Digital Commons Network^™

Losing Weight With Five A’S (5 A’S): Assess, Advise, Agree, Assist, Arrange Framework And Motivational Interviewing (Mi) For Health Behavior Change Counseling, Jacqueline Baer

Theses and Dissertations

According to the Centers for Disease Control and Prevention (CDC), obesity has reached epidemic levels and has associated with increased risk of morbidity and mortality rates. The increasing prevalence of obesity is a major public health concern. Researchers calculate that health care costs are 44% higher among moderately and severely obese older persons than for persons at normal weights. Seventy-five percent of African American (AA) women are overweight and obese according to data from the CDC and The State of Obesity: Better Policies for a Healthier America. Compared to any other racial ethnic group, AA women are more likely to …

A Quality Improvement Project To Reduce The Incidence Of Clostridium Difficile Infection Through Implementation Of Evidence-Based Terminal Clean Procedures, Tamara Cook

Theses and Dissertations

Hospital-acquired infections (HAIs) are a huge economic burden and threat to patient health and outcomes. Clostridium difficile is the most common HAI. Effective hand hygiene and proper environmental cleaning procedures are significant to preventing the spread of C. difficile infections. The research question used to guide this project is: Does the use of a monitoring system for post C. difficile isolation terminal clean procedure reduce the rate of hospital-acquired C. difficile in the acute care population? A thorough organizational assessment was performed and directed this project to identify causes that may contribute to the recurrences of C. difficile infections. The …

Tuberculosis Screening In New Healthcare Employees: A Comparison Of Quantiferon®-Tb Gold In-Tube Test And Tuberculin Skin Test, Mary C. Giovannetti

Theses and Dissertations

Background: Streamlining onboarding processes for new hires to maximize efficiency and reduce costs while meeting regulatory requirements is a constant challenge for healthcare systems’ Employee Health staff. Health screening is a required step and includes obtaining a detailed health history, tuberculosis screening, drug screens, immunizations, fit for duty examinations, obtaining medical records, clarification of disability accommodations, pre-work screens, and other tests which are time consuming and result in delays in hire dates. Faced with a high volume of potential new employee hires a major southeast healthcare system was concerned about delays in new hire start dates. The two-step tuberculin skin …

Adherence Of Nurse Practitioners To Jnc 8 Guidelines, Stephanie E. Averette

Theses and Dissertations

The purposes of the evidence based project were to implement a best practice algorithm for treatment of hypertension (HTN) based on JNC 8 guidelines; compare nurse practitioners HTN pharmacotherapy prescribing practices before and after implementation of a HTN algorithm; and compare hypertensive adult patients’ systolic blood pressure (SBP) readings before and after the implementation of a HTN algorithm. A quasi-experimental pre-test and post-test design was used to collect and analyze data from 61 patient charts to compare nurse practitioner adherence to JNC 8 guidelines for NPs’ prescribing practices and subjects’ blood pressure (BP) outcome before and after the implementation of …

Simulation-Based Interprofessional Education In A Rural Setting, Ann D. Scott

Theses and Dissertations

The purpose of this project was to examine the feasibility and acceptability of a simulation-based IPE experience for pre-licensure nursing, pharmacy, and medical students on a rurally-located campus. Using a mixed-methods, explanatory sequential approach, this project: 1) examined the feasibility of implementing a simulation-based IPE experience using telehealth tools; and 2) evaluated student perceptions of inter-professional teamwork, roles and responsibilities, and patient outcomes for collaborative practice, both pre- and post-scenario.

Quantitative data were analyzed using SPSS. Results revealed 94% agreed/strongly agreed the IPE experience resembled a real-life situation. 100% of nursing/medical students and 80% of the pharmacy students indicated they …

An Evidence-Based Process Change To Improve Mammography Adherence, Tara E. Smalls

Theses and Dissertations

Breast cancer is a significant disease—affecting 12% of American women in a lifetime. Breast cancer costs $180 billion annually in healthcare expenditures and productivity. Mammography has been identified as the greatest tool to mitigate morbidity, yet in many organizations, mammography compliance rates are decreasing. This process improvement was conducted to address the barriers to patient follow through with mammography and to recommend strategies to improve the current breastscreening process.

Principles of the Six Sigma DMAIC framework were utilized to analyze the breast-screening clinic process. Chart reviews and organization databases were applied to determine mammography adherence. The opportunities to improve current …

Assessment Of Providers’ Perception And Knowledge Of Overactive Bladder In Women: A Quality Improvement Project, Helen Wambui Ngigi

Theses and Dissertations

Background: OAB is defined by subjective symptoms, rather than objective measure, the patient’s perspective is important in managing OAB (Hung et al., 2013). As such providers need to capture the patient’s perspective of their OAB symptoms and their impact on the quality of life. A patient work up helps providers determine the cause of the symptoms as well as the degree of bother to the patient (Barkin, 2016). The diagnosis of OAB is essentially clinical and can be performed through structured questionnaires (Juliato et al., 2016). When conducting a patient history, it is important to determine the onset and severity …

Utility Of The Modified Early Warning System Score In Early Sepsis Identification, Lisa E. Hart

Theses and Dissertations

The purpose of this quality improvement project is to improve outcomes for patients presenting to the emergency department with sepsis, realizing that time is a key factor. The appraised evidence indicates that early recognition and prompt treatment improve outcomes and decrease mortality. The evidence further highlights that use of an early warning system, like the Modified Early Warning Score, can assist nurses and providers with recognizing deterioration more quickly and lead to a reduction in time to interventions. Between January 2016 and March 2017, the author conducted a retrospective chart review to compare time to antibiotic administration and lactate measurement …

Scribes Impact On Patient And Provider Experience In The Outpatient Setting, Kimberly A. Taylor

Theses and Dissertations

The purpose of this project was to evaluate the effectiveness of using scribes in the outpatient setting on patient and provider experience. A mixed methods approach with a convenience sample of voluntary patient participants scheduled for an outpatient appointment was utilized. Two primary care physicians volunteered to receive scribes. Four hospital corpsmen were selected and trained to serve in the scribe role.

This quality improvement project evaluated two aspects of experience during the implementation of the scribes. These included: 1) patient experience as indicated via a pre and post implementation questionnaire; and 2) provider experience as indicated via a pre …

Developing And Implementing A Quality Assurance Strategy For Electroconvulsive Therapy, Jessa Hollingsworth

Theses and Dissertations

The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care, however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. An audit tool was developed …

Evaluation, Treatment, And Education In The Hospice Setting By Initiating A Formalized Pain Card, Alyssa M. Soprano

Theses and Dissertations

The purpose of this DNP quality improvement project was to evaluate the use of a formalized pain card that Nurse Practitioners could use to assist clients and caregivers in making the decisions necessary for safe and effective pain management with improving outcomes by using the Brief Pain Inventory Form for measuring: 1) decreased pain, 2) increased pain, 3) pain relief. The appraised evidence suggested that there was a need for a policy standard for patients to notify when pain is unrelieved despite exhausting all other efforts to control pain (Glowacki, 2015). Forty-one (n=41) hospice patients were surveyed pre and post …

Barriers To The Use Of Guardrails On Iv Smart Pumps, Ivory Williams

Theses and Dissertations

Medication errors involving hospitalized patients have been an evolving challenge for decades. Moreover, errors related to intravenous (IV) medication administration continue to rise in hospitals despite implemented policies governing the use of Guardrails™ for safe IV medication infusion via smart pump technology. An organizational investigation was performed to identify barriers to the use of Guardrails™ among nursing staff. From 2015 through 2017, multiple interventions that aimed to identify barriers and increase nurses’ use of the safety features on IV smart pumps were implemented in the hopes of reaching a compliance goal of 90-100%. This quality improvement project assesses Guardrails™ compliance …

Picturing Rest: A Photovoice Study Of African American Women’S Perceptions And Practices Of Rest, Eboni T. Herbert Harris

Theses and Dissertations

African American women are consistently identified as being less likely to participate in sustained leisure time physical activity (Tussing-Humphreys, Fitzgibbon, Kong, & Odoms-young, 2013), yet more likely to be overweight or obese (Levi, Segal, Laurent, & Rayburn, 2014). There has been a wide range of initiatives directed towards preventing and/or reducing obesity among African Americans, such as targeted physical activity and nutrition interventions involving goal setting, group and individualized counseling, and social support. Previous research focused on African American women’s perceptions toward physical activity, nutrition, and weight; emphasize the consideration of cultural attitudes like placing a high value on rest …

Improving Leadership Communication In Nurse-Physician Dyad Teams, Lisa James

Theses and Dissertations

Background: Changes in the delivery of healthcare services in the United States have been driven by cost containment over the last 20 years. To have a thriving organization within the current healthcare environment, nurses and physicians need to closely collaborate. As healthcare organizations prepare for the value-based era, new leadership models need to be implemented. This project addressed collaboration between nurse and physician leaders with a focused communication strategy to improve team performance, engagement, and quality outcomes in the acute care setting.

Method: A quality improvement project was designed to improve communication between front line team members and …

Best Practice For Screening Adult Patients With Psoriasis For Polyautoimmunity: Celiac Disease, Rheumatoid Arthritis And Crohn’S Disease, Susan Danielle Ashbaugh

Theses and Dissertations

The purpose of this quality improvement project was to determine if screening primary care patients with psoriasis will improve early detection of celiac disease (CD), rheumatoid arthritis, and Crohn’s disease (CrD). The aim of this project is to assess the utility of early screening in patients with psoriasis in order to facilitate earlier diagnosis of CD, RA and CrD, which would consequently initiate earlier treatment and improve long-term patient outcomes. Genetic and population-based studies suggest that individuals with psoriasis have a greater risk of also having CrD, CD or RA, than do individuals without psoriasis. The literature also suggests that …