Nursing Commons^™

Addressing The Gaps: Pain Management, Multimodal Analgesia, And Crna Education, Hunter Niemeyer

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Opioid consumption, addiction, and narcotic-related deaths are a prevalent public health issue in the United States. Opioids are often administered throughout the perioperative period, and their utilization can lead to unwanted side effects and negative patient outcomes. Certified Registered Nurse Anesthetists (CRNAs) are strategically placed in hospital systems; these clinicians may advocate for the responsible administration of opioids and utilize multimodal pain strategies.

Purpose: This project assessed the knowledge and attitudes of CRNAs before and after the implementation of an educational program based on the prevention of operative pain, multimodal approaches, and the perioperative use …

Standardizing Intraoperative Handoffs Amongst Certified Registered Nurse Anesthetists, Mallory Light

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Communication errors are a leading cause of preventable medical errors and inadequate handoffs have been linked to sentinel events. Research has shown that standardizing handoff processes can reduce errors, improving patient safety, and resulting in other positive outcomes including increased staff satisfaction, without impacting handoff duration.

Purpose: The purpose of this project was to determine how the implementation of a standardized handoff tool would impact perceptions of handoff communications, retention of important patient information relayed during handoffs, staff satisfaction, and handoff duration.

Implementation Plan and Methods: Information regarding use of the tool was sent to …

Efficacy Of A Mixed Methods Training Program For Transthoracic Echocardiography, Britni Tharp

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Currently, there is a knowledge gap in CRNA education. As anesthesia providers, CRNAs are licensed to perform cardiac diagnostic imaging such as TTE during surgery, yet it is often missing from CRNA school curriculum. Other studies have shown that simulation is an effective way of teaching this crucial skill.

Purpose: The project’s goal was to establish the efficacy of using a mixed model computerized and in-person simulation program for training CRNAs in the use of TTE during non-cardiac surgery.

Methods: A training program was created that uses a computerized training session along with a …

Gastric Point-Of-Care Ultrasound Education For Certified Registered Nurse Anesthetists, Robert Graham

Doctor of Nursing Practice (DNP) Student Projects

Background: Pulmonary aspiration is a significant risk of general anesthesia and is related to increased perioperative morbidity and mortality. Gastric point-of-care ultrasound (POCUS) has been shown to be a reliable indicator of gastric contents and volume, and it can be used in the perioperative setting to detect gastric contents and make informed clinical decisions to prevent aspiration events.

Purpose: This project aimed to educate Certified Registered Nurse Anesthetists (CRNAs) at Washington University in the use of point-of-care ultrasound to assess gastric contents prior to surgery with the overall goal of improving knowledge, skills, and attitudes towards this practice …

Anesthesia Provider Education On The Adherence To The Fourth Consensus Guidelines For The Management Of Postoperative Nausea And Vomiting, Christine Johnson

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: The occurrence of postoperative nausea and vomiting (PONV) has been linked to unplanned admissions, longer post-anesthesia care recovery units (PACU) times, and decreased patient satisfaction. The Fourth Consensus Guidelines for the Management of PONV released new guidelines in 2020 outlining evidence-based practice to manage PONV. A literature review was conducted on a total of 10 studies. The findings support the methods these guidelines employ.

Purpose: This quality improvement (QI) project aims to provide education for anesthesia providers on the fourth consensus guidelines and improve provider adherence.

Methods: A six-minute educational video, post-education quiz, provider …

Education Aimed To Increase Train-Of-Four Ratio Use, Frank Bougher

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: The current state of practice surrounding non-depolarizing neuromuscular blocking drug monitoring is variable among practitioners and poses a safety risk to patients who may subsequently experience residual neuromuscular blockade and complications. The literature supports that train-of-four ratio monitoring, with an emphasis on use prior to extubation, is superior to other techniques and reduces the occurrence of complications related to residual neuromuscular blockade, improving patient safety and outcomes.

Purpose: The purpose of the project was to determine if an education intervention founded on evidence-based neuromuscular monitoring leads to increased use of train-of-four ratio in practitioner …

Educating Perioperative Nurses On Preventing Hypothermia In Surgical Patients, Bethany Geisler

Doctor of Nursing Practice (DNP) Student Projects

Perioperative hypothermia (PH) is a preventable complication of surgical procedures that has been linked to postoperative conditions such as coagulopathies, increased cardiac morbidity, surgical site infection, increased incidence of pressure ulcers, increased length of hospital stay, and increased financial expense. Anesthetic agents given to patients during surgery directly contribute to PH and associated complications.

Background: Perioperative is a time frame involving the three stages of surgery (preoperative, intraoperative, and postoperative). Hypothermia is defined as body core temperature below 36 degrees Celsius. The incidence of PH ranges from 11% to 90% depending on the anesthesia administered, type of surgery, length of …

Anesthesia Provider’S Use And Perception Of Emergency Cognitive Aids, Katie Mette

Doctor of Nursing Practice (DNP) Student Projects

Cognitive aids have been shown to increase proper use of evidence-based practice treatment strategies in emergent scenarios. These treatment strategies can be unfamiliar to the provider as emergencies are rare, and when coupled with a heightened stress level and sense of urgency, relying on memory alone can be challenging. The purpose of this project was to implement a set of emergency-use cognitive aids developed by Stanford University known as the Stanford Emergency Manual into a set of operating rooms and measure the anesthesia providers use and perception of the cognitive aid via pre-implementation and post-implementation e-mailed surveys.

Leadership Paper, Raquel Zeidlik

AI Assignment Library

The purpose of this formal paper is to explore effective nursing leadership characteristics. This essay will examine the leadership role of a nurse. Using evidence and supporting literature, the student will demonstrate their understanding of nursing leadership characteristics and skills and how they apply to clinical practice.

Promoting Personal Agency In Nursing Students' Ability To Evaluate Evidence, Kaitlyn Kelly

AI Assignment Library

In NURS450: Transition to Practice Seminar, the senior capstone for graduating nursing students and an essential studies class focused on information literacy, we examine research studies with a CASP Programme checklist, which helps students understand the validity and applicability of published research to their patient populations. In this assignment AI, specifically ChatGPT, is used to generate a fictional randomized controlled trial. Students are guided through the checklist and a group discussion on whether that study meets the requirements to be considered valid and applicable to a local population (with the assumption that the study was real). The purpose is to …

Sigra: Single-Cell Spatial Elucidation Through An Image-Augmented Graph Transformer, Ziyang Tang, Zuotian Li, Tieying Hou, Tonglin Zhang, Baijian Yang Ph.D., Jing Su, Qianqian Song

Publications

Recent advances in high-throughput molecular imaging have pushed spatial transcriptomics technologies to subcellular resolution, which surpasses the limitations of both single-cell RNA-seq and array-based spatial profiling. The multichannel immunohistochemistry images in such data provide rich information on the cell types, functions, and morphologies of cellular compartments. In this work, we developed a method, single-cell spatial elucidation through image-augmented Graph transformer (SiGra), to leverage such imaging information for revealing spatial domains and enhancing substantially sparse and noisy transcriptomics data. SiGra applies hybrid graph transformers over a single-cell spatial graph. SiGra outperforms state-of-the-art methods on both single-cell and spot-level spatial transcriptomics data …

Improving Small-Volume Antibiotic Administration For Surgical Prophylaxis, Benjamin Thomas

Doctor of Nursing Practice (DNP) Student Projects

Background: Small-volume IV antibiotics are commonly administered for surgical prophylaxis, but no clear policy on administration method exists, leading to wide variation in anesthesia provider practice at a large academic medical center. Administration via a secondary tubing set is the recommended practice to minimize significant medication losses which could lead to poor patient outcomes. This large academic medical center performed below the national benchmark for one of these outcomes–surgical site infections.

Goals and Objectives: Objectives of this project included eliminating a potential systematic shortcoming in the administration of prophylactic antibiotics. The goal was to increase the use of …

Evaluating The Effectiveness Of The Clinical Care Of The Pediatric Patient Course: A Quality Improvement Project, Cassandra Elliot

Doctor of Nursing Practice Projects

The Clinical Care of the Pediatric Patient (CCPP) is a two-day course held monthly as part of the onboarding process. This mandatory course is intended to prepare onboarding clinical staff for the provision of evidence-based care to pediatric patients. CCPP contains over 17 hours of didactic and hands-on instruction in the assessment, management, and treatment of pediatric conditions. The goal of this quality improvement project was to determine the perceived effectiveness of the CCPP course and its impact on the confidence level of clinical staff as pediatric providers during their first few months of employment. A regression analysis was used …

Utilizing The Phq9 Survey To Improve Depressive Symptoms In Opioid Dependent Adults: A Quality Improvement Project, Taylor Fuhr

DNP Projects

Significance and Background: Opioid dependence continues to be a fighting battle in our country. While many individuals do well on maintenance therapy such as suboxone, they often are faced with comorbid challenges including depression and anxiety. Research shows that the risk for depressive symptoms in opioid dependent adults increases along with the duration of use and increase of dosage (Semenkovich et al., 2014). There is no consistency among depression screening for opioid dependent adults despite the research that suggests the two often coincide with one another. The goal of this quality improvement project was to implement routine depression screening using …

Weight Loss And The Effects On Blood Pressure, Ashiqua Jackson

Doctor of Nursing Practice Projects

Obesity and hypertension directly contribute to cardiovascular disease, which is modifiable and preventable with lifestyle modification. Blood pressure (BP) control directly impacts mortality from heart disease. The literature suggests that weight reduction is associated with a decrease in BP. The project’s purpose is to assess the effect of a weight management plan on obese or overweight adults with hypertension. The best practice identified was the DASH diet for weight loss and BP reduction, followed by a medication regimen such as Semaglutide. The inclusion criteria comprised adults >18 years with a BMI > 25 and exclusion criteria of < 18 years old, BMI < 25, and a diagnosis of diabetes. Based on the inclusion criteria, a convenience sample of 27 patients was obtained from an outpatient clinic through a retrospective chart review. Obesity, hypertension, and DASH diet education were provided to the clinic staff. During the initial weight management consultation, the provider educated patients about the DASH diet. A baseline BP and weight were obtained and compared four weeks later. A two-tailed Wilcoxon and paired t-test revealed a significant systolic and diastolic BP reduction. The results were statistically significant, indicating that a comprehensive weight management plan is essential to reducing both BP and weight in overweight, obese, and hypertensive patients.

Nurse Engagement In Antibiotic Time-Outs: The Collaborative Process Of Leveraging Design To Disseminate Research Findings, Mary Lou Manning, Maribeth Kradel-Weitzel

College of Nursing Faculty Papers & Presentations

INTRODUCTION: Research findings and knowledge translation are typically disseminated via presentations at professional meetings and publication in peer-review journals. However, other opportunities to translate research evidence into practice exist, including the use of visual cues.

AIM: The aim of this paper is to describe the collaborative process of translating key research findings into a clear and compelling visual communication tool.

DESIGN: As part of a multimodal research dissemination strategy, the researchers partnered with the University Health Communication Design Program faculty to develop a visual communication strategy to promote the use of antibiotic time-outs by nurses in a health system. An …

Nutrition-Related Experiences Of Women With Perinatal Depression During The Covid-19 Pandemic: A Qualitative Study, Dahlia Stott, Cynthia Klobodu, Lisa A. Chiarello, Bobbie Posmontier, Mona Egohail, Pamela A. Geller, June Andrews Horowitz, Brandy-Joe Milliron

College of Nursing Faculty Papers & Presentations

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to …

The Intersection Between Alcohol Use And Sexual Activity Among Young Adult Male U.S. Service Members, Lindsay M. Orchowski, Bryce M. Meerhaeghe, Amber R. Lane, Donna M. Kazemi Phd, Rn, Cne, Fiaan, Brian Borsari, Cristóbal S. Berry-Cabán

Publications

AIMS: The current study explores drinking habits, preferences for alcohol use before sexual activity, and alcohol-related sexual behavior among young adult male active duty service members in the United States. BACKGROUND: Hazardous alcohol use is a significant problem among United States military service members. Whereas the association between alcohol use and sexual assault is well documented in civilian samples, less is known regarding the intersection of alcohol use and sexual activity among soldiers. OBJECTIVE: Descriptive statistics were utilized to summarize drinking habits, preferences for alcohol use before sexual activity, and alcohol-related sexual behavior. METHODS: A sample of 338 active-duty male …

A Clinical Classification Framework For Identifying Persons With High Social And Medical Needs: The Complexedex-Social Determinants Of Health (Sdh), Suzanne S. Sullivan, Kathryn M. Ledwin, Sharon Hewner

Nursing Faculty/Staff Publications

Background

First-generation algorithms resulted in high-cost features as a representation of need but unintentionally introduced systemic bias based on prior ability to access care. Improved precision health approaches are needed to reduce bias and improve health equity.

Purpose

To integrate nursing expertise into a clinical definition of high-need cases and develop a clinical classification algorithm for implementing nursing interventions.

Methods

Two-phase retrospective, descriptive cohort study using 2019 data to build the algorithm (n = 19,20,848) and 2021 data to test it in adults ≥18 years old (n = 15,99,176).

Discussion

The COMPLEXedex-SDH algorithm identified the following populations: cross-cohort …

Burnout And Its Impact On Nurses And Doctors, Zahra Tharani, Abeer Musaddique, Syeda Humera Qutb

School of Nursing & Midwifery

No abstract provided.

Seeds Of Trust Ripe As Luscious Fruits: Faculty Mentorship Forum At Aga Khan University Medical College, Rehana Rehman, Rahila Ali, Saira Khalid, Tazeen Saeed Ali

Department of Biological & Biomedical Sciences

Background & objective: Faculty members require mentoring in all stages of their professional development. Aga Khan University (AKU) has initiated mentorship programs for students and faculty at AKU Medical College (AKU- MC) and AKU School of Nursing and Midwifery (AKU-SONAM). This study aimed to explore perceptions of mentors, mentees, administrators (chairs, co-chairs, founder members and coordinators of the mentoring program) and leadership and further investigate the strengths and challenges faced by 'Faculty Mentorship Program' at AKU- MC.
Methods: We conducted a qualitative exploratory study from February till December 2021 after approval from AKU using purposive criterion sampling. Mentors, mentees, administrators …

From Crisis Management To Multi-Level Interinstitutional Partnerships: Development Of The Southeastern Conference Deans Nursing Coalition, Jeannette O. Andrews Phd, Rn, Faan, Victoria Niederhauser, Julie Sanford, Suzanne Prevost, Demetrius Porche, Janie Heath, Pamela Jeffries, Nancy Fahrenwald

Faculty Publications

The Southeastern Conference (SEC) Nursing Dean's Coalition is a purposeful alliance organized to collaboratively address several challenges that arose during the COVID-19 pandemic. Over the last three years, this strategic team of academic leaders has evolved from a crisis response team to a multidimensional support team, leveraging both individual and collective strengths, to provide several benefits to the dean members, as well as other SEC nursing faculty members, students, and institutions. Participation has grown from the original 12 deans to engage a broader team of associate deans and nurse leaders in faculty development, research, service, and diversity, equity, and inclusion. …

Improving Timeliness Of Palliative Care Referrals Within The Intensive Care Unit: A Quality Improvement Project, Stephanie Fiore

DNP Projects

Significance and Background: Palliative care (PC) services are often underutilized in the ICU. There is a lack of understanding of PC by providers, staff, patients, and families which then leads to difficulty obtaining appropriate and adequate referrals to the PC team. In the ICU practice setting, the current process for palliative care referrals (PCRs) has the attending physician as the only individual to initiate a PCR referral. Another element missing from the current process is a criteria trigger tool that other disciplines, including nursing, can use to assess the patient’s need for PCR in the first 48 hours of admission. …

Nursing Perspectives On Intimate Partner Violence Screening In The Emergency Department, Justin Cabrera

Dissertations, Theses, and Capstone Projects

Using descriptive and quality descriptive (QD) analysis, emergency department nurses from around the country completed a modified version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool to gain insight on their attitudes, knowledge, and preparedness about working with patient survivors of intimate partner violence (IPV) regarding their willingness to and comfort in engaging in IPV screening practices. In total, 1,523 responses were received from emergency department nurses currently or formerly in practice.

Findings show that there was no correlation between emergency department nurses’ education and training on IPV and willingness and comfort with IPV screening with …

Affective Domain Development In Virtual Education: Visual Thinking Strategies And Art Pedagogy, Jayne Josephsen

Nursing Faculty Publications and Presentations

Development of the affective domain is linked to increasing self-awareness of internal dialogue, such as biases and assumptions, which can affect the ability of nurses to engage in person-centered care and meet the identified patient outcomes. Through visual thinking strategies (VTS) paired with art-based pedagogy to examine grief, loss, and bereavement concepts in a hospice and palliative care nursing virtual education course, affective domain development was advanced. Foundational to this virtual educational intervention was using the VTS framework of questions and pairing them with art-based pedagogy promoting open-ended interpretation and response to the art presented. This assisted the students in …

Testing The Impact Of An Asynchronous Online Training Program With Repeated Feedback, Aimee A. Woda, Cynthia Sherraden Bradley, Brandon Kyle Johnson, Jamie Hansen, Ann Loomis, Sylvia Peña, Maharaj Singh, Kristina Dreifuerst

College of Nursing Faculty Research and Publications

Background:

Learning to effectively debrief with student learners can be a challenging task. Currently, there is little evidence to support the best way to train and evaluate a debriefer's competence with a particular debriefing method.

Purpose:

The purpose of this study was to develop and test an asynchronous online distributed modular training program with repeated doses of formative feedback to teach debriefers how to implement Debriefing for Meaningful Learning (DML).

Methods:

Following the completion of an asynchronous distributed modular training program, debriefers self-evaluated their debriefing and submitted a recorded debriefing for expert evaluation and feedback using the DML Evaluation Scale …

Home Health Nurses For Children With Invasive Mechanical Ventilation (Imv): Perspectives On Gaps And Opportunities For Recruitment, Sarah A. Sobotka, Emma Lynch, Sarah Laudon, Kim Whitmore

College of Nursing Faculty Research and Publications

Background

Children with medical complexity (CMC) dependent on invasive mechanical ventilation (IMV) often require private duty home nursing; however, there are ubiquitous shortages. Home health is an especially vulnerable nursing sector because of less competitive wages and less prominence during nursing education. We sought to understand nurses' perspectives on gaps and opportunities for recruiting home care nurses for children with IMV.

Methods

Home health nurses experienced with children with IMV were recruited for semi-structured interviews. The interview guide served as the initial codebook which was iteratively modified as themes emerged. This study presents an analysis of quotes related to field …

Nurse Leader Perceptions Of Data In The Veterans Health Administration: A Qualitative Evaluation, Janine J Wong, Richard P Sorelle, Christine Yang, Melissa K Knox, Sylvia J Hysong, Lynette E Dorsey, Patrick N O'Mahen, Laura A Petersen

Faculty, Staff and Students Publications

Healthcare systems and nursing leaders aim to make evidence-based nurse staffing decisions. Understanding how nurses use and perceive available data to support safe staffing can strengthen learning healthcare systems and support evidence-based practice, particularly given emerging data availability and specific nursing challenges in data usability. However, current literature offers sparse insight into the nature of data use and challenges in the inpatient nurse staffing management context. We aimed to investigate how nurse leaders experience using data to guide their inpatient staffing management decisions in the Veterans Health Administration, the largest integrated healthcare system in the United States. We conducted semistructured …

Treatment Of Seizures In The Neonate: Guidelines And Consensus-Based Recommendations—Special Report From The Ilae Task Force On Neonatal Seizures, Ronit Pressler, Nicholas Abend, Stéphan Auvin, Geraldine Boylan, Francesco Brigo, Maria Roberta Cilio, Linda De Vries, Maurizio Elia, Pauline Samia

Paediatrics and Child Health, East Africa

Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence-based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta-analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non-randomised studies - of interventions (ROBINS-I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). …

Interventions Co-Designed By Healthcare Providers And Clients For Improving Therapeutic Relationships In Maternal And Child Healthcare: A Pilot Study Using Human Centered Design In Rural Tanzania, Kahabi Isangula, Eunice Pallangyo, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Background

Research shows that poor provider–client interactions in maternity and child health (MCH) continue to affect health outcomes, service uptake, continuity of care, and trust in formal healthcare systems.

Objective The study’s objective was to jointly create a prototype intervention package for enhancing nurse-client relationships using human centered design (HCD) approach.

Methods A five-step HCD methodology was used: (1) Community-driven discovery through qualitative descriptive research methods using 9 focus groups with nurses and clients and 12 key informant interviews with MCH administrators; (2) consultative ideation and co-creation meetings with 10 nurses, 10 clients, and 10 administrators to co-design a rough …