Patient Care Sitter Reduction And Fall Safety Improvement, Timothy J. Bock

Doctor of Nursing Practice (DNP) Projects

The financial constraints imposed upon operational budgets by the frequent use of patient care sitters is well known among hospital leadership. Despite the high labor costs associated with direct and continuous observation, this intervention is routinely deployed by frontline care teams in an effort to preserve patients from harm, particularly from accidental falls. This reality creates an opportunity where significant budget savings can be achieved by supplanting the use of patient care sitters with more effective fall prevention strategies. This quality improvement (QI) project implemented a non-psychiatric sitter reduction and fall prevention initiative in two high volume adult acute care …

Innovation Through An Academic Practice Partnership: A New Clinical Nurse Leader (Cnl) Implementation Model, Nancy P. Taquino

Doctor of Nursing Practice (DNP) Projects

Problem

The IOM reports (1999, 2001) were catalysts for development of a new nursing role - the Clinical Nurse Leader (CNL). Academic practice partnership models are needed to integrate the CNL role in health care systems.

Context

A large integrated health care system in Northern California and a university Clinical Nurse Leader (CNL) program initiated a formal academic practice partnership, establishing a hospital based MSN CNL program.

Intervention

A CNL implementation model was developed that includes (a) academic practice partnership advisory charter; (b) academic practice partnership roles (MSN CNL program director, MSN CNL faculty liaison, and hospital-based CNL …

Development Of A Toolkit To Enhance Nursing Education Of Veteran Health Concerns, Carlee Y.S. Balzaretti

Doctor of Nursing Practice (DNP) Projects

Abstract

U.S. Veterans are a vulnerable patient population, more prone to health disparities as compared to the general population. There are 21.8 million Veterans currently in the United States, with the majority receiving their healthcare outside of the Veteran Health Administration. Veterans form a culture that is steeped in military tradition and it is essential that healthcare providers have knowledge regarding this vulnerable population to provide care that is culturally appropriate. In response to the Veteran healthcare crisis, the Department of Veteran Affairs initiated the Veteran Affairs Nursing Academy Partnership (VANAP), a joint venture between VHA medical centers and schools …

Using Multi-Modal Education In A Public Health System To Increase Rates Of Cervical Cancer Screening, Christina Nardi

Doctor of Nursing Practice (DNP) Projects

While Papanicolaou (Pap) screening has been implemented since the 1950’s, and is linked to decreased rates of cervical cancer, national screening rates are still below the national target screening rate. In Contra Costa County (CCC), the current cervical cancer screening rate is 50.92% (Contra Costa Health Services [CCHS], 2016a). This is far below the national goal of 93% and the first benchmark of 54.33% needed in order to receive state funding under the California Department of Health Care Services (DHCS) Medi-Cal 2020 waiver. The Medi-Cal 2020 waiver has a 5-year Public Health Incentives and Redesign in Medi-Cal (PRIME) program requiring …

Optimizing Engagement In The Acute Care Setting: A Nurse Driven Staffing Model, Denise D. Fall

Doctor of Nursing Practice (DNP) Projects

Health care is on the threshold of major reform. Central to this reform will be the ability to maximize patient outcomes and resource allocation. The delivery of nursing care is essential to these concepts. Nursing care delivery impacts both patient outcomes and labor costs. Every aspect of care delivery has changed over time: length of stay, acuity, payment methodologies, documentation, technology, and regulatory requirements. Yet the model by which we allocate resources to the bedside is based on an archaic notion and forecasting model around one variable. The development of effective nurse staffing strategies will ensure those delivering care are …

Improving Employee Engagement Through The Development Of An Enterprise Performance Management System, Carlton D. Abner

Doctor of Nursing Practice (DNP) Projects

There is ample evidence of our health care delivery system relying heavily on value-based outcomes. The increased focus on outcomes has required health care organizations to adjust how they approach data and how they successfully implement performance management systems. These performance management systems help the organization identify, measure, and report the organization’s performance at an enterprise level using key performance indicators clearly linked to the organization’s overall strategy. As one organization began implementing an enterprise performance management system, the goal of this project was to show how participating in projects with that level of strategic impact can lead to improved …

Developing An Electronic Health Record Training Program For New Employees, Crystal D. Figlietti

Doctor of Nursing Practice (DNP) Projects

In May 2015, an electronic health record (EHR) was implemented at an urban, long-term care facility. This facility is part of the county Department of Public Health (DPH) and was one of the last locations to implement the designated EHR system. The unique nature of the facility compared to the smaller, health care centers within the DPH network necessitated development of a customized training and onboarding program for new employees. It was not possible to duplicate an existing training program. The registered nurse (RN) informaticist assigned to the EHR used data from nursing staff surveys and information collected through a …

The Development, Implementation, And Evaluation Of A Transgender Health Resource Bundle, Lovejeet Kaur

Doctor of Nursing Practice (DNP) Projects

Transgender populations experience disproportionate social and health disparities that can negatively impact quality of life. Healthcare barriers due to gender based discrimination and lack of medical insurance and culturally competent providers contribute to low levels of access to preventative health care screenings, resulting in sub-optimal health outcomes. The unique health circumstances of transgender individuals have been understudied in the literature. As a result clinicians are often under-informed of their specific health maintenance needs and screening guidelines. To help address this disparity, a Doctor of Nursing Practice (DNP) student at the University of San Francisco facilitated the collaborative assessment, development, implementation …

Transforming Self And Systems Through Implementation Of A Caring Coach Leader Program, Priscilla Javed

Doctor of Nursing Practice (DNP) Projects

Assistant nurse managers and nurse managers, often referred to as middle managers, have a direct impact on daily hospital operations, clinical work environments, delivery of high quality safe patient care, and patient outcomes. The stressful demands of this role have caused turnover rates to soar above the national average on some of the inpatient hospital units. Instability of nursing management oversight negatively effects staff job satisfaction and delivery of high quality safe patient care. In reviewing the organizations initial orientation program for transitioning middle managers into their new role, it was missing the supportive guidance of a coach. A Caring …

Nursing Student Work-Study Internship: Partnering To Bridge The Education-To-Practice Gap, Jonalyn M. Wallace

Doctor of Nursing Practice (DNP) Projects

Abstract

Discussed for decades, the need for transitional experiences bridging educational and practice settings gained momentum in the mid-1970s with the release of Kramer’s groundbreaking book Reality Shock: Why Nurses Leave Nursing. Nursing student internship programs were developed in the 1970s as one effort to address this issue. The Northern California Region of Kaiser Permanente partners with five universities to conduct the Nursing Student Work-Study Internship Program (WSP). The program provides senior level nursing students with a paid internship in clinical practice settings, working under the supervision of RN preceptors. The aim of the program is to improve the …

Increasing The Awareness Of Trauma Informed Care In The School Setting: Giving Practitioners The Tools To Actively Participate In Trauma Related Care, Rebekah L. Sypniewski

Doctor of Nursing Practice (DNP) Projects

Of the approximately 15 million children and adolescents who have a mental health disorders that are interfering with their functioning, a mere 25% seek medical advice or treatment (Melnyk, Kelly, & Lusk, 2014). Furthermore, two thirds of youth report experience at least one traumatic event by age 16 (Suarez, Belcher, Briggs, & Titus, 2012). School health practitioners have regular contact with children and adolescents as they typically attend school five days a week, nine months out of the year. The consistent presence of the relationship between the practitioner and student creates an ideal environment for discussing the sensitive topics necessary …

A Quality Improvement Project On Diagnosis And Management Of Asthma In A Private Pediatric Setting., Sosamma Ashley

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Although national guidelines exist for the diagnosis and management of asthma, general practice differs significantly from recommendations. Quality improvement methodology when implemented can narrow quality gaps.

Objective: The objective of the project was to create and implement a plan of action to address identified gaps in key clinical activities of asthma care among pediatric population in a private pediatric setting in Northern California

Methods: The project was centered on the use of Education in Quality Improvement for Pediatric Practice (EQIPP), a program of the American Academy of the Pediatrics. Both the pediatrician and the DNP student took this …

Development, Implementation And Evaluation Of A Screening Mammography Program, Christine Natan

Doctor of Nursing Practice (DNP) Projects

Breast cancer is a major public health concern in the United States and remains a priority for national women’s health centers, primary care practices and cancer control organizations such as the American Cancer Society (ACS). The cancer care continuum includes the spectrum of prevention/risk reduction, early detection, treatment, and living with the diagnosis. Currently there are no proven primary prevention options for women at average risk of developing breast cancer; therefore, secondary prevention interventions such as screening mammography and clinical breast examination (CBE) are required to reduce morbidity and mortality. This manuscript describes a Doctor of Nursing Practice (DNP) led …

Utilizing Tiger Competencies To Improve Informatics Practice, Kwun Ying M. Fung

Doctor of Nursing Practice (DNP) Projects

Nursing Informatics (NI) is quickly becoming an essential part of nursing. From the classroom, to the bedside, and to the boardroom, nurses across the nursing continuum are expected to use NI in their practice with the hopes of delivering better quality care to their patients. However, the training and education of NI provided to all levels of nurses is unable to keep up with the pace of technology. This project seeks to improve the NI competency of the nursing workforce at a pediatric hospital through an educational course using NI competencies identified by the Technology Informatics Guiding Educational Reform (TIGER) …

Integrating Improved Geriatric Content Into A Nursing Curriculum: Enhancing The Competencies Of Nursing Students In Gerontological Care, Sylvia Andrade

Doctor of Nursing Practice (DNP) Projects

The United States is facing a critical shortage of health care professionals who are trained in geriatrics. Among the health care professions, nursing, with more than 3 million members, comprises the largest segment of the nation’s health care workforce. New nurses entering this workforce find themselves caring for an extraordinarily large number of older patients with complex health care needs, regardless of the care setting. Currently, 36 million Americans are aged 65 or older. By 2030, that number will double. Accordingly, the need is significantly greater for more gerontologically trained registered nurses to address the complex health care needs of …

Increasing Access To Primary Care Using Np’S: The Framework For An Academic Based Nurse-Managed Center In California, Prabjot (Jodie) Sandhu

Doctor of Nursing Practice (DNP) Projects

The dynamics of health care delivery and the role of health care providers is a changing canvas in the United States. The implementation of the Affordable Care Act (ACA), sets a goal to increase access to health care. The systems that support the ACA are constantly under scrutiny as failing to provide key answers to provider shortage and health care access issues. Nurse Practitioners (NPs) who are recognized by the ACA as a comprehensive part of this revolution are in a unique place to find opportunities to promote increased access to health and primary care services. While NPs in California …

No Place For Distress: Implementing A Simple Tool To Screen And Address Distress Symptoms In An Adult Outpatient Cancer Center, Ramona E. Chase

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The Distress Thermometer (DT) is a simple and valid tool that should become the standard of care in the outpatient cancer setting to help clinicians better identify psychosocial distress at an early stage. The purpose of the project was to implement distress screening with the distress thermometer (DT) with problem list (PL) to screen and address distress symptoms in an adult outpatient cancer center.

Method: The distress screening pivotal visit was incorporated into the patient’s care plan at on day 8 on the 3^rd cycle of the patients’ chemotherapy regimen. Patients graded their level of distress on …

Acute Chest Pain Triage And Management Guideline Effects On Patient Safety And Physiological Outcomes In A Primary Care Office Setting, Michael D. Hibbs

Doctor of Nursing Practice (DNP) Projects

Background: Heart disease remains the number one killer of Americans with an estimated 599,413 deaths in 2013 attributed to this condition and its treatment has inflated to an annual cost of $190 billion. This mortality is partially attributed to ineffective outpatient triage, management, and treatment of patients with acute chest pain. Methods: The purpose of this newly proposed acute chest pain triage and management guideline was: (1) to decrease inappropriate wait times and incongruous office appointments resulting in delay of care, patients being referred to the emergency room (ER) or, direct admissions to the hospital from the primary care …

Nutrition & Physical Activity Newsletters, Dianne Dwyer

Doctor of Nursing Practice (DNP) Projects

Background: School-age children in Kettering, Ohio are at risk of morbidity from chronic disease indicated by the percentage of overweight children in the state compared to national averages. A food program has been established to provide children of low-income families free and reduced meals. Currently the food program does not include education on nutrition and physical activity as recommended by national guidelines. Purpose: The purpose of this project is to add an educational intervention for nutrition and physical activity to the current food program in order to meet the current guidelines for nutrition and physical activity. Methods: Monthly newsletters …

Pneumococcal Pneumonia In The Older Adult: Increasing Patient Education And Vaccination, Jessica E. Valletta

Doctor of Nursing Practice (DNP) Projects

Background:Pneumococcal disease is a transmitted infectious illness that results in serious complications and death every year in the United States. Given their increased susceptibility to the potential complications of this disease, patients aged 65 and older are considered to be high-risk, but vaccination compliance for this population remain well below state and national goals.

Purpose: The purpose of this project was to increase pneumococcal vaccination rates among adults aged 65 and older in a primary care clinic by increasing patient education.

Methods: An educational intervention was implemented within a large primary care practice located in Central Massachusetts. Educational …

Moving Beyond The Ask: Improving Tobacco Cessation Intervention Delivery In Primary Care, Joan D. Johnston

Doctor of Nursing Practice (DNP) Projects

Background: Quitting smoking at any time benefits health. Primary care visits provide the opportunity to advise current tobacco users to initiate a quit attempt, explain available quit options and arrange for adequate follow-up care. Purpose: The purposes of this DNP project were to provide a staff development educational activity and introduce a workflow modification intended to extend the effectiveness of a tobacco cessation intervention delivered during an office visit. Methods: Medical Assistant staff members responsible for patient recruitment completed a pre-test, viewed an online tobacco educational module and completed a post-test. Using convenience sampling methodology, a cohort of …

Mitigating Caregiver Burden, Dorothea S. Frederick

Doctor of Nursing Practice (DNP) Projects

Abstract

Informal caregiving is the most common form of long-term care provided in the United States, and with the projected rapid growth of older adults, informal caregiving will be even more critical in the foreseeable future. In the United States, slightly more than 20% of informal caregivers provide care for more than one care recipient, and 10% provide care for three or more care recipients. Caring for a dependent, older adult patient may have negative effects on physical, psychological, psychosocial, social and financial health of caregivers. Careful assessment of the impact of informal caregiving on the caregiver’s functioning is imperative, …

Education Intervention Of Preconception Screening In Primary Care, Tracy Schuler

Doctor of Nursing Practice (DNP) Projects

Problem: The risk of a poor pregnancy outcome among women of reproductive age in Providence, Rhode Island is indicated by the high rates of unintended pregnancies, low multivitamin use prior to pregnancy, obesity, and smoking. Although recommended, health professionals often fail to routinely screen and educate women of reproductive age for preconception risk factors. Purpose: Evaluate the efficacy of an educational intervention on preconception risk factors, lifestyle modifications, and current screening recommendations; and introduce a preconception tool and education sheet among a population of health care providers. Method: Preconception health material and a modified preconception screening tool …

Increasing Medication Adherence In Young Adults With Latent Tuberculosis Infection: An Intervention For Quaity Improvement, Stacy St.Pierre-Thibodeau

Doctor of Nursing Practice (DNP) Projects

Background: Tuberculosis (TB) and latent tuberculosis infection (LTBI) affect a large number of persons worldwide. It is estimated that of the 15 million people infected in the United States, many are unaware of their diagnosis. Purpose: This quality improvement project focused on a more effective medication and self-management regime for treatment at a federal training program in a small rural community in Maine. The target population included young people who had tested positive for TB, many of whom are foreign born and identified as individuals at high risk for disease. Results: Through a supervised and monitored program of education, …

Management Of Adolescent Depression In The Primary Care Setting: An Educational Program For Providers, Kelly Clow

Doctor of Nursing Practice (DNP) Projects

Background: The prevalence of adolescent depression is estimated at 15-20% in the general population and often under-treated. The primary care provider is in a prime position to identify and treat depression in this age group. However, many providers feel uncomfortable with treating and managing depression in adolescents, due to a lack of education or experience. Purpose: The focus of this quality improvement project was to educate primary care providers on the current recommendations for the management of adolescent depression and provide an education sheet for both the medical and non-medical treatment of adolescent depression. An educational intervention was presented to …

Implementing The Step It Up Walking Program For Hospital Nurses To Increase Physical Movement, Molly Persby

Doctor of Nursing Practice (DNP) Projects

Nurses are at risk for obesity due to shift work, long hours, abnormal eating patterns and job stress. Obesity places nurses at risk for chronic health conditions such as diabetes and coronary artery disease. The goal for this project was to translate evidence of weight loss using the Step it Up Program by launching a pedometer-based walking program for nurses. Measurement methods included pre-intervention measurements of waist and hip circumference in order to calculate waist/hip ratio, and calculate Body Mass Index using a standard BMI Calculator. Fifteen nurses from an inpatient unit of a hospital in southeastern Ohio were issued …

Implementation Barriers Of The Phq-9 In Primary Care: A Quality Improvement Project, Angela P. Miller

Doctor of Nursing Practice (DNP) Projects

Purpose: The purpose of this research translation project was to mitigate the consequences of under-recognition, and under-treatment of depression through use of an evidence-based depression-screening tool, the PHQ-9, in a primary care setting.

Methods: A plan-do-study-act model was utilized for the implementation of this initiative. An informal educational intervention about administration and interpretation of the PHQ-9 first took place at the provider level in a primary care practice. Next, a pre and post-test study design (n=12) was administered to providers, nursing, and ancillary staff. A report was shared at monthly quality meetings with representatives from each practice in the health …

Obesity Group Medical Visits, Brenda L. Jaeger

Doctor of Nursing Practice (DNP) Projects

Background: Obesity is a major risk factor associated with multiple chronic diseases, presenting a significant global health challenge. Current evidence supports that group medical visits, an alternative format for the provision of primary care, are effective in disease management.

Purpose: The goal of this project was to examine the effectiveness of group medical visits for the management of obesity in primary care.

Methods: Individuals with a BMI greater than 30 participated in a series of six multidisciplinary group medical visits over a 12-week period. Each session included a brief individual medical visit followed by group education and discussion. Topics …

Higher Fat Low Carbohydrate Diet To Improve Health Related Quality Of Life For Overweight Or Obese Diabetics In A Primary Care Clinic, Breck Baker

Doctor of Nursing Practice (DNP) Projects

Diabetes and obesity are chronic diseases that affect individuals worldwide. The American Diabetes Association (ADA) and the American Heart Association (AHA) have developed guidelines for management of diabetes and obesity. The DNP student examined the use of the Higher Fat Low Carbohydrate (HFLC) diet, which conflicts with these frequently used guidelines. The literature on a HFLC diet suggests positive effects for type 2 diabetics, including weight loss, improved HA1c, lower BMI and no detrimental impact on metabolic markers such as cholesterol, triglycerides, or low and high density lipoproteins. The purpose of this project was to provide type 2 diabetics who …

An Evaluation Of An Educational Program For Improving The Accuracy Of Ecg Interpretation In Athletes By Primary Care Clinicians, Stephen F. Segatore Jr

Doctor of Nursing Practice (DNP) Projects

Background: In order to identify athletes at risk for sudden cardiac death (SCD), comprehensive screening that includes ECG interpretation is needed. Many primary care providers, including physicians and nurse practitioners, have reservations about including electrocardiograms (ECG) in the screening process because they lack confidence in their ability to correctly identify normal variants in the ECG of an athlete.

Method: An educational program with previously validated interpretation criteria for normal variants of the athletic heart was presented to providers at a university based healthcare clinic the Northeast. A pre and post design was used to compare the accuracy of ECG …