Doctor of Nursing Practice Spring Research Exposition
COVER
April 30, 2015
COLLEGE OF NURSING MISSION STATEMENT To develop nursing leaders for professional practice and research in diverse settings.
Programs donated by: Beta Pi Chapters of Sigma, Theta Tau International
The FSU College of Nursing is proud to welcome you to the 2015 Spring Research Exposition. This exposition features the capstone projects of 19 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). The Health Systems Leader Program (HSL) emphasizes nursing practice, ongoing improvement of health outcomes and ensuring patient safety. Graduates of the program demonstrate expertise in assessing organizations, identifying system issues and facilitating organization-wide changes in practice delivery.
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Our 2015 Doctor of Nursing Practice Graduates
Chelsea Arnold Lori Carver Rebecca Conway Carrie Beth Ent Kelly Fethelkheir Ally Fields Nicole Green* Arin Jackson Vincent Labarca Melanie Lonkani Sarah Luce Ian Macdonald Rachel Marquina Michele Martinez Jenifer Ranft Maureen Sander Susan Shkrab Katie Stefani Karen Thibodeau Candice VanDerSchaaf
* student presented project in 2014
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Chelsea Arnold BSN, RN
DNP Family Nurse Practitioner
The Impact of the 5210 Healthy Heroes Program on Children’s Body Mass Index and Healthy Lifestyle Behaviors Purpose: The purpose of this project was to evaluate the effect of the 5210 Healthy Heroes program on children’s healthy lifestyle behaviors and Body Mass Index (BMI). Method: The 5210 Healthy Heroes program consisted of six group medical visits cofacilitated by a primary care provider and health educator in a Sarasota County community health center. Analysis of parent-reported forms were used to assess the effect of the program on child Body Mass Index and healthy lifestyle behaviors. Results: Participants included six obese/overweight children and their guardians. Based on the parent report, the children in this study had the following behavioral changes from months 1-3 to months 4-6: the daily average consumption of fruit/vegetable decreased from 2.3 to 1.4 handfuls, TV/videogame time decreased from 2.7 to 2.4 hours, physical activity increased from 1.4 to 1.6 hours, and sugary beverage consumption increased from 1.6 to 1.8 cups. Child BMI increased from 27.7 kg/m2 to 28.2 kg/m2 (months 1-3 and 4-6 respectively). Conclusion: Child-parent obesity group medical visits could be a cost-effective method to improve child lifestyle behaviors, increase peer support, expand healthcare provider productivity, and increase patient and physician satisfaction. However, the 5210 Healthy Heroes program did not have a significant effect on any lifestyle behavior changes or BMI. Recommendations to improve the program include: increasing incentives for families to participate, incorporating healthy snacks into meetings, holding separate English and Spanish classes, and utilizing interactive nutrition games.
Major Professor: Barbara Battin Little, DNP, MPH, RN, APHN-BC, CNE
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Lori Carver MS, RN
DNP Family Nurse Practitioner
Assessing General and Colorectal Cancer Health Literacy Among African Americans: A Community Initiative Purpose: To assess the general health literacy and colorectal cancer (CRC) literacy of African American men and women living in the Southeastern United States, and to present the findings to focus groups in this community in order to determine effective preventive care activities in relation to colorectal cancer. Method: This project used a participatory needs assessment approach, and participants were recruited from multiple community sites. Participants were english speaking, African American men and women, 45 years or older, who are able to read and write, and have never been diagnosed with CRC. The Test of Functional Health Literacy in Adults was used to evaluate general health literacy, and the Assessment of Colon Cancer Literacy was used to evaluate colon cancer literacy. Results: Thirteen adults participated and the data revealed adequate general health literacy but inadequate colon cancer literacy. Another objective of this study was dissemination of the survey results. Unfortunately, due to low levels of participation and the inability of organizations to respond resulted in dissemination not being achieved. Discussion: Findings suggest that although a group of educated people may have a strong knowledge regarding basic health literacy, this does not translate into adequate knowledge of specific disease literacy. Accurate assessment of literacy levels need to be established for general health and any disease specific area of interest. Conclusion: Too often providers overestimate the literacy levels of their patients. Assessing health literacy in all patients should be the standard in order to ensure patients are given health advice and instruction on a level they can understand and use.
Major Professor: Roxanne Pickett Hauber, PhD, RN, CNE
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Rebecca Conway BSN, RN
DNP Family Nurse Practitioner
Epidemiology, Risk Factors and Outcomes of Respiratory Virus Infections in Adult Acute Leukemia Patients Purpose: The purpose of this study is to assess the epidemiology, risk factors and outcomes of the leukemic or HSCT population who develop respiratory viral infections. Background: Respiratory Viral Infections (RVI) are a significant cause of morbidity and mortality in adult hematopoietic stem cell transplant (HSCT) recipients, causing delayed administration of chemotherapy and HSCT, increased hospital stay and occasionally death. Respiratory viral infections (RVI) have been studied extensively in the HSCT population but less so in the acute leukemia population, which is the focus of this project. Method: This retrospective cohort study of adult patients (≼18yrs) with acute leukemia and/or after HSCT were diagnosed with laboratory documented RVI between May 1, 2010 and March 1, 2014. A list of positive RVIs from multiplex PCR was retrieved from the hospital laboratory based on patients with specific ICD-9 codes. A chart review was conducted collecting data on patient demographics, risk factors associated with RVI and outcomes/resource utilization related to treatment or management of infection. Results: There were 206 episodes of RVI in 122 patients: 162 episodes (89 patients) were post-HSCT and 44 episodes (33 patients) had acute leukemia without undergoing HSCT. In the acute leukemia patients, rhino virus accounted for 59.1% (n=26) of the infections, corona virus 13.6% (n=6), RSV 9.1% (n=4), parainfluenza virus 6.8% (n=3), metapneumovirus 6.8% (n=3) and influenza 4.5% (n=2). Risk factors associated with the progression of lower tract respiratory infection (LRTI) were male gender, low absolute neutrophil counts (ANC) and underlying disease of acute myelogenous leukemia. Conclusion: Identifying and understanding risk factors can better guide symptom management and treatment for acute leukemia patients with RVI; thus improving mortality, outcomes and resource utilization.
Major Professor: Laurie Grubbs, PhD, ARNP
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Carrie Beth Ent BSN, RN, CCRN
DNP Family Nurse Practitioner
The Influence of Telemonitoring on Depression in Adults with Heart Failure Purpose: The primary goal of this study was to test the hypothesis that adults with heart failure who received telemonitoring (TM) would report a greater reduction in depression over a period of six months than adults with heart failure (HF) who received nursing visits Background: In addition to limiting quality and length of life for over 5.8 million Americans, heart failure often presents with co-morbid depression. Depression in the presence of heart failure contributes to increased hospitalizations. Heart failure hospitalizations have a serious impact on the cost of care in the United States. Method: This longitudinal study was a part of a larger, multi-site clinical trial, in which adults with HF were recruited and randomly assigned to the intervention (TM and monthly nurse visit) or control (monthly nurse visit only) groups. An additional non-HF (healthy) group of adults were assigned to the intervention condition. A total of 60 participants completed this study. Scores on the Centers for Epidemiologic Studies Depression (CES-D) survey were used to assess depression; these were collected at both the beginning and end of the six-month study. Results: Overall, all groups had a significant reduction in CES-D scores over the course of the study. However, no significant difference in score reduction occurred between groups. Additionally, no significant difference was identified in CES-D score change among participants who lived alone compared to those living with family (TM groups only). Conclusion: Although this research suggests that home health interventions are important in reducing the severity of depression in adults with HF, this study does not provide evidence that TM is more effective than standard home health care. Further research evaluating the effectiveness of various home health and TM protocols in reducing depression in adults with heart failure is needed.
Major Professor: Cara Pappas, ND, ACNP, FNP, CCRP
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Kelly Fethelkheir MSN, RN, NE-BC
DNP Health Systems Leadership
The Impact of the Clinical Nurse Leader on Patient and Organizational Outcomes Purpose: The purpose of this study was to examine the impact of the Clinical Nurse Leader (CNL) on outcomes of three clinical microsystem settings at a medical center in the Southeast. Background: The CNL® role was developed by the American Association of Colleges of Nursing (AACN) in an effort to provide clinical leadership on the unit microsystem. The CNL role was implemented on three clinical microsystems of a large medical center. All CNLs® obtained a Master of Science degree in nursing, graduated from an AACN approved CNL® program, and successfully passed the CNL® certification exam. All CNLs® selected had been functioning on their respective units for at least six months prior to the onset of this study. Method: A comparative analysis of archival data specific to unit performance measures, the average length of stay (ALOS) and patient satisfaction scores pre and post implementation of the CNL® was conducted. Results: There was no statistical significance in the clinical performance measures except the assault rate which decreased on the mental health units. The ALOS remained constant pre and post implementation of the CNL®. There was no statistical difference in the patient satisfaction scores. Discussion: In the absence of CNL® driven initiatives, analysis revealed the CNL® does not validate its intended purpose of impacting patient outcomes. These results illustrate the need to identify improvements for implementing and sustaining the CNL® at the organizational and unit level. Efforts should be employed to provide education to all members of the healthcare team regarding the role of the CNL®, strong leadership support for the role and CNL® lead initiatives to improve care delivery and processes. Conclusion: The CNL® is in a position to positively impact patient and organizational outcomes though facilitating direct care nurses to practice at the highest level. The use of clinical performance metrics can be beneficial in evaluating the cost-benefit of the CNL® to the organization. Further research is needed on best-practices on how to manage the impact and effectiveness of the CNL® on the unit microsystem.
Major Professor: Barbara Battin Little, DNP, MPH, RN, APHN-BC, CNE
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Ally Fields BSN, RN
DNP Family Nurse Practitioner
A Study of the Effect of Initiation of Mild Therapeutic Hypothermia on Neurological Outcomes in the Cardiac Arrest Patient Purpose: Since 2010, therapeutic hypothermia (TH) has been the standard of care for successfully resuscitated comatose cardiac arrest patients. The purpose of this study was to study the effect of initiation of therapeutic hypothermia on neurological outcomes in the comatose cardiac arrest patient. Method: In this retrospective study, data of cardiac arrest survivors treated with therapeutic hypothermia from 2009 to 2014 was analyzed and compared to survivors who did not receive TH treatment. Of these, 56 patients were treated with hypothermia 33¹ 0.5° C for 24 hours, while 56 who did not fulfill inclusion criteria received comparable therapy without hypothermia. Neurological outcomes were categorized by using the modified Rankin scale (mRs). Results: Patients who underwent TH had a statistically significant greater likelihood of surviving (p<.001). Twenty-five of the 56 (45%) patients who underwent TH survived. Of this group, 79% (n=19) had a mRs of 0-3 and were considered to have a good neurological outcome. The only reliable predictor of mRs score was initial lactate level (Adjusted R2 .182, p=.003). Lower initial lactate levels predicted a greater likelihood of good neurological outcome. Discussion: The average time intervals in this study were lengthy, with the initiation of therapy in 71% of patients at greater than 220 minutes. Although initiation times were prolonged, patients who underwent therapeutic hypothermia had a greater likelihood of surviving with good neurological outcomes. Conclusion: The study validates the utility of therapeutic hypothermia as a treatment in the preservation of neurological function and in raising the likelihood of survival.
Major Professors: James Whyte, PhD, ND, ARNP
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Arin Jackson BSN, RNC-OB
DNP Family Nurse Practitioner
Addressing Nurse/Patient Communication in the Obstetrical Setting Purpose: The purpose of this study was to determine if a newly implemented care plan protocol would be associated with patient satisfaction with nurse/patient communication in the obstetrical setting. Background: Communication encompasses not only what the patient is told, but also how the information is relayed to them, the opportunity to ask questions, and how the staff responds to those questions. Method: A one-group post-test design was used to evaluate a recently implemented intervention to improve nurse-patient communication. Two survey tools were used to measure patient satisfaction: the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) questionnaire and the Care Plan Assessment Survey (CPAS). Women admitted for delivery of infants were offered three interventions to improve communication: a patient initiated care plan (birth plan), a printed copy of an individualized plan of care and patient itinerary. Nurses reviewed the plan of care with the patient and addressed concerns each shift. Results: Of the 161 women who completed the CPAS prior to discharge, those who received the care plan interventions (n=61) reported higher levels of satisfaction with nurse-patient communication than those who did not. They felt included in the development of their plan of care and their care was individualized to their needs. It was not possible to incorporate hospital HPAC data to evaluate the intervention protocol due to the short data collection period. Conclusion: The new care plan intervention was associated with high patient satisfaction. Further studies of enhanced patient involvement in birth planning and care are warranted.
Major Professor: Eileen Cormier, PhD, RN
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Vincent Labarca BSN, RN
DNP Family Nurse Practitioner
A Study of the Effect of High-Fidelity Simulation on Student Performance in Providing End-of-Life Care Purpose: The purpose of this study was to determine if a high-fidelity simulation-based (HFS) intervention would improve nursing student performance in providing end-of-life (EOL) care. Method: This study utilized a quasi-experimental research. BSN students were randomized into two groups. Both groups received a lecture that addressed key aspects of EOL care. The experimental group then participated in a simulated training session. All participants took a simulated post-test in order to identify differences in performance between the groups. Rates of occurrence and timing of interventions were used to quantify the presence of variables throughout each participantâ&#x20AC;&#x2122;s simulation experience. An independent sample t-test was performed for each individual variable to compare the mean performance of both groups. Results: A greater percentage of participants in the experimental group completed the interventions. Participants in the experimental group were also less likely to miss key interventions. Of the 12 variables, 2 were statistically significant. The participants in the experimental group had a lower mean time of performance in 8 of the remaining 10 non-statistically significant variables. Discussion: Students who received a simulation intervention in addition to an EOL care lecture were more likely to complete EOL care interventions and were more likely to be quicker in providing care than students who only received a lecture. Students who were able to practice addressed patient needs in a timelier manner and were more consistent in their delivery of care. Conclusion: This study sought to determine if students who received a simulation intervention would outperform those who did not in providing EOL care. The results of this study indicate that HFS is a suitable method of teaching and reinforcing EOL care concepts. The results of this study should provide an impetus for nursing programs to explore the integration of simulation into their curriculum.
Major Professor: James Whyte, PhD, ND, ARNP
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Melanie Lonkani BSN, RN
DNP Family Nurse Practitioner
Nurse Knowledge of Forensic Practices and Care of Sexual Assault Patient Purpose: The purpose of the study was to determine nursesâ&#x20AC;&#x2122; knowledge of forensic practices for sexual assault patients, and whether specific forensic training was associated with accuracy. Method: Florida nurses were emailed an invitation to participate in an online survey that included demographic and educational questions and ten questions about different aspects of the medical-forensic examination. The survey was available for approximately two months. Results: The responses of 1,582 nurses were included for analysis, which demonstrated a strong association between Sexual Assault Nurse Examiner (SANE) training and ability to answer correctly. SANE trained nurses scored the highest in 8 of 10 questions. Nurses with other formal training (eg. undergraduate or graduate class) ranked second in scoring. Those without formal training were least likely to answer correctly in every category. Discussion: This is the first study to assess the knowledge of a general nursing population about the medical-forensic exam and best practices for care of the sexual assault patient. Still, the data demonstrating the accuracy of the SANE trained nurse validates existing studies. Accuracy was very low when questions involved legal language or areas subject to recent innovation. Conclusion: Since approximately one third of sexual assault patients do not receive care from a SANE or other forensic specialist, the fundamentals should be integrated at all levels of nursing education to ensure optimal patient care. Further, research should focus on assessing the continuing education needs of SANEs.
Major Professor: Susan Porterfield, PhD, FNP-c
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Sarah Luce BSN, RN
DNP Family Nurse Practitioner
Purposeful Hourly Rounding, Falls Reduction and Patient Satisfaction Purpose: This purpose of the study was to identify the effect of purposeful hourly rounding (PHR) on the incidence of falls in an inpatient population. The data for the study included patient specific events and measurement of data such as patient satisfaction surveys. Method: A quasi-experimental research design was applied to compare the effects of PHR on falls reduction and patient satisfaction. The study was conducted in a 120-bed acute care hospital located in the southeastern United States. To best control the sampling and mitigate the influence of confounding variables, the 21-bed orthopedic unit was selected. All orthopedic inpatients, aged 65+, were included in the study. The investigation occurred between October-December 2014. Results: No falls occurred during the study period. Descriptive statistics were used to identify trends in the data. There were no differences in fall rates with the initiation of hourly rounding. Overall patient satisfaction was markedly reduced during the study period despite the fact that hourly rounding increased by 36%. Discussion: Consistently, the literature has cited difficulty in practice permanence and lacked conclusive evidence that hourly rounding initiatives statistically reduced the incidence of inpatient falls. Likewise, it was difficult to establish a sufficient sample size and concurrently eliminate confounding fall factors. The amalgamation of outcomes in this investigation mirrored the findings of similar studies. Conclusion: This investigation found no conclusive evidence that PHR is effective in the reduction of patient falls or the enhancement of patient satisfaction. More research is necessary to affirm or disprove these findings.
Major Professor: James Whyte, PhD, ND, ARNP
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Ian Macdonald BSN, RN
DNP Family Nurse Practitioner
Education of Parents on Sports-Related Concussions Purpose: Approximately 30 million children and adolescents in the United States participate in various forms of organized sports, and incidents of traumatic brain injuries (TBI) in emergency departments increased 62% from 2001 to 2009. Knowledge, information, and preventive interventions for TBI have been disseminated among athletic personnel at the professional, collegiate, and high school levels. However, research regarding parentsâ&#x20AC;&#x2122; perceptions and knowledge of sports-related concussions (SRC) is lacking. The purpose of this project was to determine the impact of interventions designed to improve parental awareness of sports related concussions. Method: The project used a demographic information sheet and a post intervention survey design. Surveys were used to determine the impact of three distinct educational tools on the perceptions and knowledge of sports-related concussions in a group of parents with children actively involved in sports. Results: Forty-seven percent of participants completed the demographic information sheet with the majority of them African American who had at least one child competing in high school contact sports. Eighty-five percent of the parents felt that sports-related concussions are a critical issue although only 46.8% of the parents had ever sought out information to learn more about SRC. Twenty-nine individuals participated in the post educational survey after the intervention, and the majority of parents perceived that all three educational tools were written and presented in a fashion that changed their perception, awareness and knowledge of sports-related concussions. Conclusion: Findings from the present project suggest that parents know what educational approaches work best for them. However, it also suggests that a one time educational intervention is not sufficient to move many parents to be proactive. The scarcity of published studies speaks to the need for further research focused on facilitating parents to be proactive in relation to their children and sports-related concussions.
Major Professor: Roxanne Pickett Hauber, PhD, RN, CNE
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Rachel Marquina BSN, RN
DNP Family Nurse Practitioner
Improving Diabetes Knowledge in Hispanics Purpose: The aim of this study was to determine whether participation in a culturally tailored educational session would improve overall knowledge regarding diabetes. Method: An educational intervention was administered at a church and the Redlands Christian Migrant Association locations to Spanish speaking participants. The participants were tested before, and after the intervention with the Diabetes Knowledge Questionnaire (DKQ-24). Results: There was significant improvement in participant scores following the intervention. Seventy-nine (67%) participants of those who attended completed the posttest questionnaire. Each question posed a statement regarding diabetes etiology, care or treatment. Participants were asked to give a single response- “yes,”, “no,” or “I don’t know.” A paired t-test was performed to compare the difference in the average number of correct answers in the pre- and post-intervention. This test had a p-value smaller than 0.0001, indicating a significant increase in the average number of correct answers. Each of the pre-test and post test questions were individually measured using a t-test. Significant improvements (p-value <.0001) were seen in 18 of the 24 questions in the DKQ-24. Questions in which participants performed poorly were examined to improve recommendations for possible changes in future diabetes educational interventions. Discussion: Evaluation of this culturally tailored diabetes education intervention in a Hispanic population gives an example of an effective way to promote diabetes education, elucidating the positive and challenging aspects of the intervention. Conclusion: Implications for this study suggest that a culturally tailored intervention may be effective in a Hispanic population. More research is needed to improve education.
Major Professor: Susan Porterfield, PhD, FNP-c
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Michele Martinez BSN, RN
DNP Family Nurse Practitioner
The Impact of a Nurse Led Telehealth Monitoring Program on Self-Efficacy in Adults with Heart Failure Purpose: The purpose of this project was to determine whether participating in a nurse led telehealth monitoring program affects the self-efficacy of adults with heart failure. Heart failure is a complex, chronic disease that affects approximately 5.8 million individuals in the United States. Findings from some studies suggest that self-efficacy and the ability individuals have to manage their disease, contributes to a reduction in the burdens associated with heart failure. Method: The project utilized data from a larger telehealth research study. Participants were randomly assigned to either monthly nurse visits in addition to continuous monitoring by a telehealth system or monthly nurse visits without the telehealth system for 6 months. Quantitative data was collected from participants using the Kansas City Cardiomyopathy Questionnaire’s (KCCQ) subscale of self-efficacy. Results: There was no statistically significant difference in self-efficacy scores between groups. Self-efficacy scores were increased from the baseline in both the telehealth group and the nurse visit only group. However, there was a statistically significant improvement in self-efficacy (p=0.037) over the six-month period in the nurse visit only group. Discussion: While the use of a telehealth system may facilitate self-efficacy, the present study suggests that the monthly nurse visit is equally, if not more effective in improving self-efficacy in individuals with heart failure. Conclusion: Clearly, more research is needed to determine “best fit” approaches to maximize self-efficacy and other positive outcomes for individuals with heart failure, while reducing healthcare costs.
Major Professor: Roxanne Pickett Hauber, PhD, RN, CNE
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Jenifer Ranft BSN, RN
DNP Family Nurse Practitioner
Verbal Abuse Within the Healthcare Workplace Purpose: The purpose of this secondary data analysis was to determine what characteristics have an impact on reporting verbal abuse, and what the recommendations are based on the literature. Background: The healthcare field is a stressful environment in which nurses are exposed to disruptive behavior. Disruptive behavior can be covert or overt and the most prevalent being physical, verbal, and electronic abuse. Nurses have a higher risk of experiencing verbal abuse in the workplace than any other industry, due to the high-stress environment as well as the close relationships that are formed in this industry. Method: Secondary data analysis using quantitative and descriptive design was used to analyze the relationships between verbal, physical and electronic abuse, determine the top three types of verbal abuse by demographic variables, determine the occurrences of verbal abuse by coworker by demographic variables, and make recommendations to eliminate verbal abuse in the workplace. Results: Verbal abuse was the most prevalent type of abuse found in the healthcare workplace. Verbal abuse is present even with physical and electronic abuse. The top three types of verbal abuse was gossiping, accusing, and blaming. Significant relationships were found between verbal abuse and gender, age in years, position, and experience in years. Significant relationships were also found between abuse by coworker and gender, age in years, experience in years, and education. Conclusion: Verbal abuse exists in the workplace and affects nurses negatively in their personal and professional lives. Patient care and patient safety continue to be impacted by these abusive relationships. Although, zero tolerance from verbal abuse is expected it still exist in the workplace. Stricter guidelines need to be in place to protect and allow the work environment to be safe and productive.
Major Professor: Susan Porterfield, PhD, FNP-c
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Maureen Sander BSN, RN
DNP Family Nurse Practitioner
Dissociation and Resilience in Emergency Nurses Exposed to Persistent Secondary Trauma Background: Little is known about the coping mechanisms used by emergency nurses to ameliorate the impact of daily exposure to traumatic events in order to foster resilience and facilitate development to clinical expert. Purpose: The purpose of this study is to determine if there is a relationship between years of experience in emergency nursing, level of education, dissociative tendencies and resilience in emergency nurses. Conceptual Models: Newman’s theory of health as expanding consciousness and Charney’s resilience and vulnerability model informed the study design and interpretation of findings. Method: A descriptive survey design was used. The survey (biographical, Connor-Davidson Resilience Scale [CD-RISC 10] and Dissociative Experiences Scale II [DES II] was electronically delivered to 39,800 nurses in Florida. Data was analyzed descriptively. Spearman rho correlation coefficients were calculated to examine the relationships among key variables. Results: The majority of participants (N=385) were baccalaureate prepared (33%) with up to 40 years (M=13) of experience in the emergency room. Participants’ scores on the CD-RISC 10 and DES II indicated higher resilience and lower dissociative tendencies than nonclinical populations. Nurses with higher levels of education were more resilient (r= .15, n= 366, p < .01). The more experienced nurses reported fewer dissociative responses (r= -.12, n= 381, p < .05). Higher resilience was associated with lower dissociative responses (r= -.14, n=369, p < .01). Conclusion: The findings suggest that nurses working in the emergency department over time adapt their responses to stressful situations through pattern recognition, requiring a decreased need for dissociative coping measures.
Major Professor: Eileen Cormier, PhD, RN
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Susan Shkrab
MSN, RN, NE-BC, CPHQ DNP Health Systems Leadership
Forwarding the IOM Goals for Nursing Education in Southwest Florida Purpose: The purpose of this study was to evaluate the effectiveness of an educational session and resource guide in affecting the extent of educational advancement strategies nursing leaders utilize to achieve the Institute of Medicine (IOM) recommendation of 80% BSN prepared nurses by the year 2020. Method: This descriptive study utilized a pre-test, post-test design with a survey instrument titled the â&#x20AC;&#x153;Future of Nursing Surveyâ&#x20AC;?. A regional nursing action coalition undertook the planning and implementation of an educational program and resource guide with strategies for nurse leaders to promote BSN education. Ninety minute educational presentations were conducted with nurse leaders in hospitals within a three county area. The Strategies for Increasing BSN Prepared Nurses: A Resource Guide for Employers was used during the workshop and distributed to participants for use in their organization. Results: Seventy-six (76) nursing leaders participated in the four educational sessions and completed the pre-survey for baseline data. Twenty-eight (28) participants completed the post-survey for a 37% response rate. The intent of nursing leaders to implement the strategies was mixed, with some strategies executed more often than others. Over 75% of the participants reported assessment of current proportions of BSN prepared nurses and the provision of tuition reimbursement both pre-and-post intervention. The largest post-intervention increases were in the use of a forecasting model, use of career ladders, onsite academic program recruitment, faculty serving on hospital committees, and usefulness of the resource guide. Discussion: Overall, the educational program and resource guide was successful in providing strategies to assist nurse leaders to increase the percentage of BSN prepared nurses in their organizations. Conclusion: The Strategies for Increasing BSN Prepared Nurses: A Resource Guide for Employers adds to the body of knowledge for nurse executives committed to implementing strategies for advancement of nursing education.
Major Professor: Barbara Battin Little, DNP, MPH, RN, APHN-BC, CNE
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Katie Stefani BSN, RN
DNP Family Nurse Practitioner
The Effect of a Moral Distress Workshop on New Graduate Nurses Purpose: To determine if an educational workshop on moral distress (MD) can help reduce levels of nurse moral distress. Method: A pre-test, intervention, and post-test study was conducted. The study took place in the hospital setting with a sample of nurse residents with less than six months of nursing experience. The Moral Distress Scale- Revised (MDS-R) was used to measure levels of MD before and after the workshop. Independent sample t-tests were used to determine if there was a significant difference in mean MD scores before and after the workshop. Results: Thirty (n= 30) nurse residents completed the pre-workshop MDS-R and twentytwo (n= 22) completed the post-workshop MDS-R. There was no statistically significant difference in the mean MD scores before and after the workshop (p= 0.793). Overall MD scores and MD frequency scores increased slightly after the intervention, whereas MD intensity scores decreased. Witnessing diminished patient care quality due to poor team communication was a major contributor to overall levels of nurse moral distress. Discussion: This study gives a new perspective on MD as it is one of the first studies to examine MD in new graduate nurses enrolled in a residency program. Findings suggest that the frequency of MD may not be as significant as the intensity of moral distress. Also, communication issues were particularly tied to moral distress in this group. Conclusion: There is a need for further research to address the issue of moral distress sooner rather than later in nurses and to determine how best to do so.
Major Professor: Roxanne Pickett Hauber, PhD, RN, CNE
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Karen Thibodeau BSN, RN
DNP Family Nurse Practitioner
Educating Pediatric Nurses to Provide Asthma Education to Patients and their Families Purpose: The purpose of this project was to determine the effect of the implementation of evidence-based (EB) asthma education guidelines on pediatric hospital readmissions and nurses’ asthma-related knowledge. Method: A quality improvement project was implemented using EB national guidelines to train pediatric nurses in providing asthma education to patients and their families. The setting was an inpatient 15-bed pediatric medical-surgical unit in the southeastern United States. Thirteen pediatric nurses (N=13) providing asthma education to asthmatic children and their families. Participants were given a pre-test based on the One Minute Asthma booklet (Plaut, 2008) to assess current knowledge regarding asthma treatment/prevention and medications. The nurses were then given a copy of Plaut’s booklet to read and were shown an EB based PowerPoint presentation. Nurse participants were given a post-test three weeks later. Nurses initiated the education program including one-on-one teaching and reading material to all patients admitted with a diagnosis of asthma. Results: A mean pre-test score of 77.95 (SD 9.95) and a mean of 91.70 (SD 6.03) on the post-test, showed a significant increase in asthma knowledge after participating in the nurses’ education program (P= .003). There were a total of three pediatric asthma admissions and none of them were readmitted during a three-month period. Conclusion: This study has important implications regarding the education of nurses showing a significant improvement in the participant’s test scores after participating in a structured education program. There were a total of three pediatric asthma admissions and none of them were readmitted during a three-month period.There were not enough admissions at this particular site to be able to answer the research question regarding readmissions after education program was implemented.
Major Professor: Cara Pappas, ND, ACNP, FNP, CCRP
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Candice VanDerSchaaf BSN, RN
DNP Family Nurse Practitioner
Genomic Knowledge and Perception of Advanced Practice Nurses in Florida Purpose: To determine the level of genomic knowledge, perception, and utilization by Advanced Practice Nurses (APNs) in Florida. Method: Cross-sectional descriptive design that used an online platform to survey APNs currently practicing in Florida. The Genetic and Genomics in Nursing Survey was used. Descriptive statistics were used to analyze the data. Cross tabulations provided further identification of statistically significant relationships between variables of the survey. Results: The final analysis consisted of 229 surveys. Contrasting differences in perceived advantages versus disadvantages of genomic integration in practice revealed evidence of cognitive dissonance. Advantages were perceived in terms of best practice (improved care for patients) while disadvantages were from a more pragmatic perspective (cost, non-reimbursable). Similarly differences were seen in relation to education preparation in that a majority of APNs desired to be more educated about genetics/ genomics, but few had ever had genomics in their nursing curriculum and most had not taken a continuing educational course that were specific to genetic/genomic. Less than 12% of respondents described their understanding of genetics/genomics as “very good” and even less as “excellent.” Discussion: This project provided descriptive analysis from a sample population not yet represented in other studies. Findings from the present project are congruent with evidence from other studies in demonstrating a significant gap between the rapid development of knowledge in genetics/genomics and its translation into nursing practice. Conclusion: This is one of the first efforts to examine knowledge, education preparation and perceptions on genetics/genomics in APNs. Findings highlight the need for further examination of this particular group of nurses in order to determine how best to facilitate their acquisition of the knowledge, skills and competencies related to genetics and genomics.
Major Professor: Roxanne Pickett Hauber, PhD, RN, CNE
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Florida State University College of Nursing Duxbury Hall 98 Varsity Way Tallahassee, FL 32306