Factors Impacting Serious Illness Care In Alabama: An Assessment Of The Current State Of Hospital Palliative Care, Amy M. Beasley

All ETDs from UAB

BACKGROUND: Palliative care (PC) use has been shown to offer many benefits to patients and families. Hospital PC has expanded in the United States, though growth has been limited within hospital types and geographic locations. According to the Center to Advance Palliative Care (CAPC), Alabama was rated a “D,” indicating that significant improvements in PC are needed. The purpose of this study was to develop a thorough description of access to palliative care in Alabama hospitals. METHODS: A mixed methods multiple case study was employed with quantitative data embedded into a qualitative case study approach. Four hospitals were selected based …

Increasing Patient Safety By Reducing Falls Among In-Hospital Community-Dwelling Patients 65 Years Old Or Older By Using A Shift Change Fall Safety Checklist, Janice Isaac Brooks

All ETDs from UAB

This manuscript is designed to promote and improve healthcare safety, quality, efficiency, and lower medical costs for hospitals and patients. Falls, fall injuries, and their devastating consequences are rising, yet falls are preventable even among senior patients. Search Engines and Key Terms SciWheel was used to save the literature and eliminate duplications. Key terms were used in the Boolean strings: elderly fall prevention, senior fall safety, in-hospital fall prevention, falls in the aging, and fall prevention tools. The CINAHL Plus yielded 58. PubMed search yielded 121. And Google Scholar yielded 32. The total of all three searches was 211. Thirteen …

Reducing Clabsi Rates Through Education On Maintaining Cvc Dressing Integrity: A Quality Improvement Initiative, Hanna I. Lentine

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a type of hospital-acquired infection (HAI). They arise as a complication from patients having a central venous catheter (CVC) placed. CVCs can provide numerous benefits for patients who require long-term venous access or hemodynamic monitoring. Acquiring a CLABSI can place patients at higher risk for complications, increased length of stay, and mortality. Reducing the risk of infection is imperative for all patients, but especially those who are more vulnerable to opportunistic infections, such as those in critical care units.

LOCAL PROBLEM: This quality improvement project took place at a 234-bed, level II trauma …

The Impact Of Sexual Violence On Student’S Academic And University Experiences: A Qualitative Study, Shelby Lacey

Electronic Theses and Dissertations

The prevalence of sexual violence is an ongoing public health concern within university communities. Students who experience sexual violence may be at risk for negative academic impacts including declines in grade point average (GPA), increased absenteeism, and withdrawal from school. Less information is known regarding if students who have experienced sexual violence report changes in their academic and university experiences, such as participation in class, social groups or clubs. Help-seeking through formal or informal sources may alleviate the negative consequences of sexual violence. Due to the unique environment of universities which may influence a student’s personal, social, and cultural life, …

Nurses’ Experience Of Family-Centered Rounds In The Intensive Care U, Kaitlyn Sheehan

Electronic Theses and Dissertations

A paradigm shift in the Canadian healthcare system has transitioned the patient and family from care recipients to integral and valued members of the multidisciplinary team. Implementation of family-centered care within the context of the adult Intensive Care Unit (ICU) remains slow to adopt in Canada despite evidence that open visitation and family presence offer many benefits to improve the delivery of quality care, and satisfaction with the overall patient experience. The COVID-19 pandemic has further complicated the ability of the healthcare team to effectively include patients and families into their daily multidisciplinary rounds. Restricted visitation policies, infection control and …

Community-Based Tuberculosis Contact Management: Caregiver Experience And Factors Promoting Adherence To Preventive Therapy, Micaela Sandoval, Godwin Mtetwa, Tara Devezin, Debrah Vambe, Joyce Sibanda, Gloria S Dube, Thandeka Dlamini-Simelane, Bhekumusa Lukhele, Anna M Mandalakas, Alexander Kay

Journal Articles

Delivery of tuberculosis preventive therapy (TPT) for children with household exposure to tuberculosis is a globally supported intervention to reduce the impact of tuberculosis disease (TB) in vulnerable children; however, it is sub-optimally implemented in most high-burden settings. As part of a community-based household contact management program, we evaluated predictors of adherence to community based TPT in children and performed qualitative assessments of caregiver experiences. The Vikela Ekhaya (Protect the Home) project was a community-based household contact management program implemented between 2019 and 2020 in the Hhohho Region of Eswatini. At home visits, contact management teams screened children for TB, …

Nurse-Administered Auricular Point Acupressure For Cancer-Related Pain, Barb Van De Castle, Nada Lukkahatai, Bsn Lynn Billing, Xinran Huang, Hulin Wu, Jingyu Zhang, Salahadin Abdi, Jun Kameoka, Thomas J Smith

Journal Articles

PURPOSE: The study aimed to (1) examine the feasibility of providing a training course on auricular point acupressure (APA) for clinical oncology nurses to integrate APA into real-world nursing care settings, and (2) examine the effectiveness of APA on cancer-related pain (CRP) under usual inpatient oncology ward conditions.

METHODS: This was a 2-phase feasibility study. Phase 1, an in-person, 8 hour training program was provided to oncology nurses. Phase 2, a prospective and feasibility study was conducted to evaluate the integration of APA into nursing care activities to manage CRP. Oncology patients were included if their pain was rated at …

Implementing Change: The Use Of Minocycline-Rifampin Impregnated Central Venous Catheters In Central Line Associated Blood Stream Infection Prevention In Critically Ill Patients, Shawn B. Murray

Master's Theses and Capstones

Introduction: At a large academic healthcare facility in the northeast a Gap Analysis was conducted finding quality improvement opportunities for central line associated blood stream (CLABSI) prevention in critically ill patients. Review of literature reveals the use of minocycline-rifampin impregnated (MNRI) central venous catheters (CVCs) as being an effective intervention in CLABSI prevention.

Methods: Several assessments were conducted regarding the implications of updating the facilities practice to reflect this evidence including AHRQ Gap Analysis Tool, a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Stakeholder Feedback, and Resource Allocation.

Results: Facilitators and barriers were identified in implementing this …

Streamlining The Postpartum Educational Process For Safe And Equitable Patient Care: A Quality Improvement Initiative, Shea N. Cook

Master's Theses and Capstones

Abstract

BACKGROUND:

Postpartum discharge education is essential in the care of mothers, newborns, and their families as they transition from the hospital setting to home. The U.S Department of Health and Human Services has identified postpartum discharge education content as a public health priority to reduce physical and mood-related postpartum complications. Over half of all serious morbidity and mortality complications occur after a postpartum patient leaves the hospital. It is essential that hospitals utilize the best evidence-based practices to maximize the impact of patient education during maternity care in the hospital.

LOCAL PROBLEM:

Within the given microsystem there is a …

Enhancing Nurses' Self-Efficacy In Smoking Cessation Counseling To Improve Patient- Centered Care At A Federally Funded Urgent Care Center: A Quality Improvement Initiative, Adam N. Waller Ii

Master's Theses and Capstones

Background: It is well documented that there is a high prevalence of Veteran tobacco use in the United States. Additionally, providing smoking cessation counseling in an emergency setting is beneficial. The broader Veteran Affairs (VA) macrosystem has a plethora of smoking cessation resources available for Veterans. Within a VA Urgent Care Center (UCC) a quality improvement initiative was conducted that focused on increasing registered nurses (RNs) self-efficacy in providing smoking cessation counseling. Prior to this quality improvement (QI) project, smoking cessation did not occur in this UCC. If RNs have higher self-efficacy more smoking cessation counseling will occur.

Methods …

Utilization Of The Broset Violence Checklist For Early Identification Of Aggressive And Violent Behavior To Improve Unit Safety: A Quality Improvement Initiative, Emily Sharretts

Master's Theses and Capstones

BACKGROUND: There continues to be an increase in workplace violence nationally in the healthcare setting which jeopardizes patient and staff safety. Liu et al. (2019) found about 59% of health care workers experience workplace violence. Kafle et al. (2022) emphasizes the link between workplace violence and increased levels of nurse burnout and therefore decreased job satisfaction.

LOCAL PROBLEM: The microsystem assessment revealed that there was no risk assessment tool to identifying early aggressive or violent patient behavior.

METHODS: The Plan-Do-Study-Act (PDSA) framework was used for this quality improvement project to reduce workplace violence on this unit.

INTERVENTIONS:After completion …

Using Education To Promote Waste Segregation And Waste Reduction In The Operating Room: A Quality Improvement Initiative, Sarah E. Landgraf

Master's Theses and Capstones

Background: The operating room (OR) is known to be one of the largest producers of medical waste and of the surgical specialties, orthopedic surgery tends to the largest portion of this. Waste from the OR can be mitigated by recycling non-contaminated materials. This reduces the number of raw materials needed to create new products, decreases landfill use, and lowers hospital costs.

Local Problem: It was observed that a gap in knowledge existed related to recyclables in the OR of a large medical center in New England. Also, it was observed that there was potential for waste and recycling to be …

Implementing Education For Maternity Nurses To Improve Nurses’ Knowledge, Attitudes, And Practices Regarding Postpartum Depression: A Quality Improvement Initiative, Haley Merrill

Master's Theses and Capstones

BACKGROUND: Postpartum depression (PPD) is the most common complication of childbirth, but often goes undiagnosed. Adequate patient education on PPD increases the patient’s knowledge and supports enhanced communication between patients and provider. Maternity nurses have continued interaction with new mothers and are in a vital position to educate patients regarding PPD. However, maternity nurses may lack confidence in delivering the appropriate education and resources for PPD to postpartum women.

LOCAL PROBLEM: Within the given microsystem, there was currently a gap that existed between PPD education for nurses and the delivery of PPD patient education.

METHODS: Utilizing the Plan-Do-Study-Act model, a …

Improving Initial Pain Assessments Upon Arrival To The Post Anesthesia Care Unit By Implementing The Critical Care Pain Observation Tool, Molly Jacques Ms, Rn

Master's Theses and Capstones

Abstract

Background

Pain assessments in the post-anesthesia care unit (PACU) are crucial to recovery, the discharge process, patient outcomes, length of stay, and readmission rates. It is one of the main responsibilities of PACU nurses to adequately assess and treat pain when patients are in phase one and two of recovery after surgery. A thorough and accurate pain assessment tool is needed for these critically ill patients because not all of them are able to verbally express discomfort.

Local Problem

The problem that was identified during this quality improvement project was inconsistent initial pain assessments in the PACU. Patients arrive …

Improving Patient Safety Associated With Intramuscular Injections By Educating Nurses On Recommended Practice: A Quality Improvement Project, Alex Annutto

Master's Theses and Capstones

Background: Intramuscular (IM) injections are used to deliver medication quickly and efficiently. However, the Centers for Disease Control has changed their guidelines on how to administer medication using the IM injection route. A quality improvement was conducted at Wildcat Hospital that focused on increasing healthcare professionals’ IM injection knowledge.

Methods: A pre-intervention survey was administered to RNs, LPNs, and Paramedics to assess their knowledge and IM injection technique. After the initial survey, an educational PowerPoint was presented to staff and management. This was followed with pamphlets that reviewed the information covered in the presentation. A post-intervention survey was administered to …

Reshaping Nurses’ Attitudes Toward Hourly Rounding To Increase Patient Safety And Instill Values-Based Care: A Quality Improvement Initiative, Jacqueline Juhn

Master's Theses and Capstones

Background: Hourly rounding is a form of intentional rounding (IR) to standardize care for patients to prevent adverse outcomes. Visiting patient rooms every hour and documenting any changes in client status is used as a general format for hourly rounding. Research reveals consistent hourly rounding is strongly linked with value for performance of this form of IR. Nurses’ Perceptions of Patient Rounding Scale (NPPRS) is a tool for assessing nurses’ value for their work. An educational video combined with NPPRS were utilized to create change for patients to continue to receive care that is safe, high quality, and cost-effective.

Local …

Establishing A Protocol To Address Workplace Violence And Increase The Perceptions Of Safety Among Emergency Department Nurses: A Quality Improvement Initiative, Devan M. Robidoux

Master's Theses and Capstones

Background: Violence against emergency department nurses has become a widespread phenomenon that can greatly impact a nurse's job satisfaction and performance. Research has been scarce in examining the relationship between workplace violence and its underlying consequences. There remains a disconnect between precursors of violence against nurses perpetrated by patients and the cultural expectation that violence is a part of the nurses job and, subsequently, what they signed up for when going into the field. Nurses learn that having a greater understanding of the value in the lived experience of their patients leads to better quality delivery of care. However, culturally …

Reducing Violence In The Workplace: A Quality Improvement Project, Molly Mcqueeney

Master's Theses and Capstones

Abstract

BACKGROUND: Violence in the United States has significant impacts on the healthcare system. On average, there are about 7.8 per 1,000 workers yearly that experience violent injuries (Grossman & Choucair, 2019). In 2016, it was estimated that approximately $429 million was added to treat and prevent injuries to healthcare workers (Grossman & Choucair, 2019). By implementing the Broset Violence Checklist (BVC) as a screening tool for early identification of risk for violence, there is a possibility for a reduction in the number of violent occurrences in the workplace.

LOCAL PROBLEM: Within the given microsystem, there is a lack of …

Giving Effective And Timely Hospice Education To Lessen Participant Stress (Get Helps), Caroline Rose Carter

Master's Theses and Capstones

In 2022, 1.72 million people chose to use hospice as their end-of life care. This is a 6.8% increase from 2019, and the number of patients who choose to use hospice is increasing (Summers, 2022). The aim of this quality improvement (QI) study was to decrease levels of stress reported by the patient and informal caretakers by combining the information from the hospice program’s admission packet and other approved handouts, while standardizing the verbiage through a Flesch-Kincaid readability scale to an eighth-grade reading level. Pre-survey perceived stress scores averaged 22.97 on a modified Perceived-Stress Scale, and the mean of the …

Case Reports From Women Using A Quantitative Hormone Monitor To Track The Perimenopause Transition, Maria Meyers, Richard J. Fehring, Mary Schneider

College of Nursing Faculty Research and Publications

The fertility tracking of menstrual cycles during perimenopause with a quantitative hormone monitor is a novel undertaking. Women in regular menstrual cycles have been tracking their fertility using different biomarkers since the 1960′s. Presently, there are newer electronic hormonal devices used to track fertility that provide more exact and objective data to help delineate the fertile time frame of a woman’s cycle. These devices measure quantitative levels of estrogen, the luteinizing hormone, progesterone, and follicle-stimulating hormone, all of which occur at varying levels during the menstrual cycle. As women advance toward menopause, their cycles vary in length, and their hormones …

The Clinical Observations Of Nursing Students And Recent Graduates Caring For Lgbtq+ People, Emily E. Roy

Honors Theses and Capstones

Objective: The next generation of nurses have increased educational preparation to provide affirming care to lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, but an evaluation of the effectiveness of this teaching has not been performed. The purpose of this study was to identify nursing student and recent nursing graduate observations of affirming and non-affirming care of LGBTQ+ people in healthcare settings during clinical experiences. We also sought to understand how those experiences affect their ability and willingness to provide affirming health care to LGBTQ+ people.

Methods: Participants filled out a mixed methods Qualtrics survey that was distributed through school …

Effect Of Breastfeeding Support Initiative On Knowledge, Breast Engorgement, And Newborn Feeding Behavior Among Post-Cesarean Mothers, Smitha M V Dr, Priyadarshini T, Sandhya Kashyap, Jyoti Sambharwal, Angel Joy, Ashitha Korothan, Premlata Sabarni, Sabarni Banerjee

Manipal Journal of Nursing and Health Sciences

Effect of Breastfeeding Support Initiative on knowledge, Breast engorgement, and Newborn feeding behavior among post-cesarean mothers

ABSTRACT:

Background:

Delayed breastfeeding, improper breastfeeding techniques such as difficulties in holding the baby, posture, and sucking, and poor knowledge and skills on breastfeeding leads to breast engorgement and poor feeding. The breastfeeding support initiative is a unique program encouraging lactation to improve breastfeeding and prevent complications

Objectives:

To determine the effect of the breastfeeding support initiative on the knowledge of breastfeeding, breast engorgement, and newborn feeding behavior among post-cesarean mothers.

Methods:

We conducted a Quasi-experimental study among 60 post-cesarean mothers at a selected …

Experiences Of Transgender Adults Living In West Virginia, Kerry M. Drabish

Graduate Theses, Dissertations, and Problem Reports

Background: Transgender adults experience disrespect, rejection, and discrimination. This is further complicated by the incongruence and internal conflict stemming from pressure to conform to a binary system of gender. Studies describing the experiences of transgender adults are limited. Therefore, the concept coexisting between the assigned and identified self was developed to better understand how transgender adults acknowledge turmoil and marginalization in coming to embrace identity.

Purpose: The purpose of this study was twofold: (1) describe the experiences of transgender adults living in WV, and (2) gather empirical evidence about the concept coexisting between the assigned and identified self. The …

Effectiveness Of Speech Intervention Methods In Children With Speech Delays, Andrea Noel, Rachel Windemuth, Brett Porter

Williams Honors College, Honors Research Projects

Speech delays in children is a common issue that can be treated by a wide variety of interventions. Our PICOT question is, in children, ages six months to thirteen years, with speech/language delays, how does the addition of innovative and supplemental interventions, compared with standard interventions alone, effect improvements in the delays. All three group members have known someone who has suffered from a speech delay, and we want to research the best possible methods to overcome that obstacle to answer our questions, we will begin to take on the task of creating and writing a systematic review. This review …

Access To Prenatal Care And Mental Health In Pregnant Women During Covid-19: A Systematic Review, Chloe Feezel, Marin Kahoun, Kaija Kunttu

Williams Honors College, Honors Research Projects

COVID-19 affected the world in many ways. Pregnant women were greatly impacted by a change in their access to prenatal care, from in-person care to telehealth methods, and social support being limited by social isolation. Compared with prevalence of anxiety and depression in pregnant women pre-COVID-19, pregnant women during COVID-19 reported higher levels of anxiety and depression symptoms due to the stress of circumstantial changes. The purpose of this systematic review is to review and critically appraise the evidence about access to prenatal care and mental health in pregnant women during the COVID-19 pandemic. The following PICOT formatted question will …

Reducing Blood Culture Contamination Rates Through Staff Education: A Quality Improvement Initiative, Kirsten M. Mutuberria

Honors Theses and Capstones

BACKGROUND: Blood cultures are a widely utilized tool that aids in diagnosis and treatment plans. Contaminated cultures are incredibly costly, resulting in increased length of stay, opportunistic infections, pharmacy costs, repeated laboratory tests, and decreased reimbursements. Evidence suggests higher incidence rates of blood culture contaminations (BCCs) are seen in emergency departments (ED) compared to any other unit within a hospital system. The internationally accepted threshold of 3% is not often met, although recent studies suggest a lower rate is possible, even in critical care environments. A literature review resulted in data showing that educational-based interventions focusing on adherence to facility …

Health Misinformation During Epidemiological Crises, Bethany Stefan, Alexis L. Emich, Katrina R. Lamp

Williams Honors College, Honors Research Projects

Health misinformation is more prevalent than ever in the modern age and poses serious risks for those who believe it. Medical fallacies can become especially harmful during periods of widespread disease when the misinformed respond in ways that increase threats to public health. The purpose of this systematic review is to describe and critically appraise the evidence about how health misinformation during endemics and pandemics can influence behaviors and responses, as well as the implications of interventions affecting these behaviors. A systematic search of the literature with inclusion/exclusion criteria using CINAHL Plus with Full Text, MEDLINE, and PsychINFO resulted in …

Robotic Team High Reliability Organization’S Communication Evaluation Tool, Joanne F. Mercurio

Regis University Student Publications (comprehensive collection)

Multidisciplinary team communication in robotic surgery presents several safety considerations for the intraoperative surgical patient. It is an important consideration since the surgeon and the operating room team are geographically distanced with the surgeon at the console, and the other team members situated at the patient bedside. Scrubbed team members are performing such functions as positioning the robotic arms as well as exchanging instruments, while the remaining interprofessional team members are coordinating multiple patient care activities. It therefore becomes imperative that the recognition of the potential for miscommunication is of paramount importance, and strategies need to be generated that will …

Nurse Leader Burnout: A Pre-Survey/Post-Survey Quality Improvement Project, Shannon Martinez

Regis University Student Publications (comprehensive collection)

Title of the Project: Nurse Leader Burnout: A Pre-Survey/Post-Survey Quality Improvement Project

Objective/Purpose of the project: The objective of the project was to provide time for inpatient nurse leaders to take time to visit the resiliency room and or cart. The purpose of the study is to determine if scheduled use of the resiliency room and or cart can help improve nurse leaders’ ability to clear their mind and decrease burnout. Methods: Sample size of 17 inpatient nurse leaders at Sky Ridge Medical center were sent via Survey Monkey, a pre-survey using the Occupational Fatigue Recovery scale (OFERs). After …

Implementation Of A Revised Intubation Checklist For A Critical Care Transport Team, Teresa M. Zuber

Regis University Student Publications (comprehensive collection)

Critical care transport teams are often tasked with performing endotracheal intubation (ETI) during transport while adhering “to the same standards as in-hospital emergency anesthesia” (Lockey et al., 2017). One transport team adopted a checklist in 2014 to meet this high standard, but because of changes in equipment and practice expectation, an updated version was needed. The purpose of this quality improvement (QI) project was to design an updated checklist and measure the following primary outcomes: first pass success and steps taken to mitigate hypoxia and hypotension (and/or elevated shock index) prior to intubation. Additionally, a survey was administered to the …