UBIR Repository (Univ. at Buffalo)
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An Educational Review of Extracorporeal Membrane Oxygenation Support and Anesthetic Considerations to Improve Certified Registered Nurse Anesthetist Knowledge for Intraoperative Management Strategies
No full textUB SON, DNP Research ProjectExtracorporeal membrane oxygenation (ECMO) has redefined the limitations of life support. Expanded indications have led to an influx of ECMO patients requiring surgical intervention. Variabilities exist in CRNA experience, perceived educational preparedness, and comfortability managing this patient population which may translate clinically. The purpose of this Doctor of Nursing Practice project is to increase CRNA knowledge regarding basic ECMO components, functions, physiologic alterations, management techniques, and anesthetic implications to improve intraoperative outcomes. Aims focused on determining if an educational review improved CRNA knowledge deficits, educational preparedness, and comfortability managing this population. Nursing Intellectual Capital theory focused this project on the continuing professional development of nursing. With the University at Buffalo's IRB approval, a pretest/post-test study was administered to CRNAs at a local, Western New York, tertiary and quaternary care teaching hospital and ECMO center. A pre-survey was administered assessing CRNA demographics, experience, education, comfortability, and baseline ECMO knowledge. A post-survey reassessed these variables after an educational in-service. Paired samples T-tests determined a statistically significant difference in ECMO knowledge after the intervention (p=0.002) but not how prepared (p = .221) or comfortable (p=0.506) CRNAs felt. This study uncovered a knowledge gap consistent with literature review findings and resulted in statistically significantly improved knowledge scores after an educational intervention. Future research should focus on a larger sample size through a multi-center study and include all anesthesia providers. An evidence-based ECMO reference guide served as the deliverable in this project
Examining Perceived Self-Confidence and Psychomotor Skills Competence among Recently Graduated Doctorally Prepared Family Nurse Practitioners and Adult/Gerontology Nurse Practitioners Caring for Older Adults Aged 65 Years and Older in Primary Care Settings
No full textUB SON, DNP Research ProjectBackground and Significance: To help meet the growing demand for older adult healthcare providers, it is essential that Doctor of Nursing Practice (DNP) programs graduate well-prepared, skilled, and competent nurse practitioners (NPs). Current research indicates that NPs entering practice report feeling underprepared to competently and confidently care for older adult populations. Purpose, Aim and Objective: The purpose of this DNP project is to examine barriers and facilitators impacting perceived self-confidence and psychomotor skill competence as well as psychomotor skills education needed prior to graduation among newly graduated DNP prepared FNPs and AGNPs from the University at Buffalo School of Nursing (UB SON) and Western New York Region (WNY) caring for older adults aged 65 years and older in primary care settings. The project aim is to promote smoother practice transitions among newly graduated FNPs and AGNPs caring for older adults aged 65 years and older in primary care settings. The project objective is to provide the UB SON with curricula recommendations based on project findings to better support FNP and AGNP perceived self-confidence and psychomotor skill competence required to manage primary care for older adult populations. Theoretical Framework: Benner' From Novice to Expert theory was utilized as the guiding theoretical framework. Methods and Design: A mixed-methods descriptive survey design was utilized. Participant demographic data was also collected. Protection of Human Rights and Ethical Considerations: UB Institutional Review Board (IRB) approval was obtained prior to project implementation
Increasing Provider Knowledge of Sunrise Clinical Manager to Enhance Handoff Communication between the Emergency Department and the Medical Surgical Unit
No full textUB SON, DNP Research ProjectCommunication in healthcare is defined as the exchange of accurate patient health information (PHI), which is essential in providing safe, high-quality care. Transferring responsibility for a patient from the emergency department (ED) to a Medical Surgical Unit (MSU) requires endorsing pertinent information among healthcare providers; this process is known as "handoff." Handoffs have been recognized as a major healthcare challenge due to the breakdown in communications that occurs during transitions in care. In view of the growing interest in improving handoff processes, the need for guidance in arriving at a standardized handoff practice remains a persistent barrier. The purpose of this project was to improve the knowledge of the provider using a pre-post education on the underutilized features of Sunrise Clinical Manager (SCM) to improve communication from the Emergency department and the Med/Surg Unit. The Effective Nurse-to-Nurse Communication (ENNC) was used for guidance as the theoretical framework. A sampling of full time ACPs were included with varying levels of experience and SCM knowledge. Invitation for participants was sent out using Northwell emails to the Internal Medicine team. A ten question pre and post education survey via Redcap was applied using categorical data for analysis. The overall results fell short of being statistically significant however findings were favorable to providers using enhanced features of SCM to increase communication. Overall findings may inform future development of continued SCM education with implications to support and improve handoff for healthcare organizations and providers
Examining Resiliency as a Protective Factor Against Developing Occupational Burnout Among Psychiatric Mental Health Nurses Working in a Hospital Adult Inpatient Psychiatric Setting
No full textUB SON, DNP Research ProjectBackground and Significance: Occupational burnout among psychiatric mental health (PMH) nurses is a cause of compassion fatigue, poor professional satisfaction, occupational turnover, and reduced patient quality of care. Purpose, Aims, and Objective: The purpose of this project was to examine resiliency factors that prevent occupational burnout among PMH nurses working in two adult inpatient psychiatric units in a large Western New York (WNY) medical center. The aim was to increase knowledge and understanding regarding resiliency factors that decrease occupational burnout, improve personal health, career satisfaction, and patient quality of care. This guided evidence-based recommendations for new nurse orientation and continuing education. Theoretical Framework: Polk's (1997) Theory of Resilience was the guiding theoretical framework. Polk (1997) classified characteristics of resilience into four patterns: Dispositional, Relational, Situational, and Philosophical. Methods and Design: This project utilized a quantitative analysis of two online surveys, the Professional Quality of Life Scale Version Five and the Resilience Scale-14, and demographic questions including three open ended qualitative questions. Results: The final sample size (n=26) identified moderate levels of burnout and secondary trauma stress, low levels of compassion satisfaction, and moderate levels of resiliency among participants. Conclusion: Evidenced based literature and survey findings were utilized to create recommendations and an educational brochure for promoting strategies to increase resilience and decrease occupational burnout among PMH nurses. Future Implications: APRNs have the training and skills regarding nursing science, and evidence-based practice to contribute to system change and practice policies that support PMH nurse resiliency and the prevention of PMH nurse burnout
Supplementary Notes 6: Voyageurs of the Nile (1884)
No full text[added by hand at the top and bottom in blue ink. "Voyageurs of the Nile (1884)"; "Louis Jackson 'our Caughnawagas in Egypt' Montreal Drysdale & Co. 1885"]This undated note is a list of names, presumably of the Mohawks who participated in the British campaign up the Nile River in 1884. The remarks specify that "this list of names has been spelled exactly as Louis Jackson had written it.
The Impact of an Educational Workshop Provided to Anesthesia Providers on the Route of Administering Acetaminophen for Patients Undergoing Surgeries with General Anesthesia
No full textUB SON, DNP Research ProjectAcetaminophen as a non-opioid anesthetic plays an important role in lowering opioid consumption while providing effective pain control postoperatively. In current clinical practice, the route of acetaminophen administration largely depends on anesthesia providers' preference. The purpose of this DNP project was to develop an educational workshop for anesthesia providers after determining the superior route of administering acetaminophen to maximize its effectiveness in postoperative pain management as well as promoting the utilization of acetaminophen as part of multimodal anesthesia for patients undergoing general anesthesia. Aims of this DNP project included determination of superior route of administering acetaminophen and development of a guideline to standardize the route of administering acetaminophen in a cost-effective and cost-efficient manner. The objectives were to 1) develop an educational workshop for anesthesia providers about acetaminophen 2) evaluate anesthesia providers' conceptions, opinions and barriers regarding different routes of administering acetaminophen. Dorothy Johnson's theory of Behavioral System Model was utilized as the theoretical framework to guide this project. As a pilot study, this project consisted of a pre-intervention survey, an educational workshop and a post-intervention survey. This DNP project was approved by Institutional Review Board at University at Buffalo, and consents to proceed interventions were provided to participants prior to implementation. Findings revealed a significant increase in the awareness of administering acetaminophen orally to reduce medical costs as well as the willingness of administering acetaminophen intravenously when there is a possibility of gastric tube placement. A large sample size in different anesthesia care team models are needed for future research on this topic
Assessing and Addressing Nursing Burnout and Turnover Intent During COVID-19 Pandemic Through Survey
No full textUB SON, DNP Research ProjectHealth care burnout, a result of chronic workplace stress, has negative impact on clinicians in terms of job satisfaction and personal fulfillment with adverse consequences on quality of care and patient safety. Newly graduated nurses are a vulnerable population at risk for burnout due to adjustments in their new roles causing inability to maintain work-life balance leading to turnover intent (Boamad et. al, 2017). The purpose of this Doctor of Nursing (DNP) project was to quantitatively assess nursing burnout and intention to leave the profession during coronavirus disease 2019 (COVID-19) pandemic. The aim was to draw attention to novice nursing burnout while gaining understanding of the factors that lead to this type of work-related stress. Both Maslach's Theory on Burnout and Areas of Worklife Model were used as guiding theoretical frameworks. A cross-sectional electronic survey design was employed, a total of 50 nurses participated and data was analyzed through independent samples T-tests. Study findings revealed that RNs are experiencing on average high burnout as measured by all three dimensions of the Maslach Burnout Inventory (MBI) and nearly a quarter of novice nurses had intention to leave the profession. Study limitations included implementation during a pandemic resulting in low response rate and small homogenous sample size with limited variability and generalizability of results. Future research is needed to address strategies to mitigate burnout in the workplace and nursing education
Exploring the Barriers of Minority Nurse Anesthesia Resident Enrollment and the Impact of the Diversity in Nurse Anesthesia Mentorship Program
No full textUB SON, DNP Research ProjectIn the United States, the racial and ethnic demographics of the Certified Registered Nurse Anesthetist (CRNA) workforce are not representative of the general population. A more diversified CRNA workforce that mirrors the population they serve can help decrease the health disparities that minorities face. The purpose of this study was to identify and assess the perceived barriers to minority student enrollment in nursing anesthesia programs and the impact of the Diversity in Nurse Anesthesia Mentorship Program (DNAMP) by surveying current resident nurse anesthetists (RRNA), CRNAs, and critical-care nurses. Critical Race Theory (CRT) was used as the theoretical framework to guide project progression. After obtaining IRB approval, a cross-sectional convenience sample of 125 CRNAs, RRNAs, and RNs anonymously completed an online survey reporting their experiences regarding career advancement. The results suggests that individuals that self-identify as Asian, Black, immigrants, first-generation American, and second-generation American were more likely to feel that their race or ethnic background impacted their decision or opportunity to apply to a nursing anesthesia program than individuals that do not self-identify as the aforementioned minority groups. The themes identified as impacting the decision or opportunity to apply were a lack of resources, racial/ethnic privilege, lack of diversity, academic concerns, family concerns/upbringing, and racial discrimination in the ICU. The DNAMP did not show to significantly influence minority enrollment. Future research should explore these barriers further and focus on eliminating these obstacles in order to diversify the CRNA workforce to better represent their community
Assessment of Primary Care Provider Knowledge and Recommendation of an Education Program on Low-Dose CT (LDCT) Lung Cancer Screening to Increase the Likelihood of Referral Participation
No full textUB SON, DNP Research ProjectBackground and Significance: Lung cancer screening referral by primary care providers for eligible patients is suboptimal. An identified barrier to referral by primary care providers is a lack of knowledge regarding low-dose computed tomography (LDCT). Purpose, Aims, and Objectives: The purpose of this Doctor of Nursing Practice (DNP) project was to survey and assess the current knowledge level of primary care providers regarding LDCT scanning for lung cancer screening. This project aimed to increase the knowledge level of primary care providers regarding LDCT screening. Theoretical Framework: Pender's Health Promotion theory was used as the theoretical framework for this DNP project. Methods and Design: A descriptive survey design was used. The data was collected anonymously using SurveyMonkey. The data were analyzed using the Statistical Package of Social Science (SPSS) and simple descriptive statistical analysis. Results: Primary care providers lacked knowledge regarding the criteria and clinical considerations for lung cancer screening. Conclusion: Findings from this DNP project revealed the educational needs of primary care providers to provide a practice recommendation to improve education regarding LDCT. Future Implications and Recommendations: Further research to determine patient barriers to lung cancer screening is needed. An evidence-based poster can be used in primary care offices and exam rooms as a reference for providers and to bring awareness of screening to patients
CRNA Perceptions and Practices Related to Health Literacy in the Perioperative Setting
No full textUB SON, DNP Research ProjectHealth literacy is a modifiable determinant of health and evidence suggests that improving health literacy at both the individual and organizational levels, will improve patient outcomes, provide better quality of care, and reduce unnecessary costs within the healthcare system. The purpose of this Doctor of Nursing Practice (DNP) project was to quantitatively explore the Certified Registered Nurse Anesthetists (CRNAs) perceptions and practices relating to their role in addressing and improving health literacy in the perioperative setting. The guiding framework used for the purpose of this Doctor of Nursing Practice (DNP) project was the Health Literate Care Model (HLCM), which aided in the development of the survey. A cross-sectional quantitative descriptive approach was utilized to conduct the study. Data analysis included descriptive and inferential statistics. Key findings of this study include 1) a majority of CRNAs believe that time is a barrier to implementing health literacy screening into the perioperative period, 2) an overwhelming majority of facilities do not have policies, training, or resources available to encourage CRNAs to promote health literacy in the perioperative period, and 3) a majority of CRNAs felt that health literacy was a relevant component in perioperative care