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Doctor of Nursing Practice Spring Research Exposition

COVER May 1, 2014

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 2014 Spring Research Exposition. This exposition features the capstone projects of 24 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 2014 Doctor of Nursing Practice Graduates

Jessica Aloyo Pamela Beitlich Caitlin Conroy Migling Cuervo Janet Davis Barbara Dobron Tanya Douglas Portia Glover Sarah Graham Nicole Green David Guthrie Veronica Martin Meghan McCauley Pamela McGowen Robin McGuinness Dianne Mennitt Kristen Rasnick Brooke Rogers Martha Ruder Jennifer Schnippert Charlene Small Denise Stewart Marsha Weiner Cathy Wogamon

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Jessica Aloyo RN, BSN

DNP Family Nurse Practitioner Tallahassee, Florida

The Impact of Telehealth on Heart Failure Patients: An Examination of Adverse Events Introduction: The objective of the study was to evaluate the effectiveness of telemonitoring in addressing adverse events for individuals with heart failure (HF). Adverse events were defined as unplanned primary care visits, emergency room (ER) visits, and hospitalizations. Background: Telehealth refers to the use of technology to support healthcare at a distance. A number of studies have queried the effectiveness of telemonitoring for individuals with HF, resulting in inconclusive findings that suggest the need for further research. Methods: The study utilized secondary data from a larger telehealth study. Participants were randomly assigned to a control group which received monthly nurse visits or an intervention group which received a telemonitoring system with monthly nurse visits. The system was utilized by study nurses to monitor vital signs and symptomatology reports. Data was collected during nurse visitations through a questionnaire. Participants were observed for three months. Results: A total of 28 adverse events were reported, 15 in the control group compared to 13 in the intervention group. Unplanned primary care visits represented 50%, followed by ER visits (28.6%) and hospitalizations (21.4%). However, no statistically significant relationship was demonstrated between adverse events and the use of the telemonitoring system. Discussion: Lack of significance could be attributed to limited sample size and duration of the study .The results are consistent with other telehealth studies, demonstrating the need for larger telemonitoring trials. Conclusions: Telemonitoring has the potential to improve health outcomes. Understanding the benefits for individuals with HF can improve quality of care but further research is necessary to determine best practices.

Major Professor: Roxanne Hauber, BSN, MSN, PhD

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Pamela Beitlich MSN, ARNP

DNP Health Systems Leadership Sarasota, Florida

Implementation of TeamSTEPPS in Labor/Delivery and NICU Objectives: The purpose of this study was to determine the effect of TeamSTEPPS implementation on the patient safety culture in a healthcare facility in the southeastern United States. National Patient Safety Goals push a strong focus on communication, linking a majority of sentinel events to communication breakdowns that led to harm or death for patients. As a component of patient safety, team training has shown repeated evidence for creating high performing teams that exhibit adaptability, accuracy, productivity and efficiency. Background: A key theme of suboptimal teamwork and communication was identified in the Labor and Delivery Department at the facility where the study was conducted. TeamSTEPPS was chosen as the evidence based model to improve communication. Method: The Hospital Survey on Patient Safety was administered pre and post TeamSTEPPS implementation. The results were analyzed utilizing a paired sample Mann-Whitney U test. Results: The results of the HSOPS questionnaire indicated significant improvement in 14 of 42 items included in the questionnaire (p<.05). Discussion: The results indicated limited improvements with the implementation of TeamSTEPPS. These findings are consistent with the literature. Future study requires continued monitoring of improvements to determine their durability. Conclusion: Standardized communication programs such as TeamSTEPPS can lead to improvements in a healthcare team environment, and are essential to optimizing the safety culture in facilities.

Major Professor: James Whyte, AS, BSN, MSN, ND, Phd

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Caitlin Conroy BSN, RN

DNP Family Nurse Practitioner Tallahassee, Florida

Behind the Curtain: Skin-to-Skin Contact after Cesarean Section and Influences on Breastfeeding Outcomes, Infant Feeding Responses, and Maternal Satisfaction Introduction: The benefits of immediate skin-to-skin contact (SSC) are well-documented in infants born by vaginal birth and include improved physiologic stability, increased maternal attachment behaviors, optimal infant brain development, and increased breastfeeding initiation and duration rates. However, immediate SSC is not routinely practiced during cesarean section (CS). Background: This study was performed to determine whether the initiation of SSC between mothers and infants in the operating room and thereafter would improve infant feeding responses, breastfeeding rates, and maternal satisfaction. Methods: This study utilized a quasi-experimental design with convenience sampling and a mixed methods approach. The experimental group (n= 25) was given SSC immediately after CS while on the operating table and during recovery. The comparison group (n= 16) was given routine standard care with/without delayed SSC in the recovery room. The outcomes measured include breastfeeding initiation, duration and exclusivity, infant feeding responses, and maternal satisfaction. Survey data was collected and analyzed 4-12 weeks postpartum. Results: The SSC infants had significantly earlier breastfeeding initiation, significantly longer duration of overall breastfeeding, and significantly higher rates of exclusive breastfeeding than the comparison group. Qualitative analysis of maternal satisfaction was multifactorial and influenced by several perioperative and postpartum factors. Discussion: The findings of this study suggest that SSC during CS may decrease breastfeeding initiation time, increase the rates of breastfeeding duration and exclusivity, enhance infant feeding responses, and promote maternal satisfaction. Conclusion: The incorporation of SSC immediately after birth is beneficial for all healthy newborns and mothers and should be further promoted and implemented.

Major Professors: Barbara Cottrell, MSN, RN Jolynn Greenhalgh, DNP, ARNP

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Migling Cuervo BSN, MPH, RN

DNP Family Nurse Practitioner Tallahassee, Florida

The Effect of Relationship Characteristics on HIV Risk Behaviors and Prevention Strategies in Young Gay and Bisexual Men Introduction: This study examines if relationship status, relationship ideation, and sexual agreements affect HIV/STD prevention strategies and sexual risk behaviors in young men who have sex with men (MSM) ages 18-35. Background: HIV continues to be a public health problem. In 2009 there were 48,100 new cases of HIV infection in the United States, with 61% reported in MSM. Method: A cross-sectional study design utilizing an investigator developed online survey. Results: There was a significant difference between partnered (M = 0.29, SE = 0.064) and single (M=0.46, SE=0.048) MSM when asked about condom use with their casual partner the past three months (t= -2.065, p= 0.041). Partnered MSM (M=1.28) were more likely to know the HIV status of all their partners for the past three months (t-statistic = -2.164, p-value =0.038) compared to single MSM (M=1.45). Men scoring high in relationship exclusivity (M=0.36) reported higher condom use with casual partners compared to men scoring low (M=0.65), (t = 2.806, p = 0.006). A majority of partnered MSM (58%) reported a sexual agreement. MSM reporting a restricted sexual agreement more commonly utilized condoms during oral intercourse, anal intercourse, with main partner, and casual partner compared to MSM reporting an unrestricted sexual agreement. Discussion: The study results are consistent with the limited literature available. Conclusion: The study results suggest that relationship status should be taken into consideration by healthcare providers when counseling MSM and that future behavioral intervention should target sexual agreements as a mechanism to reduce HIV/STD transmission.

Major Professor: James Whyte, AS, BSN, MSN, ND, Phd

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Janet Davis

RN, MS, NE-BC, CPHQ DNP Health Systems Leadership Sarasota, Florida

Video versus direct patient monitoring: An evaluative research Introduction: A common practice in adult, medical-surgical nursing units is to place a sitter with a patient who is at risk of self-harm or a high fall risk. This procedure is expensive, seldom reimbursed, is controversial in the literature, and is not supported by a strong body of evidence. Background: The aims of the study were to determine the prevalence of patient falls and self-harm using in-room sitters and video monitoring, and to determine the cost associated with each. Method: Video monitoring was studied in two adult, medical surgical units, using an evaluative research design, with a quasi-experimental sampling approach. Results: Measurements obtained were descriptive statistics with standard deviation and independent samples t tests. The study identified no statistically significant difference in the prevalence of falls or self-harm events when video monitoring was used to provide constant observation. There was a statistically significant lower (p<.001) average cost per patient day with the use of video monitoring. Discussion/Conclusion: The results of this study support a lower cost nursing practice that does not impose a patient safety risk for falls or self-harm associated with the implementation of video monitoring.

Major Professor: James Whyte, AS, BSN, MSN, ND, Phd

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Barbara Dobron BSN, AP

DNP Family Nurse Practitioner Sarasota, Florida

The Effect of Acupuncture on Musculoskeletal Pain, Stress, and Health-Related Quality of Life Introduction: The purpose of this study was to determine the effect of acupuncture treatments on pain, stress, and health-related quality of life. Background: The World Health Organization supports the use of acupuncture as a nonpharmacological approach for the treatment of a variety of disorders. Nursing awareness can be influential in creating a paradigm shift to increased integration of holistic health care. Method: A pilot study (n = 33) with pre/post intervention testings to evaluate the effect of acupuncture on pain and stress, and a Short Form-36 to evaluate health-related quality of life. A series of 10 acupuncture treatments on persons suffering from musculoskeletal pain and stress. Participants completed the numeric rating scale study instrument pre/post intervention and the SF-36 pre-date of service 1 and post-date of service10. Results: The study results indicated a pattern of clinical improvement in pain and stress (P< .001) following 10 visits. Multiple comparisons were performed in order to clarify the relationship between individual session clinical improvement and sustained clinical improvement over the 10-visit course of therapy. Discussion: The data supported the efficacy of acupuncture therapy on pain, stress and health related quality of life. Further research to evaluate effects of acupuncture as an adjunctive therapy for managing severe/specific types of pain and its benefits to healthrelated quality of life are warranted. Conclusion: The advanced practice nurse should consider acupuncture as an effective nonpharmacological intervention to reduce pain and stress.

Major Professor: Susan Porterfield, BA, MA, BSN, MSN, PhD

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Tanya Douglas BSN, RN

DNP Family Nurse Practitioner Tallahassee, Florida

Outcomes related to Peanut Ball use in Full Term Gestation Women with Epidural Anesthesia Introduction: Epidural anesthesia for women in labor is widely used. Epidurals can limit a womanâ&#x20AC;&#x2122;s ability to move freely and walk during labor, which is associated with increased duration of labor and instrument assisted deliveries. Background: Currently, some women use a peanut ball to help with positioning and comfort during first stage labor, but evidence of its effectiveness is lacking. Method: Using a convenience sample of women at term, this quality improvement project compares the effectiveness of the peanut ball(PB) on duration of labor, cesarean rates, and instrument assisted deliveries in 71 women with epidurals, 26 of whom did not use the peanut ball(NPB), and 51 who used the PB. Staff nurses offered the PB to women with epidurals during labor and documented gravida, para, induction agents, duration of labor, and method of delivery. Results: Descriptive statistics, multivariate linear regression and t-tests were used to analyze data. When controlling for gravida, parity, and induction agents, mean duration of first stage labor was significantly longer in women using the PB (7 hrs 51 min) than NPB (4 hrs 46 min, t=-3.397, p=.001) No difference was found between the groups for duration of second stage labor, instrument assisted deliveries, or cesarean rates. Discussion/conclusion: Because random group assignment was not used, nurses may have utilized the ball with women making slower progress during labor. PB use during labor might be associated with longer first stage labor and total duration of labor, but larger, randomized studies are needed before effectiveness of the PB can be determined.

Major Professors: Barbara Cottrell, MSN, RN Jolynn Greenhalgh, DNP, ARNP

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Portia Glover RN

DNP Family Nurse Practitioner Tallahassee, Florida

PONV Risk Assessment Tool: A Quality Improvement Evaluation Introduction: The purpose of the quality improvement (QI) evaluation is to determine the efficacy of a postoperative nausea and vomiting (PONV) risk assessment tool on surgical outpatient satisfaction scores and amount of antiemetic rescue medication use. Background: PONV is the second leading cause of unexpected admissions. A QI program consisting of an Apfel based, risk assessment tool and risk based treatment algorithm were initiated for adult patients scheduled for outpatient surgery. Method: A pharmacy-generated report of the amount of antiemetic rescue medication removed from the pyxis for September-November 2012 was compared to that of SeptemberNovember 2013 to determine if the incidence of PONV had decreased post QI initiative. Picker (patient satisfaction) score data also was collected. Data was analyzed utilizing descriptive statistics. Results: The monthly average of PONV medication vials used in 2012 and 2013, respectively, were September (16.25; 9.75), October (20.2; 16.2), November (22.75; 15) (p = 0.004935. Patient satisfaction (Picker) scores for October to December 2012 and 2013, respectively, were 87.5% and 100%. Discussion: Results indicated a significant relationship between use of the risk assessment tool and a decrease in antiemetic rescue medication use. Assessment of patient PONV risk leads to better prevention and management, ultimately resulting in an increase in patient satisfaction and decreased admissions. Conclusion: The most significant implication for practice is staff education for successful implementation of a simplified risk assessment tool.

Major Professor: Laurie Grubbs, BSN, MSN, PhD

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Sarah Graham BSN, RN

DNP Family Nurse Practitioner Sarasota, Florida

Will Early Goal Directed Therapy Decrease Mortality Rates Among Patients With Sepsis? Introduction: The Surviving Sepsis Campaign issued guidelines for sepsis management in 2004, resulting in the Institute for Healthcare Improvementâ&#x20AC;&#x2122;s protocols for the management of sepsis. Early Goal Directed Therapy (EGDT) is an example of a protocol that uses an algorithmic approach to sepsis treatment. Background: A hospital in the Southeastern US implemented the EGDT protocol in their Emergency Department. The general aims of the study included: determining how the use of the EGDT protocol affected: in-hospital mortality rates of septic patients; patient acuity; and time to identification. Method: The study used a retrospective approach comparing archival data from the medial records of patients treated for sepsis with and without the EGDT protocol. Patients with sepsis who met the study criteria were randomly selected. Results: The sample included the medical records of 59 patients with sepsis. The data did not indicate statistically significant differences in mortality rates or time to identification. Discussion: The data did not show a statistically significant difference in mortality rates or time to identification between groups. The results were inconsistent with those seen in similar studies. The small sample size limited the ability to adequately conclude that the use of the EGDT protocol did not decrease in-hospital mortality rates and time to identification. Conclusion: Use of an early identification tool for patients at risk for or suspected of having sepsis has been shown to improve patient outcomes in other studies, but due to several limitations, improved outcomes were not found in this study.

Major Professor: James Whyte, AS, BSN, MSN, ND, Phd

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Nicole Green BSN, RN

DNP Family Nurse Practitioner Tallahassee, Florida

Conventional Versus Hydrotherapy in the Management of Chronic Mechanical Low Back Pain Introduction The purpose of this study was to determine the efficacy of conventional therapy compared to hydrotherapy in the treatment of chronic low back pain. Background Low back pain is a highly prevalent condition that can have a devastating impact on the lives of individuals. There are fewer treatment guidelines for the management of chronic low back pain compared to acute low back pain and none of the guidelines address hydrotherapy as a treatment method Methods A retrospective record review was performed to compare the efficacy of conventional therapy compared to hydrotherapy. Results Forty-nine patient records (24 hydrotherapy and 25 conventional therapy) were reviewed of participants who completed their assigned therapy for CLBP. A comparison of post-treatment means revealed a statistically significant improvement for best-reported pain in favor of the hydrotherapy group (P <0.001). Both groups showed statistically significant improvements in worse pain and core stability post-treatment; however, the difference was not statistically significant. No relationship existed between treatment type and duration of treatment or age and gender. Discussion Results of this study are similar to other studies in the literature that support both aquatic and land-based therapy and exercise as an appropriate method for the management of CLBP. Conclusion The evidence supports the need for clinicians to consider a broader range of treatment methods when considering the treatment of chronic low back pain.

Major Professor: James Whyte, AS, BSN, MSN, ND, Phd

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David Guthrie ARNP, MN, CCRN

DNP Health Systems Leadership Tallahassee, Florida

Barriers to Updating Policies with Current Evidence-Based Practices Introduction: Accreditation is based on the premise that adherence to evidenced based policies will produce higher quality health services. A June 2013 review found that 42% of DOH policies accessible in DOH database were up to date. The majority of supportive evidence for some of those policies was outdated as much as 10 to 12 years. Background: Health care consistent with "best practice" was administered in little more than half of U.S. patients; even worse was that less than half of physician practices used evidence-based recommendations for care. Barriers to evidence uptake have been uncovered in the acute care setting. It would be beneficial to know whether similar barriers exist in the public health setting and whether acute care setting interventions are applicable in the public health environment. Method: A descriptive cross-sectional survey of policy making professionals in the Florida State Department of Health was done. A web-based anonymous survey collected descriptive data that was analyzed through rank ordering of BARRIERS items. Results: Barriers reported included political influence interfering with evidence uptake, a lack of a feeling of empowerment to change public health policy, and administrative influence interfering with evidence uptake. Discussion: Characteristics of the organization was cited as a major barrier. Eighty-one studies had similar findings. Respondents replying "no opinion" or non-response implied an unfamiliarity with evidence-based utilization. DNP's are skilled in utilizing strategies that facilitate the uptake of the evidence base into policies. Conclusion: Evidence-based-based practice relies on organizations recognizing deficits and establishing interventions to address those gaps.

Major Professor: Karla Schmitt, PhD, MPH, ARNP

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Veronica Martin RN, MSN, NEA-BC

DNP Health Systems Leadership Sarasota, Florida

The Impact of Bedside Reporting on Patient and Staff Satisfaction Objective The primary aim was to answer the following questions: 1) Does bedside reporting improve patient satisfaction; and 2) Does bedside reporting improve staff satisfaction. Design Bedside handoff was implemented in a health care system between October 2011 and July 2012. Pre- and post-implementation scores, from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), were evaluated three months prior and three months post implementation to determine the effect of the implementation on the patientâ&#x20AC;&#x2122;s satisfaction. Staffâ&#x20AC;&#x2122;s satisfaction with bedside handoff was evaluated with the Handover Evaluation Scale (HES) at 1 1/2 years post-implementation among registered nurse participants. Method The Mann-Whitney U was used to compare ordinal data of pre and post HCAHPS nursing communication scores from mother/baby and acute care units from a five hospital system. Two-tailed t-test was utilized to determine significance of differences observed. Results/Discussion Implementation of bedside handoff did not have a positive or negative impact on the patient experience scores of the mother baby or acute care respondents. Improvement was noted in the top box scores for nursing communication in HCAHPS post intervention for the mother baby respondents. Staff HES survey indicated significant correlations between opportunity to discuss workload and information provided (0.332, p<0.01), and between opportunity to ask questions and receive helpful nursing education (0.256, p<0.01). Conclusion Survey results suggest staff was provided significant information about patients,information was easy to follow and there was an opportunity to ask questions. Staff perceived handoff takes too much time. However, 42% were not giving bedside report at the time of the survey.

Major Professor: Karla Schmitt, PhD, MPH, ARNP

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Meghan McCauley BSN, RN

DNP Family Nurse Practitioner Tallahassee, Florida

Assessing Barriers to Healthcare Access in Chronic Disease Patients at a Transition Center: A Quality Improvement Project Introduction: Missing appointments can have detrimental consequences on health outcomes. This study aims to explore the reasons for missed appointments in a Transition Center that serves patients without health insurance or primary care providers. Background: Evidence suggests that transitional care can reduce unnecessary hospital visits and improve healthcare outcomes. Despite this, reports from an urban, community health transition center have shown that individuals are missing their scheduled appointments. Method: A descriptive telephone survey was developed and utilized to assess demographics and reasons for missed appointments at the transition center. Results: The study sample included 21 participants recruited from a missed appointment list. Descriptive analysis and frequency patterns revealed that young, uninsured, impoverished individuals are more likely to miss appointments than other individuals. Over 70% of participants reported being dependent on others for transportation, with lack of transportation being the most commonly reported reason for missing an appointment. Discussion: The findings of this study contributed a new dimension to what is known about appointment keeping. The high rate of dependence on transportation could possibly be related to the fact that access to public transportation is harder to come by in more underprivileged areas. Interventions to decrease the number of missed appointments may require improvements to the overall deprivations of this population. Conclusion: Ultimately, missed appointments can result in lost opportunity for continuity of care. Appointment keeping was significantly associated with low socioeconomic status and lack of transportation. Development of interventions effectively targeting these issues may help to improve healthcare outcomes among patients with complex care needs.

Major Professor: Cara Pappas, BSN, MSN, ND

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Pamela McGowen BSN

DNP Family Nurse Practitioner Panama City, Florida

Fear of contagion: Does perceived immunity impact nursing studentsâ&#x20AC;&#x2122; willingness to engage in the direct care of people living with HIV/AIDS? Objective: An evaluation of the relationship between undergraduate nursing students perceived level of immunity and their willingness to engage in patient care activities in those with HIV/AIDS. Participants/Setting: Forty two undergraduate nursing student volunteers at a university in the southeastern United States. Design/Methods: An experimental research study using common social psychology methodologies was used to perform this study. The participants were randomly assigned to a control or experimental group, assigned a level of immunity based on a fictitious oral swab, and given a questionnaire that reflects their feelings about caring for a patient with HIV/AIDS. The analysis of the data focused on their willingness to care for patients based on their perceived immune status. The use of deception was key to the project and was followed by a detailed debriefing and apology for the deception. Results: A total 42 undergraduate nursing students participated in the study. There were no significant differences between the two groups, normal immunity verses decreased immunity regarding their level of willingness to care for HIV/AIDS patients. Although not significant, analysis showed that both groups in the study were not as willing to perform more invasive tasks when caring for an HIV/AIDS patient. Conclusions: This experimental research study supports existing and future research showing the relationship of stigmatization among health care providers. It provided a much needed interactive, real-time study to show that evidence based stigmatization does occur.

Major Professor: James Whyte, AS, BSN, MSN, ND, Phd

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Robin McGuinness MSN, RN, NE-BC

DNP Health Systems Leadership Sarasota, Florida

Implementation of Bedside Change of Shift Report in an Emergency Department: a quality improvement project Introduction: A major issue that continues to affect the quality and safety of patient care is the failure to hand off patient information in a comprehensive way. Background: In an effort to decrease communication failures and improve the culture of safety in an ED, bedside change of shift report was implemented. Method: Kotter’s Eight Step Model for change was the framework used for the practice change. The project used a pre-post measurement design. Results: Nurses’ perception of completeness of patient care information communicated during shift change improved for the first time in 3 years. Readmission rate to the emergency department within 72 hours decreased, although not of statistical significance (p=.057) Patient flow metrics of door to discharge and door to inpatient bed did not improve, nor did the patient’s overall satisfaction with care in the emergency department. Patient’s satisfaction with being kept informed about delays improved in both the mean score and the percentile ranking nationally, although not statistically significant (p=.333; .166). Discussion: The results indicated an improvement in the staff’s perception that important patient care information is lost during shift change. This is consistent with other studies that implemented a structured handoff that included a standardized tool; face to face interaction; and involvement of the patient/family. Conclusion: It takes several strategies to support a culture of safety, with bedside change of shift report being an important component. Through standardizing the hand off process and moving it to the bedside of the patient, emergency departments may see positive results.

Major Professor: Barbara Little, DNP, MPH, RN. APHN-BC, CNE

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Dianne Mennitt MS, RN, CNS, AE-C

DNP Health Systems Leadership Tallahassee, Florida

Care of Students with Asthma in Florida Schools Introduction: The prevalence of childhood asthma in Florida is approximately 10% based on the Florida Department of Health (FDOH) data. Adherence to evidence-based asthma management practices serves to reduce medical expenses, improve school attendance, and reduce missed workdays for caretakers. Background: In 2010, an online asthma educational program for school nurses was offered to increase awareness of the National Asthma Education and Prevention Program (NAEPP) guidelines. Due to school nurses having to cover multiple schools, it is necessary for school nurses to train non-healthcare personnel in asthma management practices. Method: This study replicated the previous FDOH asthma survey of 2010 and compared results to determine if the national Guidelines for the Diagnosis and Management of Asthma were being followed. Email surveys were sent to 67 county school health coordinators. Results: The number of school office staff who routinely provide care for students with asthma has more than doubled since 2010. Other significant findings indicate an increase use of environmental processes to reduce common asthma triggers inside of school buildings through use of the U.S. Environmental Protection Agency (EPA) Indoor Air Quality (IAQ) Tools for Schools. Discussion: Results reinforce the need for school nurses to train school personnel using evidence-based asthma management practices. Conclusion: Guidelines for the Care and Delegation of Care for Students with Asthma in Florida Schools (FDOH, 2013) serves as a tool for school nurses to inform school personnel about asthma, how it is managed, and how to implement evidence-based asthma management practices in Florida school settings.

Major Professor: Laurie Grubbs, BSN, MSN, PhD

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Kristen Rasnick BSN, RN

DNP Family Nurse Practitioner Sarasota, Florida

The Evaluation of Door-To-EKG time in STEMI patients presenting to the Emergency Department Introduction: To determine if ST-Elevation Myocardial Infarction (STEMI) patients presenting to the Emergency Department (ED) received an EKG within 10 minutes and cardiac intervention within 90 minutes compared to the American Heart Association (AHA) national standard. Additionally, the study seeks to determine if STEMI patients presenting to the ED via EMS received an EKG/cardiac intervention faster than those who walk into the ED. Background: The AHA recommends that all cardiac patients receive an EKG within 10 minutes of hospital arrival and procedural balloon time is within 90 minutes. Method: The study used a retrospective, quality improvement, case-controlled design. Sixty-five de-identified records were reviewed for patients 30 years or older presenting to the ED with a diagnosis of STEMI in 2013. Results: The data did not support that all EKGs occurred within 10-minutes of arrival into the ED. EMS patient door-to-EKG times are significantly lower than walk-in patient door-to-EKG times (p=0.007). The data supported patients undergoing cardiac balloon insertions under 90-minutes (p=0.00000045). EMS patient door-to-balloon times were significantly lower versus walk-in patient door-to-balloon times (p=0.021). Discussion: Reasons for overall delay may include ED overcrowding, patients presenting to the ED with other symptoms besides chest pain, and inadequate staffing in triage. Additionally, staff level of education and experience may contribute to the delay. Conclusion: Despite the door-to-EKG time failure, the door-to-balloon time averages met the 90-minute standardized goal. It was evident that patients presenting to the ED by EMS have a shorter door-to-EKG and door-to-balloon times than patients walking into the ED.

Major Professor: Cara Pappas, BSN, MSN, ND

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Brooke Rogers BSN, RN

DNP Family Nurse Practitioner Sarasota, Florida

The Effect of Acne and Acne Treatment on Patients’ Quality of Life Introduction: Acne is the most common dermatologic condition treated by health care providers. It is known not only for its cutaneous manifestations but also for the psychological burden and negative emotional impact it has on those experiencing it. Background: While there is evidence that the effects of facial acne on patients’ health-related quality of life (HRQL) can be profound, HRQL assessment is not routinely included in treatment protocols. This study assessed HRQL of patients before and after initiation of a 4-6 week acne treatment regimen in a private dermatology clinic using the Acne Quality of Life (Acne QoL) Questionnaire. Method: A single group, pre and post-test research design was used. Baseline pre- and posttreatment Acne-QoL scores were analyzed descriptively, including differences based on gender and educational level. A matched paired t-test was computed to assess overall preand post-treatment differences. Results: Forty-four participants (n = 44) completed the pre-treatment Acne-QoL; 11 participants (n = 11) completed the questionnaire at post-treatment. Negative effects of acne on quality of life were higher among females (M = 72.5) and college-educated participants (M = 75.9) prior to treatment. Participants reported statistically significant improvements in quality of life after treatment (p<0.04). Improvements were greatest for males (M = 39.3) and college-educated participants (M = 30). Discussion: The results of this study confirm previous findings that patients’ quality of life is adversely impacted by facial acne. Conclusion: Healthcare providers should monitor not only the physical changes but also patients’ HRQL over the course of treatment.

Major Professor: Eileen Cormier, PhD, RN

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Martha Ruder MSN

DNP Family Nurse Practitioner Sarasota, Florida

Endorsement of Safe Infant Sleep; A Quality Improvement Project Introduction: The purpose of this project was to facilitate endorsement of safe infant sleep in a northwest Florida community. Background: Sudden unexpected infant deaths (SUIDS) related to unsafe sleep is a concern in Bay county and surrounding areas. The SUIDs rate between 2009 to 2011, indicates Bay, Franklin, Gulf, Calhoun, Washington and Holmes counties rank among the highest in the state. Method: A questionnaire designed to assess nurse’s knowledge of current SIDS risk reduction recommendations and methods of communicating information to parents was administered at a hospital maternity center. Crib audit surveys were conducted before and after implementation of a nurse’s educational training session to gauge safe infant sleep endorsement and parental compliance. Results: Inconsistencies and gaps in nurse’s knowledge of SIDS risk reduction recommendations were evident. Room-sharing versus bed-sharing was not emphasized consistently. Crib audits indicated compliance with the safe sleep recommendations on the mother-baby unit but compliance was less evident in the neonatal intensive care nursery. Discussion: Areas in need of improvement were identified and shared with maternity unit managers and key community agencies. Recommendations to include continuing education on SIDS risk reduction for all nurses employed at the maternity center and to develop policies to promote safe sleep environments were provided. Use of an algorithm to help guide the transition of medically stable infants in the NICU to supine sleep positions was suggested. Conclusion: A “toolkit” comprised of a variety of multi-media resources was distributed to key agency managers to promote safe infant sleep endorsement throughout the community

Major Professor: Kay Whitten, DSN, ARNP

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Jennifer Schnippert BSN, RN

DNP Family Nurse Practitioner Tallahassee, Florida

Provider practices regarding genetic screenings of patients at risk for Lynch Syndrome Introduction: This study assessed the knowledge of healthcare providers regarding Lynch Syndrome, their frequency of ordering genetic testing, and whether they provide genetic counseling to their patients or refer the patient to a genetic specialist. Background: Colorectal cancer is the third-most common type of cancer and is the secondleading cause of cancer death for men and women. Hereditary colon cancer syndromes cause about 5% of colon cancers, the most common is Lynch Syndrome. Method: This study used a descriptive, cross-sectional design to determine the extent to which healthcare providers implement practice guidelines for patients at risk for hereditary colon cancer syndromes. Data was gathered through a questionnaire distributed to physicians and nurse practitioners who specialize in family medicine, internal medicine, gastroenterology, or oncology. Results: This study showed a knowledge gap amongst PCPs when it comes to cancer genetics and the management of individuals at risk for Lynch Syndrome, however these patients are appropriately referred to a genetic specialist. It demonstrated no statistically significant differences in practice when comparing gender, age, level of education, provider type, or specialty. Discussion: While a knowledge gap was demonstrated, high-risk patients appear to be properly referred to a genetic specialist. Most providers correctly identified appropriate screening tests for patients with a known deleterious mutation. Conclusion: Medical providers have an understanding of their limitations and refer their patients to a specialist when needed.

Major Professor: Roxanne Hauber, BSN, MSN, PhD

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Charlene Small BSN, RN

DNP Family Nurse Practitioner Tallahassee, Florida

Disruptive Behavior Within the Workplace Introduction: Healthcare workers have a higher risk of experiencing disruptive behavior in the workplace than any other industry, and nurses are more susceptible than most. Background: The Joint Commission mandated all health care facilities implement procedures to deal with incidences of disruptive behavior and to minimize the sequelae of poor employee retention, patient safety issues, and added cost. The aim of this study was to determine if disruptive behavior existed in the healthcare workplace, how it was being handles and was the work environment considered safe. Method: This descriptive design used an online survey to ask nurses if they had experienced disruptive behavior and how this was handled within their organization. Disruptive behavior included any type of verbal abuse, electronic or email abuse, or physical abuse. Results: 3,067 nurses participated and a majority of them validated the occurrence of verbal, electronic, and physical disruptive behavior and the rated their overall work environment to be at high risk of experiencing disruptive behavior at least once every six months. Twentyfour statistically significant relationships were found with strongest correlations (.000) between: age and electronic abuse; position and verbal abuse; position and physical abuse; years of experience and electronic abuse; susceptibility of the organization to workplace violence and position as well as education; missing work due to disruptive behavior and position; and feeling comfortable reporting the abuse and position as well as education. Conclusion: A review of procedure needs to take place as disruptive behavior exists and not much is being done to prevent it.

Major Professor: Susan Porterfield, BA, MA, BSN, MSN, PhD

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Denise Stewart MSN, RN

DNP Health Systems Leadership Sarasota, Florida

Improving Patient Safety During Transfer of Care for the Pre-operative Patient Objectives: To improve the safe transfer of patient care from the acute care units to the perioperative suite through the adoption of a revised pre-operative checklist. Background and Significance: Errors were reported to occur during the transfer process of patients from the acute care units to the pre-operative area that placed patients at risk of harm, utilized resources that increased costs and caused increased frustration for patients, families, staff and physicians. A collaborative interdisciplinary leadership group initiated a rapid performance improvement process (PIP) to review current processes, identify safety hazards, enhance standardized tools and identify educational needs of the staff. Methods: A randomized retrospective comparison audit of 50 Operating Room pre-operative checklists, pre and post revision was conducted to determine the effectiveness of the rapid PIP. Results: An aggressive goal to reduce pre-operative checklist errors by 50% was set by the leadership group. Statistical review of the checklist audit did not meet the desired goal. Specific areas of shortcomings were identified for follow-up education Conclusions: Rigorous revisions made to the checklist as a result of regulatory requirements led to the shortcomings. These changes were necessary to provide safe, effective health care for the patients. The majority of the fall outs did not pose direct threats to the patientâ&#x20AC;&#x2122;s safety. However, this lack of compliance for a completed checklist demonstrates the need for the Health Systems Leader to continue to utilize the nursing process to promote patient safety.

Major Professor: Karla Schmitt, PhD, MPH, ARNP

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Marsha Weiner MSN, RN, CNE

DNP Health Systems Leadership Sarasota, Florida

Assessing Genetic and Genomic Competencies of Registered Nurses Working in Critical Care Units in Acute Care Hospitals in Florida Introduction and Background: Knowledge and skills in genetics and genomics (genetics/ genomics) are becoming increasingly important for all registered nurses (RNs) in the frontline of care, including those working in critical care units. The Essentials of Genetic and Genomic Nursing Competencies establish the minimal knowledge and skills expected of all practicing nurses. The aim of this study was to assess the genetic/genomic competencies of RNs working in critical care units in hospitals across Florida, compare this with the essential competencies expected of all practicing RNs, and provide information upon which educational programs in genetics and genomics for nurses could be built. Design: Registered nurses from a Florida Board of Nursing electronic mailing list were sent an invitation to participate if they were working in a critical care unit in a Florida hospital. Methods: Qualitative and quantitative data were gathered using an online electronic survey. Results: One hundred ninety-six nurses completed the survey with a completion rate of 38%. Discussion: Although a large majority of respondents were confident in their perceived knowledge and use of genetics/genomics in patient care, half reported lack of understanding of common disease genetics, confidence in counseling and referral, and/or use of family health history. Conclusion: Research in genetics/genomics is generating new understanding of genetic contributions to many common complex diseases seen in critical care units. Translating this research into practice involves nurses having knowledge and skills associated with genetic competency. Nurse leaders in practice and academic settings need to develop, implement, and evaluate educational programs that provide nurses with these competencies.

Major Professor: Roxanne Hauber, BSN, MSN, PhD

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Cathy Wogamon MSN, RN, CWCN

DNP Family Nurse Practitioner Tallahassee, Florida

Can Educating Certified Nursing Assistants (CNAs) in a Nursing Home Reduce In-house Pressure Ulcer Development? Introduction: By educating CNAs about early identification of problem areas with the skin and pressure ulcer prevention measures, the mortality and financial burden associated with pressure ulcers can be reduced. Background: Pressure ulcers account for thousands of hospitalizations and even death from ulcer related complications. Pressure ulcers account for billions of healthcare dollars annually. Methods: A pre-test/post-test design was utilized to measure the effectiveness of an evidencebased educational intervention. Pressure ulcer incidence was compared three months preintervention and three months post-intervention. A statistical analysis was completed to compare the pre-intervention / post-intervention pressure ulcer incidence. Results: Pre-test/Post-test analysis was conducted utilizing a t test (P value of 0.5387). There was reduction from 5 total pressure ulcers pre-intervention to 0 post-intervention. The Quality Indicator report showed a reduction from 12.3% in the pre-intervention quarter to 0% post-intervention. CNA reporting of skin breakdown increased by 68%. Discussion: Analysis showed no significant change in knowledge between the pre-test and post-test values, which could be related to small sample. A significant increase in CNA reporting of skin issues prior to acquiring pressure ulcers suggests that early identification of skin issues with intervention can greatly decrease the development of pressure ulcers. Conclusion: It can be concluded that CNA training regarding pressure ulcer identification and prevention measures can significantly impact pressure ulcer incidence rates in the nursing home setting.

Major Professor: Cara Pappas, BSN, MSN, ND

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


DNP Spring Research Exposition 2014