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Barriers and Facilitators of using Telehealth in Diabetic Foot Ulcer Management among Registered Nurses and Nurse Practitioners Working in Wound Care Across the Nation
No full textUB SON, DNP Research ProjectDiabetic foot ulceration has become a heavy burden on both the patient and the healthcare system. While telehealth has shown effectiveness in the management of chronic disorders, its adoption in diabetic foot care remains slow. The purpose of this Doctor of Nursing Practice project was to qualitatively explore through interviews the facilitators and barriers of using telehealth for the management of diabetic foot ulcers among registered nurses (RN) and nurse practitioners (NP) belonging to American Professional Wound Care Association. The project aim was to increase knowledge and understanding among RNs and NPs regarding utilization of telehealth in diabetic foot care to support improved patient outcomes. The Chronic Care Model and literature review findings guided development of the semi-structured interview questionnaire. Braun and Clarke’s Reflexive Thematic Analysis method was utilized to analyze data. Data analysis generated one overarching theme, There is an Opportunity for Telehealth to Continue to Gain Some Ground, and three key themes, I Do Think That There are Some Challenges; It’s Improved Our Ability to Care for Our Patients; and It’s Been Convenient for Me. Findings revealed that telehealth use among the participants contributed to improved diabetic patient outcomes, that there has been a significant increase in the use of telehealth in diabetic foot care among the participants, and that telehealth is both convenient and easy to use. Future research is needed exploring telehealth educational needs and approaches among RNs and NPs to address telehealth utilization barriers and promote diabetic patient quality of life and care
Elicitation Database
No full textThis file contains a subset of the elicitation data used in Brown's 2021 dissertation
The Impact of Integrating Behavioral Health in Primary Care for Adults with Depression and Anxiety: A Program Evaluation
No full textUB SON, DNP Research ProjectBackground and Significance: Behavioral health disorders (BH) (e.g., depression and anxiety) are most commonly seen in primary care (PC) settings. Yet only 57% of patients receive adequate treatment, partially due to a lack of provider expertise and accessibility to BH services, especially for underserved populations. The Collaborative Care Model (CCM) is an evidence-based model to treat depression and anxiety but has not been widely adopted in PC. Purpose: This project evaluated the impact of implementing the CCM in a PC practice on treatment outcomes in patients with depression and anxiety. Theoretical Framework: Neuman’s Systems Model identified precipitating factors (e.g., ineffective coping) that cause depression and anxiety, and reinforcing these skills restores health. Methods and Design: Convenience sampling was used for this project and took place in a PC office located in an underserved community. CCM adherence, Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder-7 (GAD-7) data were collected at baseline, and then weekly until treatment was completed. Furthermore, anonymous patient satisfaction surveys, composed of a 5-point Likert scale and open-ended questions, were collected post-treatment. Quantitative data was analyzed using descriptive statistics. Written qualitative data from open-ended, patient satisfaction survey questions was analyzed using descriptive and content analysis. Results: The CCM demonstrated treatment adherence of 72.7% and prevented hospitalizations in 100% of patients, regardless of disease severity. Patients reported a satisfaction rate of 96.7% with treatment and outcomes of the CCM. Additionally, all patients with moderate to severe depression or anxiety screened positive for both disorders concomitantly. Conclusions and Implications: The results indicated that integrating the CCM into PC practice demonstrated positive preliminary outcomes. Adherence to the CCM was a significant factor for BH improvement. Moreover, provider expertise and patient access to high quality and satisfying
BH treatment was enhanced by adopting the CCM
Knowledge Deficits of Cardiac/Medical Registered Nurses in Assuming an Active Role in The Code Team: An Educational Survey
No full textUB SON, DNP Research ProjectBackground and significance: Cardiac arrest is a medical emergency that requires a combination of clinical knowledge, teamwork, and appropriate resources in order to ensure patient survival. Ensuring nursing knowledge of evidence-based practices regarding cardiac resuscitation is essential to promoting positive patient outcomes. Purpose and objectives: This study evaluates the knowledge deficit and gaps in care in cardiac/medical registered nurses in assuming active team roles in a code in a Western New York hospital. The primary objective was to develop an educational, ACLS driven survey to identify and promote professional development among nurses. Theoretical framework: Lippitt, Watson, and Wesley’s change theory guided this study. Methods and design: A thorough literature review was used to establish evidence-based survey data that guided survey development. Nurses from a cardiac/medical unit were surveyed to identify cardiopulmonary resuscitation experience, Advanced Cardiac Life Support knowledge, and nursing readiness for change. Results: The average ACLS self-assessment score was 6.32(range 3-10, n=25) with 52% of respondents receiving a score of 7/10 or greater. Factors such as degree (t (23) =-0.192), years of nursing experience (t (23) =-0.993), and cardiac resuscitation experience (t (23) =0.467) were not significant to score outcome. Conclusion: Several subject matters, such as stroke and medication management, were identified as areas requiring further education. In this setting, more than half of respondents felt that ACLS certification was important to nursing on this unit. Future Implications and Recommendations: At minimum, topics such as stroke and medication management should be addressed with nursing staff. Further investigation is needed to understand the relevance of ACLS certification in this population
Risk Factors for Postoperative Nausea and Vomiting (PONV) among Adult Patients Undergoing Total Hip and Knee Arthroplasties
No full textUB SON, DNP Research ProjectBackground and Significance: Every year, over one million total hip and knee arthroplasties (THAs and TKAs) are performed and this number is expected to increase. Postoperative nausea and vomiting (PONV) causes distress for patients and is nausea and/or vomiting within 24 hours postoperatively. PONV occurs in 30-80% of patients and is associated with numerous negative consequences. There are many risk factors for PONV and there is a need for greater risk assessment and management. Purpose, Aims, and Objectives: The purpose was to examine perioperative factors influencing PONV in patients undergoing THAs and TKAs in a community hospital. Aims were to investigate risk factors and medications, increase screening, and improve prophylaxis and quality oflife. Objectives were to conduct a retrospective chart review, analyze the data, summarize the findings, and provide education and recommendations. Theoretical Framework: The Theory of Unpleasant Symptoms was the guiding framework. Methods and Design: This retrospective chart review examined 75 charts. Data was collected using a Microsoft Excel spreadsheet collection tool and analysis used logistical regression models, chi-square tests, and independent samples t-tests using the program SPSS 27. Results: A total of 28% of patients experienced PONV. Female sex (p = .05), higher Apfel risk scores (p = .03), and a history of CVA (p = .03) were significantly associated with PONV. Conclusion: The incidence of PONV was lower than average, but education and improvements in current practices need to be implemented utilizing the Apfel risk score and the new 2020 guidelines.
Future Implications and Recommendations: While study results showed some significant results, further research needs to be conducted prospectively with larger and different populations
Does an Online Educational Workshop for Certified Registered Nurse Anesthetists and Student Registered Nurse Anesthetists Reduce the Perceived Clinical Barriers of Ultrasonography Guided Neuraxial Anesthesia for Epidural Placement
No full textUB SON, DNP Research ProjectBackground and Significance: Failure to correctly identify and place epidural anesthesia catheters is a frequent complication when palpation anatomical landmark identification is utilized. Incorrect identification of relevant anatomy can lead to less efficacious anesthesia and potentially morbid complications. Recent literature suggests that ultrasound guidance to assist neuraxial anesthesia placement is beneficial in select patients. Purpose and Aim: The purpose of this Doctor of Nursing Practice (DNP) project was to create, implement, and evaluate an online asynchronous educational workshop for Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) across the United States on ultrasonography guided neuraxial anesthesia for epidural placement. Project aims were to increase knowledge and to reduce neuraxial anesthesia delivery barriers. Method and Design: An online experimental design study was utilized with 5-point Likert Scale pre and post educational surveys and an online evidence-based didactic and technical skill educational workshop delivered via an embedded PowerPoint video on SurveyMonkey. Data was analyzed using Statistical Package for the Social Sciences Statistics 26 (SPSS). Kolb’s Theory of Experiential Learning was the study theoretical framework. University at Buffalo, Institutional Review Board (IRB) study approval was granted. Data is stored as per the approved IRB protocol. Results: Findings revealed a significant increase in perceived ultrasound knowledge following the educational workshop. There was strong evidence suggesting that CRNAs are more likely to stay informed on current research in an area that they have practiced or simulated in. Further research is needed with a more diverse CRNA sample utilizing various practice models
Impact of an Educational Intervention for Anesthesia Providers about the Use of Pre-Procedural Ondansetron on Reducing Spinal-Induced Maternal Hypotension and Improving Outcomes in Patients Undergoing Elective Cesarean Section
No full textUB SON, DNP Research ProjectWhile spinal anesthesia (subarachnoid block; SAB) is a safe and preferred anesthetic technique for cesarean sections (CS), hypotension remains a frequent complication, increasing risks to both mother and baby. Recent studies have examined the benefits of prophylactically administered ondansetron as a safe and effective method in reducing spinal-induced maternal hypotension (SIH). The purpose of this Doctor of Nursing Practice project was to examine the impact of an educational intervention provided to anesthesia providers on the use of pre-procedural ondansetron in parturients undergoing elective CS to increase its utilization for reducing SIH and improving patient outcomes. Specific aims for this project were to support evidence-based education among Certified Registered Nurse Anesthetists (CRNAs), identify barriers to practice change, and evaluate self-reported incidences of SIH, nausea, vomiting, and vasopressor requirements. This post-intervention follow-up study design consisted of a pre-intervention survey, an educational intervention, and a one-month post-intervention survey. The study was conducted online and recruitment occurred through convenience sampling of CRNAs nationwide. Kurt Lewin’s Theory of Planned Change guided this project’s design and implementation. Project approval was granted by the University at Buffalo Institutional Review Board prior to implementation. Findings revealed an increase in provider knowledge and utilization of pre-procedural ondansetron administration after receiving the educational intervention. There were statistically significant reductions in barriers to practice implementation in the post-intervention group. Provider-reported efficacy of pre-procedural ondansetron revealed noted reductions in incidences of SIH, nausea, vomiting, and vasopressor requirements. Development of evidence-based guidelines for managing SIH and future research on this topic are needed
"@alex, this fixes #9": Analysis of Referencing Patterns in Pull Request Discussions
No full textThis is the author's post-print, or Accepted version, of the work. It is posted here for your personal use. Not for redistribution. The definitive Version of Record was published in Proceedings of the ACM on Human-Computer Interaction, https://doi.org/10.1145/3479529Pull Requests (PRs) are a frequently used method for proposing changes to source code repositories. When discussing proposed changes in a PR discussion, stakeholders often reference a wide variety of information objects for establishing shared awareness and common ground. Previous work has not considered how the referential behavior impacts collaborative software development via PRs. This knowledge gap is the major barrier in evaluating the current support for referencing in PRs and improving them. We conducted an explorative analysis of \textasciitilde7K references, collected from 450 public PRs on GitHub, and constructed taxonomies of referent types and expressions. Using our annotated dataset, we identified several patterns in the use of references. Referencing source code elements was prevalent but the authoring interface lacks support for it. Three classes of contextual factors influence referencing behaviors: referent type, discussion thread, and project attributes. Referencing patterns may indicate PR outcomes (e.g., merged PRs frequently reference issues, users, and tests). We conclude with design implications to support more effective referencing in PR discussion interfaces
Perceived Knowledge of Core Interprofessional Education Competencies (CIPECs) Among Recently Graduated and Current Student Registered Nurse Anesthetists: How Service-Learning Experiences Related to CIPECs Impact Knowledge, Attitudes, Skills, Professional Role Development, and Confidence in Clinical Practice
No full textUniversity at Buffalo, School of NursingAlthough the Interprofessional Education (IPE) Collaborative acknowledges the need to include core IPE competencies (CIPECs) in anesthesia curriculum, research is lacking exploring IPE experiences among newly graduated and current student registered nurse anesthetists (SRNAs). The purpose of this Doctor of Nursing Practice (DNP) project was to explore perceived knowledge of CIPECs among recently graduated and current SRNAs with service-learning experience, and how their experience impacted their knowledge, attitudes, skills, professional role development, and confidence in clinical practice related to CIPECs. Project aims were to increase CIPEC knowledge and understanding among recently graduated and current SRNA and to support the need for including service-learning experiences in Nurse Anesthesia (NA) programs. A qualitative descriptive design was utilized with individual semi-structured interviews. Questionnaire development was guided by the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and Kolb’s (2015) Experiential Learning Theory. Braun and Clarke’s Reflexive Thematic Analysis method was used to analyze data. Data analysis generated one overarching theme, We Were all There Trying to do as Many Surgeries as Possible and Help as Many People as Possible, and four key themes, You Learn to Trust your Team, Yourself, and What You Know, Laying a Foundation of Respect, It was Sometimes a Little Tense, and It Was Nice to See What I Have Learned, The Fruit of Your Labors. Findings revealed that service-learning experiences enhanced SRNA non-technical skills related to CIPECs and supported the need to include service-learning experiences in NA programs. Further research is needed exploring service-learning opportunities in NA programs
Implementation of Behavioral Health into Primary Care using a Collaborative Care Model: Clinical Staff’s Experiences
No full textUB SON, DNP Research ProjectBackground and Significance: Mental Health (MH) treatment is occurring in a Primary Care setting 43%-60% of the time verses 17%-20% occurring directly at a MH site. Primary Care Physicians (PCPs) feel inadequately prepared in Behavioral Health (BH) management therefore, team-based interprofessional (IP) care using the Collaborative Care Model (CCM) is needed to integrate BH into primary care practices. Purpose, Aims and Objectives: The purpose of this project was to understand clinical staff’s experiences in adopting CCM in an integrated care setting. Theoretical Framework: The theoretical framework Diffusion of Innovation, developed by Everett Rogers, was used for this project because it is a process by which innovation, is communicated through certain channels, over time, among a social system. It describes CCM merging BH into a primary care setting. Methods and Design: Pre study design with a mixed methods approach utilizing both quantitative (pre CCM training and implementation) and qualitative (interviews) research methodologies. The study took place at a newly integrated primary care and behavioral health clinic and include all clinic staff over the age of 18. Clinic staff were provided CCM training by a Certified Educator. The survey included demographic questions, the ORIC tool to determine implementation readiness and BH integration questions. A semi-structured interview guide was used to gather qualitative data from clinical staff. Results: A 40-question survey was sent to 11 participants with a 100% response rate. Of the 12 questions that asked about readiness to implement change only 33.3% (n=4) reported majority (>50%) positive agreement. An additional 11 questions focused on perceptions of behavioral health integration 100% (n=11) reported majority (>50%) positive agreement. Qualitative questions were asked of 5 clinic staff revealing perceived barriers, perceived benefits and suggestions for integrated care. Conclusions and Implications: Results of this pre and post implementation study indicate that the majority of clinical staff are confident and committed to implementing and continuing CCM. The results of this study could help primary care practices with a large behavioral health population treat those patients using CCM. Further research is needed to elucidate outcomes after a change like this