Digital Commons Network^™

Implementing A Hospital-Acquired Pressure Ulcer Intervention In The Icu, Audrey Gross

Doctor of Nursing Practice Projects

Background: Hospitals had been confronting greater incentives to prevent Hospital-Acquired Pressure Ulcers (HAPUs). HAPU rates had increased in the Intensive Care Unit (ICU) at an academic hospital over the past six months, especially regarding device related HAPUs.

Objectives: The primary purpose of this project’s implementation was to decrease the number of HAPUs in the ICU by 50% within a three-month timeframe. Secondary objectives were to achieve scores of 100% in terms of compliance with the Registered Nurse (RN) education module, post-test scores, and documentation.

Methods: This was a Quality Improvement (QI) project involving adult patients in the ICU of an …

Student Registered Nurse Anesthetist Perspective On The Impact Of A Clinical Mentoring Program, Sheila M. Mccarley

Doctor of Nursing Practice Projects

There is a competitive push for recruiting and retaining the Student Registered Nurse Anesthetist (SRNA) graduate. Retention efforts begin with their first clinical experience. Mentoring in the clinical setting is a critical factor in influencing the student nurse anesthetist's retention to practice. The purpose of this project was to assess whether mentoring in the local setting noted similar findings. The method involved a survey of student nurse anesthetists queried about perspectives on a clinical-based mentorship program. Certified Registered Nurse Anesthetist (CRNA) faculty members vetted the survey instrument before implementation. The project focused on students presently enrolled in their first-year clinical …

Examination Of Nurses’ Perceptions, Beliefs, And Conceptions Related To Rapid Bedside Implementation Of Prone Therapy During The Covid-19 Pandemic, Alyssa Poghen, Emily La Riviere

Doctor of Nursing Practice Projects

The COVID-19 pandemic of the SARS-CoV-2 virus created significant challenges for healthcare agencies and front-line healthcare workers. The SARS-CoV-2 virus has demonstrated a unique propensity to induce severe lung injury in the form of acute respiratory distress syndrome (ARDS). High rates of COVID-19 illness in the initial months of the pandemic in the United States led to a rapid influx of patients admitted to critical care units (CCUs) for ARDS. Prone positioning therapy (PPT) has shown substantial promise in treating refractory hypoxemia in people with severe ARDS but historically received poor acceptance as a first-line therapy. With the onset of …

Enhanced Breastfeeding Support Using Video Education To Improve Exclusive Breastfeeding Rates In A Baby-Friendly Acute Care Facility, Carol Mayernik

Doctor of Nursing Practice Projects

Exclusive breastfeeding (EBF) provides health benefits and is recommended by professional health organizations including the American Academy of Pediatrics, The World Health Organization, and the Centers for Disease Control and Prevention. Healthcare facilities support families to achieve EBF by educating clinicians and patients about the benefits of exclusive breastfeeding, providing prenatal education and hospital support to patients, and by achieving Baby-Friendly Designation through the Baby-Friendly USA, as endorsed by the World Health Organization/UNICEF. Most pregnant patients desire to exclusively breastfeed yet multiple barriers exist to achieve this goal. Evidence supports the use of video learning as an effective way to …

Development And Implementation Of An Orthopedic Enhanced Recovery After Surgery Protocol, Beth Mccoy

Doctor of Nursing Practice Projects

Abstract

As life expectancy rates have grown and individuals desire a more active lifestyle the number of total hip arthroplasty and total knee arthroplasty surgeries performed has grown significantly. Enhanced recovery after surgery (ERAS) protocols have been shown to decrease the financial impact and improve patient outcomes in total joint surgeries. After a literature review a multidisciplinary team met and developed an ERAS protocol for total joint replacement surgeries to be implemented at a 250-bed community hospital in central Illinois. After an eleven-question pre-test was given to 34 participants consisting of perioperative nursing staff, anesthesia, and surgeons assessing their knowledge …

Protecting The Integument: Changing Nursing Practice To Prevent Pressure Injuries, Latonya Lawery

Doctor of Nursing Practice Projects

The purpose of this project is to assess and improve nurses’ knowledge of pressure injuries and pressure injury preventions using evidence-based guidelines and a southeastern United States hospital’s skin integrity policy. My population of focus is direct care professional nurses caring for adults and geriatric patients in the acute care setting.

Design and Methods: The DNP student’s project is a quality improvement project using a Quasi-experimental design, which includes using a pre-test (Appendix A) and post-test (Appendex B). FADE (Appendix C) is the quality improvement method chosen for this project. FADE (Appendix C) is an acronym representing focus, analyze, develop, …

Dnp Project: Improving No-Show Rates In Primary Care, Mai-Linh T. Nguyen, Sarah M. Kuzara

Doctor of Nursing Practice Projects

Abstract

This paper explores the factors that contribute to no-show rates in the primary care setting and effective interventions to improve no-show rates. The average no-show rate in the primary care setting is 23%, (Dantas, Fleck, Olivaria, & Humacher 2018). In 2018, the no-show rate at the WeCare Clinic was 50-60%. A literature review was conducted to gather information regarding why patients choose to no-show their appointments, the common causes of high no-show rates, and effective interventions found to decrease no-show rates. We investigated the primary causes of a high no-show rate at the WeCare Clinic by interviewing staff and …

Increasing Adult Influenza Vaccination Rates In The Primary Care Setting, Leah Prescott Msn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Provision of vaccinations is one of the most basic interventions aimed at health promotion and disease prevention in the primary care setting. Despite increased public awareness and improved access to vaccinations through minute-clinic settings, health fairs, and employer-offered vaccination clinics, adults in the United States continue to fall short of national goals. Literature demonstrates vaccination rates among adults vary widely and may be affected by a multitude of factors, however vaccination rates may be greatly improved with increased provider engagement.

Objectives: The purpose of this project was to develop, implement, and evaluate a program to improve immunization rates in …

Time For Quiet Reducing Nighttime Interruptions In The Icu (Turn In-Icu): Evaluation And Implementation Of A Nonpharmacological Sleep Bundle To Improve Sleep Quality, Delirium, And Nighttime Sedation Requirements, Christina Junker, Msn, Rn, Ccrn

Doctor of Nursing Practice Projects

Background: Undisturbed, restful sleep is essential for physiological as well as psychological well-being. For critically ill patients, sleep deprivation caused by frequent nighttime interruptions is associated with poor sleep quality and negative patient outcomes.

Objectives: The purpose of this Quality Improvement (QI) project was to promote uninterrupted sleep between the hours of 10 PM and 5 AM. Outcomes for evaluation consisted of the following three components: (1) sleep quality, (2) incidence of delirium, and (3) nighttime sedation requirements. Except for sleep quality, these variables were compared before and after the intervention.

Methods: A descriptive, before and after design for data …

Nurse’S Perception Of Safety Culture And Patient Safety Following Implementation Of A Handoff Communication Process Between Pre-Operative And Operating Room Nurses, Tracy Willett, Msn, Mba, Rn, Nea-Bc, Cnor

Doctor of Nursing Practice Projects

Background: In a hospital environment the care of the patient is transferred multiple times during his or her stay. Current needs assessment indicates that nurses’ perception of safety culture with handoff communication and patient safety is an area of focus for the practice site.

Objectives: This study aimed to improve the Pre-operative and Operating Room nurses’ perception of safety culture measured with four valid and reliable survey questions. The second study’s aim was to improve patient safety with the handoff process, measured by the number of adverse events reported by the practice site.

Methods: Pre-implementation data was collected. Nurses worked …

Utilizing A Mentorship Approach To Address The Underrepresentation Of Ethnic Minorities In Senior Nursing Leadership, Kimberly Jean-Louis, Msn, Mpa, Rn, Nea-Bc

Doctor of Nursing Practice Projects

Many healthcare institutions have acknowledged the benefits of and the need for a workforce that reflects the diverse patient populations they serve. However, few healthcare organizations have made progress in increasing the diversity of their leadership teams. The American Hospital Association’s Institute for Diversity in Healthcare Management (2016) found that while minorities represent 32% of hospital patient populations across the nation, they only account for 11% of executive leadership. The objective of this DNP project was to implement a 4-month mentorship program that empowered minority nurse leaders who desire career advancement to executive leadership roles and provide them with realistic …

An Organizational Readiness Assessment And Patient Survey For Adoption Of An Opioid De-Escalation Protocol In Curative Oncology Patients, Adria Myers

Doctor of Nursing Practice Projects

Since 2012, statistics illustrate an explosion in the number of Americans admittedly misusing prescription opioids which increase the risk of long-term adverse effects. By 2016, individuals admitting to taking opioids for non medical reasons exceeded eleven million and 1.9 million of these individuals met the mental health guidelines for opioid abuse. Oncology patients represent a target population with an unmet met need for opioid reduction. Goals for de-escalation or tapering opioids for non-cancer pain have gained increasing attention across healthcare. Evidence-based opioid de-escalation guidelines specific for curative oncology patients are lacking in the literature. The aim of this DNP project …

Hpv Immunization Intervention Application In Rural Arkansas, Randi M. Wright

Doctor of Nursing Practice Projects

HPV (Human Papillomavirus) is the most common sexually transmitted infection (STI) contracted with over 33,000 cases of cancer attributable to the virus in the United States. The socioeconomical impact of HPV can be combatted with the HPV vaccine which is almost 100 percent successful in preventing infection. A strong provider recommendation is the most effective way to increase HPV vaccination. A private clinic in Arkansas with a total of 13 employees were provided HPV vaccination education. A survey was provided to evaluate knowledge on the topic prior to the presentation. An intervention bundle including 9 changes to vaccination procedures was …

Civility Promotion: How It Affects Workplace Incivility, Shawanda Lang

Doctor of Nursing Practice Projects

Incivility is also known as uncivil behavior, horizontal violence, or bullying. These terms are often used to describe the conduct an individual may display toward another that are deemed undesirable in healthcare organizations. Uncivil behavior has been an increasing topic in healthcare and has consequently gained the attention of organizations such as the American Nurses Association and regulatory agencies such as The Joint Commission. Incivility has the opportunity to affect teamwork, individual well-being, and patient safety. The aim of this project was to promote civility by bringing knowledge and awareness of the participants through an educational series. Although the pre …

Optimizing Intraprofessional Communication At Patient Handover, Allison Crabtree

Doctor of Nursing Practice Projects

This performance improvement project aimed to increase the communication competency of nurses during intraprofessional interactions at patient handover. An educational program focused on optimizing communication among nurses was implemented in a community-based, not-for-profit, rural hospital. The course was designed to incorporate a variety of instructional strategies to meet learner needs. Consistency and standardization of the patient handover process was a central theme. Topics of the course focused on the use of a standardized communication tool, the relationship of communication on patient safety, the importance of clear and effective communication, the role of the nurse as gatekeeper and facilitator of patient-specific …

Pre-Discharge Bnp: A Policy Change To Reduce Hospital Readmission, Melissa Duckett

Doctor of Nursing Practice Projects

Heart Failure (HF) is the leading cause of hospital readmission for patients 65 years of age and older. A pre-discharge B-type natriuretic peptide is a strong predictor of hospital readmission and mortality. The annual cost for admission of patients with HF is greater than $17 billion. Diagnosed heart failure patients continue to be discharged without the physician knowing their current BNP levels. The Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP) requiring the Center for Medicare and Medicaid Services (CMS) to reduce reimbursement to hospitals with high readmission rates. A change in policy should be initiated to include …

Improving Perioperative Warming Of Surgical Patients: Implementation Of A Warming Protocol, Maghy Schrage

Doctor of Nursing Practice Projects

Despite the ample amount of knowledge and interventions available to keep patients warm in the operating room, the issue of inadvertent perioperative hypothermia continues to be a problem affecting surgical patients. Unfortunately, even a mild degree of hypothermia can increase a patient’s chance for negative outcomes such as surgical site infections, bleeding, and higher risk for mortality. The project involved development of a warming protocol/guideline for a small community hospital. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of warming patients, reimbursement initiatives, and appropriate interventions.

The project study …

Examining The Association Between Emotional Intelligence And Leadership Style In Nurse Leaders, Tammy Compagnone Msn, Rn, Cpen

Doctor of Nursing Practice Projects

Background: Emotional intelligence (EI) and transformational leadership (TL) style are linked to leadership effectiveness. At our organization, there is a gap in knowledge around EI and TL in our nurse leaders.

Objective: To assess the relationship of EI and TL among nurse leaders, appraise participants ability to accurately define EI, assess their belief that education can increase the level of EI, and discover the learning method preference to increase their level of EI.

Methods: We used a descriptive-comparative survey design with a sample of nurse leaders working at a Northeast academic medical center. Participants included clinical nurse managers, nurse administrators, …

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 …

Improving Nurse-To-Nurse Handoff Communication At The Bedside Through Simulation-Based, Lisa Thornsberry Mrs.

Doctor of Nursing Practice Projects

Communication among nursing staff is crucial to the outcome of patient care. Poor handoff and communication among professionals can have a negative impact on the safety of patients. The systemic nature of the problem with miscommunication among healthcare clinicians supports the necessity of standardization of communication among nursing as a handoff of care.

Change of shift report, or nurse-to-nurse report ensures the transfer of critical information to promote patient safety and best practices. Transferring and communicating pertinent information from one shift to the next is one factor in providing continuity of care. Bedside Shift Report (BSR) is an opportunity to …

Overcoming Barriers For The Implementation Of Evidence-Based Practice Through Journal Clubs, Regina Thomas

Doctor of Nursing Practice Projects

Many barriers exist at a 134-bed rural hospital in southern Illinois that hinder generation, evaluation, and implementation of evidence-based research into practice. This DNP project was completed through a phase approach utilizing a modified version of Kotter’s Model of Change, the RNcEBP Survey to self-rate individual confidence in the EBP process, and the Iowa Model of Evidence-Based Practice to facilitate implementation of journal clubs. The RNcEBP survey revealed that nurses were familiar with the concept of EBP, have positive attitudes, and are confident that EBP changes can improve patient outcomes, but lack experience in evaluating literature to support implementing evidence-based …

Promoting Empowerment And Innovation: A Technology Initiative, Theresa Marcotte

Doctor of Nursing Practice Projects

Improving empowerment through a supportive organizational culture can lead to innovation in practice and promote positive outcomes. Supporting employee empowerment, through a supportive organizational culture and environment, provides opportunities to innovate and creatively meet desired outcomes. Using these concepts, an Associate Degree Nursing Program empowered faculty to address a strategic planning opportunity to improve practice. The innovation, a Technology Initiative, provides opportunities for evidence-based testing practices, leading to improved, first-time pass rates on the National Council Licensure Exam (NCLEX). Technology use in the classroom can improve dissemination of nursing knowledge and retention strategies and therefore improve program retention. The utilization …

An Evidence-Based Practice Assessment And Quality Improvement Initiative In Idaho's Critical Access Hospitals, Deena R. Rauch

Doctor of Nursing Practice Projects

Background: Health care providers and systems have been challenged to discard tradition-based care and outdated practices in lieu of evidence-based practice (EBP). Yet, little is known about the state of EBP, barriers and facilitators to EBP, and organizational readiness for EBP in Idaho’s Critical Access Hospitals (CAH). To affect positive change, it was necessary to understand whether providers in Idaho’s CAHs were using evidence as a foundation for practice—and, if not, what challenges existed in implementing EBP. Mitigating barriers and providing EBP education by way of webinar-based online technology has been proven to be practical and feasible. Providing EBP education, …

A Process Improvement For Depression Screening And Management In A University Health Clinic, Margaret H. Zoellers

Doctor of Nursing Practice Projects

Research indicates that among college students, there is a high prevalence of depression that is frequently undiagnosed and untreated, placing students at risk of impaired academic performance and suicidal behavior. The purpose of the evidence-based process improvement was: a) establish a depression screening and management protocol in the university health clinic, and b) increase university health clinic providers’ knowledge of evidence-based depression screening and management. Family nurse practitioner providers in the university health clinic (n=6) participated in a depression screening and management education program. Knowledge of evidence-based depression screening and management was measured prior to and after the program. A …

Suicide Prevention In The Non-Psychiatric Hospital Setting: A Nurse Education Process, Terry Bird

Doctor of Nursing Practice Projects

Background/Purpose. Numerous studies indicate that nurses and other healthcare professionals receive little or no suicide-related education or training. Unfavorable attitudes about suicide can also negatively influence caregiver behaviors and impact patient care. Evaluations of Applied Suicide Intervention Skills Training (ASIST) as a gatekeeper training intervention consistently demonstrate enhanced knowledge, more favorable attitudes, and increased intervention skills. This project aimed to conduct a small-scale pilot of ASIST for hospital nurses, effect suicide education policies, and prevent suicide sentinel events at the project site.

Design. A single comparison group pre/post testing design was used.

Methods. A combination of purposive and network sampling …

Development Of A Leadership Program For Hospital Employees:, Diana Marie Beckman

Doctor of Nursing Practice Projects

Healthcare leader’s ability to respond to the dynamic environment of healthcare is essential for positive health care outcomes. Leaders set the strategic direction for healthcare organizations, and this requires that leaders assess themselves and their employees to develop effective education programs needed to meet any knowledge gaps limiting the workforce ready to respond to the new demands. The purpose of this project is to implement and assess a revised curriculum of a leadership development program by measuring gained self-identified development of leadership practices.

Evaluating Adn Faculty Job Satisfaction, Karen M. Thies

Doctor of Nursing Practice Projects

Background

The U.S. is facing a critical shortage of nurses as the aging baby boomer generation is requiring more nursing care. Contributing to the nursing shortage is the inability to educate larger numbers of nurses, attributable to a lack of nursing faculty. Insufficient numbers of nursing faculty results in qualified applicants being turned away from nursing programs.

Project Design

This project evaluated faculty job satisfaction in 703 accredited Associate Degree Nursing (ADN) programs in the U.S. The Index of Work Satisfaction (IWS) (Stamps, 1997), was designed to measure specific factors of nurses' job satisfaction and was emailed to all full …

Increasing Primary Care Hepatitis C Screening In The 1945-1965 Birth Cohort, Maria M. Shimizu

Doctor of Nursing Practice Projects

Background: Over 3.2 million American citizens have been infected with the Hepatitis C virus (HCV). It is estimated three fourths of this population are from the birth cohort born between 1945 and 1965, otherwise known as Baby Boomers. Despite the Centers for Disease Control and Prevention (CDC; 2014) recommendations to screen this population at least one-time regardless of risk factors, screening practices in the primary care setting have been suboptimal (American Association for the Study of Liver Diseases [AASLD], 2015).

Aim: The aim of this project was to identify barriers to HCV screening of the Baby Boomer population in the …

Developing Psychiatric Nursing Competencies On An In-Patient Hospital-Based Psychiatric Unit, Beverly J. Sedlacek

Doctor of Nursing Practice Projects

Problem Statement

Offering staff development training for psychiatric nurses has not kept pace with the advances in psychiatric knowledge and skills in nursing. Purpose: The purpose of this quality improvement doctor of nursing (DNP) project was to implement a competency-based staff development program on a community hospital-based inpatient psychiatric unit to determine if the psychiatric/mental health nursing knowledge, nurse patient relational skills, and attitudes of the nurses would improve or change.

Methods

A mixed method of quasi-experimental, non-randomized pre-test/post-test and semi-structured interview design was used, which utilized a convenience sampling approach. Data were collected in two phases. Three domains of …

Implementing An Intervention To Reduce Seclusion And Restraints In An Inpatient Psychiatric Hospital, Amanda B. Lykins

Doctor of Nursing Practice Projects

The need to enhance nursing staff’s knowledge, perceptions and attitudes around alternatives to seclusion and restraint has been well validated in the literature. Seclusion and restraint use in the inpatient psychiatric setting are highly dangerous physical interventions, used to control the behavior of a mentally ill patient who is a danger to self or others. Seclusion and restraint events have the potential to cause emotional trauma, physical injury to patients or staff and the possibility of patient death. The purpose of the capstone project was to implement an evidence-based education program to, improve nursing staff’s (RN, LPN, MHA and SRNA) …