AHU Digital Repository
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Type Two Diabetes Management in the Latino Community
(2023-03-31) Cherry, Valerie; Cooper, Brenda
The Latino community makes up 31.1% of the population in the Central Florida region, and is disproportionately affected by diabetes mellitus (DM) (U. S. Census Bureau, 2019). Proper glycemic control is pivotal to the surgical management of this patient population. Poorly controlled glycemic levels impact the perioperative state and are associated with an increased risk of surgical site infection, embolic events, poor wound healing, postoperative nausea and vomiting, sepsis, and death. There is also an increased risk of further organ damage, such as end-stage renal disease, affecting medication metabolism and excretion (Dreisbach et al., 2009). Type 2 diabetes mellitus (T2DM) patients have shown to have similar surgical outcomes as their non-diabetic counterparts with proper glycemic management (Dagogo-Jack & Alberti, 2002; Tidy & Cox, 2016; Wukich, 2015). Previous quantitative improvement initiatives show a direct correlation between culturally tailored diabetes self-management education (DSME) and a reduction in hemoglobin A1C (HbA1C) (Brown et al., 2011; Chrvala et al., 2016; Fortmann et al., 2017; Garcia et al., 2015; Hildebrand et al., 2020; Hu et al., 2016; Palmas et al., 2014; Pérez-Escamilla et al., 2014; Rosal et al., 2011; Rotberg et al., 2016; Spencer et al., 2018; Weinstock et al., 2011). While this correlation has been proven, no improvement projects found utilized education primarily through an online format nor include an educational focus on disease management's long-term impact. Due to stated deficits, a quantitative improvement project was formulated to address the shortcomings and assess the correlation between DSME and HbA1C.
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The Effects of Music on Anxiety Levels in Surgical Waiting Rooms for Family and Friends
(2023-03-19) Bowen, Brittney
Preoperative anxiety has been proven to cause complications both during and after the procedure. These complications range from aggressive behavior to hemodynamic instability. One factor that may impact preoperative patient anxiety is the anxiety of the family members and friends who accompany the patient. Current literature shows a strong correlation between music and decreased anxiety in family members and friends. Therefore, this project is a quality improvement project to provide potential benefits of using music in waiting rooms and by measuring the different anxiety levels between the two groups. Advanced Aesthetics was chosen as the site for the scholarly project data collection. Working with the key players to identify possible limitations helped the researchers understand the background of the business and the environment involved in observation. Data was collected on 8 days, 4 days with music playing and 4 days without music playing. Each participant was asked to fill out a State Trait Anxiety Inventory (STAI). An independent two sample t-test was used for data analysis to compare the difference between the music group and the non-music group. Statistical analysis was completed on both the state anxiety scores and the trait anxiety scores between the music group and the non-music group. Low participation yielded results that were not statistically significant in the state anxiety scores when music was played versus when music was not played. Overall, the project was well received by both the facility where the study occurred as well as those that did participate. This study can be used for an evaluation of evidence-based recommendations on the use of music in waiting room and its effect on anxiety.
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Effects of Cleaning an Epidural Catheter Hub with Alcohol and Determination of Neurotoxicity on Rat Astrocyte Cells
(2023-01-15) Minton, Brandon; Yamber, Courtney
Patient safety must always be the first concern for anesthesia providers and aligning with evidence-based research provides best practice standards. The standard for cleansing the epidural catheter hub is rudimentary and poorly established as shown by the variations in current practice. Difference in opinions exists between cleansing the epidural catheter hubs with alcohol for bolusing administrations and the risk of causing adhesive arachnoiditis and/or neurolysis/apoptosis in the epidural space. A literature review revealed research concerning skin cleansing prior to placement of neuraxial anesthesia; however, the evidence was absent regarding best practice for epidural catheter hub access. Commentary and guidelines were made based on poor outcomes of two case studies, but no research has focused on epidural catheter hub aseptic techniques and risks to date. The intention of this scholarly project was to conduct an experimental study design with five epidural catheters and pumps infusing onto commercially available rat astrocyte cells after cleansing the epidural hubs with 70% isopropyl alcohol to test the potential presence of alcohol introduced into the epidural space and the risk of adhesive arachnoiditis and neurolysis/apoptosis. Each epidural pump would run an infusion into a sample size of five commercially available rat astrocyte cells. At completion of infusion, the commercially available rat astrocyte cells would be analyzed to determine the presence of alcohol in the cells. Data would be gathered by student co-investigators and sent for analysis using a statistical analysis software package. These results are intended to provide evidence-based recommendations for cleansing epidural catheter hubs with alcohol in anesthesia practice. Due to the nature of this scholarly project and unforeseen limitations the completion of proposed methods was not possible.
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Mentoring Undergraduate Nursing Students into Graduate Level Nurse Anesthesia Education
(2023-03-16) Derringer, Melissa; McIntyre, Gabriella
There is minimal evidence to support or discourage the use of a mentorship program to increase the number of baccalaureate nursing students with the intent to apply to graduate level nurse anesthesia education at the time of graduation. The scholarly project aimed to evaluate the effect of a mentorship program on senior baccalaureate nursing students’ intent to pursue graduate level nurse anesthesia education. The causal relationship between the mentorship program and baccalaureate nursing student intent to apply was evaluated by analyzing results from a survey at the end of the mentorship period. An 8-week mentorship program with an integrated skills lab was completed by the senior baccalaureate nursing students before the survey was completed. This scholarly project sought to provide AHU baccalaureate nursing students and faculty with a one-to-one SRNA led mentorship program. Survey results from this scholarly project are minimally significant due to a small sample size. However, due a small level of increased intent to pursue graduate level nurse anesthesia education, the project results support the need for additional implementation with an increased sample size. Positive results from future studies may prove that implementing mentorship programs can assist in growing the profession of nurse anesthesia.
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Video Versus Direct Laryngoscopy on Intubation Success Rates in the SRNA
(2023-03-16) Carter, Daniel; Geyrozaga, Rhonnie; Mahant, Rachel
General anesthesia can be supported by placing an endotracheal tube through the trachea to provide oxygenation, ventilatory support, and deliver inhaled anesthetics. Two common modes of endotracheal intubation consist of Direct Laryngoscopy (DL) or Video Laryngoscopy (VL). Studies have shown that intubation has been associated with patient complications such as airway trauma and repeated or prolonged attempts at intubation may increase the risks of more severe complications such as hypoxia, hemodynamic instability, cardiac arrest, and death. As novice anesthesia providers, student registered nurse anesthetists (SRNAs) are in the beginning processes of mastering this skill while still maintaining patient safety. Over a 3-month period, first-year SRNAs at AdventHealth University were voluntarily asked to report which tool was used for each intubation and whether the intubation was successful. The Wilcoxon signed-rank test was used to analyze this data. The project’s aim was achieved, which demonstrated a significant difference in median success rate between the two methods. Over the 3-month study period, intubation success with VL was greater than that of DL. In the first month of the study, participants utilized the VL far more than the DL and were more successful with intubating with the VL. By the third month of the study, participants began utilizing the DL more frequently and had greater success when compared to the first month. This demonstrates that VL improves SRNAs intubation success, aids in recognizing pertinent airway anatomy, knowledge, and supports a culture change to one where the use of VL in the SRNA is encouraged.