UBIR Repository (Univ. at Buffalo)
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The Prevalence of Vitamin D Deficiency Amongst a Refugee Population in Western New York
No full textUB SON, DNP Research ProjectBackground and Significance: Vitamin D is essential for musculoskeletal health, and deficiency of this vitamin can lead to adverse health outcomes. Migrants are at increased risk for impaired vitamin D levels. Purpose, Aims, and Objectives: To determine how often vitamin Dis screened and the prevalence and predictors of vitamin D insufficiency and deficiency amongst a refugee population seen at a Western New York (WNY) health clinic. Theoretical Framework: The Framework for Prevention by Nancy Milio states that the potential for healthy behavior change is not based on the individual's knowledge but rather on the options and resources available to that individual to help them succeed. Methods and Design: A quantitative cross-sectional, retrospective chart review was conducted. The data was collected from a Community Health Organization in WNY. Participants were included in the study if they were adult refugees seen at the WNY health clinics for an initial health evaluation in 2020 or 2021. Results: The screening rate for serum 25[OH]D levels were low at 1.9 %. Among those ever tested, 69 % had either insufficient or deficient vitamin D levels. The mean serum 25[OH]D concentration was 44.42 nmol/L. Conclusion: Healthcare providers should be aware that refugees are at increased risk for impaired vitamin D levels. Therefore, the screening rate should be increased along with providing education and supplementation to the refugee community. Future Implications: More research is needed on this topic as little research exists on this issue
Evaluation of Diabetes Distress Prevalence in a Medically Underserved Community
No full textUB SON, DNP Research ProjectBackground and Significance: Diabetes distress (DD) data in primary care populations is lacking. Purpose, Aim, and Objectives: The purpose was to measure prevalence of DD in adults with Type II diabetes. The aim was to improve understanding of DD. The objectives were 1) conduct a literature search; 2) conduct a survey using the Diabetes Distress Scale (DDS); 3) measure DD, demographic, and clinical data; 4) analyze the data; 5) provide a practice recommendation; 6) disseminate. Theoretical Framework: The Biopsychosocial Model guided the design. Methods and Design: A cross-sectional survey design was used. Institutional Review Board approval and participant consent was obtained before voluntary participation. Results: The project sampled 11 participants (N=l 1). The response rate was 0.79%, 63.63% being females with a mean age of 51.36 years. The means for emotional burden, physician related distress, regimen-related distress, and interpersonal distress were 1.93 ± 1. 15, 1.32 ± 0.46, 2.22 ± 1.13, and 2.09 ± 1.68, respectively. Marital status was significantly different in the emotional distress sub-scores for married (M=2.371, SD= 1.2406) and not married (M=l.150, SD= 0.1915) conditions; t (6.488) = 2.552, p = 0.041. A negative correlation occurred between family size and the emotional related subscale (p = 0.042, r = -0.621). Conclusion: DD is high in the population (18.18%). This suggests that family size and marital status are predictors of diabetes distress. Future Implications and Recommendations: Practices should evaluate mental well-being as part of routine diabetic care
Identifying Gaps in Advanced Practice Nursing Provider Knowledge & Management of Migraineurs within Primary Care
No full textUB SON, DNP Research ProjectMigraines are among the most prominent debilitating medical conditions presenting in primary care settings, affecting nearly 47 million individuals in the United States (Begasse de Dhaem et al., 2020). Research has demonstrated significant shortcomings in providers' migraine literacy, diagnostic skill, and management techniques of migraineurs. This study sought to add to the existing pool of available data with a focus on advanced practice nurses in primary care. The project design utilized a quantitative cross-sectional asynchronous survey of 10 participants, which examined various aspects of provider knowledge of migraine care. The study found that providers struggled to identify correct diagnostic criteria for chronic migraine. (N=3, 30%) of respondents were able to identify that chronic migraine was defined by 15 or more headache days per month for more than 3 months. Additionally, (N=3, 30%) correctly identified that new diagnostic criteria recommend the inclusion of patients who experience more than 8 migraine headaches as having chronic migraines. (N=3, 30%) of participants were unable to identify common preventative pharmacologic therapies of topiramate, gabapentin, tizanidine, fluoxetine, amitriptyline, and valproate acid. (N=7, 70%) of providers were unaware of or incorrectly identified topiramate as the most efficacious preventative therapy in chronic migraine. None of the participants admitted that they were very familiar with the guideline's recommendations, (N=4,40%) were not familiar at all with their availability. Future more extensive research utilizing this study will guide the development of appropriately targeted didactics for nurse practitioners working within the primary care setting
Nurse Practitioners' Attitudes Toward the Use of Telehealth Care for Patients During and After the Covid-19 Pandemic
No full textUB SON, DNP Research ProjectDuring the Covid-19 pandemic (2019-2023), telehealth care policies were incorporated into many healthcare practices. The purpose of this DNP project was to explore quantitatively and qualitatively, the current attitudes toward and the anticipated plans for future use of telehealth care among Nurse Practitioners. The aim of this DNP project was to increase knowledge and perceived understanding of the clinical appropriateness of telehealth care use among Nurse Practitioners during the recent pandemic. Lewin's Theory for Change was the guiding framework for the study. The use of telehealth for all three specialty groups (Primary Care, Psychiatry, and Other) once the pandemic ended was greater than telehealth use before the pandemic and all emphasized the use of audio and video compared to audio only telehealth. All participants reported using telehealth more for one or three-month follow-up visits than yearly exams. Psychiatric NPs utilized telehealth most often for a follow-up and were less reliant on a physical exam compared to lab work and imaging. All groups found there were times when telehealth provided the same or better care compared to in-person visits. Telehealth was used less often for patients with disabilities or low health literacy and all groups stated technology issues were "Rarely" or "Sometimes" a problem that impeded care. All specialties trended towards "Rarely" using telehealth if reimbursement rates were reduced to pre-pandemic levels. Overall, there were few differences between these specialties and all NPs believed that there were appropriate uses for telehealth care based on clinical, non-clinical, and visit type/timing factors
Vocabulary Talk Moves: Using Language to Promote Word Learning
No full textVocabulary knowledge plays a critical role in supporting text comprehension and broader learning across the school day. While school offers opportunities to build vocabulary knowledge, studies have shown that very little time is devoted to vocabulary instruction at the elementary level. This may be, in part, because educators commonly report being unsure of how to support students’ vocabulary development. In this article, I present 10 vocabulary talk moves aligned with research on word learning and show how these moves were used in early-elementary science lessons. Using these vocabulary talk moves can help educators promote word learning across the school day.This research was supported by a National Science Foundation Grant (#1620580) and an International Literacy Association Steven A. Stahl Research Grant
Certified Registered Nurses Anesthetist's (CRNAs) Use of Nitroglycerin in the Obstetric Setting
No full textUB SON, DNP Research ProjectNitroglycerin is frequently referenced in the literature as a method of relaxing the uterus. Uterine inversion (UI) and retained placenta (RP) are two indications for the use of nitroglycerin in the obstetric (OB) setting. The purpose of this DNP project was to obtain data related to anesthesia provider's experience using, dosing, routes of administration, and knowledge of nitroglycerin in the OB setting. The aim of this project was to expand the body of knowledge related to nitroglycerin in the OB setting and enhance anesthesia provider's level of comfort using nitroglycerin for OB patients. Objectives of this project included: (1) An exhaustive review of the literature and identified current evidence related to nitroglycerin in the OB setting; (2) An expert was consulted to develop a survey for CRNAs with OB anesthesia experience to identify provider's experience, knowledge, and dosing practices, and level of confidence related to nitroglycerin for OB emergencies; (3) Data was analyzed and synthesized using Statistical Package for the Social Sciences 28 (SPSS); ( 4) Findings were presented through oral dissemination at Highland Hospital in Rochester, NY. Kolb's Theory of Experiential Learning provided the guiding framework for this DNP project. This project utilized a quantitative, nonexperimental, cross-sectional observational design. A link to the SurveyMonkey questionnaire was posted to two private Facebook groups. Data was analyzed using descriptive statistics and Chi-square analysis. Survey participants included 48 CRNAs (n=48). Retained placenta was the most common indication for using nitroglycerin 37.3% (n=19), Intravenous was the most common route of administration, 51 % (n=26), Participants stated that 50-1 00mcg nitroglycerin was the most common dose used by participants. The most common dose for RP was 50100mcg 21.6% (N=l 1). Participants administered 50-l00mcg for UI at a rate of 19.6% (N=l0). Statistically significant associations were noted between education, use of nitroglycerin, and confidence using nitroglycerin in OB anesthesia. 52.9% of participants said they used nitroglycerin in OB and 51 % said they were taught about nitroglycerin for OB use. Congruent with DNP essentials and goals, this study contributes data and insights to advance practice nursing and clinical scholarship
Patients' and Parent of Patients' Perception of Care, for Telehealth Services in a Rural Urgent Care/Walk-in Clinic in Upstate New York
No full textUB SON, DNP Research ProjectIn 2020, to mitigate the public health risk of viral transmission to the novel Coronavirus, Telehealth care services was implemented in a rural clinic in Upstate New York (NY). Today, 3 years since its implementation, this Doctor of Nursing Practice (DNP) project aimed at evaluating patients' and caregivers' perception for the telehealth care received at the Alice Hyde Medical Center (AHMC) Walk-in/Urgent care clinic from March 2020 to December 2021. The purpose of this analysis was in part to inform practice by identifying challenges of telehealth care services offered, while providing an opportunity to improve health care outcomes. Indeed, the objectives for this DNP project were to 1) identify challenges faced by patients during their virtual consultations; 2) Allow stakeholders to gain insight on patients' overall experience with the telehealth encounter and 3) highlight patient health outcomes following a virtual health evaluation. The structural framework of the Plan-Do-Study-Act (PDSA) cycle was used to evaluate patients' current perception of telehealth care services received, identify areas of needed change, and translate data to improve the virtual care service offered at the Walk-in/Urgent care clinic in Upstate NY. This DNP project used a descriptive cross-sectional design to evaluate the perception of the rural population of interest towards their telehealth experience
Does Tight Glucose Control Reduce Maternal and Neonatal Complications in Women with Gestational Diabetes Mellitus
No full textUB SON, DNP Research ProjectBackground and Significance: Gestational diabetes mellitus (GDM) is a global health problem. There is no uniformity in the standard of care for glycemic goals in gestational diabetes mellitus. Purpose, Aims, and Objectives: The purpose of this Doctor of Nursing Practice project is to evaluate the outcomes of women with GDM and their infants to determine if tight glucose targets in women with GDM will reduce maternal and neonatal complications. The project objective consisted of conducting a quantitative review of retrospective chart data for women with GDM who delivered between January 2022 and December 2022. Theoretical Framework: Imogene King's Theory of Goal Attainment will be used as the theoretical framework to guide the development of the DNP project. Methods and Design: In this retrospective chart review, data was collected and analyzed to discover if there were reduced maternal and neonatal complications for pregnant women with GDM who had tight glucose control. Results: No statistical significance was found related to tight glucose control reducing maternal and neonatal complications in women with GDM. However, a relationship was discovered: five of the six complications, five of them had a pre-pregnancy BMI above 30. Future Implications and Recommendations: More studies should be done using larger sample sizes comparing varying degrees of glucose control for women with GDM. Conclusion: No statistical significance was found in this study; however, this is an important topic affecting up to 25% of pregnancies worldwide and should be further studied
Respect for the Wounded Mind: The Impact of a Recommended Clinical Practice Guideline Educational Module on Anesthesia Provider's Confidence in the Identification and Implementation of Preventative Strategies for Managing Emergence Delirium in Patients with Post-Traumatic Stress Disorder
No full textUB SON, DNP Research ProjectPost-Traumatic Stress Disorder (PTSD) is recognized throughout literature as an independent predictor of Emergence Delirium (ED) in adult patients. Literature review findings indicate a lack of knowledge currently exists regarding anesthesia provider self-confidence and self efficacy in identifying pre-operative risk reduction strategies to reduce the occurrence of ED in patients with PTSD. The purpose of this Doctor of Nursing Practice project was to examine the impact of a recommended, evidence-based clinical practice guideline educational module regarding the identification and pre-operative preventative strategies for management of ED in patients with PTSD. Neuman's Systems Theory served as the theoretical underpinning. Following approval by the University at Buffalo Institutional Review Board, a mixed methods sequential project incorporated an anonymous survey with qualitative content analysis. A convenience sample of 17 clinicians were voluntarily recruited from the project study site. Results from pre-and post-intervention survey instruments were statistically significant with thematic analysis revealing central gaps in current clinical practice; most notably a lack of individual and institutional preparedness to effectively identify and peri-operatively manage an individual with PTSD. After presentation of the educational module, mean self-confidence and self-efficacy scores improved from 3.5/5 to 4.5/5. Through a transformation in clinical understanding, this study displays promise with regards to the value of an evidence-based clinical practice guideline to assist in the anesthetic care provided to patients with PTSD. The anesthesia provider was able to establish opportunities for advancement in current clinical practice; demonstrating an acknowledgement of respect for the wounded mind
Intrathecal Dexmedetomidine Use in the Adult Surgical Patient: An Educational Workshop for Certified Registered Nurse Anesthetists
No full textUB SON, DNP Research ProjectIntrathecal dexmedetomidine (DEX) is a promising adjunct to neuraxial anesthesia due to both analgesic and non-analgesic properties. However, anesthesia providers do not use DEX as an adjunct to spinal blocks due to barriers such as unfamiliarity and lack of FDA approval. This project aimed to develop and execute an educational workshop for the intrathecal use of DEX in Certified Registered Nurse Anesthetists caring for adult surgical patients. As a result, this project increased CRNA comfort and knowledge on the benefits of utilizing DEX in the subarachnoid space, thus, increasing patient satisfaction and positive outcomes. Kurt Lewin's Theory of Planned Change is the framework for this project. Lewin's approach to change identifies the concepts that foster change and how to develop positive habits into the new standard of care. The execution of this study was a non-experimental, post-intervention follow-up type design. The intervention was an educational workshop synthesized from an extensive literature review and participant acquisition via convenience sampling. This project had no patient harm as it is nonexperimental in nature and was exempt from the UB IRB process. Consent was taken prior to participation and each participant had the option to withdraw from the project at any point effective immediately from the time of request. Data collected was anonymous. Participants did not benefit in any way from this study aside from scientific contribution and knowledge. The literature highlights extensive benefits to the use of intrathecal DEX for both analgesic and nonanalgesic properties. The deliverance of an educational workshop to practicing CRNAs regarding intrathecal DEX benefits in the adult surgical patients cultivated a scientific modality to advance nursing practice and identifies a gap in anesthesia practice