Medicine and Health Sciences Commons^™

Using Clinical Supervision To Improve Interprofessional Collaboration, Melissa Copenhaver

DNP Scholarly Projects

USING CLINICAL SUPERVISION TO IMPROVE

INTERPROFESSIONAL COLLABORATION

By

Melissa Copenhaver

Interprofessional collaboration (IPC) is important to the future of the healthcare system in that IPC is part of the solution for promoting better healthcare outcomes (Gilbert, Yan, & Hoffman, 2010; Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013). Marshall (2011) notes that “interprofessional collaborative practice promotes team identity, conserves energy by a unity in direction, and invites harmony of efforts” (p. 158). The skills needed to engage in IPC are cultivated through interprofessional education (IPE) (Reeves et al., 2013). Currently, at Northern Michigan University (NMU), there are limited opportunities included in …

Decreasing Duration Of Mechanical Restraint Episodes By Increasing Registered Nurse Assessment And Surveillance In An Acute Psychiatric Hospital, Diane Allen

DNP Scholarly Projects

Background

Application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care in order to assure patient safety and expedite release at the earliest opportunity. While current regulations require that trained staff continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. This project builds on research that demonstrated a regulatory change requiring more frequent registered nurse assessments led to decreased duration of mechanical restraint episodes in an acute psychiatric hospital.

Purpose

The purpose of this project was to implement and evaluate a practice change that required increased frequency of registered nurse …

An Inpatient Rehabilitation Interprofessional Care Pathway For Traumatic Hip Fracture: A Pilot Quality Improvement Project, Sarah Plante

DNP Scholarly Projects

Background: Each year over 300,000 older adults are hospitalized for hip fracture. The impact of the cost of hip fracture on the US health care system is estimated to be as high as $9 billion, with the typical cost of a hip fracture episode around $30,000. Formalized pathways have been developed and successfully utilized for many patient presentations, including hip fracture, in the acute setting. Although this research is important to the comprehensive care of the elderly hip fracture patient, very little research exists that outlines evidence-based best-practice for patients in the post-acute recovery period.

Purpose: The primary aim of …

A Program To Prepare Frontline Nurse Leaders For Peer Review, Suzanne K. Murdock

DNP Scholarly Projects

Introduction: The purpose of nursing peer review is to assess the quality of nursing care against established standards, identify strengths and weaknesses in practice, and identify knowledge gaps. Studies of nurse peer review predominantly focuse on staff nurse attitudes and knowledge after an educational intervention and barriers to implementation. Frontline nurse leaders (FLNL) can influence adoption of new practices such as peer review.

Purpose: The purpose of this project was to engage frontline nurse leaders in a role specific peer review program, preparing them to support their staff in the implementation of peer review in the future and providing an …

Applying Lean Methodology To Improve The Response And Management Of Postpartum Hemorrhage, Caroline Siefken

DNP Scholarly Projects

Postpartum Hemorrhage is an obstetric emergency that can lead to substantial maternal morbidity and mortality. Lean methodology is an improvement framework that addresses processes and identifies opportunities to eliminate waste and introduce efficiencies. The North Shore Medical Center uses an improvement framework modeled after the Toyota Production System that uses lean methodology to assess processes. This framework is called the North Shore Production System. This quality improvement project used the lean methodology tools from the North Shore Production System and applied them to interdisciplinary, simulated drills at the North Shore Medical Center Birthplace. After analysis of the tools, a postpartum …

Applying Lean Methodology To Improve The Response And Management Of Postpartum Hemorrhage, Caroline Siefken

DNP Scholarly Projects

Postpartum Hemorrhage is an obstetric emergency that can lead to substantial maternal morbidity and mortality. Lean methodology is an improvement framework that addresses processes and identifies opportunities to eliminate waste and introduce efficiencies. The North Shore Medical Center uses an improvement framework modeled after the Toyota Production System that uses lean methodology to assess processes. This framework is called the North Shore Production System. This quality improvement project used the lean methodology tools from the North Shore Production System and applied them to interdisciplinary, simulated drills at the North Shore Medical Center Birthplace. After analysis of the tools, a postpartum …

Depression Screening And Care Management In Diabetes Patients At Rural Health Clinics In Primary Care: Quality Improvement, Marcy Doyle

DNP Scholarly Projects

Depression is one of the leading causes of disease and disability, often found in patients with long-term chronic physical conditions such as diabetes. Collaborative care, which includes care managers, has shown to improve depression outcomes in patients; usual care has been shown to be inadequate. This quality improvement project screened patients with diabetes for depression. Patients with an elevated depression screening score were provided care management support and rescreened every two weeks to evaluate depression symptoms. A small cohort of patients from two rural health clinics participated in the improvement project. The practices noted improvement in depression screening; patients who …

Implementation Of Donor Human Milk In A Newborn Nursery: A Quality Improvement Initiative To Increase Exclusive Breast Milk Feeding, Emily Bombard

DNP Scholarly Projects

Background: At the site of this quality improvement project, exclusive breast milk feeding rates before discharge from a newborn nursery were behind benchmark goals. The aim of this project was to improve exclusive breast milk feeding rates by implementing a Pasteurized Donor Human Milk (PDHM) Program for breastfeeding newborns requiring medically indicated supplementation. The study site was a Level I newborn nursery of a 20-bed, labor, delivery, recovery, and postpartum unit within a 100-bed community hospital (i.e., the agency).

Methods: This retrospective pre-post cohort study used the Plan, Do, Study, Act (PDSA) framework for rapid cycle change to assess the …

The Evaluation Of A Breast Cancer Screening Decision Aid In The Community Setting., Kimberly Gibbons

DNP Scholarly Projects

Breast cancer screening (BCS) has been recommended to women by healthcare providers as well as professional organizations and non-profit awareness organizations for over four decades. Recently, attention is being paid to quantification of the actual benefits and harms of BCS with mammography. The harms include overdiagnosis, overtreatment and mandate of mammography screening that may not be in alignment with the individual values and preferences of women ages 40-69. This evidence translation project developed a resource for practice that was evaluated by community participants for alignment with personal value and preference-based educational needs about BCS. This project piloted a clinical practice …

Implementation Of A Physical Activity Group At A Community Mental Health Center: A Pilot Quality Improvement Project To Reduce Depressive Symptoms In Adolescents With Major Depressive Disorder, Nancy Gallagher

DNP Scholarly Projects

Major Depressive Disorder is a debilitating illness that affects millions of Americans, including adolescents. The majority of adolescents with Major Depressive Disorder (MDD) do not receive treatment. There may be a variety of reasons for this including stigma, access to care, and potential adverse reactions. People suffering from MDD are known to be at high risk for suicide. Lack of treatments adds the risk of suicide for adolescents with MDD. Identifying and implementing treatment options that are more acceptable and accessible are of the utmost importance. Although there is limited research regarding exercise/physical activity, depressive symptoms, and adolescents with MDD, …

Preventing Emergency Department Overutilization For Florida’S Seasonal Resident Population, Amanda Garcia

DNP Scholarly Projects

Background/Local Problem: Seasonal migration of elderly patients to Lee County, Florida result in overcrowding and prolonged wait times in emergency departments. Many of these seasonal residents dissociate the management of their chronic health conditions with a local provider, therefore utilizing the emergency department for non-urgent needs. Purpose: The Seasonal Resident Navigator Program was intended to enhance the coordination of primary care services for elderly seasonal residents by establishing appointments with local primary care providers (PCP) in order to reduce the overutilization of emergency services and improve patient throughput. Methods: A residency and provider assessment tool was incorporated into the Healthpark …

A Quality Improvement Project To Improve Blood Specimen Acceptance Rates In An Emergency Department, Christian Hankins

DNP Scholarly Projects

Purpose: The purpose of this project was to implement a quality improvement project to improve blood specimen acceptance rates at a specific Emergency Department (ED) using strategies to enhance knowledge, improve motivation, and reinforce skill. Background: Specimen acceptance rates continue to fall outside of the recommended target rate of 98% or higher at a specific ED. In this particular ED, the responsibility for specimen collection has shifted away from phlebotomists and towards nurses, many of whom have received little to no phlebotomy training. Without proper blood collection techniques, specimens are more likely to be rejected, and re-collection of rejected blood …

The Effect Of Mindfulness Meditation On Perceived Stress And Total Health Care Cost, Rachel Hale

DNP Scholarly Projects

Background: Chronic stress can lead to hypertension, tachycardia, and increased inflammatory markers, which put individuals at risk for chronic diseases. Mindful meditation not only decreases perceived stress but also has the potential to decrease the risk of chronic diseases and health care cost. Purpose: The purpose of this mindfulness meditation project is to reaffirm that mindfulness meditation decreases perceived stress scores and to determine whether mindfulness meditation decreases health care cost. Theoretical Model: The relation of mindfulness meditation, lowered stress levels, and chronic diseases can be explained by the social cognitive theory (SCT). Applying SCT, meditation’s goal is to alter …

Proper Prescribing Of Controlled Drugs: A Pilot Study Of A Web-Based Learning Modules’ Impact On Knowledge, Attitude, And Practice In New Graduate Nurse Practitioners, Shelly Duckett

DNP Scholarly Projects

Controlled substance abuse is a global epidemic. Several factors that influence health care providers prescribing habits have been presented in recent literature. However, the existing evidence primarily reflects the prescribing habits of physicians, while relatively little is known about the prescribing habits of nurse practitioners. The purpose of this project is to evaluate the impact of a brief web-based continuing education module targeting appropriate prescribing of controlled substances for recent graduate nurse practitioners. The project served to assess the provider’s knowledge, attitude, and practice compared to current integrated curriculum on prescribing and assess change in knowledge. Two online educational modules …

Developing A Guideline Driven Provider-To-Provider Handoff Tool For Heart Failure Patients, Nicole Dellise

DNP Scholarly Projects

The American Heart Association (AHA) and Heart Failure Society of America’s (HFSA) guideline for Management of Heart Failure in Skilled Nursing Facilities acknowledged poor communication from hospitals to skilled nursing facilities (SNF) as a barrier to optimal heart failure (HF) management. The purpose of this pilot study was to improve adherence to guideline directed HF care in SNFs through enhanced communication between hospital HF specialists and providers at SNFs. The project leader designed a guideline driven provider-to-provider HF handoff tool. Twenty-one patient discharges were evaluated in the study. Follow up phone calls were made to SNF staff nurse within 48 …

Application Of The Patient Checklist Tool In Anesthesia Handoffs, Theresa Durley

DNP Scholarly Projects

Accurate and essential communication is required during the transfer of patient care from one health care provider to another. Communication errors during the handoff process have been identified as contributing factors in sentinel events. There is a plethora of literature supporting a standardized transfer of care process as well as several accepted handoff communication tools for the various units within a healthcare institution. However, in the anesthesia domain, there is currently only one protocol specifically created for the transfer of patient care between certified registered nurse anesthetists (CRNAs). The PATIENT protocol, created by Dr. Suzanne M. Wright, CRNA, PhD (2013) …

Maternal Monitoring Of Adolescent Type 1 Diabetes Management And Its Influence On Adolescent Quality Of Life And Adolescent Depressive Symptoms, Anna Gorzny

DNP Scholarly Projects

While current literature identifies variables such as demographics, parental monitoring, and family functioning and their association with glycemic control in adolescents with type 1 diabetes mellitus, there has yet to be sufficient evidence identifying and supporting the relationships between the level of maternal monitoring and adolescent psychological wellbeing. The purpose of this scholarly project was to assess whether higher levels of maternal monitoring of diabetes management practices was associated with fewer adolescent depressive symptoms and higher adolescent quality of life. The study sample consisted of 117 adolescents between the ages of 10 and 16 with type 1 diabetes and their …

Provider Referral Of Patients With Acute Low Back Pain To Physical Therapy: Implications For Outcomes And Costs, Corinne Griggs

DNP Scholarly Projects

Because most patients with an acute episode of low back pain (LBP) enter the health care system through primary care, it is important primary care providers consider the effects of their decisions on patient outcomes and costs. Although guidelines for primary care management of acute LBP do not place emphasis on physical therapy, they have not been updated since 2007, and more recent evidence supports the use of timely physical therapy in acute LBP patients without “red flags.” Additionally, many studies indicate specialist or surgical consultation is over-utilized, inflating costs and delaying physical therapy. The aim of this project was …

Exploring Affects Of Critical Care Work Environments On Professional Quality Of Life, Marissa Monroe

DNP Scholarly Projects

Burnout and compassion fatigue among critical care nurses can affect individual patients, healthcare systems, and nurses’ health and wellbeing. Both burnout and compassion fatigue have been well described in the literature as key elements that contribute to a nurse’s overall professional quality of life, and can be directly influenced by the health of the nurses’ work environment. The AACN defined six standards of a healthy work environment, which include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. The purpose of this project is to explore which of the AACN Healthy Work Environment standards have the …

Implementation Of The 2012 American College Of Rheumatology Guidelines For Management Of Gout In A Sample Of Midwestern Native Americans, Myrth C. Condon

DNP Scholarly Projects

Gout is a well understood, yet poorly treated condition that is associated with many co-morbidities including hypertension, renal and cardiac disease, metabolic syndrome, central obesity and type-2 diabetes. The American Indian population is at risk for gout due an increased incidence of type-2 diabetes, chronic kidney disease, hypertension, and alcohol abuse. The purpose of this scholarly project was to implement the 2012 American College of Rheumatology (ACR) guidelines in a sample of Tribal members within mid-western portions of the United States. This scholarly project utilized a quasi-experimental research design with pretest – posttest methods to measure uric acid levels at …

The Effects Of A Brief Yoga Intervention On Psychologic And Physiologic Measures In Women Recovering From Substance Abuse Disorders, Robi C. Hopp

DNP Scholarly Projects

Women are the fastest-growing population experiencing substance use disorders (SUDs) in the United States. Multiple barriers e.g., mental health disorders, reduced self-efficacy, lack of social support have been identified and negatively impact acute and sustainable recovery efforts. The aim of this project was to evaluate the effects of yoga on mood status, biometrics, and self-efficacy toward yoga in a cohort at The Next Door, a substance abuse treatment center for women only. This was a quasi-experimental research approach with 14 women completing a total of 8 weekly yoga sessions over a ten-week period. Appropriate demographic data was collected. Measurements were …

Searching For A Common Thread: A Retrospective Chart Review Of Child And Adolescent Restraints And Seclusions, Mary Koziura

DNP Scholarly Projects

Child and Adolescent psychiatry is an increasingly frequented area of research. The project leader believes violence in an inpatient psychiatry setting is an underrepresented topic of research and discussion. Close quarters among patients of varying diagnoses and backgrounds, coupled with varying culture and attitudes of staff make for a teetering point—a fine line—between therapeutic interaction and safety concerns. Particularly, in the case of patients under 18, one hopes to establish an environment of nurturing, as opposed to a police state. With the fact established that children and their parents should always come first, many of the staff are often exposed …

Can The Cdc's Get Smart Program And A Decision Tree Alter Clinician Guideline Adherence For Abrs And Avrs?, Tracy R. Wilson

DNP Scholarly Projects

In previous bodies of work, researchers have not evaluated clinicians’ treatment of AVRS and ABRS by examining the impact of a national education toolkit and a decision tree tool. It is the intent of this scholarly project to determine whether an educational program based on a national education toolkit plus a decision tree tool offered to health care providers in a Middle Tennessee walk-in clinic, promoted an increase in treatment guideline adherence when diagnosing and treating acute bacterial rhinosinusitis and acute viral rhinosinusitis.

Effect Of Dietary Self-Monitoring In Caucasian And African-American Women, Julianne Tondreau

DNP Scholarly Projects

Purpose: The purpose of the study is 1) to assess the effect of dietary self-monitoring on weight loss in a population of Caucasian and African-American women and men; and 2) to determine if there is a difference in African Americans’ and Caucasians’ use of self-monitoring in weight loss.

Review of the Literature: Previous studies demonstrated increased weight loss with dietary self-monitoring; however, these studies’ samples are 70-80% Caucasian women and cannot be generalized to African-Americans or men. Studies confirming the effectiveness of dietary intake self-monitoring in non-Caucasian women and men are needed.

Methodology: Using a cohort design with prospective and …

Educating Providers: A Pilot Study On The Impact Of Standard Days Method Education In Northern Haiti, Jennifer Quigley

DNP Scholarly Projects

Preventing unintended pregnancy is a topic of global and domestic importance. In 2013, almost 290,000 maternal deaths occurred due to complications of pregnancy or child-birth; 99% of these deaths were in developing countries (World Health Organizations, 2014). Additionally, more than 4 million infants died before reaching their first birthday, a large number being attributed to multiple factors related to unhealthy timing of pregnancy (World Health Organization, 2012). The World Health Organization (2012) asserts the ability of women to adequately control the timing and spacing of pregnancy can dramatically decrease maternal mortality due to pregnancy complications and unsafe abortions, decrease infant …

Breastfeeding Intention Within A Rural Postpartum Population: Does Education Matter?, Brooke Hawkins

DNP Scholarly Projects

Purpose: The purpose of this scholarly project was to determine breastfeeding intention in a rural population after receiving education from a certified lactation consultant.

Review of the Literature: The benefits of breastfeeding for both mother and child are clearly stated in the literature. Despite the known benefits, rates of breastfeeding are decreased within rural populations. Previous research suggests education about breastfeeding benefits is beneficial in increasing these rates. In particular, previous studies focused on the contributing factors affecting a mother’s decision to breast or formula feed. However, few studies were found strictly evaluating breastfeeding intention after receiving formal …

Public Access To Naloxone: Exploring Intention To Prescribe Among Tennessee Nurse Practitioners, Kathryn L. Dambrino

DNP Scholarly Projects

Background

Drug overdose deaths have become an escalating epidemic in the U.S. and surpassed motor vehicle collisions as the leading cause of accidental death. To combat opioid overdose, naloxone distribution to the public has been initiated in some states as a harm reduction strategy. Naloxone has been used for many years among hospital professionals as a life-saving antidote to reverse the respiratory depression effects of opioids, and the FDA has approved take-home naloxone devices for layperson use. Though legislation has been introduced in many states, such as Tennessee, to allow provider prescription of naloxone to laypersons, minimal data have been …

Improving Nurses Knowledge Of Delirium And Implementation Of The R.A.D.A.R. Screening Tool At Two Post Acute Care Facilities In The United States, Kanah Lewallen

DNP Scholarly Projects

Delirium in post acute care patients is under-recognized and linked to poor patient outcomes. Nurses in the post acute care setting are currently not using a standardized tool for assessing delirium, but the literature suggests they should do this routinely. The purposes of this study were to evaluate methods for improving the management of delirium in post acute care and to evaluate the implementation of a new screening tool for delirium (Recognizing Active Delirium As Routine or R.A.D.A.R.). This quasi-experimental study was conducted at two post acute care facilities in an urban location. The study included the implementation of a …

Barriers To Health Care Among Laotian Americans In Middle Tennessee, Xaiyavong Saenphansiri

DNP Scholarly Projects

Background. Laotian Americans have unique heath beliefs and practices. The cultural differences between Laotian American patients and American health care providers can create challenges in achieving not only evidence-based, but also culturally sensitive care. Although the current literature addresses barriers to health care for Asian Americans, there are few studies related to the Laotian-American minority.

Aim. Describing the particular barriers to preventive and curative care in the Laotian-American population in Middle Tennessee would inform strategies for successful prevention and early treatment programs for this population. The purpose of the study is to describe the health beliefs and barriers to …

Pediatric Asthma Telemonitoring: Literature, Theory, And Application To Practice, Erin Christine Shankel

DNP Scholarly Projects

Asthma is one of the most prevalent and costly chronic diseases faced by Americans today. It is marked by inflammation and hyperresponsiveness of the airways which fluctuates, often unpredictably, in response to triggers. As such, it causes particular challenges symptom management, especially on the part of the patient who is tasked with dealing with these frequent fluctuations for months at a time between regularly scheduled health care appointments. This is further complicated when the patient is a child, and symptoms must be interpreted and managed second-hand by a caregiver. Uncertainty about how to manage symptoms, as well as minimization of …