Medicine and Health Sciences Commons^™

An Evidence Based Evaluation Of Patient Outcomes After The Implementation Of A New Model Of Care For Adolescent Inpatient Psychiatry, Karen Dorr

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The use of seclusion and restraint on psychiatric units can result in physical harm or even death to patients and may inflict further harm on those who have a history of abuse (Valenkamp, Delaney, & Verheij, 2014, p. 170) (Greene, Ablon, & Martin, 2006) (Martin, Krieg, Esposito, Stubbe, & Cardona, 2008). Reduction in seclusion and restraint is a basic tenant of trauma informed care. This retrospective review and program evaluation examines the implementation of a new care model on an adolescent psychiatry unit at a large suburban hospital. The new care model incorporated the use of collaborative problem solving, an …

The Effect Of Implementing Symptom Feedback Into Psychiatric Care At A Non-Profit Clinic, Deirdre Rea

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Healthcare is moving toward a value-based system with reimbursement based on performance. Charitable organizations providing health services need to demonstrate positive outcomes for continued grant funding. Measurement-Based Care (MBC) is evidence-based, can improve patient outcomes and objectively document success. Studies show most psychiatric providers do not utilize MBC in their own practices citing lack of time, and a belief that their clinical judgment supersedes a measurement tool. The purpose of the study was to establish the use of patient-reported symptom measurement tools in a non-profit psychiatric clinic and determine if an office-based strategy to proactively and regularly report to …

Improving Staffing At A Southern Virginia Hospital Using Bardach’S Policy Analysis And The Ihi Triple Aim Framework, Caitlin Crowder

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Nurse staffing is a major concern for healthcare organizations. Ensuring adequate staffing is crucial to providing quality, patient-centered care. The purpose of this project was to explore staffing policy options at a Southern Virginia Hospital using Bardach’s policy analysis and the IHI Triple Aim as frameworks. This policy analysis was conducted to offer a solution for staffing. The current staffing model at this rural Southern Virginia hospital resulted in ongoing, escalating costs that cannot be sustained over time. The three staffing options reviewed included: allowing the current staffing plan to stay in place, implementing a staffing committee, and implementing a …

Reducing Inpatient Falls On A Cardiovascular Progressive Care Unit: A Quality Improvement Study To Implement Interprofessional Intentional Rounding, Deidra Pennington

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Patient falls remain a significant concern for hospitals despite years of focus and research on the topic. Most hospitals have robust fall prevention policies in place containing numerous interventions, yet few demonstrate evidence of long-term sustainability in fall reduction. Patient falls impact overall health outcomes and result in higher costs for the patient and facility due to increased lengths of stay and more medical tests. The location for this study was the cardiovascular progressive care unit (CVPCU) at a Level 1 Trauma Center and academic hospital. This unit underwent a relocation and merger of two nursing units in the fall …

Developing And Implementing Trauma Informed Care Principles: A Pilot Project, Lisa Blair Bell

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Exposure to childhood trauma have lifelong consequences effecting the health and well-being of the individuals who experienced or witnessed the trauma. As healthcare providers, we must recognize patients who have been exposed to trauma and ensure that it is responded to appropriately. This approach is known as trauma informed care.

Objective: The purpose of this quality improvement project was to increase knowledge, opinion, and self-rated competence related to trauma informed care through the use of an educational intervention. Application of trauma informed care into daily practice was monitored through semi-structured interviews with project participants.

Methods: Registered nurses from the …

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

Measuring Levels Of Preparation For Decision-Making And Patient Satisfaction In A Breast Cancer Support Group, Catherine Hagan Aylor

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The Carilion Clinic Breast Diagnostic Center diagnoses approximately 250 women with breast cancer annually, all of whom are invited to attend the Carilion Clinic Breast Cancer Support Group (CCBCSG). The primary aim of this project was to evaluate if participants with more frequent attendance of CCBCSG had increased levels of preparation for decision-making (PDM) and higher satisfaction with breast cancer treatment decisions. A REDCap survey was emailed to 137 patients who participated in at least one CCBCSG within the past five years, with a 39.4% response rate. The survey assessed levels of patient PDM, patient satisfaction about treatment decisions, and …

Improving Hepatitis C Screenings In The 1945 To 1965 Birth Cohort In Outpatient Primary Care, Betina Muse Nakoda

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Hepatitis C virus (HCV) is a silent epidemic affecting a vulnerable patient population in our society. Among those considered high risk for having HCV are those individuals born between 1945 and 1965, termed the baby boomer population. Baby boomers are five times more likely to have and suffer mortality from HCV than any other patient population (CDC, 2018). HCV may not present with signs or symptoms until 20 to 30 years post contraction of the virus (CDC, 2018). In 2012, the Centers for Disease Control and Prevention (CDC) updated its recommendations for Hepatitis C screenings to include the baby …

Video Education: A Quality Improvement Project For Patients With Type Ii Diabetes, Brandon Lipscomb

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Background: Quality diabetes education is a key to successful diabetes treatment. Factors that hinder quality diabetes education include: allotted time for appointments, provider-patient communication, inter-personal relationship between provider and patient, and patient’s educational level. Locally speaking, the Central Virginia area has a higher rate of diabetes then compared to the average rate of diabetes in the State of Virginia. To complicate this more, the local area has a higher percentage of poverty when compared to the average poverty level of the state. Combining these two characteristics places these individuals at a higher risk for disease complications and expresses a …

What Is Baseline? A Concussion Policy Analysis, Jenny H. Crance

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract Concussion symptoms are nonspecific and may be related to other causes. Symptom scores and timeline of return to activity at many institutions are based on having no symptoms at baseline with the current measurement tools. This assumption in the diagnosis and treatment of concussions may lead to prolonged return to activity, compounded concussion symptoms, and unintended psychological and social sequelae. More baseline data is needed, especially in military academies, according to the CARE Consortium Study. During the high-stress initial training period at one mid-Atlantic military college a no-symptom baseline is unlikely for first-year students. The potential overlap of concussion …

An Evaluation Of A Pilot Inpatient Hospice Unit And The Impact It Has On End-Of-Life Care At An Academic Medical Center, Cynthia Minetree

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Research shows that acute care hospitals with inpatient hospice units have an increase in hospice resource utilization and provide end-of-life care that is more aligned with patients’ end-of-life goals compared to hospitals that do not have inpatient hospice units.

Methods: A pilot six-bed General Inpatient (GIP) hospice unit was implemented at an acute care hospital, located in Washington, D.C., to provide hospice care for patients that were not able to transfer to another inpatient setting for hospice care. A six-month evaluation of the pilot GIP hospice unit was done to evaluate the feasibility of the unit and the impact …

The Effect Of Provider Education On Discharge Information Grade Level And Readability, Amber V. Balzer

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Problem: The peri-discharge period for patients can be a complex and dangerous time. A large urban academic medical center with a readmission rate approaching 16% utilizes a standardized template called a Discharge Information Form (DIF) to convey information to inpatients at the time of their discharge. The problem is a lack of individualization with a universal template such as the DIF. Moreover, the readability and literacy level of the DIF have not been previously assessed.

Methods: A random sample of DIFs was assessed for literacy level using the Flesch-Kincaid Readability Test Tool. An in-person educational intervention was administered to a …