Nurses Shaping Healthcare
A Conference for Clinicians, Academicians
and Researchers Interested in Nursing Research
April 27, 2012
Brandt Student Center
Main Campus
Shenandoah University
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Welcome
On behalf of the Rho Pi Chapter of Sigma Theta Tau International (STTI) and the
Shenandoah University Division of Nursing, we welcome you to the 14th Annual Nursing
Research Symposium.
Modeled after the Sigma Theta Tau International goals of superior achievement,
leadership, high professional standards, creativity and scholarship, this conference is designed
to provide opportunities for clinicians, academicians and researchers to join together in an
exploration of the latest in nursing research here in the Shenandoah Valley. It also is meant to
stimulate fresh ideas about the applicability of research to practice. We hope this conference
provides you with opportunities to learn, to share, and to establish new connections and
collaborations with colleagues. Additionally, this conference is planned to address the culturally
diverse needs of our community, both in practice and education.
Special thanks to the following organizations for helping to make this program possible:
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Shenandoah University Division of Nursing
Shenandoah University Alumni Association
Winchester Medical Center
 We gratefully acknowledge the members of the Rho Pi Chapter for their creativity, hard
work and dedication to raising the level of nursing scholarship in the Shenandoah Valley.
 We would like to thank the Office of Alumni Affairs for its support and for sponsoring
our breakfast.
 We further acknowledge Lyn Bacha, Continuing Education Coordinator, and Andrea
Schmahl, Secretary. Without their assistance, none of this could happen.
 We wish to thank Rho Pi planning committee:
 Marian Newton
Beverly Van Metre
 Rosalie Lewis
John Goldizen
 Cheryl Dumont
Janice Smith
 Karen Gonzol
Wanida Wanant
 Jennifer Matthews
Kathryn Ganske
Special thanks to our Shenandoah University students assisting with introductions,
coordination, and duties as assigned! 
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Overview
All nurses have a role in scholarship and research. The Rho Pi Chapter of
Sigma Theta Tau International Nursing Research Symposium is designed to
promote evidence-based practice in clinical and scholarly endeavors. Nurses
remain engaged in all aspects of healthcare and nurses are vital for sharing
healthcare.
Keynote speaker Dr. Kenneth R. White will present “The Business Case for
Palliative Care: What Every Nurse Should Know.” Additionally, our featured panel
will present “Our Paths, Yesterday to Today,” highlighting how five Shenandoah
University graduates have shaped healthcare. An ongoing goal for this year’s
Research Symposium is to facilitate continual networking with colleagues. The day
will be lively, interactive, and filled with enthusiasm by the scholarly podium and
posters presentations of our esteemed colleagues.
Program Objectives
 Make a business case for nurse-led palliative care services which provide
high-quality patient/family-centered care across specialty practices
 Discover contributions to and directions in nursing practice based on the
experiences of experts from varied career paths
 Interact with nurse colleagues involved in scholarship
 Explore nursing research activities and other scholarly initiatives that
demonstrate how nurses shape healthcare
 Engage in strategies to expand knowledge and skills in interpreting nursing
scholarship and practice in shaping healthcare
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CONTINUING EDUCATION STATEMENT
Nursing Contact Hours
Shenandoah University is an approved provider of continuing nursing
education by the Virginia Nurses Association Continuing Education Approval
Committee, an accredited approver by the American Nurses Credentialing
Center's Commission on Accreditation. This program has been awarded five
contact hours.
To receive five contact hours, the nurse must attend all sessions, complete
an evaluation form and return it at the end of the conference for a CE certificate.
No partial credit is given. RN students attending as part of required course
curricula will not be awarded continuing education credit.
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Nurses Shaping Healthcare
Friday, April 27, 2012
Brandt Student Center, Main Campus, Shenandoah University
Rho Pi Chapter of Sigma Theta Tau International at Shenandoah University
is proud to present
The 14th Annual Research and Scholarship Symposium
Program
8:00-8:30
8:30-9:00
Registration (Brandt Student Center)
Welcome and Introductions (Ferrari Room)
Bryon Grigsby, PhD, Senior Vice President and VPAA, Shenandoah University
Kathryn Ganske, PhD, RN, Director, Division of Nursing, Shenandoah University
Beverly VanMetre, MS, BSN, CHES, RN, Vice President, Rho Pi Chapter, STTI
Invocation
Reen Markland, RN, FCN, Regional Parish Nurse Coordinator
9:00-10:00
Keynote Address (Ferrari Room)
Student Introduction: Patricia Prahlad, BSN, RN, CPHQ
"The Business Case for Palliative Care: What Every Nurse Should Know”
Kenneth R. White, PhD, MPH, MSN, RN, FACHE
10:00-10:15
Break and Silent Auction
10:15-10:45
Poster Displays and Dialogue with Nurse Researchers
10:45-11:50
Concurrent Paper Presentations
11:50-12:45
Lunch (provided) and Silent Auction
12:45-1:45
Afternoon Feature Presentation (Ferrari Room)
Student Introduction: Katherine Sartelle, BSN, RN
“Our Paths, Yesterday to Today”
John Goldizen, MSN, RN, CCRN
Carolyn Guinn, MSN, RN
Lisa Cantore Letzkus, MSN, RN, CPNP-AC, CCRN
Carol O’Leary, MSN, RN, CS, NP-C
Ruth Wenzel, MSN, RN, FNP-BC, CDE
1:45-2:15
Awards Presentation and Silent Auction Winners Announced (Ferrari Room)
Update on Chapter News
Beverly VanMetre, MS, BSN, CHES, RN, Vice President, Rho Pi Chapter, STTI
2:15-2:30
Break
2:30-3:00
Poster Displays and Dialogue with Nurse Researchers
3:00-4:05
Concurrent Paper Presentations
4:05-4:30
Program Evaluation and CE Certificates
The Nurse Planners, content experts, and presenters for the Rho Pi Scholarship and Research Day each attest there are no
conflicts of interest of a personal, financial, or professional nature in relation to this educational activity. The Nurse Planners for
this activity are: Beverly vanMetre, Cheryl Dumont, Rosalie Lewis, Marian Newton, Wanida Wanant, Kathryn Ganske, and
Jennifer Matthews
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Research Presentations
10:45-11:15 a.m.
Ferrari Room
The Motherhouse Made All the Difference:
A History of the Milwaukee Lutheran Deaconess Nurses 1863-1913
Lisa M. Zerull, PhD, RN, FCN
Room 118
Screening for Depression and Anxiety in the Obese in a Rural
Free Clinic
Cheryl Kenney, MSN, RN, FNP-BC
Room 120
Body Mass Index as a Predictor of Readiness to Change in Overweight and
Obese Adolescents
N. Danielle Lutman, MSN, RN, FNP-BC
11:20-11:50 a.m.
Ferrari Room
The Use of Virtual Reality for Stress Management in College Students
Billinda Tebbenhoff, MSN, RN, CNS
Room 118
Rural Health Providers, Their Perceptions and Readiness for Telehealth
Roberta McCauley, MSN, RN, FNP-BC
Room 120
Personality and Dissociative Disorders: Implications for Assessment,
Diagnosis and Treatment
Katherine Guard, MSN, RN, PMHCNS-BC
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Research Presentations
3:00-3:30 p.m.
Ferrari Room
The Motherhouse Made All the Difference:
A History of the Milwaukee Lutheran Deaconess Nurses 1863-1913
Lisa M. Zerull, PhD, RN, FCN
Room 118
Post Traumatic Stress Disorder in Primary Care Setting
Eleanor Gooch, MSN, RN, PMHNP-BC
Room 120
What Are the Differences in Patient Quality of Life Outcomes in
a Nurse Practitioner-Managed External Counterpulsation
Therapy Clinic and a Non-Nurse Practitioner-Managed
External Counterpulsation Therapy Clinic?
Debra Myers, MSN, RN, FNP-BC
3:35-4:05 p.m.
Ferrari Room
The Use of Virtual Reality for Stress Management in College Students
Billinda Tebbenhoff, MSN, RN, CNS
Room 118
Barriers to Enrollment in a Health Promotion Program for
Heart Failure Patients
Christine A. Newcomer, MSN, RN, GNP
Room 120
The Effects of Depression on Diabetes as Evidenced by the Relationship
between Patient Healthcare Questionnaire (PHQ-9) Scores and the
Patient’s Glycohemoglobin (HbA1c)
Lana H. Vann, MSN, RN, FNP-C
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Keynote Speaker
Kenneth R. White, PhD, MPH, MSN, RN, FACHE
Featured Panel
John Goldizen, MSN, RN, CCRN, Moderator
Carolyn Guinn, MSN, RN
Lisa Cantore Letzkus, MSN, RN, CPNP-AC, CCRN
Carol O’Leary, MSN, RN, CS, NP-C
Ruth Wenzel, MSN, RN, FNP-BC, CDE
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Kenneth R. White, PhD, MPH, MSN, RN, FACHE
Dr. Ken White has more than 38 years of experience in healthcare organizations in clinical,
administrative, governance, academic, and consulting capacities. He worked for 13 years with Mercy
Health Services as a senior executive in marketing, operations, and international healthcare consulting.
From 1995 to 2001, Dr. White served as the associate director of the graduate programs in
health administration (MHA and MSHA) at Virginia Commonwealth University. From 2001 to 2008 he
served as director of VCU’s Master of Health Administration and dual degree (MHA/JD and MHA/MD)
programs. From 2006 to 2009 he served as VCU’s first Charles P. Cardwell, Jr. Professor.
Dr. White is a Fellow and former member of the Board of Governors of the American College of
Healthcare Executives. At VCU, he holds a joint appointment as professor of nursing and visiting
professor of the Luiss Guido Carli University in Rome, Italy, and the Swiss School of Public Health, in
Lugano, Switzerland.
Dr. White received a PhD in health services organization and research from VCU. He earned an
MPH in health administration from the University of Oklahoma and an MS in nursing from VCU. Dr.
White is currently completing a post-master’s certificate at the University of Virginia to be an acute care
nurse practitioner with a specialty in palliative care and pain management.
Dr. White has extensive experience in hospital administration and consulting, particularly in the
areas of leadership development, marketing, facility planning, and management of operations. He is
coauthor (with John R. Griffith) of The Well-Managed Healthcare Organization, 5th, 6th, and 7th
editions, Thinking Forward: Six Strategies for Successful Organizations, and Reaching Excellence in
Healthcare Management (published by Health Administration Press). Dr. White is a contributing author
in the book Human Resources in Healthcare: Managing for Success and Evidence-Based Management in
Healthcare (Health Administration Press). He is also a contributing author in the books Advances in
Health Care Organization Theory (Jossey-Bass), Peri-Anesthesia Nursing: A Critical Care Approach
(Saunders), On the Edge: Nursing in the Edge of Complexity and Introduction to Health Services
(Delmar).
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Poster Presentations
Reinforcing Continuity of Care with Two Day Discharge Telephone Calls
Rosalie Lewis, MS, BSN, CMSRN, ONC
HPV Vaccine and Preteen/Teen Girls
Lynda C. Miller, RN
Efficacy of Midline Placement by Nurses at the Bedside
Melissa Freze, RN: Meredith Baker, BSN, RN; Debbie Knippenberg, RN, CRNI;
Nancy Stoop, RN; Tammy Brannon, RN; Cathy Dalton, RN; Ronee Fertig, RN;
Debbie Gnegy, RN, CRNI; Ozlem Getz, RN; Sheri Miller, RN, CRNI; Cheryl Dumont,
PhD, RN, CRNI
Gender Bias in Specialized Areas of Nursing
Cassandra Broffitt, RN; Jennifer Onyeador, Ashley Schwab, Kelly Statz, and
Rebecca Stephenson
Rounding in Acute Care
La Donna Williams, MSN,RN, CMS; Cheryl Dumont, PhD, RN, CRNI, and the
Rounding Taskforce members: Terri Wright, Vanessa Peters, Chris Francis, Mark
Miller, Susan DeVogel
Telemedicine for the Homebound Client
Sheila Wetherell, RN
Investigating Adolescent Males’ Understandings of Psychological Hurt:
A Qualitative Study
Barbara Frechette, DNP, RN, PMHNP
Interdisciplinary Research Mild Cognitive Impairment: From Idea to Publication
Marian Newton PhD, PMHNP,*List of team members at end of abstract
Patients’ Perception of Ethnically Diverse Nurses
Wanida Wanant, PhD, RN
Janice Smith, PhD, CNE, RN
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Kenneth R. White’s
Presentation
Dr. White’s presentation
The Business Case for Palliative Care:
What Every Nurse Should Know
The link to Dr. White’s presentation can be found at:
http://rhopi.nursingsociety.org/RhoPiChapter/Events/EventDescription/?CalendarEventKey=3e005f7
4-e8c9-465b-b206-9624627018c7
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Featured Panel
Presentation
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Research
Presentations
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Body Mass Index as a Predictor of Readiness to Change in Overweight and Obese Adolescents
N. Danielle Lutman, MSN, RN, FNP-BC
Elizabeth Courts, DNP, RN, FNP-BC, Faculty Mentor
Background: Childhood obesity presents a public health concern worldwide due to the effects on
morbidity and mortality. Obesity is one of the most common disorders of childhood with known
adverse consequences and is now considered a public health epidemic. Healthcare providers must work
with children and families to ensure improved health. One intervention is through an assessment of
readiness to change. Many researchers suggest that it is part of a clinician’s duty to assess and motivate
families struggling with childhood obesity rather than to prescribe interventions without measuring ones
readiness to change.
Purpose: This research study investigates two questions: What is the relationship between body mass
index (BMI) and readiness to change in overweight and obese adolescents, and, what level of BMI is
predictive of readiness to change in the overweight and obese adolescents? The purpose is to describe
the relationship between readiness to change and overweight or obesity, as defined by BMI, and to find
evidence if BMI is a predictor of readiness to change in the overweight and obese adolescent.
Methods: Adolescents presenting for routine visits will have their, height, weight, BMI, and BMI
percentile calculated by nurses in the practice trained in the data collection procedure. Based on
established percentiles, overweight or obese adolescents will be identified and recruited for the study.
Once overweight or obesity is determined, all potential subjects meeting inclusion criteria will be
provided informed consent. Consenting adolescents will be administered the Child Readiness to Change
Questionnaire, a short, self-reported questionnaire. Demographic data to include age, sex, and race will
also be collected.
Protection of Human Subjects: This research has been approved by the Human Subjects Review Board
for Shenandoah University and the Institutional Review Board for Valley Health Systems.
Findings: This research project is ongoing. Available findings will be shared as aggregate data is
collected.
Plan for Analysis: Using Pearson correlation and simple regression analysis, the relationship between
readiness to change and BMI, and the predictive BMI value will be revealed. Descriptive statistics will be
used to describe demographic data. The statistical package for the social sciences (SPSS) version 19, will
be utilized and consultation with statistically trained research faculty.
Strengths and Limitations: Parent and child readiness to change have been identified as significant
emerging areas guiding pediatric obesity intervention programs. This project further explores how BMI,
weight, and demographic factors may play a role in weight management approaches. Limitations
include a sample size that may not provide reliability and validity of the findings. Additionally,
demographic variables may demonstrate low generalizability to all populations.
Conclusions: Conclusions are to be determined.
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Screening for Depression and Anxiety in the Obese in a Rural Free Clinic
Cheryl Kenney, MSN, RN, FNP-B
Francie Bernier, PhD, RN, Faculty Mentor
Background: Obesity is at epidemic proportions in America. According to the Centers for Disease
Control and Prevention (CDC) in 2010, the prevalence of overweight and obese adult Americans was
63.8%. There has been a tremendous increase in obesity over the past two decades (CDC, 2011). The
causes for obesity are not straightforward or easy to establish. The literature questions the nature of
the association between depression, anxiety and obesity and in fact, feels that it is probably
bidirectional in nature.
Purpose: The purpose of this study is to examine the relationship between depression and anxiety with
BMI among the obese that live in a rural area of the State of West Virginia.
Methods: Adults with BMI greater than 30 are recruited. Subjects complete the PHQ 9 (9 question
depression screen) and GAD 7 (7 question anxiety screen) tools. Demographic data collected include
age, sex, race, educational level, abdominal girth, BMI and comorbidities of Hypertension, Diabetes, or
Coronary Heart Disease.
Protection of Human Subjects: Shenandoah University IRB permission was granted on January 30, 2012.
Findings: Results are pending.
Plan for Analysis: Descriptive statistics will be used to describe demographic and comorbidity data.
Pearson’s correlation will test the relationship between BMI and Depression and Anxiety scores.
Strengths and Limitations: Strength of the study is the worldwide relevance and interest of the topic on
prevention of obesity and mental illness. Screening for comorbid mental disorders with obese patients
should be a priority for nurse practitioners equivalent to screening for diabetes, hypertension or
obstructive sleep apnea. Limitations of this study include a 50 subject sample size that may not provide
reliability and validity of the findings.
Conclusions: Conclusions to be determined.
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Post Traumatic Stress Disorder in Primary Care Setting
Eleanor Gooch, MSN, RN, PMHNP-BC
Marian Newton, PhD, RN, PMHNP, Faculty Mentor
Background: Post traumatic stress disorder (PTSD) is a psychiatric disorder that is found throughout
American society. Eight to nine percent of the population may develop PTSD at some point in their
lifetime and twenty-five to thirty percent of the victims of serious trauma will develop PTSD (Grinage,
2003). Patients in primary care clinics present for treatment of physical symptoms. A mental illness
diagnosis often is an unknown co-morbid condition. Patients in primary care settings often present with
physical illnesses that may have a fundamental origin in psychiatric problems. Currently, health care
providers do not routinely screen for mental illness. Holistic theory promotes treating the whole person
with an integrated approach instead of isolated symptom management.
Purpose: The purpose of the study is to investigate whether a routine, standardized screening in the
primary care setting will identify individuals with PTSD leading to its diagnosis.
Methods: The Breslau Short Screening Scale for PTSD (Breslau, 1999), a 7 item self administered
questionnaire yielding “yes” and “no” answers, will be used to screen patients presenting for treatment
at a local primary care clinic. A score of 4 “yes” answers suggests the presence of PTSD.
Protection of Human Subjects: The study has been approved by the Shenandoah University Institutional
Review Board.
Findings: Pending completion of the project
Plan for Analysis: Nominal data will be analyzed using SPSS. The data will be distributed among the
various demographic groups including gender, age, and educational level. Findings will be compared
according to the Breslau Short Screening Scale for PTSD and will be compared to the national statistics
for PTSD.
Strengths and Limitations: A screening scale with established validity and reliability will be used. A local
primary care clinic with a large clientele was found and has proved to be very supportive of the study.
Time constraints are limiting the size of the study sample.
Conclusions: Pending completion of the project
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The Effects of Depression on Diabetes as Evidenced by the relationship between the Patient Healthcare
Questionnaire (PHQ-9) scores and the Patient’s Glycohemoglobin (HbA1c)
Lana H. Vann, MSN, RN, FNP-C
Ginger Breedlove, PhD, RN, CNM, FACNM, Faculty Mentor
Background: The purpose of the study was to determine the importance of screening for the presence of the risk
of depression in diabetic patients, as it relates to their maintenance of normal glucose levels. The screening tool
used was the Patient Healthcare Questionnaire (PHQ-9), and the results were correlated with the patient’s
hemoglobin A1c, looking for additional evidence of meaningful relationships. The literature review performed
confirmed that many diabetic patients suffer from co-morbid depression, but the use of a standardized screening
tool to assess their risk for development of depression was not common practice.
Purpose: Is there a relationship between risk for depression and a patient’s glycemic control?
Methods: The quantitative study is currently being conducted in a large, rural, private clinic in Western Virginia. A
purposeful sample of diabetic patients in one ambulatory clinic have been recruited through notification by the
site of the study, and those interested were introduced to the study by trained nurses who have volunteered to
participate in the study. Having consented, subjects will be administered the PHQ-9 Inventory in a private, quiet
area, to screen for their risk for depression. The subjects’ lab value for the hemoglobin A1c result will either be
obtained from the chart if within the last three months, or will be drawn the day of the visit if that is when the lab
was due to be drawn. The score of the PHQ-9 will be compared with the HbA1c to see if they correlate in regards
to a higher PHQ-9 score equaling a higher HbA1c, which would indicate a more depressed client having poorer
glycemic control. A lower result on the PHQ-9 would indicate a less depressed or not depressed patient and the
lower HbA1c score would show better glycemic control. Patients found to be at moderate or severe risk of
depression would be offered the initiation of medication therapy, along with counseling referral.
Protection of Human Subjects: Shenandoah University IRB approval granted; the PHQ-9 screening is administered
with the staff nurse present in the room with the client. The screening tool is part of the medical clinics electronic
medical record. The PHQ-9 scores are confidential, as part of the medical record, and are not shared with anyone
other than those staff caring for the patient. The data will be reported as anonymous data, so no association of
testing to personal data scores or lab values will be disseminated. Should the patient be found to be at risk for
suicidal or homicidal ideations, or unable to contract for their own safety or the safety of others, the medical staff
and local police would be contacted to transport the patient to the nearest hospital, which is 0.5 mile away for
further evaluation and possible inpatient admission if deemed necessary.
Findings: pending
Plan for Analysis: The statistics will be analyzed using a Pearson’s R correlation method. The study is currently
ongoing and not complete at the time of this submission.
Strengths and Limitations: The strengths of this study are that patients who may be at risk for depression will be
identified by the administration of the PHQ-9 screening tool, and treatment can be initiated. Other strengths
include improving one’s glycemic control through diagnosis and management of depression in a world-wide
chronic illness, less cost to insurance companies by accurately diagnosing and treating patients, and helping
patients at risk cope with a lifelong chronic disease through health screening and promotion. The limitations are
the short amount of time to complete the study, the small number of subjects participating, and the inability to
follow up at three, six, nine, and twelve month intervals to determine if those found at risk for depression received
medication therapy, counseling, and diabetic education would achieve better glycemic control.
Conclusions: pending
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The Motherhouse Made All the Difference:
A History of the Milwaukee Lutheran Deaconess Nurses 1863-1913
Lisa M. Zerull, PhD, RN, FCN
Background: The Milwaukee Lutheran deaconess history began with the arrival of four Kaiserswerth
trained nurses in 1849. Soon after, the Institution of Protestant Deaconesses was established to provide
an organizational infrastructure of support. With every intention of transplanting the German model of
nursing care to America, the deaconess work was slow to expand as evidenced by the numbers of
women who left the diaconate and even fewer replacements. What were the reasons for slow growth?
After several decades, the establishment of a Motherhouse became a reality in Milwaukee adjacent to
the Lutheran hospital founded in 1863. This history explores the events and organizational decisions
made during the period and the influences to the deaconess work.
Purpose: This paper examines the influence of race, denomination, and organizational decisions on the
location and focus of nursing care for the Milwaukee Lutheran Deaconesses 1863 – 1913.
Methods/ Sources: Using a case study approach, a social history is constructed taking into consideration
social, religious, gendered, and denominational influences. Primary sources obtained from the
Evangelical Lutheran Church in America Archives and the historical collections found at the Milwaukee
Historical Society and the University of Wisconsin at Milwaukee. Secondary sources from textbooks and
printed literature were used where necessary to provide context and interpretation.
Protection of Human Subjects: IRB approval received from WMC IRB in 2011—expedited review and
exempt.
Plan for Analysis: N/A
Strengths and Limitations:
Strengths: In depth analysis of available archival materials for the Milwaukee deaconesses.
Limitation: Analysis considered the documents available from the primary archival sources at the ELCA
archives and the historical society of Milwaukee.
Findings and Conclusions: The Motherhouse structure originally created at the Kaiserswerth Deaconess
Institutions in Germany in 1836 was indeed an important element to the success and sustainability of
the deaconess work in Milwaukee. Hospital nursing and other health professions providing support to
the Milwaukee hospital was the primary deaconess branch of service. Modeled after the Kaiserswerth
deaconess model, many of the women held administrative positions at the Milwaukee hospital including
the supervision of medical staff. Given the social context of the period, care provision roles provided
acceptable work opportunities for women. Religious organizations and congregations believed that
providing care to the sick and the poor was their responsibility—not the responsibility of local or larger
government. Conclusions: (1) Faith based care was and still remains an integral part of community care
of the poor and the sick; (2) Organizational structures that consider social context and in particular, the
professional roles of women in healthcare are important to the sustainability of community outreach
initiatives; and (3) More health promotion initiatives can be accomplished in the community when
congregations collaborate with local, state, and national governments and social care agencies.
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Barriers to Enrollment in a Health Promotion Program for Heart Failure Patients
Christine A. Newcomer, MSN, RN, GNP
Juliana van Olphen Fehr, PhD, CNM, FACNM, Faculty Mentor
Background: Both prevalence and incidence of Heart Failure (HF) patients has increased drastically,
especially in those older than 65 years. Causes for this increase are due to the increased number of our
population who are aging and the improvement of survival in patients suffering from coronary diseases
(Task Force for Diagnosis and Treatment of Acute and Chronic Heart Failure, 2008).
HF is the leading diagnosis for hospital 30-day readmissions for Medicare beneficiaries (AHA, 2008).
Government and other third-party payers have vested interest in preventing HF hospitalizations and rehospitalizations. New quality indicators about the discharge process for HF patients have been
developed and data about re-hospitalizations have been made public (AHA, 2009).
Purpose: The purpose of this study is to identify patient’s barriers to enrollment in the HeartLink health
promotion program for HF patients.
Methods: This was a purposeful sample of readmitted HF patients between the age of 55 to 85 who
chose not to enroll in the HeartLink program, but who would have qualified to enroll.
The participants will be approached and consented to participate in face to face interviews. There are
nine questions for the participants to answer with the structured interview. The interviews will be
recorded. The demographic data will be analyzed with descriptive statistics. The last two questions of
the interview are open-ended. A comment analysis will be conducted on these questions to assess for
themes.
Protection of Human Subjects: Approval was received from both the Shenandoah University IRB as well
as the Inova Health System IRB. No identifying information will be used or shared.
Findings: Research data is not completely collected at this time, but preliminary findings appear to
demonstrate that patients are not effectively being given information about this health promotion
program
Plan for Analysis: Data will be transcribed from the recorded interview and entered into interview tools
in the survey software program. Once all interviews are completed, descriptive statistics will be used to
determine the answers most frequently given. The open-ended questions will be summarized in a
comment analysis.
Strengths and Limitations: Conducting face to face interviews with patients can be extremely valuable in
the insight gained. Interviews can be time consuming, very challenging, and unpredictable.
Conclusions: Although not fully completed, preliminary conclusions are giving insight into some
educational techniques to help get the information out to these heart failure patients. Utilization of
correct staff with time to discuss the program would seem most beneficial in gaining enrollment into
HeartLink.
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What Are the Differences in Patient Quality of Life Outcomes in a Nurse Practitioner-Managed
External Counterpulsation Therapy Clinic and a Non-Nurse Practitioner-Managed External
Counterpulsation Therapy Clinic?
Debra Myers, MSN, RN, FNP-BC
Pam Webber, PhD, APRN, BC, FNP, Faculty Mentor
Background: Enhanced external counterpulsation therapy (EECP) is a noninvasive treatment for
patients with coronary artery disease who experience symptoms such as severe or microvascular angina,
as well as those who have had unsuccessful revascularization procedures, or are not candidates for
invasive procedures. This form of therapy is usually conducted within specialized EECP clinics. Currently,
registered nurses, nurse practitioners, or technicians administer EECP therapy, and in many cases, these
individuals also manage the EECP clinics. Each manager type has a different level of education and
clinical training; however, each can elect to take the same national EECP certification examination. An
extensive, systemic review of the literature revealed that patients who have completed EECP therapy
have shown an increase in exercise tolerance, a decrease in nitrate use, and an overall improvement in
quality of life (QoL). However, the literature is limited with regard to the impact manager type plays in
relation to these quality of life outcomes.
Purpose: To determine if there is a difference among EECP clinic managers types in relation to
improved EECP patients’ quality of life outcomes.
Methods: The design for the study is mixed methods. The methodology for the study involves an
original survey for managers (descriptive, demographic information). Patient participants will be asked
to provide basic demographic data and to complete the Ferran and Powers (1984) ‘Quality of Life Index’
survey.
Protection of Human Subjects: This research study is currently under review by Shenandoah University
IRB.
Plan for Analysis: Data will be organized in the Statistical Package for Social Sciences (SPSS) and it is
anticipated that descriptive and comparative statistics will be used for analysis.
Findings: Pending
Conclusions: Pending
Strengths and Limitations:
Strength: The outcomes of the study have the potential to identify difference between manager type
and quality of life outcomes in EECP patients.
Limitations: Limitations of the study include the fact that only three clinics and only one of each
manager type are being used. The recommended N from each clinic will be between 15-20, which is
sufficient to demonstrate significance.
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Rural Health Providers, Their Perceptions and Readiness for Telehealth
Roberta McCauley, MSN, RN, FNP-BC
Jennifer Matthews, PhD, RN, ACNS, CNE, FAAN, Faculty Mentor
Background: The incline of the prevalence of chronic disease among the growing rural populations
coupled with the shortage of health care disciplines, obligates the use of cutting-edge technology in an
endeavor to meet the health care needs of rural Americans. The need for acceptance and use of
telehealth technology is imperative in rural practices as one considers an ominous statistic that only 9
percent of the total number of physicians practices in rural areas whereas 20 percent of the population
lives rurally. Literature reveals that telehealth technology could aid in addressing and meeting the
needs of rural Americans because it could ensure the timely and efficient provision of equitable health
care to the rural population. Current literature underscores that the success and sustainability of any
telehealth applications arises from the health care providers’ participation, understanding of potential
patient outcomes, and satisfaction with the telehealth program.
Purpose: The purposes of this study are to identify and highlight the perceptions that rural health care
providers have regarding the impact of telehealth as an aid for patients to access health care delivery
and the providers’ readiness state to implement telehealth technology into their practice setting.
Methods: This study will be a quantitative approach. The “Telemedicine Adoption Survey” to assess the
provider’s perceptions of the impact of telehealth on health care delivery, was sent via US postal mail to
rural health care providers (MD, DO, NP and PA) who practice primary care medicine in the HPSA or
MUA/MUP areas of the Potomac Highlands of West Virginia. The “Practitioner Telehealth Readiness
Assessment Tool”, crafted by the Health Telematics Unit at Calgary University, Canada, was also sent to
determine the individual provider’s readiness for telehealth implementation.
Protection of Human Subjects: This research study was approved by the Shenandoah University’s
Human Subjects Review Board (HSRB) on December 6, 2011.
Findings this research project is currently being completed and the findings are pending
Plan for Analysis: Data analyses include descriptive statistics, and simple correlation and regression
techniques. The social science (SPSS) software, version 19, computes the statistical data; in addition, the
expertise of a Shenandoah University research faculty member guides the data interpretation. Statistics
will measure the correlations to determine if there is a relationship between the provider’s perception
and their readiness state to implement telehealth technologies into their provision of patient care
practices.
Strengths and Limitations: There are several limitations with this study and include the lack of
information accuracy posted on the West Virginia Board of Medicine and West Virginia Professional
Nursing web sites. The sample size is relatively small and could affect the validity of the findings. The
strength of this study is that the survey instruments are well known and these findings add to the body
of information essential to determining effect that a provider’s perception of a change affects their
readiness to participate in the change.
Conclusions: Conclusions are not finalized. Findings will be presented during an oral presentation
43
Personality and Dissociative Disorders: Implications for Assessment,
Diagnosis and Treatment
Katherine M. Guard, MSN, RN, PMHCNS-BC
Background: Personality and dissociative disorders are often difficult to treat. The literature review
shows studies linking childhood trauma to multi-axial diagnosis in the DSM-IV. Most attitudes in
treatment have become focused on symptoms and behavior rather than the early developmental
wound these individuals suffer. Many individuals, although receive short term relief, may not be getting
treatment that supports more long term benefits.
Purpose: Are our psychiatric diagnoses and behavioral approaches to treatment missing the
identification and interventions for underlying traumas. Is there a treatment approach that works with
both the underlying wound and its outer manifestation of symptoms and behaviors.
Methods: Two scenarios are given to three supervision groups of practicing therapists. The first scenario
is a behavioral or DSM-IV approach to assessing psychiatric complaints. The second scenario provides a
developmental history of the underlying trauma. After each scenario is read participants are asked to
share their thoughts, feelings, and ideas around treating each example and the two are compared. The
participants are then instructed to place the first scenario on top of the second to demonstrate the
underlying wound to the patient’s presenting symptoms and behavior.
Protection of Human Subjects: Informal research
Findings: Attitudes in treatment are more negative when a behavior or symptom only presentation is
given as opposed to a history around the underlying wound that produces more feelings of empathy and
concern.
44
The Use of Virtual Reality for Stress Management in College Students
Billinda D. Tebbenhoff, DNP, MSN, RN, PMHCNS
Doug Granger, PhD
Marian Newton, PhD, RN, PMHNP
Linda Gerson, PhD, RN
Background: Stress is a significant problem in the college population in the United States (Kadison,
2004). Consistently elevated levels of stress are associated with alterations in physical health and mental
health, impaired glucose utilization, obesity, substance abuse, sleep disturbance and perceived lower
quality of life (Kingburg, 2008). Diaphragmatic breathing and guided imagery are methods that have
been demonstrated to reduce stress (National Center for Health Technology, 2012). Advances in
technology offer students the ability to download these stress-reducing techniques through mobile
devices.
Purpose: To evaluate the effectiveness of virtual reality for stress reduction in college students.
Methods: Students interested in participating in the study met with the study coordinator and provided
informed consent. Students completed a brief paper and pencil survey reporting basic demographic
information, major of study, current stressors, current medications and first day of last menstrual
period.
A total of four salivary cortisol samples were collected. Students collected two saliva samples before
beginning the intervention (pre-intervention, time zero) and two samples after using the app daily for
two weeks (post-intervention, time one). Saliva samples were collected upon waking and 30 minutes
post waking. Saliva samples were processed by the Johns Hopkins University Center for Interdisciplinary
Bioscience; the results were sent to the project coordinator via an encrypted excel file and imported in
to SPSS.
After baseline salivary cortisol samples were obtained, students were instructed to download the
Breathe2Relax app. Students were instructed to use the app as many times a day as they wanted, but at
least one time per day for two weeks. Subjective stress ratings are collected, stored and graphed by the
Breathe2Relax app before and after each use. Users are cued to rate their stress on a screen entitled
“How do you feel?” that displays a 30 mm line with a bubble that users move from left (relaxed) to right
(stressed). The app records these ratings on a graph, 0 (relaxed) to 5 (stressed). Students reported or
showed their results to the study coordinator or research assistant who entered these data by hand in
to SPSS.
Protection of Human Subjects: IRB approval was granted by Shenandoah University.
Findings: The first aim of this quality improvement project was to evaluate the effectiveness of using a
downloadable app for reducing subjective stress in college students; the outcome measure was
subjective stress ratings. A paired T-test revealed a significant difference between the mean ratings of
subjective stress before and after the intervention (Paired T-test- Pre-intervention Baseline M=2.48,
SD=.846, Post-Intervention M=122, SD=.518, t(23)=6.6, p=<.00 eta squared is 1.48 (large effect size).
The second aim of this project was to evaluate the effectiveness of using a downloadable app for
reducing physiologic measures of stress; the outcome measure was salivary cortisol. A paired T-test did
not show a significant difference between mean cortisol values before and after the intervention (Paired
45
T-test- Pre-intervention M=.30 SD= .14 and Post Intervention M=.28 SD .13, T(23)= .51, p=.61, M=.01,
SD=.12)
The third aim in this project was to evaluate student satisfaction with using the app. Upon completion of
the two-week intervention, students were provided with a computer link to an anonymous survey of
satisfaction with using the app. Overall, students reported that they were satisfied with the app, would
recommend the app to others, found the app easy to use and effective for the purpose of stress
reduction.
Strengths and Limitations: The study size was small, N=23 and not sufficiently powered to detect a
difference in cortisol values. There was no control group. The time of data collection was near the end of
the semester. Confounding variables of alteration in sleep patterns, testing taking stress and preparing
for graduation could have influenced the study results.
Conclusions: Guided imagery and diaphragmatic breathing are useful for stress reduction but the use of
these techniques delivered via virtual reality is a newer paradigm. The results of a quality improvement
study implemented at a private college in northwestern Virginia demonstrated success with the use of a
virtual reality relaxation app for reducing subjective stress in college students. Students were satisfied
with the app and found it easy to use. Use of the app was not associated with reduction in mean salivary
cortisol values but the small sample size renders these results inconclusive. Anecdotally, students
reported improved sleep, increased focus and an improved sense of well being while using the app.
46
Poster
Presentations
47
Reinforcing Continuity of Care with 2 Day Discharge Telephone Calls
Rosalie Lewis, MS, BSN, CMSRN, ONC
The main purpose of the discharge telephone calls is to reinforce the continuity of care.
Nurses assess patients’ perception of their discharge educational needs, ensure prescribed medications
are taken, answer questions, reinforce return appointment date and time, and improve patient
outcomes to prevent an unexpected readmission to the facility. However at one of the primary care
clinics currently reported achieving only 32% for this quality measure this fiscal year (October through
January). There is a call for improvement of the number of discharge telephone calls to at least 50% by
the end of September 2012.
Purpose: This report will focus on the result of an application of Deming’s Theory (PDSA) whether the
PACT (patient aligned care team) nursing staff will improve their quality measure of contacting by
telephone 50% of their primary care patient panel within 2 days of discharge after receiving additional
training.
Methods: Refresher training using lecture and PowerPoint’s for all PACT nurses on their afternoon
training day was completed in March 2012. Handouts, post-presentation, and written evaluation will be
included in the training. Performance data will be obtained from a secure site for the month of April
and thereafter for signs of improvement. Graphic displays the percentage of Discharge telephone calls
will be developed.
Protection of Human Subjects: This is a clinical project and does not require Human Subjects Review
Board approval.
Findings: This project is in progress. The data of discharge telephone calls will be reviewed.
Conclusions: When nurses initiate discharge telephone calls to patients, they are facilitating a nurturing
partnership and collaboration. Several other patient outcomes as a result of the discharge telephone
calls will also be discussed.
48
HPV Vaccine and Preteen/Teen Girls
Lynda C. Miller, RN
Background: The human papillomavirus (HPV) is the most commonly sexually transmitted disease with millions diagnosed
each year. The HPV vaccine Gardasil was introduced in June, 2006 and is recommended b the ACIP and AAP for young women
between the ages of 9-26 years of age. Teen girls are at risk for contracting HPV since a majority of them are initiating sexual
activity prior to the primary care practitioner (PCP) recommending the HPV vaccine. The human papillomavirus infection is
highest among young women within the first 3 years of their first sexual encounter. In addition, HPV is highly associated with
the development of cervical cancer.
The PCP is in a position to recommend and play a critical role in an HPV vaccination preventative strategies since a substantial
portion of primary care is provided to the care of children and adolescents. However, there are barriers that are perceived by
the PCP to recommending the vaccine such as: 1) the personal intention of the PCP to recommend the HPV vaccine, 2) the
professional or practice barriers for the PCP to providing the HPV vaccine, 3) the parental barriers presented against the HPV
vaccine, 4) the cost/insurance barriers for the PCP, and 5) the educational barriers of the PCP themselves.
The patient and/or family assume the risk of deciding whether or not to accept the HPV vaccination. Some significant variables
having the potential to influence whether the patient and/or family accept the rationale for the HPV vaccine are found to be
the following: 1) the PCP engages in HPV vaccine communications in early pre-teen, 2) the PCP focuses the HPV education as
cervical cancer prevention, and 3) the PCP provides information on the safety of the vaccine.
Purpose: To determine the frequency with which PCPs recommend the HPV vaccine (Gardasil) to eligible teenage girls and the
frequency in which the patient and/or family accepts the PCPs rationale for recommendation and allows vaccination?
Methods: This study will be triangulated with a descriptive focus.
Protection of Human Subjects: This study will be submitted to the Institutional Review Board of Shenandoah University for
approval prior to implementation.
Plan for Analysis: The data generated from the PCP and parent survey collection tools will be transferred to an Excel
spreadsheet where it will be organized for use and then transferred to the Software Program for the Social Sciences (SPSS) 18.
The PCP and parent demographic data will be reviewed and analyzed for representation of this study. The frequency
distribution analysis will be conducted on the PCP recommendations of the HPV vaccine, as well as the acceptance of
recommendation and vaccination from the parent data.
To support the study, the other data will be reviewed and analyzed for significance for recommending the HPV
vaccine for the PCP and accepting the HPV vaccine for the parents. In addition, the stated age of the teen girl when
recommendation for the HPV vaccine is likely given by the PCP will be analyzed. The qualitative open-ended questions to the
PCP regarding perceived barriers to recommending the HPV vaccine and to the parent regarding reasons for not vaccinating
their teen girl against HPV will be reviewed for emergent themes, grouped accordingly, and presented in the findings. The
other data collected will be reviewed and analyzed if the data is deemed significant to the study.
Conclusions: The epistemological significance of this study will be to identify whether the HPV vaccine is being recommended
to teen girls given the magnitude of literature that indicates perceived barriers of the PCP are shown to affect their intention
and recommendations of the HPV vaccine. In addition, the study will be identifying whether patient and/or parental barriers
continue to influence the acceptance of the HPV vaccination. Given that education has shown to be a key factor in patient and
parental acceptance of the HPV vaccine as well as one of the barriers identified for PCPs, education will be priority. Therefore,
publication will be sought for this research proposal at the completion of the data analysis in Spring of 2012. Highlighting,
understanding, and overcoming identified barriers that prevent teen girls from becoming vaccinated with the HPV vaccine can
assist in encouraging a rise in the vaccination rate. An increase in HPV protection will eventually reduce the healthcare burden
of cervical cancer. In addition, future studies are necessary to look at ways to assist teen girls and their parents and/or
guardians in ways to complete the 3-series vaccine for full HPV protection.
Findings: Pending
49
Efficacy of Midline Placement by Nurses at the Bedside
Melissa Freze, RN
Meredith Baker, RN, BSN
Debbie Knippenberg, RN,CRNI
Nancy Stoop, RN
Tammy Brannon, RN
Cathy Dalton, RN
Ronee Fertig, RN, RN
Debbie Gnegy, RN, CRNI
Ozlem Getz, RN
Sheri Miller, RN, CRNI
Cheryl Dumont, PhD, RN, CRNI
Purpose and Background: Many patients in acute care present with chronic diseases, a history of many
IV infusions, and poor vascular condition making peripheral IV access difficult to obtain. Central venous
access is often the only option but offers another set of complications and side effects. As an alternative
in vascular access and to provide the least invasive and best access for our patients the nurses on the
Vascular Access Team (VAT) were trained to insert midline catheters at the bedside. This study was
designed to determine the efficacy of midlines in the acute care setting.
Research Questions:
1.
What is the incidence of complications for midline catheters?
2.
What is the average dwell time for midline catheters?
3.
What are the relationships between the most common infusates and complications?
4.
What are the relationships between dwell times and complications?
5.
What are the relationships between patient characteristics and complications?
Methods: This is a descriptive comparative study of current practice in a 400 bed acute care hospital.
The sample will be a convenience sample of 500 patients who have midlines inserted by the Vascular
Access Team nurses. Patients will be enrolled sequentially as they are determined to meet the criteria
for a midline. Institutional review board approval has been obtained. To assure patient safety data will
be analyzed with each additional 20 patients and the program will be stopped if complications exceed
the complication rate for other types of peripheral and central vascular access.
Plan for Data Analysis: The patient sample, infusates, dwell times, and complications will be described
in percent and frequency. Comparative analysis will be done with Chi square or T-tests to determine if
there are any differences in complications by type of infusate, length of dwell or patient demographics.
Preliminary findings: There have been 221 midlines placed. The average age of the patients needing a
midline in this study was 60.9 years (SD 17 years). The average dwell time for the midlines was 6.8 days
(SD 5.9). The minimum dwell time was one fifth of a day and this was related to physicians changing the
course of treatment unexpectedly. The longest dwell time was 48.24 days in a patient who was sent
home with the midline. There were only two incidences of phlebitis and three with infiltration. Two
patients had an associated blood stream infection.
Conclusions: This trial has demonstrated that nurses can safely and effectively insert ultrasound guided
midline catheters at the bedside. The midline has been shown to provide a more stable line for infusion
into peripheral circulation. It has advantages for patients with very poor vascular status making the
usual peripheral IV difficult to insert and maintain. It has so far not demonstrated a higher risk for any
of the infusates used. We will continue to monitor this practice for safety and efficacy.
50
Gender Bias in Specialized Areas of Nursing
Cassandra Broffitt, RN
Jennifer Onyeador, RN
Ashley Schwab, RN
Kelly Statz, RN
Rebecca Stephenson, RN
Background: As part of a nursing research course assignment to complete a nursing literature review,
the authors conducted an exploration of the apparent predominance of male nurses occupying
advanced clinical positions. The phenomena of increased male nurses in advanced roles is important to
investigate because it has broad implications for job and management trends in nursing, attracting men
to the profession, and equal employment opportunity issues.
Purpose: The research question investigated was, “Are there more males in advanced fields of nursing?”
The purpose of this study was to determine if indeed there is a higher proportion of men in advanced
areas of nursing, and if so, why are men more likely to have these higher-level positions in a field
dominated by women.
Findings: The authors utilized Google Scholar, Medline, and CINAHL as search engines to locate
pertinent articles published from 2006-2011. The seminal study identified was “The Glass Escalator”
(Williams, 1992), which was explored again in “Revisiting the Glass Escalator” (Green & Snyder, 2008).
Initially the authors found 25 articles using the key words listed below, from which nine were analyzed
and included in this literature review.
The results of the literature review offer support that men do typically progress to advanced clinical
positions more often and faster than women. The authors also found a secondary phenomenon in the
literature showing that male nurses demonstrate the same findings in administrative roles. In particular,
many sources seemed to indicate that male nurses are “fast-tracked” into advanced roles, although the
reasons behind this vary. Advanced nursing roles are more gender-conforming to society’s norms. For
this reason males may be more motivated to achieve higher positions, and sometimes they are
“pushed” into these roles by nurse managers. Finally their minority status helps them attain these
limited positions more easily.
Strengths and Limitations: As a literature review, this study is limited by the current literature.
Although its findings were published research on the topic, there was a remarkable lack of U.S.
literature, which may impact the generalizability of the findings.
Conclusions: Based on the current literature, there is certainly a trend of male nurses disproportionately
achieving advanced roles that is worth further investigation. While much of the literature provides valid
arguments regarding this phenomenon, the authors noted that there is a significant lack of recent and
relevant research. Additionally, there is a need to correlate patient outcomes and quality of care with
“fast-tracked” male nurses in advanced clinical and administrative roles. The fact that patients are
requiring more acute-level care has strong implications for future hiring practices, as the need for more
advanced nurses will increase. Therefore this topic is relevant, and the authors recommend a formal
research analysis.
Key Words: Male nurses, critical care nursing, specialized nursing, gender bias, career development,
gender advantages, hiring trends.
50
Rounding in Acute Care
La Donna Williams, MSN,RN, CMS
Cheryl Dumont, PhD, RN, CRNI
Rounding Taskforce members:
Terri Wright
Vanessa Peters
Chris Francis
Susan DeVogel
Mark Miller
Problem: Patient outcomes such as falls, pain management, pressure ulcers and patient satisfaction are
of significant interest in acute care hospitals. Falls, pressure ulcers, and poor pain management can
result in patient suffering, delayed healing and discharge and increased burden to the healthcare
system. High levels of patient satisfaction are the goal of a healthcare system but are often an elusive
target.
Literature Review: Researchers have demonstrated improvements in patient satisfaction, call bell use,
and decreased falls when nursing staff members round hourly on their patients. Eight original studies
were reviewed. Rounding was reported to have occurred every one to two hours and was accomplished
as a team effort by staff nurses, educators, administrators and unlicensed personnel. Most were
accomplished on single units with small sample sizes and over a period of a couple months. There were
no large system studies and no longitudinal studies to determine the efficacy over time. There were
also no studies demonstrating the relationships between percent compliance with rounding and
outcomes.
Pilot the Change: The decision was made not to pilot the rounding initiative but to implement
throughout the System. On August 1, 2011 all inpatient units at WMC began implementing hourly
rounding on every patient. The rounding addressed “The 6P’s”, which include Pain, Position, Potty,
Placement (belongings in reach), Proactive (ensuring all needs are met prior to leaving the room), and
Promise (staff member will return in approximately one hour).
Baseline data: At WMC in 2010 only 9 of the 14 (64%) inpatient units benchmarked in the National
Database for Nursing Quality Indicators (NDNQI) performed better than this benchmark for falls. In the
first 2 quarters of 2011 only 4 of 14 (28%) out-performed the falls benchmark. For hospital acquired
pressure ulcers (HAPU) in 2011 6 of 14 units (43%) out-performed the NDNQI benchmark and in the first
2 quarters of 2011 3 if 14 units (21%) out-performed. Picker provides a national database for patient
satisfaction. At WMC in 2010 11 of 18 (61%) units exceeded the Picker benchmark for overall positive
scores on overall patient satisfaction. In the first 2 quarters of 2011 9 of 18 (50%) units exceeded the
benchmark. Similar results have been noted in other key patient satisfaction questions.
Desired outcome: Our goal is to outperform all benchmarks for patient outcomes and patient
satisfaction more than 50% of the time in more than 50% of our units.
Practice change: A Valley Health System team was pulled together to design a study on the
effectiveness of hourly rounding. Each hospital is instituting the rounding and collecting data. This
abstract addresses what is happening at WMC only. An educational effort went out to all nursing staff.
The rounding tab in McKesson was revised for ease and consistency in documentation for charting the
hourly patient rounding. Data will be collected on falls, pain management, HAPU, and patient
satisfaction and analyzed quarterly in relation to compliance with rounding.
Evaluation: This project was initiated in August and preliminary data show increased compliance with
rounding. Other data and relationships will be analyzed on a quarterly basis.
51
Telemedicine for the Homebound Client
Sheila Wetherell, RN
Background: Homebound adults in the U.S. typically have multiple comorbid conditions that place them
at high risk of injury, hospitalization, institutionalization or death. The current health care system in the
U.S. is frequently unable to meet the needs of these immobile adults and their caregivers. Difficulties in
transporting homebound adults can result in limited access to routine care, causing delayed or crisis
care for untreated illnesses instead of prompt primary care. Purpose: The purpose of this study is to: 1)
determine if homebound patients and their caregivers experience reduced levels of self-reported stress
and increased self-reported sense of well-being and self-efficacy when supported through a 6 month
nurse practitioner telemedicine program, and 2) determine if this program reduces the annual number
of emergency department (ED) visits by homebound adults as compared to a control group.
Methods: The study will be conducted by using a randomized controlled trial with a pretest/posttest
design. A convenience sample of homebound patients in Loudoun, Clarke, Frederick, Warren, and
Shenandoah counties in northwestern Virginia and the City of Winchester will be identified by local
primary care and internal medicine practitioners. Subjects and their caregivers in both experimental
and control groups will receive surveys that measure stress, well-being and self-efficacy. Investigators
will calculate the total number of ED visits made by each homebound subject in the previous 12 months.
Experimental group subjects will receive 3 weekly telemedicine conferences (“video chats”) with a
trained nurse practitioner to monitor their health status for 6 months in addition to their monthly
physician office visits. Control group subjects will continue to maintain their normal routine of monthly
physician office visits but have no telemedicine encounters. Subjects in both groups will be
administered repeat surveys at 6 and 12 months and the total number of ED visits in the past 12 months
will be calculated.
Protection of Human Subjects: Each participating subject will receive a numerical code to maintain
anonymity and confidentiality of their survey results, ED, and demographic data. The survey scores, ED,
and demographic data will be maintained on 1 password protected computer and remain in the
possession of the research nurse practitioner at all times. Subject codes will be destroyed after
completion of the research study. Institutional Review Board review is currently pending.
Findings: This research study is currently in progress. While pending, the investigator expects that with
the added support and enhanced monitoring of the telemedicine “video chats”, patients and caregivers
will experience 1) reduced stress, 2) have increased sense of self-efficacy and well-being, and 3) fewer
ED visits related to more frequent contact with a nurse practitioner to answer questions and concerns.
Plan for Analysis: Survey results, ED, and demographic data will be analyzed using SPSS statistical
software multivariate analysis.
Strengths and Limitations: Limitations of this study are small sample size, limited geographical area, and
accuracy and honesty of subjects in answering the surveys. Strengths of this study may be that the
results are generalizable to other populations such as homebound children and their caregivers and
those living in remote or rural areas.
Conclusions: Homebound adults have extraordinary difficulty in accessing primary health care in the
U.S. Telemedicine programs can provide more effective monitoring of multiple chronic conditions and
emotional support for the homebound population.
52
Investigating Adolescent Males’ Understandings of Psychological Hurt: A Qualitative Study
Barbara Frechette, DNP, RN, PMHNP
Background: Many studies have explored emotional regulation. Although hurt has also been studied,
the ability to manage hurt is less established. Psychiatric nurse practitioners need to understand how
adolescents process, manage, and resolve their hurt feelings. Without this knowledge, practitioners
may find it difficult to help adolescents develop adaptive coping strategies. There are few tools
available for assessing the extent to which one is self-aware of hurt or how a person manages it
resolution.
Purpose: How do adolescent males process events of significant sadness or anger? What are adolescent
males experiencing when they begin to recover from hurtful situations?
Methods: In this hermeneutic phenomenological study, the investigator explored how participants
processed emotional experiences and managed and resolved hurt feelings. Male adolescents aged 13-19
receiving outpatient behavioral health services in rural Virginia volunteered to be in the study. Upon
securing informed consent, a series of one-on-one interviews were conducted and recorded. The study
was exploring the extent to which adolescent males were able to conceptualize how unresolved hurt
contributed to their mental status.
Protection of Human Subjects: IRB approval was granted by Shenandoah University.
Findings: Venting, or statements of frustration, anger or impatience with others’ behaviors, relatedness,
or statements connecting hurt with sadness, anger and other negative emotions and avoidance, or
statements ignoring or denying emotions, were the most frequent response categories.
Strengths and Limitations: A specific strength was the clarity of the raw data. A limitation was the
psychiatric setting from which participants were recruited.
Conclusions: The results show that the participants would benefit from efforts to ensure they possess
the basic conceptual tools needed to understand and express the relationship between their emotions
and experiences.
53
Interdisciplinary Research Mild Cognitive Impairment: From Idea to Publication
Marian Newton, PhD, RN, PMHNP
List of team members at end of abstract
Background: The definition of mild cognitive impairment is a transitional state of cognitive impairment
between normal aging and early dementia; recognized only 3.2% of time by clinicians. Diagnostic
criteria include factors such as memory complaint affirmed by informant, objective memory loss
abnormal for age and education, normal general cognitive function, intact activities of daily living (ADL)
and absence of dementia. Mild cognitive impairment can predict dementia and 44% of persons with
MCI convert to Alzheimer's disease in about 3 years. Mini Mental Status Exam (MMSE) does not
measure small changes in cognition. Brain imaging (MRI) has revealed marked pathology in brain areas
associated with olfaction in preclinical AD. To assess for MCI with appropriate screens and intervene
early can affect quality of life.
Purpose: A pilot study to develop screening methods for the detection of Mild Cognitive Impairment
(MCI) in community dwelling older individuals by an interdisciplinary team, including graduate students.
Methods: The Addenbrook’s Cognitive Evaluation (ACE) screens for Alzheimer’s dementia, frontotemporal dementia and general cognitive function with 82% sensitivity. The University of Pennsylvania
Smell Identification Test (UPSIT) most is the most widely used, best validated 40-item scratch-and-sniff
format with subjects choosing between 3 distracters. The interdisciplinary team administered UPSIT
along with the ACE and looked for correlations. Community dwelling adult volunteers at least 55 years of
age were used in the study. After securing informed consent, the screens were administered by the
team.
Protection of Human Subjects: IRB approval was granted by Shenandoah University.
Findings: Fifty-four subjects completed the ACE and UPSIT screens with scores demonstrating 2
Probable Alzheimer’s, 5 Probable Fronto-temporal Dementia, 6 with low cognitive function, 7 probable
MCI, and 34 with normal cognitive function. UPSIT full-scale scores were significantly related to ACE fullscale scores (r=.37, p=.005). Of 40 total UPSIT odors, mint, chocolate, lime, and cheddar cheese
predicted MCI best because MCI subjects could not identify them.
Strengths and Limitations: The two tests took approximately an hour and a shorter combined form of
ACE and UPSIT as MCI screening test would reduce possibility of participants tiring of sitting and trying
to concentrate for such a long period. Strength was that the team worked very well together and had
also tested for inter-rater reliability on non-study participants before the study was conducted.
Conclusions: The results reveal ACE may be a more sensitive assessment tool for early detection of MCI
than previous tests such as the MMSE. Certain odorants in the UPSIT may be useful in identifying MCI
especially when combined with the ACE. Our team also demonstrated power of interdisciplinary team
approach as we started with idea and obtained outcome of published research article in peer-reviewed
journal.
Team: Yvonne Teske-Occupational therapy (mental health); John Cavendish-Occupational therapy
(statistics); Marian Newton-Nursing (PMHNP); Mary Ann Kirkpatrick-Pharmacy (gerontology); Wendell
Combest-Pharmacy (pharmacology); Danielle Przychodzi-PharmD (student); Louisa Poulin-Adult Care
Center of the Northern Shenandoah Valley (geriatric nurse).
54
Patients’ Perception of Ethnically Diverse Nurses
Wanida Wanant, PhD, RN
Janice Smith, PhD, CNE, RN
Background: Across the United States, health care facilities are struggling to fill vacancies for Registered
Nurses due to the recognized nursing shortage. As a result, recruitment and retention of non-American
nurses is sought by many organizations in an effort to alleviate staffing demands. The result is the
increasing of ethnically diverse nursing population. While there is substantial research on transcultural
nursing care to patients, there are few studies that explore patients’ perception or attitude toward
ethnically diverse nurses and cultural factors that may affect the quality of care.
Purpose: Stage 1: To develop a Likert type questionnaire for data collection to investigate a patients’
perception toward ethnically diverse nurses. Stage 2: To investigate if the patients’ perception of
ethnically diverse nurses and related cultural factors is related to the quality of care provided.
Methods: Using qualitative and quantitative research methodologies, the researchers will investigate
the patients’ perception of ethnically diverse nurses and cultural factors that may affect the quality of
care. Face-to-face interviews will be used to elicit the patients’ view of ethnic diverse nurses.
Questionnaires will also be given to identify cultural factors that the patients perceive as important and
may affect the quality of care. Leininger’s Theory of Culture Care Diversity and Universality Model will be
used to guide this study.
Protection of Human Subjects: The study will be started immediately after the approval by Shenandoah
University Human Subject Review Board.
Conclusion: It is expected that the findings will be the basis for understanding of cultural factors that
may affect the quality of care given by ethnically diverse nurses. In the wake of a severe nursing
shortage, an effort to alleviate staffing demands is resulting in increased recruiting of nurses from other
countries. This study will contribute to the knowledge of nursing practice and may influence recruiting,
hiring, and orientation policies for these nurses.
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