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Item Bridging the Gap: Investigating Barriers and Motivations for Social Determinants of Health Screening Among Emergency Department Nurses(2024-04-30)Introduction: Social determinants of health (SDOH) screening is crucial in emergency departments (EDs), yet compliance with hospital standards remains inconsistent. This study explored barriers and facilitators to SDOH screening among ED nurses in an urban Philadelphia hospital. Methods: Qualitative focus groups were conducted with 18 ED nurses. Thematic analysis was used to identify barriers, facilitators, and potential recommendations for improving SDOH screening compliance. Interviewer: Primary interviewer was Demetrios Frangos, a BSN who completed this project and relevant training toward obtaining his DNP. He was also a registered nurse working in the same department as the conducted study. Laura Sinko provided technical support for the focus groups and assisted with introductions, no other researchers were involved in the interviews. Results: Barriers included perceived lack of time, skepticism about the screening tool's efficacy, discomfort with sensitive conversations, inadequate training, and resistance to punitive enforcement. Facilitators encompassed user interface features, intrinsic motivation to address social needs, fear of disciplinary action, desire for recognition, and perceived patient vulnerability. Recommendations focused on improving the user interface, enhancing workflow, educating staff on SDOH goals and resources, and reconsidering disciplinary approaches. Conclusion: Addressing identified barriers and leveraging facilitators can improve SDOH screening compliance in urban EDs. Future research should evaluate the impact of implementing these recommendations on screening rates.Item Bridging the Gap: Investigating Barriers and Motivations for Social Determinants of Health Screening Among Emergency Department Nurses(2024-04-30)Introduction: Social determinants of health (SDOH) screening is crucial in emergency departments (EDs), yet compliance with hospital standards remains inconsistent. This study explored barriers and facilitators to SDOH screening among ED nurses in an urban Philadelphia hospital. Methods: Qualitative focus groups were conducted with 18 ED nurses. Thematic analysis was used to identify barriers, facilitators, and potential recommendations for improving SDOH screening compliance. Interviewer: Primary interviewer was Demetrios Frangos, a BSN who completed this project and relevant training toward obtaining his DNP. He was also a registered nurse working in the same department as the conducted study. Laura Sinko provided technical support for the focus groups and assisted with introductions, no other researchers were involved in the interviews. Results: Barriers included perceived lack of time, skepticism about the screening tool's efficacy, discomfort with sensitive conversations, inadequate training, and resistance to punitive enforcement. Facilitators encompassed user interface features, intrinsic motivation to address social needs, fear of disciplinary action, desire for recognition, and perceived patient vulnerability. Recommendations focused on improving the user interface, enhancing workflow, educating staff on SDOH goals and resources, and reconsidering disciplinary approaches. Conclusion: Addressing identified barriers and leveraging facilitators can improve SDOH screening compliance in urban EDs. Future research should evaluate the impact of implementing these recommendations on screening rates.Item Examining the Effects of Neighborhood Disadvantage on Neural Responses to Executive Control(Temple University. Libraries, 2025)Previous research has shown that neighborhood disadvantage is strongly associated with internalizing behaviors, or negative behaviors directed towards oneself (Leventhal & Brooks-Gunn, 2000). Such behaviors have also been linked to altered neural responses during executive control as well as abnormalities within the anterior cingulate cortex (Karlsgodt et al., 2017; Marusak et al., 2016). However, it remains unclear whether neural responses during executive control mediate the effects of the neighborhood environment on internalizing behaviors. To investigate this issue, we used data from the Adolescent Brain Cognitive Development Study (ABCD Study), which contains longitudinal assessments of brain and behavior from over 10000 adolescents (N = 11876). We hypothesized that neural responses to executive control mediate the effect of the environment on internalizing behaviors, providing insights into the underlying mechanisms of these associations. The primary region of interest was the dorsal anterior cingulate cortex (dACC), a key region for executive control and working memory. We used data from the stop-signal task, which measures inhibitory control and captures dynamic responses within the executive network. Results indicate that there is an association between neighborhood disadvantage and internalizing behaviors even when accounting for any mediation, but the dACC itself does not mediate this relationship. This approach aims to deepen the understanding of how environmental factors and brain activity intersect to influence adolescent mental health.Item Nurse-Driven Spontaneous Awakening Trials(2025)Purpose/hypothesis: The purpose of this quality improvement (QI) project evaluated the impact of a nurse-driven SAT protocol on the frequency of SAT and SBT assessments and their effect on patient MV days, ICU and hospital LOS in a medical respiratory ICU (MRICU) at a level 1 trauma, teaching hospital in an urban setting. Prolonged sedation and mechanical ventilation in intensive care unit (ICU) patients are associated with adverse outcomes, including ICU delirium, ventilator-associated pneumonia (VAP), and increased length of stay (LOS). Spontaneous Awakening Trials (SATs) and Spontaneous Breathing Trials (SBTs) are evidence-based interventions designed to optimize sedation management, reduce ventilator dependence, and improve patient outcomes (Khan et al., 2014). Methods: A pre-existing, hospital-approved SAT protocol was implemented in a 28-bed MRICU unit. Data was collected for 6-weeks pre- and post-intervention. The nurse-driven project focused on adherence to SAT and SBT protocols, and measurable outcomes include MV days, ICU LOS, and hospital LOS. Results: Post-implementation data revealed statistical significance between the nurse-driven SAT assessments in relation to hospital LOS, with p-value 0.03. The pre-intervention mean hospital LOS was 20.17 days compared to 19.93 days post-intervention mean hospital LOS. Clinical Relevance: The nurse-driven SAT protocol demonstrated potential for improving mechanically ventilated patients’ outcomes by reducing their overall hospital LOS.Item Improving Patient Throughput by Implementing an Electronic Interunit Handoff(2025)Background: Emergency department (ED) boarding—the prolonged holding of patients awaiting inpatient beds—impacts care quality, efficiency, and outcomes. It contributes to overcrowding, higher mortality rates, delayed interventions, and longer hospital stays. Research has linked extended boarding to worsened clinical outcomes, particularly for critically ill patients. Problem: A suburban county hospital has faced increasing delays in patient handoffs due to challenges in reaching observation nurses for verbal reports. Communication barriers have contributed to prolonged wait times between bed assignment and the "ready to move" (RTM) status, resulting in inefficiencies in patient flow and potential impacts on care delivery. Intervention: A standardized electronic handoff system was initiated between a hospital's ED and OBS unit, replacing verbal reports with an Epic Event Log Summary and structured PACC (Pain, Ambulation, Continence, Contact) notes. Using a pre-/post-intervention design, the study measured time from bed assignment to 'ready to move' status, aiming for completion under 30 minutes. Results: Evaluation of the electronic handoff system compared the time from bed assignment to "ready to move" (RTM) status. Statistical analysis, after removing outliers, indicated a significant reduction in RTM times from 51 to 40.97 minutes (p < 0.001). The mean rank decreased from 212.64 before to 166.88 after implementation, demonstrating improved efficiency in patient transitions. Conclusion: Implementing an electronic handoff system improved workflow efficiency and standardized patient reports. Standardized templates and secure chat confirmations improved communication, reduced boarding time, and enhanced patient flow.