Digital Commons Network^™

Implementing An Emr System In A Small Psychiatric Practice, Brandy Mccrudden

Doctor of Nursing Practice Projects

Electronic medical records (EMRs) can aid in improving surveillance, monitoring, adherence to practice guidelines, improving communication, and reducing medical errors. The adoption of EMRs in psychiatry and mental health settings has been slow despite the offered benefits. This project aimed to develop an implementation and training plan to successfully transition from paper charts to EMRs in a psychiatry practice. An extensive literature review was conducted on the adoption of EMRs in mental health settings, and a guideline for implementation was created to overcome identified barriers. Implementation guidelines included a planning phase, staff training plan, and rollout using a phase-in approach. …

Improving Depression Remission Screening Compliance, Crystal Wingerter

Doctor of Nursing Practice Projects

Depressive disorders are widespread in the United States and are diagnosed and treated in the primary care setting. In 2019, there were an estimated 19.4 million adults that had at least one major depressive episode. The purpose of this project was to improve follow up and depression remission assessment for patients with a diagnosis of depression at a metropolitan family care practice clinic. The Patient Health Questionnaire (PHQ–9) was utilized for remission assessment. Front desk staff and providers were trained and granted access to the quality information system (QIS) in the electronic medical records (EMR) system which allowed easy identification …

Tranexamic Acid Protocol For Lower Extremity Total Joint Arthroplasties, Autumn Cullison

Doctor of Nursing Practice Projects

Abstract

Bleeding is a risk associated with surgery, and complications, such as hypotension, anemia, and decreased oxygen-carrying capacity, can occur. Blood transfusions have been the mainstay treatment for excessive surgical blood loss; however, transfusion has associated risks including infection, volume overload, immunological reactions, and increased morbidity and mortality (Sahu et al., 2014). Interventions to decrease surgical blood loss are essential components to improving surgical outcomes. The antithrombolytic, tranexamic acid (TXA), decreases surgical blood loss and blood transfusion requirements, thereby decreasing transfusion-related complications (Gausden et al., 2017). Despite frequent use, variance exists surrounding the administration of TXA. Current evidence and guidelines …

Improving Health Prevention Screening In A Rural Health Clinic, Shawn M. Mcnally

Masters Projects

Background: Health prevention screening has recently been highlighted in many initiatives from leading countries around the world. Breast cancer screening, cervical cancer screening and osteoporosis screenings are among the highest objectives for many of these initiatives as national health agencies focus on reducing morbidity and mortality by early detection.

Local problem: Baseline quality metrics reported for one clinic show the appropriate ordering of these health screenings is below the national benchmarks and the organizational benchmarks.

Methods: The project was designed as a quality improvement project based in a critical access region serving a rural population.

Interventions: The project intervention …

Telehealth Monitoring For Non-Hospitalized Covid-19 Positive Patients In A Rural Setting, Rebekah Leann French

Doctor of Nursing Practice Scholarly Projects

Purpose

This quality improvement project evaluates the efficacy of an outpatient COVID-19 telehealth monitoring program intended to increase access to care, decrease emergency room/urgent care visits, and hospital admissions among telehealth observed adult patients in a rural area while providing safe home monitoring during acute illness.

Rationale/Background

Prior to COVID-19 pandemic, healthcare systems within the United States encountered several challenges including healthcare inequality and decreased healthcare access, particularly in rural communities. These gaps became more apparent when a novel COVID-19 pandemic emerged straining healthcare systems in the United States and throughout the world. Challenges ranged from overwhelmed emergency room (ER) …

Improving Depression Screening Completion Rates For Medicare Patients In A Primary Care Setting, Kenneth J. Haluska

Evidence-Based Practice Project Reports

The United States Preventative Services Task Force recommends screening the general adult population for depression (Siu et al., 2016). Despite increasing clinical practice guidelines recommending depression screening, only 40-50% of depressed older adults are recognized and treated (Phoh et al., 2017). The purpose of this evidence-based practice (EBP) project was to implement a medical assistant (MA) depression screening protocol, using the PHQ-9 and staff education, to improve depression screening completion rates in Medicare patients in a primary care setting. An exhaustive literature search of eight databases yielded 14 pieces of evidence that made recommendations for best practice. The evidence was …

Naloxone Education To Improve Distribution In Primary Care: A Quality Improvement Project, Joanna Boback

DNP Projects

Significance and Background: Opioid overdose is a major public health problem in the United States. The Centers for Disease Control and Prevention (CDC) developed guidelines for prescribing opioids which have not been widely integrated into practice. These guidelines specify co-prescribing naloxone with opioids as a form of harm reduction. A policy to reflect these recommendations was needed to guide prescribing at a Federally Qualified Health Center (FQHC) in Connecticut to increase low naloxone prescribing rates. Evidence supported the use of provider education to increase prescribing rates.

Purpose: Deliver education to providers across the health system on best practices related to …

Improving Breastfeeding Rates Through Education, Julianna Youssef

Doctoral Projects

Background: Breastfeeding is beneficial for newborn babies, but there are many challenges that new mothers face that prevent them from exclusively breastfeeding.
Objective: To evaluate if re-educational training in RN’s and LVN’s is an effective way to increase the exclusive breastfeeding rates in the hospital setting.
Methods: We utilized a pretest/post-test quasi-experimental design and had the goal sample size was about 50 nurses. The nurses were given an educational PowerPoint at a monthly staff meeting. Pretests were given to the staff immediately before and posttests two weeks later. Additionally, exclusive breastfeeding rates were monitored for the three months before the …

Impact Of Teamstepps Training On Teamwork Perception In Two Primary Care Clinics, Brittaney Shaw

Doctor of Nursing Practice Projects

Background: Most healthcare delivery involves teams. After teamwork and communication breakdowns, poor patient care, errors, and inefficiencies follow. Employee engagement surveys from two Galveston County clinics showed concern with teamwork and value. TeamSTEPPS, a team training program, improved attitudes, knowledge, and outcomes, according to the Agency for Healthcare Research and Quality. Purpose: The project examined how TeamSTEPPS training affected healthcare professionals’ and administrative employees at two Galveston County primary care clinics' teamwork perspectives. PICOT Question: Among entire staff in two primary care clinics (P), what is the impact of TeamSTEPPS (I) on improving teamwork perception (O) comparing pre-post TeamSTEPPS Teamwork …

Formalized Diabetes Self-Management Education In A Safety-Net Clinic, Emanpreet Kaur

Masters Projects

Diabetes is a complex and chronic illness requiring continuous medical care with multifactorial risk reduction strategies (American Diabetes Association [ADA], 2021). More than 37 million Americans are suffering from diabetes and 90% of them have Diabetes Mellitus Type 2 (DMT2) (Centers for Disease Control and Prevention, 2021). The purpose of this article is to review the background, an organizational assessment, a literature review, and the results of the quality improvement project that took place at a safety-net clinic in the Midwest. This project included 16 patients and data was analyzed through descriptive statistics. Results include improved hemoglobin (Hg) A1c, Body …

Nurses’ Perception Of Work-Environment Uncertainty And Readiness For Organizational Change, Aishah Alsolami, Hanan Alkorashy, Mysara Alfaki, Ahmed Alkarani

Makara Journal of Health Research

Background: Healthcare organizations have a dynamic work-environment that changes constantly. This study aimed to explore whether there is a relationship between work-environment uncertainty and nurses’ readiness to participate in organizational change.

Methods: A cross-sectional study was conducted at two tertiary hospitals. The sample size was 222 nurses. A self-report questionnaire was adopted, translated to Arabic, and used for collecting data; it consists of three scales, personal data sheet, organizational readiness for implementing change scale, and perceived environmental uncertainty in hospitals scale. Descriptive statistics t-test and analysis of variance were used to analyze the data.

Results: The level …

Does Competency-Based Educational Elearning Improve Medical Assistant Knowledge And Performance In Blood Pressure Measurement And Recognition Of Elevated Bp Readings?, Janice Burkybile

Anna Vaughn School of Nursing Doctor of Nursing Practice (DNP) Projects

Inaccurate blood pressure measurement techniques can severely impact patient health, from missed diagnoses to medical mismanagement with the potential development of cardiovascular disease and chronic kidney disease. Researchers have reported for decades that all skill levels of healthcare providers perform inaccurate blood pressure measurement techniques. This problem can be attributed to one-time instruction with no refresher follow-up and no standardization of technique. Competency-based education facilitates healthcare providers to achieve competency in knowledge and performance of learned new skills and refresher training. Ultimately, competency-based education develops lifelong learners resulting in improved patient outcomes. The educational intervention was a thirty-minute eLearning codeveloped …

Impact Of Teamstepps On Team Performance In An Oral And Maxillofacial Surgery Practice, Katherine E. Lee

DNP Projects

Effective communication and teamwork skills among oral and maxillofacial surgery (OMS) teams are essential for quality and safe patient care. As some in the profession assert that the team model for delivering anesthesia care is integral to their history of safety, the model continues to be scrutinized by professional groups whose members seek to limit oral surgeons’ ability to provide anesthesia services in the office setting. This quality improvement project assessed how introducing the TeamSTEPPS Office-Based Care (OBC) program in an OMS clinic impacted team dynamics. The impact of TeamSTEPPS OBC training on attitudes and perceptions of teamwork was evaluated …

The Benefits Of Family Presence During Resuscitation, Abigail Harris, Payton Hale, Audrey Jeziorski

Scholars Week

The research provided analyzes the benefits and fears concerning Family Presence During Resuscitation (FPDR) as a standard practice in healthcare facilities. Evidence is available that FPDR supports increased familial satisfaction and psychological outcomes as well as benefits to the patient and healthcare team involved in resuscitation efforts, however this practice is not consistently implemented in healthcare facilities. Three main studies were analyzed throughout this research in order to determine the causation of inconsistent and absent policies regarding FPDR. The analysis of these studies determined that there is a lack of guidelines, education, and policies resulting in absence of family members …

Effects Of An Evidence-Based Practice Bundle Project On Nurse Empowerment, Kevin Jay Inman

Graduate Theses, Dissertations, and Capstones

The project determined the effect of an Evidence-Based Practice bundle program on nurses’ perception of empowerment. The EBP bundle included 7 interventions implemented simultaneously throughout a small community hospital. There was a significant increase in nurses’ perception of empowerment (p<.001), EBP beliefs (p<.001), and use of EBP (p<.001) after the implementation of an EBP bundle.

Improving Pediatric Medical Nurses’ Confidence In Caring For Pediatric Mental Health Patients: A Pilot Project Large Academic Pediatric Health System In The Pacific Northwest, Lauren Kalember

Doctor of Nursing Practice Projects

Problem Description

Pediatric mental and behavioral health care needs continue to increase across the nation. Approximately ten percent of pediatric hospitalizations are for a primary mental or behavioral health condition (Canvara & Johnson, 2020). With the increase in hospitalizations for mental health (MH) needs, pediatric psychiatric units are at capacity, and MH patients are admitted to pediatric general medical/surgical units for care. Most of the nurses that work on these units have not received pediatric mental health education outside of nursing school curricula and report a lack of confidence in their ability to care for pediatric MH patients. With the …

Onboarding Advanced Practice Nurses To Pre-Anesthesia Care, Megan P. Abate

Seton Hall University Dissertations and Theses (ETDs)

Onboarding advanced practice nurses to the pre-anesthesia clinic (OBPAC) is a complex process that involves the integration and familiarization of new employees with the workplace. It is considered essential for safe and efficient clinical practice and the achievement of organizational goals. Fostering independence and competency are the overall aims of the onboarding process. The preceptor ensures that new advanced practice nurses (APNs) receive the support and guidance needed when learning new skills (Simone et al., 2016). There is evidence to show that dedicating time to a well-organized onboarding plan, laying clear job expectations with precepting, and continuous mentoring increases precepting, …

Toward An Evidence-Based Framework To Guide Health Care Responses For Patients Impacted By Human Trafficking: Evaluation Of The Heal Trafficking Protocol Toolkit, Susie B. Baldwin, Cathy L. Miller, Beth J. Maclin, Sacha Williams, Hanni Stoklosa

Nursing Faculty Publications and Presentations

Trafficked persons seek health care during exploitation, but few health professionals know how to respond appropriately, and few institutions have protocols to guide this response. Currently, no empirically tested framework exists to guide protocol development for human trafficking response protocols in health care settings. Our aim was to empirically evaluate the HEAL Trafficking Protocol Toolkit's usability and effectiveness through cross-sectional survey methodology. We invited users who downloaded the free Toolkit from January 2017 through January 2018 to participate in an electronic survey and conducted descriptive quantitative and qualitative thematic analyses. Survey respondents were professionally and geographically diverse. Eighty-four percent who …

Patient-Mediated Interventions In Hospital: A Systematic Review, Georgia Tobiano, Shelley Roberts, Rachel Muir, Teresa Jerofke-Owen, Christine Ting, Sarah Thorning, Daren K. Heyland, Andrea P. Marshall

College of Nursing Faculty Research and Publications

Aims

To describe the characteristics of hospital-based, patient-mediated interventions and their impact on patient, clinician and organization outcomes.

Design

Systematic review.

Data Sources

Health literature databases (MEDLINE, CINAHL and EMBASE) were searched in August 2021. Backward and forward citation searching was conducted.

Review Methods

Studies investigating patient-mediated interventions, targeted at adult hospitalized patients were eligible. Data were extracted related to study and intervention characteristics. Narrative synthesis was used to understand intervention impact on patient, clinician and organization outcomes (as per a framework). Methodological quality was assessed using the Mixed Methods Assessment Tool.

Results

Thirty-three studies, reporting 18 interventions, were included. …

Development And Implementation Of An Evidence-Based Practice Guideline Regarding Cricoid Pressure, William Carson Ii

Doctor of Nursing Practice Scholarly Projects

Cricoid pressure (CP) has been a standard of practice since the 1960s. The purpose is to reduce aspiration of gastric content into the lungs in high-risk patients undergoing induction of general anesthesia. Aspiration has been identified as the most common cause of airway-related mortality for patients undergoing general anesthesia. The cause of airway-related mortality can be correlated to the application of CP. Incorrect application of CP may lead to adverse clinical events and outcomes. It has been demonstrated that when administering CP in a simulation-based environment, providers are applying pressure to the incorrect anatomical location and/or applying the incorrect amount …

Effectiveness Of Staff Training On Trauma-Informed Care, Brandy Tramel Williams

Doctoral Projects

The connection between experiencing trauma and the development of substance use disorder is widely recognized. Although trauma is more prevalent among individuals with substance use disorders, healthcare professionals have limited access to training focused on trauma informed care. It is crucial for those working in addiction treatment to receive training and education on trauma informed care to understand the impact of trauma and its association with substance use disorders.

This DNP project's objective was to develop and evaluate an educational presentation for staff emphasizing the importance of trauma-informed care in the context of addiction. The effectiveness of this intervention was …

Postgraduate Residency Program: Pedagogical Strategies In Bridging The Transition From Novice Nurse Practitioner To Confident Primary Care Provider, Kelly Stauter, Katherine Bydalek

CoTL 2023 Research Talks

Advancing the education of new nurse practitioners helps close the gap with the knowledge and core competencies necessary to practice independently and master delivery of quality care across the life span to vulnerable populations. Innovative teaching strategies incorporate the needs of the novice nurse practitioner and are designed to support the inclusive learning environment through educational technology, learner-centered activities, interprofessional partnerships, and local community-based agencies that facilitate active learning. Expanding the didactic and clinical training experience by integrating specialty rotations and simulation immersive events, enhances learning outside of the classroom and equips the postgraduate nurse practitioner with the skills and …

Increasing Self-Awareness In Nursing, Adrienne Irene Abbot

Walden Dissertations and Doctoral Studies

Nursing self-awareness is essential for nurses to develop relationships with co-workers and patients. In the local organization, the practice problem for this doctoral project is a perceived low level of self-awareness in nursing. This Doctor of Nursing project aimed to determine if an educational intervention focused on self-awareness and the benefit of self-awareness increased knowledge among nurses working on a medical-surgical unit. A comprehensive literature review of peer-reviewed evidence provided evidence to support this project. A total of 26 individuals (N = 26) participated in the educational intervention. Eighty-nine percent (89%) of the participants (n = 23) were female, and …

Staff Education Of Diabetic Foot Care In An Ambulatory Setting, Riza Grace Nielsen

Walden Dissertations and Doctoral Studies

One of the most important factors affecting the quality of diabetes care is the association between a patient’s knowledge and their practices. The practice gap in this primary care clinic was a lack of standardized diabetic foot care. The purpose of this DNP project was to provide nursing staff with an evidence- based, culturally congruent diabetic footcare curriculum that could help decrease inconsistencies in care. The practice-focused question for this project addressed whether an educational program for nursing staff on diabetic footcare would increase their knowledge and translate this knowledge into practice to prevent diabetic foot infections and its complications. …

Quality Improvement Initiatives And Interventions For Decreasing Falls In The Hospital Setting, Fredlyn Lolange

Walden Dissertations and Doctoral Studies

Patient falls in health care settings are a widespread and severe problem, and they often happen as a result of a complex set of causes. In the United States, between 3.3 and 11.5 falls occur per 1,000 patient days. Reducing the incidence of falls in a health care setting would bring significant positive change and decrease the incidence of harm to patients in the hospital setting. This staff education project’s purpose is based on addressing falls, a safety concern and a health issue that continues to put patients at an increased risk. Theories used to inform the project include the …

Differences Between Nurse-Led Intervention Topics, Longevity, Changed Practices, And Sustainability Planning, Robin Anselm

Walden Dissertations and Doctoral Studies

Though health care providers use evidence-based interventions (EBIs), a knowledge gap exists regarding lasting change associated with doctorate-prepared nurse interventions and sustainability planning. This quantitative cross-sectional descriptive design guided by the five pillars of the United Nations sustainable development goals (SDGs) was used to examine the differences between doctorate-prepared nurses’ sustainable EBI topics, intervention longevity, changed clinical practices, and sustainability planning. The dynamic sustainability framework, the adult learning theory, and the social learning theory framed this study. The design included a survey of 1,365 nurse anesthesiologists using a questionnaire composed of the Program Sustainability Assessment Tool (PSAT) version 2 and …

Clinical Care Protocol For Enhanced Nurse Competency In Caring For The Patient With An External Ventricular Drainage (Evd) Device, Lauren Orson

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: The focus of this Doctor of Nursing Practice Project surrounds the need for an evidence-based clinical nursing protocol to augment nurse competency and therefore streamline care to patients with an external ventricular drain (EVD).
Methods: A clinical protocol alongside tailored education was used to promote nurse competency for EVD management. A pre-implementation survey was completed evaluating the nurses’ baseline competency when managing an EVD. The nursing protocol was then implemented for bedside use. After 2 months, the survey was completed once again and paired for statistical analysis.
Results: Statistical analysis using the Wilcoxon signed-rank nonparametric test with dependent matched …

Managing Nurse Leader Stress To Promote Leader Retention, Rebecca Sue Hawkins

Walden Dissertations and Doctoral Studies

Nurse leaders are a health care group that has been provided limited support to managestress and burnout symptoms, yet the impact of leader stress burden on staff satisfaction, patient outcomes, and their own health is vital to the provision of safe, high-quality health care. The problem of leader fatigue and burnout is the ability to retain current leaders and recruit the next generation. The purpose of this staff education project was to address leadership burnout due to stress and the lack of knowledge of how to manage stress in the moment. A combination of Watson’s theory of caring and Ray’s …

Differences Between Nurse-Led Intervention Topics, Longevity, Changed Practices, And Sustainability Planning, Robin Anselm

Walden Dissertations and Doctoral Studies

Though health care providers use evidence-based interventions (EBIs), a knowledge gap exists regarding lasting change associated with doctorate-prepared nurse interventions and sustainability planning. This quantitative cross-sectional descriptive design guided by the five pillars of the United Nations sustainable development goals (SDGs) was used to examine the differences between doctorate-prepared nurses’ sustainable EBI topics, intervention longevity, changed clinical practices, and sustainability planning. The dynamic sustainability framework, the adult learning theory, and the social learning theory framed this study. The design included a survey of 1,365 nurse anesthesiologists using a questionnaire composed of the Program Sustainability Assessment Tool (PSAT) version 2 and …

Development Of A Standardized Novice Neonatal Nurse Orientation Program, Joanne Rau Pasinski

Walden Dissertations and Doctoral Studies

Abstract Neonatal intensive care units (NICUs) are fast-paced units requiring skilled nurses to care for a unique patient population. Orientation of new nurses to the NICU can be challenging for both the orientee and the preceptor. Offering an evidence-based practice orientation program by an accredited organization that is specific to NICU can be a valuable tool for both the preceptor and the orientee as well as enhance nurse, patient, and organizational outcomes. The project question explored if use of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) 15-module nursing orientation program for RNs in a NICU increased their …