Nursing Commons^™

Adoption Of Ventilator-Associated Event Bundle In Adult Critical Care Population, Renee Christine Hayes

Doctor of Nursing Practice Scholarly Projects

Problem: The utilization of mechanical ventilatory support is a periodic necessity within critical care. One significant aspect of mechanical ventilatory health management focuses on preventing the sequela of ventilator-associated events (VAE). The societal impact of VAE occurrences weighs heavily on the already burdened registered nurse (RN), health care providers including physicians and advanced practice providers, healthcare system, and overall patient and family wellbeing. Purpose: This project examined if the addition of a ventilator associated event bundle (VB) reduces the occurrence of VAE within the adult patient population requiring mechanical ventilation for longer than 48 hours. Methods: Metric review of VAE …

Post-Discharge Follow-Up Call To Impact Heart Failure Re-Admission Rates, Regina Mitchell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The clinical setting for this project, a 321-bed southeastern hospital in South Carolina, has an elevated re-admission rate for CHF patients of 22.67% (Ferguson, B. V.P. Quality, personal communication, October 21st, 2022), 1.57% above the Centers for Medicare Services (CMS) benchmark of 21.1% for payment reduction penalties. Purpose: Determine if post-discharge interview phone calls decrease CHF re-admission rates. Methods: A two-group pretest-posttest design will be used. Data will be collected during retrospective unit chart review, weekly chart review of patient participants, and structured post-discharge phone interviews. Inclusion Criteria: English-speaking, adult (>18 years of age) patients with …

Evaluating The Impact Of Rapid Response Electroencephalogram In Post-Cardiac Arrest Patients, Lauren Lee Steffen

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Timely diagnosis and treatment of nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) are critical for improving patient outcomes after a cardiac arrest. However, NCSE can only be confirmed with an electroencephalogram (EEG), which is either considerably delayed or unavailable in the Emergency Department and Intensive Care Unit (ICU). Purpose: This project aimed to describe the impact of a rapid response electroencephalogram (rrEEG) brain monitor on improving time- to- acquisition and length of stay in the Intensive Care Unit for post-resuscitated cardiac arrest survivors; additionally, does rrEEG increase nurse's knowledge and confidence in managing complex seizure patterns? Method(s): …

The Significance Of Palliative Care Education And Areas For Improvement, Lindsey Bunday

Honors Projects

Palliative care is vital in prioritizing quality of life for patients with serious illnesses. Such care is crucial to help patients understand their prognosis, address needs, and meet goals of care. However, physician shortages, improper utilization, and non-standardized medical curriculum amplify the gaps in care and demonstrate significant room for improvement. Innovative curriculum and opportunities for knowledge advancement can refine education and improve patient care.

2023 Nursing Annual Report, Children's Health System Of Texas

2023

No abstract provided.

Detection And Management Of Post Intensive Care Syndrome, Ann Tomy

Nursing | Student Research Posters

Post Intensive Care Syndrome (PICS) is a collection of symptoms that more than half of patients who survive a critical illness experience after discharge.Those symptoms include weakness, fatigue, sleep disturbances, cognitive dysfunction, post-traumatic stress disorder, mental health conditions, and a lack of effective coping strategies. PICS can significantly impact an individual's quality of life, complicating the recovery process and posing challenges for reintegration into daily activities and societal roles. The etiology of PICS is multifactorial, with the severity and duration of the illness, the nature of medical interventions in the ICU, and the pre-existing health condition of the patient all …

Assessing Lung Cancer Screening Protocols And Outcomes: A Comparative Analysis Between Indonesia And The United States, Priscilla Sitorus

Nursing | Student Research Posters

After losing a loved one to lung cancer, it can be difficult to process, especially when the diagnosis could have been made earlier. However, some may struggle to trust a healthcare system when screening protocols and care vary significantly, to the extent that it may seem unclear. Amongst both men and women, lung cancer is the worldwide leading cause of cancer-related mortality (World Health Organization, 2023), thus further creating a considerable amount of challenges that not only takes part in communities, but the overall healthcare system. Despite the increasing rate of lung cancer, Indonesia has limited screening programs available for …

Postoperative Discharge Opioid Education Including Narcan Kit Access To Prevent Overdose: A Quality Improvement Project, Arezo Aziz

DNP Projects

Significance and Background: Opioid related overdoses are considered a public health epidemic and emergency in recent years within the United States. With a staggering number of opioid related deaths which have continued to rise, steps have been taken to decrease risk within local communities through programs including personalized patient education during provider visits, the dispensing of Naloxone with opioid prescriptions and encouraging the use of alternative pain management strategies. Most recently, New York State passed a recommendation encouraging all healthcare providers to prescribe Naloxone with the first opioid prescription of each year for patients deemed high risk for overdose. A …

The Effect Of A Positive Work Culture In Emergency Service Nurses: An Ebp Proposal, Brianna M. Fitzgerald

MSN Capstone Projects

This paper aims to address the spirit of inquiry of the effect a safe work environment has on compassion fatigue in nurses in the emergency department (ED). The World Health Organization promotes an eager approach to the battle of compassion fatigue in frontline healthcare workers, stating, "Unless this is addressed, it will further add to the global nursing workforce shortage." (Stafford et al., 2022, p. 1853). Unfortunately, 69% of nurses under the age of 25 report burnout from working conditions (American Nurses Association, 2022). Improving nurses' job satisfaction and motivation levels is necessary to increase the effectiveness of nursing services …

Support Program For Dnp/Fnp Students: A Quality Improvement Project, Catie Pernice

DNP Projects

Significance and Background: Peer support programs in graduate studies can help students in a multitude of ways. Peer support programs can improve student satisfaction and decrease stress levels among students. Some graduate nursing programs offer a peer support program for students but not all. The university where this project was conducted does not offer a peer support program for Doctorate of Nursing Practice/Family Nurse Practitioner students.

Purpose: To increase student satisfaction and decrease the stress of DNP/FNP students in their first year of graduate college.

Methods: The project’s implementation and evaluation were guided by The Iowa Model Revised: Evidence-Based Practice …

Implementation Of A Human Trafficking Screening Tool In An Immigrant Services Organization, Cassandra Cooper

DNP Projects

Background

Human trafficking (HT) is a public health problem that advances the spread of disease and mental health issues and affects vulnerable populations including immigrants. HT screening tools are more reliable than clinical judgment in identifying HT victims, as even victims themselves are sometimes unaware of their own victimhood. To reduce the instances of victims being missed, HT screening tools have been validated to identify victims without the influence of personal bias.

Project Goals

1. Choose and implement a HT education module for staff.

2. Implement the AHTST for all new arrivals and from the months of November 2023 through …

Loma Linda Nurse - Vol. 31, Loma Linda University School Of Nursing

Loma Linda Nurse

FEATURES

4 | The Next Chapter for LLUSN

8 | 50 Years of West Hall

10 | Dr. Shawn Collins Named New Dean

12 | Dr. Gloria Huerta Named New Associate Dean

14 | Adventist Nursing Theory with Dr. Patricia Jones

LLUSN HIGHLIGHTS

16-23 | ALUMNI NEWS

24-27 | ACADEMICS

28-32 | HOMECOMING

33-35 | FACULTY UPDATES

Use Of A Shared Decision-Making Approach To Improve Blood Pressure Readings In A Hispanic Population With Hypertension, Narayani Koirala

Doctor of Nursing Practice Final Project Abstract

Background: Hypertension is a major risk factor for cardiovascular disease morbidity and mortality with over half of all cardiovascular deaths attributed to it (CDC, 2022). “It is estimated that one-third of adults are hypertensive worldwide. Predictions indicate that one billion individuals will be hypertensive by 2025” (Eghbali et al., 2022). Non-adherence to prescription medication and lifestyle changes is a significant problem and prevalent in the Hispanic population due to various factors related to social determinants of health.

Aim: This project aimed to increase patient adherence to hypertension treatment therapy in Hispanic adults with hypertension for improved blood pressure control and …

Learning Circles: Promoting Inclusive Care Starting In The Classroom, April Graham, Kindsey Gattman, Tobias Johnson

Articles, Abstracts, and Reports

No abstract provided.

Prenatal And Postnatal Disparities In Very-Preterm Infants In A Study Of Infections Between 2018–2023 In Southeastern Us, Robin B. Dail Phd, Rn, Faan, Kayla C. Everhart Phd, Rn, Victor N. Iskersky, Weili Chang, Kimberley Fisher, Karen Warren Phd, Rn, Heidi J. Steflik, James W. Hardin Ph.D.

Publications

Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. Methods: 367 preterms born at < 32 weeks gestational age (GA) between 2019–2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics. Results: The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). Conclusions: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

Co-Occurrence Of Mental Illness And Substance Use Among Us Pregnant Individuals, 2012-2021, Zhong Li, Curisa M. Tucker Phd, Rn, Cassie L. Odahowski Phd, Mph, Kacey Y. Eichelberger, Jiajia Zhang Ph.D., Peiyin Hung Ph.D

Publications

Aim: Substance use disorders are increasingly prevalent among pregnant individuals, with evident risks of adverse perinatal outcomes. This study examines substance use (tobacco, alcohol and marijuana) among pregnant individuals with mental illness. Methods: A national representative sample of pregnant individuals were derived from 2012 to 2021 National Survey of Drug Use and Health data. Associations of past-year mental illness with past-month polysubstance use and each substance use were analyzed by logistic regression models, with complex sampling weights and survey year. Results: Among 6801 pregnant individuals, 16.4% reported having any mental illness (AMI) in 2012 and 2013, increasing to 23.8% in …

Recommendations For Sugammadex Administration In Standard And Special Populations, Kristen E. Mattson, Alexa Brummund

Doctor of Nursing Practice Projects

The purpose of this project was to collect evidence-based information regarding sugammadex administration in both standard and selected special populations. Special populations included renal failure, breastfeeding, pregnancy, and pediatrics. The objectives of the project were to collect and present current research to the host facility, define barriers to the use of sugammadex, and assess the participants’ knowledge of sugammadex use in special populations. A guideline for sugammdex administration was created and presented to the host facility through a poster presentation and quick reference guide. A voluntary post-implementation survey was implemented, and the results were recorded, analyzed, and displayed in the …

Shivering In Postpartum Women: Development Of A Perioperative Protocol For Women Undergoing Cesarean Section, Lindsay Dawson, Kara Peters

Doctor of Nursing Practice Projects

In obstetric patients undergoing a cesarean section, a spinal anesthetic is the most common form of anesthesia (Hannallah, 2016). An intrathecal (or spinal) block is not benign. Postpartum shivering is a potential risk with any neuraxial procedure, with an incidence of 40-80% specifically following a spinal anesthetic (Feng et al., 2021). Patients who experience shivering are at a greater risk for postoperative complications, impaired mother-newborn bonding, and decreased patient satisfaction. Both nonpharmacological and pharmacological treatment options exist for prevention and treatment of postpartum shivering. The objective of this project was to introduce a standardized, evidence-based protocol to decrease the incidence …

Anesthesia Management For The Preeclampsia Or Hypertensive Parturient, Britanie Sumpter

Doctor of Nursing Practice Projects

Preeclampsia is a placental disease characterized by abnormal maternoplacental blood vessels and placental dysfunction resulting in fetoplacental hypoperfusion and maternal multi-system organ dysfunction (Wang et al., 2019). Expectant management of a hypertensive or preeclamptic parturient includes antihypertensive medications, magnesium sulfate for seizure prophylaxis, and early delivery of the fetus (ACOG, 2020). Neuraxial anesthetic-induced sympathectomy combined with circulating antihypertensives, magnesium sulfate therapy, and intravascular volume depletion in preeclampsia is thought to contribute to exaggerated hypotension.

Persistent refractory hypotension after neuraxial anesthesia in parturients with preeclampsia or hypertension has been an ongoing issue affecting obstetric providers at the host facility. This project …

Diversity, Equity, & Inclusion In Nurse Anesthesia: Bridging The Gap, Aminat Yusuff-Akinbo

Doctor of Nursing Practice Projects

The nurse anesthetist plays a crucial role in the healthcare system. Through intensive training, they provide safe and effective anesthesia care to patients across various healthcare settings. Currently, the nurse anesthesia field lacks diversity, with underrepresentation of minority groups such as Black, Hispanic, and Indigenous individuals. The United States Census revealed that there are more than 325 million residents. Yet only 10.9% of nurse anesthetists are of diverse racial backgrounds. This lack of diversity limits the cultural perspectives and experiences brought to patient care and perpetuates disparities in healthcare outcomes. An increase in diversity can improve care for individuals and …

Integrating Psychotherapy In A Psychiatric Outpatient Clinic, Ayesha Baluch

Doctor of Nursing Practice Projects

Mental illness is common in the United States, affecting millions of people. Although there are effective medications for mental illness, psychotherapy in addition to pharmacotherapy provides the best outcomes. This project aimed to improve providers' psychotherapy screening and education of patients about psychotherapy utilization. A pre-implementation survey was conducted to evaluate psychotherapy screening and the barriers faced by providers to utilize psychotherapy screening. An education session was provided to the providers about the importance of psychotherapy screening and education. Data showed that the providers discussed psychotherapy with eight patients (40%) and educated four patients (20%) pre-implementation. Data showed that the …

Improving Depression Screening In Primary Care, Grace Wilson, Annmarie O'Connor

Doctor of Nursing Practice Projects

Depression remains an increasingly prevalent and underdiagnosed disorder affecting approximately 21 million adults in the United States with only 66% seeking treatment (NIMH, 2022). Untreated depression can lead to worsening mental and physical health which negatively impacts a person’s quality of life. The implementation of routine depression screening in primary care is recommended by the US Preventive Services Task Force (USPSTF) to improve early detection leading to improved outcomes (USPSTF, 2023). Despite increased depression prevalence and USPSTF recommendation, there remained an absence of routine depression screening in a primary care practice in Midwest Illinois which led to the development of …

Nurses' Experience Implementating Weighted Blankets In Inpatient Psychiatric Unit, Michael Ragen

Doctor of Nursing Practice Projects

The complexity of treating sleep difficulties in patients with concurrent psychiatric disorders continues to be a struggle for the medical community. The mechanism that causes psychiatric disorders can induce insomnia or hypersomnia (Khurshid, 2018). There is also a growing interest in disturbed sleep ability to induce psychiatric episodes (Verkhratsky et al., 2020). This classic “Chicken or Egg Scenario” meets the modern focus on creating the best outcome for patients with the least medication, spurring interest in the holistic management of sleep disorders. The literature has little information on the use of weighted modalities for sleep management and anxiety in an …

Lung Cancer Screening In A Primary Care Clinic For Coal Mine, Glenda Mills, Sarah Cobb

Doctor of Nursing Practice Projects

Lung cancer is the leading cause of mortality for both men and women in the United States. Guidelines are set by the American Cancer Society for annual screenings of at-risk patients. Early identification of lung cancer risk and screening with low-dose CT scans can increase detection and treatment thereby reducing risk of death or disability. Coal miners are exposed to numerous cancer-causing agents, such as toxic chemicals, dust pollution from coal, and diesel exhaust fumes. However, primary care clinics serving coal miners lack lung cancer screenings despite the increased risk miners face. Patients were screened using criteria set forth by …

Establishing Routine Multiple Micronutrient Supplementation During Pregnancy In An Impoverished Guatemalan Community, Marissa Schuette, Erin Brueggemann

Doctor of Nursing Practice Projects

Pregnant and breastfeeding women in impoverished settings face heightened nutritional demands, placing them and their children at increased risk of inadequate nutrition's detrimental effects. Existing literature suggests that supplementing with multiple micronutrients (MMS) may offer superior protection against morbidity and mortality compared to traditional iron and folic acid (IFA) formulations. This research is set in the Land of Hope (LOH) clinic, located in Escuintla, Guatemala, a community served by the non-profit organization ER Abroad. The study aims to assess the feasibility of standardizing MMS provision to pregnant women at LOH, coupled with supplementary education on pregnancy and nutrition. The team …

Enhanced Recovery After Surgery (Eras) Protocol For Bariatric Surgery, Krista Bunch

Doctor of Nursing Practice Projects

Bariatric surgery has been utilized in treating severe obesity and offers several benefits, such as sustainable weight loss, treatment of various metabolic comorbidities, and improved life expectancy (Sundbom et al., 2017). With these benefits and procedural improvements, there has been a marked increase in the demand for bariatric surgery and increased interest in shifting some of these procedures to an ambulatory care setting (Stenberg et al., 2022). However, postoperative complications such as pain, nausea, and inability to tolerate oral intake can cause patients to experience an increased length of stay in the hospital and suboptimal outcomes (King et al., 2018). …

Improvement In Patient Compliance For Gynecological Care, Tracee Williams

Doctor of Nursing Practice Projects

This quality improvement project implemented the patient-initiated follow-up (PIFU) pathway in a gynecology clinic setting. PIFU has potential to lead to decreased no-show appointments and increased patient autonomy in outpatient healthcare practices. Barriers that influence compliance with plans of care include lower socioeconomic status, racial and ethnic minorities, and unmet social needs such as food insecurity, healthcare travel and cost, and child/adult care needs. In addition to higher rates of no-show appointments, individuals facing these barriers have increased comorbidities. Prior to implementing the PIFU model, patients between the ages of 18 and 42 completed a patient satisfaction survey to better …

Reducing Hemoglobin A1c Using Diabetes Self-Management Education And Support (Dsmes) For Hispanic Adults In A Primary Care Setting, Gita Gyawali Sedai

Doctor of Nursing Practice Final Project Abstract

Background: Members of the Hispanic population have a 50% or higher chance of developing diabetes and often do so at a younger age than other adults in the United States (CDC, 2022a). Diabetes complications also impact the Hispanic population harder, with higher rates of kidney failure caused by diabetes, along with diabetes-related vision loss and blindness (CDC, 2022a). DSMES programs have shown significant improvements in A1C and blood sugar control in different settings (Powers et al., 2020). However, it has not been implemented in many primary care settings.

Purpose: The purpose of this project was to implement and evaluate …

Psychometric Evaluation Of The “Providing Validation” Measure In Vascular Anomalies, Bryan A. Sisk, Anna M. Kerr, Amy R. Newman, Dandan Chen, Jennifer W. Mack, Bryce B. Reeve

College of Nursing Faculty Research and Publications

We assessed the psychometric properties of the “providing validation” subscale of PedCOM measures for parents of children with vascular anomalies and adult patients. A total of 139 adult patients and 78 parents completed surveys. The mean score for patients was 3.7 (standard deviation 1.0), and for parents was 4.0 (standard deviation 0.9). “Providing validation” measures demonstrated high internal consistency and good model fit to a unidimensional model for both patients and parents using confirmatory factor analysis. The measures also demonstrated convergent validity with co-administered measures. This study demonstrated the validity of “providing validation” measures for parents and adult patients with …

Preparing Nursing Students To Manage Acculturative Stress Experienced During Study Abroad Experiences: Novel Use Of Immersive Simulation And Cognitive Behavioral Strategies, Theresa Schnable, Christine A. Schindler, Jeffrey D. Roche, Karli Webster, Christopher E. Larkee, Maharaj Singh, John F. Ladisa

College of Nursing Faculty Research and Publications

This pilot study adds to the understanding of interventions to manage acculturative stress experienced during undergraduate study abroad programs. It was designed to evaluate the impact of cognitive behavioral strategy training combined with intentional practice during mixed reality (MR) simulations on acculturative stress. Participants included a convenience sample of undergraduate nursing students enrolled in a faculty-led study abroad course. Students participated in two MR simulations within a virtual environment over back-to-back days. Simulations were written by nursing faculty experts to reproduce realistic clinical situations students may encounter while studying in Peru. The Generalized Self-Efficacy Scale, State-Trait Anxiety Inventory, and Slater-Usoh-Steed …