24th Annual Nursing scholarship Symposium by Millersville University

- The Department of Nursing -

24th Annual

Scholarship Symposium Friday, April 30th, 2021

- Millersville University -

24th Annual Scholarship Symposium

TABLE OF From our Chair ......................................................................................3 Agenda .......................................................................................................4 Agenda in Detail ..............................................................................5 Doctor of Nursing Practice Students ................... 16 Masters of Science in Nursing Students ........... 29 Faculty ...................................................................................................... 70 Find us at ............................................................................................... 71

FROM OUR CHAIR: Thank you for joining our 24th Annual Scholarship Symposium. This event has long served as the showcase for our graduate students' culminating projects. Since joining the MU Department of Nursing in 2000, I have never missed a symposium, and each year, I am inspired and awed by the amazing work of our students. In recent years, our Symposium has grown through the addition of Doctor of Nursing Practice 3 students and our Harrisburg MSN program expansion. This year, we are thrilled to showcase the work of more than 50 MSN and DNP students. I hope you enjoy the day as much as we have enjoyed working with our students to prepare! Kelly A. Kuhns, PhD, RN, CNE Chair and Professor DNP Program Director Department of Nursing

24th Annual Scholarship Symposium

MORNING 08:00 Welcome 08:15 DNP Cohort IV 09:15 DNP Cohort III 11:00 MSN Posters (G1) 11:30 MSN Podiums (G1) 12:30 Lunch 4

24th Annual Scholarship Symposium

AFTERNOON 13:00 MSN Posters (G2) 13:30 MSN Podiums (G2) 14:30 MSN Posters (G3) 15:00 Post-Test 15:15 Evaluations 15:30 Awards 5

DNP COHORT IV Treating Students with PANDAS: Implications for School Nurses Tiffany Boyd Motivational Interviewing of Diabetes Mellitus Patients Shelly Corle Educating School Nurses about E-cigarette use and Associated Adverse Health Effects Alicia Shelkin

Improving the Detection of Paternal Postpartum Depression with Prenatal Education Taasha Guillette Self-Monitoring for Weight Loss in Adults with Obesity Heather Shuker Implementing SBIRT on a Psychiatry Consult Liaison Service in the Acute Hospital Setting Kelly Fetterhoff

DNP COHORT III Improving LGBT+ Healthcare Education and Training for Healthcare Professionals Bryan Weinberg-Wonsidler Implementation of Provider Education for Appropriate Screening and Treatment of Asymptomatic Bacteriuria Angela Krick Implementation of a Telehealth Nurse Navigation Program Laurette7Flannery Implementing Medication Assisted Treatment in the Emergency Department Anne Hinkle Mindfulness Intervention for Opioid Use Disorder Patients at a Family Practice Jen Marvelous Aquatic Therapy in Managing Chronic Lower Back Pain among Older Adults. Mary Njogu

MSN POSTER GROUP 1 Opioid Use Disorder and Medication Assisted Treatment in Primary Care Setting Titus Leitoro Interventions to Promote Optimal Quality of Life for Patients with Primary Adrenal Insufficiency: Implications for Primary Care Providers Paula Grannells The Impact of Graduate Nurse Residency Programs on Staff Retention: 8 Implications and Recommendations for Nurse Educators and Future Hospital Programs Melanie Stoltzfus Use of a Continuous Glucose Monitor and its Impact on Hypoglycemia, Morbidity and Mortality on the Adult Diabetic Patient Danielle Sweigart Adolescent Suicide Screenings in the Primary Care Setting: Implications for Practice Cheryl Boulanger

MSN POSTER GROUP 1 Breastfeeding Support at the Primary Care Level Jenna Bentz

Advising Patients who Desire to Pursue Dietary Changes to Control Their Blood Pressure and Cholesterol Levels: A Literature Synthesis Rebekah Shue Evidenced-Based Interventions to Reduce Obesity in School Age Children: 9 Implications for Family Nurse Practitioners Farida Aliyeva Multi-Modal Interventions and Adherence to Treatment for Patients with Heart Failure: Implications for Family Nurse Practitioners Terianne Rineer The Impact of Antibiotic Stewardship Programs on Antimicrobial Resistance in the Outpatient Setting Caitlin Ness

MSN PODIUM GROUP 1 Novel Diagnostic Testing for Lyme Disease Compared to Standard Two-tiered Testing: Are New Diagnostic Technologies on the Horizon? Michelle Reed Looking Beyond the Complete Blood Count: Appropriate Ferritin Levels to Diagnose Iron Deficiency without Anemia in Adolescent Females? Gena L. Getz

The Role of Vitamin D Supplementation in Preventing Respiratory Tract Infections: Dosing and Population Considerations Hannah Erwin Heart Disease Prevention in the Fire Service Emily Serikstad

MSN POSTER GROUP 2 Medication and Care Compliance of the HIV Patient Under the Care of a Nurse Practitioner with Specialized HIV Training Elisabeth Cate-Freeman Slowing the Progression of Non-alcoholic Fatty Liver Disease: Implications for Family Nurse Practitioners Amanda Hess

11Pain Management Chronic Non-Cancer Through Multidisciplinary Treatment Plans Justin Rogers Are Patients More Satisfied with Care Provided by a Nurse Practitioner or a Physician in Primary Care? Kristl Molina The Contributory Factors to Hearing Loss in Adult Workers Christina Wirth

MSN POSTER GROUP 2 Portable Ultrasound in Primary Care: Implementing Scientific Teaching Methods Identified for a Successful Training Program David Zook Medical Marijuana and Chronic Pain Robert Kinsey Family Caregivers of Those Affected by Opioid Dependency: Support and Recovery Resources for the Family Nurse Practitioner 12Silknetter Michaella Extended Length of Stay in the ED Increases Mortality Rates Mary Kay Stauffer Screening for Adverse Childhood Experiences in the Adult Population Laxmi Bajgai

MSN PODIUM GROUP 2 For School Age Children, Does a School Nurse Consult Improve Chronic Absenteeism Versus the Standard Student Attendance Improvement Plan (SAIP) Jodi Haberstroh Rural Access to Mental Health Services via Telemedicine: The Role of the Family Nurse Practitioner Heather J. Wagaman

13 Resources for Families of The Utilization of Online Support Children with Chronic Illnesses: Implications for Primary Care Providers Laura Yiengst Cost Effective Integrative Therapies for Acute Stress Management Janine Muir

MSN POSTER GROUP 3 Educating the Elderly Population Regarding Risk for Falls and Falls Prevention: Implications for Primary Care Providers Rosa Gingrich Patients with Congestive Heart Failure and Use of Outpatient Palliative Care: Implications for Primary Care Providers Jamie Kehler Nurse Practitioner’s Role on Caregivers’ Burden Hang 14Pham Influenza Vaccine Impact on Influenza-Related Hospitalization: An Integrative Review Afolake Ogunfuwa Physical Activity as an Intervention to Prevent Dementia: Implications for Family Nurse Practitioners Hanh VU Diabetic Medication Cost Effect on Diabetic Medication Adherence Gregory Peters

MSN POSTER GROUP 3 Deprescribing Benzodiazepines in Elderly: Importance of Patient-Provider Collaboration Sonia Sebastian The Importance of Breastfeeding Support in the Workplace Natalie Goss Literature Review for the Creation of a Sepsis Screening Tool in Primary Care Jocelyn Ramirez

15 Patient Satisfaction with Telemedicine Services Versus In-Office Visits Cindy Stovall Prescribing Aspirin as Primary Prevention in Cardiovascular Heart Disease for Patients with Diabetes Rebecca Schaeffer Understanding and Addressing the Effects of Screen Time on Adolescent Health: Recommendations for Nurse Practitioners Faith Dreibelbis

DOCTOR OF NURSING PRACTICE PROJECTS

24th Annual Scholarship Symposium

Treating Students with PANDAS: Implications for School Nurses Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a health condition that is not widely known. However, it is becoming increasingly diagnosed in more recent years. School Nurses may frequently see students who exhibit signs of PANDAS, but they may be unfamiliar with best practices to care for these students. To date, there is not a standardized Individualized Healthcare Plan (IHP) for students diagnosed with PANDAS. A standardized IHP is essential to provide exceptional care for students with a diagnosis of PANDAS while they are in school.

Tiffany Boyd MSN, BS, RN, CSN

24th Annual Scholarship Symposium

Motivational Interviewing of Diabetes Mellitus Patients Diabetes mellitus is a complicated disease process that affects millions of Americans yearly and causes serious even fatal complications if left uncontrolled. Those complications include renal failure and disease cardiac complications neuropathy and retinopathy. These complications to reduce quality of life and ultimately and in death type two diabetes mellitus requires patient self management in order to maintain glycemic control however many of these patients like interest education and ambivalence to the necessary lifestyle changes necessary for a healthier life motivational interviewing as a patient centered counseling technique. Which can encourage patients to make informed decisions regarding their health to successfully manage their disease and diminish serious complications throughout their lifetime. This project will encourage change and give knowledge to those patients who are ready to make changes in their life and their disease process.

Shelley Corle MSN, RN, FNP-C

24th Annual Scholarship Symposium

Implementing SBIRT on a Psychiatry Consult Liaison Service in the Acute Hospital Setting Screening, Brief Intervention, and Referral to Treatment (SBIRT) is used to screen for substance use, provide a brief intervention and refer patients with dangerous substance use for treatment. Over the past decade, dangerous substance use and substance use related deaths have dramatically increased. SBIRT has been implemented in a variety of settings across the world as a strategy to decrease substance use and prevent further deaths. Substance Use Disorder (SUD), and more specifically Opioid Use Disorder (OUD), is a national epidemic. With the increasing amounts of people suffering from SUD, any point of contact with a healthcare professional trained in substance abuse treatment could be used as an opportunity to get patients into treatment. Patients who are medically admitted to the hospital are not always given SUD treatment while in the hospital and may not be referred for treatment when they are discharged. The purpose of this project is to determine if a psychiatry consult liaison service in the acute care hospital setting can be used as a point of contact to implement SBIRT, and increase the likelihood of them participating in SUD treatment for patients suffering with comorbid SUD and psychiatric illness.

Kelly Fetterhoff MSN, CRNP, PMHNP-BC

24th Annual Scholarship Symposium

Implementation of a Telehealth Nurse Navigation Program Venous leg ulcers are open wounds that are difficult to heal. Despite receiving care from wound care professionals, patients living in the community encounter barriers to following through with the treatment recommendations and this affects their perception of being able to participate in life activities. Literature has identified that healing and maintaining skin integrity in a patient with a venous leg ulcer requires proper ulcer care, leg elevation, compression, and leg exercise. Patients tend to become non-concordant with these requirements due to physical, psychosocial, functional, and financial limitations. Nurse navigators are registered nurses that possess the skills and experiences to identify and address barriers and use their resources to alleviate identified barriers. In addition, the nurse navigator builds a relationship with the patient and provides education and encouragement to complete the interventions required to promote ulcer healing. The aim of this project is to determine if a telehealth nurse navigation program will be able to address the obstacles that preclude the participant from performing self-care activities, thus improving the self -perception of their ability to participate in life activities.

Laurette Flannery MSN, RN, CRNP

24th Annual Scholarship Symposium

Improving the Detection of Paternal Postpartum Depression with Prenatal Education Transitioning into the role of the parent can be very stressful for both mother and father. In the past, maternal depression has received a lot of attention from healthcare providers and the medical community. However, it is essential to acknowledge the potential risk for paternal postpartum depression, which has been underreported, underrecognized, underdiagnosed, and undertreated. Due to the effects, paternal postpartum depression can have on the father, mother, child, and family, it is imperative for healthcare providers to assess both the mother and the father for postpartum depression after the delivery of a child. In addition, the utilization of third trimester patient/partner multimodal education about paternal postpartum depression is an opportunity to present the importance of assessment, detection, recognition, and treatment to this population. Through the Edinburgh Postnatal Depression Scale (EPDS), healthcare providers can administer this quick, easy screening questionnaire at postpartum visits and throughout the first year postpartum. Early risk assessment and identification of paternal postpartum depression will allow fathers to receive treatment for their depression, which will improve outcomes for the entire family.

Taasha Guillemette MSN, RN, CRNP

24th Annual Scholarship Symposium

Implementing Medication Assisted Treatment in the Emergency Department The opioid crisis has been a relentless problem that has increased in severity over the last decade. Clinicians practicing in an Emergency Department (ED) setting encounter patients with opioid use disorder on a frequent basis. Medication Assisted Treatment (MAT) is a pharmacological means to treat Opioid Use Disorder (OUD) which can reduce cravings and maintain sobriety. In recent years, an evidence-based practice change started in many organizations incorporates implementing MAT from the ED setting to treat OUD with intention of outpatient follow up for further prescriptions. During this scholarly project, a written educational workflow resource was created and made available to a group of ED providers to determine whether it would increase use of MAT in this setting. After a three month period of implementation, outcomes measured were the number of MAT buprenorphine prescriptions and doses given in the ED. These numbers were compared to a similar three month period pre intervention. Results of the project were statistically significant, leading to a mean of 9.667 total instances of MAT post intervention (M=9.667, SD=2.52) in comparison to a mean of 2.667 in the pre intervention group (M=2.667, SD=1.15). Having a readily available workflow resource will positively affect this population as clinicians may write an increasing number of prescriptions for MAT from the ED setting with referral for outpatient follow-up. This indicates clinical significance for this population as it may lead to improved quality of life with sustained recovery. Plans to continue having an available and up to date resource are sustainable and low cost and may lead to decreased healthcare costs and improved outcomes for this population.

Anne Hinkle MSN, FNP-BC, AGACNP-BC

24th Annual Scholarship Symposium

Implementation of Provider Education for Appropriate Screening and Treatment of Asymptomatic Bacteriuria Currently, it is recommended that patients with asymptomatic bacteriuria not be screened or treated with antimicrobial agents. Asymptomatic bacteriuria frequency is 1%6% in premenopausal women and the incidence increases to 22% in women over the age of 90 years. The overall prevalence of asymptomatic bacteriuria increases with age in both men and women. There is an abundance of literature that demonstrates a lack of provider knowledge regarding these recommendations. The purpose of this project is to provide a multi-modal educational intervention directed at providers with the intention of decreasing inappropriate screening and subsequent treatment of patients with asymptomatic bacteriuria. The intervention resulted in a decrease in proportion of urinalysis for asymptomatic patients from 40-60%. The intervention is sustainable and has the ability to be reproduced in other settings including hospitals, primary care provider offices, and urgent care centers.

Angela Krick MSN, RN, FNP-BC

24th Annual Scholarship Symposium

Mindfulness Intervention for Opioid Use Disorder Patients at a Family Practice A mindfulness intervention, consisting of two 30-minute classes, reminder calls, and a follow-up visit was offered by a nurse at a family practice in Philadelphia. The patient population was people in recovery from opioid use disorder who attended a medication-assisted treatment clinic at the practice. The project looked at whether the mindfulness intervention was accepted by patients and whether the intervention influenced patient cravings for opioids.

Jen Marvelous MSN, RN

24th Annual Scholarship Symposium

Aquatic Therapy in Managing Chronic Lower Back Pain among Older Adults Chronic lower back pain is a major health problem affecting many people across the globe (Abadi, Choo, Emulai,Sankaravel, & Razli, 2019). It is the cause for repeated visits to health care providers. Moreover, it causes a great annual economic burden on the United States due to decreased worker productivity, increased treatment costs, and the costs of maintaining disabled homebound senior adults. Many health care providers commonly prescribe opioids to manage this crippling condition (Centers for Disease Control and Prevention [CDC], 2016). This has led to serious opioid addiction, overdose, and death (CDC, 2016). In recent years, an increased focus has been placed on aquatic therapy for the management of chronic lower back pain (Abadi, et al.,2019). Water has distinctive properties that make it an ideal treatment for this condition.

Mary Njogu MSN, RN, AGNP

24th Annual Scholarship Symposium

Educating School Nurses about E-cigarette use and Associated Adverse Health Effects Although traditional tobacco use amongst adolescents is declining across the United States, the popularity of electronic cigarette (e-cigarette) use is rising, posing a health risk to American youth across the United States. According to the Centers for Chronic Disease Prevention and Health Promotion (2020) approximately half of high school students in the United States reported having used an electronic vaping product within the few years that they were first marketed. E-cigarette use is linked to future traditional cigarette use, increased respiratory infections and lung damage, cancer, and nicotine addiction. Public schools across the nation offer education about e-cigarette use in health classes, but adolescents continue to experiment with e-cigarettes. The U.S. Preventive Services Task Force (USPSTF) recommends education by a primary care clinician to prevent tobacco product initiation among adolescents. Healthcare providers often avoid discussing e-cigarette use with adolescents because of a lack of knowledge about e-cigarettes. School nurses can provide this primary prevention intervention because they have daily interaction with students. Educating school nurses about e-cigarette use and the associated health risks may open the door for communication with adolescents in a one-onone setting. Increasing the knowledge about electronic cigarette use and other tobacco products may increase the school nurses’ confidence to engage in a conversation about vaping. This project's goal is to increase school nurses’ knowledge about ecigarette use and associated adverse health effects. It is anticipated that increased knowledge will increase willingness and confidence of school nurses to provide educational materials, counsel against e-cigarette use, and offer reliable online resources to adolescents for cessation of ecigarette use.

Alicia Shelkin MSN, RN, CRNP, CSN

24th Annual Scholarship Symposium

Self-Monitoring for Weight Loss in Adults with Obesity Dietary self-monitoring is an evidence-based behavioral technique that can be used as part of a behavioral change strategy to elicit weight loss in adults with obesity. Frequency and consistency of dietary tracking as well as adherence to self-monitoring is associated with successful weight loss and weight maintenance. There is ample evidence to support the widespread recommendation of this low-cost weight loss technique to help the millions of people afflicted with overweight or obesity who are at risk of a myriad of poor health consequences. Therefore, this evidence translation project will involve implementing dietary self-monitoring in a primary care clinic in an attempt to help people with obesity to lose weight.

Heather Shuker MSN, CRNP

24th Annual Scholarship Symposium

Improving LGBT+ Healthcare Education and Training for Healthcare Professionals Purpose: To better understand the current state of the integrated care literature on addressing LGBT+ healthcare education and training interventions, evaluating systematic literature reviews from 2015 - 2020 on LGBT+ healthcare education and or training for healthcare providers in order to identify and compile current evidenced based research to improve educational interventions for health care providers on LGBT+ healthcare.

Conclusion: LGBT+ healthcare educational training should use a multi-modal approach to enhance understanding and competence, should include individuals of the LGBT+ community in the design and implementation of LGBT+ education, the inclusion and integration of LGBT+ healthcare in academic curricula and professional training, and the need for studies to evaluate the long term retention and application of LGBT+ healthcare knowledge and changes is attitudes and behaviors of healthcare professional in relation to LGBT+ individuals and the community.

Bryan Weinberg-Wonsidler MSN, AGNP-C, CRNP, CNRN

MASTER OF SCIENCE IN NURSING PROJECTS

24th Annual Scholarship Symposium

Evidenced-Based Interventions to Reduce Obesity in School Age Children: Implications for Family Nurse Practitioners Childhood obesity is a worldwide problem that affects their physical and mental health. Health conditions such as cardiac disease, diabetes, cancer, depression, and anxiety revolve around obesity as the main risk factor. Primary Care Providers have an important role in educating and implementing interventions to prevent or reduce obesity in children. The CINAHL, and MEDLINE databases were used to obtain high quality articles related to reducing obesity in school age children. The literature was evaluated using the John Hopkins evidence appraisal tool. A comprehensive review of the literature was conducted to evaluate the interventions that are most effective for primary care providers to reduce obesity in school age children. Initiating anticipatory guidance and education are important steps to fight the epidemic of obesity. Screening and diagnosis starting with the newborn stage and continuing with each well visit is important to prevent or identify and treat childhood obesity. There is need for increased awareness and identification of obesity in the primary care setting. The rise in obesity among children indicates the need for new strategies that involve more than individual-level behavior change or post-assessment treatment. The prenatal and early childhood periods are critical times for growth and healthy lifestyle development.

Farida Aliyeva BSN, RN, CV-BC

24th Annual Scholarship Symposium

Screening for Adverse Childhood Experiences in the Adult Population Researchers demonstrated an interrelation between adverse childhood experiences (ACEs) and detrimental health outcomes. The negative impact of ACEs can be lifelong and can be associated with high-risk behaviors including substance abuse and unsafe sex. ACEs can also have a negative impact on physical and mental development. According to the World Health Organization (WHO), sixty one percent of United States adults who were surveyed reported that they have endured at least one type of ACE. Despite having strong evidence that ACEs are linked to negative health outcomes, primary care providers have not incorporated screening for ACEs into routine practice. The inadequate screening and lack of early identification of ACEs in the primary care setting has resulted in inadequate diagnosis and treatment for many chronic health conditions. The CINAHL, MEDLINE, and Google Scholar data bases were utilized to obtain peer-reviewed articles related to the clinical question of how does screening for adverse childhood experiences (ACEs) compared to no screening affect more accurate identification of chronic illness and subsequent recommendation for supportive interventions. The literature was evaluated using the Johns Hopkins Evidence appraisal tool. An extensive review and synthesis of literature was conducted to identify the impact of screening for ACEs on patient health outcomes. ACEs may have significant lifelong negative health outcomes and frequent hospital utilization. Despite this overwhelming evidence, very few primary care providers have implemented routine screening for ACEs. Research findings support the need for implementation of ACEs screening in primary care.

Laxmi Bajgai BSN, RN

24th Annual Scholarship Symposium

Breastfeeding Support at the Primary Care Level Breastfeeding provides a number of health benefits for both mother and child. Breastfeeding is recommended over formula feeding by several professional organizations including the American Academy of Family Physicians, the Centers for Disease Control and Prevention, and the World Health Organization. Despite the profuse health benefits and these recommendations from major health organizations, breastfeeding rates in the United States remain much lower than the nationally published goals. Breastfeeding initiation rates remain high, but by three and six months postpartum breastfeeding rates drop significantly. The presence of breastfeeding support in the primary care setting may assist mothers and have an impact on maintaining suitable breastfeeding rates. The CINAHL and MEDLINE databases were searched to gather existing literature related to the clinical question what are the best practice approaches for primary care providers to increase breastfeeding frequency and duration. The Johns Hopkins Evidence-Based Practice Appraisal Tool was used to evaluate the literature obtained and it was then reviewed and synthesized. It was discovered that a multidimensional approach is needed to effectively support breastfeeding at the primary care level. This multifaceted approach includes increasing healthcare providers’ knowledge base related to breastfeeding, providing breastfeeding support in both the prenatal and postpartum period, and having a formalized lactation consultation program in place.

Jenna Bentz BSN, RN, CLC

24th Annual Scholarship Symposium

Adolescent Suicide Screenings in the Primary Care Setting: Implications for Practice Suicide is defined by the Centers for Disease Control as the loss of life caused by harming oneself with the objective of death. A suicide attempt is when someone injures/hurts themselves with the purpose of putting an end to their life, but they do not die as a consequence of their actions. Suicide is the 2nd leading cause of death amongst adolescents and young adults between the ages of 15-24 and is the 10th leading cause of death in general in the United States. It is an act which creates not only harm and/or death for the person themselves, but also affects those left behind with resultant emotional, mental, financial, and physical distress. Adolescent screenings, as well as prompt and specific follow up, are imperative to identifying and reducing the effects of suicidal ideation. The MEDLINE Complete, CINAHL Complete, and APA PsycInfo databases were used to attain pertinent and relevant studies which guided the recommendations for suicidal screenings. The Johns Hopkins evidence level and quality guide was used to appraise the research and findings, and to assure superior quality recommendations. Primary care settings, and the involvement of the nurse practitioner (NP), are ideal initial interactions for utilizing screening tools and proactively addressing risk factors for suicidal ideation in adolescents. The research demonstrates early screening and intervention does impact the adolescent’s attitude and intentions with regard to suicidal ideation.

Cheryl Boulanger BSN, RN

24th Annual Scholarship Symposium

Medication and Care Compliance of the HIV Patient Under the Care of a Nurse Practitioner with Specialized HIV Training There is a growing demand for primary care for persons with Human Immunodeficiency Virus (HIV). With advances with antiretroviral medications persons with HIV are living longer and therefore requiring more primary care for such comorbidities as heart disease, high cholesterol, hypertension and diabetes (White, 2016). Primary care providers are seeing more persons with HIV in the office setting but are ill equipped to undergo the demands of monitoring the patient with other medical issues in addition to their HIV. Primary care providers do not have the specialty training in caring for an aging HIV population (Schwartz, 2020). Nurse practitioners with specialized HIV training may be able to meet the care needs to achieve better patient compliance than those non-specialized providers (Sherbuk, 2019). CINAHL, EBSCO, and Medline databases were all used to obtain high quality articles related to patient compliance to antiretroviral therapy and care of the HIV patient when treated by a nurse practitioner who is specially trained in HIV care compared to being treated in the primary care setting without a specially trained provider. The literature was evaluated by using the Johns Hopkins Evidence Appraisal tool. Review and synthesis of the literature was performed to identify the compliance of care for HIV patients cared for by HIV trained nurse practitioners compared to primary providers. Eleven articles found demonstrated that primary care providers are not comfortable prescribing antiretroviral (ART) medications, and that patients who are cared for by an HIV-trained nurse practitioner are more compliant and have better health outcomes.

Elisabeth Cate-Freeman BSN, RN, CEN, CFRN

24th Annual Scholarship Symposium

Understanding and Addressing the Effects of Screen Time on Adolescent Health: Recommendations for Nurse Practitioners The time adolescents spend using electronic devices, both for education and leisure, has become increasingly concerning. The resulting sleep disturbances due to the increase in screen exposure has been deemed a public health issue by the American Academy of Sleep Medicine. The literature suggests that adolescents require eight to ten hours of sleep a night for optimum health. However, an alarming 70% of youth are getting an inadequate amount each night with an average reported sleep duration of 6.2 hours on weeknights. The aim of this analysis was to explore how screen time in youth affects physical and psychological health. Current evidenced-based literature outlines how the amount and quality of sleep is negatively affected by the light emitted from screens. This leads to increased fatigue, decreased alertness, compromised cognitive functioning, and impaired mood. Additionally, interventions and recommendations are discussed including how educating parents and caregivers, as well as teenagers, is beneficial in addressing these health concerns. Involving all parties in the discussion increases the likelihood of acceptance of change and is vital in initiating recommended daily screen time limitations, especially prior to bedtime. Evidence supports that in high school students, enforcement of screen time limitations compared to unrestricted screen time improves sleep outcomes in this population.

Faith Dreibelbis BSN, RN, CEN

24th Annual Scholarship Symposium

The Role of Vitamin D Supplementation in Preventing Respiratory Tract Infections: Dosing and Population Considerations Vitamin D supplementation has been identified as having a role in preventing respiratory tract infections (Martineau et al., 2017; Rondanelli et al., 2018). To identify which patient populations might benefit from supplementation, a literature search was completed. Of the 20 articles reviewed, it was determined that individuals with a serum 25 -hydroxyvitamin D [25(OH)D] level less than 30 ng/mL (75 nmol/L) were at increased risk of RTI episodes and severity (Dubnov-Raz et al., 2015). Protective effects of vitamin D supplementation were noted with weekly or daily dosing of vitamin D supplementation versus bolus high-dose supplementation. The protective effects were stronger in patients with baseline 25(OH)D levels less than 10 ng/mL (25nmol/L) (Martineau et al., 2017). Vitamin D supplementation may be a cost-effective way to reduce the incidence and severity of RTIs in populations at risk for VDD when given in daily or weekly doses.

Hannah Erwin BSN, RN

24th Annual Scholarship Symposium

Looking Beyond the Complete Blood Count: Appropriate Ferritin Levels to Diagnose Iron Deficiency without Anemia Micronutrient deficiencies, such as iron deficiency without anemia (IDWA) are a silent global issue, however, the World Health Organization estimates iron deficiency affects more than 73% women and 42% of children worldwide. Adolescent females are a vulnerable patient population due to increased nutritional demands for growth and development, in addition to monthly blood loss via menstruation. Iron deficiency can cause headaches, fatigue, poor memory and attention, palpitations, activity intolerance, and subsequent anemia that can be commonly overlooked or misdiagnosed. The lack of consensus among medical providers in the determination of proper iron stores, is compounded with the arduous task of recognition when there is concomitant chronic disease, inflammatory disorders, and pregnancy. The CINAHL, OVID, and MEDLINE databases were used to obtain high quality evidence related to the clinical question of appropriate use of ferritin in the screening for iron deficiency without anemia beyond a complete blood count in adolescent females. The literature was evaluated using the Johns Hopkins Evidence-Based Practice Appraisal Tool. An extensive review and analysis of the literature was performed to identify best practice and appropriate serum ferritin levels to diagnose iron deficiency without anemia in adolescent females. Early identification can improve patient quality of life, decrease consequences of under recognition and ensure proper treatment.

Gena L. Getz BSN, RN, CCRN, TCRN

24th Annual Scholarship Symposium

Educating the Elderly Population Regarding Risk for Falls and Falls Prevention: Implications for Primary Care Providers In the United States it is estimated that one third of older adults fall annually (CDC). Falls can affect quality of life and may even result in traumatic injuries or death (CDC). Falls tend to be unreported to primary care providers in 50% of older adults who have experienced a fall (CDC). There are many modalities in healthcare to help prevent most falls in the elderly population, but these modalities are not standardized in with primary care providers. Many elderly patients are not aware of interventions to prevent falls. The purpose of this project was to determine best practices in falls prevention education among primary care providers. Primary care providers assess and manage issues that may put patients at risk for falls. The CINAHL, OVID, and SCIENCE DIRECT databases were used to obtain evidence-based research articles pertaining to the question of: In patients over the age of 65 years of age, how does specific falls prevention education by a primary care provider compared to standard of care affect the number of falls experienced by this population? Literature was reviewed using the Johns Hopkins evidence appraisal tool. The literature was evaluated and synthesized to conclude the importance of fall prevention education and resources available to the elderly through their primary care provider. Falls prevention education by primary care providers and including patients in their plan of care regarding fall prevention with each visit reinforces education and creates awareness on causes of falls and interventions available to prevent falls.

Rosa Gingrich BSN, RN

24th Annual Scholarship Symposium

The Importance of Breastfeeding Support in the Workplace Breastfeeding can be a glorious experience for both mother and baby, but it is not one that comes lightly to all. Difficulty latching, milk supply, inverted and/or cracked and bleeding nipples are just some difficulties that can occur. Feeding an infant, whether it be breastfeeding or formula feeding, can be mentally and physically draining. It is just one of the jobs of motherhood and not everyone considers the time, energy, effort required during pregnancy planning and early pregnancy. Successful breastfeeding happens with support, support from inside the immediate circle, the family as well as external support. Returning to work has been associated with shorter breastfeeding duration. Women who return to work often face difficulties continuing breastfeeding. One barrier women face are work environments that are supportive of breastfeeding. Family and social support, available resources, level of education, maternal age, and economic status of the mother and core circle of support play an integral part of the decision and success to breastfeed. In the United States, a working mother and her family receive a maximum of 12 weeks paid leave to navigate these life changes. The CINAHL and MEDLINE databases were used to obtain high quality evidence related to workplace support for continued breastfeeding and lactation. A comprehensive review of literature was conducted using the Johns Hopkins evidence appraisal tool. This review was done to acknowledge factors that affect breastfeeding success rates after mothers return to work. The literature was explored to discover if workplace support, or lack thereof, played a part in the length a working mother breastfeeds her child. The need for continued research is vindicated by the growing number of mother’s returning to work within the first year of childbirth.

Natalie Goss BSN, RN

24th Annual Scholarship Symposium

Interventions to Promote Optimal Quality of Life for Patients with Primary Adrenal Insufficiency: Implications for Primary Care Providers Primary adrenal insufficiency (PAI) occurs when the adrenal glands stop making enough of the hormone cortisol. PAI is a life threatening, but treatable condition caused by adrenal tuberculosis or autoimmune adrenocortical insufficiency. The latter is the most notable cause of PAI in developed countries with a prevalence estimated to be 93-220 per million with female preponderance. Although treatment for PAI has been available for over 65 years, there is still limited data on the etiology, ideal glucocorticoid (GC) replacement, lifestyle adjustments, or dietary effect and adrenal crises (AC) are becoming more prevalent. Approximately 8% of people with Addison’s disease experience an AC every year. Standardized patient and family education regarding disease pathogenesis, medication management, lifestyle management, and AC prevention could be conducted at annual well visits by both family and specialty providers. Repetition is key to help solidify education in order to prevent AC. The physiological pathways are damaged in PAI, requiring parenteral or enteral administration of glucocorticoids to maintain homeostasis during physiological and psychological stress. The pathogenesis of primary adrenal insufficiency requires the patient to become their own provider to prevent AC, however functional impairment may limit their ability to perceive or intervene. The purpose of this capstone project was to review and synthesize literature on best pharmacological and non-pharmacological practices, education, AC prevention, and gaps found that are detrimental to health-related quality of life in patients diagnosed with primary adrenal insufficiency. The clinical question answered through this literature synthesis was: In patients with primary adrenal insufficiency, will combined non-pharmacological and pharmacological therapy improve the health-related quality of life (HRQoL)?

Paula D. P. Grannells BSN, RN

24th Annual Scholarship Symposium

For School Age Children, Does a School Nurse Consult Improve Chronic Absenteeism Versus the Standard Student Attendance Improvement Plan (SAIP) Chronic absenteeism is associated with long term academic and social dysfunctions. The likelihood of dropping out of high school increases with chronic absenteeism and can affect the long- term life expectancy of those that are chronically absent. Chronic absenteeism is seen in over 6 million school age students per year. It is driven by individual, family and school conditions that accentuate the need to have school nurses intervene. Currently, in the State of Pennsylvania, the Student Attendance Improvement Plan (SAIP) is used to understand the barriers to school attendance and advocates to improve these barriers, but the school nurse has not been asked to be part of the attendance team or consulted for students who are chronically absent. The CINHAL, MEDLINE , EDUCATIONAL and SOCIAL WORK databases were used to obtain articles related to the clinical question of how adding a school nurse consult can help to improve chronic absenteeism in school age children compared to the standard SAIP, which does not include a nurse consult. A comprehensive review and synthesis of the literature was conducted to identify the school nurse’s role with chronic absenteeism, as a member of the interdisciplinary SAIP team, and to identify best practice approaches to improve absenteeism in chronically absent students by allowing the school nurse to be consulted as part of the SAIP team. Currently, there is a lack of research that defines a nurse consult as part of the interdisciplinary SAIP team.

Jodi Haberstroh BSN, RN, CSN

24th Annual Scholarship Symposium

Slowing the Progression of Non-alcoholic Fatty Liver Disease: Implications for Family Nurse Practitioners Non-alcoholic fatty liver disease (NAFLD) is a progressive liver disease that affects patients and families. NAFLD affects both the pediatric and adult population. Persons with NAFLD can progress to steatohepatitis, advanced fibrosis, and cirrhosis that may lead to a liver transplant or the disease could progress to liver cancer. There are currently no approved medications for the treatment of NAFLD. The CINAHL, MEDLINE and ScienceDirect databases were used to obtain high quality articles related to the clinical question of, do lifestyle changes and Vitamin E supplementation decrease the progression of advanced liver disease. The literature was evaluated using the Johns Hopkins evidence appraisal tool. A comprehensive review and synthesis of the literature was conducted to identify specific lifestyle strategies and vitamin supplementation that impact the progression of liver disease in patients diagnosed with NAFLD. Research implies lifestyle changes of diet, weight loss, and exercise, decrease the progression of liver disease in patients with NAFLD. In addition, the research indicates that making lifestyle changes, may help to prevent others from developing NAFLD. There was insufficient research available to suggest that Vitamin E supplementation is effective in preventing the progression of liver disease.

Amanda Hess BSN, RN, CCRN

24th Annual Scholarship Symposium

Patients with Congestive Heart Failure and Use of Outpatient Palliative Care: Implications for Primary Care Providers Congestive heart failure (CHF) is a progressive chronic illness that often results in decreased quality of life. After an initial CHF diagnosis, over forty percent of patients are hospitalized at least four times throughout the rest of their lives. By 2030, it is estimated that CHF hospitalizations will cost the United States healthcare system up to seventy-billion dollars per year. Past studies have demonstrated that the implementation of palliative care (PC) reduces hospitalizations for patients with various chronic illnesses. The CINHAHL, MEDLINE, Science Direct, Health Source: Nursing Academic Edition, and PUBMED databases were used to locate scholarly articles to determine if there was a correlation between the utilization of outpatient palliative care (OPC) services and a reduction in hospitalizations and emergency department (ED) visits for the population of patients with CHF. The level of evidence was evaluated by using the Johns Hopkins nursing evidence-based practice evidence level and quality guidelines. A comprehensive review and synthesis of literature was performed to determine if outpatient palliative care services are correlated with decreased hospital utilization for patients with CHF. Some research findings demonstrated a relationship between increased OPC use and decreased hospitalizations. However, other studies did not exhibit a direct correlation between these variables. The heterogeneity of the population, medical practices, and regional cultures presents as a culprit to the cause of mixed results. The overall evidence suggests that primary care providers could expect a decrease in ED utilization and inpatient hospitalizations after integrating early OPC into their practice for patients with CHF.

Jaime Garrett Kehler BSN, RN

24th Annual Scholarship Symposium

Medical Marijuana and Chronic Pain Chronic pain affects over 50 million people per year and is one of the leading reasons that people seek medical care. Medical marijuana is gaining in acceptance by the medical community for the treatment of many conditions, including chronic pain. Historically, the effectiveness of medical marijuana for the treatment of pain was under studied due to the federal prohibition and regulation on marijuana. With medical marijuana gaining legalization in many areas of the country, there had been an increased in the number of authors looking at the efficacy of marijuana in the treatment of chronic pain. The purpose of this literature review was to analyze the available literature to determine if medical marijuana is affective in the treatment of chronic-non cancer pain. The terms medical marijuana, cannabis and chronic pain were used to search for evidence that looked at the effectiveness of medical marijuana in the treatment of chronic-noncancer pain that were published between 2013 and January 2021 from databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed Complete and MedLine. Twelve articles that were literature reviews of over 100 random controlled trials were selected for this review. It was demonstrated that the efficacy of medical marijuana for chronic pain varied, with many researchers finding week or no evidence, while others concluding that medical marijuana was effective. This author concluded that there is not sufficient evidence to conclude that medical marijuana is effective in treatment for chronic pain and that there is a need for further research on this subject.

Robert Kinsey BSN, RN

24th Annual Scholarship Symposium

Opioid Use Disorder and Medication Assisted Treatment in Primary Care Setting Opioids are a group of chemicals, both natural and synthetic, that work in nerve cells and the brain's opioid receptors to block or reduce pain perception (Rosenblum, Marsch, Joseph, & Portenoy, 2008). Opioids have a significant reinforcement effect, defined as a highly addictive drug, thus associated with increased odds for continued use despite harmful and sometimes fatal outcomes such as disability, relapse, and even death. The Center for Disease Control (CDC) reported that in 2017, 70,237 drug overdoses occurred in the United States of America, and 67% of those were opioid related. The American Psychiatric Association Diagnostics and Statistical Manual of Mental Disorders (DSM-5) defines opioid use disorder as a pattern of identified problematic opioid use leading to distress or problems (Fareed, 2014). The medication-assisted treatment intervention methodology uses medication in conjunction with other behavioral, cognitive, and psychosocial measures to provide a holistic approach to care. The CINAHL, OVID, and Medline databases were used to search for quality evidence that addresses the practice question of whether medication-assisted treatment compared to nonmedicinal treatment affects outcomes such as sustained recovery and prevention of future overdose? The quality of the literature was evaluated using the John Hopkins appraisal tool. An extensive review and synthesis of the literature was performed to identify the impact of medication-assisted treatment compared to non-medicinal interventions in adult patients with opioid use disorder in primary care settings. As compared to cognitive behavioral therapy alone, it was concluded that Buprenorphine and Naltrexone have demonstrated ample evidence of efficacy in the treatment of opioid use disorder in primary care settings. Evidence also revealed that these medications are not utilized as often as they should. Recommendation for the primary care provider is included.

Titus Leitoro BSN, RN

24th Annual Scholarship Symposium

Are Patients More Satisfied with Care Provided by a Nurse Practitioner or a Physician in Primary Care? A positive light in the United States over the past decade is that Americans are living longer with chronic health conditions due to primary care access. The availability of healthcare coverage to more than 20 million Americans who were uninsured, or underinsured, was facilitated by the passage of the Affordable Care Act, and is expected to have a positive impact on American health, morbidity, and mortality for future generations. However, the grim reality is that the Association of American Medical Colleges estimates that by the year 2030, the United States will have a deficit of approximately 122,000 physicians actively practicing as healthcare providers. Hence, there is an enhanced need for primary care providers within American communities, and abroad, to prevent, treat, and manage acute and chronic health conditions. Stakeholders who have knowledge of this stark reality have promoted nurse practitioner (NP) full practice authority legislation and sparked interest within communities to employ NP’s to fill this provider gap. Evidence from the CINAHL, OVID, PubMed, and ERIC databases was evaluated to retrieve scholarly articles that supported answering the PICO question are patients receiving care in a primary care setting more satisfied with care provided by a nurse practitioner versus a physician. Often, patients in primary care settings are unfamiliar with the NP role. Hence, this can create barriers to the perception of care. However, patients who are familiar with the NP role in primary care, and have received primary care services from an NP provider, seem to be as satisfied with their care in comparison to the care that has been historically provided by that of a physician. More research is needed to understand the specifics of perceived patient satisfaction with primary care regarding the strengths and weaknesses of NP versus physician providers.

Kristl Molina BSN, RN

24th Annual Scholarship Symposium

Cost Effective Integrative Therapies for Acute Stress Management Daily stress is an occurrence that every person encounters. How an individual exhibits and copes differs for each person. As the world continues to demand more, an individual’s stress burden also increases. With the continued stigma associated with use of anti-depressants, discouragement of prescribing medication such as benzodiazepines, and the shortage of behavioral health services, calls for practitioners working in family practice to incorporate effective strategies to help individuals with acute stress. It is necessary for practitioners to have evidence-based knowledge of alternative therapies that are cost-effective to help off-load the stress burden, increase resilience, and improve quality of life. In this literature review the author examined multiple integrative therapies giving evidence of the effectiveness of these therapies at mitigating the acute stress response and the cost-effectiveness of each. Multiple databases: CINAHL, Science Direct, PubMed, Google Scholar were systematically searched for random controlled trials, quasiexperimental studies, systematic and literature reviews published in peerreviewed journals from 2011-2021. Key words in the English language were stress management, primary care, acute stress, cost-effective, allostasis, allostatic load. Each article was independently evaluated for validity, reliability, and applicability using the John Hopkins Evidence Based Practice Tool. Multiple integrative therapies have been thoroughly researched in a variety of settings providing a body of evidence that these techniques do mitigate the perceived stress response with mixed evidence reducing the physiological acute response to stress and increasing quality of life. Unfortunately, integrative therapies are traditionally expensive and not included in insurance plans. Secondarily, each therapy was evaluated for the cost-effectiveness. Research was limited but promising, providing evidence that mindfulness, music therapy, auricular acupressure and diaphragmatic breathing are cost-effective.

Janine Muir BSN, RN

24th Annual Scholarship Symposium

The Impact of Antibiotic Stewardship Programs on Antimicrobial Resistance in the Outpatient Setting Antimicrobial resistance has caused a large number of infections to become increasingly difficult to treat, as the antibiotics typically prescribed have become less effective. The burden of antibiotic resistance has impacted our healthcare system with increased medical costs, lengthier hospital stays, and higher rates of mortality. As an initiative taken by many healthcare systems, antibiotic stewardship programs were created to improve prescribing practices and patient outcomes. This review was performed to explore the present literature related to improving antimicrobial resistance with the implementation of antibiotic stewardship programs. Specifically, interventions that were effective in the outpatient setting will be addressed. Analysis of these findings suggest that these programs create long term positive effects on reducing antimicrobial resistance.

Caitlin Ness BSN, RN

24th Annual Scholarship Symposium

Influenza Vaccine Impact on Influenza-Related Hospitalization: An Integrative Review In the United States, during the fall and winter seasons, there is a yearly outbreak of a viral upper respiratory tract infection caused by the Influenza virus type A and B. This infection is called Influenza. The CDC estimated that for the 2019 - 2020 Influenza season, there were 38 million Influenza infections in the USA which resulted in 400 thousand hospitalizations and 22 thousand deaths. While the CDC recommends yearly Influenza vaccination as the best way to protect the population from Influenza, vaccine hesitancy remains a major barrier to all vaccinations in the country. In this paper, the author analyzed current information on the impact of Influenza vaccination on rates of Influenza-related hospitalizations. A search was done for related evidence using the CINAHL and Medline databases using the words “Influenza” and “Hospitalization”. The results were limited to peer reviewed English articles published in the last five years. The reference lists were also searched for related articles. Upon initial review, 12 articles were chosen for further analysis. The selected articles were evaluated using the Johns Hopkins Evidence-Based Practice Appraisal Tool. While the effectiveness of Influenza vaccine in preventing hospitalization following Influenza was variable, most evidence suggests a moderate effect.

Afolake A. Ogunfuwa BSN, RN

24th Annual Scholarship Symposium

Diabetic Medication Cost Effect on Diabetic Medication Adherence Diabetic patients have an increased cost burden compared to other chronic illnesses due to the cost of the medications and glucose monitoring supplies. This additional cost burden can lead to cost-related-nonadherence (CRN) causing their diabetes to be less controlled. Poor glucose control in diabetic patients can lead to a lower quality of life and increased overall medical expenses. A literature review was performed evaluating evidence from 2013-2020 that focused on diabetic patients and how outof-pocket medical expenses affected their ability to adhere to their medication regimen. Overall, for individuals with diabetes, their out-of-pocket cost are increased and the level of adherence to their diabetic medication regimen decreased. Further, the ability of a patient to absorb the cost of these out-of-pocket expenses was related to the patient’s income level and ability to pay for their basic needs. Having an upfront conversation about their ability to pay for the medication can help reduce this cost burden, increasing their adherence to their medication.

Gregory Peters BSN, RN

24th Annual Scholarship Symposium

Nurse Practitioner’s Role on Caregivers’ Burden According to the CDC, six out of ten adults in the United States have some form of chronic illness, contributing to the nation’s $3.8 trillion in annual healthcare costs (2021). This number rose from $3.3 trillion in 2019. Moreover, this figure excludes the pediatric population. Many of these chronic illnesses can impact activities of daily living (ADL) for many senior citizens. This could range from meal preparation to support with financial decisions. Although many states continue the ongoing process of researching costeffective ways to assist with elder care, most of the responsibility falls to family members. As the primary caregiver, those families struggle with incorporating the care of their elderly loved one’s into their own daily routines. Those routines may interfere with personal needs and/or employment. This can be physically, emotionally, as well as financially taxing. Caring for an older family member could result in the deterioration of one’s own health, employment status, or family structure. The stress brought upon these caregivers can turn into illnesses. Therefore, as an advanced practice provider, it is important to recognize these factors early on to help alleviate detrimental outcomes for caregivers. The CINAHL database was utilized to attain articles investigating the clinical question of what the Nurse Practitioner’s role is on caregivers’ burden. The articles were then evaluated for quality using the Johns Hopkins evidence appraisal tool. An extensive review and synthesis of the research articles were conducted to understand why and how the Nurse Practitioner can intervene to reduce caregivers’ role strain for those receiving paid or unpaid care services. The evidence supported that NP should participate in the development of public policies, include caregivers in the treatment plan, and recommend more resources for caregivers, but also concluded that more research is needed to specifically compare the burden from paid versus unpaid care to tailor interventions appropriately.

Hang Pham BSN, RN

24th Annual Scholarship Symposium

Literature Review of the Use of Sepsis Screening Parameters in Primary Care Sepsis is estimated to cost the United States (U.S.) health system over $24 billion dollars a year and accounts for 6% of U.S hospitalizations (Schmidt, et al., 2020). Sepsis is a lifethreatening condition that can lead to the development of long -lasting health symptoms such as weakness, hallucinations, weight loss and memory problems, and can also result in death. Unfortunately, there is no standardized tool for the assessment and identification of sepsis risk in the primary care setting. Because of this, patients are at risk for deterioration into sepsis by the time they present to the emergency department. A literature review was completed to identify key parameters in identification of sepsis patients, prior to their admission to the hospital. Fourteen articles were reviewed, and common patient assessment parameters arose, but no single inclusive tool was identified for the outpatient setting. Lack of primary care sepsis identification criteria proposed the need for additional research and the possible creation of a standardized tool that includes vital signs, identification of at-risk health conditions and point of care lab values in the primary care setting. The themes that emerged and proposed outpatient sepsis assessment and identification measures will be further defined and outlined within the paper.

Jocelyn Ramirez Harrell BSN, RN, CPEN

24th Annual Scholarship Symposium

Novel Diagnostic Testing for Lyme Disease Compared to Standard Two-tiered Testing: Are New Diagnostic Technologies on the Horizon? Lyme disease (LD) is caused by the spirochete bacteria Borrelia burgdorferi, and is the most prevalent vector-borne disease in the United States, primarily occurring in the Northeast and upper-Midwestern United States. Climate change has caused spread of LD to non-endemic areas, putting primary care clinicians across North America at the forefront of diagnosis and treatment of LD despite lack of experience managing the disease. Without early treatment, LD can cause neurologic, cardiac, and musculoskeletal symptoms and becomes more difficult to treat. Current diagnostic testing includes an indirect standard two-tier test using enzyme immunoassay with immunoblot or modified two-tier approach using two immunoassays. However, these tests are limited by misinterpretation of results, crossreactivity with other infections, lengthy return times on results, timing of the test in relation to antibody response, and inability to distinguish past from current infection. Recent technological advances have made it possible to improve the modified two-tier algorithm with more robust indirect antibody tests, as well as produce promising direct tests for the presence of the bacteria in blood. This literature synthesis seeks to review available evidence on improved and novel diagnostic tools for LD diagnosis. Upon conclusion, recommendations for primary care providers are included.

Michelle Reed MPH, BSN, RN

24th Annual Scholarship Symposium

Multi-Modal Interventions and Adherence to Treatment for Patients with Heart Failure: Implications for Family Nurse Practitioners Heart failure is a global epidemic that wreaks havoc on nearly 24 million people and resulted in $43.6 billion in costs to Americans in 2020. Often plaguing individuals with multiple co-morbidities, patients with heart failure are commonly prescribed six or more medications along with prescribed lifestyle modifications. Despite continued education and technological and pharmacologic advances, heart failure remains a leading cause of death and disability in the United States. For individuals affected by heart failure, it is not only death that they face as consequence but often many years of deteriorating quality of life, riddled with secondary infections, hospital admissions, and health care expenses. A review of literature was completed to determine the efficacy of adherence to heart failure interventions on hospital readmissions. The EBSCO, PubMed and Science Direct databases were used to obtain high quality articles that would aid in answering the question of whether a combination of pharmacologic and non-pharmacologic adherence interventions are superior to pharmacologic interventions alone in patients with heart failure. The literature was evaluated using the Johns Hopkins Evidence Appraisal Tool. While there is a need for further research regarding efficacy of specific combinations of therapeutic multimodal adherence interventions in heart failure, research indicates that combining pharmacologic and non-pharmacologic interventions improves adherence more than pharmacologic interventions alone.

Terianne N. Rineer BSN, RN, CEN, TCRN, CPEN

24th Annual Scholarship Symposium

Chronic Non-Cancer Pain Management Through Multidisciplinary Treatment Plans Chronic, non-cancer pain (CNCP) can be addressed with numerous pharmacological, nonpharmacological, and alternative interventions, which has proven difficult to manage effectively. Creating a safe, effective, and lasting pain relief to those patients on a regular basis is challenging, as no one method of treatment can be singularly effective. A literature synthesis was conducted after exploring the CINAHL and Google Scholar databases for current evidence-based practice recommendations for safe, satisfactory, and best outcomes of CNCP relief therapies. It was discovered that as pain is often individualized due to physical, mental, or emotional variances, pain relief therapies have not been streamlined into one clear guideline. Primary care providers often see between 20% to one-third of their patient population for chronic pain (Coffey et al., 2015; Kallman & Backryd, 2020). The evidence was further investigated to determine if referral to a pain management specialist versus primary care management affects outcomes or patient satisfaction. The literature again reinforced the individualized pain symptoms one might experience and the need for a multimodal, multidisciplinary, and multiple provider team which has shown to improve outcomes and patient satisfaction. Working with multidisciplinary teams has also been demonstrated as having positive effects for patients experiencing CNCP. Examples of multimodal and multidisciplinary therapies have been presented in this literature synthesis for the use of the family nurse practitioners in CNCP management. Research is limited and further exploration to identify how generalizable and realistic multimodal pain therapy would be to the population at large.

Justin Rogers BSN, RN

24th Annual Scholarship Symposium

Prescribing Aspirin as Primary Prevention in Cardiovascular Heart Disease for Patients with Diabetes In modern day medicine, recommendations and guidelines for managing certain diseases are all established through research that has been gathered and analyzed. As new evidence is collected and synthesized, recommendations and guidelines may change to reflect the latest literature. This is widely recognized as evidence-based practice. Cardiovascular heart disease is one such condition in which the recommendations for treatment have evolved in recent years. While the guidelines supporting the usage of aspirin for secondary prevention of cardiovascular heart disease have remained steadfast, the same cannot be said regarding the usage of aspirin for primary prevention. Due to the antiplatelet effects of aspirin and the increased risk for bleeding, there has been controversy over whether the benefits of low dose aspirin outweigh the risks. This is especially important to consider for patient populations who are at an increased risk for developing cardiovascular heart disease. The purpose of this capstone project was to review and evaluate both past and current research to determine if providers should prescribe low dose aspirin for the primary prevention of cardiovascular heart disease for patients who have been diagnosed with diabetes.

Rebecca Schaeffer BSN, RN, CMSRN

24th Annual Scholarship Symposium

Deprescribing Benzodiazepines in Elderly, Importance of Patient-Provider Collaboration Polypharmacy and inappropriate medication use among the geriatric population is of great concern. Long-term use of benzodiazepines in elderly population can cause dependence, cognitive impairment, and psycho motor issues which may lead to an increased risk for falls, delirium and, a poor quality of life. Deprescribing is the process of supervised withdrawal of potentially inappropriate medications to decrease adverse effects; a process that is best conducted with clear healthcare provider communication and patient input. Deprescribing of inappropriate medications assist towards reducing polypharmacy and improving quality of life in elderly. The CINAHL and MEDLINE databases were searched to obtain evidence pertaining to the topic of deprescribing in elderly. A comprehensive literature review and synthesis of 15 articles were conducted to evaluate the effects of patient-provider collaboration in deprescribing benzodiazepines in elderly. The John Hopkins Nursing Evidence-Based Practice Appraisal Tool was used to assess the quality and strength of each article. Lack of patient and care giver involvement, lack of standardized teaching tools, and coordination of care were noted as barriers of effective deprescribing. Elderly patients and their care givers might be more agreeable to deprescribing if they understand the adverse effects of prolonged benzodiazepine use. Regular review of medications and shared decision-making may improve adherence and health outcomes in the elderly. Patient education and patient -provider collaboration are effective ways to deprescribe benzodiazepines in elderly patients. Further research is needed to review and develop patient educational tools and standardized clinical practice guidelines for health care providers to assist in deprescribing benzodiazepines in geriatric patients.

Sonia B Sebastian BSN, RN-BC

24th Annual Scholarship Symposium

Heart Disease Prevention in the Fire Service Sudden cardiac death consists of approximately 45% of firefighter lineof-duty deaths according to the Centers for Disease Control (2018). In 2020, the United States Fire Administration reported a total of 96 firefighter deaths. Thirty-five of those deaths were due to COVID-19, 11 deaths were directly related to structural fireground operations or inside a burning structure. The remaining 50 deaths were related to heart attack, cardiac arrest, and stroke (Firefighter Nation Content Directors, 2021). The goal of this literature review was to analyze the causes for the increased risk for cardiovascular disease in the fire service and make recommendations based on this data. Research was obtained by searching the Cumulative Index to Nursing and Allied Health Literature (CINHAL), EBSCO and Medline databases by using the keywords cardiovascular disease, obesity, smoking, mental health, post-traumatic stress disorder (PTSD), firefighters, sudden cardiac death, heart disease, and prevention. A total of 28 articles were included in this literature synthesis. Some causes for the increased cardiovascular disease risk include obesity, hypertension, hyperlipidemia, lack of a nutritional environment, interrupted sleep, lack of physical activity, exposures to toxins, and the nature of the line of work. Many recommendations have been made and include mandatory annual medical screenings, implementing wellness and fitness initiatives, banning smoking, and enacting obesity standards. Evidence revealed a strong recommendation that healthcare providers be knowledgeable about the physiological strain of firefighting and be aggressive when evaluating and treating cardiovascular disease and its risk factors.

Emily Serikstad BSN, RN, CCRN

24th Annual Scholarship Symposium

Advising Patients Who Desire to Pursue Dietary Changes to Control their Blood Pressure and Cholesterol Levels: A Literature Synthesis Despite the multitude of advancements that have emerged within the American healthcare system in recent decades, one outcome has remained unchanged: Heart disease continues to be the chief cause of death among United States citizens (Centers for Disease Control and Prevention, 2021). Many of the most common health comorbidities seen in practice today such as hypertension, hyperlipidemia, diabetes mellitus, and obesity, have a cascade-like effect on the development of heart disease if they are not properly managed (Mayo Foundation for Medical Education and Research, 2021). Knowing this, adequately controlling these components of health is crucial, and healthcare providers recommend lifestyle modifications as the first approach that should be instituted. Particularly, making health-conscious dietary changes has been promoted, as it is implicated in lowering both blood pressure and serum cholesterol levels; however, it is unclear to what extent dietary changes alone can affect these risk factors. The following literature synthesis examines nineteen quantitative studies that examine the impact that select dietary modifications have upon blood pressure and serum cholesterol levels. The quality of each study was reviewed using the Johns Hopkins appraisal tool and overall considerations are discussed. Findings included that the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and plant-based diets all yielded a statistically significant decrease in blood pressure, with the DASH diet having the most extreme reduction in blood pressure. Additionally, cholesterol levels were decreased in these diets, however, the most significant reduction in total cholesterol levels were observed in vegetarian diets with the addition of fiber, soy, and nuts.

Rebekah Shue BSN, RN, CVRN, CCRN

24th Annual Scholarship Symposium

Family Caregivers of Those Affected by Opioid Dependency: Support and Recovery Resources for the Family Nurse Practitioner An emerging crisis born out of the opioid epidemic is the destabilization of families who have a member with substance use disorder (SUD). The emotional toll that SUD has on the individual and the family unit is substantial. Stress, marital problems, stigma and social isolation, domestic violence, and financial strain are just a few of the consequences (Sapp & Hooten, 2019). In addition, without support and engagement from primary care providers, family members, they are at higher risk for developing chronic medical and psychiatric health conditions (Ellis et al., 2020). A literature synthesis was completed reviewing 36 articles from EBSCOhost, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline databases, and the Cochrane Database and Systematic Reviews, in order to examine current evidence addressing the family caregiver of an opioid addicted person. The literature revealed that family nurse practitioners can create individualized care plans that utilize a variety of best practices including cognitive behavioral therapy, SUD education, familiarization with social support groups, recognizing codependency, and teaching healthy coping skills (McCann & Lubman, 2018). The family nurse practitioner (FNP) is an underutilized tool in the opioid crisis and as such, resources for the FNP that promote the support and recovery for families are valuable for best outcomes of the family caregiver. Those affected with SUD have a better chance at sustained recovery in a stable, healthy environment, through multidisciplinary and individualized care plans.

Michaella Silknetter BSN, RN

24th Annual Scholarship Symposium

Extended Length of Stay in the ED Increases Mortality Rates Emergency Departments across the globe are facing an urgent crisis. With the introduction of the novel coronavirus, SARS-CoV-2 the already stressed emergency department faces even more hurdles. This review was taken to determine processes that can be put into place in order to ensure best possible patient outcomes for all patients presenting to the Emergency department for care. This review was done to explore existing body of literature relating to timely care in the emergency department. It is known that patients who present with multiple comorbidities possess the potential for worse prognosis. With the increase in demand for critical care beds for those presenting with COVID-19 it could potentially lead to shortages of resources for those with multiple comorbidities in need of critical care as well.

Mary Kay Stauffer BSN,RN,TCRN

24th Annual Scholarship Symposium

The Impact of Graduate Nurse Residency Programs on Staff Retention: Implications and Recommendations for Nurse Educators and Future Hospital Programs The nursing workforce is constantly changing. Hiring and training newly licensed registered nurses (NLRNs) requires valuable time and resources. Many new nurses leave the institution within a year of hire, and the turnover of nurses leads to understaffing, frustration among the existing nurses, and financial burden on the institution. The nursing workforce is aging, and a shortage of registered nurses is predicted. Hospital leaders have recognized the depth of this problem. In an effort to alleviate the burden of NLRN turnover and standardize and ease the transition for the novice nurses, many hospitals have designed and implemented nurse residency programs (NRPs) as a part of the new hire onboarding process. The CINAHL, MEDLINE, ScienceDirect and Health Source: Nursing/ Academic Edition databases were used to obtain high quality articles related to the question of whether hospitals that utilize a NRP have a higher nurse retention rate compared to hospitals that do not have a NRP. Article quality was determined using Johns Hopkins evidence appraisal tool. A literature review and synthesis were conducted to identify the effect of a NRP on nurse retention. Nurse retention is one way to measure the effectiveness of a NRP. Retention rates are used as a surrogate measure for job satisfaction. Research indicates that the one-year turnover rate for graduates of a NRP is lower than those hospitals that do not have a NRP, but more research is needed to evaluate the long-term effects of NRPs on nurse retention rates.

Melanie Stoltzfus BSN, RN

24th Annual Scholarship Symposium

Patient Satisfaction with Telemedicine Services versus In-Office Visits Telemedicine platforms, including the ability to have a healthcare provider consult visits over computers, tablets or smartphones, may have been previously underutilized. However, now telemedicine is changing the trajectory of healthcare availability. As technology has evolved, telemedicine has grown in its capability to expand telehealth throughout the world. Telehealth services allow for flexibility, convenience and decreased cost for patients. The “aim” of this literature synthesis was to examine factors that influence patients’ satisfaction with telehealth services compared to in office visits, face to face visits, and the implication this has for primary care providers. A systematic search was done using CINAHL and Medline to obtain articles related to the clinical question of how satisfied are adult patients with telemedicine visits versus in-office visits before and after COVID19 pandemic of 2020. The literature was evaluated by using the Johns Hopkins evidence appraisal tool. Convenience, access to technology, cost, travel time, outcomes, relationships with the care provider, age, and ease of technology use were among factors that influenced patient satisfaction. Recently, the COVID-19 pandemic quickly forced medical providers and patients to quickly learn and utilize telemedicine. The pandemic created a huge public health issue and patients were forced to try telemedicine options to access their healthcare. Overall, findings suggest that despite telemedicine being quickly forced upon patients, patients continue to be equally if not more satisfied with telemedicine before and after the COVID19 pandemic. As healthcare providers move forward with telemedicine visits, it will be important to understand patients’ and providers’ satisfaction, knowledge and ability to access telecommunication technology all while continuing to improve patient outcomes.

Cindy Stovall BSN, RN

24th Annual Scholarship Symposium

Use of a Continuous Glucose Monitor and its Impact on Hypoglycemia, Morbidity and Mortality on the Adult Diabetic Patient Diabetes is a serious chronic illness that is diagnosed in both primary care and specialty practices far too frequently. Achieving the best glycemic control is the desired goal for both providers and patients due to the optimization of health and the prevention of long-term consequences, worsening health status, or death. Self-care and self-management has proven to be a large part of diabetes treatment and lifestyle. Hemoglobin A1c (HbA1c) has been the gold standard to evaluate glycemic control. To achieve a desired lower HbA1c, hypoglycemia is often a condition that diabetic patients have to combat, which can be life threatening. In recent years, data has shown that other values such as glucose variability and time (with blood glucose) in a certain range are also very critical indicators of glycemic control. A continuous glucose monitor (CGM) is a tool that diabetic insulin dependent patients are able to utilize to assist with self-managing their disease. A CGM is able to display both blood glucose variability and also time in range. The aim of this literature synthesis is to examine if the use of a CGM can decrease the risks of hypoglycemia, morbidity and mortality in insulin-dependent diabetic patients. CINAHL, MEDLINE and SCIENCE DIRECT databases were utilized to procure articles of high quality to explore this clinical aspect of care. The John Hopkins evidence appraisal tool was used to evaluate the literature, and a thorough review and analysis was performed to distinguish if and how the use of a CGM can decrease complications, morbidity and mortality in the life of these patients. The results of the searches and appraisals revealed high levels of evidence supporting the use of a CGM and its impact upon complications, consequences of hyperglycemia and mortality. CGM use is often managed by specialty endocrinology offices, however, primary care providers can order and manage CGM for their diabetic patients. Basic CGM care recommendations are provided.

Danielle Sweigart BSN, RN

24th Annual Scholarship Symposium

Physical Activity as an Intervention to Prevent Dementia: Implications for Family Nurse Practitioners Dementia affects millions of people worldwide. In the United States, approximately one out of every six women and one out of every ten men, living past the age of 55 will develop dementia. It has become one of the main causes of disability and dependency in the elderly population. Given the high prevalence of dementia and its burden for patients as well as their caregivers and the community, it is important to investigate methods to decrease the risk of dementia. Current evidence supports positive effects of physical activity on many aspects of life. Practitioners recommend physical activity to manage many chronic conditions. The literature suggests physical activity may offer benefits for preventing dementia as well. This capstone project analyzed and synthesized current evidence to determine the relationship between regular physical therapy and the risk of developing dementia with aging. Clinical implications for Family Nurse Practitioners and suggestions for future studies are also provided.

Hanh Vu BSN, RN

24th Annual Scholarship Symposium

Rural Access to Mental Health Services via Telemedicine: The Role of the Family Nurse Practitioner Mental health issues are a growing burden to the overall healthcare economy. It is estimated that nearly 1 in 5 adults suffers from a mental illness, yet only one-third of individuals with a mental health condition actually seek treatment (Balestra, 2019). More significantly impacted are those individuals who live in rural communities. Rural residents suffer significant health disparities, lower life expectancies and are more likely to die from drugs, alcohol or suicide (Myers, 2019). Primary care serves as an important entry point for rural residents to access healthcare services, including those for mental health. Telemedicine, which has seen a significant increase in utilization and adoption due to the COVID-19 pandemic, has the potential to address mental healthcare delivery gaps and health status inequalities. The CINAHL, PUBMED, MEDLINE and GOOGLE SCHOLAR databases were queried to obtain high quality articles related to the question, how telemedicine can aid family nurse practitioners (FNPs) in improving access for rural communities to mental health services. The literature was evaluated using the Johns Hopkins evidence appraisal tool. A comprehensive review and synthesis of the literature was conducted to identify the role telemedicine can play in remediating rural mental health disparities. Family nurse practitioners are uniquely positioned to play a central role in delivering and coordinating mental health care for rural-dwelling people. FNPs may be the only healthcare provider available for patients within a rural community and within the family practice setting FNPs are often the first to treat patients with common mental illnesses, such as depression and anxiety. Telemedicine allows FNPs to expand access to services, deliver more effective care management, and foster the integration of primary and mental health services which eliminates the artificial separation of mind and body.

Heather J. Wagaman BSN, RN

24th Annual Scholarship Symposium

The Contributory Factors to Hearing Loss in Adult Workers Globally hundreds of millions of people are affected by hearing loss. Nationally, tens of millions of Americans suffer from hearing loss, and prevalence is increasing. With the world's aging population, the number of adults over age 65 with disabling hearing loss is expected to climb to 500 million people by 2050. Hearing loss is more than what is sometimes thought of as an expectation of aging and a nuisance. Hearing plays a critical role in maintaining social interactions, cognition, and quality of life. Researchers have found that those affected by hearing loss are more likely to suffer from anxiety, depression, and overall lower quality of life than persons without hearing loss. The purpose of this paper is to systematically review the literature to investigate the various contributing factors to hearing loss in adult workers with the intent to improve awareness and promote interventions to improve workers' quality of life. A comprehensive search using the CINHAL database was conducted to find relevant articles primarily published after 2016. Inclusion criteria encompassed noise-induced hearing loss, occupational noise-induced hearing loss, sensorineural hearing loss, hearing loss disease factors, and smoking effects on occupational hearing loss. One thousand three hundred fifty full-text articles or abstracts written in English were reviewed for relevance. A total of seventeen articles were selected for inclusion in this paper based on their research design, publication date, and relevance to the inclusion criteria. Analysis of the research indicates numerous modifiable and non-modifiable occupational and non-occupational factors contribute to hearing loss in adult workers.

Christina Marie Wirth BSN, RN, COHN, COHC

24th Annual Scholarship Symposium

The Utilization of Online Support Resources for Families of Children with Chronic Illnesses: Implications for Primary Care Providers Caregiver empowerment is a key component of the nursing paradigm and central to providing holistic care and is a means of improving patient and family health and wellbeing. Caregivers represent a diverse array of individuals and include parents, family members, friends, and other relatives. A major barrier to caregivers achieving empowerment is stress and anxiety brought on by the caregiver role itself. Becoming a parent is one of the most exciting stages in an individual’s life, but many parents also simultaneously become caregivers when their children develop chronic illnesses early in life. Technology permeates all facets of society but is still underutilized in the realm of caregiver resources. The CINAHL and MEDLINE databases were used to obtain high quality articles related to the clinical question of what is the effect of telehealth and online support groups on caregiver emotional wellbeing in families of children with chronic illnesses. The literature that was chosen was evaluated using the Johns Hopkins evidence appraisal tool. A complete review and synthesis of the literature was conducted to identify what forms of online support were most effective on improving the wellbeing of caregivers in families of children with chronic illnesses. Caregivers identified not having access to internet services and feeling unsure how to utilize online resources provided to them as barriers for not widely utilizing telehealth within this population. Primary care providers are in a unique role to be able to educate caregivers on online resources available to them and to bring awareness to their value.

Laura Yiengst BSN, RN, CCRN, TCRN

24th Annual Scholarship Symposium

Portable Ultrasound in Primary Care: Implementing Scientific Teaching Methods Identified for a Successful Training Program The increased presence of portable ultrasound in many medical specialty areas is used to augment the physical exam and is now gaining popularity in primary care. Medical ultrasound education is slowly being integrated into medical schools around the globe. What is not well known is the scientific evidence supporting how competent portable ultrasound education can be implemented for advanced healthcare providers. The purpose of this capstone project was to determine what methods of instruction are most effective for healthcare providers in gaining cognitive and psychomotor competency in the use of portable ultrasound in rural outpatient settings. The CINAHL, ScienceDirect, PubMed, and MEDLINE data bases were searched for high quality articles which were then evaluated using the Johns Hopkins evidence appraisal tool. Nineteen articles were identified, reviewed, and synthesized for common emerging themes. The resulting themes included Elearning, didactics, simulation, hands-on clinical setting, feedback, and competency-based testing. Incorporating these themes into a robust portable ultrasound training program are paramount to competent medical providers utilizing portable ultrasound at the bedside. As this technology advances with telemedicine, future randomized control studies are required for the standardization of portable ultrasound training programs and how this tool may be used to support increased patient outcomes. The implications of this project relate to how these six pillars are incorporated into an educational US program. It is up to the educators to use the science in the development of their respective US programs. Educators should develop US programs tailored for the students by integrating effective teaching strategies discussed in this capstone project that support all six pillars.

David Zook BSN, RN

Faculty KELLY A. KUHNS, PHD, RN, CNE PROFESSOR DEPARTMENT CHAIR TERESA HARTMANN, PHD, RN ASSISTANT PROFESSOR JENNY MONN, DNP, FNP-BC ASSISTANT PROFESSOR DAWN LAMBERT, PHD, RN ASSISTANT PROFESSOR

70 DNP, CRNP CAYLEIGH MINTER, ASSISTANT PROFESSOR & GRADUATE PROGRAM COORDINATOR SUSAN MOYER, PHD, RN, CNE ASSISTANT PROFESSOR LINDA LEE, DNP, MS, NP-C ASSISTANT PROFESSOR MICHELE CHRONISTER, DNP, FNP-BC, IBCLC ASSISTANT PROFESSOR TRACEE MATINCHECK, MSN, FNP-BC INSTRUCTOR

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