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Item Open Access Implementation of a Standardized High-Fidelity Simulation Program(2024-07-04) Motte, Cheryl; Sherrod, Bradley; Graduate Nursing Science; College of Nursing; Graduate Nursing Science; College of NursingSimulation in nursing education has been used for centuries as an essential approach to teaching new skills to nursing students. An abundance of literature has been written on the benefits to students when using simulation to augment the nursing curriculum. One of the benefits to students who participate in simulation is increased confidence. The C-Scale was used in a pre-test/post-test design to measure students' confidence before and after three simulation experiences. Aggregate mean scores were calculated for each of the five questions in each simulation. In Junior and Senior cohorts, post-test scores were higher than pre-test scores in each simulation. Based on these results, the students increased their confidence levels in the categories of hypovolemic shock, heart arrhythmias and fatal rhythms, asthma, and therapeutic communication. Additionally, based on student comments, participation in simulation scenarios was an enjoyable way to learn clinical situations that might be encountered in an actual clinical setting.Item Open Access A Pediatric Capacity Management Plan(2024-07-03) Perkins, Heather; Sherrod, Bradley; Graduate Nursing Science; College of Nursing; Graduate Nursing Science; College of NursingHospital capacity constraints is a contributing factor associated with access to care barriers in both adult and pediatric populations. Due to the limited number of pediatric hospitals there is a need to evaluate solutions to remove these barriers. The tertiary hospital for this project experienced an increase in capacity related denials for pediatric patients needing transfer with 3 patients declined in 2021 and an increase of 182 patients declined in 2022. These drastic numbers created a call to action to create solutions for this issue. In review of pediatric capacity management tactics at project site, it was identified that there was not a specified pathway or resource to manage patient flow operations, creating inconsistency and lack of efficiencies throughout. The framework utilized for project creation and implementation was through the Plan, Study, Do, Act (PDSA) model. The implementation of a pediatric flow coordinator and capacity management strategy was established with a goal to reduce capacity related denials by 10%-15% within specified time frame. The time frames in comparison were the months of January through May, 2023 and 2024 to maintain consistency regarding patient volumes. Post project results demonstrated a positive result with a 31% reduction in pediatric capacity denials. The positive outcome associated with this project is encouraging as a goal for healthcare organizations is to care for the right patient, at the right place, and at the right time. Creating solutions that contribute to efficient patient flow is essential, resulting in positive impacts such as better patient outcomes, positive patient experience, and productive financial results within organizations.Item Open Access Evaluation of Doctor of Nursing Practice Program Assignment Scheduling on Student Well-being(2024-04) Hill, Heather; Hodges, Alexis; Graduate Nursing ScienceBackground: Doctor of Nursing Practice (DNP) student well-being is essential for workload manageability. There is limited literature that reviews DNP students' well-being and the implications for improving student well-being for success in a DNP program. This project aims to evaluate the impact of aligning DNP core course assignments on student well-being and managing workloads. Method: The Model for Continuous Quality Improvement. The model steps include: • planning: the project problem • creating: surveys and course templates • intervention: schedules coordination • reflections: future recommendations. Results: Survey results were overall positive for students and faculty. Student survey common themes included: program manageability, school/professional/family balance difficulties, and increased stressors. Conclusion: Study feedback indicated stressors can affect student workload manageability in a DNP program. However, student well-being was overall positive regarding the alignment of assignment schedules. Additionally, students appreciated faculty availability and support in their DNP studies.Item Open Access Expedited Partner Therapy: A Harm Reduction Tool for Local Health Departments(2024-04-24) Brayboy, Coty; Conway, Blair; Graduate Nursing ScienceBackground: Expedited Partner Therapy (EPT) is essential for combating sexually transmitted infections (STIs), yet its adoption is limited in local health departments (LHDs). Purpose: This quality improvement project aimed to assess and emphasize the necessity of enhancing EPT utilization in LHDs and to bolster STI prevention. Methods: Examined existing EPT usage and identified implementation obstacles. Proposed strategic measures for wider adoption involving a review of a southern state’s STI data, STI clinic protocols, and insights from the STI Access and Availability Survey. Conducted onsite training sessions for LHD STI personnel. After these sessions, participants utilized an evaluation tool to gauge their agency's ability to incorporate EPT, their comfort in prescribing EPT, and identified barriers to EPT integration within their LHDs Results: Out of the three LHDs that participated in this project, only one intended to implement or expand EPT. Additionally, 83% of participants with prescriptive authority felt comfortable or extremely comfortable prescribing EPT. Conclusions: The hurdles pinpointed in the uptake of EPT by clinicians in LHDs include concerns related to clinic staffing and EPT not within the scope of the enhanced role registered nurse (ERRN). Implications for Nursing: Enhancing EPT uptake necessitates addressing systemic barriers and promoting provider readiness in LHDs and buy-in to expand the enhanced role registered nurse (ERRN) scope to include EPT.Item Open Access Providing Culturally Sensitive Addiction Treatment for People of the Catawba Tribe(2024-04-17) Chu, Jaymee; Lee Ann, Long; Graduate Nursing ScienceItem Open Access Reducing Emergency Department Bounce-Back Through Nurse-Driven Discharge Education(2024-04-23) Fountain, Madison; Conway, Victoria; Graduate Nursing ScienceA bounce-back is an emergency department (ED) visit by a patient previously treated and discharged who has subsequently checked back in within 48 hours for treatment (Montoy et al., 2019). Bounce-backs constitute a significant healthcare problem, causing decreased health in our population and an increase in the total cost of healthcare (Curcio et al., 2020). The national bounce-back average is 4%, and healthcare systems implement few interventions to solve the issue despite support within the literature to justify that thorough nursing education at discharge lowers bounce-backs. Nurse-to-patient educational gaps in the ED discharge process have decreased emergency nurses' competence and confidence in discharge teaching. The primary objective of this DNP project was to determine if improved nursing education at the time of discharge would decrease bounce-backs. This DNP project found a correlation between bounce-backs and teach-back method implementation, which led to nurse-driven education during discharge. The IOWA method and the Institute for Health Improvement (IHI) recommendations were utilized to implement the teach-back method and incorporate an emergency nursing discharge tool. In this DNP project, many emergency nurses were unaware of bounce-backs, never used the teach-back method, and never received teach-back or discharge training. The project’s barriers included a small sample size, no standardized discharge tool or process, and response bias. The study's findings suggest that emergency nursing staff's increased attention to the discharge process positively impacts the rate at which bounce-backs are seen. Further education should focus on the vulnerable populations contributing to bounce-backs.Item Open Access A Vascular Access Pathway to Decrease Computed Tomography Contrast Extravasations in Emergency Department Patients(2024-04-22) Jones, Kelly; Long, Lee Ann; Graduate Nursing ScienceAim: This evidence-based project aimed to create a pathway tool for emergency department staff to utilize during peripheral intravenous (PIV) placement to decrease patient harm secondary to iodinated contrast media extravasations in patients requiring contrast administration. Methods: A literature review was conducted and utilized to create a vascular access intervention pathway for emergency department clinicians to utilize during PIV placement. The pathway was displayed in the emergency department for clinicians to reference. Results: The results presented a decrease in iodinated contrast media extravasations by 17% in emergency department patients over a six-month implementation period. Conclusion: The created vascular access pathway tool could help improve patient satisfaction scores and prevent patient harm secondary to computed tomography.Item Open Access Increase the awareness and intent to pursue a Doctor of Nursing Practice degree in Black, Indigenous, and People of Color to improve healthcare and health equity access.(2024-04-22) Keelen, Mengesha; Long, Lee Ann; Graduate Nursing ScienceThis Doctor of Nursing Practice (DNP) project aims to increase the knowledge, awareness, and intent to pursue advanced practice nursing degrees among nurses and future nurses of all non-European people. Moreover, a secondary expectation of this DNP project, although not an outcome, aspires to reduce health disparities and improve patient outcomes through a more diverse and multicultural advanced nursing practice profession. Through mentorship, exposure, and access, the number of advanced practice nurses of color can increase, thus decreasing provider-to-patient ratios and increasing positive patient outcomes. Approximately seventy students, including both males and females, participated in implementing the DNP project over ten weeks. The implementation occurred at a community college in North Carolina. The Associate’s Degree program breakdown of students was as follows: 28 first-year, 19 are 2nd year, and 24 are transitioning from Licensed Practical Nurse (LPN) to an associate degree in nursing (ADN). Of these students, only five are male, and the rest are female. Regarding race/ethnicity, the collected Fall data of students were thirty-seven African American, thirty-two White, four Hispanic/Latino, and four Multiracial. The implementation project, which focused on exposing LPN and associate degree nursing students to DNP and master-prepared nursing fields, has been successful. The intent is for these students to pursue these degrees eventually. Ninety-nine percent of students who previously had minimal exposure to the degree and process now express a willingness to consider an advanced degree in nursing, demonstrating a significant increase in their awareness.Item Open Access Evaluating Employee Motivation in Expanding Adult Primary Services: A Grant-Funded Project(2024-04-09) Smith, Devin; Vinson, Krystle; Graduate Nursing ScienceMany parts of North Carolina are considered rural, especially in Eastern North Carolina. In these rural areas access to healthcare continues to be an ongoing concern. Employee motivation was evaluated as a local health department utilized grant-funding to help expand clinical services. The RE-AIM framework was utilized by completing Bono’s Six Thinking Hats exercise, a pre-and post-expansion survey as well as continued education on the topic of employee motivation and how it relates to grant funding. Employee motivation was evaluated, and progress was made towards the greater goal of the grant-funded project. It was found that post-expansion of services, after all interventions of the project, all results in the survey were improved regarding employee motivation, with the most significant being in improved clear communication. Through these findings, employee motivation is an excellent factor in evaluating departmental change. It is also important to consider grant funding and its success as a factor to departmental change.Item Open Access Expanding Access to Health Care for Agricultural Workers(2024-04-02) Glenn, Nicole; Conway, Victoria; Graduate Nursing SciencePurpose: This quality improvement project offered free hypertension screenings to agricultural workers in a single farm in rural North Carolina to gain insight into whether the participants felt that onsite screenings during working hours on the farm would improve their access to health care. Sample: A convenience sample of 42 agricultural workers on a single farm in rural North Carolina. Method: Over the course of 12 weeks, agricultural workers on a single rural farm were offered screenings for hypertension. Before conducting the screening, each participant completed a pre-screening survey and a post-screening survey. Demographic surveys were also completed after the screening and education had concluded. This project was deemed quality improvement via a self-assessment process; therefore, Institutional Review Board (IRB) approval was not required. Findings: Most participants felt that onsite visits during working hours would improve their accessibility to health care. Conclusion: Rural agricultural workers face a disadvantage in health care due to time constraints, affordability, and transportation. These social determinants contribute to a lack of health care access, which in turn affects long-term health and well-being. Providing onsite visits to agricultural workers can improve access to health care by closing the gap between these social determinants of health and accessibility.Item Open Access Pre-Exposure Prophylaxis (PrEP) Utilization in the College-Health Setting(2024-05-04) Hall, Christina; Conway, Victoria; Graduate Nursing SciencePre-exposure prophylaxis (PrEP) medication was introduced in 2012 to reduce the chance of acquiring HIV via sex by 99 percent (Centers for Disease Control and Prevention [CDC], 2022). Despite having a prevention method with such promising results, underutilization continues to be a concern in North Carolina. The CDC stated that 32,490 people in North Carolina could have benefitted from PrEP, but only 5,288 were prescribed the medication (CDC, 2022a). This quality improvement project aimed to evaluate the beliefs and habits of providers at a university in North Carolina regarding PrEP and, thus, their medication utilization. Providers in this setting serve as gatekeepers in disseminating PrEP but face institutional barriers. Continued education and evaluation of their attitudes and comfort with prescribing PrEP can allow these concerns to be addressed, making providers more likely to utilize this means of HIV prevention.Item Open Access Evaluating Heart Failure Knowledge(2024-04-20) Nichols, Lauren; Vinson, Krystle; Graduate Nursing ScienceAim: To evaluate the effectiveness of Krames education on patients with heart failure who have been admitted to the hospital with a heart failure exacerbation. Design: Quantitative research Methods: Exclusion criteria included less than one year of heart failure diagnosis, sedating procedure that day, palliative consult, dementia diagnosis, unwillingness to participate, end-stage renal disease, and increased shortness of breath/work of breathing/oxygen demands. Inclusion criteria included at least one heart failure hospital admission, having seen Krames education in the past, willingness to participate, being alert and oriented, being able to talk without getting short of breath, and being close to baseline respiratory status. Data Sources: I used PubMed and Google Scholar to find a heart failure knowledge test to implement this project. Results: Diet and nutrition are the most common areas of weakness, while symptoms and behaviors are the most common areas of strength for participants. Conclusion: The Atlanta heart failure knowledge test is a reliable indicator for testing heart failure knowledge. While Krames education does have the latest guidelines for heart failure education, most patients have trouble retaining the information and need re-education periodically. Implications for the profession and/or patient care: This study proved the need for periodic knowledge assessment and re-education for patients with chronic conditions. Impact: The study aimed to improve organizational health literacy by evaluating the knowledge retained by Krames heart failure education. The study showed that organizations need to ensure patients are up to date on the latest guidelines for their chronic conditions to better care for themselves after discharge from the hospital. This study impacted the heart failure patients and the health care providers that serve these participants.Item Open Access Health Literacy Improvement in Low Literacy Population(2024-04-15) Stephens, Jamie; Vinson, Krystle; Graduate Nursing ScienceBACKGROUND: Health literacy impacts health disparities as it relates to a social determinant of health. There is little research on policies or programs to improve. However, not mutually exclusive, low health literacy correlates with low education and low literacy population. Decreased health literacy increases health care costs, morbidity, primary and secondary prevention, and reduced compliance with medications or treatment plans. OBJECTIVE: To empower individuals in the low education/low literacy high-risk population to actively participate in their health goals and care planning by developing accurate and accessible educational video resources that provide an expandable framework to improve health literacy and health outcomes. Through quantitative and qualitative feedback, empowerment was measured through increased participation and engagement with a survey. METHOD: Registered adult learners at a non-profit organization (n=21) worked with private volunteer tutors (n=14) to improve literacy by viewing optional educational videos on general health topics. The learners and tutors completed a brief written questionnaire marking participation, as well as comprehension, and engagement of video. KEY RESULTS: Total participation of completed surveys was 75 percent amongst the different sample groups. There was 55% participation of the target high-risk adult student population. Questionnaire results identified the video length, interest level, and comprehension level was adequate for the target population. Participation barriers included participants missing learning sessions, decreased readiness to change lesson planning, and Wi-Fi connectivity. CONCLUSIONS: Further evaluation of the program to determine if video resources improve health literacy. This will require increased longevity of the pilot program, formal pre- and post-health literacy evaluations, and producing more video content.Item Open Access Assessing and Improving Nurses' Cultural Competence(2024-05-04) Ngo, Anita; Long, Lee Ann; Graduate Nursing ScienceIntroduction: Cultural competence is an important component of patient care and needs to be implemented more by nurses. Addressing cultural competence will assist in improving patients’ health, decreasing healthcare disparities, and increasing patient satisfaction. This qualitative improvement project aimed to assess and improve nurses’ cultural competence. Method: A quality improvement project was implemented at a North Carolina hospital, which included a pre- and post-survey and an education intervention. The Cultural Competence Scale for Nurses Short Form (CCSN-SF) was used pre- and post-survey. The Plan-Do-Study-Act (PDSA) cycle was utilized to determine the need for changes in the project. Results: The pre-and post-survey results revealed that the cultural competence education was effective. Discussion: Increasing nurses’ cultural competence can help immigrant patients overcome healthcare barriers and it is important for an organization to emphasize cultural competence education. The CCSN-SF can be implemented to assess nurses’ cultural competence without utilizing too much time.Item Open Access Behavioral Health Nurse Champion Project(2024-04-15) Davis, Jenna; Conway, Victoria; Graduate Nursing ScienceBackground: Literature supports providing nurses with more than educational interventions to empower staff. The organization already uses a behavioral health response team (BERT) to support staff, but no current peer-led group exists to support nurses’ education in behavioral health. Aims: The quality improvement project aimed to create the role of the behavioral health nurse champion (BHNC), who would provide peer-led support, educate on behavioral health, and partner with mental health resource nurses (MHRNs) on creating a survey. Methods: The BHNC attended virtual monthly meetings, often led by an expert on a topic. The project lead partnered with the MHRNs to create surveys on an existing intervention that provided peer support, the BERT response. A survey with six questions was created for bedside nurses to complete. Data Analysis: This quality improvement project was unable to determine the effectiveness of the BHNC role due to low participation. However, a survey completed by bedside nurses was used to assess knowledge gaps that could serve as the foundation for future education. Results: Four nurses and a supervisor regularly attended the virtual monthly meetings during the BHNC development phase. An identified need is finding ways to engage and recruit staff. Twenty-two nurses completed BERT surveys from September 15, 2023, to October 31, 2023. Limitations and Implications: Email recruitment was ineffective in gaining attendance. BERT surveys must also be promoted as this is a new process in the organization. Conclusion: Continue with the champion role and the BERT surveys, but discuss the necessary next steps with stakeholders.Item Open Access Increasing Awareness of Cardiovascular Risks that Impact Black Men through Barbershop Conversation(2024-04-18) Lamb, Crystal; Vinson, Krystle; Graduate Nursing ScienceBlack men have suffered abuse and mistreatment within our healthcare system. Past events proliferated medical mistrust and created a separation between provider and patient. As a result, many individuals within the Black community look to people of influence for guidance. A barbershop is a central gathering place for influential people within the Black community. Individuals regularly visit the barbershop for services, advice, fellowship, and direction. Historically, barbershops in the Black community have been a conduit for disseminating important information. As health disparities continue to permeate through marginalized groups, specifically Black men, it is imperative that community-based partnerships are established in efforts to bridge the gap. This project aims to increase awareness of cardiovascular risks that impact Black men through barbershop conversation by highlighting the medical term metabolic syndrome. This three-phase project intends to assess the knowledge base, disseminate new knowledge, and evaluate retention and understanding. Findings support the need for further community-based partnerships and more equitable opportunities to impact the outcomes for Black men.Item Open Access Dementia with Dignity: Methods to Reduce Incidence and Severity of Challenging Encounters(2024-04-18) Isbell, Patrice; Long, Lee Ann; Graduate Nursing SciencePsychological and behavioral challenges are frequently exhibited by individuals living with dementia. Often the interaction between a caregiver and the individual is the precipitant for those behaviors. The leadership of a Continuing Care Retirement Community (CCRC) identified a knowledge and skills gap in staff preparedness to respond to behavioral challenges exhibited by individuals diagnosed with dementia. These behaviors complicate the delivery of adequate care and preservation of the individual’s dignity. They can also lead to caregiver fatigue, caregiver attrition, and emotional, verbal, or physical harm to the individual living with dementia. The primary objective of the Dementia with Dignity project was to enhance caregiver knowledge and confidence in their skills through targeted didactic and experiential educational sessions. Participants completed pre- and post-intervention surveys. Immediately post-intervention, participants showed significant increases in dementia knowledge and competence, suggesting an enhanced level of caregiver preparedness to engage individuals affected by dementia. Although an unmeasured objective, it was anticipated that these enhanced skills would contribute to the preservation of dignity and the enhancement of quality of life for those living with dementia.Item Open Access Implementation of a Group Lifestyle Intervention Program for Staff and Hispanic Patients(2024-04-17) Baccus, Jesse; Long, Lee Ann; Graduate Nursing ScienceTwo-thirds of the adults in the United States (US) are overweight or obese, which can lead to diabetes and cardiovascular disease (Jarvis, 2019). More than one in ten adults currently has diabetes, almost 50% of the US population has prediabetes, and it is estimated that another 8.5 million adults have diabetes but are undiagnosed (Centers for Disease Control and Prevention, 2022). This is a concern for the US population and healthcare system, as diabetes can lead to further complications such as stroke, neuropathy, renal disease, and peripheral vascular disease (Jarvis, 2019). The Hispanic population has now become the largest minority group in the US, comprising 18% of the US population, or 59.9 million people (Leng et al., 2022). The prevalence of diagnosed diabetes in the US is higher in the Hispanic population at 12.5%, as compared to non-Hispanic blacks at 11.7% and non-Hispanic whites at 7.5% (US Department of Health and Human Services, 2020). Hispanics are also being newly diagnosed with diabetes at higher rates, 9.7 per 1,000 persons, when compared to non-Hispanic blacks, at 8.2 per 1,000 persons, or non-Hispanic whites at 5.0 per 1,000 persons. Diabetes places a massive financial burden of $327 billion annually on our society, according to conservative estimates (US Department of Health and Human Services, 2020). Research indicates that when recognized, insulin resistance found in diabetes and pre-diabetes can be reversed with simple lifestyle modifications such as proper diet and exercise (van Ommen et al., 2018). The purpose of this project was to help Hispanic patients implement these types of lifestyle changes using the Med-South Lifestyle Program. The in-person classes and written curriculum were offered in both Spanish and English to help decrease any language barrier. When discussing with providers and key leaders at the partner organization, it was apparent that education for the Hispanic patient population was lacking and that increased health education could improve patient health outcomes. Spanish-speaking patients had not had the option to take part in lifestyle modification groups such as the Diabetes Prevention Program or Med-South Lifestyle Program due to a lack of involvement from Spanish interpreters (Centers for Disease Control and Prevention, 2023; Center for Health Promotion and Disease Prevention, n.d.). Therefore, offering the Med-South Lifestyle Program in Spanish was an identified opportunity for improvement within the organization. Spanish-speaking patients face even more challenges in their health due to the language barrier, a lack of educational opportunities, transportation, lack of insurance, and long work hours. The partner organization has been aware of many of these challenges faced by the Hispanic population, and the organization offers seasonal outreach events throughout the year. However, health education takes time and effort, and many of these patients have admitted feeling powerless after receiving a diagnosis of a chronic illness that they do not understand, even when providers use an interpreter. Tackling the chronic disease epidemic of obesity, hypertension, and diabetes requires a targeted educational approach that the Med-South Lifestyle Program can provide. It was identified that Hispanic patients within the partner organization would benefit from a health education program in their native language to empower them and increase their understanding of how to fight chronic conditions. This lifestyle intervention DNP project aimed to decrease incidences of obesity and improve hypertension and diabetes in the Hispanic population. For Spanish-speaking patients to have a chance to combat diabetes, hypertension, and other chronic illnesses, they need bilingual health educators to help guide them on their wellness journey. Health educators can guide patients in creating personally developed action steps with realistic health goals. This project aimed to provide classes to Spanish-speaking patients following the Med-South Lifestyle Intervention Program curriculum. The project topic of interest was to decrease incidences of obesity and to improve hypertension and diabetes in the Hispanic population.Item Open Access Making the MOST of Advance Care Planning(2024-04-01) Dillon, Lexie; Conway, Blair; Graduate Nursing ScienceBackground and local problem: This project sought to improve patient confidence and satisfaction in Advance Care Planning (ACP) as applied to completing Medical Orders for Scope of Treatment (MOST) forms in a geriatric primary care clinic in central suburban North Carolina. The project was designed in response to the perceived difficulty experienced at the project site of maintaining two MOST forms on file for each patient for use during emergencies and hospitalizations. Methods: The project utilized group education sessions and a chart review drive to increase knowledge and address chart gaps. Results: Participants responded well to group education sessions and increased their knowledge and confidence about ACP. The review drive helped to decrease the number of patients who were not compliant with the host site policy, exceeding project goals. Conclusions: This project faced few barriers to implementation and improved record-keeping at the site. Participants discussed concepts with their peers and in a one-on-one setting to make choices in line with their values.Item Open Access Assessing Shock Anxiety in Patients with ICDs(2024-04-15) Hawkins, Taylor; Bell, Anne; Graduate Nursing ScienceBackground The Electrophysiology department at the collaborating institution for this DNP Project serves approximately 3,500 patients with implantable cardiac devices such as ICDs, pacemakers, and loop recorders. The site was identified as having no set metric to assess the patient's psychological response to the implantation of an ICD. Instead, the clinic intervenes with extensive education or a referral for Cardiac Psychology following an ICD shock based on patient history, clinical presentation, and shared decision-making. Objective The Florida Shock Assessment Scale (FSAS), created by Tripp et al. (2019), measures ICD-specific fears to target patients' psychological distress and the need for intervention. The objective is to prophylactically incorporate this tool at a patient's follow-up visit to identify patient-specific needs related to their ICD. Methods This project included 24 patients (n=24) with ICDs implanted (67% male, 33% female, 45% white, 54% African American, 25% previously shocked, and 75% never shocked). Patients were recruited at their routine follow-up ICD visits, where the clinic staff screened them for participation. The endpoint of the project was to identify patients with ICD-related anxiety and if cardiac psychology was indicated. Results Out of the sample, two patients who had been previously shocked were identified to have increased anxiety and were offered cardiac psychology. The female patient willingly accepted a referral to cardiac psychology. Each FSAS item was averaged, and two critical score items were identified to contribute to ICD-related anxiety: item 2 and item 8. Conclusion Knowledge of the clinic’s resources and education gave each patient a sense of safety and security in their ICD. In return, this improved quality of life and cardiac health.