Digital Commons Network^™

Increasing Medical-Surgical Nurses' Skills And Knowledge On Wound Assessment And Documentation Through An Educational Approach, Jewels Knight

Doctor of Nursing Practice Projects

Background: Hospital acquired pressure injury rates are increasing while other hospital acquired condition rates are decreasing. Pressure injuries are expensive and place patients at a higher risk of death. Accurate wound assessment and documentation to satisfy the present on admission indicator could positively affect hospital acquired pressure injury rates.

Purpose: The purpose of this process improvement project was to increase nurses’ skills and knowledge towards proper wound assessment and documentation and to increase nurses’ knowledge on why comprehensive skin assessments and documentation of the observations are important for positive patient outcomes.

Method: This project consisted of offering an educational …

Using The Cdc’S Healthcare Personnel And First Responders: How To Cope With Stress And Build Resilience During The Covid-19 Pandemic Education Resources To Reduce Burnout Of Intensive Care Nurses At An Urban Acute Care Hospital, Elizabeth Gilbert

Doctor of Nursing Practice Projects

Background: Nurse burnout is a serious problem, as documented by many studies. Burnout has been shown to lower quality of life, performance level, and organizational commitment while also increasing a nurses' desire to leave the job. Despite this knowledge, nurse burnout continues to be present, especially among nurses who work in intensive care units (ICUs). Hospitals need ICU nurses to care for critically ill patients; therefore, it is essential to educate ICU nurses on burnout and initiate measures to decrease burnout in this vulnerable population.

Purpose: The goals of this study are to explore nurse burnout in the medical intensive …

The Effectiveness Of A Virtual Shared Medical Appointment On Opioid Safety Education Participation In The Veteran Population Within A Va Health Care System, Jana Falkner

Doctor of Nursing Practice Projects

Background: From 2019 to 2021, there has been an increase in opioid prescribing, leading to the current death rate of 136 Americans per day from an opioid overdose (Centers for Disease Control and Prevention [CDC], 2021). In response to these shocking statistics, a Veterans Administration (VA) health care system initiated a face-to-face interdisciplinary opioid safety shared medical appointment (SMA). Although the face-to-face Opioid Safety SMA was successful in increasing opioid safety awareness, participation, and attendance for the SMA have declined over the last year.

Purpose: The purpose of the DNP project was to improve attendance for veterans participating in the …

Reducing Hospital Readmissions Through A Standardized Heart Failure Educational Program For Community Based Nurse Case Managers, Greta Abernathy

Doctor of Nursing Practice Projects

Background: Heart failure is a high-risk health condition that impacts a patient's heart, causing it to pump at a weaker pace than a healthier person's heart (Mayo Clinic, 2020). Associated with frequent hospital admissions, heart failure affects millions of Americans in the United States (Fleg, 2018) and results in repeated readmissions, costing thousands of dollars per admission and decreased quality of life.

Purpose: This DNP project aims to implement an evidence-based educational model of care for nurse case managers within a community setting focused on Heart Failure (HF) that will improve the heart failure patient's ability to self-manage their disease …

The Use Of The Centers For Disease Control (Cdc) Outpatient Antibiotic Stewardship Program To Reduce Unnecessary Antibiotic Prescriptions Written For Sinusitis In A Rural Urgent Care Clinic Setting, Melanie Maddox

Doctor of Nursing Practice Projects

Background: The discovery of antibiotics has been a significant success in fighting bacterial infections. According to the Centers for Disease Control (CDC), in 2018, inappropriate prescribing of antibiotics contributed to antibiotic-resistant conditions, which led to 2 million infections, and has killed about 23,000 Americans annually (Chaney, 2018: CDC, 2019). By 2050, 10 million people are expected to die globally due to bacterial resistance, with the cost potentially reaching $100 trillion (WHO, 2019).

Purpose: The purpose of the DNP Project is to decrease unnecessary antibiotic prescriptions for the diagnosis of sinusitis in a rural urgent care clinic and increase provider awareness …

A Multi-Modal Strategy To Activate Pronation For Acute Respiratory Distress Syndrome Patients, Meredith Mccrorie

Doctor of Nursing Practice Projects

Background: Acute Respiratory Distress Syndrome (ARDS) is an acute pulmonary process that compromises the health of patients in the Intensive Care Unit (ICU). ARDS can progress to irreversible fibrosis causing the lungs to become noncompliant, adversely affecting ventilation or gas exchange (Buckley et al., 2019). An ARDS diagnosis accounts for 30-40% mortality rate which is an improvement from 60% in the last two decades. The clinical course of this disease is highlighted by Acute Hypoxic Respiratory Failure (AHRF) evidenced by chest radiographs revealing bilateral dense consolidations. Manual pronation of ARDS patients has shown an increase in alveolar function with end …

Utilizing Multimodal Education To Impact Provider Documentation Of Post-Anesthesia Evaluation In A Rural Hospital, Jennifer Coffman

Doctor of Nursing Practice Projects

Background: Hospital policy, Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (TJC) require a post-anesthesia evaluation to be completed and documented no later than forty-eight hours following surgery or any other procedure requiring anesthesia. This evaluation is required any time general, regional, or monitored anesthesia has been administered to the patient and must be completed by a certified anesthesia provider. One rural hospital facility’s post-anesthesia documentation compliance has declined to 79%, compared to the previous quarter’s report of 95%.

Purpose: The Doctor of Nursing Practice (DNP) project aimed to improve post-anesthesia documentation through a multimodal educational intervention. …

Prenatal Education For Black Mothers And Their Support Persons As An Intervention For Improving Initiation Of Breastfeeding, Sandra King

Doctor of Nursing Practice Projects

Background: The benefits of breastfeeding are commonly known; however, the rates of exclusive breastfeeding among the Black community are less than those of other ethnic groups. Providing breastmilk or formula to an infant is an individual decision. Influential factors such as cultural background, employment status, socioeconomic status, level of education, and availability of support from family members and health care providers correlate with the method a mother chooses to feed her infant. Increasing breastfeeding initiation immediately after birth is a necessary precedent for uptake in the exclusivity of breastfeeding.

Purpose: This Doctor of Nursing Practice project aims to improve prenatal …

Implementation Of A Diabetes Self-Management Education Program In The Rural Health Care Setting To Improve Glycemic Control In The African American Adult Population, Patricia Jackson

Doctor of Nursing Practice Projects

Background: According to the Center for Disease Control (CDC), Type 2 Diabetes Mellitus (T2DM) is a significant epidemic health problem worldwide. Furthermore, with the generality of T2DM-associated complications increasing, individuals living with chronic diseases must be competent in self-management to prevent long-term complications (CDC, 2021). Therefore, this Project Investigator aims to decrease the reported home glycemic control and improve diabetes self-management education among African American individuals in rural healthcare using the DSMEP tool.

Purpose: The purpose of the DNP project was to implement and assess the Diabetes Self-Management Education Program (DSMEP) effect on African American individuals in the rural health …

Stroke Care: Achieving Recommended Door To Computed Tomography Times In Ambulatory Patients Presenting To The Emergency Department Of A Rural Hospital Through The Application Of American Stroke Association Guidelines, Ricardo Paitz

Doctor of Nursing Practice Projects

Background: Time matters in stroke care, and every second counts because the extent of irreversible neuronal damage increases over time (Saver, 2006). Therefore, the American Stroke Association (ASA) recommends a door to computed tomography time of 20 minutes or less for patients presenting with signs of acute ischemic stroke. This time metric in stroke care is often not met, resulting in the delay of care of patients which translates to poorer outcomes, including death and a decreased quality of life in patients who have suffered an acute ischemic stroke (Kamal, Sheng, et al., 2017).

Purpose: The purpose of this DNP …

Utilization Of Staff Education To Improve The Management Of Aggression And Violence In The Rural Inpatient Psychiatric Setting, Clara Ugwuibe-Ogunseye

Doctor of Nursing Practice Projects

Background: Workplace violence (WPV) is a global concern and an occupational hazard faced by healthcare professionals worldwide. Aggression and violence can result in serious injury to the patient, healthcare professional, other patients, or visitors and cause stress to healthcare workers, and increase work absences (Picot, 2021).

Purpose: This DNP process improvement project aim was to utilize an educational training program on violence risk assessment, therapeutic communication, and verbal de-escalation techniques, to improve the confidence of mental health nursing staff in using early intervention to manage aggressive, violent patients. This education and early intervention reduced rates of aggression and violence escalation, …

Reducing Admissions Of Adult Congestive Heart Failure Patients In The Acute Care Setting, Jamekia Calhoun

Doctor of Nursing Practice Projects

Background: Heart failure (HF) is a clinical diagnosis that affects about 1 to 2% of the population worldwide. Poor education regarding self-care behaviors after discharge has contributed to increased readmissions after acute hospitalization. Hospital readmissions cost is approximately one hundred thousand dollars. This increase in cost has forced the Centers for Medicare and Medicaid Service (CMS) to place penalties on organizations with high readmission rates. The organization may be penalized for increases in readmission rates by decreasing the percentage of the combined total Medicare payments received from the CMS (Centers for Medicare and Medicaid Services [CMS], 2021)

Purpose: …

Implementation And Evaluation Of A Post-Op Coronary Artery Bypass Graft Extubation Checklist To Reduce Prolonged Intubation In The Intensive Care Unit, Melissa Bailey

Doctor of Nursing Practice Projects

Background: Total intubation time of post-op coronary artery bypass graft (CABG) patients is set by the Society of Thoracic Surgeons (STS) guidelines. STS states that post-op CABG patients need to be extubated within twelve hours of end anesthesia time with a recommendation of fewer than six hours. The project site had a total intubation time of greater than seventeen hours before removing the outliers. The current process does not result in a total intubation time of fewer than six hours. Implementation of an extubation checklist was chosen as the intervention for this DNP project.

Purpose: This DNP project aims to …

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 …

Nursing Care For Transgender And Nonbinary Patients An Educational Model For Forensic Nurse Examiners, Shoshana Dickerson

Doctor of Nursing Practice Projects

One of the greatest barriers to healthcare faced by the transgender and nonbinary (TGNB) population is the lack of access to providers who are knowledgeable in providing safe, appropriate, and gender-affirming care. LGBT education for most nursing baccalaureate nursing programs contains only 2.12 hours of LGBT-related content in their curricula, with even less time specifically devoted to transgender health topics. One foundational intervention for addressing healthcare disparities among the TGNB population is to provide better and more inclusive education for nurses about gender-affirming care. The purpose of this quality improvement project was to design, implement, and evaluate an interactive educational …

Benefits Of Ambulation In Older Adult Population, Kelsie E. Wilkes

Doctor of Nursing Practice Projects

Background: Loss of mobility is an outcome of aging. Decreased ambulation leads to a loss of mobility and ultimately a loss of independence. There are additional health risks associated with loss of mobility. There can be challenges to facilitating ambulation and mobility in an aging population.

Objective: A literature review of the benefits of ambulation/mobility and the risks of loss of mobility was conducted. The purpose was to promote ambulation/mobility in a community-based setting and educate those caring for the adult population about the importance of ambulation.

Methods: A presentation was provided to staff and participants of …

Improving Medication Communication Hospital Consumer Assessment Of Healthcare Providers And Systems (Hcahps) Score, Danyel Weldon Munster

Doctor of Nursing Practice Projects

Nurses provide education on medication purposes and side effects to hospitalized patients. Patient satisfaction surveys measure this intervention with the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). HCAHPS determines a portion of hospital reimbursement and star rating. By improving patient satisfaction through effective medication communication, the hospital’s star ratings and reimbursements increase. Various clinical settings utilize the teach-back method to improve patient understanding and participation in their medication education. This quality improvement project aims to improve HCAHPS medication communication-specific scores through scripted, nurse-delivered teach-back interventions. The student DNP educated the staff nurses on an adult medical-surgical unit, …

Reducing Incidence Of Contrast-Induced Acute Kidney Injury Through Nursing Education, Hilarie Rankin

Doctor of Nursing Practice Projects

Contrast-induced acute kidney injury (CI-AKI) occurs commonly in patients following percutaneous coronary intervention (PCI) and has been linked to increased patient morbidity, higher risk for cardiovascular mortality, and a large burden of annual healthcare costs. The implementation of evidence-based care standards by nursing staff has been shown to reduce incidence of CI-AKI. Current discrepancies in nursing care have been linked to increased incidence of CI-AKI; therefore, the need for enhanced nurse buy-in with evidence-based protocols is paramount. The primary investigator sought to increase knowledge of CI-AKI and nursing compliance with an established evidence-based protocol at a single center hospital. After …

Sepsis Initiative: Champion Series, Ashlie Barnes

Doctor of Nursing Practice Projects

Sepsis is defined as a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a higher risk of mortality than with sepsis alone. Each year, more than 1.7 million people are diagnosed with sepsis in the United States, and at least 270,000 Americans die. There is no confirmatory diagnostic test to diagnose sepsis. Therefore, clinical judgment based on evidence of infection and organ dysfunction is key.

Despite thousands of articles and hundreds of trials, sepsis plays …

Improving Health Literacy For Diabetics In A Rural Community, Elissa Purvis

Doctor of Nursing Practice Projects

Adults with type II diabetes mellitus need to understand the disease and manage their chronic condition to live a healthy and comfortable life. This project aimed to educate adults with type II diabetes mellitus in self-management of their chronic illness to increase their health literacy to improve their heart health, kidney health, nutrition, and exercise. The project utilized a Doctor of Nursing Practice (DNP) approach to education for adults with type II diabetes mellitus on the disease process.

METHODS: This project is a quality improvement project focused on educating adults with type II diabetes mellitus in managing their chronic conditions …

Early Antibiotic Administration For Sepsis, Joseph Hooks

Doctor of Nursing Practice Projects

Sepsis is a life-threatening organ dysfunction caused by the body's response to an infection causing systemic inflammation. Timely intervention with broad-spectrum antibiotics is linked to improved outcomes, reversal of organ failure, and decreased hospital length of stay. Studies show that the incidence of sepsis is increasing, while mortality related to sepsis has declined over the past several decades. Effective treatment of the source of infection is key to improving sepsis recovery and preventing septic shock. Epidemiologic studies are showing startling increases in sepsis cases with falling mortality rates. Sepsis awareness is a primary focus of quality improvement initiatives in hospitals …

Increasing Colorectal Cancer Screening Rates Through Education, Kayla Metz

Doctor of Nursing Practice Projects

Colorectal cancer is the second leading cause of cancer deaths in the United States. Adenomatous polyps cause 90% of colorectal cancer. These polyps can be identified before they become cancerous through numerous colorectal cancer screenings. There are many ways to help cover the cost of screenings or to make them no cost to patients, but the number of individuals who have ever been screened or who are current with screening recommendations remains low. This DNP project aims to provide education to providers and individuals regarding the various type of colorectal cancer screening options. A reduction in fears and improved knowledge …

Using Infographics To Improve Completion Rates Of The Sepsis Protocol Bundle, Stephen Newbern

Doctor of Nursing Practice Projects

Hospitals have sepsis protocols that must be implemented when a patient shows positive signs and symptoms of a septic infection. Nurses learn about sepsis in nursing school and rarely further their education beyond this basic understanding of the disease. So, when nurses fail to comply with organizational instructions outlined within a defined sepsis protocol bundle, this often leads to a progression of severe sepsis in a patient and, most likely, increased cost for the healthcare facility. Multiple sepsis protocol bundle failures negatively impact organizational ratings established by The Joint Commission for patient care and are highly associated with increased sepsis …

Re-Educating Healthcare Workers In Long-Term Care Facilities To Improve Hand Hygiene Compliance, Jennifer A. Ukeje

Doctor of Nursing Practice Projects

Hand hygiene is one of the most significant measures for protecting nursing home residents from healthcare-associated infections (HAIs). An estimated 1.6 million to 3.8 million infections occur each year; of these infections, 32% of all healthcare-associated infections (HAIs) are urinary tract infections (UTI), 15% are pneumonia (lung infection), and 14% are bloodstream infections. The high incidence of HAIs in nursing homes is due to multiple factors such as understaffing, inadequately trained staff, staff to resident ratio, lack of antibiotics stewardship, and the increasing clinical complexity of the average nursing home. In addition, most long- term care (LTC) residents are older …

Increasing Compliance On Pain Reassessment At A Rural Hospital Swing Bed Unit, Stephanie Melson

Doctor of Nursing Practice Projects

The overarching goal of this project is to ensure patient pain reassessment is completed on all patients in accordance with the facility and The Joint Commission (TJC) standards after the intervention. The last four surveys of the rural critical access hospital yielded subpar results showing noncompliance with pain reassessment. Utilizing quality improvement measures such as staff education and charting reminders, gaps in practice were found and utilized to optimize the care to patients related to pain and reassessment. The study seeks to improve the pain reassessment skills and compliance of nursing staff at a rural critical access hospital. Initial non-compliance …

Mentoring New Graduate Nurses To Promote Staff Retention, Elsie Anwah

Doctor of Nursing Practice Projects

Nursing mentoring programs promote professional socialization in new graduates to increase patient safety, enhance clinical competency, improve job satisfaction, and reduce turnover. A structured mentoring program helps the new graduate experience a more controlled and intentional learning experience. Implementing a well-designed experience helps to increase job satisfaction and decreased turnover. The mentorship program utilized Patricia Benner’s theory ‘From Novice to Expert model.’ The project design was based on quality improvement which followed the focus, analyze, develop, execute, and evaluate (FADE) methodology. The goal of the project was to measure the intent to stay of new graduate nurses through Intent to …

Improving Suicide Risk Assessment Through Educational Program Implementation, Timothy Booth

Doctor of Nursing Practice Projects

Background: Unsustainable behavioral health education focused on comprehensive suicide risk assessment performance contributes to decreased registered nurses’ perceived self-efficacy in assessing and caring for suicidal patients.

Purpose: To educate medical-surgical and progressive care registered nurses in assessing patients for suicide risk factors and warning signs comprehensively.

Design Method: A quasi-experimental designed quality improvement project with evidence-based suicide educational program implementation. Project results yielded a 56.7% increase in registered nurses’ perceived self-efficacy in assessing and caring for suicidal patients. Future DNP work will focus on sampling a larger population (N) to decrease opportunities for the skewness of project results …

Can Provision Of Additional Education For Nursing Staff Increase Breastfeeding Knowledge And Feelings Of Self-Efficacy?, Akeba Deqwan Thompson

Doctor of Nursing Practice Projects

Background: Post-partum nurses are responsible for preparing new mothers with the necessary skills to feed and care for their infants and need proper education to effectively and confidently discuss feeding options with their patients.

Purpose: This quality improvement project aims to increase nursing knowledge of breastfeeding and their feeling of self-efficacy in promoting breastfeeding as an option to new mothers.

Design Methods: A quasi-experimental design including a pre-test/post-test used to quantify the effect of education on therapeutic communication, nursing responsiveness, and feelings of self-efficacy.

Conclusion: An overall increase in feelings of self-efficacy and knowledge of breastfeeding was noted amongst nursing …

Implementing An Antibiotic Stewardship Education Program To Decrease Antibiotic Prescriptions In An Urgent Care Clinic, James Gramling

Doctor of Nursing Practice Projects

Antibiotics are often prescribed for respiratory infections. These infections often have a viral rather than a bacterial source. Overuse of antibiotics is associated with increased potential for adverse effects, increased healthcare costs, and increasing antibiotic resistance. The purpose of this DNP project was to determine if implementing an antibiotic stewardship program at an urgent care clinic would decrease the number of antibiotic prescriptions written for acute respiratory tract infections. An educational session consisting of didactic and PowerPoint presentations was provided to each provider at the urgent care clinic. Medical records were reviewed for four weeks after completion of the session …

A Quality Improvement Project To Improve The Management Of Patients At Risk For Falls, Crystal Medici

Doctor of Nursing Practice Projects

Background: Falls are one of the most common adverse events in the hospital. Falls can result in injury, increased hospital length of stays, increased costs and use of hospital resources, and death. The risk of falling is even higher for hospitalized patients due to unfamiliar environments, new medications and treatments, acute illness symptoms, surgery, bed rest, lines, tubes, and catheters.

Purpose: This quality improvement project aimed to increase awareness of the importance of fall prevention in the hospital setting and educate nursing staff on fall prevention to decrease patient falls.

Methods: This project utilized a quasi-experimental study design that includes …