UVM Health Services

2020 Doctor of Nursing Practice Evidence-Based Projects

All students enrolled in the Doctor of Nursing Practice (DNP) program will complete a project as one of the requirements for completion of the program and graduation. The DNP candidate will produce an academic product that will be evidence of the mastery, utilization, and expression of the knowledge gained while working toward this degree. Students will demonstrate the identification and resolution of an identified practice issue via implementation of the DNP project and consequently will make a contribution to the practice setting, the community and/or in an academic setting.

Doctor of Nursing Practice Program Evidence-Based-Practice Colloquium Wednesday, April 15, 2020

 

Student:  Jacqueline Bray, B.A., RN, DNPc

Advisors:  Deborah Wachtel, DNP, MPH, APRN and Robin Sherman, APRN-BC

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

Purpose: Despite harm reduction efforts to reduce comorbidities, Hepatitis C virus (HCV) infections among individuals with opioid use disorder tripled between 2010 and 2015 in the United States. Shifting the disease burden from chronic to acute HCV, could result in $12 billion cumulative savings to Medicaid over two years. Patients receiving medication for OUD (mOUD) remain at risk for HCV, yet  many mOUD programs only screen patients upon admission. This project aims to implement a HCV re-screening protocol in a mOUD program, determine protocol sustainability, and secondarily evaluate need for HCV point of care testing.

 

Student: Maria Delia Crosby, RN DNPc

Advisors: Rosemary Dale, Ed.D., APRN and Eileen Curtis, MSN

Project Title: Screening for palliative care services in an assisted living facility

Purpose: To determine whether the integration of validated community-based palliative care screening tool in an assisted living setting will identify older adults with unmet palliative care needs. 2. To determine if tool implementation could lead to a referral for palliative care consultation. 

 

Student: Nadia S. Fletcher, RN, BSN, DNPc

Advisor: Christina Harlow, DNP, APRN

Project Title: Assessing Maternal Satisfaction of Perinatal Care Provided In A Rural Ob/Gyn And Midwifery Clinic

Purpose: Women’s childbirth experience can have long-term consequences on overall health and well-being. Positive experiences can lead to maternal empowerment and ease of transition into motherhood, while negative experiences are associated with poor maternal health outcomes like postpartum depression and requests for cesarean delivery in subsequent births (Nilver, 2017). Evaluating women’s perspectives of maternal care received allows for appropriate assessment and improvements in the quality of care provided to ensure positive, evidence-based and respectful care. The purpose of this project is to develop a formalized method of evaluating patient’s satisfaction with perinatal care delivered at a rural Ob/Gyn and Midwifery clinic with the intent of improving care.

 

Student: Lyndsey Gates, MSN, RN, DNPc

Advisor:  Jason Garbarino, DNP, RN-BC, CNL and Llynne Kiernan, DNP, MSN, RN-BC

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

Purpose: In 2018, Vermont was faced with a $74.7 million financial impact related to nursing shortages.1 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. The purpose of this feasibility project was to combine the four sub-roles of expert practitioner, educator, researcher, and consultant, as defined by Manley (1997), to design and develop a new pathway for military combat medic entry into the nursing profession.2

 

Student: Caitlin Gerity, B.A., RN, DNPc

Advisor:  Deborah Wachtel, DNP, MPH, APRN

Project Title: Improving Behavioral Health and Social Determinants of Health Screening in Primary Care

Purpose: Detection and intervention of depression, substance use disorder, and social determinants of health (SDOH) in primary care improves quality of life, prevents complications, reduces health care costs and inequities, and leads to health promotion1,2. This project aimed to increase behavioral health and SDOH screening rates through implementation of a screening process utilizing validated patient questionnaires in a community-based internal medicine office.

 

Student: Karen B. Gibbs BSN, RN, DNPc

Advisors:  Brenda Hamel-Bissell Ed.D, RN and Prema Menon MD, Ph.D

Project Title: Improving Nurses’ Attitudes, Beliefs, and Practices in Screening for Suicide Risk in Hospitalized Patients

Purpose: Forty-seven thousand deaths from suicide occur annually in the United States. Nurses’ attitude, education and self-confidence toward suicide prevent compliance with requisite suicide risk assessment screenings. Providing nurses with facts about suicide, intervention methods, structured screening tools, and referral resources have been shown to change attitudes and increase screening rates. This quality improvement project provided nurses with education on suicide in order to improve rates of suicide risk screenings on in-patient units at a 550-bed academic medical center.

 

Student: Rachel Greene, RN, DNPc

Advisor: Jean Pelski, Ph.D., APRN, NNP-C

Project Title: Clinical Management of Postpartum Hemorrhage in Community Birthing Hospitals in Vermont: A Gap Analysis to Promote Best Practice

Purpose: Despite advances in research and medical technology, the rates of postpartum hemorrhage (PPH) continue to rise. Annually, these preventable events are the cause of one-fourth of maternal deaths worldwide. In order to manage PPH as an obstetric emergency and reduce maternal mortality and morbidity rates, the effective application of evidence-based interventions is required including timely diagnosis and immediate access to appropriate resources. The purpose of this DNP project is to conduct a gap analysis within a sampling of community birthing hospitals in Vermont to examine the existing clinical management of PPH.

 

Student: Julie Desrochers Holland, MPH, RN, DNPc

Advisor: Christina Harlow, DNP, APRN, FNP-BC

Project Title: Evaluation of Clinician Prescribing Practices for Contraceptive Care: A Quality Improvement Collaboration

Purpose: Primary care providers (PCPs) have the training and opportunity to provide contraceptive care. Unplanned pregnancy is a major public health issue for which up to 50% of the population is at overall lifetime risk.  Reproductive life planning during healthcare visits can reduce rates of unintended pregnancy, initiating pathways toward contraception or preconception planning. Preconception counseling can prevent adverse maternal and child health outcomes. Studies suggest contraceptive counseling protocols and reproductive intent screening are effective tools. PCPs have opportunity to screen and provide appropriate interventions. This project compares and contrasts clinician practices with international and national guidelines. The purpose is to evaluate preventive reproductive healthcare practices in a primary care setting, identifying opportunities to meet the contraceptive healthcare needs of people of reproductive age.

 

Student: Brianna Johnson, BSN, RN, OCN, DNPc

Advisors: Jennifer Laurent, Ph.D., APRN, Emelia Wollenburg, MPH and Denise Smith, M.S.

Project Title: Measuring the Impact of Rise VT: Evaluating community-based obesity prevention initiatives with a standardized intensity score

Purpose: Children born today will lead less healthy and shorter lives than their parents, unless effective population-level interventions to reduce obesity are implemented.  Research suggests that multilevel community-based initiatives are associated with future reductions in childhood obesity. The Community Programs and Policies Intensity Score (CPPI) is a standardized metric to evaluate multisector efforts over time, which has been found to correlate with future reductions in childhood obesity at the population level. The purpose of this project was to quantify the impact of a community-based initiative to reduce childhood obesity (Rise VT) using the Community Programs and Policies Intensity (CPPI) score.  A secondary aim was to assess the feasibility of using the CPPI score for ongoing program planning and evaluation statewide.

 

Student: Katherine Judge, RN, DNPc

Advisor: Hendrika Maltby, RN, Ph.D

Project Title: From Evidence to Practice: Promoting Continued and Exclusive Breastfeeding in Rural Eastern Uganda

Purpose: Malnutrition is responsible for about one third of deaths globally among children under the age of five. Over 65% of these deaths, often associated with inappropriate feeding practices, occur during the first year of life and disproportionately affect those living in resource poor countries. Breastfeeding has been established as a uniquely protective and effective measure in providing infants with the nutrients they need for healthy growth and development. According to Ugandan demographic surveys (2016), less than 43% of infants age 4-5 months are breastfed.

 

Student: Erin Leighton, B.S., RN, DNPc

Advisors: Margaret Aitken, DNP, APRN and Jennifer Allaire, M.S., APRN

Project Title: Telehealth Visits for Common Concerns in a Primary Care Setting: Establishing a Protocol

Purpose: The purpose of this project was to expand telehealth visits in a nurse practitioner-run primary care practice, via designing effective protocols and educating clinicians on telehealth use, requirements, documentation, and billing in order to complete telehealth visits successfully

 

Student: Murphy Neenan, B.S., RN, CEN, DNPc

Advisors: Stuart Whitney, Ed.D., RN, CNL, Jessica Cullen, RN and Javad Mashkuri, MD

Project Title: Essential trauma Care Documentation Redesigning a Community Hospital’s Trauma Flow Sheet

Purpose: Poor or absent trauma documentation has negative consequences on continuity of care, errors related to treatment, poor validity when used as a data source, and increased time to order completion (Lorenzetti et al., 2018; Jones, 2016). Nursing staff at a Vermont community hospital emergency department (ED) expressed frustration when utilizing the existing trauma flow sheet. The purpose of this project was to redesign and implement an evidence-supported trauma flow sheet for efficient, accurate, and comprehensive documentation of trauma encounters.

 

Student: Jessica Okrant, B.S., RN, OCN, DNPc

Advisor:  Stuart Whitney, Ed.D., RN, CNL

Project Title: Development of a Medical Surveillance Program: Recommendations for At-Risk Employees

Purpose: This project sought to evaluate current policies and procedures regarding HD exposure workplace practices at large academic medical centers in the Northeast, improve education of HD exposure, and develop a standardized medical surveillance program (MSP) at one large academic health network.

 

Student: Katherine Rose, B.S., RN, OCN, DNPc

Advisors: Jennifer Laurent, Ph.D., APRN and Iris Toedt-Pingel, MD

Project Title: Development of Hospital-Wide Policy for Pediatric Needle Procedures at an Academic Medical Center

Purpose: Needle procedures are traumatic experiences for pediatric patients, and have been linked to formation of phobias and lifelong decreased healthcare utilization (Nixon et al., 2010; Noel et al., 2009). Pain management during needle procedures and hospital wide standardization of needle procedures are known to increase patient satisfaction, while decreasing long-term adverse outcomes related to seeking health care (Rosenberg et al., 2016, Friedrichsdorf et al., 2018). The purpose of this project was to develop a hospital-wide standardized policy for pediatric needle procedures at an academic medical center.

 

Student: Lydia Sachs, M.A., RN, DNPc

Advisor: Jean Pelski, Ph.D., APRN, NNP-C

Project Title: Transcutaneous Bilirubin Measurement in a Rural Teaching Hospital: A Quality Improvement Assessment

Purpose: Up to 84% of term neonates develop jaundice, a sign of hyperbilirubinemia that warrants bilirubin measurement (Muchowski, 2014). The AAP recommends systematic evaluation of hyperbilirubinemia risk for every infant. Serum bilirubin tests involve needle sticks, introducing anxiety, pain, and cost (Lago et al., 2017; AAP Subcommittee on Hyperbilirubinemia, 2004). Transcutaneous bilirubin (TcB) measures bilirubin without needle sticks, may offer reduced costs, but is less accurate, and may increase phototherapy rates (Pratesi, et al., 2016; Kuzniewicz et al., 2009). This project aimed to determine the effect of TcB measurement on needle sticks, phototherapy rates, and cost of bilirubin measurement at a rural teaching hospital.

 

Student: Page Tomlinson, B.S., RN, DNPc

Advisor: Margaret Aitken, DNP, APRN

Project Title: An Initiative to Educate and Support Young Adults Diagnosed with Hypertension

Purpose: Hypertension is a common diagnosis in the US with significant long-term effects. While guidelines for optimal blood pressure managementexist for adults diagnosed with hypertension, young adults lag behind older adults in treatment and control3.The young adult is arguably more capable of lifestyle changes, primarily due to fewer physical limitations than older adults. Promotion of disease self-management is the most effective way to engage young adults in seeking control over their blood pressure1,2. Lifestyle modificationas a young adult decreasecosts of care and risk for cardiovascular events, while lack of guidance and support at this stage of life may increase risk for cardiac events over their lifetime.

 

Student: Nicole Valcour, MPH, M.A., RN, DNPc

Advisors: Hendrika Maltby, Ph.D., RN, FACN and Loretta Charles, M.S.N., MPH, FNP-BC

Project Title: Working Title: Collaborative Design of Program evaluation of public health interventions in Kamuli, Uganda  

Purpose: A well-designed evaluation can be the key to delivering the greatest impact from public health programs1. The purpose of this project is to design an evaluation of public health interventions in Kamuli, Uganda. The University of Vermont Public Health Nursing program has been working for ten years with two NGO’s in the communities surrounding Kamuli, Uganda in the implementation of evidence-based improvements in household sanitation, safety and hygiene.  Feedback from the community has been positive, but no formal evaluation has been carried out.

 

Student: Elisa Vautier, B.S., RN, DNPc

Advisor: Mary Val Palumbo, DNP, APRN, GNP-BC

Project Title: Improving the Diagnosis of Alzheimer’s Disease and Related Dementia in Primary Care

Purpose: The number of Vermonters living with Alzheimer’s disease and related dementia (ADRD) is expected to increase by 42% to 17,000 by the year 2025 (Richardson, 2017).  Missed and delayed diagnoses impact patient safety, treatment opportunities, and increase health care costs. Contributing factors to delayed and missed diagnosis include provider education deficits, perceived difficulties of detection, and lack of tools perceived as helpful (Bradford, et al., 2009). This project assesses current practices of diagnosing ADRD in primary care, identifies barriers to diagnosis, and develops and evaluates an evidence-based tool to assist in the diagnosis and treatment of ADRD.

 

Student: Kimberly A. Ward B.S., RN, DNPc

Advisor: Mary Val Palumbo DNP, APRN and Katina Cummings, Health Workforce Program Manager

Project Title: Evidence Based Treatment for Excessive Alcohol Consumption and Concurrent Hypertension

Purpose: Excessive alcohol consumption is a preventable risk factors for hypertension, heart Carol Buck-Rolland, Ed.D, APRN, PNP disease, and stroke, which are the leading causes of death in the U.S[1]. Though alcohol-related deaths number 88,000 annually in the U.S.[2], alcohol use has the lowest treatment rate of behavioral health disorders at 10%[3].  Excessive alcohol consumption may compromise treatment of hypertension by primary care providers (PCP). This project aims to increase PCP and patient awareness of the connection between hypertension and excessive alcohol use and promote screening of excess alcohol consumption.

 

Student: Kiersten Wulff, RN, DNPc

Advisor:  Carol Buck-Rolland, Ed.D, APRN, PNP

Project Title: Evaluating a volunteer doula program at an academic medical center in Vermont

Purpose: Continuous labor support isrecognized as a component of high quality maternal healthcare, yet access to doulas is not universal. Hospital-based doula programs can minimize barriers to continuous labor support, and evaluation of hospital-based doula programs is needed.This project evaluated a pilot volunteer doula program at an academic medical center.

Scholarworks Link: https://scholarworks.uvm.edu/cnhsdnp/ (Students will upload Projects in June 2020)