UBIR Repository (Univ. at Buffalo)
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Gaps in Knowledge and Barriers to Certified Registered Nurse Anesthetists in New York State and Across the Country Using Adequate Personal Protective Equipment and Barriers to Smoke Evacuator Use in the Operating Room During Electrocauterization
No full textUB SON, DNP Research ProjectElectrocauterization produces surgical smoke, a gaseous byproduct, known to contain potentially hazardous contents. Despite evidence of detrimental health effects exposure can cause, reduction efforts have been slow to be implemented. Certified Registered Nurse Anesthetists (CRNAs) are exposed to surgical smoke through inconsistent smoke evacuator use and frequent inadequate personal protective equipment (PPE) use. The study purpose was to assess awareness of surgical smoke hazards and protective measures used in operating rooms and by CRNAs, and to identify barriers that prevent CRNAs from protecting themselves. The aim was to promote awareness of surgical smoke hazards, educate CRNAs about appropriate PPE that should be worn and convey importance of smoke evacuator use during electrocauterization. A cross sectional design using an online survey and the guidance of Kurt Lewin's Change Theory, sampled 66 CRNAs that were members of New York State Association of Nurse Anesthetists (NYSANA) or the CRNAs and SRNAs Facebook page. A summary of study findings and evidence-based data were sent to those platforms. 77.3% were concerned about surgical smoke. Approximately 50% disagreed their employer prioritizes reducing surgical smoke exposure or provides education. Barriers to adequate PPE use include lack of policy and supplies. CRNAs desire more protection from surgical smoke. Places of employment should increase education and consider developing protocols to limit surgical smoke exposure. A study strength included adequate sample size. A limitation was participants didn't reveal state of practice, which limited assessment of differences in knowledge and practices by location. Future research should evaluate knowledge of these topics and practices by state
Primary Care Provider's Attitudes, Beliefs, Knowledge and Perceived Barriers in Providing Tobacco Cessation Counseling to the Seriously Mentally Ill
No full textUB SON, DNP Research ProjectPeople with serious mental illness are more attached to nicotine than the non-mentally ill. This attachment is a primary reason that these patients die an average of 15-20 years earlier than the general population, mostly from tobacco related diseases. U.S. Preventive Services Task Force (USPSTF) guidelines direct primary care providers to provide this counseling at each visit, but the literature points to a disparity in the provision of this with this population. An exploration of the mindset of primary care providers in providing such counseling to this population was explored with this survey. Attitudes, beliefs, knowledge and perceived barriers of primary care providers regarding this in three New York urban primary care clinics providing care to the mentally ill were identified. A non-experimental cross-sectional survey was utilized to understand these factors, using the Theoretical Domains Framework as a model to guide the project and design. Most respondents in this study were neutral on their knowledge base of smoking cessation counseling, though slightly less assured of prescribing varenicline, but had positive attitudes to providing such counseling. Time and more immediate pressing needs were seen as barriers. Respondents consistently asked if their patients smoked and advised them to stop at each visit, but were less consistent with counseling referrals. Future research should be guided by more sophisticated statistical tests correlating all the factors surveyed with actual practice. In addition, determining if any focused in-service education regarding smoking cessation counseling actually increases such counseling rates
Promoting Skin Cancer Screening and Patient Education for Adults Aged 18 Years and Older by Nurse Practitioners Working in Primary Care Settings
No full textUB SON, DNP Research ProjectSkin cancer is the most common malignancy in the United States. Although preventable, approximately one in five Americans will develop skin cancer in their lifetime (American Academy of Dermatology Association [AADA], 2022). Primary care nurse practitioners (NPs) can play a significant role in adult skin cancer screening, prevention and patient education. The purpose of this Doctor of Nursing Practice (DNP) project was to examine the significance of and need for annual skin cancer screening among adult patients aged 18 years and older performed by primary care NPs. The aim for this DNP project was to promote skin cancer screening and patient education within primary care settings to improve patient care quality and outcomes. Pender's Health Promotion Model acted as the guiding theoretical framework. An online survey was created and data was analyzed using descriptive statistics. A total of 8 primary care NPs who are current members of the New York State Nurse Practitioner's Association (NYS NPA) participated. Study findings revealed that primary care NPs perceive a benefit to skin cancer screening in primary care. However, improvement is needed to standardize and increase the frequency of screening and patient education. Study limitations include a small sample size and limited variability in participant demographics. Future studies are needed to evaluate the effectiveness of implementing a validated skin cancer screening tool within the electronic medical record (EMR) and how being able to identify at-risk patients affects the primary care NP's plan of care
Supplementary Notes 3: Seneca place names
No full textThis undated note includes the place name "Scajaquady," which is identified as Seneca for "a little east of Niagara Street." Michelson credits the 19th-century missionary to the Seneca Asher Wright in a parenthetical. There is another term present, with its pronunciation spelling and English translation
An Educational Intervention with Clinical Recommendations to Address Gaps in Knowledge and Barriers to Intraoperative Use of Nitrous Oxide in New York State Certified Registered Nurse Anesthetists
No full textUB SON, DNP Research ProjectPatients could benefit from having nitrous oxide as part of their anesthetic without adverse effects. Providers are often reluctant to use it due to preconceived notions about its safety profile. It is a missed opportunity for improved delivery of care which would also benefit the healthcare system and advanced practice nursing. The purpose of this project is to quantitively examine comfort and knowledge of New York State (NYS) certified registered nurse anesthetists (CRNAs) in using nitrous oxide to provide safe and effective anesthesia through an online survey which will guide evidence-based clinical recommendations. The aim of this project is to increase CRNA comfort and knowledge in the use of nitrous oxide intraoperatively to safely improve their patient's outcomes. Project objectives include a comprehensive review of literature, developing a questionnaire to assess CRNA knowledge and comfort with intraoperative nitrous oxide use, distributing the survey, data synthesis and analysis, developing clinical recommendations, a post-recommendation survey and, project dissemination to faculty at the University of Buffalo. Kurt Lewin's Change Theory is used as the guiding framework for this project. The project followed a pre-post study design to explore NYS CRNA's gaps in knowledge and barriers to intraoperative nitrous oxide use in an online setting. There was an increase in knowledge in CRNAs with six to ten years of experience and increased comfort with nitrous oxide after the intervention. Clinical guidelines for nitrous oxide will facilitate its appropriate use in improving outcomes. Future interventions should formalize educational interventions to hopefully reach more CRNAs
Understanding Preanesthetic Fasting Practices and Experiences of Pediatric Patients and Caregivers
No full textUB SON, DNP Research ProjectFasting prior to surgery is a widely accepted practice guideline intended to reduce the risk of pulmonary aspiration due to the loss of protective airway reflexes associated with anesthetic drugs. As both prolonged and inadequate fasting durations are associated with increased morbidity, adherence to fasting guidelines is crucial to ensuring patient safety. The purpose of this project was to explore fasting practices and experiences of pediatric patients and their caregivers at a children's hospital in Western New York. Aims included enhancing understanding of patient and caregiver compliance with fasting guidelines and associated experiences, improving compliance with guidelines, and improving pediatric perioperative experiences and outcomes. Pender's Health Promotion Model acted as the guiding framework for this cross-sectional study. Quantitative data collected from surveys completed by parents and caregivers of pediatric patients demonstrated low pediatric compliance with fasting guidelines, inconsistent delivery of fasting education, poor caregiver understanding of education, and distressful caregiver and patient experiences associated with fasting. Average fasting durations were 7.64 hours (clear liquids), 7.45 hours (breast milk), 10.01 hours (formula), and 13.65 hours (solids), all well exceeding current recommendations. Project findings provide further insight into our understanding of pediatric preoperative fasting processes, practices, experiences and caregiver perspectives and rationales for fasting behaviors. Future research may investigate the impact of interventions implemented to improve pediatric compliance with current fasting guidelines
Evaluation of Burnout Among Hospice and Palliative Care Nurses
No full textUB SON, DNP Research ProjectBurnout is a major factor to nurse turnover and shortages. Hospice and palliative care (HPC) nurses are at an increased risk of burnout. The purpose of this Doctor of Nursing Practice (DNP) project was to quantitatively evaluate burnout levels among HPC nurses providing care to adult patients with serious and terminal illnesses at a large HPC organization within Western New York (WNY), as well as to make a recommendation to the organization to mitigate the effects of burnout among nurses. This project aimed to understand burnout levels among nurses at the HPC organization. The objectives were to 1) evaluate burnout among nurses at the HPC organization; 2) conduct a literature review; 3) survey nurses employed at the HPC organization; 4) analyze the data obtained from the survey; 5) make a recommendation to the HPC organization; and 6) disseminate study findings. Donabedian's model was utilized to guide the development of this project. A quantitative study was conducted using the Professional Quality of Life Scale version 5.0. The sample size was 39 participants. The Hospice homecare department had statistically higher secondary traumatic stress when compared to Palliative Care (Home Connections). Additionally, the Hospice homecare department had statistically higher burnout as compared to the on-call department. The study concluded that hospice nurses would benefit from interventions to reduce burnout, and these recommendations were made to the HPC organization. Future studies should further evaluate the relationship between burnout levels and other healthcare professionals
Proposed Utilization of a Handoff Check List
No full textUB SON, DNP Research ProjectHandoff from anesthesia providers to labor and delivery (L&D) postanesthesia care unit (PACU) nurses is a critical moment in patient care that requires accurate and efficient communication to ensure patient safety and continuity of care (Halterman et al., 2019). Clinical information exchange is a crucial component of handoff, which occurs within health care during transfer of patient care from shift to shift, team to team, and department to department (Sharp et al., 2019). Handoff checklists provide a potential way to improve communication and reduce errors during care transitions. This qualitative descriptive study involved development and evaluation of a handoff checklist in the context of anesthesia providers and L&D PACU nurses. Participants reviewed the checklist for efficacy and efficiency via a questionnaire that also allowed them to provide open-ended comments. Participants were anesthesia providers (anesthesiologists and certified RN anesthetists) and L&D nurses who provided care for patients on a day-to-day basis. Perceptions among providers regarding the importance of anesthesia handoff were generally positive, with 72.2% of respondents felt that SACT can foster improvement in the handoff process in an OR setting. And 44.4% identified that SACT advocates changes in the present processes that may cause more issue
Impact of an Education Intervention Integrated 2ith Current Evidence-Based Guideline Directed Medical Therapy to Improve Nursing Knowledge and Promote Self-Efficacy in Cardiac Step-Down Unit Nurses
No full textUB SON, DNP Research ProjectThe cardiac step-down unit (CSDU) has a high turnover of patients and nurses, demanding highly trained nurses to provide quality care to post-acute myocardial infarction (AMI) patients in a short time frame. The lack of nurses' knowledge of updated guidelines and therapy for AMI patients can lead to less-than-optimal care. This Doctor of Nursing (DNP) project aimed to quantitatively explore the effects of an education intervention integrated with updated guideline directed medical therapy for AMI patients presented to nurses in the CSDU. Albert Bandura's Self Efficacy theory and Patricia Benner's nursing model, from "Novice to Expert," served as the theoretical framework for the project. The project involved surveying the nurses with a demographic survey, a pre-test knowledge and self-efficacy questionnaire, performing a one hour lecture on updated guidelines and care of AMI patients, and a survey with a post-test knowledge and self-efficacy questionnaire. A purposive, convenient sample with 27 nurses from CSDU was utilized. A paired samples t-test was used to analyze the pre and post-ACS/GDMT and pre and post-GSE mean test scores. ANOV A was used to explore the relationship between Pre-ACS/GDMT mean test scores and years of nursing experience. The study showed that the educational intervention given to the cardiac step-down nurses increased the nurses' knowledge significantly (p=<.001 ), and no significant relationship exists between years of experience and nurses' knowledge. The study supported the need for continuous education on updated guidelines and medical therapy on AMI for nurses as new guidelines evolve to keep them up-to-date on their practice
Evaluating Primary Care Providers' Barriers to Initiating Palliative Care Early in Patients with Serious Illness
No full textUB SON, DNP Research ProjectPalliative care (PC) is a medical approach that aims to improve the quality of life for patients with serious illness and their families. Although there are many benefits to PC, several barriers exist that prevent the early initiation of PC in the primary care setting. The purpose of this Doctor of Nursing Practice (DNP) project was to quantitatively evaluate primary care providers (PCPs) barriers to initiating PC early in patients with serious illnesses among nurse practitioners (NPs) that graduated from a large university in New York (NY). The project aimed to provide further insight into the barriers and deliver a recommendation to the university regarding them. King's theory of goal attainment was used to guide the DNP project. A cross-sectional design with a one-time online survey was sent to the university's school of nursing alumni. Data were analyzed using descriptive statistics and Fisher's exact test. The results showed that the most frequently selected barriers that moderately or completely interfere with patients receiving PC early enough to benefit from its services include family reluctance to accept PC (80%), the perception that PC indicates health professionals are giving up (72.7%), an association of PC with death (63.6%), and difficulty with reimbursement for services (63.6%). This project provides further insight into the barriers to early PC. However, future research is needed regarding the barriers, and the impact PC education can have on addressing the barriers to PC in the primary care setting