2024 SON Research and Scholarship Day abstracts

We are excited about the 3rd Annual School of Nursing Research and Scholarship Day on Wednesday, April 3rd. Join us at the Norman C. Nelson Student Union Upper Ballrooms as we continue to celebrate the research and scholarship of our faculty, students and researchers.

Transforming Health Care through Nursing Research and Evidence-Based Practice

Accepted abstracts

Effectiveness of an Educational Intervention at an Academic Medical Center to Reduce Stigma of Accelerated Pre-licensure Nursing Students Toward Patients Living with HIV
James Miller Doctor of Health Administration^1,2, Elizabeth Franklin PhD<sup>1

1</sup>University of Mississippi Medical Center, School of Health Related Professions, Jackson, MS. ²University of Mississippi, School of Nursing, Jackson, MS

Introduction: Some health care providers may be reluctant to care for patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). The inclusion of educational opportunities for students to advance knowledge of HIV transmission risks, while decreasing stigma, is important, and many health care providers have not participated in these types of activities, which could promote learning and the practice of unbiased care.

Methods: This quantitative study aimed to determine if a comprehensive supplemental educational intervention might produce a significant increase in student knowledge regarding HIV transmission and prevention while also producing a significant difference in the attitudes, perceived discrimination, and equity for people living with HIV (PLWH). Two validated instruments were used to gather data from Accelerated Bachelor of Science in Nursing (BSN) students at an academic medical center.

Results: Eighteen questions measured HIV knowledge, and each counted one point. The mean pre-test and post-test was 13.83 and 17.37, respectively. The mean difference was 3.54. The resulting p-value from the paired t-test was less than 0.001, which shows a highly significant improvement. Additionally, student responses on four questions regarding attitudes, discrimination, and health and social equity resulted in a significant difference, which suggested that students' level of empathy for PLWH increased.

Conclusion: The information presented in the comprehensive educational format and inclusion of PLWH in this activity is effective and would be beneficial for all health care professionals.

The CRAM Deck: Finding a way to CRAM pharmacology
Allison Princiotta Master of Nursing, Jennifer Hargett Doctorate of Nursing Practice

University of Mississippi Medical Center, School of Nursing, BSN, Jackson, Mississippi

Background: Content memorization is essential when learning pharmacotherapeutics for nursing students. The CRAM card was developed as a tool for students to organize and condense a large volume of material in an undergraduate pharmacology course. The students were first exposed to course content through PowerPoint lecture. The CRAM deck was designed to have students spend out of classroom time with the material, organizing medications and drug classes using the CRAM pneumonic (C-class, R-route, A-adverse effects, M- monitoring). Students were encouraged to personalize content to promote learning and then further make comparisons, analyze differences, and bring forward pharmacological management. A variety of formats were accepted from electronic files to physical notecards.

Method: An optional, online, anonymous mid-semester survey was utilized to identify student perceptions of course materials and assignments for helpfulness and effectiveness. Similarly, upon completion of the course, a standardized post-course evaluation offered opportunity to free-text responses, such as what they liked about the course and recommended changes.

Results: The mid-semester survey results indicated the CRAM deck as the second most helpful source for the course. Analysis of the final course survey had similar positive reviews. Evaluations demonstrated student satisfaction and increased learning due to the implementation of the CRAM deck as a tool to increase student learning.

Conclusion: Overall, the creation and application as a study tool of the CRAM deck was beneficial to the survey respondents. Student surveys also identified the need for changes to the content of cards and medications included in each unit of study. This material will likely serve as a reference for the students as they increase their nursing care knowledge and continue to build and incorporate pharmacology in future courses.

Engagement in Advance Care Planning Among Community-dwelling adults with Non-Oncological Chronic Diseases
Lesley Thweatt MSN, RN, CNE¹, Katie Hall PhD, RN, CNE<sup>2,1

1</sup>University of Mississippi Medical Center School of Graduate Studies in the Health Sciences, Jackson, MS. ²University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: Engaging in action measures, such as advance care planning (ACP), can reduce burdens in decision-making, reduce conflicts among family members, and improve patient and caregiver outcomes. However, further exploration into strategies to help patients and families prepare to take the action needed to engage in ACP conversation is crucial. This research explores the relationship between engagement in advance care planning among community-dwelling adults with non-oncological chronic diseases.

Methods: The study will use a quasi-experimental, two group, pretest-posttest design with convenience sampling to 1) determine if engagement in ACP increases after completing ACP education and 2) examine if confounding variables can help predict engagement in ACP. Participants will participate in an educational session to complete three steps within The Conversation Project Starter Guide. Engagement will be evaluated at baseline and one month after the educational sessions using the 34-item ACP Engagement Survey. Action will be measured post-test with the 25-action items from the ACP Engagement Survey. Confounding variables will be collected at baseline using a demographic questionnaire to collect age, race, gender, religion, marital status, insurance status, diagnosis, and zip code. Data will be analyzed using paired t-tests to compare pre- and post-test engagement scores and logistic regression will be used to determine if any of the confounding variables are predictors of the outcome.

Outcomes/Conclusion: This research is currently ongoing based on concepts and instruments identified and validated in the literature. The research team utilized a substruction table to display the connection of theoretical variables with operational methods to identify logical consistency and flow in a proposed research study. The research team is hopeful the knowledge gained from this study will not only add to the literature surrounding this topic but will help encourage patients and providers to incorporate more focused education to increase ACP.

Notes: A version of this abstract has been presented at the University of Mississippi Medical Center SGSHS Research Day in Fall 2023. Revisions have been made as the research has evolved; therefore a new poster will be printed.

Nurses' use of the five rights of medication in a comprehensive care unit: A best practice implementation project
Jaclyn Smith MSN, RN, Linda Upchurch DNP, APRN, ANP-BC

University of Mississippi Medical Center, Jackson, MS

Background: The five rights of medication administration are utilized by nurses daily to prevent patient medication errors. In the United States alone, between 7,000 and 9,000 medication administration errors occur annually. Continuing education is imperative in preventing medication errors and maintaining a high level of safe and quality nursing care. The objective of this project was to educate and provide reinforcement of medication administration rights and best practices.

Methods: This project was conducted utilizing an audit and feedback strategy as defined by the JBI Evidence Implementation Framework. Included in the project was the use of the JBI Practical Application of Clinical Evidence System for pre- and post-audit data analysis and the Getting Research into Practice matrix to identify barriers, strategies, and outcomes. The project identified eight best practice criteria for medication administration to be utilized by nurses, including the five rights. After baseline audits were conducted, barriers were identified, and educational interventions were implemented to improve adherence to best practices. A follow-up audit was conducted, and results from both audits were compared.

Results/Lessons Learned: Two of the eight criteria, including checking the expiry date of medication and verbal identification of patient identifiers, were found to have lower percentages of adherence based on baseline audit data. Nursing staff education and visual reminders were implemented. Post-implementation audits were conducted and showed increased adherence to medication administration best practices.

Conclusions: Staff education and visual reminders for best practices contribute to improvement in adhering to the five rights associated with medication administration. Annual competency training to reinforce best practices will ensure quality and safe patient care is maintained and prevent the incidence of medication errors.

Reducing medication administration errors by nurses in a Mississippi ambulatory care clinic: A best practice implementation project
Leah Arnold RN-BSN, Robin Christian DNP, FNP-C

University of Mississippi Medical Center School of Nursing, Jackson, Mississippi

Background: Medication administration errors pose a significant risk to patients and healthcare providers globally. Nursing processes such as the 'rights' of administration have been used to prevent errors when carrying out medication orders. This project aimed to implement best practice recommendations regarding medication administration by nurses using the ‘rights' in an ambulatory women's clinic.

Methods: The JBI Evidence Implementation framework and Getting Research into Practice audit/feedback method were used to complete this project. Best practice recommendations included eight audit criteria measured with observational audits pre and post-implementation. After the baseline compliance audit was conducted, three barriers to best practice were identified: frequent interruptions during medication preparation, limited oversight/guidelines related to medication ordering, storage, and disposal, as well as poor staff awareness of clinic medication administration policy and procedure.

Results: Due to the clinical significance of this project, goals for compliance with best practice recommendations were set at 100%. The baseline audit showed compliance rates among four of the eight criteria to be less than 100%, ranging between 60-95%. Implementation strategies included the designation of an "Error Free: Don't bother Me" zone for medication preparation, standardization of medication ordering using par-levels and monthly checks of stocked medication, and staff re-education on robust medication administration policy and procedure. The post-implementation audit showed compliance to be at 100% among all criteria except one that improved from 60% to 90% compliance.

Conclusions: Reducing medication errors using the ‘rights' of administration and other nursing processes has been shown to reduce errors. Reducing medication administration errors must consider factors outside of the individual nursing processes. Ambulatory clinics may consider utilizing electronic medication administration devices such as barcode scanners to reduce errors and improve patient safety. Collaborating to improve clinical practice areas and implement evidence-based practice may enhance the uptake of new and existing evidence.

A Preliminary study in Alterations in the Cervical Microbiome, Bacterial Vaginosis, and HPV infection in specimens from STRIDES (Studying Risk and Improving Disparities in Mississippi

Carolann Risley Ph.D., MSN^1,2,3,4, Nicolas Wentzensen MD, Ph.D.⁴, Rajesh Talluri PhD⁵, Sydney Reaves MS¹, Lavanya Challagundla Ph.D.^6,7, Laree Hiser Ph.D.¹, Nita Maihle Ph.D.⁸, Samira Grifoni Ph.D.^1,2, Kenyata Owens MS⁹, Karimi Masoumeh Ph.D.¹, Jake Johnson MS, MB(ASCP)⁷, Jackie Starrett MLS (ASCP)⁷, Ashish Jannela Ph.D.⁹, Mary Stewart Ph.D.¹⁰, Lei Zhang Ph.D., MBA¹, Kim Geisinger MD¹¹, Thomas Dobbs MD^12,13, Michael Garrett Ph.D.^3,7, Joey Granger Ph.D.¹⁴, Megan Clarke Ph.D., MHS<sup>15

1</sup>University of Mississippi Medical Center - School of Nursing, Jackson, MS. ²University of Mississippi Medical Center - Cancer Center and Research Institute, Jackson, MS. ³University of Mississippi Medical Center - Cell and Molecular Biology, Jackson, MS. ⁴National Cancer Institute, Rockville, MD. ⁵University of Mississippi Medical Center - Department of Data Science/Biostats Al, Jackson, MS. ⁶University of Mississippi Medical Center - Cell Molecular Biology/Molecular and Genomics Core Facility, Jackson, MS. ⁷University of Mississippi Medical Center - Molecular and Genomics Core Facility, Jackson, MS. ⁸University of Mississippi Medical Center - Department of Medicine, Jackson, MS. ⁹University of Mississippi Medical Center - Center for Analytics, Jackson, MS. ¹⁰MSU - School of Nursing, Meridian, MS. ¹¹East Carolina University (ECU), Greenville, NC. ¹²University of Mississippi Medical Center - School of Population Health, Jackson, MS. ¹³Mississippi State Department of Health, Jackson, MS. ¹⁴University of Mississippi Medical Center - Department of Physiology and Biophysics, Jackson, MS. ¹⁵National Cancer Institute (NCI), Rockville, MD

Previous studies suggested alterations of the cervical microbiome may affect natural history of cervical HPV infections. In STRIDES (Studying Risk and Improving Disparities), a statewide cervical cancer screening cohort in Mississippi, we observed a high prevalence of bacterial vaginosis (BV). Here we conducted 16S microbiome testing to characterize the cervical vaginal microbiome (CVM) and its role in HPV natural history.

We selected cervical samples (n=96; age<25) and performed automated DNA isolation, 16S rRNA V4 amplicon library preparation, and sequencing on Illumina NextSeq2000. Sequences were imported into QIIME 2 to assign taxonomy. We evaluated microbiota in 4 subgroups based on HPV and clinical BV status, (HPV-/BV-,HPV+/BV-,HPV-/BV+,and HPV+/BV+), performing differential abundance testing using DESeq2 to determine microbial populations. Within-sample and between-sample diversities were assessed with alpha and beta indices. We assessed CVM diversity using the Shannon Diversity Index and compared the four categories using Kruskal-Wallis test.

The population demographics (listed in the electronic health) record were 74% Black females, 24% White females, and 2% from a combined racial group. Significant differences in the diversity of organisms were found (p<0.0001) between groups with the HPV+/BV- group displaying the most diversity. For relative abundance within categories, the top three genera were Lactobacillus, Gardnerella, and Shuttleworthia. Shuttleworthia showed an 8.6-fold increase in abundance in groups positive for HPV and/or BV compared to the double negative group.

Findings suggest a novel new species, Shuttleworthia, plays a role in the CVM, particularly in the context of HPV infection and/or the presence of BV. A larger study is underway to address the role of microbiome alterations in the progression from HPV infection to cervical precancer. Additionally, next steps will also include investigations to improve the diagnosis of BV and direct research on targeted therapies such as probiotics.

A windshield survey: Preparing future nurses for practice in diverse populations
Johnna Riddick MSN, Stephanie Tullos MSN, Tiffany Griffin DNP

University of Mississippi Medical Center School of Nursing, Jackson, Miss.

The Joint Commission has identified health-related social issues as a root cause of health disparities. In the education of undergraduate students, a windshield survey gives a glimpse of challenges their future clients may face regarding housing, water sources, activity, and access to care. Windshield and walking surveys have commonly been used to identify community needs among various demographical backgrounds. However, as healthcare moves towards a model geared toward health-related social needs, a windshield survey remains fundamental in the education of future nurses. By earlier introduction for future health care providers, the root causes of disparities may be better understood, and the causes addressed for improving quality of care throughout the lifespan.

Harvest for Health in Survivors of Chronic Disease: A Demonstration Project in the Alabama Black Belt and Mississippi Delta Region
Angela Duck PhD¹, Jennifer Bail PhD², Katie Hall PhD<sup>1

1</sup>University of Mississippi Medical Center School of Nursing, Jackson, MS. ²University of Alabama at Huntsville School of Nursing, Huntsville, Alabama

Background: The Alabama Black Belt and Mississippi Delta region of the United States is an area marked by poverty, health inequities, and lack of access to resources. Behavioral risk factors associated with chronic disease include obesity, low fruit and vegetable (F&V) consumption, and physical inactivity. Vegetable gardening, a holistic approach to addressing access to healthy food and safe spaces for physical activity, is associated with healthier diets, increased physical activity, better health-related quality of life, and lower mortality. This demonstration project expands upon the Harvest for Health vegetable gardening intervention for cancer survivors by: (1) including survivors of other chronic diseases (i.e., heart disease and diabetes); and (2) targeting areas with known health inequities. The purpose is to assess: 1) gardening acceptability (engagement, satisfaction, sustainability, and safety); and 2) changes over time in health behaviors (fruit and vegetable [F&V] intake, and physical activity) and outcomes (physical performance and anthropometrics).

Methods: Chronic Disease Survivors (CDS) were recruited across 15-counties in Alabama and Mississippi and provided with gardening supplies and paired with a Master Gardener (MG). MGs mentored participants in planning, planting, and maintaining a vegetable garden over a 3- month period. Data collection consisted of an electronic survey (baseline, post-intervention, 6- month follow-up) and community-based physical assessments (baseline and post-intervention)

Results: Participants (n=137; 92% African American; Mage=65) included individuals with a history of diabetes (56%), heart disease (29%), and cancer (26%). Seventy-five percent of participants engaged in gardening ≥3 times a week. Significant improvements in F&V intake (+0.73, p=0.04), physical activity (+49.6, p < 0.01), and 4 of the 7 physical performance measures were observed, while positive trends were noted in others. Seventy-two percent of participants expanded their garden at 6-month follow up.

Conclusions: Harvest for Health was acceptable and associated with improved health behaviors and outcomes.

Utilizing Virtual Motivational Interviewing to Impact Autonomous Motivation for Physical Activity Among Adolescents
Melissa Klamm PhD¹, Mary Stewart PhD², Angela Duck PhD¹, Crystal Lim PhD³, Lei Zhang PhD¹, Joseph Tacy PhD⁴, Tamara Brocks BSN<sup>5

1</sup>University of Mississippi Medical Center, School of Nursing, Jackson, MS. ²Mississippi State University, School of Nursing, Meridian, MS. ³University of Missouri, Columbia, MO. ⁴Lamar University, Beaumont, TX. ⁵University of Mississippi Medical Center, School of Graduate Studies in Health Sciences, Jackson, MS

Background: Adolescents need at least 60 minutes of physical activity (PA) every day. Yet, the number of minutes of daily PA steadily decreases from childhood through adolescence. This occurs despite evidence that high levels of PA and limited minutes of sedentary behavior (SB) decrease the incidence of heart disease, type II diabetes, and cancer. Motivational interviewing (MI) is a behavioral counseling technique that focuses on behavior change areas, such as PA. This research aimed to evaluate a nurse-led virtual MI (vMI) intervention to guide youth toward increased PA compared to education alone.

Methods: Participants completed the Behavioral Regulation in Exercise Questionnaire (BREQ-2) and wore an accelerometer on their dominant wrist for eight days. Participants in the treatment group received an individual vMI session with the researcher, while control group participants received individual education with the assistant. All participants received follow-up calls at weeks four and eight. During the calls, those in the treatment group received follow-up MI, while the control group asked follow-up questions about information received previously. At 12 weeks, all participants repeated the BREQ-2 survey and wore the accelerometer again for seven days.

Results: The total number of participants was 19. At post-intervention, the treatment group had a significant decline in the frequency of prolonged SB >60 minutes (p = 0.001) and a nonsignificant increase in the average length of moderate-vigorous PA (MVPA) bouts >10 minutes (p = 0.058). The treatment group had significant increases in autonomous motivation – identified (p < 0.001) and intrinsic (p = 0.003). The overall autonomous motivation score for the BREQ-2 significantly increased in the treatment group (p < 0.001).

Conclusions: The study revealed promise for vMI to positively impact PA among adolescents. Although a novice in MI, a nurse-led MI session elicited change talk in participants toward individualized changes to improve health behaviors.

Notes: This abstract was accepted as a podium presentation at another conference. Therefore, I do not have a previous poster to upload.

The Association between Population Density and Clinical/Psychosocial Outcomes in Women with HIV in the Southern United States: A retrospective longitudinal analysis
Deborah Konkle-Parker PhD, FNP¹, J. David Cleveland MS², Dustin Long PhD², Vipina Nair MD³, Margaret Fischl MD⁴, Gina Wingood DPH⁵, Andrew Edmonds PhD<sup>6

1</sup>University of Mississippi Medical Center, Schools of Nursing, Medicine and Population Health, Jackson, MS. ²University of Alabama at Birmingham, Birmingham, AL. ³University of Mississippi Medical Center Preventive Medicine, Jackson, MS. ⁴University of Miami, Miami, FL. ⁵Emory University, Atlanta, GA. ⁶University of North Carolina, Department of Public Health, Chapel Hill, NC

Purpose: Compared to those living in urban areas, people with HIV living in rural areas face challenges including worse access to HIV care, insufficient transportation, and isolation. The purpose of this study was to examine associations between population density and multiple psychosocial and clinical outcomes over a 6-year period among participants of the largest cohort of women with and without HIV in the United States.

Methods: Women with HIV at Southern sites of the Women's Interagency HIV Study (n = 561) in 2013-2018 were categorized and compared by population density quartiles. We compared several psychosocial and clinical outcomes for women living in the most rural quartile vs. women living in the most urban quartile.

Results: Although women in the lowest density quartile reported higher incomes than women in the highest density quartile, women in that quartile had greater odds of not attending an HIV care visit in the last six months (OR = 0.64; 95% CI 0.43, 0.95), yet, they had higher odds of HIV viral suppression (OR = 1.64; 95% CI 1.13, 2.38). Women in the most urban quartile had greater odds of unsuppressed HIV, after controlling for income, employment, and health insurance, despite reporting greater HIV care adherence and similar medication adherence. Women in the lowest density quartile did not have a discernibly higher odds of perceived discrimination in healthcare settings (OR = 1.20; 95% CI 0.78, 1.83), a finding that contrasted our previously published analysis of baseline, cross-sectional data.

Discussion: Further investigation into reasons for disparities in outcomes by population density is needed. Over time, perceived discrimination in healthcare settings because of one's HIV status can change, and we hypothesize that it decreased over the study period among those in lower density areas because individuals felt more open and accepted in the settings where they received healthcare.

PLATFORM FOR STUDYING CHRONIC DISEASES OVER TIME: The MACS/WIHS Combined Cohort Study (MWCCS)
Deborah Konkle-Parker PhD, FNP¹, Venetra McKinney MS<sup>2

1</sup>University of Mississippi Medical Center, Schools of Nursing, Medicine and Population Health, Jackson, MS. ²University of Mississippi Medical Center, Department of Medicine, Jackson, MS

Background: Cohort studies provide long-term comprehensive information on many health concerns. For the Multicenter AIDS Cohort Study (MACS), starting in 1983, it was discovery about the new HIV/AIDS phenomenon in men who have sex with men (MSMs), the main population that was affected in those early days. For the Women's Interagency HIV Study (WIHS), starting in 1993, it was discovery about the impact of HIV/AIDS in women. The two long-term studies merged in 2019 as the MACS/WIHS Combined Cohort Study (MWCCS) to focus on discovery regarding the impact of HIV on individuals aging with HIV, enrolling both people with and without HIV, which is a unique contribution. A parallel study, examining the impact of HIV in young women of reproductive years, is the Study of Treatment and Reproductive Options (STAR). This poster provides information for potential investigators using these cohort platforms.

Methods: MWCCS, currently in an enrollment wave, expects to consist of >5000 individuals over the age of 30, with and without HIV, in 14 sites around the U.S. STAR, a new cohort, expects to consist of 1500-2000 women in reproductive years in 6 states in the Southeastern U.S. The MWCCS specific aims are wide-ranging, from cardiometabolic, neurocognitive, pulmonary, aging, cancer, psychosocial and health disparities, while STAR focuses on impacts in young women, especially in or after pregnancies, such as depression, the oral cavity, and sexually transmitted infections. Platform and career development aims are strong, with attention paid to making data and specimens available to investigators.

Results: More than 700 publications have resulted from MACS, WIHS, MWCCS and STAR, with many externally funded grants using the platforms

Conclusions: These platforms can be very useful in supporting nursing research in conditions associated with both vulnerable women in reproductive years, and in vulnerable aging adults, with or without HIV

Promoting Clinical Judgment and Communication Using Student-led Rounding
Deidra Morgan DNP¹, Melissa McBride MSN², Sarah McGraw DNP<sup>1

1</sup>University of Mississippi Medical Center, School of Nursing, Jackson, MS. ²University of Mississippi Medical Center, Jackson, MS

Background: Traditional approaches to sharing nursing content often fall short of connecting theoretical knowledge with clinical reasoning. Novice nursing students tend to focus on one aspect of their client's care while failing to consider the many variables that affect client outcomes. Changes in the inpatient setting, including staffing shortages and higher patient acuity, require that today's nurses can synthesize assessment information and apply it to meet client needs. Furthermore, The Joint Commission recently reported that two of the most common causes of adverse events that result in harmful outcomes are failures in communication and teamwork.

Methods: In an effort to teach students to think like a nurse, foster teamwork, and improve interpersonal communication, we developed a student-led rounding activity. This activity was built using the Clinical Judgement Measurement Model (National Council of State Boards of Nursing.

Results/Lessons Learned: A post-activity survey revealed that the majority of students felt confident in their ability to recognize and analyze pertinent assessment findings, prioritize and implement nursing interventions, and evaluate the client's response to the care provided. Students also reported confidence in their clinical reasoning and communication skills.

Conclusion: Survey results demonstrate that student-led rounding is a beneficial activity. This activity can easily be incorporated into other courses.

Preventing aggression in pediatric inpatient units: a best practice implementation project
Johnna Riddick MSN, Jorri Davis DNP

University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: In pediatric settings, there has been an increase in patients with mental health problems, who experience aggressive and threatening behavior toward the clinical care staff. Without proper policies, education, and means to identify patient triggers for aggressive behavior, nurses are unable to safely care for these children and are at risk of being injured during aggressive outbursts. The objective of this project was to promote evidence-based practices regarding the prevention and management of aggression in hospitalized pediatric patients in medical-surgical units.

Methods: Using the JBI Evidence Implementation framework, this project sought to optimize compliance with best practices for early identification and management of aggressive behaviors in pediatric inpatient units. Three barriers to best practice were identified after a baseline chart audit including the lack of an organizational policy to prevent and manage aggressive behavior, the lack of identification of triggers that precipitate aggressive behavior, and the lack of utilization of an aggression prevention care plan. To address these barriers the team created a unit protocol for prevention and management of aggression, an easy way to document triggers, and a general pediatric aggression care plan.

Lessons Learned: Continuing education and ongoing refreshers can affect the quality of patient care and outcomes by offering occasions to improve or strengthen knowledge. There is still much work to be done at an organizational level to develop a policy, adopt more formal tools/resources, and provide formal training.

Conclusions: A new care plan was created and is helpful for nursing staff in caring for aggressive patients. Shared knowledge of triggers can be profound in preventing aggressive outbursts and staff injuries. However, formal training and risk assessment tools need to be adopted to truly support evidence-based practices. Continued nursing education is essential and should continue to be supported, utilized, and encouraged by the entire organization.

Educational intervention for adult patients with short-term indwelling urinary catheters in an outpatient setting: best practice implementation project.
Michelle Hughes MSN, Jorri Davis DNP, Michelle Palokas DNP

University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: Having an indwelling catheter increases the chances of a patient developing a catheter-associated urinary tract infection (CAUTI). Complications of an indwelling catheter include bacteriuria, which can lead to CAUTIs. Scientific evidence supports written and verbal education on catheter care and proper catheter securement to help prevent CAUTIs. This project aimed to educate patients and their caregivers on proper catheter care and management and implement a care package for home use for the patient to help prevent CAUTIs.

Method: This project used the JBI Evidence Implementation Framework to promote evidence-based practices regarding indwelling urinary catheters. The audit criteria for the project were identified using the JBI Evidence Summary. Baseline audits were conducted to measure compliance and identify gaps between the evidence and practice. Barriers were identified, and strategies were implemented. Post-implementation audits were conducted to determine changes in compliance.

Results/Lessons Learned: Baseline audits revealed a seventy percent compliance with two of the audit criteria and a sixty-seven percent compliance with the third audit criteria. Targeted strategies to address these barriers were identified and implemented with a follow-up audit yielding one hundred percent for all three criteria. Continuing education is vital to patient care. Posting a reminder of supplies for care packages assists with ensuring the patients have supplies to care for their indwelling foley catheter at home.

Conclusion: This evidenced-based implementation project enhanced best practices by implementing educational strategies on self-care for an indwelling foley catheter to assist the patient in decreasing their risk of developing a CAUTI. Recommendations included providing verbal and written education to the patient and their caregiver, ensuring the nurses were educated on proper catheter care annually, and implementing a care package for the patient to include written education on foley care and extra catheter supplies, including catheter secures and leg and bedside urinary bags.

Mobile health application, self-care, and diabetic kidney disease: a feasibility and effectiveness trial
Deloris Slade DNP

University of MS Medical Center School of Nursing, Jackson, MS

Introduction: Persons living with diabetes are vulnerable to serious collateral complications which can be delayed or prevented with proactive self-care along with appropriate medical therapies. Mobile health applications demonstrate efficacy in improving self-care in patients with diabetes. However, the feasibility as well as the potential to improve health outcomes of persons living with DKD by provision of acceptable, cost-effective support of self-care practices is unknown. Specifically, we lack knowledge of the effectiveness of nursing interventions, including the utilization of mobile health applications in this population.

Methods: The proposed research will be a single-arm, pre- and post-comparison trial to determine the feasibility of use and the effect of a 12-week mobile health application intervention on self-care behaviors and health outcomes in individuals with diabetic kidney disease. After enrollment, participants will initiate a Diabetes Self-Management Questionnaire- Revised (DSMQ-R), followed by a 12-week mobile health application intervention. Subsequently, participants will complete a second DSMQ-R, along with a Mobile Application Rating Scale and TWente Engagement with Ehealth Technologies survey.

Results: This research aims to explore whether the use of a mobile health application to promote self-care behaviors in persons living with diabetic kidney disease will be feasible and effective at improving clinical health outcomes of laboratory markers including serum hemoglobin A1c, serum creatinine, serum estimated glomerular filtration rate, and urinary protein. It is anticipated enrollment and recruitment will begin in October 2023 with preliminary data available February 2024.

Conclusion: Descriptive statistics will characterize the sample of participants. Additionally, to determine differences in pre and post scores self-care scores and clinical health outcomes within the intervention group, paired t-tests will be performed; and to determine if dose of intervention, age, gender, race, zip code, educational level, or insulin use impact feasibility of application, Chi-Square testing will be performed.

Prevalence and Disparity of Substance Use Disorders in The All of Us Research Program
Azad Bhuiyan MD, PhD, MPH^1,2, Saijun Zhang PhD, MSY³, Lei Zhang PhD, MBA¹, Marinelle Payton MD, PhD, MS, MPH<sup>2

1</sup>School of Nursing, University of Mississippi Medical Center, Jackson, MS. ²School of Public Health, Jackson State University, Jackson, MS. ³School of Applied Sciences, The University of Mississippi, Oxford, MS

Background: Substance use disorders (SUDs) are a public health problem in the United States. It is a rising concern due to prescription misuse and abuse and drug overdose mortality. This study investigates the prevalence and disparities of substance use disorders (SUDs) in the All of Us Research Program, focusing on ethnicity, race, gender, and age groups.

Methods: The epidemiologic study was applied with the cohort built using the All of Us Research Workbench, and data were extracted from Electronic Health Records using the registered Tier and version 7 data set. SUDs were classified based on various conditions, including alcohol-related disorders, opioid disorders, cannabis disorders, and others, using specific ICD-10 codes.

Results: The results indicate that out of 53,054 participants in the current EHR, 78% with SUDs are from non-Hispanic ethnicity, and 17% are from Hispanic ethnicity. In terms of race, 47% are Whites, 30% are Blacks or African Americans, 1% are Asians, and 15% are not SUDs. Regarding gender, 49% of females have SUDs. Concerning age, 44% of individuals within the 45-64 age group have SUDs, followed by 29% above 65 ages and 27% among the 18-44 age group.

Conclusion: Disparities exist in SUDs, with higher prevalence among non-Hispanic ethnicities, white race, and the middle age group. The study suggests that healthcare providers and public health professionals should be aware of this disparity and work towards reducing it and improving health equity for specific populations.

Exploring Allostatic Load as an Objective Measure of Chronic Stress
Katie Hall PhD, RN¹, Masoumeh Karimi PhD, MPH¹, Laree Hiser PhD¹, Wondwosen Yimer PhD², Deborah Konkle-Parker PhD, FNP<sup>1

1</sup>University of Mississippi Medical Center, School of Nursing, Jackson, MS. ²University of Mississippi Medical Center, School of Population Health, Department of Data Science, Jackson, MS

Background: Subjective stress measurements are validated in the literature, but having an objective measure to complement the self-reported data would be beneficial, especially in high-risk populations. AL is an objective measure of physiological adaptation that can be used to indicate cumulative stress within physiological systems. However, further exploration of AL is needed, including the validation of indicators to include in the AL index specific to women with or without HIV. The study's purpose was to 1) identify the optimal set of indicators in an allostatic load index (ALI) and 2) explore the relationship between AL and perceived stress.

Methods: Data are from participants in the Women's Interagency HIV Study (WIHS) during 2014-2019 whose perceived stress scores on the PSS-10 questionnaire were in the highest (n=103) and lowest (n=103) quartiles based on cohort distribution. An ALI was created based on a combination of 15 indicators selected based on literature review of components utilized within AL indices from four physiological systems. The index was operationalized by the sum of dichotomized risk scores, where each indicator was scored as "1" (high risk) or "0" (not high risk) based on clinical indication of risk.

Results: We reduced indicators from 15 to 5 by conducting linear regression models. ALI scores from the 5 identified indicators range from 0-4 with a sample mean of 0.43 (SD=0.80). ALI and perceived stress scores had a mild relationship (r=0.215; p=0.002) Regression analysis indicated that an increase in ALI score was associated with an increase in perceived stress (β=3.09, 95% CI=1.16-5.03). This relationship was also identified within HIV positive and negative subsets.

Conclusion: Continued exploration of this index by additional statistical methods is needed to evaluate the relationship between ALI and subjective stress scores to identify which specific indicators are best to include in the ALI score for women with and without HIV.

Notes: This presentation was selected for presentation at SNRS in Feb 2024 as a podium.

Frailty assessment for geriatric trauma patients in a level 1 trauma center: a best practice implementation project
Amber Kyle MSN, RN, Michelle Palokas DNP, RN, CPN

University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: Geriatric trauma is a significant public health burden reflective in the increasing volume of hospitalization following a traumatic event. Frailty, a geriatric syndrome related to the body's inability to physiologically respond to stressors, is a strong predictor of mortality and morbidity for this population. The objective of this project was to promote evidence-based practices (EBPs) regarding frailty assessments in older adult trauma patients at the University of Mississippi Medical Center.

Methods: This project was guided by the JBI Evidence Implementation framework, which utilizes the audit and feedback process and a structured approach to the identification and management of barriers and enablers to compliance with recommended EBPs. Two EBPs, based on a JBI Evidence Summary, were utilized as audit criteria. Baseline audits were completed via electronic health record (EHR) reviews. Next, barriers to EBPs were identified, then strategies to address the barriers were planned and implemented. Follow-up audits were conducted, using the same two audit criteria and methods, and compared to the baseline audits.

Results: Baseline audits revealed an 0% compliance with the two EBPs. Barriers to EBPs were identified and included trauma providers' unawareness of EBPs related to frailty assessment, and lack of frailty documentation options in the EHR. Strategies to address these barriers included a provider education and brainstorming session, and creation and EHR implementation of a frailty assessment tool. Post-implementation audits revealed an average 88% compliance with the two EBPs, an 88% increase from baseline.

Conclusions: The clinical audit process used in this project resulted in improvements in compliance with EBPs regarding frailty assessments in older adult trauma patients. Continued education is vital for compliance sustainability and should continue to be supported, utilized, and encouraged by trauma leadership.

Malnutrition among medically complex children: a best practice implementation project
Regina QaDan MSN, FNP-BC, Jorri S. Davis DNP, FNP-C

University of Mississippi Medical Center School of Nursing, Jackson, Mississippi

Background: Malnutrition's impact on pediatric health affects children with chronic conditions in both developing and developed nations. Yet, despite their vulnerability, medically complex children lack standardized screening tools and protocols for managing those at considerable risk of malnutrition. The objective of this project is to implement evidence-based practices addressing the critical need for strategies to manage malnutrition in this at-risk pediatric population.

Methods: This evidence implementation project followed the JBI framework aiming to improve malnutrition risk practices in children with medical complexity. Baseline audits revealed gaps in nutritional screening highlighting barriers such as the absence of validated screening tools and protocols for managing malnutrition risks in this specific patient population. Criteria were adjusted for the outpatient setting, and follow-up audits assessed post-implementation changes, demonstrating the successful adoption of improved practices in evaluating malnutrition risk in medically complex children.

Lessons Learned: Establishing a standardized approach to nutritional screenings can positively impact patient care and outcomes, supporting early identification of those at considerable risk for malnutrition. Applying protocols for follow-up management serves as a strategy to promote adherence to evidence-based practice guidelines. Staff education on both appropriate screening tools and management protocols allowed this project to successfully increase screening rates for patients during their initial clinic visit.

Conclusions: Consistent use of standardized screening tools and adherence to the established protocol should be maintained and supported by routine audits for ongoing improvement in practice. Additionally, ongoing education for Pediatric Complex Care clinic staff and the nutrition team is recommended to reinforce best practices.

Independent double-checking of high-risk medications among hospitalized pediatric patients: A best practice implementation project
Reagan McMurtery BSN (now in the DNP program), Michelle Palokas DNP

University of Mississippi Medical Center School of Nursing, Jackson, Mississippi

Background: Medication errors can lead to prolonged hospital stays, readmissions, and death. Compared to adults, medication errors among pediatric patients have a greater possibility to cause harm due to weight-based, fractional doses. Potential adverse drug events occur three times more often in the pediatric population. This project aimed to promote evidence-based practices (EBPs) regarding independent double-checks (IDCs) of high-risk medications (HRMs) on a pediatric acute care unit, 3 Children's.

Methods: This project was guided by the JBI Evidence Implementation framework, which is grounded in the audit and feedback process and a structured approach to the identification and management of barriers and enablers to compliance with recommended EBPs. Nine EBPs, based on a JBI evidence summary, were utilized as audit criteria. Baseline audits were completed via an online nursing staff survey, a policy/procedure review, and an interview with the nurse manager. Next, barriers to EBPs were identified, then strategies to address the barriers were developed and implemented. Follow-up audits were conducted, using the same nine audit criteria and methods, and compared to baseline audits.

Results: Baseline audits revealed an average 70% compliance with the nine EBPs. Barriers to compliance were identified, including lack of nursing staff knowledge/training regarding IDCs of HRMs and an unclear policy and procedure regarding HRMs and IDCs. Strategies to improve EBP compliance were implemented and included an online education module, reminder cards on the computers on wheels, a tip sheet in the medication preparation room, and revisions to the Children's High-Risk Medication policy. Post-implementation audits revealed an average 77% compliance with the nine EBPs, a 7% increase from baseline.

Conclusions: The clinical audit process used in this project resulted in improvements in compliance with EBPs regarding IDCs of HRMs. To sustain these gains, nursing education regarding IDCs should be continued through annual nursing education and new hire checkoffs.

Heart Failure: Disease Management Programs: A Best Practice
Amy Johnson FNP-BC, Linda Upchurch DNP, ANP-BC, APRN

University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: Heart failure affects thousands of patients annually, often resulting in hospitalization, emergency room visits, and decreased quality of life. Scientific evidence supports disease management programs using a multidisciplinary approach to improve patient outcomes in heart failure. The objective of this project was to promote evidence-based practices regarding the implementation of a disease management program for heart failure patients.

Methods: Using the JBI Evidence Implementation framework, this project sought to promote adherence to best practices for early identification of symptoms of heart failure exacerbation and prevention of emergency room visits and hospitalizations to reduce morbidity and mortality. Two barriers were identified after a baseline chart audit, including a lack of a disease management program and onsite access to the needed multidisciplinary team. A protocol was developed to implement a disease management program, and a virtual relationship was established to establish a multidisciplinary team to address these barriers.

Lessons Learned: Disease management programs are vital to managing heart failure by reducing emergency room visits, hospitalizations, morbidity, and mortality. For this project, implementing a disease management program for heart failure patients improved adherence to best practices. The strategic components of the disease management program allowed for early identification of exacerbation symptoms and intervention to prevent exacerbation.

Conclusions: The evidence-based implementation project enhanced best practices by implementing a protocol in the rural health clinic to ensure that all heart failure patients should be enrolled in a disease management program. Recommendations would be to utilize the electronic health record to quickly identify heart failure patients and their status in a disease management program. Quarterly chart audits should be performed to determine heart failure patients' enrollment status to ensure sustainability.

Association of PROMIS Self-Report Tools With Salivary Biomarkers
Laree M. Hiser PhD¹, Karen Arrant PhD, RN², Jung Hye Sung Lee ScD, MPH¹, Lei Zhang PhD, MBA<sup>1

1</sup>University of Mississippi Medical Center, School of Nursing, Jackson, Mississippi. ²University of Louisiana, Monroe, Kitty DeGree School of Nursing, Monroe, Louisiana

Background: Self-report tools are often used in nursing research as proxies for physiological phenomena, but the concordance of results from PROMIS scales and biomarkers is rarely reported. In a small (n=31) randomized controlled trial with a yoga intervention to reduce stress and improve sleep, PROMIS self-report tools and laboratory measurements of salivary biomarkers were used (Arrant and Stewart, 2019).

Methods: Salivary cortisol and α-amylase biomarkers were quantified by enzyme-linked immunosorbent assays (ELISAs) on samples self-collected for three consecutive days in the morning and evening prior to and following the 12-week intervention. Cortisol values are the difference between median concentrations in the morning and evening to account for the normal diurnal cycle. Morning and evening measurements are averaged for α-amylase. PROMIS tools with a Likert scale measured symptoms experienced in the past week pre- and post-intervention for sleep disturbance, anxiety, and depression. Hours of sleep for three days were self-reported before and after the intervention. Correlations were conducted between pre- and post-intervention differences in PROMIS t-scores, average hours of sleep, and biomarker concentrations.

Results: No statistically significant correlations were found between cortisol (a biomarker for stress), and t-scores for PROMIS tools measuring sleep disturbance (r = ˗0.05, p=0.79), anxiety (r =0.04, p=0.84), depression (r = ˗0.27, p=0.15), nor self-reported hours of sleep (r = ˗0.04, p=0.81). Similar non-significant correlations were obtained for a biomarker of the sympathetic nervous system associated with quality of sleep, α-amylase, and PROMIS tools for sleep disturbance (r =0.08, p=0.68), anxiety (r = ˗0.11, p=0.56), depression (r = ˗0.01, p=0.96), or self-reported hours of sleep (r=0.03, p=0.86).

Conclusion: Our study suggests that self-report measures may be poor proxies for objective biomarker data used to assess physiological changes in Caucasian women older than 50. Further study is needed with a larger and more diverse sample.

Potential Novel Biological Risk Factor for Cervical Cancer
Laree M Hiser PhD, Samira Grifoni PhD, Carolann Risley PhD, NP

University of Mississippi Medical Center, School of Nursing, Jackson, Mississippi

Background: Cervical cancer incidence and death rates are higher in Mississippi than in the U.S. for all races. This is not readily explained by screening or vaccination rates for human papillomavirus (HPV) which suggests a biological contribution. The epi-cytoskeleton is a potential mechanism proposed to have an environmental etiology and be associated with populations. The objective of this study is to explore the presence of tri-methylated lysine (TMeK) on tubulin in human cells.

Methods: To establish the existence of TMeK as a post-translational modification on tubulin, cultured human cervical cancer cell lines with HPV16 (SiHa), HPV18 (HeLa), or no HPV (C-33A) were used. Breast cancer (MCF-7) and colorectal cancer (HCT-15) cell lines were controls. Cell lines were arrested in various phases of the cell cycle (G0/G1, G1/S, and G2/M) to examine reversibility of the modification. Antibodies were used to separate all proteins with TMeK from lysates by immunoprecipitation. Identification of tubulin was by gel electrophoresis and immunoblots.

Results: TMeK-modified β-tubulin (but not α-tubulin) was most prominent in SiHa cells arrested in G0/G1. This modification was stable in the methanol-containing solution in Pap smear vials for one month. Similar, but less pronounced, results were seen in other cervical cancer cell lines.

Conclusions: Our preliminary results support the hypothesis that a methyl transferase involved with regulation of nuclear proteins associated with epi-genetics also acts in the cytoplasm on β-tubulin to affect type-specific transport of the HPV virus. TMeK-α-tubulin is in the G2/M phase of mouse cells. However, TMeK-modified β-tubulin has not been reported. Further studies to verify this novel finding and identify the specific lysine residue that is tri-methylated are needed prior to mechanistic studies. The long-term goal is to develop a screen for biological risk factors of infection with high-risk types of HPV that will assist with personalized management of patients.

Notes
Supported by a University of Mississippi Medical Center School of Nursing Seed Grant and a John C. Ruckdeschel Cancer Center and Research Institute (CCRI) Pilot Grant Award

Student hand hygiene at Piney Woods Boarding School: A best practice implementation project
Mwendaendi Lewanika-Anderson DNP, Michelle Palokas DNP

University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: Commonly transmitted illnesses in schools include respiratory infections (colds, flu) and gastrointestinal infections (norovirus, rotavirus). Because hands are the first transmission mechanism of many of school-related illnesses, effective student hand hygiene (HH) decreases the spread, and therefore can lessen missed school days. This project aimed to promote evidence-based practices (EBPs) regarding HH at Piney Woods School, a coeducational college preparatory boarding school in Mississippi.

Methods: This project was guided by the JBI Evidence Implementation framework, which is grounded in the audit and feedback process and a structured approach to the identification and management of barriers and enablers to compliance with recommended EBPs. Six EBPs, based on a JBI evidence summary, were utilized as audit criteria. Baseline audits were completed via electronic surveys (one for the school nurse and one for students), created using the Qualtrics platform. Next, barriers to EBPs were identified, then strategies to address the barriers were developed and implemented. A follow-up audit will be conducted, using the same six audit criteria and methods, and compared to the baseline audit.

Results: The baseline audit revealed an average 90% compliance with the six EBPs, but only 51% compliance with the EBP regarding HH education for students. Barriers to compliance were identified and included poorly designed HH stations, low quality and outdated HH products, and lack of student knowledge regarding HH. Strategies to improve EBP compliance were implemented and included redesigned HH spaces at the entrances of classrooms, updated HH products, and student HH education. Post-implementation audits are in progress.

Conclusions: The in-progress post-implementation audits will aid the project team in determining if the strategies implemented affected compliance with EBPs. Ongoing HH education may be necessary to sustain EBP compliance, and therefore reduce school-related illnesses and related absenteeism.

Promoting evidence-based practices regarding extravasation and infiltration (pediatric populations): an evidence-implementation project
Brandy Wilson MSN, RN, CPN, FNP-C, Linda Upchurch DNP, APRN, ANP-BC

University of Mississippi Medical Center School of Nursing, Jackson, Mississippi

Background: Peripheral intravenous (PIV) therapy, the most common invasive procedure in hospitals, frequently results in complications. Infiltrations occur when infused fluids enter surrounding tissue without harming the skin, while extravasations irritate the skin and tissue, occasionally necessitating surgical intervention. Evidence-based practices advocate for quality standards such as Assess, Touch, Compare (ACT) and a 60-minute rounding tool to address the rising intravenous complications. An evidence implementation project was planned, initiated, and completed to decrease the complications associated with infiltration and extravasation at the site of peripheral intravenous catheters.

Methods: This evidence implementation project used the JBI Evidence Implementation framework to improve adherence to best practices in managing pediatric patients with PIV access, reducing infiltration and extravasation rates. A baseline audit identified inconsistent adherence to the policy, including the crucial hourly rounding to assess the infusion site.

Lessons Learned: Continuing education and protocols can positively impact the quality of care of pediatric patients with PIV by allowing staff to improve or strengthen the knowledge and skills necessary to prevent infiltrations and extravasations.

Conclusions: To enhance adherence, strategies were implemented, including in-person education on hourly PIV assessment using the ACT method and introducing a rounding tool with charge nurses. Additionally, an algorithm for extravasations and infiltrations was developed and implemented, significantly improving post-implementation audits regarding adherence to best practices.

Healthcare professionals in hospital settings identifying children who have been exposed to maltreatment: a best practice implementation project
Amanda McCullough MSN¹, Michelle Palokas DNP², Anna Laura King MSN<sup>1

1</sup>University of Mississippi Medical Center School of Nursing, Jackson, MS. ²University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: Approximately 15% of the nation's children are believed to have experienced abuse or neglect, also known as child maltreatment (CM), in the past year; however, this statistic is likely lower than the actual prevalence due to under-reporting and challenges in identifying abuse. This project aimed to promote evidence-based practices (EBPs) regarding healthcare professionals (HCPs) in a pediatric acute care unit identifying children who have been exposed to CM.

Methods: This project was guided by the JBI Evidence Implementation framework, which is grounded in the audit and feedback process and a structured approach to the identification and management of barriers and enablers to compliance with recommended EBPs. Seven EBPs, based on a JBI evidence summary, were used as audit criteria. Baseline audits were completed via a policy review, electronic survey, interview with the clinical outcomes coordinator, and electronic health record (EHR) reviews. Next, barriers to EBPs were identified, then strategies to address the barriers were developed and implemented. Follow-up audits were conducted, using the same seven audit criteria and methods, and compared to baseline audits.

Results: Baseline audits revealed an average 64% compliance with the seven EBPs. Barriers to compliance were identified and included: HCPs lack of knowledge regarding CM EBPs and the absence of available resources for HCPs regarding CM. Strategies to improve EBP compliance were implemented and included introduction of a validated bruising clinical decision rule in electronic and print format, and HCP education dissemination via informational forums. Post-implementation audits revealed an average 88% compliance, a 24% increase from baseline.

Conclusions: There is a noticeable gap in HCP recognition and management of CM. The implementation of ongoing education and visual resources can enhance HCPs' ability to recognize such cases. Future plans include collaborating with nursing informatics to enhance the EHR screening process for CM across all clinical settings.

Association of Social Support with Depressive Symptoms Comparing Women and Men Who Have Sex with Men.
Matthew Byrd MSN, RN¹, Aaron Samuel Breslow PhD², Todd Brown MD, PhD³, Mardge Cohen MD⁴, Amber D'Souza PhD⁵, Andrew Edmonds PhD, MPH⁶, Christina Mehta PhD, MPSH⁷, Matthew Mimiaga ScD, MPH, MS⁸, Frank Palella MD⁹, Nicole Perez PhD, RN, PMHNP-BC¹⁰, Adam Visconti MD, PhD¹¹, Deborah Jones-Weiss PhD¹², Tracy Wilson PhD¹³, Jenni Wise PhD, RN¹⁴, Deborah Konkle-Parker PhD, FNP<sup>15

1</sup>University of Mississippi Medical Center, School of Graduate Studies, PhD in Nursing, Jackson, MS. ²Albert Einstein College of Medicine, Bronx, NY. ³John Hopkins University, Baltimore, MD. ⁴Hektoen Institute of Medical Research, Chicago, IL. ⁵John Hopkins Bloomberg School of Public Health, Baltimore, MD. ⁶University of North Carolina at Chapel Hill, Chapel Hill, NC. ⁷Emory University, School of Medicine, Atlanta, GA. ⁸University of California Los Angeles, Los Angeles, CA. ⁹Northwestern University, Chicago, IL. ¹⁰New York University Rory Meyers College of Nursing, New York, NY. ¹¹Georgetown University, Washington, DC. ¹²University of Miami, Miami, FL. ¹³SUNY Downstate Health Sciences University, New York, NY. ¹⁴University of Alabama at Birmingham, Birmingham, AL. ¹⁵University of Mississippi Medical Center, Jackson, MS

Abstract
HIV has evolved to be considered a chronic disease, due to remarkable biomedical advances in HIV prevention, treatment, and management. Men and women with HIV must now grapple with prevailing health-related issues, such as comorbidities (e.g., depression, SUDs, etc.). Depression is the most common behavioral health burden impacting men and women with HIV, while also being regarded as highly stigmatizing. It is known that people with HIV experience mental health problems at a much higher rate. This study utilizes data from the MACS/WIHS Combined Cohort Study (MWCCS). MWCCS is a longitudinal cross-sectional collaborative research program with over 5,000 participants which includes patients with and at risk for Human Immunodeficiency Virus (HIV). The AIM of this study is two-fold: (1) to investigate how social support and depression differ between men who have sex with men (MSMs) and women in MWCCS, and (2) to examine the association between social support and depression when comparing MWCCS MSMs and women. Correlation and regression analyses will be utilized to exam the variables of social support and depression as measured by the mMOS-SS and CES-D, respectively. We anticipate that social support is strongly associated with the level of depression and is significantly different when comparing MSMs and women in MWCCS. Due to the difference in networks, we expect that there is a stronger sense of social support among MSMs as compared to women. Once depressive symptoms are recognized in individuals, it is important to determine if targeted interventions that provide social support (i.e., emotional & informational support and/or positive social interaction) for these individuals can reduce depressive symptoms and improve mental health as a component of their well-being. Understanding the difference in social support when comparing MSMs and Women in MWCCS may help identify targeted support services to improve overall wellbeing and health outcomes.

Patient Hand Hygiene in a residential aged care facility: A best practice implementation project
Jannette Silvania MSN, RN, CRRN, Michelle Palokas DNP, RN, CPN

University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: Hand hygiene (HH), for both health care workers (HCWs) and patients, is an important measure to prevent healthcare-associated infections in residential aged care facilities (RACFs). Studies regarding HCWs' and patients' perceptions and behaviors have indicated that despite understanding its importance, patient hand hygiene (PHH) is not a deliberate practice. This project aimed to promote evidence-based practices (EBPs) regarding PHH in a RACF.

Methods: This project was guided by the JBI Evidence Implementation framework, which is grounded in the audit and feedback process and a structured approach to the identification and management of barriers and enablers to compliance with recommended EBPs. Six evidence-based practices (EBPs), based on a JBI evidence summary, were used as audit criteria. Baseline audits were completed via observations, electronic staff surveys, and electronic health record (EHR) reviews. Next, barriers to EBPs were identified, then strategies to address the barriers were developed and implemented. Follow-up audits were conducted, using the same six audit criteria and methods, and compared to baseline audits.

Results: Baseline audits revealed an average of 64% compliance with the six EBPs. Barriers to compliance were identified and included HCWs' lack of knowledge regarding the multimodal approach to PHH, unavailability of PHH products, patient inability to use HH products independently, and inaccurate or missing documentation of PHH education in the EHR. Strategies to improve EBP compliance were implemented, including HCW education, increasing the number and usability of PHH supplies, and standardization of PHH documentation in the EHR. Post-implementation audits revealed an average 76% compliance with EBPs, a 12% increase from baseline.

Conclusions: Multiple strategies were implemented and introduced during nursing skills fairs, daily morning huddles, and clinical committee meetings. The strategies were successful in improving compliance with PHH EBPs. To sustain and advance compliance, HCWs must continue to perform and prioritize PHH as routine patient care.

Discharge planning for inmates with mental health issues released from prison: a best practice implementation project
Melanie King MSN, ACNP-BC, PMHNP-BC, Michelle Palokas DNP, RN, CPN

University of Mississippi Medical Center School of Nursing, Jackson,, MS

Background: Many prisoners will be released to the community, and 80 % of inmates returning to the community have chronic medical conditions such as mental health disorders and medical conditions. Discharge planning in the prison setting is critical to the continuity of the healthcare pathway, given the recognized link between health outcomes and reoffending. The project aimed to promote evidence-based practices (EBPs) regarding discharge planning for inmates with mental health issues released from a Mississippi state prison.

Methods: This project was guided by the JBI Evidence Implementation framework, which is grounded in the audit and feedback process and a structured approach to the identification and management of barriers and enablers to compliance with recommended EBPs. Nine EBPs, based on a JBI evidence summary, were utilized as audit criteria. Baseline audits were completed via a procedure review and electronic health record (EHR) reviews. Next, barriers to EBPs were identified, then strategies to address the barriers were developed and implemented. Follow-up audits were conducted, using the same nine audit criteria and methods, and compared to baseline audits.

Results: Baseline audits revealed an average 56% compliance with the nine EBPs. Barriers to compliance were identified and included unclear discharge planning policies and lack of staff knowledge regarding EBPs. Strategies to improve EBP compliance were implemented and included updating two discharge policies, creation and implementation of a discharge planning checklist aligned with EBPs, and related staff education. Post-implementation audits revealed an average 94% compliance with the nine EBPs, a 38% increase from baseline.

Conclusions: Updating policies and procedures to reflect discharge planning EBPs and related staff education improved compliance with EBPs. Continued staff education regarding discharge planning is necessary for sustainment of EBP compliance. Updates to the EHR, including addition of the discharge planning checklist, were recommended and may further improve compliance.

Opioid overdose prevention education and training for non-medical bystanders in the public school setting: A best practice implementation project
Kimberly Baugh BSN, Robin Christian DNP, FNP-C

University of Mississippi Medical Center, School of Nursing, Jackson, MS

Background: Opioid drug use is increasing at alarming rates. Educating non-medical bystanders on opioid overdose recognition and reversal techniques is critical to preventing fatal opioid overdoses in the public school setting. The objective of this project was to improve non-medical bystanders' response to opioid overdose within a public school setting by educating school staff members on the signs of opioid overdose and the administration of naloxone.

Methods: The JBI Evidence Implementation framework was used in this project to optimize compliance with best practices for early identification of the signs and symptoms of opioid overdose and prevention by administering naloxone. Three barriers to best practice were identified after a baseline audit. The barriers included a lack of education and training related to opioid overdose to non-medical bystanders and a lack of on-campus naloxone availability. To address these barriers, all school personnel participated in an opioid overdose presentation and naloxone administration training.

Results: Educating non-medical bystanders regarding opioid overdose prevention measures can improve the response and outcome of a potential opioid overdose in a public school setting. The training educated non-medical staff regarding best practice recommendations, which could potentially prevent a fatality on campus related to opioid drug use. The pre-and post-audit results will be used to determine if best practice recommendations were followed with the implementation strategies regarding opioid overdose prevention and naloxone administration.

Conclusions: Opioid overdose prevention education and training should be completed yearly during staff development for non-medical bystanders in the public school setting. By increasing awareness of signs and symptoms related to an opioid overdose, prevention measures can be deployed to decrease the likelihood of a fatality of a student, staff member, or campus visitor while on school grounds. Continued education is vital and should continue to be supported, utilized, and encouraged by the school district.

Caring for Obstetric Patients in the Emergency Department Setting: a Best Practice Implementation Project
Abigail Neary BSN, RN, Linda Upchurch DNP, APRN, ANP-BC

Univeristy of Mississippi Medical Center, Doctorate of Nursing Practice, Jackson, Mississippi

Background: Obstetric emergencies can happen unexpectedly, and frontline providers need to be prepared to respond to improve the outcome of both mother and baby. The highest causes of maternal deaths globally are cardiovascular conditions, sepsis, hemorrhage, embolism, and hypertensive disorders. The highest causes of infant mortality around the world are birth defects, preterm birth, sudden infant death syndrome, and pregnancy complications. Mississippi has the highest rates of infant mortality, with a rate of 8.5 per 1,000 births and a maternal mortality rate of 82.5 deaths per 100,000 births.

Methods: Using the JBI Evidence Implementation framework, this project sought to optimize adherence to best practices for early identification and education on obstetric emergencies to improve maternal and infant outcomes. Two barriers were identified after a baseline chart audit, including not having a triage policy for obstetric patients in the emergency department and no training on obstetric emergencies for the emergency department nurses. To address these barriers, the nursing staff participated in a simulation training event on obstetric emergencies, and the department also implemented a new triage policy process for obstetric patients.

Results: The annual competency training with obstetric emergency simulation benefitted the collaborative staff in strengthening current knowledge and skills with obstetric patients. Simulation is a strategy to encourage evidence-based practice guidelines at the point of care, allowing clinical skills to be acquired through deliberate practice. A triage policy process was also implemented to ensure that obstetric patients were dispositioned to the appropriate place, with the potential for improving maternal and neonatal outcomes.

Conclusions: A triage policy process is beneficial not only for the flow of the emergency department, but for the outcomes and disposition of obstetric patients. Continued nursing education and annual competency is vital and should continue to be supported and encouraged through the hospital's nurse education department.

Early Enteral Nutrition Among Mechanically-Ventilated Adult Patients in the Critical Care Unit: A Best Practice Implementation Project
Phillip Swanson BSN, Linda Upchurch DNP

University of Mississippi Medical Center, Jackson, MS

Background: Mechanically ventilated patients in the critical care unit are at risk for severe nutritional deficits. Early enteral nutrition initiation for these patients may reduce their risk of mortality, hospital-acquired infections, and prolonged hospital stays. This project aimed to promote evidence-based practices regarding the proper timing and initiation of enteral nutrition in mechanically ventilated patients in the intensive care setting.

Methods: Using the JBI Evidence Implementation Framework, this project sought to optimize adherence with best practices concerning enteral nutrition administration for ventilated patients. Three barriers to best practice were identified after a baseline chart/policy audit: a lack of a structured policy/procedure, a lack of education on nutritional needs for intubated patients, and a lack of effective communication with providers. A draft procedure was made to guide nutritional care, relevant education was provided to staff, and communication reminders were placed in the department to address these barriers.

Results/Lessons Learned: Implementing a detailed protocol for nurses to follow ensured that nutrition was considered as early as possible. Educating nurses on the importance of adhering to the recommended practices and effectively communicating them to the provider ensures that the care team's goals of optimal nutritional management are aligned. For this project, the implementation strategy improved adherence to best practices.

Conclusion: A structured policy, appropriate education, and effective communication can help improve outcomes concerning ventilated patients' nutritional management. A similar policy should be submitted for formal approval of use. Laminated copies of the protocol and the communication reminders should be placed on the unit pending approval. Continued nursing education can also ensure no knowledge deficits among the staff concerning ventilated patients' nutritional management.

Fall prevention in older adults within the hospital setting: A best practice implementation project
Kaitlynn Wright DNP, Jorri Davis

University of Mississippi Medical Center School of Nursing, Jackson, Mississippi

Background: Falls in elderly hospitalized patients are common safety incidents. Although hospitals work hard to prevent falls, there remains substantial challenges within the elderly demographic. The objective of this project was to promote evidence-based fall prevention practices for older hospitalized patients.

Methods: This project optimized hospital fall prevention best practices for older adults using the JBI Evidence Implementation framework. After baseline chart audits using the GRiP process, three barriers to best practice were identified: a lack of education on patients at higher risk for falls for CNAs and RNs, a lack of a simplified area to document multifactorial interventions to prevent falls in the EHR, and a lack of staff education on how to provide medical reviews for elderly patients at high risk for falls. A fall prevention poster was designed placed in patient rooms at the project site, and staff were educated on how to identify elderly patients at risk for falls. RNs and CNAs were surveyed to assess effectiveness of fall prevention education and posters. Charts were also audited to see if elderly patients at higher risk for falls had more than two fall prevention interventions (environment adaptation, medication review, patient education on fall risk and prevention) in place.

Lessons Learned: It was determined that the fall prevention posters were successful at helping to determine multifactorial interventions to prevent falls for almost half of the subjects. Implementing evidence-based practice in nursing units can be challenging but rewarding. Fostering a culture that values continuous learning and embraces change to is essential for successful implementation of any project.

Conclusions: Laminate fall prevention posters with patient fall risk information made fall prevention interventions more multifactorial and patient-specific. At project completion, 45% of subjects had more than two fall prevention measures planned based on individual risk factors secondary to fall prevention posters.

Sedation Assessment of Intubated Adult Patients in an Emergency Department: A best practice implementation project
Kathryn Sinn BSN, RN, Linda Upchurch DNP, APRN, ANP-BC

University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: To reduce the risk of adverse effects, nurses are responsible for assessing and managing sedation levels of intubated patients. Most emergency department nurses never receive training on sedation management post-intubation. Providing appropriate sedation largely relies on the nurse's judgment and assessment skills. This project aimed to promote evidence-based practices regarding the importance of effectively assessing sedation levels for intubated patients using a validated tool.

Methods: Using the JBI Evidence Implementation framework, this project sought to promote evidence-based practices regarding the sedation of intubated patients in the emergency department. Two barriers to best practice were identified after the baseline audits, including that the nurses do not receive education on the use of a validated tool for sedation assessment of intubated patients, and there are no existing tools, policies, or protocols to reference for measuring and adjusting sedation of intubated patients. To address these barriers, education on using a validated tool for assessment was incorporated into annual nursing competencies, and multiple tools were incorporated into the clinical setting.

Lessons Learned: Continuing education and ongoing competency refreshers affect the quality of patient care and outcomes by offering occasions to improve or strengthen expertise and proficiency. Education is a strategy to encourage evidence-based practice guidelines at the point of care, allowing clinical skills to be acquired through deliberate practice.

Conclusions: The department now has cards to place on the nurses' badge reels with instructions and helpful tips to remember when assessing intubated patients and a laminated tip sheet on every computer to reference while documenting. All nurses were given instructions on adding the validated tool for assessment to the "favorites" tab on the left side of their documentation in the EHR to serve as a reminder. Nursing education on this topic can be continued by the unit's nurse educator.

Best practices assessment of chlorhexidine gluconate bathing in the critically ill in an intensive care setting in Mississippi: A best practice implementation project
Stephanie Addison PhD, DNP, CRNA, FAAN, Robin Christian PhD, DNP, CRNA, FAAN

University of Mississippi Medical Center, Jackson, MS

Background: Daily chlorhexidine gluconate (CHG) bathing in the critically ill can prevent health-acquired infections (HAIs). Educating nurses on the importance of daily CHG bathing is imperative to increasing the compliance of CHG bathing. This project aimed to improve adherence to evidence-based practices regarding daily CHG bathing in the critically ill.

Methods: The JBI Evidence Implementation framework was utilized for this project, and audit criteria were obtained from the JBI evidence summary to measure compliance for the best-recommended practices for CHG bathing in the critically ill. Following a baseline assessment, three barriers to best practices were identified. These barriers included a lack of education for nurses on the benefits and necessity of daily CHG bathing, nurses not identifying patients needing CHG baths, and the absence of a policy documenting CHG allergies. Strategies to overcome these barriers include creating an education handout for all nurses in the unit, implementing electronic health record (EHR) documentation for CHG allergies, and providing laminated posters for CHG bathing reminders in each patient room.

Lessons learned: A critical care unit is a fast-paced environment with numerous important tasks and interventions. Providing education on the importance of daily CHG bathing can improve compliance with best-recommended practices. Friendly reminders help ensure daily CHG baths are completed. Baseline audit results showed a compliance rate of 36.7% for criteria 1 and 0% for criteria 2, 3, and 4.

Conclusions: Implementation of strategies to overcome the barriers improved compliance significantly. Continuing education will help maintain compliance rates, ensure new hires receive the proper education, and provide a refresher for current nurses.

Nurse-led education promoting antibiotic adherence: An evidence-based implementation project
Leslie Raggett BSN, DNP, FNP

University of Mississippi Medical Center, Jackson, MS

Background: Improper antibiotic adherence can lead to ineffective treatment, antimicrobial resistance, and reoccurring healthcare visits. Antibiotic adherence is a vital aspect of optimizing patient care and reducing healthcare costs. The objective of this project was to promote evidence-based practices regarding antibiotic adherence through nurse-led education[JD1] [LR2] in an urgent care setting.

Methods: Using the JBI Evidence Implementation framework, this project sought to optimize compliance to best practices for antibiotic adherence by creating educational resources to support both patient and provider in proper antibiotic adherence in order to improve the effectiveness of treatment and reduce reoccurring visits. A baseline chart audit and anonymous electric survey revealed two barriers to best practice including a lack of education for patients on antibiotic prescription adherence and a lack of facility guidelines related to antibiotic stewardship. To address these barriers pamphlets were created on the importance of antibiotic adherence along with outpatient, community-based facility guidelines on antibiotic adherence including stewardship.

Lessons Learned: Assessing and continuing education assist providers in prescribing responsibly and patients in adhering to antibiotic practices. Providing educational materials to patients and having facility guidelines is a strategy to encourage evidence-based practice guidelines as a standard of care to support the highest quality outcomes. For this project, the educational pamphlets and facility guidelines improved antibiotic adherence compliance with best practices.

Conclusions: Facilities should have antibiotic adherence guidelines specific to the community they serve that educate on antibiotic stewardship and provide a standard of care. Educational materials such as the pamphlet on the importance of antibiotic adherence provide patient-friendly information to patients that is clear and concise to promote compliance. Succeeding audit intervals is recommended at the clinical director's discretion for the continuation of evaluation and assessment of educational interventions based on the final percentage of compliance compared with best practices.

Trends in Sexual Risk Behavioral Responses among High School Students between Mississippi and the United States: 2001 to 2019 YRBSS
Jennifer Brumfield BSN, MHS¹, Carolann Risley PhD, RN, WHNP^2,3,4, Kimberly Douglas PhD, RN², Masoumeh Karimi PhD, MPH², Gordon Gartrell BSN, RN¹, Rodolfo Vargas MS⁵, Lei Zhang PhD, MBA<sup>2,6,7

1</sup>University of Mississippi Medical Center, School of Graduate Studies in Health Sciences, Jackson, MS. ²University of Mississippi Medical Center, School of Nursing, Jackson, MS. ³University of Mississippi Medical Center, School of Medicine, Department of Cell and Molecular Biology, Jackson, MS. ⁴University of Mississippi Medical Center, Cancer Center and Research Institute, Jackson, MS. ⁵Mississippi State Department of Health, Office of Health Data and Research, Jackson, MS. ⁶University of Mississippi Medical Center, John D. Bower School of Population Health, Jackson, MS. ⁷University of Mississippi Medical Center, School of Health Related Professions, Jackson, MS

Background: Early sexual reproductive health (SRH) education is linked to a reduction in risky sexual behaviors. Sexually transmitted infections (STIs) are rising at alarming rates. Risky sexual behaviors, including initiation of sex before age 13, having more than four sexual partners, and lack of use of condoms, increase the probability of infection and cancer. Educating students about the link between risky behaviors and cancer is vital to reduce morbidity and mortality.

Methods: A trend analysis of the Youth Risk Behavior Surveillance System (YRBSS) data between 2001 and 2019 was conducted. Results from four survey responses related to sexual risk behaviors among 9th to 12th grade in Mississippi students were compared with their US peers.

Results: Between 2001 and 2019, favorable declines in 3 out of 4 sexual risk behaviors were observed. Declining prevalence was reported for "ever had sexual intercourse," "age of sexual initiation at age 13 or younger," and "having 4 or more sexual partners in their lifetime" are promising. However, fewer students report using condoms. The adjusted prevalence rates for Mississippi students in all 4 measures were higher than the national responses.

Conclusions: Our analysis supports the need for early sexual reproductive health education to promote health. States with increased behavioral risk among students should consider trends in data to improve education and policy.

Structure and effectiveness of patient education regarding dietary management in adults with type 2 diabetes mellitus: A best practice implementation report
Lenzy Fisher Doctorate of Nursing Practice, Robin Christian Doctorate of Nursing Practice

University of Mississippi Medical Center School of Nursing, Jackson, Mississippi

Background: Type 2 diabetes mellitus causes insulin resistance and affects the regulation of blood glucose levels. Studies show that residents of rural communities have a higher prevalence of type 2 diabetes mellitus with inadequate meal choices and the inability to regulate meal timing with medications. Positive patient outcomes can be attributed to an individualized care plan and one-on-one interaction with a diabetes care specialist. This project aimed to highlight the importance of patient education in managing this disease.

Methods: Using the JBI Evidence Implementation framework, this project sought to promote evidence-based practices regarding patient education for patients with type 2 diabetes mellitus. Two barriers to best practice were identified after a baseline audit was performed. Patients were uneducated on diabetes management due to limited time allotted to the provider during appointments and insufficient resources and patient education provided. To address these barriers, the patients were referred to a Diabetic Educator to provide focused information sessions. In addition, the primary care providers provided additional supplemental material and resources after each appointment.

Results: Patients reported increased knowledge of their chronic disease management after the one-on-one interaction with the diabetic educator. Patients reciprocated information using the teach-back method, which determined evidence of the decreased knowledge gap. In addition, patients received detailed, personalized information from the primary provider.

Conclusions: The healthcare team must continue assessing patient knowledge to identify barriers to learning, and efforts to address such barriers should be made to provide patients with pertinent information to empower them to take charge of their health and provide guidance for management.

An education program for African Americans diagnosed with Type 2 Diabetes Mellitus in a family medicine clinic: A best practice implementation project
Stacia Dunson RN, MSN, FNP-C, Robin Christian DNP, FNP-C

University Of Mississippi Medical Center School of Nursing, Jackson, Mississippi

Background: Type 2 Diabetes has profoundly impacted the African American population in the United States over the last five years. African Americans develop complications from Type 2 diabetes more often than Caucasians due to the lack of education about the disease, improper diet, and poor glucose monitoring. Diabetic education programs help decrease patient complications and increase knowledge to control disease. The objective of this project was to promote evidence-based practice regarding education in African American patients with Type 2 Diabetes with a A1C greater than 8% in the primary care clinic.

Methods: Using the JBI evidence implementation framework, this project sought to determine the effectiveness of a 12-week diabetic education program promoting evidence-based practice in primary care for diabetics with A1Cs greater than 8%. Barriers were identified after a baseline chart audit, including lack of time during clinic visits to effectively educate patients about diabetes and complications, limited training on diabetes among staff, and integration into a care pathway for adults with diabetes. To address barriers, clinical staff participated in training sessions on topics discussed in the education program.

Results: The chart EHR review provided information showing a decrease in A1C levels and weight among those participating in the program. Pre-audit data did not show 100% compliance with the eleven criteria. Upon completion of the education program, post-audit data showed all eleven audit criterion were met with 100% compliance. Due to success of compliance, clinic applied to become a diabetes education certified site and awaiting approval.

Conclusions: Education for African Americans with Type 2 Diabetes and A1c greater than 8% should be implemented in all practices. Literature packets were created and disseminated to patients to provide continuous education in the home. The clinic will continue to offer the education program to all diabetics with hemoglobin A1C greater than 8%.

Prevalence of the Sexual Violence Experiences among Mississippi Public High School Students- Findings From Analysis of YRBSS
Masoumeh Karimi PhD, MPH¹, Rodolfo Vargas MS², Lei Zhang PhD, MBA<sup>1

1</sup>University of Mississippi Medical Center, School of Nursing, Jackson, Mississippi. ²Mississippi state Department of Health, Jackson, Mississippi

Background: Sexual violence is a frequent adverse experience reported by youths leading to serious mental health issues and marginalized youth are even at a higher risk. Looking at the prevalence of sexual violence is the first step to identify at-risk groups and plan for prevention or treatment.

Methods: This study is a secondary analysis of the Youth Risk Behavior Surveillance System (YRBSS) focused on the prevalence of sexual violence experiences among Mississippi (MS) public high school students. Mississippi started to collect data on youth sexual violence experiences in 2019.

Results: Among all Mississippi high school students who participated in 2019, 11.3% reported having experienced sexual violence during the past 12 months compared to 10.8% of their peers at the national level. The prevalence increased for both MS (12.3%) and US (11.0%) in 2021. Further analysis of 2021 data indicated that female participants reported a higher prevalence of sexual violence experiences both in MS (female: 15.3%; male: 8.6%) and US (female: 17.9%; male: 4.6%). Participants who self-identified as racial minorities reported a higher prevalence of sexual violence experiences both in Mississippi and US. That includes Hispanics (MS: 22.3%; US: 11.3%), and multiple race (MS: 20.8%, US: 14.7%) participants. The prevalence was higher in White (MS: 13.5%; US: 11.9%) compared to Black respondents (MS: 8.3%; US: 7.4%). Participants who identified their sexual orientation as "Questioning", reported the highest prevalence of sexual violence experiences in Mississippi (30.4%). Following them, "Gay, Lesbian and Bisexual" participants reported high prevalence both in Mississippi (22.4%) and US (23.6%).

Conclusion: To protect youth mental health, specifically those who are at higher risk, it is important to provide social and mental support and services for sexual violence victims and educate teenagers to prevent such adverse experiences.

Multidisciplinary rounds in the adult critical care unit: A best practice implementation project.
Marianna Ballard MSN, Robin Christian DNP

University of Mississippi Medical Center School of Nursing, Jackson, MS

Background: Communication, collaboration, and evidence-based practice are essential to deliver safe, effective, efficient, and person-centered care in the complex environment of the critical care unit. Multidisciplinary rounds capitalize upon multiple disciplines' diverse skills and expertise to coordinate patient care, optimize communication, standardize performance, and reduce the risk of harm or error. The objective of this program was to promote evidence-based practice and implement multidisciplinary rounds in the adult critical care unit at a regional hospital in Mississippi.

Methods: Using the JBI Evidence Implementation framework, this project aimed to establish performance consistent with best practice evidence regarding multidisciplinary rounds within the adult critical care unit. After a baseline audit, barriers to best practice were identified, including time and staffing restrictions, rounding structure, interruptions and distractions, and organizational culture. The project was planned and implemented using a multidisciplinary approach to address these barriers. Planning focused on stakeholder engagement and feedback, educating staff, and formulating a rounding checklist. For the intervention, a kick-off multidisciplinary meeting was held, following which processes were modified, and rounds were then conducted biweekly.

Results: Team roles and the structure of the meeting process should be clearly defined to enhance participation, avoid distractions, and ensure the efficient use of participants' time. A simple checklist that establishes clear patient goals based on evidence-based practice can help maintain time efficiency and care coordination across disciplines. Post-implementation, compliance with best practices increased from zero to 57 percent.

Conclusions: Multidisciplinary rounds provide opportunities for the healthcare team to collaborate and enhance patient safety, quality, and communication. In the future, rounds could be expanded by adding additional disciplines or meeting dates. In addition to the rounds checklists, a short form could be developed for bedside nurses to provide structured feedback regarding best practice compliance to enhance communication during the meeting.

Youth Behavioral Risk Prediction Using Machine Learning Methods
Yufeng Zheng PhD, Masoumeh Karimi PhD, MPH, Kimberly Douglas PhD, RN, Lei Zhang PhD, MBA

Uuniversity of Mississippi Medical Center, Jackson, MS

Background: Suicidal ideation, attempts, and deaths among adolescents constitute a significant and escalating health issue. In 2019, suicide comprised 11% of adolescent deaths in the U.S., ranking as the second-leading cause of death among American teenagers. Despite efforts, accurately forecasting suicidal thoughts and behaviors in adolescents remains a formidable challenge.

Methods: This research aimed to discern the precise prediction models for adolescent suicidal ideation using machine learning (ML) techniques. Predictors were chosen via two distinct methods: expert insights and parametric models. The study utilized data from the Mississippi Youth Risk Behavior Surveillance System (YRBSS), encompassing responses from Mississippi public high school students spanning 2001 to 2019. A diverse range of features, including depression, substance use, bullying, violence exposure, online activities, dietary habits, and sports involvement, were employed to train the models. Support vector machine (SVM), random forest, and neural network (NN) algorithms were applied to the YRBSS data, with suicide ideation or attempts serving as outcome variables.

Results: Our experimental results indicate the NN model best predicts suicide ideation, while the SVM model or random forest better predicts suicide attempt. When blindly tested on the new Mississippi YRBSS 2021 dataset, the same conclusions hold.

Conclusions: These prediction models for suicide ideation and attempts hold potential to assist Mississippi public high school educators, parents, and policymakers in targeting risk behaviors more effectively, thereby aiding in the prevention of adolescent suicide in Mississippi.

Prevalence of pediatric obesity and severe obesity using electronic medical records data from a vulnerable population in Mississippi, 2013 – 2019
Kisa Harris MPH¹, Crystal Lim PhD², William Hillegass PhD, MD¹, Brian Christman MS¹, Xiaojian Liu MS¹, Shanda Sandridge DNP³, Michael Welsch PhD¹, Lei Zhang PhD⁴, Abigail Gamble PhD<sup>1

1</sup>University of Mississippi Medical Center, School of Population Health, Jackson, MS. ²University of Missouri, Department of Psychology, Columbia, MO. ³University of Mississippi Medical Center, Department of Pediatrics, Jackson, MS. ⁴University of Mississippi Medical Center, School of Nursing, Jackson, MS

Background: This study assessed the prevalence of obesity and severe obesity among youth from an academic medical center in Mississippi using electronic health records, 2013 – 2019.

Methods: Data were extracted for patients aged 2 to 19 years using the electronic medical records. The prevalence of obesity and severe obesity were calculated by race, sex, age, type of insurance, and rural-urban residence in Mississippi. Multivariable regression explored the relationship between these variables and body mass index z-score.

Results: Significantly more youth had severe obesity (17.4%; 95% CI, 16.8%-18.1%) than obesity (14.7%; 95% CI, 14.1%-15.2%), and severe obesity was highest in non-Hispanic Black females (19.9%; 95% CI, 19.1%-20.8%). Age (β=0.123, p<0.001) was positively associated with zBMI, with the quadratic term for age (β= -0.004, p<0.001) fitting a non-linear moderating association with increasing cross-sectional age.

Conclusion: Findings suggested that early intervention may present the best opportunity for prevention. Translational studies of intervention approaches tailored for youth in Mississippi are warranted.

Exploring the Relationship Between Support and Stress Among Caregivers of Children Newly-diagnosed with Diabetes Mellitus
Sara Cartee BSN¹, Katherine Hall PhD², Kim Hoover PhD<sup>3

1</sup>University of Mississippi Medical Center, School of Graduate Studies in Health Sciences, PhD in Nursing Science, Jackson, MS. ²University of Mississippi Medical Center, School of Graduate Studies in Health Sciences, School of Nursing, Jackson, MS. ³University of Mississippi Medical Center, School of Nursing, Professor Emeritus, Jackson, MS

Background: Approximately 187,000 children under 20 in the U.S. have type 1 diabetes. Given the current trend, as many as 587,000 could be diagnosed by 2050. The daily tasks of diabetes management can be overwhelming to parents and caregivers, especially during the time following initial diagnosis, including but not limited to insulin injections, fingerstick glucose testing, carbohydrate counting, ketone testing, and monitoring for hypoglycemia. Previous quantitative studies have examined the effect of caregiver peer and social support interventions on caregiver and child outcomes, targeting one specific source of support. Other studies utilizing qualitative designs have described caregivers' experience of receiving support or their experience of lacking support. What has not been thoroughly examined is the relationship, if one exists, between the various types of support and caregiver stress.

Methods: The proposed exploratory, cross-sectional study seeks to examine if a relationship exists between the type and level of support received among parents and caregivers of children newly-diagnosed with diabetes and caregiver stress. Caregivers will be recruited online from diabetes organizations to complete self-reported surveys. The type and level of support received will be measured using a researcher-developed Likert scale. Caregiver stress will be measured using the Pediatric Inventory for Parents. Factor analysis, frequency distribution, chi-square, and linear regression will be used to determine if there is a relationship between the type and level of caregiver support and caregiver stress.

Results/Conclusions: Results and analysis are not yet complete in this ongoing study. However, the research team is hopeful that through this research, a relationship will be found between caregiver support and caregiver stress, opening the door for future research on the most prominent findings.

Critical Incident Stress Debriefing in the Pediatric Intensive Care Unit: Caring for the Caregivers
Gordon Gartrell MSN, RN, NEA-BC, CEPN, CCRN, CEN, CPEN, TCRN

University of Mississippi Medical Center, School of Graduate Studies, Jackson, Mississippi. University of Mississippi Medical Center, School of Nursing, Jackson, Mississippi

Background: The Pediatric Intensive Care Unit (PICU) is an extremely stressful and intense clinical environment. While there are only approximately 344 PICUs in the United States, this clinical specialty consistently has one of the highest rates of staff turnover in the inpatient setting. The stresses of caring for critical ill or injured children contribute to the elevated rate of staff turnover in this clinical setting.

Purpose: The aim of this research is to determine whether the implementation of a critical incident stress debriefing (CISD) protocol will lessen the emotional impact and improve the perceived well-being of the clinical staff in a PICU setting.

Method: Using a longitudinal, quasi-experimental design, the research team will distribute surveys for four weeks to a multidisciplinary team in the PICU of a large, metropolitan academic health science center. This survey evaluates the mental health of the PICU staff members using the Hospital Anxiety and Depression Scale (HADS) and their perceived quality of life using the Professional Quality of Life (ProQOL) scale. Basic demographic information will also be collected. A CISD protocol will then be implemented by the PICU staff. After twelve weeks of utilizing the CISD protocol, surveys will be redistributed to staff and data will again be recollected. Using a paired t-test, the utilization of a CISD protocol will be evaluated. A Pearson's chi-square test will be utilized to evaluated the differences in perception of critical incidents and debriefing between multiple disciplines. A one-way ANOVA test will be used to analyze the differences in well-being between the varying clinical disciplines being evaluated.

Conclusion: By better understanding the impact that CISD protocols can have on the PICU setting, healthcare leaders can implement practices that will lead to a reduction in staff turnover and an overall improvement in the well-being of clinicians in pediatric critical care.

3rd Annual SON Research and Scholarship Day Registration

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UMMC Norman C Nelson Student Union – Upper Ballrooms, Jackson, MS 39216

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