Digital Commons Network^™

Impact Of Gamification In An Online Rn To Bsn Program, Deosha Anderson

Doctor of Nursing Practice Projects

This quality improvement project aimed to enhance student engagement in an online RN to BSN program by incorporating gamification strategies into the curriculum. Traditional teaching methods often fail to maintain student interest, leading to low engagement and reduced program completion rates. This project sought to determine the impact of gamification on student engagement compared to no gamification. The intervention involved integrating gamified elements into the online RN to BSN program to create a more interactive learning environment. The project employed a quantitative, quasi-experimental design with a pre-intervention and post-intervention assessment. Data on student engagement metrics, including login frequency, time spent …

Enhancing Student Simulation Debriefing Using Video Recording, Lisa Hall

Doctor of Nursing Practice Projects

This quality improvement project aimed to show how video recording can increase vivid feedback by expanding the students' memory by reviewing the recording to recall and reflect on their roles during the simulations. This project sought to help the learner understand how well the simulation ran and what was done to improve its performance. The interventions involved video recording each simulation scenario. The recording was used during the debriefing session to help the students recall and reflect on their actions during the scenario. The project employed a quantitative, quasi-experimental design with a pre-intervention and post-intervention assessment. Data was collected using …

Promoting The Incorporation Of Regional Anesthesia To Improve Pain Management For Lower Extremity Surgeries, Kendra Knaga

Doctor of Nursing Practice Projects

Opioid addiction in the United States is a healthcare crisis and continues to increase yearly. Multimodal pain management is a priority intervention that needs to be implemented to manage pain with less intra and postoperative opioid use. Peripheral nerve blocks are one alternative that can be used to decrease opioid use and assist in controlling pain for foot and ankle surgeries. This project aims to educate, develop, and create a protocol for popliteal nerve blocks at Hillsboro Area Hospital in Hillsboro, Illinois. As a result, the long-term goal is to reduce opioid administration and improve pain control. An educational PowerPoint …

Optimizing Digital Proficiency To Improve Perceived Self-Efficacy In Telehealth Nurses, Serena Young

Doctor of Nursing Practice Projects

The use of telehealth to provide care management services has increased as healthcare continues to evolve. Seven million Americans were predicted to use telehealth in 2020, which increased to over 35 million through the pandemic. These services have been shown to decrease healthcare disparities and promote positive health outcomes. Education and training for nurses providing telehealth services have not kept up with the increased demand. Nurses providing care management telehealth services in a large tertiary health system have low perceived self-efficacy for technology. Leaders in the organization believe this is causing a lack of digital proficiency in their workforce. This …

A Wellness Initiative: Mindfulness Training For Unlicensed Assistive Personnel To Promote Self-Care And Enhanced Well-Being, Julia Aurora Clarke Msn, Rn, Cns

Doctor of Nursing Practice Projects

Background: Burnout leads to decreased staff engagement, productivity, and high attrition rates. The nursing staff most impacted are Unlicensed Assistive Personnel (UAP); therefore, to combat burnout, resilience is to be cultivated. Resilience begins with self-care, which is nurturing the self: mind, body, and soul to safeguard well-being.

Objectives: This project provided mindfulness training as a wellness initiative to promote self-care skills and enhance well-being among the UAP within a healthcare facility.

Methods: This project followed an evidenced-based quality improvement practice framework ( Mindful Self-Care Scale-Brief and IHI- Well-Being Assessment Survey) and used a pre-post-test design to compare …

Reducing 30-Day Hospital Readmission Rates By Addressing Social Determinants Of Health In The Home Health Care Setting, Kelly-Ann Federle Reilly

Doctor of Nursing Practice Projects

Background: In 2013, Medicare penalties for high hospital readmission rates spurred initiatives to reduce these figures. Despite efforts, 25% of elderly patients are readmitted within 30 days post-discharge, often due to unaddressed Social Determinants of Health (SDoH) like food, housing, and medication access.

Objectives: The project aimed to assess the effectiveness of interventions targeting SDoH for patients over 65 receiving home care services. It specifically sought to evaluate the impact of these interventions on 30-day readmission rates, focusing on addressing food, housing, and medication insecurities.

Methods: This project evaluated interventions targeting SDoH in-home care among patients over 65 to reduce …

Combating The Opioid Crisis: Opioid And Naloxone Training In A Rural School District, Phadra K. Murray

Doctor of Nursing Practice Projects

Background: The opioid epidemic is plaguing North Carolina and has crept its way into the academic setting of many elementary, middle, and high schools in the state, causing school nurses to scramble and search for ways to keep students safe. This DNP project was designed to educate school nurses in a rural county in eastern North Carolina about opioid education and naloxone administration. This project intended to increase the knowledge and confidence level of school nurses in case of an opioid overdose emergency within the school. As more and more children and adolescents experiment with opioids, there is an urgent …

Lncreasing Clinical Judgment And Critical Thinking Skills Using The Ncsbn Clinical Judgment Measurement Model In Licensed Nursing, Kathryn Roberts

Doctor of Nursing Practice Projects

Licensed nurses are having problems with critical thinking and using clinical judgment when caring for patients (Rogers & Franklin, 2023). There has been increased emphasis on critical thinking and clinical judgment in nursing school curriculum but not in hospital/orientation curriculum (Dickison et al., 2019). This quality improvement project aims to address the gaps in critical thinking and clinical judgment skills among licensed nurses by focusing on integrating the NCSBN-CJM, and cues into the prebriefing of the Respiratory Distress/Oversedation Scenario within the project hospital orientation program. The project utilized a quasi-experimental study design to investigate the cause-and-effect relationship by integrating the …

Improving Empathy With Simulation: A Quality Improvement Project, Jami Layne

Doctor of Nursing Practice Projects

This study examines the effectiveness of simulation-based training in enhancing empathy levels among undergraduate nursing students. A lack of empathy can negatively impact the healthcare outcomes of patients (Levett-Jones et al., 2019). Improving the empathy levels of nursing students can improve patient outcomes and impact student learning outcomes such as the student’s ability to think critically and improve communication and social skills (Chua et al., 2021; Ferri et al., 2017; Hakansson Eklund et al., 2019; Koukourikos et al., 2021). The purpose of the quality improvement project was to improve empathy levels in undergraduate associate degree nursing students and increase the …

Medication For Opioid Use Disorder In A Community Mental Health Clinic, Hannah Magness

Doctor of Nursing Practice Projects

Background: Over 100,000 people died from opioid-related overdoses in the United States in 2023. People experiencing homelessness (PEH) are at especially high risk of co-occurring mental illness and substance use disorder, and face added barriers to accessing medical and psychiatric care. Buprenorphine is a life-saving medication used to treat opioid use disorder (OUD).

Objective: This project assessed the feasibility of altering prescribing practices at a community mental health clinic in King County, Washington to incorporate medication for opioid use disorder (MOUD) into standard clinic procedures.

Methods: This project was a mixed-methods, formative evaluation that assessed the need for and barriers …

Evaluating The Effectiveness Of A Vaginal Breech Birth Training Program, Kathleen Lynch, Rachel Mackriell

Doctor of Nursing Practice Projects

Introduction: Most providers do not have the skills, knowledge, or confidence to safely support vaginal breech birth (VBB) despite 3-5% of all pregnancies being breech at term. The presence of a provider skilled in VBB reduces risk in VBB, however VBB skills are not a standard part of birth provider training. Identifying an effective instruction method can make VBB training more accessible.

Methods: We conducted a secondary data analysis of 3940 surveys submitted by self-selected participants in an international hybrid VBB training program from May 2021 to February 2024. Pre- to post-training analysis using non-paired t-test and chi-squared comparison was …

Implementation Of Non-Pharmacological Sleep Checklist In Adult Intensive Care Unit (Icu) To Decrease Delirium, Recine Anne Alinea, Nancy Lamptey

Doctor of Nursing Practice Projects

Background: Delirium is a prevalent problem in Intensive Care Unit (ICU) patients, affecting up to 80% and resulting in poor outcomes such as increased length of stay in the hospital, prolonged hospitalization, cognitive impairment, and sometimes death. Nonpharmacological therapies, particularly those that promote sleep, have been found to prevent delirium.

Objective/Aim: To determine the efficacy of a nonpharmacological sleep checklist intervention in lowering the incidence of delirium in ICU patients and increasing nurses' knowledge and confidence in the implementation of the sleep bundle/checklist.

Method: A quality improvement project with a pre-post mixed methods design was carried out in a 28-bed …

Improving Access To Early Interventions For Prediabetic Patients, Kimberleigh M. Telling

Doctor of Nursing Practice Projects

Approximately 88 million Americans, or nearly one-third of the population, have prediabetes. This condition has a high rate of progression to type 2 diabetes, reaching 70%. However, early identification, diagnosis, and participation in lifestyle interventions can effectively reduce the risk and promote euglycemia. Regrettably, 85% of those with prediabetes are unaware. The goal of this quantitative quality improvement project was to enhance the use of the prediabetes diagnosis code by primary care providers, who play a crucial role in preventing type 2 diabetes. The purpose was to improve access to early intervention for individuals with prediabetes, following the guidelines of …

Implementing A Foot Screening Project For Diabetic Patients In An Assisted Living Facility, Beatrice L. Bailey

Doctor of Nursing Practice Projects

Diabetes impacts around 422 million individuals globally, resulting in 1.5 million reported annual deaths. Type 2 diabetes affects approximately 35.4% of the population in the United States, with 1.4 million new cases identified each year. When not managed properly, diabetes can spiral into a long list of complications. Among the various challenges in diabetes management, foot complications stand out as significant and often avoidable. Without proper attention, these complications can lead to severe health issues. To address this concern, this project focuses on resolving standard foot inspection practices within an assisted living facility in central Mississippi. The goal is to …

Improving Outcomes For Women Following Gynecological Surgery Through Implementation Of Multimodal Analgesia As Part Of An Enhanced Recovery After Surgery (Eras) Protocol, Shannan M. Case

Doctor of Nursing Practice Projects

The opioid epidemic in the United States has been a continuous public health crisis, as opioid-associated overdose has become one of the leading causes of death. The risk of opioid misuse increases following exposure to opioids perioperatively. As a result, anesthesia providers are facing a significant shift in practice to decrease opioid administration while adequately managing perioperative pain. While opioids have historically been the mainstream for perioperative pain management, multimodal analgesic (MMA) regimens as part of Enhanced Recovery After Surgery (ERAS) programs are being utilized as alternative methods. With these programs, opioids are reduced by administering non-opioids with neuraxial and …

Conflict Resolution In Healthcare: The Vital Role Of Developing Conflict Management Skills Among Nurse Leaders, Kris Maddalena

Doctor of Nursing Practice Projects

Nurse leaders at the unit level play a vital and indispensable role in acute care settings. Their influence extends beyond administrative tasks, as they significantly impact crucial factors such as nurse retention rates, patient outcomes, and the overall work environment of the unit-level teams. Effective unit-level leadership has been consistently associated with improved outcomes, increased job satisfaction, and decreased turnover among nurses (Aiken et al., 2011). This DNP project is focused on enhancing conflict management skills among unit-level nurse leaders in an acute care setting. The project followed a quality improvement sequence, which included obtaining a needs assessment for unit-level …

The Implementation Of A Diabetic Foot Screening Tool Into A Primary Care Practice, Joanna P. Barnett

Doctor of Nursing Practice Projects

Inconsistent guidelines and nonadherence to diabetic foot screening recommendations are ongoing problems. This project aimed to promote the prevention of diabetic foot complications by detecting complications early and determining who is at high risk. An educational intervention provided for clinicians addressing the importance of foot assessments and the use of a diabetic foot screening tool was provided. After the education was provided, a pre-and post-test comparison was assessed for increased knowledge. Due to a small sample size and the need to assess results quickly, the plan-do-study-act method guided the project. Post-intervention, the goal was to have four providers increase the …

Evaluation Of A Revised Clinical Ladder Program In Addressing Clinical Competence And Performance, Accountability, Professional Growth, Rewards And Benefits, Job Satisfaction And Engagement, And Autonomy And Decision Making, Vaughn Hansen Msn, Rn, Ne-Bc

Doctor of Nursing Practice Projects

Background: The surge of nurses leaving the profession has increased in recent years raising concerns that unless systemwide changes are implemented this trend will increase exponentially for years to come. Healthcare organizations struggle to retain an experienced, competent nursing workforce and seek ways to keep them from leaving. A clinical ladder program is one potential method being implemented in which healthcare organizations mitigate the exodus of nurses and create a healthier work environment.

Objectives: This doctoral project aimed to measure the perceptions of how well a revised clinical ladder program influenced the nursing workforce satisfaction in the following areas: clinical …

Implementation Of The Adult Adhd Self-Report Scale In A Mental Health Clinic, Anne Hocking

Doctor of Nursing Practice Projects

Less than 20% of adults with attention deficit hyperactivity disorder (ADHD) are adequately treated due to overlapping symptomology of comorbid psychiatric conditions. Anxiety and depression are the most common comorbid psychiatric conditions in adults with ADHD. Diagnosis, treatment, and outcomes of adults with ADHD are impacted due to inadequate screening. The setting for this project occurred in a Veteran Affairs mental health outpatient clinic in central Illinois. The process was implemented by screening adults diagnosed with depression or anxiety using the adult ADHD self-report scale (ASRS). Of the 150 participants, 90 scored higher than 17 on the self-report scale, indicating …

Improving Nursing Communication By Implementing Communication Tools In A Bsn Undergraduate Program To Improve Patient Outcomes In Practice, Christopher Jackson

Doctor of Nursing Practice Projects

Communication deficiencies were identified among baccalaureate nursing students at South College in Nashville, TN, necessitating changes needing to be made in the nursing curricula. To address the flaws, the quality improvement project proposed implementing changes in clinical assignments during clinical rotations in medical-surgical nursing courses. The project manager discussed the purpose and usage of the SBAR tool, and the students then demonstrated the use of the tool. The clinical faculty rated the students using an eight-question Likert survey to assess the students’ confidence and competency three times; the first assessment at the end of the shift without guidance from their …

Implementation Of A Nurse-Driven Early Mobility Protocol In Critical Care To Reduce Intensive Care Unit Acquired Weakness (Icuaw), Wendy Key

Doctor of Nursing Practice Projects

Background: Intensive care unit acquired muscle weakness (ICUAW) is a syndrome of general weakness that occurs while a patient has a critical illness. Almost half of all ICU patients develop ICUAW. The most common occurrence of ICUAW is seen in patients diagnosed with prolonged mechanical ventilation, severe sepsis, or difficulty weaning from mechanical ventilation (MV). Bedrest is the number one risk factor for the development of ICUAW and the elderly are at higher risk. The best treatment for ICUAW is early mobility which has shown positive effects for decreasing ventilator days and intensive care unit (ICU) length of stay (LOS). …

Utilizing A Multidisciplinary Team Approach To Opioid Stewardship At An Interventional Pain Clinic, Georgemarie Garber

Doctor of Nursing Practice Projects

Background: The opioid epidemic is a preventable health threat that is a recognized national problem by the Centers for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS). The evidence-based Opioid Stewardship (OS) toolkit is essential in the opioid epidemic because it supports identifying patients at risk for opioid aberrancy. However, at the Interventional Pain Management Clinic (IPMC), a chart review on the completion rates of the OS toolkit components for new patients admitted in June 2022 revealed that providers were not consistently completing components of the OS toolkit such as Opioid Risk Tool (ORT), the Morphine …

Implementation Of A Patient Care Specialist Role To Enhance The Patient Experience In A Pediatric Emergency Department, Jillian Brodeur

Doctor of Nursing Practice Projects

Background: Patient-centered care (PCC) has been an emerging trend in healthcare for the past two decades (Walsh et al., 2022). PCC and the patient experience have become essential measures of the quality of care provided and are linked to reimbursement dollars and improved patient outcomes (Rapport et al., 2019).

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to improve the patient experience in the Emergency Department (ED) of a metropolitan hospital. The DNP project focused on the benefit of a patient advocate in the ED to improve the patient experience. The project sought to improve …

Improving Influenza Vaccination Rates In A Primary Care Clinic: A Quality Improvement Crusade, Janet Lowe

Doctor of Nursing Practice Projects

Background: Research consistently shows that influenza vaccines prevent medical appointments, treatments, and disabilities. In the United States (U.S.), 25-49 million individuals contracted influenza from October 2022 through January 2023. However, despite a greater community consciousness regarding viral contagions and the improved availability of vaccinations through primary care settings, ambulatory clinics, and local pharmacies, adults in the U.S. continue to miss the national influenza vaccination goals of 70%.

Purpose: This Doctor of Nursing Practice (DNP) project aimed to boost influenza immunization rates and comprehension of vaccination benefits among patients in a primary care setting during the influenza season. The DNP student …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

Improving Early Sepsis Recognition And Treatment By Utilizing The Surviving Sepsis Campaign In Emergency Department Patients, Rebecca Smith

Doctor of Nursing Practice Projects

Background: Sepsis is a physical reaction to infection that can cause bodily injury, organ deterioration, and death (Sepsis Alliance, 2022). Early sepsis identification and intervention requires staff engagement in quick recognition and implementation of care (Jorgensen, 2019). Septic patients require prompt initiation of intravenous fluids, hemodynamic observation, and appropriate laboratory testing (Evans & Rhodes, 2021). Rapid detection of sepsis can prevent patients from progressing to severe sepsis and septic shock, increasing the risk of mortality (Jorgensen, 2019). As a result of the high mortality rates and complications associated with this health disparity, evidenced-based care bundles were developed to improve care …

Let Us Talk About It: Using A Communication Tool To Improve The Timeliness Of Rapid Responses, Lajaynees Singleton

Doctor of Nursing Practice Projects

Background: In healthcare emergencies, minutes matter. Code blue, code stroke, and rapid responses are processes put in place by hospitals to save lives and improve the outcome of deteriorating patients. At a local medical facility in Alabama, the process for calling codes and rapid responses created miscommunication and delays in the code team’s arrival. An assessment revealed that a purchased clinical communication device (CCD) was underutilized.

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to improve the communication of code blue, code stroke, and rapid responses by utilizing the CCD.

Methods: The quality improvement project consisted …

Implementing An Emergency Severity Index (Esi) Triage Refresher Training To Decrease The Under-Triage Rate In The Emergency Department (Ed), Monique Wallace

Doctor of Nursing Practice Projects

Background: The Emergency Severity Index (ESI) is a triage tool used in most emergency departments in the United States (U.S.) that assesses acuity and resource allocation for emergency care patients. Registered nurses (RNs) must assign the appropriate triage category to ensure patients are seen in a proper time frame, have ideal patient outcomes, and have efficient patient throughput.

Purpose: This quality improvement project aims to decrease the under-triage rate of patients in the emergency department (ED) by implementing an Emergency Severity Index (ESI) triage refresher training.

Methods: This project used an A3 methodology. The triage specialist completed retrospective chart reviews …

Implementing An Emr System In A Small Psychiatric Practice, Brandy Mccrudden

Doctor of Nursing Practice Projects

Electronic medical records (EMRs) can aid in improving surveillance, monitoring, adherence to practice guidelines, improving communication, and reducing medical errors. The adoption of EMRs in psychiatry and mental health settings has been slow despite the offered benefits. This project aimed to develop an implementation and training plan to successfully transition from paper charts to EMRs in a psychiatry practice. An extensive literature review was conducted on the adoption of EMRs in mental health settings, and a guideline for implementation was created to overcome identified barriers. Implementation guidelines included a planning phase, staff training plan, and rollout using a phase-in approach. …

Improving Depression Remission Screening Compliance, Crystal Wingerter

Doctor of Nursing Practice Projects

Depressive disorders are widespread in the United States and are diagnosed and treated in the primary care setting. In 2019, there were an estimated 19.4 million adults that had at least one major depressive episode. The purpose of this project was to improve follow up and depression remission assessment for patients with a diagnosis of depression at a metropolitan family care practice clinic. The Patient Health Questionnaire (PHQ–9) was utilized for remission assessment. Front desk staff and providers were trained and granted access to the quality information system (QIS) in the electronic medical records (EMR) system which allowed easy identification …