UBIR Repository (Univ. at Buffalo)
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Perceived Barriers, Facilitators, and Needs Regarding Workflow and Communicating Test Results to Patients Among Health Care Providers Working in an Outpatient Neurology Clinic
No full textUB SON, DNP Research ProjectA lack of knowledge exists regarding evidence-based practices for communicating test results to patients in the outpatient neurology setting. The purpose of this Doctor of Nursing Practice project was to qualitatively explore the perceived barriers, facilitators, and needs regarding workflow and communicating test results to patients among health care providers (HCPs) working in an outpatient neurology clinic in Western New York. The project aim was to promote knowledge and understanding regarding communicating results to patients among HCPs in the outpatient neurology setting to improve patient-centered notification of test results to decrease diagnostic errors and improve patient satisfaction. The primary objective was to develop an evidence-based test result communication algorithm for HCPs at the project site. A qualitative descriptive approach was used with semi-structured individual interviews. The Relational Coordination Theory and a review of current evidence guided the creation of the semi-structured interview questionnaire. Institutional Review Board approval was granted. Braun and Clarke’s Reflexive Thematic Analysis method was used for data analysis. Data analysis generated one overarching theme, An Institutional Wide Protocol For Communicating Test Results…I Wish It Were A Little More Standard, and three key themes, A lot of Communication Barriers, A More Concise Policy for Communicating Test Results Would be Very Helpful All the Way Around, and There Would be Some Benefit to Having a Script [Protocol] for Giving Test Results. Future research is needed with larger, more diverse samples and from patients’ perspectives
Development of an Intensive Care Protocol to Guide Subglottic Secretion Drainage Endotracheal Tube Utilization and Maintain Ventilator Associated Pneumonia Prevention Compliance
No full textUB SON, DNP Research ProjectSubglottic secretion drainage endotracheal tubes (SSD ETTs) are an effective ventilator associated pneumonia (VAP) prevention strategy when properly used among mechanically ventilated patients. This Doctor of Nursing Practice capstone examined the SSD ETT-specific gap in knowledge among intensive care clinicians and the need for an SSD ETT protocol at a local facility. Lewin’s (1947) Theory of Change provided the framework for this capstone, which incorporated a quasi-experimental pretest-posttest study. Intensive care nurses and respiratory therapists were invited to participate, which included a pre-educational questionnaire, SSD ETT educational presentation, and post-educational questionnaire. Questionnaires sought to measure knowledge and confidence with SSD ETT care practices, VAP prophylaxis, facility resources/support, and the proposed protocol. In addition, questionnaires encouraged participants to provide feedback on the proposed protocol. The educational presentation was displayed via PowerPoint, and included evidence-based SSD ETT care practices, VAP prophylaxis recommendations, and the proposed protocol. The study recruited 25 clinicians via convenience sampling, but only 14 participants completed both questionnaires. A paired t-test was used to compare data points of completed questionnaires. The results showed a significant improvement with SSD ETT familiarity (p=.001), SSD ETT design understanding/care (p =.002), SSD ETT suction and cuff pressure understanding (p=.004), perceived comfort of SSD ETT suction lumen care (p=.02), and manometer location (p=.02). Lastly, a finalized SSD ETT protocol will be provided to the local hospital to guide clinicians on SSD ETT care practices to ensure optimal VAP prevention
Knowledge Levels, Attitudes, and Educational Needs among Novice Registered Nurses Related to Factors for Implementation of the CIWA-Ar Protocol for Adult Patients Experiencing Alcohol Withdrawal Symptoms on Non-Psychiatric Medical Surgical Units
No full textUB SON, DNP Research ProjectBackground and Significance: Alcohol withdrawal syndrome (AWS) may be incorrectly assessed and/or go unrecognized by novice nursing professionals within hospitals settings related to symptom complexity. Effective implementation of the CIWA-Ar protocol is integral in mitigating adverse events and improving patient outcomes. Purpose, Aims and Objective: The purpose of this project was to examine knowledge levels, attitudes, and educational needs related to CIWA-Ar protocol implementation for adults at risk for AWS on non-psychiatric hospital units among registered nurses with zero to five years of experience. The aim was to increase knowledge levels regarding educational needs to promote patient safety and quality of care and to guide creating an evidence-based in-service outline and recommendations for new nurse orientation at the hospital. Theoretical Framework: The Health Decisions Model was the guiding theoretical framework. This model attempts to explain healthcare-related decision- making processes based upon pre-existing medical belief systems through six conceptual factors that synergistically influence behaviors. Methods and Design: This project utilized a quantitative analysis of a three-part, 75-item electronic survey constructed to explore knowledge levels, attitudes, and educational needs of novice RNs regarding the care of adults with AWS and the CIWA-Ar protocol for the purpose of guiding educational protocols. Results: The participants (n=l 7) identified needs related to symptom identification, timeframes associated with decline, and improved staffing. The sample generally perceived adults with AWS as medically sick who need psychiatric help. Additionally, the participants' performed well on basic knowledge of the CIWA-Ar protocol but desired further specialized training
Online Stress Management Training for Student-Parents in Higher Education
No full textDoctor of Social Work Capstone ProjectThe effectiveness of online stress management training at reducing perceived stress in student-parents pursuing a post-secondary education was examined using a quantitative methods approach. Implementation Science was utilized to assess potential interventions and associated barriers and facilitators. The evidence-based Stress Free Now (SFN) program was chosen, and access provided to a convenience sample of 19 student-parents recruited from Queens College, the City University of New York (CUNY), and the University at Buffalo. The intervention was provided through a campus-based early care and education program in which 7 staff were provided with in-service training to build their capacity to support implementation. Through use of a 7 question Likert scale survey administered before and after staff training, it was determined that the in-service training was effective at increasing participants’ knowledge and proficiency with the SFN intervention. The Perceived Stress Scale (PSS-10) was used to assess perceived stress for student-parents before and after SFN training. Of the 19 participants, 16 completed the PSS-10 prior to training and 2 following training. The results indicated a decrease in stress for participant 1 and an increase for participant 2 which, with the small sample size, makes the effectiveness of the Stress Free Now program at reducing perceived stress for student-parents unable to be determined in this study. Future research is needed to include provision of the program with additional environmental supports such as childcare and on-campus space to engage in training in order to increase the post-survey completion rate. An in-person version of stress management training should also be trialed to provide additional data on the effectiveness of in-person versus on-line training. The SFN program will continue as a service to student-parents at its current site as well as additional centers in CUNY
Perceived Barriers and Facilitators of Using Shared Decision-Making in Providing Care to Adult Inpatients during the COVID-19 Pandemic among Advanced Practice Providers
No full textUB SON, DNP Research ProjectShared Decision Making (SDM) is a patient-centered healthcare delivery model that supports a bi-directional relationship where patients and providers work together to make treatment and care planning decisions based on best available evidence. The purpose of this Doctor of Nursing Practice project was to explore perceived barriers and facilitators of using SDM among advanced practice providers (APPs) in a large Western, New York teaching hospital during the COVID-19 pandemic. The project goal was to provide evidenced-based policy recommendations for APPs working at the hospital to promote utilizing SDM in patient care practice. The SDM 3 Circle Model acted as the guiding theoretical model for this DNP project. A qualitative descriptive design was utilized with semi-structured individual interviews. Braun and Clarke’s reflexive thematic analysis method was used to analyze data. The analysis of the data generated one overarching theme, In A More Perfect World, We Would be Better About Bringing All Interdisciplinary Team Members Together with the Family and Patient to Discuss Goals of Care, and three key themes, 1) Providers Just Don’t Initiate Goals of Care Discussions… People Shouldn’t Have to Suffer Because We [Providers] Don’t Want to have Awkward Conversations;
2) The Pandemic Made Us [Providers] More Acutely Aware of Barriers to Delivering Care; and
3) Understanding What a Patient’s Goals of Care Are and Tailoring Our Recommendations Based on Shared Decision Making. To enhance SDM and improve bi-directional patient-provider relationships, findings revealed that future research is needed particularly focusing on addressing health literacy gaps
Data supporting "Seasonal flow types of glaciers in Sermilik Fjord, Greenland, over 2016-2021"
No full textGreenland glaciers have three primary seasonal ice flow patterns, or “types:” terminus driven, runoff driven, and runoff adapting. To date, glacier types have been identified by analyzing flow at a single location near the terminus; information at all other locations is discarded. Here, we use principal component (PC) / empirical orthogonal function (EOF) analysis to decompose multi-year time series of glacier speed, combined from three satellite-derived products at four glaciers feeding Sermilik Fjord, Greenland. This improves on single-point methods by yielding temporal patterns (PCs), which allow identification of glacier type, and associated spatial patterns (EOFs), which ensure the result reflects data at all locations on the glacier. We find that the leading mode is uniformly signed over the entire glacier domain, that this mode explains the majority of the variance in speed, and therefore that glacier type can be inferred from the leading PC. We find that Helheim Glacier was terminus-driven, Fenris Glacier and Midgard Glacier were runoff-adapting, and Pourquoi-Pas Glacier was runoff-driven over 2016-2021. Our classification agrees with previous work for Helheim and Midgard Glaciers, but differs at the other two. At all but Fenris Glacier, the leading PC correlates significantly with the speed pattern observed at the single point used in previous analyses. Thus, Fenris Glacier has more complex flow patterns than single-point analysis can capture, and wider spatial analysis techniques such as EOF/PC are required. We suggest that, due to its low computational cost and inclusion in standard analysis packages, EOF/PC analysis should be used for assessing glacier type.Heising-Simons Foundatio
Impact of the Use of Pork Derived Neuromuscular Block Models to Improve Ultrasound Guided Regional Anesthesia Simulation Training
No full textUB SON, DNP Research ProjectThe application of ultrasound (US) technologies for regional anesthesia has seen significant growth and is considered the gold standard and prevailing modality for practice. This expansion highlights the need for increased training requirements and instructional tools for anesthesia providers to practice related skill sets. Research demonstrates that simulation training in ultrasound-guided regional anesthesia can improve both participant knowledge and skill and point to phantom model based training, including pork meat derived models, as a recommended first step. This Doctor of Nursing Practice (DNP) project developed pork meat derived neuromuscular block models for an ultrasound-guided regional anesthesia simulation training with Certified Registered Nurse Anesthetists (CRNA’s) and compared self-confidence, competence, effectiveness, performance skills, and accuracy of ultrasound-guided regional anesthesia skills and techniques. Kolb's Experiential Learning Theory was applied as a theoretical framework to guide development. The design was quasi-experimental with inclusion of questionnaires, surveys, and an in-service session. In pre-survey results CRNA’s reported being neutral or unrealistic in their understanding of regional anesthesia anatomy (38%), ability to troubleshoot needle placement and visualization (30%), and when providing regional anesthesia (38%). Statistically significant improvements (P<0.05) in four topics of perceived competence and confidence testing were found. All participants (100%) agreed or strongly agreed that the training materials developed areas of knowledge, skills, and techniques. Project results suggest improved perceived competence and confidence after utilization of the pork meat derived neuromuscular block models. This project supports the benefits of incorporation of such models into anesthetist training programs
An Educational Intervention to Improve Comfort with Applying and Interpreting Transcutaneous CO2 and End-tidal CO2 Monitoring in the PACU
No full textUB SON, DNP Research ProjectPurpose: The purpose of this study was to assess the effectiveness of an educational program about
measuring ventilation using devices that assess carbon dioxide levels in patients recovering from a
surgical procedure.
Theoretical Framework: Kurt Lewin’s theory of change was used to guide this project’s development.
Design: A pre-post survey of knowledge attainment from an educational intervention about measuring
ventilation using EtCO2 and tcPCO2 devices in the PACU was distributed to current members of the
American Society of PeriAnesthesia Nurses.
Methods: Participants received a 12-question pre-intervention (5 were related to demographics) and a
5-question post-intervention survey. Non-demographic survey questions utilized a 1-5 Likert scale to
assess comfortability or confidence. The intervention created was a voice-over presentation designed to
improve PACU RN’s comfort and confidence with using and interpreting tcPCO2 or EtCO2 in the PACU.
Results: PACU RNs (N = 108) reported they ‘never’ or ‘rarely’ used EtCO2 (n = 57, 52.7%) monitoring or
tcPCO2 (n = 93, 86.1%) monitoring in the PACU. A paired t-test revealed statistically significant
differences in the PACU RN's pre-survey and post-test comfortability of applying and interpreting EtCO2
or tcPCO2 monitors (P < 0.05).
Discussion: This study revealed that a voice-over educational presentation could improve nurses’
confidence in implementing CO2 monitoring in a PACU setting. The survey also demonstrated that EtCO2 monitoring is more commonly used in the PACU than tcPCO2 monitoring.
Conclusions: Capnography monitoring should be considered a standard of care for PACU patients. It is
critical to educate registered nurses working in the PACU before implementing EtCO2 or tcPCO2
monitoring
Utilization of Telepsychiatry during the COVID-19 Pandemic as an Alternative to the Traditional Care Delivery Model to Reduce Access Disparities and Improve Health Outcomes among Patients with Serious Mental Illnesses
No full textUB SON, DNP Research ProjectBackground and Significance: One in five (51.5 million) Americans were diagnosed with psychiatric disorders in 2019; of this total, 13.1 million adults were classified as having serious mental illness (SMI). Individuals with SMIs have the highest rate of 30-day re-admissions. These factors contribute to astronomical annual psychiatric care costs which was estimated to total 750 billion in 2021. Purpose, Aims and Objective: The purpose of this DNP Project was to examine whether implementation of telepsychiatry during the COVID-19 pandemic is linked to better health outcomes among patients with SMIs at a local South Bronx (NYC) clinic. Theoretical Framework: The Institute for Healthcare Improvement’s Model for Improvement theory which includes PDSA was used as the conceptual framework for this study. Method and Design: A retrospective review of patients’ charts was conducted to collect data on services usage comparing in-person care versus telehealth modalities. Chi-squared test was deployed to complete data analysis. Results: Findings showed increased clinic attendance rates and fewer missed visits with use of telepsychiatry compared with in-person care for all patients, including those carrying SMI diagnoses. Conclusion: Telepsychiatry is a better alternative to care as usual for all patients attending the DNP Project site or behavioral health clinic located in the South Bronx (NYC). Future Implication and Recommendations: It is beneficial for outpatient clinics to offer hybrid (in-person/telehealth) access to psychiatric patients, including those with SMIs
Evaluation of the Impact of a Collaborative Care Model in a Rural Pediatric Primary Care Setting
No full textUB SON, DNP Research ProjectBackground and Significance: Mental health conditions have been a growing concern among children and adolescents but remain under-diagnosed and under-treated in pediatric primary care. The problem is more pronounced in rural areas where the access to mental health care is limited. The collaborative care model (CCM) provides mental health care within the primary care setting and has demonstrated increased access to care and improved mental health outcomes. However, the adoption of CCM is not widespread. Purpose, Aims and Objectives: The purpose of this Doctor of Nursing Practice (DNP) project is to understand if the implementation of the CCM in a rural pediatric primary care office is beneficial to patients and staff. Objective 1: to examine the efficacy of a CCM for adolescents receiving mental health treatment in a rural primary care practice. Objective 2: to understand how clinic staff members in a rural primary care office perceive the CCM. Theoretical Framework: Peplau’s Theory of Interpersonal Relations will be used as the theoretical framework to guide the development of this DNP project. Methods and Design: A mixed methods design was used. Patient outcomes were collected before and after receiving the CCM. Individual interviews and surveys were conducted to understand staff experiences regarding the implementation of the CCM in the pediatric primary care setting. Results: Patient data from the 34 patients enrolled in the model showed a decrease in both anxiety and depression symptoms. Interview data from the five staff members interviewed revealed five themes: promoting care efficacy and whole person care, team approach enhancing commitment and respect, increased access to mental health care, improving prescribing practice and concerns regarding sustainability. Results of the staff survey indicated that the collaborative care model has been beneficial to their practice. Conclusion: The CCM can be implemented into primary care settings to increase the access to mental health needs and access for children and families in rural areas. Future Implications and Recommendations: Further research is warranted regarding the collaborative care approach and identification of flexible payment models to support the CCM