Evaluation Of Simulation On Medication Errors In The Pediatric Intensive Care Unit, Carrie Clark

Dissertations

Problem: Medical errors are the third leading cause of death in the United States, the most common medical error being medication error. Pediatric patients are at an increased risk of medication error due to medication dosage calculation and the use of frequent high hazardous drugs.

Methods: The quality improvement (QI) project implemented the use of descriptive observational design using retro and prospective data. The data was collected over a 4-week and 4-week period by gathering data via safety and environmental management survey (SEMS).

Results: The data gathered consisted of an increase in medication errors of 150%. The data collected yielded …

Screening For Food Insecurity In A Suburban Pediatric Urgent Care, Rachel Foutz

Dissertations

Problem: Screening for Social Determinants of Health (SDOH), including food insecurity (FI) should be done on a regular basis at a child’s pediatrician. Many children in the state of Missouri do not have a pediatrician or do not regularly see their pediatrician and are therefore never being screened for FI.

Methods: This observational descriptive quality improvement (QI) project utilized a prospective observational analysis to implement a voluntary FI screening tool in a pediatric only urgent care. The project sampled pediatric patients aged two days to 21 years of life. All participants were given local resources after completing the screening. The …

Acute Agitation Intervention Tool For Reduction Of Polypharmacy, Brooks J. Propst

Dissertations

Introduction: Patients with behavioral health diagnoses are among the highest risk for
aggression. For pediatric patients with behavioral health needs, urgent treatment is
needed for aggressive behavior, due to the potential unwanted outcomes. The purpose of this Quality Improvement (QI) pilot project was to implement an Acute Agitation Intervention Tool that uses the Broset Violence Checklist (BVC) to guide
pharmacological intervention for mild and moderate to severe agitation in pediatric
patients with behavioral health needs ages 8 to 18 to decrease the number of medications that patients are getting per agitation event over a 12-week period.

Methods: This QI included …

Pediatric Streptococcal Pharyngitis Testing And Treatment Practices, Amanda Welch

Dissertations

Objective: The purpose of this pilot quality improvement study was to implement SmartPhrases and assess its impact on adherence to the Infectious Disease Society of America (IDSA) guideline for Group A Streptococcus (GAS) pharyngitis testing and treatment in pediatric patients ages 1-16 years old. The aim was to use SmartPhrases to improve adherence with the IDSA guideline by 30% for GAS pharyngitis swabbing and 10% for appropriate antibiotic prescribing in three months.

Methods: A retrospective data analysis approach was used, in reviewing SmartPhrases data from the electronic health records (EHR) in a metropolitan Urgent Care. This data were collected from …

Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll

Dissertations

Abstract

Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.

Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.

Results: Following implementation, Gardasil9 first dose uptake increased …

Implementation Of A Situation, Background, Assessment, Recommendation (Sbar) Patient Handoff Tool In The Electronic Medical Record (Emr), Kristen L. Chandler

Dissertations

Abstract

Purpose and Problem: Handoffs that are poorly conducted are implicated in 80% of preventable adverse events in healthcare facilities. Within a Pediatric Rehabilitation Facility in Maryland Heights, Missouri it was observed that nurse handoffs were not conducted and lacked the use of a standardized evidence-based tool, resulting in nurse dissatisfaction with the handoff process and miscommunication. Recognized by the World Health Organization, The Joint Commission, and Agency for Healthcare Research and Quality, the Situation, Background, Assessment, Recommendation (SBAR) evidence-based tool is effective in improving handoff communication, improving nurse satisfaction, reducing adverse events, and promoting patient safety. The purpose of …

Implementing Obesity Management Guidelines In Rural Primary Care, Taylor Bell

Dissertations

Abstract

Problem: In the United States, obesity is one of the leading causes of death among Americans and rates of obesity continue to rise. Geographic location significantly affects the number of obesity cases, with rural areas being affected more than other locations. Despite this, obesity continues to be undertreated by rural primary care providers.

Method: This quality improvement (QI) pilot project utilized a descriptive, observational design to evaluate the implementation of an evidence-based clinical practice guideline algorithm for obesity management in a rural primary care clinic. An algorithm was implemented on patients aged 18-60 years and with a BMI of …

Improving Postpartum Depression Screening Practices In The Postpartum Setting, Courtney Lynn Cole

Dissertations

Abstract

Problem: Postpartum Depression (PPD) is frequently undetected in women due to barriers that limit effective recognition and diagnosis. Depression screenings and treatment referrals improve outcomes in the immediate postpartum period. Follow-up methods for positive depression screens are often missed by postpartum care teams.

Methods: A descriptive, observational design was used for this quality improvement project. A formalized depression screening protocol was created to help guide nursing staff on a Postpartum Unit when detecting a positive depression screen. Convenience sampling was utilized and the sample included patients aged 18-45. Data collected throughout this quality improvement project included Edinburgh Postnatal Depression …

Implementation Of A Structured Discharge Checklist For Children Admitted To The Hospital With Acute Asthma, Nicholas Fleming

Dissertations

Abstract

Problem: The transition process from a hospital setting to home is critical for pediatric patients and their families. However, there is no standardized process to ensure asthma discharge orders and asthma action plans are printed at the time of discharge

Methods: This observational quality improvement project utilized a pre-and-postimplementation of the Kamishibai Card (K-Card) process for pediatric discharge checklist compliance in an inpatient pediatric general medicine unit. This project used a sample of all children aged 2 years to 21 years with an asthma diagnosis admitted to the inpatient general medicine pediatric unit. This project included an …

Attention-Deficit Hyperactivity Disorder: Improving Outcomes Through Early Identification, Tina Lusk

Dissertations

Problem: Failure to identify and treat attention-deficit hyperactivity disorder (ADHD) is associated with academic underachievement, social difficulties, negative physical and mental health effects. Evidence suggests approximately 3% of a broad-based population sample and roughly 13% of an at-risk population are undiagnosed despite significant symptomology (Downey & Zun, 2018; Madsen et al., 2018; Okumura et al., 2019). The United States (U.S.) has no structured screening system for ADHD. Consequently, children receive no referral for diagnosis or treatment to mitigate its effects.

Methods: The Institute for Healthcare Improvement (IHI) Model for Evidence-Based Practice using the Plan Do Study Act (PDSA) cycle guided …

Self-Care Practices In Doctoral Nursing Students And Effects On Educational Experience, Megan Lutman

Dissertations

Problem: Doctoral nursing students are often faced with stressors on top of their schooling, one of which is continuing to work while pursuing their education. This in combination with normal life stressors can be challenging. The purpose of this project was to survey doctoral nursing students on what their current self-care practices.

Methods: An exploratory needs assessment project was created to gather data from Doctor of Nursing practice (DNP) and Doctor of Philosophy (PhD) nursing students in an urban, mid-sized, Midwestern, public university to identify current self-care practices, barriers to self-care, preference of self-care practices, and the impact these …

Evaluation Of A Substance Abuse Screening Tool In The Pediatric Emergency Room, Jody Sims

Dissertations

Abstract

Background: Substance abuse among adolescents is one of the most serious social health problems in the United States. The prevalence of alcohol use in adolescents is as high as 80%, while opioid overdose deaths among adolescents have risen by greater than 50% in the last 10 years. Alcohol, tobacco, and other substance use has also increased among youth and is not being properly evaluated in the pediatric hospital setting. The purpose of this project was to evaluate the use of a substance abuse screening tool with SBIRT trained staff in the pediatric emergency room setting.

Methods: The CRAFFT substance …

Improving Pediatric Asthma Outcomes Through Pictorial Asthma Action Plans, Julia Donovan

Dissertations

Problem: Asthma is the leading chronic disease of children and the leading cause of childhood emergency department (ED) visits, hospitalizations, and missed school days. Asthma action plans (AAPs), including photographs or pictures of asthma medications, symptoms, triggers, and devices, have improved parents’ understanding of their child’s asthma and have increased their comfort level in caring for their child.

Methods: An interventional pre-post study with a mixed-method research design, at a large, urban, primary care pediatric clinic with two locations, evaluated the effectiveness of a pictorial AAP on a child’s asthma control. A pictorial AAP was provided, and a childhood asthma …

Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke

Dissertations

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …

Self-Care, Resilience, Self-Compassion, And Burnout In Doctoral Nursing Students: An Exploratory Needs Assessment, Logan Justice

Dissertations

Abstract

Problem: In the United States, one in three nurses experience symptoms of burnout, and doctoral nursing students are additionally challenged to juggle multiple school, work, and life demands (Reith, 2018; Woo et al., 2020). The purpose of this project was to explore the current self-care practices of doctoral nursing students to understand how self-care relates to resilience and burnout.

Methods: This exploratory needs assessment utilized a convenience sample of Doctor of Nursing practice (DNP) and Doctor of Philosophy (PhD) nursing students at a medium sized midwestern university. An electronic data collection survey was constructed to assess student self-care practices, …

Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs

Dissertations

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …

Is Heart Health As Simple As Gut Microbiota?, Elizabeth A. Moxley

Faculty Articles, Papers, and Other Scholarship

The current mortality statistics for cardiovascular disease (CVD) in the United States (US) and on a global scale are staggering. CVD is responsible for approximately 31% of global deaths,¹ and approximately 25% of adults in the United States (US) have CVD.² The American Heart Association has identified eight primary measures for improving and maintaining cardiovascular health: Life’s Essential 8.³ However, a lesser recognized measure that has a profound effect on cardiovascular health has recently emerged,^4-5 that of the gut microbiome. The link between cardiovascular health and diet is not merely due to essential nutrients found in …

Rn To Bsn End-Of-Program Evaluation Revision, Nichol Tate

Doctor of Nursing Practice Projects

The data in an end-of-a-program student survey are crucial for maintaining a high-quality program and meeting accreditation standards. This quality improvement project aims to formulate a revised end-of-program evaluation survey for graduates to use to provide feedback to make necessary improvements to the program and employ better communication and access to educators for students to feel connected and important. After the item analysis method was used to review the questions and revise the survey, the revision of the survey was sent to the current summer RN to BSN students to complete and provide data about the overall program. Another method …

Improving Nurses Wound Care Knowledge Utilizing An App, Monica Amador

Student Scholarly Projects

Practice Problem: Nurses needed additional wound care support, but formal training was not in the budget at this time. Nurses needed a quick reference guide to help them assess, document, and treat wounds correctly until the hospital could provide adequate training.

PICOT: The PICOT question that guided this project is; “When treating wound care patients within a hospital setting (P), how does the implementation of a wound software app. (I) as compared to pre-existing nursing knowledge (C) increase a nurse’s self-reported ability to accurately assess and treat wounds (O) during a 10-week period? (T)”

Evidence: Based on a thorough and …

Clients In Uganda Accessing Preferred Differentiated Antiretroviral Therapy Models Achieve Higher Viral Suppression And Are Less Likely To Miss Appointments: A Cross-Sectional Analysis, Esther K. Nkolo, Jessica Clinkscales Ejike, Simon Sensalire, Juliana Nabwire Ssali, Immaculate Ddumba, Jacqueline Calnan, Carolina Gonzalez, Nelly Maina, Melaku Dessie, Lauren Bailey, Ugochukwu Amanyeiwe, Thomas Minior, Karishma Srikanth, Herbert Kadama, Khushi Patel, Dina Patel

Publications

INTRODUCTION: The Uganda Ministry of Health recommends facility- and community-based differentiated antiretroviral therapy (DART) models to support person-centred care for eligible clients receiving antiretroviral therapy (ART). Healthcare workers assess client eligibility for one of six DART models upon initial enrolment; however, client circumstances evolve, and their preferences are not routinely adjusted. We developed a tool to understand the proportion of clients accessing preferred DART models and compared the outcomes of clients accessing preferred DART models to the outcomes of clients not receiving preferred DART models. METHODS: We conducted a cross-sectional study. A sample of 6376 clients was selected from 113 …

Pcos Health-Related Quality-Of-Life And Depressive Symptoms Across The Lifespan: Comparative Study, Pamela J. Wright Phd, Ms, Med, Rn, Cen, Abbas S. Tavakoli, Cynthia F. Corbett Phd, Rn, Faan

Publications

The purpose of this cross-sectional study was to compare health-related quality of life (HRQoL) and depressive symptoms among peri-postmenopausal women with polycystic ovary syndrome (PCOS) aged ≥43 years relative to premenopausal women with PCOS aged 18-42 years. An online survey link comprising questionnaires about demographics, HRQoL, and depressive symptoms was posted onto two PCOS-specific Facebook groups. Respondents (n = 1,042) were separated into two age cohorts: women with PCOS aged 18-42 years (n = 935) and women with PCOS aged ≥43 years (n = 107). Data from the online survey were analyzed using descriptive statistics, Pearson correlations, and multiple regression …

Assessing And Strengthening New Provider Education Related To Extrapyramidal Symptoms And Antipsychotic Medication Usage, Mesiah O'Mar Porter Jr.

Doctoral Dissertations and Projects

Inadequate recognition and treatment of extrapyramidal symptoms (EPS) pose as a major liability to providers, as EPS can be life-threatening to patients, as they develop into metabolic syndrome, tardive dyskinesia (TD), or even death. Thus, insufficient usage of AIMS testing can negatively impact providers’ ability to meet associated care practice standards, when treating psychotic patients with antipsychotic medications. As a result, an evidence-based practice, quasiexperimental project was completed, utilizing the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare. In alignment with this version of the revised Iowa Model, a pilot study was initiated to progress toward a formal …

Lung Cancer Screening Implementation, Jessica Lee Digiorgio

Doctoral Dissertations and Projects

The Lung Cancer Research Foundation has stated that lung cancer is one of the leading causes of death worldwide. In 2022, 236,740 individuals were diagnosed with lung cancer, and 130,190 American lives are lost annually from lung cancer. Smoking is the number one risk factor for lung cancer and is responsible for approximately 80% of deaths related to lung cancer. Because of the high mortality rates from lung cancer, the American Cancer Society recommends the use of the U.S. Preventive Services Task Force (USPSTF) screening tool. Individuals who meet the criteria defined by the USPSTF qualify for yearly low-dose computed …

Managing Burnout In Nursing, Karen Starnes Bell

Doctoral Dissertations and Projects

Burnout is a widespread phenomenon characterized by a reduction in energy that manifests in exhaustion, lack of inspiration, and feelings of frustration which may lead to reduced work efficacy and multiple absences. In the nursing profession, long hours, the pressure of quick decision-making, and the stress of caring for patients who may have poor outcomes may contribute to burnout. This integrative review was conducted to identify variables that contribute to nurse burnout and discover strategies organizations can implement to reduce or prevent nurse burnout.

Nursing Faculty Experiences Of An Academic Merger: A Transcendental Phenomenological Study, Sherry Michelle Boone

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study was to describe the experience of undergoing a merger of two or more academic institutions within the United States for nursing faculty who chose to voluntarily depart the organization following the merger. The theoretical framework guiding this study was social capital theory as it discusses the importance of relationships and the resources those relationships provide. While assets may be acquired during a merger, social capital must be developed over time and is important for building a new combined healthy organizational culture. The study included nine participants who departed the institution in the timeframe …

Does A Telehealth Education Program Improve Lifestyle Behaviors Of Individuals With Prediabetes?, Loretta A. Richardson

Doctoral Dissertations and Projects

Chronic conditions are a considerable burden on the healthcare system, and one that is becoming increasingly prevalent is diabetes. Prediabetes is a condition that has become more common and diagnosed in many patients before an actual diagnosis of diabetes. Healthcare professionals strive to empower individuals to make lifestyle changes to prevent diabetes from occurring by informing individuals on how to manage prediabetes. For individuals that do not make the necessary changes to lower their hemoglobin A1c to below the standards of less than 5.6%, a diagnosis of diabetes occurs. It is estimated that five per 1000 individuals are diagnosed with …

Nonpharmacologic Measures To Maintain Or Increase Bone Density In Patients At Risk For Osteoporosis: An Integrative Review, Katie Saporsky

Doctoral Dissertations and Projects

Osteoporosis is a major phenomenon, impacting a large proportion of the population of the United States. Effective prevention and mitigation strategies for this condition and its related complications are necessary to promote health and well-being for the aging population. Current pharmacologic agents used to combat osteoporosis bring the risk of adverse effects, resulting in poor patient adherence. Nonpharmacologic methodologies, specifically weight-bearing exercise, targeted nutrition, and whole-body vibration, have proven to be successful in increasing bone mineral density and mitigating the risk of osteoporosis and its related complications. Implementing these methodologies results in increasing bone mineral density, strength, and well-being.

Kangaroo Care Impact On Maternal Health: An Integrative Review, Alexis Ann Lawson

Doctoral Dissertations and Projects

Health care should progress and change as the needs of the population change. As light is shed on the mothers’ experiences during the postpartum period, there is an increasing need to find and implement evidence-based interventions to promote their health and wellness. As a vulnerable population, postpartum women require appropriate treatments and interventions to avoid postpartum complications. Three key themes of postpartum health and well-being that directly and significantly impact mothers are postpartum depression, maternal and infant attachment, and exclusive breastfeeding. This integrative review addressed the correlation between each of these themes and how kangaroo care, upright skin-to-skin contact, impacts …

A Clinical Nurse Leader Nurse Navigator Program For Heart Failure Patients, Shanna Lantel Negron

Doctoral Dissertations and Projects

The purpose of this integrative review is to examine the literature regarding nurse-led educational interventions, transitional care (TC) strategies for heart failure (HF) patients, nurse navigation, HF self-care, and the clinical nurse leader (CNL) role to support integrating a CNL into the care delivery model serving as a nurse navigator (NN) for adult HF patients being discharged home from the hospital. The basis for this review is to identify an innovative way to improve patient reported and clinical outcomes for the HF population which increases each year. The economic and symptom burden associated with this disease is high further enhanced …

Prenatal Educational Strategies To Increase The Duration Of Breastfeeding: An Integrative Review, Kayla Caryl Carter

Doctoral Dissertations and Projects

Although breastfeeding is the best source of nutrition for infants, many women in the United States of America do not breastfeed their infants. Infants should be breastfed for the first 6 months of life. Not only does this benefit the baby, but the mother as well. While prenatal education has been linked with improvements in breastfeeding rates, little research has been completed on which educational strategies are most effective. The purpose of this integrative review is to determine effective prenatal educational strategies for increasing the duration of breastfeeding. The strategies reviewed were single methods, multiple methods, and education with continued …