Digital Commons Network^™

Self-Management Of Type 2 Diabetes Mellitus For Underserved Population In A Multicultural Community, Timothy L. Gbehan

Doctor of Nursing Practice Projects

Diabetes self-care management is a critical piece in achieving healthy glycemic control among patients diagnosed with type 2 diabetes mellitus (T2DM) to improve their health outcomes and eventually result in a reduction of healthcare costs. This quality improvement project aimed to develop a diabetes self-management guideline for Native American Elders living in a low-income apartment complex. Thirteen residents with Type 2 Diabetes Mellitus (T2DM) participated. Culturally tailored educational discussions and individualized coaching sessions occurred weekly. A pre-and post-survey were administered to assess each resident’s self-efficacy in managing their T2DM. Additionally, blood sugar measurements were recorded and compared at the start …

An Elearning Module To Prepare Clinical Nurse Faculty To Foster Clinical Judgment: A Quality Improvement Project, Erin Melissa Armstrong

Doctor of Nursing Practice Projects

Background and Problem: Many nursing students graduate with poorly developed clinical judgment skills placing patients at risk for poor outcomes. Nurse faculty can address this problem but are often unprepared. Research shows that faculty development focused on high-level teaching strategies supported by Tanner’s Clinical Judgment Model can prepare faculty to foster students’ clinical judgment skills in the clinical setting. Clinical faculty must be better prepared to develop students’ cognitive processes to prepare practice-ready nurses.

Purpose: This quality improvement project seeks to design and implement an eLearning module for clinical nurse faculty to (1) increase faculty’s self-efficacy in fostering clinical judgment …

Educating Reimbursement Specialists About Plagiocephaly: Improving Efficiency Of The Prior Authorization Process For Providers, Healthcare Staff, And Patients, Emily N. Nelson

Doctor of Nursing Practice Projects

Deformational plagiocephaly (DP) is a condition in which an infant’s head becomes deformed and flattened because of molding forces that manipulate the malleable cranium. DP is very common, impacting an estimated 46% of infants within the United States. The resulting asymmetries of the head and face carry implications for functional, social, and emotional interactions. Helmet therapy is the recommended treatment for persistent moderate-to-severe plagiocephaly. It is most effective when started before six months of life with decreasing correction as the child nears one year old. Helmet therapy is very effective but is also expensive, and insurers have highly variable policies …

Implementing An Education Program To Increase Advance Care Planning Awareness Among The Native American Population, Sonam Yangzom

Doctor of Nursing Practice Projects

Advance care planning (ACP) involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes (Jones et al., 2021). Advance care planning rates in the United States are generally low, with significantly lower rates among marginalized groups of Native Americans (Jones et al., 2021). The purpose of this quality improvement project was to implement a culturally appropriate educational intervention that increases participation in completing advance care planning among older Native American residents through individual approaches and easy-to-read educational materials. Twelve residents participated in the quality improvement project, which entailed …

The Effect Of Education On The Early Identification And Reporting Of Delirium Symptoms In An Acute Hospital Setting., Myriam Ann Roby

Doctor of Nursing Practice Projects

Background: There is a notable increase in delirium incidence in patients on an orthopedic unit of a large Twin Cities healthcare organization. The Confusion Assessment Method tool is completed upon admission, and staff nurses have a knowledge deficit pertaining to positive baseline results, and the understanding this correlates with patients exhibiting delirium symptomology. The nurses on the orthopedic unit frequently contact the evening cross-cover hospitalist with post-surgical patients experiencing agitation, change in cognition, and adverse events such as falls. Staff nurses and hospitalist providers must appropriately identify early signs or risk factors of delirium to provide proactive measures to prevent …

Improving Intensive Care Unit Nurses’ Well-Being Through Implementation Of A Mindfulness Training Program, Taralyn R. Gutierrez

Doctor of Nursing Practice Projects

Background: Intensive care unit (ICU) nurses experience the effects of stress and burnout due to the challenging environments they work in. Mindfulness-based stress reduction (MBSR) techniques, including smartphone applications, have been studied extensively, and evidence has shown that even brief exercises effectively reduce stress.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to examine the feasibility and effect of the smartphone application Insight Timer on stress and burnout among ICU nurses who work in a large northern Nevada hospital.

Methods: This quality improvement project invited ten ICU nurses to participate in this project through convenience sampling. …

Test Anxiety In Undergraduate Nursing Students: Implementation Of A Brief Mindfulness Exercise, Lesley Locken Bonfe

Doctor of Nursing Practice Projects

Nursing students experience test anxiety that may compromise their performance on class examinations, affecting their trajectory through their prelicensure nursing program. Nurse educators significantly impact student outcomes throughout the curriculum and are integral in supporting students with test anxiety. It is imperative to recognize precipitating factors of test anxiety and appoint prophylactic interventions for alleviating stressful situations. In turn, this will provide nursing students with practical and supportive strategies to alleviate testing-induced stress. This scholarly paper discusses the implementation of a brief mindfulness exercise before class examinations to combat test anxiety in undergraduate nursing students at a small midwestern college. …

Standardizing Therapeutic Drug Monitoring For Clinic Patients On Amiodarone, Anna Melnichuk

Doctor of Nursing Practice Projects

The side effects of amiodarone can be severe and potentially lethal (Vassallo & Trohman, 2007). Amiodarone is frequently prescribed for supraventricular arrhythmias, specifically atrial fibrillation, without any standardized monitoring for adverse effects. In this quality improvement (QI) project, providers were encouraged to use a protocol containing evidence-based recommendations built into the Electronic Health Record (EHR ) when prescribing amiodarone in outpatient encounters. Providers were emailed with education on the protocol and how to use it. A survey was sent to providers seven weeks later to assess the usefulness and ease of use of the protocol. EHR reports were run to …

Screening And Early Recognition Of Sepsis In Home Hospital And Home Care Patients, Tina S. Gronseth

Doctor of Nursing Practice Projects

Problem Statement: In 2018, septicemia was the number one diagnosis for hospital inpatient stays for ages 65-74 in the United States (Agency for Healthcare Research and Quality, 2018). Most hospital admissions due to sepsis come from the community- as many as 87% (Rhee et al., 2017). People over 65 are 13 times more likely to end up hospitalized due to sepsis (Sepsis Alliance, n.d.). Sepsis in Home Hospital Care (HHC) and Home Care (HC) patients is prevalent because these patients are typically over 65. HC and the HHC program within the project site have noted a rise in hospital readmissions …

Bridging Communication In End-Of-Life Care At A Midwest Veterans Home, Taylor Karrow

Doctor of Nursing Practice Projects

Palliative care is specialized care for those with serious disease and focuses on providing relief from symptoms (Radbruch et al., 2020). The goal of palliative care is to improve quality of life for both the patient and the family. As the COVID-19 pandemic continued to change healthcare delivery and visitor restrictions, alternative approaches to safely deliver care to both the patient and family have been uncovered. A Midwest veterans home was looking to bridge the gap in communication between staff, resident, and family during end-of-life care. Creation of an online accessible educational resource for nursing home staff is an alternative …

Nursing Competency Alignment Project (Ncap), Lainey S. Kotta

Doctor of Nursing Practice Projects

Background: The lack of a standardized nursing competency model for a large healthcare organization prevented it from opportunity as a system.

Objective: This evidence-based project's purpose was to select a nursing competency model that a large healthcare organization will use to evaluate nurses, standardize nursing competency training language for the healthcare organization, develop an education plan for nurse educators on the selected nursing competency model, and develop an implementation plan for the nursing competency model.

Methods: This project utilized a three-cycle Plan-Do-Study-Act (PDSA) change framework. Cycle One involved nursing leaders from the eight hospitals and 60 clinics of the large …

Self-Care Practices For Nursing Faculty To Alleviate Burnout, Michal Ward

Doctor of Nursing Practice Projects

Drawn to the service and caring profession are compassionate and empathetic individuals. However, burnout is endangering the health of nursing faculty, nursing students, nurses, patients, and communities. Since identifying burnout, mounting efforts have increased to combat burnout symptoms. Evidence of burnout is emotional exhaustion that produces a feeling of alienation from job-related activities, resulting in a decline in job performance (Poncet et al., 2007). Holdren et al. (2015) posit that it is to be overworked until one feels lethargic, even to depletion. Therefore, burnout depletes the qualities of compassion and empathy that calls on nursing faculty when mentoring, assisting, and …

Implementation Of A Loneliness Assessment Tool And Education Program In Assisted Living, Andrea B. Belle Isle

Doctor of Nursing Practice Projects

Purpose: To combat loneliness in assisted living (AL) settings, particularly after the COVID-19 pandemic, providers need to be aware of the definition of loneliness, its consequences, and appropriate interventions.

Method: Educational content on loneliness’s definition, consequences and interventions was delivered via PowerPoint to five nurse practitioners. Five nurse practitioners evaluated the education session’s effectiveness via questionnaire and the Three-Item Loneliness Scale was administered to fifteen cognitively intact patients in AL settings. Four nurse practitioners then evaluated the Three-Item Loneliness Scale’s implementation. The Plan-Do-Study-Act cycle was used for this quality improvement project.

Findings: Based on the post-education survey results, the Three-Item …

Using Nurse Education To Promote Advance Care Planning For Memory Care Residents Affected By Dementia: A Pilot Project, Janelle S. Thoreson

Doctor of Nursing Practice Projects

Background: Advance care planning (ACP) can help with end-of-life goals-of-care identification and timely hospice enrollment for individuals affected by dementia. Known barriers to effective ACP include nurse knowledge and confidence deficits. Evidence from an academic literature review suggests that providing dedicated ACP education can foster effective nurse-led ACP conversations.

Objectives: Increase the number individuals affected by dementia having documented nurse-led ACP conversations, nurse knowledge and confidence with ACP, and appropriate hospice utilization. Setting/Participants: Eight nurses from three memory care facilities within a Midwestern United States (U.S.) senior housing organization.

Methods: An educational module regarding ACP in dementia care was created …

Standard Work For Nurse Leaders: A Quality Improvement Project, Kimberly W. Boysen

Doctor of Nursing Practice Projects

Providing role clarity and defining the standard work of nursing leaders is essential to reduce burnout, increase the quality of care provided, and ensure there is an adequate supply of qualified nurse leaders (Kelly & Adams, 2018; Seichter, 2018).Standard work is the established best and most reliable method and sequence of work to minimize waste and maximize performance providing routine and structure to create clear expectations for the nurse leader (Thomas Jackson, 2012). The additional responsibilities of leadership can lead to burnout, and the risk is further perpetuated when a leader does not effectively understand the complexities of their role …

Transforming Nurse Practitioner Education Through Faculty Simulation Preparedness, Abby Z. Evans

Doctor of Nursing Practice Projects

The National Organization of Nurse Practitioner Faculties (NONPF) endorsed that all nurse practitioner (NP) programs utilize simulation in the curriculum to assess NP student learning and competency (2020, p. 7). Before implementing simulation-based education in NP curriculum, the NONPF reported that participation in a faculty development program is essential (2020, p. 25). A small, Midwest private University was the practice site for this Doctor of Nursing Practice (DNP) quality improvement (QI) project. At the project site, there was inconsistency and a lack of best practice principles with simulation activities in the DNP-NP Program of Study. Also, informal conversations with faculty …

School-Based Health Centers: Accessible Health Care For Uninsured And Underinsured Children, Jessica Miehe

Doctor of Nursing Practice Projects

Access to affordable health care is essential to community health outcomes. Health care is not easily accessible to all, especially children who are uninsured and underinsured. Children affected by social determinants are more likely to be uninsured and underinsured, resulting in access barriers. Using Penchansky and Thomas's access theory, this project designed and implemented a school-based health center (SBHC) to develop meso-level change and improve health care access for uninsured and underinsured children. The SBHC was implemented in a Midwest public school-district. Health care services were no-cost and included primary care, mental health services, chronic illness management, and health education. …

Evaluating The Impact Of Mindfulness-Based Practices On Nursing Students’ Perceived Stress Levels, Kendra-Ann I. Seenandan-Sookdeo

Doctor of Nursing Practice Projects

Undergraduate nursing students report high levels of stress associated with academia and multiple life responsibilities. This quality-improvement pilot project sought to evaluate the outcomes of focused breathing sessions and the use of a Nursing Process Self-Care Plan (NPSCP) Bookleton students' perceived stress levels. The Transpersonal Care Theory facilitated the implementation of holistic student-centered classroom-based strategies. Fourteen students from a first-semester nursing course completed the pre-and post-test Perceived Stress Scale (PSS) survey and digital narrative questionnaires (DNQ). Descriptive and inferential statistics appraise the results from the PSS survey. Data from the DNQ were examined for patterns. Overall, the project findings support …

Father Engagement In Family Home Visiting, Alicia F. Ugarte-Delrio

Doctor of Nursing Practice Projects

Background: Family home visiting programs provide antepartum and parenting support to families identified as "high-risk" to promote healthy parenting habits and behaviors that result in positive health outcomes for the child and the family as a whole. However, home visiting programs rarely include fathers as integral participants in services despite fathers' critical role in the family.

Purpose: This project aims to support public health nurses in serving fathers in family home visiting services by developing and implementing an infrastructure for working with fathers.

Theoretical Framework: The theoretical framework used to guide this project was the FamilyCentered Care Theory.

Methods: Six …

Implementation Of Telehealth In Low-Income Hud Housing For Seniors With Priority To Native Americans, Tracy J. Cowell

Doctor of Nursing Practice Projects

This quality improvement project was to implement a telehealth program into a low-income senior living community that gives priority to Native Americans. Education was provided to each participant along with established guidelines for increased knowledge related to telehealth and technology while maintaining culturally appropriate individual training, in small groups, and via phone calls. Data was collected prior to the implementation of the project and three months post-implementation. The findings suggest that transportation was not a factor in missed provider appointments, 54% of participants agreed they would participate in telehealth, 100% of participants were given a laptop with 1-year of internet …

The Development And Implementation Of An Employee Education Session And Self-Checklist Teaching Face Mask Compliance To Cafeteria Workers At A University In The Midwest, Stephanie M. Dombrowski

Doctor of Nursing Practice Projects

The COVID-19 pandemic has contributed to the need for public health education. The enforcement of the statewide face mask mandate required the public to make a rapid behavior change. The face mask mandate also required higher education institutions to develop and implement evidence-based education modules to help decrease the risk of COVID-19 transmission. University cafeteria workers were required to wear masks while preparing and serving food.

The project takes place within a cafeteria at a local university in the Midwest during the beginning phases of the statewide face mask mandate. The population of focus includes 14 cafeteria workers responsible for …

Implementation Of A Pilot Telehealth Training Module (Ttm) For Clinical Preceptors: Facilitating Student Return To Clinic During Covid-19, Choua Yang Polaski

Doctor of Nursing Practice Projects

Problem: The COVID-19 pandemic led to the sudden and widespread implementation of the telehealth platform, changing health care forever. Telehealth is not a new concept, but health systems have been slow to adopt its widespread use due to strict regulations and low reimbursement rates. At the onset of the pandemic and with state executive orders, systems canceled traditional face-to-face visits or converted them to telehealth visits. In-person preceptorships for advanced practice clinicians (APC) were put at a standstill to reduce the spread of the virus and preserve personal protective equipment. The rapid implementation of the telehealth platform provided one opportunity …

Health And Wellness Coaching For Chronic Disease Management, Heather A. Bateman

Doctor of Nursing Practice Projects

The focus of this quality improvement project was to improve the perceived health and wellbeing of Native American elders residing in low-income housing. Guidelines were established to provide health promotion activities that included screening, weekly vital signs, culturally appropriate individualized health coaching and education talk circles within a community-based wellness clinic. Data was collected prior to project implementation and again at three months post-implementation. Findings suggest that health coaching and education improve hypertension control as evidenced by mean a population improvement of 12 mm Hg. There was not a significant difference in the responses from the health survey measuring confidence …

Oral Care Prior To Elective Surgery, Jennifer Ferrier

Doctor of Nursing Practice Projects

Objective: This study aimed to understand baseline oral care completion rates before elective cardiovascular surgery (CVS). There are germs in the oral cavity (Li et al., 2000) that reproduce frequently (Quinn & Baker,2015). Intubation through an unclean mouth can translocate germs to the lungs (Davis & Finley, 2012). Oral care, specifically brushing teeth, may reduce hospital-acquired pneumonia (HAP). Oral care completion before elective surgery is likely variable but remains unknown.

Methods: Surveys were administered to the patients in the preintervention and intervention groups. Patients in the intervention group were provided information on oral care, dental supplies, and an intentional conversation …

Decreasing The Cost Of Surgery: A Standardized Process And Decision Tool To Evaluate Surgical Supplies, Shayna K. Fleming

Doctor of Nursing Practice Projects

Purpose: Management of disposable sterile supplies and implants is an opportunity to ensure quality patient care at an acceptable cost for both the patient and the organization. It is essential to have the right supplies available and reduce the economic and environmental waste for every patient without compromising the quality of care. This project aims to standardize the workflow for evaluating surgical supplies and reduce expired supplies.

Problem: In the pediatric operating room (OR) population, would a standardized process and decision support tool to review disposable sterile surgical supplies compared to the current unstandardized process result in fewer expired supplies …

Implementation Of A Standardized Nurse To Nursing Assistant Hand-Off Process In The Inpatient Setting, Laura T. Goebel

Doctor of Nursing Practice Projects

Communication is critical to nursing and considered to be the backbone of successful nursing collaboration (Kear, 2016). Effective communication during delegation from the registered nurse (RN) to the nursing assistant (NA) is important for optimal teamwork and work-flow in the fast-paced inpatient setting. Inconsistencies in the delegation process lead to frustration and disconnect among the nursing staff at a suburban inpatient hospital unit which was the site of this DNP project. The goal of the project was to improve communication, teamwork, and efficiency of work-flow through the use of a standardized RN to NA hand-off delegation tool. A pre-implementation survey …

Leading Through A Pandemic: The Role Of The Trained Observer, Maggie T. Hall

Doctor of Nursing Practice Projects

As a result of the COVID-19 pandemic, healthcare teams were faced with unprecedented personal protective equipment (PPE) challenges (Thomas et al., 2020). These constraints required unprecedented PPE use and reuse among health care workers (HCW).This included continual full day use of PPE items, which are historically disposable, single use items changed between patients. These challenges required immediate intervention to keep HCWs, patients, and the community safe. As a result, a team of specially trained observers was established to promote HCW safety. A quality improvement study was launched with the purpose to understand the impact of this team on HCW’s self-efficacy …

Nursing Students Are More Than Just “Broke College Kids”, Jessica L. Hoy

Doctor of Nursing Practice Projects

College students face many challenges within the classroom as a key component of their growth. However, a background of poverty, housing, and/or food insecurity places higher education students at risk for course failure, attrition, and delayed or non-achievement of career goals. The Institute for Healthcare Improvement (McPherson et al, 2021) reports more students from disadvantaged backgrounds are entering post-secondary healthcare education programs, but this increase is not reflected in completion rates. Previous studies have shown financial hardships and negative academic outcomes can be overcome through mentoring. To determine the effectiveness of faculty mentoring for students from poverty, mentors who navigated …

Incorporating Evidence-Based Simulation Principles In A Primary Care Program, Kevin Charles Carlson

Doctor of Nursing Practice Projects

No abstract provided by the author.

Implementation Of An Office Ergonomic Self-Assessment Checklist For Student Satisfaction In Reducing Risk Of Musculoskeletal Associated Disorders, Jennifer S. Quiram

Doctor of Nursing Practice Projects

As the learning platform has moved online for students at a Midwest university, they spend more time using personal computers. Unaware of the association between computer use and musculoskeletal injury, students may not recognize poor ergonomic practices. The project manager implemented a quality improvement initiative to increase first-year Doctor of Nursing Practice (DNP) students’ satisfaction in reducing the risk of associated musculoskeletal disorders. Seven participants responded to a pre-assessment survey,and85% reported they had never used an ergonomic self-assessment tool and had not configured their workstations based on recommendations from a professional organization such as the National Institute of Health. The …