Other Nursing Commons^™

Impact Of Behavioral Genetic Traits On Weight Maintenance Success Following Medically Supervised Very Low Calorie Diet, Lori Elizabeth Arguello

Doctoral Projects

Obesity has reached worldwide epidemic proportions and is associated with the leading causes of death. A person’s predisposition to obesity is strongly related to genetics and specific genes have been identified that influence weight control. The aim of this quantitative retrospective chart review is to identify the impact of behavioral genetics on weight loss maintenance following a medically supervised very low calorie diet. A total of 330 patient charts that met inclusion criteria were reviewed. Six behavioral genetic results were reviewed which included snacking, hunger, satiety, eating disinhibition, food desire, and sweet tooth along with patient weight at 3, 6, …

Fentanyl Administration On Emergence From Surgery And Post Anesthesia Care Unit Discharge Times And Pain Scores, Andrew Ernst Wetzel

Doctoral Projects

Problem: Pain has been historically mismanaged potentially leading to a host of negative physiological consequences. Today’s dynamic health care reform offers an opportunity to increase satisfaction with care. Utilizing the PICO question, in adults undergoing laparoscopic cholecystectomy over a 12 month period, does medication with fentanyl during emergence versus not medicating during emergence reduce the need for pain medications and discharge times? Evidence/Background: Two national studies surveyed patient perception of pain management following surgery. The first, conducted by Apfelbaum et.al (2003) showed that 80% of patients experienced acute pain after surgery with 86% rating that pain as moderate …

Reducing Hypotension In Elective Cesarean Section Patients With Administration Of Ondansetron Prior To Spinal Anesthesia: A Retrospective Chart Analysis, Linsey Erin Phipps

Doctoral Projects

The birth of a child is one of the most memorable moments in a woman’s life, and many women undergo an elective cesarean section, requiring spinal anesthesia. At this time, the patient and the unborn child’s well-being become the anesthetist’s main focus. The ultimate goal of anesthesia providers is to provide the safest care to the patient. Spinal anesthesia has many benefits, but has a common side effect of hypotension, which can also result in nausea. Hypotension, dangerous to mother and child, is often treated with vasopressors, but can also cause nausea, which is treated by the administration of ondansetron. …

Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgical Patients 65 Years Of Age Or Older, Simon Jack Gibson

Doctoral Projects

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two …

Efficacy Of Intravenous Ondansetron In Relieving Nausea/Vomiting And Pruritus Post Epidural Administered Opioids In The Obstetric Patient, Benjamin Stephen Butler

Doctoral Projects

One prominent side effect in the use of a neuraxial anesthesia is pruritus, with an incidence in the obstetric patient of 60-100% (Kumar & Singh, 2013). Another side effect of an epidural placement is nausea and vomiting. Nausea and vomiting occurs frequently during the progress of labor and is difficult to determine an incidence that is related to epidural opioid administration (Chestnut, Wong, Tsen, Ngan Kee, Beilin, & Mhyre, 2014). A review of literature was performed and established evidence that ondansetron is effective in reducing incidence of pruritus in intrathecal administered opioids for cesarean sections in the obstetric patient. No …

Exploring Asian Indian's Perceptions Regarding Organ Donation, Sandip Suprai

Doctoral Projects

Organ donation saves many lives and gives many people a second chance at life. With over 123,000 candidates on the organ transplant list, it is crucial to increase organ awareness in an effort to increase organ allocation. The growing Asian Indian population in the United States along with low rates of organ donation in this unique cultural group provides an opportunity to explore perceptions and barriers that may exist. This study will explore the perceptions of Asian Indians regarding organ donation. Findings will provide much needed data for interventions to educate and promote organ awareness in this ethnic group. Increasing …

Assessing Readiness For Interprofessional Learning About Sepsis Among Registered Nurses, Physicians, And Respiratory Therapists In A Community Hospital, Katie Choy

Doctoral Projects

Interprofessional teamwork and education have been advanced as methods to address the complexities of patient care (National Academy of Medicine [NAM], 2011-2013). One area needing further exploration is health care professionals' readiness to learn together in the acute care setting. The application of interprofessionalleaming (IPL) focused on sepsis education and improvement in sepsis outcomes in a community hospital has not been fully assessed. This descriptive, quantitative study explored interprofessional readiness to learn, perceptions of professional identity, and understanding of roles and responsibilities, by examining three subgroups. Registered nurses (n = 52), physicians (n = 29), and respiratory therapists (n = …

A Comparison Of Educational Approaches To The End-Of-Life-Nursing Education Consortium (Elnec) Course, Jennifer L. Bodine

Doctoral Projects

Purpose: The purpose of this project was to compare the effectiveness of two different educational approaches to teaching the End of Life Nursing Education Consortium course.

Background: Terminally ill patients frequently visit the emergency department for palliative care. However, various references show that staff does not have the knowledge base necessary to provide quality end-of-life care in the emergency setting.

Method: Participants from the emergency department at a Level I Trauma Center were recruited. A quantitative, cross-sectional pilot study was conducted to investigate whether lecture or lecture with simulation was more effective in increasing the knowledge base of participants regarding …

Teaching And Evaluation Of Suicidal Assessment, Five-Step Evaluation And Triage (Safe-T) In The Emergency Department, Evangeline Rico

Doctoral Projects

Suicide remains to be a global and a national problem, and it continues to be one of the leading causes of death in the United States (U.S.) The Emergency Department (ED), being the gateway to the hospital can provide a great opportunity to assess each patient for suicidal ideation, and evaluate if patients present with risk factors for suicide. The competency of the ED staff plays a critical role in early recognition of patients who are at risk, and in implementing a plan of care for those with positive screens. However, researchers showed that knowledge deficit and lack of education …

The Impact Of Intensive Case Management On Hospice Utilization, Debra Lowry Hummel

Doctoral Projects

Objective: The purpose of this study is to examine if patients enrolled in multi-disciplinary intensive case management program (ImPACT) alter the patient’s end-of-life path or setting of death.

Methods: The quality improvement project is a quantitative retrospective study that compared patients receiving standard primary care vs intensive case management (ImPACT) during 2/2013-1/2014. It is a secondary analysis of a larger study of a quality improvement evaluation that took place at the Veterans Administration facility in Palo Alto, Ca.

Results: Among the 82 patients who died, 19 were enrolled in ImPACT for approximately 249 days compared to 63 who received standard …

Therapeutic Listening Communication In Children With Autism And Hyperacusis, Jennifer Margaret Hughes

Doctoral Projects

Hyperacusis, or auditory hypersensitivity, is defined as abnormally sensitive hearing and in some cases an extreme sensitivity, where normally tolerated sounds are perceived as excessively, even painfully loud. This is a debilitating condition for children with autism, causing activity limitations and participation restrictions, also leading to peer isolation and habitual sound avoidance behaviors.

This research explores a means of modifying the auditory environment of a child with hyperacusis in a safe, effective way for the purpose of improving attention span and facilitating learning. The small pilot study (n=4) was a single-subject, multiple-baseline design, conducted with school-aged children in the special …

Effect Of An Emergency Nurse Heart Failure Educational Intervention, Lori Hudgens

Doctoral Projects

Background: Research indicates many nurses lack the appropriate heart failure (HF) education necessary to assist with readmission reduction efforts. Employer approved nurse HF education has resulted in improved nurse HF knowledge, and, reduced readmissions.

Problem: ED nurses require a competent knowledge of heart failure to effectively educate heart failure patients upon admission to the ED. No research has been conducted with ED nurse specific populations to assess ED nurse knowledge of heart failure, and, to determine if heart failure educational interventions increase ED nurse' HF knowledge.

Aims: To evaluate the effectiveness of an ED nurse b.eart failure educational intervention in …

How To Start A Nurse Practitioner Faculty Managed Clinic: Missing Components?, Johnna Edmunds

Doctoral Projects

A serious need exists for improved access to primary care for vulnerable populations. Nurse Practitioner Faculty Managed Clinics (NPFMC) can help to alleviate this problem. The purpose of this qualitative, descriptive study was to identify and examine the beginning components necessary for implementing this inter-professional collaboration. A comprehensive literature review identified the absence of these components, which were then revealed through the interviews with founders of NPFMCs. Prior to the interviews two manuals were reviewed about the process of starting a free clinic. Questions were explored relating to the participants’ experiences in starting a NPFMC. Review of the manuals was …

Intraspinal Drug Delivery Reservoir Refill Procedure By Non-Physician Clinicians: A Nation-Wide Survey Of Training, Pocket Fill Experience, And Life-Long Learning Behaviors, Gail Mcglothlen

Doctoral Projects

Intraspinal drug delivery (IDD) is a safe and efficacious method used to deliver medications for the treatment of chronic neurologic disease that requires periodic reservoir refills that can place patients at risk for a rare, accidental but potentially life-threatening, pocket fill. In the United States (US), non-physician clinicians perform this procedure. This study reports the results of a nationwide survey completed by 65 non-physician clinicians, obtained through social media, who performed the reservoir refill procedure. The results of the survey showed no standardized training was used, lack of attention to existing clinical practice guidelines in the training given, lack of …

Constructivist Learning Strategies In A Nurse Residency Program, Floyd M. Hammon Iii

Doctoral Projects

Nurses are knowledge workers in technologically advanced social environments providing care to patients with complex biopsychosocial health care needs. The Nurse Residency Program (NRP) is a transition to practice program designed to facilitate the professional socialization of the newly licensed registered nurse (NLRN) with the goal of developing competency in providing safe and quality patient-centered care. Constructivist learning strategies are an instructional framework that promotes social facilitated self-directed learning. The purpose of the project is to determine if using constructivist learning strategies are an effective learning method in a NRP as measured by the Casey-Fink Graduate Nurse Experience Survey.

Examining The Satisfaction Levels Of Hospice And Palliative Care Nurses In Education, Clinical Confidence And Knowledge Of Self Care Practice, Monica Wooldridge

Doctoral Projects

The purpose of this descriptive exploratory research study was to measure hospice and palliative care registered nurses self-reported information on end of life education and self- care practices including overall satisfaction with end of life education, self-rating of clinical confidence and knowledge of self-care practice. As no tool for measuring this was found in literature, this study included development of a new survey tool. Participants were solicited on a volunteer basis at end of life conferences and professional meetings for a period of ninety days. A total of 88 surveys were returned. Results revealed that the majority of respondents reported …

Comparison Of Outcomes In Heart Bypass Patients Undergoing Insertion Of An Internal Jugular Vein Central Line By Ultrasound Compared To Traditional Landmark Technique, Sayha Ol Ma

Doctoral Projects

Patients that undergo heart bypass surgery require central line placement from a healthcare provider. To place this device one must use either ultrasound guided or landmark technique. Using ultrasound guided compared to landmark technique may reduce complications. The goal of this project was to determine if ultrasound use of central line placement is a safer practice compared to using the traditional technique.

A retrospective chart review was performed to compare internal jugular central line placement by ultrasound with the traditional landmark placement to evaluate results related to patient outcomes. Data from fifty health records were analyzed using chi-square. The complications …

The Regional Study Of Sleep-Related Behaviors Of Nurse Anesthetists: Personal And Professional Implications: A Replication Study, Jarrod Fontenelle

Doctoral Projects

Universally, anesthesia providers are expected to be knowledgeable, astutely responding to clinical challenges while maintaining a prolonged vigilance for administration of safe anesthesia and critical care. A fatigued anesthetist is the consequence of cumulative acuity manifesting as decreased motor and cognitive powers. This results in patient harm, impaired judgement, late and inadequate responses to clinical changes, poor communications, and medical errors. With increased expectations and medical-legal claims, anesthesiologists work to provide efficient and timely services, but are rendered sleep deprived themselves. It is the right time to address the issue of the health of anesthesia providers and the profession. The …

Simulation And Educational Strategies To Decrease The Incidence Of Medication Errors In A Small Rural Acute Care Hospital, Queen Victoria Walters

Doctoral Projects

The Institute of Medicine (IOM) estimates 1.5 million medical errors occur per year (2007). Medication errors are the leading medical error. Medication errors are defined as adverse drug events, and are 100% preventable. Some categories of adverse drug events include, medications administered at the wrong time, by the wrong route, using the wrong method of administration, and administration of the wrong dose of medication. Adverse drug events also include administration of an overdose of medication or the omission of medications as well as administering the wrong medication.

The purpose of this capstone project was to increase the competency of nurses …

Evidence-Based Strategies To Minimize Risk For Opioid Pain Medication Misuse Among Patients With Chronic Pain In A Primary Care Setting, Carolyn Diane Coleman

Doctoral Projects

Background: Prescription opioid pain medication misuse has become a nationwide epidemic. Many states have implemented prescription drug monitoring programs (PDMP) to assist in combating the problem of prescription opioid pain medication misuse. Evidence-based clinical practice guidelines as well as the PMDP should be utilized by healthcare providers to guide treatment of chronic pain with opioid pain medications. Purpose: The purpose of this doctoral capstone project was to determine if providers are accessing the Prescription Drug Monitoring Program (PDMP) and utilizing evidence-based guidelines to minimize opioid pain medications misuse among patients with chronic pain in a primary care setting. …

Attention Deficit Hyperactivity Disorder And Mindfulness Practice In Children And Adolescents: A Comprehensive Review Of Evidence-Based Research, Donna Nikander

Doctoral Projects

Attention Deficit Hyperactivity Disorder (ADHD) is the most common mental illness in the United States among male and female children and adolescents between the ages of 3 and 17. The emerging fields of neurobiology and neuroimaging have proposed a relationship between mindfulness meditation therapies—initially referred to as mindfulness-based stress reduction (MBSR) and now simply known as mindfulness—and improvements in attention and self-regulation, two major problem areas for ADHD sufferers. Furthermore, recent studies suggest that mindfulness therapies may be effective in reducing symptoms of ADHD in children and adolescents. The purpose of this paper is to review, analyze and synthesize the …

Admission Medication Reconciliation Process To Improve Patient Outcomes, Vanessa Ann Irwin

Doctoral Projects

Medication reconciliation is an important process in the acute care setting that has implications for patient safety and outcomes. The medication reconciliation process occurs at transitions in care and involves disciplines including; nurses, pharmacists, and physicians. The role of the nurse in the admission portion of the process includes collecting and entering home medication information into the electronic medical record. It is crucial for the medication information to be entered in an accurate, timely, and complete manner.

The addition of the electronic medical record has not solved documentation challenges related to medication reconciliation but has added more transparency of issues. …

Commercial Sexual Exploitation: The Role Of The Advanced Practice Nurse In Screening Patient At-Risk, Sheri Rickman Patrick

Doctoral Projects

Problem: Human trafficking or commercial sexual exploitation (CSE) is a global problem effecting every country including the United States. The impact of human trafficking while it is devastating to individuals, the impact goes well beyond individual victims and undermines the health, safety and security of all nations (U.S. Department of State Publication, 2007, p. 5).This research is an attempt to assess the knowledge of advance practice nurses or nurse practitioners (NP) in the subject of commercial sexual exploitation and their willingness to screen their patients who may be at-risk.

Methods: The design was web-based with advanced practice nurses who are …

Factors Leading To Rapid Response Team Interventions In Adult Medical-Surgical Patients, Christine M. Tarver

Doctoral Projects

Rapid Response Team Intervention (RRTI) is a widely used intervention in acute care hospitals in the United States. Demonstrated effectiveness in preventing transfer to higher level of care or in decreasing in-hospital mortality has not been established. This exploratory study used a retrospective chat1 review to examine differences between medical-surgical acute care inpatients who had an RRTI and a control group. CutTent literature lacks information on proactive detection of patients who may be more likely to deteriorate and therefore require a Rapid Response Team Intervention. Therefore, this study's PICO question was: Are there statistically significant differences between medical-surgical adult inpatients …

Nurses Caring For Adults With Autism In An Emergency Department: A Survey Of Knowledge, Shauna Marie Miller

Doctoral Projects

Autism is a complex neurodevelopmental disorder characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior. The nurse (RN) in the emergency department (ED) plays an important role in the receiving, treatment, and management of the patient with autism. RNs must understand the unique challenges of caring for individuals with autism. Fortunately, autism is an active area of research, with copious resources available to assist those affected by this disorder; however, no studies were found evaluating nurses’ knowledge of autism and the number of resources for nurses caring for this population was limited. Nursing is an …

Bio-Identical Hormones Utilized For Treating Menopausal Symptoms: Are They Safe?, Maria D. White

Doctoral Projects

The use of compounded bioidentical hormones in the various forms of gels, creams, and troches has increased in popularity. The population of menopausal women is at a crossroads with the cascade of symptoms and determining what are their options. The Endocrine Society, the Food and Drug Administration, and the National Menopause Society do not support the use of bioidentical hormones, despite the support for bioidentical hormone replacement therapy (BHRT) by the American Academy for Anti-Aging Medicine and other proponents for BHRT. The literature review reveals the need for studies documenting the safety of BHRT. The objective for this study was …

Pain Management At End Of Life When There Is A Co-Occurrence Of Substance Use Disorder: A Qualitative Metasynthesis, Kristina Olfson

Doctoral Projects

Pain management, end of life (EOL) care, and substance use disorder (SUD) are individually identified as National healthcare challenges and priorities. Despite 50 years of advances in the understanding of pain management, pain is still inconsistently assessed and undertreated in all populations, including those with life limiting illness. When a patient with a life limiting illness and history of SUD is encountered, pain management becomes further complicated. Effective pain management for all patients, regardless of coexisting complications, is an ethical obligation of health care providers. Given the lack of research into EOL pain management of patients with SUD, it is …

A Comparison Of Pedagogical Approaches To Error Communication Training, Marie Annette Gilbert

Doctoral Projects

Purpose: The purpose of this study was to compare the effectiveness of two different pedagogical approaches to error communication training.

Background: The literature advocates full, transparent communication following a medical error. However, many barriers to such disclosure exist. A significant barrier is healthcare providers do not feel prepared for these difficult conversations. This can be particularly challenging in a pediatric setting when the conversation with a parent may be more demanding than similar conversations in the non-pediatric settings.

Method: Individuals from three different professional groups were recruited; physicians, pharmacists, and nurses. A randomized controlled study was conducted to investigate …

Access To Care Barriers For Native American Veterans, Joanne Kristen Rhoads

Doctoral Projects

There are very few studies that examine Native American Veterans and access to care issues. Therefore, the researchers implemented an exploratory, descriptive, qualitative project to explore and identify the potential barriers that Native American Veterans have experienced with access to healthcare and participation in veteran benefit programs. A purposeful sample consisted of 14 Native veterans from the American Indian Veteran Association who were eligible for veteran services, and were willing to participate in the project. Fieldwork was performed in the natural environment of the Sierra Nevada foothills on the ancestral homeland of a California Tribe. The facilitator utilized a demographic …

Evaluating The Perceptions Of Quality Of Life In Informal Caregivers Caring For Hospice Patients, Rashandra Fisher Laws

Doctoral Projects

Maintaining or improving quality of life for informal caregivers is important as they endure the burden of providing care to terminally ill loved ones on a daily basis. Caregivers are at a greater risk for depression, deteriorating physical health, financial difficulties, and premature death than demographically similar non-caregivers (Demiris et al., 2010). The goal of this capstone project was to determine the effectiveness of the creativity, optimism, planning, and expert information (COPE) intervention, which address specific needs of the family and caregiver.

Twenty informal caregivers completed the Quality of Life (QoL) Index tool, which measured their perceptions of five different …