UBIR Repository (Univ. at Buffalo)
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Home-Based Primary Care as an Intervention to Reduce Emergency Room Visits Among Homebound Older Adults: An Effective Initiative to Reduce Cost and Improve Quality of Care?
No full textUB SON, DNP Research ProjectAttention is warranted to address a gap in healthcare access to services for homebound populations, typically over the age of 70 years old. The increased number of homebound seniors has led to exorbitant Medicare expenditures. The purpose of this Doctor of Nursing Practice project was to evaluate the effectiveness of home-based primary care (HBPC) in addressing this gap as well as assessing its effectiveness in reducing costly services that increase Medicare expenditures, namely ER visits and hospitalizations. The aim of this project was to evaluate HBPC interventions as it relates to meeting the typically unmet care needs of homebound populations. This was done through specific objectives, including 1) Evaluating the current state of nursing science, 2) Utilizing systems theory as a guide to assess delivery structures that hinder access to this population, and 3) Evaluating and analyzing data through scientific methods. The chosen theoretical framework utilized in this DNP project was Systems Theory. This observational pilot study utilized a pre-purposed, pre-existing data set obtained from a retrospective chart review. IRB approval was obtained before the project's initiation with strict adherence to protocol. Results of the comparative analysis showed consistency between sample populations and identified reductions in utilization patterns and overall costs upon variable assessment in the practice setting group. Given limitations, primarily concerning study design, future, higher-level studies are indicated to address the known gap in care access and advance an apparent gap in nursing science amongst this population as well as appropriate evidence-based interventions
Perspectives on Scholarly Communication: Volume 5
No full text2023, FallPerspectives on Scholarly Communication: Volume Five, like its preceding volumes, is a student-created open monograph. Graduate students in the University at Buffalo's Department of Information Science authored this compilation for the LIS 577: Scholarly Communication course during the fall term of 2023. Each chapter is the culmination of a student's semester-long investigation into an aspect of scholarly communication for which he or she has established an informed position. The text was developed under the Creative Commons license CC BY-NC-SA 4.0 as an open educational resource, which can be adapted for future sections of the Scholarly Communication course or for similar courses offered at other institutions
Evaluation of an Education Intervention on Anesthetic and Hemodynamic Care for Left Ventricular Assist Device Patients Undergoing Non-Cardiac Surgery
No full textUB SON, DNP Research ProjectIn an effort to reduce morbidity and mortality from heart failure the left ventricular assist device (LVAD) has been utilized as a permanent implantable support device. As these devices become more common anesthesia providers should have a complete knowledge of the necessary care for this specialty population. The purpose of this Doctor of Nursing Practice (DNP) project was to quantify nurse anesthetist knowledge base of intraoperative anesthetic care of L V AD patients. The aim of this project was to ultimately increase nurse anesthetist knowledge base of interoperate care for L V AD patients. This project used a quasi-experimental pretest-posttest design utilizing a test of knowledge relating to care of L V AD patients throughout the operative periods. Kurt Lewin's theoretical framework was used to guide the development of this DNP project. Participants consisted of thirteen Certified Registered Nurse Anesthetists who are employed at a regional L V AD center in Western NY. Data was collected utilizing a test of knowledge that was administered via SurveyMonkey and distributed via email. Multiple statistical analysis were conducted, including paired T-test and ANOVA. A paired sample T-test to evaluate the participants overall pre-test and post-test mean scores was performed, the results were overwhelmingly significant. There was a significant difference in the pretest scores (M= 7.08, SD=l.83) and posttest scores (M=13.66, SD=2.30); t(l 1)= -8.74, p=<0.001. This project has the potential to improve patient outcomes by improving provider knowledge of this specialty population throughout the operative period. Future research should include an expansion in participants across a variety of hospital settings
Anesthesia Providers' Practices and Attitudes Regarding Perioperative Anxiety
No full textUB SON, DNP Research ProjectPerioperative anxiety should be a priority for anesthesia providers, as it is associated with a myriad of adverse clinical outcomes and increased costs, however this phenomenon is frequently underdressed and undertreated in practice. The purpose of this DNP project was to improve the management of perioperative anxiety. Primary aims included determining provider attitudes regarding perioperative anxiety, and identifying barriers and facilitators to adopting evidence based practices. Lewin's Theory of Change was used the theoretical framework for the project. This was an exploratory, descriptive study with cross sectional design, that consisted of a onetime survey of anesthesia providers working for a private group in western New York. There were 28 participants in the study. The current standard of practice identified at the site is the use of clinical judgement for anxiety assessment and the medication midazolam for treatment, which is not congruent with current evidence-based practice standards. However, providers indicated that anxiety management is an important part of their practice, which is an important facilitator for change. Barriers to change reported included resistance from management and technology considerations. An educational tool that emphasizes the importance of identifying and treating perioperative anxiety (the problem), ineffectiveness of current assessments and interventions ( challenges the current norm), and inform of superior practices was created to address identified resistances to change. The project deliverable was be provided to the anesthesia group in order to disrupt the current equilibrium and encourage staff members to adopt new practice
Evaluation of an Educational Intervention to Address Gaps in Knowledge, Barriers and Opinions in Certified Registered Nurse Anesthetists for the Administration of Remifentanil for Labor Analgesia
No full textUB SON, DNP Research ProjectThe need for alternative methods of managing labor pain have been continuing to increase due to more labor women presenting with contraindications to epidural analgesia, which is currently the gold standard in the United States for labor pain management. Remifentanil is a systemic opioid that has been established as safe and effective when used for labor analgesia. The purpose of this Doctor of Nursing Practice (DNP) project was to quantitatively explore the current knowledge, barriers and opinions among Certified Registered Nurse Anesthetists (CRNAs) as to assess the impact of an educational intervention in the use of remifentanil for labor analgesia in a small community hospital with a large volume of labor patients in Upstate New York. The aim was to improve the knowledge and understanding of the use of remifentanil for labor analgesia. Lewin's change theory acted as the guiding framework of this project and helped to promote change through the educational intervention for the study participants. The project utilized a quantitative, pre-and post-test design to evaluate the effectiveness of an educational intervention for CRNAs (n=15) on the administration of remifentanil for labor analgesia. Statistically significant improvements in mean scores (p<.05) from pre-to post-survey was established on each survey question, indicating that the educational intervention was effective in increasing knowledge and comfort level of the use of remifentanil for labor analgesia. 80% of participants agree or strongly agree with using remifentanil as an option to treat labor pain if it were available following the educational presentation. Future implications of this project are to help develop protocols based on the current literature for labor units for the use of remifentanil for labor analgesia
What are the patient perceptions of telehealth visits and its role in substance use disorder treatment and sobriety with cisgendered gay, bisexual and queer-identifying males in New York State?
No full textUB SON, DNP Research ProjectSince the onset of the COVID-19 pandemic, and subsequent lockdown in March 2020, telehealth delivery of psychiatric care became the norm. This delivery method has had a positive effect with access, delivery, and continuity of care for all individuals, but even more so for those who identify as cisgendered gay, bisexual, and queer males who are seeking substance use treatment in New York State (NYS). The purpose of this project was to qualitatively explore these individual's perceptions of access to, and continuity of, care via telehealth. The aim was to understand perceptions, along with positive and negative implications of telehealth as an aspect of care moving forward in a post pandemic world. Objectives included conducting a comprehensive literature review, sending out a brief survey to those individuals who are accessing substance use treatment, analyze the data, and develop recommendations for further use The Donabedian Model acted as a guiding framework for this project. Methods and Design: This project utilized a quantitative and qualitative analysis of a 16-question electronic survey delivered via Survey Monkey exploring patient perceptions of telehealth as a delivery method for substance use treatment. Results: The participants (n=15) showed a positive perception overall with regards to telehealth delivery but as a component of treatment vs sole component. Measures of central tendency, as well as possible t-test and/or ANOV A will be utilized to analyze data. Institutional Review Board (IRB) approved will be granted and data will be collected and stored as per protocol. Participation is completely voluntary and anonymous
Practice Patterns of Certified Registered Nurse Anesthetists for Neuromuscular Blockade Reversal in Patients at Increased Risk for Post-Operative Pulmonary Complications
No full textUB SON, DNP Research ProjectAdequate reversal of neuromuscular blockade is required to prevent residual neuromuscular blockade (rNMB). rNMB is associated with post-operative pulmonary complications (PPCs) including hypoxemia, airway obstruction, atelectasis, pneumonia, increased 30-day readmission rate, and death. Older adult and obese populations are at increased risk for the development of rNMB and PPCs. The choice of pharmacological reversal can significantly alter rNMB and PPC incidence. Studies have found sugammadex to decrease rNMB and PPC incidence in older adults and obese patients. The purpose of this project was to analyze neuromuscular blockade reversal practice patterns in older adult and obese patients of Certified Registered Nurse Anesthetists (CRNAs) at a Western New York hospital. The aim ofthis project was to highlight any deviations from evidence-based practice. Kurt Lewin's change theory was the theoretical framework to guide this project. Practice patterns were assessed via a self-administered 25question survey. The survey gathered data on CRNA demographics, rNMB knowledge, and use of sugamrnadex and neostigmine in practice. The survey was completed by 11 CRNAs. 45.5% of participants agreed that rNMB is a current problem in anesthesia practice. Sugamrnadex was the reported reversal agent in older adults in 65% of participants while 100% of participants reported using sugammadex in obese patients. Survey findings support that alteration of neuromuscular blockade reversal practice patterns should be encouraged in patients at increased risk for PPCs. Future research should identify barriers to the use of sugamrnadex within the older adult population
Knowledge Levels and Educational Preferences in Type 2 Diabetic Patients in a Rural Primary Care Clinic
No full textUB SON, DNP Research ProjectDespite medical advancements, the management of type 2 diabetes is an issue in healthcare. Providers in rural areas face an increased obstacle, as there are limited resources and poor accessibility to diabetes educators. The literature demonstrates that peer support, multidisciplinary care, and telehealth are assets to diabetes education in limited-access areas. Becker's (1974) health belief model was the theoretical framework that guided this project. The purpose of this DNP project was to quantitatively evaluate the effectiveness of current education provided by a nurse practitioner (NP) in a primary care clinic in rural Delevan, New York. This project aimed to increase the knowledge levels of type 2 diabetic patients by delivering a practice recommendation on how to improve diabetes education. A survey was administered to type 2 diabetics in the clinic, assessing knowledge about diabetes and educational preferences. Data from the survey were analyzed using Statistical Package for Social Science (SPSS) version 28. Frequencies and inferential statistics were utilized to present an overview of the data. The mean score on the knowledge assessment was 10 out of 15. The majority of patients prefer face-to-face interaction for diabetes education. Participants found diabetes educators valuable. Independent t tests were used to examine any group differences in response to the survey questions. There was no statistical significance among knowledge scores and if patients were diagnosed at Delevan Health Center, if they were educated by an NP or diabetes educator, or if they utilized online sources for education
Assessing Current Techniques of Nurse Anesthetists in Extending Epidural Blockade for Cesarean Section
No full textUB SON, DNP Research ProjectBackground and Significance: The practice of extending an existing labor epidural analgesia to surgical anesthesia for a cesarean section has become common practice. Neuraxial anesthesia is the preferred anesthetic technique for a cesarean delivery as it poses far less complications than general anesthesia for the laboring mother. It is important for the certified registered nurse anesthetist to provide safe and high-quality care for the laboring mother in need of a cesarean section with an existing epidural in place. Purpose, Aims, and Objectives: The purpose of the Doctor of Nursing Practice is to explore the current techniques amongst Nurse Anesthetists in converting labor epidural analgesia to a surgical epidural for cesarean section. The aim of this DNP project is to identify current techniques surrounding the practice of nurse anesthetists providing the extension of epidural blockade for cesarean section. Theoretical Framework: Kurt Lewin's Theory of Change will act as the guiding framework for this DNP project. Methods and Design: This DNP project used both a quantitative and qualitative approach guided by survey questionnaire administered through REDCap online to explore the current techniques of nurse anesthetists providing care to laboring mothers requiring an epidural extension for a cesarean section. Results: Survey data displayed a majority comfort level in nurse anesthetist management of a laboring epidural with a varying method in technique leading to the occurrence of adverse events, indicating the need for clinical guidelines. Future Implications: Develop clinical guidelines to aid nurse anesthetists in the management of the laboring epidural in need of extension for a cesarean section
Second Victim Syndrome: The Need for and Design of a Program to Reduce Caregiver's Emotional Responses after a Clinical Error
No full textUB SON, DNP Research ProjectBackground and Significance: Second victim syndrome, if left untreated, can cause sleep disturbances, decreased job satisfaction, impaired cognitive function, frustration, difficulty concentrating, loss of confidence, depression, self-doubt, anxiety, and avoidance of patient care. 7 6% of providers have experienced personal or professional impacts as a direct result of an adverse patient outcome, yet only a handful of healthcare facilities have a program in places specifically for working with second victim sufferers. Purpose, Aim, and Objectives: To evaluate healthcare providers experiences and support for second victim syndrome at a level one trauma center. Theoretical Frameworks: Kurt Lewin's change theory. Methods and Design: A cross-sectional anonymous survey. Target population; operating room, ICU, and emergency room healthcare workers. SPSS version 28 used for analysis of quantitative data. Open-ended question responses were meticulously reviewed. Results: n=18. 57.1 % of night-shift workers have admitted to experiencing symptoms of SVS compared to only 9 .1 % of day shift workers. This association is statistically significant X2 (1) = 4.923, p = 0.026. Night shift and ICU healthcare workers may be at increased risk. Gender, hired position and education level play no significant role in the development of SVS symptoms Conclusions: Knowledge, awareness, and support for struggling healthcare workers will be continuously provided to target population with the help of project deliverable. Future Implications and Recommendations: Expansion on healthcare units included in study. Study on other careers outside of healthcare