Nursing Commons^™

Prenatal And Postnatal Disparities In Very-Preterm Infants In A Study Of Infections Between 2018–2023 In Southeastern Us, Robin B. Dail Phd, Rn, Faan, Kayla C. Everhart Phd, Rn, Victor N. Iskersky, Weili Chang, Kimberley Fisher, Karen Warren Phd, Rn, Heidi J. Steflik, James W. Hardin Ph.D.

Publications

Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. Methods: 367 preterms born at < 32 weeks gestational age (GA) between 2019–2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics. Results: The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). Conclusions: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

Co-Occurrence Of Mental Illness And Substance Use Among Us Pregnant Individuals, 2012-2021, Zhong Li, Curisa M. Tucker Phd, Rn, Cassie L. Odahowski Phd, Mph, Kacey Y. Eichelberger, Jiajia Zhang Ph.D., Peiyin Hung Ph.D

Publications

Aim: Substance use disorders are increasingly prevalent among pregnant individuals, with evident risks of adverse perinatal outcomes. This study examines substance use (tobacco, alcohol and marijuana) among pregnant individuals with mental illness. Methods: A national representative sample of pregnant individuals were derived from 2012 to 2021 National Survey of Drug Use and Health data. Associations of past-year mental illness with past-month polysubstance use and each substance use were analyzed by logistic regression models, with complex sampling weights and survey year. Results: Among 6801 pregnant individuals, 16.4% reported having any mental illness (AMI) in 2012 and 2013, increasing to 23.8% in …

Recommendations For Sugammadex Administration In Standard And Special Populations, Kristen E. Mattson, Alexa Brummund

Doctor of Nursing Practice Projects

The purpose of this project was to collect evidence-based information regarding sugammadex administration in both standard and selected special populations. Special populations included renal failure, breastfeeding, pregnancy, and pediatrics. The objectives of the project were to collect and present current research to the host facility, define barriers to the use of sugammadex, and assess the participants’ knowledge of sugammadex use in special populations. A guideline for sugammdex administration was created and presented to the host facility through a poster presentation and quick reference guide. A voluntary post-implementation survey was implemented, and the results were recorded, analyzed, and displayed in the …

Shivering In Postpartum Women: Development Of A Perioperative Protocol For Women Undergoing Cesarean Section, Lindsay Dawson, Kara Peters

Doctor of Nursing Practice Projects

In obstetric patients undergoing a cesarean section, a spinal anesthetic is the most common form of anesthesia (Hannallah, 2016). An intrathecal (or spinal) block is not benign. Postpartum shivering is a potential risk with any neuraxial procedure, with an incidence of 40-80% specifically following a spinal anesthetic (Feng et al., 2021). Patients who experience shivering are at a greater risk for postoperative complications, impaired mother-newborn bonding, and decreased patient satisfaction. Both nonpharmacological and pharmacological treatment options exist for prevention and treatment of postpartum shivering. The objective of this project was to introduce a standardized, evidence-based protocol to decrease the incidence …

Anesthesia Management For The Preeclampsia Or Hypertensive Parturient, Britanie Sumpter

Doctor of Nursing Practice Projects

Preeclampsia is a placental disease characterized by abnormal maternoplacental blood vessels and placental dysfunction resulting in fetoplacental hypoperfusion and maternal multi-system organ dysfunction (Wang et al., 2019). Expectant management of a hypertensive or preeclamptic parturient includes antihypertensive medications, magnesium sulfate for seizure prophylaxis, and early delivery of the fetus (ACOG, 2020). Neuraxial anesthetic-induced sympathectomy combined with circulating antihypertensives, magnesium sulfate therapy, and intravascular volume depletion in preeclampsia is thought to contribute to exaggerated hypotension.

Persistent refractory hypotension after neuraxial anesthesia in parturients with preeclampsia or hypertension has been an ongoing issue affecting obstetric providers at the host facility. This project …

Diversity, Equity, & Inclusion In Nurse Anesthesia: Bridging The Gap, Aminat Yusuff-Akinbo

Doctor of Nursing Practice Projects

The nurse anesthetist plays a crucial role in the healthcare system. Through intensive training, they provide safe and effective anesthesia care to patients across various healthcare settings. Currently, the nurse anesthesia field lacks diversity, with underrepresentation of minority groups such as Black, Hispanic, and Indigenous individuals. The United States Census revealed that there are more than 325 million residents. Yet only 10.9% of nurse anesthetists are of diverse racial backgrounds. This lack of diversity limits the cultural perspectives and experiences brought to patient care and perpetuates disparities in healthcare outcomes. An increase in diversity can improve care for individuals and …

Integrating Psychotherapy In A Psychiatric Outpatient Clinic, Ayesha Baluch

Doctor of Nursing Practice Projects

Mental illness is common in the United States, affecting millions of people. Although there are effective medications for mental illness, psychotherapy in addition to pharmacotherapy provides the best outcomes. This project aimed to improve providers' psychotherapy screening and education of patients about psychotherapy utilization. A pre-implementation survey was conducted to evaluate psychotherapy screening and the barriers faced by providers to utilize psychotherapy screening. An education session was provided to the providers about the importance of psychotherapy screening and education. Data showed that the providers discussed psychotherapy with eight patients (40%) and educated four patients (20%) pre-implementation. Data showed that the …

Improving Depression Screening In Primary Care, Grace Wilson, Annmarie O'Connor

Doctor of Nursing Practice Projects

Depression remains an increasingly prevalent and underdiagnosed disorder affecting approximately 21 million adults in the United States with only 66% seeking treatment (NIMH, 2022). Untreated depression can lead to worsening mental and physical health which negatively impacts a person’s quality of life. The implementation of routine depression screening in primary care is recommended by the US Preventive Services Task Force (USPSTF) to improve early detection leading to improved outcomes (USPSTF, 2023). Despite increased depression prevalence and USPSTF recommendation, there remained an absence of routine depression screening in a primary care practice in Midwest Illinois which led to the development of …

Nurses' Experience Implementating Weighted Blankets In Inpatient Psychiatric Unit, Michael Ragen

Doctor of Nursing Practice Projects

The complexity of treating sleep difficulties in patients with concurrent psychiatric disorders continues to be a struggle for the medical community. The mechanism that causes psychiatric disorders can induce insomnia or hypersomnia (Khurshid, 2018). There is also a growing interest in disturbed sleep ability to induce psychiatric episodes (Verkhratsky et al., 2020). This classic “Chicken or Egg Scenario” meets the modern focus on creating the best outcome for patients with the least medication, spurring interest in the holistic management of sleep disorders. The literature has little information on the use of weighted modalities for sleep management and anxiety in an …

Lung Cancer Screening In A Primary Care Clinic For Coal Mine, Glenda Mills, Sarah Cobb

Doctor of Nursing Practice Projects

Lung cancer is the leading cause of mortality for both men and women in the United States. Guidelines are set by the American Cancer Society for annual screenings of at-risk patients. Early identification of lung cancer risk and screening with low-dose CT scans can increase detection and treatment thereby reducing risk of death or disability. Coal miners are exposed to numerous cancer-causing agents, such as toxic chemicals, dust pollution from coal, and diesel exhaust fumes. However, primary care clinics serving coal miners lack lung cancer screenings despite the increased risk miners face. Patients were screened using criteria set forth by …

Establishing Routine Multiple Micronutrient Supplementation During Pregnancy In An Impoverished Guatemalan Community, Marissa Schuette, Erin Brueggemann

Doctor of Nursing Practice Projects

Pregnant and breastfeeding women in impoverished settings face heightened nutritional demands, placing them and their children at increased risk of inadequate nutrition's detrimental effects. Existing literature suggests that supplementing with multiple micronutrients (MMS) may offer superior protection against morbidity and mortality compared to traditional iron and folic acid (IFA) formulations. This research is set in the Land of Hope (LOH) clinic, located in Escuintla, Guatemala, a community served by the non-profit organization ER Abroad. The study aims to assess the feasibility of standardizing MMS provision to pregnant women at LOH, coupled with supplementary education on pregnancy and nutrition. The team …

Enhanced Recovery After Surgery (Eras) Protocol For Bariatric Surgery, Krista Bunch

Doctor of Nursing Practice Projects

Bariatric surgery has been utilized in treating severe obesity and offers several benefits, such as sustainable weight loss, treatment of various metabolic comorbidities, and improved life expectancy (Sundbom et al., 2017). With these benefits and procedural improvements, there has been a marked increase in the demand for bariatric surgery and increased interest in shifting some of these procedures to an ambulatory care setting (Stenberg et al., 2022). However, postoperative complications such as pain, nausea, and inability to tolerate oral intake can cause patients to experience an increased length of stay in the hospital and suboptimal outcomes (King et al., 2018). …

Improvement In Patient Compliance For Gynecological Care, Tracee Williams

Doctor of Nursing Practice Projects

This quality improvement project implemented the patient-initiated follow-up (PIFU) pathway in a gynecology clinic setting. PIFU has potential to lead to decreased no-show appointments and increased patient autonomy in outpatient healthcare practices. Barriers that influence compliance with plans of care include lower socioeconomic status, racial and ethnic minorities, and unmet social needs such as food insecurity, healthcare travel and cost, and child/adult care needs. In addition to higher rates of no-show appointments, individuals facing these barriers have increased comorbidities. Prior to implementing the PIFU model, patients between the ages of 18 and 42 completed a patient satisfaction survey to better …

Exploring Caregiver Support For Advanced Practice Nurses Following An Error, Sunnie L. Nield

Student Works

Advanced Practice Registered Nurses (APRN) are a growing population of employed individuals within the healthcare system, working in outpatient and inpatient settings. Like other healthcare professionals, nurse practitioners can and do make errors while practicing. Nevertheless, little to no research has focused on them. This research aimed to better understand nurse practitioners’ attitudes towards error approach, perception, and cause using the Medical Error Attitude Scale (MEAS). Additional purposes included the further exploration of APRNs' experiences following an error and support they may or may not receive. A convenience sample of ARPNs licensed in Utah was sent an electronic survey via …

Reducing Hemoglobin A1c Using Diabetes Self-Management Education And Support (Dsmes) For Hispanic Adults In A Primary Care Setting, Gita Gyawali Sedai

Doctor of Nursing Practice Final Project Abstract

Background: Members of the Hispanic population have a 50% or higher chance of developing diabetes and often do so at a younger age than other adults in the United States (CDC, 2022a). Diabetes complications also impact the Hispanic population harder, with higher rates of kidney failure caused by diabetes, along with diabetes-related vision loss and blindness (CDC, 2022a). DSMES programs have shown significant improvements in A1C and blood sugar control in different settings (Powers et al., 2020). However, it has not been implemented in many primary care settings.

Purpose: The purpose of this project was to implement and evaluate …

Maternal Prebiotic Supplementation During Pregnancy And Lactation Modifies The Microbiome And Short Chain Fatty Acid Profile Of Both Mother And Infant, Jacquelyn M. Jones, Stacey N. Reinke, Mahsa Mousavi-Derazmahalleh, Johan Garssen, Maria C. Jenmalm, Ravisha Srinivasjois, Desiree Silva, Jeffrey Keelan, Susan L. Prescott, Debra J. Palmer, Claus T. Christophersen

Research outputs 2022 to 2026

Background & aims: Improving maternal gut health in pregnancy and lactation is a potential strategy to improve immune and metabolic health in offspring and curtail the rising rates of inflammatory diseases linked to alterations in gut microbiota. Here, we investigate the effects of a maternal prebiotic supplement (galacto-oligosaccharides and fructo-oligosaccharides), ingested daily from < 21 weeks' gestation to six months’ post-partum, in a double-blinded, randomised placebo-controlled trial. Methods: Stool samples were collected at multiple timepoints from 74 mother–infant pairs as part of a larger, double-blinded, randomised controlled allergy intervention trial. The participants were randomised to one of two groups; with one group receiving 14.2 g per day of prebiotic powder (galacto-oligosaccharides GOS and fructo-oligosaccharides FOS in ratio 9:1), and the other receiving a placebo powder consisting of 8.7 g per day of maltodextrin. The faecal microbiota of both mother and infants were assessed based on the analysis of bacterial 16S rRNA gene (V4 region) sequences, and short chain fatty acid (SCFA) concentrations in stool. Results: Significant differences in the maternal microbiota profiles between baseline and either 28-weeks’ or 36-weeks’ gestation were found in the prebiotic supplemented women. Infant microbial beta-diversity also significantly differed between prebiotic and placebo groups at 12-months of age. Supplementation was associated with increased abundance of commensal Bifidobacteria in the maternal microbiota, and a reduction in the abundance of Negativicutes in both maternal and infant microbiota. There were also changes in SCFA concentrations with maternal prebiotics supplementation, including significant differences in acetic acid concentration between intervention and control groups from 20 to 28-weeks’ gestation. Conclusion: Maternal prebiotic supplementation of 14.2 g per day GOS/FOS was found to favourably modify both the maternal and the developing infant gut microbiome. These results build on our understanding of the importance of maternal diet during pregnancy, and indicate that it is possible to intervene and modify the development of the infant microbiome by dietary modulation of the maternal gut microbiome.

Preventing And Responding To Workplace Violence In The Emergency Department, Janina La Porte, Stefanie Lai, Alicia Rodriguez

Articles, Abstracts, and Reports

No abstract provided.

Fall Prevention Quality Initiative: Implementation Of Fall Ambassador Safety Team (F.A.S.T.), Jerome Codilla, Joanna Arraiza, Joanna Felix-Mendez, Grace Marie Rillorta, Isabel Shellburne-Vargas

Articles, Abstracts, and Reports

No abstract provided.

Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation, Shanekia Garrett, Stefanie Lai, Jairo Pagan, Wendy Lu, Katie Whitehead

Articles, Abstracts, and Reports

No abstract provided.

Developing A Health Equity-Minded Curriculum: The Impacts Of Cancer Care, Leanna Ross, Camille Ashley, Julianne Luttrell, Krismae Jimenez

Articles, Abstracts, and Reports

No abstract provided.