Determining Care Delivery Model Feasibility Using Discrete-Event-Simulation, Tanya Scott

Doctor of Nursing Practice (DNP) Projects

Background: The need for inpatient pediatric psychiatric services to address the growing issue of pediatric mental health in a multi-state integrated hospital enterprise is straining the system’s capacity to provide timely mental health care.

Local Problem: Lack of access to specialty pediatric psychiatric treatment for dual diagnosis medi-psychiatric care management is a patient quality and safety issue. Insufficient capacity contributes to longer emergency room boarding times and inpatient length of stay for patients who have a mental illness.

Methods: Use of digital simulation methodology to analyze the behavior of a dynamic event-driven care delivery workflow and to optimize quality patient …

Responding To A Deteriorating Patient: An Educational Intervention For Outpatient Clinic Nurses, Angela N. Ikeme

Doctor of Nursing Practice (DNP) Projects

Responding to a Deteriorating Patient:

An Educational Intervention for Outpatient Clinic Nurses

Background: Dynamic and evolving healthcare practices require nurses to continually acquire knowledge and confidence to provide optimal care. Organizations that recognize nurses’ educational needs and develop strategies to meet them empower nurses to improve the quality and safety of patient care.

Local Problem: The need for a continuing education program to improve outpatient clinic nurses’ knowledge, skills, and self-confidence prompted the implementation of this project.

Method: Single cohort education intervention as a test of change to assess the knowledge and confidence participants acquired in a pre- and …

Reducing 30-Day Heart Failure Hospital Readmissions Through The Implementation Of A Telehealth Education And Screening Program, Madison Geib, Jo Loomis, Maria (Dupi) Gomez Cogan

Doctor of Nursing Practice (DNP) Projects

Heart Failure (HF) is a difficult disease to manage. It requires knowledge on weight monitoring, diet, exercise, medications, and symptom management. With this difficulty, there is a high incidence of HF patient readmissions into the hospital, especially in the first 30-days after discharge, showing that patients are not well equipped to manage their HF on their own at home. A review of the available literature found that some of the most common reasons for readmission include poor discharge planning, a lack of continuation of care, as well as a lack of education and adherence to their medications (Mathew & Thukha, …

Community Health Worker Program: Adverse Childhood Experiences And Early Childhood, Arelis Sandoval

Doctor of Nursing Practice (DNP) Projects

Background: Adverse childhood experiences (ACEs) negatively affect childhood development and long-term health outcomes. Latino children face multiple adversities and social determinants of health compounded by ACEs. Community Health Workers (CHWs) have access to work with families to improve resilience and mitigate the effects of ACEs in this population.

Local Problem: In the Central Valley of California, CHWs provide support and resources to a largely Latino population with increased poverty rates, low educational attainment, lack of health insurance, and many chronic health issues, putting families at a higher risk for ACEs exposure. CHWs need further training to apply ACEs knowledge to …

Trauma-Informed Treatment For Alcohol Use Disorder: Improving Long-Term Recovery, Aline M. Bales

Doctor of Nursing Practice (DNP) Projects

Background: This DNP project aimed to assess the feasibility of implementing trauma-informed care to Ria Health's telehealth AUD MAT recovery treatment model for patients with co-occurring PTSD, targeting high relapse rates due to cravings. Trauma-informed care addresses traumatic histories that can potentiate emotional dysregulation leading to maladaptive coping responses manifesting as cravings with addiction memory.

Methods: An integrated review assessed the prevalence of co-occurrence of AUD and PTSD, assessed interest in Ria Health patients, patients recruited from Ria Health if they mentioned cravings, offered concurrent trauma-informed care with medicated assisted treatment for 16-20 sessions, trauma-informed care used Polyvagal Theory techniques …

Improving Health Outcomes For Lgbtq+ Youth Through Provider Education, Marissa Simko

Doctor of Nursing Practice (DNP) Projects

Background and Problem: LGBTQ+ adolescents and young adults (ages 12-25 years) are known to have higher rates of physical and mental health concerns compared to heterosexual and cisgender youth. Within the LGBTQ+ youth community, rates of suicidality, substance misuse, homelessness, and STIs are higher than in the general population. LGBTQ+ youth have greater challenges accessing healthcare and higher rates of healthcare discrimination. This paper presents a quality improvement project focused on improving evidence-based practices in LGBTQ+ healthcare through the development and implementation of a LGBTQ+ youth centered educational workshop for healthcare providers.

Methods: This project was organized in …

Improving Outcomes In Persons Who Inject Drugs: A Multidisciplinary Healthcare Initiative, Carla S. Martin

Doctor of Nursing Practice (DNP) Projects

Background: Outpatient parenteral antimicrobial therapy is the standard of care for patients who require long-term antimicrobial therapy but is not considered a safe discharge option for persons who inject drugs (PWID). Many PWID leave against medical advice before completing therapy, resulting in high emergency department utilization and frequent readmissions.

Local Problem: A 646-bed academic and Level I trauma center where opioid overdoses are 6.5 times higher than the state average experiences disproportionately high PWID admissions. Prolonged hospitalization for the duration of antimicrobial therapy increases costs and reduces access for other acute care patients.

Methods: A prospective cohort of PWID discharged …

The Dedicated Education Unit: Increasing Capacity And Confidence, Heather Marie Van Housen

Doctor of Nursing Practice (DNP) Projects

Background: In the American Association of Colleges of Nursing (AACN) 2020 annual survey, nursing schools turned away 66,274 entry-level applications to baccalaureate nursing programs in the United States due to a faculty shortage and clinical placement sites (AACN, 2021).

Local Problem: Hospitals need more qualified nurses to meet community needs. The need for clinical faculty and additional clinical placement sites disrupts the workforce pipeline through local nursing schools. A new approach to clinical education is needed to prepare more students for the growing complexities of independent nursing practice.

Methods: Dedicated Education Unit (DEU) implementation to expand pre-licensure nursing student clinical …

Predicting The Risk Of Falling With Artificial Intelligence, Ann Aquino

Doctor of Nursing Practice (DNP) Projects

Predicting the Risk of Falling with Artificial Intelligence

Abstract

Background: Fall prevention is a huge patient safety concern among all healthcare organizations. The high prevalence of patient falls has grave consequences, including the cost of care, longer hospital stays, unintentional injuries, and decreased patient and staff satisfaction. Preventing a patient from falling is critical in maintaining a patient’s quality of life and averting the high cost of healthcare expenses.

Local Problem: Two hospitals' healthcare system saw a significant increase in inpatient falls. The fall rate is one of the nursing quality indicators, and fall reduction is a key performance indicator …

Enhancing Nurse Manager Resilience With A Resilience-Enhancing Toolkit, Rosarina A. J. Pelikan

Doctor of Nursing Practice (DNP) Projects

Background: Nurse managers have one of the most stressful jobs in nursing leadership. They experience more burnout and are more likely to leave the job or leave the nursing profession altogether, leading to vacancies or burned-out leaders.

Local Problem: The organization experienced high nurse manager turnover. Of 12 positions, four have more than two years of experience, three have less than two years, and five are filled with interims.

Context: Strategies to address burnout are decreasing stressors or arming leaders with skills to withstand stressors. The organization offers programs that address burnout but are designed to be used outside of …

Effects Of Leadership Education And Mentoring For Assistant Nurse Managers, Karen T. Descent

Doctor of Nursing Practice (DNP) Projects

Background: Nurse manager knowledge and leadership styles influence quality of care, patient satisfaction, staff engagement, and retention. Dissatisfaction with the assistant nurse manager (ANM) role can lead to high job turnover with negative influences on patient satisfaction, quality of care, workforce engagement, and achievement of organizational goals.

Local Problem: Two hospitals and one free-standing ambulatory surgery unit of a large integrated healthcare organization experienced high ANM turnover due to role dissatisfaction, ANM frustration with low-quality care in the units they oversaw, and patient satisfaction metrics below the 65th percentile. The regional healthcare system leadership team recognized the need to increase …

Responding To A Deteriorating Patient: An Educational Intervention For Outpatient Clinic Nurses, Angela N. Ikeme

Doctor of Nursing Practice (DNP) Projects

Responding to a Deteriorating Patient:

An Educational Intervention for Outpatient Clinic Nurses

Background: Dynamic and evolving healthcare practices require nurses to continually acquire knowledge and confidence to provide optimal care. Organizations that recognize nurses’ educational needs and develop strategies to meet them empower nurses to improve the quality and safety of patient care.

Local Problem: The need for a continuing education program to improve outpatient clinic nurses’ knowledge, skills, and self-confidence prompted the implementation of this project.

Method: Single cohort education intervention as a test of change to assess the knowledge and confidence participants acquired in a pre- and …

Improving Patient Safety For Surgical Clearance: A Preop One Stop Shop, Anna Benedictos

Doctor of Nursing Practice (DNP) Projects

Problem: Medical clearance is required for patients scheduled for surgery, also known as “patient optimization.” Ineffective and inefficient patient optimization is a major contributor to surgery postponements, procedure cancellations, and patient dissatisfaction.

Context: Ambulatory care clinics often lack resources to medically clear patients prior to scheduled surgery. Poor surgical optimization continues to occur on the same day of surgery, resulting in case cancellation or delay in a suburban, 169 bed community hospital with 9 operating rooms and approximately 500 surgical procedures per month.

Interventions: A nurse-led PreOp One Stop Shop (POSS) utilized a standardized checklist to perform preoperative surgical assessment. …

Implicit Bias In Nursing: Raising Awareness, Fostering Change, Jeanette C. Sandoval

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Extensive research evidence demonstrates that implicit bias can lead to differential treatment of patients based on race, gender, weight, age, income, language, and insurance status. Evidence-based interventions that couple implicit bias mitigation with therapeutic communication skills can contribute to the delivery of equitable care.

Local Problem: Implicit bias in healthcare occurs when unconscious behavior that is not favorable to the patient population served perpetuates unequal treatment and contributes to poor healthcare outcomes.

Methods: Knowledge of implicit bias in the nursing staff was assessed through a validated and reliable survey tool before and after participation in an online LMS …

Using Critical Incident Debriefing After Code Blue Events To Support Registered Nurses, David L. Boyd

Doctor of Nursing Practice (DNP) Projects

Using Critical Incident Debriefing after Code Blue Events to Support Registered Nurses

Section I: Abstract

Background: During a code blue event (CBE), the environment becomes highly stressful and intense. Nurses rapidly transition from performing life-saving procedures on their patients to carrying out their usual duties. Without proper debriefing, nurses cannot properly process their emotions leading to increased burnout and secondary traumatic stress (Stamm, 2010).

Local Problem: In 2021, the nurses at Providence Saint John’s Health Center (2021a) responded to 110 CBEs, a 43% increase from 2020. Without a process for critical incident debriefing (CID), these nurses were exposed to trauma …

Implementing An Infant-Driven Feeding Practice Model, Ann P. Nguyen

Doctor of Nursing Practice (DNP) Projects

Neonatal feeding practices have been the focus of many quality improvement studies due to large variations in care practices. Traditionally, the model for neonatal feeding has been a volume-based approach, one that focuses on a prescribed quantity consumed rather than the infant’s physiologic and developmental maturity (Fry et al., 2018). Recent literature has emphasized the benefits of a more developmentally supportive feeding approach in neonatal intensive care units (NICU), the infant-driven feeding model (IDF).

The IDF model focuses on individualized care, quality of the feed, and continuous assessment of feeding cues both before and during the feeding experience. Current literature …

Save The Children Community Health Worker Program – Adverse Childhood Events Prevention, Jieun Lee

Doctor of Nursing Practice (DNP) Projects

Background: Adverse childhood experiences (ACEs) are potentially traumatic events that occur between the ages of 0 to 17 in which are directly associated, in a dose–response manner, to many of the most common and serious health problems in the United States.

Local Problem: 62% of California residents have experienced at least one ACE, and 16% have experienced at least four ACEs. ACEs are linked to nine of the ten leading causes of death in the United States Adults with four or more ACEs are 37.5 times more likely to attempt suicide, 3.2 times more likely to have chronic lower respiratory …

School-Based Development And Implementation Of An Educational Toolkit, Chantel M. Kilford Ms

Doctor of Nursing Practice (DNP) Projects

The purpose of this evidence-based change in practice is to increase knowledge and confidence among healthcare providers and teachers within a high school setting by providing an educational tool kit about behavioral disorders in children. The disorders that will be focused upon are conduct disorder, oppositional defiant disorder, and common co-morbidities of these disorders. There will be education about an appropriate childhood, evidence based mental health assessment tool that assesses childhood mental health, including how to score the tool and interpret the results. Evidence suggests that healthcare providers and teachers are not confident or knowledgeable about identification, assessment, and behavioral …

Educating Novice Nurses And Nurse Practitioners About Military Sexual Trauma Screening, Alyssa D. Freeman

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Military sexual trauma prevalence has continually increased over the past 25 years. Exposure to sexual trauma, violence, and abuse result in notable health consequences. The Veterans Health Administration has led the integration of universal Military Sexual Trauma (MST) screening and training. Purpose: The purposes of this project were to educate novice nurses and nurse practitioners about MST and to increase their knowledge and comfort in MST screening techniques. Methods: Following an educational session, a pre- and post-study design was used to evaluate improvement in knowledge and comfort screening for MST. Thirty-two participants including PBRNR Nurse Residents, …

Improving Culturally Competent Lgbtq+ Care Among Primary Care Providers, Christopher Diaz

Doctor of Nursing Practice (DNP) Projects

Purpose: Although general efforts have been made to identify, address, and improve the standing of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, many of these individuals continue to experience stigmatization and discrimination daily. These experiences influence the health of these individuals, which leads to several health disparities including an increased risk for numerous physical and mental health conditions.

Methods: Using nationally developed guidelines, the author of this project developed two didactic-style educational presentations for primary care providers to improve cultural competency for LGBTQ+ individuals. Eight providers completed both presentations, which explored the attitudes, knowledge, and beliefs/practice intentions of …

A Toolkit To Adequately Screen Pregnant Women For Depression And Thus Increase Screening In An Outpatient Obstetrical Clinic, Katherine Doherty

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal depression is a common health complication during pregnancy. Untreated depression among perinatal women is associated with adverse health outcomes for infants and mothers. Screening during the perinatal time period is needed to identify and treat depression and to prevent adverse health outcomes.

Purpose: The purpose of this clinical project is to equip health care providers with the knowledge and tools needed to screen pregnant women for depression and thus increase the amount of screening done in an outpatient obstetrical clinic.

Methods: An evidenced- based educational tool kit was developed to increase provider knowledge of perinatal depression …

Screening For Opioid Use Disorder In Emergency Department Observation Unit Patients, Kendra M. Cull (Lehman)

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Opioid use disorder (OUD) is an issue that impacts the healthcare system daily, and has been declared a national public health concern Purpose: The purpose of this DNP Quality Improvement (QI) project was to screen patients aged 16 and older for Opioid Use Disorder (OUD) who presented to the Emergency Department Observation Unit (ED OBS) in a Urban Academic Medical Center regardless of chief complaint. The goal of this project was early identification of OUD and rapid referral to outpatient resources to facilitate recovery compliance. Methods: The QI project utilized a registered nurse led screening …

Shared Decision Making For Primary Care Patients With Medical Complexities, Cori B. Fappiano

Doctor of Nursing Practice (DNP) Projects

No abstract provided.

Outcomes Of Directly Observed Therapy In People Living With Hiv Who Experience Homelessness And Substance Use Disorder, Mara C. Clawson

Doctor of Nursing Practice (DNP) Projects

Background: Antiretroviral directly observed therapy, in which nurses or other allied health professionals provide patients with daily medication, is an evidence-based solution for viral load suppression in people living with HIV who experience homelessness. Purpose: This quality improvement project aimed to assess the outcomes of antiretroviral directly observed therapy at one urban clinic caring for people living with human immunodeficiency virus who experience homelessness and substance use disorder. Methods: Data was collected from the electronic health record for the antiretroviral directly observed therapy patient cohort (n = 33); 10 of them were surveyed. Fisher exact tests determined nonrandom associations between …

Mindfulness Training In A Pediatric Practice With Adolescents And Young Adults, Rebecca Brady

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Access to support for behavioral and mental health in adolescents and young adults difficult. Depressive symptoms go unrecognized which can lead to severe symptoms, hospitalizations, and suicides. The lack of mental health services challenge the management of depression in this age group. Mindfulness may be a helpful tool in supporting mental health. Purpose: The purpose of this project was to improve depression symptoms among youth through engagement in mindfulness activities. Methods: A pre/post-intervention approach was used to measure the effectiveness of a synchronous, online educational platform to guide participants in mindfulness activities. Practice sessions were utilized based on …

Enhancing Transgender Informed Healthcare For Nursing Students: An Educational Intervention, Olivia Bass

Doctor of Nursing Practice (DNP) Projects

Background: Limited teaching of transgender related healthcare competencies is seen in baccalaureate nursing curriculum, resulting in inadequate preparation of healthcare providers to care for this population of patients. This discord can prevent transgender patients from seeking healthcare and affect access to needed services. Purpose: The purpose of this DNP project was to educate accelerated Bachelor of Science in Nursing students at an institute of higher education on providing culturally responsive healthcare for transgender patients. Methods: An in-person educational intervention focused on improving clinical and cultural knowledge for transgender patients was implemented and evaluated. A pre-intervention survey and post-intervention survey …

Implementation Of An Acne Management Smartset To Guide Primary Care Providers’ Management Of Acne Patients, Emily Thomas

Doctor of Nursing Practice (DNP) Projects

Background: Primary care providers (PCPs) commonly refer adult acne patients to dermatology due to lack of confidence in treatment initiation and maintenance, resulting in delayed patient care, limited access to dermatology appointments, and an ongoing knowledge gap within the primary care setting. Purpose: To support PCPs with acne diagnosis and treatment recommendations by hosting acne education sessions and implementing an Acne Management SmartSet for acne treatment. Methods: The DNP student held acne education sessions during staff meetings at two primary care sites, then disseminated surveys to participants to determine if the education session and SmartSet were clinically useful. Data pertaining …

Improving Home Health Nurses' Knowledge Of Heart Failure Self-Care Management, Nenette Hoffman

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure results in life-altering and devastating illnesses, predominantly among older adults. Heart failure management is complex, and requires patients and their caregivers to actively monitor symptoms and sufficiently understand care management to maintain health-promoting behaviors. While home health nurses have the primary role as patient educators of their patients with heart failure, evidence from the literature indicates that nurses lack sufficient knowledge to fulfill this role.

Local Problem: Nurses’ inadequate knowledge of heart failure self-care management has been associated with insufficient patient education, the inability of patients to perform heart failure self-care management, worse clinical outcomes, and …

Diabetes Prevention And Management Education For Punjabi-Sikh Older Adults, Mandeep K. Gill

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: South Asians from Bangladesh, Pakistan, and India have a higher prevalence of diabetes than the general global population and are also more susceptible to developing diabetes due to biological and lifestyle factors. The South Asian diet is high in refined grains and monounsaturated fatty acids, increasing the risk of diabetes.

Local Problem: Congregants of a Sikh gurdwara (place of worship) lacked knowledge of diet and lifestyle in relation to preventing and managing diabetes. Many senior congregants have been diagnosed with diabetes or are at high risk of developing the disease.

Methods: Knowledge of diabetes prevention and management were …

Decreasing Seclusion And Restraint Events Among Clients Within An Inpatient And Crisis Stabilization Behavioral Health Facility, Karen Lee Richards

Doctor of Nursing Practice (DNP) Projects

Background: Despite global shifts in behavioral health treatment, changes regarding use of seclusion and restraint (S/R) continues to be extremely slow. Local Problem: Increasing S/R events and subsequent staff injuries and financial burden. Methods: A quality improvement project providing education in trauma-informed care (TIC), sensory modulation (SM), and S/R debriefing (S/RD). Interventions: Education and training for S/RD, TIC, and SM using a variety of materials and methods over a 6 to 12-month period was provided to staff within a 16-bed inpatient adult psychiatric health facility (PHF) and a crisis stabilization unit (CSU). Because of positively affecting the use of S/R, …