Digital Commons Network^™

Differences In Student Perceptions With Virtual Clinical Simulation, Melissa Wheeles

Doctor of Nursing Practice Projects

Background: Simulation has been a part of nursing education since its inception, with virtual clinical simulation gaining expanded use since the Coronavirus Pandemic. Once considered only a supplemental teaching method, this form of education has become an imperative means of program progression for nursing students when hospital clinical spaces are limited.

Purpose: The purpose of the study is to evaluate potential differences in nursing student perceptions of anxiety and self-confidence with clinical decision making in virtual clinical simulation compared to traditional face-to-face clinicals.

Design Methods: A descriptive, quantitative study using the NASC-CDM© tool completed by 5th (final) semester …

Fall Prevention: The First Line Of Defense. Integration Of Innovated Strategies To Decrease Falls For The Hospitalized Patient, Milledge Smalls

Doctor of Nursing Practice Projects

Background: Falling is defined as an accidental encounter with the ground or other surfaces. Individuals with dementia are at a greater risk for falls due to conditions such as neurological impairments in perception or cognition. Presently, 50 million people live with dementia worldwide, which is projected to increase to 152 million by 2050 because of a rise in life expectancy and an aging population. The incidence of falls has rapidly become a major public health problem around the world. Approximately 30% of people older than 65 years of age fall each year, and patients with dementia cost the nation $236 …

Preventing Complications Of Undiagnosed Diabetic Peripheral Neuropathy In Rural Healthcare Settings, Kendra Ward Harris

Doctor of Nursing Practice Projects

Background: Diabetic peripheral neuropathy (DPN) affects the lives of approximately 50% of all persons diagnosed with diabetes. Patients who are minorities, residents of rural communities, low income, or non-compliant with treatment, have a higher risk of developing DPN. The long-term effects interfere with the patient’s abilities to carry out activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Patients incur debt from medical expenses, depression from the inability to perform self- care, and became withdrawn because of their distorted body image.

Purpose: The purpose of this project was to use the Michigan Neuropathy Screening Instrument (MNSI) …

Efficacy Of Handoff Education For Icu Nurses When Transferring Patients To The Operating Room, Sandra Ruth Horace

Doctor of Nursing Practice Projects

Background: The transition of care from the Surgical Intensive Care Unit (SICU) to the Anesthesia team in the Operating Room (OR) is a vulnerable time for patients. There is currently no formal process for the patient transitioning from the Surgical ICU to the OR. The disarray of this transition can lead to serious omissions in communication and be harmful to the patient.

Purpose: Currently, there is no formalized or universal process for handoff communication between the SICU team and the Anesthesia team. This project aimed to provide handoff education for SICU nurses when sending a patient from the OR. This …

Effect Of Increased Confusion Assessment Method For The Intensive Care Unit Delirium Assessments On Patients In The Surgical Intensive Care Unit, William Lemon

Doctor of Nursing Practice Projects

Delirium is an acute syndrome of the central nervous system (CNS) that affects patients of all ages and all hospital areas. Furthermore, delirium can lead to frequent complications for these patients, especially those in intensive care units (ICU) (Kanova, Sklienka, Burda, & Janoutova, 2017). Nationally delirium affects 20-80% of patients that require ICU care (American Nurses Association, 2019). In the Surgical intensive care unit (SICU) at the acute care hospital used in the project, the average number of patients suffering from delirium is about 23%. The purpose of this project was to provide a more in-depth analysis of delirium, and …

Hypertension Education And Management Intervention (Hemi) In The Urgent Care Setting, Conrad L. Cash

Doctor of Nursing Practice Projects

Background: Hypertension, being a very prominent disease, is a common problem found during urgent care visits. By beginning in the urgent care setting, hypertension management can be started early; thereby preventing complications from uncontrolled hypertension.

Purpose: This DNP project aimed to improve patient knowledge of hypertension and overall blood pressure readings by providing one-to-one provider-patient education.

Design Method: This DNP quality improvement project was a pre- and post-test design using quantitative data. The goal was to access if there was a change in patient education pre, post, and three months follow-up along with a change in blood pressure.

Results: …

Increasing Staff Awareness And Screening Practices For Adverse Childhood Experiences At A Primary Care Clinic, Kayla Wright

Doctor of Nursing Practice Projects

Adverse childhood experiences (ACEs) are present in approximately 60% of the adult population in the United States. There is a correlation between adverse childhood experiences and chronic health conditions as adults. Despite the evidence showing this correlation, there is a lack of screening for ACEs in the primary care setting. Many primary care providers and staff are unaware of ACEs or the correlation with chronic health conditions and substance abuse and, therefore, do not understand how to or recognize the benefits of screening in primary care. With education for providers and staff, primary care is the ideal setting to perform …

Preventing Unplanned Pregnancies: The Impact Of Prevention Education, Eliza Dudley

Doctor of Nursing Practice Projects

Teenage pregnancy and unplanned parenthood are social issues in many communities, states, and developed and undeveloped countries. The impact of early, unplanned pregnancy is detrimental to the adolescent's health, mental health, and physical well-being. Teenage pregnancy may be considered a social issue that is often the result of inadequate sexual and reproductive education, both in adult parents and teenagers. Despite recent reductions in teenage pregnancies, in recent years, more than 20 million teenagers experienced parenthood before graduating from high school. Programs are needed to prevent the possible stigma, physical and emotional risks of unplanned teenage pregnancy, lower adolescent pregnancy rates, …

Increasing Lung Cancer Screening Referrals In Patients With Tobacco Use Disorder, Emily Thornberry

Doctor of Nursing Practice Projects

Lung cancer in the United States is a substantial cause of mortality. According to the American College of Radiology’s Lung Cancer Screening Registry, only 1.9% of eligible patients were screened for lung cancer in 2016. The National Comprehensive Cancer Network and U.S. Preventative Services Task Force (USPSTF) guidelines recommend lung cancer screening (LCS) in high-risk patients. The USPSTF recommends screening current and former smokers aged 55-80 years who have smoked for 20 or more pack-years, and for former smokers, those that have quit within 15 years.

Unifying Vision: Strategies That Influence Nurse Self-Care Practices In Intensive Care Unit Nurses, Latoya Parks

Doctor of Nursing Practice Projects

Background: The notion of self-care should include more than physical health; the concept should also include emotional, mental, and spiritual self-care. Self-care behaviors are tailored to an individual's perceptions and values.

Purpose: The primary focus of this project aimed to improve nurse’s self-care practices. Through interviews with executive leadership at a large urban hospital, the project facilitator identified the need for easy access to self-care strategies for ICU nurses.

Design Method: The Plan-Do-Study-Act (PDSA) Model for Quality Improvement was used for this project. A systematic review of the literature was performed to ascertain the effectiveness of self-care strategies for …

The Evaluation Of Nurse Residency Program On New Graduate Nurse Retention, Trenisha Wilson

Doctor of Nursing Practice Projects

Healthcare settings are facing a major challenge in recruiting nurses in this demanding field. Nurse residency programs are designed to assist new graduate registered nurses with their transition to nursing practice. The nurse residency program assists new graduate nurses to develop their nursing skills, enhance their overall performance, and decrease turnover rate.

Purpose: The purpose of this project is to evaluate the effectiveness of the Veteran Affair Medical Center’s ability to retain new graduate nurses after attending a new graduate residency program.

Design Methods: This study is a retrospective pre-test and post-test design of the impact of the …

Improving Patient Outcomes With Post-Op Education For Nurses Caring For Patients Undergoing Total Joint Replacement, Amanda Collier

Doctor of Nursing Practice Projects

Background: Surgical site infections (SSI) are the third most reported nosocomial infection causing an increased length of stay, increased healthcare cost, and a substantial increase in morbidity. A SSI is an infection developing within 30 days of surgery without using an implant and within one year of surgery utilizing any form of implant. Typically SSI occurs at the time of incision. However, poor postoperative wound care can lead to an SSI.

Purpose: This project aims to educate nursing staff on care of the total joint replacement (TJR) patient to reduce readmission rates for postoperative SSI.

Design Methods: This …

Decreasing The Impact Of Diabetes In The Adult And Older Adults Rural Health Population Utilizing Phone Calls As Part Of The Chronic Care Management Program, Adrienne Shambray

Doctor of Nursing Practice Projects

This quantitative study was developed in order to evaluate the impact of phone calls on patient outcomes using the Chronic Care Management program (CCM). In January 2015, the Centers for Medicare and Medicaid Services (CMS) implemented the (CCM), with the goal of improving health and quality of care for high-risk patients. The administration and physicians at the clinic of focus for this project recognized a need for the facility to help improve and manage these patients’ care to prevent issues such as hospital readmission. This project aimed at following patients in the program with the chronic condition of diabetes mellitus …

Early Detection Of Sepsis In Direct Admit Hospitalized Patients: Implementing A New Sepsis Screening Checklist, Connie Lasley

Doctor of Nursing Practice Projects

Background: Early detection of sepsis in hospitalized patients in small rural hospitals can save lives. Subtle changes in patients can go undetected by nurses and doctors, leading to septic shock, increasing the length of stay in the hospital or death. In a small Alabama hospital, nurses were missing the early signs and symptoms of developing sepsis due to a lack of a monitoring system and proper education regarding sepsis.

Objective: The development of a sepsis screening checklist to place on each direct admitted patient’s chart to collect vital signs every four-hours each 12-hour shift to alert nurses of early signs …

Methods Of Educating Nursing Students On Proper Handwashing To Enhance Infection Control During The Covid Pandemic, Yulanda King

Doctor of Nursing Practice Projects

Background: Medical professionals have commonly been urged to use soap and water to sanitize their hands to prevent contamination and disease transmission. However, thorough handwashing requires a couple of minutes to clean hands thoroughly. Considering that health professionals must sanitize their hands' multiply times during a day, handwashing consumes a significant amount of time away from bedside care. Time spent away from patients may also result in a substantial decrease in the quality of healthcare services provided by the medical institution.

Purpose: This project evaluates the current policy and procedure for appropriate use of handwashing versus hand sanitizer in the …

Case Management Of Primary Care Patients, Bernadette Webster

Doctor of Nursing Practice Projects

Case management (CM) offered in primary care is a collaboration, guided by the registered nurse, working to coordinate all aspects of care for the patient and the family. The purpose of this quality improvement/assurance project was to provide nurses in primary care with the education and methods of CM to assist in more effectively managing care for a patient after testing positive for COVID-19. An intervention was delivered to registered nurses (RN) in the primary care setting designed to improve knowledge and skill with case management for patients with high care needs or recently diagnosed with COVID-19. A templated note …

Impact Of A Novel Application In Electrocardiogram Interpretation Confidence And Performance In Nurse Practitioner Students, Hailey Bobin Cole

Doctor of Nursing Practice Projects

For the last hundred years and to this day, one of the most important diagnostic tools in medicine has been the electrocardiogram (EKG or ECG). The decision to pursue a life-saving intervention, or not, may be heavily based on the interpretation of the results of a diagnostic test. With the weight of impacts to outcomes, one would think there would be ample, if not excessive, time and effort given to teaching practitioners how to interpret an ECG. Unfortunately, with each graduating class of physicians, nurse practitioners, and physician assistants, all of whom have within their scope of practice to interpret …

Satisfaction Of Telehealth For The 55+ Population, Cynthia Schweizer

Doctor of Nursing Practice Projects

There is a primary care need for the 55+-year-old population related to the increasing aging population, physician shortages, and, more recently, Coronavirus Disease 2019 (COVID-19) to implement Telehealth care. The Telehealth project will include the 55+ population to provide more participants for the project at an internal medicine clinic. Telehealth's contribution and interventions will affect causal factors such as moderating or mediating factors of health problems. Some of those factors include insufficient primary care coverage due to decreasing numbers of primary care providers (PCP), the increasing older population, complex health issues that come with aging, the need for frequent follow-up …

A Multi-Client Simulation To Improve Communication, Prioritization, And Clinical Judgment Among Nursing Students, Adam K. Combs

Doctor of Nursing Practice Projects

Background: Hospital administrators have noted a lack of clinical judgment in novice nurses, which can result in negative client outcomes. This paper describes the implementation of a multi-client simulation experience with the purpose of determining if the experience improved communication, prioritization, and clinical judgment.

Method: A descriptive, pretest postest study, using the National League for Nursing (NLN) Jeffries Simulation Theory, examined the perceived competence of 37 senior level Associate Degree Nursing students.

Intervention: The participants rated their perceived competence on the Perceived Competence Scale and were scored on the ISBAR Interprofessional Communication Rubric (IICR) and the Lasater Clinical Judgment Rubric …

Prescription Labels: Get To Know Them, Karen Adams

Doctor of Nursing Practice Projects

Low health literacy is a problem for millions of Americans resulting in increased use of healthcare resources resulting in poor health outcomes. The older adult population is continuing to grow and is the largest user of healthcare. Use of pharmaceutical regimens to manage chronic illnesses is the most commonly used treatment modality. Unfortunately, people with low health literacy may have trouble understanding and following their providers instructions. It can be difficult to read directions on over the counter and prescription medication bottles. Community-based health educational programs benefit the maintenance of older adult health. The purpose of this project was to …

Improving The Process Of Making Preoperative Home-Medication Recommendations, Andrew Standefer

Doctor of Nursing Practice Projects

Improving the Process of Making Preoperative Home-Medication Recommendations

Many patients presenting for surgery have a list of prescribed medications they take daily to treat various comorbidities. Even though prescription drugs may offer patients therapeutic benefits during the perioperative period, they may also cause adverse effects when used in conjunction with anesthesia during surgery (Marley, Calabrese, & Thompson, 2014). Therefore, identification of medications for the preoperative patient to take or withhold is necessary.

Research indicates that clinicians often make inappropriate decisions regarding preoperative medication management in settings where no guideline exists (Renew, Bolton, Alvarado, & De Ruyter, 2015; Symons & McMurry, …

Cultivating Appropriate Prescribing In A Primary Care House Calls Practice: A Quality Improvement Project, Sarah J. Marzolf

Doctor of Nursing Practice Projects

Problem Description: Polypharmacy in the frail elderly can lead to suboptimal management of medical issues. Primary Care Providers (PCPs) often lack knowledge of best practices regarding deprescribing and lack a systematic process for assessing mediation appropriateness. A quality improvement project was developed and executed at Housecall Providers, a home-based primary care practice in Portland, Oregon to facilitate the incorporation of deprescribing into daily practice.

Interventions: Following a literature review, a curriculum was developed and utilized during an educational intervention for PCPs regarding deprescribing best practices. A system for introducing new PCPs to evidence-based deprescribing for the frail elderly. This information …

Educational Session To Improve The Knowledge And Confidence Of State Agency Surveyors In Deficiency Citation Of Immediate Jeopardy Findings In Nursing Homes, Aileen Renolayan, Msn, Ma, Rn, Phn

Doctor of Nursing Practice Projects

Background: The oversight of nursing homes is a shared federal-state responsibility. Under the agreement with Centers for Medicare and Medicaid Services (CMS, 2018), state survey agencies assess nursing homes using standard surveys. Several studies indicate that the type of deficiencies issued to nursing facilities varies significantly by state, suggesting inconsistency in the survey process for issuing deficiencies. For example, variation in Immediate Jeopardy (IJ) citations among state agency surveyors has been the subject of reports from the Government Accountability Office (GAO, 2019) and the Office of the Inspector General (OIG, 2014).

Objective: To determine if a 1-hour educational session about …

Using Five Wishes To Improve Advance Care Planning In A Maryland Primary Care Practice, Amanda Bridges, Msn, Acnp-Bc

Doctor of Nursing Practice Projects

Background: Advance Care Planning (ACP) at this primary care practice was minimal and lacked a consistent process to document existing advance directives (AD) or educate patients about ADs.

Objectives: The purpose of this QI project was to improve ACP engagement, documentation of existing ADs and educate patients about Five Wishes.

Methodology: Adults, at each office encounter, were asked three kiosk questions: Do you have an AD, know what ADs are and want to discuss ACP? The responses were uploaded to the EHR to become an evidence backed, visual reminder. Affirmation of existing ADs were descriptively documented. ACP engagement was analyzed …

Using Multi-Faceted Validated Tools To Evaluate The Functional Outcomes And Quality Of Life In Patients Undergoing Elective Spine Surgery And Associated Referral Patterns For Post-Hospital Rehabilitation: A Quality Improvement Project, Mercy Oigbokie, Msn, Agnp-C, Aprn

Doctor of Nursing Practice Projects

Background/Significance: A lack of validated multi-facet assessment tools to assess postoperative patients’ functional ability and quality of life may result in untimely or no referrals to rehabilitation.

Objective: The objective of the DNP project was to introduce the use of validated multi-facet questionnaires in assessing patient-reported outcomes and to assess effect on the time in generating prescriptive rehabilitation therapies and the type of therapies following elective spine surgery evaluated in the outpatient neurosurgery clinics.

Methods: This was a quality improvement (QI) project comprising of 100 patients (50 pre and 50 post the intervention). After the introduction of baseline data, the …

Mitigating Delirium For The Elderly Post-Operatively Without Medication, Ann Lo Basso

Doctor of Nursing Practice Projects

Background: Often occurring after surgery, or hospitalization, the development of delirium in older adults, initiates a cascade of events culminating in loss of independence, increased morbidity and mortality, and high health care costs (Oh, et al., 2017).

Objective: The purpose of this quality improvement (QI) project was to adapt and implement best practices using HELP for managing older patients with postoperative delirium through the existing 1:1 observation structure and implementing cognitive care strategies. The 1:1 sitter roles and responsibilities were redesigned to include non-pharmacological, multicomponent interventions.

Methods: The QI project used a pre-test post-test intervention design comparing groups before and …

Mentoring In Nurse Anesthesia: Positively Influencing Job Satisfaction, Patricia J. Tharp

Doctor of Nursing Practice Projects

Mentored nurse anesthetists reported greater job satisfaction in a pilot study (N=19), preceding this study. The purpose of this study was to examine mentoring in nurse anesthesia as it relates to job satisfaction, based on Patricia Benner’s theory “Novice to Expert.” The study was a non-experimental and measured job satisfaction. Twelve nurse anesthetists employed at a gastroenterology center were given paper surveys, after signing an informed consent. Surveys used in this study included a demographic questionnaire, a survey on mentoring, and the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS). The surveys were returned in a sealed envelope. Subjects were asked …

Improving Provider Confidence And Partnership With Lgbt Patients Through Inclusivity And Education, Katherine Rowe

Doctor of Nursing Practice Projects

The focus of this project utilizes patient recommendations for LGBT-inclusive intake practices to increase provider confidence in communication with LGBT patients using pre-and post-survey data comparing provider confidence before and after a 20-minute video education session. LGBT-inclusive provider education has been shown to be deficient if not nonexistent in most educational settings, yet, LGBT individuals have increased risk of negative health disparities, violence, and discrimination. Research examining the ability for small changes in provider education to enable positive health outcomes for this vulnerable and marginalized population is imperative for the quality of life of these communities. A quasi-experimental design utilized …

Improving Nursing Students’ Attitudes And Beliefs About Transgender Clients Through The Use Of A Simulated Clinical Experience, J. Alex Thompson Msn, M.Ed., Rn, Cne

Doctor of Nursing Practice Projects

Background: Negative healthcare experiences may lead to poor health outcomes for transgender individuals, but nursing curricula give little attention to transgender healthcare. This study engaged nursing students in a simulated clinical experience (SCE) which featured a young adult transgender male in an acute care setting to determine whether participation would have a significant impact on student nurses’ attitudes and beliefs about transgender individuals.

Methods: The convergent parallel mixed-methods design used a one group pretest-posttest and a post-case debriefing interview to examine undergraduate nursing student attitudes and beliefs toward transgender individuals. Participants (N=27) reported their feelings via the Transgender Attitudes and …

Self-Efficacy In Emerging Nurse Leaders: The Effects Of A Virtual Community Of Practice On Nurse Educators In A New Practice Role, Kevin Daugherty Hook Msn, Ma, Ms, Agpcnp-Bc, Crnp

Doctor of Nursing Practice Projects

Background: Clinical nurse educators in long-term and skilled nursing facilities have an opportunity to exercise new leadership skills in bridging the gap between education and practice.

Objective: To assess the effects of a virtual Community of Practice (CoP) on the self-efficacy of clinical nurse educators who work in newly developing leadership roles in a large long-term and skilled nursing organization operating in multiple sites across the United States.

Methodology: The exploratory pilot study used a one group pre-test/posttest method. A convenience sample was used to enroll participants with newly created roles in clinical education. The Leader Efficacy Questionnaire (LEQ) was …