Digital Commons Network^™

Lung Cancer Screening In A Primary Care Clinic For Coal Mine, Glenda Mills, Sarah Cobb

Doctor of Nursing Practice Projects

Lung cancer is the leading cause of mortality for both men and women in the United States. Guidelines are set by the American Cancer Society for annual screenings of at-risk patients. Early identification of lung cancer risk and screening with low-dose CT scans can increase detection and treatment thereby reducing risk of death or disability. Coal miners are exposed to numerous cancer-causing agents, such as toxic chemicals, dust pollution from coal, and diesel exhaust fumes. However, primary care clinics serving coal miners lack lung cancer screenings despite the increased risk miners face. Patients were screened using criteria set forth by …

Community Educational Session On Identifying The Signs Of Depression And Resources Available, Desiree Young

Doctor of Nursing Practice Projects

The DNP Project was designed to educate the community on identifying the signs of depression and the community resources available to them. The intent of the project was to improve the community’s knowledge of depression symptoms and the community resources available that offer assistance to those dealing with these symptoms. There is a great need for education on depression signs, as many in various communities suffer from untreated depression, which often leads to negative outcomes. The impact of the project implementation was measured by using pre- and post-survey data evaluating the participants' overall knowledge of the signs of depression, stigma …

Essential Collaborations Among Case Managers And Providers Regarding Discharge Processes, Lashawnda Richardson

Doctor of Nursing Practice Projects

Communication is vital between case managers and providers when patients need care coordination post-discharge. This includes but is not limited to facilitating home health services, ordering durable medical equipment, sending referrals to rehabilitation facilities, and sponsorship for uninsured or underinsured patients. This gives case managers the opportunity to educate providers on the discharge needs they ordered for their patients. The collaboration between case managers and providers allows for timely discharge planning and providing patients and their families with accurate information regarding their discharge needs.

Impacts To Anxiety, Depression, And Psycho-Spiritual Metrics After Ketamine-Assisted Psychotherapy In Palliative Care Patients At The Aims Institute, Thomas Luedeke

Doctor of Nursing Practice Projects

There is considerable evidence that palliative care patients disproportionately experience anxiety, depression, and existential distress related to their chronic illnesses. Additionally, conventional therapies tend to be less effective in the treatment of this patient population. As such, research is being conducted into novel therapies. One of the promising therapies currently under active investigation is ketamine-assisted psychotherapy (KAP) which involves a combination of the administration of the dissociative anesthetic ketamine combined with psychotherapy.

Two clinical trials are being conducted at the Advanced Integrative Medical Sciences (AIMS) Institute in Seattle, WA, the purposes of which are to evaluate integrative care for patients …

Improving Integrated Care Through An Interprofessional Communication Education Module Using Teamstepps®, Hailey Drangsholt, Natalie Truong

Doctor of Nursing Practice Projects

Background: Despite spending the most money on healthcare per capita (World Health Organization, 2020), the United States (US) has the worst health outcomes for birthing persons and newborns, measured by maternal mortality, infant mortality, and preterm birth rates. These outcomes are attributed to inadequate access to care and errors in interprofessional communication. Intervention: This quality improvement initiative implements early intervention of an interprofessional communication training using an evidence-based interprofessional collaboration frame called TeamSTEPPS®. Measures: Effectiveness of this intervention was evaluated using pre- and post- qualitative survey data gathered from participants. Outcomes: Of the 8 survey participants, 100% of …

Sepsis Criteria On Triage (Scot): Sepsis Alert, Kristie Givens

Doctor of Nursing Practice Projects

Sepsis is a serious life-threatening condition that kills hundreds of thousands of patients every year and is a major leading cause of death. Sepsis is a medical emergency where early identification and prompt treatment are crucial for survival. Despite assessment tools for early recognition, a delay in antibiotic therapy remains. A sepsis alert (Code Sepsis) in the emergency department could improve sepsis care, spare countless lives, and save billions of dollars nationwide, annually. The implementation of a Code Sepsis will trigger a team to deliver immediate treatment and ensure one hour antibiotic administration times. The John Hopkins Nursing Evidence-Based Practice …

Improving Initial Lactic Acid Compliance Of Suspected Septic Adults In A Rural Emergency Department, Nataleigh Jones

Doctor of Nursing Practice Projects

Background: Sepsis remains one of the leading causes of death in hospital settings. The doctor of nursing practice (DNP) project demonstrated areas that the hospital is doing satisfactorily with compliance and many areas for improvement within the organization regarding sepsis compliance. The DNP project demonstrated the effectiveness of the sepsis best practice advisory (BPA) tool in increasing sepsis bundle compliance in the emergency department (ED).

Purpose: The purpose of this DNP project is to help aid in the early recognition of sepsis and improve initial lactic acid compliance in a local emergency department. Many tools help with the early recognition …

Implementation Of A Postpartum Depression Screening Protocol, Samantha Abercrombie

Doctor of Nursing Practice Projects

Background: Postpartum depression (PPD) is a major depressive disorder that can occur after having a baby and anytime during the first year postpartum (Centers for Disease Control and Prevention [CDC], 2021). Symptoms of PPD may include anger, crying more than usual, withdrawing from family, inability to bond with the baby, feelings of anxiousness, or thoughts of the mother harming herself or the baby. PPD can yield many challenges and hinder daily living activities. Recent research by the CDC (2021) estimates that 1 in 8 women experience manifestations of PPD. Findings also suggest that 1 in 5 women were not …

Utilization Of A Simulation Electronic Documentation Model For Healthcare Providers To Reduce Documentation Errors In A Hospital Setting, Icy Moton-Hale

Doctor of Nursing Practice Projects

Background: Electronic health records (EHRs) are commonly used within healthcare systems across the United States. Although EHRs were developed to provide safe delivery of care, poor documentation quality remains a problem. Poor HER documentation can negatively affect many patients’ health outcomes.

Purpose: The purpose of the DNP project was to determine the degree to which using a simulated electronic documentation model to train nurses in an acute care unit would decrease documentation errors and missed care and decrease missed opportunities for patient education in EHRs.

Methods: The theoretical framework was underpinned by the Donabedian model, positing that factors associated with …

Compassion Fatigue And Burnout In Mission Trip Providers, Camille Roland

Doctor of Nursing Practice Projects

Compassion fatigue (CF), burnout (BO), lack of compassion satisfaction, and impaired mental health have had catastrophic effects on nurses, providers, and support staff in the past few years due to COVID-19, labor shortage, an influx of critically ill patients, and long hours. Compassion fatigue was coined by Figley as a state of exhaustion and dysfunction biologically, psychologically, and socially because of prolonged exposure to compassion stress. Related concepts identified as burnout and secondary traumatic stress (STS) play an inclusive role in one’s ability to cope with daily environmental stressors causing physical, emotional, and mental breakdown. The link between …

Advanced Care Planning In Primary Care, Kaylee Beals, Amanda Merriman

Doctor of Nursing Practice Projects

In Illinois, the do-not-resuscitate (DNR) form that is legally binding in all healthcare facilities is known as the Practitioner Orders for Life-Sustaining Treatment (POLST) form. The Patient Self-Determination Act (PSDA) of 1991 mandates only certain facilities to discuss advanced care planning (ACP). Primary care offices are not included in this mandate. Therefore, no structured process exists for primary care providers to identify patients who may benefit from ACP discussions. The purpose of this Doctor of Nursing Practice (DNP) project was to initiate conversations about ACP with patients 55 years and older in a primary care office and complete POLST forms …

Expansion Of Heart Failure Education From Hospital To Clinic, Abigail M. Fischer

Doctor of Nursing Practice Projects

Heart failure education is vital to the long-term management of this condition. Education recommendations for heart failure are given by the American Heart Association (AHA) and the American College of Cardiology (ACC). Recommendations include verbal instruction and written materials regarding the patient’s medication plan, recognition of symptoms, what to do when symptoms occur, and the importance of daily weights.

This project aimed to provide outpatient clinic providers and staff with resources and education necessary to educate heart failure patients. The project expanded use of an inpatient heart failure education packet for outpatient use. This was accomplished by conducting educational sessions …

Enhancing Communication Pathways Between Care Environments To Improve Patient Outcomes, Heather Tucker

Doctor of Nursing Practice Projects

Conducting hand-off communication among healthcare providers can impact patient outcomes. Lack of communication between healthcare entities at the time of care transition can produce patient harm and lead to adverse events such as medication errors, hospital readmission, and unnecessary emergency department visits. The project goal was to evaluate the impact of communication between acute care and primary practice nurses using a standardized, electronic communication tool within the EHR upon patient discharge from a community-hospital based setting. During implementation, forty-two patients were included in the project based on primary practice follow-up location. Of the 42 eligible patients, the acute care nurses …

Subcutaneous Infusions For Comfort Care Patients, Kelci Steeples

Doctor of Nursing Practice Projects

Over 75% of hospice cases fail to eliminate pain despite high quality hospice care (Herr et al., 2010). The purpose of this quality project was to improve pain management in end-of-life patients via subcutaneous medication administration. An orderset was created to include subcutaneous infusion medications using the collaborative efforts of pharmacy leadership and palliative medicine leadership. Patients requiring pain management who were under hospice or palliative care and, lost intravenous (IV) access, were considered for this quality improvement project. A total of eleven patients met project qualifications, but unfortunately, two patients passed away before receiving pain medications subcutaneously. Project findings …

Advance Care Planning In Primary Care, Isabel Butterfield, Darby Creasey, Jenna Dean

Doctor of Nursing Practice Projects

Advance care planning (ACP) is the process of preemptively making choices regarding medical preferences for end-of-life care, while still having decision-making capacity. Many patients don’t have an advanced directive (AD), or documentation of these decisions. This planning improves the individual’s perception of quality of life, a good death, and autonomy over their healthcare. The discussion regarding ACP can take place in primary care at wellness visits for patients over 18 years old, while healthy and able to discuss their wishes with a trusted medical provider. Providers have tools to aid patients in completing AD; however, barriers include lack of knowledge, …

Depression Screening In Hematology/ Oncology Outpatient Clinic, Nikki Marshall Msn, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Oncology patients have multiple factors that can lead to depression, such as treatments, end-of-life decisions, stressors from home, pain, financial responsibilities, and transportation needs. If depression goes unaddressed, it can diminish the quality of life in oncology patients.

Objectives: (1) The purpose of this evidence-based practice (EBP) project is to improve Hematology/ Oncology (HEM/ONC) patient quality, with improved screening (PHQ-9 screening tool) and identification as well as referral for adult patients (18 and older). (2) Assess the knowledge, perception of depression, and confidence level of utilizing the PHQ-9 screening tool in the hem/onc outpatient clinic staff. (3) To increase …

Roadmap To Reduce Barriers To Medical Aid In Dying For Rural Coloradans: A Health Policy Analysis And Advocacy Campaign, Ashley D. Fry Msn, Apn, Agacnp-Bc, Achpn

Doctor of Nursing Practice Projects

Background: Medical aid in dying (MAID) is a process by which a terminally ill adult with a prognosis of six months or less can request prescription medications to end their life. Colorado’s End-of-Life Options Act requires that two physicians participate in the process to certify terminal illness and prescribe medications. Nearly all rural and frontier counties face shortages of medical professionals. These conditions challenge rural residents who want to access MAID. Advanced practice registered nurses and physician assistants can address gaps in rural and frontier counties; on average, they outnumber physicians in these communities.

Aims: The aims of this health …

Management Of Stage I And Stage Ii Labor Arrest Disorder To Reduce Primary Cesarean Section Birth Rate For African American Women, Ariam Yitbarek Mha, Bsn, Rn, Nea-Bc

Doctor of Nursing Practice Projects

Background: Cesarean section delivery rate in the United States has reached an alarming rate of over 30%. African American women experience a higher cesarean birth rate compared to Caucasian Women. The repeat c-section rate for all patients is greater than 80%. These findings underscore the need for intervention to reduce primary cesarean section deliveries in African American Women.

Objective: This quality improvement project aimed to implement caregiver education on the ACOG/SMFM definition of the first and second-stage labor arrest disorder to reduce primary cesarean section birth for African American women.

Method: This pre-and post-intervention quality improvement project was conducted on …

Improving Early Utilization Of Palliative Care Services To Impact Quality Of Life, April Mcdonald

Doctor of Nursing Practice Projects

Despite studies indicating the benefits of palliative care, many barriers remain that prevent individuals from accessing this specialty service. Palliative care needs improved utilization. The purpose of this quality improvement project was to improve the utilization of palliative services and increase general knowledge and confidence among nursing staff within one nursing home facility. In the intervention bundle, training was provided on the use of a Palliative Referral Flowchart and the Palliative Performance Scale (PPS) along with evidence-based materials made available to residents and families. Data was collected pre and post intervention. Knowledge was improved by 26 %. Confidence was improved …

The Impact Of Palliative Care Education On Acute Care Nurses, Heather Sadler

Doctor of Nursing Practice Projects

The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to improve acute care nurses’ knowledge of evidence-based palliative care interventions utilizing the framework from the End-of-Life Nursing Education Consortium (ELNEC) training modules. Increasing the knowledge, comfort, and competence of acute care nurses has the potential to improve end-of-life care delivery in the acute care setting. A lack of access to specialized inpatient palliative care service teams was identified in a rural county in the Southeastern United States. This county is served by a small, criticalaccess hospital. The frontline nursing staff of this facility regularly provides end-of-life …

Combating Compassion Fatigue In The Emergency Department, Pam Packard

Doctor of Nursing Practice Projects

Combating compassion fatigue in the emergency department is vital to nurses’ well-being. Compassion fatigue is the result of negative physical, emotional, and spiritual strains that often burden nurses. The weight of compassion fatigue is explored throughout this conceptualization of Combating Compassion Fatigue. Two questions were explored: Does compassion fatigue affect compassion satisfaction? If so, is compassion fatigue a precursor to suboptimal compassion satisfaction?

Decreasing Nursing Burnout Post Covid-19 Pandemic Through Complementary Therapies, Linda Martiin

Doctor of Nursing Practice Projects

This quality improvement project aimed to address the problem of nursing burnout post COVID-19 pandemic through complementary therapies. Nursing burnout can be mental, emotional, or physical exhaustion which an excessive amount of prolonged stress can cause. Nursing burnout has affected nursing staff worldwide, directly impacting the care provided to patients and the patient's satisfaction. The Nursing Worklife Model was utilized as the theoretical framework for this project (Appendix A). The literature review exhibits the prevalence of nursing burnout in nursing staff. A quantitative study was utilized for this project. The Oldenburg Burnout Inventory was utilized to establish the participant's level …

Zone Tools For Symptomatic Heart Failure:A Mixed-Methods Approach, Devaswa Bhagawati

Doctor of Nursing Practice Projects

Purpose: The Hospital Readmission Reduction Program (HRRP) under the Affordable Care Act has been used to incentivize organizations to reduce readmission rates for multiple conditions including Heart Failure (HF). Zone tools (stoplight tools, or action plans) have been used for patient education to promote outpatient management of HF patients. These tools indicate how to monitor symptom changes and what follow-up action needs to be taken by the patient. With increasing blending of technology in healthcare, these tools are now integrated with digital monitoring technologies. This evaluation explores the effect of these technologies on the 30-day and 60-day rehospitalization rates in …

Needs Assessment To Improve Sepsis Bundle Compliance In The Emergency Department, Jenesa Chin, Rae Maierhofer

Doctor of Nursing Practice Projects

Sepsis is a leading cause of morbidity and mortality worldwide. Treatment depends on time-sensitive antibiotic initiation, fluid resuscitation, and vasoactive support. Early recognition and bundled care are core tenets of management. Thus, this project aims to identify barriers to sepsis bundle compliance in a local community emergency department. Specifically, how do perceived barriers to sepsis bundle compliance as identified by staff correspond with quantitative delays in care as demonstrated by chart data? This mixed-methods needs assessment consists of staff surveys and analysis of extracted chart data. Staff surveys revealed barriers including staffing shortages, difficulty with intravenous (IV) access, and lack …

Education Regarding Advance Directives Improves The End-Of-Life Choices Documentation In Heart Failure Patients, Phebe Hagins Wright

Doctor of Nursing Practice Projects

Background: Heart failure affects the lives of more than 6 million people in the United States and outpatient heart failure clinics offer an opportunity to educate patients while providing evidence-based care. A needs analysis revealed that many heart failure patients do not have an advance directive (AD) on file.

Purpose: The DNP project aims to implement an educational program that provides the tools and knowledge to heart failure patients to assist patients in determining their end-of-life care goals and allow them to document these goals in the Five Wishes document.

Methods: This quality improvement project consisted of a didactic educational …

Utilization Of Remap Conversation Tool To Improve Advance Care Completion In The Home-Based Palliative Care Community Setting, Gwendolyn Starkey

Doctor of Nursing Practice Projects

Background: The World Health Organization and the American Society of Clinical Oncology guidelines endorses mandatory communication skills training in care goals for seriously ill patients (Back et al., 2019). In one survey of primary care providers (PCP), 68% reported no formal training to discuss advance care planning (Comer et al., 2020). Advance care planning is essential to manage chronic conditions in our growing aging population to provide the best patient care. This manuscript aimed to discuss best practices and techniques in advance care planning and optimize skills to provide patient-centered care conversations that honor patient wishes, reduce unwanted hospitalizations, and …

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 …

Advantages Of Early Utilization Of Palliative Care In The Pediatric Icu: A Scoping Review, Shelby Noel Cain Bsn, Rn, Cpn, Dana Pabalate Zimmerman Msn, Rn, Charis Elizabeth Oji Msn, Aprn, Cpnp-Pc/Ac, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Abstract Purpose/Background Despite the increased use of palliative care in adults, only a tiny percentage of children with life-limiting illnesses or life-threatening conditions receive palliative care before dying. Palliative care has low utilization, and consults are often made late in a child’s hospitalization or diagnosis. Palliative care remains underutilized among hospitalized pediatric patients resulting in unnecessary treatments, costly and lengthy hospitalizations, and deaths occurring in the intensive care unit (ICU) rather than at home. The purpose of this scoping review is to evaluate current literature to determine the use and effect of pediatric palliative care, specifically, whether consultation of palliative …

A Chronic Obstructive Pulmonary Disease Pilot Using Risk Stratification To Improve Resource Allocation And Reduce Readmissions, Linda Gould

Doctor of Nursing Practice Projects

Background: Chronic Obstructive Pulmonary Disease (COPD) impacts 250 million people, is associated with high hospital readmission rates, and costs over $50 billion annually. Purpose: Apply risk stratification identifying higher risk patients to prioritize complex, time-consuming interventions and resources. Methods: Patients hospitalized with COPD were risk stratified using PEARL. Moderate-high risk patients were referred to specialty nurse practitioners, who used real-time interventions and motivational interviewing during intense weekly visits over 30 days targeting self-management, patient-specific risks, and resources. Results: No patients were readmitted or died during the pilot using risk stratification with patient-specific tertiary preventive care to …

Developing A Standardized Process For An Effective, Evidence-Based Fall Management Program To Reduce Falls In A Nursing Home Setting, Katrina K. Little

Doctor of Nursing Practice Projects

Background: Falls among the elderly population, aged 65 years and older, are a significantly growing public health problem. For elderly people residing in residential care facilities and facility administrators, falls are of great concern due to the post-fall associated consequences. Preventing resident falls in long-term care is a priority to reduce injuries and associated costs.

Project Design: This evidence-based quality improvement (EBQI) pilot project focused on fall prevention and was conducted on 1 unit (3 long-term care hallways) at a facility that provides both long-term care (LTC) and short-term rehabilitation services in Utah County, Utah. Interventions chosen for the Falls …