Christine E. Lynn College of Nursing

Purpose The purpose of this quality improvement project is to educate outpatient mental health providers at the West Palm Beach VA Healthcare System (WPBVHS) on the importance of pregnancy testing among women veterans of childbearing age (WVCBA) before prescribing psychotropic drugs (PDs) and to increase pregnancy testing to reduce maternal and fetal risks.
Background There are significant maternal and fetal risks associated with using prescription psychotropic drugs during pregnancy including increased risk of gestational diabetes, congenital malformations, neural tube defects, craniofacial disorders, spontaneous abortion, preterm birth, low birth weight, and possible developmental delays and learning disabilities. Half of mental health providers in America prescribe women of childbearing age psychotropic drugs without testing for pregnancy.

Caring for chronically ill patients, such as those suffering from dementia, can have a significant impact on the stress levels of healthcare professionals. Healthcare professionals are often physically and mentally affected by the stress experienced in their jobs, which may result in compassion fatigue. Compassion fatigue negatively affects healthcare providers, patients, and healthcare organizations. Current guidelines encourage education with self-care strategies to prevent or decrease the effects of compassion fatigue. This quality improvement project aimed to increase knowledge of compassion fatigue among the interprofessional staff at an adult daycare and improve clients' behavioral and psychological symptoms of dementia (BPSD). Within a six-week timeframe, a one-time educational intervention about compassion fatigue and mitigation strategies was implemented. Participants completed a preintervention ProQOL5 assessment and pre- and post-intervention surveys of knowledge about compassion fatigue. Although the sample was small and the time was short, analysis of the quantitative data showed significant improvement in knowledge about compassion fatigue post-intervention. The results of the ProQOL5 also demonstrated differences in compassion satisfaction and compassion fatigue among participants based on demographics. There were no documented changes in the BPSD of the clients who attended the adult daycare. It was recommended that new and current staff education about compassion fatigue be incorporated into the training programs. Future projects should include larger sample sizes, more extended periods of study time, and methods for tracking BPSD symptoms.

Purpose: The purpose of this project is to implement the American College of Obstetricians and Gynecologists (ACOG) recommendations regarding postpartum depression (PPD) screenings, while also providing education on the topic itself to create a PPD assessment program. By doing so we will 1) Monitor the percentage of patients who are able to receive the PPD screenings as recommended by ACOG, and 2) assess the change of the patient’s perception of PPD knowledge during the postpartum period compared to the antepartum period.
Methods: The Edinburgh Postpartum Depression Screening (EPDS) tool will be utilized to screen the risk of the expecting mothers at the first visit, the last visit. A PPD perception of knowledge assessment tool was designed to assess the patient’s knowledge regarding the topic which will be measured through a 5-point Agreement Likert Scale upon the first encounter (antepartum) as well as on the last (postpartum).

The purpose of this study was to explore differences in perceived stress, glucocorticoid receptor (GR), and the expression of histone acetylation (HAT) of the corticotropin-releasing hormone (CRH) gene between non-Hispanic Black and non-Hispanic White women in their 2nd trimester of pregnancy. Black women are 2–3 times more likely to experience preterm birth (PTB) and maternal mortality than White women (Hoyert, 2022; Martin et al., 2019). Researchers have reported chronic stress associated with factors such as experiencing discrimination, financial hardship, and abuse may induce dysregulation of the stress hormones (Kramer et al., 2013; Shapiro-Mendoza et al., 2016). Likewise, the stress hormones glucocorticoid and CRH dysregulation have been linked to early labor, preeclampsia, and maternal death (Kramer et al., 2013; Shapiro-Mendoza et al., 2016; Yu et al., 2013). Additionally, social status, gender, education, and income are recognized as social determinants of health.
This study used an observational, cross-sectional design to analyze the differences in perceived stress, depression, GR, and HAT of the CRH gene between a group of Black and White pregnant women in their 2nd trimester of pregnancy. This study analyzed perceived stress, depression, and peripheral blood monocytes cells (PMBC) using secondary, deidentified data from pregnant women. The Perceived Stress Scale was used to measure stress, the profile in Mood Depression Scale measured depression, a chromatin immunoprecipitation (ChIP) to quantitative Polymerase chain reaction (qPCR) analysis was used to measure GR and HAT of the CRH gene. The data were analyzed using correlation and analysis of covariance (ANCOVA) to examine relationships and the differences between groups.

The purpose was to study the results Professional Certified Nurse Coaches (PCNCs) potentially have in mutually patterning the human energy field toward a higher wave frequency pattern of power as measured by the power as knowing participation in change tool and reflected in the narrative pattern profiles obtained from in-depth interviews. Participants were nurses working during the COVID-19 pandemic. Using Barrett’s (1986, 2020) power as knowing participation in change theory an explanatory convergent parallel mixed method using a single group with repeated measures (pre/post) and qualitative directed content analysis was used. A method for apprehending pandimensional awareness of unity and a mutual rhythmic-frequency process of-analysis-synthesis and were developed for the synthesis of numeric and textual data within a unitary perspective. Findings included a statistically significant effect for the total and four interrelated dimensions with a large effect size, except for the dimension involvement, which had a medium effect size. The results were the same when controlling for years of experience indicating that regardless of years of experience, professional nurse coaching appears to be beneficial. Six essences were identified and articulated as a group, as individuals, and across time. Joint displays show the synthesis. These findings have implications for nursing research, caring sciences, nursing education, nursing practice, policy, and professional nurse coaching.

Urinary incontinence (UI) poses a significant challenge for women across different cultures, as their diverse perceptions of UI impact their decision-making and choices, which are influenced by personal beliefs and preferences. Although research on women's experiences with urinary incontinence has shown substantial progress, encompassing various cultural contexts, more studies are still needed to examine cultural factors and employ the framework of transcultural nursing theory. Additionally, limited research has explored the experiences of older women with urinary incontinence in Nepal. This descriptive phenomenological study aims to explore the lived experience of older Nepalese women dealing with urinary incontinence. By applying the theory of culture care diversity and universality and employing the Colaizzi process for phenomenological data analysis, this study seeks to interpret the experiences of older Nepalese women living with urinary incontinence. Data collection involved conducting semi-structured interviews with 16 participants aged between 60 and 80 years. Three themes emerged from the data: (1) Interference with daily living, (2) Modification of lifestyle, and (3) Impact on the whole family. The findings underscored the need for effective treatments and support systems to assist women with urinary incontinence in managing their symptoms.

The purpose of this qualitative research study was to explore the lived experience of families who donated their neonate’s organs at the end of life. The experiences of five mothers and one father were elicited from those who experienced this phenomenon. Heideggerian hermeneutic phenomenology served as the methodology as well as the guiding philosophy for this research study. Watson’s theory of Unitary Caring Science and the Caritas Processed provided the caring lens through which the research was completed. Deikelmann’s seven stage process for analysis was employed and through which four relative themes emerged: Enhancing the Fullness of the Baby, Celebrating the Ongoing Presencing of the Baby Within the Family, Ameliorating Grief through the Hope of Donation, and Being Embraced Within a Healing Environment. The four relational themes are represented with an aesthetic interpretation of the experience.

Although there appears to be heightened awareness of the alarming rise in adolescent mental health concerns, treatment initiation and adherence to traditional therapies remains low. Nurses are at the forefront of exploring innovative youth-friendly therapeutic options that engage adolescents who otherwise may be reluctant to care. Human-animal interactions (HAIs) are alternative approaches where animals are integrated as therapeutic partners to help break down barriers, build trust, uncover meaning, and foster transformation. Equine-assisted learning (EAL), a type of HAI, was the focus of this research. This study explored the lived experience of adolescents who participated in an equine-assisted learning program guided through the lens of the theory of unitary caring and the hermeneutic-phenomenological unitary-caring research method. Eleven participants between the ages of 11-19 were interviewed. The outcomes of improved self-confidence, better mood, healthier relationships, and an optimistic outlook were supported by the literature. Six essences evolved from the narratives: troubled by turbulent connections; embracing uncertainty and vulnerability; awakening to the shared human-horse condition; attuning as one; engaging harmonically; and cultivating peace and joy. These essences, blended with the theory of unitary caring, led to the discovery of the antecedents of transformational change defined in the conceptual representation of the Unitary Caring Relatedness Model. These findings contribute to nursing and HAI literature and suggest a model that may be implemented in adolescent practice.

Clinical question: In parents with children 3-5 years of age with reported behavioral disorder problem behaviors (P), how does implementing a mindful reading strategy with their children, (I) compared to traditional reading or no reading (C) effect parents’ perception of problem behaviors and parent-child relationship (O) within 8 weeks (T)? This quality improvement DNP project examined the effectiveness of an online video parent training program, Mindful Reading Strategy for Parents, created based on the recommendations of Susan Hendler Lederer, PhD (Lederer, 2018). The theory of Nursing as Caring by Boykin & Schoenhofer was used to ground this project in caring (Boykin & Schoenhofer, 2015; Boykin & Schoenhofer, 2019). A convenience sample of three English speaking participants with children aged 4 and 5 with parental reported behavioral disorder problem behaviors were recruited from an outpatient clinic and preschool. They were assessed prior to the video training and 8- weeks after using the Parent Perception Survey and Pre- and Post- Parent Survey. Parents reported improved parental perception of child's behavior, perception of at least one behavioral disorder problem behavior in their child, and perception of parent- child relationship. No changes in child's psychotropic medication regimen post intervention were reported and 66% of parents read to their child at least 4 times per week during intervention. In this project, the Mindful Reading Strategy for Parents training program can have a positive effect on parents’ perception of problem behaviors and parent-child relationship. Implications include increasing parent and provider education of benefits of early intervention of mindfulness embedded reading strategies for children. Based on participant feedback, shortening the video training program may improve parent participation.

Heart failure (HF) is a clinical syndrome with various manifestations (Groenewegen, Rutten, Mosterd, & Hoes, 2020). However, self-care for patients with complex illnesses, such as HF, can be very challenging. The Centers for Disease Control and Prevention [CDC] (2020) reported that an estimated 6.2 million adults in the United States had HF. It is generally estimated that between 1% and 2% of adults in developed countries have HF (Groenewegen et al., 2020). Although important advances in managing HF were made before approximately 1990, improvements have been significant since that time (Choi et al., 2019). However, some patients with HF still struggle. The prognosis of HF remains poor for most patients. One estimate suggests 87%, 73%, 57%, and 35% survival rates at 1, 2, 5, and 10 years, respectively (Groenewegen et al., 2020). A radical treatment for HF is a heart transplant, but due to the shortage of donated organs, this option remains out of reach for most patients (McDonagh et al., 2021). Recent success in the transplantation of a porcine heart into a human recipient suggests that some HF patients may benefit from this procedure in the future, but today, patients diagnosed with HF may receive a heart transplant from a diseased human donor (Kotz, 2022).