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 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, secretary, and Andrea Schmahl, secretary. Without
their assistance, none of this could happen.
 We wish to thank Rho Pi planning committee:
 Marian Newton
Beverly VanMetre
 Rosalie Lewis
John Goldizen
 Cheryl Dumont
Janice Smith
 Karen Gonzol
Wanida Wanant
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.
The 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,” which highlight 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
 How to make a business case for nurse-led palliative care services which
provide high-quality patient/family centered care across specialties practices.
 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 curriculum will not be awarded continuing
education credit.
VNA disclosure statement... (planners and faculty)
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Nurses Shaping Healthcare
Brandt Student Center, Main Campus, Shenandoah University
Friday, April 27, 2012
Rho Pi Chapter of Sigma Theta Tau International (STTI) 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, BSN, MS, 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, 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 Path, 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, BSN, MS, 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
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Research Presentations
10:45-11:15 a.m.
Rm. 115
“The Motherhouse Made All the Difference”:
A History of the Milwaukee Lutheran Deaconess Nurses 1863 - 1913
Lisa M. Zerull, PhD, RN, FCN
Rm. 118
Post Traumatic Stress Disorder in Primary Care Setting
Eleanor Gooch, RN, MSN, PMHNP-BC
Rm. 120
Body Mass Index as a Predictor of Readiness to Change in
Overweightand Obese Adolescents
N. Danielle Lutman DNPc, RN, FNP-BC
11:20-11:50 a.m.
Rm. 115
The Effects of Depression on Diabetes as Evidenced By the
Relationship Between the Patient Healthcare Questionnaire
(PHQ-9) Scores and he patient’s Glycohemoglobin (HbA1c)
Lana H. Vann DNPc, MSN, RN, FNP-C
Rm. 118
Rural Health Providers, Their Perceptions and Readiness for
Telehealth
Roberta McCauley, DNPc, MSN, RN, FNP-BC
Rm. 120
Rural Health Providers, Their Perceptions and Readiness for
Telehealth
Roberta McCauley, DNPc, MSN, RN, FNP-BC
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Research Presentations
3:00 -3:30 p.m.
“The Motherhouse Made All the Difference”:
Rm. 115
A History of the Milwaukee Lutheran Deaconess Nurses 1863 - 1913
Lisa M. Zerull, PhD, RN, FCN
Rm. 118
Screening for Depression and Anxiety in the Obese in a Rur
Free Clinic
Cheryl Kenney, DNPc, MSN, RN, FNP-BC
Rm. 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, DNPc, MSN, RN, FNP-BC
3:30 – 4:05 p.m.
Rm. 115
The Use of Virtual Reality for Stress Management in College
Students
Billinda Tebbenhoff, MSN, RN, CNS
Rm. 118
Barriers to enrollment in a health promotion program for Heart
Failure Patients
Christine A. Newcomer, DNPc, RN, GNP
Rm. 120
???
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Keynote Speaker
Kenneth R. White, PhD, MPH, MSN, 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’ experience in healthcare organizations in clinical, administrative,
governance, academic, and consulting capacities. He worked for 13 years with Mercy Health Services as
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 (VCU). From 2001- 2008, he
served as the 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 2 Day Discharge Telephone Calls
Rosalie Lewis, BSN, MS, CMSRN, ONC
HPV Vaccine and Preteen/Teen Girls
Lynda C. Miller, RN
Efficacy of Midline Placement by Nurses at the Bedside
Melissa Freze, 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
Gender Bias in Specialized Areas of Nursing
Cassandra Broffitt, 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
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Poster Presentations
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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Keynote Speaker
Kenneth R. White
Presentation
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Dr. White’s presentation,
"The Business Case for Palliative Care:
What Every Nurse Should Know”,
can be found on www…
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Featured Panel
Presentation
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25
26
27
28
29
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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 DNPc, RN, FNP-BC (Primary Investigator)
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-BC (DNP applicant)
Dr. Francie Bernier, PhD, RN, Doctoral Advisor
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, RN, MSN, PMHNP-BC
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 DNPc, MSN, RN, FNP-C
Dr. Ginger Breedlove
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. Once consented, the 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, RN, GNP, DNP student
Mentor: Dr. van Olphen Fehr, CNM, PhD, FACNM
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 rehospitalizations 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, DNPc, MSN, RN, FNP-BC (Primary Investigator)
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 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, DNPc, MSN, RN, FNP-BC (Primary Investigator)
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.
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Personality and Dissociative Disorders: Implications for Assessment,
Diagnosis and Treatment
Katherine M. Guard
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.
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The Use of Virtual Reality for Stress Management in College Students
Billinda D. Tebbenhoff, 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 Ttest- 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 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.
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44
Poster
Presentations
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Reinforcing Continuity of Care with 2 Day Discharge Telephone Calls
Rosalie Lewis, BSN, MS, 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.
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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. 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
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.
Findings: Pending
Plan for Analysis: Pending
Strengths and Limitations: Pending
Weaknesses: Pending
Conclusions: Pending
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Efficacy of Midline Placement by Nurses at the Bedside
Melissa Freze, 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 (VAT) 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.
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Gender Bias in Specialized Areas of Nursing
Cassandra Broffitt, Jennifer Onyeador, Ashley Schwab, Kelly Statz, and Rebecca Stephenson
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.
49
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
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.
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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 selfreported 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.
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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.
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Interdisciplinary Research Mild Cognitive Impairment: From Idea to Publication
Marian Newton PhD, 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 full-scale
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 Przychodzin - PharmD (student); Louisa Poulin
- Adult Care Center of the Northern Shenandoah Valley (geriatric nurse).
53
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 of 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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