Digital Commons Network^™

Smiling Mind: A Mobile Based Application To Reduce Stress, Agnes Rodrigues

Doctor of Nursing Practice Final Manuscripts

It has been recognized healthcare professionals experience high levels of stress at work with many working in environments characterized by high productivity targets, overtime, customer aggression, continuous organizational changes, and employee shortages. Mindfulness-based interventions such as mobile based meditation applications have gained popularity in the workplace given their potential benefits in decreasing workplace related stress, their ease of use, and cost-effectiveness. The purpose of this evidence based project (EBP) project was to reduce perceived workplace stress and to increase mindfulness using a mobile meditation application. Employees of an outpatient psychiatric clinic used the mobile meditation application Smiling Mind to meditate …

Psychosocial Distress Screening For Patients With Cancer: A Value-Based Approach To The Integration And Delivery Of Holistic Care, Candy Cheung

Doctor of Nursing Practice (DNP) Projects

Background: Patients with cancer (PWC) have a high prevalence of experiencing psychosocial distress as they bear the burden of the disease. Emphasis is needed on psychosocial care, as the COVID-19 pandemic negatively impacts mental health. Psychosocial distress screening is considered a standard practice by the National Comprehensive Cancer Network (NCCN), which recommends using the validated Distress Thermometer (DT) as a screening tool.

Local Problem: The DNP project ambulatory infusion clinic (AIC) site does not have a standardized distress screening tool for staff. There was a lack of awareness of an existing non-validated distress screening and little to no intervention or …

Integrating Culturally Tailored Interventions To Increase Cervical Cancer Screening: A Quality Improvement Initiative In A Primary Care Clinic, Marife Centeno Solomon

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: While the incidence of cervical cancer in the US has significantly decreased due to the utilization of vaccination and screening tests, Asian, Native Hawaiian, and other Pacific Islander women consistently have the lowest rate of cervical cancer screening, making them at risk for undetected cervical cancer disease.

Problem: The low cervical cancer screening uptake can be attributed to a knowledge deficit about cervical cancer and its screening and the importance of early detection. Being an immigrant and with limited English proficiency can hinder women of Asian, Native Hawaiian, and other Pacific Islander from getting screened for cervical …

Stop The Bleed And Seize Control: Educating Emergency Department Staff On Maternal Hypertension And Hemorrhage, Mayra A. Portillo-Guerra

Master's Projects and Capstones

Problem: A Not-for-Profit Hospital accredited by the Joint Commission was fined for not having a current policy or procedure set in place for the treatment of obstetric emergencies. This quality improvement project implemented a simulation and a training video to prepare Emergency Department (ED) nurses and clinical staff for the awareness of preeclampsia and postpartum hemorrhage (PPH).

Context: This quality improvement project was implemented in two different Emergency Room locations for this Not-for-Profit Hospital. One of the campuses does not have a Labor and Delivery (L&D) unit while the other one does. The overarching goal is to increase awareness of …

Utilization Of The Nurse Practitioner Skillset In Partnership With The Medical Device Industry, Daniel C. Rowland

Doctor of Nursing Practice (DNP) Projects

BACKGROUND: Millions of nurse practitioners (NP), physician assistants (PA), and registered nurses (RN) are optimistic that their current employers will help them reach their full potential. One area that can add value to the hospital and empower employees to work to the full scope of their practice, and utilize the skillsets like that of an NP, is to train these providers to support medical device equipment in the operating room instead of relying on medical device representatives (MDRs) of medical device companies.

METHODS: Training NPs, PAs, or RNs how to support neurological medical device equipment will better utilize the skillset …

Evaluation Of An Educational Presentation On Improving Nursing Students’ Knowledge About Medication Reconciliation, My Trinh

Doctor of Nursing Practice Scholarly Project

Medication reconciliation is the process of comparing a patient’s medications that they are currently taking and comparing it with newly ordered medications or comparing the list to another source of information. It is completed to avoid and reduce the risk for potential adverse drug events, medication discrepancies, and improve communication between transition of care settings. Although people acknowledge and perceive the value of medication reconciliation as an important process in reducing medication errors and patient harm, healthcare team members including nurses may receive little formal training and education in school. The purpose of the Doctor of Nursing Practice (DNP) scholarly …

The Use Of Appreciative Inquiry In Identifying Pueblo Core Values, Kristyn N. Yepa

Doctor of Nursing Practice Scholarly Projects

This study used appreciative inquiry to identify core values or concepts essential to the Jemez Pueblo community to inform an evaluation framework used by community strength-based programs in Jemez Pueblo. Key informant interviews and a focus group were conducted in Jemez Pueblo with key program staff and tribal leaders. The audio recordings were transcribed and analyzed using inductive reasoning to identify core values. In addition, grounded theory was used to develop a conceptual model from the themes generated from the analysis. The PICOT question was, "Can the Appreciative Inquiry method help uncover core values of a Pueblo community?"

Conducting A Root Cause Analysis To Improve Intake Processes And Record Review In Home Health, Christina Guerrero

Doctor of Nursing Practice Projects

Minimization of adverse events, reduction of inpatient admissions, and prevention of polypharmacy within home health are of importance due to the increasing number of Medicare beneficiaries. In 2019, CMS reported 5,266,931 patients were served by home health agencies, accounting for 7,439,849 episodes of care. It is projected that the number of beneficiaries will rise from 54 million to more than 80 million by the year 2030. Medical errors are now the third-leading cause of death in the United States, surpassing diabetes, Alzheimer’s, and stroke. The Agency for Healthcare Research and Quality identifies a lack of institutional intake processes as the …

Dnp Final Report: Skilled Nursing Facility Readmissions: An Evidence-Based Telemedicine Innovation Project, Debra B. Graham

DNP Final Reports

Background: Nationally, 20% of patient readmissions occur within the first 48 hours after arrival to a skilled nurse facility (SNF), and 40-68% of these readmissions are potentially avoidable. Since 2016, the Centers for Medicare and Medicaid penalized SNFs when their return to hospital (RTH) percentages was above national benchmarks. The four SNFs in this project experienced rising transfer rates and diminished RTH percentages since 2017, despite using in-house providers Monday through Friday. Furthermore, there was no provision to address patients’ changes in conditions after hours.

Purpose: This evidence-based practice (EBP) project aimed to standardize the care provided to …

Introduction Of Semaglutide As An Effective Option For Obese Patients Motivated To Lose Weight, Crystal Garcia-Martinez

Cohort X

Obesity has become a global crisis with a tremendous impact on patients and costs reaching billions of dollars each year. Prevention and treatment of this condition will be crucial to ongoing efforts to prevent its long-term complications. Health care providers may have the opportunity to educate patients and address weight management issues before serious complications develop. The United States Centers for Disease Control and Prevention, the American Heart Association, and many publications in the medical literature focus on methods that might be used to target weight loss with diet and exercise. Unfortunately, many patients have had little to no success …

Thiazide-Like Diuretics As First-Line Treatment To Improve Blood Pressure Management, Raquel Okubo

Cohort X

Background: Thiazide diuretics are currently the first-line treatment for hypertension (HTN). This class of drugs includes hydrochlorothiazide (HCTZ) and the thiazide-like diuretic, chlorthalidone (CTDN). The quality improvement project began in the fall semester with a 10- day reflective practice log to assess my current practice. A review of the clinical practice log allowed me to evaluate my current practice and identify three opportunities to improve my practice. I developed three potential PICOT questions and selected one for the QI project with the guidance of my Doctor of Nursing Practice (DNP) chairperson. I performed a literature review to gather the best …

Is Dietary Teaching Via Telehealth Effective In Lowering Hgba1c In Adult Patients With Prediabetes Or Type 2 Diabetes?, Mia Mccallum-Crawford

UNLV Theses, Dissertations, Professional Papers, and Capstones

Prediabetes and Type 2 diabetes mellitus (T2DM) are two common conditions diagnosed in the primary care setting. Both conditions benefit from a healthy lifestyle, managing blood sugar levels, and getting diabetes self-management education and support (DSMES). Within the past two decades, the healthcare community in the US has witnessed a substantial rise in diabetes among adults. Overall, the self-management of diabetes continues to worsen nationally. The purpose of this project is to improve patients’ self-management of both Prediabetes and T2DM through nutrition and show how nutritional counseling via telehealth provided by a nurse practitioner can improve HgbA1C values over 3 …

Nurses Leading In Bridging The Culture Gap: Communicating With The Deaf Community, Veronica C. Leftridge

Electronic Theses and Dissertations

Nurses provide patient care in clinics, hospitals, homes, churches, schools, communities, and military, as well as on emergency medical helicopters. When a nurse is assigned to care for a patient, the patient expects the nurse to be culturally competent, communicate effectively, and provide safe quality care. However, cultural incompetence is observed when nurses provide care for Deaf patients, but they are unfamiliar with Deaf culture. In addition, communication is a fundamental skill nurses learn in nursing school, but course content in nursing programs rarely touches on how to communicate effectively with Deaf patients. Of the approximately 325 million people in …

Implementation Of A Polypharmacy Deprescribing Protocol Among Older Adults In A Community-Based Care Organization, Johanne Cazeau

Doctor of Nursing Practice Scholarly Projects

Background: Polypharmacy, defined as the use of five or more medications, has the potential to increase morbidity, mortality and decrease quality of life. Older adults are disproportionately affected by polypharmacy. Decreasing polypharmacy could prevent morbidity and mortality while saving millions of dollars annually. The use of the ARMOR tool has been shown to decrease polypharmacy and the prescribing of inappropriate medications among the elderly.

Local problem: There is a high prevalence of polypharmacy among older adult patients at the managed care organization where this quality improvement project was implemented. Among a panel of 30 members, almost all (n=29) were taking …

Dnp Final Report: Seal The Deal In Dementia Care, Christian D. Garrett

DNP Final Reports

Background: Individuals with dementia are often burdened with behavioral problems, which augment health care costs and burden of disease. Treatment of behavioral symptoms with pet therapy is acknowledged to be emotionally beneficial. Robotic pets have demonstrated similar promising effects without the undesirable outcomes of traditional pet therapy. Robotic pet therapy offers an effective replacement to traditional pet therapy.

Objective: The DNP scholarly project rigorously appraises the effectiveness of the SAR, PARO, an FDA approved biofeedback device, for non-pharmacological treatment of dementia-related symptoms.

Methods: An experimental design with repeated measures guided the study. Pre- and post- measures included reliable, valid tools …

Dnp Final Report: Mission Cyborg: An Ebp Project Integrating Hybrid Learning In An Undergraduate Nursing Course, Mary A. Thomas

DNP Final Reports

In modern times it is an expectation of students that technology be incorporated into how they receive their education. The COVID-19 pandemic brought to light how pure reliance on traditional face-to-face (F2F) learning can be detrimental to student learning. Many institutes of higher education had already implemented hybrid/blended learning prior to the pandemic and saw no difference in their NCLEX-RN pass rates. This evidence-based practice project gathered, reviewed, and synthesized evidence in order to determine if implementing different teaching strategies would maintain or improve student performance on both unit exams and end of course exit exams.

Psychological Safety In Pre-Licensure Nursing Simulation, Lauren Rickman

DNP Projects

Background

Simulation-based experiences (SBEs) allow learners to use clinical decision-making, clinical judgment, and hands-on skills to analyze and respond to realistic clinical situations in a controlled, interactive environment. Psychological safety (PS) is essential for increasing a learner's engagement in an SBE. Psychologically safe learning environments allow students to feel valued and comfortable speaking up and taking risks without consequences to themselves or others, promoting learning and innovation. Measuring PS may help simulation faculty improve their learning environment by supporting learning-oriented behavior and boosting students' clinical competency.

Purpose

The purpose of this Doctor of Nursing Practice (DNP) scholarly project was to …

Implementation Of A Decision Tree To Address Moral Distress, Tijuana Milton

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Healthcare workers (HCW) face daily challenges in the workplace environment. A relatively new problem called moral distress (MD) may present itself, but it may go unrecognized. The healthcare profession is being robbed of qualified personnel due to moral distress. The overall objective of this project was to help healthcare workers identify moral distress and seek resources to assist with the mitigation of moral distress. The outcome of this project demonstrated bedside HCWs showed higher levels of MD. Leadership must be intentional with providing education about the signs and symptoms of MD and assist employees to recognize and utilize available resources …

Development Of A Point-Of-Care Ultrasonography Workflow Within A Rural Clinic, Lauren Myers

Masters Projects

Abstract

Background and Objectives: Healthcare has revolutionized with advancements in ultrasound technology. Among these advancements and the increasing availability of imaging modalities is point-of-care ultrasonography (POCUS) technology.

Problem: While POCUS has gained considerable ground in primary care, infrastructure to support its utility is deficient. The purpose of this project was to design, pilot, and evaluate a POCUS workflow to facilitate technology utilization and increase access to care.

Methods: Program development and evaluation involves the design, implementation, and evaluation of an evidence-based workflow for POCUS technology. The project was intended to address the needs of individuals in a rural setting. Participants …

Implementation Of Daily Nhppd Calculator In The Acute Care Setting, Spencer Y. Cho

Student Scholarly Projects

Practice Problem: In the United States, it is estimated that hospitalized patients experience an adverse event that require a rapid response and/or code blue event in 3% to 18% of hospitalizations.

PICOT: In the adult medical-surgical inpatient (P), does the implementation of a daily NHPPD calculator (DNC) (I) compared to an annual staffing methodology for calculating NHPPD (C) reduce rapid response calls, code blue episodes, and unplanned admission to critical care (O) over 8 weeks (T).

Evidence: Seven studies provided evidence that implementation of staffing methodology, nursing surveillance, and nurse staffing that supports meeting targeted nursing hours per patient …

Behavioral Code Team, Daniel Mcgrath

Student Scholarly Projects

Practice Problem: The organization lacked an evidence-based intervention for behavioral emergencies within the inpatient acute care setting, leading to increased mechanical restraints. A security-driven paradigm was the organization's primary tool for addressing behavioral crises and lacked a more patient-centered treatment and support paradigm.

PICOT: The PICOT question that guided this project was In the Veteran patient population admitted to acute inpatient services (P), how does having a behavioral code team respond to behavioral emergencies (I) compared to the current practice (C) affect the prevalence of mechanical restraint usage (O) within an eight week period (T).

Evidence: Seven …

An Evidence-Based Practice Handbook For The Reduction Of Perioperative Pressure Injuries: An Implementation Guide, Krystal Dopson

Student Scholarly Projects

The Association of Perioperative Nurses (AORN) Prevention of Perioperative Pressure Injury Tool Kit is a comprehensive set of evidence-based practices that can reduce the development of pressure injuries (PI) (AORN, 2022). A bundled set of prevention strategies is positively associated with reducing the development of injury or ulceration and improved patient outcomes. To effectively implement this Prevention of Perioperative Pressure Injury Tool Kit, there are evidenced strategic practices to support change readiness, including engaging stakeholders around the reasons for the change, gaining leadership support, assembling an interprofessional implementation team, providing compelling information that highlights the need for the change, and …

Discharge Care Bundle To Reduce Copd 30-Day Readmission Rates In A Hospital Acute Care Unit, Dao Vang

Student Scholarly Projects

Practice Problem: Chronic obstructive pulmonary disease (COPD) readmissions severely impact patients’ health, mortality, and quality of life and increase unnecessary healthcare use and spending. Utilization of a protocol and discharge care bundle to reduce the readmission rate for COPD patients is critical to combat the problem.

PICOT: The PICOT question that guided this project was in adult patients 65 years or older admitted to a hospital acute care unit for acute exacerbation of COPD (P), does a protocol and discharge care bundle (I) compared to no protocol and no discharge care bundle (C) reduce the 30-day hospital COPD readmission rate …

Improving Access And Delivery Of Mental Health Care To Veterans Through A Care Coordination Pilot At A Texas Department Of Veterans Affairs Hospital, Jacqueline Buval

Doctor of Nursing Practice Projects

Background: Mental health (MH) disorders are among the leading cause of disabilities in adults, with an even greater prevalence among Veterans who served in combat. Forty percent of troops returning from combat zones report suffering from post-traumatic stress disorder (PTSD) or depression and 33% report trouble accessing MH care. Access to care is directly influenced by care coordination procedures in health care systems. If care coordination is poor or lacking, patients remain in settings that are inappropriate for their level of care. Implementing a care coordination program can improve care transitions, provide the necessary support for patients to successfully …

Utilizing Motivational Interviewing Intervention To Improve Compliance With Self-Care Among Hispanic Adults With Obesity, Type 2 Diabetes Mellitus, And Hypertension, Mariagorety O. Nwiloh

Cohort X

Obesity, hypertension, and type 2 diabetes mellitus (type 2 DM) have continued to plague the healthcare system and the economy of the United States of America. They are most common among African Americans and Hispanic Americans. The objective of this quality improvement project was to improve compliance to self-care regarding self-monitoring of blood glucose, blood pressure, and exercise to achieve target fasting blood glucose (FBG) ≤ 120 mg/dL, blood pressure (BP) ≤ 130/80mm Hg and a weight loss of ≥5 pounds among adult Hispanics aged 18- 65 years old. A weekly motivational interviewing (MI) session was conducted for 6 weeks …

Implementation Of A Zone Of Silence During Administration Of Breastmilk To Decrease Nurses’ Distractions In A Neonatal Intensive Care Unit: Quality Improvement Project, Lauren Crociata

DNP Projects

Introduction: In the NICU, breastmilk is handled and administered as safely and carefully as a medication. Administration errors occur when incorrect breastmilk is administered to the wrong patient. This can lead to the transmission of infectious disease and create the loss of trust between families and the healthcare team during a neonate’s NICU stay. Nurses are often faced with interruptions and distractions during administration, and evidence shows that interventions to reduce nurses’ distractions lead to reduction of administration errors in inpatient settings. This quality improvement project took place in a level III NICU. It implemented an evidence-based zone of silence …

Evaluating Telehealth As A Means Of Communicating With Living Donors And Its Effect On Quality Of Care, Ashley Anne Hamby Rn Msn

Doctor of Nursing Practice Projects

Background: Despite the advantages of living donor kidney transplantation (LDKT), there are barriers that potential donors face that make living donation less appealing. Research supports the use of telehealth as an effective method of enhancing access to care and building efficiencies.

Aims/Objectives: To evaluate access to care, effectiveness, financial impact, and experience after implementing telehealth as a means of communicating with living donors.

Methods: Utilizing a pretest-posttest design, an analysis was performed among medically cleared donors evaluated in-person between January 1, 2019 to December 31, 2019 (Control Group; N=64) and donors evaluated via telehealth (Zoom®) between January 1, 2021 to …

A Telehealth Blood Pressure Education Program On Hypertension Knowledge, Selfcare, And Behavior, Cheynnie N. Burnett Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: Hypertension poses a significant risk for morbidity and mortality. Regular blood pressure monitoring, medication compliance, and/or lifestyle modifications have shown to improve control. Digital communication in healthcare, such as telemedicine provides patients and primary care offices an opportunity to improve access to care and education.

Objectives: This Quality Improvement (QI) Project aimed to answer the question: In adult patients with a diagnosis of hypertension, what is the effectiveness of implementing an evidence- based telehealth blood pressure management program in a primary health care setting, when compared to baseline, on blood pressure knowledge, management, and self-care over a nine- week …

Reducing Catheter-Associated Urinary Tract Infections: Beyond The Bundle, Deana Cirillo

Student Scholarly Projects

Practice Problem: Catheter-associated urinary tract infections (CAUTIs) are preventable but are still the most common healthcare-associated infection (HAI) worldwide, encumbering the health of patients and escalating financial burden on society (CDC, 2021; Shadle, 2021).

PICOT: In adult patients with spinal cord injury, does direct observation of urinary catheter insertion, compared to the standard of care, reduce the rate of catheter-associated urinary tract infections, within ten weeks of implementation?

Evidence: Multiple factors contribute to Healthcare-Associated Infections (HAIs), but hand hygiene is the most important prevention measure to decrease contact transmission (Gould et al., 2017). The Centers for Disease Control (CDC) clinical …

Nurse-Driven Protocols For Abdominal Pain In The Emergency Department, Chris Schmidt

Student Scholarly Projects

Practice Problem: Emergency department (ED) crowding hinders the opportunity to deliver safe, quality care to abdominal pain patients and detrimentally affects clinical outcomes. Leadership of a rural community ED recognized a comparable issue by introducing a nurse-driven protocol (NDP) to reduce patient length of stay (LOS) and the rate of patients who leave the department prior to physician evaluation.

PICOT: The PICOT question that guided this project was: For adult patients in an emergency department, how does a nurse-driven protocol for abdominal pain compared to no protocol use affect the LOS and left without being seen (LWBS) rate over 10 …