Medicine and Health Sciences Commons^™

An Evidence-Based Approach To A Replacement Hospital Training Curriculum, Mark D. Beck

Doctor of Nursing Practice (DNP) Projects

Creation of a training and educational curriculum for a new or replacement facility is daunting in its own right, but without a repository of organizational knowledge cataloging the transfer of tacit to explicit knowledge from the organizations previous library of facility openings, the task becomes Herculean, with as many tasks and cast of characters as the original myths. Navigating the shoals, eddies and tides of the various aspects of this project revealed the need for a comprehensive knowledge management solution to training that is coupled with healthcare design principles and initiatives. This purpose of the DNP project is about the …

Evidence-Based Change In Practice: Development And Implementation Of Type Ii Diabetic Flow Sheet, Kathryn Grimleybaker

Doctor of Nursing Practice (DNP) Projects

Ten percent of the National Health Service annual budget goes to treat complications from diabetes (Lancet, 2010). The American Diabetes Association® (ADA, 2013) estimated that diabetics in the United States incur $176 billion annually in direct medical costs for treatment with hospitalization being the main component of the expenditures. California has the largest population of diabetics and the highest annual cost at $27.6 billion (ADA, 2013). The Healthcare Cost and Utilization Project (HCUP, 2008) found that the average cost of hospitalization in 2008 for a patient with diabetes was $10,937 in contrast to $8,746 for a patient without diabetes. The …

Advantages And Limitations Of Anesthesia And Sedation Practices Used Among Acute Ischemic Stroke Patients During Endovascular Revascularization Therapy, Margaret Korzewski

Doctor of Nursing Practice (DNP) Projects

In order to safely and efficiently perform endovascular revascularization procedures among acute ischemic stroke (AIS) patients, general anesthesia or sedation is often required. However, anesthesia management during these procedures varies significantly worldwide and the procedural logistics have not been established yet. At some institutions AIS patients are intubated and paralyzed, while at other facilities, there is no routine protocol. In 2011 the University Hospital used “action nurses” (critical care float pool nurses) to provide pharmacological paralysis with sedation for intubated AIS patients under direct supervision of the neurointerventionalist. However, clinical outcomes among AIS patients undergoing endovascular procedures were poor. Exclusive …

A Novel Psychotropic Risk Assessment To Enhance Medical Management Of Patients With Behavioral And Psychological Symptoms Of Dementia, Nancy C. Trego

Doctor of Nursing Practice (DNP) Projects

There is growing evidence and concern documenting the risks of antipsychotic use, and psychotropic medication burden in general, for older adults with behavioral and psychological symptoms of dementia (BPSD). Yet nearly 25 percent of all long term care residents take antipsychotics for behavioral disturbances associated with dementia as “off-label” use, despite their modest efficacy and FDA black box warnings (CMS, 2013). Expert consensus calls for non-pharmacological strategies as the first line treatment, yet some patients with BPSD may require a combination of non-pharmacological interventions and pharmacological treatments for symptom reduction (AGS, 2011). The relief of debilitating symptoms aims to improve …

Motivational Interviewing Education For San Mateo County’S Adolescent Healthcare Providers: Focus On Healthy Diet And Physical Activity, Emilie J. Gruhl

Doctor of Nursing Practice (DNP) Projects

Motivational interviewing has been endorsed by San Mateo County as an evidence-based effective form of behavior change counseling. Eighty percent of pediatric healthcare providers in San Mateo County have been trained in motivational interviewing, however 70% of the providers use it less than 50% of the time. The goal of this project was to reeducate the adolescent providers of San Mateo County in motivational interviewing with an emphasis on individualized training and feedback, directed toward healthy diet and exercise. Results of the quality improvement project showed an average 2.5-point increase in provider confidence on a zero to ten-point scale, and …

Design And Implementation Of A Sustainable, University-Based, Emergency Medical Response Service, Octavia A. Mandel Struve

Doctor of Nursing Practice (DNP) Projects

Collegiate-based emergency medical services (EMS), designed primarily to provide pre-hospital basic life support and emergency services, are venues by which nurses and other healthcare professionals, with an understanding of community health and social network issues, can maximize health promotion objectives for university and college campus communities. These EMS systems also provide vital support to city and county emergency services and promote positive community relationships with neighboring areas. They can provide excellent opportunities for students to develop critical skills for success in the healthcare and business world. The sustainability and vibrancy of collegiate-based EMS systems are primarily related to impact, benefit …

Implementation Plan For Emr And Beyond, Lori Katterhagen

Doctor of Nursing Practice (DNP) Projects

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties …

Lean Management Principles To The Creation Of Postpartum Hemorrhage Care Bundles, Bethan Faulkner

Doctor of Nursing Practice (DNP) Projects

Postpartum hemorrhage (PPH) is the number one cause of pregnancy-related death in the US. The Maternity local improvement team (LIT), co-led by an Obstetrician and Board Certified Clinical Nurse Specialist found that each month the maternity unit averages 40 PPHs with 1-2 resulting in an emergency. Over a 6-month period, the LIT decreased response time for emergencies significantly. Supply retrieval time decreased by 99.9%, MD response time decreased by 81%, and Family Centered Care increased by 100%. They recently turned their attention to prevention. Given the lack of literature on preventing PPH in postpartum units, the team developed a PPH …

Innovative Approach To New Nurse Residency, Meaningful Use And Health Care Reform, Pamela V. Stanley

Doctor of Nursing Practice (DNP) Projects

The project’s aim was to examine the financial impact of replacing registered nurse (RN) travelers, RN registry and RN overtime with new graduate RNs. Newly graduated RNs are often viewed by hospital administrators as a more costly staffing resource. This project contributes knowledge regarding the potential cost savings with the utilization of a centralized float pool incorporating new graduates. In addition, it contributes a novel idea for reducing organizational costs of implementing an electronic medical record with the utilization of new graduates as super users.

A new graduate program, which incorporated the use of a formal preceptor and mentoring program, …

Improving Value Based Purchasing Through The Implementation Of The Clinical Nurse Leader Role: The Chief Nursing Officer’S Case For Change, Leanne M. Hunstock

Doctor of Nursing Practice (DNP) Projects

The healthcare industry is focused on the implementation of the Affordable Care Act, the payment reform package from Centers for Medicare and Medicaid Services and the development of Accountable Care Organizations. The decisions, behaviors, and practices of medical and clinical staff directly impact patient care, quality, and subsequently cost and reimbursement. The imperative to balance quality and patient safety with cost effectiveness requires a complex orchestration of all the elements of care within the clinical microsystem. A priority is to support and enable bedside nurses’ daily practice, priorities, and decision-making. This can be accomplished through the implementation of the Clinical …

The Design, Implementation And Evaluation Of A Technology Solution To Improve Discharge Planning Communication In A Complex Patient Population, Susan M. Manfredi

Doctor of Nursing Practice (DNP) Projects

Unnecessary delays in discharge planning can extend the length of stay (LOS) and add non-reimbursable days for socially and medically complex patients thereby increasing the financial burden to healthcare organizations. The literature supports enhanced discharge communication strategies and the use of checklists to facilitate safe and timely discharges. Following root cause analyses of significant discharge delays, one hospital identified gaps in communication as key precursors associated with discharge planning breakdown when discharging patients to skilled nursing facilities. Review of these events demonstrated the need for concurrent communication strategies between multidisciplinary care team members in planning for complex discharges.

Following a …

Transforming The Journey For Newly Licensed Registered Nurses: A Community Based Transition-To-Practice Program In Ambulatory Care Settings, Cathryn A. Halford Dnp

Doctor of Nursing Practice (DNP) Projects

Abstract

In response to the job shortage for newly licensed registered nurses (RNs), transition to practice and residency programs have been established in many areas of the country including the San Francisco Bay Area. The programs were designed as demonstration projects to assist new graduates by increasing their competence, confidence, and skills, and their employability. Evidence from new graduate programs suggests that the programs provide an important bridge that is necessary for the critical transition from classroom to clinical practice and from newly licensed RN to qualified nursing professional. The University of San Francisco (USF)

Transition-To-Practice (nurse residency) program in …

The Creation And Implementation Of Interprofessional Simulation Leadership Scenarios, Angeline C. Delucas

Doctor of Nursing Practice (DNP) Projects

Healthcare is in a historical state of change creating an era that requires superior leadership skills. Leaders face burgeoning challenges in a competitive environment ensconced in reform. Today’s dynamic healthcare environment demands that nurse and interprofessional leaders be astute in a variety of areas including: fiscal responsibility and accountability, organizational politics, interpersonal skills, human resources, communication, conflict resolution, and emotional intelligence. Some areas such as fiscal management are considered hard skills, or skills which can be taught, while others such as conflict resolution are referred to as soft skills, or skills that are learned through experience. Though soft …

Influencing Change In Healthcare Providers: Communication Strategies For A New Era In Healthcare, Ceonne Raasikh

Doctor of Nursing Practice (DNP) Projects

Effective provider communication is the key to patient engagement. However, many providers are not able to effectively communicate with patients, in part due to low health literacy. Evidence in the literature supports the use of specific strategies aimed at improving communication with patients. The purpose of this quality initiative was to influence providers to adopt new communication strategies with their patients. Pharmacists, nurses and physicians were invited to participate in a free, full-day, educational event. During the event providers were alerted to the issue of health literacy and provided communication strategies to improve patient comprehension and engagement. Following the presentation, …

Improving The Implementation Of The Acute Care Nurse Practitioner (Acnp) Role: Development Of Acnp Role Implementation Guidelines, Megan Elizabeth Liego

Doctor of Nursing Practice (DNP) Projects

With the implementation of the Patient Protection and Affordable Care Act (PPACA) and the Value Based Purchasing (VBP) initiative, hospitals and the health System have rolled out a strategic goals of focusing on meeting the VBP objectives and standardizing care within their hospitals. To help meet these goals and improve patient care, many hospitals have looked toward the implementation of the acute care nurse practitioner (ACNP) role in the hospital setting. There is a lack of guidelines, though, on how to implement the ACNP role. This has led to several barriers, which have created variation in practice and outcomes across …

Interprofessional Roles Shoulder Dystocia: Maximizing Safety In Community Hospitals, Elizabeth Yznaga

Doctor of Nursing Practice (DNP) Projects

Prompted by evidence that clinical simulations improve patient safety, team simulations are emerging in hospital settings. Accrediting organizations such as the U.S. Joint Commission on Accreditation of Healthcare Organizations and the American College of Obstetricians and Gynecologists (Joint Commission, 2004, American College of Obstetricians and Gynecologists, 2002) have recommend simulation of obstetrical emergencies, including shoulder dystocia for hospital teams. National patient safety mandates for simulation training of critical events have not been available to small, rural hospitals because of lack of talent and equipment, creating a gap in resources. Other than demonstrations by manikin companies, this author has currently been …

Adoption Of Innovation: Impact Of Rituximab (Rituxan®) Faster Infusion On Oncology Nurses' Perceptions, Practice, And Resource Utilization, Keith Dawson

Doctor of Nursing Practice (DNP) Projects

The translation of advances in clinical research into clinical practice in a manner that provides benefits while reducing potential harm is a challenge within the health care delivery system. Data from a phase III multicenter clinical trial led to the 2012 US Food and Drug Administration (FDA) approval of a 90-minute infusion of rituximab (Rituxan) starting at Cycle 2 for patients with non-Hodgkin’s lymphoma who did not experience a Grade 3 or 4 infusion-related adverse event during Cycle 1. The 90-minute rituximab faster infusion will result in a significant change in how nurses in the United States have been administering …

Recognition Of Compassion Fatigue Among Medical-Surgical Nurses: The Provision Of Education To Manage The Effects, Kandace Woodruff

Doctor of Nursing Practice (DNP) Projects

The Institute of Medicine (IOM) (2010) recommends that healthcare organizations make the “recruitment and retention of qualified nurses a priority”. The ability to comply with the recommendation is fraught with challenges. Nurses are required to care for patients across the age span with varying medical complexities. There are work related stressors which are inherent to the care of a more acutely ill patient population. The tenuousness produced by this type of environment can predispose the nurse to a stress induced phenomenon known as, Compassion Fatigue. The literature is abounding with information related to compassion fatigue among various nursing specialties. However, …

A Gap Analysis Of Nursing Systems And Practices In Malaysia: Culturally Appropriate Interventions To Advance Nursing, Chenit Ong-Flaherty

Doctor of Nursing Practice (DNP) Projects

This project comprises a gap analysis of differences between American and Malaysian nursing programs, and additionally, proposes culturally appropriate interventions for Malaysian nursing to adopt American nursing models. The gap analysis was conducted on nursing systems and practices in Malaysia undertaken to identify the differences between Malaysian and American nursing, and the influences that affect Malaysian nursing. The aim is to facilitate the use of the American Nurses Credentialing Center (ANCC) Pathway to Excellence Practice Standard #4: Orientation Prepares New Nurses for the Work Environment, and #6: Professional Development is Provided and Used. The proposal of culturally appropriate interventions as …

Creating An Interactive Dnp Project Repository:A Model For Change, Sara D. Guido Dr.

Doctor of Nursing Practice (DNP) Projects

The creation of systems that can provide bridges to information technology requires rethinking old ways of doing business. In the past, individual universities and colleges would accommodate theses and dissertations on their library sites. Some of these sites are public and can be accessed by everyone, while some require university-specific affiliation.

This project aims to apply knowledge and skills related to information systems and technology. With the growth of the DNP clinical doctorate programs, and final outcome projects there is a need for specialized DNP database for a new method of data entry and retrieval for DNP’s. The creation of …

Rn Transition To Practice Program In The Primary Care And School Settings: Development, Implementation, And Evaluation, Maria-Idalia O. Lens

Doctor of Nursing Practice (DNP) Projects

New graduate registered nurses (RN) are facing a difficult time finding jobs since the economy of the United States has declined. Since then the California Institute of Nursing and Health Care, along with funding from the Betty Moore Foundation, have developed RN transition programs. These programs were developed to increase skills, confidence, and experience among new RN graduates to promote their transition into the nursing workforce. The programs also were designed to retain newly licensed nurses in the nursing profession while engaging competencies that could be transferred to both acute and outpatient care settings. In addition, the programs are intended …

An Educational Workshop: Introducing An Evidence-Based Psychotherapy Strategy "Tool Kit" For The Treatment Of Chronic Depression, Kimberleigh Christine Cox

Doctor of Nursing Practice (DNP) Projects

No Abstract Available

Exploring The Value Of Group And Traditional Obstetrical Appointments To Reduce Health Disparity, Helene M. Holbrook

Doctor of Nursing Practice (DNP) Projects

Disparity in health outcomes is influenced by socioeconomic factors that may include access to important healthcare information in a culturally sensitive way. Can a group appointment model like the CenteringPregnancy model provide a more effective means for engaging Spanish-speaking pregnant women? Research studies using the group prenatal appointment model show increased pregnancy knowledge, readiness for labor and higher satisfaction compared with individual prenatal appointments. This paper discusses the importance of reducing disparities in birth outcomes using a group appointment model conducted in partial fulfillment for the Doctor of Nursing Practice degree.

Entry-Level Clinical Nurse Leader: Evaluation Of Practice, Eira Ilse Klich-Heartt

Doctor of Nursing Practice (DNP) Projects

The Clinical Nurse Leader (CNL) is a master-prepared generalist accountable for patient outcomes through application of evidenced-based practice at the microsystem level. Accelerated nursing programs are educating entry level nurses as CNLs in a novel Model C program. This doctoral project evaluates entry-level master’s CNL graduates with the CNL end-of-program competencies to determine whether these graduates are able to have positive effects on patient, systems, and leadership outcomes in clinical settings.

The Impact Of Patient-Centered Narrative Interviewing On The Perceptions Of Primary Care Clinicians: A Pilot Evaluation, Michael James Terry

Doctor of Nursing Practice (DNP) Projects

In this project, psychiatric nurses were trained in patient-centered narrative interviewing approaches and placed in a variety of healthcare sites and conditions to function as consultants. Primary care clinicians (PCCs) in those sites selected patients that each clinician felt was frustrating or difficult and arranged for the consultant to interview them. The consultants then presented patient information to the PCC, data typically difficult to obtain using a standard medical interviewing format. The consultant and PCC discussed the new information provided. The PCC than determined if the information provided was valuable, whether it changed their clinical decision-making regarding this patient's diagnosis …

Newborn Umbilical Cord Care: An Evidence Based Quality Improvement Project, Janeen Marie Whitmore

Doctor of Nursing Practice (DNP) Projects

No Abstract Available

A Success Story In Shifting The Paradigm Together : Partnership Between Service And Education In Building An Onsite Clinical Nurse Leader Program, Enna Edouard Trevathan

Doctor of Nursing Practice (DNP) Projects

Access to advanced academic preparation has been an important consideration in the design of educational programs for the working professional nurse. Nursing education has a history of developing and implementing strategies to respond to their needs beyond the traditional, on campus classroom setting. Nursing programs were early adopters of distance learning technologies, from the first two-way audio, one-way video classes, to satellite, two-way video classes to the recent proliferation of web-based programs. However, an innovative alternative is proposed - bringing the course work to the employment setting and designing the program to be responsive to the learning needs of the …

Health Literacy And Medication Adherence, Seanny Minn

Doctor of Nursing Practice (DNP) Projects

No Abstract Available

Child Neurology Curriculum, Ruth K. Rosenblum

Doctor of Nursing Practice (DNP) Projects

Provision of comprehensive health services to children and adolescents is a central role for school nurses. Children with chronic health conditions are at the intersection of the health and education systems. Recently, educators, neurology care providers (MD/NP/PA) have initiated discussions about the impact of a child’s health on their ability to learn. The purpose of this project was to develop a child neurology curriculum for school nurses. A needs assessment survey was distributed. The survey results revealed a need for further education and training in child neurology diagnoses. Four areas were chosen for curriculum development:seizures/ epilepsy, headaches/migraines, tics, and post-concussion …

Improving Medication Safety By Implementing A Just Culture, Karen S. Lounsbury

Doctor of Nursing Practice (DNP) Projects

No Abstract Available