Digital Commons Network^™

Perioperative Advanced Directives, Derek Washer

Doctor of Nursing Practice Projects

Technology and surgical techniques continue to improve, resulting in more clients with advanced directives presenting to the operative suite for surgery or procedures requiring anesthesia. Anesthesia providers are in a critical position to discuss with the surgical patient or surrogate any alteration or reconsideration to their advanced directive. Unfortunately, patients and anesthesia provider discussions at a North Texas hospital were limited due to a knowledge deficit, an outdated hospital policy rescinding all directives perioperatively, and an inadequate consenting mechanism. The perioperative advanced directives project involved updating the hospital policy to current national guidelines and developing a “DNR Under Anesthesia” consenting …

Opioid Free Anesthesia, Sarah Medina

Doctor of Nursing Practice Projects

Patients undergoing surgery are often given opioids intraoperatively. Administration of opioids is associated with untoward side effects that include nausea, respiratory depression, constipation, ileus, hyperalgesia, prolonged length of stay, and the potential for dependence (Garimella & Cellini, 2013). Emerging research on the topic of opioid-free anesthesia (OFA) is available and indicates several benefits of OFA, including reduction in postoperative pain, reduction in postoperative nausea and vomiting, reduction in postoperative shivering, and improved oxygen saturation levels (Mulier et al., 2018). This quality improvement project aimed to advance anesthesia providers' understanding of OFA by creating an OFA guideline and providing a learning …

Cultural Competency Training For U.S. Army Security Force Assistance Brigade (Sfab) Brigade Medical Teams, Jacob Blount

Doctor of Nursing Practice Projects

The United States Army began standing up Security Force Assistance Brigades (SFAB) in February 2018. The Brigade Medical Team (BMT) is an 11-person, interdisciplinary Army National Guard team. National Guard Soldiers only have one weekend per month and two weeks of annual training per year to develop/maintain cultural competence. The researcher investigated the efficacy of the Cross-Cultural Competence Trainer (3CT) V2 course to develop and maintain cultural competency in BMT personnel. Pre-test results were obtained from three military medical personnel and a post-test immediately after the course. Participants completed a longitudinal test 28-31 days after the post-test. There was a …

Development And Implementation Of An Orthopedic Enhanced Recovery After Surgery Protocol, Beth Mccoy

Doctor of Nursing Practice Projects

Abstract

As life expectancy rates have grown and individuals desire a more active lifestyle the number of total hip arthroplasty and total knee arthroplasty surgeries performed has grown significantly. Enhanced recovery after surgery (ERAS) protocols have been shown to decrease the financial impact and improve patient outcomes in total joint surgeries. After a literature review a multidisciplinary team met and developed an ERAS protocol for total joint replacement surgeries to be implemented at a 250-bed community hospital in central Illinois. After an eleven-question pre-test was given to 34 participants consisting of perioperative nursing staff, anesthesia, and surgeons assessing their knowledge …

Impact Of A Standardized Neurologic Exam On Diagnosis Of And Referral Pattern For Neurologic Disorder In Pediatric Toe Walking, Allison Hotze

Doctor of Nursing Practice Projects

Successful management of toe walking, a common patient complaint addressed by pediatric orthopedic providers, requires detection of concerning neurologic causes for toe walking. However, nurse practitioners in an outpatient orthopedic clinic were not following recommended guidelines for the history and physical exam for children who toe walk, resulting in delayed referrals and poorer patient outcomes. A performance improvement project was initiated that included an educational intervention, chart review, and data analysis. The goal was to improve the performance and documentation of neurologic exam when nurse practitioners saw patients for an initial visit for toe walking. A literature review provided evidence-based …

Improving Nurse Resilience, Brandon Hedgspeth

Doctor of Nursing Practice Projects

The national average nurse turnover rate was 18.2% in 2017 (Ackerson & Stiles, 2018). A contributing factor for nursing turnout rates was nurse burnout and compassion fatigue (Barratt, 2018; Cleary, Kornhaber, Thapa, West, & Visentin, 2018; Cope, Jones, & Hendricks, 2016; Magtibay, Chesak, Coughlin, & Sood, 2017; Delaney, 2018; Manomenidis, Panagopoulou, & Montgomery, 2019; Poulsen, 2015). Improvement in nurse resilience was revealed to reduce burnout and compassion fatigue in nurses (Ackerson & Stiles; Delaney). The primary goal of this quality improvement project was to evaluate the use and impact of resiliency education on the resiliency of nurses in the hospital …

Implementation Of Enhanced Recovery After Surgery (Eras) Protocol After Cystectomy: A Quality Improvement Project To Evaluate Bowel Function With Implementation Of Eras Protocol, Weruche Agube

Doctor of Nursing Practice Projects

Abstract

The purpose of this Quality Improvement project was to develop and implement an enhanced recovery after surgery (ERAS) protocol for cystectomy patients at a regional hospital in central Illinois. Specific goals included reducing patient’s length of hospital stay, reducing occurrence of postoperative ileus after surgery as well as educating the nurses involved in patient care about effective implementation the protocol. An educational presentation and knowledge assessment via testing was developed and subsequently presented to the nurses both inpatient and outpatient at the host facility. A specific protocol was crafted after discussion with stakeholders and the ERAS protocol was finalized …

Evaluation Of Obstructive Sleep Apnea In Veterans With Coexisting Psychiatric Symptoms, Zenith Perpignani

Doctor of Nursing Practice Projects

Abstract

There is a growing body of evidence that suggests a correlation between post-traumatic stress disorder (PTSD), nightmares with broken sleep, obstructive sleep apnea (OSA), and worsening of symptoms by OSA, Veterans who received treatment at a Midwest Veteran Affairs (VA) Center for Behavioral Health were often subject to variable wait times between scheduling of behavioral health and primary care providers (PCP). The purpose of the doctoral project was to reduce a Veteran's wait time for evaluation by a PCP after having been identified as at risk for OSA during routine psychiatric evaluation. The project examined Veteran's reports and measures …

Healthy Jacksonville, Erica Hunt, Alison Fornoff

Doctor of Nursing Practice Projects

Abstract

According to the Morgan County Community Needs Assessment, a significant opportunity for improvement exists in healthcare access among individuals in the northeast region of Jacksonville, Illinois. Tools to screen clients, interventions to identify the healthcare needs, and access to appropriate resources can promote improved health of individuals and the community. The Healthy Jacksonville Initiative was created to improve access to healthcare and community resources for the underserved people of Jacksonville, Illinois. The goal of this project was to implement a community resource registry and individualized needs assessment for community health care workers to use in order to better serve …

Steep Trendelenburg Associated Postoperative Vision Loss Prevention Education, Mitchell Coval

Doctor of Nursing Practice Projects

Postoperative vision loss (POVL) is a rare, but devastating complication that has been reported following robot-assisted laparoscopic surgeries that require prolonged steep Trendelenburg positioning. A central Illinois hospital had recently established a robot-assisted surgical program but lacked active interventions to reduce POVL risk due to a knowledge gap of the anesthesia providers. Following a comprehensive literature review, a PowerPoint educational program was provided at an anesthesia staff meeting. An evidence-based cognitive aid to provide a quick reference of POVL risk reduction strategies was created by the author in collaboration with the stakeholder. Once approved, the cognitive aid was attached to …

Patient Assessment And Provider Education Regarding Antibiotic Use In The Treatment Of Viral Uris In The Urgent Care Setting, Ashlee Schoby, Candra D. Hulskotter

Doctor of Nursing Practice Projects

Improving Antibiotic Stewardship Through the Use of Patient Assessment and Provider Education Regarding Treatment of Viral URIs in the Urgent Care Setting

Candra Kronewitter and Ashlee Schoby

Date of Award

Spring 5-2020

Document Type

DNP Project

Project Team Faculty Member

Mary Zerlan, CRNA, DNP, APN

Project Team Faculty Member

Kay Gaehle, PhD

Keywords

Antibiotics, Antibiotic stewardship, URIs, Upper respiratory infections, Urgent care, ABUSE screening tool

Abstract

Antibiotic-resistant bacteria is a growing problem in the United States. The misuse or overuse of antibiotics is being considered the leading cause. Nearly 2-million individuals are infected with resistant bacteria yearly, and antibiotics prescribed …

A Pilot Of Prenatal Transitional Care Services In The Urgent Care Setting, Alexandra Huddleston, Gloria Pryzgoda, Tiffany Hazel

Doctor of Nursing Practice Projects

Established prenatal care leads to better outcomes and reduced healthcare expenditures. Inadequate prenatal care is associated with numerous risks. Many women face a variety of barriers that contribute to inadequate prenatal care. The purpose of this project was to create and pilot a new transitional care protocol to improve the referral rate of pregnant patients to establish prenatal care at a midwestern physician services (MPS) women’s health care clinic after a MPS express care visit. An extensive literature review was conducted, and a streamlined referral process linking pregnant patients to obstetric care was created to address identified barriers. The referral …

Implementing Quality Into Practice: Nurse Driven Protocol To Reduce Unnecessary Telemetry Use, Richard Clapp

Doctor of Nursing Practice Projects

Abstract

Background: As part of the American Board of Internal Medicine's Choosing Wisely initiative, the Society of Hospital Medicine issued the recommendation to reduce unnecessary use of continuous telemetry monitoring in the inpatient setting. Outside of its primary purpose continuous telemetry monitoring rarely positively impacts clinical decision making and overuse can lead to unnecessary and costly diagnostic work-ups, cause alarm fatigue, lead to emergency department congestion, and increase institutional financial burden.

Objective: Pilot an evidenced based nurse driven protocol for discontinuation of continuous telemetry monitoring to reduce unnecessary telemetry use among adult patients hospitalized outside of the intensive …

Laryngotracheal Stenosis, Kelsey Stuckey

Doctor of Nursing Practice Projects

Laryngotracheal stenosis (LTS) is the luminal compromise at the laryngeal, subglottic, or tracheal level (Gelbard et al., 2014). Various etiologies for LTS exist. Endotracheal cuff over-inflation, inappropriately sized endotracheal tubes, and sudden movements of the tube contribute to injury, as well as anatomical differences(Cardillo et al., 2010; Divatia & Bhowmick, 2005; Medina et al., 2009; Miñambres et al., 2009; Nikolovski et al., 2019; Zaghi et al.,2016). The influence of estrogen may contribute to the development of LTS in women during the third through fifth decades Dedo & Catten, 2001; Poetker et al., 2006; Valdez & Shapshay, 2002). The project goal …

Trauma Informed Care: Paving The Way To Better Patient Outcomes, Sarah Halsey, Amy L. Armstrong

Doctor of Nursing Practice Projects

Trauma-informed care (TIC) is an approach that enables healthcare clinicians to understand the effects of trauma and create a safer environment. Providers acknowledge the pervasive nature of trauma but lack proper tools and training to implement. It has been suggested that trauma is the prime determinant of health outcomes. Therefore, providing training and cultivating a change towards a trauma-informed organization, has the capability to change health outcomes.

The purpose of this project was to establish a program at SIU Medicine in which new employees are trained on the importance of TIC. Working closely with the Director of Population and Community …

Reducing Emergence Delirium In Combat Veterans Through The Development Of A Decision-Tree Utilizing Ketamine And Precedex, Joseph Oldani, Russell Arendt

Doctor of Nursing Practice Projects

Emergence Delirium incidences in the combat veteran population warrant unique anesthetic considerations. Examples of these considerations include the exclusion of a benzodiazepine and the use of low dose Ketamine or Precedex infusions. Researching these considerations, an anesthetic decision tree coupled with a screening questionnaire was developed and implemented in a hospital in Southern Illinois. The tool was developed based on a thorough literature review and a need to condense this information into a working knowledge for clinical application. Implementation of the project included staff education on the tool and the management of Emergence Delirium by using Ketamine and Precedex. A …

Diabetes Management, Christina Varady

Doctor of Nursing Practice Projects

Diabetes Self-Management Education and Support (DSMES) has been shown to improve diabetes management. A Midwest, private family practice did not offer formal diabetes education. The purpose of this project was to increase patient education for recently diagnosed patients with type 2 diabetes who had not yet reached their management goals. A second purpose was to develop quality educational material for the provider in this practice. These objectives were met by identifying patients who were not at the optimal goal of HgA1c of 7% per the American Diabetes Association (ADA) guidelines and providing quality diabetes education and follow up to these …

Safe Sleep Modeling In The Neonatal Intensive Care Unit, Barbara Garrison

Doctor of Nursing Practice Projects

Abstract

Approximately 3,500 babies die each year due to sleep related deaths. The 2016 American Academy of Pediatrics Policy Statement clearly states that all health care workers should model safe sleep for infants less than 12 months of age prior to discharge from the hospital. However, at a large, Midwest, level IV, University-based neonatal intensive care unit (NICU), safe sleep was not being modeled. The purpose of this project was to increase adherence to the American Academy of Pediatrics recommendations by implementing a unit-based quality improvement project focusing on policy development, staff education, and parent education.

Although starting out as …

Preoperative Assessment Of Patients In An Enhanced Recovery Program, Edward Mitzelfelt

Doctor of Nursing Practice Projects

All patients undergoing surgery are at risk for perioperative morbidity and mortality (Gabriel et al, 2018) and a patient’s physical status plays a key role in patient outcomes (Hopkins et al, 2016). Enhanced recovery programs are intended to improve perioperative outcomes, facilitate postoperative recovery, and reduce loss of functional capacity (Feldheiser et al, 2016). Preoperative assessment allows for identification of risk factors which can be modified, with the aim of decreasing perioperative complications. A small community hospital had no standardized preoperative evaluation tool to use for their enhanced recovery patients. The purpose of this project was to create and implement …

Pain Control Options For The Parturient: Pamphlet Development For Patient Education, Alyssa R. Jimerson

Doctor of Nursing Practice Projects

Epidural analgesia has traditionally been requested by the parturient population as the primary choice of pain control during labor, despite the availability of other viable options (Pitter & Preston, 2001). Viable pain control options available during labor include, neuraxial anesthesia, peripheral nerve blocks, pharmacological, and non-pharmacological measures. Lack of education regarding the availability of various pain control options for parturient women is identified as a cause of missed pain relief opportunities (Vargens, Silva, & Progianti, 2013). The purpose of this project was to develop a pamphlet prototype for an obstetrics department at a tertiary care center in central Illinois, explaining …

A Difficult Vascular Access Algorithm Using Intraosseous Devices In The Elective Pediatric Surgical Population, Cory R. Austin

Doctor of Nursing Practice Projects

In pediatric patients undergoing elective surgery, anesthesia is commonly induced via mask inhalation followed by peripheral IV placement before proceeding to airway management. However, IV access is often unpredictable and difficult to obtain in pediatric patients, with attempt success between 35% to 74%. During IV attempts, many dangerous clinical situations can occur amid limited options to deliver necessary medications. Failure to attain IV access may ultimately require extremes such as CVC placement or procedure cancellation. In this project, a difficult vascular access algorithm including intraosseous devices as an alternative was developed based on current evidence, existing algorithms, and implementation site …

Efforts To Improve Breast Cancer Screening In A Rural Primary Care Clinic, Michelle Voudrie, Simi Dhillon

Doctor of Nursing Practice Projects

Breast cancer is the second-leading cause of cancer-related deaths among women in the United States. The American College of Obstetricians and Gynecologists (ACOG) recommend women at average risk of breast cancer to begin screening mammography starting at age 40. Mammography has been recognized as the most substantial tool to detect breast cancer. However, many rural organizations have seen a decrease in mammography compliance rates. The goal of this project was to create an evaluation and follow-up protocol for women in a rural primary care clinic who meet the criteria for ACOG’s guidelines for breast cancer screening which promotes increased compliance …

Dedicated Preceptors Improve Nurse Residency, Anne Hustad

Doctor of Nursing Practice Projects

Research and evidence support the use of dedicated preceptors during new nurse residency programs to increase nurse retention after the orientation period. A small rural Illinois hospital introduced a nurse internship program in 2017 without the use of dedicated preceptors. The program continued throughout 2018 and nurse retention did not improve as anticipated by the hospital leadership. In early 2019, this author collaborated with the education department to implement a new nurse orientation program that introduced the use of dedicated preceptors. An education bundle was developed and presented to the dedicated preceptors outlining expectations and an orientation checklist. Pre-implementation focus …

Optimizing Data Accessibility To Impact Bcma Compliance, Lucy A. Bischof, Margott Montesinos

Doctor of Nursing Practice Projects

Background: The integration of health information technology (HIT) is an expectation during the healthcare delivery process to ensure quality and accuracy. Data generated from HIT can help facilitate quality initiatives. HIT such as Barcode Medication Administration (BCMA) has been successfully introduced in the healthcare industry with a demonstrated positive impact on patient safety. A small test of change was implemented on a Medical Surgical (MS) and Intensive Care Unit (ICU) which included automated daily BCMA compliance reports sent to leadership compared to the current standard process.

Objectives: To examine impact of reports on the BCMA compliance data. To examine leadership …

Addressing Hypertension Health Literacy In Black Individuals Who English Is Their Second Language, Uche Olateru

Doctor of Nursing Practice Projects

Hypertension is a primary preventable risk factor for cardiovascular disease. Despite advances in preventive and treatment measures, related to blood pressure control, the prevalence of hypertension in the United States remains high among Black People of immigrant and non immigrant communities. Healthcare is increasingly complex, and health literacy problems have increased due to demands by healthcare stakeholders for patients to assume a more independent role in taking charge of their health. A quality improvement project was conducted in a Faith based community to improve the knowledge of participants about hypertension. The objective of this project was to enhance lifestyle management …

Assessing The Need For Mental Health Interventions Within The Law Enforcement Community, Lizzi Varga Reinard

Art Therapy Counseling Final Research Projects

This research explored mental health interventions within the police. There is a need for mental health in law enforcement (O’Hara, 2018; Blue Help, 2019; Waters & Ussery, 2007; Mohandie & Hatchert, 1999; Miller, 1999; Violanti, 2010). Having been a law enforcement officer myself, I have experienced the stigma and the need of mental health care. I used a cross-sectional survey design to obtain further information on police officers in a Midwest county in the United States to assess the need for mental health interventions. I created response artwork prior to obtaining the survey results (to help assess and sort through …

Examining Black Art Therapy Graduate Students' Experiences With Racial Battle Fatigue, Marilyn Holmes

Art Therapy Counseling Final Research Projects

ABSTRACT Examining Black Art Therapy Graduate Student’s Experiences with Racial Battle Fatigue by Marilyn Holmes Chairperson: Jayashree George, DA, ATR-BC, LMFT, SEP Racial Battle Fatigue (RBF) is a term used to describe the psychological and physiological symptoms Black students experience after repeated exposure to microaggressions in higher academic settings (Smith, Yosso, & Solorzano, 2006). In this study, I sought to explore the specific experiences with RBF of current and former Black art therapy in their graduate programs and supervision. Supervision is an essential and necessary aspect of art therapy education that involves power dynamics that can be complicated by race. …

Increasing The Completion Of Advance Directives In Patients With Chronic Obstructive Pulmonary Disease In The Primary Care Setting, Cynthia Davis

Doctor of Nursing Practice Projects

When considering patients with COPD, current evidence indicates that discussions related to prognosis, illness trajectory, and goals of care between the provider and patient do not happen as they should. Consequently, without any advanced directives, the default in crisis is “do everything”. This gap in practice supported the need to implement an evidence-based assessment protocol regarding advance care planning needs in patients with COPD. The purpose of this project was to increase the number of COPD patients having advanced directives in a mid-western primary care clinic. The protocol included a chart review to assess for completed advanced directives among patients …

Development Of A Propofol Administration Protocol For Soy Or Egg-Allergic Patients, Kayla Tisza

Doctor of Nursing Practice Projects

The use of propofol for anesthesia and the prevalence of food allergies are both increasing. Propofol’s preparation contains soybean oil and egg lecithin, raising concerns about cross-sensitivity. No widely accepted practice protocol regarding the administration of propofol in soy or egg-allergic patients exists, and the evidence of anaphylactic reactions in this population is inconclusive. This project involved the creation of a protocol that details the use of propofol for soy or egg-allergic patients at a regional medical center in central Illinois.

Collaboration with clinical stakeholders and an extensive review of the literature guided the development of an algorithm based protocol …

Developing And Implementing Guidelines For Amniotic Fluid Embolism, Clayton Shick

Doctor of Nursing Practice Projects

Knowing that amniotic fluid embolism (AFE) is such a rare but harmful condition, a hospital in Metro-East St. Louis requested the creation of a checklist to ensure that all anesthesia providers quickly recognize and initiate appropriate management for AFE. The quality improvement project involved identifying the best evidence and collaborating with facility stakeholders to implement the use of an updated, evidence-based checklist to guide providers in the management of AFE. Via an open discussion PowerPoint presentation, CRNAs and anesthesiologists at the facility were provided education about AFE and the importance of using a checklist to facilitate management of AFE. The …