Pediatric Palliative Care Training To Advance Nurses’ Knowledge And Increase Patient Referrals, Whitney Lynn Stone, Lisa Merritt, Tammy Childers

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

Objective: The purpose of this evidence-based practice quality improvement project was to implement an educational intervention to improve pediatric palliative care services in a Pediatric Intensive Care Unit (PICU). The goal was to improve nurses’ knowledge of palliative care and increase the number of palliative care consults.

Methods: Educational sessions were created using the End-of-Life Nursing Education Consortium (ELNEC) Pediatric Curriculum. Participants included 46 PICU nurses. Knowledge of palliative care was measured at three timepoints; pre-, immediately post- and four weeks post-intervention. The number of palliative care referrals were measured at two timepoints; three months pre- and three months post-intervention. …

Pressure Injury Prevention: A Quality Improvement Project Utilizing Incontinence Care Education, Laura Renner

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

Objective: Evaluate whether the initiation of incontinence care education can improve pressure injury knowledge by an average of 5% in post-test scores over 1 month. Design: Theoretical Framework: Lewin’s Three-Step Model for Planned Change and Evidence-Based Practice Improvement Model. Setting/Local Problem: A 20-bed acute care geriatric unit in a large metropolitan hospital in middle Tennessee with inappropriate use of incontinence management products. Participants: Nurses and nursing assistants employed at the project site. Intervention/Measurements: An educational tool was developed to improve knowledge on pressure injury prevention through incontinence management. A pre-test and post-test were conducted immediately before and after educational tool …

Implementation Of An Educational Guide To Improve Icu Delirium Awareness And Detection, Samantha Payne, Samereh Abdoli

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

Intensive care unit (ICU) delirium is a prevalent condition that can occur in up to 80% of critical care patients. It can increase hospital length of stay, morbidity rates, and recovery time. It can also demand higher costs for care and long-term effects on the patient. A good practice statement, issued by the Society of Critical Care Medicine, acknowledges the importance of delirium awareness (Devlin, 2018). For ICU nurses, educational approaches of ICU delirium have shown significant increases in delirium awareness and detection. The purpose of this project was to determine if an evidenced-based education program on delirium would improve …

Utilization Of A Drug Use Screening Assessment: A Quantitative Study To Reduce Benzodiazepines In Inpatient Detoxification, Malerie Lazar Bolinsky, Mary Johnson, Sarah Devault

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

The use of benzodiazepines in the inpatient psychiatric setting is common for patients undergoing drug and alcohol detoxification but does not come without risks. Too high of a dose of benzodiazepines are often administered during detoxification when patients are not adequately assessed on admission. Current literature supports utilization of a screening tool for drug use can reduce unnecessary benzodiazepine use. This study implemented the Drug Use Screening Tool in a drug and alcohol detoxification unit of inpatient psychiatric hospital to evaluate severity of drug use on admission and established a statistically significant reduction in the use of as-needed benzodiazepines prescribe.

The Implementation Of An Evidence-Based Intervention To Increase Physical Activity In Overweight And Obese Children, Mollie Katherine Dowland

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

Abstract

Background: Childhood obesity is an expanding issue of social and medical concern that requires a multidisciplinary approach for prevention and treatment (Ross et al., 2014). With 13.7 million children and adolescents in The United States considered overweight or obese, it is evident that change needs to transpire. Literature supports the use of behavioral incentives to increase a child’s physical activity, maintain or decrease weight, and improve body mass index (BMI) over time (Allafi, A., 2020; Finkelstein, E. et al., 2013; Groffik, D. et al, 2008; Staiano, A. et al., 2017).

Methods: This project executed change through the facilitation of …

Overcoming Barriers To Implement Depression Screening Post-Stroke, Cameron Haeseker, Erin Morgan, Eric Wilson

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

Abstract

Background

One-third of all stroke survivors are expected to develop post-stroke depression, which is linked to lower quality of life, impaired recovery, increased risk of recurrence and an overall increase in mortality (Robinson & Jorge, 2015).

Objectives

Despite this link, outpatient clinics including the stroke clinic of focus do not consistently use a formal depression screen. Therefore, a pilot project utilizing the framework of the IOWA Model of Evidence Based Practice to implement this American Stroke Association recommended guideline may result in a permanent adoption of screening (Iowa Model Collaborative, 2017).

Purpose

The purpose of this evidence-based practice project …

Increasing Advance Directive Rates In Primary Care: Implementation Of A Redesigned Form, Abbie Cheatham, Samereh Abdoli

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

Background: Less than half of individuals 65 and older have completed an advance directive despite evidence to their benefit. Lack of advance directives can have emotional and financial consequences for the family and individual. A major barrier to advance directive completion is the high literacy level most state sponsored forms are written at, with the average form written at a high school level. Methods: This quality improvement project was a three-month trial to increase the number of advance directive rates at a primary care clinic in the Knoxville area. Five Wishes, written at an 8th grade reading level was …

Improving Patient Outcomes One Warm Patient At A Time, Lindsey King, Marcus Austin Robison, Julie Bonom Dnp, Michael Godbold Md

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

Patient Temperature measurement postoperatively reveals that hypothermia occurs in surgical patients 25-90% of the time. Unintended perioperative hypothermia can be linked to many negative patient outcomes such as increased incidence of surgical site infection (SSI), delayed wound healing and increased length of hospital stay, to mention a few. Any single or combination of the aforementioned issues can eventually lead to an increase in patient morbidity and mortality. The purpose of this proposed quality practice improvement project is to increase the compliance of hypothermia prevention strategies, specifically forced air warming, at the implementation site. The targeted practice improvement is aimed at …

Advancing The Care Continuum For The Homeless: A Shelter-Based Care Coordination Project Focused On Mental Health, Alexandra H. Sain, Allyson Neal Dr, Deborah Nichols Mrs.

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

Advances in the care continuum are crucial for those with serious mental illness, especially those homeless individuals in the community. Schizophrenia is a leading cause of re-hospitalization and disability, accounting for billions of dollars spent in the United States. A prominent city shelter reports the prevalence of schizophrenia among its guests, and the community recognizes homeless shelters as the greatest source of 911 calls with countless surrounding emergency department visits. This project’s purpose is to implement a shelter-based, internal process to identify these high-risk guests and increase their subsequent care coordination services. Outcomes reflect individual benefits with increased shelter-based contacts …

The Development Of Evidence-Based Practice Mentors Through A Competency-Based Educational Program: A Leadership Perspective, Laura C. Moore, Tracy L. Brewer, Pamela Hardesty, Diana Burdick

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

One of the most productive strategies to achieving the safest, high-quality patient care is promoting the widespread use of evidence-based practice (EBP) in clinical settings. Despite the considerable emphasis and support for EBP, many clinicians still fail to translate current research into clinical practice. To address the pervasive lack of EBP among clinicians, an EBP project was developed at an acute care pediatric facility to increase EBP utilization via the implementation of a virtual EBP educational program. The findings from this project describe the establishment of an EBP educational program with the intent to create a critical mass of EBP …

Anesthesia-To-Post Anesthesia Care Unit Handoff Standardization, Cassie Lee Bivens, Mark Timothy Cresap, Steven Michael Halcomb, Maureen Essie Taylor

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

Abstract

The exchange of medical information from one medical professional to another is known as the handoff. Communication errors during the transition period of handoffs can lead to medication errors, delays in care, high stress within the work environment, and increased burnout of the nursing staff. Approximately 1,744 deaths and a total of $1.7 billion in malpractice costs were related to healthcare communication failures from 2012 to 2017. One of the areas of the hospital where effective handoffs are critically important, given the high frequency, is in the post-anesthesia care unit (PACU). Major organizations such as the Joint Commission, the …

Effect Of Implementing Admission History Optimization On Perceived Nurse Documentation Burden, Chelsea Smith Hardin, Mary Johnson

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

Abstract

Electronic health records (EHR) and computer-based documentation is a powerful tool which has been adopted extensively in the last twenty years. The effect of EHR integration on staff has not been well studied, especially among nurses.

Purpose

The purpose is to investigate how optimization of nursing documentation effects the burden of documentation on nurses.

Methods

This project evaluated the admission history documentation at a community hospital that used essential data sets (EDS) to optimize the documentation process for nursing. To evaluate the documentation burden, the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey will be used before implementation …

Quality Improvement: Education And Implementation Of Proper Narcotic Handling Practices By Nurse Anesthetists, Shelby Stevenson, Anne Hendershott, Alexis Asprah

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

Medication errors are estimated to occur once in every 150-300 surgeries (Wahr et al., 2017, p. 36). Unsafe injection practices can lead to increased morbidity and mortality, diminish the overall quality of life for patients, and contribute to substantial increases in healthcare costs. A large majority of unsafe injection practices are caused by a lack of education or mistaken beliefs regarding safe injection practices. Educational reinforcement of safe narcotic handling techniques has significant potential to increase the appropriate use of narcotic syringes among nurse anesthesia providers. The long-standing impact of this project could lead to a reduced number of ‘never …

Educating Healthcare Professionals To Identify And Care For Victims Of Human Trafficking, Kathleen L. Messman

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

Background: Health Care Professionals (HCPs) report a need for education, training, and appropriate healthcare guidelines to identify and treat those affected by human trafficking. Approximately 88% of survivors report having been in contact with an HCPs while being trafficked without the knowledge or intervention of an HCP. Population: 16 staff from a Federally Qualified Health Center in rural in East Tennessee, including medical and dental staff, mental health counselors and receptionists attending onsite training. Methods: A pretest-posttest-4 week follow up posttest design was utilized to determine whether an educational intervention increased knowledge and confidence in HCPs. A modified PROTECT Provider …

Computer-Based Learning For Opioid Use Disorder, Jordan Taylor Bentz, April Snell

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

Over the last several decades, the prevalence of Opioid Use Disorder (OUD) has escalated in the U.S., leading to an opioid epidemic that ravages the wellbeing of the nation. Despite all alleviating efforts, opioid-related morbidity and mortality continue to rise across most states, including Tennessee. Currently, medication-assisted treatment (MAT) is the most highly regarded method of treatment for OUD; however, MAT programs differ significantly on the pharmaceutical agent of use, adjuncts to treatment, and philosophy of care. Unfortunately, this inconsistency often leads to poor treatment retention in MAT programs. This project aimed to improve MAT retention for patients with OUD …

Promoting Nurse Well-Being During A Global Pandemic Through The Community Resiliency Model, Sherissa Manganello

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

Since the COVID-19 pandemic started a few years ago, there has been an increase in mental health issues due to the chronic emotional, physical, and psychological stress that everyone has had to endure. COVID-19 has had long-lasting consequences on the entire healthcare system, especially with nurses as the foundation for providing quality patient care. While nurses are the trusted professionals, they also have one of the most emotionally and physically demanding careers (Ward-Miller et al., 2020). In addition, there is a global health crisis of nursing shortages that continues to grow through COVID-19, which directly affects patients’ quality of care …

The Periviable Infant: The Implementation Of A Standardized Perinatal/Neonatal Outpatient Consultation Program, Janna Wright

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

Common ethical principles are the foundation for why we ask parents for informed consent before proceeding with their infant's care. Respecting parental decisions in periviable resuscitation can benefit from adopting a new practice. This evidence-based practice project detailed the identified needs-based practice change for a standardized perinatal/neonatal outpatient consult concerning the periviable infant. Initiating early consultation of high-risk deliveries provides an understanding of parental wishes and satisfaction in decision-making, care of their infant, and bereavement support through a shared decision-making model. The project aligns with value-based care delivery, designed to improve healthcare by focusing on outcomes. Larrabee's Evidence-Based Practice model …

Cancer Risk Assessment: Implementation Of A Standardized Tool To Identify Women At Risk For Hereditary Cancer Syndrome, Gillian Harris, Karen Lasater

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

Background

Though literature identifies improved patient survivability with use of cancer genetic testing (CGT), routine use of risk assessment and referral to genetic services by oncologists remains low.

Objectives

To increase the number of patients identified as being at risk for hereditary cancer syndromes (HCS) and the number of patients sent for genetic counseling in a gynecologic/oncology office.

Methods

Ambry Genetics’ “AVA” (Ambry’s Virtual Assistant) screening tool was implemented and sent to all new patients visiting the office for any reason to assess their risk for HCS. Pre- and post-implementation rates of risk identification and referral to genetic services were …

Delirium Screening To Prevent Falls In The Long-Term Care Setting, Jonathan David White, Bsn, Rn, Samereh Abdoli, Phd, Rn

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

Abstract

Background

Nearly 30 million people fall in the United States (U.S.) every year with 20% resulting in serious injury. These incidents disproportionately occur in the elderly population. Of the 1.6 million people living in long-term care (LTC) settings in the U.S., between 50-75% experience a fall annually with many experiencing multiple falls. This population is 2 times as likely to experience such an event – and due to increased age, they are least likely to recover. Delirium, a main contributing factor to fall, has been found to go undetected in as many as 66% of individuals in the clinical …

Improving Patient Health Literacy: Implementation Of Health Literacy Tool & Hematology Oncology Patient Education Checklist, Ala'a Samih Mitoubsi

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

Purpose: Increase health literacy and communication using a tool with a discharge checklist to facilitate communication and understanding among patients, physicians, and nursing staff.

Background and significance: In the United States, 90 million people are affected by low health literacy impairing their ability to understand and comprehend health information (Institute of Medicine et al., 2004). Another 40 million Americans have difficulty reading complex texts that makes reading health information difficult (Institute of Medicine et al., 2004). The Affordable Care Act emphasizes the need for increased self-care as a key strategy for improving health care costs and improving the quality …

The Use Of A Peanut Ball During Labor In Nulliparous Term Singleton Vertex Pregnancies To Decrease The Primary Cesarean Rate: An Evidence-Based Practice Improvement Project, Megan Elizabeth Honaker

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

BACKGROUND: Current statistics indicate cesarean section rates in nulliparous term singleton vertex (NTSV) pregnancies, a singleton first pregnancy > 37 weeks’ gestation in a vertex position, of 32.8% and rising. A peanut ball, a tool used to optimize pelvic opening and fetal head rotation, can decrease labor length and cesarean section rates. The aim of this evidence-based practice improvement project was to reduce the cesarean rate in NTSV pregnancies by 1% within three months. The project occurred in an urban 12-bed labor and delivery unit in Middle Tennessee. Participants included laboring women meeting NTSV criteria. METHOD: Plan- do- study- act cycles …

A School-Based Cognitive Behavioral Progrm To Improve Adolescent Mental Health, Amanda Harper

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

Problem. While anxiety and depression are prevalent in the adolescent population and can have significant long-term consequences, treatment rates remain low. The gold standard for treatment is cognitive behavioral therapy (CBT), but this is often unavailable.

Methods. This project aimed to increase access to CBT through a school-based program. Students from a local homeschool cooperative participated in the Creating Opportunities for Personal Empowerment (COPE). Measures of anxiety and depressive symptoms were collected at baseline, after the program, and one month after the program. A Friedman test was used to evaluate medians’ differences on the screening tools at all three time …

Recognizing Delirium In The Picu: An Evidence-Based Practice Improvement Project, Abigail Begovich

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

Introduction: Pediatric delirium is underrecognized in the pediatric population and can lead to increased length of stay, hospital costs, and post-traumatic stress disorder (PTSD). Using a standardized screening tool to assess for delirium is an easy way for bedside nurses to evaluate patients and intervene as necessary. This quality improvement project aimed to implement the Cornell Assessment of Pediatric Delirium (CAPD) and complete a delirium screening on applicable patients once a shift > 85% over four months.

Methods: Between January 2020 to May 2020, bedside nurses completed a delirium screening assessment on applicable patients, first on paper and then …

Implementation Of Standardized Hereditary Breast And Ovarian Cancer (Hboc) Risk Assessment And Genetic Referral, Melissa M. Hessock

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

Objective: To increase identification and genetic referral rates for women at risk of Hereditary Breast and Ovarian Cancer (HBOC).

Design: Evidence-based practice improvement initiative

Setting/Local Problem: Private suburban OB/GYN practice in Tennessee with no standardized process for HBOC risk assessment or genetic referral.

Participants: Women age 18 or older, presenting for routine well-woman visits.

Intervention/Measurements: Using PDSA (plan-do-study-act) cycles, a familial risk assessment tool was selected, and a clinical decision-making algorithm for risk assessment and genetic referral was designed and implemented for use in well-woman encounters. Pre-implementation and post-implementation risk identification and referral rates were …