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Doctor of Nursing Practice Spring Research Exposition May 4, 2017

COLLEGE OF NURSING MISSION STATEMENT To educate clinicians, leaders, scholars, and advanced practitioners who will transform nursing through collaborative care and multi-faceted health care settings, while enhancing the quality of life for people of all cultures, economic levels and geographic locations.

FSU College of Nursing Spring Research Exposition May 4, 2017 Welcome

Dr. Susan Porterfield

Clinical Research Presentation

Hannah Cameron

Clinical Research Presentation

Christie Jones

Clinical Research Presentation

Jill Koepke

Nurses’ Perceptions and Practices Related to Alarm Management: An Evaluation of a New Alarm Management Policy and Educational Program

College of Nursing

Undergraduate Nursing Students’ Knowledge of the Nurse’s Role in the Management of Dysphagia

Aggressive Patient Behaviors: Exploring Education, Organizational Culture, and Nurse Retention

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 2017 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


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 83 credit hours and 1005 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 40 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).


Our 2017 Doctor of Nursing Practice Graduates

Sabrina Baker Kimberly Callow Hannah Cameron Simona Devenish Heather Franklin Amber Gennie Natalie Glover Kendra Harley Amanda Hill Christina Jones Jill Koepke Cheyenne Pradere Ebony Robertson Jennie Strickland Taryn Talley Brittany Tenorio Gerald Trotman Francesca Walters Claire Winfree Elizabeth Zdunich


Sabrina Baker BSN, RN

A Study of the Risk of Phlebitis due to Peripherally Infused Amiodarone Purpose: To determine if IV Amiodarone administered via a peripheral IV places patients at increased risk of phlebitis, and to determine whether or not patient age, catheter size, dosage and duration, hypertension, diabetes, coronary artery disease, peripheral vascular disease, and smoking are linked to increased rates of phlebitis. Methods: An analysis of retrospective data for patients that were admitted to a Cardiovascular Intensive Care Step-Down unit between July 1, 2016 and December 31, 2016. Inclusion criteria included patients greater than 18 years of age, ordered to be placed on an Amiodarone drip that was administered via a peripheral IV. Results: All told, 32% of patients that were administered IV Amiodarone via a peripheral developed phlebitis. Of those patients, those greater than 70 years of age were at an increased risk of developing phlebitis. Individuals with a history of CAD were less likely to develop phlebitis. Discussion: High rates of phlebitis in patients receiving IV Amiodarone via a peripheral IV is a health concern for the quality of care delivered to patients. Clinically, older patients are at the greatest risk, and thus, should receive therapy via central line whenever possible. While the study does not directly explain lower rates in patients with heart disease, the investigator hypothesizes that this is likely due to the high-prevalence of antiplatelet therapy in this population. Conclusion: The results of this study indicate a need to reflect on the use of peripherally infused Amiodarone, especially in older adults.

Major Professor: James Whyte, PhD, ND, ARNP


Kimberly Callow BSN, RN

Screening and Identification of Intimate Partner Violence: Applications to Emergency Department Nursing Staff Purpose: The purpose of this project was to identify facilitators and barriers to screening for IPV among ED registered nurses. Methods: This needs assessment-involved participation of a purposive sample of 216 licensed ED nurses registered with the Florida Department of Health database. Respondents completed an online survey based on the Attitudes toward Survivors of Intimate Partner Violence (ATSI) instrument developed by Nicolaidis at al. (2005) regarding perception, attitudes, beliefs, barriers and practices for screening and identification of IPV. Results: Respondents were best able to identify IPV if patients presented with unexplained bruising (59.3%), an overbearing patient/partner (41.2%), depression/anxiety (38.0%) or emotional abuse (54.2%). As a group, practitioner confidence was low, yet significantly higher among those who had received training in the past (p=.006). After completion of the survey, participants could access a 30-minute educational video of personal accounts of IPV survivors. Discussion: While most respondents (84%) had reported exposure to training, 64.8% believed they needed more training in order to improve their ability to assess, identify and treat IPV. Findings support the implementation of continuous IPV training for all clinicians practicing in an emergency room setting. Conclusion: Exposure to IPV training clearly shapes perceptions and attitudes regarding the IPV crisis. Respondents recognize a need for additional training. It is therefore concluded that ongoing IPV trainings should be made easily accessible and free of cost to all practitioners providing care in emergency department settings. Furthermore, use concrete examples of abuse with every patient contact. This improved assessment approach builds practitioner knowledge and confidence, directs proper healthcare interventions and promotes domestic violence advocacy.

Major Professor: Laurie Grubbs, PhD, ARNP


Hannah Cameron MSN, BSN, RN

Nurses’ Perceptions and Practices Related to Alarm Management: An Evaluation of a New Alarm Management Policy and Educational Program Purpose: Nurses are at risk for alarm fatigue related to the cry wolf effect from an overwhelming number of alarms in the hospital setting, which means patients are at high risk for serious adverse events. The purpose is to evaluate the impact of an alarm management policy and educational program on nurses’ perceptions and practices of alarm management in an acute care hospital. Methods: Nurses from an acute care hospital in the Southeast U.S. attended a mandatory alarm management education program. The hospital implemented the evidence-based alarm management education to achieve The Joint Commission National Patient Safety Goal.06.01.01. Pre- and post-tests were administered to evaluate the education and the changes in nurses’ perceptions and practices of clinical alarms. Results: A total of 417 nurses attended the educational program, but only 215 nurses (51%) completed both pre- and post-tests. Significant improvements were made in alarm perceptions and practices. Nurses suggested unit specific alarm education, improved staffing, and updated equipment. Discussion: Nurses who participated in the alarm education reported improvement in their alarm management practices and changes in their perceptions of clinical alarms. Results suggest that the alarm education heightened nurses’ awareness of the scope of the alarm problem. Conclusion: Findings support the benefits of continued education in alarm management for nurses. Bedside nurses are a critical member of a multidisciplinary alarm management team, as they are frontline in patient safety and most at risk for experiencing alarm fatigue.

Major Professor:

Barbara Battin Little, DNP, MPH, RN, APHN-BC, CNE


Simona Devenish BSN, RN, CMSRN

An Educational Intervention to Improve Nurses’ End of Life Care Competency Purpose: The purpose of this quality improvement (QI) project was to develop and evaluate the efficacy of an educational intervention aimed at reducing knowledge gaps and improving nurses’ competencies in providing end of life care. Methods: To assess change in perceived competency, nurses completed the End of Life Professional Caregiver Survey (EPCS) prior to and after participation in the educational intervention. Feasibility of the educational intervention was also assessed. Data was analyzed in Microsoft Excel using descriptive statistics. Results: Twenty-three medical surgical nurses employed at a regional hospital in the southeastern United States participated. The nurses reported increases in perceived competency on all three factors of the EPCS, including patient and family centered communication, understanding of cultural and ethical values, and effective care delivery following the educational module. Nurses also reported the educational intervention was feasible and would benefit their practice. Discussion: Nurses who completed the educational intervention reported increases in end of life care competencies. The findings of the QI project are consistent with previous studies and support the benefit of end of life care educational initiatives to improve nurses’ knowledge and skills in end of life care regardless of years of experience or specialty area. Conclusions: This project underscores not only a need for continuing educations on caring for end of life care patients, but the potential benefits to patients and their families when nurses translate their knowledge to improved quality of care.

Major Professor: Eileen Cormier, PhD, RN


Heather Franklin MPH, BSN, BA

Training and Beliefs on Administration and Discussion of HPV Vaccinations Purpose: The purpose of this research was to determine a relationship between HPV vaccination administration, educational background, and comfort-level discussing the vaccine by nurses in Florida. Methods: The study is a quasi-experimental, descriptive survey. Participants were emailed an invitation to complete the online survey if they had a valid RN or NP license in Florida. The survey tool was developed by the PI, comprised of 21 items using a Likert scale and write-in answers. Results: No significance was found between the types of nurse and whether or not they recommended the vaccine but RNs tended to recommend it less than other providers. Weak correlation was found (r= 0.143, p< 0.001) with the difference between recommendations of males to females. Strong correlations were found regarding the comfort level of RNs and NPs to recommend or not recommend the vaccine to ages 9-17 (r=0.641, p< 0.001) and ages 18 and older (r=0.556, p<0.001). Others wrote in that while they felt educated on the vaccine was important, they still felt uncomfortable due to their own concerns. Additionally, no statistical significance was found between education levels and if the respondent felt their education prepared them for these conversations. Discussion: Education is key in whether or not healthcare providers promote the benefits of the vaccine. Nurse preparation programs could include education that is specific to HPV since it has the potential to affect so many. Additionally, facilities can ensure continuing education is in place to assist providers in staying current on changes to the research and protocol. Conclusion: Overall, providers appear to have a comfort level at either extreme about the HPV vaccine. Implications for practice should include additional education and inclusion of more healthcare providers.

Major Professor: Susan Porterfield, PhD, FNP-c


Amber Gennie BSN, RN

The Experience of the HIV Disclosure Process during Childhood Purpose: The purpose of this project is to explore the circumstances surrounding the HIV disclosure method among adults who were diagnosed with HIV as children. Methods: This practice improvement study utilized a cross sectional retrospective design to explore the experiences surrounding disclosure in this population. The aims of this study were to (1) improve current HIV disclosure methods for children and (2) increase the literature available to caregivers and health care providers who have to disclose HIV status to children. This was accomplished through the use of a semi-structured interview guide administered to participants in an on line format. Results: Overall, the main results of the study showed participants were negatively effected by their disclosure processes. There was a pattern of grief associated with disclosure, much of which appeared linked to who disclosed to them, and the circumstances surrounding the disclosure. A large portion of the participants identified with feelings of anger, feelings of doom, and abandonment. Sixty percent felt they received enough information about the virus during the disclosure through referrals to health educators, websites, and written information. Of the ten participants, six also felt their outlook since the disclosure has moved in a positive direction. Conclusions: The current study illustrated key features of the disclosure process by exploring them in adults who experienced the full array of developmental activities since disclosure. This will offer valuable insight into the process of disclosure for those who care for this highly vulnerable population in clinical settings.

Major Professors: James Whyte, PhD, ND, ARNP


Natalie Glover BSN, RNC-NICIII

Moral distress and the perception of ethical work climate among nurses in neonatal and pediatric intensive care settings: a statewide survey Purpose: The purpose of this study was to explore demographic factors of nurses suffering from moral distress related to ethical perceptions within the hospital setting such as: gender, age, years of professional experience, highest level of education, and employment in Magnet designated hospitals. Methods: This quantitative, descriptive, correlational study utilized an online format to deploy the Moral Distress Survey – Revised, Neonatal-Pediatric Version and the Hospital Ethical Climate scale to neonatal and pediatric nurses in Florida. A convenience sample of 404 nurses responded voluntarily and anonymously. Analysis included descriptive statistics and t-tests exploring statistical significance among groups. Results: An inverse relationship existed between moral distress and perception of ethical climate (spearman correlation -.636). A direct significant correlation of Hospital Ethical Climate scale total scores among nurses working within Magnet designated institutions (1.971, p<0.05) indicated greater perceived ethical support overall. In addition, these nurses had significantly higher Hospital Ethical Climate scale scores demonstrated in subsets addressing hospital dynamics among peers (2.121, p<0.05), patients (1.994, p<0.05), the hospital (2.320, p<0.05), and physicians (2.707, p<0.05). Discussion: A broad range of MDS-R total scores (0-336) emphasize that moral distress is a subjective experience (mean 96.26, SD ± 62.53). However, factors such as employment in Magnet designated institutions, and education level influence ethical climate perceptions. Conclusion: This is the first known study to show significant findings that Magnet designated institutions positively affect the nurses’ perceptions of hospital ethical support in core dynamic relationships. Magnet designated institutions show strong evidence of fostering positive ethical support and institutional strategies to minimize moral distress and it’s deleterious consequences.

Major Professor: James Whyte, PhD, ND, ARNP


Kendra Harley BSN, RN

Compassion fatigue among hospice and palliative care nurses in Florida: A workforce enhancement project. Background: Compassion fatigue is identified as the emotional effect of being indirectly traumatized by helping those who experience primary traumatic stress. Caregivers such as nurses often do not recognize the impact this concept may have on oneâ&#x20AC;&#x2122;s own quality of life and job satisfaction. Amongst nurses, hospice and palliative care nurses have been identified as being at highest risk for developing CF. Purpose: The purpose is to examine if perceived risk for compassion fatigue (CF) improves job satisfaction towards workplace environment among hospice and palliative care nurses in Florida. Methods: This study is a quantitative, descriptive quasi-experimental design, which explored if understanding the risk of CF by hospice or palliative care nurses could improve job satisfaction towards their workplace environment. A convenience sampling method was used and a total sample size of 23 participants was recruited. Results: The mean change (pre and post intervention) for recognizing the risk of CF or burnout was -0.7 (SD= 5.8) and no statistically significant change was observed among the participants. Job satisfaction (pre and post intervention) was 2.0 (SD=17.9) and no significant finding was noted. Although no statistical significance was found the results indicated that CF was found to be lower during the pre-intervention stage and higher during the post-intervention stage. Job satisfaction was higher pre-intervention and lower during post-intervention. Conclusions: This study provides insight into the phenomenon of CF and its potential to affect hospice and palliative care nurses. With a newfound awareness and increased knowledge, CF has the potential to be increased and could affect job satisfaction. Increased awareness and evaluation via educational intervention is essential for recognizing CF and its potential affect on job satisfaction within the selected group of nurses.

Major Professor: Susan Porterfield, PhD, FNP-c


Amanda Hill BSN, RN

HPV vaccine for adolescent males: Factors affecting parental decisions to vaccinate Purpose: To determine among parents of males, what factor(s) affect parental decision making to consent to the administration of the HPV vaccine? Methods: This project was descriptive in nature and data was collected at a PTA meeting at West Orange High School in Winter Garden, Florida in the form of a paper and pencil survey. Convenience sampling was used in order to obtain data. A sample size of 31 surveys was utilized for data collection. Twenty-two questions from the HPV Immunization in Sons (HIS) Survey developed by Noel Brewer and Paul Reiter were used. Results: The most important reason for not getting a son HPV vaccinated was anticipation that their son would be more likely to have sex if vaccinated. Lack of information regarding the vaccine was the second most important reason reported, followed by feeling the vaccination was too new to make a decision. Of those who vaccinated their son, the number one reason for getting their son vaccinated was because their doctor recommended it. Only one in three of the respondents had their sons vaccinated for HPV. Nearly all parents had heard of the HPV vaccine, although only half realized it could be given to males. Discussion: The need for initiating protection from HPV infection early needs to be emphasized because waiting to vaccinate until an adolescent is perceived to be sexually active may lead to missed opportunities for prevention. Conclusion: Parents showed both in the literature and in this study that they were worried the HPV vaccination for their son would condone sexual activity. Lack of education is a major contributing factor to this. ARNPs can be at the forefront of vaccination education, helping parents understand the need for early intervention.

Major Professor: Susan Porterfield, PhD, FNP-c


Christina Jones


Nursing Students’ Knowledge of the Nurse’s Role in the Management of Dysphagia Purpose: The purpose of this study was to evaluate nursing students’ knowledge of the nurse’s role in the management of dysphagia and to determine whether an educational intervention increased their knowledge and perceived understanding. Methods: A quasi-experimental, pre/post-test educational intervention design was used for this study. Thirty-eight pre-test and thirty-seven post-test participants enrolled in their final semester of an undergraduate nursing program participated. To evaluate for retention of knowledge, an addendum to the original study was approved, whereby a separate group of ten nursing students who had received a similar educational intervention on dysphagia 1.5 years prior were administered the same post-test as the primary group. Results: Post-test performance revealed statistically significant changes in several areas of nursing assessment (identifying signs and symptoms of aspiration pneumonia, p=0.05), management (identifying appropriate nursing diagnoses for individuals with dysphagia, p=0.03); determining specific nursing interventions, including the importance of oral care using a toothbrush in the prevention of dysphagia-related complications (p<0.001), and interprofessional collaboration in the management of dysphagia (determining to consult the SLP prior to providing compensatory swallow strategies or thickened liquids when dysphagia or aspiration is suspected, p=0.01). Likewise, post-test participants reported an increased understanding of their role in the management of dysphagia. While the retention group demonstrated retention of knowledge in some areas, this group exhibited greater difficulty identifying signs and symptoms of dysphagia and aspiration. Conclusion: Nurses play an integral role in the interprofessional management of dysphagia. An educational intervention on this topic was found to increase knowledge and perceived understanding in several key areas one group of nursing students. While retention of knowledge was identified in the retention group, this group performed more poorly in several crucial areas suggesting that previously learned material had not been reinforced during their undergraduate nursing curriculum.

Major Professor: Susan Porterfield, PhD, FNP-c


Jill Koepke BSN, RN

Aggressive Patient Behaviors: Exploring Education, Organizational Culture and Nurse Retention Purpose: To identify relationships between organizational support, educational efforts, participant demographics, and nurse retention with aggressive patient behaviors and determine the incidence of aggressive patient episodes. Methods: A quantitative descriptive survey was completed online with a convenience sample (N=4,083) of registered nurses comprising of 40 questions. The survey was emailed to all current licensed nurses over a five-week period obtained from the Florida Board of Nursing public contact list. Results: The majority of nurses (85.8%) experienced or witnessed at least one episode of patient aggression within the past year. Eight demographic variables were statistically significant (p <0.001) predictors of aggression (primary practice, hospital setting, <2 years of experience, full-time status, age 21-30 years, separated from spouse, Bachelor and Associate prepared and nursing as a first profession). Nurses who received education on aggressive patient behaviors felt more prepared, less distressed, and reported less disruption to their workflow. Incidence of aggression was not related to nursing retention, however a high level of distress related to aggression was associated with intent to leave the current position. Discussion: This study demonstrates that most nurses are the direct recipient of at least one aggressive episode in both the outpatient and inpatient healthcare settings. Younger, less experienced nurses reported a greater incidence of aggressive episodes and their level of college preparation did not differ with the rate of aggressive exposure. While there was a correlation between high levels of distress with aggressive experiences and intent to leave their current position, if education was provided, nurses would feel more prepared and less distressed ultimately improving retention. Conclusion: Experiencing patient aggression is a commonplace amongst nurses in the current healthcare environment. Preparing nurses early in school to effectively cope with aggressive patients can increase workplace safety, decrease burnout, and improve quality of care.

Major Professor: Cara Pappas, ND, ACNP-BC, FNP-BC


Cheyenne Pradere BSN, RN

The Impact of Stroke Prevention Clinics on Hospital Readmission after Ischemic and Hemorrhagic Stroke Purpose: The purpose of this project was to identify the role SPCs have on hospital readmission with aims to: 1) examine readmission rates for patients discharged after an ischemic or hemorrhagic stroke, 2) identify if there is a reduction in readmission rates after SPC attendance, and 3) explore all-cause mortality and patient demographic information. Methods: A retrospective study design was performed for patients admitted between October 1, 2015 to September 30, 2016. Charts were obtained from the electronic health records of an acute care hospital. Descriptive statistics were utilized to describe the demographic factors of the sample related to hospital readmission post stroke. Results: The charts for 280 patients were available for analysis and revealed an average readmission time of 11 days. Patients most at risk for readmission include patients discharged home with three or more comorbidities; most notably hypertension, lipidemia, and diabetes. SPC attendance information was unavailable for this study, and analysis on SPC impact on hospital readmission is ongoing. Discussion: This study indicates that patients discharged home after an IS with 3 or more medical conditions have a higher risk of death and re-hospitalization than patients with alternative discharge dispositions and less comorbidities. These findings coincide with current literature on stroke, and solidify the importance of stroke prevention by managing modifiable risk factors after discharge. Our study extends previous investigations by analyzing just how quickly patients are readmitted after stroke (calculating time between discharge and readmission). This approach allows for further insight on how soon post-stroke patients may need to follow-up after discharge. Conclusion: Stroke will remain one of the leading causes of death unless diligent clinical practice discovers systematic ways to encourage lifestyle modifications to prevent further illness. Strong collaborations between acute care facilities and SPCs may prove effective in achieving this goal.

Major Professor: Susan Porterfield, PhD, FNP-c


Ebony Robertson BSN, RN

Nurse’s knowledge and attitudes towards caring for the patient with Sickle Cell Disease Purpose:To improve knowledge about the pathophysiology of SCD, nurse’s understanding of timely care when complications of SCD occur, and improve nurse’s knowledge, attitudes, and perception when caring for an individual with SCD. Methods: The study used a pre-post test design to determine the effect of an educational module on Sickle Cell Disease. The educational module was developed and offered on line through the use of a common instructional development software package. We administered the General Perceptions about Sickle Cell Disease Patients Scale and the Medical Condition Regard Scale (MCRS). Results: A total of 12 participants completed the questionnaire, all of who were Registered Nurse’s all of whom had experience treating patients with Sickle Cell Disease. The cumulative scores indicated a numerical improvement in scores on the General Perceptions about Sickle Cell Disease Patients Scale (p=. 057). The three domains on the scale that showed statistically significant improvements (p<. 05) were questions related to nurses’ ability to have a personal relationship, caring for and emphasizing with a patient with Sickle Cell Disease. Discussion: Healthcare providers are often skeptical of individuals who frequently visit the hospital and often label these individuals as drug seeking. This misconception and perceived attitudes can lead to ineffective communication between provider and patient, which may result in suboptimal management of Sickle Cell Disease. Conclusions: The results suggest that the nurse’s attitudes towards Sickle Cell Disease patients may be improved through a short and relatively simple educational module. Nurses play a major role in evaluating, treating, and managing Sickle Cell Disease patients and it is important that nurses receive adequate education regarding the disease and associated complications.

Major Professor: James Whyte, PhD, ND, ARNP


Jennie Strickland BSN, RN

Prisoners as Patients in Acute Care Settings: Nursesâ&#x20AC;&#x2122; Identification of Caring Nurse-Patient Interactions Purpose: The United States accounts for only 5% of the worldâ&#x20AC;&#x2122;s population yet it has more than 20% of the worldâ&#x20AC;&#x2122;s prison population. At some point during incarceration, prisoners may need to be hospitalized in a community setting. Nurses will be providing care to this population. The purpose of this project was to determine how registered nurses identify caring when this/her patient was a prisoner. Methods: A cross-sectional descriptive design online survey using a convenience sample. The data for the project were analyzed through the use of descriptive statistics. Results: There were 2,130 participants who completed the survey in its entirety. In three out of four categories evaluated (clinical, humanistic, and comforting care), a majority of the participants perceived they very often or almost always used caring behaviors when caring for prisoner patients. In the relational care section of the survey participants perceived that they were less likely to use identified caring behaviors. Discussion: Findings from this project revealed that 77% of participants perceived that they provide care that is without disapproval very often or almost always. Previous studies concluded that nurses were judgmental in providing care to prisoner patients. Yet, the present project did confirm results from previous studies that suggest the differing of cultures (custody vs. care) make it difficult to provide certain aspects of care and may be the reason for the responses noted in the relational care part of the survey. Conclusion: Findings from this project suggest that in general, nurses provide care to prisoner patients using caring behaviors. A number of participants also emailed the researcher anecdotes and comments leading the investigator to conclude there would be great value in adding a qualitative component to methodological approaches in future studies.

Major Professor: Roxanne Pickett Hauber, PhD, RN


Taryn Talley BSN, RN

Use of a Smartphone Application in the Self-Management of Heart Failure Purpose: The purpose of this project was to evaluate the use of a smartphone application in heart failure (HF) patient self-management. The aims were: (1) to improve HF patient self-management techniques after hospital discharge, (2) decrease readmissions/emergency room (ER) visits for HF patients, and (3) evaluate patient satisfaction of the WOWME2000 application. Methods: This project utilized a quasi-experimental design with an interventional approach to evaluate change in patient behavior. The sample (N=33) was randomly divided into an intervention (N=21) and control group (N=12). Both groups received HF management education prior to hospital discharge. Additionally, the intervention group downloaded the WOWME2000 smartphone application focusing on HF self-management. Both groups were surveyed before and 30 days after intervention to measure patient adherence to lifestyle modifications and HF hospital visits. Results: The intervention group demonstrated a significant increase in performing daily weights compared to the control group. Readmissions/ER visits resulted in 25% (N=3) of the control group returned for HF treatment, while only 14% (N=3) of the intervention group had returned. The majority of participants also found the WOWME2000 application was assistive. Discussion: Overall, both groups increased their daily weights and medication adherence, proving increased education is beneficial. The significance in increased weight monitoring and lower hospital visits in the intervention group leads us to assume that the WOWME2000 is assistive in HF self-management. However, much of the data were not significant due to the small sample size. Conclusion: Although this research showed some improved health outcomes for HF patients, a larger study is needed to substantiate the results. This study also identified a place for smartphone applications within medical management of chronic disease. Nurse practitioners can incorporate technology into their practice for improving overall self-management and quality of care.

Major Professors:

Cara Pappas, ND, ACNP-BC, FNP-BC Denise Tucker, PhD, RN, CCRN


Brittany Tenorio BSN, RN

Factors Influencing Cessation of Breastfeeding Practices Purpose: The World Health Organization (WHO) and the American Academy of Pediatrics state that exclusive breastfeeding in infants should occur for the first six months of life. This project sought to determine factors that influence the continuation and cessation of breastfeeding in a group of mothers. Methods: A qualitative study design using simple content and categorical analysis was completed over a six-month span. Fifty-one mothers consented and provided demographic information prior to discharge. Of those, 35 mothers participated in a telephone interview conducted three months postpartum. Results: Twenty-nine mothers (82.9%) were still breastfeeding and 18(62.1%) of the 29 were exclusively breastfeeding at three months postpartum. Six mothers (17.1%) had breastfeeding cessation between 3 weeks and 2.5 months with the most common factors being insufficient breast milk supply and return to work. Of mothers who continued to breast feed, knowing the benefits of breastfeeding, having support from family/ friends, and because it was easy/convenient were the most common reasons to do so. Discussion: Results from this project demonstrated that exclusive breastfeeding rates in this sample were above recommended guidelines for Healthy People 2020 and the CDC. Also, knowledge and support from family and friends were important to continuation of breast feeding; factors identified in previous studies. Common factors associated with breastfeeding cessation in the literature were also identified in this project. Conclusion: Project findings support previous studies in terms of factors supporting and hindering breastfeeding by new mothers and underscore the benefits of education and support groups. Future research should include focus on longer breastfeeding (six months) with larger sample sizes. Also, effort should be directed toward interventions that reduce factors seen as barriers to continuation of breast feeding.

Major Professor: Roxanne Pickett Hauber, PhD, RN


Gerald Trotman BSN, RN

Efficacy of Group Visits for Hypertension Education Purpose: Hypertension (HTN) affects 29% of the adult U.S. population, yet itâ&#x20AC;&#x2122;s estimated that only 52% of those diagnosed have their blood pressure under control (CDC, 2015). Educational programs may constitute one means of helping patients manage their hypertension. The purpose of this project was to examine the patientâ&#x20AC;&#x2122;s understanding of hypertension and evaluate the benefit of group hypertension education. Method: Participants with new onset hypertension were recruited from physician offices in the Florida Panhandle and given an educational program followed by a post educational assessment. Pre-educational mean arterial blood pressures (MAP) and body weight were obtained and compared with 1-month post educational MAPs and body weights. Paired t-tests were used to analyze the results. Results: The pre-educational average MAP (N=18) was 100, (SD=5.3). Post-educational mean MAP (N=18) was 95 (SD=4.4). The average MAP change from the first to last reading was 4.9 (SD= 5.6). Overall reduction in MAP was statistically significant, (p= 0.001). To assess the learning benefit of group education, a pre-educational and post-educational test was given. Mean pre-test score was 89.2 (SD= 6.2). The mean post-test score was 100 (SD= 0). Mean changes in test scores were -10.8 (SD= 62). The statistical significance of the pre and post-test were analyzed using a t-test with significance being (p < 0.05). Average change in scores was statistically significant (p < 0.001). Discussion: A positive educational experience was verified through pre and post-tests. Post-educational blood pressure readings indicate positive blood pressure control. Conclusion: Statistically significant increases in knowledge and improvement in MAP over a 1-month post educational period were seen. Results suggest that group education may be effective for blood pressure control and maintenance.

Major Professor: Laurie Grubbs, PhD, ARNP


Francesca Walters BSN, RN

The Effects of Music on Adult Patients Undergoing Elective Cosmetic Surgery Purpose: To determine if relaxing music can be used as a nursing intervention to minimize patient anxiety before, during, and after surgery. Method: A convenience sample of 50 adult female patients from a plastic surgery office in the southeastern US were assessed using the State-Trait Anxiety Inventory Questionnaire (STAI) and Bio-Well software system one week before and after surgery. The experimental group (N=25) listened to the Liquid Mind radio station on Pandora for one hour daily one week before surgery, throughout the procedure, and one hour daily for the week after. The control group (N=25) did not listen to this music. A paired t-test was used to compare results. Results: The paired t-test results for STAI and Bio-Well were higher post intervention, however were not statistically significant. Using mean scores of STAI results pre- and post-operatively, the standard deviation of change in the experimental group was 13.1 as compared to 7.86 in the control group. However, no significant differences were found between groups using either method of data collection. Discussion: Evidence from this study did not show that music significantly reduced anxiety in the perioperative process. However, the experimental group revealed a higher standard deviation of change between pre- and postoperative STAI results, therefore they may have had some anxiety reduction. The small sample size, choice of music, and adherence to the study protocol may have affected the results. Conclusion: This study should be replicated with larger samples, in diverse populations, and in a variety of other surgical settings. Music is noninvasive, cost effective, and free from side effects. Adding music to the surgical setting to reduce stress and anxiety in patients may promote patient health and wellbeing.

Major Professor: Denise Tucker, PhD, RN


Claire Winfree BSN, RN

The Effectiveness of Kinesiology Tape on Medial Tibial Stress Syndrome in Adult Runners. Purpose: The purpose of this study was to compare the effectiveness of kinesiology taping versus therapeutic ice massage in reducing pain from Medial Tibial Stress Syndrome in adult runners as measured by reported pain levels before and after the treatment period. Introduction: Medial Tibial Stress Syndrome is a condition characterized by painful symptoms on the medial aspect of the tibia, often referred to as shin splints, and is one of the most common causes of pain in running athletes. Recently, kinesiology tape has gained popularity for treating such injuries. Methods: This project utilized a quasi-experimental design. Participants were healthy males and females over the age of 18 who suffered from MTSS. Participants regularly ran or jogged for exercise. Participants randomly assigned to: 1) Treatment group who applied kinesiology tape and 2) Ice Massage (Control) Group. Participants completed 3 runs without treatment followed by 3 runs with their assigned treatment. Results: In the ice massage group, the mean pain score before intervention was 3.67 (SD = 0.84) and after intervention was 3.67 (SD= 0.96). In the KT group, the mean pre-intervention pain score was 3.52 (SD=1.30) and mean post-intervention pain score was 2.10 (SD=1.80); t=1.60, p=0.16. There was a weak-to-moderate positive correlation (0.38) between using an intervention (ice massage or KT) and decreasing average pain scores during running. Conclusion: There was not a statistically significant difference in pre or post-intervention pain scores with either ice massage or KT. Even though there was not a significant change in the KT group, there was a numerical trend toward pain reduction. All participants benefited from some form of intervention.

Major Professor: James Whyte, PhD, ND, ARNP


Elizabeth Zdunich MSCP, BSN, RN

Veteran and Caregiver Needs: Addressed or Left Wanting on Mississippi, Alabama, and Floridaâ&#x20AC;&#x2122;s Gulf Coast Purpose: The purpose of the study was to examine the experiences of veterans discharged from the military after September 2001 and their support networks in the Gulf Coast area to determine: (1) what needs are being experienced during reintegration to civilian life, (2) what are common threads between different veteran groups, and (3) what resources are currently available or still unavailable to fill the needs identified? Methods: A Qualtrics survey with demographic data, depression and anxiety indices was completed by participants and audiotaped interview questions of veterans and caregivers were compiled at motorcycle-centric events throughout the Gulf Coast. Results: Many Gulf Coast recent veterans are experiencing significant difficulty reintegrating into society. Membership and support from groups, including motorcycle-centric groups, assists markedly in the transition. A significant number of veterans indicated on depression and anxiety indices that they were at risk for suicide, including two who have previously attempted suicide of the 20 interviewed. Integration for some has been very difficult. Many veterans indicated that they felt more successful in the reintegration process if they remained in military job settings, continued to do the same job, or were picked up on contract doing similar work. Discussion: Support for returning veterans by community groups and other veteran groups eases reintegration burden significantly. Conclusion: Research focusing on how to streamline informing veterans on the Gulf Coast about local community interest groups, including fringe groups, across the spectrum would help pave a path for greater veteran engagement.

Major Professor: James Whyte, PhD, ND, ARNP


Florida State University College of Nursing Duxbury Hall 98 Varsity Way Tallahassee, FL 32306

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