School of Nursing Capstones

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    A Quality Improvement Initiative to Explore Barriers Facing Associate Degreed Nurses Obtaining a Bachelor’s Degree [paper]
    (2021-12) Gersbach, Kendal; Garcia, Theresa
    In 2010, the Institute of Medicine recommended that 80% of nurses in the workforce be BSN-prepared by the year 2020 (IOM, 2010). As shown by multiple surveys, the United States did not meet this recommendation by the year 2020. In 2018, a survey conducted by the U.S. Department of Health and Human Services using The National Center for Health Workforce Analysis team reported that only 63.9% of the RNs surveyed held a BSN degree (U.S. Department of Health and Human Services, 2019). The question remains to what is preventing more ADN-prepared nurses from advancing their degree to BSN and beyond. This project aims to identify barriers ADN nurses perceive when enrolling in or completing a bachelor’s degree.
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    A Quality Improvement Initiative to Explore Barriers Facing Associate Degreed Nurses Obtaining a Bachelor’s Degree [poster]
    (2021-12) Gersbach, Kendal
    In 2010, the Institute of Medicine recommended that 80% of nurses in the workforce be BSN-prepared by the year 2020 (IOM, 2010). As shown by multiple surveys, the United States did not meet this recommendation by the year 2020. In 2018, a survey conducted by the U.S. Department of Health and Human Services using The National Center for Health Workforce Analysis team reported that only 63.9% of the RNs surveyed held a BSN degree (U.S. Department of Health and Human Services, 2019). The question remains to what is preventing more ADN-prepared nurses from advancing their degree to BSN and beyond. This project aims to identify barriers ADN nurses perceive when enrolling in or completing a bachelor’s degree.
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    A Quality Improvement Initiative: Implementing a Standardized Education Protocol to Improve the Blood Culture Collection Process in a Rural Hospital Setting [paper]
    (2023-12) Heredia, Edward R.; Cropley, Stacey
    Blood culture contamination represents a deviation from the quality standard of care and has financial ramifications for hospital organizations. Skoglund et al. (2019) determined that the direct and indirect hospital costs associated with a contaminated blood culture were $12,824 compared to $8,286 for a negative blood culture. Preventing a single blood culture contamination results in a cost savings of $4,538. Blood cultures are widely considered necessary and essential laboratory tests performed to diagnose severe infections (Doern et al., 2020). Blood cultures are collected by a registered nurse or a health technician with phlebotomy certification. The most common indicator of blood culture contamination is directly linked to the improper collection of blood culture specimens. Cases are classified as false positives when the automated blood culture system produces a signal and detects no microorganisms (Ebihara et al., 2019). Financial ramifications of contaminated false positives include unnecessary hospitalization, extended length of stay and risk of associated hospital-acquired conditions, additional diagnostic tests, various costly clinical procedures, and increased work for clinical staff (Steed, 2017). A study by Lalezari et al. (2020) found the median length of stay in patients with a contaminated blood culture was 2 days longer than the median length of stay in patients with a negative culture. In the United States (U.S.), 4% of hospitalized patients will die from a hospital-acquired infection (Shalini & Abiselvi, 2015). Given that blood culture contamination is directly linked to the specimen collection process, this quality improvement project will target the blood culture collection procedure and implement an evidence-based intervention to ensure that the proper blood culture collection procedure is practiced, and that the procedure adheres to the facility's improved protocol. This quality improvement project will standardize and improve the blood culture collection procedure at Crane Memorial Hospital due to detected inconsistencies with staff improperly obtaining blood culture specimens, and the quality improvement project will explore the effectiveness of implementing an evidence-based standardized education protocol to add consistency and accuracy to the blood culture specimen collection process.
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    A Systematic Review Examining Patient and Provider Attitudes Toward Use of Medication for Opioid Use Disorder [paper]
    (2023-12) Trejo, Anyssa; Page, Tracey
    Introduction: Despite drastically rising rates of opioid overdose related deaths, rigid opinions of both patients and providers against the use of medication for opioid use disorder persist in the face of well-established evidence indicating that medication for opioid use disorder is the gold standard of care. The purpose of this systematic review of the literature is to examine the source and effect of negative perceptions and to make recommendations to providers to improve treatment and outcomes for this population. Methods: A systematic review of the literature was conducted to identify the source and extent of perceptions of both patients with opioid use disorder and their providers regarding medication for opioid use disorder. The Neuman Systems Model was used to guide the review to see the patient as a system with many parts that responds to environmental stressors and to bring providers’ focus back to the client’s well-being. Results: Seven articles were included to identify two major themes describing patient and provider attitudes toward medication for opioid use disorder. The first theme identified was that providers and patients carry negative perceptions toward medication for opioid use disorder. The second theme indicated that medication for opioid use disorder is perceived as a replacement drug by providers and patients. Discussion: It is apparent that there is a negative view towards medication for opioid use disorder by both healthcare providers and patients struggling with opioid use disorder. Negative attitudes upheld by healthcare providers and patients continue to prevent access to effective treatment for those struggling with opioid use disorder.
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    A Systematic Review of Common Symptoms Associated with Urinary Tract Infections in the Elderly [paper]
    (2022-12) Woodall, Lynn; Garcia, Theresa
    Introduction: Urinary tract infections (UTIs) are a common infection seen in primary care. There are many key predictive factors including age, gender, comorbidities, and symptom presentation that can be used to quickly identify UTIs for rapid treatment to be implemented. Methods: This systematic review of literature was guided by Dorothea Orem’s Self Care Deficit Theory, and by using databases including CINAHL, PubMed, and Medline to gather and evaluate articles for relevance and guidance. A Rapid Critical Appraisal Tool was used to further screen these articles for relevance and validity through a screening process with inclusion criteria to include or exclude articles for the review. The articles reviewed were used to answer the clinical PICOT question presented and the articles were presented in the form of an evidence synthesis table to give a side-by-side comparison of the research. Results: Six cohort studies were ultimately included and used based on relevance, to show strong evidence that there are many key predictive factors of UTI in the elderly population that a provider can assess for in their practice to identify and quickly treat before complications occur. All six studies were able to support the clinical question presented. Discussion: Based on the studies reviewed, there is evidence that improvements can be made in identification and rapid treatment of UTIs in the elderly with further quality improvement projects, more research into the signs and symptoms noted in a larger population with the key focus on identification prior to having positive confirmation of urinary tract infection.
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    A Systematic Review of Common Symptoms Associated with Urinary Tract Infections in the Elderly [poster]
    (2022-12) Woodall, Lynn
    Introduction: Urinary tract infections (UTIs) are a common infection seen in primary care. There are many key predictive factors including age, gender, comorbidities, and symptom presentation that can be used to quickly identify UTIs for rapid treatment to be implemented. Methods: This systematic review of literature was guided by Dorothea Orem’s Self Care Deficit Theory, and by using databases including CINAHL, PubMed, and Medline to gather and evaluate articles for relevance and guidance. A Rapid Critical Appraisal Tool was used to further screen these articles for relevance and validity through a screening process with inclusion criteria to include or exclude articles for the review. The articles reviewed were used to answer the clinical PICOT question presented and the articles were presented in the form of an evidence synthesis table to give a side-by-side comparison of the research. Results: Six cohort studies were ultimately included and used based on relevance, to show strong evidence that there are many key predictive factors of UTI in the elderly population that a provider can assess for in their practice to identify and quickly treat before complications occur. All six studies were able to support the clinical question presented. Discussion: Based on the studies reviewed, there is evidence that improvements can be made in identification and rapid treatment of UTIs in the elderly with further quality improvement projects, more research into the signs and symptoms noted in a larger population with the key focus on identification prior to having positive confirmation of urinary tract infection.
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    A Systematic Review on The Supplementation of Zinc to Treat Depression [paper]
    (2023-12) Strunck, Kaymee M.; Garcia, Theresa; Page, Tracey
    As rates of depression continue to increase and current pharmacological first – line treatments are not producing high levels of remission alternative treatment options should be investigated. While links between zinc and depression date back to the 1980’s little is known about the effects of zinc supplementation on depressive symptoms. To answer this question a systematic review was conducted to determine if current literature supported the supplementation of zinc to treat depressive symptoms. CINAHL, PubMed, and MEDLINE Complete were searched for relevant literature addressing the relationship between zinc and depression. Seven articles were identified that met inclusion criteria and included three randomized control trials (Gosh et al., 2022; Sarris et al., 2019; Yosaee et al., 2020), three cross-sectional studies (Li et al., 2018; Mousa & Al-Diwan, 2023; Nakamura et al., 2019) and one cohort study (Jung et al., 2017). The total sample size across studies was 18,942. Results yielded that increasing zinc in the diet via supplementation improved symptoms of depression as evidenced by a decrease in self-reported depressive symptoms and individuals who reported consuming an adequate amount of zinc in the diet reported a decrease in depressive symptoms. There was also an association between low serum zinc detected in blood and worse depressive symptoms. Findings from this review suggest that increasing zinc in the diet can decrease depressive symptoms and that low levels of zinc in the diet are related to increased depressive symptoms. Future studies should include RCT’s on larger populations of patients diagnosed with MDD and explore zinc as a monotherapy for depression to determine if zinc alone could be a primary, secondary, or tertiary treatment for depressive symptoms.
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    Alternative Treatment for ADHD: A Systemic Review of Polyunsaturated Fat Supplementation Interventions in Children [paper]
    (2023-12) Rutherford, Mikhaila; Littlefield, Amber
    Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that is usually diagnosed in childhood. The primary treatment is the use of stimulant medications. Alternative treatments have also been developed but not rigorously scientifically tested. One alternative treatment that has received publicity recently is a dietary intervention of supplementing children with polyunsaturated fatty acids, commonly known as omega-3 and omega-6/fish oil. Current scientific literature presents conflicting findings regarding the efficacy of fatty acid treatment of ADHD symptoms. This systematic review aims to summarize current randomized controlled trials that examined the use of fatty acids in the management of various cognitive and behavioral factors related to inattention, hyperactivity and impulsivity in children with ADHD symptoms. Methods: The author obtained evidence from articles published between 2017 and 2022 from CINAHL, PubMed, ScienceDirect, and Medline. Papers eligible for inclusion included: full-text, peer-reviewed randomized controlled trials. Quality assessment was conducted, using Melnyk and Fineout-Overholt’s Rapid Critical Appraisal Checklists. Results: Of the 647 papers identified, 8 studies met the inclusion criteria. Common themes were 1) Omega-3 & 6 polyunsaturated fat supplementation has mild impact on a variety of ADHD symptoms and 2) Omega-3 & 6 polyunsaturated fat supplementation has very few adverse side effects. Discussion: Results suggest that fatty acid supplementation may have mild to moderate positive effects of children’s ADHD symptoms and that there are minimal side effects associated with using them for this purpose.
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    Alternative Treatment for ADHD: A Systemic Review of Polyunsaturated Fat Supplementation Interventions in Children [poster]
    (2023-12) Rutherford, Mikhaila
    The purpose of this project is to compare the current research available regarding the effects of polyunsaturated fatty acids/omega-3 supplementation (PUFAs) on ADHD symptoms in children. The conceptual framework that guided this systematic review was the Neuman’s Systems Model (Petiprin, 2020). Neuman’s System Model is a strong guide to develop nursing knowledge because it encompasses looking at the entire person, in addition to their interactions within their environment and other people. All people are complex individuals and treatment considerations should be made toward their unique multidimensional qualities, including taking into account individual family preferences for treatment.
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    An Interprofessional Quality Incident Review Team: Effects on Reporting and Resolution [paper]
    (2019-12) Burgoon, Courtney; Dolan, Diana; Willson, Pamela
    Background: Since the Institute of Medicine's (IOM) report, To Err is Human, there has been increased focus on patient safety, to include use of incident reporting systems for gathering data to improve knowledge and decrease e1rnrs in the hospital. With increased pain and suffering, and cost associated with errors, the justification for these processes are clear. It is known that underreporting of incidents continues. There is a need for reporting systems, with available research focusing on organizational safety culture, ba1Tiers to reporting, and the acceptance of reporting systems in practice. Process improvement methods to increase incident reporting, and resolution of incidents is lacking in literature. Method: A descriptive repeated measures quality improvement project was undertaken at baseline, 3-months, and 6-months post intervention. Quality metrics were number of patient safety incidents and time to resolution of incident review. The intervention consisted of the development of An Interdisciplinary Quality Incident Review Team (QIRT) at a 147 bed acute care hospital in central Texas, U.S. A. The QIRT process, involved education of staff and managers on the new processes of reporting, evaluating, and completing incident reports. Results: Implementation of the QIRT process resulted in an increase in overall reporting of patient safety incidents in the categories of medication errors, hospital, nursing, and safety. At 3- months and 6-month post intervention, incident reports increased by 41% (n=21) and 59% (n=30). Hospital Incidents made up greatest increase in rep01i types, while Medication Errors had the fewer rep01is. Time to resolution of Nursing Incident reviews had the largest decrease in resolution time with an average of 11 days. Nursing Incident reporting demonstrated that consistency lead to sustainability over time, as the number of reported incidents continued to increase during the 6-month follow-up. Conclusions: Implementation of the QIRT, including educational materials and expectations for nursing staff and managers, increased incident reporting in all areas. Education regarding rep01iing, awareness ofrep01ied events, and follow-up from the QIRT were shown to increase reporting across the organization. Nursing incident rep01is were the only category where the time from the incident was reported, to resolution of the incident in the rep01iing system decreased.
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    Barriers and Outcomes for Low-income Women with Mental Illness During Post-Partum [poster]
    (2023-12) Bibles, Sharmelle R.
    Introduction: Maternal mortality among low-income mothers in the United States (U.S.) is steadily increasing (Eckert, 2020). The risk for developing mental illness is higher among middle- and low-income households, where 1 in 4 women report depression during pregnancy and 1 in 5 report having postpartum depression (Awini et al., 2023). Several research studies have examined social determinants of health (SDOH) impact on mental healthcare treatment among pregnant and post-partum women. However, gaps in the literature suggest that more research is needed to examine mental health outcomes for mothers and babies with untreated mental illness during the post-partum period. This systematic literature review aims to identify barriers to healthcare, patient outcomes, and helpful interventions for post-partum women with mental illness in low-income communities. Methods: The author extracted data from articles between 2018 and 2023 via CINHAL, Pubmed, and Psychinfo electronic databases. An ancestry search strategy was also used for data collection. Articles selected for this study meet inclusion criteria: (1) primary research articles, (2) published in English, (3) published in a peer-reviewed journal, (4) published within the last five years, and (5) addressed or related to barriers and outcomes for low-income, post-partum women with mental illness. The Rapid Quality Critical Appraisal Tool, adapted by Melnyk and Fineout-Overholt (2019), was used to appraise and evaluate quality of the literature. Results: 1,512 articles were identified, and seven studies met inclusion criteria. Five common themes were identified across studies as barriers for low-income post-partum women in need of mental healthcare: (1) lack of social and community support, (2) lack of transportation and community resources, (3) lack of financial assistance and income, (4) lack of provide education (understanding) and advocacy (5) lack of mental health education. Discussion: Results suggest a critical need for multiple stakeholders to address the complex barriers and social determinants of health that result in poor outcomes for low-income postpartum women with mental illness.
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    Barriers and Outcomes for Low-income Women with Mental Illness During Post-Partum: A Systematic Review [paper]
    (2023-12) Bibles, Sharmelle; Littlefield, Amber
    Introduction: Maternal mortality among low-income mothers in the United States (U.S.) is steadily increasing (Eckert, 2020). The risk for developing mental illness is higher among middle- and low-income households, where 1 in 4 women report depression during pregnancy and 1 in 5 report having postpartum depression (Awini et al., 2023). Several research studies have examined social determinants of health (SDOH) impact on mental healthcare treatment among pregnant and post-partum women. However, gaps in the literature suggest that more research is needed to examine mental health outcomes for mothers and babies with untreated mental illness during the post-partum period. This systematic literature review aims to identify barriers to healthcare, patient outcomes, and helpful interventions for post-partum women with mental illness in low-income communities. Methods: The author extracted data from articles between 2018 and 2023 via CINHAL, Pubmed, and Psychinfo electronic databases. An ancestry search strategy was also used for data collection. Articles selected for this study meet inclusion criteria: (1) primary research articles, (2) published in English, (3) published in a peer-reviewed journal, (4) published within the last five years, and (5) addressed or related to barriers and outcomes for low-income, post-partum women with mental illness. The Rapid Quality Critical Appraisal Tool, adapted by Melnyk and Fineout-Overholt (2019), was used to appraise and evaluate quality of the literature. Results: 1,512 articles were identified, and seven studies met inclusion criteria. Five common themes were identified across studies as barriers for low-income post-partum women in need of mental healthcare: (1) lack of social and community support, (2) lack of transportation and community resources, (3) lack of financial assistance and income, (4) lack of provide education (understanding) and advocacy (5) lack of mental health education. Discussion: Results suggest a critical need for multiple stakeholders to address the complex barriers and social determinants of health that result in poor outcomes for low-income postpartum women with mental illness.
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    Barriers in Seeking Treatment for Perinatal Depression in Low-Income African Americans: A Systematic Review [paper]
    (2022-12) Basa, Jessica; Garcia, Theresa
    Introduction: Perinatal depression is a mood disorder that can occur during pregnancy and within four weeks of childbirth. Individuals at the greatest risk for perinatal depression include low-income African American and Hispanic women. African American women are least likely to seek psychiatric treatments for perinatal depression. Current literature presents conflicting findings as to the existence of racial and ethnic differences in screening and treatment for perinatal depression. This systematic review aimed to summarize and categorize the barriers faced by low-income, pregnant Black/African American women that discourages treatment engagement for depression. Methods: The author abstracted evidence from articles published between 2008 and 2021 from CINAHL, PubMed, and ScienceDirect electronic databases and ancestry search strategy. Papers eligible for inclusion included: full-text, peer-reviewed studies, and a focus on the barriers for low-income, pregnant African Americans in seeking treatment for depression. Quality assessment was conducted, using Melnyk and Fineout-Overholt’s Rapid Critical Appraisal Checklists. Results: Of 8,715 papers identified, 7 studies met the inclusion criteria. Common themes were 1) avoidance of psychiatric medications with greater preference for faith-based interventions and 2) time constraints and costs as significant barriers to treatment for perinatal depression in this population. Discussion: The results suggest the need to include faith-based approaches to appeal more to African American women, ask more culturally sensitive questions, integrate mental health services in obstetric clinics, and offer virtual appointments and/or options for mothers to bring their children for easier convenience.
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    Barriers in Seeking Treatment for Perinatal Depression in Low-Income African Americans: A Systematic Review [poster]
    (2022-12) Basa, Jessica; Garcia, Theresa
    Introduction: Perinatal depression is a mood disorder that can occur during pregnancy and within four weeks of childbirth. Individuals at the greatest risk for perinatal depression include low-income African American and Hispanic women. African American women are least likely to seek psychiatric treatments for perinatal depression. Current literature presents conflicting findings as to the existence of racial and ethnic differences in screening and treatment for perinatal depression. This systematic review aimed to summarize and categorize the barriers faced by low-income, pregnant Black/African American women that discourages treatment engagement for depression. Methods: The author abstracted evidence from articles published between 2008 and 2021 from CINAHL, PubMed, and ScienceDirect electronic databases and ancestry search strategy. Papers eligible for inclusion included: full-text, peer-reviewed studies, and a focus on the barriers for low-income, pregnant African Americans in seeking treatment for depression. Quality assessment was conducted, using Melnyk and Fineout-Overholt’s Rapid Critical Appraisal Checklists. Results: Of 8,715 papers identified, 7 studies met the inclusion criteria. Common themes were 1) avoidance of psychiatric medications with greater preference for faith-based interventions and 2) time constraints and costs as significant barriers to treatment for perinatal depression in this population. Discussion: The results suggest the need to include faith-based approaches to appeal more to African American women, ask more culturally sensitive questions, integrate mental health services in obstetric clinics, and offer virtual appointments and/or options for mothers to bring their children for easier convenience.
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    Bedside Educational Tool: Improving Patient Education and Nursing Documentation [paper]
    (2019-12) David, Katie; Willson, Pamela; Dolan, Diana
    Background: The purpose of the Bedside Educational Tool (BET) project was to increase patient discharge knowledge by expanding Krames education selections recorded in the discharge and maintained in the Electronic Health Record (EHR). Methods: A descriptive pre- post-comparison evidence-based improvement project was unde1iaken to determine if cueing with a collaborative patient point-of-care educational tool facilitated nurse-patient education and discharge documentation. To establish a baseline, chart audits of patients discharged from a 32-bed medical-surgical unit within a large 378 bed acute care hospital for a consecutive 18-day period was performed. Three instruments were used in this project 1) Bedside Educational Tool (BET), 2) Nurse Usability and Usefulness Survey, and the 3) Patients Discharge Record from the hospital. Implementation consisted of initiation of the BET sheet and nursing education regarding documentation of Krames selections. Audited discharge records compared the Krames education selections in the EHR from 101 pre­ implementation charts to 129 post-implementation charts. Results: All nurses on the pilot unit 41 (100%) participated in the implementation of the BET. 37 (90.24%) nurses on the unit participated in the BET project HealthStream education. EHR Krames educational documentation increased after implementing the BET tool by 96% and the number of Krames items selected per patient increased 229%. Nurses surveyed found the BET tool both easy to use and successful in the development of the collaborative patient-centered education. Conclusions: In hospitalized patients, the introduction of a patient-nurse bedside education collaborative tool (BET) increased collaborative patient-centered education and the Krames education selections recorded in the discharge plan and the final EHR.
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    Bedside Educational Tool: Improving Patient Education and Nursing Documentation [poster]
    (2019-12) David, Katie; Dolan, Diana; Willson, Pamela
    Background: The aim of the Bedside Education Tool (BET) project was to increase patient discharge knowledge by expanding Krames© Patient Education (Krames) selections recorded in the Electronic Health Record (EHR). Methods: A descriptive pre- post-comparison evidence-based improvement project was undertaken to determine if cueing with a collaborative patient point-of-care educational tool facilitated nurse-patient education and discharge documentation. Three instruments were used: 1) BET Sheet, 2) Nurse Usability and Usefulness Survey, and 3) the patients EHR Discharge Record education section. Nursing staff were educated regarding documentation of Krames selections in the EHR. EHR record audits (N=230) were reviewed; 101 pre-implementation records and 129 post-implementation records. Results: Nurses on the selected medical-surgical unit, (N=37, 90.24%) participated in the BET project after education. BET project HealthStream education was completed. EHR Krames documentation increased 153% and the number of Krames items selected per patient increased 229% after the BET implementation. Conclusion: In hospitalized patients, the introduction of a patient-nurse bedside education collaborative tool (BET) increased collaborative patient-centered education and Krames education selections recorded in the EHR discharge plan.
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    Behavioral Cuing: Improving Hospital Visitor Hand Hygiene Behaviors [poster]
    (2019-05) Sumner, Lauren
    Background: Visitors hand hygiene (VHH) prior to entering intensive care (ICU), telemetry, and intermediate care units is crucial in preventing spread of infections. During the influenza 2018-2019 outbreak, 50% of units' population tested positive for the influenza viruses; adding to the hospital acquired infection rates of the three units. An Agent-Based Model of infection spread approach was used with the goal of preventing infection transmission by hospital visitors in three high risk care units. Specifically, a visitor low dose educational intervention consisting of visual static and verbal cuing was undertaken to improve VHH behavior. Method: A four-week, pre-post-observational design (N=635) was completed by trained observers during day and nigh shifts for a large tertiary hospital to determine VHH rates. Strategies of visual static cuing included educational posters and patient door signage and verbal cuing to wash and/or sanitize hands by health care workers. Results: VHH adherence for the ICU was very low at baseline; out of 228 consecutive observations 20% (n=46) adherence was found. After behavioral cuing intervention, 407 observations resulted in 42% adherence to hand washing behaviors. Conclusion: Low does educational cuing strategies increased VHH behaviors. However, additional public education is needed to decrease infection spread from community sources.
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    Breast Cancer Risk Among Transgender Individuals Undergoing Gender Affirming Hormone Therapy: A Systematic Review [paper]
    (2023-12) Brown, Tiffany Nacole
    Introduction: This review addresses the breast cancer risk among transgender individuals undergoing gender-affirming hormone therapy, a crucial but understudied aspect in transgender healthcare. Focusing on gender affirmation, transgender individuals often face healthcare challenges, leading to gaps in broader health concerns like cancer screening. This research, framed by Dorothea Orem's Self-Care Deficit Nursing Theory, aims to fill this gap, comparing the incidence of breast cancer in transgender populations to cisgender counterparts. Methods: A thorough search was conducted in MEDLINE Complete, PubMed, and CINAHL Ultimate from 2013 to 2023. Search terms included transgender, trans, breast cancer, malignancy, tumor, gender affirming therapy, hormone therapy. Studies focusing on transgender individuals undergoing hormone therapy were included, with exclusions for non-English articles and those published before 2013. Results: From 681 articles identified, rigorous screening led to eight studies meeting inclusion criteria. These studies offered a comprehensive view of breast cancer incidence in transgender individuals undergoing gender affirming hormone therapy. Notably, transgender women on estrogen therapy had a higher breast cancer incidence compared to cisgender men, yet lower than cisgender women, while transgender men on testosterone therapy showed similar rates to cisgender men. Discussion: The findings suggest a need for personalized breast cancer screening strategies tailored to transgender individuals. The review emphasizes healthcare providers' role in initiating breast health discussions and the importance of adapting clinical guidelines to transgender individuals' unique needs. Acknowledging the current literature's limitations, the review advocates for more research, policy reform, and advocacy to ensure inclusive and affirming healthcare for the transgender population.
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    Can an Emergency Department Triage Protocol Initiative Reduce the Length of Stay in Low-Acuity Patients? [paper]
    (2023-05) Daemen, Cynthia
    The purpose of this quality improvement project was to decrease emergency department (ED) length of stay (LOS) for low acuity patients. Overcrowded hospital Emergency Departments (ED) and long length of stays (LOS) can result in decreased quality of care and increased mortality. In addition, ED patients with long wait times and length of stays can negatively impact patient satisfaction scores, increase the likelihood for patient safety incidents, and increase overall cost of care. A patient’s LOS is the amount of time that is spent in total number of minutes from their arrival to their discharge from the ED. A patient’s wait time and LOS can be affected by several factors such as the number of patients in the department, ED admission holds, and staffing census. Triage is the area where most patients seeking ED care are screened and the nurse determines where the patient will be assigned. While often the ED cannot control holds or staffing, the triage time can be shortened using approved triage protocols to improve flow and decrease the number of patients in the department. This quality improvement project implemented an educational initiative to increase use of existing triage protocols and LOS for low acuity patients in a Level II trauma facility in Central Texas. The 12-month pre-intervention average LOS for patients seen in 2022 was 115 minutes and the average percentage of nurses using and documenting a triage protocol was 4.5%.
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    Early Steps, Lasting Impact: Enhancing Autism Screening Guidelines for Early Interventions [poster]
    (2023-12) Torres, Amber
    The purpose of this project is to encourage providers to conduct advanced screening for children who are at high risk or who they suspect may have ASD but don’t meet the full criteria for diagnosis to facilitate the earliest interventions.