Nursing Commons^™

Exploring The Effects Of Psychosocial Factors And Relationships To Postpartum Depression Symptoms Among Iranian Immigrant Women Living In Canada: A Cross-Sectional Study, Monica Gola

Electronic Theses and Dissertations

Introduction: Immigrant women’s health garners attention as migration creates changes in social networks and parenting needs. The effect of psychosocial factors, such as maternal self-efficacy, measured by ability to manage parenting responsibilities, social support and cultural postpartum practices on postpartum depression symptoms are not well known in Canadian immigrant women. Methodology: A cross-sectional descriptive survey design guided by Bandura’s Reciprocal Determinism was used to explore the relationships between psychosocial factors including: maternal self-efficacy, social support, cultural postpartum practices; and symptoms of postpartum depression (PPD) among recent Iranian immigrant women living in Canada. Results: A total of 114 participants completed the …

Introducing A Trauma-Informed Care Model To Address Racial Disparities In Perinatal Outcomes Among African American Women, Mariah K. White

Honors College Theses

Racial disparities in maternal and infant health have remained an issue within the United States despite efforts to advance and improve our health system. Most maternal deaths are preventable, especially with early and adequate maternal care. Infant mortality occurs for several reasons, but inadequate care usage increases the risk for adverse outcomes. Prenatal care usage within the United States has been inadequate for numerous years, most commonly among African American women, despite its known benefit. Low prenatal care usage among African American women can be attributed to community barriers, social injustices, trauma, discrimination, and health care mistrust. Trauma is common …

Shared Decision Making In Self-Care Management And Health Outcomes Of Adolescents And Young Adults With Sickle Cell Disease, Judith M. Odityo

Dissertations and Theses (Open Access)

Background: Shared decision making (SDM) is a model of care with a potential to guide disease self-care management and promote optimal health outcomes in adolescents and young adults (AYA) with sickle cell disease (SCD).

Aims: To identify the perceived involvement of AYA with SCD in the SDM process and examine its association with self-care management and health outcomes.

Methods: Data were collected from a major sickle cell center. Using a cross-sectional design, participants completed surveys and data were analyzed with descriptive statistics, analysis of variance, multiple linear regression, and correlational statistics.

Results: Participants (N=25) were on average age 22.72 (SD …

Endothelial To Mesenchymal Transition In Human And Murine Congenital Diaphragmatic Hernia Pulmonary Hypertension, Jamie L. Gilley

Dissertations and Theses (Open Access)

Background: Congenital diaphragmatic hernia (CDH) is one of the most complex congenital disorders, characterized by pulmonary hypertension and hypoplasia. CDH-associated pulmonary hypertension (CDH-PH) features devastating morbidity and mortality (25-30%) among neonates. An unmet need is determining the mechanisms triggering CDH-PH to save infants and improve their quality of life. Prior data suggest abnormal remodeling of the pulmonary vascular extracellular matrix, presumed to be driven by endothelial-to-mesenchymal transition (EndoMT), hinders postnatal vasodilation and limits efficacy of anti-PH therapy in CDH. Although abnormal vascular development and remodeling are known CDH traits, there is limited data on the role of EndoMT in CDH-PH. …

Noninvasive Screening Of Nonalcoholic Fatty Liver Disease Among People Living With Hiv, Essi M. Havor

Dissertations and Theses (Open Access)

Background: Nonalcoholic fatty liver disease (NAFLD) disproportionately affects up to 75% of people living with HIV (PLWH). Given the high HIV prevalence in Houston and Harris County, knowledge of the prevalence of NAFLD in PLWH is needed to inform prevention efforts. In addition, such knowledge is required to raise awareness among at-risk individuals and healthcare professionals.

Specific Aims: This cross-sectional study aimed (1) to examine the demographic, behavioral, clinical, and psychosocial characteristics of PLWH in Houston/Harris County, Texas, and to estimate the prevalence of NAFLD, (2) to determine factors associated with the severity of NAFLD, and (3) to identify specific …

Weight Loss Communication And Treatment In Primary Care, Courtney Russell, Sarah Puckett, Jessica Mcrill

Doctor of Nursing Practice Projects

Obesity is undertreated in the primary care setting as a single medical condition. Obese patients are higher risk for comorbid conditions including heart disease, hypertension, diabetes mellitus and stroke. There is no universal screening tool implemented in the primary care setting for obesity management. An extensive literature review was completed to identify barriers in the primary care settings for providers to treat obesity as a disease state, assess current practices for weight management in these settings, and to identify health behaviors of adult patients with obesity. This project implemented the Five A’s Communication Tool to identify patients willing to discuss …

Use Of Anticipatory Guidelines In Late Infants And Toddlers 12 To 24 Months In Primary Care, Claire E. Eller

Doctor of Nursing Practice Projects

Anticipatory guidance is a well-known and utilized method that has been implemented in a majority of pediatric primary care offices. As the need for efficiency grows and increasing patient volumes climb, there is a growing need for strategies to provide this information effectively and efficiently. Prior evidence can be utilized to identify the most critical knowledge caregivers and parents will require. Our findings indicate safety, communication, nutrition, social development, and behavior as cornerstone topics for anticipatory guidance. To increase the volume of education provided to parents and caregivers, alternate methods beyond verbal discussion could be used. After gathering scientific literature …

Implementing The Timed Up And Go Test To Prevent Falls, Shamika Allen

Doctor of Nursing Practice Projects

Falls are the most reported injury within the geriatric population. Behavioral health patients have the most injurious falls, with falls impacting multiple things such as staffing, cost, injury, and quality of life for the patient (Ocker et al., 2020). Currently, the standardized fall assessment for new patients upon admission is the Morse Fall Scale (MFS). This fall assessment was intended to assess the level of fall risk for patients who are on an acute medical floor during their hospital stay. The Timed Up and Go test (TUG) is a fall assessment that has been used in geriatric patients to assess …

Implementing An Emr System In A Small Psychiatric Practice, Brandy Mccrudden

Doctor of Nursing Practice Projects

Electronic medical records (EMRs) can aid in improving surveillance, monitoring, adherence to practice guidelines, improving communication, and reducing medical errors. The adoption of EMRs in psychiatry and mental health settings has been slow despite the offered benefits. This project aimed to develop an implementation and training plan to successfully transition from paper charts to EMRs in a psychiatry practice. An extensive literature review was conducted on the adoption of EMRs in mental health settings, and a guideline for implementation was created to overcome identified barriers. Implementation guidelines included a planning phase, staff training plan, and rollout using a phase-in approach. …

A Multifaceted Approach To Promoting Speaking Up Behavior In A Community Hospital, Carrie Carls

Doctor of Nursing Practice Projects

Introduction

This project describes results of a multifaceted approach to promoting Speaking Up Behavior (SUB) among nurses in a community hospital. Patient safety outcomes, perception of healthy work environment, and nurse retention are connected to caregiver communication.

Methods

Interventions included development of a structured SUB communication and debriefing tool, SUB administrative policy, leadership rounding and verbal support for SUB, formal recognition of SUB, and SUB education including role-playing activities. Cross-sectional surveys evaluating nurse comfort and confidence with SUB using validated tools were implemented before and after the multifaceted interventions.

Results

The bedside nurse voluntary turnover rate reduced from 14.5% to …

Caring For The Adult Patient With Autism: Development Of Staff Education And An Online Toolkit For Healthcare Providers, Kristen Conkle

Doctor of Nursing Practice Projects

There are disparities in knowledge among healthcare workers when caring for adult patients with autism spectrum disorder (ASD). Lack of knowledge about the characteristics of this population and strategies to enhance care pose a barrier to treatment during hospitalization. A computer based educational module was developed and assigned to staff at a community hospital. An online toolkit for healthcare providers was developed to aid staff in recognition of triggers and supplied adjunct methods for communication. A pre and posttest of healthcare provider knowledge and stigma regarding autism was performed. Achievement of the training was robust among staff; of the one …

Developing An Advocacy Campaign To Minimize Barriers To Srna Political Awareness, Alejandra Villescas

Doctor of Nursing Practice Projects

Continuous advocacy and political participation have secured better working conditions and recognition of certified registered nurse anesthetists (CRNAs), translating into better patient care. This project aimed to launch an advocacy campaign targeting student registered nurse anesthetists (SRNAs). A pre-lesson survey was designed to identify SRNAs’ political participation barriers and assess their political literacy. Additionally, a lesson was developed to help SRNAs’ understand CRNA advocacy. To evaluate the educational tool, a post-lesson survey was created. These materials were distributed via email to all SRNAs (n=320) enrolled in a CRNA program in Illinois. Only 51 students completed the pre-lesson survey, and 39 …

Second-Victimhood Among Anesthesia Providers & The Effects On Patient Outcomes, Erika Aitken

Doctor of Nursing Practice Projects

Anesthesia providers work in environments promoting productivity with tremendous pressure to begin the next case regardless of any recent adverse events that may have occurred (Wands, 2021). Certified nurse anesthesiologists (CRNAs) potentially struggle with a lack of recognition, a high number of hours, inadequate work-life balance, and limited professional advancement, which all contribute to high stress levels within the field (Andrade & Dantas, 2015). A healthcare professional involved in an unexpected adverse event, medical error, or patient-related injury is labeled as a second victim. Thirty anesthesia providers from a central Illinois hospital viewed a PowerPoint presentation, completed a survey, and …

Improving Pulmonary Rehabilitation Referral And Uptake For Chronic Obstructive Pulmonary Disorder, Amanda Frassato

Doctor of Nursing Practice Projects

Abstract

Participation in pulmonary rehabilitation (PR) for patients with Chronic Obstructive Pulmonary Disease (COPD) improves exercise capacity and quality of life and reduces readmissions and mortality. Despite its benefits, PR is underutilized in the treatment of COPD. Referral to PR is impacted by provider knowledge of who and how to refer, the burden of making a referral, the provider’s positive or negative influence and accessibility to a PR program. In contrast uptake of PR by patients is impacted by patient knowledge of what PR entails and how it will help their health. This project aimed to increase referrals to PR …

Cbt Technology Implementation With Pediatric And Adolescent Populations, Tracey W. Kreipe, Heath Gage, Sandra Obiebi

Doctor of Nursing Practice Projects

Abstract

Digital therapy is a growing healthcare intervention improving limited access to specialty care for specific populations and geographic areas. Cognitive Behavioral Therapy (CBT) applications focus on treating anxiety and depression and assist pediatric and adolescent patients in learning behavioral techniques as they wait for 3-6 months or longer to see a mental health provider. Such delays are attributed to the national shortage of mental health practitioners and the further scarcity of fewer psychiatric providers in rural areas, causing the potential for adverse patient outcomes. The setting for this 8-week quality improvement project was a pediatric care clinic that sees …

Short Term Medical Mission Gerd And Ulcer Treatment Guideline, Robin Risky

Doctor of Nursing Practice Projects

The United States conducts over 6,000 international medical mission trips each year. The short-term nature of these trips, unfamiliarity with the patient population, language barriers, limited resources, and inadequate staff training are just some of the factors that make it challenging to provide quality care. One way to avoid doing harm is to follow evidence-based guidelines when treating common conditions. This quality improvement project sought to provide an evidence-based protocol for short-term medical missions (STMMs), guiding providers and pharmacy staff on the treatment of GERD and peptic ulcer. This project was implemented in a rural health clinic at the Land …

Improving Depression Remission Screening Compliance, Crystal Wingerter

Doctor of Nursing Practice Projects

Depressive disorders are widespread in the United States and are diagnosed and treated in the primary care setting. In 2019, there were an estimated 19.4 million adults that had at least one major depressive episode. The purpose of this project was to improve follow up and depression remission assessment for patients with a diagnosis of depression at a metropolitan family care practice clinic. The Patient Health Questionnaire (PHQ–9) was utilized for remission assessment. Front desk staff and providers were trained and granted access to the quality information system (QIS) in the electronic medical records (EMR) system which allowed easy identification …

Compassion Fatigue And Burnout In Mission Trip Providers, Camille Roland

Doctor of Nursing Practice Projects

Compassion fatigue (CF), burnout (BO), lack of compassion satisfaction, and impaired mental health have had catastrophic effects on nurses, providers, and support staff in the past few years due to COVID-19, labor shortage, an influx of critically ill patients, and long hours. Compassion fatigue was coined by Figley as a state of exhaustion and dysfunction biologically, psychologically, and socially because of prolonged exposure to compassion stress. Related concepts identified as burnout and secondary traumatic stress (STS) play an inclusive role in one’s ability to cope with daily environmental stressors causing physical, emotional, and mental breakdown. The link between …

Sti Education For Adolescents, Maryann Van Ryn, Lucy Nyrongo

Doctor of Nursing Practice Projects

Adolescents make up the majority of STI cases in the United States; however, most STI education has not targeted them and their unique needs. This quality improvement project aimed to create an evidence-based educational tool for sexually transmitted diseases (STIs) for adolescents in a pediatric clinic. Next, we created a dynamic QR code to access the flyer digitally on a patient's mobile device. The QR code was printed and placed in an accessible location in the office. The dynamic QR code allowed us to capture data on the total number of scans and provided the demographics of the scanners and …

Increasing Education And Awareness Of Patients Who Identify As Transgender In Primary Care​, Cindy Wallace

Doctor of Nursing Practice Projects

Background. Lesbian, gay, bisexual, and individuals who identify as transgender and queer (LGBTQ) often experience negative healthcare encounters (Parameshwaran et al., 2017). According to the Williams Institute of Law (2022), there are 1.3 million adults who self-identify as transgender. This education project utilized a pre/post-test design to explore attitudes, practices, and knowledge of primary care providers when interfacing with individuals who identify as transgender in primary health care settings.

Theoretical Framework. This project was guided by Lewin’s Change Theory.

Methods. Primary care providers in an urban community health clinic received a pre and post-education survey. A teaching session was delivered …

Introduction Of A Spinal Care Pathway Triage Protocol In The Secondary Care Setting, Tonicia I. Boston

Doctor of Nursing Practice Projects

Background: Back pain is considered the leading cause of disability worldwide. Providing effective multidisciplinary care for clients with chronic back pain (CBP) has been an ongoing issue globally. Improper care management of CBP creates personal, economic, and societal burdens that significantly affect patients, their families, and the healthcare system. Purpose: This quality improvement project aimed to successfully integrate a spinal care pathway (SCP) electronic decision support tool (e-tool) into a multidisciplinary spinal care program, to improve providers’ satisfaction with care delivery and their satisfaction with CBP patient outcomes. Methods: This DNP project used an evidence-based quality improvement (EBQI) design to …

Utilizing Gastric Point-Of-Care Ultrasound Assessment For Patients With Questionable Npo Status, Carolina Botero

Doctor of Nursing Practice Projects

Perioperative aspiration is a rare but serious complication with high morbidity and mortality for patients. This event often occurs from anesthetic depression of protective airway reflexes. NPO guidelines are implemented before anesthesia to eliminate the presence of any gastric contents. However, patients with certain comorbidities may still persist with a full stomach before an anesthetic. Patients may complicate matters further by not following NPO instructions, the patient’s NPO status may be unknown, or the timing of surgery may prevent adequate NPO times. In these situations, the anesthesia provider is faced with the difficult decision to alter, delay or potentially cancel …

Foley Catheter Algorithm, Chary Mathew

Doctor of Nursing Practice Projects

Urinary catheterization, indwelling and intermittent are simple and common procedures performed in hospitals, emergency rooms, nursing homes, and clinics to ensure adequate urinary output in patients who cannot void efficiently or closely monitor fluid intake and output. Though simple and straightforward in most cases, catheterization can become a challenging procedure with complications in the absence of a standardized protocol for difficult catheterization (Ghaffary et al., 2013). This Quality Improvement Project aimed to develop a standardized Foley catheter algorithm/ flow chart available in our institution's intranet and laminated charts in nursing stations and procedure rooms with Foley catheter insertion indications, types, …

Advanced Care Planning In Primary Care, Kaylee Beals, Amanda Merriman

Doctor of Nursing Practice Projects

In Illinois, the do-not-resuscitate (DNR) form that is legally binding in all healthcare facilities is known as the Practitioner Orders for Life-Sustaining Treatment (POLST) form. The Patient Self-Determination Act (PSDA) of 1991 mandates only certain facilities to discuss advanced care planning (ACP). Primary care offices are not included in this mandate. Therefore, no structured process exists for primary care providers to identify patients who may benefit from ACP discussions. The purpose of this Doctor of Nursing Practice (DNP) project was to initiate conversations about ACP with patients 55 years and older in a primary care office and complete POLST forms …

Active Learning Techniques To Improve Emotional Intelligence Among Student Registered Nurse Anesthetists, Sydney Bontz

Doctor of Nursing Practice Projects

Students enrolled in nurse anesthesia programs are challenged to meet rigorous and lengthy clinical and didactic requirements throughout doctoral-level curriculums. Historically, admission into nurse anesthesia programs has been based on categories such as academic performance, intensive care nursing experience, and the curriculum vitae. However, emerging research has exhibited emotional intelligence as an essential skill for varying situations that may be encountered. Additionally, training can be utilized to increase emotional intelligence levels (Lolaty et al., 2012).

The goal of this doctoral project was to provide emotional intelligence training for first-year student registered nurse anesthetists (SRNAs) at a mid-size University in the …

Remifentanil In Labor Analgesia, Courtney Silberberg

Doctor of Nursing Practice Projects

Labor has the potential to be the most excruciating and intense physical pain a woman experiences in her life. Neuraxial anesthesia, which includes epidural, spinal, or combined spinal-epidural technique, is the gold standard for pain control in laboring patients (Lee et al., 2017). Seemingly forgotten, a subset of parturients cannot experience the benefits of neuraxial anesthesia due to several absolute and relative contraindications. These women rely on other options for labor pain control. Remifentanil has emerged as a preferred opioid option for labor and delivery due to its rapid onset (peak effect in 1.1 minutes) and rapid metabolism by non-specific …

Expansion Of Heart Failure Education From Hospital To Clinic, Abigail M. Fischer

Doctor of Nursing Practice Projects

Heart failure education is vital to the long-term management of this condition. Education recommendations for heart failure are given by the American Heart Association (AHA) and the American College of Cardiology (ACC). Recommendations include verbal instruction and written materials regarding the patient’s medication plan, recognition of symptoms, what to do when symptoms occur, and the importance of daily weights.

This project aimed to provide outpatient clinic providers and staff with resources and education necessary to educate heart failure patients. The project expanded use of an inpatient heart failure education packet for outpatient use. This was accomplished by conducting educational sessions …

A Comparison Of Erector Spinae Plane Block And Epidural Analgesia For Major Abdominal Surgery, Charles Serrano

Doctor of Nursing Practice Projects

A large tertiary care center in central Illinois saw an increase in erector spinae plane (ESP) block administration for abdominal surgery patients, but many anesthesia providers at the facility were not acquainted with the ESP block. This project aimed to develop a comprehensive educational program concerning the ESP block compared to thoracic epidural analgesia for major abdominal surgery patients and ultimately improve patient care. The program introduced the relevant anatomy, indications, technique, advantages, and disadvantages of ESP block and epidural analgesia. Additionally, the risks, benefits, and costs of both adjunctive therapies were compared. The current literature shows that the thoracic …

Tranexamic Acid Protocol For Lower Extremity Total Joint Arthroplasties, Autumn Cullison

Doctor of Nursing Practice Projects

Abstract

Bleeding is a risk associated with surgery, and complications, such as hypotension, anemia, and decreased oxygen-carrying capacity, can occur. Blood transfusions have been the mainstay treatment for excessive surgical blood loss; however, transfusion has associated risks including infection, volume overload, immunological reactions, and increased morbidity and mortality (Sahu et al., 2014). Interventions to decrease surgical blood loss are essential components to improving surgical outcomes. The antithrombolytic, tranexamic acid (TXA), decreases surgical blood loss and blood transfusion requirements, thereby decreasing transfusion-related complications (Gausden et al., 2017). Despite frequent use, variance exists surrounding the administration of TXA. Current evidence and guidelines …

Establishing A Diabetes Self-Management Resource For The Self-Pay Client In A Rural Clinic, Emily Birkhead

Doctor of Nursing Practice Projects

Self-management of type 2 diabetes mellitus remains a prominent health concern across the United States. Adherence to treatment plans, medication, and glucose monitoring are often limited by out-of-pocket costs for the client. Diabetes Self-Management Education (DSME) is a set of domains that includes: medication adherence, glucose monitoring, nutrition, exercise, and effective coping mechanisms. DSME programs are provided across the United States helping those with Type 2 diabetes mellitus on their daily habits and management of the condition. DSME programs are largely unavailable to rural communities due to cost and distance barriers, resulting in diabetes education not being readily available in …