UBIR Repository (Univ. at Buffalo)
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Patient Satisfaction with Telehealth During COVID-19
No full textUB SON, DNP Research ProjectIn response to COVID-19, telehealth expansion provided access to essential health care during an unprecedented public crisis. Although telehealth has existed for decades, most providers were inexperienced with telehealth when the pandemic arrived. Previous governmental constraints were lifted, recognizing the urgency to provide care, maintain social distancing, and keep patients safe. However, the surge in telehealth brought concerns with the quality of care, patient satisfaction, and privacy. The objective of this quantitative study is to conduct a comprehensive assessment of telehealth to determine the patients' satisfaction with the provider-patient relationship, quality of exam, efficacy in health care delivery, and overall quality of care. After obtaining IRB approval from the University of Buffalo and Westchester Medical Center, patients were recruited from the population that presented to the COVID tent at an upstate medical center, sought medical care via telehealth, and agreed to a telehealth satisfaction survey. The healthcare transformation brought about by telehealth resembles Kurt Lewin’s model of understanding behavioral change within organizations (Arora,2021). Lewin's theory is based on recognizing an urgent need to change, overcoming fears, creating a new reality, and stabilizing the change by incorporating some of the new policies and procedures to create a new norm. Patient satisfaction with telehealth was influenced by many factors, including travel time, convenience, access to healthcare, cost savings, clinical outcome, provider relationship, and inhibiting influences. Additional research with a larger sample will need to be done to appreciate an accurate level of patient satisfaction. A multi-pronged approach is needed to eliminate the persistent racial and socioeconomic disparities in healthcare and telehealth, exacerbated by the COVID-19 pandemic. COVID-19 has given nurse practitioners a unique opportunity to reform healthcare through policy and regulatory changes, under the guise of patient preference and safety, to advocate for permanent legislative changes (Stucky et al.,2020)
Evaluating the Prevalence of Unanticipated, Conventionally Difficult Airways Encountered by Certified Registered Nurse Anesthetists, Practicing in New York State, Between January 2020 and January 2021, with an Appraisal of Post Encounter Documentation
No full textUB SON, DNP Research ProjectBackground and Significance: Airway difficulty and the dreaded “cannot intubate, cannot ventilate” scenario introduce the potential for severe, debilitating, and possibly life-threatening anesthesia related complications; therefore, documentation of such events remains paramount in preventing future airway emergencies and subsequent systemic sequalae. Purpose, Aims, and Objectives: The purpose of this Doctor of Nursing Practice (DNP) project was to examine the perceptions, difficult airway experience, and post encounter documentation modalities of Certified Registered Nurse Anesthetists (CRNAs) practicing in New York State (NYS). Project aims included: 1) identifying unanticipated difficult airway prevalence; 2) interpreting provider compliance with current documentation; 3) determining the efficacy of current documentation; and 4) standardizing post encounter documentation. The objectives included: 1) evaluating current literature; 2) evaluating CRNA perceptions and current practices; and 3) providing a white paper report of the findings to a relevant governing entity. Theoretical Framework: Kurt Lewin’s three step model for change. Method and Design: NYS CRNAs were surveyed via Survey Monkey regarding difficult airway experiences and current airway documentation methods. Results: Independent sample t-tests were used in SPSS version 28. Statistical significance was achieved for CRNA satisfaction or dissatisfaction with current documentation methods based on electronic medical record (EMR) factors: ease of access to previous anesthetics (p = 0.02), user friendliness (p = 0.01), and airway specific documentation characteristics (p < 0.001). Eighty-nine percent of respondents expressed a need for improvement in current post encounter documentation and 84% stated they would utilize a difficult airway database
Improving Knowledge and Comfort Level of Prescribing Contraceptives for Pediatric Care Providers in the Primary Care Setting
No full textUB SON, DNP Research ProjectBackground and Significance: Despite the wide variety and accessibility of contraceptive methods, unwanted pregnancy continues to effect adolescent populations. Pediatric primary care providers often lack contraceptive knowledge, preventing them from appropriately discussing and prescribing contraceptives to their adolescent patients. Purpose, Aims, and Objectives: The purpose of this Doctor of Nursing Practice project was to examine the impact that a content expert reviewed contraceptive educational PowerPoint had on improving knowledge of, and level of comfort for, prescribing contraceptives to adolescents among pediatric primary care providers. The project aim was to promote pediatric primary care providers' knowledge and comfort level for prescribing contraceptives to adolescents. Theoretical Framework: Kern's 6-Step Approach was the theoretical framework that guided this DNP project. Methods: A quantitative pre and post intervention pilot study design was used. Utilizing SurveyMonkey, participants completed a pretest, viewed the educational PowerPoint presentation, and then completed a posttest. Results: Statistically significant results were found supporting that increased participant knowledge level of contraceptives was associated with increased level of comfort for prescribing contraceptives to adolescents, including emergency contraceptives. The educational intervention did not impact desire to change clinical practice. Conclusion: Education is needed among pediatric primary care providers regarding discussing and prescribing contraceptives to adolescents. Additionally, further research is needed exploring and examining knowledge deficits and facilitating factors for comfortably prescribing contraceptives to adolescent patients among pediatric primary care providers
Sleep Screening and Promotional Practices on An Acute Inpatient Psychiatric Unit: A Quantitative Descriptive Study and The Formulation of Hospital Policy
No full textUB SON, DNP Research ProjectBackground & Significance: Diagnostically, sleep is often overlooked or clustered within other disorders’ symptomology despite playing a large role in mental and physical health.
Consequentially, sleep dysfunction is rarely assessed independently, and is undertreated within hospital settings. Poor patient outcomes such as increased suicidality, psychosis, or aggression can result. There is a clinical practice gap regarding how inpatient sleep is managed.
Purpose, Aims, & Objectives: The purpose of this study was to identify sleep promoting care practices within adult inpatient psychiatric settings, and to inform sleep screening policies within a WNY hospital. This project aims to increase awareness, knowledge, and understanding among psychiatric nurses regarding sleep disorders and screening methods in order to promote sleep.
Theoretical Framework: The Roy Adaptation Model served as the guiding theoretical framework for this DNP project.
Methods & Design: A quantitative non-experimental descriptive approach was utilized. A web- based survey was created to identify current sleep care practices. Univariate analysis was applied to describe the phenomena of interest and formulate evidenced-based recommendations for hospital policy.
Findings: Participants indicated use of pharmacological and non-pharmacological sleep promoting care practices. A vast majority indicated use of medications, application of grounding techniques, sleep training, or environment adjustments (noise, light, temperature). Additionally, participants noted a delay in addressing sleep in care plans.
Conclusion: Current care practices revolve around treating symptoms, not disorders. Implementing a sleep disorder screen upon admission might improve patient outcomes via early identification and treatment of sleep dysfunction
Creating Education-Based Podcast Streaming Service Guidelines and Recommendations for Doctor of Nursing Practice Student Registered Nurse Anesthetists and Nurse Anesthesia Faculty at the University at Buffalo, School of Nursing
No full textUB SON, DNP Research ProjectPodcasts are being used more frequently by students and professionals in healthcare for reasons including reviewing lecture content, learning new information, and staying current on new literature. Podcasts are convenient because they are pre-recorded, and listeners can play the podcast content at any time. Though podcasts are being used more frequently, most institutions do not have their own facility regulated podcast that controls what information is offered to students and faculty. The purpose of this DNP project was to identify current evidence-based literature surrounding podcasts in education and podcast creation for the University at Buffalo Certified Registered Nurse Anesthetist (CRNA) Program. The aim of this study was to facilitate student and faculty education through access to research and evidence-based guidelines for podcast creation. The objectives were to conduct a review of current literature, survey CRNAs and SRNAs, analyze data, and create evidence-based guidelines for the podcast. The guiding theoretical framework was Alfred Bandura’s Social Cognitive Theory with an emphasis on two constructs information exchange, and self-efficacy. Participants were recruited through the CRNA and Student Registered Nurse Anesthetist (SRNA) Facebook page to complete a survey. The survey data was then analyzed and interpreted using descriptive statistics to determine participants current podcast experience, qualities of podcast content and style that may enhance podcast success, and the likelihood that the podcast will be used by students and faculty. Out of 52 participants 28 agreed that they listened to podcasts regularly and 39 agreed they were helpful in education. The most commonly cited characteristics desired in a podcast included shorter length, dialogue between two hosts, relevant material to anesthesia, and a corresponding social media account
Identifying Contributing Factors to Opioid Use Disorder Stigma among Acute Care Registered Nurses to Develop Practice Change Recommendations for Care Delivery Improvement
No full textUB SON, DNP Research ProjectOpioid use disorder (OUD) is associated with multiple adverse patient and health care outcomes. Treatment and harm reduction strategies can be facilitated by acute care nurses; however, stigma is a significant barrier. Thus, this project sought to identify contributing factors to OUD stigma among acute care registered nurses (RNs) to develop practice change recommendations to reduce OUD stigma and improve care delivery to patients with OUD. Project objectives were to 1) review the literature to identify potential contributing factors to OUD stigma, 2) develop a survey to evaluate OUD stigma and potential contributing factors, 3) administer surveys to acute care RNs, 4) analyze results to determine contributing factors to OUD stigma, and 5) develop targeted practice change recommendations. This study was implemented under the guidance of Lewin’s Three-Step Model of Planned Change and utilized a descriptive research design. Survey responses from a sample of 47 acute care nurses were analyzed using descriptive, inferential, and correlational analyses. Results from data analysis and the literature review suggest that working in the intensive care unit, inadequate addiction education and professional training, decreased compassion satisfaction, and secondary traumatic stress may contribute to OUD stigma among acute care RNs. Practice change recommendations were developed to target the identified contributing factors to reduce OUD stigma and improve care delivery to patients with OUD at the project site. Future research should seek to verify study results and further investigate other potential mediating factors to OUD stigma, such as burnout and familiarity with OUD
Utilization of The Universal American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Score via Retrospective Chart Review to Guide Anesthesia Providers in Modifying Perioperative DNR Orders
No full textUB SON, DNP Research ProjectThe literature has proven that there exists apprehension among anesthesia providers in
initiating transparent conversations regarding potential surgical risks and modification of DNR
orders. For this reason, the practice of automatic suspension continues to transpire clinically.
The purpose of this Doctor of Nursing Practice project (DNP) is to identify high risk frail
patients using The Universal American College of Surgeons National Surgical Quality
Improvement Program (ACS NSQIP) surgical risk calculator and offer guidance to anesthesia
providers for when discussions regarding modification of perioperative (periop) Do Not
Resuscitate (DNR) orders should be initiated. Ruland's Peaceful End of Life Theory provides
a theoretical framework for this project. This theory utilizes perspectives of awareness,
sensitivity, and compassion to generate a peaceful and purposeful transition from life to death
for both patients and their caregivers. A retrospective chart review was performed to determine
the ACS NSQIP surgical risk of 40 patients. The predicted risk for any and serious
complications was then compared against the patient's need for intensive care unit (ICU) stay,
post-operative (post op) assisted ventilation, length of stay (LOS) and death in order to generate
a cut off risk score for when substandard surgical outcomes are highly likely and for when
discussions for the modification of DNR orders should take place. The hypothesis for this study
is that there exist an ACS NSQIP cut off risk score that correlates with poor surgical outcomes
and aides in determining when perioperative DNR orders should be modified
Creation of an Enhanced Recovery After Surgery (ERAS) Protocol for Outpatient Total Hip and Knee Arthroplasty
No full textUB SON, DNP Research ProjectDue to widely reported improvements to surgical and economic outcomes Enhanced Recovery After Surgery (ERAS) protocols have become popular over the last decade. Its adoption within orthopedic surgery has been slower, despite substantial increases in demand projected for the next decade. This quality improvement (QI) study created a standardized ERAS pathway for total hip and knee arthroplasty (THA/TKA) performed in an ambulatory surgical center along with establishing key baseline quality improvement metrics. The theoretical framework guiding this project is Kurt Lewin’s Change Theory in which we will refreeze the informal adoption of ERAS measures embraced by the proposed project site into a formal ERAS protocol. Following a retrospective review of 709 THAs/TKAs performed between August 1st 2021 and October 1st 2021 utilizing a stratified sampling technique, baseline QI metrics and ERAS components utilized in usual care were established. An ERAS protocol was created, combining published ERAS pathways and usual care practices identified within this facility. The study found that many ERAS components were already in use at this facility and that this facility surpassed QI benchmarks available within the literature, though opportunity exists for future improvement. Through the formalization of an ERAS protocol for THA/TKA and the establishment of QI benchmark indicators this study contributes to the available evidence supporting the use of ERAS protocols in outpatient THAs/TKAs. Future studies can build upon this study by examining if formalization of protocol improved care and assessing the impact of individual ERAS components on QI outcomes
Magnesium Sulfate Usage Among Advanced Practice Nurses Specializing in Nurse Anesthesiology
No full textUB SON, DNP Research ProjectBackground and Significance: Postoperative pain results from inflammation to damaged tissue
and should be treated aggressively to avoid undesired outcomes related to pain.
Purpose, Aims, and Objectives: The purpose of this proposed DNP project was to identify rates
of magnesium usage among anesthesia practitioners via survey of members of a closed nurse
anesthesia specific Facebook group. Aims included identifying gaps in knowledge and to provide
education to bridge gaps, thus improving patient outcomes by guiding practice with current
evidence. Objectives were to: (1) conduct an extensive review of the literature that focused on
usage of magnesium in the perioperative period to reduce postoperative pain; (2) identify rates of
usage among nurse anesthetists and student nurse anesthetists; and (4) present evidence-based
practice guidelines for the use of magnesium in the perioperative setting.
Theoretical Framework: Everett Roger’s Theory of The Diffusion of Innovation guided this
project.
Methods and Design: This project had a cross-sectional survey and a descriptive design.
Specifically, a survey was administered to participating members of the closed Facebook group
for nurse anesthesia practitioners as well as students. A link was published to the survey via
Survey Monkey. Data was analyzed by a T-Test as well as an ANOVA analysis.
Results: Survey participants included 72 CRNAs (87.9%) and 10 SRNAs (12.2%) for a total of
82 participants (n=82). Practitioners endorsed using magnesium never (17.1%), almost never
(19.5%), sometimes (47.6%), and almost always (15.9%). Reasons for using magnesium
included intraoperative/postoperative pain control (76.8%), anesthesia coadjuvant (42.7%),
cardiac protection (17.1%), PONV (11%), prolonged neuromuscular blockade (4.9%), and other
(12.2%) (bronchodilation, electrolyte replacement, enhanced recovery after surgery [ERAS], and hypertension [HTN]). Reasons magnesium was not used included lack of availability (37.8%),
lack of time (26.8%), lack of knowledge (37.8%), and other (22%) (lack of anesthesiologist buyin,
low pain procedure, and short case length).
Conclusion: Nearly 50% of practitioners endorsed using magnesium in the perioperative period,
with a majority utilizing for pain control. The most common reason magnesium was not used
was short case length, and low pain provoking case type. Practitioners reported being in the
precontemplation phase of change, meaning they were not yet ready to begin thinking of
changing their practice.
Future Implications and Recommendations: Future recommendations are to identify
appropriate patients/cases and include magnesium in the perioperative period to reduce pain in
the postoperative period
A tour of public-use market research
No full textFor many student entrepreneurs, there can be apprehension about relying on subscription-based academic library resources introduced in traditional classroom instruction. Once graduation day arrives, there is no guarantee they will have continued access to the databases to which they are accustomed. While we want to encourage students to use the vast resources available to them through the library’s subscriptions, we must acknowledge the alumni restriction of access as a reality for many academic libraries. This lesson was created in response to numerous student questions regarding the best resources for secondary market research after graduation, especially when building a start-up company. While academic librarians can and should ensure students have knowledge of all subscription databases, it is essential that we empower our graduates with an array of reliable public resources and show that libraries are valuable and essential to lifelong learning