Digital Commons Network^™

Enhancing Diversity In The Nursing Workforce: An Evaluation Of Multicare’S Nurse Pipeline Program, Mckenzie Golden

Doctor of Nursing Practice Projects

Associations exist between poor racial/ethnic representation in the healthcare workforce and lower quality of care, increased disability and mortality in communities of color (Jones et al., 2021; The Sullivan Commission 2004). Research supports that pipeline programs introducing underrepresented students to careers in nursing and allied health are effective at increasing diversity in nursing, student self-efficacy and influence them toward such careers in healthcare (Butler & Ampadu, 2020; Crews et al., 2020; Mei et al., 2022). This study is a program evaluation utilizing a descriptive mixed methods survey to assess the influence of Multicare’s nurse camp on alumni from the 2016-2020 …

Improving The New Graduate Nurse Residency Program Through Enhanced Preceptor Education, Janelle Schwittay

Doctor of Nursing Practice Projects

New graduate nurse residency programs' primary function is to provide new graduates with clinical experience and bridge the gap between student and competent registered nurse (Walsh, 2018). While the focus of these programs is on teaching new graduates, a gap in practice has been identified when it comes to the education of the nurses that are training these new graduates. The purpose of this program evaluation was to increase preceptor feelings of preparedness for the precepting role, as well as increase preceptor education attendance rates to at least 50% of eligible nurses. This was a program evaluation with a pre-/post-test …

Educating Primary Care Providers To Include Community Health Care Workers Within A Healthcare System, Bobbi Beard

Doctor of Nursing Practice Projects

Background: Evidence shows community health workers (CHWs) can effectively deliver proven behavior change strategies to prevent chronic disease (CD) and enhance preventive care efforts in primary care. However, CHWs are still an unfamiliar term in healthcare and remain underutilized.

Objective: To determine whether providing education regarding the role of the CHW to PCPs can increase the use of CHWs within a health care clinic.

Setting: Primary Care Providers (PCPs) at an ambulatory primary care clinic in Washington State that is part of a research and learning/teaching (Academic) hospital and healthcare system.

Design: Guided by Wiedenbach’s Prescriptive Theory, this study features …

Evaluating The Quality Of Electronic Decision Aids For Birth Control And Recommendations For Practice In Primary Care, Diane Beary, Linda Lee

Doctor of Nursing Practice Projects

Aims

The aims for this project were to evaluate the quality of electronic decision aids (DAs) for birth control using the International Patient Decision Aids Standards quality criteria checklist and to query primary care providers on current practices around their use of decision aids to assist patients when choosing a method of birth control.

Background

Since the advent of the internet in the early 2000s and subsequent increase in electronic dissemination of DAs, there has been international awareness highlighting the lack of quality control with their content. This is significant because DAs that provide information on methods of birth control …

Mindfulness For Inpatient Psychiatric Clinical Staff: Designing And Evaluating A Pilot Intervention To Reduce Stress And Burnout, Daniel Brusser

Doctor of Nursing Practice Projects

Background: The COVID-19 pandemic has both highlighted and compounded a burnout crisis among the healthcare workforce. Healthcare professionals are experiencing workplace stress and professional burnout in substantial numbers, which has resulted in multiple negative consequences including decreased productivity, poor staff retention, and increased organizational costs. While effective multi-pronged approaches to address stress and burnout among healthcare professionals account for the problem at all levels from individual to organizational, a growing evidence base supports the implementation of mindfulness-based interventions as one strategy to reduce stress and burnout and build resiliency.

Objectives: The purpose of this DNP project was to design …

Evaluating Levels Of Depression, Anxiety And Stress In Women Undergoing Ivf Treatments, Melinda Eng

Doctor of Nursing Practice Projects

Purpose: The purpose of this study was to determine and evaluate the prevalence of depression, anxiety, and stress in women undergoing infertility treatment at a fertility clinic. To evaluate for a potential relationship between the intervention (in vitro fertilization (IVF) treatment) and its effects on the prevalence of depression, anxiety, and stress. The goal is to increase provider awareness of changes in depression, anxiety, and stress levels that occur throughout treatment cycles.

Design: Sixteen women receiving medical treatment for infertility participated in the study from the Fertility and Endocrine Associates in Louisville, KY. The project was a quasi-experimental study with …

Implementation Of A Patient Satisfaction Survey: A Pilot Project, Amy Brenner

Doctor of Nursing Practice Projects

Background: Patients who report higher satisfaction scores have better healthcare outcomes and lower financial burden in comparison to those who report lower satisfaction scores. Those less satisfied with their medical care tend to have poorer physical and mental health, which can impact daily life. For students in particular, health status impacts academic performance. Patient satisfaction surveys are a standard tool used to determine areas needing improvement within a healthcare delivery system.

Objective: The purpose of this project was to implement a patient satisfaction survey at a student health center on a university campus.

Design: The project was a two-month pilot …

Identifying And Addressing Racial Disparities At Step’S Suboxone Clinic Program Requirements, Maye Ismail

Doctor of Nursing Practice Projects

Problem: In 2017 the United States declared the opioid epidemic a public health emergency. Since then, the opioid epidemic has been worsening and the rate of overdose deaths by drugs has been rising. In 2020, 91,799 drug overdoses were reported compared to 70,630 overdose deaths in 2019. Death by opioid and synthetic opioid overdose is prevalent among all racial and ethnic groups, however, not all people have equal access to treatment. Buprenorphine is an effective first-line medication for opioid use disorder that reduces the risk of overdose and serious opioid related complications. People of color receive a significantly lower amount …

Exploring Current Practices Of Pediatric Providers Serving Transgender/Gender Non- Conforming (Tgnc) Youth 12 Years Of Age And Under In The Washington, Alaska, Montana, Idaho Region, Perry Loiselle, Luke Van De Krol

Doctor of Nursing Practice Projects

Transgender and gender non-conforming (TGNC) youth 12 years of age and under, often present first to their pediatric primary care providers for needs related to their gender identity. Primary care providers are uniquely positioned to address needs for these individuals and their families. Many primary care providers have no additional training for this special population, especially for pre-pubescent TGNC patients, and have varied levels of comfort and strategies regarding signaling acceptance, screening and assessing practices, referral practices, and discussing gender and physical characteristics topics. This project explores current practices of primary care providers in the Washington, Alaska, Montana, Idaho (WAMI) …

An Evaluation Of A Palliative Care Consult Screening Tool For The Intensive Care Unit: A Quality Improvement Project, Justin Yoshimoto

Doctor of Nursing Practice Projects

Patients in the intensive care unit (ICU) are at risk for unmet palliative needs. A palliative care consult screening tool, designed by the Center to Advance Palliative Care (CAPC), was trialed in a 6-week retrospective chart review of patients admitted to a 30-bed ICU in Washington State. for a 6-week period in 2021. The screening tool included a collection of 8 unit-specific criteria, where if a patient met any of the criteria, that patient was flagged for a potential palliative care consult. The aim of this project was to evaluate the screening tool for its ability to identify and triage …

Nurses Perceived Barriers To Performing Bedside Reports, Victoria Odoh

Doctor of Nursing Practice Projects

The Joint Commission in Accreditation (JCAHO) describes three attributes of good quality care as using available resources to achieve the best possible clinical outcomes and providing care that exceeds patients’ expectations. The Commission also emphasizes the creation of a culture of safety through the prevention of errors and the use of patient safety standards. Accordingly, the practice of patient-centered bedside shift reports (BSR) has received much acclaim due to its potential to improve communication between nurses, enhance patient safety, and increase patient and family satisfaction. Despite the evidence on the benefits of bedside reports, some nurses in different patient care …

Assessing Staff Knowledge Of Hcv And Perceived Barriers To Treatment At An Integrated Substance Use Disorder Clinic, Samuel Medick

Doctor of Nursing Practice Projects

The purpose of this project was to: 1) assess staff members’ knowledge regarding transmission, disease processes, and treatment outcomes for HCV; 2) identify staff perceived barriers to care for patients; 3) evaluate staff perception of how barriers are being addressed at an organizational level at an integrated outpatient substance use disorder (SUD) clinic. Responses to open-ended questions were analyzed for themes and re-presented in sequential surveys according to Delphi methodology to achieve consensus among respondents. Knowledge gaps for staff were identified regarding the high cure rates offered by medications as well as the increased risk of liver cancer as a …

Expanding Suicidality Triage To Primary Care Nurses: Improving Confidence And Knowledge, Gabrielle Geiger

Doctor of Nursing Practice Projects

Suicide is a growing public health crisis and there is an increasing need for skilled medical professionals educated to triage patients experiencing suicidality. Most of the training available for triage and resource utilization is offered to professionals already working in a behavioral health discipline. Given the increasing prevalence of suicide and depression, individuals experiencing mental health crises face reduced access to specialized care, complicated referral processes, and exceedingly long waitlists. In response, they are seen with increasing frequency in primary care settings where nurses are not as prepared to manage their needs appropriately. The aim of this project was to …

Nursing Care For Transgender And Nonbinary Patients An Educational Model For Forensic Nurse Examiners, Shoshana Dickerson

Doctor of Nursing Practice Projects

One of the greatest barriers to healthcare faced by the transgender and nonbinary (TGNB) population is the lack of access to providers who are knowledgeable in providing safe, appropriate, and gender-affirming care. LGBT education for most nursing baccalaureate nursing programs contains only 2.12 hours of LGBT-related content in their curricula, with even less time specifically devoted to transgender health topics. One foundational intervention for addressing healthcare disparities among the TGNB population is to provide better and more inclusive education for nurses about gender-affirming care. The purpose of this quality improvement project was to design, implement, and evaluate an interactive educational …

Adult Depression Screening In Primary Care, Jeremy Bang

Doctor of Nursing Practice Projects

Routine depression screening of adults in primary care is recommended by many US professional organizations. This quality improvement project found a low baseline rate of screening at a primary care clinic and attempted to increase the rate by creating a revised depression screening workflow. The workflow was created based on staff recommendations gathered through Appreciative Inquiry-grounded interviews. Its efficacy was evaluated by comparing depression screening rates before and after its implementation, and staff evaluated outcomes with anonymous surveys. Overall depression screening rates at the clinic increased from 20.83% to 29.14% (p < .001) in response to the project’s interventions. Continued improvement of the depression screening process at the clinic and other clinics in the parent organization calls for soliciting further staff suggestions and expanding evaluation measures.

Association Between Neurological Pupillary Index And Constriction Velocity In Traumatic Brain Injury Patients And Discharge Disposition: A Retrospective Project, Sunita Khadka

Doctor of Nursing Practice Projects

Background: Autonomic pupillary dysfunction and neurological deterioration are common after both primary and secondary traumatic brain injury and require frequent pupillary and neurological assessment. An automated pupillometer has provided promising results in predicting pupillary changes and patient outcomes in Traumatic brain injury. Aim: This project aimed to explore the prevalence of automated pupillometer in the neurosurgical intensive care unit. This project hypothesized that there is no association between Neurological pupil index, constriction velocity, and discharge disposition. Methods: Automated pupillary assessment using an automated pupillometer (NPi-200) was performed on patients with traumatic brain injury between January 2014 and January 2022. Results: …

Preventing Kernicterus: Racial Equity For Neonatal Jaundice, Sarah Christensen

Doctor of Nursing Practice Projects

Neonatal jaundice is a common phenomenon among infants worldwide but the condition may progress to severe hyperbilirubinemia and if this progression is left unchecked, kernicterus may result. Kernicterus is the result of bilirubin toxicity that has reached the brain. It may result in irreversible hearing loss, brain damage, and death. Black and African American infants represent twenty five percent of reported kernicterus cases in the United States. This racial health disparity represents a practice gap that this project aims to highlight and address through provider education. Midwives and paraprofessionals at a midwifery organization in the Pacific Northwest were invited to …

Optimizing Food Access In The Enhanced Shelter Environment: A Policy Evaluation Project, Reanna Moore

Doctor of Nursing Practice Projects

In the unhoused population, food access is a basic human need important not only for adequate nutrition, but also reducing feelings of food insecurity. Enhanced shelters are well poised to impact food access by providing meals and storage options for shelter residents. However, food hoarding behaviors, food safety concerns, and limited budget add complication to this problem. Shelter policies that optimize the availability of meals, food storage, and kitchen use have the potential to positively impact food security, but must be balanced with the individual needs of the shelter. It is important for enhanced shelters to identify best practices and …

Best Practices For Health Equity And Antiracism Curriculum For Healthcare Workers Regarding Sb 5229, Amanda Osei, Iman Yunis

Doctor of Nursing Practice Projects

Interpersonal racism, bias, and discrimination can often directly contribute to poor healthcare outcomes. Their correlation can be seen in infant mortality, maternal mortality, life expectancy, heart disease, cancer, and more (Bailey et al., 2017; Gee & Ford, 2011). The COVID-19 health pandemic reinforces this pattern of health inequity. Structural inequalities during the pandemic further emphasized racial and ethnic disparities in BIPOC populations. BIPOC populations are more likely to have conditions associated with increased risk of illness from COVID-19 relative to their white counterparts (Raifman et al., 2020). Barriers to achieving health equity include lack of policy addressing health inequities and …

Implementation Of Mindfulness-Based Intervention To Reduce Compassion Fatigue And Burnout, Mario Velasquez

Doctor of Nursing Practice Projects

Background and Problem Statement

Compassion fatigue and burnout are commonly experienced by healthcare professionals due to working in stressful situations while utilizing their sense of self in the provision of care (Baguley et al., 2020; Lee et al., 2019; Zhang et al., 2018). Compassion fatigue and burnout are attributed to high turnover rates seen in the nursing field, estimated to reach 400,000 by 2025 (Brown et al., 2018). In addition to the financial burden incurred by healthcare systems, burnout can have detrimental health consequences for the nurses (Ameli et al., 2020; Lee et al., 2019; Pospos et al., 2018). Although …

A Public Health Critical Race Praxis Approach To Anti-Racism In Nursing Academia, Nawaf Alfaouri

Doctor of Nursing Practice Projects

Structural racism persists through every level of society, from housing, economic participation, education, criminal justice, access to healthcare, to poor healthcare outcomes. A critical dimension of structural racism is the persistent normalization of negative racial attitudes towards people of color, a manifestation of which is negative and harmful racist stereotypes presented in media, literature, and outdated medical knowledge. Internalization of structural racism gives rise to implicit and explicit bias towards different racial groups which poses health risks to patients of color. Studies have shown that health disparities persist for people of color even when controlling for socioeconomic differences among races, …

Healthcare Disparities In Rural Veterans, Matthew Johnson

Doctor of Nursing Practice Projects

Veterans, as a population, tend to have higher levels of disability than the civilian population. The Veterans Affairs (VA), as an organization, is infamous for the bureaucratic challenges it presents to those seeking services. The complicated, confusing, and lengthy process of accessing care through the VA often presents a barrier in and of itself. Due to these and many other factors, veterans suffer from higher rates of disability, chronic illness, and mental illness compared to the general population. Rural veterans face additional barriers to healthcare based on their locale, including increased physical distance to care, and a shortage of general …

Improving Access To Appropriate Level Of Psychiatric Care For Youth In Washington State, Natasha Zamora

Doctor of Nursing Practice Projects

Objective: To advocate for better mental health coverage for adolescent youth, the goal of this DNP project was to identify disparities across levels of care based on insurance type to propose a solution that improves accessibility to appropriate levels of care for all adolescents.

Design: This is a patient advocacy project that utilized a retrospective chart review.

Setting: The setting for this project was a 27-bed hospital-based adolescent behavioral health unit in a hospital in Tacoma, WA.

Participants: Participants included 875 patients admitted to the unit between April 2020 and April 2021. Methods: Patient charts from the desired time frame …

Improving Continuity Of Mental Health Care For Women: Jail Release To Community Re-Entry, Janin Khaleel

Doctor of Nursing Practice Projects

Introduction: This formative Delphi study assesses 1) potential policy changes most needed to support mental health care continuity for women being released from two urban jails, 2) barriers to women obtaining mental health services after release, and 3) understanding what community resources are promoting continuity of mental health care after jail release.

Methodology: This is a policy project that uses the Delphi method. In phase one, a primarily qualitative survey was administered to jail health experts to explore project aims. Results were analyzed with thematic analysis, and themes were used to develop a primarily quantitative second survey with Likert scale …

Building Resources For Transgender And Non-Binary Youth: A Sexual Health Toolkit, Emma Lieuwen

Doctor of Nursing Practice Projects

Background: Transgender and nonbinary (TGNB) youth make up almost two percent of the student population in the United States (Johns et al., 2019). They face usual challenges of adolescence, including identity, relationships with parents and peers, and body image, but also must navigate stigma, discrimination, and difficulties accessing necessary resources and information (Tankersley et al., 2021). Particularly, the sex education TGNB youth receive is often inadequate in relevant content for navigating puberty, sex, and relationships (Haley et al., 2019; Pampati et al., 2020). Youth may be left feeling ill-prepared for intimacy, puberty, or coming out, and be more likely to …

A Formative Evaluation Using Re‐Aim Framework For Enhanced Shelter Services, Raissa Meegan

Doctor of Nursing Practice Projects

Background: Poor health is not only a major cause of homelessness but being homeless also worsens existing health issues. Effective interventions that address the unique needs of this population are a critical component of ending homelessness. A review of literature has revealed four evidence-based approaches that includes a Housing First approach, Trauma Informed Care (TIC), case management, and service integration as key priorities for homeless service providers. It is important for service organizations supporting this population to conduct program evaluations to ensure best practices are utilized in program implementation.

Objectives: The objective was to perform a formative evaluation guided by …

Group-Based Diabetes Self-Management Education For Somali Population With Type Ii Diabetes Mellitus, Hamdi Abdi

Doctor of Nursing Practice Projects

Background and Purpose: Type II Diabetes Mellitus (T2DM) is a serious chronic disease that requires knowledge, daily self-management, and lifestyle modifications. T2DM is a widespread disease in Western world, however, it affects racial minority immigrant populations, including Somalis at disproportionally higher rates than the general population. This quality improvement project was developed and piloted to discern whether culturally appropriate small group-based education program for Somali patients with T2DM may improve self-management skills to alleviate long-term complications.

Methods: This project used descriptive statistics to compare participants’ knowledge and T2DM self-management behavior pre and post intervention. Subsequent to Seattle University IRB approval, …

Be-Fast Assessments In Emergency Departments To Increase Recognition Of Posterior Circulation Strokes, Hannah Kramer, Alvina Wong

Doctor of Nursing Practice Projects

Posterior circulation strokes are often missed in emergency departments due to atypical symptom presentation that leads to poor prognosis and increased medical costs related to treatment. The purpose of this project is to increase identification of posterior circulation strokes by providing an educational tool and introducing a revised stroke assessment tool that includes symptoms caused by posterior circulation strokes. Success of project implementation was measured by improved test scores of post education and post intervention questionnaires, increased use of the BE-FAST assessment tool, increased completed MRIs, and an increase in the number of confirmed posterior circulation strokes. This multi-part quality …

Standardizing Substance Use Screening And Increasing Access To Harm-Reducing Treatment Through A Pilot Implementation Of Screening, Brief Intervention, And Referral To Treatment (Sbirt), Sydney Berkman, Lianabell Soto-Silva

Doctor of Nursing Practice Projects

The objectives of this project are to introduce standardized universal screening for substance use through the implementation of the screening, brief intervention, and referral to treatment (SBIRT) tool at Country Doctor Community Health Centers (CDCHC). The patient population for this pilot were patients ages 18 and older seen in person by one of the four participating providers at CDCHC. The specific aims of the pilot were to: 1) increase drug and alcohol use screening rates for patients ages 18 and older from 0% to 25% by April 1st, 2022, and 2) to offer a brief intervention and/or referral to treatment …

Use Of Virtual Resources For Older Adults With Mild Depressive Symptoms, Stephanie Sirisithi

Doctor of Nursing Practice Projects

With the higher prevalence of depression and disrupted access to healthcare caused by the COVID-19 pandemic, there was a rapid shift towards utilizing virtual platforms for treating patients. The use of technology was an innovative way of solving the dilemma but use of this is low among older adults and minorities of low socioeconomic status due to education and access.

The purpose of this study was to develop a guide of virtual resources for residents of an assisted living and to assess its usability and effectiveness in reducing depressive symptoms in lower socioeconomic status and minority older adults. The Donabedian …