UBIR Repository (Univ. at Buffalo)
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A Quality Improvement Project to Reduce Wait Times Associated with Chemotherapy and the Impact on Patient Satisfaction, Cost, Anxiety and Length of Stay
No full textUB SON, DNP Research ProjectPatients admitted to the hospital specifically to receive chemotherapy more often than not experience long wait times. Long wait times can negatively affect patients, can also increase costs by increasing length of stay, as well as consume unnecessary hospital resources. Literature suggests that the redesign of workflow could lead to a decrease in chemotherapy associated wait times. The purpose of this study was to reduce wait times associated with chemotherapy and to examine the link between reducing wait times, anxiety, and length of stay while increasing satisfaction. Objectives of this study were to determine wait times associated with chemotherapy. Next, to redesign the workflow associated with the elective chemotherapy program and to measure and compare pre and post data on the patient factors of satisfaction, anxiety and length of stay. A mixed method design was utilized with a Plan-Do-Study-Act quality improvement framework. Wait times decreased by 41% and, in doing so, length of stay was found to be less impacted than expected. Satisfaction and anxiety were measured quantitatively, with results suggesting that decreasing wait times did improve both anxiety and satisfaction; these results were found to be statistically significant; p=0.014, p=0.03. Qualitative trends noted that patients felt their time was better respected and that the redesign of the chemotherapy program created a more efficient and seamless process. International Review Board (IRB) approval was obtained from the State University at Buffalo and the State University at Upstate. Review of all electronic medical record data involved minimal identifiers, leaving only basic demographic information such as gender, age range and cancer diagnosis
Text Database
No full textThis file contains the narrative text data that was used in Brown's (2021) dissertation
Engraftment Syndrome and Mucositis in Autologous Transplant
No full textUB SON, DNP Research ProjectMucositis and engraftment syndrome are two complications of autologous stem cell transplant. Mucositis causes pain, decreased oral intake, and increases risk of infection during transplant. Engraftment syndrome is a complication that causes fever, rash, pulmonary infiltrates, diarrhea, vomiting, and hypoxia during transplant which then can lead to more days in the hospital, more days on antibiotics, and increased transfusions needed. Engraftment syndrome can require treatment with steroids and be life-threatening in some cases. The purpose and aim of this project was to look at mucositis and engraftment in syndrome in patients who received a hyperbaric oxygen treatment prior to transplant versus those who did not. Increasing knowledge of engraftment syndrome and mucositis with and without hyperbaric oxygen treatment will improve guidance for prevention and treatment in autologous transplant patients. The theoretical framework for this project is Neuman’s System Model. This project was a retrospective chart review of data collected during the autologous stem cell transplants at the University of Rochester in which some of the patients received an HBO treatment prior to transplant. Statistical analysis of data did not yield significant results but did lead to insights into autologous stem cell transplant patients, HBO, engraftment syndrome, and mucositis. Mucositis and engraftment syndrome in this particular patient population needs additional research in order to improve patient outcomes by preventing complications
Children with Persistent Asthma During the COVID-19 Pandemic: A Retrospective Analysis of ED Usage Patterns and Clinical Practice Recommendations prior to and during the Pandemic for Pediatric Health Care Providers
No full textUB SON, DNP Research ProjectChildren with persistent asthma during the COVID-19 pandemic may be more susceptible and vulnerable to COVID-19 infection. Using a retrospective chart review, data was collected and analyzed on Emergency Department (ED) utilization by children with asthma during and prior to COVID-19 to determine if ED utilization increased or decreased. A comprehensive review of research literature showed that new practice recommendations for children with persistent asthma were instituted to prevent infections, provide continued asthma care during the pandemic and to improve their outcomes. The purpose of this Doctor of Nursing Practice (DNP) Project was to provide information that promotes knowledge and collaboration among Advanced Practice Nurses working in School Based Health Clinics (SBHC’s) and in other outpatient clinics within the city of Buffalo, NY. The objectives of this DNP Project were to share research data analysis results on ED utilization and to provide review of literature findings on practice recommendations initiated during COVID-19 for children with persistent asthma. Orlando’s Nursing Process Discipline Theory was used as the framework to guide the development of this DNP Project Proposal. The design of this project is a quantitative descriptive data analysis utilizing a retrospective chart review. The data was statistically analyzed for frequency distributions and descriptive analysis. Since this DNP Project acquired de-identified data from a retrospective chart (EMR) review; there were no associated risks, and the confidentiality of the patients were protected. Further research is needed for future practice of these recommendations with asthmatic children and improved outcomes
Expert Review of a Life Coach Program for Secondary Stroke Prevention
No full textUB SON, DNP Research ProjectStrokes can lead to death, mild to severe disability and an overall decreased quality of life. The first five years following the initial injury, patients have the highest risk of subsequent stroke and death. Post-stroke patients that are discharged home may not have any further intervention or guidance in making healthy life choices to prevent a second stroke or further deterioration. A Life Coach program was developed by a clinician to assist patients in making healthy lifestyle choices for secondary stroke prevention and to offer guidance to increase quality of life. After reviewing the program, it was determined that the Life Coach program should be standardized and organized according to current evidence. Once the evidence based and standardized program was developed, it was reviewed by experts to gain consensus that the program followed best practices, was user friendly, and feasible for delivery in a healthcare setting. This report describes the Life Coach Program and the process of gaining expert consensus on the content, usability and feasibility. The final version of the program content is presented and will be tested for efficacy in a future research study of patients who have experienced a stroke and are motived to improve their health to prevent reoccurrence of stoke
Perceived Barriers and Facilitators to the Utilization of Spinal Anesthesia for Patients Undergoing Total Hip Arthroplasty among Certified Registered Nurse Anesthetists Practicing in New York State
No full textUniversity at Buffalo, School of NursingAn estimated 500,000 total hip arthroplasties (THA) are performed annually in the United States (U.S.), with this number expected to almost triple by 2040. Although spinal anesthesia in THA is an evidence-based practice, approximately 30% of cases are performed using this technique in the U.S. The purpose of this Doctor of Nursing Practice (DNP) project was to identify perceived barriers and facilitators to the utilization of spinal anesthesia for patients undergoing THA among Certified Registered Nurse Anesthetists (CRNA) practicing in New York State (NYS). Lewin’s Change Theory was the theoretical framework guiding this project. A cross sectional design utilizing online surveys was utilized. A total of 89 CRNAs were recruited via a New York State Association of Nurse Anesthetist (NYSANA) Facebook posting and an email sent to NYSANA members. Univariate statistics were utilized to analyze data. Results indicated that 75.3% of participants commonly use spinal anesthesia for THA. Barriers to use included patient fear of adverse effects (mean score 3.97), surgeon preference for anesthesia technique (mean score 3.94), patient understanding of spinal anesthesia (mean score 3.91), surgery delays caused by spinal anesthesia (mean score 3.82), and organizational culture resistance to change (mean score 3.80). In NYS, spinal anesthesia use for THA appears to be more common than anticipated based on U.S data, indicating a regional difference in practice. Efforts among CRNAs are needed to increase use of spinal anesthesia in THA and improve THA patient outcomes
Perceived Barriers and Facilitators regarding End-of-Life Care Discussions with Patients aged 60 years and Older among Adult Gerontology Nurse Practitioners
No full textUB SON, DNP Research ProjectAdvanced Practice Nurses (APNs) are responsible for educating older adult patients on their state of health and well-being and for supporting them to make sound and reasonable end-of-life care (EOLC) choices. The purpose of this Doctor of Nursing Practice (DNP) project was to qualitatively explore what APNs perceive as barriers and facilitators regarding EOLC discussions among adults aged 60 and older. The project aim was to increase knowledge, understanding, and level of comfort and confidence among APNs regarding having EOLC discussions with older adult patients. University at Buffalo Institutional Review Board approval was granted. A qualitative descriptive design with individual semi-structured interviewing was utilized. Literature review findings and Christiansen’s Heath Change Trajectory Model were used as the theoretical framework to guide development of the interview questionnaire. Data was analyzed using Braun and Clarke’s Reflexive Thematic Analysis method. One overarching theme, It’s Not Ok That People Suffer Endlessly and Needlessly…What Do You Want? What Do We Need to Do to Honor You as A Human Being? and three supporting key themes, Education, Education, Education...There Does Need to be Training, People [Patients and Families] Don’t Truly Understand What It Is That We are Talking About, and Cultural Change within the Healthcare Systems, Education within the Healthcare Community...Particularly in a Primary Care Setting resulted from the data analysis. Further research is needed exploring patient, family, and provider EOLC discussion barriers and facilitators
Evaluating Propofol Disposal Policy Awareness, Adherence, and Barriers Among Local and National Certified Registered Nurse Anesthetists
No full textUniversity at Buffalo, School of NursingThe purpose of this Doctor of Nursing (DNP) Project was to evaluate existing propofol disposal policies and propofol disposal policy awareness, adherence, and barriers among Certified Registered Nurse Anesthetists (CRNAs) on staff at a local hospital in Buffalo, New York and working nationally. An exploratory mixed methods design using two anonymous online self-administered surveys with one open ended question, one for local CRNAs and one for national CRNAs, were utilized to collect data. CRNAs on staff at the local hospital were recruited by email. The national CRNA sample was recruited via a post on a CRNA Facebook page. Survey responses were analyzed with descriptive statistics using Microsoft Excel and Statistical Packages for Social Sciences (SPSS) version 27. Content analysis was utilized to code open ended survey responses into themes. Lewin’s Theory of Planned Change was the project theoretical framework. Findings revealed that most (66.7%) of the local CRNA participants (n=6) reported awareness of their facility propofol disposal policy but when presented with the actual policy, only 16.67% reported awareness. None of the local CRNAs reported adherence to the policy. About half (48.6%) of the national CRNA participants (n=107) reported awareness of the policy, and 5.61% were unsure. Half (50%) of the sample reported adherence to facility propofol disposal policy and 34.62% were unsure of their hospital policy. Barriers identified by both samples included a lack of awareness and lack of access to appropriate disposal receptacles. Future research is needed further exploring propofol disposal barriers identified by both groups
Developing and Evaluating the Effectiveness of a Multimedia Case Study on Improving Postoperative Education: Ensuring Patients Receive Contraceptive Education After Sugammadex Exposure
No full textUB SON, DNP Research ProjectBackground and Significance: Female surgical patients who are of childbearing age, using oral hormonal contraceptives as their primary form of birth control, are at risk for developing unwanted pregnancy after exposure to the medication sugammadex. Sugammadex is most often administered by members of the anesthesia team to reverse pharmacologically induced paralysis. Despite this being a known phenomenon within anesthesia specialties, there exists little formal guidelines on how to effectively educate this patent population and document its occurrence. Purpose, Aims, and Objective(s): 1) Develop an educational multimedia video; 2) Describe perceived barriers by anesthesia and perioperative staff in providing effective post-op education;
3) Offer evidence-based solutions to improve patient contraceptive education; 4) Obtain and analyze expert reviews of the video; 5) Disseminate the findings of the project; 6) Identify strengths, limitations, and implications for future research. Theoretical Framework: The theoretical framework guiding the course of this project is the Content, Input, Process, Product (CIPP) model. Methods and Design: The development of an educational video outlines how anesthesia and perioperative staff can identify and educate the at-risk population, and formally document its occurrence using a Sugammadex Exposure Form. The video was expertly reviewed for clinical accuracy, systems efficiency, and educational efficacy. Protection of Human Rights and Ethical Considerations: Volunteer actors signed rights and consents to participate in the project, its reproduction, and use. Written credit of participants was provided within the video’s credits. Video evaluators had their identities remain anonymous if requested
An Educational In-Service on the Environmental Effects of Anesthetic Gases
No full textUB SON, DNP Research ProjectAnesthetic gases possess varying degrees of greenhouse gas effects and ozone depleting properties. Despite being hundreds to thousands of times worse for the environment than carbon
dioxide, they are considered “medically necessary,” and omitted from regulations that would
limit their discharge into the atmosphere. Anesthesia providers can minimize the damaging effects through limiting flow rates and gas selection; nitrous oxide and desflurane are the worst offenders, sevoflurane is the least. The purpose of this study was to educate certified registered nurse anesthetists (CRNA) on the environmental effects of anesthetic gases to increase their
likelihood of adopting environmentally conscious practices. Lewin’s Field Theory’s six
fundamentals for changing group behavior provided the theoretical framework. Inherent in this theory are the complex interactions between dynamic thoughts, forces, emotions, and mathematical representations of environmental problems. A quasi-experimental pre-test/post-test study was administered to 25 CRNAs recruited from a national Facebook group; 13 completed the study. COVID restrictions mandated online only participation. Paired T-tests determined the relationship between the in-service intervention and knowledge gain, increased likelihood of using low flows, and decreased likelihood of using desflurane and nitrous oxide. Provider knowledge, increased likelihood of using low flows, and decreased likelihood of using nitrous oxide were statistically significant; t(12)=-7.50, p<0.001, t(12)=-2.86, p=0.014, and t(12)=2.52, p=0.027. Decreased likelihood of using desflurane was not statistically significant; t(12)=2.13, p=0.054. This study suggests the in-service increased CRNA likelihood to alter delivery factors related to harmful gas emissions and should be replicated using a larger sample