A Toolkit To Assist Massachusetts School Nurses Start Elementary School Substance Use Prevention Education Programs, Caitlin Pettengill

Doctor of Nursing Practice (DNP) Projects

Purpose: Massachusetts currently only mandates fifth-twelfth grade substance use prevention. Literature states it is counter productive to wait until the adolescent years to initiate substance use prevention due to the adolescent developmental stage of social conformity. Starting evidence-based substance use prevention education in early elementary school will arm children with the knowledge and confidence they need to make healthy choices and reduce future high school drug rates.

Methods: A toolkit was created to assist Massachusetts elementary school nurses to start a substance use prevention program in their schools/districts. The toolkit was presented and evaluated in January 2018 by the …

Critical Choices Conversation Pilot Project, Lorena Paul

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) and advance directives (AD) inform the provision of health care that aligns with clients’ goals and wishes. Less than 30% of female cancer care clients presented AD when admitted for care to a Magnet® designated hospital located in the Southwest United States (U.S.).

Methods: A quality improvement project took place on a 25 bed in-patient cancer care unit to improve these rates. The nurses received ACP training and used a clinical support tool to facilitate discussions with clients. A Palliative Care Clinical Nurse Specialist assisted as needed.

Results: Seven nurses accomplished a self-paced learning activity …

Increasing Annual Influenza Vaccination Rates Through Primary Prevention Strategies Among Health Care Workers In A Psychiatric Long-Term Care Facility: An Evidence-Based Approach, Kathleen Miller

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Influenza is a highly infectious, serious respiratory virus that causes almost 226,000 hospitalizations and averages 36,000 deaths annually in the United States (U.S.). Those at the highest risk for influenza-related complications and death include the elderly, the very young, those with chronic disease, and people with weakened immune systems. Since 1981, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee for Immunization Practices (ACIP) have recommended that all medically eligible healthcare workers (HCWs) receive an influenza vaccination annually. Despite recommendations, many HCWs decline the seasonal influenza vaccination putting themselves and their patients at risk. The CDC …

Evidence-Based Interventions: Improving Influenza Vaccination Rate Among Health Care Workers (Hcws) Targeting Direct Care-Givers, Jennelyn Fraser-Johnson

Doctor of Nursing Practice (DNP) Projects

Background: Influenza is a contagious disease affecting over three million people every year. It is associated with yearly seasonal outbreaks which increases the risk of mortality among immune-compromised, hospitalized clients, clients in long-term care facilities and also enhances the risk of infection in healthcare workers (HCWs). Nosocomial infections and employees’ absenteeism are often associated with the flu. A high influenza vaccination rate in health care professionals reduces the risk of influenza infection as well as being a cost- effective strategy to reduce lost work hours. A Joint Commission criterion for accreditation for healthcare facilities is to achieve a 90% …

Measuring The Impact: A Re-Aim Framework For Evaluation Of A Needle Exchange Program, Lindsay Novacek

Doctor of Nursing Practice (DNP) Projects

Background: Needle exchange programs (NEPs) have been widely documented over the past three decades as an effective and economic approach to controlling human immunodeficiency virus (HIV). As of July 1st, 2016, these programs have been legalized in North Carolina. Purpose: To perform stage 1 of an evaluation of a needle exchange program in North Carolina by utilizing a public health framework: the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Methods: First, the RE-AIM framework was used to create a plan for a program evaluation of a local NEP. Then, the first stage of the evaluation was completed. NEP program participants …

Screening For Traumatic Brain Injuries (Tbi) In Veterans: A Quality Improvement Project To Change The Identification And Referral Process In Primary Care Providers., Chiara Simonini

Doctor of Nursing Practice (DNP) Projects

Background: The incidence of traumatic brain injuries (TBI) among veterans has increased exponentially in those who served in Operation Enduring Freedom and Operation Iraqi Freedom. Identification and treatment for these injuries remains difficult due to variance in screening methods, interpretation of results, and barriers to access to care. Purpose: The goal of this quality improvement project is to improve TBI screening process offered to veterans by healthcare workers and providers in an outpatient VA clinic in the northeast. Methods: Current standards of practice and provider knowledge were assessed through focus groups, pre-intervention survey, followed by educational outreach to provide …

Using Cognitive Behavioral Therapy To Treat Insomnia In Adults, Alexandra Christodoulou

Doctor of Nursing Practice (DNP) Projects

Background: Insomnia is a physically, mentally, and psychologically complicated and distressing medical condition that can affect adults with or without comorbid conditions. Research indicates that cognitive behavioral therapy (CBT) is an underutilized, but extremely beneficial intervention that may support individuals in overcoming insomnia and other comorbid conditions, without ever ingesting a pill. Unfortunately, CBT is underutilized due to the patient educational time requirements; therefore, medication is often prescribed as a first line of treatment for insomnia. Adults suffering from insomnia with or without comorbid conditions such as psychiatric disorders or cancer have benefitted from CBT as opposed to oral …

Hypertensive Management For African American Patients, Aleksandrya Bracey-Asiedu

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The rates of angioedema amongst African American patients using angiotensin- converting- enzyme- inhibitors (ACE-I) are five times greater than non-African American counterparts (01.-07 percent vs. 0.5-3.5 percent). Although ACE-I agents are widely prescribed, they have less therapeutic control in hypertension amongst this group of patients and high incidences of life threating side effects.

Methods: The purpose of this quality improvement (QI) project was to assess provider knowledge related to established guidelines from the Joint National Committee (JNC) on hypertension management, as well as their knowledge of the side effects of ACE-I for African American patients. A pre …

Reducing Readmissions In Bipolar Patients With Discharge Interventions, Alexandra Steeves

Doctor of Nursing Practice (DNP) Projects

Purpose: The purpose of this DNP project was to evaluatea discharge protocol with interventions to improve the process of discharge from the in-patient setting and transition the patient into the community.

Methods: This program evaluation centered on evaluating a discharge protocol currently in place and adding revised interventions to strengthen the discharge planning process. De-identified data was viewed on readmission rates and interviews were conducted with stakeholders involved with the discharge process.

Results: There were a total of twelve participants in the evaluation period of pre and post evaluation interviews. Review of the interviews resulted in four themes relating to …

A Quality Improvement Project For Co-Occurring Disorders In Outpatient Behavioral Health, Erin Sheehan

Doctor of Nursing Practice (DNP) Projects

Purpose: Patients with mental health diagnoses often have co-occurring alcohol use disorders, which can exacerbate their psychiatric symptoms. A standardized assessment tool should be utilized for screening for alcohol use disorders in outpatient mental health programs so that interventions can be implemented when a co-occurring disorder is identified. The purpose of this project was to provide clinicians with education and to improve the process for screening patients with mental health disorders for problematic drinking behaviors to implement recommended interventions when appropriate to improve the overall quality of the patient’s care and increase the clinician’s knowledge and confidence in treating co-occurring …

A Quality Improvement Project To Improve Type 2 Diabetes Mellitus Screening In Asian Americans Using Body Mass Index Cut Point Of 23, Annie Samuel

Doctor of Nursing Practice (DNP) Projects

Background: Asian Americans are at a higher risk for Type II Diabetes than other groups and disproportionately develop Type II Diabetes Mellitus at younger ages, although having a lower Body Mass Index (BMI) compared to non-Hispanic whites.

Methods: A group of 22 Nurse Practitioners (NP) in New York were presented an evidence-based educational intervention along with a five-item pre-test and post-test to determine if they had acquired new knowledge on the issue. A follow-up survey was conducted to test if the intervention changed individual NP practice in screening Asian Americans in adult primary care clinics.

Results: The overall mean …

Stop The Stigma! Eliminating Implicit And Explicit Bias Toward Adult Obese Women Receiving Gynecological Care: A Quality Improvement Project To Cultivate Empathy And Increase Knowledge Of Best Practices, Mary Ellen Burke

Doctor of Nursing Practice (DNP) Projects

Background: Increased weight carries significant health risks, yet obese individuals face stigma, implicit and explicit bias by health care providers that affects quality of care and increases health care avoidance. Obese women may delay or avoid gynecological care due to fear of stigma, inadequate equipment and embarrassment about their weight. Review of Literature: In the United States, 70.7% of adults, almost three quarters of the adult population are overweight or obese. Purpose: The purpose of this quality improvement project was to improve the quality of care and empathy toward obese women by health care providers in an OB/GYN practice through …

Managing Patients At High-Risk For Breast Cancer: An Elearning Module For Primary Care Providers, Erin Chaney

Doctor of Nursing Practice (DNP) Projects

Women at high-risk of developing breast cancer must be screened appropriately and educated about breast cancer reduction strategies much earlier than those of average risk. The National Comprehensive Cancer Network (NCCN) (2017) has identified guidelines for the care of this group. This project focused on the development of education for providers, specifically an eLearning module, to help translate guidelines into practice. Providers of adult primary care (including internal medicine and family practice) from four clinics in Snohomish County, Washington, were asked to participate in an eLearning module regarding the care of patients at high-risk for breast cancer. Repeated measures surveys …

Screening Adults With Substance Use Disorder For Adverse Childhood Experiences, Teri Murtha

Doctor of Nursing Practice (DNP) Projects

Background and purpose-Exposure to adverse childhood experiences results in increased morbidity and mortality among individuals with substance use disorders. Screening for histories of childhood trauma, and integration of trauma-informed care is lacking among health care practitioners. Integrating screening for histories of childhood abuse in person’s seeking treatment for substance abuse disorders can facilitate identification of individuals interested in additional support and resources to support their recovery. The purpose of this study was to assess the effectiveness and feasibility of a screening interview protocol for ACEs and to determine the presence of ACEs among individuals with substance use disorder (SUD) …

Improving Blood Pressure Control Among Hispanic Patient Population By Enhancing Providers' Attention To Culturally Competent Solutions Aimed At Increasing Self-Care And Treatment Adherence At And Post Hospital Discharge: A Quality Improvement Project, Katarzyna Swistak

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Hypertension is a primary, preventable risk factor for coronary heart disease, heart failure, and stroke. However, despite advances in preventive care and treatment modalities related to blood pressure control, the prevalence of hypertension in the United States remains at an undesirable level and disproportionately affects Hispanic patients. Purpose: The purpose of this quality improvement (QI) project was to determine if a culturally sensitive, multifaceted intervention focused on promotion of hypertension awareness and self- management strategies increases treatment compliance and blood pressure control among Limited English Proficiency (LEP) Hispanics. Design/Methods: The DNP project included a QI …

Educating Health Care Professionals To Improve Communication In Advance Care Planning, Laura E. Clubb

Doctor of Nursing Practice (DNP) Projects

DNP Project Goal:The goal and expected outcome of this DNP project was to increase providers’ self-reported preparedness and comfort levels by 50% when discussing advance care planning (ACP) and end of life wishes with patients.

Background: The Institute of Medicine designed ACP as a national health priority. However, health care professionals often do not facilitate discussions of ACP with patients, even in patients with chronic or life-limiting illnesses. This occurs due to professionals’ lack of knowledge about ACP, lack of comfort when discussing the issue, and a misperception that the patient may be too young or not sick enough …

Hepatitis C Virus Education For Nurse Practitioners In Primary Care, Michele Broskey

Doctor of Nursing Practice (DNP) Projects

Purpose: The object of this Quality Improvement (QI) project was to appraise the effectiveness of a web-based education resource for APN’s knowledge of HCV recommendations.

Methods: An educational intervention was conducted for APNs working in primary care medicine to increase provider knowledge of screening, diagnosing and management of viral Hepatitis C which utilized a web-based provider-specific curricula. A pre-test and post-test survey was used to assess the APN’s Knowledge, Attitude and Practices (KAP) regarding the current published evidence. Continuing education credits and small financial incentives were offered for participation. The curriculum was evaluated by an Infectious Disease expert APN.

Results: …

Improving Patient Discharge Satisfaction Scores By Implementing Teach-Back Instructions In A Community Hospital Emergency Department (Ed): A Quality Improvement Project, Kristen Burke

Doctor of Nursing Practice (DNP) Projects

Background: Health literacy and patient satisfaction play a role in healthcare today and it is the responsibility of all providers to ensure that patients are educated about the care they received in the ED and what they should be doing upon discharge. The teach-back method ensures patients have a complete understanding of their ED stay and discharge instructions.

Purpose: The purpose of this quality improvement project was to increase patient satisfaction scores by implementing the evidenced-based, patient-centered, teach-back method for all patient education opportunities.

Methods: The DNP student led the ED leadership team and staff nurses in a quality improvement …

Medication Reconciliation In An Ambulatory Care Community Mental Health Practice, Matthew Bock

Doctor of Nursing Practice (DNP) Projects

Purpose: To improve medication safety among behavioral health patients at a community-based outpatient psychiatric practice in Western Massachusetts through implementation of an evidence-based medication reconciliation protocol.

Methods: Gaps in the current medication reconciliation process were identified by reviewing the current process with outpatient supervisors in the practice. A sample of 25 patients, the majority with more complex comorbid medical conditions, were selected to participate in an evidence-based medication reconciliation process. Medications, both prescribed and over the counter, were reconciled either in office or in the home.

Results: There was a significant increase in the number of medications identified post-intervention. On …

Development And Evaluation Of An Emergency Department-Based Nurse Practitioner Care Delivery Model, Tiesha Johnson

Doctor of Nursing Practice (DNP) Projects

Background: Acute mental health care needs are not always optimally managed in the Emergency Department (ED) with the traditional approach to care and management. The ED encounter for psychiatric patients is lengthy, costly, fragmented, inefficient and often ineffective, contributing to poor outcomes.. Purpose: To introduce the evidence- based advanced nursing practice model to ED professionals and staff for feedback and evaluation of an ED-based Psychiatric Nurse Practitioner care delivery model for the acute care of psychiatric patients. Implementation: The care delivery model was created based on evidence and presented to professionals and staff at one medical center ED. A focus …

Best Practice Medication Reconciliation In The Outpatient Setting, Meghan J. Hession

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Medication safety is a focus of the Joint Commission’s National Patient Safety Goals and research supports improved medication reconciliation as a strategy to reduce medication errors and adverse drug events. In a busy, outpatient specialty clinic where patients are routinely considered for high-risk pharmaceutical therapies, a consistent medication reconciliation process is essential for patient safety and positive health outcomes. Purpose: To improve consistency of medication reconciliation in this high-risk outpatient setting. Method: Based on a gap analysis between evidence-based and current practice, a quality improvement intervention was implemented to increase patient engagement in the medication reconciliation process. A …

Using A Professional Language Interpreter During Discharge To Promote Self-Care Management For Spanish-Speaking Patients With Congestive Heart Failure: A Quality Improvement Project, Lucy Ankrah

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and Review of Literature: The high rate of hospital readmissions has become a national issue after the Affordable Care Act began and was found to be related to lack of proper education and communication during discharge, coupled with medication nonadherence. Purposes/Goal: The overarching goal of this DNP project was to improve lifestyle management of Spanish-speaking congestive heart failure (CHF) patients and to reduce their 30-day readmission rate. The intent of the project was to improve patients’ understanding of CHF exacerbation, medications, and discharge instructions geared to increase home self-management and reduce recidivism. The specific aims were (a) to …

Introducing Screening For Family Risks In Young Children In Primary Care, Sarah Kells

Doctor of Nursing Practice (DNP) Projects

Background: One in four children in the United States under the age of five is at risk for developmental, behavioral or social delay. Genetics and environment, including exposure to adversity, play a major role in healthy neurological development. The Survey of Well-being of Young Children (SWYC) as a screening instrument was developed to address perceived barriers and standardize physiological, psychosocial and family risks screening in primary care to identify those who would benefit most from early intervention.

Methods: This quality improvement project involved an information session for providers and staff at a Federally-Qualified Health Center in Western Massachusetts to …

Reducing Delays In Sexually Transmitted Infections(Sti) Treatment: A Quality Improvement Project To Improve Timely Communication Among Providers And Patients, Kattie Khadar

Doctor of Nursing Practice (DNP) Projects

Abstract

Purpose: To use a nurse-communication intervention for timely provider notification of abnormal chlamydia, gonorrhea and syphilis infections, to reduce delays in treatment at a large Northeastern United States hospital. Methods: The hospital’s communicable disease report was reviewed daily, and treatment of all patients who were seen in the Infectious Disease clinic and diagnosed with chlamydia, gonorrhea and syphilis infections was monitored. Emails were sent to inform treating providers whenever a patient was not treated within 72 hours after diagnosis. Data from patients in the three months preceding was compared with data during the three months of nurse-communication intervention …

Center Based Help For Elder Depression And Emotional Reinforcement (Cheer), Jennifer Taylor

Doctor of Nursing Practice (DNP) Projects

Purpose.

The aim of this project was to decrease depression of those socially isolated, and/or homebound seniors, through behavioral activation by using CHEER and emotional support, along with bridging access to programs and the needs of seniors in the community.

Background.

As we age we face functional, medical, and social complexities that frequently become hard to manage. Depression is a problem that is present but often goes unrecognized in society. It is more prevalent in younger adults, however, depression has more acute affect in older persons. Depression can potentially be debilitating and increase adverse events with other health issues such …

A Quality Improvement (Qi) Project To Reduce Emergency Department (Ed) Readmissions Among Patients With Limited English Proficiency (Lep) Through Utilization Of Interpretive Services By Healthcare Providers, Christine Ndissi

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Patients with Limited English Proficiency (LEP) are a vulnerable population with greater risk for poor health outcomes due to provider-to-patient communication barriers. Emergency Department (ED) health providers are routinely confronted with problems of ineffective communication thereby, leading to lack of patients’ knowledge of their diagnoses and medications, and subsequently lead to medication-related adverse events and ED readmissions. Purpose: The purpose of this DNP quality improvement (QI) project is to evaluate the standards of care and examine factors that contribute to underutilization of interpretive services for patients with LEP who seek care at the ED to …

Alzheimer’S Dementia Screening In Primary Care: Quality Improvement Project To Identify Those At Risk, Kirstin Drake

Doctor of Nursing Practice (DNP) Projects

Background: Identifying Mild Cognitive Impairment (MCI) and Alzheimer’s Dementia (AD) in the Primary Care Practice (PCP) setting can initiate intervention early, before negative consequences occur including decreased quality of life and caregiver burden.

Purpose: To identify individuals at risk for AD and initiate early treatment and intervention. Methods: The Montreal Cognitive Assessment (MoCA) and Functional Activities Questionnaire (FAQ) were used as screening tools; adults age 65 and older were participants.

Implementation Procedure: Within the Internal Medicine Clinic, the standard annual wellness visits include Registered Nurses that administer a Mini-Cog screening tool with the patients. The Mini-Cog is a brief …

Increasing Provider Competency: A Quality Improvement Project Applying Best Practice Protocol For Contraception Counseling And Larc Insertion To Females Of Reproductive Age In Primary Care, Logan Pearl

Doctor of Nursing Practice (DNP) Projects

Background: Long-acting reversible contraception (LARC) including intrauterine devices (IUDs) are safe, effective, and economical methods of preventing unintended pregnancy and their associated poor outcomes. Barriers to use, such as lack of awareness, knowledge, and provider competency in counseling and insertion can be mitigated. The Doctor of Nursing Practice (DNP) student undertook this quality improvement (QI) project to explore the benefits of IUDs, mitigate identified barriers, and to improve community health.

Purpose: The purpose of the QI project was to investigate and create best-evidence protocols for counseling patients to select the most effective forms of contraception and to educate primary care …

Implementation Of The State Avoidable Rehospitalizations (Staar) Initiative In A Np-Led Transitional-Care Program To Reduce Readmission Rates And To Provide Safe Transitional Care In Post-Cardiac Surgery Patients:A Quality Improvement Project, Araceli Carrera

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Readmissions after cardiac surgery are often preventable, costly, and potentially life-threatening events. Hospital readmissions may be influenced by low health literacy and ineffective transitional care. The Centers for Medicare and Medicaid Services have included reducing hospital-bundled payment for frequent occurrence of readmissions and episodic care after coronary artery bypass grafting in 2017. Purpose: This Quality Improvement project explored the impact of applying the STAAR initiative to reduce unplanned readmissions, and to provide safe transitional care in post-cardiac surgery patients. Design/Methods: This was a QI project design with educational and observational methods. The DNP student used the transitional-care toolkit …

Improving Patients' Understanding Of Their Electronic Medical Record Data In Order To Improve Self-Management - A Quality Improvement Project, Erin Amelia Roth

Doctor of Nursing Practice (DNP) Projects

Background: Patients are increasingly given access to their electronic medical records (EMRs) to help them keep track of their care, but many may have a difficult time understanding what is in them. Programs such as NoteAid assist in translating medical records and may increase the number of patients who actively use their EMRs, a development which may improve the management of chronic diseases.

Purpose: To work on a translation system developed by the University of Massachusetts Informatics group to make outpatient records more understandable for adult patients with chronic disease by using and testing a machine-learning database (NoteAid). Patients’ self-management …