Medicine and Health Sciences Commons^™

Spiritual Care: The Overlooked Need In End-Of-Life Care, Michael Howard Vrmeer

Doctor of Nursing Practice Scholarly Projects

Background: A number of studies have validated the use of the FICA tool to evaluate a patient’s spirituality. FICA has been helpful in many palliative care settings to screen for spiritual problems that influence the patient's overall health. Aim: The project was a quality improvement initiative with the purpose of implementing the FICA tool as part of the admission assessment to increase chaplain referrals for inpatient palliative care services. Methods: The staff received an in-service on using the FICA questions on admission, and a prompt to complete the screen was placed at each work station in the project setting. Results: …

The Impact Of Nurse Leader Learning Labs On Nurse Managers' Perception Of Leadership Competency In The Acute Care Setting, Carolyn Rivers Swinton

Doctor of Nursing Practice Scholarly Projects

Problem Statement: It is critically important that our nurse managers (NMs) have the leadership skills to support the care team in providing safe care to patients. Historically, nurse managers have received minimal training in the leadership role. Failure to address NMs’ coaching needs can compromise the organization's ability to achieve operational goals. Purpose: The project's primary aim was to improve NMs’ perceptions of leadership competency in the acute care setting through experiential nurse leader learning labs. The secondary aim was to demonstrate that the confident and prepared nurse manager can achieve organizational goals in the acute care setting. Method: There …

The Effects Of Debriefing On Nurse Distress After Perinatal Loss, Russin Marie Kelly

Doctor of Nursing Practice Scholarly Projects

Labor and delivery nurses are the first-line caregivers for women suffering a perinatal loss which involves miscarriage, stillbirth, and infant death. This loss of life can cause nurses’ distress. This project proposes using the PEARLS healthcare debriefing tool as an intervention to decrease distress and improve nurse satisfaction. Before and after the debriefing intervention, a survey allowed the nurse to rate their distress from zero to ten using the distress thermometer and answer questions about job satisfaction. The data analyzed shows that the debriefing intervention decreased nurse distress after perinatal loss compared to the prior practice of no debriefing after …

Expanding The Discharge Bundle To Reduce Preventable Readmission Among Adult Patients With Heart Failure, Leah Caccam Ramos

Doctor of Nursing Practice Scholarly Projects

Individuals with a heart failure (HF) diagnosis have a high risk of readmission following hospital discharge, increasing care costs. In an academic medical center (AMC) in Charleston, SC, the all-patient-related DRG of HF had 576 30-day readmissions for FY 2020, equivalent to a 26.3% readmission rate. This project aimed to decrease the readmission rate of adult patients diagnosed with HF admitted to cardiac units in the AMC by expanding the discharge bundle. The current discharge process is not bundled. The discharge bundle elements include HF education, pharmacy medication reconciliation, medication counseling, and appointment to the HF clinic prior to discharge. …

Improving Hand Hygiene In A Rural Critical Access Hospital, Katherine H. Miller

Doctor of Nursing Practice Scholarly Projects

Hand hygiene adherence is the single most important infection control practice among healthcare workers in United States hospitals. Hand hygiene is cost effective and adherence to protocols can reduce hospital acquired infections and employee illness. While hand hygiene adherence has been shown through research to improve patient safety and reduce hospital acquired infections, adherence to hand hygiene protocols among healthcare workers is poor and improvement efforts lack sustainability. A potential barrier to performing hand hygiene includes failure of healthcare workers to realize they are carrying microbes on their hands and what proper hand hygiene is, whether using soap and water …

Post-Discharge Phone Calls In The Emergency Department: Do Follow-Up Calls Increase Patient Satisfaction And Reduce Post-Discharge Complications?, Saraann K. Fagan

Doctor of Nursing Practice Scholarly Projects

Improvements in discharge instructions are necessary in emergency departments (EDs) across the United States (US). Multiple factors, such as the fast-paced environment and varying levels of acuity in the ED, contribute to inadequate discharge instructions and change is necessary to further prevent negative outcomes. The purpose of the evidence-based practice project was to implement post-discharge follow-up phone calls to ED patients to improve patient satisfaction scores regarding discharge instructions for at-home care and to reduce post-discharge complications. The project was implemented over a three-month period in early 2021 in the ED of a local hospital in Charleston, South Carolina (SC). …

Biopsychosocial Multidisciplinary Treatment Impact On Risk Of Opioid Misuse, Michael A. Palacio

Doctor of Nursing Practice Scholarly Projects

From 1999 to 2014, over 165,000 persons in the United States died from an overdose related to prescription opioids (Centers for Disease Control and Prevention [CDC], 2016). In response, the CDC released guidelines that propose nonpharmacologic and nonopioid pharmacologic therapy as preferred methods for chronic pain control (Dowell et al., 2016). The purpose of this project was to examine the biopsychosocial multidisciplinary treatment impact on risk of opioid medication misuse among adult chronic opioid-dependent noncancer pain clinic patients with and without a psychiatric disorder. Engel’s (1977) biopsychosocial model was used to evaluate whether multidisciplinary treatment impacted the risk of opioid …

Attitudes Towards Treating Injured Patients In Urgent Care, Erin Beverly

Doctor of Nursing Practice Scholarly Projects

There has been published literature on the topic of clinician bias and the effects of bias on patient care, however, a review of the literature did not yield any research on the topic of clinician bias towards treating patients injured in motor vehicle accidents (MVA’s). There has been concern about clinicians not preferring to see patients injured in MVA’s however this is only anecdotal. If this topic is to be addressed through quality improvement efforts, there should first be scholarly evidence to support these efforts. This study employed a prospective survey of a convenience sample of clinicians who practice in …

Eastern European Orthodox Christian Immigrant Women: A Pilot Study And Needs Assessment, Kimberly A. Babich-Speck

Doctor of Nursing Practice Scholarly Projects

The healthcare perceptions of the Eastern European Orthodox Christian immigrant women (EEOCIW) to the United States (U.S.) are under-represented in the literature. Although they appear similar to Americans, their cultural and religious traditions are outside the mainstream American culture. This pilot study and health needs assessment examines the women’s healthcare perceptions of 14 EEOCIW and identifies similarities and differences with 25 U.S. born Orthodox Christian women (USOCW). Between September and November 2020, interviews were conducted with Orthodox Christian immigrant women from Eastern Europe and Orthodox Christian women born in the U.S. Questions covered the perceptions of women’s healthcare, factors influencing …

Hospital Acquired Pressure Injuries (Hapi) In Critical Care: A Quality Improvement Project, Bonnie M. Fagan, Susan Butz

Doctor of Nursing Practice Scholarly Projects

In a large mid-western hospital, Hospital Acquired Pressure Injury (HAPI) rates are elevated in critical care units. Education sessions, a visual reminder, and skin rounds may increase use and documentation of 5-layer silicone dressings to prevent pressure injuries. The Plan-do-study-act (PDSA) method for quality improvement and Jean Watson’s Theory of Human Caring were utilized as the theoretical framework for the project. The purpose of the project was to reduce the incidence of HAPI in Medical Intensive Care Unit (MICU) II. Project objectives included education on HAPI prevention and documentation, skin rounds, and the addition of a visual documentation cue on …

Evaluating Va Nurse Acceptance Of Virtual Healthcare Technology During The Coronavirus Outbreak, Francesca Bryan-Couch

Doctor of Nursing Practice Scholarly Projects

At a regional Veterans Administration (VA) hospital, nurses performing case management were unable to perform face-to-face visits with patients due to coronavirus. Care coordination and discharge planning efforts occurred through telephonic case management to preserve personal protective equipment and reduce transmission rates through social distancing. Trust and rapport between patients and nurses were reduced without personal contact. Peplau’s theory of interpersonal relations described six nurse roles and three phases of relationship development required to create therapeutic nurse-patient relationships. Connectedness was a key concept considered to be the path to a successful meaningful therapeutic nurse-patient relationship (Hrabe, 2005).

To evaluate current …

Professional Quality Of Life Indicators And Turnover Intention In Forensic Nurses, Leigh Anne Meyer

Doctor of Nursing Practice Scholarly Projects

Background/Significance: Significant barriers to forensic nurse workforce development exist, affecting patient access to care. Retention of forensic nurses is a persistent problem. Turn-over of forensic nurses can be attributed to many factors related to professional quality of life, including compassion satisfaction (CS), burnout (BO) and secondary traumatic stress (STS).

Methods: A convenience sample of forensic nurse program coordinators was used to identify the effect of an educational session on professional quality of life and strategies for reducing stressors within the role on ProQOL-5 and TIS-6 scores using a pre- post-test quasi-experimental survey design. Correlation between professional quality of life indicators …

Implementation Of A Perioperative Pathway For Individuals With Or At High Risk For Obstructive Sleep Apnea, Kimberly Claude

Doctor of Nursing Practice Scholarly Projects

Background At the Veterans Affairs Boston, pre-operative screening for obstructive sleep apnea using the STOP-Bang questionnaire and referral to pulmonary service for those who fail screening is not reliably completed. For patients identified as having OSA or at high risk for OSA, advice on how to reduce postoperative risk may not be adequately communicated through the perioperative process. The project aim is to construct and implement a perioperative pathway to ensure surgical patients with OSA or suspected OSA receive evidence-based care throughout the perioperative period.

Methods The intervention for this quality improvement project was an evidence-based perioperative pathway which includes …

Identification Of Variables For Hemoglobin A1c Prediction, Erica A. Richards

Doctor of Nursing Practice Scholarly Projects

An evolution in healthcare is taking place throughout our country. Healthcare providers are required to achieve an ever-growing number of regulatory and metric-driven standards. This transformation aims to improve both the quality and cost of healthcare in the United States. Diabetes mellitus (DM) is one of the most costly chronic diseases in the United States. Since DM has high mortality, high morbidity, and low quality of life rates, it is no wonder that DM is one of the focuses of the National Committee for Quality Assurance performance improvement tools known as the Healthcare Effectiveness Data and Information Set (HEDIS). In …

Implementing Telemental Health To Improve Access To Mental Healthcare In Rural Vermont, Julia Mcdougal Ronconi

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Mental health access in rural areas is a national problem. Of strategies to increase access, telemental health has the highest level of evidence.

PURPOSE: This project aimed to implement a telemental health program in rural Vermont to: (a) increase the number of rural-dwelling patients who enter treatment for anxiety and depression, (b) evaluate the effectiveness of telemental health for depression, anxiety, and overall functioning, and (c) evaluate patient satisfaction with the accessibility, quality, and affordability of the service.

METHODS: Adult psychiatric diagnostic evaluation, medication management and psychotherapeutic interventions were delivered via telemental health. The service was marketed to Health …

Nurse Educators Influence On Student Success, Callie Whittington

Doctor of Nursing Practice Scholarly Projects

Passing nursing licensure exams is important to promising nurses. The number of times a graduating nursing student must take The National Council Licensure Examination-Registered Nurse (NCLEX-RN), reflects upon the institution of higher education as a gauge of the quality of their training programs and preparation. Student outcomes are very important to overall standing of the nursing programs, as the first attempt NCLEX-RN pass rates affect status of the nursing program. The nurse educator’s role in student success is vital and the level of education for the nurse educator can play a valuable part in this as well.

The researcher of …

Reducing Missed Appointments With Specialized Appointment Reminders, Lindsay Sanders

Doctor of Nursing Practice Scholarly Projects

Specialized appointment reminders (SAR) via the neurodiagnostic team (NDT) reduce missed appointments (MA) for neurodiagnostic (ND) outpatient testing (OT) compared to other types of appointment reminders (AR) via the Central Scheduling department (CSD). MA have negative consequences for patients and the healthcare organization. MA interrupt the patient's continuum of care and contribute to negative outcomes in the patient's condition. MA negatively impact the healthcare organization by creating an imbalance of labor productivity due to the testing area appearing to be overstaffed. Other patients have limited access to care due to MA taking up a time slot on the schedule, which …

Understanding The Prevalence Of Compassion Fatigue, Compassion Satisfaction, And Resilience In Primary Care, Christina M. O'Connell

Doctor of Nursing Practice Scholarly Projects

Compassion fatigue (CF), its components of burnout (BO) and secondary traumatic stress (STS), and compassion satisfaction (CS) affect healthcare providers and staff and can dramatically influence patient care and access to primary care services. Resilience is a tool which serves as a protective factor that can mitigate CF and enhance CS. There is a gap in research regarding the relationship between compassion fatigue, compassion satisfaction, and resilience among primary care providers and frontline staff. Additionally, the current COVID-19 pandemic has revealed healthcare’s deficits related to staff and provider burnout, a myriad of workforce safety issues, disparities in care, and a …

Perceived Critical Success Factors For Native American And Non-Native American Pre-Licensure Nursing Students In Northern New Mexico, Karen E. Nielsen

Doctor of Nursing Practice Scholarly Projects

Considering the consistent healthcare system load demands, nursing shortages persist, especially in remote areas of the United States. It is vital that students interested in attending nursing school and working in their home communities have expanded nursing program access and supports in order to supply the necessary nursing workforce in remote areas. Lack of diversity in the nursing profession weakens healthcare delivery. Native Americans are underrepresented as nursing students and employed nurses. Measures to provide a more diverse workforce should concentrate on recruitment, retention, and graduation rates of underrepresented minority nursing students. Limited research is available surrounding Native American nursing …

Evaluating The Impact Of A Mindfulness Intervention On Mindful Attention And Awareness, Resilience To Stress, And Perceived Stress In Newly Licensed Nurses In A Nurse Residency Program, Vicki L. Washington

Doctor of Nursing Practice Scholarly Projects

Background: A career in the healthcare profession of nursing provokes significant stress in newly licensed nurses. Previous studies suggested that mindful practice enhanced well-being by bringing awareness to thinking and living in the present moment (being mindful), decreased stress, and enhanced resilience to stress. Purpose: The purpose of this study was to evaluate the impact of a mindfulness intervention on mindful attention and awareness, resilience to stress, perceived stress, and health status in newly licensed nurses in a nurse residency program (NRP).
Methods and Procedure: This mixed-methods quasi-experimental study used a pretest-posttest design with an intervention and comparison group. Surveys …

Preoperative Education In Lumbar Fusion Patients: Impact On Postoperative Disability Perception, Megan Curtis

Doctor of Nursing Practice Scholarly Projects

Background/Review of Literature: A lumbar fusion is a complex surgical intervention with many postoperative guidelines and restrictions. Preparing patients with surgery specific education has shown to decrease their sense of disability and postoperative pain in other surgical specialties, but a disparity exists in spinal surgery.
Purpose: To examine the effect of a preoperative education class for lumbar fusion patients on their perceived level of disability, the number of patient phone calls made to the neurosurgery office, the number of postoperative emergency room (ER) visits, and the number of hospital readmissions after surgery.
Methods: A quality improvement project utilizing a quantitative …

Feasibility And Acceptability Of A Process Change For Patients With Medicaid To Receive Larc In A Private Obgyn Office, Laura Mills

Doctor of Nursing Practice Scholarly Projects

Background and Review of Literature: Long-acting reversible contraception (LARC) is an effective form of contraception that has been shown to have high rates of satisfaction and few contraindications for patients. However, patients with Medicaid coverage may face barriers and challenges in obtaining LARC. Often, providers in small obstetrics and gynecology (OBGYN) private practices are unable or unwilling to provide LARC placement due to financial burdens as a result of limited Medicaid reimbursement. Regardless of insurance carrier or size of practice, patients should have access to the contraception method of their choice.
Purpose: This project aims to determine the feasibility and …

Mentorship Experience Among Nurse Practitioners, Chelsea L. Noble

Doctor of Nursing Practice Scholarly Projects

Background and Review of Literature: The current literature provides the context of mentorship and its benefits across various disciplines. Nursing and medicine use mentorship frequently to guide each new generation of healthcare providers. There is a current lack of research focusing on nurse practitioners as it relates specifically to mentorship.
Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate mentorship in nurse practitioners and across subspecialties.
Methods: A descriptive correlational study was conducted. Data were collected using the Mentor Evaluation Tool (MET) and the National University Hospital Mentorship Evaluation (NUH ME) tool that were administered …