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Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Increasing Equitable Access To Care: Implementation Of Universal Palliative Care Screening In The Intensive Care Unit, Sarah Weaver

Student Scholarly Projects

Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations.

PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame?"

Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance …

Retrospective Evaluation Of Depression Screening Process Among Older Adult Patients In Primary Care For Quality Improvement., Ashley Dru Larson

Doctor of Nursing Practice Papers

Background: Depression is not a normal process of aging; it is a diagnosable and treatable medical condition. The US Preventive Services Task Force (USPSTF) recommends that older adults be screened for depression annually.

Aim: The purpose of this evidence-based practice (EBP) project was to evaluate the depression screening process for older adults (age 65+) in a primary health care setting and provide recommendations to the primary health care clinic for improving it.

Methods: This EBP project involved collecting retrospective data from August to October 2022, including aggregate data (demographics), from all older adults who were seen in …

Iris Nursing Strong Program: Benchmark Study, Sonia Bunyard, Keviesha Lacy

MSN Capstone Projects

The change project we are presenting is the IRIS-Nursing Strong program. IRIS stands for: Increasing, Reason & Relaxation, Implementation, Strategies all aimed to prevent nursing burnout. The Iris flower symbolizes hope and strength as nurses are healthcare providers who constantly provide that hope and strength to their patients. We plan to develop this program in the workplace to infuse that hope and strength back into the nurses who spend so much time taking care of others. The goal is to offer a non-judgmental environment, recognize early signs of distress in ourselves and our peers, provide …

Impacting Nurse Job Satisfaction And Engagement Through Shared Governance, Meghan K. Douglas

Doctor of Nursing Practice Scholarly Projects

Problem: Shared governance (SG) has been identified as an effective process to promote shared decision-making between direct care nurses and nursing leadership. However, barriers were identified at a large hospital system in the Southeastern United States (US) that postponed the full implementation of SG. This prevented nurses from having input on policies and actions that directly affected their work. Purpose: The purpose of this evidence-based project (EBP) was to determine if unit-based SG improved job satisfaction and engagement for nurses on inpatient medical-surgical units at a large hospital system in the Southeastern US. Method: Five medical-surgical units were identified to …

Organizational Readiness For Implementing A Postpartum Depression Screening Protocol In The Nicu, Deanna L. Suber

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Postpartum depression (PPD) is a major depressive disorder that is the most common complication following childbirth, occurring in about 16% of new mothers (Berns et al., 2021). Mothers with infants in the Neonatal Intensive Care Unit (NICU) are 40% more likely to develop PPD but are not typically screened for this complication (Berns et al., 2021; Cherry et al., 2016; Garfield et al., 2021). Implementing a PPD screening protocol in the NICU could help increase the detection of PPD in this population but would first require an evaluation of organizational readiness to ensure sustainability. Purpose: The purpose of …

Implementing The Use Of The Emergency Severity Index Triage Tool In Urgent Care, Sakeena Spencer

Doctor of Nursing Practice Projects

Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has …

Implementation Of Routine Screening To Detect Early Cases Of Depression And Anxiety In Hispanic Adolescents In The Primary Care Setting, Latoya Hayward

Doctor of Nursing Practice Projects

Depression and anxiety are among the leading causes of illness and disability in adolescents and are two of the most prevalent mental health conditions in Latino youth. If left unrecognized and untreated, these conditions can lead to decreased quality of life and increased rates of suicide. Researchers recommend early mental health screening to occur in the primary care setting. Through routine screening using evidence-based screening tools (PHQ-9 and GAD-7), the primary goal of this quality improvement project was to increase early detection of depression and anxiety in primary care and initiate early treatment. Project methods included implementation of new workflow, …

Inspiring Excellence In Doctoral Nursing Education Through Partnership: Incorporating An Innovative Change Model To Improve Dnp Project Outcomes, Melanie Brewer, Debbie Conner, Transition Management Partners, Llc

All Faculty and Staff Scholarship

Background/Introduction

Franklin University, a leader in educating working adults, formed an academic practice partnership with OhioHealth. Integrating the OhioHealth Change Management Model (CM) into the Doctor of Nursing Practice (DNP) program marks a deviation from a theory-based project to a more theory-to-practice model for managing organizational change. The CM provides leadership-driven DNP students with access to an innovative, real-world approach to prepare to transform organizations, systems, and healthcare through evidence-based interventions.

Purpose

The CM is a novel, goals-focused, data-driven approach used to manage people while implementing evidence-based practice, policy, or business change in an organization. The model includes Identifying executive …

Improved Data Communication With Frontline Staff, David Sprecher

Master's Projects and Capstones

Problem: Frequently, communication from the Quality Department (QD) needs to be filtered through several organizational layers without first-hand knowledge of what message was given to frontline staff. Current mechanisms of communication between the QD and front-line microsystem teams have barriers preventing them from being consistent and reliable.

Context: Research has found that collaborating with and supporting frontline staff was key to establishing a culture that supports change and a focus on safety. Establishing open communication and effective teamwork with individuals on the frontline leads to shared values within a team and better collaboration which drives performance improvement.

Interventions: For trended …

Instituting A Preceptor Program In Home Health, Abbi Arnold

Master's Projects and Capstones

Problem: Staff being unfamiliar with the role of being a preceptor impacts their ability to perform the job well. Insufficient understanding of a new role creates stress and uncertainty which can lead to poor employee retention or high job dissatisfaction.

Context: The setting for this project is a large hospital-based home health agency that has an average daily census of 375 patients. The project was a collaboration between home health management and the quality department.

Measures: A measurement strategy was developed to meet the outcome measure, process measure, and balancing measure. The outcome measure was increasing the nurses’ understanding of …

Improving The Delivery Of Discharge Instructions On The Postpartum Unit By Increasing The Nurses' Knowledge, Judy Anne Settles

Master's Projects and Capstones

Abstract

The field of nursing prides itself on two critical functions: safety and patient education. One of the mechanisms for both education and safety is the discharge process. Improvements in the discharge process have been shown to increase patient comprehension and safety. This study is grounded in the (Barach & Johnson, 2006) healthcare organizational framework called the 5 Ps microsystems assessment to explore the impacts and improvements in the discharge instruction process on a postpartum unit in a large organization. It was found that HCAHPS scores regarding discharge instructions were 55-60%, which is below what is considered satisfactory. Utilizing the …

Quantification Of Obstetric Hemorrhage, Alma Garcia

Student Scholarly Projects

Practice Problem: The practice problem identified involved the inconsistent measurement of blood loss during the postpartum period due to the standard practice of estimating blood loss. Estimates are subjective measures that can have variable results based on interpretation and thus provide minimal meaningful data.

PICOT: The question that guided this project was structured in the following PICOT format. In postpartum women (P), how does the implementation of quantitative blood loss measurements (I), compared to estimated blood loss measurement (C), affect the early identification of severe hemorrhage (O), during the recovery period (T)?

Evidence: Obstetric hemorrhage is a preventable event that …

Understanding Modern Drivers Of The Employee Experience In Healthcare, Antonio Pangallo, Tim Atwell, Kristi Roe, Adrienne Boissy

Patient Experience Journal

Employee engagement has been considered the guiding metric to convey the health, loyalty, and performance of the healthcare workforce. However, the pandemic created new challenges and stimulated deeper conversations around remote work, systemic racism, inclusivity, trust, well-being, and mental illness, which calls into question whether engagement alone is enough. Using an employee experience model deployed in other industries, we identified key drivers of six employee experience (EX) outcomes. We conducted a panel study with close to 5,000 nurses and physicians to identify and prioritize current key drivers specific to the healthcare employee experience. Relative weights analyses suggest that being treated …

Addressing Anxiety In Hospitalized Adults Using A Music Intervention, Raina M. Rochon

Student Scholarly Projects

Practice Problem: The practice problem is anxiety related to hospitalization among adults in an acute care setting. Increased anxiety can lead to other issues while hospitalized including disruptive behaviors.

PICOT: The PICOT question that guided this project was: In hospitalized medical-surgical adults (P), how does the implementation of a music intervention as an adjunct to standard distraction techniques (I) compared to standard care (C) affect symptoms of anxiety as observed by the rate of behavior de-escalation team calls (O) within eight weeks (T)?

Evidence: There were five systematic reviews, four systematic reviews with meta-analysis with high level of …

Implementing A Diabetes Risk Screening Protocol In The Primary Care Setting., Anna Marks

Doctor of Nursing Practice Papers

Abstract

Background: Over one-third of the United States population, approximately 86 million individuals, are estimated to have prediabetes (CDC, 2021a). If left untreated, prediabetes will progress to type II diabetes mellitus (T2DM) in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop T2DM within their lifetime (Hostalek, 2019).

Purpose:The purpose of this quality improvement project was to implement and evaluate the American Diabetes Association MyChart Diabetes Risk Assessment tool in a primary care clinic to optimize the early identification of prediabetes and T2DM in non-pregnant adults ages 18 to 70 …

Reducing The No-Show Rate At A Community Mental Health Organization., Philip E. Pippen

Doctor of Nursing Practice Papers

Relative to other outpatient healthcare specialties, appointment nonattendance (no-shows) is most prevalent in psychiatric settings. Upon meeting with a community-based mental health organization in Louisville, KY (LCMHO), referral no-shows for intake appointments were identified as a significant issue. LCMHO’s intake appointment no-show rate, estimated at 25 – 40%, exceeded nonattendance trends in the literature. The purpose of this evidence-based practice (EBP) project was to develop and implement a referral engagement reminder intervention for improving intake appointment attendance. A systematic approach guided by the Model for Improvement was applied to foster this evidence-supported practice change. The project’s findings included a 16% …

A Feasibility Study To Identify If The Induction Of The Relationship Based Care Program Enhance The Caring Skills Of Registered Nurses?, Jennifer Millet

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this Doctor of Nursing Practice project was to educate the Registered Nurses (RNs) to implement the Relationship Based Care (RBC) model and Jean Watson’s Theory of Human Caring principles into their practice. The model and principles were put into practice by the RNs, followed by examining the RNs perception and practices of caring and confidence skills had improved after the intervention. The mission of this project was to promote quality outcomes and patient satisfaction through caring relationships. Strengthening these relationships will help the caregiver experience the essence of care and be able to better connect to another …

Reducing Falls Related To Toileting, Brian Locastro

Student Scholarly Projects

Practice Problem: The practice problem for the medical-surgical unit is a high rate of falls associated with toileting activities, despite universal fall precautions for all patients. The current fall rate is an average rate of 4 falls per 1,000 patient days.

PICOT: The PICOT question that guided this project was: Among adult patients in the inpatient medical-surgical unit (P), what is the effect of adding a toileting care plan (I) to the current practice of universal fall precautions (C) to reduce the severity and incidence of falls (O) within an 8-week period (T)?

Evidence: Nine high-quality articles supported a toileting …

The Effect Of Transfer Of Care Protocol On The Rehospitalization Rates In Psychiatric Patients, Fernando Guillen Msn, Cnp, Pmhnp-Bc

Student Scholarly Projects

Practice Problem: The problem involved the transition of psychiatric care from long psychiatric hospitalizations to community-based psychiatric treatment which has developed into shorter inpatient psychiatric hospitalizations, which in turn has developed into a significantly higher number of individuals being readmitted within one year of inpatient discharge.

PICOT: In adult patients undergoing inpatient acute psychiatric care (P), how does the use of a transfer of care protocol (I), compared to current transfer of care practice (C), affect the rate of readmission within 30 days for inpatient acute psychiatric care (O), in 10 weeks?

Evidence: The evidence from an extensive literature review …

Nurse-Led Intervention: Implementing Early Mobilization Of Patients In The Intensive Care Unit, Lou A. Hill

Student Scholarly Projects

Practice Problem: Immobility of patients in the hospital intensive care unit can cause longer stays in the intensive care unit and the hospital. Evidence-based early mobilization of patients helps to reduce length of stay (LOS) and avoid many detrimental sequelae, leading to short and long-term debilitation.

PICOT: The PICOT question that guided this project was: In the adult medical and surgical intensive care units (P), how does implementation of a nurse-driven protocol for early mobility (I), affect the LOS in the intensive care units and the LOS in the hospital (O), as opposed to not using a protocol for early …

Predictors Of Engagement In Nursing Professional Practice: Transforming Organizational Culture In The Post-Covid Healthcare Environment, Jennifer Garnand

Dissertations

Cultivating the shared belief that individuals matter within an organization enhances the empowerment of staff and supports enthusiastic engagement in organizational efforts aimed toward a common mission, vision, and goals (McShane & Von Glinow, 2019). The nursing profession has been plagued by an unprecedented decrease in engagement and diminished job satisfaction, particularly following the prolonged tenure of the COVID-19 pandemic, leading to subsequent attrition amidst a staffing crisis. This quantitative predictive correlational study seeks to determine whether proactive and persevering characteristics, professional identity, and passion of nurses are predictors of engagement in a post-COVID healthcare environment. The research was based …

A Nursing-Driven Delirium Protocol, Alexandria Gray Bridges

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Delirium is a common, often preventable, condition in hospitalized patients and is associated with increased complications, worse outcomes, increased risk of death, and increased health care costs. Purpose: The purpose of this project was to determine if, utilizing a nursing-driven, non-pharmacological intervention, based on the NICE Guidelines, can decrease the incidence of delirium. Methods: Using the Iowa Model of Evidenced Based Practice to Promote Quality Care (Iowa Model), an EBP project was implemented. Patients were identified as being at risk of delirium using The Confusion Assessment Method (CAM) and these patients received the non-pharmacologic intervention as part of …

Assessing The Readiness Of Chf Patients To Use The Medisafe App To Increase Medication Adherence, Janet Lynn Kubas

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Heart failure (HF) is a complex cardiovascular disease that affects 6.2 million Americans and is associated with high morbidity and mortality, with almost 400,000 deaths annually. Medication adherence in HF can lower the risk of death and rehospitalization. As many as 46% of heart failure patients have medication nonadherence. The 2021 Update to the 2017 American College of Cardiology Expert Consensus Decision Pathway for Optimization of Heart Failure Guidelines recommends smartphones or other mobile health (mHealth) applications (apps) for medication adherence tracking. Purpose: This evidence-based practice project aimed to assess the readiness of HF patients admitted to an …

The Use Of A Clinical Pathway To Increase Child Abuse Screenings Of Young Children With Fractures, Stephanie Li Schaller

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Nationally, infants and young children who present to emergency departments with fractures are not being screened adequately for possible physical abuse with a skeletal survey (Paine & Wood, 2018; Shelmerdine et al., 2014; Wood et al., 2019). Without universal screenings, implicit bias along racial and socioeconomic lines becomes a factor in deciding which children with fractures get screened, resulting in either under-or over-utilization of skeletal survey screenings (Kim et al., 2017; Paine & Wood, 2018). When child abuse is not diagnosed correctly, further abusive injuries or death can occur (Ravischandiran et al., 2010). Purpose: This evidence-based practice project …

Addressing Polypharmacy: Implementing The Medication Appropriateness Index Clinical Tool To Increase Deprescribing By Healthcare Providers, Lori Floyd

Doctor of Nursing Practice Projects

Background: Polypharmacy is a national and local issue of concern within healthcare. Deprescribing medications has been identified as a plausible solution for patients experiencing polypharmacy. However, many healthcare providers are unaware of the practice of deprescribing and, if aware, may not be implementing clinical tools for deprescribing effectively. The family medicine clinical site supplies an opportunity for healthcare providers to utilize an evidence-based clinical tool to review medications, identify if inappropriate, and deprescribe if indicated.

Purpose: The purposes of the Doctor of Nursing Practice (DNP) project were to increase deprescribing activity among prescribing healthcare providers and to increase prescribing healthcare …

Evaluation Of The Implementation Of The Munro Pressure Ulcer Risk Assessment Scale To Mitigate Pressure Ulcers In The Perioperative Setting, Sherry Lynn Grandison

Doctor of Nursing Practice Projects

Background: The process of implementing appropriate skin assessment and documentation throughout the patient’s operative experience assists in the early detection of pressure ulcers.

Purpose: This Doctor of Nursing Practice (DNP) project had two goals. The first was to determine a practical tool that would ensure that surgical nurses demonstrate competence and comply with the process of identifying compromised skin integrity, and the second goal was to effectively communicate the findings with other clinical team members.

Methods: The DNP project focused on the use of the Munro Pressure Ulcer Risk Scale Assessment Tool to identify pressure ulcers and to promote collaboration …

Reducing Inpatient Falls And Falls With Injury, Constance Leigh Cannon

Electronic Theses and Dissertations

Patient falls are a costly problem for many inpatient hospitals and are exacerbated by poor training of nursing and ancillary staff. The researcher sought to determine if there was a difference in inpatient falls and falls with injury after a hospital facility in the Southwestern United States revised its fall prevention policy, reorganized its fall prevention committee, and provided new interventions for nurses assessing patients for fall risk. In this quantitative, retrospective, comparative project, the researcher reviewed data from 2017–2020 related to the facility’s fall prevention program, including its new interventions and efforts to involve patients in their safety and …

Prescribed Pediatric Extended Care: A Program Evaluation On The Impact To Families Of Children With Medical Complexities., Jody Rogers

Graduate Theses, Dissertations, and Capstones

This is a paper about the impact of Prescribed Pediatric Extended Care (PPEC) on families of children with medical complexities.

Improved Monitoring Of Depression And Suicidal Ideation In Low-Income Adolescents Through Evidenced Based Provider Education, Sunday Adeyeye

Doctor of Nursing Practice Final Manuscripts

Background: Adolescents from low-income status experience more prevalent thoughts of suicide than their financially secure peers. Nearly 15% considered taking their own life. Suicidal ideation among adolescents in California ranges from 4% to 67%. Depression and suicidal thoughts are underdiagnosed among adolescents, with higher disparities among minority and lower socioeconomic backgrounds.

Purpose: This project involved consistent screening of high-risk adolescents for potential depression and suicidal ideation using a patient health questionnaire recommended by the U.S. Preventive Services Task Force screening.

Process: This project involved adolescents 12–18 years old who had visited a federally qualified healthcare center in San Bernardino, California. …