Health and Medical Administration Commons^™

Implementation Of An Evidence-Based Guideline To Improve Vital Sign Assessment And Documentation In The Emergency Department, Mary Darden Mason, Jennifer Lynn Smith, Laura Sturla

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: The emergency department (ED) is a fast-paced area at risk for medical errors. Studies have found that patients with abnormal vital signs (VS) experience preventable adverse events and worse process outcomes, such as extended length of stay (LOS) times and increased readmission rates. Despite ongoing reports of VS inconsistencies, there remains a lack of evidence-based VS assessment and documentation standards across healthcare, which results in missed opportunities to mitigate deficits in quality of care.

LOCAL PROBLEM: The project site, a 19-bed rural ED in Maryland, lacked a standardized process delineating VS assessment frequency for the ED nurses, …

Implementation Of A Continuing Education Module On Triage Practices For Pediatric Emergency Room Nurses, Catherine Nicholson, Lindsey Lakas, Marian Malone

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: More than 35 million U.S. children visit the emergency department (ED) each year. Triage is the family’s first interaction with the healthcare team and a crucial component of care that directs the course of the ED visit. The use of standardized triage protocols, like the Emergency Severity Index (ESI) algorithm, is shown to improve overall patient health outcomes in the pediatric ED. For triage algorithms to be safe and effective, continuing education for pediatric ED nurses is important.

LOCAL PROBLEM: Patients at a local pediatric emergency department are being inaccurately triaged - assigned a higher or lower acuity level …

Implementation Of A Screening, Brief Intervention, And Referral To Treatment Protocol For Treatment Of Opioid Use Disorder In Post-Carceral Populations, Adaora Ede, Mary Johnson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Opioid use disorder (OUD) is a pressing public health issue in the US affecting marginalized populations the most. Within the correctional setting, 65% of inmates are affected with OUD, worsening health outcomes when untreated.

LOCAL PROBLEM: This evidence-based practice (EBP) project targeted justice-involved individuals with co-occurring OUD at a behavioral health clinic in Johnson City, Tennessee. This project aimed to improve outcomes related to recidivism and relapse through clinician education and the implementation of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol.

METHODS: Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was the guiding EBP model for the …

Mindfulness-Based Educational Module For Nurses Caring For Pediatric Mental Health Patients, Brianna Mai Desjardins, Katherine Marie Newnam

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Emergency pediatric nurses have the added stress of not only caring for medical patients but must also care for patients experiencing mental health issues. Many nurses feel unprepared to care for this specialized patient population. To bridge this gap, mindfulness-based interventions (MBIs) have been shown to provide nurses with the skills needed to care for mental health patients. This same concept can be applied to pediatric patients. Pediatric-focused mindfulness-based techniques can be used to help pediatric patients manage their symptoms.

LOCAL PROBLEM: The setting for this project was an urban pediatric emergency department in East Tennessee. At the state …

Evaluation Of Registered Nurses’ Knowledge And Confidence In Encouraging Cardiac Surgery Patients To Participate In Digital Education, Katelin A. Welch, Jewyl Gibson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Background: Cardiac surgery remains a necessary means of medical management for cardiac disease. Patient anxiety is a common mental health challenge experienced by cardiac surgical candidates. Preoperative educational videos can reduce anxiety and improve the surgical experience.

Local Problem: This project was conducted for hospital nurses caring for cardiac surgery patients. Cardiac patients are assigned digital education to educate them about their procedures. Regardless of availability, nurse and patient engagement of the material is low. Competing nursing priorities prevent nurses from disseminating education to cardiac surgery patients, thus increasing patient anxiety. Educating nurses on utilizing digital surgery …

Psychosocial Consequences Of Diagnosed Malignant Melanoma, Savanna Eve Smallwood-Corcoran, Mary Johnson, Lindsay Frazier

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Psychosocial consequences frequently accompany the diagnosis of malignant melanoma (MM), such as fear, anxiety, burden, and distress. Patients are not receiving the proper psychiatric care needed to address the psychosocial consequences they are experiencing. Patients diagnosed with MM have expressed a lack of assessment and supportive care by providers to address psychosocial consequences they are experiencing.

LOCAL PROBLEM: The setting for the quality improvement project was a private dermatology clinic in Knoxville, Tennessee. There was no standard procedure for anxiety screening at the site. Comparable to published studies, there is a lack of procedures for screening patients …

Identifying Risk And Improving Outcomes: Application Of The Gad-7 Screening Tool Used Among Patients With Chronic Pain In An Outpatient Setting, Connor J. Cochran

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: It is estimated that chronic pain affects one in every five adults and that one in every three adults will be diagnosed with an anxiety disorder within their lifetime, indicating an overlap in both chronic pain and anxiety. Early identification of anxiety in the outpatient setting has the potential to increase identification and referral rates to specialized care.

Local Problem: An outpatient primary care facility that treats patients with chronic pain located in Philadelphia, Pennsylvania was the project setting. Prior to implementation, there was no standard process for identifying anxiety in patients.

Methods: The Iowa model of Evidence-Based Practice …

Improving Human Papillomavirus (Hpv) Vaccination Rates Through Age-Based Flagging, Savannah Jo Garcia, Karen Lasater

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

DNP SCHOLARLY PROJECT ABSTRACT

BACKGROUND: Over forty million Americans are currently infected with human papillomavirus (HPV). HPV can cause life threatening cancers of the cervix, vagina, vulva, penis, anus, and throat. Only half of U.S. adolescents have completed the HPV vaccine series.

LOCAL PROBLEM: The setting for this evidence-based improvement project is a rural family practice clinic in Texas. Texas has the largest group of teenagers not protected against HPV in the country. The project’s purpose is to investigate the effect of age-based flagging on adolescent vaccination rates in a rural community through evidence-based practice.

METHODS: Project …

Implementation Of Standardized Contraceptive Education To Improve Larc Initiation In Postpartum Individuals, Gracie E Clayton, Melissa M. Hessock, Amanda Flood

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Approximately 50% of pregnancies in the United States are unintended, leading to negative health, psychosocial, and financial outcomes. Supported methods for preventing unintended pregnancies are promoting education and access to highly effective contraceptive methods, including long-acting reversible contraceptives (LARCs). Studies demonstrate counselor knowledge and bias contribute to underutilization of LARCs, highlighting the need for standardized education.

LOCAL PROBLEM: The setting for this practice improvement project was a rural obstetrical unit in Tennessee where there was no standardized postpartum contraceptive education. Rates of contraceptive use at postpartum discharge were low. The purpose of this project was to implement …

Pediatric Vaccine Pain Management & Perceptions Of Caregivers And Nursing Staff: An Evidence-Based Project, Madison K. Bears, Tami H. Wyatt

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: In an age with many diseases controlled through immunization and herd immunity, the significance of immunization can wane in public memory. In children, injection pain is an obstacle to vaccination and can cause anxiety around medical visits, healthcare avoidance, delayed immunizations, and needle fear (McMurty et al., 2015; Shah & Sui, 2019; Taddio et al., 2022). Evidence-based vaccine pain relief techniques are described in the literature (Shah et al., 2009; Wu et al., 2022; Taddio et al., 2015), yet their use in practice is minimal (Taddio et al., 2022).

Local Problem: An evaluation of a pediatric clinic …

Acute Stress Disorder And Post-Traumatic Stress Disorder Screening In Pediatric Trauma Patients, Samantha Irizarry, Marian Malone, Megan Waddell

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Two-thirds of U.S. children and adolescents report experiencing one or more potentially traumatic events by age seventeen. 13.4% of the North Carolina pediatric population ages 0-17 have undergone two or more traumatic adverse childhood experiences, compared to 14% of the U.S. population. Early identification reduces the by-products of underdiagnosis of ASD and PTSD, such as mental illness, developmental delays, poor academic performance, and challenges with social interactions.

LOCAL PROBLEM: The project site is a level-one pediatric trauma hospital in Charlotte, North Carolina, seeing more than 130,000 patients annually. Before project implementation, there was an absence of ASD …

Reducing Iatrogenic Opiate Withdrawal In The Picu: An Evidence-Based Practice Improvement Project, Kaitlin Kirk Ogle, Marian Malone, Will Guider

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Current recommendations to reduce pain associated with mechanical ventilation is the administration of opiate and benzodiazepine infusions for Pediatric Intensive Care Unit (PICU) patients. If these infusions are weaned too quickly, iatrogenic withdrawal syndrome (IWS) often occurs. IWS symptoms include tachycardia, hypertension, diaphoresis, fever, irritability, tremors, clonus, hyperactive reflexes, vomiting, and diarrhea. Untreated IWS can lead to life-threatening complications.
LOCAL PROBLEM: The PICU at the project site contains fourteen beds and treats critically-ill pediatric patients. There was no standardized withdrawal assessment tool in practice. The purpose of this project was to implement the Withdrawal Assessment Tool-Version 1 …

The Effect Of Focused Client Education On Case Management & Readmission Rates In Homeless Individuals With Co-Occurring Disorders Admitted To A Jail Diversion Program, Pallavi Rao, Mary Johnson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Individuals with both mental illness(es) (MI) and substance use disorder (SUD) occurring simultaneously are known as having co-occurring disorders (COD). The rates of COD found among homeless individuals (H-COD) are higher than in the general population. The presence of both conditions prevents H-COD individuals from overcoming their hardships and places them at a higher risk of being involved in the criminal justice system.

Local Problem: Jail diversion programs (JDPs) admit a high rate of H-COD clients nationally and locally at the project site in Knoxville (JDP-K). The Office on Homelessness reported about 80% of those admitted to JDP-K are …

Initiating A Skin-Care Bundle In The Emergency Department To Decrease Hospital-Acquired Pressure Injuries In Geriatric Patients, Suzanne Babcock, Pamela Hardesty

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Adults 65+ comprise 15.2% of the United States (U.S.) population and 17.9% of Emergency Department (ED) visits. Aging causes changes to skin, including thinning and loss of elasticity. Annually, in the U.S., 2.5 million individuals develop Pressure Injuries (PI), causing 60,000 deaths. Hospital acquired PIs in the U.S. cost $26.8 billion annually, over $10,000/patient and increase the length of stay by greater than four days.

LOCAL PROBLEM: This project occurred in a 27-bed Geriatric Accredited Emergency Department in a southeastern U.S. city where patients 65+ comprise 40% of the patient volume annually. PIs can begin developing within two hours. …

Sleep Hygiene Interventions For Hospitalized Pediatric Patients, Courtland E. Kunz, Marian Malone

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

ABSTRACT

BACKGROUND: Adequate sleep is found to improve overall physical and mental health. Unfortunately, hospitalized children receive significantly less sleep than what is recommended by the National Sleep Foundation.

LOCAL PROBLEM: Patient and family feedback at the project site demonstrated inadequate sleep and a noisy hospital environment. The objective of this EBP project is to improve sleep for the hospitalized pediatric patient.

METHODS: The Johns Hopkins Evidence Based Practice Model for Nurses and Healthcare Providers was used as the framework for this project. The PROMIS Sleep Disturbance 4a questionnaire was the tool used to measure pediatric patients’ …

Reducing Hopelessness In Patients With Parkinson’S Disease: Educational Intervention, Kara R. Callear, Pamela Hardesty

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Reducing Hopelessness in Patients with Parkinson’s Disease: Educational Intervention

BACKGROUND: Parkinson’s disease (PD), features several non-motor manifestations, including cognitive dysfunction, which impacts patients and their families. Depression, hopelessness, and anxiety are all prevalent in the psychiatric conditions of PD. In fact, at least 50% of those diagnosed with PD will experience some sort of depression, hopelessness, or anxiety disorder after diagnosis (Ray & Agarwal, 2020). The specific purpose of this project was to help patients with PD diagnosis feel less hopeless and more resilient when coping with their symptoms of PD.

LOCAL PROBLEM: The project setting was a …

Improving Oncofertility Discussions And Referrals: Implementation Of A Formal Fertility Preservation Program, Mackenzie Danielle Browning, Melissa Marie Hessock

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Impaired fertility is a risk of life-saving cancer treatment in adolescents and young adults (AYAs). Despite this known risk and clinical practice guidelines that stress their importance, treatment-associated fertility risk education and preservation referrals are often neglected in this population.

LOCAL PROBLEM: The site of this evidence-based practice improvement project is an outpatient hematology-oncology clinic serving adults with varying cancer diagnoses. The site did not have a standardized approach to ensure treatment-associated fertility risk education and fertility preservation referrals were provided to AYAs with newly diagnosed cancer. The purpose of this project was to implement a formal fertility preservation …

Ultrasound-Guided Intravenous Access As A First-Line Approach By Nurses: A Quality Improvement Project, James Austin Burkhart, Pamela Hardesty, Melissa Mcdonald

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Up to 9% of patients admitted to EDs (Emergency Departments) have difficult intravenous insertion access issues (DIVA). This creates delays in patient care that includes interruptions for physicians providing medical emergency care. Often the utilization of RNs to perform US (ultrasound) IV insertions is limited related to lack of training and supportive policies.

Local Problem: The site for this project was an ED Level 1 Trauma Center associated with a large teaching hospital located in the southeastern U.S. Prior to the implementation of the process improvement project, there was no formal education of RNs in the use of US …

Implementation Of Standardized Patient Education To Improve Adherence With Colonoscopy For Colorectal Cancer Screening, Melissa Leal Hearn, Melissa M. Hessock, Tara L. Hahn

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Colorectal cancer (CRC) is the third leading cause of cancer deaths among men and women in the U.S. CRC is preventable and manageable when detected early. Approximately 30% of average-risk Americans are overdue for colonoscopy screening. Colonoscopy screenings can reduce death by 67%. Current evidence suggests CRC screening education improves screening uptake among men and women at average-risk age.

LOCAL PROBLEM: The setting of this practice improvement project was a private colorectal surgery practice in South Texas, serving primarily Hispanic/Latino and Caucasian patients. Cancellation rates before colonoscopy were 16.8%, and there was no standardized education for CRC …

Decreasing Perioperative Medication Errors With Standardized Labeling Education, Stephanie Mccain, Emily Almond, Anna Wong, Julie Bonom

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Medication errors are prevalent within the perioperative setting (Wahr et al., 2017). The anesthesia provider is the sole professional in charge of the medication process in the operating room, which results in fewer safety checks than in other healthcare settings (Nanji et al., 2016).

LOCAL PROBLEM: The proposed scholarly project aimed to reduce medication errors at an academic medical center in the Southeast using an educational module focused on standardized narcotic syringe labeling. The participants were anesthesia providers in the operating room at the project site.

METHODS: The Evidence-Based Practice Improvement model was used to guide the development, implementation, …

Implementation Of A Single-Patient-Use Airway Taping Product In The Operating Room, Savannah Sierra Nicole Craig, Kaitlin D. Burrell, Jennifer Patrick

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Anesthesia providers use adhesive tape to secure advanced airway devices. Rolls of adhesive tape serve as reservoirs for pathogens. Rolls of tape do not have instructions on how they are to be reused, cannot be disinfected, and should not be repurposed. The re-use of rolls of tape poses a risk to patient safety.

LOCAL PROBLEM: The project facility was an academic medical center in the Southeast region of the United States. The facility does not have taping practice guidelines in place. Rolls of tape are handled without gloves, used by several providers, placed on multiple patients’ faces, and stored …

Implementation Of Standardized Handoff Report In The Post Anesthesia Care Unit, Christie Faye Cox, Godsy Raju, Alyssa Garcia, Nicole Odom, Jennifer Patrick

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Handoff communication is a critical event as it involves the transfer of patient details, authority, and responsibility from one clinician to another. The variations in handoff can lead to increased opportunities for clinician error due to the distinct possibility of the anesthesia providers omitting critical patient information.

LOCAL PROBLEM: The site for this quality improvement project is an academic medical center in the Southeastern region. The purpose of this quality improvement project was to implement a standardized anesthesia handoff tool for anesthesia providers. The aim of this project was after one month of implementation, the mean anesthesia …

Educational Intervention On Pediatric Concussions For Providers, Melissa Callaway, Robert Cornette

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

The purpose of this project was to find a gap in care within my community and fill the need with evidence-based practice. The process of evidence-based practice requires systematically searching and grading existing literature and basing a recommended practice change based on what is discovered. The recommendation is then applied translated to clinical practice. For the purposes of this project, the community which I am a part of needed improvement on the education of healthcare providers regarding post- concussive care in the pediatric population. Regardless of the explosion of research in concussions- translation to practice remains deficient. Concussions remain a …

How Nurses Perceive Their Task Load When Caring For Behavioral Mental Health Patients In The Pediatric Emergency Department, Emily Cameron, Robert Cornette

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Introduction: Pediatric behavioral mental health patients are being seen more frequently in the emergency department setting. With this ever-growing number of cases comes the need for trained staff, including registered nurses, to care for these children during a mental health crisis. With this increase comes increased stress of nurses’ workload. The purpose of this project was to identify nurses’ perceptions of their workload when completing three identified tasks: communication, procedures, and initial intakes. Methods: The National Aeronautics and Space Administration (NASA) Task Load Index tool was used to measure nurses’ perceptions of how difficult each task was to complete. …

Effectiveness Of An Evidenced-Based Cognitive Behavioral Therapy Intervention For Adolescents In A School Setting, Sarah Ellen Gray, Kimberly Michaela Carter, Amanda Harper

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

The adolescent years are a formative time when rapid hormonal and physical changes stimulate the developing mind. Exposure to poverty, abuse, violence, and lack of peer and social support causes an increase in vulnerability to the development of mental health problems. The COVID-19 pandemic has also exacerbated symptoms of depression and anxiety. Regardless of the risk factors, anxiety and depression continue to be significant health problems, affecting thousands of adolescents yearly in the United States. The first-line treatment recommendation for managing anxiety and depression symptoms is cognitive behavioral therapy (CBT). However, access to a provider for CBT treatment is …

Quality Improvement Project To Improve Patients' Satisfaction Of Care With Implementation Of A Standardized Telephone Communications Pathway, Brandie Haga, Nicole Dunford, Karen Lasater

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

With more and more cancer care being delivered to patients in an outpatient setting, it is becoming essential for clinics to have a standardized telephone communication pathway system. A telephone communication pathway can positively impact patients' quality of life since we know that delaying medical care can negatively impact health, creating otherwise avoidable complications and stress and diminishing patients' confidence in their care. Without a well-developed telephone communication pathway system, symptom management and experience suffer, and the quality of patient care decreases. A strategy was formulated to assess patient satisfaction with a newly implemented standardized telephone communication pathway form using …

Implementation Of A Home-Based Walking Program To Address Cancer-Related Fatigue, Mary Catherine Hyatt, Karen Lasater, Michelle Payne

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Background: The non-treatment of cancer-related fatigue (CRF) in adult oncology patients on treatment is a clinical practice issue identified globally and at the local Hematology and Oncology Clinic. Despite the growing evidence supporting physical activity to address CRF, this problem remains prominent. Objective: An 8-week home-based walking program was implemented at the local clinic to address this problem. This project aimed to increase the prevalence of managing CRF and reduce the severity of CRF. Methods: With the provider's recommendation, adult oncology patients on active treatment at the Hematology and Oncology Clinic registered for the program in …

Implementation Of An Evidence-Based Diabetic Screening Tool In Rural Belizean Communities, Morgan Lee Taylor, Annelyse Caffrey

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Significance/Background: Type II Diabetes Mellitus (TIIDM) is a growing epidemic in Belize. The prevalence is increasing yearly, responsible for considerable health complications and deaths. Rates are much higher in Belize than in any other developing Central American country, and many rural citizens are undiagnosed and untreated. Access to healthcare is complex, and travel is often required in rural areas. Primary care visits in Belize are significantly less than in surrounding North and Central American countries. As a result, chronic illnesses such as TIIDM often go undiagnosed among children, adolescents, and adults- leaving TIIDM a leading cause of death in Belize. …

Non-Opioid Pain Relief: Use Of Vitamin D In Central Appalachia, Christina Brown, Karen Lasater, Teresa Tyson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Overdose deaths have exceeded US war fatalities since WWII. Central Appalachia faces high substance use rates and poor health determinants. The opioid epidemic costs $740 billion annually. Providing 100 million chronic pain sufferers alternative pain control is efficacious, equitable, and reduces opioids. The author collaborated with a nurse-led mobile clinic in Central Appalachia to identify evidence-based non-opioid pain relief options for practice translation. In patients with hypovitaminosis D, the body will increase parathyroid hormone production to absorb calcium resulting in skeletal or muscular pain. Vitamin D’s steroid properties reduce inflammation by dampening proinflammatory cytokines. Framework: The Johns Hopkins Nursing …

Implementation Of Provider-Completed Asthma Action Plans In A School Setting, Madison G. Branham, Amanda Harper

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

This evidence-based practice project aimed to implement and evaluate the use of a provider-completed asthma action plan (PCAAP) in a school-based setting by evaluating the number of school absences and unscheduled healthcare visits related to asthma exacerbations. This project was implemented in a middle school setting over a three-month period, using the Iowa Model to guide intervention. Data were collected via chart review to compare the number of absences and unscheduled asthma-related healthcare visits from the current academic year to the same time in the previous year. Although the number of unscheduled asthma-related healthcare visits was not impacted, data show …