bluuebunny/crossref_metadata_2025 huggingface dataset:
Honoring and Utilizing the Preoperational Thinkers
Authors: Paquette J.
Published: February 2018

Examines the relationship between thought processes and artmaking in preoperational learners (children from about two to seven years of age). Suggests that these children learn and communicate in the art room in a natural, revelatory, and quite ephemeral, way. Includes a sample art lesson plan for preoperational learners and investigates ways to connect with children's youthful thought processes in elementary art instruction.
Isolation and Community in Short Story Collections by Z.Z. Packer, Jhumpa Lahiri, and Mary Gaitskill
Authors: Howe Katy
Published: February 2018

Looking at short story collections by Z.Z. Packer, Jhumpa Lahiri, and Mary Gaitskill, this work explores the protagonists' development of identity in relation to others. Using relational psychoanalysis as a theoretical base, this thesis probes the tension between involvement in community and maintaining individuality.
American Suburban
Authors: Ashworth James
Published: February 2018

A collection of poetry that examines contemporary American suburban life through the author's reflections on his own working class consciousness and aspirations for a middle class lifestyle.
Digital Democracy
Authors: Larsen Kathryn
Published: February 2018

Examines if the accessibility of more affordable digital production equipment and desktop video editing systems has democratized the quantity and quality of independent documentaries submitted to PBS (Public Broadcasting Service) stations for broadcast. Includes data gathered from surveys and interviews with PBS program and production personnel, independent filmmakers, and public television program distributors. Explores the relationship between the concept of radical democracy and public broadcasting of local productions.
DNA Sequence Analysis of a Bioluminescent Marine Bacterium
Authors: Ryder Benjamin
Published: February 2018

Studies the sequencing of the DNA fragment containing the gene phaC (PHA synthase) and undertakes the search for open reading frames and putative gene matches in a bioluminescent marine bacterium.
Nietzsche
Authors: Pate Anthony
Published: February 2018

Analyzes how Nietzsche's philosophy of the Ubermensch and Baudrillard's ideas about simulation and hyperreality apply to the journeys undertaken by the protagonists of the films, Blade Runner, Fight Club, and Miami Vice. Explores how the protagonists adapt and master their unique worlds through self-awareness, self-reliance, and strength resulting from radical self-exposure to hardship.
Dismantling the Cult of Manliness
Authors: Capalbo Peter
Published: February 2018

Explores the argument that several of Virginia Woolf's male characters, including Septimus Smith, Mr. Ramsay, and Bernard (in The Waves), challenge traditional male gender expectations in Britain after World War I. Examines Woolf's use of the concept of manliness in structuring her novels and her presentation of a series of men who do not conform to the British ideal of masculinity and who, thereby, allow her to expose the multiple fallacies of that ideal and a culture supported by such a concept. Posits that Woolf's work suggests that a new, more inclusive, understanding of gender is an important first step towards true gender equality.
A Person of Interest
Authors: Lepre Jesse
Published: February 2018

Presents a drama-based screenplay which explores the stereotyping of the modern Italian-American male in contemporary American society.
The Female Singing Voice
Authors: Guerreiro Shirley
Published: February 2018

A study of perceived changes that may occur to the voice within the menstrual cycle The study examines factors that may affect women's voices and examines if there is a change occurring in the female singing voice during the premenstrual phase of the menstrual cycle. Journals and questionnaires of premenstrual vocal and physiological symptoms of seven female voice students were used during two menstrual cycles. Vocal Teacher journals were also used to see if relationships could be found. The median score for various variables were calculated to produce graphs for visual comparison looking for relationships between days of the menstrual cycle, physiological symptoms, and vocal symptoms. The results of this study showed that there was no change to the female singing voice within the menstrual cycle.
"Sometimes Saying Nothing...Says the Most"
Authors: O'Brien Lawrence
Published: February 2018

After nearly one hundred years of publication and copious literary criticism, Emily Dickinson remains one of the most enigmatic figures in American literature and her poetry among the most inscrutable. In deceptively simple ballad stanza, Dickinson can be by turns, mysterious or playful or deadly serious or misleading or insightful or obscure, but, above all, puzzling. Her poems consistently and continually resist easy paraphrase or simple interpretation, very often towards the end of challenging accepted "truth" by revealing inherent contradictions. She has some clear affinities to both the methodologies of apophatic discourse and to différance, which Derrida himself has said are virtually indistinguishable. By analyzing Dickinson's style and content and by offering readings of a number of her poems, I ask the reader to understand her poetry in a postmodern theoretical context that makes deconstruction a viable reading strategy.
Title Killer Was Here
Authors: Trimbach Elizabeth
Published: February 2018

This is a collection of free-verse poetry. Some pieces are more narrative, some more experimental. One piece could be called a language poem. All in all, this is a post-language, hybrid collection.
An Opposing Self
Authors: Gamache Christine
Published: February 2018

People have always been both frightened and fascinated by the unknown, and themes touching on the existence of things beyond human understanding have longevity in the literary arena as well as in popular culture. One such theme is that of the doppelgänger, or double, which has been around for centuries but was first made popular by Jean-Paul’s (Johann Paul Friedrich Richter) work Hesperus in 1795. Due to a resurgence in the nineteenth century in the popularity of Gothic literature, doppelgängers, or variations of this double motif, found their way into some of the most famous works of literature by the most notable writers of the century, including Edgar Allan Poe’s “William Wilson” (1839), Feodor Dostoevsky’s “The Double” (1846), Hans Christian Andersen’s “The Shadow” (1847), and Oscar Wilde’s The Picture of Dorian Gray (1891). The theme has persisted through the twentieth century and into the twenty-first, recent examples being the popular films Secret Window (2004) starring Johnny Depp, Shutter Island (2010) starring Leonardo DiCaprio, and Black Swan (2010) starring Natalie Portman.
Although the popularity of the double has remained constant over the past few centuries, the presentation and interpretation of doubles have not. Prior to the Romantic period, the appearance of a doppelgänger was almost always seen as an evil portent, often foretelling disaster and the death of the protagonist. The character of the double, in manifest form, was represented as something outside of the person plagued by it, part of the realm of the supernatural, and certainly something to be feared. But with the growing interest in the human mind, and especially the unconscious, in the Romantic Period, people started viewing the double as something that could possibly come from within an individual. This new way of looking at the theme of the double fit the interests and feelings of the times, especially the idea that there were parts of ourselves over which we had no conscious control. The evolution of the double as a literary motif thus reflected the changing attitudes of the times, its horror lying now not outside of the human psyche but secretly locked within it. As Rosemary Jackson observes, there was “an explicit shift from a presentation of a demonic ‘other’ as supernaturally evil, the devil in a conventional iconography, toward something much more disturbing because equivocal, ambiguous in its nature and origins. . . . The double then comes to be seen as an aspect of the psyche, externalized in the shape of another in the world” (44).
A Study of Cape Verdeanness In Postcolonial Cape Verdean Poetry
Authors: Alpert David
Published: February 2018

Cape Verdeanness is another name for Cape Verdean cultural identity. Postcolonial Cape Verdeanness refers to Cape Verdeanness as it has expressed itself since July 5, 1975, the first day of Cape Verdean independence. Postcolonial Cape Verdeanness has previously been described at length in the social sciences scholarship. Postcolonial Cape Verdeanness has previously been implicitly rather than explicitly represented in descriptions of postcolonial Cape Verdean poetry in the scholarly literature.

This study is a first of its kind consideration of postcolonial Cape Verdeanness. It is also the first time Cape Verdeanness of any kind has been explicitly represented by means of a review of Cape Verdean cultural productions. The methods of this study include a review of the findings of the social sciences regarding postcolonial Cape Verdeanness, a review of the scholarly literature on postcolonial Cape Verdean poetry, and an analysis of a group of postcolonial Cape Verdean poems, including contributions from both the Cape Verdean Islands and the Cape Verdean diaspora.

The findings of this study are that postcolonial Cape Verdean poetry provides a significant lens into postcolonial Cape Verdeanness that both overlaps and complements the lens on Cape Verdeanness provided by the social sciences. Furthermore, postcolonial Cape Verdeanness demonstrates a rupture from colonial-era Cape Verdeanness. Because of this rupture, Cape Verdeanness has now expanded to reflect universal concerns in addition to specifically Cape Verdean ones.
Engaging Students in Art Beyond the K-12 School Environment
Authors: Ducharme Melanie
Published: February 2018

This purpose of this thesis is to investigate a unit of instruction for a mural project with a community organization.

The question I sought to answer through this research was: How can I design a unit of instruction in collaboration with a local organization that will potentially engage students in a community-based work of art while also promoting a sense of community among the students?

Though this thesis research, I learned to collaborate with an organization to create a hypothetical unit of instruction. Also, I wanted to discover how I can create a learning experience that is engaging and personally meaningful to students. The unit of study that I created is inquiry-based towards sparking the interest of students through open-ended questioning. I designed lessons that involved cooperative group work where students would work towards a common goal. This thesis will show that cooperative group work has the potential to develop a sense of community among students while meeting the needs of a community organization.
Helping Students Gain A Better Understanding of Writing
Authors: Ulmer Jessica
Published: February 2018

The primary purpose of this study is to develop a curriculum for first-year writing that can be taught at the two-year college to help students transfer writing skills to courses taken afterwards. The second chapter aims to define what transfer is and identify a few different approaches to teach for transfer, which led to the discovery of the Writing about Writing pedagogy as developed by Douglas Downs and Elizabeth Wardle. This research was influenced heavily by Anne Beaufort’s College Writing and Beyond as well. Following this, the third chapter examines the nature of the two-year college that makes it uniquely difficult to teach for longer term transfer of writing skills. Finally, chapter four features a review of the Writing about Writing pedagogy and textbook, which leads to development of a course sequence for use at a two-year college. This study supports the implementation of an introduction to writing studies course sequence at the two-year college level to aid in the transfer of writing skills.
Exploring the Mitigating Effects of Early Somatosensory (Tactile) Stimulation and Acoustic Discrimination Experience in Neonatal Hypoxic-Ischemic Male Rats
Authors: Taubin Patricia
Published: February 2018

The focus of this study was to determine the effects of early somatosensory (tactile) stimulation and acoustic discrimination experiences in hypoxic-ischemic (HI) male rats on long-term behaviors, learning sensory, and brain weight outcomes. 58 Wistar rats were randomly assigned to one of the three conditions: no stimulation, somatosensory stimulation and auditory stimulation. To observe the effects of the early life stimulation on adult behavioral measures, the following testing was performed: analysis of exploratory behavior, acoustic discrimination, spatial/memory learning, and brain weight. Overall we hypothesized that somatosensory and auditory interventions earlier in life would have beneficial effect on subjects’ performance in all the testing. Results suggested that tactile and auditory stimulation in early life did not have any significant beneficial effects on improving spatial learning, auditory processing or exploratory behavior in HI and sham subjects. However, some beneficial effect was found in the spatial memory task but only for the tactile HI and auditory sham group.
The Interaction Effect of Spirituality and Negative Life Experiences on Depression
Authors: Burkhart Hollis
Published: February 2018

Investigates the healing/ameliorating effect of one's spiritual beliefs and practices in moderating depression when faced with negative life experiences. Beck's Depression Inventory II, Piedmont's ASPIRES, and Sarason's Life Experiences Survey were the instruments administered to 51 adult patients at two pastoral counseling centers over a four month period. Findings indicate significant inverse correlations between spirituality and depression and a moderating effect of spirituality on depression when negative life experiences are included.
Napping to Reduce Sleepiness, Fatigue and Improve Reasoning for Nursing Shift Workers
Authors: Bourdony Cheryl
Published: February 2018

Shift work outside the normal working hours of 6 a.m. to 6 p.m. is a requirement in acute and chronic care facilities that provide nursing care on a 24-hour basis. Slightly more than 30% of full-time health care workers are shift workers. Shift work sleep disorder, defined as a primary complaint of insomnia and excessive sleepiness, has been diagnosed in almost ten % of shift workers. The excessive sleepiness and fatigue nursing shift workers experience often lead to performance impairment and diminished attentiveness that may affect job productivity and patient safety. Napping is the most natural countermeasure against sleepiness. This quasiexperimental study was performed to detemine whether a 20 minute nap during the niight shift could reduce sleepiness and fatigue and improve cognitive functioning among nursing shift workers in an acute care setting. Ten study participants were randomly assigned to participate in both the control (no nap) and the intervention (nap) within the two week study. Self-testing of fatigue and sleepiness, and a timed reaction test programmed into a personal digital assistant (PDA) were performed throughout the two shifts. Results showed a trend toward a reduction in sleepiness and fatigue were reduced when nursing staff took a 20 minute nap during shift work, that was sustained through the remainder of the shift. The Advanced Practice Nurse is critical to advancing napping for shift workers because she/he can interpret, evaluate, and participate in research, create evidence-based policy, and collaborate with key stakeholders.
A Program Evaluation of a Nurse-led Interdisciplinary Heart Failure Clinic
Authors: Reis Savard Victoria
Published: February 2018

Heart failure (HF) is a major health disparity that accounts for a vast number of hospitalizations as well as re-hospitalizations. In 2006. the estimated direct cost of HF in the United States (US) was 29.6 billion dollars (American Heart Association [AHA], 2005). HF is not only costly but it also accounts for approximately 287,000 deaths in the US each year (AHA). Significant improvements in patient outcomes are evident when patients are referred to HF clinics. From the literature it appears that referred clients have less frequent re-hospitalizations in addition to improved quality of life. Nurse-led outpatient HF clinics offer behavioral specific knowledge necessary to engage in health promotion. Due to the complexity of the disease, it is appropriate to refer clients diagnosed with HF to nurse-led outpatient HF clinics. The purpose of this project was to validate and possibly expand knowledge about specific aspects of the nursing role in particular that contribute to improved outcomes in nurse-led HF clinics. A nurse interview and nurse-client observations were performed with specific emphasis on the role of the nurse. Scores were assessed on five clients using the Minnesota Living with Heart Failure questionnaire. Each demonstrated improvement on questionnaire responses during the six month period, with scores varying in improvement from I 0-12 points at the six month mark. Statistics related to re-hospitalization rates and ER visits were provided for the program evaluation by the clinic. The HF clinic demonstrated a 30 day re-hospitalization rate less than the national average of 24o/o, with a percentage of 18.6o/o. Components of a successful program were observed during an evaluation of the program. Recommendations and implications for advanced practice are discussed.
Does an Online Computer Based Critical Care Orientation Program Support the Learning Needs of a Multigenerational Workforce?
Authors: Brady Patricia
Published: February 2018

The complexities of today's health care system challenge acute care hospitals to provide comprehensive nursing orientation programs while meeting the needs of a multigenerational workforce. To prepare nurses to provide the highest quality of care for patients, nursing orientation must provide updated content, be cost effective, time sensitive and comprehensive, stimulate critical thinking skills, and include relevant evidence-based knowledge. Although a comprehensive nursing orientation is essential to every area of practice, specialties, such as critical care nursing, require specialized knowledge and additional skill sets that necessitate a more comprehensive training program while being sensitive to the needs of a multigenerational workforce. These considerations produce additional challenges for hospital orientation programs when considering the lack of available educators, projected nursing shortage, limited resources to accommodate multiple learning styles, and the current influence of healthcare economics. In an attempt to address orientation challenges, organizations such as the American Association of Critical Care Nurses (AACN) have developed online programs. The purpose of this paper is to evaluate one such program, the AACN Essentials of Critical Care Orientation (ECCO) program. ECCO was evaluated to determine if this online computer based orientation program would support the learning needs of multigenerational critical care nurses. Twenty-one nurses representing four generations of nurses from 11 hospitals in the United States completed an 18 question survey. Although the survey results supported the ECCO program as a useful tool for critical c
Evaluation of the Culturally Competent Nursing Modules
Authors: Silva Ann
Published: February 2018

The dramatic aging of the U.S. population and the growing proportion of racial and ethnic minority groups are two factors that continue to increase the urgency of addressing health disparities (State of Aging and Health in America [SAHA], 2007). With 40% of the U.S. population currently consisting of either immigrants or first-generation Americans, it is imperative that healthcare facilities provide cultural competence training for their nurses to ensure that all patients receive quality care(Hascup,2010). Recognizing cultural diversity integrating cultural knowledge, and acting in a culturally appropriate manner enables nurses to be more effective in initiating nursing assessments and serving as client advocates (American Nurses Association [ANA], 1991). The purpose of this project is to evaluate the Culturally Competent Nursing Modules commissioned by the Office of Minority Health, as an effective program for increasing cultural awareness in a long term care facility. Findings from this program evaluation indicate that the Culturally Competent Nursing Modules can facilitate increased cultural awareness among nurses in a long term care facility.
School Based Nutrition and Exercise Program
Authors: Amalfitano Darlene
Published: February 2018

The purpose of this project was to develop a school-based nutrition and exercise program aimed at encouraging and teaching healthful lifestyle choices and facilitating behavior change. A premise of the program was that sustainable changes in diet and physical activity accomplished in childhood may be carried into adulthood and may assist in the prevention of obesity in later years. The Ecological Theory by Urie Bronfenbrenner and Nola Pender's Health Promotion Model (2006) were the frameworks that guided this program development. The program duration was six weeks, and sessions met two times per week with 4th, 5th, and 6th grade participants. Children were given a pre-test to assess their knowledge base about healthy food choices, their activity levels, as well as to record a baseline weight.
Development of the Stroke Modules for Kent County Hospital Stroke Unit
Authors: Bird Barbara
Published: February 2018

Stroke is the number one cause of disability in the United States and costs over $68 billion annually. The majority of strokes are preventable but require education of the public on modifiable risk factors and prevention. Nurses play a major role in education related to prevention and care of stroke patients. The purpose of this project was to develop a self study educational program for nurses caring for stroke patients. A four module program was created. It was piloted by the sample population of nurses working on the stroke unit at Kent County Hospital. There was a thirteen point improvement in scores from the pre-test to the post-test scores after completing the educational modules. The Advanced Practice Registered Nurse (APRN) plays a key role in implementing, updating and evaluating the program as well as serving as a resource for nurses caring for stroke patients. The APRN should be instrumental in providing education and resource information to the stroke patient and their family. Recommendations are to implement the educational, self-study stroke modules throughout the hospital for use by all nurses who might care for a stroke patient.
Gangs and Social Policy
Authors: Doucette Karen
Published: February 2018

Youth involvement in gangs in urban areas is significantly increasing. These youth are at high risk for physical, mental, emotional, and behavioral disorders. Exposure to community violence is linked to aggressive behavior, lower academic performance, lower levels of social competence, and negative mental health outcomes. The purpose of this paper is to set the agenda on how to deal with gangs and gang members from a social policy perspective. This paper will outline the nature of the gang problem in Providence, Rhode Island from three different perspectives: Violence, Forgiveness, and Practice. Literature will be presented and discussed and recommendations for social policy using Ortiz's (2007) Social Diagnosis will be presented.
Quality Management of Chemotherapy: Induced Nausea and Vomiting with Minimal Constipation
Authors: Danzer Mary
Published: February 2018

Although clients diagnosed with colorectal cancer (CRC) are receiving more advanced and successful chemotherapy treatments, the side effects of these treatments continue to cause anxiety, discomfort, pain, and a diminished quality of life. Treatments must be developed to avoid some of the most unpleasant symptoms a client experiences as a result of these treatments. The purpose of this study was to examine the incidence of constipation related to the treatment of chemotherapy-induced nausea and vomiting (CINV) and to identify treatments that are successful in managing constipation while maintaining effective control of CINV. Constipation can be a significant problem with a negative impact on lifestyle during chemotherapy and needs aggressive management. Use of ondansetron as an antiemetic is associated with the development of constipation. A retrospective study was performed to identify the rate of constipation among a cohort of CRC clients and to determine effective treatment of constipation in the CRC client undergoing chemotherapy. Results of the study include increased rate of constipation in the study group, and limited documentation of symptoms and treatments. The study provided evidence that constipation is a significant side effect of CINV treatment with ondansetron and requires a comprehensive history to determine etiology. Communication is an important aspect of care, with the Clinical Nurse Specialist (CNS) informing staff of client history and insuring continuity of care. Implications and recommendations are identified and discussed.
The Impact of Timing, Selection, and Dosage of Preoperative Prophylactic Antibiotics on Preventable Surgical Site Infections
Authors: Insana Cathy
Published: February 2018

Surgical site infections (SSIs) are a subset of a larger group of infections that are known as hospital acquired infections (HAis). SSIs are a huge financial burden, costing billions of dollars in excess hospital charges every year. There is a considerable amount of evidence-based practice recommendations that can help reduce the incidence of SSIs. Research has supported the efficacy of preoperative antibiotic prophylaxis when appropriately selected and timed according to published guidelines. In addition to these measures, re-dosing of antibiotics must occur for those procedures that last more than four hours in order to continue to maintain tissue perfusion throughout the surgical procedure. The purpose of this study was to evaluate the timely administration, appropriate selection, and dosage of preoperative prophylactic antibiotics in surgical patients in one community hospital. A retrospective research design was used to obtain information on 100 randomly selected colon, hysterectomy, total hip and knee arthroplasty cases. Data were collected on those surgical procedures that occurred between October 1, 2010 and March 31 , 2011. During this time period, there were eight documented SSIs, three involving an organ space, and five that were superficial. In more than half of the colon and hysterectomy cases, the prophylactic antibiotic was administered less than 30 minutes before surgical incision, and in more than half of the total hip and total knee arthroplasty cases, antibiotic administration was between 30-60 minutes. All the procedures met the SCIP recommendations for timing and selection of prophylactic antibiotic. This study suggests that to ensure adequate tissue perfusion prior to surgical incision, the antibiotic should be administered in the preoperative holding unit, immediately prior to transfer to the operating room. This would assure that the antibiotic is given 30-60 minute timeframe, thus reducing the potential for the development of a SSI. Recommendations for further research and advanced nursing practice are discussed.
Effects of a Simulation Educational Experience on Critical Care Staff's Recognition of Stressors Affecting Performance and Use of Teamwork Skills
Authors: Paradis Heidi
Published: February 2018

Human limitations are sources of medical error that result in injuries, deaths and cost reaching millions. Preventing human errors from reaching patients is an imperative goal of a healthcare system that desires to reduce costs and produce quality outcomes. There is a mounting body of evidence that safety culture measurement and intervention can impact the safety and quality of healthcare.
Alarm Fatigue: A Risk Assessment
Authors: Baillargeon Erica
Published: February 2018

Alarm fatigue is the phenomenon which occurs when nurses become
overwhelmed by the high number of alarms in the clinical environment. This is a
significant patient safety issue as delayed or inappropriate responses can and have
resulted in patient harm. The purpose of the observational study was to conduct a risk
assessment of alarm fatigue at an acute care teaching hospital in Providence, RI.
Observations of telemetry alarms and response were conducted, utilizing a standardized
tool on two medical surgical units over a six week time period. Participants were 36
nurses working on the two units at time of observations. Alarms were quantified to
determine the percentage of false, technical, valid, and nuisance alarms. Alarm frequency
was calculated and average response time to critical and leads off alarms were
determined. Nurses were found to be at risk for and experiencing alarm fatigue based on
high alarm frequency, increased number of false and nuisance alarms, and a delayed
response to leads off conditions. The findings in this study are consistent with what is
occurring in healthcare organizations nationally, as evidenced by a recent Joint
Commission Sentinel Event Alert about medical device alarm safety that cited alarm
fatigue as a major contributing factor. Recommendations and implications are presented
and discussed.
Prevention Management of Postoperative Nausea and Vomiting in Ambulatory Setting: How Well are We Identifying Patients with Motion Sickness?
Authors: Capasso Sheila
Published: February 2018

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting
(PDNV) continue to be a serious problem in the ambulatory setting. These symptoms are
among the most undesired complications following surgery and can adversely affect the
quality of recovery for many patients. Previous research has concluded that the
identification of risk factors for PONV/PDNV is a first step in developing effective
prevention strategies. The purpose of this study was to examine the incidence of PONV/
PDNV in the ambulatory setting in female clients who were treated with transdermal
scopolamine (TDS) for motion sickness as compared to those patients who were not
treated with TDS. The study design was a two-group retrospective chart review. Of the
group identified with a positive history and not treated with TDS, 54% (n=6) developed
PONV /PDNV as compared to 26% (n=3) that were treated. This pilot study provided
preliminary support that preoperative identification of PONV/PDNV risk factors and
treatment with TDS reduces PONV/PDNV. Standardized, comprehensive risk factor
identification in the preoperative period is indicated.
Mandatory Influenza Vaccination for Healthcare Workers: Do Nurses Agree?
Authors: Nightingale Meghan
Published: February 2018

Influenza is a significant cause of morbidity and mortality among hospitalized patients.
Health care workers are considered a high-risk group for influenza, and annual
vaccination is the most effective way to prevent getting influenza. Increasing concern
about inadequate levels of healthcare work vaccination has led many groups to
recommend mandatory vaccination for healthcare workers. The state of Rhode Island was
considering mandatory vaccination in 2012 for all healthcare workers, with only medical
exemption, but this movement was halted. Research focused on the perception of nursing
personnel toward mandatory influenza vaccination is lacking, and considering that
registered nurses are one of the largest healthcare groups that would be affected, this is an
area of concern. The purpose of this research study was to examine the perception of
nursing staff toward mandated vaccination at a hospital in Rhode Island. The survey used
a mixed methods design, including forced choice questions and an open-ended question,
developed for purposes of this research. The study participants included RNs employed
in inpatient units. Most of the nurses disagreed that healthcare workers should be
mandated to get immunization and disagreed that a vaccine policy requiring mandatory
vaccination was fair. They also disagreed that hospital policy requiring influenza
vaccination keeps them from getting influenza or keeps their patients from getting
influenza. In one of the first states considering mandatory vaccination statewide, these
results are an important consideration before implementation of this potential measure.
An Exploration of the Barriers in the Prevention and Control of High Blood Pressure Among West African Immigrants in Rhode Island
Authors: Udeh Ntaobasi
Published: February 2018

This is a report of a pilot study to explore the barriers to the prevention and control of
high blood pressure by West African immigrants in Rhode Island. The incidence of high
blood pressure is high in African Americans with many possible contributory factors
documented. However, little is known about possible barriers to the control of high
blood pressure among specific black ethnic populations such as West African immigrants
living in Rhode Island. A qualitative research design employing a semi-structured
interview was utilize to explore the issue. The barriers to high blood pressure
management reported by these West Africans immigrants reported included:
psychosocial stressors, inability to adopt lifestyle changes such as diet and exercise,
belief system, and a lack of complete adherence to medication regimen. The study also
highlighted the fact that some primary care providers for these patients are not following
the recommended interventions for the management of high blood pressure in people of
black ancestry. The findings of this pilot study support the need for provider use of
available treatment guidelines for population from black ancestry and the necessity for
adequate patient education in the areas of stress management strategies and lifestyle
modification as adjuncts to medication prescribed for high blood pressure management.
Development of a Community-Based Lactation Support Program
Authors: Bryant Susan
Published: February 2018

Background. Despite the recommendations from leading health organizations and the documented health benefits for both mother and infant, breastfeeding success rates continue to be suboptimal.

Design. A program development design was used for this Community-Based Lactation Support Program. This pilot was the first step in accomplishing the long term goal of expansion of the program to the entire community of Scituate and the state of Rhode Island.

Objectives. The objectives of this program were to increase exclusive and sustained breastfeeding rates in the town of Scituate through education and support and to ensure a positive breastfeeding experience for the breastfeeding family. The program was designed to enhance, not replace, existing breastfeeding support services and healthcare providers.

Method. The objectives were accomplished through individual support, education, and empowerment in the home environment using a public health nurse implemented program.

The pilot consisted of a program design utilizing the Precede/Proceed framework for: project promotion and recruitment; pre-natal interview and breastfeeding education; postpartum home visit; and follow-up phone assessments at one week, two weeks, one month, and three months after delivery.

Results. The four mothers who participated in the pilot reported an increase in confidence and knowledge and sustained, exclusive breastfeeding during follow-up phone assessments.
Preventing Ventilator-Associated Pneumonia: Educating Emergency Room Nurses
Authors: Ferrazzano Dana
Published: February 2018

Ventilator-associated pneumonia (VAP) is the second most common hospital acquired infection and is primarily found in the intensive care units. The presence of an endotracheal tube is the primary risk factor for developing VAP. Many times the process of intubation occurs pre-hospital, in the emergency room (ER) or in the operating room. Ventilator associated pneumonia is associated with increased hospital stay and costs. Evidence-based guidelines have been developed to decrease the occurrence of VAP and decrease patient mortality. Preventative measures are initiated on the intensive care unit once the patient is transferred. The purpose of this study was to evaluate the impact of an educational program on ER nurses knowledge of VAP and preventative measures to decrease VAP.

The study took place at Rhode Island Hospital, a level 1 trauma center located in Providence, RI. Participants were ER nurses who worked in the critical care area of the ER. A pre-intervention-posttest design was used to evaluate emergency room nurses knowledge regarding VAP. The intervention consisted of a posterboard and study guide that provided information regarding evidence-based guidelines that could be implemented in the ER such as oral care, and head of bed elevation. The overall results on the pre and posttest demonstrated that ER nurses were unaware that oral care and the use of chlorhexidine were important interventions to reduce the incidence of developing VAP. Recommendations and implications for advanced practice nursing and the need for future research are discussed.
Timelines of Oral Care and Early-Onset Ventilator Associated Pneumonia Prevention
Authors: Francoeur Kristen
Published: February 2018

Hospital-acquired infections, including ventilator associated pneumonia (VAP), are a significant cause of morbidity and mortality and associated with increased costs and length of stay (Chastre & Fagon, 2002; NNIS, 2004). Ventilator associated pneumonia is believed to primarily result from aspiration of oropharyngeal secretions around the endotracheal tube cuff into the lungs (Grap, Munro, Unoki, Hamilton, & Ward, 2012). A randomized control trial tested early application of oral chlorhexidine (CHG) on oral microbial flora and VAP in trauma patients and suggested that early (within 12 hours of intubation) application may reduce VAP rates in trauma patients (Grap, Munro, Hamilton, Elswick, Sessler & Ward, 2011). The VAP rate in a local Level 1 trauma center, 11-bed trauma intensive care unit (TICU) was 8.7 per 1000 device days, above the national average (NHSN, 2011). The purpose of this research was to explore the relationship between the time of insertion of an endotracheal tube and first CHG application and early onset (within 72 hours of intubation) VAP. A retrospective chart review of the records of randomly selected adult intubated trauma patients hospitalized on the TICU was conducted. Collected data included: time of intubation; timing of CHG application; VAP occurrences; and length of intubation. Less than half (45.8%) of patients received early CHG application, and most (79.2%) were intubated in the emergency department (ED), suggesting that VAP prevention measures begin in the ED. Of the patients reviewed, five developed VAP; three occurred in patients who had received oral CHG within 12 hours of intubation. A CNS-driven collaboration with other disciplines and departments is essential to implement VAP prevention measures and provide comprehensive, quality care.
Examining Chronic Stress in Spouses of Active Duty Military Members
Authors: Joseph Cristina
Published: February 2018

Even in the absence of wartime stressors, the military lifestyle is characterized by frequent challenges that affect not only the military member, but also his or her spouse and children. Due to frequent relocations and deployments, military spouses are often relied upon to become the primary child-rearers, make occupational sacrifices, deal with financial concerns independently, organize relocations, and cope with lack of social support. These multiple responsibilities can create a myriad of stressors, which over time lend themselves to the formation of chronic stress. The purpose of this exploratory study is to determine if spouses of active duty military members display chronic stress according to the Trier Inventory for the Assessment of Chronic Stress (TICS-LE). Seventy-one female military spouses responded to the TICS-LE online. Mean scores for all the factors on the TICS-LE ranged between 1.03 and 2.05, which was lower than expected given the plethora of stressors associated with the military lifestyle. Findings suggested that chronic stress levels experienced by military spouses may be mitigated by high quality social support systems, the demographic factors of the military spouse and whether the military family has developed resilience after years of being embedded in the military lifestyle. This major paper project underscores the need for advanced practice nurses to be aware of the multiple stressors that military spouses face, unique cultural phenomena present in military life, and its possible implications on the psychological and physical functioning of military spouses.
Nurses Perceptions of Family Presence during Resuscitation in the Emergency Department
Authors: Jennings Jennifer
Published: February 2018

Family presence during resuscitation has been a controversial and much debated topic for many years. In the past decade, the movement toward family presence has steadily grown. The Emergency Nurses Association (ENA) and the American Heart Association (AHA) have endorsed family presence and incorporated guidelines for its implementation. Although becoming more accepted in practice, there are still many hospitals without family presence policies, and some nurses and other health care providers continue to identify concerns about its’ use. The purpose of this project was to survey nurses’ perceptions of family presence during resuscitation in the Emergency Department. A researcher developed a survey which was left in the study site’s Emergency Department break room for a period of two weeks. The target samples were Registered Nurses (RNs) employed in the ED. Thirteen out of 59 RNs completed the survey. More than half of the respondents believed in general that family should be present, that family presence encouraged increased professional behavior from the RN, and families being present can facilitate closure. Recommendations and implications for advanced practice nursing and the need for future research are discussed.
Exploring Barriers to Code Status Discussions
Authors: Dickson Christina
Published: February 2018

It is imperative that Advanced Practice Registered Nurses (APRNs) have the skill set necessary to initiate code status discussions with people. The literature supports that healthcare providers tend to avoid the topic, for reasons that include feeling uncomfortable, not having enough time, and not wanting to take away hope. How do we break down these barriers to ensure that healthcare providers feel comfortable and prepared to have code status discussions? The purpose of this project was to explore perceived barriers encountered by the Advanced Practice Registered Nurse (APRN) student population. A survey was developed that included sections on comfort level with code status discussion, beliefs about DNR, barriers encountered in code status discussions, and two open ended questions. Findings revealed that participants overall were comfortable with having code status discussions, but were unfamiliar with the MOLST tool, a relatively new measure being used to facilitate code status discussions. Most participants believed that patients should always be informed about code status and should be asked if they would like to be a DNR. Numerous barriers were cited, the most common being unrealistic expectations and feeling uncomfortable addressing the issue of code status. More education, time and support, were cited as what would enable participants to have better conversations. Starting these discussions in the primary care office and then ensuring that this information is passed on could potentially improve outcomes. Advocating for policy changes at the institutional, state, and national levels is needed. Quality, patient-centered code status discussions are imperative in ensuring the patients are allowed to have good deaths.
Neuroscience Nurses' Perceptions of the Barriers to Identifying and Treating Pain in Acutely Brain-Injured Adult Patients
Authors: Iannotti Kimberly
Published: February 2018

Pain management for the critically ill adult can be daunting. Numerous factors contribute to this challenging process including altered level of consciousness (LOC), inability to speak, life support measures, family input, level of sedation, paralyzing agents, restraints, cognitive impairment, and numerous other factors. The current practice related to pain management in the neurologically critically ill adult patient population is limited by inadequate pain scales, altered neurological status, and atypical pain-associated behaviors. Additionally, nurses are challenged by unclear practice guidelines. The critical care nurse is required to assess and manage pain, as well as implement specific interventions based on the patient’s exhibiting characteristics or behaviors. The purpose of this study was to explore the neuroscience nurses’ perception of the barriers to identifying and treating pain in the acutely brain-injured adult patient. Participants were registered nurses working on a Neurocritical Care Unit. The methodology included two short answer questions and 15 Likert format questions rating the frequency of specific barriers. Nurses reported declining neurological status and subjective assessment tools as the most frequently seen barriers to pain assessment and management. Development of pain assessment measures in the brain-injured acutely ill adult patient continues to be important. The need for nurse-driven research to explore alternate measures to identify pain in the neurological patient is indicated. Implications for advanced practice are discussed.
Reducing Hospital Acquired Pressure Ulcers
Authors: LeBlanc Jessica
Published: February 2018

Pressure ulcers have been a persistent issue in hospitals for many years and continue to remain a major cause of morbidity and mortality. Most hospital acquired pressure ulcers (HAPUs) are considered preventable and are identified by the National Quality Forum as a nurse-sensitive quality indicator. Intensive care patients in particular tend to be at a higher risk to develop PUs and prevention in the intensive care population continues to be a major challenge in many hospitals. Recently, some intensive care units have been utilizing a preventative silicone foam barrier dressing applied to patients admitted to the unit in order reduce the incidence of HAPUs. The purpose of this research was to determine if a silicone foam border dressing applied to medical intensive care patients would result in a decreased sacral HAPU occurrence rate in the medical ICU. The data collection took place at the Miriam Hospital, a 247-bed tertiary care hospital in Providence, Rhode Island. The medical ICU at the Miriam Hospital is a 16-bed unit. A retrospective chart review was conducted on 250 medical records that were coded with ICD-9 codes for pressure ulcers. Group One (treatment group) included medical intensive care unit patients who had preventative dressings applied to the sacrum. Group Two (comparison group) included patients who did not have a preventative dressing applied. Results demonstrated that there was a decrease in the occurrence rate of HAPUs after the preventative dressings were initiated. Recommendations and implications for advanced practice nursing are discussed.