Doctor of Nursing Practice

Title: Increasing HCV Screening Utilizing Electronic Medical Records in a Family Practice Setting
Description: This study was a non-experimental, cross-sectional design with retrospective electronic medical data review to assess the effectiveness of an EMR intervention in Hepatitis C Virus (HCV) screening for those born between 1945-1965 birth cohort. The study measures three months pre-EMR provider prompt and three months post-EMR provider prompt. Screening, statistically the patients who met HCV screening criteria increased from 27.9% to 72.1% post-EMR provider prompt screen. With the increase in screening, the study showed an increase overall HCV testing from 5.6% to 37.6% post-EMR provider prompt screen. This increase in both screening and testing for HCV, allows the possibility to capture those undiagnosed Hepatitis C patients and provide the patient with appropriate linkage to care to decrease overall morbidity and mortality within the given birth cohort. The success of utilizing an EMR prompting system, will allow the opportunity for further research in other aspects of health maintenance.
subject: Hepatitis C
Center for Disease Control and Prevention
CDC
infectious disease
baby boomers
family practice

Title: "Intending to Stay" - Defense
Description: Richard Scepura's defense of the dissertation, "Intending to Stay- Retention, Structural Empowerment, and Dialysis Nursing: Integrating Kanter's Theory and the Refined Nurse Worklife Model."
subject: Retention
structural empowerment
burnout
dialysis
Kanter's Theory

Title: Intending to Stay- Retention, Structural Empowerment, and Dialysis Nursing : Integrating Kanter's Theory and the Refined Nurse Worklife Model
Description: Copyrights are retained by the author. Please contact Richard C. Scepura for further use of this material.
subject: Retention
Structural Empowerment
Dialysis
Burnout
Kanter's Theory

Title: Irritable Bowel Syndrome and Vitamin D Insufficiency: The Effects of Vitamin D Level on Irritable Bowel Syndrome
Description: Mary Pollock presents research for the dissertation titled, "Irritable Bowel Syndrome and Vitamin D Insufficiency: The Effects of Vitamin D Level on Irritable Bowel Syndrome."
subject: IBS
Irritable Bowel Syndrome
vitamin D
deficiencies

Title: Irritable Bowel Syndrome and Vitamin D Insufficiency: The Effects of Vitamin D Level on Irritable Bowel Syndrome
Description: There is existing research noting a possible correlation between vitamin D insufficiency and irritable bowel syndrome (IBS). The etiology of irritable bowel syndrome is unknown with the goal of the health care provider being symptom control. There are studies suggesting insufficient vitamin D levels may cause an inflammatory response in the gut leading to symptoms of irritable bowel syndrome. This study noted a possible correlation between insufficient vitamin D levels and irritable bowel syndrome in a small rural gastroenterology practice in Western Pennsylvania. A literature review was performed on IBS, vitamin D, and the possible correlation between vitamin D and IBS. The diagnosis of irritable bowel syndrome was broken down into IBS/ diarrhea, IBS/ constipation, and IBS/mixed according to the ROME criteria that is used in daily practice. Out of 118 patients with the diagnosis of IBS that were included in the study, only 62 of these patients had a vitamin D level drawn within the last 5 years. Thirty of these patients had insufficient vitamin D levels. The expected value from the Chi-Square test as derived from a proportional analysis of low vitamin D levels in the general population of the United States was 19.8. The observed value from this study is 30, a 10.2 value higher than the expected value. The Chi-square test indicated significance, thereby the (30) IBS patients (48.3%) the total patients with low levels of vitamin D as compared (32) IBS patients (51.1%) of the total patients with normal levels of Vitamin D, where Chi-square (1, n = 62) = 7.6, p < .006. Further investigation into a possible correlation between vitamin D insufficiency and symptoms of irritable bowel syndrome in the adult patient would be a positive step towards this challenging functional bowel disorder.
subject: Irritable Bowel Syndrome
IBS
vitamin D
deficiencies

Title: LBTQIA+ inclusive healthcare versus traditional: Comparing patient satisfaction
Description: Gayle Kempinski defends the dissertation "LBTQIA+ inclusive healthcare versus traditional: Comparing patient satisfaction."
subject: Sexual minorities
Sexual and Gender minorities
Cultural competence
Socioeconomic factors
Gay and lesbian studies
Equality-- Health aspects

Title: LGBTQIA+ inclusive healthcare versus traditional :: Comparing patient satisfaction
Description: Study Aim: The aim of this study was to evaluate the difference in patient satisfaction scores between lesbian, gay, bisexual, transgender, questioning or queer, intersex, and asexual (LGBTQIA+) individuals who receive healthcare from LGBTQIA+ inclusion clinics and LGBTQIA+ individuals who receive healthcare from traditional clinics. Background: LGBTQIA+ individuals have unique healthcare needs and require safe, affirming, culturally competent, and inclusive healthcare environments that will meet these unique needs, eliminate health disparities and inequities, and improve patient reported outcomes such as patient satisfaction. Theoretical Framework: This study was guided by the Health Equity Framework, centered on three foundational concepts: equity at the core of health outcomes; multiple, interacting spheres of influence; and a historical and life-course perspective. Methodology: Study protocol review and approval were obtained from Edinboro University’s Institutional Review Board. This study was an on-line questionnaire study and was conducted using a nonexperimental, nonrandom, cross-sectional study adhering to a quantitative methodology. A nonrandom convenience sample of LGBTQIA+ individuals (n=56) was selected, and study participants were invited to participate in this study via an on-line survey link by way of Qualtrics. Data were collected using the Short-Form Patient Satisfaction Questionnaire (PSQ-18). Results: To test for differences in patient satisfaction between groups, the independent samples t-test statistical method was utilized. There was not a statistically significant difference in mean values between groups. Due to assumption violations, the Communication sub-scale was tested using the independent samples Mann-Whitney U test to determine if the distributions in the two groups were significantly different from each other. It was found that the distributions in the two groups significantly differed. Conclusions: LGBTQIA+ inclusion health plays a critical role in improving patient satisfaction and the health and well-being of LGBTQIA+ individuals. Implications for Nursing Practice: Nursing professionals play an integral role in transforming healthcare for LGBTQIA+ individuals and must align their practices with their professional duty of delivering equitable and culturally competent and sensitive care to LGBTQIA+ individuals. Recommendations: Further research is needed with larger sample sizes to investigate the relationship between receiving healthcare from LGBTQIA+ inclusion clinics and improved patient satisfaction and whether there is a difference in patient satisfaction between those who receive healthcare from LGBTQIA+ inclusion clinics and those who do not. Because study respondents who went to LGBTQIA+ inclusion clinics had significantly higher communication satisfaction than those who did not go to inclusion clinics, the impact of culturally competent communication on improved patient satisfaction should also be investigated further in future research., Copyrights are retained by Gayle Kempinski. Contact the author for further use of this material.
subject: Gay and lesbian studies
Sexual minorites
Cultural competence
Equality -- Health aspects
Sexual and Gender Minorities
Socioeconomic factors

Title: Open Access Colonoscopy Quality Improvement: A Doctor of Nursing Practice Led Initiative
Description: Michelle DeLeon presents research for the dissertation titled, "Open Access Colonoscopy Quality Improvement: A Doctor of Nursing Practice Led Initiative.", Copyrights are retained by the authors. Please contact the authors for future use of this material.
subject: open access colonoscopy
colerectal bowel preparation
rural populations

Title: Open Access Colonoscopy Quality Improvement: A Doctor of Nursing Practice Led Initiative
Description: Colorectal cancer is a leading cause of death in the United States with colonoscopy fundamental to any colorectal cancer screening program. Open access colonoscopy allows procedures to be performed in a timely manner to detect adenomas. The efficacy of adenoma detection is largely dependent on the quality of colonoscopy bowel preparation. Adenoma detection rate of open access screening colonoscopies and quality of split dosed bowel preparation was measured in a rural private gastroenterology practice in Central Pennsylvania using the 2017 Registry Individual Measure Flow created by the Centers for Medicare & Medicaid Services (CMS) noting the quality of bowel preparation at the time of review. Open access screening colonoscopy reports were reviewed for ICD-10 codes for 3 risk factors for colorectal cancer, age 50 years and greater, and CPT codes for colonoscopy procedure without modifiers resulting in early termination of the procedure. The annual adenoma detection rate of open access screening colonoscopy patients who me the inclusion criteria was 44.47 % with 96.7% of open access screening colonoscopies rated to have optimal bowel preparations. These findings suggest that open access screening colonoscopy can be a timely, patient-centered method of effective, high quality colorectal cancer screening., Copyrights are retained by the authors. Please contact the authors for further use of this material.
subject: open access colonoscopy
colorectal cancer screening
rural populations
bowel preparation quality
adenoma detection rate

Title: Patient Portal Engagement at a Pediatric Office: Reasons Why Individuals Are Not Using the Patient Portal
Description: Sherry DelGrosso presents data regarding the dissertation "Patient Portal Engagement at a Pediatric Office"
subject: Nursing

Title: Patient Portal Engagement at a Pediatric Office: Reasons Why Individuals Are Not Using the Patient Portal
Description: This descriptive study explores the reasons individuals bringing their child(ren) to the pediatric office are not using the patient portal. There was negligible use of the patient portal as shown by a retrospective review of data usage reports via the eClinicalWorks software. Additionally, staff reported that they still answered many calls for information (immunization records, lab results, medication refills, appointment scheduling, and care-related questions), all of which were easily obtained through the portal. The objective of this study is to determine the reasons why individuals bringing the child(ren) to a rural pediatric practice in Central Pennsylvania are not using the patient portal. The scope of the survey is broad, as overall knowledge of the patient portal and its capabilities is assumed to be low based on current usage data. A convenience sample of individuals was pursued. The survey questions focused on the potential contributing factors to the individual’s lack of portal usage. Demographic data were obtained as part of the survey to identify the characteristics of the participants. The results revealed that the lack of patient portal usage would be responsive to change with some practice planning and education., Sherry DelGrosso, 2019.
subject: Nursing
Medical records
Pediatrics

Title: Reducing Prolonged Hyperoxia in Mechanically Ventilated Patients Through Implementation of a Conservative Oxygen Weaning Protocol Versus the Current Practice: A Quality-Improvement Project in Three Intensive Care Units at a Level II Trauma Tertiary Care Hospital
Description: Background: Hyperoxia is known to be detrimental in healthcare, yet it continues to be a problem in mechanically ventilated patients. Oxygen weaning protocols have been discussed in many studies that have evaluated various outcome measures with mixed findings. A study completed by Cuevas et al. (2020) evaluated respiratory therapists' compliance with an oxygen weaning protocol. The conclusions of this study found that the protocol was often not followed. At a level II trauma hospital tertiary care hospital in three ICUs, patients' FIO2s were not being weaned in a timely manner. Due to the previous research on the risks of hyperoxia and poor outcomes, a conservative oxygen weaning protocol was developed. The aim of this study was to assess if implementing a conservative oxygen weaning protocol would improve oxygen weaning times in mechanically ventilated patients compared to the current oxygen weaning practice. Methods: Out weaning program evaluation was completed using the PARISH framework and Lewin’s change theory to evaluate and implement evidence-based practice. This evaluation was conducted using quantitative, retrospective, consecutive sampling; a quasi-experimental methodology was used to compare the current oxygen weaning group (before intervention group) and a conservative oxygen weaning group (after intervention group) in three ICUs at a level II trauma tertiary care hospital. Intervention: A conservative oxygen weaning protocol was developed and implemented in three ICUs at one medical center. Mechanically ventilated patients with a P/F ratio is ≥ 150 qualified for the oxygen weaning protocol. The weaning pathways are determined by the PaO2 on the ABG. After the initial FIO2 wean, the SpO2 will be used for FIO2 weaning. FIO2 weaning will be continued as long as the SpO2 level is ≥ 4% of the ordered goal SpO2 until the FIO2 is 0.3. Results: The current oxygen weaning group had 34 patients, and the conservative oxygen weaning group had 18 patients that met the inclusion criteria. Both groups had non-normal distribution. The current oxygen group had a p-value= 1.827e-08 and the conservative oxygen group had a p-value= 6.213e-06. Mann-Whitney U test was completed, and the result was a p-value = 0.05735. Therefore, there was no statistically significant finding that the implementation of the conservative oxygen weaning protocol improved oxygen weaning times. Though there was no statistical significance, the conservative oxygen weaning groups did show improvement in weaning time. Conclusions: The statistical findings for improvement in oxygen weaning time to 0.3 with the implementation of a conservative oxygen therapy protocol showed no statistical significance. Evaluating the conservative oxygen weaning groups' data showed improvement in weaning times. Further research is needed on the implementation of a conservative oxygen therapy protocol to evaluate the improvement of FIO2 weaning times in mechanically ventilated patients, as well as the effectiveness of consistent weaning protocols with staff compliance., Copyrights are retained by the author. Please contact Colleen Sansoucie for further use of this material.
subject: Hyperoxia
Oxygen in the body
Artificial respiration

Title: Reducing Same-Day Surgical Delay and Cancellation Occurrences:: A Quality Improvement Project in an Outpatient Surgery Center

Title: Reducing same-day surgical delay and cancellation occurrences:: A quality improvement project in an outpatient surgery center.
Description: Patients presenting for surgical procedures must meet specific criteria in order to be deemed ready for surgery. Same-day surgical delays and cancellations often occur due to patients’ inability to follow preoperative instructions. The goal of this quality improvement project was to decrease the number of same-day surgical delay/cancellation occurrences due to patient nonadherence of preoperative instructions. The Institute for Healthcare Improvement’s Plan-Do-Study-Act (PDSA) Cycle was used in order to test an intervention on a smaller scale in order to determine if it leads to improvement. An evidence-based, standardized preoperative instruction pamphlet was developed and distributed to the patients across three specialties at an outpatient surgery center over a four-week time period. Surgical delay/cancellation occurrences decreased from 4.94% in the pre-intervention phase to 0.57% in the intervention phase. All same-day case cancellations during this project occurred due to patients’ nonadherence to preoperative instructions, more specifically, fasting guidelines. Evidence supports using a standardized, evidence-based, written pamphlet for delivery of preoperative instructions in successfully reducing same-day surgical cancellations. Further research is needed in preoperative instructions for patients speaking languages other than English as well as for patients who cannot read., Copyrights are retained by the author. Contact Lauren M. Hostetler for further use of this material.
subject: Nursing
Preoperative education
Preoperative care
Medical appointments and schedules
Ambulatory surgery

Title: A Retrospective Chart Review of a Nasal Decolonization Program to Decrease Surgical Site Infections: at a Community Based Medical
subject: Nursing
Povidone-Iodine
Surgical Wound Infections

Title: A Retrospective Chart Review of a Nasal Decolonization Program to Decrease Surgical Site Infections at a Community Based Medical Center
Description: Background: Surgical site infections (SSI’s) are a major concern for patients, providers, and healthcare organizations worldwide. SSI’s remain the costliest and most common of all hospital-acquired infections (HAI’s) (Septimus, 2019). It is estimated that SSI’s occur in 2 percent to 5 percent of all patients undergoing surgery, translating to 160,000 to 300,000 people annually at a cost of $3.5 to $10 billion (Ban et al., 2017). An SSI substantially increases morbidity and mortality as patients are twice as likely to die, are 60% more likely to be admitted to the intensive care unit (ICU), and the readmission rate is five times higher than patients who do not have a hospital-acquired SSI (Darouiche, 2019). Research Question: Did the intervention of preoperative nasal decolonization using the Profend Nasal Decolonization Kit, 10% povidone-iodine (PVP-I), reduce surgical site infections in patients undergoing an orthopedic surgery with implantation, to include total joint arthroplasty (TJA) and an orthopedic fracture repair, in a 12-month period preintervention compared to a 12-month period post-intervention? Objective: The objective of this DNP project was to evaluate the effectiveness of using a 10% PVP-I Nasal Decolonization Kits in the prevention of SSI’s in patients undergoing an orthopedic surgery for a TJA or fracture repair at the medical center. Methods: This DNP project used a retrospective data review from data points previously collected as part of standard work performed in the EMR. All patient information was blinded when the information was displayed. A standard report from the EMR was run to collect all data. Results: The preintervention group was composed of 431 patients and the postintervention group contained 365 patients. The preintervention group had eight postoperative infections for an infection rate of 1.86%. The postintervention group had an infection rate of 0.27%. This resulted in a p-value of 0.0367 using a two proportions z-score, showing a statistical improvement in SSI’s. Conclusion: The facility successfully implemented a nasal decolonization program with 10% PVP-I that decreased the number of infections, had a higher compliance rate for PVP-I nasal swab over the national average for mupirocin, and showed potential cost savings for the medical center., Copyrights are retained by Earl V. Laih.
subject: Nursing
Nasal manifestations of general disease
Surgical Wound Infection
Risk Factors
Povidone-Iodine

Title: School nurses' lived experience with the identification of substance use in the adolescent school population
Description: Copyrights are retained by the authors.
subject: School nursing
Substance abuse
Teenagers

Title: School nurses’ lived experience with the identification of substance use in the adolescent school population.
Description: School nurses are favorably positioned to play an essential role in both primary and secondary prevention and can be among the first to identify students at risk for substance use. However, for school nurses to succeed in this role, a determination must be made regarding their current level of knowledge of the identification of students who are using substances. Based on a review of the literature, there is a nationwide epidemic related to substance use in the United States which does not discriminate regarding the vulnerable adolescent population. Studies have shown the use of trained behavioral health counselors in schools that support the use of school-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs; however, there has been no determination of the feasibility of utilizing school nurses as gatekeepers to screening students in rural Pennsylvania (PA) school settings. Currently, the literature suggests that there have been no studies to date on the lived experience of school nurses’ perceptions of barriers and facilitators in the identification of students at risk for substance use. A qualitative research design was used to acquire a greater understanding of the barriers and facilitators among school nurses in rural areas. Discoveries from this research may increase attention to the resources needed in rural areas to assist nurses in this public health epidemic and suggest avenues to improve the identification of students who are using, thus decreasing the adolescent substance use rates., Copyrights are retained by the authors. Please contact Christine Varner and Jill Rodgers for further use of this material.
subject: School Nursing
Rural schools
Youth
Teenagers
Knowledge-to-Action Framework

Title: The Triad of Diabetic Uropathy: An Evidenced-Based Practice Educational Intervention for Healthcare Professionals Caring for the Latino/Hispanic Populations
Description: Background: Limited awareness and knowledge of diabetic uropathy can lead to preventable yet detrimental conditions that negatively impact quality of life. Diabetic uropathy encompasses a triad of diabetic sequela affecting the genitourinary tract: Diabetic Bladder Dysfunction (DBD), Genitourinary Tract Infections (GUTIs), and sexual dysfunction. Many of these complications can remain undetected, advance to irreversible conditions, and become life-threatening. The Centers for Disease Control and Prevention (CDC) (2021) estimates that more than half of Latino adults in the United States will develop Type 2 Diabetes (T2D) in their lifetime. Diabetes is the 5th leading cause of death among Latinos in the United States (CDC, 2015) and complications are disproportionately worse in this population (CDC, 2021). The World Health Organization (WHO) estimates that as much as 90% of people living with diabetes have some form of diabetic uropathy (Agochukwu-Mmonu et al., 2020). Despite the high prevalence, these complications have been largely underestimated and overlooked (Wittig et al., 2019). Recognizing the link between diabetes and occult diabetic uropathies may therefore help clinicians prevent life altering diabetic complications through early screening and detection. Immediate priority and preventative interventions to halt this sharp rise of T2D is crucial for the health of the nation and the world. Purpose: The purpose of this project was to develop, implement, and evaluate an online EBP educational program regarding diabetic uropathy to determine its effectiveness on increasing knowledge of diabetic uropathy among healthcare professionals caring for the Latino population. Methods: The project was based on an intervention employing a one group pretest-posttest survey with a convenience sample of forty-eight participants. A 1-hour online EBP educational program on the triad of diabetic uropathy was developed and implemented by the primary investigator through Zoom Communications, Inc. Participants were healthcare professionals (n = 48) consisting of nurse practitioners, physicians, physician assistants/associates, and registered nurses. Evaluation of knowledge was examined using a peer-reviewed investigator-created survey administered via Zoom polling feature immediately before and after intervention. Descriptive statistics and a paired t-test were performed on Microsoft Excel to analyze the results. Results: A paired t-test showed that participants had significantly higher post-test mean scores (M = 8.98) when compared to the pre-test mean scores (M = 5.90) (p < 0.001). Higher scores indicate greater knowledge of diabetic uropathies. The difference in mean scores was 3.08, demonstrating a 30% average increase in knowledge among participants. Conclusion: Despite limitations, the online EBP educational program appears to be an effective tool for increasing knowledge of diabetic uropathies. Further research on diabetic uropathies, particularly as they relate to the Latino population, is needed to expand the scant literature currently available that explores the pathogenesis of diabetic uropathies and the impact on the Latino population. Additional educational programs would build on knowledge and awareness that may mitigate diabetes and its complications., Copyrights are retained by the author. Please contact Lucia Diaz for further use of this material.
subject: Diabetes
Hispanic Americans
Genitourinary organs
Uropothy
Sexual disorders

Title: The Use of Technology as a Tool to Increase Sun Protective Behaviors of Parents for Their Children.
Description: Sarah Cohen Kaveney presents research for the dissertation titled, "The Use of Technology as a Tool to Increase Sun Protective Behaviors of Parents for Their Children."
subject: sun protective behavior
spot UV indicator
technology

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