Practice Implementation and Dissemination

Gaps in delivering evidence-based treatments in U.S. health care reflect numerous challenges, including misalignment of policies and practices, limitations in organizational and leadership support and constrained resources for training and implementation. Improvements in implementation and dissemination are intended to integrate new practices within a specific health care setting or context. The dissemination of evidence-based practice is important in introducing new practices to a new or specific audience. Using strategies for adoption and integration of evidence-based practice efforts are important in addressing gaps in evidence-based treatments further leading to reduce challenges in implementation.

Effects of perioperative exercise interventions on lung cancer patients: an overview of systematic reviews

Authors: Weijiao Zhou, MSN, Ph.D. pre-candidate; Seoyoon Woo, Ph.D., RN; Janet L. Larson, Ph.D., RN, FAAN
Poster number: 1
Presentation date: Monday, April 5, 9:40 a.m.

Impaired exercise capacity, pulmonary function and health-related quality of life (HRQOL), and postoperative pulmonary complications(PPCs) are common in surgical lung cancer patients. Numerous systematic reviews address these health problems and examine the effects of exercise intervention. However, differences in the quality and scope of the reviews and discordant findings from the reviews make it difficult to implement the evidence. This study appraised and synthesized these systematic reviews. Seven reviews were included. High/moderate-quality evidence showed postoperative exercise interventions could increase exercise capacity and muscle strength, and low-quality evidence showed postoperative interventions may increase the physical component of HRQOL and decrease dyspnea. Low-quality evidence showed preoperative exercise interventions may increase exercise capacity and pulmonary function and decrease the risk of PPCs. Postoperative and preoperative exercises have the potential to improve health outcomes in surgical lung cancer patients. This study supports the implementation of exercise interventions.

Nursing Practice Surrounding Administration of As Needed Intravenous Pain and Sedation Doses in the Pediatric Intensive Care Unit

Authors: Anna Pokriefka, BSN, RN, DNP-S; Janella Reske, MSN, RN, CPNP; Heidi Flori, MD; and Elizabeth Duffy, DNP, RN, CPNP
Poster number: 2
Presentation date: Monday, April 5, 9:50 a.m.

Bolus off the pump (BOP) is a new delivery method for intravenous as-needed (PRN) pain and sedation doses in the pediatric intensive care unit (PICU) at C. S. Mott Children’s Hospital. Nurses decide when a dose is needed based on pain scores and Richmond Agitation-Sedation Scale score goals. After one year of BOP, it is unknown if it is more efficient and desired than the traditional method of giving PRNs from the Pyxis. This project aims to assess current nursing practice surrounding administration of intravenous pain and sedation medications. This includes evaluating nursing documentation that supports the decision to administer a PRN dose. Another aim is to increase nurse knowledge of the efficiency of each PRN method. If BOP is more efficient, sustainability efforts aimed at this delivery method could increase its use and improve nursing satisfaction for administering PRN pain and sedation doses. Project implementation concludes in March.

Implementing Standardized Post-Intensive Care Unit Syndrome Education in the Pediatric Intensive Care Unit

Authors: Abigayle Alger, BSN, RN; Tonie Owens, MSN, RN, CNS-C; and Elizabeth Duffy DNP, RN, CPNP
Poster number: 5
Presentation date: Monday, April 5, 10 a.m.

Post-intensive care unit syndrome (PICS) is a complex and common result of a patient’s admission to the intensive care unit resulting in physical, cognitive or psychological symptoms. There are approximately 5.7 million annual admissions to the ICU and of those, 4.8 million will survive. Greater than 50% of the surviving patients will suffer from component of PICS (Traube et al., 2016). This quality improvement project will include implementing standardized caregiver education related to PICS and assessing the feasibility of the intervention. A customized pediatric brochure will be given to the caregivers of patient’s admitted to the pediatric intensive care unit (PICU) by the bedside nurse. These nurses will then be surveyed to assess feasibility of the intervention. This project will take place in the PICU at C.S. Mott Children’s Hospital.

A pilot study to assess the feasibility and acceptability of a peer-based HIV testing and counseling intervention to increase HIV testing among female sex workers in Guatemala

Authors: Ava Padgett and Erin Kahle
Poster number: 6
Presentation date: Monday, April 5, 10:10 a.m.

Female sex workers (FSW) in Guatemala experience high prevalence of HIV in the context of barriers to health care and discrimination. Community-engaged approaches are effective in promoting education, reducing barriers and increasing prevention of HIV. We conducted a pilot study to explore the feasibility and acceptability of increasing HIV testing and prevention through peer-based HIV testing and counseling among FSW in Guatemala. Study participants (N=24) attended an HIV testing and counseling training and participated in two follow-up, peer-based HIV testing and counseling sessions. Average HIV knowledge increased 25% post-training (p=0.01). All participants completed the first HIV testing and counseling session, and 83% completed the second session. Participants reported generally high acceptance of the training and testing sessions. Data from this project will inform the development of a larger HIV prevention intervention to increase HIV testing and engagement in HIV prevention through community engagement and empowerment.

National Survey of Clinical Learning Center Sustainability Efforts

Authors: Jessica Marsack, Ph.D., RN, CMSRN; Meg Czerwinski, Ph.D., RN, BA; Melissa Bathish, Ph.D., RN, CPNP-PC; and Deborah Lee, Ph.D., FNP, ACNP-BC
Poster number: 12
Presentation date: Monday, April 5, 10:20 a.m.

Simulation education is necessary to teach the psychomotor skills needed to safely perform clinical tasks and procedures. However, the cost and accumulation of plastic waste is extensive, and little research exists regarding best practices for environmental sustainability in simulation education. Therefore, the aim of this work was to survey the state of current sustainability practices in health care simulation. Of 77 simulation centers in 31 different states, 82% stated “no” or “I’m not sure” when asked if their center had a written sustainability plan, 42% said their center recycled supplies, and 97% reused supplies in some way. However, only 36% felt the sustainability efforts of the institution were appropriate. These results reflect an interest in sustainability but a lack of solutions in current practice. It is imperative that we understand and implement sustainable practices to reduce the environmental impact of plastic waste while maintaining fidelity in simulation education.

Developing and validating an online resource directory for a life skills intervention aimed at same-sex attracted youth

Authors: Tanaka Chavanduka, MPH; Gregory Sallabank, MA; Alison Walsh, Ph.D., MPH, MFA; and Rob Stephenson, Ph.D.
Poster number: 20
Presentation date: Monday, April 5, 10:30 a.m.

The Centers for Disease Control and Prevention has outlined geographically and racially diverse regions in the United States heavily impacted by HIV. We aim to test the efficacy of an online life skills intervention on cognitive and behavioral HIV-related outcomes for same-sex attracted adolescent men (ages 13-18) to reduce HIV-related risk factors that can continue across the lifespan. We describe the development of the online intervention, with particular attention to the process for developing and validating a local resource directory of over 8000 LGBT-friendly resources. We describe the methods and validation systems used to identify, validate and enroll local resources into a complex online intervention. Tools that foster self-efficacy and resilience can empower LGBTQ+ youth to establish control of their individual health during a critical life period. The identification and validation of local resources is a central element of this process and a vital step for this overlooked population.

Education Impact in Medical Surveillance for Handling of Hazardous Drugs

Authors: Kristiana Hila
Poster number: 29
Presentation date: Monday, April 5, 10:40 a.m.

Proper handling techniques and surveillance programs are crucial for the safety and well-being of individuals working with hazardous drugs (HD). Active measures must be taken to identify workers at risk for exposure to HD through the management of their daily job requirements. The purpose of this study is to explore the impacts of education on those handling HD, specifically nurses who are exposed and their beliefs on exposure. Medical surveillance is only one of the ways recommended to help limit any harmful exposures to employees and can consist of things such as educational sessions. The use of educational seminars or training can equip nurses and staff with the knowledge to properly handle HD. Conclusively, these interventions and process of implementation can act as a base of knowledge for the future integration of education in medical surveillance throughout many varying health systems to protect the well-being of their employees. 

Development of the National COVID-19 Convalescent Plasma Project Website

Authors: Kathy Sliwinski and Megan J. Eagle, MSN, MPH, FNP-BC
Poster number: 35
Presentation date: Monday, April 5, 10:50 a.m.

My experiences in working on the National COVID-19 Convalescent Plasma Project include assisting with the development of the National COVID-19 Convalescent Plasma Project website and an investigation of convalescent plasma as a treatment option for COVID-19. By working with an interdisciplinary team of physicians and graduate students with backgrounds in biostatistics, epidemiology and public health, we worked to further develop the “Health Care Providers” component of the website. We added a variety of up-to-date literature on the use of convalescent plasma as a treatment option for COVID-19, monitored FDA postings and clinical trials, and found additional helpful resources including COVID-19 multilingual resources. Meaning: By applying the skills I’ve developed in my global nursing studies, I was able to help on a national context. We were able to develop the National COVID-19 Convalescent Plasma Project website and provide an abundance of resources for physicians and other health care providers.

Combine: Preferences for a HIV prevention app among MSM (men who have sex with men) in the rural southern U.S.

Authors: Leland Merrill, Rob Stephenson, Ph.D., and Jeb Jones
Poster number: 48
Presentation date: Monday, April 5, 11 a.m.

Uptake of HIV/STI testing among men who have sex with men (MSM) in the rural southern U.S. is low. However, HIV/STI testing is a fundamental gateway to preventative services. Thus, it is critical that we identify methods to increase uptake of HIV/STI testing among this population that is disproportionately affected in terms of HIV and STI incidence. Methods and findings: We propose to adapt an existing, efficacious HIV prevention app, HealthMindr, for MSM in rural areas to address issues specific to this population. We will conduct in-depth interviews, focus group discussions, and surveys to identify preferences of key stakeholders and potential end-users for a sexual health app for sexual minorities in the rural southern U.S. The results of this research will be used to inform the development of an app to promote HIV/STI testing and overall sexual health among MSM in the rural southern U.S.

A Qualitative Exploration of Home-Based Care Provider Needs in Disaster Affected Settings

Authors: Sarah Dickey and Sue Anne Bell, Ph.D., FNP-BC, NHDP-BC, FAAN
Poster number: 54
Presentation date: Monday, April 5, 11:10 a.m.

With climate change fueling an increasing frequency and intensity of disasters, it is imperative that health care providers are prepared to meet the increased health care needs that come with disasters. The purpose of this study was to address the knowledge gap around mental health needs of home-based care providers in disaster affected settings. This qualitative study used focus groups with home-based care providers (n=25) in disaster affected locations to understand challenges providers face. Findings suggest a need for disaster-related mental health care for providers in order for them to address the complexities of working in disaster response and recovery in a home-based setting. Although providers displayed resilience and adapted to meet the needs of their patients, increased mental health training can aid home-based care providers in their increased responsibility of providing home health services post disaster.

Public health information dissemination during the Covid-19 pandemic: The experience of home health care providers

Authors: Zoe Rettell and Sue Anne Bell, Ph.D., FNP-BC, NHDP-BC, FAAN
Poster number: 55
Presentation date: Tuesday, April 6, 10:40 a.m.

The objective of this study was to understand the experiences of home health care providers in coordinating with local, state and federal government during the COVID-19 pandemic. This study addresses the experiences of home health providers’ attitudes surrounding communications during the COVID-19 pandemic. This qualitative study interviewed 27 home health professionals on their experiences providing care during the COVID-19 pandemic. We identified three themes that contributed to provider confusion around effective care practices: lack of cohesive messaging across government agencies, slow information dissemination to home health care agencies, and lack of policy flexibility in light of the pandemic. These findings highlight the need for information dissemination strategies targeted towards home health agencies during public health emergencies. Our next steps are to explore the development of interventions to promote effective methods of information exchange between care providers and public health officials to ensure that evidence-based care planning occurs.

Impact of K-Cards on Nursing Practice

Authors: Jessica Viale; Amanda Chiti, BSN, RN, CPHON; Nancy Tena, MSN, CNS-BS, CPHON, BMTCN; and Elizabeth A. Duffy DNP, CPNP
Poster number: 62
Presentation date: Tuesday, April 6, 10:50 a.m.

Central line-associated bloodstream infection (CLABSI), defined as a laboratory confirmed infection that occurs due to the insertion of a central line, creates several health concerns in pediatric oncology patients. These infections can further hinder an already immunocompromised patient's health. CLABSI may result in fevers, respiratory distress and, unfortunately, death. One way health care providers work to reduce the incidence of CLABSI is by utilizing a central venous catheter care bundle. The components of this bundle include specific guidelines for practitioners to follow. Steps in this bundle are often missed, resulting in an increased incidence of CLABSI. Kamishibai cards (K-Cards) is a tool created to reduce the incidence of missed steps by providing a checklist providers can refer to while caring for a patient. In October 2020, the Coach Carr Cancer Unit began the implementation of K-cards. The focus of this quality improvement project is to assess the usability of the K-Cards and their impact on nursing practice. This project is ongoing and implication will be discussed.

Diabetes prevention and risk evaluation

Authors: Bradley Liestenfeltz, BSN, RN; Mario Pallazola; and Laura Saslow, Ph.D.
Poster number: 65
Presentation date: Tuesday, April 6, 11 a.m.

Individuals with an immediate family history of Type 2 diabetes are themselves at increased risk of developing the disease. This study aims to examine the differences in disease risk perceptions and cues to action received by normal weight (BMI<25) and overweight (BMI>25) individuals with a family history of Type 2 diabetes. This cross-sectional analysis of individuals surveyed with a family history of diabetes found overweight individuals self-identified as higher risk for developing type 2 diabetes compared to normal weight individuals. Overweight individuals also experienced greater cues to action to engage in diabetes prevention interventions. It appears that efforts to increase awareness of disease risk and provide cues to action to increase program engagement are effectively targeting the population in need. Further research into engagement in the Diabetes Prevention Program should utilize the knowledge that overweight individuals are receiving cues to action and bridge the gap between those cues to action and making sustainable lifestyle changes.

Substance Use and Suicidality among Adolescent Psychiatric Inpatients

Authors: Kaitlyn McDonald; Clare Hoerster, BSN honors student; Jai P. Ahluwalia, medical student, New York Medical College; Rhonda Schultz, BSN, RN; Robert J. Ploutz-Snyder, Ph.D., research professor,  PStat®; and Stephen Strobbe, Ph.D., RN, PMHCNS-BC, CARN-AP, FIAAN, FAAN
Poster number: 66
Presentation date: Tuesday, April 6, 11:10 a.m.

Among adolescents with mental health conditions, concurrent substance use has been linked to more complicated clinical presentations, and poorer outcomes. We examined demographic and clinical characteristics among adolescents (n=133, ages 14-18) admitted to a psychiatric inpatient unit at a major university hospital who were screened for substance use and suicidality. Fully half (n=67, 50%) reported any past year substance use, with the most common being marijuana (n=59, 45%), followed by alcohol (n=36, 27%). Eighty two percent (n=108) acknowledged suicidal thoughts prior to admission. Those who used alcohol and/or other drugs were 4.5 times more likely to endorse suicidal thoughts than those who did not. In addition, those with any past year substance use were significantly more likely to report intent to complete suicide. Our findings demonstrate strong associations between substance use and suicidality, and the importance of screening for substance use among adolescent psychiatric inpatients.

Preliminary Evaluation of a Multi-site, Patient-Centered Cancer Care Intervention: The Alliance to Advance Patient-Centered Cancer Care

Authors: Chelsea Andrews, MPH; Sara Turner, MS; Martha Quinn, MPH; Robert Ploutz-Snyder, Ph.D., PStat®; Bidisha Ghosh, MS; Bingxin Chen, MA; Debra Barton, Ph.D., FAAN, RN; and Christopher Friese, Ph.D., RN, AOCN, FAAN
Poster number: 71
Presentation date: Tuesday, April 6, 11:20 a.m.

Despite advances to cancer care in the United States, vulnerable and underserved populations are disproportionately affected by a highly fragmented system. How well do the Alliance to Advance Patient-Centered Cancer Care (Alliance) interventions address cancer care concerns at the patient, clinical staff and institutional levels? In 2018-19, a total of 719 patients were enrolled across four reporting Alliance sites: 65.7% received navigation services, the average time between scheduling and attending the first oncology appointment was 11.2 days, and the percentage of missed appointments was 22.1%. In a subset analysis (n=70), 62.9% of patients reported feeling actively engaged in treatment and 70.0% reported "feeling heard" in decisions about their care. The Alliance is a promising approach to addressing cancer care concerns (e.g., access, engagement and adherence to care) at the patient, clinical staff and institutional levels. Strengths of this approach include multidisciplinary implementation teams and a patient-centric philosophy.

Neonatal Pain, Agitation, and Sedation Scale Use, Reliability, and Validity: A Systematic Review

Authors: Mikayla E. Morgan, BSN honors student; Stephanie Kukora, MD; Michelle Nemshak, DNP, RNC-NIC, ACCNS-N; and Clayton J. Shuman, Ph.D., MSN, RN
Poster number: 73
Presentation date: Tuesday, April 6, at 11:30 a.m.

The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) is recommended by the American Academy of Pediatrics to measure neonatal pain and sedation. However, little is known regarding its reliability and validity for diverse neonatal subpopulations. Twenty-nine studies were included in our review, demonstrating broad application of N-PASS and good or excellent reliability and validity for various neonatal subpopulations. Our systematic review found N-PASS to be valid and reliable for many but not all neonatal subpopulations. There is a lack of support for N-PASS reliability and validity for measuring prolonged pain and sedation in non-mechanically ventilated infants and for acute pain in post-operative infants in any gestational age category. Overall, N-PASS is a psychometrically sound and pragmatic instrument evaluating pain and sedation for most neonatal populations. Future research using N-PASS is encouraged to evaluate and report its validity and reliability, especially for neonatal subpopulations not included in this review. 

Perceived Work Exposures and Health Risks Among Michigan Nail Salon Workers

Authors: Jenny Dang
Poster number: 74
Presentation date: Tuesday, April 6, 11:40 a.m.

Nail salon workers face many occupational hazards including exposure to harmful chemicals, ergonomic risks and immigrant-related factors such as language barriers. Research has been conducted on the connection between nail salon work and various health outcomes, however little is known about how the workers themselves come to understand these risks. Having a better understanding of workers’ perceptions on health and safety concerns can inform future interventions in clinical practice, policy and research that will address these issues. This qualitative study was informed by the phenomenology methodological framework. It was found that lack of or discrepancies in knowledge, pressure from customers and lack of resources for immigrants increased risk for exposure. The findings suggest that there is a strong need for culturally appropriate educational interventions (such as training on hazards and refresher courses) and policy changes in nail salons, nail product companies and vocational training programs to address occupational hazards.

TouchPoint: Undergraduate Immersion Activity

Authors: Linda Macera-DiClemente, DNP, BA, RN, and Peggy Ann Ursuy, Ph.D., RN, PPCNP-BC
Poster number: 75
Presentation date: Tuesday, April 6, 11:50 a.m.

TouchPoint is an innovative approach to the traditional clinical post-conference for pre-licensure BSN students in an immersion experience. The main objective of TouchPoint is to build relationships between faculty and students by connecting and exploring feelings, emotions, fears and anxieties in an unscripted method of deep, meaningful, reflective sharing. The TouchPoint activity is a synthesis of moving stories told by nursing students. These sessions are valuable for students as they witness death, experience newfound independence and autonomy, practice anticipation and apply new knowledge acquisition with critical thinking at the bedside. TouchPoint sessions promote psychological safety, build resiliency and enhance student metacognitive knowledge and awareness. The safe space created optimizes a structured learning activity that opens discussion of sensitive topics such as death, dying, gossip, loss, unsupportive nursing staff, joy and happiness as the patient goes home, and the supportive nature of nurse mentors throughout these positive and negative experiences.