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Latinas’ lack of knowledge regarding cervical cancer screening (CCS) guidelines has a significant impact on CCS adherence and ultimately impacts their health outcomes related to cervical cancer. Studies have demonstrated that small media, culturally relevant educational interventions are highly effective in improving Latinas’ knowledge of CCS (Moran et al., 2016; Thompson et al., 2019; Warner et al., 2018). The purpose of this scholarly project was to implement and evaluate the efficacy of a small media educational intervention on Latinas’ knowledge of CCS and human papillomavirus (HPV) and evaluate the participants’ satisfaction with the intervention. A convenience sample of 50 Hispanic female patients between the ages of 21-65 was obtained from a community health center in the Southeast region of the United States. The fotonovela utilized in the Thompson et al. (2019) study was the intervention used for this project; it was offered in Spanish and English and included information on CCS and HPV. A pre- and post-test questionnaire assessing the participants’ CCS and HPV knowledge was administered. In addition, the post-questionnaire included questions that evaluated the participants’ satisfaction with the fotonovela. Following implementation of the fotonovela, participants significantly increased their average post-test CCS and HPV knowledge scores (Pre: 50.6; Post: 83.6, p<.000). All 50 participants (100%) reported overall satisfaction with the fotonovela. The findings of this project were both statistically and clinically significant indicating that the fotonovela is an effective and favorable educational intervention, thus its implementation is warranted in healthcare settings that provide care to Latinas.
Many people are affected by chronic pain. The use of opioids for pain has resulted in an increase in the number of opioid-related overdose deaths. The Center for Disease Control (CDC) created opioid prescribing guidelines to help providers safely prescribe opioids for chronic pain. The purpose of this project was to create an electronic medical record (EMR) template and urine drug test (UDT) alert to increase the providers’ adherence to the CDC opioid guidelines in a small, hospital-owned, family practice clinic. A pre/post implementation chart review tool was used to evaluate the medical records of 60 patients prescribed chronic opioids. The tool was used to determine if providers were adhering to the guidelines. Measures included the number of patients who completed an annual UDT, signed control substance agreement (CSA), documented pain diagnosis, quarterly office visits, and if providers reviewed the prescription drug monitoring program (PDMP) every 3 months. Adherence improved in the post-implementation data compared to pre-implementation. There were statistically significant increases in CSA (p=.000), PDMP reviewed (p=.000), annual UDT (p=.005), and quarterly appointments (p=.006). Although not statistically significant, there was an increase in documented pain diagnosis (p=.492). Implementation of an EMR template and UDT alert led to an increase in provider adherence to opioid prescribing guidelines.
For decades, district level administrators and policy makers have been searching for ways to combat the ever growing issue of teacher attrition. Each year teachers leave the profession prior to retirement age. This problem is even more prevalent in schools who serve low-income, high-minority students.
The purpose of this qualitative transcendental phenomenological study was to determine the lived experiences that keep elementary school teachers teaching in low-income, high-minority schools, when so many of their peers choose to leave. For this study, six elementary level teachers, who have taught in the same low-income, high-minority school for five years or more, participated in one hour long semi-structured interviews. These interviews helped see through the lens of the participants, providing rich, real world experiences they used to sustain their positions when so many of their peers leave.
The results revealed that both intrinsic and extrinsic motivators played a role in the teacher’s decision to remain in low-income, high-minority schools. These motivators ranged from their professional work environments to past experiences as teachers and students. The information discovered during this study may help administrators and policy makers find ways to increase teacher attrition especially in low-income, high-minority schools
Introduction: Postoperative delirium is a common cognitive complication characterized by an abrupt disturbance in brain function after surgery. It occurs in 15 to 25% of patients undergoing major elective surgeries and up to 50% of patients who have had high-risk procedures such as cardiac surgery or hip fracture repair. Postoperative delirium can result in negative outcomes such as increased healthcare costs, increased length of stay, and lasting cognitive impairment. Although nurses play a critical role in recognizing delirium, the complication remains under-recognized and poorly managed. This finding emphasizes the need for improved delirium recognition and management strategies; therefore, educational initiatives designed to improve delirium care are necessary for nurses caring for patients with this complication.
Objectives: This study evaluated the effect of structured delirium education on nursing knowledge, recognition, and management of delirium.
Methods: This quality-improvement project utilized the Nurses’ Delirium Knowledge Assessment (NDKA) tool, a 36-item scale divided into three subscales, to evaluate medical-surgical nurses’ knowledge before and immediately following the implementation of an on-demand web-based delirium education module. Participation in this study was voluntary and consisted of nurses working on two surgical units. Assessment scores were evaluated pre-and post-education and the Wilcoxon signed-rank test was used to detect significant changes.
Results: Sixteen nurses participated in the study. Overall mean scores improved from 67.99% on the pre-assessment to 81.84% on the post-assessment. Subscale mean scores also improved and were as follows: knowledge of assessment tools and scales 71.84% pre and 87.5% post, general knowledge of delirium 75.89% pre and 85.71% post, and risk factors for delirium 56.25% pre and 72.32% post.
Conclusion: The educational intervention provided in this study increased nurses’ knowledge and recognition of delirium, validating similar findings in the literature. An educational intervention delivered via electronic format is an effective method to provide delirium education to nurses. Improving nursing knowledge of delirium is essential in improving patient outcomes.
Purpose:
The purpose of this educational project was to determine whether interprofessional team members who participate in a structured educational session demonstrate an increase in knowledge, confidence and self-efficacy in the care of adult brain tumor (ABT) patients. The aim was to evaluate baseline ABT knowledge of neuroscience registered nurses (RNs) and advanced practice providers (APPs) and to identify barriers associated with specialized educational programs.
Methods:
An evidence-based education program on ABT’s was developed and delivered to neuroscience interprofessional team members in a single institution in Charlotte, North Carolina. Three measurement tools were used for data collection. One tool was used to collect demographic information, one was used for a knowledge pre/post-intervention and one for the participants to rate their confidence level. RNs and APPs functioning in a neurosurgical, neurointensivist or neurohospitalist role were eligible to participate. Travel RNs were excluded.
Results:
Seventeen care providers participated in this project. Descriptive statistics were used to analyze the demographic characteristics of the participants, belief in supplemental education, and pre/post-intervention knowledge assessment items. McNemar’s test for paired binary data and StataCorp v.16 statistical software (2019) were used. Six participants recalled prior education specific to ABTs and 94% (n=16) believed additional education would be beneficial. A statistically significant increase in correct responses from the pre-posttest was seen in one question pertaining to histological grading classification system (p=.031). The lowest response recorded on the confidence survey was regarding the APP’s level of comfort in discussing treatment plans with patients and caregivers.
Implications:
The results of the project created a basis for understanding neuroscience team members level of knowledge and confidence. Further study is needed to determine effective educational strategies for the neuroscience team.
Keywords: brain neoplasm, clinical guidelines, specialized training
Commercial wearable devices that collect health and fitness data are widely used. These devices sense and collect a variety of personal data, which can be shared by users with other people and with third parties. Yet, the collection of personal data by these sensor devices and the sharing of it poses several risks, including stalking, secondary use, aggregation, and inferences. In this dissertation, I present a new and an increased understanding of fitness tracker users’ sharing practices, concerns, awareness, and needs. The main goal is to design controls and features that empower users over the sharing and privacy of their information.
My research utilized different approaches, including semi-structured interview, survey, and participatory design studies. Overall, the findings uncover several sharing patterns by fitness tracker users, with practices in each pattern based on the intended audiences. While users do not consider much of the data collected by their devices sensitive, they have concerns about the possibility of abusing their data. However, users have limited awareness about the potential to infer personal information from the primary data collected by activity trackers. My research provides several factors that might impact users’ perceptions and attitudes towards inferences in the context of IoT wearable devices. Lastly, my research presents a set of taxonomies for sharing and privacy controls and mechanisms in fitness tracker platforms and contributes several design guidelines.
Guidelines recommend prescribing four classifications of medications for individuals with heart failure with reduced ejection fraction (HFrEF). Individuals on guideline directed medical therapy (GDMT) have been shown to have reduced mortality and morbidity. If all eligible individuals were on GDMT, lives saved could be improved by 60% annually. The largest impact comes from prescribing GDMT with the lowest prescribing rates. Further evidence has confirmed there is a lack of guideline adherence in outpatient prescribing. Use of provider reminders with decision support improves adherence to guidelines.
Study Objectives: Determine the prescribing behaviors of advanced practice providers (APPs) and physicians before and after implementation of a provider reminder tool that offers decision support in outpatient prescribing.
Methods: This scholarly project occurred over two months in the fall of 2020. Eligibility criteria to have reminders placed in the chart included adults with HFrEF with a left ventricular ejection fraction (LVEF) less than 40%, seen by an APP or physician in an outpatient cardiology practice. When patients were seen in the office for their scheduled visit, providers had access to their electronic medical record (EMR) with the reminder tool sent as a provider communication note for all visit types. An additional paper reminder tool was handed to the provider for in-person visits. Following patient visits, prescribed medications were recorded to allow for pre-post comparisons. Analysis included descriptive statistics and McNemar’s test for paired nominal data using StataCorp v.16 statistical software (2019). Subgroup analysis was performed by provider type and visit type.
Results: A convenience sample of 120 consecutive provider-patient encounters was evaluated in a southeastern United States outpatient cardiology practice. Compliance with renin-angiotensin-aldosterone system (RAAS) inhibitors, beta blockers (BB), and hydralazine-isosorbide dinitrate (H-ISDN) were numerically improved, though not statistically significant. Compliance to aldosterone antagonists (MRA) showed significant improvement after the intervention for all patients (35.8% to 41.7%, p=.020), which continued after adjusting for contraindications by medication classification. Post intervention prescribing was improved in all visit types for all medication classes except RAAS inhibitors, beta blockers, and H-ISDN in virtual visit formats. Visit type influenced prescribing of RAAS inhibitors and MRAs. In-person RAAS inhibitor and MRA prescribing had significant improvement after the intervention (78.3% to 95.7%, p = .0455; 39.1% to 56.5%, p =.0455, respectively). Improvement in prescribing was noted for APPs and physicians, except for beta blockers among physicians. Subgroup analysis of provider type did not yield any statistical difference. Uptitration of medications were numerically increased for beta blockers and RASS inhibitors. Uptitration was significantly higher in heart failure providers for RAAS inhibitors as compared to non-heart failure providers (29%; 6.5%, p=.004). The opposite was true for beta blockers, with non-heart failure providers uptitrating more (19.2%), but it was not statistically significant.
Conclusions: This scholarly project demonstrated that an electronically delivered, paper generated provider reminder tool with decision support can clinically impact guideline adherence. With in-person visit type, the tool was statistically impactful. These findings are consistent with the literature. Given the uptake in the frequency of virtual visits following the coronavirus disease pandemic, virtual visit type reduced initiation of RAAS inhibitors and beta blockers, which require vital sign data. Provider type did not impact guideline prescribing. Being a heart failure specialist positively impacted prescribing.
ABSTRACT
VICTORIA MARIE POILLUCCI. Breaking Down Barriers to Early Goals-of-Care Discussions with Terminally Ill Cancer Patients (Under the direction of DR. KELLY POWERS)
Opportunities to discuss options for care when faced with a life limiting disease is the right of all patients. Yet, healthcare provider feelings of awkwardness, fear of diminishing hope, and fear of failing to cure can result in missed opportunities to explore what patients really want for end-of-life care. Because these Goals-of-Care Discussions are not occurring, patients often receive unwanted and expensive care. The purpose of this quality improvement project was to evaluate the effect of education on oncology providers’ self-efficacy for Goals-of-Care Discussions, and to explore barriers and opportunities to promote completion of earlier Goals-of-Care Discussions. Two white board scribe videos were created to educate providers and for consideration for future use to show patients as an ice breaker to begin these difficult conversations. The sample included 66 Oncologists, Nurse Practitioners, and Physician Assistants from a large academic cancer center in the southeast United States. A Wilcoxon Signed Rank test showed a statistically significant immediate improvement in the oncology provider’s self-efficacy after viewing the videos (p<.001). Thematic analysis revealed 5 themes: lack of sufficient clinic time, provider comfort level, documentation as key to communication, protocol development, and oncologist versus palliative care (whose job is it?). Education for healthcare providers and tools to help initiate conversations with patients can help improve self-efficacy in conducting Goals-of-Care Discussion. Future research is needed to look at the cost of unwanted care and how developing a comfort level with having discussions surrounding end-of-life can reduce healthcare costs and improve patient centered care.
Food insecurity (FI) has negative health effects throughout the lifespan, yet there is a disconnect between national recognition of FI as a health issue and FI screening in the clinical setting. The purpose of this project was to determine if an educational intervention increased knowledge of FI’s role on health, the screening and referral process, and using ICD-10 coding to document FI. A pretest-posttest design was used, sampling clinicians across five clinical sites. Participants received virtual education and completed a pre-, post-, and 3-month follow-up survey to measure knowledge, attitudes, and willingness to address FI issues. A retrospective ICD-10 coding report for FI was obtained to measure frequency of use per clinic site. Thirty-one clinicians completed the pre- and post-survey, and twelve clinicians completed all three time points. Participants’ knowledge of FI and knowledge of referral resources was significantly improved from the pre- to post-survey (p <0.001, p < 0.000 respectively). Clinicians showed a significant change in their intent to ask patients about FI (p < 0.000) and to refer patients to community food resources (p < 0.000); this remained at the 3-month follow-up (p < 0.001). There was not a significant change in the use of the ICD-10 code for FI throughout the measurement period. The results of this project support findings in the literature that a point-in-time educational training on FI could improvement clinicians’ knowledge, as well as their willingness to screen patients for FI and connect them to food resources.
