Digital Commons Network^™

Adverse Childhood Experiences (Aces) Education Implementation For Graduate Nursing Students, Courtney Kovachevich

Dissertations

Chronic conditions are a leading cause of death and disability in the United States (U.S.). Adverse Childhood Experiences (ACEs) are risk factors for chronic conditions and death; however, screening and assessment of ACEs do not occur in primary care settings. A barrier to screening is a lack of knowledge and education during providers’ didactic courses. To address this barrier, a standardized education tool was implemented into a midwestern public graduate nursing Doctor of Nursing Practice (DNP) curriculum. The design was a Quality Improvement (QI) project with a descriptive cohort design and purposive sample. The inclusion criteria were students in the …

Reducing Pediatric Morbidity Through Development Of A Clinical Practice Guideline, Deanna Kroh

Dissertations

Peripheral intravenous therapy is a commonly utilized treatment modality for the care of acutely ill pediatric patients. Two risk factors include infiltration and extravasation injuries. These injuries, peripheral intravenous infiltration or extravasation injuries (PIVIEs), can vary in their clinical manifestations from minor discomfort to harm as severe as loss of limb or disfigurement. Clinicians caring for patients at risk of developing PIVIEs need to be able to act quickly to reduce potential morbidity. The purpose of this project was to create a clinical practice guideline (CPG) that would guide staff intervention if a PIVIE occurs, with the ultimate goal of …

Implementation Of An Evaluation Of Davita Clabsi Protocol To Reduce Bloodstream Infections In Acute Hemodialysis Patients, Emmy Le

Dissertations

Abstract

Problem: Central line-associated bloodstream infection (CLABSI) is the primary cause of morbidity and mortality in End-Stage Renal Disease (ESRD) patients on hemodialysis. It is associated with severe medical conditions, prolonged hospitalization, and financial burden. Despite its convenience and simple operation, central venous catheter (CVC) account for 70% of all CLABSI occurrence and increase the risk for septicemia and death.

Methods: This quality improvement (QI) project utilized a descriptive observational pilot design to identify the effect of DaVita CLABSI Protocol on CLABSI occurrence rate. Quantitative data was collected retrospectively and prospectively via electronic medical record (EMR) review before and …

Family Mentorship Program In The Pediatric Organ Transplant Population, Kristin Rich

Dissertations

Abstract

Problem: At a comprehensive pediatric medical center in the Midwest, there are currently no structured support programs for pediatric transplant patients and their families A regulated and structured family mentor/support program for transplant patients and their families can provide the outlet they require to feel supported by peers who have also gone through the same journey of pediatric solid organ transplantation. Methods: A descriptive program evaluation design utilizing the Stetler model to evaluate data regarding the family mentor/support programs in the diabetic and sickle cell departments at a Midwestern children’s hospital. The purpose was to gather meaningful data for …

Education To Improve Long-Acting Injectable Antipsychotic Use, Travis Donald Wolfangel

Dissertations

Purpose: Long-acting injectable (LAI) antipsychotics are underutilized as an evidence-based treatment for schizophrenia and schizoaffective disorder. The purpose of this quality improvement project was to determine if a web-based LAI education module changed advance practice prescribers’ knowledge, attitudes, and practice behaviors regarding LAI antipsychotics one month after receiving LAI education at a community-based mental health organization.

Methods: This QI project was an observational pre- post-educational design. The 20-item Knowledge, Attitudes, and Practices (KAP) questionnaire was used to assess advanced practice providers’ knowledge retention, attitude changes, and practice modifications regarding LAI antipsychotics and prospective patient chart reviews were performed. …

An Evaluation Of Mindstrong™ Implementation With Graduate Nursing Students, Angela B. Sabblut

Dissertations

Problem: Nursing graduate students are at increased risk of greater stress, anxiety, and depression (Hoying, 2020; Melnyk et al., 2020). Cognitive Behavioral Therapy is the gold standard in the treatment of anxiety and depression (Hoying et al., 2020; Melnyk et al., 2015; Melnyk et al., 2020). MINDSTRONG™, a CBT-based training program, has been proven in many studies to be effective in helping individuals prevent or cope with these issues (The Ohio State University College of Nursing, 2020).

Methods: This Quality Improvement (QI) project was a descriptive-observational, pre-post design. Sample and setting were nursing graduate students from a Midwestern, middle-sized urban, …

Evaluation Of An Education Program Implementation For Adults With Stage 4 And 5 Chronic Kidney Disease, Dana Marie Carter

Dissertations

Abstract

Problem: Patients with long-term medical conditions represent a significant public health issue. Therefore, patients diagnosed with a chronic illness must have a high level of health literacy (HL) to manage their condition effectively. This Quality Improvement (QI) project evaluated the impact of an existing education-based program for stage 4 and 5 chronic kidney disease (CKD) patients and its effect on laboratory values compared before and after an NP-led education program that included vascular access, and modality choices.

Methods: A retrospective chart review was completed on 20 patients with an inclusive diagnosis of CKD stage 4 or 5 from …

Implementing A D/Deaf Educational Module For Graduate Nursing Students, Brenda J. Pauley

Dissertations

Problem: Nurse practitioners lack knowledge and skills to effectively communicate with D/deaf individuals which potentiates risk for health disparities and gaps in care. Graduate nursing programs rarely incorporate D/deaf-focused education in their curriculums.

Methods: This descriptive quality improvement project implemented the first D/deaf-focused educational online module at a Midwestern university’s College of Nursing. A purposive sample of 38 BSN-DNP students enrolled in the Spring Intensive completed a pre- and post-education survey. Both surveys assessed students’ D/deaf perceptions through Lewis and Keele’s (2020) D/deaf and Hard of Hearing Interaction Beliefs Scale for Registered Nurses (DdHH-IBS/RN) and evaluated students’ knowledge through a …

The Impact Of Music Education On Middle School Students’ Attendance Rates And Academic Achievement On Math And English Language Arts, Irene Wang Shi

Dissertations

In recent years, students’ standardized test scores have become one of the major measurements for students’ learning. However, music as a non-tested subject is often viewed as a lesser valued subject compared to core subjects. The purpose of this study was to investigate the impact music programs have on student academic achievement and attendance rate. The data was collected from one middle school of a large school district located in the northeast of Missouri. The study population includes sixth, seventh, and eighth-grade students who enrolled in the 2017-2018, 2018-2019, and 2020-2021 school years. The population was divided into students who …

The Impact Of The Phq-8 On Referrals To Psychotherapy Services For Oncology Patients, Sarah Beckmann

Dissertations

Abstract

Problem: Nearly seven million individuals will be struggling with both cancer and depression by 2040. Patients with cancer face a multitude of challenges. These challenges can impact a patient’s mental health and ability to cope with a cancer diagnosis. Currently, there is a large treatment gap among patients who are coping with both cancer and depression. Healthcare providers are neglecting to use evidence-based screening tools to assess patients for depression upon admission to inpatient treatment.

Methods: This quality improvement project took place at a large metropolitan comprehensive cancer center in the Midwest. A descriptive observational design was utilized. Prescreen-post …

Implementation Of A Critical Event Debriefing Tool In The Pediatric Intensive Care Unit, Tara Fiala

Dissertations

Problem: Working in the Pediatric Intensive Care Unit (PICU), staff encounter critical patient events without warning. Debriefing after adverse patient events has been shown to give staff the opportunity to process these events in an open, honest, and judgement-free environment. Debriefing has been recognized as a tool for detecting medical errors, improving team communication, providing emotional support, and analyzing team performance.

Methods: A descriptive, observational pilot study was used to implement the DISCERN tool into a large, midwestern, urban PICU. The aim of the quality improvement project was to achieve a debriefing tool completion rate of 20% over a one-month …

Life Matters, Marina Fischer

Dissertations

Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.

Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …

Implicit Bias Training For Perinatal Nursing, Racheal Lakine-Harden

Dissertations

Problem: Maternal and fetal morbidity and mortality is a rising health care crisis in the United States. Black women are disproportionately affected. Clinician implicit bias and medical racism have been named as factors in this crisis. Recommendations to address this public health peril include; educating and raising awareness among front-line perinatal nursing staff on implicit bias and its consequences for Black women. The purpose of this project is to evaluate the impact of implicit bias training on nurses’ awareness of implicit bias, attitudes, and beliefs about disparities, and the likelihood to engage in behaviors to reduce or address racial bias …

Healthcare-Associated Pressure Injury Prevention In The Intensive Care Unit, Ross Quinton

Dissertations

Problem: Healthcare-associated pressure injuries (HAPIs) occur when prolonged pressure is on the sacrum, coccyx, elbows, and heels, during a hospital stay. HAPIs can result in increased morbidity and mortality, and prolonged hospital stays, which consequently requires excess expenditure on treatment. Early specialty mattress placement can prevent HAPI acquirement.

Methods: This quality improvement (QI) pilot project aimed to increase specialty prevention mattress usage in the intensive care unit (ICU). A sleep surface decision tree was implemented into the admission process in a 30-bed ICU. A retrospective record review was used to examine demographics, comorbidities, HAPI risk, length of stay, and when …

Effect Of A Turn Clock On Hospital-Acquired Pressure Injury Incidence, Sydney Warren

Dissertations

Problem: Hospital-Acquired Pressure Injuries (HAPIs) are the only quality metric increasing in incidence and are preventable. HAPIs are wounds to bony prominences during a hospitalization and can increase hospital costs, morbidity, and mortality. HAPIs could be prevented through interventions, including repositioning patients every 2 hours and using a turn clock method. The aim of this quality improvement (QI) pilot project was to decrease HAPI incidence.

Methods: A turn clock method was implemented on a general medicine floor at a mid-sized, suburban medical center utilizing a descriptive retrospective observational design. Data was collected for the pre-intervention timeframe from June through August …

Lifting As We Climb: Giving Voice To Black Female Mentorship Stories And Exploring Factors That Lead To Successful Mentoring Outcomes, Channon Peoples, Margaret Brockmeyer, Dawn Indelicato-Faw

Dissertations

As researcher-practitioners, we noted that the literature on mentorship has increased dramatically in recent years. However, the literature lacks attention to female paired mentoring relationships, especially relationships between women of color. Although we did not initially set out to fill this gap, our research does bring attention to the power of mentorship relationships between women of color. We explore three critical factors of an effective, female mentor-mentee relationship: social capital development (i.e., expand networks, build relationships), social and emotional learning (i.e., strengthen emotional resilience, increase self-awareness), and awareness of intersectionality (i.e., interact with role models, draw upon one’s unique identities). …

Fall Risk Screening In Community Dwelling Elders Through Self-Assessment, Natasha Dickinson

Dissertations

Problem: Falls and fall-related injuries are considered preventable. Fall risk screening is crucial in the prevention of falls and fall-related injuries in community dwelling elders. The purpose of this quality improvement project was to initiate the use of the CDC’s self-rated Fall Risk Questionnaire (Self-rated FRQ) screening tool and CDC-guided education in a cohort of community dwelling seniors at a geriatric agency.

Method: A pre-post assessment was conducted on community dwelling seniors 65-years and older. A convenience sample of eligible participants (N=16) was taken from a geriatric agency in a Midwest, metropolitan city. Fall incidence and fall-related injuries …

Implementing Patient Acuity Scale On A Medical-Surgical Unit, Coreen Ladd

Dissertations

Problem: Nurses commonly report dissatisfaction with their workload levels due to inequity of shift assignments. Imbalanced workload distribution has been shown to lead to missing or delayed care. Increased nursing workload has been linked to increased fall rates, healthcare associated infections, and avoidable deaths. Research has shown that patient classification is more accurate when an instrument is used. The purpose of this quality improvement project was to implement a patient acuity tool to aid nurse-patient shift assignments on a medical-surgical unit. The project aimed to provide a standardized and objective method of measuring patient acuity.

Methods: The project took place …

Effect Of A Trauma Informed Care Tool In A Pediatric Cardiac Intensive Care Unit, Taylor Park

Dissertations

Problem: Parents of infants less than one-year-old with complex congenital heart disease (CCHD) experience significant stress while their child is admitted to the pediatric cardiac intensive care unit (PCICU), often resulting in trauma to parents and their families. Trauma informed care (TIC) seeks to minimize the impact of emotional trauma and it acknowledges previous trauma an individual may have experienced.

Methods: The purpose of this quality improvement (QI) project was to assess the thrive guide’s ability to decrease parental stress in the pediatric cardiac intensive care unit (PCICU). The aim was to decrease parental Perceived Stress Scale (PSS) scores by …

Doubling Down On Sepsis: A Quality Improvement Project To Improve Sepsis Bundle Compliance On An Inpatient Oncology Unit, Kayla Slay

Dissertations

Problem: Sepsis is a leading cause of death worldwide, and the second most common cause of death in cancer patients. Early management of sepsis through use of sepsis bundles have been shown to improve patient outcomes, yet bundle adherence is unfortunately inconsistent.

Methods: A two-nurse team, called the Sepsis Sidekicks, was a process improvement initiative to increase compliance with the center for Medicare and Medicaid Services (CMS) sepsis bundle and improve patient outcomes related to sepsis. The observational quality improvement project utilized a Plan-Do-Study-Act (PDSA) model over a six-week period where quantitative data was collected using a retrospective chart review. …

Evaluating The Effectiveness Of Implementing Depression Screenings With Uninsured African American Adults, Pamela Talley

Dissertations

Problem: Uninsured African Americans are underdiagnosed and often untreated for depression. Individuals usually do not present to their primary care provider with a complaint of depressed mood, however, may report symptoms such as decreased energy, general body aches, digestive concerns, somatic complaints, or older adults' memory or cognitive problems. The purpose of this quality improvement pilot project was to examine the results of the implementation of a depression screening (PHQ-9) in a primary care setting for uninsured adults for detection, diagnosis, and treatment of depression in African American clients.

Results: The PHQ-9 screening questionnaire was given to 100% (N …

Screening For Social Determinants Of Health In A Comprehensive Pediatric Sickle Cell Disease Clinic, Marie Turner

Dissertations

Problem: Social determinants of health (SDOH) affect health outcomes across the lifespan. The American Academy of Pediatrics recommends routine screening for SDOH. Poverty is a SDOH affecting health outcomes in children, especially in children with a chronic disease such as sickle cell disease (SCD). Children with sickle cell disease have a high burden of SDOH. This project sought to describe the SDOH barriers experienced by pediatric patients with SCD.

Methods: A descriptive survey/observational design, using a convenience sample of pediatric patients ages 0-19 years old in a comprehensive SCD clinic at a large, urban, Midwestern academic medical center was utilized …

Readmit Clinical Risk Index: Identifying Risk Factors To Reduce 30-Day Psychiatric Readmissions, Victoria Faulkner

Dissertations

Abstract

Problem: There has been a growing concern in the past decades over the increase in community-based adults who require readmission to psychiatric care shortly after discharge. It is estimated that nearly half of discharged psychiatric patients will be readmitted within twelve months after discharge. This has been primarily attributed to the absence of screening tools and resources to assists behavioral healthcare providers in identifying socio-demographic factors contributing to readmissions. Screening tools like the READMIT Clinical Risk Index identify patients at risk for psychiatric readmission. This quality improvement project aims to identify socio-demographic factors that lead to 30-day readmission …

Evaluating Mindfulness On Loneliness In An Older Adult Population, Jessica Tieskoetter

Dissertations

Problem: Loneliness is a widespread public health concern and has negatively impacted mortality and health outcomes among older adults. This quality improvement project’s purpose was to evaluate mindfulness on loneliness and quality of life among adults aged 65 years and older, participating in a weekly befriending socialization program.

Methods: A descriptive cohort design was utilized to assess loneliness pre-and post-implementation of a mindfulness telephone line over three months. A convenience sample of 22 older adults enrolled in a befriending socialization program was used. The Iowa Model of Evidence-Based Practice framework was applied to guide the implementation of a practice change …

When St. Louis School Nature Leaders And Environmental Partners Work Together Nature-Based Learning Inspires Joy And Curiosity In K-2 Students, Julie Frisch, Melissa Politte

Dissertations

This study focused on what values teachers saw in nature-based learning, what outcomes they saw for their students, and what factors have enabled them to do nature-based learning. This explanatory sequential mixed-methods study looked at nature-based learning in St. Louis elementary schools with kindergarten through second-grade students.

We used purposive sampling to choose six schools to examine further through case studies. We then conducted interviews with 8 teachers on qualities of nature-based learning captured in 12 words.

We identified five themes from our interviews and observations: Every School Needs a Nature Champion, Community Bridges in Nature-Based Learning, There is Magic …

Initiation Of Procalcitonin Screening As A Marker In Antibiotic Therapy De-Escalation, Briana Kile

Dissertations

Problem: The overuse of antibiotics has created antimicrobial resistance (AMR)

resulting in treatment failure for bacterial infections. To combat AMR, clinicians should

only prescribe antibiotic therapy when clinically warranted. It is easy to misdiagnose a

viral infection. However, any delay in the initiation of antibiotic therapy in a bacterial

infection may lead to increased morbidity and mortality. These patients with non-specific

clinical symptoms may be misdiagnosed without a rapid and definitive diagnostic test.

Methods: This quality improvement (QI) initiative utilized an evidence-based clinical

guideline for procalcitonin (PCT) levels for antibiotic therapy de-escalation. WBC counts

were collected two-days and one-day before …

Implementation Of A Protocol Nurse In The Emergency Department, Marissa Kramer

Dissertations

Abstract

Problem: Increased wait times and extended length of stay (LOS) of patients in the Emergency Department (ED) are contributing to overcrowding, burdening EDs worldwide. A nurse can initiate patient care using protocol order sets while a patient is in the waiting room; however, triage nurses are often too busy to complete these orders. Scheduling a nurse to complete these protocol order sets could reduce ED overcrowding and patient LOS.

Method: A convenience sample was used to retrospectively chart review and collect data utilizing an excel spreadsheet with patients 40 years of age and older with a chief complaint of …

Standardized Approach To Early Mobilization Of The Critically Ill Pediatric Patient, Courtney Mccarty

Dissertations

Problem: Many pediatric intensive care units (PICU) do not have early mobilization guidelines in place. Early mobilization (EM) is defined as any exercise initiated for a patient within 48 hours after PICU admission. Several studies show that use of early mobilization in this setting can lead to improved outcomes for pediatric patients such as reduced delirium, maintenance of muscle strength, and little reduction in functional deficits. Initiation of an EM guideline should be done to improve patient outcomes by discharge.

Methods: This QI project used a descriptive design to collect prospective data after a new EM guideline was implemented. …

Implementing A Standardized Nursing Communication Tool To Improve Inpatient Nursing Communication, Ashley D. Nator

Dissertations

Implementing a Standardized Nursing Communication Tool to Improve Inpatient Nursing Communication

Ashley D. Nator

B.S. Nursing, University of Missouri-St. Louis, 2018

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice with an emphasis in Family Nurse Practitioner

August 2022

Advisory Committee

Cathy Koetting, PhD, DNP, APRN, CPNP, PMHS, FNP-C

Chairperson

Sarah Jackson, DNP, APRN, FNP-C

Amy Terbrock, MSN, PCCN, SCRN, RN

Copyright, Ashley D. Nator, 2021

Original: 08/2021 Revised: 09/2021, 10/2021, 04/2022

Abstract

Problem: Patient handovers occur among nurses more than 4,000 times …

Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith

Dissertations

Problem: CAUTIs (catheter-associated urinary tract infections) are a common hospital-acquired condition (HAC) that increase length of hospital stays, hospital costs, and risk for patient mortality. CAUTI rates in a PICU increased in 2021 from the year 2020. A rapid cycle PDSA revealed nurses were not using soap and water for foley catheter care, which is the recommended cleanser by the Centers for Disease Control and Prevention (CDC).

Methods: An observational descriptive design was used to evaluate foley catheter cleaning and CAUTI rates. PICU nurses completed behavior surveys regarding foley catheter cleaning practices. An education intervention occurred when nurses answered anything …