Nursing Commons^™

Increasing Continuous Positive Airway Pressure Compliance With Various Telemedicine Interventions: An Integrated Literature Review, Tracy Partington

Doctor of Nursing Practice (DNP) Projects

Aims and Objectives. This literature review's objective was to synthesize evidence from previously published literature on telemedicine interventions' effectiveness on CPAP (Continuous Positive Airway Pressure) therapy compliance.

Background. It is estimated that 22 million Americans suffer from a form of Sleep Apnea (SA), and those up to 80 percent of the cases of moderate to severe Obstructive Sleep Apnea (OSA) are undiagnosed (Sleep Apnea, n,d). The first-line therapy for OSA is CPAP. However, CPAP therapy is associated with low compliance rates.

Design. Systematic review.

Method. A multi-database literature search was conducted to identify published literature between 2009 and 2020. …

Implementation Of A Mental Health Environmental Risk Assessment Tool, Alan Le

Doctor of Nursing Practice (DNP) Projects

Background: Patient suicide is a serious safety issue, especially in mental health settings since suicides disproportionately affect psychiatric patients. Environmental hazards are a primary contributing factor in patient suicide cases.

Problem: Mental health staff may lack tools and training to perform proper environmental risk assessments, which is the case at a psychiatric crisis residential center in northern California that utilized no environmental risk assessment tool.

Methods: An environmental risk assessment tool was implemented at the site for four months to increase staff confidence, ability to identify hazards and decrease risk of patient suicides.

Interventions: The Suicide and …

Regulatory Orientation To Support Transition To Academic Leadership, Annmarie Munana

Doctor of Nursing Practice (DNP) Projects

Background: As pre-licensure nursing education is burdened by levels of regulations and standards, it is important the academic leader understand regulatory compliance and the applicable federal, state, and local rules and laws. At a multi-campus university, the leader’s ability to address regulatory issues is critical to the program’s success.

Local Problem: The university’s campus leader regulatory orientation lacks consistency and standardization of content and resources. This situation results in campus leaders having varying degrees of knowledge and competency ensuring academic regulatory compliance.

Context: Regulatory compliance stems from external influences and multiple layers of regulations and accreditation. The university provides onboarding …

Purposeful Nurse Hourly Rounding: Plan To Decrease Patient Falls During A Pandemic, Robbie Masangkay

Doctor of Nursing Practice (DNP) Projects

Problem: Patient falls remain a critical and persistent safety problem in healthcare today. The prolonged impact of the COVID-19 pandemic raises leadership concerns regarding the safe care of high-risk COVID patients and mitigating the increased stress and potential risks of infection to clinical staff.

Context: This Doctor of Nursing Practice (DNP) scholarly project details implementation of an evidence-based purposeful nurse hourly rounding (PNHR) pilot project designed to decrease the incidence of patient falls on a designated COVID-19 unit.

Measure: A modified PNHR rounding tool was implemented to guide focused elements for key nurse/patient interactions.

Interventions: …

Use Of Simulation To Improve Nurse's Response To Covid-19 Code Blue: A Literature Review, Charity Shelton

Doctor of Nursing Practice (DNP) Projects

Background

Healthcare workers in the acute care setting must be ready to respond to emergencies at any given time. The recent COVID-19 pandemic put strains on the healthcare workforce that have brought challenges and new competencies for how healthcare workers safely respond to emergencies. To ensure healthcare workers maintain these competencies, specific training must occur to improve emergency response and outcomes. Specifically, there needs to be training for healthcare workers to respond to COVID-19 code blue emergencies safely and with skilled interventions.

Problem

A code blue in the acute care setting is a medical emergency that requires nurses, physicians, and …

Building Excellence Through Shared Governance And Continuous Process Improvement, Deborah Reitter

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Nursing shared governance in the hospital setting is a well-established structure for shared decision-making between staff nurses and nurse leaders to improve nursing practice, quality of care, and patient safety. Establishing effective, shared governance can take several years: new skills must be acquired, new behaviors accepted, and new professional commitments made. Newcomers to shared governance require support, education, and the opportunity to acquire requisite skills; otherwise, interest, commitment, and achievement of desired outcomes cannot be sustained.

Local Problem: A large hospital in California established a shared governance structure in 2018. Performance gaps between two high-performing Nursing Unit Councils …

Creating A Pipeline To Increase Diversity In Executive Leadership Positions, Trarina Harris

Doctor of Nursing Practice (DNP) Projects

Background: Minority nurse leader presence at the executive leadership level is suboptimal, with insufficient pathways to increase representation. The lack of diversity in executive leadership threatens efforts to improve patient care and reduce disparities (Jerome Harris, 2021).

Local Problem: Practices to increase the diversity of executive nurse leaders at a pediatric medical center have had very little to no impact. Frontline nurses and nurse executives are not racially or ethnically representative of the increasingly minority patient populations served.

Context: As a commitment to increasing workforce diversity, the medical center developed an executive-level Racial Equity Taskforce, which aligned with the …

Nurse Practitioner-Led Care Pods: A Team Communication Enhancement Model, Miranda Saint-Louis, Miranda Saint Louis

Doctor of Nursing Practice (DNP) Projects

Background: Communication has become a key performance measure in the shift to value-based healthcare. Given the impact of communication failures on patient harm, length of stay, and dissatisfaction with care, new models of care with better communication through structured teamwork and interdisciplinary collaboration are needed.

Problem: In a 16-bed geriatric medical/surgical unit of a New York City multispecialty community hospital, the workflow structure unintentionally created inconsistent handoff communication, gaps in continuity of care, missed care events, and inattention to the patient’s priorities in the care plan. A gap analysis identified communication deficiencies that impacted team effectiveness and patient care …

Successfully Spreading Improvement Work Using A Proven Framework, Rachel Lynn Wyatt

Doctor of Nursing Practice (DNP) Projects

Background: Hospital-acquired pressure injuries (HAPIs) are rising in the United States, increasing six percent between 2014 and 2017 alone (Agency for Healthcare Research and Quality [AHRQ], 2019). Approximately 60,000 patients die from complications related to HAPI annually (Padula & Delarmente, 2019).

Local Problem: In a Northern California Level II Trauma acute care hospital, HAPIs increased by 422% over two years, 2016-2018, with most of the HAPIs occurring in the Intensive Care Unit (ICU).

Context: This project sought to spread the Interventions by Braden Subscale protocol to seven medical-surgical units in the hospital using the Institute for Healthcare Improvement’s (IHI) Framework …

Providing Hypertension Education For African Immigrants At A Southern California Congregation During The Covid-19 Pandemic, Esther Oshunluyi

Doctor of Nursing Practice (DNP) Projects

Providing Hypertension Education for African Immigrants at a Southern California Congregation During the COVID-19 Pandemic

Abstract

Background: Hypertension (HTN) is one of the major risk factors for cardiovascular disease and the prevalence is highest among African Americans (AAs) (American Heart Association, 2017). The difference in the management and outcomes of HTN between African Americans and Whites is most disparate with lack of education being a major contributor to uncontrolled HTN among African Americans, especially among African Immigrants (Lackland, 2014).

Problem: According to church leadership at the project setting, the majority of their adult African Immigrant population is believed to have …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Transcatheter Aortic Valve Replacement: Implementation Of Shared Decision-Making, Liesel Buchner

Doctor of Nursing Practice (DNP) Projects

Background: The setting for this study is the structural heart program of a large healthcare organization in the Greater Sacramento area in California. Aortic stenosis (AS) is the most common cardiovascular valvular disease in the elderly. The treatment of AS is complex and over the last decade, the transcatheter aortic valve replacement (TAVR) procedure has changed the management of this high-risk group and has become the standard of care.

Problem: The structural heart team performs an average of 170 TAVR procedures annually. The program is relatively new, and although it is performing above the national averages for specific program outcome …

Preparing Nurses In Management Positions For Bedside Care During Times Of Crisis, Trevor Murray

Doctor of Nursing Practice (DNP) Projects

Background

The purpose of this quality improvement project was to increase perceived self-efficacy in performing bedside skills among nurse leaders. As the demand for nurses increased, these leaders anticipated a direct role in providing patient care in the event of a patient surge due to COVID-19.

Problem

Due to the COVID-19 pandemic and Delta variant, hospital nursing leaders were and still are concerned with the challenge of providing enough competent nurses to deliver care. The DNP project prepared nurses who work in leadership roles to take or assist in taking a patient assignment.

Methods

Nurse leaders attended a skills lab …

Streamlining Care For Children With Autism Spectrum Disorder, Siavash Rostami Jafarabad

Doctor of Nursing Practice (DNP) Projects

Background: Autism spectrum disorder (ASD) is a chronic and developmental disorder that affects about one out of every 65 children in California, and one in 59 children in the United States. Children with ASD have difficulty communicating and interacting with others, and experience oversensitivity to new stimuli and environments.

Problem: In healthcare settings, children with ASD experience numerous challenges related to lack of adequate knowledge and education of staff regarding ASD, and lack of appropriate environmental and sensory resources which reduce quality of care provided to this population.

Methods: The project took place in a Psychiatric Emergency Services (PES) Unit …

Targeting Pre-Operative Booking Processes To Decrease Risks Of "Never Events", Rebecca Lynn Poths, Rebecca Lynn Poths

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Wrong patient, wrong procedure, wrong site, and wrong side surgeries are such egregious errors that are known as “never events.” Root cause analyses can pinpoint a failure yet do little to determine if corrective action has reduced the risk of recurrence.

Context: Monitoring surgical cases prospectively to identify weaknesses that could help identify specific risk factors to avert and move toward zero defects. The setting for this quality improvement project is a >300-bed Level III trauma hospital, where the risk of wrong-site surgeries and lack of standardized processes in the surgical pre-operative booking process was of concern to …

Telehealth Appointments To Increase Therapy Compliance In Patients With Mosa, Tracy J. Partington

Doctor of Nursing Practice (DNP) Projects

Background: At the VA Puget Sound Healthcare System, care as usual for patients with a new diagnosis of mild obstructive sleep apnea (MOSA) is a letter directing the patient to call the continuous positive airway pressure (CPAP) clinic to establish ongoing care.

Local Problem: This model has resulted in low therapy compliance and does not afford patients the ability to discuss their diagnosis and treatment options with a licensed healthcare provider. A literature review showed telemedicine interventions increase therapy compliance in patients with MOSA.

Context: The Doctor of Nursing Practice project implemented an evidence-based practice change to improve therapy compliance …

Manager Onboarding To Improve Knowledge And Confidence To Lead, Christine (Tina) K. Asiimwe

Doctor of Nursing Practice (DNP) Projects

Background: Primary care (PC) is increasingly the setting for affordable, coordinated, end-to-end patient care, with PC managers in charge of organizational performance. While PC managers are central to high-functioning teams, they often receive inadequate onboarding.

Local Problem: Primary care onboarding competes with other operational priorities and faces time constraints, lack of mentorship, and cost.

Context: At an integrated healthcare system, a need was identified to develop structured, role-specific onboarding for newly hired PC managers to improve knowledge and confidence to lead.

Interventions: Bauer’s Four Cs framework for onboarding guided the development of a manager onboarding program for 12 new PC …

Patient Placement Matters: The Impact Of Unnecessary Lateral Movement On Patients, Jacqueline Strinden

Doctor of Nursing Practice (DNP) Projects

Patient Placement Matters: The Impact of Unnecessary Lateral Movement on Patients

Abstract

Background: National trends to decrease the number of licensed beds have created inpatient capacity constraints which have resulted in increased unnecessary lateral patient movement events, which contribute to decreased patient safety and quality of care. The incidence of adverse events increases significantly when multiple unnecessary lateral relocations result from secondary efforts to relieve hospital capacity constraints and improve efficiency.

Problem: At a 352 acute care hospital, 12,906 patient movement events were evaluated over a baseline period of three months resulting in an average of 1.48 unnecessary lateral patient …

The Effects Of Naloxone Education Among Adults In Alameda County, Patricia Ronnica Tinglin

Doctor of Nursing Practice (DNP) Projects

Fatal opioid overdose is a growing concern in the United States (U.S.). The pharmaceutical companies assured the medical community that opioid pain relievers were not addictive. As a result, providers prescribed them at a significantly higher rate, which led to more extensive use of authorized and unauthorized opioid use before it was realized that they could be highly habit-forming (The U.S. Department of Health and Human Services [HHS], 2019). A growing body of evidence supports providing naloxone education as a means of harm reduction. The quality improvement project aims to implement educational sessions for adult patients seen at East Bay …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Designing And Implementing A De-Escalation Toolkit To Improve Staff Education And Competency On De-Escalation Within A Mental Health Outpatient Setting, Balraj Bajwa

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this study is to develop and implement a de-escalation toolkit to help improve memory, retention, and utility of de-escalation techniques within an outpatient mental health crisis stabilization unit.

Problem: The aforementioned crisis stabilization unit has elevated rates of patient aggression/violence and staff present with difficulty recalling de-escalation techniques due to the lapse in memory and/or retention.

Methods: The project was introduced to the stakeholders of the crisis stabilization unit and input was obtained on the design and components of the toolkit. Various analyses were conducted to ensure the appropriate implementation of the project.

Intervention: A de-escalation …

Implementation Of An Acute Care For The Elderly (Ace) Unit In A Community Hospital, Kimberly A. Colonnelli

Doctor of Nursing Practice (DNP) Projects

Background: “Baby boomers” (born between 1946 and 1964) represent 15% of the total population of the United States (Population Reference Bureau, 2019), but 50% of its total healthcare expenses (Mattison, 2021). Growth of this population will have a corresponding rise in demand on healthcare resources. Replication of a geriatric inpatient care model (Palmer et al., 1994) was introduced in a large geographically and ethnically diverse integrated care delivery system.

Problem: The demographic for this small community hospital located in Northern California has a larger percentage of patients over the age of 65 compared to other facilities within this …

Using Simulation To Improve Covid-19 Code Blue Outcomes, Charity Shelton

Doctor of Nursing Practice (DNP) Projects

Background

Healthcare workers in the acute care setting must be ready to respond to emergencies at any given time. The recent COVID-19 pandemic put strains on the healthcare workforce that have brought challenges and new competencies for how healthcare workers safely respond to emergencies. To ensure healthcare workers maintain these competencies, specific training must occur to improve emergency response and outcomes. Specifically, there needs to be training for healthcare workers to respond to COVID-19 code blue emergencies safely and with skilled interventions.

Problem

A code blue in the acute care setting is a medical emergency that requires nurses, physicians, and …

A Peer Feedback Process To Improve Assistant Nurse Manager Job Satisfaction, Juanita A. Jularbal-Walton

Doctor of Nursing Practice (DNP) Projects

Problem

Healthcare organizations offer different methods of training for emerging and newly hired Assistant Nurse Managers (ANM). Without sufficient orientation to what the role requires, new ANMs receive many requests without adequate guidance on how to respond to patient, staff, and leadership requests. This experience creates unhealthy work environments with low job satisfaction and high turnover rates.

Context

Peer feedback provides an opportunity to reflect on the purpose of the Assistant Nurse Manager role. With sufficient orientation and peer feedback, front-line assistant nurse managers develop competency and role satisfaction, as evidenced by reduced turnover and improved retention.

Intervention

This project …

Bullying In The C-Suite: A Nurse Leader Perspective, Kimberly Ann Colonnelli

Doctor of Nursing Practice (DNP) Projects

An estimated 35% of American workers have experienced bullying, and in 80% of those situations, the perpetrator was a supervisor or boss. 1 However, the reality is that bullying can come from anyone in the workplace, including subordinates. Victims are generally well liked and good performers, making them feel like threats to a bully’s power base. Bullying, unlike harassment, is not a legally defined behavior, so no laws currently exist to punish it. Victims are, therefore, at the mercy of their bosses, supervisors, co-workers, and human resource departments for protection or relief. Bullying is not a singular event, but rather …

Development And Implementation Of An Evidence-Based Practice Mentor Fellowship, Stacy L. Alves

Doctor of Nursing Practice (DNP) Projects

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017).

Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation.

Context: …

Manager Onboarding To Improve Retention, Knowledge, And Confidence To Lead, Christine Asiimwe

Doctor of Nursing Practice (DNP) Projects

Objective: The purpose of this paper is to review the literature on manager onboarding best practices and their impact on turnover intention, knowledge, and confidence to lead teams in primary healthcare settings.

Background: Primary care onboarding is often insufficient due to competing operational priorities, time constraints, lack of mentorship, and cost. With primary care increasingly the setting for affordable, coordinated, end-to-end patient care, primary care managers must be well-prepared to lead the care team.

Methods: A review of the literature identified best onboarding practices associated with job satisfaction and turnover, reduced time to proficiency, increased knowledge, and confidence to lead. …

Providing Hypertension Education To African Immigrants At A Southern California Congregation During The Covid-19 Pandemic, Esther Oshunluyi

Doctor of Nursing Practice (DNP) Projects

Objective: To review methods that could contribute to improved knowledge of hypertension among African immigrants at a California congregation. The difference in the management and outcomes of hypertension between African Americans and Whites is most disparate in cardiovascular disease, with lack of education documented as a major contributor for African Americans (Lackland, 2014) and African immigrants (Turson-Ocran et al., 2020). African Americans differ slightly in culture, health, and migration history from Africans who are 21st century immigrants from Africa (African immigrants); however, there are more similarities than differences between them (Terrazas, 2009). This brief report will describe a Doctor of …

Purposeful Nurse Hourly Rounding: A Plan To Decrease Patient Falls During A Pandemic, Robbie Masangkay

Doctor of Nursing Practice (DNP) Projects

Aims: This paper describes the design of a purposeful nurse hourly rounding pilot to decrease the incidence of patient falls on a COVID-19 designated unit in an acute hospital setting.

Background: Falls in acute care hospitals are a persistent patient safety problem. The COVID-19 pandemic has added to concerns to safely care for high-risk COVID patients while mitigating the risk of infection for frontline staff.

Methods: A PNHR pilot project was designed for implementation in a 28-bed COVID-19 designated unit in a not-for-profit acute hospital in California. A modified PNHR rounding tool guides focus points for every nurse/patient interaction. Pre- …

Utilizing Digital Technology To Address Loneliness And Isolation In Older Adults Through A Community-Based Connection Model: Responding To A Pandemic, Melissa A. Nagel

Doctor of Nursing Practice (DNP) Projects

Problem: Loneliness and social isolation, both of which can have serious detrimental effects on health and well-being, have become more prevalent during the recent COVID-19 pandemic, particularly in the older adult population. During part of the past year, older adults were strongly encouraged to follow strict quarantine measures because of their vulnerability to the virus. This forced isolation exacerbated the already existing issue of loneliness and social isolation in this population.

Interventions: Older adults who are members of a local non-profit community organization, focused on increasing independence and social vitality, were invited to participate in a virtual, interactive social engagement …