Title:Nursing (Doctor of Nursing Practice) Projects
Abstract:These projects were created by students of the Malek School of Health Professions Doctor of Nursing Practice (D.N.P.) degree. These projects were created as part of the requirements for receiving their degree.
Hairy Cell Leukemia (HCL) is a rare form of leukemia that invades the spleen and bone marrow causing several pancytopenia. Little is known about the HCL patients' perception on illness uncertainty and treatment-specific optimism. Purpose: This study aims to explore correlations between uncertainty in illness and treatment-optimism and to present the descriptive summary of numerical and categorical data analysis in patients with relapsed and refractory HCL. Methods: Mishel's uncertainty in illness-community form (MUIS-C) and Cohen's treatment-optimism (CTO) questionnaires were used through a mail survey method. A total of 31 participants completed the questionnaires from a phase II study at the National Cancer Institute, NIH. Data were analyzed using a descriptive summary statistics and Pearson correlations. Results: Both MUIS-C (=0.85 and CTO (=0.84)were tested for reliability with Cronbach's coefficient . The total score for MUIS-C showed a moderately negative correlation with the total score for CTO (Pearson’s r=0.61, p=0.000). Conclusions: The negative Pearson’s r-value indicated an inverse relationship between MUIS-C and CTO. This finding is consistent with other cancer related uncertainty-optimism studies where patients with higher disease uncertainty exhibit lower levels of optimism. Future work should focus on a larger sample and factor analyses to examine variability among observed variables with focus on identifying specific factors that affect uncertainty and optimism.
It is widely believed that attendance at regular prenatal care visits improves outcomes for both the infant and the mother. Yet, within the inner city clinic there is a wide disparity in the number of prenatal care visits. Women who fail to receive early and regular prenatal care are at higher risk for complications associated with perinatal morbidity and mortality. Inadequate prenatal care is attributable in part to a combination of poor communication among providers and patients, and perceptions of provider indifference. In order to determine what additional prenatal services clinic attendees desired, a 25 item survey was administered by clinic staff to 18 patients before and 11 patients after delivery (last trimester and first postpartum visit). The survey questions were the same for both surveys with the addition of two questions in the postpartum visit that determined gestational age at the time of delivery, and the adequacy of prenatal care based on missed appointments. All the participants included in the second survey reported delivery at term and had adequate prenatal visits (equal to or greater than 10 visits). The participants in the current study indicated there was a preference for group prenatal care, and that clinic should be limited to two hours with specific classes for childbirth education, breastfeeding instructions, and care of the newborn. The women indicated that group discussions around the common discomforts of pregnancy should be available while providing one-on-one visits with the healthcare provider.
Purpose: This pilot project evaluated whether the pain assessment instrument Brief Pain Inventory (BPI) embedded in the Electronic Medical Record (EMR) used by providers in a primary care setting of Fort Belvoir Community Hospital would improve documentation of pain assessments.
Background/Significance: The Office of the Surgeon General's Pain Management Task Force (PMTF) determined that pain management in the military treatment system should have a biophysical focus and pain assessments reflect a multidisciplinary approach. Health-information technology, such as electronic health records, has the potential to facilitate the assessment of pain through the incorporation of valid pain assessment tools that would provide a comprehensive and timely assessment of pain patients.
Methods: This project used a quasi-experimental design using non equivalent groups to determine the difference, if any, in pain assessment documentation after the introduction of a pain assessment documentation tool, the Brief Pain Inventory (BPI), as a template embedded into the existing EMR.
Results: The data was aggregated and summarized and a paired t-test was used to compare results between patient encounters pre- and post-implementation of the BPI. Strong evidence demonstrated a high effectiveness of the BPI to improve pain assessment documentation, particularly in the area of patient functioning: general activity, walking, work, mood, enjoyment of life, relations with others, and sleep.
Conclusion: Embedding a validated tool for comprehensive pain assessment in an EMR enables providers to perform a comprehensive assessment of pain patients that reflects a multidisciplinary approach to pain management.