Doctor of Nursing Practice Students

DOCTOR OF NURSING PRACTICE COHORT IV PROJECTS

25th Annual Scholarship Symposium

Interdisciplinary Collaboration in Addressing the Needs of Students Diagnosed with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is an autoimmune disorder associated with a sudden onset of OCD and/or tics and frequently diagnosed between the ages of 3 and puberty. This sudden onset of OCD and/or tics can lead to unwanted behaviors in school. Interdisciplinary collaboration between the school nurse, school counselors, psychologists, and principals are important to increasing referrals to the school nurse which can assist in further identification of the behaviors, referral to outside healthcare providers, and contributes to improved school outcomes. The primary purpose of this project was to provide education on PANDAS leading to an increase in referrals of students to the school nurse. A self-directed online educational intervention was employed for all district-wide school nurses, counselors, principals, and psychologists. A pretestposttest design was utilized to assess knowledge related to PANDAS before, immediately after, and six-weeks after the educational intervention. A referral log was also implemented to track the number of referrals to the school nurse from school counselors, principals, and psychologists for behaviors consistent with PANDAS. Final sample size included 19 participants. A paired t test showed a statistically significant gain in pretest to posttest scores suggesting the education intervention was effective. In addition, initiation of a referral process led to an increase in school nurse referrals, supporting the value of school nursing and interdisciplinary collaboration.

Tiffany M. Boyd

MSN, BS, RN, CSN

25th Annual Scholarship Symposium

Motivational Interviewing to Increase Adherence of Therapies for Improved Management and Outcomes Among Patients with Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is a complicated disease process that impacts millions of Americans yearly. Type 2 diabetes mellitus can cause severe, even fatal complications, including renal disease and failure, cardiac complications, neuropathy, and retinopathy. These complications reduce the quality of life and ultimately can result in death. Type 2 diabetes mellitus requires patient self-management to maintain glycemic control through diet, glucose monitoring, and medication regimes

Method: A multimodal education program using the Diabetes Assessment form, educational materials, and motivational interviewing was provided to patients with a hemoglobin A1c greater than 7.0 by team members. The healthcare members were a healthcare providers (MD/CRNP’s), licensed practical nurse, and medical secretary. Diabetes Assessment Form and hemoglobin A1c was completed pre-intervention and post-intervention. Motivational interview conversations were completed via telemed two and four weeks after consent was obtained. Eight of nine patients completed the project.

Results: Initial hemoglobin A1c ranged between 7.4 and 13.2. (SD 2.702). Overall, there was no statistically significant difference in hemoglobin A1c following the MI interventions. However, five patients (55%) did show a decrease of the hemoglobin A1c. Four of the eight patients demonstrated a clinically significant decrease in hemoglobin A1c (decrease of greater than 0.5%). Further, of those patients whose hemoglobin A1c, none increased by greater than 0.3%. Medication adherence has been found to be a consistent challenge for patients with diabetes. Data collected on the DAF preintervention demonstrated that 55% (n=4) were taking their mediations daily as instructed, 33 % (n=3) were medicating most of the time and one patient took their medication sometimes.

Sustainability: Utilizing the DAF could be a cost effective, quality-based care initiative that will continue to optimize health as evidenced by outcomes and patient experience. Motivational interview is a valuable tool that could allow for improved communication between providers, nursing, and patients. Conversations between all parties can influence efficient, cost-effective changes in challenging situations, Further, quality care measures will continually be connected to pay out from CMS and utilizing the DAF will continue to support the quality initiatives suggested by CMS.

Conclusion: Motivational interviewing can be utilized by various health professionals and can be delivered within a short time. Improvement of health management in short-term intervals is a feasible goal; however, short-term variables are unreliable. Long-term implementation commitment would be a key element to success within the quality improvement study. Motivational interviewing can also decrease the cost of care long-term for the insurance companies and patients by reducing hospital stays, diminishing the need for multiple medications, and lost wages due to multiple appointments necessary to manage the disease. Education with MI in chronic disease management can forward healthcare into a positive intervention for all involved in the healthcare system.

Michelle Lee Corle

MSN, CRNP

25th Annual Scholarship Symposium

Integrating Evidence Based Screening, Brief Intervention, and Referral to Treatment (SBIRT) into a FNP Program

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a care model used to identify substance misuse, reduce use, and assist patients in getting the proper treatment. SBIRT has been extensively researched and shown to reduce dangerous use of alcohol and drugs, as well as creates a bridge between the general medical setting and specialized treatment centers. SBIRT began in the primary care setting and has been used to screen patients for risky substance use, provide a BI and refer patients to the ap- propriate treatment. Any point of contact with a healthcare professional trained in SBIRT could be used as an opportunity to get a patient into treatment. My evidence-based practice (EBP) project integrated SBIRT into the curriculum of a graduate level Family Nurse Practitioner (FNP) program in south-eastern PA via the D2L/Bright space online environment, to increase the students’ knowledge of Substance Use Disorders (SUD) and their treatment and increase their motivation to work with patients with SUD. A pre-and post-test design was used to compare the mean (paired t-test) scores of the Shortened Version of Alcohol and Alcohol Problems Perception Questionnaire (the SAAPPQ), Drug and Drug Problems Perception Questionnaire (DDPPQ) and a tenquestion knowledge test before and after the students completed the online education (n=67). All results were statistically significant. The education improved role adequacy, task self-esteem, motivation, role legitimacy, and satisfaction of FNPs when working with patients who abuse alcohol. Role adequacy, role legitimacy, role support, task specific self-esteem and job satisfaction were also increased in FNPs when working with patients who abuse drugs. There was also a statistically significant increase in knowledge following the education.

Kelly Anna Fetterhoff

MSN, CRNP, PHMNP-BC, CARN-AP

25th Annual Scholarship Symposium

Utilizing Prenatal Education and the Edinburgh Postnatal Depression Scale to Improve the Detection of Depression Among Men in the Postpartum Period

Background: Transitioning into the role of the parent can be very stressful for both mother and father. In the past, maternal postpartum depression (MPPD) has received a lot of attention. Paternal postpartum depression (PPPD), in contrast, has been underreported, underrecognized, underdiagnosed, and undertreated and it is essential to acknowledge the potential risk for this depression. Because of the effect postpartum depression, whether it be maternal or paternal, can have on the father, mother, child, and family, healthcare providers need to assess both the mother and the father for postpartum depression.

Purpose: The utilization of a prenatal multimodal educational initiative concerning PPPD presented an opportunity to introduce the importance of assessment, detection, recognition, and treatment of this depression to parents and healthcare providers. Further, the Edinburgh Postnatal Depression Scale (EPDS), was utilized to screen and identify at-risk fathers. Early risk assessment and identification of PPPD allows fathers to receive treatment for their depression, which improves outcomes for the entire family and reduce healthcare costs.

Method: A multimodal education program using discourse, flyers, and posters was provided to 17 fathers between 32 weeks and 36 weeks of gestation, and paternal contact information was gathered by team members. Three months postpartum, a questionnaire was sent using Qualtrics to the participating fathers through their preferred contact method. A sample of fathers (n=5) responded to the questionnaire including the completion of the EPDS and other demographic information. A score of 10 or greater was considered indicative of PPPD. The questionnaire was available in English and Spanish.

Results: One of the five participants scored greater than 10, all fathers reported that receiving education enabled them to detect PPPD within them if present, and four out of five participants reported that the verbal presentation was the most effective and receptive mode of education. Cronbach’s alpha coefficient revealed that the results were reliable at .737.

Sustainability/Conclusion: Developing and adopting guidelines for screening men during the postpartum period is vitally important. To successfully educate and screen men, it is imperative for healthcare providers and members of the obstetric team to educate themselves about PPPD. Understanding signs and symptoms of this depression provides the opportunity for earlier detection and treatment implementation, which decreases adverse outcomes for fathers, mothers, and children. Creating an inclusive environment allows fathers to become more involved in the perinatal process, improves the family dynamics, and improves paternal outcomes. Future projects can include same sex partnerships or marriages, adoptive parents, and foster families.

Taasha Guillemette

MSN, CRNP

25th Annual Scholarship Symposium

Implementation of an Educational Program and School Nurse Procedure to Address Adolescent Vaping

Problem: Although traditional tobacco use among adolescents is declining across the United States (US), the popularity of electronic cigarette (ecigarette) use is rising, posing a health risk to American youth. Public schools across the nation offer education on e-cigarette use in health classes, but adolescents continue to experiment with e-cigarettes.

Purpose: The purpose of this Doctor of Nursing (DNP) project was to increase school nurses’ knowledge about e-cigarette use and resulting adverse health effects and to create a district-level nursing procedure for screening adolescents for nicotine addiction and making subsequent referral to appropriate resources.

Methods: The quality improvement project was developed to educate and initiate a change in practice by the implementation of a nursing procedure to screen adolescents for possible nicotine addiction and make subsequent referral to appropriate resources. The participants completed a pre-test prior to attending an educational presentation about adolescent e-cigarette use and a review of the nursing procedure to follow when adolescents were suspected of vaping. After the presentation, participants completed a post-test and a six week follow up test.

Results: The educational presentation increased school nurses’ knowledge about adolescent e-cigarette use. School nurses also indicated a change in nursing practice through the implementation of a new nursing procedure for screening adolescents for nicotine addiction and making subsequent referral to appropriate resources.

Implications: This DNP scholarly project confirmed the need for school nurses to receive professional development education regarding e-cigarette use. Education on a variety of health-related topics may be beneficial for school nurses. Additionally, it identifies that up-to-date policies, including a policy on adolescent vaping, can result in positive practice changes.

Alicia Shelkin

MSN, AGPCNP

25th Annual Scholarship Symposium

Dietary Self-Monitoring for Weight Loss in Adults with Obesity

Obesity is a global health problem that leads to a myriad of poor health consequences when untreated. Dietary selfmonitoring is an evidence-based behavioral technique that can be used as part of a behavioral change strategy to elicit weight loss in adults who are obese (BMI of 30 or greater). Frequency and consistency of dietary tracking as well as adherence to dietary self-monitoring is associated with successful weight loss and weight maintenance. Therefore, this project was designed to translate this evidence into practice in a primary care setting in Eastern Pennsylvania.

Heather E. Shuker

MSN, CRNP

DOCTOR OF NURSING PRACTICE COHORT V PROJECTS

25th Annual Scholarship Symposium

Improving Knowledge Retention Post-Stroke

Retaining stroke education after discharge is pertinent for recovery and gives patients insight of their risk factors, how to control their risk factors and how to recognize stroke symptoms to activate emergency medical systems should stroke symptoms occur, and therefore prevent strokes in the future. Studies that assessed knowledge retention among stroke patients revealed that stroke knowledge either did not improve or is not retained after hospital discharge despite education provided in the hospital and education provided post discharge (Kitzman, Hudson, Sylvia, Feltner, & Lovins, 2018, Olaiya et al. 2017). The purpose of this project is to implement a standardized approach to stroke patient education in the outpatient Advance Practice Nurse (APN) stroke clinic. The goal is to ensure stroke patients receive and retain stroke education tailored to their specific risk factors and how to activate emergency service should they have stroke symptoms.

Naomi Acheampong

CRNP

25th Annual Scholarship Symposium

Impact of Improved Parental Coping and Success with Pediatric Constipation Treatment

Constipation is a common childhood health issue and accounts for multiple primary care and specialty care visits. Extensive research has been conducted assessing pharmacological and non-pharmacological interventions. Medications have been found to be effective treatment. Despite this knowledge being used to formulate treatment plans, children continue to be symptomatic.

An identified barrier to successful treatment is parental coping. Research shows that constipation treatment can be challenging for parents which can decrease compliance with the treatment regimen. The focus of this project will be to assess parental coping using a validated and reliable tool and then provide an education intervention. The goals will be to decrease parental stress and improve coping with chronic illness. Success will be measured by parental report of treatment satisfaction.

Lisa Ingalls

MSN, CRNP

25th Annual Scholarship Symposium

Adverse Childhood Trauma (ACES), Secondary Trauma, and Suicide Prevention

Military service members have increased reported rates of adverse childhood events, particularly in women (Katon et al., 2015). Harris (2018) describes the correlation between adverse childhood events (ACES) and toxic stress and its negative health effects throughout adulthood. Increased ACE scores put military service members at a higher risk for suicide, Novotney (2020) reports 17 service members die by suicide daily, a higher rate than civilians. High ACES scores can be used to identify individuals at risk for poor mental health outcomes. Secondary traumatic stress disorder (STS) also compounds post-traumatic stress disorder (PTSD) in service members and health care workers exposed to multiple traumatic experiences. Those affected by STS and PTSD can experience changes in personality, work performance, and maladaptive thinking (Coetzee & Klopper, 2010). Exposure to trauma, death, personal safety, and ethical dilemmas are impacting military health care professionals in their civilian life and work life (Chargulaf et al., 2019). Chargulaf et al. (2019) Researched the effects of military nurse’s role of duality to provide compassionate care to the injured and need to accomplish the military mission creates an internal conflict and can create distrust and emotional impacts at the end of deployments. Burn out (BO) and compassion fatigue (CF) also are reported among a cross sectional study of 344 military deployed medical providers with 30% reporting symptoms, resulting in disengagement and feelings of distress (Chargulaf et al., 2019).

Resiliency strategies can be implemented to decrease poor health outcomes and suicide. The importance of resiliency and ability to process, discuss and connect with peers is key. By providing ACE’s surveys to medical service members, leadership can identify the population with highest scores and provide critical support to those who are at risk and exposed to STSD.

Diane Klescewski

BSN, MSNE

25th Annual Scholarship Symposium

Integrating Psychosocial Interventions in Office-Based Opioid Treatment Programs

The prevalence of opioid use disorder (OUD) in the United States is at a record high and continues to rise sharply. In the period ending April 2021, there was an estimated 100,306 drug overdose deaths in the United States. This was a 28.5% increase from the previous year. This increase in opioid-related overdoses has led to the expansion of office-based opioid treatment (OBOT) which has significantly improved access to safe and effective opioid dependence therapy in primary care offices. In addition to medication management, the American Society of Addiction Medicine (ASAM) recommends psychosocial interventions which have always been the standard of care in opiate treatment programs (OTP). There is limited literature on recommendations for specific psychosocial interventions in OBOT programs. There is therefore a need to gain a better understanding of the psychosocial interventions needed. This review will look at the retention rates of patient with a history of opioid use who are on medicationassisted treatment with no psychosocial counseling compared to a group of patients who have a brief counseling session with their provider at the scheduled medication appointment.

James Ndungu

MSN, CRNP

25th Annual Scholarship Symposium

Implementing Screening for Child Sex Trafficking in the Emergency Department

With an estimated 199,000 children in the United States being sex trafficked per year, emergency departments are an important rescue entry point for victims of these crimes (Hardy, Compton, & McPhatter, 2013). In 2019, Pennsylvania was 4th highest in the United States for active criminal cases for human trafficking (Feehs & Currier Wheeler, 2021). Route 15 running through central Pennsylvania has been identified nationally as one of the busiest corridors for transport and solicitation of sex trafficking within the country due to its linking of the metropolitan areas of New York and Maryland. In addition to this, 42% of sex trafficking victims in 2020 were trafficked by their own family members and caregivers. Online recruiting of victims also continues to increase as more and more victims have access to social media and the internet (Polaris, 2022). Unfortunately, screening this patient population remains difficult as there are no widely implemented screening tools utilized across emergency departments, and healthcare provider education remains limited in this area. Review of literature identified important themes of staff education and knowledge, identification of risk factors and signs in victims, utilization of youth focused screening and mixed population screening of both adults and youth. This project is quality improvement focused by implementing a sixitem validated tool to screen for child sex trafficking within a level II trauma center with a medium sized emergency department that cares for both adult and pediatric patients. By screening patients for child sex trafficking, the aim is to identify the need for increased support and resources within the community for victims, families, and support persons.

Jocelyn Ramirez Harrell

MSN, CRNP, CPEN

25th Annual Scholarship Symposium

Combatting Heart Disease in the Fire Service

Sudden cardiac death consists of approximately 45% of firefighter line-of-duty deaths according to the Centers for Disease Control and Prevention (2018). Firefighters are at an increased risk for a multitude of reasons including 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. Research has been performed in these areas to evaluate why the increased risk and what can be done to help reduce or eliminate risk. Four common themes emerged from the literature and included requiring mandatory annual medical screenings, enacting fitness initiatives, encouraging good nutrition, and supporting mental health. This project aims to help reduce the risk of adverse cardiac events in firefighters by implementing an educational program regarding the importance of obtaining an annual medical exam.

Emily Serikstad

MSN, CRNP

25th Annual Scholarship Symposium

Burnout Among Acute Care Nurses

The number of registered nurses (RNs) in the United States (U.S.) is about three times higher than physicians and surgeons, making RNs extremely important to the healthcare system (Bakhamis et al., 2019). At least 1 out of every 10 nurses worldwide are suffering from high burnout according to a recent systemic review and meta‐analysis across 49 countries (Woo et al.,2020). Janeway (2020) states that the prevalence of burnout in nurses in the United States ranges from 35 to 45%. Due to the high percentage of burnout, it has been referred to as a “parallel pandemic” (Howell, 2021). Nursing professionals are at considerable risk of burnout due to chronic stress at work (Dall’Ora et al., 2020). High levels of chronic stress may affect one's mental, physical, and emotional health and may significantly impact the performance of the nursing professional (de Oliveira et al., 2021). Burnout may have a negative impact on the quality of care provided, leading to issues with patient safety and medical errors (de Oliveira et al., 2021, de Oliveira et al., 2019). According to Howell (2021), burnout is an epidemic affecting those working on the frontlines of patient care. For nurses, burnout reduces the ability to provide quality care. Every day, nurses face the dilemma of being human, empathetic, and caring, in a work environment with many responsibilities, inadequate staffing, long shifts, and sometimes less than desirable working conditions. Several studies have shown nurses present moderate to high levels of burnout syndrome (Adriaenssen et al., 2015). Since the onset of the pandemic, burnout has increased significantly, especially in acute care settings. The increasing shortage of nursing professionals and the increased turnover rate has significantly increased the level of stress and workload (De Oliveira et al., 2021). Most of the studies in literature are systematic reviews and very few studies provide evidence of valid interventions for burnout. There is a need for longitudinal studies to address interventions for prevention of burnout.

Kathryn Treaster

MSN

25th Annual Scholarship Symposium

Prevention of Substance Use Disorder Among Health Care Workers

The purpose of this literature review was to explore substance use disorder among health care workers. Understanding the prevalence and pattern of substance use in this population will allow for the creation of a program to protect health care workers from drug diversion and impairment. Substance abuse has reached epidemic proportions in the United States and remains very costly to the healthcare system. Health care professionals are equally at risk for developing substance abuse disorders; in fact, health care professionals are affected at the same rate as the general population. It is essential that the issue of substance use disorders in health care professionals be addressed for the safety of both the affected individuals as well as patients.

Julia F. Wauchope

PMHNP-RN