Digital Commons Network^™

Tranexamic Acid Protocol For Lower Extremity Total Joint Arthroplasties, Autumn Cullison

Doctor of Nursing Practice Projects

Abstract

Bleeding is a risk associated with surgery, and complications, such as hypotension, anemia, and decreased oxygen-carrying capacity, can occur. Blood transfusions have been the mainstay treatment for excessive surgical blood loss; however, transfusion has associated risks including infection, volume overload, immunological reactions, and increased morbidity and mortality (Sahu et al., 2014). Interventions to decrease surgical blood loss are essential components to improving surgical outcomes. The antithrombolytic, tranexamic acid (TXA), decreases surgical blood loss and blood transfusion requirements, thereby decreasing transfusion-related complications (Gausden et al., 2017). Despite frequent use, variance exists surrounding the administration of TXA. Current evidence and guidelines …

Impact Of Teamstepps Training On Teamwork Perception In Two Primary Care Clinics, Brittaney Shaw

Doctor of Nursing Practice Projects

Background: Most healthcare delivery involves teams. After teamwork and communication breakdowns, poor patient care, errors, and inefficiencies follow. Employee engagement surveys from two Galveston County clinics showed concern with teamwork and value. TeamSTEPPS, a team training program, improved attitudes, knowledge, and outcomes, according to the Agency for Healthcare Research and Quality. Purpose: The project examined how TeamSTEPPS training affected healthcare professionals’ and administrative employees at two Galveston County primary care clinics' teamwork perspectives. PICOT Question: Among entire staff in two primary care clinics (P), what is the impact of TeamSTEPPS (I) on improving teamwork perception (O) comparing pre-post TeamSTEPPS Teamwork …

Improving Pediatric Medical Nurses’ Confidence In Caring For Pediatric Mental Health Patients: A Pilot Project Large Academic Pediatric Health System In The Pacific Northwest, Lauren Kalember

Doctor of Nursing Practice Projects

Problem Description

Pediatric mental and behavioral health care needs continue to increase across the nation. Approximately ten percent of pediatric hospitalizations are for a primary mental or behavioral health condition (Canvara & Johnson, 2020). With the increase in hospitalizations for mental health (MH) needs, pediatric psychiatric units are at capacity, and MH patients are admitted to pediatric general medical/surgical units for care. Most of the nurses that work on these units have not received pediatric mental health education outside of nursing school curricula and report a lack of confidence in their ability to care for pediatric MH patients. With the …

Implementing A Teamstepps® Approach With An Interdisciplinary Team To Increase Successful Post-Surgical Discharge Efficiencies, Ann Marie Moynihan Msn, Aprn, Nea-Bc, Onc

Doctor of Nursing Practice Projects

Background: Communication breakdowns contribute to discharge delays in the acute care settings. TeamSTEPPS® is and evidence-based program that seeks to optimize patient outcomes by improving communication and teamwork.

Objectives: The primary aim of this Quality Improvement (QI) project was to increase by 5% the number of patients discharged by noon. The secondary aims of this project were to improve the interdisciplinary team's communication and to improve workforce efficiencies and use of staff time.

Methods: A pre and post intervention design was used to collect and analyse the rate of successful discharges by noon, in addition to evaluating the interdisciplinary team’s …

Therapeutic Inertia In The Pharmacologic Treatment Of Type 2 Diabetes Mellitus: Investigation Of Causes And Recommendations For Change, Kelly Walton

Doctor of Nursing Practice Projects

Diabetes mellitus (DM) is a pervasive chronic condition and a serious global health issue. Type 2 diabetes mellitus (T2DM) comprises approximately 90-95% of all DM cases (Centers for Disease Control and Prevention [CDC], 2022). The prevalence of T2DM has risen rapidly over time; in fact, the number of adults diagnosed with T2DM over the past 20 years has more than doubled (CDC, 2022). T2DM currently affects an estimated 462 million people globally (equal to 6.28% of the world’s population), including more than one out of every 10 Americans (American Diabetes Association [ADA], 2018; CDC, 2022; Khan et al., 2020). In …

Barriers To Attending Vaginal Breech Birth In The American Healthcare System: A Qualitative Analysis, Hilary Schumer

Doctor of Nursing Practice Projects

A fetus is considered breech when the presenting part is the buttocks, foot/feet, or hips. Annually, approximately 5% of all pregnancies in the United States (U.S.) are breech at term (Centers for Disease Control and Prevention, 2021). Vaginal delivery of a breech baby is increasingly rare in the U.S., as 95% of those presenting as breech at term are delivered via cesarean section (Centers for Disease Control and Prevention, 2021). While the number of vaginal breech deliveries has been trending downwards since the 1970s, the rate dropped precipitously in 2000 after the Term Breech Trial (ACOG, 2020; Freeze, 2019; Hunter, …

Improving Intravenous Catheter Insertion Success In Difficult Access Patients, Heidi Berry

Doctor of Nursing Practice Projects

Around one in every nine Emergency Department (ED) patients have Difficult Intravenous Access (DIVA) and 25% of ED patients will require more than one attempt (Fields et al., 2014a). Failed insertion attempts contribute to decreased patient satisfaction, care delays, and financial losses. The freestanding ED affiliated with a multi-state, not-for-profit healthcare system in an urban community had difficulty with first-attempt Peripheral IV (PIV) insertion success in identified patients. The target population was the clinical staff of the freestanding ED which included Registered Nurses and Paramedics. The objective outcome was to enhance personal knowledge of PIV catheter insertion in difficult-access patients …

Evaluating A Rapid Response Team Performance To Implement Best Practice In Rapid Response Team Protocol, Pansy Samuel

Doctor of Nursing Practice Projects

Background

Rapid Response Teams (RRT) provide clinical resources to improve patient safety outcomes at healthcare institutions. This team promptly responds to deteriorating patient conditions to prevent further deterioration and reduce mortality rates. Rapid response teams do not always perform optimally. Reasons for this performance failure include breakdowns in communication, team dynamics, or other variables that can often be adjusted when the team members understand the role these variables play in undermining the performance of the RRT. An understanding of the perceptions of the RRT members regarding their roles and potential areas of improvement did provide valuable data that was utilized …

Implementing The Use Of The Emergency Severity Index Triage Tool In Urgent Care, Sakeena Spencer

Doctor of Nursing Practice Projects

Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has …

Implementation Of Routine Screening To Detect Early Cases Of Depression And Anxiety In Hispanic Adolescents In The Primary Care Setting, Latoya Hayward

Doctor of Nursing Practice Projects

Depression and anxiety are among the leading causes of illness and disability in adolescents and are two of the most prevalent mental health conditions in Latino youth. If left unrecognized and untreated, these conditions can lead to decreased quality of life and increased rates of suicide. Researchers recommend early mental health screening to occur in the primary care setting. Through routine screening using evidence-based screening tools (PHQ-9 and GAD-7), the primary goal of this quality improvement project was to increase early detection of depression and anxiety in primary care and initiate early treatment. Project methods included implementation of new workflow, …

Addressing Polypharmacy: Implementing The Medication Appropriateness Index Clinical Tool To Increase Deprescribing By Healthcare Providers, Lori Floyd

Doctor of Nursing Practice Projects

Background: Polypharmacy is a national and local issue of concern within healthcare. Deprescribing medications has been identified as a plausible solution for patients experiencing polypharmacy. However, many healthcare providers are unaware of the practice of deprescribing and, if aware, may not be implementing clinical tools for deprescribing effectively. The family medicine clinical site supplies an opportunity for healthcare providers to utilize an evidence-based clinical tool to review medications, identify if inappropriate, and deprescribe if indicated.

Purpose: The purposes of the Doctor of Nursing Practice (DNP) project were to increase deprescribing activity among prescribing healthcare providers and to increase prescribing healthcare …

Evaluation Of The Implementation Of The Munro Pressure Ulcer Risk Assessment Scale To Mitigate Pressure Ulcers In The Perioperative Setting, Sherry Lynn Grandison

Doctor of Nursing Practice Projects

Background: The process of implementing appropriate skin assessment and documentation throughout the patient’s operative experience assists in the early detection of pressure ulcers.

Purpose: This Doctor of Nursing Practice (DNP) project had two goals. The first was to determine a practical tool that would ensure that surgical nurses demonstrate competence and comply with the process of identifying compromised skin integrity, and the second goal was to effectively communicate the findings with other clinical team members.

Methods: The DNP project focused on the use of the Munro Pressure Ulcer Risk Scale Assessment Tool to identify pressure ulcers and to promote collaboration …

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 …

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

Doctor of Nursing Practice Projects

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

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

Doctor of Nursing Practice Projects

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

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

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

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

Doctor of Nursing Practice Projects

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

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

Improving Continuity Of Mental Health Care For Women: Jail Release To Community Re-Entry, Janin Khaleel

Doctor of Nursing Practice Projects

Introduction: This formative Delphi study assesses 1) potential policy changes most needed to support mental health care continuity for women being released from two urban jails, 2) barriers to women obtaining mental health services after release, and 3) understanding what community resources are promoting continuity of mental health care after jail release.

Methodology: This is a policy project that uses the Delphi method. In phase one, a primarily qualitative survey was administered to jail health experts to explore project aims. Results were analyzed with thematic analysis, and themes were used to develop a primarily quantitative second survey with Likert scale …

Improving The New Graduate Nurse Residency Program Through Enhanced Preceptor Education, Janelle Schwittay

Doctor of Nursing Practice Projects

New graduate nurse residency programs' primary function is to provide new graduates with clinical experience and bridge the gap between student and competent registered nurse (Walsh, 2018). While the focus of these programs is on teaching new graduates, a gap in practice has been identified when it comes to the education of the nurses that are training these new graduates. The purpose of this program evaluation was to increase preceptor feelings of preparedness for the precepting role, as well as increase preceptor education attendance rates to at least 50% of eligible nurses. This was a program evaluation with a pre-/post-test …

Changing The Ways Bedside Nursing Staff Think About ‘All Things Urinary Catheters, Angela Foard

Doctor of Nursing Practice Projects

The purpose of this project was to bring attention to the importance of the bedside nursing staff’s "back to the basics" approach to nurse-led interventions to help reduce the number of increasing hospital-acquired infections (HAI), specifically catheter-associated urinary tract infections (CAUTI). The motivation to address this problem was due to the bedside nursing staff under-utilizing best practice interventions to prevent insertions and re-insertions of urinary catheters. A high number of urinary catheter insertions and re-insertions increases the risk of a CAUTI. Evidence-based interventions should be reinforced and utilized by bedside nursing staff to prevent insertions and re-insertions. Evidence-based nurse-led practices …

The Impact Of Mindful Breathing On Stress Of Employees Working From Home, Lindsey Goldberg

Doctor of Nursing Practice Projects

This DNP project was designed to decrease stress among employees working from home (WFH) by educating them on mindful breathing practices. Through the implementation of a mindful breathing activity, the intended project outcome was to improve stress levels of employees working from their homes. Mindful breathing is an evidence-based strategy that has demonstrated decreased stress levels. Mindful breathing was implemented among two companies employing an estimate of 170 WFH employees to improve health and well-being with potential long-term positive impact on sustainability of organizations in the post-COVID, work from home environment. The participants were invited to perform 8-minutes of daily …

Inpatient Observation Safety Assistant Practices, Jennifer Knight

Doctor of Nursing Practice Projects

Abstract

Introduction. Sitter usage is a patient safety practice used across healthcare organizations and the world. Sitters go by many other names, such as patient safety assistants, patient care assistants, care partners, and observation partners. There is literature that supports different variations of practices in healthcare facilities. A scoping review of the literature revealed multiple initiatives to reduce sitter cost and observation through nurse empowerment.

Purpose of Root Cause Analysis. The purpose of this root cause analysis is to determine why personnel inconsistently use the sitter policy. The appraised data will be used to improve the sitter process at this …

Improving Access To Reproductive Life Planning Following Implementation Of One Key Question® In Practice, Ashley Wittler

Doctor of Nursing Practice Projects

Abstract

Inadequate reproductive life planning (RLP) education is a widespread problem for women in the United States. This deficit leaves women without necessary guidance regarding contraceptive choices and maximizing pre-conception health. Use of RLP is endorsed by the American College of Obstetricians & Gynecologists (ACOG) and the Center for Disease Control (CDC). Lack of use of an RLP tool in a large, multi-site obstetrical and gynecological practice located in the Metro East is an issue that greatly impacts the patient population. The goal was to initiate the use of an evidence-based RLP tool, known as One Key Question®. The use …

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 …

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 …

Implementing An Evidence-Based Multifactorial, Multidisciplinary Fall Prevention Program In A Nursing And Rehabilitation Center To Reduce Fall Rates Among Patients, Tincy Poovathur

Doctor of Nursing Practice Projects

Falls are the leading cause of morbidity and mortality in the elderly in the United States. Patients in long-term care facilities are at increased risk for falls, accounting for 20 percent of fatal falls that require hospitalization. The economic and social burden of falls and fall-related injuries is significant. Fall-related injuries and their resulting expenditures are expected to increase substantially with the increasing aging population making this a problem of high priority. The literature recommends and supports incorporating evidence-based fall prevention initiatives into long-term care facility safety programs to address this problem. Based on the literature review and the facility's …

Improving The Nurse Patient Assignment Process On A Medical Surgical Unit, Kevin K. Mcewan

Doctor of Nursing Practice Projects

Background: Nurse patient assignments on an adult medical surgical unit at a community hospital are often accomplished with inconsistent processes and rationales. Each charge nurse utilizes individualized processes to determine which patients will be best teamed-up and assigned to the available nurses. There are frequently no acuity measurements system or set criteria by which the number or types of patients can or should be assigned to any given nurse, nor are staff skill or competency considered in the assignment process.

Project Design: A pilot project was conducted on a medical/surgical unit. The project utilized the American Association of Critical Care …

Implementing Teamstepps® Training For An Interdisciplinary Healthcare Team To Improve Teamwork, Tina J. Dimarino, Msn, Rn, Cnor, Casc

Doctor of Nursing Practice Projects

Background: Ineffective teamwork and communication increase the risk of adverse patient outcomes. An evidence-based teamwork training intervention was implemented to improve teamwork and communication.

Aims /Objectives: The team participated in a TeamSTEPPS® training program. The aims and objectives were to improve the staff’s attitudes and perceptions of teamwork and communication; pre, post and sustained at 30-days, reduce the number of documented near misses and measure for daily use of the newly acquired skills.

Methods: This is a quality improvement project with a one group, pretest and posttest design. The TeamSTEPPS® intervention was presented to the healthcare team. Participants’ teamwork attitudes …

Mindfulness Training In Mitigating Implicit Bias: Improving Cultural Competency For Nurses Caring For Lgbt Individuals, Daniel Terrell, Msn, Rn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Equitable care remains a goal of the United States healthcare system, with cultural competency training used as one intervention to mitigate disparities. Cultural competency education is primarily based on racial and ethnic differences, often omitting other marginalized groups. Implicit bias consequences are not addressed in such training programs despite the association with health outcome disparities. Research related to implicit bias has demonstrated the ability to promote malleability in implicit associations.

Objectives: This project assessed a mindfulness meditation exercise intervention on nursing awareness in interacting with lesbian, gay, bisexual, and transgender (LGBT) patients. Additionally, an LGBT health education module that …

Improving Nurse Manager Job Satisfaction: An Urban Academic Quality Improvement Project, Patricia A. Winston, Ms, Rn, Nea-Bc, Fache

Doctor of Nursing Practice Projects

Background: It is important that the nurse managers are able to contribute to organizational vision, mission, and goals by influencing others, sharing the vision, and implementing it (Boyce, 2018). They are pivotal to the successful accomplishments of the hospital mission. The issue of recruiting, developing and retaining nurse managers is one that challenges many health care institutions, hospitals, hospitals, and health systems. The literature regarding this concern was reviewed and the paucity of useful science in this regard led to question of how to improve the job satisfaction and job retention of nurse managers at urban academic medical centers.

Objective: …

Design And Implementation Of A Nursing Peer Review Program In A Two-Hospital Setting, Joan L. Goss Ms, Rn, Acns-Bc

Doctor of Nursing Practice Projects

Background and Purpose: The Institute of Medicine’s (IOM) landmark publication To Err Is Human: Building a Safer Healthcare System measured the impact of medical error on the American public in both unnecessary human suffering and unsustainable financial cost to the US healthcare system. Nursing literature suggests that peer review of safety events can help mitigate the impact of medical errors by increasing nurse accountability for practice and empowerment for leading change.

Methods: Fourteen volunteers were selected from over 900 direct care nurses to participate in a four-month Nursing Peer Review Program (NPRP) pilot. Structure, process, and outcome measures of implementation, …