were used. The key terms used were communication barriers, language barriers, nurse, nurses, nursing, and health outcomes. The search revealed 719 articles. Seven articles …

The Ways In Which Women’S Suffrage Affected Healthcare, Madison M. Weber

The Review: A Journal of Undergraduate Student Research

The 19th Amendment had and continues to have a major impact on women’s healthcare in the United States. Prior to suffrage, women had little to no ability to voice their thoughts on and change policies that regarded their own health. This essay addresses the way in which the vote both directly and indirectly impacted healthcare; including workplace conditions, maternal and reproductive rights, racial disparities, political advocacy and healthcare, the different waves of feminism, and how this has all affected modern healthcare for women. From progressive articles being published in women's magazines, to the establishment of marital rape, to the availability …

How Do Community Dwelling Non-English Speaking Patients And Caregivers Perceive Their Medication Management?, Julia Cosner, Sarah Miner, Yvette Conyers

The Review: A Journal of Undergraduate Student Research

Non-English-speaking individuals face a linguistic and cultural barrier to managing prescribed medications in the community. Wilson et al. (2005) found that limited English proficient (LEP) patients reported more misunderstanding and negative drug reactions when taking prescribed medication compared to English-speaking patients. Not only is the inappropriate management of medication dangerous, but it is also a disparity in health care that is inequitable. The purpose of this literature review is to collect community-dwelling non-English-speaking patient and caregiver experiences with managing medication. These perspectives will highlight what is successful and what needs to be improved regarding non-English-speaking patient medication interactions. Literature suggests …

Moderating Effects Of Parental Feeding Practices And Emotional Eating On Dietary Intake Among Overweight African American Adolescents, Mary Quattlebaum, Dawn K. Wilson-King, Allison M. Sweeney, Nicole Zarrett

Faculty Publications

This study examined the effects of parental feeding practices and adolescent emotional eating (EE) on dietary outcomes among overweight African American adolescents. Based on Family Systems Theory, it was hypothesized that parental feeding practices, such as parental monitoring and responsibility, would buffer the effects of EE on poor dietary quality, whereas practices such as concern about a child’s weight, restriction, and pressure-to-eat would exacerbate this relationship. Adolescents (N = 127; Mage = 12.83 ± 1.74; MBMI% = 96.61 ± 4.14) provided baseline data from the Families Improving Together (FIT) for Weight Loss trial and an ancillary study. Dietary outcomes (fruit …

Mapping Inequalities In Exclusive Breastfeeding In Low- And Middle-Income Countries, 2000–2018, Natalia V. Bhattacharjee, Laauren E. Schaeffer, Simon I. Hay, Arianna Maever L. Amit, Veincent Christian F. Pepito, Local Burden Of Disease Exclusive Breastfeeding Collaborators, 477 Co-Authors

Ateneo School of Medicine and Public Health Publications

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target …

Caregiving Stress And Self-Rated Health During The Covid-19 Pandemic: The Mediating Role Of Resourcefulness, Elliane Irani, Atsadaporn Niyomyart, Jaclene A. Zauszniewski

Faculty Scholarship

Family caregivers faced unprecedented circumstances and experienced increased levels of stress during the COVID-19 pandemic. Resourcefulness can minimize the effect of stress on health outcomes. The purpose of this study was to examine the associations between caregiving stress during the pandemic, resourcefulness, and self-rated health and assess the mediating effect of resourcefulness. A convenience sample of 70 family caregivers of adults with chronic and/or disabling conditions was recruited using social media groups and professional networking platforms. Data were collected using an online survey and analyzed using linear regression. Mediation analysis was conducted using the PROCESS macro. Higher levels of caregiving …

Relationships Between Cortisol, Sleep, Stress, And Mood Among Night Shift Nurses, Teresa Bigand, Panshak P. Dakup, Devon Hansen, Marian Wilson, Benjamin Thomas, Steven James, Lois James, Shobhan Gaddameedhi

2021 Providence Nurse Research Conference

Background: Working night shift is a physical and emotional stressor related to negative health outcomes. Cortisol is a biomarker that has been related to an increased risk for metabolic syndrome among adults. Cortisol levels follow a circadian rhythm in humans; levels reach a peak in the early morning and drop to the lowest level in the late evening. Changes in cortisol levels have been related to changes in mood or sleep and to exposure to stressful situations. In a group of Registered Nurses, the impact of consecutive 12-hour night shifts on relationships between cortisol levels, sleep, stress, and mood, was …

Team Up Against Sepsis: Six Tasks In Sixty Minutes, Karin Kloppel, Barbara Richards

2021 Providence Nurse Research Conference

Background: Sepsis is the number one cause of mortality in hospitals nationwide. Our hospital system has identified sepsis mortality reduction as a top priority. Early recognition and treatment through improving sepsis bundle compliance was the selected focus in a 40-bed Emergency Department (ED) a community-based hospital.

Purpose: To evaluate the impact of a team response to sepsis alerts on sepsis outcomes in the ED in an acute care hospital.

Methods: Prior to implementing a team approach to sepsis alerts, ED staff were surveyed to describe awareness of SIRS and sepsis criteria and of sepsis bundle intervention metrics. Challenges identified …

Reducing Hospital Acquired Pressure Injuries On An Advanced Care Unit, Dawn Doud, Lynn Stapleton

2021 Providence Nurse Research Conference

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) are increasing nationwide. HAPIs are a negative outcome of hospitalization and these conditions are not eligible for reimbursement, resulting in billions of dollars of healthcare costs to hospitals. HAPI rates were noted to climb on an advanced care unit in a community-based hospital in the Pacific Northwest. In order to reduce this patient harm event, the nurse manager partnered with the nursing professional development specialist to lead a HAPI prevention quality improvement plan.

PURPOSE: To decrease HAPI rates on the Advanced Care Unit.

METHODS: The nurse manager conducted a deep dive on all HAPI events …

Pain Management Trends Among Adults Hospitalized With Cellulitis: An Evidence-Based Practice Project, Nonna Dobyns, Teresa Bigand, Kristopher Darath, Denise Ogorek

2021 Providence Nurse Research Conference

Background: Cellulitis is an acute infection of the skin resulting in acute pain and often requires pharmacological analgesics. Past studies revealed that more than half of patients receiving inpatient medical care in the United States received opioid analgesics for pain management during the hospital stay. While opioids are regarded as the strongest analgesic available to ease physical pain, these are habit-forming drugs that contribute to negative outcomes such as opioid use disorder and increased risk for accidental overdose and death. Recommendations for acute pain management in the hospital setting include prescribing less than 50 morphine milligram equivalents (MME's) per day …

Break Habits Of Registered Nurses Working In The Acute Care Setting During The Covid-19 Pandemic, Michelle Bradberry, Gisele Nicole Bazan, Sahar Mihandoust, Jamie Roney, Marian Wilson, Teresa Bigand

2021 Providence Nurse Research Conference

Background: Nurses report high levels of burnout and stress while working in the acute care setting, especially during the current COVID-19 outbreak. Evidence suggests that taking a restorative break during an extended, 12-hour shift may help mitigate stress and translate to better patient and caregiver outcomes. Yet, little is known about how Registered Nurses report taking breaks in the context of the pandemic.

Purpose/Aims: The purpose of this project was to describe the frequency of breaks reported by nurses working 12-hour shifts during the COVID-19 pandemic, and to test for demographic differences between nurses reporting fewer compared to more breaks …

Pilot Testing A Novel Tool To Assess Resilience Among Nurses Delivering Direct Patient Care In Teams In The Hospital Setting, Tiara Benson, Ma Fe Chase, Amanda Miles

2021 Providence Nurse Research Conference

Background: With the appearance of the COVID-19 pandemic, nurse emotional well-being has suffered, with burnout being highly reported. Team resilience may mitigate feelings of burnout, and is defined as homeostasis among the healthcare team while experiencing continuous change. Strategies for enhancing resilience of individuals are prevalent, yet nurses often deliver care in a team setting. While some literature offers insight on nurse team resilience, no valid and reliable tools currently exist to measure this concept. Purpose: To develop and pilot test a tool to measure team resilience among nurses delivering direct patient care in an acute care hospital in …

Pediatric Surgery Nurses Lead And Coordinate Covid-19 Recovery Efforts, Shelly Johnson, Alice E. Dupler

2021 Providence Nurse Research Conference

Background: In early 2020, the appearance of the novel COVID-19 virus became a global concern, infecting hundreds of thousands of people. To reduce the spread of the virus, the United States government instituted social distancing and required hospitals to take steps to create extra beds for patient with COVID. One method to increase hospital capacity was the cancellation of scheduled, elective surgeries. In one large pediatric hospital in the Pacific Northwest, there was no formal process in place for cancelling elective procedures or for prioritizing when or how to reschedule the case. Because nurses were being called on to provide …

Covid In Our Backyard: The Lived Experiences Of Rn To Bsn Students Facing A Pandemic, Shelly Johnson, Alice E. Dupler, Deanna J. Koepke

2021 Providence Nurse Research Conference

Background: Relationships exist between improved patient outcomes and Registered Nurse (RN) caregivers with an earned Bachelor’s degree or higher compared to those with an associate’s or diploma in nursing. However, nurses who are working and attending a bridge program to obtain a Bachelor of Science in Nursing (BSN) report high levels of stress which may increase risk for withdrawing from the program or quitting work. Furthermore, providing direct patient care during the COVID-19 pandemic may significantly increase stress among those who are concurrently finishing a nursing advanced degree. Little is known about how front-line caregivers perceive the experience of working …

Reducing Specimen Labeling Errors To Promote Patient Safety: A Quality Improvement Project At An Inpatient Department In A Regional Acute Care Hospital, Jihye Johnson

2021 Providence Nurse Research Conference

Background: Mislabeled specimen can cause patient harm by delaying treatment or by inappropriately administering treatment based on incorrectly assigned results. National patient safety goals have consistently called for a reduction of these errors in the hospital setting to zero. The specimen labeling errors on one inpatient department (IPD) at an acute care hospital in Eastern Washington were noted to be elevated from 2019 to 2020, potentially threatening patient safety. An evidence-based technique called the Red Rule has been linked to an improvement in lab labeling performance in the hospital setting.

Purpose/aims: The primary purpose of the QI project was to …

Evaluation Of A Coronary Artery Bypass Graft Care Steps Program, Sheri Havel, Karen Colorafi, Mirjeta Beqiri

2021 Providence Nurse Research Conference

Background: Across the U.S., 20% of cardiothoracic surgery patients who are discharged to home experience unplanned readmission within 30 days of discharge. Readmissions and postsurgical complications are associated with poor patient outcomes, increased mortality rates, and increased cost of healthcare. Evidence-based recommendations for reducing preventable readmission are limited, although there is some indication that high quality pre-operative and discharge education can reduce this burden. Providing appropriate patient education at time of discharge from acute care to home regarding medication adherence, prescheduled follow-up appointments, wound management and monitoring, and symptom management education is theorized to have a significant positive impact on …

Postpartum Depression Screening To Improve Maternal Outcomes, Jill Goebel, Jeff Ramirez

2021 Providence Nurse Research Conference

Background: Postpartum depression (PPD) is correlated with worsened maternal and infant health outcomes, and an estimated10-20% of women experience this condition after giving birth. Universal depression screening for PPD in maternity and well-child appointments is the standard of care. However, PPD screening is not well-integrated into outpatient lactation visits which assist new moms with difficulties breastfeeding. To address this gap, routine PPD screening and education was implemented in an outpatient lactation clinic servicing postpartum women in Eastern Washington. Purpose: The purpose of this quality improvement project was to implement the use of PPD screening in a lactation clinic to …

Implementing Ideal Discharge Planning: A Quality Improvement Project On An Inpatient Unit​, Dawn Doud, Brenda Senger, Karen Colorafi, Teresa Bigand

2021 Providence Nurse Research Conference

Background: Effective discharge teaching reduces 30-day hospital readmissions, decreases unnecessary emergency room visits, improves patient satisfaction, and is cost effective for hospitals by improving the Centers for Medicare and Medicaid Services (CMS) measures for reimbursement. Evidence suggests that standardized discharge teaching templates embedded within the electronic health records lack patient engagement and can fail to meet individual patient discharge education needs. A need was identified to improve the discharge planning process on an advanced care unit in a community based hospital.

Purpose: The purpose of this project was to evaluate and assess the implementation of an evidence based toolkit, IDEAL …

Exploring The Relationship Between Exposure To Nature While At Work And Burnout Among Female Nurses On Day Shift, Jamie Roney, Sahar Mihandoust, Stephanie Dunkle

2021 Providence Nurse Research Conference

Background: Registered Nurses working extended shifts in the hospital setting may report burnout, which reduces caregiver satisfaction, increases turnover, and potentially translates to delivery of suboptimal patient care. To align with the quadruple aim, efforts are needed to reduce nurse burnout. Limited literature suggests that visual access to nature, either via artwork or exterior landscaping, may reduce burnout. However, more research is needed to understand whether visual access to nature influences burnout among Registered Nurses delivering direct patient care.

Purpose/Aims: The purpose of this study was to explore the relationship between visual access to exterior landscaping or nature artwork and …

Employed Mothers’ Satisfaction With The Breastfeeding Provisions In The Patient Protection And Affordable Care Act In Two Northwestern U.S. Hospitals, Rebecca Penders

2021 Providence Nurse Research Conference

Background: Breastfeeding is the gold standard for infant nutrition. Many workplace barriers to lactation exist for mothers returning to work after the birth of an infant. In 2010 the Breastfeeding Provisions in the Patient Protection and Affordable Care Act (BP-PPACA) was enacted as the first federal breastfeeding law which outlined specifically break time and a place to pump for businesses with over 50 employees who employed hourly wage workers. There is little known about the satisfaction of hospital employees pumping/lactation experience after the BP-PPACA.

Purpose/Aims: The purpose of this study was to determine the extent to which employed mothers' …

Promoting Mobility In Post-Surgical Patients: A Quality Improvement Project, Abel Sawa, Teresa Bigand

2021 Providence Nurse Research Conference

Background: Hospitalized patients suffer negative outcomes related to lack of mobilization activities such as falls with injury or infection. Mobility requires a multi-disciplinary team approach including Registered Nurses (RNs), Certified Nursing Assistants (NA-Cs), and Physical/Occupational Therapists (PT/OTs) to promote best patient outcomes. The Johns Hopkins Culture of Mobility toolkit provides evidence-based practices for integrating multi-disciplinary mobilization efforts for hospitalized patients. This toolkit had not been implemented on a busy orthopedic post-operative nursing unit in one large hospital.

Purpose/aims: To test the impact of the culture of mobility toolkit on caregiver perceptions of mobility barriers and evaluate the implementation …

Effectiveness Of Apfel Simplified Risk Score In Predicting Postoperative Nausea And Vomiting In Day Surgery Unit, Leni Alejo, Cherry De Guia, Cynthia Rodriguez, Cassandra Luck-Bird

2021 Providence Nurse Research Conference

Background: Postoperative nausea and vomiting (PONV) continues to be a perioperative complication despite improvement in quality and safety of anesthesia care causing an increased overall healthcare cost and sometimes serious physical complications. The American Society of PeriAnesthesia Nurses (ASPAN) supports that risk assessment for PONV helps with its prevention which is in line with the Society of Ambulatory Anesthesia's (SAMBA) current guidelines for PONV management. Literature supports that PONV can be predicted and prevented in patients by assessing risk factors such as gender, smoking status, history of PONV and use of postoperative opioids, among others. At present there is no …

Exploring The Relationship Between Covid-19 Unit Designation And Nurse Burnout Syndrome, Gisele Bazan, Tiffany Patterson, Kelsey Sawyer, Jamie Roney, Erin Whitley, Sahar Mihandoust, Joann Long

2021 Providence Nurse Research Conference

Background: The COVID-19 pandemic impacted healthcare due to surges in infected patient and respiratory failure. Nursing burnout syndrome (NBS) results from occupational factors leading to mental health problems. Nurses working in intensive care units (ICUs) dedicated to caring for COVID-19infected individuals may be even more susceptible to NBS due to increased burdens of futile care delivery and high mortality rates within overstretched healthcare systems. Identifying socio-demographic, work-related, and psychological predictors of NBS may help organizations mitigate, or at least minimize, the negative psychological impact on ICU nurses working during future pandemics.

Purpose/Aims: The aim of this study was to compare …

Improving Outcomes For Pregnant Women With Severe Hypertension, Danette Schloeder

2021 Providence Nurse Research Conference

Background: In 2019, a large hospital in Alaska joined the Alaska Perinatal Quality Collaborative (PQC). The first project was the AIM Hypertension Project. The goals of the project were to reduce severe maternal morbidity among preeclampsia cases by 20% and Increase the timely treatment of hypertension to 80%. Other process and structure measures included education, simulation, clinical debriefs, and follow-up visits.

Methods/Approach: The PQC used monthly educational sessions, data collection and review of every case with severe hypertension, and Plan-Do-Study-Act cycles. Data collection occurred over an 18-month period. Cases were identified by the Washington State Hospital Association database and reviewed …

Improving Primary Care Screening For Familial Hypercholesterolemia, Mary Nametka, Brenda Senger

2021 Providence Nurse Research Conference

Background: Familial Hypercholesterolemia (FH) is the most common genetic condition resulting in cardiovascular disease, a leading cause of death in the United States. FH is estimated to affect 1 in 250 individuals with elevated lipid levels present from birth. An estimated 90% of individuals with FH remain undiagnosed. '

Purpose: The purpose of this quality improvement project was to increase provider awareness and promote screening for FH among adults ages 20 years and older. '

Methods: This quality improvement project consisted of an online educational intervention for providers working at an outpatient clinic regarding FH. Outcomes included: 1) pre-intervention …

Pain Management Trends Among Adults Hospitalized With Cellulitis: An Evidence-Based Practice Project, Syndey Pham, Teresa Bigand, Brenda Senger, Kenn Daratha, Kris Daratha

2021 Providence Nurse Research Conference

Background: Cellulitis is an infection of the skin causing swelling and acute pain. Two and a half to three and a half million adults seek care in the emergency department annually for this condition. Opioid medications are commonly administered and prescribed for pain, especially following the Joint Commission’s campaign in 2001 characterizing “pain as the 5th vital sign”. An estimated 22% of older adults hospitalized with a painful medical condition receive a new prescription for an opioid medication. Evidence suggests that there is no difference in pain outcomes among adults prescribed opioid versus non-opioid medications for acute pain conditions in …

Differences In Perceived Patient Mobility Barriers Among Nurses From Various Departments And Location Work Sites, Teresa Bigand, Danell Stengem, Crystal Billings, Jennifer Hoople, Tiffanie Rampley, Elena Crooks, Nathaniel Nickerson, Brandon Clem

2021 Providence Nurse Research Conference

Background: Hospitalized patients suffer negative outcomes related to lack of mobilization activities such as falls with injury or infection. Mobility requires a multi-disciplinary team approach including Registered Nurses (RNs), Certified Nursing Assistants (NA-Cs), and Physical/Occupational Therapists (PT/OTs) to promote best patient outcomes. The Johns Hopkins Culture of Mobility toolkit provides evidence-based practices for integrating multi-disciplinary mobilization efforts for hospitalized patients. This toolkit had not been implemented on a busy orthopedic post-operative nursing unit in one large hospital.

Purpose/aims: To test the impact of the culture of mobility toolkit on caregiver perceptions of mobility barriers and evaluate the implementation of the …

Development Of A Smartphrase In The Electronic Health Record To Promote Chemotherapy And Immunotherapy Safety, Mary Jo Sarver, Monica Mcmanus, Amy Allen, Bethany Johnson, Dennielle Padgett, Elizabeth Ser

2021 Providence Nurse Research Conference

Background: Chemotherapy-immunotherapies are high risk medications that can include multi-drug and multi-day regimens with narrow therapeutic indexes and high risk for toxicities. Susceptibility for errors exists if adherence to protocol is inconsistent or if pertinent patient specific information is omitted. Prior to the creation of the "SmartPhrase" in the Electronic HealthRecord (EHR) pre-administration safety checks were on paper, not included in the EHR, not standardized among clinicians, and not completed every time. Chart audits revealed a need for consistent, centralized documentation to enhance patient safety while minimizing professional liability. A trans-disciplinary team created a "SmartPhrase" template for streamlining relevant …