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Dear 2017 DNP Graduates,
Congratulations on your achievement of a terminal degree in Nursing from East Tennessee State University College of Nursing. Your hard work and dedication to the Doctor of Nursing Practice Program has finally paid off. Your exciting journey is just beginning and I cannot wait to see the positive impact you will have in Nursing. With this degree and title, comes an overwhelming sense of responsibility; the faculty and I are confident that you will meet and exceed our expectations. You have sacrificed a lot to reach this goal and you have earned this degree. Again congratulations-go forth, be strong, connect with your patients, and provide the best healthcare possible to the people you will touch.
Wendy Nehring, PhD, RN, FAAN, FAAIDD
Dean, College of Nursing
I attribute my success to this—I never gave or took any excuse.
Congratulations 2017 DNP Graduates!
As the Associate Dean of Graduate Programs and Associate Professor at ETSU College of Nursing, I commend your dedication and perseverance while attaining this terminal degree in nursing. I send you warm and best wishes for a new career path ahead. I hope you find happiness and satisfaction in everything you do in the future. You should be very proud of your accomplishments! Again, congratulations!
Myra L. Clark, PhD, RN, FNP-C
Director of Graduate Programs & Associate Professor, College of Nursing
Caring is the essence of nursing.
2017 DNP Scholarly Projects
Dr. Erin Elizabeth Bailey
Dr. Erin Bailey
BSN-DNP Perceptions of the DNP Essentials and How They Apply to Future Advance Practice Roles
Researchers throughout available literature have shown growth in DNP programs, positive perceptions of the DNP degree, and DNP graduates struggling to actualize DNP education to practice. However, BSN-DNP students’ perceptions of the foundation of the degree have not been assessed. The purpose of this study is to explore BSN-DNP students’ perceptions of the DNP Essentials, upon which the program is based, and how they see the Essentials apply to their future advanced nursing practice roles. The study is informed by Benner’s (1982) theory of Stages of Clinical Competence.
A qualitative descriptive study design was used and sample participants were full-time students at a state university’s BSN-DNP program in the southern region.
The findings from the data analysis show three themes emerging around the general concept of Becoming a DNP, which included Uncertainty of Role, Preparation for Role, and Values of Role.
Implications of the findings provided insight into the perceptions of BSN-DNP students on the DNP Essentials and how they will be applied to future practice. The findings inform DNP faculty regarding students’ understanding of the Essentials and how to better connect the Essentials to practice.
Dr. Mandy Marie Brannen
Dr. Mandy Marie Brannen
Improving Health Outcomes for Mother and Baby through PCP Education
Postpartum depression is a serious mental illness that can have negative consequences to the mother and baby. Depression screening takes place at prenatal and postpartum visits; however, subsequent follow-up rates for mental health care is lacking. This project assessed primary care providers’ perceptions, knowledge, interventions, and barriers associated with postpartum depression.
A pre-experimental pre-test post-test design was used to assess primary care providers working with pregnant women, and up to 12 months postpartum. Providers were employed at a federally qualified health center and were assessed on the topic of depression. A four-point Likert scale was utilized with the highest value indicative of the most positive response. An evidence-based educational intervention, given by a clinical expert on perinatal mood disorders was followed by the post-test questionnaire. Data was analyzed with the Wilcoxon Signed Ranks Test.
Findings suggest that providers have a more positive response about knowledge, interventions, and barriers associated with postpartum depression following an educational intervention. Additionally, mental health care follow-up rates increased from 10% to 12.5% following the educational intervention.
Quality improvement efforts involving evidence-based educational interventions on postpartum depression, given to primary care providers, may assist in improving health outcomes for both mother and baby.
Dr. Holly Dillon Dockery
Dr. Holly Dillon Dockery
The Development, Implementation, and Evaluation of a Web-Based Learning Module on Advanced Care Planning: Enhancing the Knowledge of Clinical and Advance Practice Nurses in Tennessee
The use of a web-based learning modules has been suggested as a way to reach out to healthcare professionals to improve the processes surrounding Advanced Care Planning (ACP) for adults with chronic conditions. The purpose of this project is to develop, implement, and evaluate an ACP educational program for clinical nurses and advance practice nurses in Tennessee.
The program is guided by the PRECEDE-PROCEED model, which has been shown to be effective for healthcare education. The non-experimental design included a needs assessment, personal profile/demographic survey, an educational intervention in the form of a web-based learning module with associated pre-post-tests, and program evaluation.
71 responses were received from an electronic needs assessment survey and 21 participants were recruited for program completion. Knowledge was increased after completion of the program and additional information was received from participants’ feedback substantiating the need for education on advance care planning and related topics.
The use of a web-based learning module is likely to be effective to enhance the knowledge of nurses practicing in a variety of roles and suggests that this method of learning can be implemented in a variety of clinical and community settings. The module content can be tailored to meet the needs of a variety of healthcare and allied health disciplines such as medicine, therapy, and social work to reach many professionals. Concise, state-specific clinical practice guidelines regarding ACP, and the development of a state-wide advance directive repository remain important future recommendations.
Dockery, H.D. (2016, October). The Development, Implementation, and Evaluation of a Web-Based Learning Module on Advance Care Planning: Enhancing the Knowledge of Clinical and Advance Practice Nurses in Tennessee. Poster session presented at the Tennessee Nurses Association/Tennessee Association of Student Nurses Annual Joint Convention, Murfreesboro, TN.
Dr. Osahon Kings Enodunmwenben
Dr. Osahon Kings Enodunmwenben
Decreasing Inpatient Readmissions in Homeless Patients
The purpose of this project was to identify the problem of inpatient hospital readmission at Hennepin County Medical Center (HCMC) Minneapolis, MN, causes of avoidable readmission and create a Quality Improvement (QI) program for key health officials including essential steps in discharge planning, transitional care, follow-up appointments, and long term care.
A quality management tool (Fishbone diagram) was used to identify, explore and display possible causes of inpatient readmissions. A Retrospective Chart Review (RCR) was conducted using Electronic Medical Records (EMR) at HCMC identifying the patients who were readmitted within 30 – 90 days after discharge from January 1st to December 31st 2015. Convenience sampling was used to compare the readmission rates of housed and homeless patients.
There were 20,962 discharges at HCMC between January 1st and December 31st 2015. There were 4262 who had a risk score of 3. The patients with a priority risk score of 3, had a 1063 (25%) rate of readmissions in 2015 and of these admissions 965 were housed and 98 where homeless. Of the housed patients 25% where readmitted within 30 days, while the homeless group had a 29% readmission rate. Overall, the results from the RCR showed that there is no significant correlation between homelessness and inpatient readmissions at HCMC. Although the rate of readmission was four percentage points higher in homeless patients compared to housed patients, the findings was not statistically significant (p = 0.107).
Based on the results, it is important to specifically address the group with extreme
risk score (3) who are frequent users of the Emergency Department (EDs). These patients
will be the target of our proposed recommendations. In line with the recommendations
from the Institute of Medicine (IOM, 2001), to provide patient care that is “safe,
effective, patient-centered, timely, efficient, and equitable”, a quality improvement
program was developed that will be disseminated to stakeholders involved in transitional
care at HCMC.
Dr. Mary Hoft
Dr. Mary Hoft
Educating First Responders to Identify, Provide Care, and Protect Victims of Human Trafficking
The purpose of this project was to increase community first responders’ knowledge and awareness of human trafficking, and improve the ability to identify and respond to the needs of human trafficking victims.
The study was a mixed, quasi-experimental design with a pre-test and 90-minute educational intervention, and included instruction in the use of a screening guide. Three months later post-tests were administered and participant group interviews were conducted.
Quantitative Results: The pre-test mean scores ranged from .5265 to .8395. Post-test mean scores ranged from .6494 to .8395. The within agency means increased between pre- and post-test scores, and increases ranged from .0398 to .1965. The mean score between pre- and post-test scores significantly improved (p < .05) for all but one agency. The pre- and post-test means for the total participants was .5798 and .71968 with a .13928 difference. The paired t-test for total scores was significant at p < .05; total effect size was large (Cohen’s d = 1.084961). Qualitative Results: Themes that emerged from the informal group interviews after post-test completion included: confidence in the ability to recognize trafficking victims, ability to effectively respond to victims, a desire to educate co-workers about human trafficking, a plan to keep the screening protocol available for use in the work setting, change in services to screen for and educate high risk clients about human trafficking, and a desire to collaborate with other participating agencies to develop a coordinated county-wide response to human trafficking
This project provided an opportunity for a member of the nursing profession to begin
emerging as an expert in human trafficking prevention and highlight the leadership
roles advance practice/DNP prepared nurses can assume in this human tragedy that severely
impacts the physical and mental health of victims.
Dr. Adam Jason Horn
Dr. Adam Jason Horn
Impacting Inpatient Psychiatric Readmission Rates by Focusing on Subset of High Risk Populations: Determining Characteristics of Subset of High Risk Populations and Releasing Recommendations for Practice
Readmission rates are being increasingly used as a quality indicator, including possible loss of funding. Psychiatric readmission rates far exceed rates for medical, surgical or maternal/neonatal health readmissions and the local inpatient psychiatric facility in Johnson City, Tennessee exceed the national average. While treatment options are available and effective in reducing readmissions rates for general consumers of inpatient psychiatric treatment, a subset of individuals resistant to traditional interventions exists. This project identifies the characteristics of this subset and develops a protocol for aforementioned facility.
Chart review of the electronic health records of 50 most frequently readmitted to the local inpatient psychiatric facility in Johnson City, TN. Key participants (e.g. discharge planners, prescribers, nursing, administration, etc.) were interviewed for baseline perception of issue. Systems-based, evidence-based treatment recommendations/protocol was developed. Key participants were again interviewed for perception of protocol usefulness.
Protocol developed included increase use of long-acting agents when not contraindicated, admissions to consistent treatment team, brief length of stay defined as two or three day maximum, and referrals to Intensive Outpatient Programs (IOP) available at facility. Key players were overwhelmingly receptive to protocol and conversations regarding implementations
The results of this study indicate there is a great need and desire for evidence-based guidelines for the reduction of inpatient psychiatric readmission rates among the subset of high utilizers within the psychiatric community. While a significant amount of research has been conducted regarding reduction the reduction of psychiatric readmission rates, little to none has been completed evaluating the subset of high utilizers.
Dr. Khairunnissa Aziz Jooma
Dr. Khairunnissa Aziz Jooma
Educating the Mental Health Providers to become Cultural Competent to identify and provide care regarding Depression in Muslims
The purpose of this project was to increase the cultural competency skills of mental health providers and assist them in becoming well equipped in assessing, diagnosing and treating depression in Muslims.
A descriptive study applying two theorists, Dr. Madeleine Leininger’s Culture Care and Diversity and Universality theory, and Dr. Campinha-Bacote Cultural Competent Care Model in a pilot format. A convenience sampling method was used to recruit 25 healthcare professionals as participants. Two tools using pre and post implementation survey was conducted and the data analyzed and presented using descriptive statistics.
For both the assessment tools, there was an increase in the range of 68%-73% from pre assessment to post assessment in the levels of cultural competency and knowledge of beliefs and practices regarding treatment in Muslims with depression. For the IAPCC-R the mean pre-test scores was 69.57 (SD = 8.005) and the post-test score was 74.26 (SD = 8.092), The Wilcoxon Signed-Rank Test revealed that post-test ranks were statistically significantly higher than pre-test ranks (Z = -2.924; p <.003). Within the constructs of the IAPCC-R, the Wilcoxon Signed rank Test revealed increased scores: Cultural awareness: (Z= -3.200; p < 0.001) Cultural Knowledge (Z=-1.997; p <0.046) and Cultural skill (Z= -2.953, p <0.003). For the MCMHS scale, the mean pre-test scores was 61.32 (SD = 8.132) and the post-test score was 66.32 (SD = 8.839). The Wilcoxon Signed-Rank Test revealed that post-test ranks were statistically significantly higher than pre-test ranks (Z = -2.653; p < .008).
The findings of this study supports this proponent and highlights the need to educate all mental health providers to become culturally competent in caring of culturally / ethnically diverse population, more specifically focusing on family and community perceptions of mental health and beliefs in treatment when caring for mental illness in Muslims.
Conwill, W.L. & Jooma, K. (2008). Thwarting ethnoviolence against Muslim women: Performing
identity in social action. Journal for Social Action in Counseling and Psychology, 1(2), 30-47
Dr. Carissa Nichole Myers
Dr. Carissa Nichole Myers
Keeping Elderly at Home: Identifying Caregivers’ Health Status and Needs
Informal caregivers provide the majority of care for elderly patients residing in the community, but these caregivers are not being accurately identified and supported. Identifying caregivers and supporting caregivers may prevent caregiver burden and loss of identity, with a primary goal of keeping the care recipient in the home longer.
A protocol was developed and implemented to identify informal caregivers using a decision tree in a primary care practice. The caregivers’ perceived health status and needs were then addressed using two tools, and the caregivers were provided with a developed caregiving resource card. Follow-up was conducted in four weeks for reevaluation.
A total of 127 elderly patients were screened using the decision tree, 88 did not need a caregiver, 25 needed a caregiver and had a caregiver, and 14 needed a caregiver but did not have a caregiver. Six caregivers consented to being in the study, and five caregivers completed the screening with the intervention and follow-up. All five of the caregivers reported the resource card being useful and providing awareness to unknown resources.
A new protocol was implemented to assist with identifying and supporting informal caregivers in a primary care setting. Project analysis showed the importance of screening for informal caregivers among this patient population and providing support to these caregivers to ensure the care recipient stays in the home longer. This protocol pilot may be replicated on a larger scale to further evaluate the Caregiver Decision Tree to identify informal caregivers.
Myers, C., Ousley, L, Weierbach, F. (2016, October). Keeping Elderly at Home: Identifying Caregivers’ Health Status and Needs. Poster session presented at the Annual TNA-TASN Joint Conference, Murfreesboro, TN
Dr. Denise Ruth Spisso
Dr. Denise Ruth Spisso
Medication Reconciliation Implementation in a Rural Health Clinic
The purpose of the Doctor of Nursing Practice quality improvement project was to implement and evaluate a systematic collaborative medication reconciliation process in a primary care practice in a rural health clinic in Northeast Tennessee.
Implementation of a systematic collaborative medication reconciliation process in a Northeast Tennessee rural health clinic was the primary aim of the project. The objectives of the project focused on implementation of a defined systematic collaborative medication reconciliation process that was inclusive of all patient contact points within the pilot clinic. The objectives were established to comply with federal reporting and aims, identification of data for medication reconciliation analysis and reporting, and determining project impact on patient total clinic visit times. The project identified medication reconciliation data required for analysis of the clinic and individual provider performance. Clinic performance was based on total provider encounters compared with total provider completed medication reviews and medication reconciliations.
A comparison of 3574 patient encounters with completed medication reconciliations Pre- and post-implementation (79.11% and 87.71%) showed a significant increase of 8.6% (p=0.0001). A time impact analysis revealed that implementation occurred with no significant increase in patient total clinic visit times. The findings led to a quality improvement project that was designed to improve medication reconciliation by improving quality, safety, and efficiency of clinical medication management.
Results of the quality improvement project may be used as a guide when implementing a medication reconciliation process within a rural health primary care clinic. Implementing a systematic collaborative medication reconciliation process inclusive of all patient contact points within a clinic supports a multidisciplinary approach to healthcare.
Dr. Ramona Craft Whichello
Dr. Ramona Craft Whichello
Emotional Intelligence in Nurse Administrators
Health care organizations face tremendous change and complexity. Nurse administrators must develop skills to build and sustain work environments that promote teamwork and positive patient outcomes. Emotional intelligence (EI) is the ability to perceive emotions, to access and generate emotions, to understand emotions and emotional knowledge, and to regulate emotions. The study examined pre- and post-EI scores for statistically significant improvement after an EI educational offering and evaluated the relationship amongst RN turnover, RN satisfaction, and Total EI scores.
Nurse Administrators at a Veterans Affairs Medical Center (VAMC) were the population of interest and included individuals with job titles of chief nurse operations and acute care, chief nurse geriatrics and extended care, nurse manager, and assistant nurse manager. A one-group pretest-posttest design purposive sample of nurse administrators (n = 13), using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) to measure EI before and after an EI leadership development offering.
A branch score for managing emotions was significant (p < 0.05). Pre- and post- total EI, area, branch, and task scores were not significant (p > 0.05). Total pre-EI scores showed a low average level of EI (99.89, 98.86 respectively). RN satisfaction was high and RN turnover was low.
Leadership development opportunities on emotional intelligence (EI) for nurse administrators are important aspect of continued growth. EI can change over time and may have a positive impact on RN satisfaction ad RN turnover.
Whichello, R.C. (2017, April). Emotional Intelligence: Impact on Teamwork. Team Building Retreat for Learning Resource Center Staff, Asheville, NC
2017 DNP Graduates
Erin Elizabeth Bailey
Shaquita Lashea Bonds
Mandy Marie Brannen
Leonard Anthony Dinardo
Holly Dillon Dockery
Charles David Edwards
Osahon Kings Enodunmwenben
Theresa Ann Gibbs
Alan Michael Hicks
Nathan R. Hitchcock
James Marett Holbrook
Adam Jason Horn
Khairunnissa Jooma Aziz
Carissa Nichole Myers
Paige Noel Reed
Deana McThenia Rhinehart
Holly Kaimanakea Gyure Sawyer
Ashley Nicole Shouse
Denise Ruth Spisso
Krissa Marie Trombetta
Ramona Craft Whichello