Medicine and Health Sciences Commons^™

Use Of An Evidence Based Verbal Health Literacy Screening Tool In An Inpatient Setting., Dakota Lawler

Doctor of Nursing Practice Papers

Patients who are categorized as having low health literacy have been shown to utilize emergency services more frequently, have increased hospitalizations, and have poorer health outcomes, yet very few medical facilities screen for these at risk patients. The purpose of the process change was to evaluate the feasibility of implementing an evidence based verbal health literacy screening tool into the admission process on a progressive care unit at an urban hospital. After an education session on the screening process, nurses were set to administer the Expanded Brief Health Literacy Screening (EBHLS) to patients admitted to the floor. At the end …

Improving Adherence In Adults With Hypertension Using Personalized Pictogram Pill Cards., Janneve P. Sankawulo-Knuckles

Doctor of Nursing Practice Papers

Non-adherence with prescribed hypertension (HTN) treatment significantly increases the risk for cardiovascular disease and stroke, leading to increased morbidity, mortality, and burden to the health care system. HTN affects one in three American adults and costs the health care system approximately $48.6 billion annually in direct (providers/health professionals fees, hospital services, prescription medications) and indirect (premature mortality) medical expenses (CDC, 2018; 2016). This quality improvement (QI) project implemented a personalized pictogram pill card intervention for adults with HTN at an urban, federally-qualified health care clinic in west Louisville. Pictogram pill cards were provided to hypertensive adults with medium and low …

Nutritional Assessment Process Revision In Adult In-Patients., Amanda Hellmueller

Doctor of Nursing Practice Papers

Thorough and appropriate nutritional screening upon admission to the hospital can mitigate the negative consequences often associated with secondary malnutrition. At a suburban hospital in the southeastern United States, there was an 250% increase in consults to dieticians upon initiating use of the Malnutrition Screening Tool (MST) as the primary form of nutrition screening, which has been previously shown to have a high false positive rate. As a result, the workload of the dieticians increased. This time spent on analysis of false positive screenings takes away from time that could be spent on truly malnourished or at-risk patients. This quality …

Educating Primary Care Providers On Assessment Of Herbal Supplements Used By Latino Patients., Elizabeth Arnold

Doctor of Nursing Practice Papers

Background: Latino population health care practices are rich in heritage and deeply rooted in ideas and traditions (CDC, 2008). Complementary and alternative medicine (CAM), specifically herbal supplement use, is widely practiced among this population. Literature suggests that there is a significant gap in provider-patient communication regarding herbal supplement use (Malika et al., 2017).

Aims: The purpose of this project was to assess commonly used herbal supplements or vitamins and implement a population-specific education for providers in a primary care clinic predominantly serving Latino patients. The project aim was to increase provider assessment and documentation of herbal supplement and vitamin use …

Development And Implementation Of A Diabetes Management Flow Sheet In A Primary Care Practice: A Quality Improvement Project., Lace N. Houston

Doctor of Nursing Practice Papers

Primary care practices that do not utilize electronic medical records (EMR) could pose difficulty in adhering to clinical guidelines for diabetic patients. Diabetes flow sheets are a one page document that includes current practice guideline recommendations for easy access of results to promote comprehensive care. The main objective of this project was to promote adherence to diabetes guidelines with the use of a diabetes flow sheet for providers that do not utilize an EMR.

Plan-Do-Study-Act was the design for this project. A total of 50 medical records were randomly selected at a primary care office. A pre and post-implementation of …

Expedited Partner Therapy: Advancing Health Policy In Kentucky., Brianna C. Tomlinson

Doctor of Nursing Practice Papers

Innovative strategies have become necessary in the treatment of patients diagnosed with sexually transmitted infections (STIs) and their partners due to increasing rates of infection, transmission, and reinfection. Expedited Partner Therapy (EPT) is an evidence-based approach for providers to improve partner treatment and decrease reinfection rates in patients with certain STIs. However, state-based legislation governs practice implementation and EPT remains prohibited in Kentucky (KY) despite Centers for Disease Control and Prevention (CDC) endorsement. Delay in policy change presents increased risk for reinfection and continued transmission in KY. John Kingdon’s Multiple Streams framework (2003) was used to analyze EPT policy in …

Implementation Of An Educational Workshop On The Use Of Evidence-Based Lifestyle Management Programs To Prevent Diabetes., Angela Leinenbach

Doctor of Nursing Practice Papers

Prediabetes does not have to lead to type 2 diabetes. Lifestyle management programs (LMPs) have been shown to reduce the risk of conversion to type 2 diabetes (Diabetes Prevention Research Group (DPRG), 2002), however, research suggests providers refer to LMPs less than 10% of the time (Shiffman et al., 2009). The purpose of this project was to improve prediabetes management by increasing primary care (PCP) referrals to a local Diabetes Prevention Program (DPP) through the use of an educational intervention to increase knowledge of DPP, prediabetes documentation, and steps for DPP referral. The ACE Star Model of Knowledge Transformation guided …

Reducing Falls Through An Education Intervention To Increase Nurse-Promoted Mobility In Hospitalized Patients., Tamara Slater

Doctor of Nursing Practice Papers

The aim of this project was to determine if educating registered nurses (RNs) on the importance of nurse-promoted patient mobilization could increase RN knowledge on patient mobility and reduce the rate of patient falls on a cardiology/neurology nursing unit in a southeastern area of the United States. This project was a quality improvement project with a pre-test/post-test design. The intervention included a teaching session for RNs and posted reminders. The teaching session included information on the use of a mobility algorithm, where to locate mobility equipment, and the physical therapy referral process. The reminders included flyers posted around the unit …

Reducing Burnout Among Mental Health Providers Using A Mindfulness Intervention., Joy Lindsey-Buckler

Doctor of Nursing Practice Papers

Burnout has been recognized as a barrier to quality care and expected patient outcomes for nearly 50 years (Freudenberger, 1974). Burnout, an “occupational phenomenon”, a syndrome of untreated chronic work-place stress, (WHO, 2019). Burnout has three factors: emotional exhaustion described as depletion of energy, depersonalization characterized by, increased levels of detachment; finally, reduced feelings of personal accomplishment with reduced feelings of professional efficacy. Health care providers (HCPs), Mental Health Providers (MHPs) and staff providing care in substance use disorder programs, experience high levels of burnout. Mindfulness practices have demonstrated efficacy in reducing burnout among HCPs.

Purpose: The purpose of …

Pediatric Discharge G-Tube Toolkit., Kimberly Hall

Doctor of Nursing Practice Papers

Surgically placed gastrostomy tubes (G-tubes) are used in pediatric patients to provide proper nutrition and hydration when illness or trauma renders the child unable to consume adequate oral intake. Parents/caregivers are given education and training on their child’s G-tube, which varies from hospital to hospital. Parents/caregivers are responsible for all aspects of the G-tube once discharged from the hospital. Studies have shown that after discharge, ER visits and/or unscheduled clinic visits are necessary for G-tube complications, many of which could be dealt with at home given the proper education and resources. The aim of this project was to provide a …

Feasibility And Implementation Of The Columbia-Suicide Severity Rating Scale For Assessing At-Risk Adult Patients In The Emergency Department., Elise Hawkins

Doctor of Nursing Practice Papers

Background: Suicide is the tenth leading cause of death in the United States. Individuals who ultimately commit suicide often seek healthcare in the year prior to their death for unrelated medical complaints without detection of suicidal ideation. The Emergency Department (ED) has been identified as a key stakeholder in detecting suicide risk. Research supports the use of a universal evidence-based screening tool for all patients who present to the ED in order to identify those at risk for future suicide attempt, and to provide appropriate follow-up resources.

Aims: The aim of this scholarly project was to promote a …

The Use Of Simulation To Practice Pre-Exposure Prophylaxis Sexual Health Risk Screening, Management, And Follow-Up Within A Doctor Of Nursing Practice Program., Skyler K. Frye

Doctor of Nursing Practice Papers

Introduction: Incidence and prevalence for human immunodeficiency virus (HIV) has yet to experience a significant decline. Increasing provider knowledge regarding use of Pre-Exposure Prophylaxis, an HIV prevention drug, correlates with increased provider risk screening & prescribing PrEP. Standardized patient (SP) simulation is an effective teaching method for healthcare students to increase knowledge and confidence in providing sexual healthcare.

Purpose: The purpose of this project was to evaluate an educational program aimed at increasing participant knowledge attainment and self-confidence in the ability to ascertain a sexual health history and advance the participant’s ability to manage PrEP candidates in a primary …

Improving Caregiver Coping And Reducing Recidivism With A Pediatric Burn Discharge Education Toolkit., Lindsay Hack

Doctor of Nursing Practice Papers

In 2015, 4,506 children from 0-19 years of age were hospitalized with burn injuries in the United States (Center for Disease Control and Prevention, 2017). From 2013-2014, 325 out of 11,940 pediatric burn patients discharged from US facilities had unscheduled readmissions within 30 days (Wheeler et al., 2018). Adequate discharge education and quality of transitions from hospital to home will help prevent negative health outcomes and readmissions (Braet, Weltens, Bruyneel, & Sermeus, 2016). In this quality improvement project, caregivers of pediatric burn patients were assessed on their day of discharge with the Readiness for Hospital Discharge Scale (RHDS)- Parent Form …

Implementing An Updated Evidenced-Based Maintenance Central Line Bundle (Clb) Policy: Monitoring Adherence And Central Line Associated Blood Stream Infections (Clabsis) In A Medical Intensive Care Unit (Micu)., Kimi Hart

Doctor of Nursing Practice Papers

Purpose: The purpose of this project was to update the current policy of CLB maintenance of CVCs by incorporating the latest recommendations from the literature, providing education and disseminating the new policy. Outcomes were measured by evaluating the effect on policy adherence and incidence of CLABSIs in a medical intensive care unit (MICU). Policy adherence was defined by the completion of CLB maintenance components.

Methods: This study included a pre- and post-interventional design utilizing a retrospective chart review to evaluate adherence to CLB maintenance interventions and incidence of CLABSI rates pre and post-implementation of a new CLB maintenance policy that …

An Intervention To Improve Emergency Room Nurses' Swallow Study Implementation And Documentation., Amanda B. Hicks

Doctor of Nursing Practice Papers

Stroke is the 5^th leading cause of death when isolated from other cardiovascular diseases in the United States (U.S.) (CDC, 2017). The Centers for Disease and Control (CDC) indicated that 795,000 people have a stroke each year with 65% suffering from some form of dysphagia, or difficulty swallowing. Implementing a simple screening by a trained nurse can detect dysphagia and prevent adverse outcomes, such as aspiration. In the emergency department (ED) of a suburban acute care facility, a pattern of inconsistent Toronto Bedside Swallow Screening Tool (TORBSST) was noted for 24 consecutive months. The purpose of this quality improvement …

The Use Of Simulation And Experiential Learning To Practice Prenatal Care Management Within A Doctor Of Nursing Practice Program., Heather J. Locke

Doctor of Nursing Practice Papers

Background: Many barriers have been identified that affect patient-provider gestational weight gain (GWG) counseling, including lack of time, insufficient training, concern about the sensitivity of the topic, and the provider perception that the advice is ineffective (Ronnberg et al., 2015; Stotland et al., 2010). Simulation-based learning (SBL) is an evidence-based clinical education strategy that mimics real-life situations as a high-quality interactive experience that complements clinical experiences to develop entry into practice competency (SSH, 2015).

Aims: The purpose of this project was to implement an educational program that incorporated a combined teaching method of a didactic module and a standardized patient …

Implementation Of An Evidence-Based Physical Activity And Nutrition Program In An After School Setting., Tylar A. Williams

Doctor of Nursing Practice Papers

Childhood obesity rates are continuously rising despite efforts to curb the trend. Sedentary behaviors and lower socioeconomic communities have been linked to the overall increase in childhood obesity rates. Additionally, poor understanding of childhood obesity and its adverse effects, has been shown to contribute to the increase in sedentary behaviors of children. The purpose of this study was to evaluate the feasibility of an after school, childhood obesity program and its effects on physical activity and nutrition behaviors and knowledge base. The childhood obesity program that was used was the 5-2-1-0 Lets Go out of school program. The intervention was …

Efficacy Of Care With Assertive Community Treatment In Severe Mental Illness., Rex Dewan

Doctor of Nursing Practice Papers

Background: Severe mental illness is a devastating and undertreated problem in our society. Assertive Community Treatment (ACT) services could help fill the void left from the deinstitutionalization movement providing the severely mentally ill the needed support while allowing them to remain in their communities.

Aim: This evidence-based scholarly (EBP) project addressed the following question; How does length of time in ACT affect the number or length of hospitalizations, and incarcerations in patients with severe mental illness.

Methods: This project is a program evaluation of an Assertive Community Treatment Team Program in a metropolitan city. The impact evaluation consists of data …

Effectiveness Of Girls Only! Prevention Education Program For Self-Esteem Enhancement In At-Risk Adolescent Girls., Kennetha A. Porter

Doctor of Nursing Practice Papers

Background: Low self-esteem in adolescent girls has been found to be associated with risky behaviors including illicit drug use, early sexual intercourse, and delinquent behaviors. In addition, mental health concerns such as anxiety, depression, and body dissatisfaction have also been found to be associated with low self-esteem. Group-based interventions for increasing self-esteem and general well-being have been found to decrease risky behaviors and the symptoms associated with varying mental health problems.

Aims: To implement Girls Only! group-based intervention to improve self-esteem in at-risk adolescent girls living in a residential home.

Methods: A pretest posttest design was used to implement Girls …

Implementation Of A Heart Failure Risk Screening Tool In A Primary Care Setting., Paige Abell

Doctor of Nursing Practice Papers

Introduction: Heart failure (HF) is a progressive disease that is difficult to identify in its early stages. The Health ABC HF screening tool allowed primary care providers to identify and target interventions at their highest risk patients.

Purpose: The purpose of this project was to introduce providers to the Health ABC HF screening tool and assess the feasibility of using this tool in a primary care setting.

Intervention: Six primary care providers used the Health ABC screening tool for 4 weeks on their patients over age 65 with a diagnosis of hypertension, diabetes mellitus, or atherosclerosis. Providers then completed …

Sepsis Bundle Compliance In The Icu After Implementation Of An Educational Intervention., Courtni Breann Carwile

Doctor of Nursing Practice Papers

Purpose: The purpose of this project was to determine the effect of an educational intervention delivered to ICU nursing staff and providers on sepsis bundle compliance and mastery of the bundle metrics.

Methods: This study included a sepsis educational program that utilized a pre-and post-education survey to determine mastery of the sepsis bundle metrics. Retrospective data of the Sepsis 5-piece composite scores were collected and compared.

Results: 86 ICU nurses (71.6% of the nursing staff) participated in the educational intervention and the surveys. The mean survey score pre-intervention was 73.5%, and 100% post-intervention. Sepsis 5-piece composite score means increased from …

An Educational Intervention On Daily Chlorhexidine Gluconate Bathing And Central Venous Catheter Infection Rates In The Pediatric Population: A Quality Improvement Initiative., Jennifer Cothern

Doctor of Nursing Practice Papers

The use of Central Venous Catheters (CVCs) in the healthcare setting is essential to patient survivability. While convenient, the utilization of such devices places patients at risk for Central Line- Associated Bloodstream Infections (CLABSI). The US spends nearly $2 billion dollars annually treating CLABSIs. The utilization of CLABSI bundles has shown to be effective in infection prevention. Daily bathing with Chlorhexidine Gluconate (CHG) is recommended by the Centers for Disease Control and Prevention (CDC) and is often included in CLABSI bundles. In an attempt to reduce the incidence of CLABSIs at a metropolitan pediatric hospital in the Southern US, a …

Human Trafficking Education For Pre-Licensure Nursing Students: A Quality Improvement Project., Mollie Elizabeth Flowers

Doctor of Nursing Practice Papers

Human trafficking is a form of modern slavery and a violation of human rights (Scanwell, Macdonald, Berger, & Boyer, 2018). An estimated 40.3 million individuals are being trafficked globally at any one time with 14,500 to 17,500 being trafficked within the United States annually (Polaris, 2018; Mason et al., 2016; Richards, 2014). An estimated 87% of human trafficking victims were seen by health care professionals during the time they were being trafficked and went unrecognized. (Lederer & Wetzel, 2014). This project utilized the Plan– Do- Check -Act model for quality improvement. (Agency for Healthcare Research and Quality, n.d.). This project …

Increasing The Confidence Of Primary Care Nurse Practitioner Students In Caring For Patients With Preexisting Opioid Use Disorder., Christopher T. Hannon

Doctor of Nursing Practice Papers

Background: In the United States, more people die from drug overdoses related to increased heroin and fentanyl use than homicides and car accidents combined (Sederer & Marino, 2018). Frustrations and negative perceptions (stigma) on behalf of primary healthcare providers may result in negative health outcomes for patients, poor therapeutic relationships and lack of opportunity to engage clients in substance use treatment (Khenti et al., 2017).

Purpose: The purpose of this project was to implement a contact-didactic education module to improve adult gerontology primary care (AGPCNP) and family nurse practitioner (FNP) students’ attitudes towards OUD patients, and to increase their therapeutic …

Feasibility Of Online Psychoeducation For Bipolar Disorder., Scott Alan Kristie

Doctor of Nursing Practice Papers

Problem Statement: Bipolar disorder (BD) is a chronic mental disorder that can negatively affect an individual’s quality of life (QoL). Psychoeducation (PE) programs are an evidence-based psychosocial adjunct, recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of BD. However, the majority of individuals with BD are not given access to formal PE programs.

Purpose: An online PE program was implemented at three outpatient local mental health settings in order to increase access to PE for adults with BD. The World Health Organization Quality of Life brief (WHOQOL-BREF) scale was used to assess the intervention’s …

Prescribing Probiotics In Tandem With Antibiotics In A Pediatric Setting., Allyson Riggs

Doctor of Nursing Practice Papers

Gastrointestinal (GI) discomfort including antibiotic associated diarrhea (AAD) is a common side effect of antibiotic therapy. As antibiotic use continues to increase, more patients are affected by AAD. Significant evidence has been found on using probiotics for the treatment and prevention of GI distress and AAD. Provider education is needed in the clinical setting to share evidence and make recommendations on best practice. The goal of this intervention was to increase the rate at which providers prescribe probiotics in tandem with antibiotics, via increased provider education. A retrospective Electronic Health Record (EHR) review was conducted once before and once after …

Safe Sleep In The Nicu., Amy Rudd

Doctor of Nursing Practice Papers

Sleep related infant deaths continue to be an issue in Kentucky with 95% of deaths having at least one sleep related risk factor identified. Evidence from the literature suggests safe sleep practice in the neonatal intensive care unit is inconsistent and nurses may face many barriers when implementing safe sleep. The purpose of this project was to determine current nursing knowledge and practice of safe sleep, as well as how parent education occurs in a local NICU through the use of a survey. The survey was developed and distributed to staff at University of Louisville Hospital NICU nurses to determine …

Analysis Of Unplanned Extubations At A University Neonatal Intensive Care Unit., Elizabeth Turcotte

Doctor of Nursing Practice Papers

Unplanned extubations represent a serious adverse event that occurs within neonatal intensive care units. The current literature on unplanned extubations suggests that the incidence of these events can be reduced in the clinical setting. UEs represent the primary respiratory-related adverse event in the neonatal intensive care unit (NICU) and can result in cardiopulmonary collapse requiring emergent reintubation (Carvalho, Mezzacappa, Calil, & Machado, 2010). Staff members of the University of Louisville’s neonatal intensive care unit collected data surrounding unplanned neonatal extubations from November 2017 through December 2018. These data have been used to target modifiable risk factors temporally associated with unplanned …

Decreasing Musculoskeletal Injuries Among Operating Room Personnel Through The Use Of Anti-Fatigue Mats., Hannah Raake

Doctor of Nursing Practice Papers

Work-related musculoskeletal disorders (WRMDs) are a common occurrence among operating room (OR) personnel due to certain job requirements including standing in a static position for long periods of time. The American Association of Operating Room Nurses (AORN) ergonomic guidelines support interventions (anti-fatigue mats, shoe in-soles, etc.) aimed at decreasing the rates of WRMDs among OR personnel. A 3-month pre- and post-intervention trial was established at one Southern Indiana hospital to assess the efficacy of anti-fatigue mats in the OR theatre. Two anti-fatigue mats were placed in each OR, cardiovascular operating room (CVOR), and endoscopy room for use with each case. …

Oxygen Use In The Delivery Room And The Outcome Of Bronchopulmonary Dysplasia: A Retrospective Review., Blair Wagner

Doctor of Nursing Practice Papers

Recent evidence confirms the first 10 minutes after birth are extremely important for the short and long-term outcomes of premature infants, specifically for the risk of developing bronchopulmonary dysplasia (BPD). Neonates who are resuscitated with 100% oxygen concentration in the delivery room during the first 10 minutes after birth have a 35% chance to develop BPD (Vento, 2009). Neonates who are resuscitated with lower oxygen levels in the first 10 minutes of life have a 15% chance of developing BPD. BPD is diagnosed when a neonate requires oxygen at ³28 postnatal days or at 36 weeks corrected gestational age, along …