College of Nursing
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Item Open Access Anesthesia Providers’ Perceptions of Ultrasound-Guided Arterial Line Placements: A DNP Project(2024-12-02) Pearce, LauraCurrent evidence shows the use of ultrasound guidance is advantageous for arterial line placements in reducing complications and increasing efficiency. Despite this evidence, no formal guidelines have been established regarding ultrasound-guided arterial line placements, leaving anesthesia providers to use their clinical judgment and personal preferences when placing these invasive lines. At this time, there is a lack of understanding regarding anesthesia provider preference for utilization of ultrasound technology for perioperative arterial catheterization. The purpose of this DNP quality improvement project was to develop, implement, and evaluate the perceived adequacy of an educational resource designed specifically for anesthesia providers to improve awareness and utilization of ultrasound for arterial line placement. This project took place at the main operating suite of a large medical facility in eastern North Carolina. CRNAs at this site were provided information on the basics of ultrasound use, troubleshooting tips, and the current research regarding ultrasound-guided arterial line placements. The results showed that confidence level and likelihood of using ultrasound-guidance for arterial line placements increased following the implementation period. Participants also identified a lack of equipment as a barrier to using ultrasound in their practice. Future projects should focus on increasing access to ultrasound equipment and the addition of a hands-on ultrasound workshop to further increase confidence and skill.Item Open Access Assessing CRNAs’ Perceptions of the Adequacy of a Quick-Reference Guide for Evaluating Airways of Patients with Obesity: A Quality Improvement Project(2024-12-02) Craney, TylerObesity (BMI > 30 kg/m2 ) has increased to over 40%, and morbid obesity (BMI > 40 kg/m2 ) to more than 9% of the United States population. Subsequently, there are more patients with obesity presenting for surgery and anesthesia. The increased adiposity in obese patients alters anatomy and physiology and places them at higher risk for difficult perioperative airway management. There are a variety of techniques to properly assess these risks, however no single source could be found that succinctly incorporated predictive scales for properly identifying and managing potential difficult airways in patients with obesity. The purpose of this Doctor of Nursing Practice quality improvement project was to assess CRNAs’ perception of a newly developed quick reference guide as a useful tool for their practice as it pertains to airway assessment in patients with obesity. The CRNAs used the provided quick reference guide for a period of two weeks and were surveyed before and after regarding their current assessment practices and patient populations. None of the providers reported using ultrasound in their assessments, despite receiving education of its high specificity and sensitivity in predicting difficult airways in patients with obesity and some CRNAs still reported patients with obesity are more difficult to intubate, which contradicts current literature. Limitations to this project are the small sample size and unequal pre- and post-implementation survey responses. Knowledge gained from this pilot project could be used in future quality improvement and policy efforts aimed at improving anesthesia care of patients with obesity.Item Open Access Implementation of a Standardized Handoff Report for Nurse Anesthetists in the Intra-Operative Setting: A Quality Improvement Project(2024-12-02) Pierce DoHandoffs amongst anesthesia providers are complex, rapid, and frequent. The responsibilities of a nurse anesthetist consist of providing safe and effective anesthesia before, during, and after surgery. While individual anesthesia providers often use systematic methods for giving report, anesthesia departments typically do not use common reporting tools, which may improve the quality and continuity of information, perception of patient safety, and healthcare worker satisfaction. This Doctor of Nursing Practice (DNP) project aimed to assess anesthesia providers' perceptions of adequacy of the PATIENT Mnemonic to facilitate standardized handoffs of anesthetized patients. This quality improvement project was completed at a Level I trauma center located in the southeastern region of the United States. A pre- and post-survey design was utilized to complete a single Plan, Do, Study, Act cycle to assess user perceptions of the PATIENT Mnemonic amongst a non-randomized group of CRNAs. Based on project data, a shorter version of the PATIENT Mnemonic tailored to anesthesia providers at the project site would do well. Eliminating aspects reported to be redundant or unnecessary would shorten the time it takes to give report, may make the handoff process more seamless, fluid, and similar to how most CRNAs already give report. Two limitations of this quality improvement project were the small sample size and limited time for implementation. Overall, continuing this quality improvement project would be a low cost, low risk, and high reward since it has the potential to reduce patient harm and improve patient outcomes.Item Open Access Anesthesia Providers’ Perceptions of Ultrasound-Guided Arterial Line Placement: A Doctor of Nursing Practice Project(2024-11-23) Allison RogersDespite multiple studies supporting the advantages of ultrasound guidance, no formal processes are consistently followed, leaving anesthesia providers to use clinical judgment and personal preferences when selecting methods for arterial line placement. The goal of this project was to identify the perceptions of anesthesia providers regarding ultrasound guided arterial line placement in their current practice and after utilization of an educational resource. Pre- and post-implementation data were collected over a two-week period using Qualtrics software and analyzed using Excel. Anesthetists reported several barriers towards implementation including inadequate education and training on ultrasound-guided arterial catheterization, lack of available ultrasound equipment, and prolonged procedure set-up and duration. The anesthetists’ confidence and likelihood of using ultrasound for arterial line placement increased, suggesting that these anesthetists are willing to attempt ultrasound for arterial line placement in future cases. Further education on ultrasound techniques for arterial line placement may increase provider confidence and prevalence for utilization of ultrasound. Several limitations were identified, including a small sample size (n=9), resulting in only 6 participants completing the pre-implementation survey and 5 participants completing the post-implementation survey. The smaller sample size limited statistical significance, and the ability to generalize the results to the overall population of CRNAs. If this quality improvement project was to be replicated, an ultrasound workshop conducted by the project lead would greatly benefit overall CRNA comfortability and confidence with using ultrasound, and therefore, participation.Item Open Access Assessing Anesthesia Providers’ Perceptions of Ultrasound Use with Arterial Line Placement and the Impact of an Educational Resource: A DNP Project(2024-12-02) Breanna Nicole LoveUltrasound guidance with arterial line placement is associated with increased success rates while lowering the risk of complications related to multiple attempts. Despite multiple studies supporting the advantages of ultrasound guidance, no formal processes are consistently followed. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to develop, implement, and evaluate the perceived adequacy of an educational resource designed specifically for anesthesia providers for improving awareness and utilization of ultrasound for arterial line placement. A literature search and synthesis was performed, a single Plan-Do-Study-Act cycle was implemented, and an educational handout and PowerPoint Voiceover were created. Surveys were created using Qualtrics, and nine participants were emailed instructions, educational resources, and individualized links to the surveys. Participants were asked to utilize the resources during a two-week implementation period and then complete a post-survey. Following data analysis using Microsoft Excel there was an increase in awareness of the advantages of ultrasound-guided arterial line placement and an increase in perceptions that ultrasound use with arterial line placement is superior to traditional palpation techniques. Barriers the participants faced may be why they are unlikely to use ultrasound-guidance despite their positive perceptions of the technique. In the future, evaluating perceived barriers of anesthesia providers related to ultrasound use with arterial line placement may allow the implementation of ways to decrease barriers and improve utilization of ultrasound with arterial line placement. This QI project improved anesthesia providers' knowledge and raised awareness of barriers related to ultrasound use with arterial line placement.Item Open Access Implementation of a Standardized Handoff Report for Nurse Anesthetists in the Intra- Operative Setting: A Quality Improvement Project(2024-12-02) Grace Elizabeth MookThe anesthetic period is a dynamic moment in patient care, and the role of anesthesia providers during anesthesia handoff carries a tremendous amount of responsibility. The operating room environment offers an additional layer of complexity and distractions during anesthesia handoff. The purpose of this Doctor of Nursing Practice project was to assess anesthesia providers' perceptions of adequacy of the PATIENT mnemonic to facilitate standardized handoffs of anesthetized patients. The goal was to gain a better understanding of CRNA perceptions of this method in order to assess its usefulness as a handoff checklist in the transfer of care. This quality improvement project was conducted in the operating rooms of an outpatient surgery center located in the southeastern region of the United States. A pre-and post-survey design was used to complete a single plan, do, study, act cycle to assess perceptions of a standardized anesthesia handoff checklist among a nonrandomized convenience sample of CRNAs who volunteered to participate in the project. The CRNAs reported in the post-implementation survey that the PATIENT mnemonic was easy to use but not more efficient, comprehensive, or appropriate in length compared to their personally used handoff methods. There was a net neutral response regarding whether the tool was more time consuming, lent itself to errors, and overall satisfaction using the mnemonic. Limitations included a small sample size and number of survey responses. Recommendations for future study involve CRNA collaboration in the creation of an anesthesia handoff checklist as well as anesthesia handoff project champions.Item Open Access Assessing Certified Registered Nurse Anesthetists’ Perceptions of the Adequacy of a Quick-Reference Guide for Evaluating Airways of Patients with Obesity: A Quality Improvement Project(2024-12-02) Amy Lee NygrenObesity is a growing health concern and increases the risk of a difficult airway. Recent evidence indicates a combination of airway assessment techniques may be most effective in predicting difficult airways in patients with obesity, but determining which combination to use is difficult. The purpose of this project was to assess the perceptions of adequacy of the quick-reference guide format as a useful tool for CRNA practice when assessing the airways of patients with obesity. A literature review was conducted to identify the airway assessment techniques that are most accurate in predicting difficult airways in patients with obesity. Then, a quick-reference guide was created to present these techniques together. Ten CRNAs were asked to complete a pre-implementation survey, use the quick-reference guide for two weeks, and complete a post-implementation survey. Comparison between the pre- and post-implementation surveys showed that perceptions of usefulness of the STOP-Bang score, Mallampati score, and thyromental distance increased during the project. Perceptions of usefulness of neck circumference and thyromental distance to neck circumference ratio changed little. Overall perceptions of usefulness of the quick-reference guide were moderate. The results from this project could indicate that a quick-reference guide may act as a helpful addition to the pre-anesthetic assessment. However, this project was conducted for a short period of time with few participants, so further investigation needs to be conducted to better understand what alterations to the quick-reference guide may improve utility.Item Open Access A Review of Parental Bereavement Interventions: Implications for Clinical Practice, Research, and Policy(2024-05-23) Floyd, Abigail Joan; Ramkumar, RheaThe untimely death of a child is an incredibly traumatic experience for parents and their loved ones. It uproots every aspect of their life, leading the bereaved parents to be far more likely to have poorer physical and mental health outcomes. This traumatic form of bereavement should have comprehensive grief-focused, high-quality interventions available for parents and extended family members. The purpose of this rapid review was to explore and describe the bereavement interventions available for parents and family that have been published within the past 5 years. Records identified 123 full-text articles that were reviewed, and 14 of those were included for data extraction and synthesis, using Cochrane Rapid Reviews Methods Group with the addition of keyword searches. The 14 articles were analyzed by evaluating description of bereaved parents, accessibility of interventions, who delivered interventions, and the type and delivery time of interventions. Four types of interventions were identified, including Web-based, community-based, hospital-based, and psychotherapy interventions. This rapid review has implications for clinical practice, research, and health care policy that can increase the availability of support and quality of interventions for bereaved parents and family members.Item Embargo COVID-19 AND COLLECTIVE TRAUMA: A QUALITATIVE DESCRIPTIVE STUDY EXPLORING THE EXPERIENCE OF A PANDEMIC FROM A NURSING PERSPECTIVE(East Carolina University, July 2024) Evans, Kara HedvigThe COVID-19 pandemic can be described as a collective trauma – a shared traumatic experience that will continue to impact physical, mental and psychosocial health for years to come. For nurses, the impact was compounded by existing workplace concerns including burnout, traumatic stress, and unhealthy work environments that also contribute to poor patient outcomes. While there is broad recognition of the importance of nurse well-being to public health, prior research emphasized individual-level causes and interventions that have had limited impact. Therefore, the purpose of this study was to explore the experience of nurses in the aftermath of the COVID-19 pandemic to develop knowledge of the structural and social factors that influence nurse well-being. This qualitative descriptive study employed collective trauma as a sensitizing framework and was conducted in two phases. Phase I results indicated that two years into the pandemic, disrupted connections between nurses and their peers, patients, and the community challenged participants’ sense of meaning and purpose. Phase II data, collected two years later, extended these findings by illustrating how the pandemic’s long-term impact on collective identity and social capital intersects with systemic deficiencies in the work environment to influence nurse well-being.Item Open Access Leadership Development Supported by Scientific Tools(2024-08-07)Leadership requires ongoing introspection and analysis as one moves through the various stages of professional growth and development. This paper analyzes various leadership styles with the intent of understanding the impact of leadership on an environment that improves team engagement and patient experience in a very busy ED. Through the use of personality assessment tools, leader development plans were creäted and implemented for a novice manager team utilizing evidence-based leadership tactics. Outcomes improved in the areas of staff turnover, patient experience, and team engagement, validating the project’s intent that leader development is essential in today’s ED environment. As young leaders are brought into leadership roles, professional development is essential to the creation of a healthy practice environment not only for staff retention but also for the patients served.Item Open Access Developing Mentorship for Novice Sexual Assault Nurse Examiners(2024-07-26) Katherine WasowskiExecutive summary of DNP project to fulfill the requirements of the DNP-FNP program.Item Open Access A Medication Quality Improvement Project for the Surgical Time-out: Executive Summary(2024-07-26)Implementation of the inclusion of medication time-outs in the surgical time-outs in operating rooms is essential. The Quality improvement project implemented at this rural North Carolina hospital warranted this need. It proved to be a beneficial step in improving the quality and safety of surgical patients.Item Open Access Improving Adherence to Treatment in Hypertensive Patients(2024-07-26) Krista WhitleyExecutive summary for the completion of the DNP programItem Open Access Transforming Health with Breast Density Insights(2024-07-11) Williams, Sharon KempItem Open Access Pulmonary Prehabilitation in Patients Undergoing Thoracic Lobectomy(2024-07-23) Ormond, JadeAn executive summary for the completion of a DNP degree.Item Open Access Using Social Media for Education in Women’s Health(2024-07-23) Helton, HeatherThis Executive Summary is a component of the DNP program.Item Open Access Burnout Among Ambulatory Nurse Managers: Insights from Qualitative Focus Groups(2024-07-23) Rimmer, SamanthaExecutive summary for the completion of the DNP program.Item Open Access Increasing Access to the Sleep Medicine Specialty for Veterans(2024-07-23) Lindsey BarrettExecutive Summary for the completion of the DNP program.Item Open Access Written Asthma Action Plan for Adult Patients: Executive Summary(2024-07-23) Toler, RebeccaExecutive summary used to fulfill the requirements of the Doctor of Nursing Practice program.Item Open Access Impact of a Home Telehealth Heart Failure Outpatient Order Set on Veteran Hospitalizations(2024-07-21) Ballard, MelissaCongestive heart failure (CHF) admissions are above the national Veterans Affairs (VA) benchmark at a large health care facility serving Veterans in Western North Carolina (WNC) The VA has outpatient home services, including telehealth, that can manage CHF patients and avoid hospitalizations This project updated the home telehealth (HT) consultation form to include blood pressure and target weight range goals for Veterans with CHF in the outpatient setting. After the intervention HT received fewer consults and only 9% of the forms included weight and blood pressure goals It was discovered that registered nurses can place CHF consultations to HT which increases patient access to care Providers and nurses need education regarding establishing CHF blood pressure and target weight goals to improve CHF care for Veterans