Nursing Commons^™

Utilizing A Stress And Coping Model Into A Preventive Abusive Head Trauma Parent/Caregiver Educational Program, Camile Williams

Doctor of Nursing Practice (DNP) Projects

Abusive head trauma (AHT) is a serious form of child maltreatment that is the primary cause of fatal head injuries in children younger than 24 months and is the cause for over 50% of severe or fatal traumatic brain injury incidences. These injuries can be caused by impact, shaking, or the combination of shaking and impact. These multi-factorial injuries can cause intracranial and spinal damage, retinal hemorrhages, and fractures of ribs and other bones. The age and severity of injuries will be used to assess the diagnosis of AHT. When AHT occurs, it is often tied to the behavior from ...

Charge Nurse Orientation, Angela Zafke

Nursing Capstones

Traditional undergraduate training focuses heavily on clinical skills with minimal emphasis on leadership. In practice, a nurse with clinical prowess is often promoted to the charge nurse position. Taking on the leadership role of a charge nurse can be a stressful experience without proper training and preparation that leads to burnout and turnover. With more experienced nurses facing retirement, now is the time to prepare future nursing leaders. This starts with adequately preparing a nurse to lead within the unit in the charge nurse role. A comprehensive literature review was conducted regarding charge nurse orientation. Charge nurse competencies were not ...

Oral Chemotherapy: Safe Handling In The Home, Cynthia Huff

DNP Qualifying Manuscripts

Background: According to the National Institute for Occupational Safety and Health (2016), oral anticancer agents (OAC) are hazardous drugs (HD) and require the same safe handling interventions in the home setting as in controlled health care environments. The use of a safe handling checklist for OAC administration is a way nurses can provide safe handling education to patients and caregivers and assess for understanding and competency for critical tasks. Effective home management strategies outlining caregiver protections, proper storage, administration of OACs, spill clean-up, and waste disposal could reduce exposure risks to toxic agents.

Objective: To present a safe-handling checklist and ...

Usp Compliance: A Hazardous Drug Safe Handling Ppe Toolkit For Infusion Nurses, Cynthia Huff

Doctor of Nursing Practice (DNP) Projects

Problem: Safety concerns have existed for more than 40 years about how hazardous drug (HD) exposure contributes to long- and short-term adverse health outcomes for healthcare workers (HCWs). Careless handling may cause toxic residues to infiltrate hospital environments and patient care areas, and can even be traced to patients’ homes. New government regulations will require healthcare organizations to minimize exposure risks to HCWs by fully implementing the U.S. Pharmacopeia (USP) Convention Chapter 800: Hazardous Drugs: Handling in Healthcare Settings (USP, 2016) on December 1, 2019. According to Polovich and Olsen (2017), “The implementation of the USP <800> Standards will represent ...

Improving Nurse Engagement Through Unit Practice Councils: A Literature Review, Pavna Sloan

Doctor of Nursing Practice (DNP) Projects

Problem: According to The Advisory Board Company, nurses are the least engaged group of healthcare employees (The Advisory Board Company, 2014). This finding concerns healthcare organizations because those with a high percentage of disengaged nurses have increased nurse turnover rates and decreased patient satisfaction and safety scores (Kutney-Lee et al., 2016). Shared governance, in the form of the Unit Practice Councils (UPC), is a model healthcare organizations implement to increase nurse engagement. A review of the current literature is needed to evaluate if the model is effective.

Purpose: The purpose of this article is to provide a comprehensive literature review ...

The Effects Of Moderate-Severe Plaque Psoriasis On Patient Well-Being And Prevention Of Flares, Glenn Devera

Nursing | Senior Theses

Psoriasis is a chronic skin condition that is indicated by red, patchy and scaly skin that can be painful when irritated. Patients with psoriasis have an increased risk for a number of chronic diseases. Despite the expansion of treatments for moderate-to-severe psoriasis over the last decade, patients may still find that treatment strategies are not as successful, leaving them dissatisfied with their treatments. A relationship built upon trust between the nurse and the patient diagnosed with psoriasis may serve to help ensure optimal care. A comprehensive literature review was performed and found that best practices for patient management need to ...

The Youthful Pandemic, Brook Sahlemariam

Nursing | Senior Theses

This paper attempts to examine the neurological, physical, and societal effects of e-cigarette use among youth and young-adults in North America. Furthermore, the paper investigates the parallels between e-cigarette users, tobacco users, and dual users in regard to behavioral patterns, reasons for use, and age of initiation.

Apneic Oxygenation: An Adjunctive Therapy For Laryngoscopy During Anesthesia Induction, Yaro Hoffman

Doctoral Projects

Endotracheal intubation is an essential component within the skill set of anesthesia providers. Rapid arterial desaturation remains a primary risk factor during laryngoscopy and intubation. The risk for hypoxemia exists because during endotracheal intubation, patients are apneic or hypo-ventilating (Wong et al., 2017). Apneic oxygenation (AO) has been advocated to attenuate hypoxemia during endotracheal intubation (Pavlov et al., 2017).

The aim of this project was to assess for any knowledge deficits regarding AO among anesthesia providers and assess the willingness of these providers to include AO into their current practice. The project investigator conducted an education session involving the evidence-based ...

Type One Diabetes Mellitus In Immigrant And Minority Pediatric Populations, Kristina Nielson

Student Works

Type 1 diabetes mellitus (T1DM) is a prevalent chronic illness affecting children and adolescents. Globally, it is estimated that at least 1 million children under the age of 19 years are affected by T1DM. Immigrants and minorities have worse diabetic outcomes than the majority population. The purpose of this article is to identify common challenges in children with T1DM who are part of immigrant or minority populations. Major health challenges for children with T1DM who are immigrants or minorities include issues regarding access to healthcare, communication, and cultural adaptation. Access of children with T1DM to high-quality healthcare and new diabetes ...

Factors Predicting Sustainability: A Correlational Study Of One Multi-Site Program, Meredith L. King Jensen

All Dissertations, Theses, and Capstone Projects

Healthcare organizations invest significant economic, physical, and human resources to implement changes and expect sustained benefits for their investments in the long term. The primary aim of the study was to gain a better understanding of sustainability and five factors (champions, leadership support, policy, resources, and training and education) that might predict long-term sustainability within the context of one Safe Patient Handling and Mobility (SPHM) program implemented in a large, nationwide system more than 7 years ago. The secondary aim was to examine the number of nursing staff injuries, the most notable positive outcome of the program immediately post implementation ...

Improving Latent Tuberculosis Infection (Ltbi) Screening And Treatment In A School-Based Setting, Andrea Bell

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: San Diego County’s tuberculosis (TB) incidence rate is nearly double than the national rate. In 2019, there have been 5 cases of active TB in the county’s public high schools, which have demonstrated the need for prevention interventions in this setting.

Objectives: This evidence-based project is aimed to increase awareness, screening and treatment of latent TB infection (LTBI) in the school setting.

Methods: A TB risk assessment form and consent was sent in the registration packets. A one-time TB educational presentation was given to high school freshman students with a pretest and posttest. For students at-risk ...

Effects Of Standardized Self-Care Behavior Education On Self-Efficacy Outcomes In Type Ii Diabetes Mellitus, Nishita Patolia Bsn, Rn, Dnp Student

Doctor of Nursing Practice Final Manuscripts

An evidence-based practice (EBP) project was implemented in a primary care setting to decrease Hemoglobin A1c (HgbA1c) levels and increase self-efficacy in Type II Diabetes Mellitus (T2DM) diagnosed individuals. According to the Centers for Disease Control (CDC), 30.3 million adults have diabetes in the United States, and one in four do not know they have it (CDC, 2017). It is a disease that can be managed and reversed with standardized self-management education. Self-management interventions can improve diabetes knowledge and encourage patient participation in caring for their health (Flode, Iversen, Aarflot, & Haltbakk, 2017).

The purpose of this evidence-based project was to improve type II diabetes mellitus (T2DM) self-management through nursing education, focusing on self-efficacy and medication adherence guided by the American Association of Diabetes Educators 7 Self-Care Behaviors (AADE7). The objectives were: (a) decrease HgbA1c levels by 0.5% or more and (b) increase self-efficacy by 15% with the use of the Stanford Patient Education Resource Center’s Self-Efficacy for Diabetes questionnaire (SPSE).

Eleven participants were recruited through provider referrals, flyers, and cold calls. Inclusion criteria included a T2DM diagnosis and HgbA1c greater than or equal to 7%. It was a requirement to obtain a HgbA1c level and fill out the SPSE prior to the intervention. Each participant received personalized nurse-led education, which included healthy eating, medication adherence, exercise, healthy coping, and reducing risks.

A total of 10 participants completed the program, including obtaining HgbA1c levels three months postintervention. There was significant improvement in postintervention scores with the mean increasing from 6.16 to 7.8 (M_pre = 6.16, M_post = 7.80 on 1 – 10 scale; t = 3.697, p < .01). HgbA1c levels decreased in ...

Insulin Injection Re-Education For Improved Glycemic Control, Daniela Shon

Doctor of Nursing Practice Final Manuscripts

Title: Insulin Injection Re-education for Improved Glycemic Control

Background: Patients on insulin therapy often continue to show suboptimal glycemic control. Data from adult patients with T2DM have demonstrated that 56.1% had poor control, despite adherence to treatment, oral and injectable. Poor glycemic control stems from many sources, including poor self-efficacy regarding insulin dosage adjustment, inaccurate insulin dosing, expired insulin, lipohypertrophy of the injection site and technique, and equipment issues.

Purpose: This project aimed to implement and assess the efficacy of re-education in the insulin injection technique for improved glycemic control.

Methods: This project was conducted based on the John ...

Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden

Doctor of Nursing Practice Final Manuscripts

Abstract

TITLE: Mental Health Screening For Low-Income Adolescents

BACKGROUND: Nearly 80% of adolescents in the United States will suffer from a mental illness and not receive evaluation or services. Children from low socio-economic backgrounds have an increased risk of mental health disorders which permeate into adulthood, leading to additional negative sequel and lower quality of life. Among adolescent mental health conditions, depression and anxiety are the most common. Literature has suggested provider intuition alone has low sensitivity and specificity for detecting mental illness and that screening tools are indicated.

PURPOSE: The aim of this project is to implement standardized routine ...

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and ...

Bridging The Gap: Improving Hospital Discharge Through Utilization Of A Priority Care Clinic, Kristian Jamerson

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Poorly coordinated care often results in poor health outcomes. Best practices in academic literature recommend effective programs that consist of comprehensive discharge planning, complete and timely communication of information, medication reconciliation, patient and caregiver education using the teach-back method, open communication among providers, and prompt follow-up visits with an outpatient provider after discharge. Using a priority care clinic (PCC) for follow-up is one approach to decrease hospital readmissions.

Purpose: To implement an evidence-based program utilizing a PCC to facilitate post-discharge transition-in-care and reduce hospital readmissions.

Evidence-based Intervention: A PCC assists patients in their transition of care from the ...

Implementing A Basal-Bolus Insulin Regimen Via A Manual Insulin Pump Device, Helen Stearns

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose:The purpose of this evidence-based practice project is to decrease glycated hemoglobin (HgbA1C) levelsby initiating use of a manual insulin pump in patients with Type II Diabetes Mellitus (T2DM) with poor glycemic control who are on multiple daily insulin injections (MDII).

Background: Uncontrolled hyperglycemia is associated with a myriad of complications and co-morbidities that are generally associated with vascular changes that include nephropathy, neuropathy, blindness, stroke, and heart disease (Winter et al., 2015). Coronary artery disease and cerebrovascular disease alone accounts for approximately 65% of the deaths in diabetic patients (Molinaro & Dauscher, 2017). Achieving and maintaining therapeutic glycemic ...

It's More Than Just "Baby Blues" - Screening For Postpartum Depression In A Pediatric Setting, Breanna M. Lazar, Martha G. Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Postpartum depression (PPD) is estimated to affect up to 1 out of 7 women. Evidence and American Academy of Pediatrics (AAP) guidelines support maternal screening for PPD in a pediatric setting during well-child visits. The pediatric office is frequently visited during the first year of life and is a suitable setting to perform screening.

Aims of Service Change: Implement AAP recommended PPD screening at a busy primary care practice in Southern California using the Patient Health Questionnaire (PHQ-9).

Details of Innovation: In this pilot project, mothers (who were not patients of the pediatric practice) consented to be screened ...

Eating For Two Without Eating Too Much: Optimizing Gestational Weight Gain, Sandra Pope

Doctor of Nursing Practice Final Manuscripts

This evidence-based pilot project was implemented to optimize gestational weight gain (GWG) among women enrolled for prenatal care at a private practice. Evidence from meta-analyses and large studies show: 1) an association between excess GWG and increased risk of fetal macrosomia and increased cesarean delivery; 2) 66% of women do not know their healthy GWG target; 3) a 20% reduction in excess GWG in women receiving diet or exercise interventions or both. In addition, visual plotting of weight gain has helped overweight adults reduce and maintain weight loss over a one-year period. Nutrition assessment using a validated nutritional screening questionnaire ...

Assessing The Need For Standardized Pre-Chemotherapy Education: An Outpatient Oncology Clinic Initiative, Spana Patel

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: In a diverse southern California outpatient oncology clinic, assess the need for standardized pre-chemotherapy education for newly diagnosed cancer patients to aid in the improvement of health literacy, self-management of side effects, satisfaction, and reduction of anxiety.

Background: Cancer patients often feel anxious, overwhelmed, and confused by the abundance of information and medical jargon that they must digest. One southern California outpatient oncology clinic identified the need for consistent, standardized procedure in providing chemotherapy education and assessing treatment knowledge in newly-diagnosed cancer patients as evidenced by: inconsistent attendance in educational classes and or appointments, inability to articulate treatment ...