2018 DNP Graduate Project Abstracts

The UTHealth Cizik School of Nursing proudly presents the DNP Project abstracts for the 2018 Class of DNP Graduates.https://digitalcommons.library.tmc.edu/dnp/1004/thumbnail.jp

Nurses\u27 Perceptions of Structural Empowerment: A Practice Review Process Pilot

Nurses are professionally and morally obliged to monitor and evaluate nursing practice via active participation in review mechanisms that are designed to promote patient safety and care delivery, thereby improving patient care quality (American Nurses Association [ANA], 1988, 2001, 2004; O\u27Rourke, 2006). The purpose of this Doctor of Nursing Practice (DNP) project was to develop, pilot, and evaluate a nurse practice review process with frontline nurses within Fresno Heart & Surgical Hospital (FHSH), a small specialty hospital, affiliated with Community Medical Centers (CMC) in Fresno, California. A nurse practice algorithm was subsequently developed and structural empowerment was assessed with the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II) (Laschinger, Finegan, Shamian, & Wilk, 2001). While there was a small sample size, the DNP project evaluation demonstrated that frontline nurses want to participate in improvement activities within the facility and believed the nurse practice review algorithm would effectively monitor and evaluate nursing practice

Understanding Thermometry at Low Temperature

Cryogenics play a vital role in building a Dynamic Nuclear Polarization (DNP) target for electron scattering experiments. The target material temperature was monitored using thermometry in order to evaluate their stability for use in the low temperature cryogenic bath of a DNP target. In this project, I investigated there solutions and accuracies of carbon ceramic, Cernox, Allen-Bradley, and thermocouple sensors at five known temperatures

A Framework for Integrating Oncology Palliative Care in Doctor of Nursing Practice (DNP) Education

Doctor of Nursing Practice (DNP) faculty play a critical role in preparing students to meet the complex needs of the nation as the number of cancer rates and survivors rise (National Cancer Institute, 2018) and as an unprecedented number of older Americans enter into the healthcare system with complicated comorbidities (Whitehead, 2016). Palliative care has dramatically expanded over the past decade and has been increasingly accepted as a standard of care for people with cancer and other serious, chronic, or life-limiting illnesses. Advanced practice registered nurses (APRNs) are recognized as important providers of palliative care (Walling et al., 2017). A 2-day course was held with support from the National Cancer Institute to enhance integration of palliative oncology care into DNP curriculum. The course participants (N = 183), consisting of DNP faculty or deans, practicing DNP clinicians, and students, received detailed annotated slides, case studies, and suggested activities to increase student engagement with the learning process. Course content was developed and delivered by palliative care experts and DNP faculty skilled in curriculum design. Participants were required to develop goals on how to enhance their school\u27s DNP curriculum with the course content. They provided updates regarding their progress at integrating the content into their school\u27s curriculum at 6, 12, and 18 months post course. Results demonstrated an increase in incorporating oncology palliative care in DNP scholarly projects and clinical opportunities. Challenges to inclusion of this content in DNP curricula included lack of: perceived time in curriculum; faculty educated in palliative care; and available clinical sites

Journey to the DNP

In this article, Dr. Jake Creviston shares details about his personal journey to earning the DNP (Doctor of Nursing Practice) degree. Creviston clarifies what the degree is and suggests opportunities and responsibilities for future DNPs

Diversifying the Healthcare Workforce: Transition of the Combat Medic to Baccalaureate-Prepared Nurse

Purpose The creation of a combat medic to accelerated Bachelor of Science in Nursing (BSN) program may offer a way to positively contribute to the nursing workforce. Therefore, the purpose of this feasibility project was to combine the four sub-roles of expert practitioner, educator, researcher, and consultant1, to design a new pathway for military combat medic entry into nursing. Methods A comparative analysis elucidated gaps in 219 different nursing skills, didactic and general education requirements, clinical hours, and transfer credits between combat medic training and the BSN curriculum at a Vermont university. Identified gaps were compared to nursing licensure requirements. A sample of combat medics was surveyed for interest level in pursuing a BSN, desired employment setting, and intent to work at the bedside for two years or longer. Feedback was collected from faculty and administrators and at schools with similar existing programs. Results Two program plans of study for 24- and 32-month completion were developed, (dependent on transfer credits and demonstrated skill competencies). Participating combat medics (84%) reported being “very interested” and 16% reported being “interested” in pursuing an accelerated program in nursing. Combat medic participants (100%) indicated that they would remain at the bedside for two years or longer. Conclusion The proposed program pathway was well-received and may offer a way to alleviate medic unemployment rates and contribute to the nursing workforce. Plans for further research include a cost-benefit analysis, more precise sampling to gauge interest levels, and determinants of requisite supplies, physical space, clinical placements, and faculty. Keywords: Nurse, Military, Medic, BSN, RN References Manley, K. (1997). A conceptual framework for advanced practice: An action research project operationalizing an advanced practitioner/consultant nurse role. Journal of Clinical Nursing, 6, 179–190

Russian roulette with unlicensed fat-burner drug 2,4-dinitrophenol (DNP) : evidence from a multidisciplinary study of the internet, bodybuilding supplements and DNP users

BACKGROUND: 2,4-Dinitrophenol (DNP) poses serious health-risks to humans. The aims of this three-stage multidisciplinary project were, for the first time, to assess the risks to the general public from fraudulent sale of or adulteration/contamination with DNP; and to investigate motives, reasons and risk-management among DNP-user bodybuilders and avid exercisers. METHODS: Using multiple search-engines and guidance for Internet research, online retailers and bodybuilding forums/blogs were systematically explored for availability of DNP, advice offered on DNP use and user profiles. Ninety-eight pre-workout and weight-loss supplements were purchased and analysed for DNP using liquid-chromatography-mass-spectrometry. Psychosocial variables were captured in an international sample of 35 DNP users (26.06 ± 6.10 years, 94.3 % male) with an anonymous, semi-qualitative self-reported survey. RESULTS: Although an industrial chemical, evidence from the Internet showed that DNP is sold 'as is', in capsules or tablets to suit human consumption, and is used 'uncut'. Analytical results confirmed that DNP is not on the supplement market disguised under fictitious supplement names, but infrequently was present as contaminant in some supplements (14/98) at low concentration (<100mcg/kg). Users make conscious and 'informed' decisions about DNP; are well-prepared for the side-effects and show nonchalant attitude toward self-experimentation with DNP. Steps are often taken to ensure that DNP is genuine. Personal experience with performance- and appearance enhancing substances appears to be a gateway to DNP. Advice on DNP and experiences are shared online. The significant discrepancy between the normative perception and the actual visibility suggests that DNP use is-contrary to the Internet accounts-a highly concealed and lonesome activity in real life. Positive experiences with the expected weight-loss prevail over the negative experiences from side effects (all but two users considered using DNP again) and help with using DNP safely is considered preferable over scare-tactics. CONCLUSION: Legislation banning DNP sale for human consumption protects the general public but DNP is sold 'as is' and used 'uncut' by determined users who are not dissuaded from experimenting with DNP based on health threats. Further research with stakeholders' active participation is imperative for targeted, proactive public health policies and harm-reduction measures for DNP, and other illicit supplements

Improving Surveillance of Hepatitis C Infections Among Patients Receiving Medication Treatment for Opioid Use Disorder

Background: Despite harm reduction efforts, Hepatitis C virus (HCV) infections among individuals with opioid use disorder tripled between 2010 and 2015 in the US. Shifting disease burden from chronic to acute HCV, could result in $12 billion cumulative Medicaid savings in two years. Patients receiving medication for OUD (mOUD) remain at risk for HCV, but only receive screening upon admission. This project aims to implement a HCV re-screening protocol in a mOUD program, determine protocol sustainability, and secondarily evaluate need for point of care testing. Methods: Patients with a negative screening result upon admission were prompted to opt in/out of re-screening. Participants were offered onsite venipuncture. Patients declining, were asked if they’d reconsider if blood sample were obtained via finger stick. Stakeholders provided feedback regarding sustainability via online surveys. Results: Of the 496 eligible patients, 429[PMV1] (86%) completed the survey with 124 (29%) interested in rescreening, and 52 (41%) completed a venipuncture. Of these, 9 (17%) tested positive for HCV antibody and 7 (14%) had detectable HCV RNA. Of patients declining re-screening, n=185[PMV2] (52%), endorsed amenability to finger stick. Stakeholders (n=24) agreed that rescreening was easy to implement and appropriate to integrate into practice. Conclusions: Provision of less invasive screening modalities may increase rescreening uptake. Introducing opportunities for HCV re-screening leads to earlier detection and subsequent treatment initiation, and increases identification rates overall. Integration of HCV screening services at mOUD treatment programs provides a sustainable approach to HCV surveillance, and has the potential reduce the burden of infectious disease

Use of an Evidence‐Based Guideline for Management of Side Effects from Long‐Acting Reversible Contraceptives: A Quality Improvement Report

Introduction Many health care providers believe that women who initiate long‐acting reversible contraceptives (LARC) discontinue the method because of side effects too soon for the method to be economical. The purpose of this quality improvement project was to implement and evaluate an evidence‐based telephone triage nursing guideline for management of side effects of LARC with an ultimate goal of reducing the number of early discontinuations. Process A telephone triage guideline was adapted from the Contraceptive Choice Project\u27s Clinician Call Back System, supplemented with evidence‐based resources, and approved by clinicians at 2 community women\u27s health and midwifery offices. Baseline retrospective data were collected on all women over the age of 18 who had LARC inserted at the 2 sites in the year prior to guideline implementation and in the 3 months after implementation. Rates of LARC removal at or before 3 months postinsertion, before and after guideline implementation, were evaluated. Outcomes Approximately 1 in 5 women called for help managing LARC side effects. Of the callers, 3 of 32 (9.4%) women receiving standard care discontinued their LARC prior to 3 months, whereas 0 of 24 women who were triaged using the guideline discontinued their LARC prior to 3 months (P = .12). Cramping, bleeding, and malposition or expulsion were the most common concerns and reasons for discontinuation. Discussion Fewer women than anticipated called to report side effects, and even fewer chose to discontinue their LARC early. There were fewer discontinuations with guideline use, but this was not a statistically significant difference. Most women did not discontinue their LARC early for any reason, including side effects