Medicine and Health Sciences Commons^™

Retrospective Evaluation Of Depression Screening Process Among Older Adult Patients In Primary Care For Quality Improvement., Ashley Dru Larson

Doctor of Nursing Practice Papers

Background: Depression is not a normal process of aging; it is a diagnosable and treatable medical condition. The US Preventive Services Task Force (USPSTF) recommends that older adults be screened for depression annually.

Aim: The purpose of this evidence-based practice (EBP) project was to evaluate the depression screening process for older adults (age 65+) in a primary health care setting and provide recommendations to the primary health care clinic for improving it.

Methods: This EBP project involved collecting retrospective data from August to October 2022, including aggregate data (demographics), from all older adults who were seen in …

Implementation Of Scripted Debriefings Following Neonatal Delivery Room Resuscitations., Kimberly M. Knott

Doctor of Nursing Practice Papers

Abstract

Background: The functioning of neonatal delivery teams can be affected by technical and non-technical skills of individual team members. The team in this project was challenged by varying knowledge and skill levels and did not have a standardized process for debriefing resuscitation events. The literature shows that debriefings can aid in improving knowledge, skills, teamwork, and communication of resuscitation teams.

Purpose: The purpose of this quality improvement project was to implement a scripted, post-resuscitation debriefing with the neonatal delivery team to improve non-technical skills of the resuscitation team and identify challenges to providing optimal care.

Method: Scripted, …

Trauma-Informed Schools: A Quality Improvement Project For A Rural Public-School System., Channing Kay

Doctor of Nursing Practice Papers

Abstract

Background: Adverse Childhood Experiences (ACEs) are traumatic events that occur from birth to adulthood and have shown to be significant in increasing the risk for both physical and psychological anomalies (Felitti et al., 1998). ACEs are not siloed to poor communities but were observed in 67% of adults throughout 25 US states (Felitti et al., 1998). Despite the significance found in the literature, few preventative measures are being implemented to protect against these experiences.

Setting: The project seeks to address mental health disparities associated with rural-underserved populations. The school system participating in the project is a rural community school …

Feasibility Of An Emergency Department Fall Screening Tool And Intervention Bundle Checklist On Nursing Fall Prevention Documentation: A Quality Improvement Project., Bailee E. Pope

Doctor of Nursing Practice Papers

Background: The World Health Organization (2018) and The Joint Commission (2015) define falling as a sudden, unplanned involuntarily advancement toward the ground, that may or may not result in injury. Fall rates are directly related to a facility’s mortality and morbidity rates, delayed patient care, additional diagnostic testing, and increased length-of-stay. Evaluating the practices of a local emergency department (ED), it was noted that ED nurses are not documenting their acknowledgment of a patient’s risk for falls, and also failed to chart interventions aimed at preventing falls. Failing to implement these practices into regular patient care can lead to negative …

School Nurses’ Participation In Accommodations For Children With Epilepsy: A Quality Improvement Project., Paula A. Johnson

Doctor of Nursing Practice Papers

Abstract

Epilepsy is the most frequent, chronic, neurological condition in childhood, impacting 0.5 to 1% of the population. Documented learning problems associated with childhood epilepsy include memory problems, attention deficits, reading difficulties, and processing speed abnormalities. Epilepsy also impacts psychological health with poor self-esteem, a high incidence of bullying, and poor school performance. The Every Student Succeeds Act identifies the school nurse as a leader in chronic disease management; advocating for students to receive the resources and support they need to achieve academic success. The large Midwestern school system, studied in this capstone project, has 804 known students with epilepsy. …

Quality Improvement: Piloting A Pediatric Obesity Prevention Screening Tool And Intervention In A Family Practice Setting., Erin Shaye Semeyn

Doctor of Nursing Practice Papers

Background: In the United States today, nearly one third of children fall into the category of overweight or obese. Because it is extremely difficult to treat childhood obesity once it occurs, prevention is the optimal approach to childhood overweight and obesity (Brown & Perrin, 2018; Cooper & Mandel, 2020). An ideal time to address obesity prevention health behaviors is during pediatric primary care visits. Since the COVID-19 pandemic began in the United States in 2019, visits to primary care offices, including visits to an urban university-based family practice clinic in Kentucky, dropped as some pediatric patients and their caregivers worried …

A Policy Project: Implementing Safe Firearm Storage Legislation In Kentucky., Maggie M. Wiser

Doctor of Nursing Practice Papers

Ensuring the safe storage of firearms in the home is a research-supported method of reducing the incidence of firearm injury and death, specifically unintentional injury and self-harm in the pediatric population. The American Academy of Pediatrics recommends keeping all firearms stored locked, unloaded, and separate from ammunition. While evidence shows that implementing laws regulating the storage of firearms can be effective to reduce morbidity and mortality, the state of Kentucky currently has no such regulations. For this DNP project, John Kingdon’s Multiple Streams Framework was used as a guideline for policy analysis with the intention of identifying opportunities to advocate …

Implementing A Diabetes Risk Screening Protocol In The Primary Care Setting., Anna Marks

Doctor of Nursing Practice Papers

Abstract

Background: Over one-third of the United States population, approximately 86 million individuals, are estimated to have prediabetes (CDC, 2021a). If left untreated, prediabetes will progress to type II diabetes mellitus (T2DM) in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop T2DM within their lifetime (Hostalek, 2019).

Purpose:The purpose of this quality improvement project was to implement and evaluate the American Diabetes Association MyChart Diabetes Risk Assessment tool in a primary care clinic to optimize the early identification of prediabetes and T2DM in non-pregnant adults ages 18 to 70 …

Quality Improvement For Timely Extubation In An Urban Community Icu., Connor Epperson

Doctor of Nursing Practice Papers

Background: Prolonged duration of mechanical ventilation (MV) is associated with higher morbidity, mortality, and increased resource utilization. Research has shown that the coordination of spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) through standardized protocols increases frequency of readiness to extubate assessments, thus reducing time on MV.

Purpose: The purpose of this project was to improve weaning protocol adherence by re-educating RN staff about the current weaning protocol and the importance of interdepartmental communication to perform coordinated SATs/SBTs, thus reducing MV duration.

Intervention: Education was provided to nursing staff on the current weaning protocol and the …

Reducing Delirium In Medical Intensive Care Unit., Hope Kathryn Eppley

Doctor of Nursing Practice Papers

Background: Delirium in MICUs (medical intensive care units) is an acquired and detrimental condition patients often seen in MICU. This condition has a high prevalence and can result in increased risk of death, comorbidities and length of hospital stay. Prevention is critical to avoid an increased risk of mortality.

Aim: The purpose of quality improvement (QI) project was to implement a delirium bundle in a medical intensive care unit (MICU) to reduce delirium by 20% over an 8-week period.

Method: This QI project utilized the IHI rapid cycle quality improvement model, using two cycles of the Plan-Do-Study-Act (PDSA) model …

Development Of A Project To Improve Prenatal Education At A Rural Medically Assisted Treatment Center Focused On Neonatal Abstinence Syndrome And Parenting Skills., Tracey Brink

Doctor of Nursing Practice Papers

Abstract

Background: Many women who suffer from substance use disorder syndrome (SUDS) have low self-esteem and can be labeled as “unfit parents” which can impede infant bonding and maternal sobriety. Parent and self-efficacy are associated with improved maternal-infant attachment and sobriety (Adams, et.al. 2021). The earlier prenatal education is implemented, the more empowered the mothers will feel to be able to help their infants and themselves.

Setting: A medically assisted treatment center (MAT) for pregnant women who presents with SUDS. The six-bed inpatient facility is in a rural county in central Kentucky.

Purpose: To create an educational program about parent …

Implementation And Evaluation Of Asthma Education Cell Phone Application: Asthmaxcel, Within An Allergy And Asthma Specialty Practice., Michael Stefan Swift

Doctor of Nursing Practice Papers

Abstract

Background: Asthma is the leading chronic illness among pediatric patients. One of the most significant obstacles facing asthma care is adherence to asthma management plans. In the pediatric population, adolescents (ages 12-17) traditionally have poor asthma management. Research shows that adolescents respond well to technology-based education and that improving adolescent healthcare literacy leads to better asthma control.

Environment: This project took place at an allergy and asthma specialists office. This private practice includes primary care allergy, asthma, and immunology services that follows roughly 120 adolescents with asthma.

Purpose: The purpose of this project was to provide the allergy and …

Multicomponent Approach To Delirium Prevention In The Acute Care Setting: An Evidence-Based Quality Improvement Project., Kelley James

Doctor of Nursing Practice Papers

Background: Acutely ill, hospitalized individuals are at an increased likelihood of developing delirium. Between 30-35% of those patients admitted to the hospital will develop delirium, and as a result, these individuals will face an increased risk of mortality, adverse medical events, restraint usage, and incur a more extended hospitalization. The literature supports early screening utilizing the Confusion Assessment Method (CAM) tool and nurse-driven, multicomponent interventions to aid in preventing its development.

Environment: This project was implemented in a long-term, acute care facility specializing in patients requiring long-term mechanical ventilation, advanced wound care, pulmonary and respiratory care, and the rehabilitation of …

Reducing Weekly Screen Time Use In College Students., Anna Louise Davidson

Doctor of Nursing Practice Papers

Background: Screen time overuse is a serious problem currently affecting college students. Studies have shown that too much screen time use can contribute to symptoms of depression and anxiety as well as stress, insomnia, and sedentary behavior contributing to obesity and cardiometabolic issues. Though much research has been devoted to assessing and reducing screen time use in children and adolescents, there are fewer published studies on interventions specific to college students. Therefore, the interventions for adolescents (ages 13 to 17) were reviewed and synthesized, as college students are close in age and brain development to late adolescent stage.

Setting: The …

Improving Trauma-Informed Education And Parenting For Resource Parents At A Foster Care Agency., Courtney Albers

Doctor of Nursing Practice Papers

675,000 children nationwide were involved with the foster care system in 2019, and nearly all children within the foster care system are actively suffering from the effects of trauma. Resource parent trauma-informed trainings, such as Resource Parenting Curriculum (RPC) developed by The National Child Traumatic Stress Network, are associated with improved parental perceptions towards trauma-informed care, improved child outcomes, and placement stability. Foster care agencies have trauma-informed state-based curriculum, but it does not meet the needs of resource parents, specifically those caring for children with developmental delays or disorders. The project was implemented at a therapeutic foster care agency for …

Reducing The No-Show Rate At A Community Mental Health Organization., Philip E. Pippen

Doctor of Nursing Practice Papers

Relative to other outpatient healthcare specialties, appointment nonattendance (no-shows) is most prevalent in psychiatric settings. Upon meeting with a community-based mental health organization in Louisville, KY (LCMHO), referral no-shows for intake appointments were identified as a significant issue. LCMHO’s intake appointment no-show rate, estimated at 25 – 40%, exceeded nonattendance trends in the literature. The purpose of this evidence-based practice (EBP) project was to develop and implement a referral engagement reminder intervention for improving intake appointment attendance. A systematic approach guided by the Model for Improvement was applied to foster this evidence-supported practice change. The project’s findings included a 16% …

Implementation And Evaluation Of A Mental Health Referral Pathway For School Nurses., Jessica Rivera

Doctor of Nursing Practice Papers

Nearly one in six American children between the ages of six and 17 have a treatable mental disorder (American Academy of Family Physicians [AAFP], 2020). Still, less than half do not receive help from a mental health professional (Whitney & Peterson, 2019). School nurses have an opportunity to bridge the gap by improving youth access to mental health care. Purpose: The purpose of this quality improvement project was to implement and evaluate a mental health referral pathway for school nurses. The specific aims were to improve school nurses' preparedness to recognize and address mental health concerns and to increase the …

Neonatal Developmental Care Makes Sense: Implementation Of An Evidence-Based Guideline For Developmentally Appropriate Multi-Modal Positive Sensory Exposures., Nicole Moseley Jaeger

Doctor of Nursing Practice Papers

Background: There is increasing awareness of the contribution of the neonatal intensive care (NICU) environment and the importance of developmental care (DC) interventions to long-term outcomes in high-risk infants. Care at the project site reflected that given at many hospitals, where positive sensory experiences and negative sensory mitigation are done but inconsistently. There was not a guideline in place for DC interventions.

Setting: The project site housed a newly renovated single-family room (SFR) NICU with 12 licensed Level II beds and ability to flex to 19 beds. Neonates at gestational ages ≥28 weeks, requiring critical care for a …

It Takes Heart: Cardiovascular Disease Risk Reduction In The Underserved And Underinsured Population Of Louisville, Kentucky., Emily Storms Shutt

Doctor of Nursing Practice Papers

Abstract

Background: Cardiovascular disease is responsible for half a million deaths per year in the United States. Both the state of Kentucky and city of Louisville have statistics of the presence of cardiovascular disease that are higher than the national average.

Setting: This project took place at Have a Heart Clinic in downtown Louisville, Kentucky.

Purpose: The purpose of this project was to decrease CVD risk factors in Louisville’s underserved neighborhoods.

Procedures: A random sampling of patients attended the free CVD health screening. Cardiometrics were obtained and the information was inputted to the American College of Cardiology’s free atherosclerotic CVD …

Improving Confidence And Job Satisfaction In Emergency Nurses Through Teamstepps., Anna Moore

Doctor of Nursing Practice Papers

Problem Statement: New-graduate nurses (NGNs) are experiencing job dissatisfaction related to low communication confidence leading to high turnover rates and avoidance behaviors.

Purpose: To improve communication confidence and job satisfaction in NGNs through a nurse-led education session on emergency department (ED) communication techniques.

Methods: One online class lasting ~60 minutes was provided to educate NGNs on standardized emergency communication techniques. A pre-test post-test design was used with evaluations occurring before the education, immediately after, and 30 days later.

Results: Descriptive statistics were used to analyze the sample makeup. The Wilcoxon signed-rank test was used to calculate significant changes in communication …

Impact Of Palliative Care Screening Process Implementation Among Intensive Care Unit Registered Nurses., Logan Marie Griffith

Doctor of Nursing Practice Papers

Background: Palliative care is specialized care for individuals living with serious illness(s), focusing on providing symptom relief and improving quality of life (Center to Advance Palliative Care, 2020), but not all hospitals have a process to assess for palliative care needs.

Significance: Without a well-defined process for assessing patients’ readiness for palliative care, patients’ needs may not be consistently met. Approximately only 14% of people worldwide who need palliative care services receive this care (World Health Organization, 2020).

Purpose: The purpose of this quality improvement project was to implement a palliative care screening process to identify patients with palliative care …

Comprehensive Pain Assessment For Veterans In Long-Term Care., Christopher Jenkins

Doctor of Nursing Practice Papers

Background Literature supports the need for comprehensive pain assessment (CPA) in long-term care facilities. CPAs provide valuable information for facility providers and health care staff to intervene appropriately regardless of cognitive ability. Without the use of such tools, pain can go undertreated or ignored for this underserved population causing undue suffering and poor quality of life. Chronic pain perpetuates an endless cycle of immobility, falls, injury, functional decline, and eventual death for this population.

Purpose: A CPA was implemented, evaluated, and integrated into the care processes in a long-term care facility for veterans

Method: The IHI improvement model with a …

Reducing Rates Of Contrast-Induced Nephropathy In The Cardiac Catheterization Laboratory: A Program Evaluation., Sarah Schaefer

Doctor of Nursing Practice Papers

Background: Cardiac catheterizations use intra-arterial contrast media to view the coronary arteries. The use of contrast media can cause contrast-induced nephropathy (CIN). CIN is an abrupt deterioration in renal function that can occur up to 72 hours post-procedure. This diagnosis is associated with increased morbidity and mortality, increased hospital costs, and increased length of stay.

Setting: The project took place in a 432-bed urban facility located in the Midwest region of the United States.

Purpose: The purpose of this QI project was to evaluate if the implementation of an intravenous hydration protocol pre-, intra-, and post-cardiac catheterization decreases the occurrence …