Nursing Commons^™

Improving Timely Palliative Care Consultation In The Micu: A Nurse-Driven Quality Improvement Initiative, Sandy Louise Gray

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Improving Timely Palliative Care Consultation in the MICU: A Nurse-Driven Quality Improvement Initiative

Sandy L Gray

Background: Early palliative care in intensive care units improves outcomes and reduces costs, yet referrals are often delayed. At J.W. Ruby Memorial Hospital’s medical intensive care unit (MICU), baseline median time to consultation was 112 hours (mean=246), exceeding recommended benchmarks and highlighting the need for a standardized process.

Purpose: This quality improvement project evaluated a nurse-driven screening tool to improve timeliness and consistency of palliative care consultations in the MICU.

Intervention: The tool was embedded in the electronic health record (EHR) …

Factors Influencing Emergency Department Utilization Among Heart Failure Patients In The Home Health Care Setting: A Secondary Data Analysis, Lynette Ramlogan

Theses & Dissertations

Heart failure is a chronic, progressive condition affecting over 6 million adults in the United States and remains a leading cause of morbidity and mortality, contributing to approximately 380,000 deaths annually. Disparities in health outcomes for individuals with heart failure are further exacerbated by social determinants of health (SDoH), including socioeconomic status, healthcare accessibility, and availability of social support, particularly among vulnerable populations. Insurance coverage plays a critical role in influencing access to care, treatment adherence, and overall health outcomes among patients with heart failure. For patients receiving home health care (HHC) services, limited caregiver support and inadequate socioeconomic resources …

A Mixed Methods Study: The Influence Of Educational Preparation, Clinical Experience, And Orientation On Nursing Professional Development Role Transition Experience, Lauren Elizabeth Moran

Theses & Dissertations

This study explored the role transition experiences of novice Nursing Professional Development (NPD) practitioners, examining how educational preparation, clinical experience, and orientation programs influence successful adaptation. NPD practitioners are essential in facilitating learning, mentoring staff, and advancing nursing excellence; however, transitions from clinical nurse to NPD practitioner are often marked by role ambiguity, limited confidence, and insufficient preparation. Despite the importance of this role, research on novice NPD practitioners’ transition experiences remains limited. This mixed-methods explanatory sequential study, guided by the Nurse Educator Transition (NET) model and From Novice to Expert frameworks, explored factors influencing the role transition of novice …

Exploring Lgbtq+ Competency In Healthcare, Jordan Whiteman

Honors College Theses

Marginalized groups such as the LGBTQ+ community are known to face healthcare disparities that negatively affect their process of navigating healthcare systems. This project explores the perceived lack of representation and understanding of the LGBTQ+ community within healthcare settings, exposing the deficits in knowledge for unique challenges and inequalities these patients may face. By viewing the literature, a myriad of complications faced by LGBTQ+ people in clinical settings can be identified. They possess a generalized feeling of mistrust towards the healthcare system. Healthcare staff overall describe low confidence with caring for this demographic. Heteronormativity’s presence in the field of healthcare …

Exploring The Reassessment Of Palliative Home Care Clients: A Mixed Methods Study, Maya Canham

Theses and Dissertations (Comprehensive)

Introduction: The timely reassessment of clients receiving palliative home care (HC) is critical for supporting clinicians with care planning and service delivery. However, there is little information on the frequency of reassessments and factors driving reassessment in palliative HC clients.

Objectives: The objectives of this study were to: (i) determine the proportion of palliative HC clients reassessed with the interRAI Palliative Care (interRAI PC) instrument, (ii) calculate the average interRAI PC reassessment interval, (iii) identify the key factors driving interRAI PC reassessment at various intervals, and (iv) explore the factors that influence palliative HC clinicians to reassess their clients in …

Methodological And Clinical Concerns In The Study On Postpartum Hypertension Management, Takaki Tanamoto, Kyosuke Kamijo, Yusuke Tsutsumi, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

[Introduction] We read with interest the recent study by Rosenfeld et al.¹ However, we have several clinical and methodological concerns about this study.¹

First, this study's propensity score matching (PSM) lacked key clinical confounders, including perinatal risk factors and the highest systolic/diastolic blood pressures. Smoking, alcohol use, and multifetal gestation, which influence blood pressure during pregnancy,²,³ potentially affect both primary and secondary outcomes. Additionally, the authors did not report standardized mean differences before and after PSM, which are essential for assessing balance.⁴

“Ringleader Who Has No Power”: A Qualitative Study Of Parent Uncertainty During A Nicu Admission Unrelated To Prematurity, Erin Rholl, Steven R. Leuthner, Kathryn J. Malin, Joanne Lagatta, Krisjon R. Olson

College of Nursing Faculty Research and Publications

Background

Parents of preterm infants experience stress related to uncertainty which impacts parent health outcomes. Less is known about the experience of parents whose infants are admitted for reasons other than prematurity. In this study we sought to describe (1) the experience of parents whose infants are admitted to a level IV NICU for reasons unrelated to prematurity in relation to uncertainty and (2) the effect of social and structural determinants on parent experience with uncertainty.

Methods

This single center qualitative study utilized interviews, questionnaires, and chart review at 2 time points: 2 weeks after admission and 3 months after …

Effectiveness And Safety Of Intravenous Iron Therapy In Outpatient Obstetrical Clinic For Treatment Of Iron-Deficiency Anemia During Pregnancy, Ellen M. Murrin, Olivia S. Lebeau, Lillian Singer, Mark A. Kassab, Peyton Kalan, Julie Costanzo, Scott A. Sullivan, George L. Maxwell, George R. Saade, Antonio F. Saad

Department of Obstetrics & Gynecology Faculty Publications

Background

Iron-deficiency anemia (IDA) affects over one-third of pregnant patients globally, contributing to severe maternal morbidity and adverse neonatal outcomes. Oral iron supplementation, while cost-effective, is limited by poor absorption, significant gastrointestinal side effects, and poor adherence. The use of intravenous (IV) iron addresses many of these concerns, including eliminating GI side effects and the need for daily therapy. However, administration of IV iron in pregnant patients is typically restricted to specialized infusion centers or hospitals due to concerns about acute side effects, cost, resource utilization, the need for fetal heart rate monitoring, and extended infusion times.

Methods

This descriptive …

Evaluation Of A Quality Cpr Coach Simulation-Based Competency Training: From Learning Outcomes To Patient Outcomes, Katie L. Mcdermott, Kari L. Rajzer-Wakeham, Jennifer M. Andres, Christine A. Schindler

College of Nursing Faculty Research and Publications

Background

Variability in cardiopulmonary resuscitation (CPR) quality and skill decay result in suboptimal application of CPR, which impacts patient outcomes following an arrest. Quality CPR Coach is a supplementary code team role that provides real time, verbal feedback directly to chest compressors to cognitively offload the team leader and ensure high-quality, goal-directed CPR delivery.

Methods

Design, implementation, and evaluation of a simulation-based Quality CPR Coach competency curriculum. Multi-modal assessment and evaluation methods were used.

Results

Statistically significant increase in confidence, perceived ability to verbalize Coach responsibilities, and knowledge. Participants demonstrated accurate Coach role performance across progressively scaffolded simulated compression event …

Assessing Family Caregiver Readiness For Hospital Discharge Of Patients With Serious Or Life-Limiting Illness Using Electronic Health Record And Self-Reported Data, Joan M. Griffin, Diane E. Holland, Catherine E. Vanderboom, Brystana G. Kaufman, Allison M. Gustavson, Jeanine Ransom, Jay Mandrekar, Ann Marie Dose, Cory Ingram, Zhi Ven Fong, Ellen Wild, Marianne E. Weiss

College of Nursing Faculty Research and Publications

Objective

To assess how patient and caregiver factors influence caregiver readiness for hospital discharge in palliative care patients.

Study Setting and Design

This transitional care study uses cross-sectional data from a randomized controlled trial conducted from 2018 to 2023 testing an intervention for caregivers of hospitalized adult patients with a serious or life-limiting illness who received a palliative care consult prior to transitioning out of the hospital.

Data Sources and Analytical Sample

Caregiver readiness was measured with the Family Readiness for Hospital Discharge Scale (n = 231). Caregiver demographic, intra- and interpersonal factors were self-reported. Patient demographic, comorbidity score, …

Rapid Implementation Of Open-Access Pandemic Education For Global Frontline Healthcare Workers, Jacqueline Christianson, Erica Frank, Stacen Keating, Susan Boyer, Miriam Chickering

College of Nursing Faculty Research and Publications

Background

The recent global pandemic posed extraordinary challenges for healthcare systems. Frontline healthcare workers required focused, immediate, practical, evidence-based instruction on optimal patient care modalities as knowledge evolved around disease management.

Objective

This course was designed to provide knowledge to protect healthcare workers; combat disease spread; and improve patient outcomes.

Methods

A team of global healthcare workers responded by rapidly creating a competency-based online course. To promote transcultural applicability, the course was developed by an international team of more than 45 educators from over 20 countries. Course delivery included a built-in language translation tool, routine updates, and several innovative course …

Health Equity And Children With Medical Complexity/Children And Youth With Special Health Care Needs: A Scoping Review, Elizabeth A. Flasch

College of Nursing Faculty Research and Publications

Children with medical complexity (CMC) and children and youth with special health care needs (CYSHCN), compared with the general population, engage with the health care system at increased rates, at multiple life stages, and for a myriad of reasons (Berry et al., 2015). Operational definitions of CMC and CYSHCN are very limited, with the terms conflated and differentiated across the literature. Because of the lack of standardized definitions and general conflation of the two terms across the literature, CMC and CYSHCN will be used interchangeably for this review. Allshouse et al. (2018) defined CMC as a subset of CYSHCN “as …

Factors Associated With Health Decision-Making Autonomy On Own Healthcare Among Tanzanian Women: A 2022–2023 Demographic Health Survey Study, Tausi Seleman Haruna, Henry Ofori Duah, Rebecca Lee

College of Nursing Faculty Research and Publications

Background

Women’s health decision-making autonomy is fundamental for the health and well-being of women and their children. It empowers women to make health decisions and exercise their rights and choices surrounding their health. Like most parts of Africa, women’s autonomy in Tanzania remains contentious, with an estimated 19% prevalence of health decision-making autonomy in 2015. Given the impact of women’s health decision-making autonomy on women’s health outcomes and the fact that women’s health decision-making autonomy is an ongoing process affected by advancements in technology, economic growth, and social and cultural shifts, understanding the sociodemographic correlates of women’s autonomy is imperative. …

Critical Care Advanced Practice Providers As Partners In Advancing Pediatric Intensive Care Unit Nursing Knowledge: A Needs Assessment., Mary Seidl, Meghan Roller, Whitney Seul, Laura Rose, Christine A. Schindler

College of Nursing Faculty Research and Publications

Background

Critical care advanced practice providers (APPs) are frontline providers in many pediatric intensive care units (PICUs). From 2020 to 2022, there was a significant downward shift in nursing experience level in the PICU at the authors’ institution. APPs may help provide additional in situ education.

Methods

Data were collected using role-specific needs assessment of PICU nursing staff and providers, assessing concept related to knowledge and job stress.

Results

Findings overwhelmingly demonstrated desire for more APP-led education. Overall, 27% of nurse respondents strongly agreed that current knowledge was adequate to provide safe and best care for their patients, and 47% …

Nurse Perspectives On Labor Union Participation Prior To Implementation Of A Collective Bargaining Agreement: A Qualitative Study, Jacqueline Christianson, Bonnie Sommers-Olson, Cathleen Fox, Norah L. Johnson

College of Nursing Faculty Research and Publications

Background: Patient advocacy is a duty for professional nurses; however, not all nurses are empowered to advocate for meeting patients’ needs. Participation in labor unions may serve as a venue for nurses with limited institutional decision-making authority to advocate for patient needs; however, unionization can be a time-intensive and fraught process.

Purpose: This study examined how nurses participating in a new union in an urban United States hospital described their reasons for participating in a labor union during collective bargaining.

Methods: Content analysis of participant's interviews that took place between January and March 2023, after the nurses voted to unionize …

Sex Work Patterns Among Transgender And Gender Diverse People: A Latent Class Analysis, Madeline Stenersen, Anjum Umrani, Irelan Fricke, Jessica L. Zemlak

College of Nursing Faculty Research and Publications

Sex work is a diverse profession encompassing a broad range of people, and services. Though overrepresented in sex work communities, transgender and gender diverse (TGD) individuals are underrepresented in sex work literature. Further, sex work literature continues to underrepresent the heterogeneity evident in the sex work community and the practices that occur within it. The present study utilized data from the 2015 United States Transgender Survey (USTS) to conduct a latent class analysis (LCA) to identify patterns of different types of sex work among TGD adults (N = 2,153) and understand the demographic characteristics associated with engagement in different types …

Evidence-Based Best Practices For Diabetes Education And Self-Care In Appalachia: A Literature Review., Angela J Occidental, Inga M Zadvinskis, Jacqueline Hoying

Nursing Articles

INTRODUCTION: The Appalachian Region has a higher prevalence of type 2 diabetes mellitus (T2DM) and associated adverse health outcomes. Although numerous papers report best practices for diabetes care and education, a clinician-friendly, synthesized summary of best practices tailored to Appalachian cultural preferences is lacking.

PURPOSE: This paper uses the Melnyk & Fineout-Overholt evidence-based framework to identify the best practices for T2DM care and education for Appalachian residents.

METHODS: A comprehensive literature search using the databases CINAHL, Academic Search Complete, and PubMed was guided by a PICOT question. Quality appraisals were completed for fifty-two articles; thirty papers were selected to synthesize …

Determinants Of Short Interpregnancy Intervals In High-Income Countries: A Systematic Review, J. Dunne, D. Foo, J. Jancey, G. Pereira, B. Kefale, D. G. Belay, G. Dhamrait, A. T. Gebremedhin, K. B. Mruts, S. D. Nyadanu, A. Roy, G. A. Tessema

Research outputs 2022 to 2026

Short interpregnancy intervals (IPIs) of <6–18 months are associated with adverse maternal and child outcomes. This study aimed to identify the individual, relationship, community, and societal factors that influence short IPIs in high-income countries. A comprehensive search was undertaken in CINAHL Plus, Ovid/EMBASE, Ovid/MEDLINE, Ovid/PsycINFO, ProQuest, PubMed, Scopus, Web of Science, and Google Scholar for articles published in English from 1st January 1990 to 26th October 2023. Studies were included if they reported an effect estimate of at least one determinant of pregnancy spacing in a high-income country. The quality of the included studies was assessed using the Johanna Briggs Institute Critical Appraisal Tool and Cochrane Risk Assessment Tool. Multi-level factors at the individual, relationship, community, and societal level were systematically identified through the socio-ecological model. This study is registered with PROSPERO (CRD42020176311). Of 2005 unique articles, 220 were identified for full-text review, and 55 met the inclusion criteria representing a total of 27,103,055 women from 13 high-income countries. All the included studies were deemed to be of moderate to high quality. Most of the studies reported determinants of short IPI at the individual level, with non-use of contraception the most common reported factor. Peer influence was a factor at the relationship level, and access to health care and reproductive services were impactful at the community and societal levels, respectively. Future research and efforts should support the development and implementation of policies and practices that support optimum pregnancy spacing from a comprehensive socio-ecological position.

Determining Space Requirements For Small And Sick Newborns And Their Mothers In Health Facilities: A Systematic Review, Natalie Strobel, Georgia Whisson, Derek Swe, Rajesh Mehta, Amy Budrikis, Karen Edmond

Research outputs 2022 to 2026

Background There are currently no World Health Organization and United Nations Children Fund benchmarks or ‘norms’ for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Specifically, there is limited evidence on optimal bed space requirements in SSN units such as special care nurseries and neonatal intensive care units (NICUs). Through this systematic review, we aimed to gather evidence on the optimal space requirements needed for SSNs and their mothers in health facilities, particularly at level 2 district hospitals. Methods We included simulation, experimental, and observational studies, as well as guidelines …

From The Icu Bedside: Applying The Transnational Clinical Academic Doctorate Lens To A Clinically Embedded Phd Journey, Gideon U. Johnson

Research outputs 2022 to 2026

Aim: To critically reflect on a transnational, clinically embedded doctoral journey undertaken during and after the COVID-19 pandemic, and to draw conceptual and systemic lessons for doctoral education and clinical academic nursing pathways. Background: Reflective accounts of doctoral study exist, yet few examine practice-based PhDs conducted across different countries and health systems during a global crisis. This paper analyses one such pathway—enrolment at an Australian university with research embedded within the UK National Health Service—to explore resilience, identity formation, mentorship ecologies and organisational conditions that support or hinder clinical academic development. Method: Using analytic autoethnography and reflective case study logic, …