Doctoral Projects

A student presents her project before an audience in an auditorium

Students in the PhD, DNAP and DNP programs conduct research that forms the basis of a doctoral project as a degree requirement. View completed projects (* denotes published title).

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, FNP-BC

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.