Doctor of Nursing Practice Spring Research Exposition April 28, 2016
COLLEGE OF NURSING MISSION STATEMENT To develop nursing leaders for professional practice and research in diverse settings.
http://nursing.fsu.edu
FSU College of Nursing Spring Research Exposition April 28, 2016 Welcome .................... Dr. Susan Porterfield Clinical Research Presentation .... Alicia Craig-Rodriguez Florida’s Nurse Practitioners and Transition to DEA Prescribing: A Needs Assessment
Clinical Research Presentation .... Charmaine Gilmore
Nurses’ Knowledge of Depression and Factors Affecting Intent to Assess for Depression in Myocardial Infarction Patients
College of Nursing
Clinical Research Presentation .... Ellen Huenink Assessment of Needs for NICU Parent Support Programs
Poster Presentations and refreshments Please chat with our DNP students about their clinical research and enjoy refreshments. 1
The FSU College of Nursing is proud to welcome you to the 2016 Spring Research Exposition. This exposition features the capstone projects of 20 graduating Doctor of Nursing Practice students. These students have completed a rigorous program of study designed to prepare them for the highest level of nursing practice. As reflected in their capstone projects, these nurses are prepared to generate and use evidence to strengthen nursing practice and improve patient outcomes. I am so proud of these students and their accomplishments and I am excited by the difference they will make in healthcare. Welcome to the exposition and I hope you enjoy the presentations.
Judy McFetridge-Durdle, Dean Florida State University College of Nursing
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About the DNP Program
The Doctor of Nursing Practice (DNP) degree is designed to prepare nurses for the highest level of clinical practice in the profession of nursing. The FSU doctoral program consists of 90 credit hours and 1000 clinical hours for post-baccalaureate nurses. Based on a transcript evaluation, applicants with a MSN degree may be eligible to transfer in a maximum of 42 credits. The Family Nurse Practitioner Program (FNP) prepares students for advanced practice in a complex health care system, requiring integration of all the roles of the advanced practice nurse: clinician, leader, educator, consultant, and researcher. Graduates are eligible for the FNP national certification and licensure as an Advanced Registered Nurse Practitioner (ARNP).
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Our 2016 Doctor of Nursing Practice Graduates
Andrew Blix Alicia Craig-Rodriguez Mary Elizabeth Davis Nancy DeVries Daiquiri Frieling Amy Gallagher Sarah Garrett Charmaine Gilmore Ellen Huenink Sarah Jackson David Lowery Dawn Lyke Kristin Owens Bridget Ratner Jessica Scharein James Sellers Christina Smith Abisoye Somorin Kyrie Stewart Sarah Whipple
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Andrew Blix BS, BSN, RN
Hepatitis C Screening Practices at a County Health Department: A Gap Analysis Purpose: Hepatitis C Virus (HCV) infection is a growing problem in the U.S. and most patients remain undiagnosed. CDC guidelines from 2012 recommend one-time screening of everyone in the 1945-1965 birth cohort. The penetration of this guideline at a county health department was unknown and barriers to its adoption were unclear. The purpose of this study was to evaluate and compare the HCV screening practices in the health department to the CDC guidelines and goals. Using gap analysis, actual screening practices at the health department were evaluated and compared to the guideline. Barriers to the guideline were studied and recommendations were made for improvement. Methods: Using a serial cross-sectional design, aggregate, de-identified patient visit and diagnosis data from 2011-2014 at the county health department was examined to determine HCV screening prevalence for patients born from 1945-1965. This was compared to the 2012 CDC guideline. Providers were interviewed to identify barriers to screening. Results: HCV screening prevalence improved to 25.9% in 2014, but remained significantly below the 100% birth cohort screening guideline. Notable barriers included confusion over and a lack of familiarity with the guideline, an attitude that current practices were adequate, cost concerns, and a perceived lack of referral sources. Discussion: While the health department’s HCV screening prevalence within the birth cohort is above the U.S. average, there is room for improvement. Interventions for improvement include offering information sessions regarding specific knowledge deficits and attitudinal factors as well as integrating screening protocols into the workflow. Conclusion: This study supports findings in the literature that this guideline is not being implemented extensively and implies that sustainable improvements in guideline compliance can be better achieved by first addressing locally relevant barriers.
Major Professor:
Barbara Battin Little, DNP, MPH, RN, APHN-BC, CNE
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Alicia Craig-Rodriguez MBA, BSN, RN
Florida’s Nurse Practitioners and Transition to DEA Prescribing: A Needs Assessment Purpose: The purpose of this project was to examine the current knowledge gaps of Florida Nurse Practitioners (APRNs) regarding opioid prescribing with emphasis on confidence within five knowledge domains: 1) federal and state guidelines; 2) opioid classes and proper doses; 3) risk assessment skills; 4) monitoring of treatment; and 5) overall confidence in dealing with challenges of opioid prescribing. Methods: Cross sectional design and convenience sample of 1511 active Florida APRNs who completed an online needs assessment survey. The data were analyzed using descriptive statistics that included measures of central tendency and spread, frequency distributions and cross tabulations. Results: In all five knowledge domains, only respondents with prior opioid training and current or previous DEA licensure had significantly fewer limitations in prescribing opioids. Those with prior opioid training and previously held DEA licensure exhibited more confidence in their knowledge of federal and state regulatory guidelines, opioid dosing regimens, risk assessment, and long term monitoring of patients. Discussion: These results suggest that there is a statistically significant gap in knowledge and confidence among Florida’s APRNs who have not had previous training in opioid prescribing, nor have current or previous DEA licensure. Neither level of education, nor years of practice experience increased confidence levels in prescribing opioids for pain management. Conclusion: This study illuminates the existing knowledge gaps in opioid prescribing for the management of chronic, non-cancer pain. With the recent statutory changes in Florida, nursing leaders must proactively prepare and educate APRNs before the transition to DEA prescribing. This study also supports the premise that a future educational intervention in DEA prescribing would benefit Florida’s APRNs as they prepare for this important change in practice.
Major Professor: Laurie Grubbs, PhD, ARNP
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Mary Elizabeth Davis BSN, RN, CCRN
Addressing the Issue of Quality Nursing Care and Patient Satisfaction Purpose: Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is commonly used as a metric for quality. This project examined the relationship between nursing sensitive indicators on HCAHPS and patient outcomes as measured by specific National Database of Nursing Quality Indicators (NDNQIs)- incidence of falls, pressure ulcers, and 30-day readmissions. The specific aim of this study was to determine if there is a relationship between nurse specific patient satisfaction and patient outcomes. Methods: Using a correlational descriptive design and retrospective record review, data was collected and analyzed from two inpatient (cardiac and diabetic) units in a 489 bed, not for profit, regional hospital. Measures, which included demographics, length of stay, HCAHPS scores, and NDNQIs, were analyzed in relation to individual nurse specific HCAHPS. Results: On the cardiac unit, lower satisfaction appeared to be correlated with poor patient outcome. The diabetic unit’s patient outcomes declined as patient satisfaction with responsiveness declined. Less association was found between demographic factors and satisfaction, yet some negative association was found between increasing length of stay and satisfaction. Statistical significance was not found as the result of a limited number of data points. Discussion: Patient satisfaction and patient outcomes play significant importance for health care institutions given that they are both used as metrics to determine reimbursement. Nurses play a critical role in the patient experience; consequently understanding nurse specific patient satisfaction and how it influences patient outcomes is important. It can be used to improve patient satisfaction, patient outcomes, and lastly, hospital’s bottom lines. Conclusion: This study stimulates the need for further study to determine the role of patient satisfaction with nurses in relation to patient outcomes. Future research should include a larger population and additional confounding variables. Similar future projects may illuminate the true nature of patient satisfaction and patient outcomes so they both can be improved.
Major Professor: Roxanne Hauber, PhD, RN
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Nancy DeVries BSN, RN
Care Management and Self-Care Support for High-Risk Patients in a Patient-Centered Medical Home Purpose: The purpose of this study was to:1) assess the care-management and self-care support practices for patients identified as high- risk at a Federally Qualified Health Center (FQHC), and 2) to determine the extent to which the current practices were in alignment with National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) recognition requirements. Methods: This quality improvement study utilized a gap analysis to evaluate the practices of the FQHC. A pre- and post-intervention audit was conducted using the PCMH application standard 4B: Care Management and Self-care Support. Clinical staff participated in a debriefing and an education session addressing the results. Results: There was a significant difference in the scores from the first analysis (M=0.17, SD=0.50) to the second analysis (M=0.47, SD= 0.51) with regard to documentation of treatment goals; t (35) =-2.743, p=0.010. The results suggest that the intervention was effective in increasing compliance with documentation of treatment goals. Despite this 183.33% increase (16% baseline, 47% post-intervention), the results failed to meet the NCQA PCMH criteria for accreditation. Discussion: This study found a care-management gap regarding documentation of treatment goals for high-risk patients by FQHC providers. Involving staff in the PCMH application and audits can increase awareness of best practices for meeting the standards. While providers spoke of having treatment goals, some voiced concern that additional documentation was time-consuming considering other care activities. Moving forward, it is anticipated that the education, process changes, and cultural changes accompanying PCMH transformation should help facilitate provider documentation of care management and self-care support activities for high-risk patients at the FQHC. Conclusions: Nurse practitioners working in practice settings seeking PCMH recognition should take an active role in the process, serving as change agents and champions of this enhanced model of care.
Major Professor:
Barbara Battin Little, DNP, MPH, RN, APHN-BC, CNE
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Daiquiri Frieling RN, BSN
Knowledge of Alternative Therapy Use in the Management of Asthma Symptoms in Florida Purpose: Among adults with asthma in Florida this study aimed to (1) explore the prevalence of alternative therapy use to manage their asthma symptoms, (2) evaluate patient knowledge of alternative therapies, (3) assess level of communication with PCP about alternative therapy use. Methods: A quantitative cross sectional design guided the administration of an online, multiple choice survey. English-speaking adults who resided in Florida, had internet access and an asthma diagnosis for at least 1 year were eligible to participate. The variables investigated were: knowledge of alternative therapies, prevalence of alternative therapy use in Florida, relationship between asthma knowledge and use of alternative therapies, and communication of alternative therapy use with health care providers. Data was analyzed using IMB SPPS version 22. Results: A total of 28 participants, 68% female and 32% male (M= 28 years, S.D. = 9). Gender influenced the use and type of alternative therapies used. Approximately 14% of participants used an alternative provider for treatment and information, but 40% were unaware of potential side effects with conventional medications. Over 50% of participants did not communicate alternative therapy use with their primary healthcare provider Conclusion: Gender was found to be a statistically significant determinant for use of alternative therapy and type of therapy used. The prevalence of alternative therapy use was higher among this sample than predicted. Discussion: The results suggest a need to improve education of patients and providers regarding alternative therapy use, potential risks, and communication. Communication between providers and patients about use of alternative therapies is vital to patient safety and health outcomes.
Major Professor:
Kimberly Hires, PhD, RN
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Amy Gallagher BSN, RN
Florida’s Advanced Registered Nurse Practitioner’s Perceptions, Understanding, and Knowledge of Transitional Care Teams Purpose: The purpose of this project was to assess the current knowledge, perceptions, and understanding of transitional care teams among advanced registered nurse practitioners (ARNPs) in the state of Florida. Methods: A quantitative, descriptive cross-sectional research method was utilized. An electronic survey was distributed to all FL employed ARNPs between October and November 2015. A total of 583 surveys were received, 496 of which completed. Questions included demographic data, clinical experience, educational background, and transitional care knowledge and use. Data was analyzed using frequency and descriptive statistics. Results: Results revealed that 74.6% of ARNPs have no experience working with transitional care teams and 72.2% have never received education related to transitional care services. However, 97.2% of respondents believe transitional care involves the use of an ARNP and 97.3% believe transitional care services would improve patient outcomes following inpatient discharge. Discussion: This study demonstrates that despite formal education or experience, FL ARNPs assume the use of transitional care services is something they may participate in and ultimately improve patient outcomes. Transitional care resources should be made available for training and proper implementation of interprofessional teams caring for vulnerable populations across healthcare settings. Conclusions: There remain gaps in knowledge and utilization of transitional care services throughout the healthcare market. With the expanding population and increasing number of individual’s insured and suffering from chronic diseases the health industry must be prepared for the influx of patient’s requiring both acute and long term care. In an effort to address the lack of health care services available to the growing population we must develop and expand our use of transitional care teams.
Major Professors: Cara Pappas, ND, ACNP, FNP, CCRP
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Sarah Garrett BSN, RN
Does a School Based Vaccination Program Improve Influenza Vaccination Rates? Purpose: The purpose of this paper was to examine influenza vaccination rates of school-aged children, six to twelve years of age, in Suwannee County, Florida. A secondary purpose was to examine the influence of influenza vaccination rates after the implementation of a School Based Influenza Vaccination Program in Suwannee County, Florida. Methods: A non-experimental retrospective chart audit was collected through the Suwannee County Health Department (SCHD) Florida SHOTS records and Healthy Schools, LLC to measure the number of influenza vaccinations administered. The objectives were to review the number of influenza vaccinations administered to school age children, six to twelve years old, in Suwannee County for 2013, 2014, & 2015, compare SCHD influenza vaccination rates to influenza vaccination rates after the Healthy Schools, LLC school based vaccination program implementation, and evaluate influenza vaccination rates for Healthy Schools, LLC program by comparing vaccinations rates for 2014-2015 and 2015-2016. Results: The influenza vaccination rate increased from 0.68% in 2013 when vaccines were offered at SCHD, to 17.6% in 2014 when they were administered through both organizations. In 2015, the relative rate of vaccination was 0.36% at SCHD alone, but when combined with Healthy Schools, LLC rates, the relative rate of influenza vaccination increased to 10.8%. Discussion: This study indicates that implementation of a School Based Vaccination Program is effective in increasing influenza vaccination rates. Dual-organization administration of influenza vaccinations is more effective than only offering vaccinations through the health department. The School Based Vaccination Program helps address barriers to influenza receipt including, access to care and fear of needles. Conclusion: Barriers still exist in getting school-aged children influenza vaccines. However, this study indicates that the Healthy Schools, LLC School Based Vaccination Program increased vaccination numbers. Utilizing the health department and school based program are the best approach to serve this area.
Major Professor:
Bobbi Jamison, EdD, MSN, MBA, ARNP-bc Susan Porterfield, PhD, FNP-c
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Charmaine Gilmore BSN, RN
Nurses’ Knowledge of Depression and Factors Affecting Intent to Assess for Depression in Myocardial Infarction Patients Background: Depression is common following myocardial infarction (MI). Research has suggested a relationship between depression and increased mortality, as well as increased health care expenditures in MI patients. Nurses' knowledge of depression and personal- and work-related factors may influence intent to screen for depressive symptoms in MI patients. Purpose: To explore nurses’ knowledge of depression and factors which influence their intent to assess for depressive symptoms in MI patients. Methods: Using a descriptive, cross-sectional design, a convenience sample (N=1201) of nurses completed an online, self-report survey which included a demographic survey, the Depression Knowledge Test, and personal- and work-related factors which may influence intent to assess for depression. Data analysis included descriptive statistics, correlational analyses, and analysis of variance (ANOVA). Results: Mean depression knowledge score was 15.91 (83.7%). No significant relationship was noted between demographic characteristics and level of depression knowledge. Significant associations were found between personal- and work-related barriers for assessment and gender, age, education level, years of work experience, and type of facility. Conclusions: This study provides evidence that nurses are knowledgeable about depression. Various factors affect nurses’ intent to assess for depression in MI patients. Nurse educators and nurse managers should work to identify potential assessment barriers and provide educational training related to depression screening and available screening tools to facilitate assessment of depression in MI patients.
Major Professor: Lucinda Graven, PhD, MSN, ARNP
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Ellen Huenink BSN, RN
Assessment of Needs for NICU Parent Support Programs Background: NICU parents experience emotional distress leading to depression, anxiety, and adverse infant outcomes. Positive coping mechanisms and support programs have been shown to decrease emotional distress among parents. Parents may not cope positively in stressful situations, and support programs often are underutilized. Purpose: To determine the types of coping mechanisms utilized by NICU parents, and the types of support programs parents are interested in attending. To determine if sociodemographic and length of stay differences impact the types of coping mechanisms utilized, and the types of support programs preferred. Methods: A cross-sectional survey utilizing the Brief COPE tool, as well as questions about demographics and preferred support program styles was used. Descriptive statistics were used to determine the most frequently used coping mechanisms and most preferred support program styles. ANOVA was used to compare sociodemographic characteristics with coping strategies and support program styles. Spearman’s rho correlation coefficients was used to determine associations between utilized coping strategies and preferred support program styles. Results: NICU parents used a variety of coping mechanisms with active coping, use of emotional support, instrumental support, positive reframing, planning, acceptance, and religion being the most common. Support classes were preferred to focus on infant development and talking with other NICU parents. Caucasians were more likely to utilize coping mechanisms of active coping, planning, emotional support, acceptance, instrumental support, and venting when compared to other races. Women were more likely to utilize the self-blame coping mechanism compared to men. Younger parents were more likely to utilize venting and denial coping mechanisms. Conclusion: This study supports the need to develop NICU support groups with parents’ needs and coping preferences in mind. Tailoring the support groups to deal with parental expectations about their infant development as well as arrange meetings with parents who have experienced the same ordeal are key in supporting parents.
Major Professor: Susan Porterfield, PhD, FNP-c
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Sarah Jackson BSN
Exploring Physiological Stability with Implementation of Pediatric Early Warning Score Purpose: The purpose of this project was to compare a nursing studentâ&#x20AC;&#x2122;s assessment skills by the effectiveness of PEWS versus non-PEWS as measured by the acuity of simulated pediatric patients. It was hypothesized that the nursing student will determine differences in acuity of simulated patients using PEWS. The project sought to determine the effect of the application of PEWS by nursing students. Methods: A pretest posttest design was used to test the effect of an intervention designed to aid nursing students in determining the acuity of infants in an acute care setting. Results: A sample of Expert (11) and Novice (9) participants were recruited for the study. Comparisons were made initially by comparing the mean scores of the Novice Group before and after the intervention. There were statistically significant differences in trial 2(P<.05) and Trial-3 (P<.001). Comparisons were then made between the expert and novice pre and posttest scores. The novice pre-test differed from the expert scores in all three trials (p<.005), with the novices assigning higher scores across the board. Discussion: Novices had completed their pediatric training, but initially over-estimated acuity in the scenarios. This is likely related to their lack of confidence in acute situations. The intervention, although brief, appeared to diminish this effect. The results indicate that even novice performers can improve their skill in assigning acuity using a standardized instrument with limited training. Conclusion: In this study the novice nurse assigned greater acuity to the infants initially. In a sense this is positive, since underestimating acuity could be extremely dangerous. It is essential that nurse educators focus on means by which to train students in acuity assessment using standardized tools.
Major Professor: James Whyte, PhD, ND, ARNP
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David Lowery BSN, RN
Delirium Tremens Prevention: An Analysis Purpose: The project evaluated the effectiveness of the screening tools/protocols employed by a Southeastern U.S. hospital, in detecting heavy alcohol consumption and preventing development of delirium tremens. Methods: A descriptive comparative design was employed using a retrospective record review to determine the effects of the TWEAK (Tolerance/Worried/Eye-Opener/Amnesia/Kut Down), CAGE (Cut/Annoy/Guilt/Eye-Opener), and CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol Scale) tools in screening/treating patients at risk for developing delirium tremens. Data were extracted from the first 100 charts in 2014 of all adult patients admitted to the facility with a diagnosis of delirium tremens and analyzed using Microsoft Excel 2013 software. Data included age, gender, TWEAK/CAGE/CIWA scores, length of hospital stay, and behavioral health consults. Results: Institution staff utilized the TWEAK questionnaire for 36% of the patients (n=35) at risk for Alcohol Use Disorder (AUD) while the CAGE tool was used in 25% (n=24) of the cases. 97 total patients presented with a diagnosis of delirium tremens during the 2014 calendar year with 39% (n=38) receiving no AUD screening. CAGE and TWEAK detected 50% (n=8) of the sixteen total cases requiring treatment under CIWA-Ar protocol. TWEAK was more effective at 37.5% (n=6) with CAGE at 12.5% (n=2). Discussion: 5% - 20% of hospitalized patients undergo more advanced levels of AUD, including delirium tremens. While most patients may not progress to life threatening DTs, under- recognition of AUD can increase the risks of seizures, anxiety, mechanical ventilation for the patient, and longer stays in the hospital and the ICU (McPeake et al, 2013). Conclusion: Findings from the project suggest that TWEAK is a more effective screening tool. However, given the small sample size and evidence of a lack of consistent use of a screening tool, duplication of the study with a larger sample size is warranted. In addition, proper education and monitoring is needed to ensure that staff including doctors, nurses, and respiratory specialists, are consistent in their screening of â&#x20AC;&#x153;at riskâ&#x20AC;? patients.
Major Professor: Roxanne Pickett Hauber, PhD, RN
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Dawn Lyke BSN, RN
Nurses' Perceptions of their Competencies in Managing Mentally Ill Patients in the Acute Care Setting Purpose: Patients with psychiatric conditions who are admitted to acute care settings often have higher acuity levels and are at increased risk for adverse outcomes. Literature suggests that hospital nurses lack competency in caring for mentally ill patients and subsequently find these patients difficult and burdensome. The purpose of this study was to assess nurses' perceived competency in providing care to patients with mental health problems in an acute care facility. Methods: The study was descriptive. A convenience sample of Registered Nurses was recruited from five hospital units at a medical facility in Southwest Florida. Participants completed the Behavioral Health Care Competency (BHCC) survey in Qualtrics to assess their competency in caring for patients with psychiatric comorbidities in relation to assessment, practice/intervention, use of psychotropic medications, and resource adequacy. Data were analyzed descriptively. ANOVA and Tukeyâ&#x20AC;&#x2122;s t-test were computed to assess differences between nursing units. Results: Emergency nurses scored highest on all BHCC subscales and orthopedic nurses scored lowest. Nurses reported they felt most competent in the assessment of suicide risk and drug or alcohol problems and accessing resources to assist them in managing patients with comorbid behavioral or psychiatric issues. They reported the least confidence in their ability to recommend psychotropic medications to providers and initiate interventions for patients with psychiatric issues, in particular, intervening to manage hallucinations, conflict and aggressive behavior. Significant differences were found between the emergency room and nurses in other practice settings. Discussion: Higher perceived competency among emergency room nurses is likely related to exposure to multiple patients with behavioral issues associated with psychiatric illness and substance abuse problems. Conclusion: The findings suggest that nurses in medical settings would benefit from further education and training on how to interact therapeutically, intervene effectively and recommend psychotropic medications for patients with comorbid psychiatric problems.
Major Professor: Eileen Cormier, PhD, RN
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Kristin Owens BSN, RN
An Assessment of the Relationship between Autonomy and Job Satisfaction Among Floridaâ&#x20AC;&#x2122;s Nurse Practitioners Purpose: The purpose of the study was to explore the relationship between autonomy and job satisfaction among nurse practitioners (NPs) in Florida. Methods: The project utilized descriptive-correlational design to survey Florida NPs using the MNPJSS and DPBS tools, both of which utilize a likert scale. Results: Data saturation was achieved after six weeks of data collection, resulting in a total of 1000 participants. The mean score for the MNPJSS tool was 18.93 with a standard deviation of 8.021. The lowest possible score for this tool was 10 and the highest was 60. The mean score for the DPBS tool was 122.11 with a standard deviation of 18.304. The lowest possible score for this tool was 30 and the highest was 150. There was a negative correlation between NP satisfaction and every component of autonomous behaviors in practice. There was a significant difference in autonomous behaviors for males (M=125.83, SD=16.01) and females (M=121.62, SD=18.54); t (871) = 2.197, p=0.028. Discussion: Nurse practitioners in Florida report having moderate amounts of autonomous behaviors yet are dissatisfied with their challenge of work/autonomy in practice. Males reported having more autonomous behaviors in practice than females. Conclusions: Although the law restricts Florida NPs in many ways, they still report being moderately autonomous in their practice. However, job satisfaction for them is still low in regard to their autonomy. Given that the study found a negative correlation between job satisfaction and autonomy among Florida NPs, it is imperative that future studies explore ways to improve Florida NP satisfaction. More research is needed to explore the reported differences in autonomous behaviors between female and male NPs.
Major Professor: Susan Porterfield, PhD, FNP-c
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Bridget Ratner BSN, RN
Mortality Rates with SCVO2 Monitoring in Sepsis Purpose: The purpose of this study was to determine if there was an association between mortality rates and SCVO2 monitoring in patients with a diagnosis of sepsis, the frequency of SCVO2 monitoring and if itâ&#x20AC;&#x2122;s a cost effective tool. Methods: This was a retrospective cohort study of 50% of all septic patients admitted to the Intensive Care Unit in eight hospitals. De-identified data from the quality improvement software on mortality rates was gathered. Results: Among the 708 patients for this study, 176 patients received SCVO2 monitoring as part of their care and 532 patients did not. There were a reported 39 deaths in those patients with SCVO2 monitoring and 79 deaths in the population without monitoring. The median number of deaths with SCVO2 monitoring was 5.14 while deaths in patients without SCVO2 monitoring had a median death rate of 10.6. A p -value of 0.004 determined there was a significant difference in mortality rates when SCVO2 monitoring was utilized. The frequency of SCVO2 monitoring by the hospitals ranged from 4.6% of the time to 48.6%. Discussion: This study did find that patients with SCVO2 monitoring had lower mortality rates. Two of the eight hospitals in the study did not have higher mortality rates with SCVO2 monitoring however, these hospitals did not use SCVO2 monitoring as frequently as some of the other hospitals. Previous studies have looked at whether or not all of the SCC guideline were necessary in the care of patients with sepsis and found that protocol based care and usual care may be equivalent or superior to the SCC early goal directed care. Conclusions: Although SCVO2 monitoring does not direct the care of the patient with sepsis, SCVO2 monitoring and mortality rates are improved when it is utilized. Further research is needed on how to treat the SCVO2 value in an effort to improve patient outcomes.
Major Professor: Susan Porterfield, PhD, FNP-c Denise Tucker, PhD, FNP-c
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Jessica Scharein BSN, RN
Evaluation of Migraine Headache Treatment in the Emergency Department Purpose: Pain associated with headaches can be severe and disabling. Headaches, in particular migraines, are associated with high healthcare utilization by patients seeking acute pain relief. The absence of standard guidelines contributes to high variability in pharmacologic treatment of acute headaches in emergency rooms (ER) and primary care settings. Despite recommendations to avoid use of the opioid analgesics, they continue to dominate headache management. The purpose of this study was to identify the most commonly prescribed medications for headache related complaints in the ER and primary care setting. Methods: The study was descriptive and used de-identified archival data from a primary care medical practice that is part of a larger healthcare organization. The convenience sample included electronic health records (EHRs) of patients with an ICD-9 headache diagnosis from a primary care practice who had presented to the ER for headache or migraine within the past five years. Descriptive statistics were used to analyze extracted data. Results: The EHRs of 49 primary care patients met inclusion criteria. The three most frequently administered medications during ER visits were ketorolac (19%), metoclopramide (18%), and diphenhydramine (17%). The most commonly prescribed discharge medications in the ER were butalbital-combinations (49%). Primary care providers most often diagnosed and prescribed migraine specific medications for initial management (42%) but also commonly prescribed butalbital-combinations (26%). Discussion: The high frequency of non-opioid analgesic administration in both settings may reflect increased provider knowledge of the association between opioid use and headache recurrence. While less well known, butalbital combinations are associated with higher risk of headache disorder progression from episodic to chronic with as few as five uses per month. Conclusion: The findings suggest providers adhere to prescribing recommendations when considering opioids and headaches. They could benefit from further education about the association between butalbital-containing products and development of chronic headache disorders.
Major Professor: Eileen Cormier, PhD, RN
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James Sellers
BSN, RN, CCRN, CFRN, CEN, NR-P
Workplace Violence and Incivility in the Healthcare Setting Purpose: The purpose of this project is to describe the incidences of verbal abuse (i.e. situational details, witnesses present, patients involved), determine common characteristics of witnesses and victims of verbal abuse, and determine if there are specific demographic characteristics that make one more prone to be a victim or a witness of verbal abuse. Methods: Through Qualtrics, an online survey tool, participants were e-mailed an invitation to participate if they held a valid nursing license in the State of Florida and had an e-mail address on file with the Florida Board of Nursing. Cross tabulation and chi-square statistics were used to determine any correlation and significance of the variables. Results: Over 70% of respondents were victims of or witnesses to multiple episodes of verbal abuse occurring over various periods of time. Verbal abuse is more likely to occur in hospital and high-acuity settings. Verbal abuse takes place with witnesses or patients present. Less than half of victims or witnesses knew the actual reason for the verbal abuse. Physicians and nurse leaders are the most common instigators. Nurses with 1-5 years or greater than 35 years of experience were more likely to be victims or witnesses. Level of nursing training or degree attained had no significance on being a victim or witness to verbal abuse. Discussion: Types and occurrences of verbal abuse were described in this study, as well as the settings and characteristics of nurses most likely to be victims of or witnesses to verbal abuse. Conclusions: Most nurses have been victims of or witnesses to verbal abuse. Disruptive behaviors, such as verbal abuse, are costly in terms of patient care, medical errors, and employment. A better understanding of verbal abuse can help end it, leading to safer and more effective patient care settings.
Major Professor: Susan Porterfield, PhD, FNP-c
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Christina Smith BSN, RN, CCRN
Critical Care Nursing Retention Purpose: this project was to determine the critical care nursesâ&#x20AC;&#x2122; current education levels, if they were enrolled in a baccalaureate or higher degree programs, intent to leave and relationship between utilization of advanced practice nurses in critical care and intent to stay. Method: This descriptive study was a cohort of one organization consisting of 12 hospitals in the Southeastern United States. Using a web-based questionnaire, critical care nurses were asked to evaluate critical care nursing intent to stay and the correlation to advancement of education level, as well as advanced registered nurse practitioner utilization in critical care. Results: A review of 245 participants revealed that there is an association between critical care nursing intent to stay and educational advancement (BSN or higher), as well as utilization of advanced registered nurse practitioners in critical care. Over three-quarters (77.5%) of the participants agree that using advance practice registered nurses as team leaders and mentors in the critical care units would improve job satisfaction and nursing retention. Discussion: An association between advancement of degree and intent to stay at the critical care bedside was discovered, especially among the graduate degree students. A profound association between utilization of ARNPs in critical care as team leaders/mentors and intent to stay was also discovered revealing 77.5% of the respondents agreeing employee satisfaction and intent to stay would improve. Conclusion: The findings of this study reaffirmed previously known evidence of the relationship between intent to stay. However, these results demonstrated need for further research with respect to advancement of degree and intent to leave the critical care bedside, as well as utilization of the ARNP as a more centralized role in critical care as a nursing mentor/leader and the association with intent to leave the critical care bedside.
Major Professor: Susan Porterfield, PhD, FNP-c
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Abisoye Somorin BSN, RN
Pain Management, Self-Efficacy and Quality of Life: A Cross-Sectional Quantitative Study Introduction: Sickle Cell Disease patients often receive inadequate pain management due to inadequate clinician education, negative attitude and failure to apply pain management guidelines. Understanding patientsâ&#x20AC;&#x2122; perceived self-efficacy and quality of life could shed light on the potential impart of opioids use in sickle cell patients Purpose: This study explored the relationships among the morphine- equivalent dose of opioids used, self-efficacy and the quality of life of SCD patients in the United States. Method: This was a cross-sectional quantitative study of adult sickle cell disease patients. Data were collected online through questionnaire using a standardized Quality of life (QoL), Short Form 36 (SF-36) questionnaire and a nine-items Self-efficacy concept tool . Result: The result showed that there was a significant negative correlation between the dose of opioids used and patientsâ&#x20AC;&#x2122; self-efficacy (-0.659xx, p=0.05) and quality of life (-0.698xx, p=0.05). In addition, the regression revealed that vitality (energy) (b = 0.52, t = 2.46, p < 0.05) and the self-efficacy (b = -0.79, t = -2.61, p < 0.05) independently predict the morphine equivalence of the opioids used by sickle cell disease patients. Conclusion: These findings have implication for understanding opioids use among sickle cell patients. Furthermore, the findings will aid in teaching healthcare practitioners as well as patients and their families about the need for multimodal analgesic regimen thereby reducing opioids use.
Major Professor: James Whyte, PhD, ND, ARNP
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Kyrie Stewart BSN, RN
Breast cancer literacy among female undergraduates at a southeastern university Purpose: The purpose of this project is to determine breast cancer literacy rates for a group of female undergraduate college students. Methods: A cross-sectional design with convenience sampling was used. The sample included 283 undergraduate females between ages 18 and 32. A paper-and-pen survey, which included demographic questions and the Breast Cancer Literacy Assessment Tool (Breast-CLAT), was administered. Analysis using arithmetic means and independent sample t-tests were performed. Results: The overall literacy score was 80.3%, with a score of 80% considered ‘functionally literate’. Nursing majors and upperclassmen (classified as junior or senior) had significantly higher literacy rates, specifically in the screening and prevention categories. Women with a positive family history in a first degree relative scored lower in the ‘awareness’ category. Family history of breast cancer, ethnicity, nor age was statistically significant in overall score. Discussion: For university educated women, a score of 80.3% barely meets the recommended level for literacy; a finding which supports the CDC’s focus on young adult women. When the sample was analyzed by groups (nursing majors vs. other majors and upperclassmen vs. lowerclassmen) nursing majors and upperclassmen scored significantly higher; inferring that level of education, whether in the nursing field or not, has the greatest impact on breast cancer literacy. Women with a positive cancer history in a first-degree relative may have scored lower in the awareness category due to a ‘hyper-vigilant’ state; there were inaccuracies in their perceptions (i.e. they perceived situational risk that did not exist). The lack of statistical significance in ethnicity suggests the equalizing effect of education. Conclusions: Although functionally literate, educational efforts need to focus on ‘awareness’ in this population; dispelling common myths regarding breast cancer. Research opportunities for the future include focusing on women under age 40 and investigating whether or not disparities exist between college-educated and non-collegeeducated women.
Major Professor: Roxanne Pickett Hauber, PhD, RN
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Sarah Whipple RN
Building Resiliency in Staff Nurses through Reappraisal: A Pilot Study Purpose: Evidence suggests that acute care nurses are at high risk of compassion fatigue and burnout, but those with higher resiliency are at lower risk. The aim of this pilot study was to evaluate the feasibility and acceptability of the “3 Good Things” method of positive cognitive reappraisal and determine if the intervention improved nurses’ resilience and reduced their risk of compassion fatigue and burnout. Methods: A convenience sample of acute care nurses at a large community hospital in Florida completed pre- and post-intervention surveys following an information session on resilience and the “3 Good Things” method of cognitive reappraisal. Participants were asked to record “3 Good Things” in a journal daily over 21 days. The Professional Quality of Life (PROQOL5) and Workplace Resilience Inventory (WRI) as well as a feasibility/acceptability questionnaire were used. The surveys were compared to determine any changes in resilience and compassion fatigue and burnout scores between pre- and post-intervention. Results: Of the 17 nurses who completed the pre-intervention surveys and information sessions, 7 returned the post-intervention surveys with their journals. Participants reported an increase in compassion satisfaction and a decrease in burnout and/or secondary traumatic stress (compassion fatigue). All of the participants reported the intervention was easy to implement, beneficial and would recommend it to others. Discussion: The low number of participants who returned journals and surveys suggests the study design could be altered to increase participation and intervention follow through. The improvements in compassion satisfaction and reduction in burnout and compassion fatigue suggest further testing of the “3 Good Things” method of positive reappraisal is warranted with a larger and more diverse sample of nurses. Conclusion: The intervention was shown to be acceptable and feasible with some modifications of the study design needed to increase participation.
Major Professor: Eileen Cormier, PhD, RN
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Florida State University College of Nursing Duxbury Hall 98 Varsity Way Tallahassee, FL 32306