Doctoral Projects

Faculty Mentor, Advisor or Committee Chair: Debra Kosko, DNP, MN, FNP-BC, FAANP

Project Title: Increasing Bone Density Screening Rates in a Rural Community Health Organization

Abstract: An estimated 10 million individuals in the United States have osteoporosis which can lead to fractures, disability and premature death (LeBoff et al., 2022). The annual costs associated with fractures are $57 billion and are expected to increase to over $95 billion by 2040 (LeBoff et al., 2022). Despite the significant healthcare costs associated with osteoporosis-related fractures, routine bone density screening remains underutilized in primary care settings (LeBoff et al., 2022). Women and older adults are particularly vulnerable, with disparities in screening rates among different ethnic and socioeconomic groups (Wu & Dai, 2022). A retrospective analysis of health records of primary care patients from a large rural community-based healthcare organization was conducted to assess osteoporosis screening rates. Data from May 1, 2022, to May 1, 2024, revealed that 30.4% of eligible women (aged 65 and older) and 3.7% of eligible men (aged 70 and older) had bone density screening ordered. To address these gaps, a quality improvement project was implemented using an online slide presentation and an evidence-based algorithm. The goal of the algorithm was to provide clinical decision support to providers for osteoporosis screening and treatment. In the three months following the intervention, screening rates declined. Among 7,506 women aged 65 and older seen post-intervention, screening rates dropped from 30.4% to 20.4%. Similarly, for 3,739 men aged 70 and older, screening rates declined from 3.7% to 2.1%. Statistical analysis indicated a significant decrease in screening rates among women overall (Z = 19.3, p< .001), women seen in women’s health (Z = 3.48, p< .001), and men aged 70 and older (Z = 4.6, p< .001). The decrease in screening rates suggested barriers such as decreased prioritization of osteoporosis screening and time constraints for provider training. The findings highlighted the complexity of implementing effective provider education and decision-support tools in large healthcare organizations. Addressing these challenges is essential to improving osteoporosis screening and treatment, which can significantly impact patient outcomes and healthcare costs. Future quality improvement initiatives could focus on optimizing provider engagement, refining educational interventions, and enhancing system-wide integration of osteoporosis screening (Wu & Dai, 2022).

Faculty Mentor, Advisor or Committee Chair: Lisa Chaplin, DNP, NP-C

Project Title: Sleep Enhancement Order: A Quality Improvement Project

Abstract: Hospital-acquired delirium is a concerning issue, especially for older adults and those with neurological conditions. It can lead to serious complications, longer hospital stays, and increased healthcare costs. Studies show that improving sleep quality in hospitalized patients can help reduce the risk of delirium. Although a sleep enhancement order was available to improve rest, its utilization on a Neuro Specialty Unit remained inconsistent, primarily due to the absence of formal education for nursing staff. This quality improvement project explored whether a structured educational plan could improve staff knowledge of the sleep enhancement order. To measure the impact of the intervention, a pre-and post-intervention quality improvement project was conducted with registered nurses and patient care technicians. The initiative included assigning an online educational module designed by the site hospital system focused on sleep enhancement, along with reinforcing the education during daily huddles. A presurvey captured baseline knowledge, familiarity, and advocacy, while a post-survey assessed changes after the intervention. The data were analyzed using Wilcoxon signed-rank tests. Out of 53 initial participants, 35 completed both pre-and post-surveys. The results showed a significant improvement in knowledge, with scores increasing from 57.1% to 85.7% correct responses (Z = 3.7, p < .001). Familiarity with the sleep enhancement order rose from 68.6% to 94.3% (p < .001), and advocacy for its use significantly increased from 17.1% to 62.9%. These findings suggest that structured education can greatly enhance staff understanding iv and engagement with sleep enhancement orders, ultimately improving patient care by reducing delirium risk. Some challenges included a simultaneous initiative that may have influenced participation, and the lack of a validated survey tool. Future recommendations include expanding the initiative across the hospital, integrating sleep enhancement education into staff training, and evaluating its impact on patient health over a longer period. This project highlights the critical role of education in improving adherence to clinical protocols and enhancing patient outcomes. A structured sleep enhancement education program could be a valuable strategy for reducing delirium and optimizing inpatient care.

Faculty Mentor, Advisor or Committee Chair: Catherine Horvath, DNP, CRNA

Project Title: Evaluating the Effectiveness of Cannabis Education for Resident Registered Nurse Anesthetists

Abstract: The purpose of this study was to evaluate Resident Registered Nurse Anesthetists’ (RRNAs) knowledge and perceived confidence regarding the physiologic and pharmacologic effects of cannabis use and to assess the impact of an evidence-based educational intervention reviewing anesthetic considerations. A quantitative one-group quasi-experimental design with pre- and post-intervention surveys was performed to measure change in knowledge and confidence. After the educational intervention, participating RRNAs (n = 30) had a significant increase in knowledge, with correct responses improving from 55.7% pre-intervention to 77.6% post-intervention (z = 2.41, P = .008). Reported on a Likert-Scale from least (1) to most (5) confident, RRNA confidence levels increased in identifying both physiologic effects (pre M = 2.71, post M = 4.13, P < .001) and pharmacological effects of cannabis (pre M = 2.57, post M = 4.10, P < .001). Participants additionally reported perceived importance of cannabis education for RRNAs. This study demonstrated that an educational intervention on the anesthetic implications of cannabis use can significantly enhance RRNA knowledge and confidence, underscoring the importance of including cannabis education in nurse anesthesia training.

Faculty Mentor, Advisor or Committee Chair: Krista White, PhD, RN, CCRN, CNE

Project Title: Impact of an Evidence-Based Obstetrical Emergency Response System on Decision to Delivery Interval and Maternal and Neonatal Clinical Outcomes

Abstract: Obstetrical (OB) emergencies can occur at any time during pregnancy, affecting both maternal and neonatal patients. In the United States (U.S.), approximately 700 people die annually from pregnancy-related complications. Obstetrical emergencies are spontaneous and contribute to rising U.S. mortality rates. Optimizing OB emergency care delivery should be prioritized to help mitigate these disparities. Research evidence supports the use of OB emergency response systems to help improve patient outcomes and care delivery. This quality improvement project implemented Code OB with an OB Rapid Response Team (OB-RRT) in a tertiary perinatal hospital. Project aims were to (1) evaluate the impact on decision-to-delivery interval (DDI); (2) measure maternal (quantitative blood loss [QBL], ICU admissions) and neonatal (APGAR scores, NICU admissions) outcomes; and (3) assess nurses’ knowledge. Maternal and neonatal retrospective deidentified electronic medical record (EMR) data of qualified OB emergencies were gathered between July and September 2024. Prospective deidentified EMR data of cases utilizing Code OB were collected between October and December 2024. Prior to go-live, training sessions were conducted with labor and delivery, mother baby unit nurses, and members of the interdisciplinary OB-RRT. Nursing knowledge was assessed using a test administered immediately after training and six weeks later. Retrospective data (n = 29 cases) revealed an average DDI of 42:08 minutes while Code OB prospective data (n = 17 cases) revealed an average DDI of 15:28 minutes (p <.001). No significant differences were found in maternal QBL and ICU admissions, or neonatal APGAR scores. Three NICU admissions occurred with Code OB compared to nine admissions prior implementation. Nursing knowledge significantly improved from post-test #1 to post-test #2, 83.1% to 88.7% respectively (p = .02). Results from this project are congruent with the literature. The deployment of Code OB and OB-RRT enhanced the rapid response system and significantly reduced DDI for OB emergencies to effectively deliver safe and equitable standards of care. Training staff improved sustained knowledge related to Code OB. Additional studies related to OB emergency care are needed to further evaluate maternal and neonatal measures.

Faculty Mentor, Advisor or Committee Chair: Megan McAuliffe, DNP, CRNA

Project Title: An Exploration of CRNA Knowledge of Medical Supply Waste and Strategies for Mitigating its Financial and Environmental Impact

Abstract: This study explored the knowledge and clinical practice gaps among CRNAs regarding the environmental and financial impact of medical supply waste. Additionally, this study examined the current education regarding sustainability practices among CRNAs, while further investigating if sociodemographic factors such as education and years of experience influenced supply waste. Furthermore, the barriers to medical supply conservation and recycling interventions were explored. Seventeen out of thirty possible respondents were included in the final analysis. 70.6% of the participants did not receive education during their anesthesia program on sustainable practices. Additionally, 82.4% of the respondents did not receive this education in their workplace. The most reported barriers to recycling were inadequate information/knowledge on recycling and sustainability (70.6%), work or production pressure (70.6%), and lack of recycling facilities within the hospital (70.6%). There was a significant increase in the percentage of answers correct from a mean of 50.7% (SD = 12.1) pre-educational intervention to 68.4% (SD = 12.6) post-educational intervention, t (16) = 4.7, p < .001. Our results suggest that with formal medical supply waste education and training, CRNAs may be more inclined to make informed decisions regarding the implementation of sustainable practice changes in the workplace.

Faculty Mentor, Advisor or Committee Chair: Mary Scott-Herring, DNP, CRNA, Megan McAuliffe, DNP, CRNA, Angela Mund, DNP, CRNA, Nancy Crowell, PhD

Project Title: The Impact of Policy Education on Certified Registered Nurse Anesthetist and Student Registered Nurse Anesthetist Political Astuteness and Engagement

Abstract: Certified Registered Nurse Anesthetists (CRNAs) are crucial members of modern day healthcare, serving a pivotal role in anesthesia practice and patient care. In today’s quickly evolving medical field, it is essential for CRNAs to stay informed about healthcare policies. This article explores the relationship between policy education of CRNAs and Resident Registered Nurse Anesthesiologists (RRNAs) with their political astuteness scores, as evaluated by a Political Astuteness Inventory (PAI) scale. It also explores political engagement efforts among CRNAs and RRNAs. A virtual survey was distributed to 3000 CRNAs and RRNAs via the American Association of Nurse Anesthesiology. The results showed CRNAs had significantly higher PAI scores (M = 10.8, SD = 4.3) than RRNAs (M = 7.1, SD = 3.4), t(100) = 3.16, p =.002. Means were compared using two-tailed, independent samples t-test. Although no other comparisons showed statistically significant differences, it is important to note that the survey yielded only a 3.4% response rate. These results are to be interpreted with caution given the low response rate and underpowering of statistical reliability. Further research with larger sample sizes would be beneficial to this area of research to effectively demonstrate the relationship between policy education and political astuteness/engagement among CRNAs and RRNAs.

Faculty Mentor, Advisor or Committee Chair: Melicia Escobar, DNP, CNM, WHNP-BC, FACNM

Project Title: Implementation of Transfer-Specific Plans and Transfer Anticipatory Guidance at a Birth Center: A Quality Improvement Project

Abstract: Community birth settings, including birth centers, require well-coordinated transfer processes to ensure safe maternal and neonatal outcomes. Despite established best practice guidelines, many birth centers lack standardized documentation of transfer anticipatory guidance. This quality improvement (QI) project aimed to implement and evaluate the use of structured transfer-specific plans and anticipatory guidance documentation at a birth center to improve staff practices and preparedness. A pretest-posttest QI design was used at a freestanding birth center. The intervention included a staff education session on transfer planning, implementation of a standardized electronic health record (EHR) note for documenting anticipatory guidance at 18-22 and 28-32 weeks, and modifications to birth plans at 37+ weeks to include transfer planning. Pre- and post-intervention surveys assessed staff knowledge, attitudes, practices, and barriers. Chart audits measured compliance with documentation protocols. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test. All five birth center staff members participated. Improvements were observed in staff knowledge regarding the importance of early transfer planning (Z = 2.24, p = 0.025) and client safety (Z = 2.00, p = 0.046). Documentation compliance increased, with 80% of charts including anticipatory guidance at 18-22 weeks, 88.9% at 28-32 weeks, and 100% including a transfer plan at 37+ weeks. Staff commitment to integrating these practices was confirmed in post-intervention surveys. This QI initiative successfully improved transfer planning documentation and anticipatory guidance around transfer in a birth center setting. Despite the small sample size and time constraints, findings support the feasibility of structured anticipatory guidance protocols in community birth settings. Future efforts should focus on sustaining these improvements and expanding education to hospital-based teams to enhance interdisciplinary collaboration.

Faculty Mentor, Advisor or Committee Chair: Leslie Arceneaux, DNP, FNP-BC, CNS, CDCES

Project Title: The Impact of Patient Reminders, Tracking and Telehealth Option on Annual Wellness Visit Attendance

Abstract: The Annual Wellness Visit (AWV) is a crucial component of preventive health services for Medicare beneficiaries to discuss health status, identify risks, and create personalized prevention plans, ultimately improving outcomes and well-being. However, many eligible individuals do not take advantage of this benefit. This program evaluation investigated the impact of implementing customized appointment reminder messages, telehealth options, and tracking of AWV participation through the Aledade system on patient attendance in an independent internal medicine practice. The evaluation consisted of a quantitative analysis of attendance records before and after the intervention and a survey collection of qualitative data on staff experiences. Postimplementation attendees were more likely to be under 65, between age 65 and 70, with fewer over 90. There was no difference in percentages of male and female attendees between the pre-and post-implementation periods, X2(1) = 0.2, p = .679. There was a significant increase in individuals not disclosing race/ethnicity post-implementation, X2(6) = 24.6, p < .001, with a subsequent decrease in all the identified race categories. A shift occurred to Medicare-only insurance. Notably, there were no initial visits in the post-implementation period compared to 9.4% pre-implementation. Only 26 out of 1,349 attendees opted for telehealth, and they tended to be older, male, white, and insured. Determining changes in AWV attendance proved challenging due to the absence of data on patients who scheduled appointments but did not show up and the fact that attendance and scheduling data were identical. Staff were satisfied with the Aledade and telehealth option but found the reminder system unfriendly and the phone call features least beneficial. This program evaluation emphasizes the importance of enhancing the internal medicine practice’s reminder system, gaining insight into barriers to telehealth access and patient preferences while gathering demographic information. These efforts will help tailor annual wellness services to meet diverse patient needs and promote equity. Additionally, it provides insight into a better understanding of patients’ insurance needs and enhanced staff training to maximize the utility of technological systems. Overall, the results emphasize the importance of innovative approaches to increase AWV participation and improve patient satisfaction in preventive healthcare.

Faculty Mentor, Advisor or Committee Chair: Ella T. Heitzler, PhD, WHNP, FNP, RNC-OB

Project Title: Impact of Reproductive Hygiene Electronic Education on Clinic Visits for Recurrent Vaginitis and Urinary Tract Infections

Abstract: Bacterial vaginosis (BV) and urinary tract infections (UTIs) are common infections which have been shown to impact quality of life for women. Contemporaneously, electronic education has been shown to have a positive impact on patient knowledge and outcomes. The primary purpose of this quality improvement project was to evaluate the impact of electronic education on the rate of visits for a chief concern of vaginal infection and/or UTI symptoms over an eight-week period in an obstetrical and gynecological urgent care clinic. The project also aimed to determine the percentage of patients who are offered the electronic education and accessed it. A QR code was developed for the project and allowed non-pregnant women aged 18- 65 presenting with symptoms of UTI and/or BV to access electronic education about these conditions. The education addressed risk factors for recurrence, provided an algorithm for UTI and vaginitis, and posed questions to ask before visiting a provider. Results indicated a statistically significant decrease (61% pre-intervention vs 50.8% post, X2 = 14.2, p = <.001) in the percentage of visits for a chief concern of vaginal infection and/or UTI symptoms. Findings also indicated 74% of eligible patients who were offered electronic education accessed it. Electronic education has the potential to impact reproductive hygiene and reduce visits for UTIs and vaginitis; therefore, it should be implemented widely. Future work should evaluate the impact of electronic education on the frequency of vaginitis and/or UTI diagnosis, recurrence, and on other health concerns.

Faculty Mentor, Advisor or Committee Chair: Peggy Slota, DNP, RN, CNS, FAAN & Kelly Thompson-Brazill, DNP, ACNP-BC, FCCM (Co)

Project Title: Evaluating the Impact of A Mobile Mindfulness Application on Indicators of Burnout in Clinical Staff

Abstract: Nursing burnout significantly impacts quality of life and professional satisfaction leading to high turnover rates and a reduction in the quality of care for patients. It is commonly seen in the literature that mindfulness-based stress reduction (MBSR) programs, including those accessible by mobile applications, equip nursing and other clinical staff with tools to effectively cope with stress, with the goal of decreasing burnout symptoms. Objectives: The primary objective of this quality improvement project was to evaluate whether an MBSR program delivered through the Calm mobile application impacted symptoms of burnout within a diverse group of clinical staff. Methods: This project used the PDSA model to evaluate use of the application among clinical employees consisting of a pre-intervention education meeting and an eight-week MBSA program delivered via the Calm application provided to all employees. Participants working as clinical staff within one large healthcare network located in the Southeastern region of the U.S. completed a pre- and post-intervention survey using the Mini Z 2.0, shared mobile application statistics, and contributed to a post-intervention semi-structured interview. Pre- to postintervention changes were analyzed via t-tests and correlation analyses were used to determine if application engagement time was related to a change in burnout scores. Results: Of the 15 participants, only three completed both the pre- and post-survey and only one completed all eight weeks of the intervention. No differences were found in burnout scores (M = 38.7 on the pre- and post-survey). The supportive workplace subscale improved slightly (M = 19.3 vs. 19.7) while the EMR stress scale decreased slightly (M = 19.3 vs. 19.0). Interview findings suggest that engagement was constrained by personal and workplace conditions. Conclusion: The limited timeframe for and engagement with the intervention and the influence of workplace stressors impacted the non-effectiveness. MBSR success depends on consistent engagement, institutional support, and leadership involvement for meaningful impact.

Faculty Mentor, Advisor or Committee Chair: Intima Alrimawi, PhD, MSN, MPH, BSN

Project Title: From Novice to Expert: The Influence of Nurse Residency Programs on NICU Nurse Retention and Role Confidence

Abstract: New graduate nurses are susceptible to high turnover in the first year of practice due to challenges in the nursing workforce that hinder role confidence and their ability to efficiently manage patient care. To effectively meet the unique needs of new nurses entering the workforce, organizations must establish a framework such as nurse residency programs to enhance retention, role confidence, care management, and quality of care. This quality improvement project used a prospective cohort with pre- and post-test design to evaluate the effectiveness of a nurse residency program in the neonatal intensive care unit. The primary aim of the NRP was to evaluate its impact on retention and role confidence. The secondary aim was to evaluate the impact on the ability to manage patient care. Twenty-three new graduate nurses hired between May and August were enrolled into this program in addition to their standard 12-week orientation process. The Casey-Fink Graduate Nurse Experience survey was administered at the beginning of the program and the end to evaluate role confidence and care management. Participants attended monthly two-hour sessions for three months. Four participants did not complete the post-survey. The objectives were focused on leadership, strengths, and quality. Descriptive statistics were utilized to summarize key metrics using the CFGNE subscales to identify the impact on role confidence and care management. Using independent samples tests, participant characteristics were compared to subscale scores to identify trends. The survey measured intent to stay within the organization, and retention rates were compared to a comparable group hired in the previous year that did not participate in a nurse residency program. The completion of the residency program showed improvements in retention, role confidence, and care management. New graduate nurses self-reported increased confidence and management of care at the completion of the project intervention. Retention rates increased by 11% after the completion of the NRP. The results of this project support the notion that organizational investment in NRPs positively influence the transition to practice for new graduate nurses.

Faculty Mentor, Advisor or Committee Chair: Megan McAuliffe, DNP, CRNA, Carrie Bowman-Dalley, PhD, CRNA, Sarah Rollison, DNP, CRNA, CNE, CHSE, Nancy Crowell, PhD

Project Title: Exploration of SRNA Medication Error Reporting in the Perioperative Setting

Abstract: There is a plethora of data that analyzes medication administration errors (MAEs) conducted by healthcare professionals and trainee groups, including undergraduate nursing students and anesthesia residents; however, there is a paucity of literature regarding student registered nurse anesthetists (SRNA)-specific MAEs. SRNA perceptions, workplace culture, methods of self-reporting, and barriers to self-reporting in clinical training environments have not been examined. This study utilized a survey that explored MAEs self-reported by SRNAs as well as MAEs observed by SRNAs that other anesthesia providers committed. The survey yielded a 3.73% response rate. Fifty-six participants were included in the final analysis. Over half of the respondents who made an MAE (n=35) during their clinical training, self-reported the error (n=19). The most frequent errors involved incorrect dosing (65.7%), followed by administering the wrong medication (40%). When asked to rate barriers for not reporting errors on a 5-point agreement scale, fear-related concerns emerged as the most common responses— specifically, fear of losing trust (M=3.6) and fear of disciplinary actions (M=3.6). These findings highlight the need for further exploration of the benefits and effectiveness of standardized error reporting systems that may mitigate the barriers associated with reporting.

Faculty Mentor, Advisor or Committee Chair: Ella Heitzler, PhD, WHNP, FNP, RNC-OB & Mara Evans, DNP, CNM (Co)

Project Title: Trauma Informed Care Education for the Perinatal Nurse: A Quality Improvement Project

Abstract: Trauma is a widespread adversity that has affected 70% of those within the United States. Violence against women has been documented as early as the 16th-century with sustained effects through today. Perinatal trauma, or obstetrical violence, impacts 1 in 5 persons, leading to mental and physical ramifications while also harming patient trust in healthcare. Disproportionate rates of trauma are found amongst Black, Hispanic, and multiracial women and those whose gender identities exist outside the heteronormative framework due to systemic impacts of racism and culturally incompetent care. Perinatal nurses, appropriately armed with tools to combat trauma, are prepared to not only work with those with a history of trauma but also to protect patients from incurring new traumas. Due to the widespread incidence of trauma, it is recommended that healthcare professionals adopt a TIC approach as a universal precaution. The primary aim of this QI project was to assess the impact of trauma-informed education tailored specifically for perinatal nurses (n = 25) on their perceived knowledge, attitudes, and practices. The secondary aim was to identify barriers to utilizing TIC practices in the perinatal setting. This project assessed the effectiveness of a didactic educational intervention amongst perinatal nurses via a modified and validated trauma-specific pre-and post-survey over a ten-week period. Results demonstrated statistically significant improvements in perceived knowledge (t = 4.17, p = .007) and practices (t = 6.64, p = <.001).  While attitudes didn’t change significantly, 67% of participants explicitly mentioned appreciating education that incorporated perinatal trauma from the patient’s perspective. Barriers to TIC were identified as fear of re-traumatization, time constraints, and lack of organizational support.  This project demonstrates that a tailored educational intervention can increase the perinatal nurse’s knowledge and practices regarding trauma. Future projects should emphasize the patient perspective, historical and current disparities in perinatal trauma, and ways to limit barriers to using TIC practices with direct patient care. Dissemination of TIC education to more perinatal healthcare personnel may impact future rates of perinatal trauma and obstetrical violence. 

Faculty Mentor, Advisor or Committee Chair: Karen McCrea DNP, APRN, FNP-C

Project Title: Implementation and Evaluation of a New Perinatal Depression Order Set in a Birthing Center

Abstract: With the rising census of higher acuity patients presenting to emergency departments, practice changes are focusing on how to manage this issue while also maintaining patient satisfaction and safety. Patient satisfaction plays a major role in hospital reimbursement, litigations, staff rewards and incentives, and overall patient loyalty. Multiple studies have proven the effectiveness of hourly rounding on inpatient units in improving satisfaction scores, and, more recently, this practice has been studied in critical care settings, such as emergency departments. The aim of this project is to support existing literature on the effectiveness of hourly rounding on patient satisfaction in the emergency department setting and to offer guidance on future studies with similar aims. This project was conducted in a 13-bed, nonprofit, rural, community emergency department. Staff were provided education on hourly rounding, and satisfaction scores 12 weeks – pre- and post-intervention were collected. Adherence with hourly rounding was also compared pre- and post-intervention to assess the effectiveness of educational intervention. While this project did not show statistically significant results, patient satisfaction scores did increase clinically, which is important on an institutional level and can help support this as an efficient practice change to increase patient satisfaction scores. This project presents an opportunity to identify and address the need to improve patient satisfaction; while hourly rounding has been identified as a key to addressing this measure within emergency departments, there is room to broaden this practice change to adjust to any environment and foster a culture that embraces the importance of establishing patient-centered practices.

Faculty Mentor, Advisor or Committee Chair: Peggy Slota, DNP, RN, CNS, FAAN & Kelly Thompson-Brazill, DNP, ACNP-BC, FCCM (Co)

Project Title: Addressing Dysmenorrhea through Mindfulness and Yoga Poses

Abstract: Dysmenorrhea affects a significant proportion of premenopausal women, often leading to decreased quality of life and reliance on pharmacological treatments. While conventional treatments are common, they are not always effective and come with a list of unwanted side effects. Evidence suggests that holistic approaches, including yoga and mindfulness practices, may offer an alternative for pain management. This quality improvement (QI) project aimed to evaluate the impact of yoga poses and mindfulness intervention on menstrual pain severity and treatment response in premenopausal women. A pre-post intervention study was conducted with participants experiencing primary dysmenorrhea. Participants engaged in mindfulness and yoga poses over three menstrual cycles. Pain severity was assessed using the Visual Analog Scale at baseline and post-intervention. Data on demographic factors, previous treatment history, and engagement with mindfulness techniques were collected. Participants’ adherence to the intervention was also tracked over time. Pain ratings significantly decreased over time, with the most substantial reduction occurring between the initial and second assessments (p < .001). Among participants who completed all follow-ups, pain scores dropped from 7.3 to 2.8. Adherence to mindfulness techniques fluctuated, with most of the participants practicing several times per week. Additionally, 80% of participants found the intervention feasible and planned to continue incorporating holistic practices into their routine. While the small sample size limits generalizability, findings align with previous research supporting yoga and mindfulness as effective non-pharmacological treatments for dysmenorrhea. Clinical significance is suggested by the observed pain reduction and patient-reported feasibility. Future studies with larger sample sizes are recommended to explore long-term adherence, potential demographic influences on treatment response, and the integration of holistic interventions into routine care. The findings suggest that yoga poses, and mindfulness intervention may be an effective and feasible approach to managing dysmenorrhea. Given the low-cost and non-invasive nature of these interventions, incorporating them into standard care protocols could improve menstrual pain management.

Project Title: A Comparative Study of Human and Artificial Intelligence Interpretations of Thoracic Radiographs in Diagnosing Pneumonia

Abstract: This retrospective observational study assessed the diagnostic accuracy of two free, commercially available artificial intelligence (AI) models—Chester and CXR-LLaVA—compared to human radiologists in detecting pneumonia on chest radiographs from 173 adult patients at four urgent care centers. Chester showed higher specificity (78.2%) but lower sensitivity (45.8%), while CXRLLaVA exhibited better sensitivity (64.6%) at the cost of reduced specificity (66.7%). Despite delivering results within seconds—far quicker than the average 40.6-minute reading time for radiologists—neither AI model reached the 90% threshold for clinical reliability. Notable discrepancies, particularly in false negatives, highlight the need for radiologist oversight to prevent missed diagnoses. These results suggest that while current AI tools for chest radiograph interpretation are cost-effective and efficient, they still fall short in reliably detecting pneumonia, particularly in low-prevalence, real-world settings where portable X-rays are frequently used.

Faculty Mentor, Advisor or Committee Chair: Jill Ogg-Gress DNP, FNP-c, ENP-c, APRN

Project Title: Impact of Hourly Rounding on Patient Satisfaction in the Emergency Department

Abstract: With the rising census of higher acuity patients presenting to emergency departments, practice changes are focusing on how to manage this issue while also maintaining patient satisfaction and safety. Patient satisfaction plays a major role in hospital reimbursement, litigations, staff rewards and incentives, and overall patient loyalty. Multiple studies have proven the effectiveness of hourly rounding on inpatient units in improving satisfaction scores, and, more recently, this practice has been studied in critical care settings, such as emergency departments. The aim of this project is to support existing literature on the effectiveness of hourly rounding on patient satisfaction in the emergency department setting and to offer guidance on future studies with similar aims. This project was conducted in a 13-bed, nonprofit, rural, community emergency department. Staff were provided education on hourly rounding, and satisfaction scores 12 weeks – pre- and post-intervention were collected. Adherence with hourly rounding was also compared pre- and post-intervention to assess the effectiveness of educational intervention. While this project did not show statistically significant results, patient satisfaction scores did increase clinically, which is important on an institutional level and can help support this as an efficient practice change to increase patient satisfaction scores. This project presents an opportunity to identify and address the need to improve patient satisfaction; while hourly rounding has been identified as a key to addressing this measure within emergency departments, there is room to broaden This practice change to adjust to any environment and foster a culture that embraces the importance of establishing patient-centered practices.

Faculty Mentor, Advisor or Committee Chair: Elke Zschaebitz, DNP, ARPN, FNP-BC, FNAP

Project Title: Perceptions of Improved Patient-Provider Communication and Satisfaction Using Digital Language Interpreter Services in a Military Orthopedic Clinic: A Quality Improvement Project

Abstract: Limited English proficiency (LEP) presents a significant barrier to effective patient-provider communication and contributes to health disparities, even within the universally accessible U.S. Military Health System. This quality improvement (QI) project evaluated the impact of implementing real-time digital interpreter services on communication and satisfaction among LEP patients and healthcare providers in a high-volume military orthopedic clinic. The project used a cross-sectional post-survey design over ten weeks. Adult LEP patients and healthcare providers were surveyed after using a Google-supported digital interpretation tool during clinical encounters. Survey instruments included 5-point Likert-scale items and open-ended questions, developed in alignment with National CLAS Standards to assess perceptions of communication quality and satisfaction. A total of 54 patients and 23 providers participated. Findings showed 98% of patients were extremely satisfied, and all reported improved understanding. Over 96% strongly agreed they left with a good understanding of their care. Providers reported similar satisfaction, with 91% finding communication easier and 87% agreeing patients left with clear understanding. Open-ended responses emphasized better communication, direct engagement, and patient comfort. Providers suggested future enhancements, such as video and audio features with full language coverage, to strengthen the tool. Data were collected using Qualtrics and analyzed in SPSS, with thematic analysis applied to qualitative responses. The intervention aligned with ethical standards and CLAS guidelines, supporting equity and culturally responsive care. In conclusion, real-time digital interpretation services significantly improved perceived communication and satisfaction for LEP patients and providers. Results support integrating such tools into routine practice to reduce language barriers, advance health equity, and improve care quality in military healthcare settings.

Faculty Mentor, Advisor or Committee Chair: Vera Barton-Maxwell, PhD, APRN, FNP-BC

Project Title: Impact of Educational Intervention About Remote Patient Monitoring (RPM) for Hypertension (HTN) on Nurse Practitioner (NP) Knowledge and Practice Behavior

Abstract: Hypertension (HTN), a modifiable and preventable risk factor for heart disease, stroke, kidney disease and dementia, is a leading cause of death in the United States (US). However, blood pressure is not controlled in 77.5% of individuals with HTN. Remote patient monitoring (RPM) for HTN is an effective, evidence-driven, team-based telehealth strategy to control HTN, that is underutilized. This quality improvement (QI) project evaluated the impact of an educational intervention about RPM for HTN on the knowledge and practice behavior of nurse practitioners (NPs) at a single center outpatient cardiology practice. Thirteen NPs enrolled in this QI project completed a one-hour, live educational session about RPM for HTN. In this pretest-posttest design project, NP knowledge was evaluated by comparing correct responses to a five-question knowledge quiz before and two months after the educational session. Practice behavior of NPs was evaluated by assessing NP referral rates to the RPM for HTN program two months before and after the educational session. Data analysis demonstrated a significant increase in mean percentage correct on knowledge quizzes, from 52.3% [(SD = 25.2), range 20% -100%] pre-educational session to 63.2% [(SD = 27.5), range 40% – 100%] t (12) = 3.09, p = .005 post-educational sessions, and a significant increase in the referral rate from 0.0% to 12.8% [ z = 1.87, p = .031] after the educational session. Although the educational session had a significant impact on both NP knowledge and practice behavior, there remained a gap in NPs accurately identifying referrals to the RPM for HTN program. Future implications could include a best practice alert (BPA) in the electronic medical records (EMR) system to facilitate identification of appropriate referrals. Another limitation of this project, that possibly impacted participation, was that only a single live educational session was offered. A recommendation for future projects, would be to offer remote learning options for educational sessions including follow-up sessions to reinforce practice behavior. Keywords: quality improvement, uncontrolled hypertension, remote patient monitoring, educational intervention, educational session, nurse practitioner knowledge, practice behavior, pretest-posttest, telehealth, team-based, knowledge quiz, referral rate

Faculty Mentor, Advisor or Committee Chair: Catherine Horvath, DNP, CRNA

Project Title: Getting in the Right Headspace: A Mindfulness Intervention to Reduce Stress and Improve Perceived Performance in SRNAs

Published: In press

Abstract: Student registered nurse anesthetists (SRNAs) experience high levels of chronic stress during the clinical and didactic portions of their curriculum. While high-fidelity simulations can be helpful learning tools, they can cause psychological and physiologic stress. The purpose of this study was to examine if a 4-week mindfulness intervention decreased perceived stress in SRNAs overall and during simulation and improves perceived performance during a high-fidelity simulation. This study examined 20 first-year SRNAs, with 10 each in the control and intervention groups. The intervention group used the mindfulness application, Headspace, daily over a 4-week period. After a 4-week intervention period, all participants completed surveys before and after high-fidelity simulation reporting perceived stress and performance. Heart rate and blood pressure were obtained before, during, and after simulation. Survey results reported no statistically significant differences between the control and intervention groups in overall stress levels, stress in simulation, or perceived performance during simulation. There were no significant differences in heart rate or blood pressure between control and intervention groups either. Only 1 student in the intervention group reported using Headspace as directed, while most students reported using Headspace once a week. Due to the limited use of Headspace by participants, the researchers were unable to conclude if mindfulness applications have a significant effect on perceived stress, physiologic indicators of stress, and perceived performance in simulation. Future studies should explore mindfulness applications with longer interventions and strategies to ensure participant compliance as well as examining other mindfulness practices used by SRNAs.

Faculty Mentor, Advisor or Committee Chair: Katherine Thorpe, DNP, CRNA

Project Title: Anesthesia Handoffs and Malignant Hyperthermia: Investigating the Effectiveness of Education of a Transfer Checklist

Abstract: MHAUS and the Ambulatory Surgery Foundation created a clear-cut plan for the transfer of the malignant hyperthermia patient from an ASC to a RHCF. The ASC Transfer Plan contains the 8 most important clinical details to include in an effective handoff report in this scenario. An exhaustive literature review revealed a lack of information on anesthesia provider awareness of this document and its contents. Malignant hyperthermia is a significant threat to the ambulatory surgery patient under anesthesia. It is imperative that anesthesia providers be aware of all aspects of malignant hyperthermia anesthesia care, and this includes a streamlined transfer to a RHCF. This study was conducted to raise awareness of the transfer plan, gauge anesthesia provider knowledge, and educate anesthesia providers on the topic of transfer handoff of the malignant hyperthermia patient.

Faculty Mentor, Advisor or Committee Chair: Pam Biernacki, DNP, APRN, FNP-C

Project Title: The Impact of Utilizing a Patient Acuity Tool on Registered Nursing Workload and Job Satisfaction

Abstract: The United States continues to face a national nursing workforce crisis, requiring a focus on solutions to maintain nurses at the bedside. Unmanageable workloads remain a leading factor for nurses leaving direct patient care roles. Uneven and insufficient distribution of acuity in nursing assignments results in job dissatisfaction, adverse patient outcomes, and potential legal implications. This quality improvement project (QI) explored the impact of a patient acuity tool (PAT) on assignment and job satisfaction. Registered nurses on an inpatient 36-bed surgical unit participated in a pre- and post-survey measuring assignment and job satisfaction. The PAT was implemented over a 12-week period where charge nurses utilized scores to distribute acuity evenly among assignments. Assignment distribution compliance was tracked, and random assignment audits were completed at the end of the implementation period. Six survey participants’ pre- and post- implementation satisfaction responses were successfully paired and analyzed utilizing the Wilcoxon signed-rank test. There was no statistically significant difference in job assignment or assignment satisfaction following implementation. The tool was deemed easy to use and an accurate measure of acuity by nearly half of participants. Audit data suggested a clinically significant difference in even distribution of acuity between day shift and night shift. Difference in acuity distribution can be related to fluctuations in acuity, continuity of care requests by nursing, or failure to re-evaluate acuity and assignment distribution for subsequent shifts. More research is needed to investigate factors that can mitigate workplace stressors to improve assignment and job satisfaction in the healthcare sector.

Faculty Mentor, Advisor or Committee Chair: Carrie Bowman-Dalley, PhD, CRNA

Project Title: The Use of the Reader Role During Emergency Manual Implementation in an Intraoperative Crisis

Abstract: The implementation of a designated reader role during intraoperative emergencies may enhance the effectiveness of emergency manuals (EM), by ensuring critical interventions are not overlooked. New evidence suggests that a designated person to read the EM, referred to as the “reader role,” improves efficacy of EM use during emergencies. Hypothesizing that the lack of a designated reader could hinder EM use, a cross-sectional survey was conducted within a large anesthesia staffing company to assess attitudes towards the reader role and EM utilization. Data was analyzed through descriptive analysis and Chi Square ratio to identify barriers and facilitators to the designation of a reader role. While only a third of respondents viewed the absence of a reader as a barrier, most agreed that having one would be beneficial. Despite this, few reported using a reader during past crises, most likely due to unfamiliarity with the role. Registered Nurses were favored to fill the reader role based on their perceived strengths in coordination and time management skills. Although the reader role is underutilized, increasing awareness and establishing clear protocols during crises can improve the use of cognitive aids in emergency situations. Further research should refine the definition of the reader role and explore effective training models.

Faculty Mentor, Advisor or Committee Chair: Catherine Horvath, DNP, CRNA

Project Title: Point-of-Care-Ultrasound of the Airway (POCUS-A) in Predicting Difficult Airway Management: An Educational Pilot Study

Abstract: The objective of this study was to evaluate the impact of educational interventions on the use of Point of Care Ultrasound of the Airway (POCUS-A) among student registered nurse anesthetists (SRNAs) to enhance their competency by focusing on essential assessment parameters. Traditional assessment methods are often inadequate in detecting airway abnormalities, which can compromise patient safety. Through hands-on training and guided instruction in POCUS-A, we aimed to improve SRNAs proficiency in airway assessment, ultimately fostering greater confidence and accuracy in predicting challenging airway scenarios. The study found that after training, confidence in identifying airway structures and predicting difficult airways improved. However, knowledge scores did not significantly differ based on prior POCUS experience or level of anesthesia training. This study concluded that incorporating POCUS training into nurse anesthesia education can significantly improves SRNAs confidence and knowledge in airway management and even brief ultrasound training could enhance clinical readiness. Ultimately, this study underscores the importance of incorporating POCUS-A into anesthesia education to better prepare future anesthesia providers

Faculty Mentor, Advisor or Committee Chair: Carrie Bowman-Dalley, PhD, CRNA

Project Title: Developing and Implementing a Structured Mentorship Program Using a Private Online Mentorship Platform to Connect Resident Registered Nurse Anesthesiologists (RRNAs) and Certified Registered Nurse Anesthesiologist (CRNA) Alumni: A Pilot Study

Abstract: Although studies have demonstrated successful outcomes with mentorship in various healthcare professions, barriers such as lack of structure, time constraints, incompatible personalities, and communication style differences are frequently encountered. Furthermore, there is little research focused on Resident Registered Nurse Anesthesiologists (RRNA) mentorship by Certified Registered Nurse Anesthesiologists (CRNA) alumni. Thus, researchers designed and implemented a structured RRNA and CRNA alumni mentorship program utilizing RRNA input and specific communication requirements over a three-month period to determine if it was associated with reduced RRNA stress, enhanced mentorship success, and increased alumni fulfillment. This study utilized a quantitative, quasi-experimental design. Surveys were distributed using the Qualtrics® platform and data was analyzed using SPSS software. Eleven pairs participated. Pre to post-intervention surveys showed that perception of academic preparedness increased from 5 (1) to 7 (1.5) (p=.10) out of 10, clinical preparedness increased from 4 (2) to 7 (0) (p=.04) out of 10, and average daily stress remained at 8.0 (2.5, 3) (p=.26) out of 10. However, the percentage of stress attributed to school decreased 10% (p=.06). In the final surveys, all RRNAs agreed that their mentor provided clinical advice and increased their confidence. One hundred percent of CRNA mentor participants ranked it as “very or completely true” that mentorship was meaningful and worthwhile, and 85% felt they contributed professionally and were happy and satisfied while mentoring. Our study validated that RRNAs experience significant stress and demonstrated that a structured CRNA alumni mentorship program improved RRNAs’ perception of clinical preparedness, increased their confidence in the clinical setting, and reduced the stress they attributed to school. The current study also suggests that this mentorship program had meaningful effects on the mentor, including a sense of happiness, connection, and professional satisfaction.

Faculty Mentor, Advisor or Committee Chair: Melody Wilkinson DNP, APRN, FNP-BC, FAANP

Project Title: Implementation of a Patient-Driven Printed Social Determinants of Health Screening Tool in a Rural Health Clinic: A Quality Improvement Project

Abstract: Social determinants of health (SDOH) influence 80% of overall health-related outcomes. Rural areas often have worse measures of SDOH than urban areas, which increases health disparities. Primary healthcare providers (PCPs) work in collaboration with community healthcare workers (CHW) to play a crucial role in addressing SDOH to reduce health disparities. PRAPARE is an evidence-based, validated, and comprehensive screening tool for identifying unmet SDOH. This quality improvement (QI) project’s primary aim was to implement a patient-driven SDOH screening tool in a rural health clinic to identify unmet social needs and improve CHW referral rates for Medicaid patients. Secondary aims included identifying individual unmet social needs and determining staff comfort and satisfaction with the screening tool and process. A retrospective data analysis comparing pre- and post-intervention data over a 12-week period was utilized. The data revealed a statistically significant increase in CHW referral rates from 0% to 1/1% (z = 2.14, p = .016). The PRAPARE screening tool was administered to 37 out of 372 patients (9.9%), identifying 16 patients with at least one unmet social need. Out of the 16 who screened positive, 4 CHW referrals were placed (25%) while 12 patients refused the referral (75%). The most prevalent unmet needs were medicine and healthcare (24.3%), food (21.6%), clothing (18.9%), and utilities (16.2%). Staff indicated a high level of confidence and satisfaction with the screening tool process, however, due to the small sample size, no statistical comparison was made. The PRAPARE tool significantly increased CHW referrals and identified numerous unmet social needs. The project identified a notably higher prevalence of unmet social needs compared to existing literature, highlighting the importance of screening for unmet SDOH in rural settings. The project also underscores the importance of examining effective strategies to connect patients to resources and ensure sustained engagement in care after identifying their unmet social needs. Future research should explore the standardization of the screening process and reasons for referral refusals. Effective policy measures and continued refinement of screening processes are essential for improving health equity for all.

Faculty Mentor, Advisor or Committee Chair: Mary Scott-Herring, DNP, CRNA

Project Title: An Exploration of Anesthesia Providers’ Education and Management Regarding Cannabis Use in the Perioperative Period

Abstract: Increased prevalence of cannabis use in the United States presents new and unique challenges for anesthesia providers in the perioperative period. However, there is a knowledge deficit among anesthesia providers regarding the anesthetic management of cannabis users. We aimed to address a potential knowledge gap via an educational intervention consisting of a live presentation. Following the educational intervention, there was a significant increase in knowledge scores from 64.6% correct pre-educational session to 88.6% correct post-educational session (p = 005). In summary, our research findings discovered that an educational intervention on anesthetic management for cannabis users improved knowledge. In addition, after an educational intervention, participants intended to incorporate questions about cannabis use in their perioperative practice compared to current practice (pre-survey).

Faculty Mentor, Advisor or Committee Chair: Lori Brien, DNP, ACNP-BC

Project Title: Reducing Arterial Blood Gas Sampling By Implementing Continuous Capnography in the Medical ICU: A Quality Improvement Project

Abstract: Continuous waveform capnography is a noninvasive method of monitoring end-tidal carbon dioxide (ETCO2) that can be applied to patients using invasive positive pressure ventilation (IPPV). Despite its availability at the project site, capnography was an underutilized method of monitoring. This quality improvement (QI) project aimed to reduce arterial blood gas (ABG) sampling in the medical intensive care unit (MICU) through implementing continuous capnography. A pre- and post-intervention design was used, comparing data from January-March 2024 with September-November 2024. Additional aims included increasing nursing staff confidence and knowledge as it relates to capnography, evaluating provider’s indications for ABG sampling with capnography in place, and assessing the ventilator days pre- and postintervention. Results showed a significant increase in capnography use (55.7% of IPPV cases, p <0.001). ABG sampling increased from 63.9% to 76.1% (p=0.002), potentially due to inconsistent capnography use and variability in provider practices. However, out of all ABGs collected, capnography was present in 30.2% of cases whereas capnography was not present in 69.8%. Staff education demonstrated a significant improvement in nursing confidence and knowledge (p<0.001). Provider indications for ABG sampling were collected and compared with and without the presence of capnography. Lastly, ventilator days increased in the postintervention period (p<0.001).

Faculty Mentor, Advisor or Committee Chair: Bryan Boling, DNP, AGACNP-BC, FCCM & Catherine Tierney, DNP, ACNP-BC

Project Title: Impact Of The Implementation Of A Neurosurgical Consensus Model For Risk-Based Timing Of Venous Thromboembolism Prophylaxis In Adults With Acute Traumatic Brain Injury and Intracranial Hemorrhage: A Quality Improvement Project

Abstract: Venous thromboembolism (VTE) is a preventable but potentially fatal complication in patients with acute traumatic brain injury (TBI) and intracranial hemorrhage (ICH). The optimal timing of pharmacologic VTE prophylaxis (VTEp) in this population remains controversial due to the competing risks of hemorrhage progression and thromboembolic events. The absence of standardized guidelines for risk-based timing of VTEp contributes to variability in clinical decision-making, delays in prophylaxis initiation, and increased patient morbidity. This quality improvement (QI) project aimed to evaluate the impact of implementing a neurosurgical consensus model for risk-based VTEp timing in adult TBI patients with ICH, with the primary objective of improving provider adherence to standardized VTEp recommendations while maintaining hemorrhagic safety. A retrospective pre- and post-implementation analysis was conducted at a large, Level 1 trauma/academic medical center. The project included 205 adult patients with TBI and ICH, 100 admitted before and 105 after the implementation of the consensus model. The intervention consisted of a multidisciplinary-approved neurosurgical consensus model integrated into clinical workflows through provider education and electronic health record (EHR) decision support. Data were analyzed to assess provider adherence to VTEp recommendations, shifts in risk stratification, and hemorrhagic complications. The results demonstrated a statistically significant increase in provider adherence to VTEp recommendations, rising from 43.0% pre-implementation to 94.3% post-implementation (X²(1) = 63.3, p < .001). A significant shift in risk stratification was observed, with low-risk classifications increasing from 52.0% to 69.5% and moderate-to-high-risk categorizations decreasing correspondingly (X²(2) = 6.8, p = .033). Only one patient experienced hemorrhage progression post-implementation, and this event was deemed unrelated to VTEp administration. The findings suggest that a structured, consensus-driven approach improves adherence to best practices without increasing hemorrhagic risk. The success of this project underscores the critical role of standardization in optimizing clinical decision-making, reducing variability in provider practice, and enhancing patient safety. Future research should explore the long-term impact of consensus models on VTE incidence, functional recovery, and multicenter validation of risk-based prophylaxis guidelines to further refine neurosurgical care standards.

Faculty Mentor, Advisor or Committee Chair: Debora Dole, PhD, CNM, FACNM

Project Title: LATCH Assessment Protocol and its Impact on Exclusive Breastfeeding at Discharge

Abstract: This quality improvement project evaluated the implementation of a structured, replicable protocol—the LATCH scoring system—to standardize breastfeeding assessments and improve exclusive breastfeeding rates at discharge within a military treatment facility’s postpartum unit. Exclusive breastfeeding provides vital benefits for maternal and infant health, yet breastfeeding rates at this facility were significantly below national standards (33% vs. 84%). The LATCH protocol, a standardized tool for evaluating breastfeeding effectiveness through key components such as latch, swallowing, nipple type, comfort, and positioning, was introduced to align the facility’s practices with evidence-based global health standards. The protocol aimed to standardize breastfeeding assessments, provide targeted support, and improve breastfeeding outcomes. Data collection involved retrospective and prospective chart audits to compare breastfeeding outcomes before and after protocol implementation. Results demonstrated significant improvements in exclusive breastfeeding rates post-protocol (61.4% vs. 46.6%, p = .009) and increased lactation consultant visits (98.6% vs. 92.0%, p = .009). While initial LATCH scores showed no significant differences (p = .741), the post-protocol group received enhanced breastfeeding support. Logistic regression revealed that individuals in the post-protocol group were 1.8 times more likely to exclusively breastfeed than those in the pre-protocol group (OR = 1.80, p = .011). These findings demonstrate the LATCH protocol’s ability to standardize care and significantly enhance exclusive breastfeeding rates, contributing to improved maternal and infant health outcomes. The project underscores the importance of standardized breastfeeding assessment tools and targeted interventions in promoting breastfeeding success.

Faculty Mentor, Advisor or Committee Chair: Lauren A. Arrington, DNP, CNM, FACNM

Project Title: The Impact of Ambulation and Mobility Programs on Cesarean Birth Rates: A Program Evaluation with an Equity-Focus

Abstract: Cesarean birth rates in the United States remain above recommended levels, especially among those with low-risk pregnancies. With notable racial and ethnic disparities, Black and Hispanic communities are experiencing the highest rates of cesarean deliveries. Encouraging ambulation and mobility during labor is associated with increased rates of spontaneous vaginal birth, but the impact of mobility and ambulation on cesarean birth rates has not been studied in a hospital setting through a health equity lens. This project aimed to evaluate the effectiveness of hospital-based ambulation and mobility programs in reducing nulliparous, term, singleton, vertex (NTSV) cesarean birth rates and assess potential racial and ethnic disparities in NSTV cesarean birth rates and access to ambulation and mobility. A retrospective program evaluation was conducted at a Magnet hospital in the Mid-Atlantic region. Data were analyzed from four time periods: preintervention, post-nursing education, post-early labor lanes, and post-education reinforcement. Outcomes included NTSV cesarean birth rates, labor support tool utilization, and racial and ethnic variations in program participation and birth outcomes. While the overall NTSV cesarean birth rate decreased from 31.2% to 27.7% after implementation, the reduction was not statistically significant. Use of labor support devices and mobility interventions was significantly associated with vaginal birth (p < .001). Black patients had the highest NTSV cesarean birth rates (41.2%), significantly higher than other racial groups (p < .001), despite comparable use of labor support tools. Ambulation and mobility programs were associated with a downward trend in NTSV cesarean birth rates, though statistical significance was not achieved. Persistent racial disparities highlight the need for targeted interventions to address inequities in labor management and birth outcomes. Further research should explore patient comorbidities, clinical decision-making processes, and qualitative experiences to improve equity-focused maternity care.

Faculty Mentor, Advisor or Committee Chair: Elke Zschaebitz, DNP, APRN, FNP-BC

Project Title: Expanding Knowledge and Communication Practices Regarding Genital Herpes and Sexual Health Among Providers in a Rural Mental Health Practice

Abstract: Sexually transmitted infections, including genital herpes, affect people of all genders, sexual orientations, socioeconomic classes, education levels, races, ethnicities, and ages. Genital herpes infection can have a profound impact on a person’s romantic and social interactions and overall mental health. All too often, sexual health assessment and discussion regarding the psychosocial effects of genital herpes and other sexual health concerns are lacking within the mental health field. This quality improvement project aimed to assess mental health providers’ baseline knowledge of the genital herpes virus and improve providers’ comfort levels in discussing sexual health concerns with their patients, thereby enhancing rates of sexual health assessment in the mental health setting. A pretest-posttest design was used in a convenience sample of outpatient mental health providers. Inclusion criteria for participants at the project site involved full-time and part-time employees providing therapy or psychotropic medication management services to clients 18 years and older in person, through video platform or telephone modalities. The Herpes Knowledge Scale was administered to participants pre- and post-educational intervention. A qualitative survey was also administered to participants to explore current practice procedures, any intent to change practice due to received education, and other opinions about the topic. A student’s t-test was used to assess pre and post-test scores. One hundred percent of participants reported not regularly engaging in sexual health assessment before the start of the project. However, 100% of participants also acknowledged the importance of such evaluations and indicated a desire to implement sexual health assessment in their practice due to participating in this QI project. The results of this project support the idea that exploring sexual health in a knowledgeable and non-judgmental way in the mental health setting provides for an improvement in patient care.

Faculty Mentor, Advisor or Committee Chair: Catherine Tierney, DNP, ACNP-BC

Project Title: Implementing Critical Incident Debriefing in the Surgical ICU to Enhance Nurse Attitudes and Well-Being

Abstract: Critical care nurses often experience exposure to traumatic events that can negatively impact their mental health, contributing to professional burnout, moral distress, and turnover. Critical incident debriefing has shown promise in mitigating these effects by providing psychological support and improving team dynamics. This quality improvement (QI) project evaluated the effectiveness of the TeamSTEPPS debriefing tool in enhancing ICU nurses’ wellbeing, job satisfaction, and attitudes toward critical incidents. A pre- and post-intervention design was employed to assess the impact of critical incident debriefing over a three-month period in a Surgical Intensive Care Unit (SICU). Nurses completed surveys before and after the implementation of the debriefing period. Debriefs were held after critical incidents and guided by the TeamSTEPPS debrief checklist. Participants’ wellbeing, job satisfaction, attitudes, and experiences with critical incidents were evaluated using Likert-scale items in the survey. The survey results revealed statistically significant improvements in participants’ wellbeing (p = 0.005), job satisfaction (p = 0.023), and attitudes toward critical incidents (p = 0.015). The well-being score shifted from neutral to slightly more positive post-intervention. Job satisfaction also increased, with nurses reporting increased professional satisfaction. Attitudes toward critical incidents became more positive, reflecting improved emotional resilience and coping strategies. Debriefing sessions were conducted in 94% of critical incidents, surpassing the target goal of 80%. The results of this QI project suggest that implementing the TeamSTEPPS debriefing tool positively impacted ICU nurses’ well-being, job satisfaction, and attitudes toward critical incidents. The intervention helped address the psychological strain associated with high-stress environments and improved team dynamics. However, challenges like sample size limitations, data collection barriers, and the lack of long-term follow-up were identified. Future studies should explore the long-term effects of debriefing, evaluate the impact on nurse retention and burnout, and include multidisciplinary perspectives to validate these findings further. This project highlights the importance of structured debriefing processes in improving nurse wellbeing and job satisfaction in critical care settings. Healthcare organizations should prioritize integrating standardized debriefing tools and ongoing education to support nurse retention and enhance patient care.

Faculty Mentor, Advisor or Committee Chair: Kelly Thompson-Brazill, DNP, ACNP-BC, FCCM

Project Title: Improving Adult Cardiovascular Surgery Nurses’ Knowledge and Assessment of Health Literacy through a Targeted Nursing Education Intervention

Abstract: Cardiovascular disease patients have lower health literacy levels (HL) than any other chronic disease population, leading to increased morbidity, mortality, and hospital readmissions. Nurses play a key role in identifying and educating patients with low HL levels, yet formal assessments are rarely integrated into practice. This project aimed to improve cardiovascular surgery nurses’ knowledge and confidence in assessing HL while evaluating the feasibility of incorporating a validated screening tool – Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) – into clinical practice. This quality improvement project using a pre- and post-test comparative design was conducted at a Level I trauma and teaching hospital. Nurses completed an independent-study, optional video-guided educational module covering HL, tailored education, and how to utilize REALM-SF into their practice. Pre- and post-tests assessed changes in nurse’s knowledge and confidence over a four-week period, then REALM-SF implementation rates were tracked over an eight-week period. Pre-intervention, 91.3% of nurses assessed HL informally, and only 7.5% had prior training. After the intervention, familiarity with HL significantly increased (56.5% to 87.0%), awareness of validated tools improved (21.7% to 81.8%), and confidence in performing assessments significantly rose (p < .001). Postintervention, 60.9% of nurses reported always considering HL levels in patient education (vs. 17.4% pre-intervention). The screening tool was successfully integrated within the system, though workflow adaptations are needed for sustainability. Overall, the marked improvement in nurses’ HL knowledge and assessment confidence supports a broader integration of HL screening into nursing practice.

Faculty Mentor, Advisor or Committee Chair: Edilma Yearwood, PhD, RN, PMHCNS-BC, FAAN

Project Title: Evaluating the Impact of Psychopharmacological Education for Staff Nurses in a Psychiatric Outpatient Faculty

Abstract: Psychiatric disorders impact millions of people. Psychotropic medications are considered the first line of treatment. Other interventions include, therapy, lifestyle changes, nutrition, and social support. Medications often come with undesirable side effects, possibly leading to nonadherence. The risk of adverse medication interactions make management critical. Psychiatric nurses play a major role in the care of patients with mental health disorders, frequently serving as the first point of contact. It is of utmost importance that psychiatric nurses stay informed about medication-related facts and updates. The purpose of this quality improvement project was to evaluate the impact of psychopharmacological webinar education on knowledge of medication side effects, interactions, and patient education strategies in a psychiatric outpatient facility. This project was guided by the Plan-Do-Study-Act theoretical framework and Adult Learning Theory. A needs assessment of the project site was conducted, which suggested an educational intervention for nurses was needed, to address knowledge deficits of medication side effects, medication interactions, and patient education strategies. After the project was formally introduced, a demographics survey was distributed, followed by a pre-test survey. The intervention was a psychopharmacological webinar on commonly prescribed psychiatric medications, mechanisms of action, indications and contraindications. The webinar also reviewed patient education techniques to promote patient adherence, and approaches to identify, monitor and manage common and adverse reactions associated with psychotropic medications. The post-test was administered two months later. Open text boxes were included in the pre and post-test to provide participants with opportunity to include qualitative responses. Those responses were analyzed and included in project findings. Wilcoxon signed ranks test was used for data analysis, and the quantitative results were not statistically significant. Despite some improvement in nurses’ knowledge per the qualitative responses, the project had limitations. Opportunities for refining the structure and clarity of the pre- and post-test questions, along with the small sample size, and the exclusively female participant group, were noted as areas for enhancement. Nevertheless, these insights could serve as a foundation for future projects.

Faculty Mentor, Advisor or Committee Chair: Mary Scott-Herring, DNP, CRNA

Project Title: Evaluating the Impact of an Advocacy Toolkit on Improving Political Astuteness Among CRNAs

Published: Journal of Nurse Anesthesia Education

Abstract: There is an existing knowledge gap pertaining to advocacy and policy amongst Certified Registered Nurse Anesthesiologists and Student Registered Nurse Anesthesiologists. The purpose of this project was to create a legislative toolkit with an educational intervention for Certified Registered Nurse Anesthesiologists (CRNA) and Student Registered Nurse Anesthesiologists (SRNA) in the United States to close their knowledge gap on the laws governing their practice, the state legislative process, and how they can advocate effectively for their profession. Educating CRNAs/SRNAs on policy and advocacy using tailor-made legislative toolkits can be useful in improving the profession’s political knowledge and participation in political events

Faculty Mentor, Advisor or Committee Chair: Amy Culbertson, DNP, APRN, FNP-BC

Project Title: Utilizing an Education Program about Mindfulness and Stress Reduction to Decrease Burnout in Advanced Practice Providers

Abstract: Burnout is a concern for all healthcare professionals including advanced practice providers (APP). As APPs responsibilities have intensified, the risk for burnout has also increased. This fatigue can affect the APPs mental health as well as lead to poor patient outcomes. This purpose of this quality improvement project was to assess the impact of an educational program about mindfulness and stress reduction for APPs within a cardiology setting. The participants first completed a presurvey using the Burnout Assessment Tool (BAT). Emails describing different stress reduction and mindfulness techniques were sent weekly to the APPs for six weeks. Interventions included meditation, yoga, diaphragmatic breathing, body scan, journaling, and mindful walking. The seventh week, participants completed another BAT. Sixteen participants started this project and five completed it (N=5). Overall, the results were mixed and not statistically significant. Initially, the median total BAT scores were low (1.78/5) indicating that a lower level of burnout existed among the participants. There was a nominal increase in these scores (2.04/5). The subscale scores also showed minimal change from pre to post intervention. Participants most enjoyed the mindful walking and yoga education. Journaling was the least popular activity. Four out of the five participants stated they would recommend this program to a colleague. Even though results were mixed, and further studies are needed, it is possible that implementing a mindfulness and stress reduction program could be beneficial to APPs.

Faculty Mentor, Advisor or Committee Chair: Megan McAuliffe, DNP, CRNA

Project Title: Emergency Surgical Front-of-Neck Airway Access: Effectiveness of a Didactic and Simulation- Based Training Intervention to Improve Performance and Self-Efficacy among Student Registered Nurse Anesthetist

Abstract/Summary: Simulation is a valuable tool for developing technical skill and self-efficacy for high-risk, low-frequency events such as a cannot intubate, cannot oxygenate (CICO) scenario. There is a deficiency of evidence regarding CICO events and emergency front of neck access (eFONA) training for student registered nurse anesthetists (SRNAs). This study explored if a low-fidelity simulation training utilizing a 3D-printed cricothyrotomy task trainer and educational intervention increased self-efficacy, improved performance measures (performance time, performance checklist scores), and increased expert performance levels (performance time, performance checklist score, completion of critical performance checklist steps) regarding scalpel-bougie-tube surgical cricothyrotomy (SBT-SC) among SRNAs. This pilot study utilized a quasi-experimental pretest-posttest design. Ten SRNAs participated in this study. Statistical analysis with paired t-tests demonstrated statistically significant improvement in mean self-efficacy scores (3.13 to 4.5 out of 5, P<.001), mean performance completion time (103.5 seconds (SD 34.5) to 55.9 (SD 17.9) seconds (P<.001)), mean performance checklist scores (5.5 to 9.1 out of 10, (P<.001)), and completion of critical checklist steps. Six participants completed the post-intervention SBT-SC in under 60 seconds while completing all critical checklist steps. One participant met expert performance benchmark criteria following the intervention. This study supports low-fidelity simulation for SBT-SC education and training for SRNAs.

Faculty Mentor, Advisor or Committee Chair: Catherine Tierney, DNP, ACNP-BC

Project Title: The Impact of Targeted Multimodal Pain Pathway Education at a U.S. Military Hospital

Abstract/Summary: Acute pain is often treated with opioids. Patients presenting for surgery receive opioids before, during, and after the surgical procedure. These practices can lead to persistent postoperative opioid use (PPOU), now recognized as a surgical complication. Prolonged opioid use can lead to substance use disorder (SUD). Mental health concerns across all populations have recently been highlighted, but they are not new. PPOU and SUD, in combination with new or preexisting mental health concerns, can lead to devastating and, in extreme cases, unintended death or suicide. It has been studied and documented that the military population is at higher risk in these situations. The opioid epidemic has had a more significant impact in some communities, such as the rural and lower socioeconomic areas. This is due to multiple factors. However, all populations have been impacted by the opioid crisis, which has forever changed our global landscape. Military medicine is often the benchmark for practices outside of the military setting. Protocols and standards are common throughout the military, yet there is no protocol or consensus for preoperative prescribing of non-opioid medications for patients having surgery. This paper focuses on strategies to change providers’ practices and increase attention as an upstream measure to minimize opioid exposure in patients having surgery and, therefore, reduce the occurrence of PPOU when treating patients’ pain related to a surgical event.

Faculty Mentor, Advisor or Committee Chair: Edilma Yearwood, PhD, PMHCNS-BC, FAAN

Project Title: Reducing Patient Wait Times in a Primary Care Setting to Improve Patient Satisfaction

Abstract/Summary: Prolonged wait times in the primary care setting can greatly affect patient satisfaction, and ultimately, patient outcomes. The goal of this project was to assess how patient completion of a health history form and a depression screening tool while waiting to see a provider, compared to medical assistants obtaining patient intake, affected patient wait times and patient satisfaction within adults at a family medicine practice. The primary investigator of the project conducted a retrospective review of wait times in the two months prior to the implementation of the practice change. After collecting this data, the practice change was implemented over the course of a 10 week period. The practice change involved the administration of a health history intake form and the Patient Health Questionnaire-9 (PHQ-9), while the participants were waiting to be seen by their provider. For the purposes of this project, wait times were defined as the time from check-in to the time the provider marked the participant as “ready to be seen.” The participants were asked to complete a patient satisfaction survey, modeled after the Patient Satisfaction Questionnaire Short Form (PSQ-18), after being seen by their provider. The sample size was 158 individuals pre-implementation and 68 individuals post-implementation. A total of 47 individuals completed the patient satisfaction survey post-practice change. The mean pre-practice change wait time was 39.206 minutes and the mean post-practice change wait time was 39.250 minutes. The project did not produce statistically significant data (p=.494). Overall, further research is needed to reduce wait times in primary care and to evaluate the relationship between wait time and patient satisfaction.

Faculty Mentor, Advisor or Committee Chair: Mary Scott-Herring, DNP, MS, CRNA; Megan McAuliffe, DNP, CRNA; Nancy Crowell, PhD; and Lauren Suszan, DNP, MSN, CRNA

Project Title: An Exploration of Tranexamic Acid Administration in the High-Risk Obstetric Patient: A Retrospective Chart Review

Abstract/Summary: Postpartum hemorrhage (PPH) remains one of the leading causes of maternal death in the United States (US). There are several risk factors known to increase the risk of PPH and the use of tranexamic acid (TXA) has been widely researched in clinical situations with high bleeding risk. The aim of this study was to evaluate if the administration of TXA in a high-risk OB population in the US reduced the incidence of PPH, estimated blood loss (EBL), and blood/colloid administration following cesarean section. This retrospective chart review of OB patients was completed at a community hospital and information on TXA administration, blood/colloid administration, and intraoperative and 24-hour EBL was evaluated for all patients who had a cesarean section within the study parameters. Intraoperative and 24-hour EBL were significantly higher in patients who received TXA compared to those who did not. Patients who received TXA were also more likely to receive colloids and blood products and experience PPH. This study found that TXA administration did not reduce the incidence of PPH in high-risk OB patients undergoing cesarean section at this single institution.

Faculty Mentor, Advisor or Committee Chair: Melody Wilkinson, DNP, APRN, FNP, FAANP

Project Title: Impact of Virtual Mental Health Visits, With Home Visitation, on Depressive Symptoms in Rural Peripartum Individuals

Abstract/Summary: Mental health conditions are the most common complication during the peripartum. Mental health services provided via telehealth are shown to be a viable option when face-to-face services are not available. Those living in rural areas experience a higher burden of depression with less access to mental and behavioral health resources. This project was an evaluation of a pilot project looking at the impact of virtual mental health visits, with home visitation, on depressive symptoms in rural peripartum individuals. The pilot took place in a home visiting population in the rural mountainous southwestern United States. The primary aim was to see how the pilot impacted client mental health. Two secondary aims looked at the impact on access to mental health services and the role of demographics on the use of mental health services. Client satisfaction was assessed. Forty-four first-time mothers were analyzed showing no statistically significant relationship between the virtual mental health services and client PHQ-9 and GAD-7 scores (p=.904 and p=.923, respectively). Comparing rates by year, counseling offered increased by 19.4 percentage points from 2022 to 2023, but this was not statistically significant, X2(1) = 2.4, p = .124. There was a 58.3 percentage point increase in offering online services, a statistically significant increase, X2(1) = 12.0, p < .001. There was a 10.3 percentage point increase in receipt of counseling services, but not statistically significant, X2(2) = 1.9, p = .393. There were no significant differences by year in baseline PHQ-9, Mann Whitney U = 126.5, p = .59 or in GAD7, U = 99.5, p = .38. Ethnicity, intimate partner violence, substance use, and age may be associated with receipt of counseling services. The average patient satisfaction rating was 4.5/5 (SD = 0.9), with 94.9% indicating high satisfaction. Virtual mental health visits have the potential to improve rural peripartum depression and anxiety. However, larger scale projects, with improved data collection are needed to further evaluate the effectiveness of virtual mental health visits in rural peripartum populations.

Faculty Mentor, Advisor or Committee Chair: Pamela Biernacki, DNP, APRN, FNP-C

Project Title: Mixed Methods Evaluation of a Novel Interactive Perinatal Telehealth Program

Abstract/Summary: Mental health conditions impact one in five perinatal patients as the most common complication of pregnancy and birth; leading to the need for an individualized telehealth program for this at-risk population. Telehealth has increased exponentially since the COVID-19 pandemic, bringing to the forefront telehealth as a convenient, cost-effective, and timely healthcare delivery modality. Perinatal telehealth programs support mental health, maternal satisfaction, and postpartum preparedness. However, few studies examine the impact of these programs on maternal outcomes other than satisfaction.

This project evaluated a fully online midwife-led perinatal program that highlighted very satisfied people over time and supported their mental health needs. The program used unlimited, on-demand, interactive text messaging, biweekly video teleconferencing, and educational videos to prepare pregnant people for postpartum. A mixed methods retrospective, descriptive design measured satisfaction and examined participant feedback from a convenience sample of 66 former clients who completed the program between December 2019 and December 2022.

Several clients sought the program for mental health support, having a personal history of anxiety (65.2%, n  = 15) or depression (30.4%, n = 7). Upon program completion, 93.3% (n = 14) were extremely likely to recommend the program and 80.0% (n = 12) felt well prepared for postpartum. Physical fitness and ongoing mental health support were the most desirable future supplemental topics. Survey results showed 86.2% (n = 25) were very satisfied with the program over time, and most (65.5%, n = 19) said the program was very important for pregnant people, with video teleconferencing and text messaging rated more beneficial than educational videos. Mental health support ranked as the most useful focus area. Interviewed participants described the program as a “lifeline.”

Faculty Mentor, Advisor or Committee Chair: Mary Scott-Herring, DNP, MS, CRNA

Project Title: Preoperative Fasting Times and Post-Induction Hypotension Among Infants Undergoing Elective Surgical Procedures: A Retrospective Analysis

Abstract/Summary: The incidence of hypotension among healthy, non-hospitalized infants (30 days-364 days old) after inhalational sevoflurane induction, prior to incision, is not well documented among those undergoing routine surgery. A retrospective chart review was conducted to determine the incidence of post-induction hypotension among infants undergoing elective surgery at a tertiary pediatric medical center in the mid-Atlantic United States. Almost all (85.2%) patients reportedly had a prolonged nil-per-os (NPO) time. A chi-square test of independence was used to examine the relationship between hypotension and prolonged NPO status, and no statistically significant relationship was found (X2(1) = 0.31; P = 0.58). Although most patients in this retrospective analysis reported a prolonged NPO time, anesthetic records did not indicate that they developed hypotension between the induction of anesthesia and surgical stimulation.

Faculty Mentor, Advisor or Committee Chair: Mary Scott-Herring, DNP, MS, CRNA

Project Title: Assessing the Impact of Simulation on Circulating Nurses’ Role in Anesthesia Procedures

Abstract/Summary: High-fidelity simulation has been shown to improve healthcare providers’ critical thinking and clinical skills. In this quality improvement project, we explored if there was an increase in knowledge retention regarding circulating RNs and their role in assisting anesthesia when a simulation was added to a pre-existing education module. Data were collected using an electronic 10-question survey pre-, post-, and one-month post-intervention that was administered to newly hired circulating RNs. The simulations and survey focused on patient positioning for a spinal anesthetic, environmental noise control during the induction sequence, application of cricoid pressure, treatment for a laryngospasm, use of the endotracheal tube stylet, and assistance with a bougie catheter. This novel quality improvement project introduces a method of educating circulating RNs on how to assist with anesthesia procedures.

Faculty Mentor, Advisor or Committee Chair: Mary Scott-Herring, DNP, MS, CRNA, Crystal O’Guin, DNP, CRNA, Nancy Crowell, PhD, and Jose Riel Sanariz, CRNA

Project Title: TXA Utilization in Total Hip Arthroplasty: An Educational Intervention and Retrospective Pre-Post Correlational Study

Abstract/Summary: Evidence suggests that tranexamic acid (TXA) can minimize blood loss and the use of colloids during total hip arthroplasty (THA) procedures. An educational intervention and retrospective pre-post correlational study targeting the anesthesia department was conducted at a mid-sized community hospital that did not have clinical practice guidelines or protocols for administering TXA. Tranexamic acid administration practices and patient outcomes were compared pre- and post-educational intervention for patients undergoing primary THAs. The study included 63 patients for the pre-intervention and 56 patients for the post-intervention group. Patient demographics, medical history, and delivered anesthetic were evaluated to ensure that the pre- and post-intervention groups were comparable. The post-intervention group was more likely to receive TXA than the pre-intervention group (94.6% vs. 81.0%; p = 0.03) and the post-intervention group was also more likely to receive TXA before incision than the pre-intervention group (98.1% vs. 90.2%; p = 0.01). Although the overall incidence and timing of TXA administration significantly improved, there were no significant differences in median perioperative blood loss nor frequency of colloid administration between the 2 groups. Limitations of this study included the imprecise measurement of blood loss and limited attendance of anesthesia personnel at the educational intervention.

Keywords: Anesthesia, Blood loss, Educational Intervention, Tranexamic Acid, Total Hip Arthroplasty

Faculty Mentor, Advisor or Committee Chair: Mary Scott-Herring, DNP, MS, CRNA, and Carrie Bowman Dalley, PhD, CRNA

Project Title: CRNAS’ Role in Reduction of Sharps Waste in the Operating Room

Abstract/Summary: This project was implemented to identify and explore Certified Registered Nurse

Anesthetists’ (CRNA) knowledge, current practices, and barriers to proper sharps waste disposal practices in the operating room. Approximately 100 CRNAs who practice anesthesia in the Mid-Atlantic region at 12 different hospitals were given an electronic survey. Forty CRNAs completed this 15-question de novo quantitative descriptive survey. The survey was created by three researchers and five experts in the field to ensure validity. Data was analyzed using the chi-squared test and the Mann-Whitney U test. Thirty-seven percent of respondents reported placing unbroken vials, and 46.4% reported placing empty plastic syringes with needles still attached in sharps containers. The majority of survey respondents (73.7%) agreed that they had inadequate information on the proper disposal of sharps and that additional teaching material would be helpful.

Faculty Mentor, Advisor or Committee Chair: Bryan Boling, DNP, AGACNP-BC, FCCM, and Kelly A. Thompson-Brazill, DNP, ACNP-BC, CCRN-CSC, FCCM

Project Title: The Effect of Guideline Education on Anticoagulation Management and Professional Collaboration in ECMO Patients

Abstract/Summary: This project aims to assist nurses and advanced practice nurses in preventing thrombosis and bleeding during ECMO treatment. It suggests following established anticoagulation guidelines, providing comprehensive education, and promoting teamwork among healthcare professionals. This approach can enhance patient outcomes by increasing knowledge and collaboration, ultimately leading to optimal administration of unfractionated heparin.

Over approximately 20 weeks, the project was undertaken to enhance knowledge pertinent to anticoagulation management in patients undergoing Extracorporeal Membrane Oxygenation (ECMO). This initiative involved facilitating educational sessions tailored for nurses and Advanced Practice Providers (APPs) and focused on improving collaborative processes between these healthcare professionals.

The data for the project was collected through electronic surveys for education and the Collaboration and Satisfaction about Care Decisions (CSACD) tool to evaluate collaboration. Paired sample t-tests were used to compare the education results. The analysis revealed that the education sessions significantly impacted knowledge of medication compatibility, laboratory testing, and safety protocols with a p-value of 0.024, which was statistically significant at the project’s significance level of 0.05. However, the results did not show statistical significance for collaboration, with Z values ranging from -1.717 to -0.103 and p-values ranging from 0.086 to 0.918.

After conducting a comprehensive review of the collaboration data, it was discovered that even though the initial collaboration scores were promising, none of the p-values attained the necessary level of statistical significance (p < 0.05) in the Wilcoxon Signed R Test. Consequently, the research was unable to detect any notable alterations in collaborative procedures between nurses and APPs.

The educational program improved participants’ knowledge of anticoagulation management for ECMO patients, positively impacting their clinical decision-making and patient care. However, collaboration between nurses and APPs showed only slight improvement. The project recognizes the need for enhanced communication, structured interprofessional rounds, and defined roles in managing anticoagulation for ECMO patients.

This QI project underscores the significance of ongoing education and enhanced collaboration in anticoagulation management for ECMO patients. It emphasizes the implications of addressing these aspects to improve patient care.

Faculty Mentor, Advisor or Committee Chair: Mary Haras, PhD

Project Title: Impact of Frailty Screening in a Burn Center: A Quality Improvement Project

Abstract/Summary: Burn injuries create significant risk for the development of new or worsening frailty. Identifying patients’ risk for frailty is key to recognizing patients who are at risk for negative health outcomes and who may benefit from consultation by a geriatric medicine specialist. The FRAIL scale screening tool is an efficient assessment tool which utilizes the five Fried frailty phenotype components to classify risk for frailty. A quality improvement project was conducted in a burn center setting to examine if use of the FRAIL scale screening tool would impact the number of patients who receive a consultation to the geriatric medicine team within a 10-week period. The primary aim was to determine how many burn patients received a consultation for a comprehensive geriatric assessment with secondary aims to evaluate the feasibility of implementing a frailty screening tool in a burn center and to stratify adult burn patients’ risk of frailty into categories based on the FRAIL scale measurements: robust (FRAIL score 0), prefrail (FRAIL score 1-2), or frail (FRAIL score 3 or greater). The data revealed a three-fold increase in the number of consultations to the geriatric medicine team noted between the pre-frailty tool and post-frailty tool groups with statistical significance (X2(1) = 9.17, p = .002). The frailty screening tool was most often administered on the first (54.5%) or second (31.8%) hospital day, with 13.6% of patients having the tool administered on the third or later hospital day. Among the post-frailty tool group, the stratification of frailty risk was as follows: 27.3% robust, 45.4% pre-frail, and 27.3% frail. The FRAIL scale is shown to be beneficial in identifying patients at risk for frailty as compared to clinical practice without use of a formal screening tool. Through review of the timeline of administration of the FRAIL scale screening tool, the tool is also shown to be feasible to implement in the burn center setting. Further, the clinical significance of the majority of patients being classified as pre-frail underscores the need to accurately identify patients’ frailty risk and implement measure to mitigate adverse outcomes.

Faculty Mentor, Advisor or Committee Chair: Kelly A. Thompson-Brazill, DNP, ACNP-BC, CCRN-CSC, FCCM

Project Title: The Effect of an Educational Program on Central Line Bundle Compliance

Abstract/Summary: A prevalent complication that often arises in conjunction with central venous catheters (CVC) is central line-associated bloodstream infections (CLABSIs). Central line (CL) bundles are widely used by healthcare organizations to prevent CLABSIs; however, not all institutions consistently adhere to bundle protocols. A single academic level-1 trauma center was chosen for this quality improvement (QI) project. The institution sees many acutely ill patients who need CVCs, however, a few of its units struggle to achieve > 80% CL bundle compliance. This QI project assessed whether reduced CLABSI rates and improved CL bundle compliance could result from implementing an educational program on a unit with low CL utilization and low CL bundle compliance. This project also examined whether an educational program would enhance nursing knowledge and confidence in using the CL bundle and lead to cost savings for an institution. For this project, a hybrid educational program that combined an eLearning module with hands-on instruction and return demonstration was utilized. Pre-and post-questionnaires were given to registered nurses (RNs) before and after the educational program to assess their knowledge and confidence with the CL bundle. CL bundle audit data was used to compare pre-and post-education bundle compliance. This project examined CL bundle compliance before and after an educational program in two similar units: one that received the education (the treatment unit) and one that did not (the control unit). The CL bundle analysis revealed a statistically significant increase in total bundle compliance on the treatment unit, from 65.2% before to 71.1% after the educational program was implemented (p <.001). A statistically significant decline (p <.001) was seen in the control unit’s compliance rate, which decreased from 93.0% to 69.8%. The results of the pre-and post-questionnaires revealed an 11.3 percentage point increase in RN knowledge, which was not statistically significant (Z = 1.93, p =.054). A statistically significant improvement in confidence ratings for knowledge of the project site’s CL bundle components was found in pre- and post-questionnaires (Z = 2.46, p =.014). The findings of this project illustrate the effectiveness of a hybrid educational program in enhancing CL bundle compliance and RN confidence with the CL bundle.

Faculty Mentor, Advisor or Committee Chair: Melody Wilkinson, DNP, APRN, FNP-BC, FAANP

Project Title: Educating Primary Care Providers on Naloxone Distribution in a Rural Federally Qualified Healthcare Center

Abstract/Summary: Opiate overdose is a leading cause of death in the United States. Universal distribution of naloxone medication is an effective harm reduction strategy that decreases deaths related to opioid use, and educating health care providers has proven effective in increasing naloxone distribution in a rural outpatient setting. This quality improvement project (QI) was implemented over 12 weeks, and it introduced an evidence-based educational session for primary care providers in a rural federally funded and qualified healthcare center (FQHC). The education session provided information related to naloxone use and overdose prevention and encouraged providers to distribute naloxone universally. The project measured the change in naloxone medication kit distribution by primary care providers after the educational session was implemented. A secondary aim measured provider satisfaction with the educational session components. Chart abstraction was used to track the number of naloxone kits distributed 12 weeks before the project’s onset and during implementation. Weekly data was collected on the number of naloxone kits distributed. The satisfaction survey was implemented at two points: immediately after the educational session ended and after the implementation period. Before implementation, the distribution of naloxone medication kits occurred at a rate of 2.7 per 1000 patients; following implementation, the rate of distribution for naloxone medication kits increased to 28.8 per thousand patients. The findings indicate a statistically significant increase (z=11.3, p < .001) in the distribution of naloxone medication kits. Providers expressed high satisfaction in the educational session, confidence in naloxone education, and competence in naloxone distribution. Post-implementation survey responses indicated that the universal distribution of naloxone medication kits was feasible and suggested interest in long-term sustainability at the FQHC. The education of primary care providers on the universal distribution of naloxone medication kits in the FQHC setting is feasible. It may be an important tool in community-based harm reduction strategies aimed at decreasing opioid overdose.

Faculty Mentor, Advisor or Committee Chair: Ella Heitzler, PhD, WHNP-BC, FNP-BC, RNC-OB

Project Title: Impact of Education on RN Readiness to Screen for IPV  in a Perinatal Emergency Department

Abstract/Summary: Pregnant people are vulnerable to the initiation and intensification of intimate partner violence (IPV), which can cause adverse maternal and neonatal outcomes; however, screening for IPV does not occur as often as screening for other high-risk conditions of pregnancy. Nurses in perinatal emergency settings are poised to identify and support pregnant and postpartum survivors of IPV, but insufficient training is consistently cited as a barrier to screening for IPV among nurses. The purpose of this quality improvement project was to evaluate the impact of registered nurse (RN) education on readiness to manage IPV screening, rates of IPV screening completion, and rates of IPV-related social work consults in a perinatal emergency department. Survey data collected before and after RN education was compared to evaluate readiness to screen for IPV using a modified version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool (Short et al., 2006). Deidentified chart data was collected pre-post to assess rates of IPV screening completion and IPV-related social work referrals. Participants were RNs working in a perinatal emergency department (n = 8). Survey results compared before and after education demonstrated statistically significant improvements in perceived preparedness (p < .001), perceived knowledge (p < .001), and four of five opinion scales regarding readiness to screen for IPV. Participants better understood protocols and policies for IPV screening following education. Rates of IPV screening completion increased significantly from 80.79% pre-training to 86.94% post-training (z = 1.77, p = .038). This project demonstrates that brief, site-specific education on IPV screening policies, protocols, and resources for nurses may improve their readiness to screen for IPV and improve rates of IPV screening completion. Future projects should evaluate the long-term impact of education on RN readiness to screen for IPV, the optimal frequency to provide RN education on this topic, and alignment of IPV screening education for nurses with a trauma and violence informed approach.

Faculty Mentor, Advisor or Committee Chair: Vera Barton-Maxwell, PhD, APRN, FNP-BC

Project Title: Analyzing the Impact of Remote Video Monitoring on Patient Fall Rates: A Pilot Program Evaluation

Abstract/Summary: Falls in hospitalized patients are associated with negative patient outcomes and increased healthcare costs. Evidence supports the use of multifactorial fall prevention interventions. Multifactorial interventions can include staff education, early mobility, bed/ chair alarms, purposeful rounding, and patient monitoring with a staff member when appropriate. Historically, physical sitter monitoring (PSM) has been utilized to decrease falls, but evidence of effectiveness is lacking. Hospitals have been replacing PSM with remote video monitoring (RVM) as RVM has shown to decrease falls and increase the number of patients monitored. The purpose of this Doctor of Nursing Practice project was to evaluate the effectiveness of a RVM program after its implementation on a 37-bed neurological, non-intensive care pilot unit in an acute care center. The primary aim was to evaluate fall rates by answering the clinical question: How did fall rates compare among high-falls risk patients while receiving either RVM, PSM, or standard of care with no monitoring over a three-month period? The secondary aim was to evaluate staff satisfaction with RVM from the perspectives of registered nurses, remote safety observers, and nursing assistants/ unit secretaries/ patient attendant safety aides (referred to as PASAPlus staff). A retrospective data analysis design was utilized for this project. Data collected from August to November were analyzed. Sources of data included patients’ electronic charts, site-specific report sheets for sitter staffing and falls, and staff satisfaction survey results. A total of 459 charts of high-falls risk patients who met inclusion and exclusion criteria were identified. Zero falls were identified in patients who received RVM or PSM, and eight falls without injury were identified in patients who received standard of care with no monitoring. There was no statistically significant difference in fall rates with monitoring (0.0%) versus no monitoring (1.8%), z= 0.64, p= 0.261. Staff satisfaction was evaluated utilizing survey results. There was no statistically significant difference in the likelihood to recommend RVM by clinical role, Kruskal-Wallis H= 0.241, p= 0.88. Data were clinically significant to support that monitoring patients could decrease falls. Continued evaluation of RVM with data from hospital wide dissemination was recommended.

Faculty Mentor, Advisor or Committee Chair: Mary Scott-Herring, DNP, MS, CRNA

Project Title: Relationship Between Emotional Intelligence and Burnout Among Anesthesia Providers

Abstract/Summary: Previous studies have shown that higher emotional intelligence (EI )leads to lower incidence of burnout in clinical healthcare workers. However, there are currently no published studies that explore this relationship in anesthesia providers. This study aimed to investigate 1) if anesthesia providers with higher emotional intelligence were less likely to meet burnout criteria and 2) whether demographic factors played a role in likelihood of burnout. In this study, 21 Certified Registered Nurse Anesthetists (CRNAs), 23 physician anesthesiologists, and 6 Anesthesiologist Assistants (AAs) completed the 16-item Wong and Law Emotional Intelligence Score (WLEIS) and the 16-item Maslach Burnout Inventory (MBI). T-test analysis was used for data interpretation to answer the emotional intelligence and burnout relationship proposed by the study. A statistically significant correlation was found between higher EI and lower incidence of burnout (P = 0.022). No statistically significant relationships were found between demographic variables and rates of burnout. Burnout is a tremendous issue among anesthesia providers, and further exploration into the influence of emotional intelligence on burnout may be instrumental to decreasing burnout incidence.

Faculty Mentor, Advisor or Committee Chair: Lois Wessel, DNP

Project Title: Impact of Open Access Scheduling System on No-Show Rates in an Urban Federally Qualified Health Center

Abstract/Summary: No-show appointments impact health outcomes, contribute to health disparities, and threaten the financial survival of Federally Qualified Health Centers (FQHCs). Preventive health screenings and management of chronic diseases were drastically reduced during the COVID-19 pandemic and require innovative methods to improve access to care. Open access eliminates long lead times and provides a more flexible appointment scheduling. The purpose of this quality improvement project was to measure the impact of open access scheduling on no-show rates in an urban FQHC. 

A pre-post interventional design compared two days per week of no-show data for a span of 10 weeks between two family medicine physicians’ schedules. No-show data from the pre-intervention group (N = 175) were collected from October 17–December 20, 2022 and compared to no-show data from the open access post-intervention group (N = 82) collected from October 16 –December 19, 2023 using a z-test of proportions. The mean age of the show and no-show populations were compared using a two-tailed independent sample t-test. Reasons for no-show in the open access post-intervention group were identified and staff satisfaction was measured through a survey (N =16) that included a Likert scale.

The no-show rate in the post-intervention open access group (3.5%) was significantly lower than the rate in the pre-intervention group (36%), p < .001. Pre-intervention no-show group was significantly younger (M = 42.3, SD = 20.1, n = 63) than the show group (M = 48.4, SD = 17.1, n = 112), p = .021. The post-intervention age for the no-show group (M = 67.3, SD = 1.2, n =3) was significantly older than the show group (M = 39.9, SD = 21.1, n = 79), p < .001. No themes emerged in the reason for no-show due to low population number (n =3). Overall, the open access satisfaction surveys reflected positive staff perceptions with respect to the intervention.

This project demonstrated a 90% reduction in no-show rates and shows promise that a flexible health appointment method such as open access will decrease no-show rates. Future longitudinal studies with larger FQHC populations will further add value to support the evidence.