Family Practice Nursing Commons^™

Biopsychosocial Variables Associated With The Development Of Chronic Low Back Pain In Healthcare Workers, Jena Pauli

Theses and Dissertations

ABSTRACT

Purpose: Worldwide the incidence and prevalence of acute low back injury with pain (ALBIP) is increasing in healthcare workers (HCW). Approximately 27% of ALBIP result in chronic low back pain (CLBP). The primary aim of this study was to identify biopsychosocial factors that contribute to the development of CLBP. A secondary aim was to examine the predictive value of reliable and valid screening instruments to identify individuals at highest risk for CLBP.

Significance: Low back pain is the second most commonly reported pain condition in the United States, one of the leading causes of sick leave and …

Implementation Of Provider And Workflow Strategies To Increase Adherence To Tqip Guidelines In Traumatic Brain Injury, Regina Thompson

Theses and Dissertations

Traumatic brain injury (TBI) is a leading cause of death and permanent disability worldwide. The American College of Surgeon’s Trauma Quality Improvement Program (TQIP) has developed a set of recommendations for the management of trauma-related injuries, including TBI. The objective of this evidenced-based practice project was to implement provider- and workflow-based strategies to improve adherence to TQIP recommended guidelines for the placement of intracranial pressure (ICP) monitors. The primary outcome measured was number of ICP monitors placed post-intervention.

The author reviewed available literature and found six articles pertaining to guideline implementations. Analysis of the literature was performed utilizing Melynk and …

Implementation Of A Depression Screening Tool For Cardiovascular Patients In The Primary Care Setting, Amber Nicole Ballentine

Theses and Dissertations

Background: Patients with cardiovascular disease (CVD) have a two-fold increased risk of depression as compared to patients without CVD. According to the American Heart Association (AHA, 2016), there is no gold-standard procedure for screening for depression in cardiovascular patients. Screening for depression varies greatly across specialties and practices, often leaving a gap for detection and treatment of depression in cardiac patients. There are many depression screening tools available; however, the AHA recommends use of the patient health questionnaire (PHQ) screening tool. The PHQ-2 and PHQ-9 questionnaires are the most brief, sensitive, and specific depression screening tool for patients with …

Structural Stress And Otherness: How Do They Influence Psychological Stress?, Christine Dewilde

Theses and Dissertations

Background: The Theory of Cultural Distress offers a framework for understanding the potential outcomes in patients who do not receive care that incorporates their cultural beliefs (DeWilde & Burton, 2017).This study represents initial steps in researching the theory byexploring the layering of stressors that place the patient at risk for Cultural Distress. Methods: Utilized aCross-sectional descriptive correlational analysis of intersecting identities (Structural Stressors), ethnicity-related stressors (Otherness) and ethnic-identity (Otherness) to develop understanding of the potential effects of these variables on psychological stress. Independent variables included intersecting identities, perceived ethnic discrimination, concern for stereotype confirmation, own group conformity pressure, and …

Home Exercise Therapy For The Treatment Of Knee Osteoarthritis, Kezia Nixon

Theses and Dissertations

Knee pain is the chief complaint of most osteoarthritis patients, and encourages them to seek medical attention. Unfortunately, pharmacological approaches to the treatment of knee osteoarthritis have been found to be inadequate. Given the prevalence and chronicity of osteoarthritic knee pain, there is an obvious need for treatments that can be provided for the course of the disease, with minimal adverse side effects. Exercise therapy has been found to significantly improve both pain and function among individuals with knee osteoarthritis. The primary objective of this quality improvement project was to investigate the effectiveness of a home-based therapeutic exercise program on …

The Effect Of A Compassion Fatigue Awareness And Self-Care Skills Educational Program On Retention Among Certified Nursing Assistants Working In A Veterans Nursing Home, Michele M. Dreher

Theses and Dissertations

Background: Compassion fatigue is defined as the emotional and physical exhaustion that can affect helping professionals and caregivers over time. Certified nursing assistants (CNAs) are at high-risk for compassion fatigue due to their daily exposure to those who are suffering from a myriad of chronic medical and behavioral illnesses along with repeated workplace stressors. If not addressed early, compassion fatigue can adversely impact a CNA’s wellbeing and quality of resident care. Compassion fatigue is associated with high absenteeism, high turnover, and low retention rates. Despite these challenges, there is no published research on the effects of a workplace compassion …

Initiating The Loeb Criteria In Long-Term Care, Janice Khauslender

Theses and Dissertations

Urinary tract infections are one of the most commonly reported infections in long-term care. Current practices often rely on non-specific symptoms, rather than specific genitourinary symptoms, to aid in the decision to obtain a urine culture. The literature does not support this practice due to the high prevalence of asymptomatic bacteriuria among long-term care patients, which does not have adverse outcomes when untreated. Antibiotics do not eradicate asymptomatic bacteriuria and place patients at risk of adverse reactions and increased risk of multi-drug resistant organisms. This clinical improvement project applied the Loeb criteria in two long-term care facilities to reduce the …

Forensic Patient Flow: An Imbalance Between Capacity And Demand, Versie J. Bellamy

Theses and Dissertations

Background: The United States (U.S.) has an ever-growing incarcerated population. The sheer volume of this population coupled with inefficient patient flow through the judicial and health care systems, create a large imbalance between the high demand for services and the capacity to deliver them. The delay in criminal defendants accessing mental health services is impacted by the lack of patient flow, which creates barriers to entering and exiting the forensic hospital system. The increasing demand for inpatient forensic services, coupled with a static supply of resources, warrants further intervention by treatment and service providers. Identifying and removing barriers to patient …

Efficiency Of Ambulatory Blood Pressure Monitoring Vs. 5-Day Serial Monitoring In A Military Treatment Facility, Kadijatu Kakay

Theses and Dissertations

The purpose of this process improvement project is to determine efficiency of ambulatory blood pressure monitoring (ABPM) vs. 5-day blood pressure checks in a military treatment facility. The sample consists of male and female active duty soldiers ages 18 to 54 years without a previous diagnosis of hypertension (HTN). The soldiers were assigned to a unit that is physically and mentally challenging, has demanding training opportunities and duty requirements, and are rapidly deployable in support of peacekeeping, humanitarian and combat missions.

The data collection method included a retrospective chart review of 128 charts randomly selected between June 2016 and May …

Using Ultrasound Guided Peripheral Intravenous Catheters In Difficult Access Patients, Courtney Prince

Theses and Dissertations

The purpose of this quality improvement project is to compare the use of ultrasound to guide placement of peripheral intravenous (USGPIV) catheters versus standard techniques in difficult access patients, as measured by the number of attempts required to obtain venous access and total cost related to means of obtaining peripheral venous access between a nurse driven USGPIV and VAT team consults or physician assistance. The appraised evidence indicates USGPIV increases the number of successful PIV placements, prevents non-essential central lines and excessive needle sticks, and reduces patients and healthcare professionals frustrations (An et al., 2016, Au et al., 2012, Dargin, …

Utilization Of The Usda Supertracker System In High Schools: A Quality Improvement Project, Twanda D. Addison

Theses and Dissertations

Obesity is a major chronic care condition proven to affect more than 12 million children and adolescents, age 2 to 19; categorizing approximately 17% of America’s youth as obese or overweight. As a result, Congress established federal mandates targeting obesity by enforcing nutritional policies for cafeteria and competitive foods to enhance learning environments. Establishing federal nutritional guidelines in education allows more than 31 million children to receive meals at a free or low cost in more than 96,000 public and nonprofit private schools. As such, the purpose of this quality improvement project is to compare individual food choices with the …

Evaluation, Treatment, And Education In The Hospice Setting By Initiating A Formalized Pain Card, Alyssa M. Soprano

Theses and Dissertations

The purpose of this DNP quality improvement project was to evaluate the use of a formalized pain card that Nurse Practitioners could use to assist clients and caregivers in making the decisions necessary for safe and effective pain management with improving outcomes by using the Brief Pain Inventory Form for measuring: 1) decreased pain, 2) increased pain, 3) pain relief. The appraised evidence suggested that there was a need for a policy standard for patients to notify when pain is unrelieved despite exhausting all other efforts to control pain (Glowacki, 2015). Forty-one (n=41) hospice patients were surveyed pre and post …

Scribes Impact On Patient And Provider Experience In The Outpatient Setting, Kimberly A. Taylor

Theses and Dissertations

The purpose of this project was to evaluate the effectiveness of using scribes in the outpatient setting on patient and provider experience. A mixed methods approach with a convenience sample of voluntary patient participants scheduled for an outpatient appointment was utilized. Two primary care physicians volunteered to receive scribes. Four hospital corpsmen were selected and trained to serve in the scribe role.

This quality improvement project evaluated two aspects of experience during the implementation of the scribes. These included: 1) patient experience as indicated via a pre and post implementation questionnaire; and 2) provider experience as indicated via a pre …

Improving Leadership Communication In Nurse-Physician Dyad Teams, Lisa James

Theses and Dissertations

Background: Changes in the delivery of healthcare services in the United States have been driven by cost containment over the last 20 years. To have a thriving organization within the current healthcare environment, nurses and physicians need to closely collaborate. As healthcare organizations prepare for the value-based era, new leadership models need to be implemented. This project addressed collaboration between nurse and physician leaders with a focused communication strategy to improve team performance, engagement, and quality outcomes in the acute care setting.

Method: A quality improvement project was designed to improve communication between front line team members and …

Developing And Implementing A Quality Assurance Strategy For Electroconvulsive Therapy, Jessa Hollingsworth

Theses and Dissertations

The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care, however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. An audit tool was developed …

Barriers To The Use Of Guardrails On Iv Smart Pumps, Ivory Williams

Theses and Dissertations

Medication errors involving hospitalized patients have been an evolving challenge for decades. Moreover, errors related to intravenous (IV) medication administration continue to rise in hospitals despite implemented policies governing the use of Guardrails™ for safe IV medication infusion via smart pump technology. An organizational investigation was performed to identify barriers to the use of Guardrails™ among nursing staff. From 2015 through 2017, multiple interventions that aimed to identify barriers and increase nurses’ use of the safety features on IV smart pumps were implemented in the hopes of reaching a compliance goal of 90-100%. This quality improvement project assesses Guardrails™ compliance …

Losing Weight With Five A’S (5 A’S): Assess, Advise, Agree, Assist, Arrange Framework And Motivational Interviewing (Mi) For Health Behavior Change Counseling, Jacqueline Baer

Theses and Dissertations

According to the Centers for Disease Control and Prevention (CDC), obesity has reached epidemic levels and has associated with increased risk of morbidity and mortality rates. The increasing prevalence of obesity is a major public health concern. Researchers calculate that health care costs are 44% higher among moderately and severely obese older persons than for persons at normal weights. Seventy-five percent of African American (AA) women are overweight and obese according to data from the CDC and The State of Obesity: Better Policies for a Healthier America. Compared to any other racial ethnic group, AA women are more likely to …

Effects Of Sepsis Protocols On Health Outcomes Of Adult Patients With Sepsis, Monika U. Mróz

Theses and Dissertations

Sepsis is a condition that arises from the host’s own exaggerated response to an infection, directed towards pathogens, but causing multiple organ failure. Sepsis is one of the most common causes of death, and a considerable absorber of healthcare resources. This frequently fatal condition, despite progress in technology and improving knowledge of pathophysiology, is still poorly understood, carries high mortality and morbidity rates, and survivors are often left with permanent disabilities and poor health outcomes.

Initial presentation of sepsis is often nonspecific, making diagnosis difficult, and causing lifesaving treatment delays. Sepsis guidelines are derived from emerging evidence-based research. While there …

Nursing Attitudes Towards Suicidal Patients In The Emergency Department: Assessment Interview Training, Belinda Beaver

Theses and Dissertations

This project sought evidence for the effectiveness of pedagogy in professional nursing continuing education and its effect on emergency department nurse attitudes towards patients seeking crisis intervention for suicide. Approximately 12 million emergency department (ED) visits annually were for patients suffering with mental illness and/or suicidal ideation. Emergency department staffs were often not adequately prepared to manage these problems. The purpose of this project was to examine the impact of an educational initiative on nurses’ attitudes about patients expressing suicidal ideation in the emergency departments 2 rural southeastern towns.

The project question was; in two different rural community emergency departments …

Mysleep101©: An Educational Mobile Medical Application For Sleep Health In Primary Care, Sonya Cook

Theses and Dissertations

Insufficient sleep has emerged over the past few decades as a public health concern. As little as 1 to 2 hours of sleep loss can produce extreme fatigue and physiological drives similar to thirst and/or hunger which increases the risk of motor vehicle accidents, work related mistakes and injuries. Sleep restriction whether voluntary or involuntary has produced a culture of chronic sleep deprivation that can be seen throughout the population. Chronic lack of quality sleep has been shown to adversely affect cardiovascular health, cognitive function, memory, immune responses and hormonal regulation among other homeostatic functions. Sleep disorders represent the cause …