Digital Commons Network^™

Implementing The 5a’S Of Obesity Management In Primary Care, Holly H. Rowell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The prevalence of obesity continues to increase globally, with greater prevalence in the southern United States, resulting in higher costs to the healthcare system and greater risks for the development of other chronic diseases. Purpose: Determine if implementing the 5A’s of Obesity Management among primary care providers in a rural, low-income healthcare setting will increase the diagnosis of obesity and result in a subsequent decrease in weight among patients who are obese. Methods: An educational session was held to familiarize providers with the 5A’s of Obesity Management and the importance of obtaining and documenting proper height …

Human Papillomavirus Vaccination Rates Among Adolescents In South Carolina, Rebecca Jane Morrison

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Among adolescents 11-17 years of age in South Carolina, low rates of human papillomavirus (HPV) vaccination can negatively impact health outcomes through increased risk of acquiring HPV-associated cancers.

Purpose: To determine if the 4 Pillars™ Immunization Toolkit increased HPV vaccination rates among adolescent patients.

Methods: The 4 Pillars™ Immunization Toolkit was the framework for this bundled intervention. Pillar 1, convenience and easy access, included after-school HPV express clinics. Pillar 2, communication, utilized staff motivational interviewing skills, campaign promotion materials, documentation of declination, and second-dose callback appointments. Pillar 3, enhanced vaccination systems, was designed to use …

Improving Dementia Symptoms Through Personalized Music, Lindsay Grainger

SC Upstate Research Symposium

Alzheimer's disease and related dementia (ADRD) is a prevalent, costly, and complicated disease. With over 6 million Americans affected and the cost of treatment soaring to over $320 billion dollars annually, there is a growing need for low-cost interventions to treat symptoms. Routinely listening to personalized music selections has been shown to reduce agitation—the most common symptom of Alzheimer’s disease and related dementia. The purpose of this study was to provide a personalized music listening (PML) intervention of thirty minutes to 10 nursing home residents with dementia. Thirty-minute PML sessions occurred multiple times a week over six weeks. The inclusion …

Post-Discharge Follow-Up Call To Impact Heart Failure Re-Admission Rates, Regina Mitchell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The clinical setting for this project, a 321-bed southeastern hospital in South Carolina, has an elevated re-admission rate for CHF patients of 22.67% (Ferguson, B. V.P. Quality, personal communication, October 21st, 2022), 1.57% above the Centers for Medicare Services (CMS) benchmark of 21.1% for payment reduction penalties. Purpose: Determine if post-discharge interview phone calls decrease CHF re-admission rates. Methods: A two-group pretest-posttest design will be used. Data will be collected during retrospective unit chart review, weekly chart review of patient participants, and structured post-discharge phone interviews. Inclusion Criteria: English-speaking, adult (>18 years of age) patients with …

Implementation Of A Pcp Referral In Urgent Care For Patients With Hypertension, Teri Alesha Scott

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adult patients with uncontrolled hypertension at Saluda Pointe Urgent Care (SPUC) do not have an established primary care provider (PCP) for follow-up.

Purpose: To improve access to care by establishing patients with uncontrolled hypertension (>140/90) with a PCP.

Method: Implement a PCP referral at SPUC for patients with uncontrolled hypertension. The Primary Care Connection Center (PCCC) contacted the referred patients within 72 hours to schedule an appointment. An Organizational Change Management (OCM) Solutions survey measured provider attitude and readiness for change before and after implementation.

Inclusion Criteria: Adult patients 18 and older, without an …

A Response Team Approach To Reducing Restraint Use In The Emergency Department, Sarah Place

Doctor of Nursing Practice Scholarly Projects

Assaults on staff are doubling in the healthcare field, and due to the urgent need to secure the environment, the use of restrictive measures is at times, the safest choice. The following project examined the implementation of a Behavioral Emergency Response Team approach in an Emergency Department, and the effects it had, on reducing the use of violent restraints, assaults on staff, and increase confidence of staff in managing difficult situations. An anonymous survey was used to measure staff confidence while handling agitated patients, and an event report was used that identified if de-escalation techniques were employed to assist in …

Early Palliative Care Screening Among Solid Tumor Oncology Patients, Kaitlin Lothe

Doctor of Nursing Practice Scholarly Projects

While there are extensive benefits of integration of early palliative care, referral to this specialty tends to occur late in the disease course after some form of suffering has already occurred (Hausner et al., 2021). The purpose of this DNP student’s quality improvement project was to improve care coordination and increase rate of palliative care referrals of solid tumor oncology patients through implementation of an evidence-based trigger tool for palliative care screening. Participants were recruited from a 36-bed inpatient adult medical oncology unit where identified patients meeting criteria were included in the study. Data for this study included participant demographics, …

Michigan Appropriateness Guideline For Intravenous Catheters And The Impact On Utilization And Infection Ratios In Peripherally Inserted Central Catheters, Kasey Smith Bustamante

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adult patients are at increased risk for central line-associated bloodstream infections when central line utilization rates are increased and are inserted inappropriately, based on patient criteria. Purpose: Determine if utilization of the Michigan Appropriateness Guidelines for Intravenous Catheters (MAGIC) will reduce central line utilization ratios (focusing on peripherally inserted central catheters (PICC)) and reduce risk of central line-associated bloodstream infections among an adult population in the Trauma Surgical Care Unit (TSCU) and Medical Intensive Care Unit (MICU) at a tertiary care center in the South Carolina Pee Dee Region. Methods: The Plan Do Study Act (PDSA) quality improvement …

Hpv Vaccine Hesitancy: Improving Vaccination Rates In The Pediatric Primary Care Setting, Stephanie Meltzer Carper

Doctor of Nursing Practice Scholarly Projects

Problem statement: The Human Papillomavirus (HPV) vaccine protects against carcinogenic strains of HPV and is administered during childhood to provide maximum protection during peak risk for exposure and HPV disease. Despite demonstrated efficacy, HPV vaccine hesitancy leads to decreased vaccination rates in the pediatric primary care setting. Purpose: This quality improvement project aims to improve HPV vaccination rates at SouthernMED Pediatrics, Summerville, South Carolina. Methods: A pre-intervention survey was administered to identify parental concerns regarding the HPV vaccine to create a customized educational handout. Health care providers systematically used motivational interviewing, presumptive approach communication techniques, and a customized educational handout …

Improving Communication And Workflow Among Advanced Practice Providers And Nurses On Nightshift In An Intensive Care Unit, Chelsey Alise Durr Massey

Doctor of Nursing Practice Scholarly Projects

Problem Statement: There is often a lack of streamlined communication on nightshift among the reduced care team in acute care settings. The absence of organized collaboration and shared decision-making contributes to strained professional relationships between the advanced practice provider (APP) and the nurse. Purpose: Nightly provider-nurse bedside rounds were implemented in a 21-bed cardiovascular intensive care unit (CVICU) using a goal sheet to improve communication among the APPs and nurses. Methods: A pretest-posttest design in which surveys were used in this quality improvement (QI) project to determine perceptions of communication between APPs and nurses. Inclusion Criteria: All APPs and rotating …

Impact Of A Standardized Checklist On Post Discharge Appointment Attendance And Readmission Rates Of Veterans With A Mental Health Diagnosis, Henretta N. Milton-Williams

Doctor of Nursing Practice Scholarly Projects

Inpatient readmissions are among the most severe problems facing hospitals. Readmissions are most common in the first two to five days after discharge, especially among veterans with mental illnesses at the Columbia Veteran Administration Hospital System (CVAHS) inpatient units. The discharge planning process should begin as soon as a patient is admitted and should be updated throughout the inpatient stay to ensure a safe transition of care from inpatient to outpatient. This Doctor of Nursing Practice (DNP) quality improvement project is aimed to develop and implement a standardized checklist to streamline and organize the discharge planning for all veterans admitted …

Using The Buzzy Device To Decrease Pain, Fear, And Anxiety With Venipunctures And Injections, Lisa Santiago Sauls

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Anxiety, fear, and pain related to initiating peripheral venous access or injections are a high priority in the ambulatory infusion clinic setting for both children and adult populations.

Purpose: To determine if the Buzzy device will decrease anxiety, fear, and pain related to adult patients undergoing peripheral venous access or injections in ambulatory infusion clinics.

Methods: Age, sex, route of medication the patient is receiving. A post-procedure questionnaire assessed the participant's satisfaction with the Buzzy device. Pain, fear, anxiety, and patient satisfaction were all measured using a visual analog scale.

Inclusion Criteria: Patients aged eighteen and above receive …

Implementation Of A Peer To Peer Concussion Management Program And Its Effect On Concussion Knowledge And Reporting Behaviors In Collegiate Club Sports Athletes, Brian Wallace Stefan

Doctor of Nursing Practice Scholarly Projects

Problem: Concussions continue to be a common injury in both athletes and non-athletes across the world. In college, symptoms and recovery time from concussion injuries can lead to loss of social interaction, class time, and participation in school events such as sports. For collegiate club athletes at the University of Pittsburgh, there is currently no mandated concussion protocol, making injury management more difficult. Purpose: This project's purpose was to determine whether a peer-to-peer concussion education tool is a viable implementation option to improve the concussion environment for this population compared to their current structure with no protocol. Method(s): A five-step …

Implementation Of Daily Multidisciplinary Rounding Audits Of Adherence To An Indwelling Catheter Protocol Impact On Catheter-Associated Urinary Tract Infections, Jacqueline April Wright

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Catheter-associated urinary tract infections (CAUTIs) among critical care patients negatively impact the trajectory of the patient’s hospitalization through increased mortality, morbidity, length of stay, and cost. To combat this, hospitals have implemented bundles in compliance with evidence-based practice models to reduce CAUTIs. Purpose: Determine if implementing a daily multidisciplinary rounding audit of established CAUTI prevention protocol decreases the occurrence of CAUTIs in critical care patients with indwelling urinary catheters. Methods: Participants in this quality improvement project included critical care nurses and providers participating in daily multidisciplinary rounds on all critical care patients with indwelling urinary catheters admitted to …

Unlocking Population-Specific Treatments To Render Equitable Approaches And Management In Cardiovascular Disease (Upstream Cvd): African American Emerging Adults, Shannon Bright Smith

Theses and Dissertations

Cardiovascular disease (CVD) is the leading cause of death in America. African American people have disparate CVD outcomes, and African American emerging adults (AAEAs) aged 18-25 have CVD risk factors. This study aimed to examine the state of CVD risk factors in AAEAs, assess upstream and population factors in AAEAs attending a southeastern historically black college/university (HBCU), compare their perceived and objective CVD risk, explore their level of CVD knowledge, and examine responses when they learn their objective CVD risk.

Chapter 1 presents background literature on CVD in AAEAs and the research plan. Chapter 2 presents a newly synthesized situation-specific …

Reducing Falls Among Adult Psychiatric Inpatients Using K-Cards With The Epi, Epfrat Factors, And Nursing Judgment, Katelyn Dunn

Doctor of Nursing Practice Scholarly Projects

In the United States, the highest rates of falls are in the psychiatric inpatient population. Fall reduction was as an organizational goal of the project site, a 352-bed hospital in the Southeastern United States. The Epic Predictive Index (EPI), an automated fall risk assessment tool, had recently been adopted. This project evaluated the impact of an enhanced fall reduction strategy involving the use of Kamishibai Cards (K-Cards), which are a compliance reminder for healthcare staff, to support additional evidence-based identification of fall risk among adults receiving inpatient psychiatric care at the facility. The use of K-Cards with each patient’s current …

Substance Use Disorder Treatment Among African American Men Living In The Rural South Of The United States, Serge Raoul Wandji

Theses and Dissertations

Substance use disorders (SUD) affect more than 40 million Americans. African American (AA) men are disproportionally affected by the negative health and social consequences of SUD, and men in rural areas may be particularly at risk due to disadvantaged socioeconomic conditions and persistent race-related stressors such as perceived discrimination. The overall purpose of this study is to advance the understanding of factors associated with SUD treatment acceptance and relapse potential among Southern rural AA men.

This purpose was achieved by determining differences in treatment acceptance and relapse potential by race and gender among rural residents admitted in a SUD treatment …

Nurse Perceptions Of Caring And Professional Governance, Lan Angela Nguyen

Theses and Dissertations

Background: Caring, a characteristic of an effective work environment, and clinical nurse control over the professional governance of nursing practice results in higher nursing retention and better patient outcomes. Although the concepts of caring and professional governance of nursing practice, and their discrete associations with patient outcomes, are widely studied, little to no research is published on the nature of the relationship between caring and professional governance of nursing practice. Without understanding this relationship, it is challenging to explore the impact of this relationship on nursing practice and patient outcomes.

Aims: The purpose of this study was to describe nurse …

Preventing Pressure Injuries In Prone Positioned Patients In The Critical Care Unit, Tyler Dashiell Huddle

Doctor of Nursing Practice Scholarly Projects

Problem statement – Pressure injuries acquired by critical care patients in the prone position negatively impact their health, increases the length of stay, increases medical costs, decrease hospital reimbursement, and result in poorer patient outcomes.

Purpose – Determine if implementing a checklist before the prone position maneuver and maintenance skincare thereafter decreases pressure injuries in prone-positioned critical care patients.

Methods – Pre-intervention data will be collected retrospectively, and post-intervention data will be gathered in a seasonally similar timeframe for critical care patients in the prone position and the incidence of pressure injuries.

Inclusion criteria – All patients in the critical …

Impacting Rn Intent To Leave By Developing Emotional Intelligence In Frontline Nurse Leaders, Kristin W. Smith

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Registered Nurse (RN) turnover is defined as the frequency at which RNs leave the organization within a specified timeframe (Shimp, 2017). Turnover can correlate negatively to patient satisfaction and outcomes, mortality, and overall healthcare costs (Copanitsanou et al., 2017). Frontline leaders, especially those with high emotional intelligence (EI), can have a significant positive influence over RN turnover, yet there is little focus or standard approach on frontline leader EI development (Mansel & Einion, 2019).

Purpose: This DNP project aims to determine if providing professional development focused on emotional intelligence to frontline nursing leaders will impact RN intent to …

Organizational Readiness For Implementing A Postpartum Depression Screening Protocol In The Nicu, Deanna L. Suber

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Postpartum depression (PPD) is a major depressive disorder that is the most common complication following childbirth, occurring in about 16% of new mothers (Berns et al., 2021). Mothers with infants in the Neonatal Intensive Care Unit (NICU) are 40% more likely to develop PPD but are not typically screened for this complication (Berns et al., 2021; Cherry et al., 2016; Garfield et al., 2021). Implementing a PPD screening protocol in the NICU could help increase the detection of PPD in this population but would first require an evaluation of organizational readiness to ensure sustainability. Purpose: The purpose of …

Evaluating The Use And Effectiveness Of Digital Mental Health Resources For Acute Care Nurses, Ashley M. Turbyfill

Doctor of Nursing Practice Scholarly Projects

Statement: The burnout phenomenon has been exacerbated over the last almost two years due to the COVID-19 pandemic (Maunder et al., 2021). Healthcare organizations must respond by implementing evidenced-based mental health initiatives to increase staff coping skills to reduce stress and emotional exhaustion (Galanis et al., 2021). While the project organization can access large-scale aggregate data about resource usage and its overall mental well-being, they cannot assess what percentage of users are nurses and the personal impact on their mental well-being. Due to these limitations, the organization cannot gauge how the nursing staff uses and responds to offered resources. …

Using A Clinical Reminder Tool To Impact Vitamin D Screening, Mercy Roy

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Chronic pain patients with widespread musculoskeletal pain are not adequately screened for possible vitamin D deficiency by healthcare providers. Purpose: This quality improvement project (Q.I.) aimed to improve the screening rates for vitamin D among healthcare providers by implementing a clinical reminder tool within the documentation section of the electronic medical records (EMRs) in an outpatient federally funded pain clinic located in the Southeastern region of South Carolina. Methods: A clinical reminder template was embedded within the EMR documentation to increase screening for vitamin D levels for chronic pain patients among healthcare providers. Data were collected six weeks …

Decreasing Pressure Injuries From Respiratory Devices In The Pediatric Intensive Care Unit, Samantha Nicole Elliott

Doctor of Nursing Practice Scholarly Projects

Problem: Patients developing pressure injuries while admitted to the hospital has become a nationwide problem. The national annual cost of treating pressure injuries is $11 billion dollars, with up to $70,000 dollars for stage four pressure injuries (Cooper et al., 2020).

Purpose: The purpose of this project was to implement the use of a silicone foam dressing under respiratory devices, monitored using kamishibai cards (k-cards) to decrease pressure injuries. K-cards are a rounding tool that staff can use to identify barriers that prevent the standard of care.

Intervention: A pre-study, three-month period, was compared to the implementation period in the …

Screening For Prediabetes In The Inpatient Setting, Mikayla Jordan Moore

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Many patients that utilize the hospital system do not see a primary care provider and, therefore, miss important screenings. The hospital system can provide convenient screenings, or screenings conducted whenever a patient encounters the health system regardless of their chief complaint (Obinwa et al., 2020).

Purpose: Determine whether convenient prediabetes screenings administered to admitted patients on an Intermediate Critical Care Unit (ICCU) detect prediabetes at a higher rate than no formal screenings.

Methods: Participants will be sampled from those admitted to an intermediate critical care unit at a large acute-care facility.

Inclusion Criteria: Any adult patient (>18 …

Establishing A New Graduate Nurse Peer Mentoring Program, Teresa Biediger Bowers

Doctor of Nursing Practice Scholarly Projects

Problem Statement: New Graduate Nurses (NGN) report increased stress, likely due to decreased confidence and social support (Frogeli et al., 2019). The most current NGNs are disadvantaged as much of their undergraduate clinical experience has been affected by the COVID-19 pandemic (Smith et al., 2021). At the end of their residency, information gathered from former NGNs suggested they feel they need "more support" during the residency. Purpose: The purpose of this quality improvement project was to determine if the addition of a peer mentor to the already existing nurse residency program would improve nurse confidence, job satisfaction, and intent to …

A Nursing-Driven Delirium Protocol, Alexandria Gray Bridges

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Delirium is a common, often preventable, condition in hospitalized patients and is associated with increased complications, worse outcomes, increased risk of death, and increased health care costs. Purpose: The purpose of this project was to determine if, utilizing a nursing-driven, non-pharmacological intervention, based on the NICE Guidelines, can decrease the incidence of delirium. Methods: Using the Iowa Model of Evidenced Based Practice to Promote Quality Care (Iowa Model), an EBP project was implemented. Patients were identified as being at risk of delirium using The Confusion Assessment Method (CAM) and these patients received the non-pharmacologic intervention as part of …

Assessing The Readiness Of Chf Patients To Use The Medisafe App To Increase Medication Adherence, Janet Lynn Kubas

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Heart failure (HF) is a complex cardiovascular disease that affects 6.2 million Americans and is associated with high morbidity and mortality, with almost 400,000 deaths annually. Medication adherence in HF can lower the risk of death and rehospitalization. As many as 46% of heart failure patients have medication nonadherence. The 2021 Update to the 2017 American College of Cardiology Expert Consensus Decision Pathway for Optimization of Heart Failure Guidelines recommends smartphones or other mobile health (mHealth) applications (apps) for medication adherence tracking. Purpose: This evidence-based practice project aimed to assess the readiness of HF patients admitted to an …

The Use Of A Clinical Pathway To Increase Child Abuse Screenings Of Young Children With Fractures, Stephanie Li Schaller

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Nationally, infants and young children who present to emergency departments with fractures are not being screened adequately for possible physical abuse with a skeletal survey (Paine & Wood, 2018; Shelmerdine et al., 2014; Wood et al., 2019). Without universal screenings, implicit bias along racial and socioeconomic lines becomes a factor in deciding which children with fractures get screened, resulting in either under-or over-utilization of skeletal survey screenings (Kim et al., 2017; Paine & Wood, 2018). When child abuse is not diagnosed correctly, further abusive injuries or death can occur (Ravischandiran et al., 2010). Purpose: This evidence-based practice project …

Improving Self-Efficacy In Heart Failure Care, Tracy Bennett Mcleod

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Heart Failure contributes significantly to the morbidity and mortality of the adult population and is one of the leading causes of 30-day readmissions. The cost of heart failure is a substantial healthcare burden. Purpose: The purpose of this project was to determine if implementing the “Rise Above Heart Failure” educational program would improve heart failure knowledge, weight monitoring, and reduced re-admission rates in heart failure patients. Methods: A pre-test and post-test survey named The Dutch Heart Failure Knowledge Scale was utilized. Van der Wal, Jaarsma, Moser, and Van Veldhuisen (2005) developed this questionnaire to evaluate patients' knowledge. The …