Medicine and Health Sciences Commons^™

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Enhancing Newer Nicu Nurse Confidence With Resuscitation Through High-Fidelity, In-Situ Crisis Resource Management, Karen Rose

Doctor of Nursing Practice Final Manuscripts

Neonatal resuscitation is a low-volume, high-risk occurrence. Given the infrequency of resuscitation, newer neonatal intensive care unit (NICU) nurses may have little to no exposure to neonatal resuscitation events. This can lead to a lack of confidence in resuscitation skills, contributing to burnout, poor patient outcomes, and the potential for nursing turnover. This evidence-based practice project, guided by the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care, focused on enhancing the perceived confidence in neonatal resuscitation skills among newer NICU nurses. To achieve this, multidisciplinary, high-fidelity, in-situ neonatal resuscitation crisis resource management (CRM) simulated events were implemented. …

Scaffolding Information Literacy Learning For Undergraduate Nursing Students: A Mixed-Method Exploration Of Student Il Self-Efficacy, Hanneke Croxen, Jody Nelson, Lisa Mckendrick-Calder, Wanhua Su

Quality Advancement in Nursing Education - Avancées en formation infirmière

Abstract

Purpose: Information literacy (IL) competency is an essential component of evidence-informed nursing practice. It is integral to introduce and develop core information literacy competencies for evidence-informed practice within undergraduate education programs. Research has shown undergraduate students may experience challenges with information literacy skills. More research to inform teaching methodologies that effectively enhance students’ skills and abilities, as well as their self-efficacy with these skills, is needed. This article describes an innovative teaching strategy, called journal club, which uses scaffolded learning activities in small groups over one semester.

Methods: This mixed-methods research study used a non-experimental pre-post survey and was …

Nurses’ Perceptions Regarding The Use Of The Nursing Process; A Descriptive Qualitative Study At Hayatabad Medical Complex, Peshawar, Pakistan, Kashif Khan

Theses & Dissertations

Background: The Nursing Process (NP) is a comprehensive approach to care, integrating nursing intuition, goal-oriented tasks, patient-centered care, critical thinking, and evidence-based practice (EBP). It aims to enhance patient outcomes and well-being by identifying, treating, and preventing health problems. Widely acknowledged as a valuable instrument in healthcare, it emphasizes the crucial function of nursing. This study fills the gap in the literature by exploring nurses' perspectives on the utilization of the NP in Pakistan.
Purpose: The study aimed to explore nurses' perceptions regarding the use of the nursing process and to identify the barriers and facilitators to its implementation in …

Evidence-Based Practice In Perioperative Nursing: Barriers And Facilitators To Compliance, Benita Ramage, Paula Foran

Journal of Perioperative Nursing

Evidence-based practice (EBP), in combination with clinical expertise and patient values and wishes, enables delivery of exceptional patient-centred care. Providing our perioperative patients care that is informed by best evidence has been proven to provide a safer and higher standard of care.

Best evidence forms the basis for standards and guidelines for nursing practice published by organisations such as Australian College of Perioperative Nurses (ACORN), Australian and New Zealand College of Anaesthetists (ANZCA) and Australian Commission on Safety and Quality in Health Care (ACSQHC). While perioperative nurses strive to provide the best possible care for their patients there is sometimes …

Performance Improvement Project Implementing Rapid Cycle Deliberate Practice Simulation To Improve Team Performance During Administration Of Moderate Sedation By Non-Anesthesia Providers In The Interventional Platform, John Kost, Matthew Snyder

DNP Scholarly Projects

A steady increase in procedures in interventional platforms has required the administration of moderate sedation and analgesia by non-anesthesia providers. Of concern is managing the delicate balance between different levels of sedation on a continuum to ensure safe and effective care. Moderate sedation achieves suppression of consciousness while maintaining a patent airway and intrinsic respiratory drive compared to deep sedation where airway patency and respiratory function can be compromised. Administration of moderate sedation by non-anesthesia providers in interventional platforms leads to a higher rate of procedural complications. Rapid Cycle Deliberate Practice (RCDP) simulation will be utilized to educate non-anesthesia providers …

Addressing Adolescent Sexual Health Through An Educational Toolkit For Providers In Rural Alaska, Anna M. Martin, Tracy L. Brewer, Hannah E. Warren

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Introduction. Adequately addressing an adolescent’s sexual health is essential during the child’s development yet, 33% of adolescents have health visits with no mention of sexual health. On average, primary care providers spend approximately thirty-six seconds discussing sexual health topics with adolescents despite recommendations for comprehensive education. Alaska Native youth face significant disparities regarding sexual and reproductive health care. Implementation and evaluation of a comprehensive educational toolkit regarding various sexual health topics for rural healthcare providers in Alaska revealed positive outcomes in discussing sexual health with an adolescent.

Methods. Larrabee's Model for Evidence-based Practice Change guided the development, implementation, and …

Implementation Of A Code Lobby Surge And The Impact On Left Without Being Seen Rates, Nicole Plouffe

Student Scholarly Projects

Practice Problem: Crowding of emergency departments contribute to higher-than-average left without being seen (LWBS) rates. LWBS patients pose risks to the hospital as well as to one’s own health.

PICOT: The PICOT question that guided this project was in a pediatric emergency department (P), does implementation of a “Code Lobby Surge” (I), compared to standard care (C), decrease left without being seen rates (O) within eight weeks (T)?

Evidence: Surge interventions and decreasing the visual of crowding have shown to decrease LWBS rates.

Intervention: “Code Lobby Surge” was implemented to decrease LWBS rates and improve throughput within the …

Health Librarians As Part Of The Perioperative Care Team, Gemma Siemensma

Journal of Perioperative Nursing

Chances are you may never find a librarian in the operating suite, unless as a patient, but they do play a vital role in enabling the work of perioperative nurses. A perioperative nurse’s role can encompass a variety of tasks at the pre-operative, operative and post-operative stage and includes the daily use of information resources to ensure evidence-based practice (EBP) occurs. This article explores the role of health librarians in the perioperative environment and highlights resources and services that are offered to assist perioperative nurses.

Creating A Primary Care Track In Prelicensure Nursing Education, Janice E. Hawkins, Lynn L. Wiles, Jamela Martin, Beth Tremblay, Karen Higgins, Ingrid Mahoney

Nursing Faculty Publications

BACKGROUND: RNs practicing in primary care (PC) increase access to health care and contribute to better patient outcomes and cost savings, yet undergraduate nursing education traditionally focuses on disease-oriented care. This article describes a curricular track for infusing PC prelicensure programs.

METHOD: PC content is threaded across four semesters with targeted assignments and clinical experiences. Providing clinical immersion experiences with practicing RNs as preceptors in community and PC settings is a key component of this initiative.

RESULTS: Student feedback has been favorable. Students stated they gained insight to the role of RNs in PC through class assignments and clinical rotations. …

A Quality Improvement Initiative To Improve Access And Patient Flow In A Non-Emergency Walk-In Care Clinic, Renee J. Broze

DNP Scholarly Projects

Background: A community-based non-emergency walk-in clinic in Southern New Hampshire experienced high volume and inefficient workflows during the pandemic, causing delays in care, long visit times, and low net promoter scores.

Purpose: Institute an evidence-based approach to improve work efficiency through innovative models of care.

Methods: A literature review on best practices for workflow redesign guided the project. The project instituted an on-demand telemedicine service and a clinic fast-track workflow. A mixed methods approach analyzed pre /post cycle times, net promoter scores, and themes from staff interviews. Pre/post cycle times analyzed 12,767 completed appointments.

Results: There was a statistically significant …

Implementation Of Quantitative Blood Loss Tool To Detect Postpartum Hemorrhage After Vaginal Delivery, Rachael Williams

Dissertations

Problem Maternal deaths and comorbidities related to postpartum hemorrhage (PPH) continue to be high despite being quite preventable. The delay in recognition and treatment of PPH due to the use of imprecise estimated blood loss (EBL) instead of precise measurement using quantitative blood loss (QBL) attributes to this issue.

Methods For this quality improvement (QI) project, a descriptive, observational design was used to gather quantitative data regarding QBL implementation instead of EBL as well as the number of PPH’s identified. A pilot cohort of staff nurses participated by documenting QBL two hours after each delivery. The nurses were given an …

Implementing A Troponin Trending Toolkit In A Rural Emergency Department To Increase Provider Adherence To Troponin Trending Guidelines, Ace Beam

Doctor of Nursing Practice Projects

Background: Cardiac biomarkers are used for the diagnosis and risk stratification of patients with chest pain and suspected acute coronary syndrome (ACS) (Kamal, 2021). Cardiac troponin is the only biomarker recommended to be used for the diagnosis of acute myocardial infarction (AMI) at this time due to its superior sensitivity and accuracy (Kamal, 2021). Emergency departments routinely provide care for patients presenting with chest pain symptoms and should be prepared to utilize evidence-based guidelines for troponin trending to effectively evaluate these patients.

Purpose: The purpose of the DNP project was to improve emergency department healthcare provider compliance to evidence-based high-sensitivity …

Enriching The Perioperative Enhanced Recovery After Surgery (Eras) Program For Patients Undergoing Whipple Procedure For Pancreatic Cancer, Natalie E. Fisher

Doctor of Nursing Practice Final Manuscripts

Pancreatic cancer remains one of the most complex and lethal diseases worldwide with surgical resection as a major treatment choice. Although surgery may be one of the only options for advanced pancreatic cancer, it is not without a lengthy hospital stay, a long list of possible postoperative complications, and an increased risk for readmission after discharge. Enhanced recovery after surgery (ERAS) programs have been implemented for years in other surgical services for cancer care. These programs have now been extended and researched to include patients undergoing surgery for pancreatic cancer. These programs are designed to assist patients and their families …

Diet, Exercise, Self-Monitoring, Technology, And Motivational Interviewing For Weight Loss In Adults, Ashleigh D. Warburton

Evidence-Based Practice Project Reports

Obesity, an epidemic in the United States (US), affected 42.4% of adults as of 2017-2018 (Hales, 2020). Comorbidities associated with obesity, such as cardiovascular disease, cancer, and diabetes (Orringer et al., 2020), are some of the leading causes of death in the US (Kochanek et al., 2020). The purpose of this evidence-based practice (EBP) project was to answer the following PICOT question: In adult patients aged 19 years or older who are considered overweight or obese as measured by body mass index (BMI) of ≥ 25 kg/m2 (P), how effective is diet and exercise combined with self-monitoring, a phone application, …

The Development Of Evidence-Based Practice Mentors Through A Competency-Based Educational Program: A Leadership Perspective, Laura C. Moore, Tracy L. Brewer, Pamela Hardesty, Diana Burdick

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

One of the most productive strategies to achieving the safest, high-quality patient care is promoting the widespread use of evidence-based practice (EBP) in clinical settings. Despite the considerable emphasis and support for EBP, many clinicians still fail to translate current research into clinical practice. To address the pervasive lack of EBP among clinicians, an EBP project was developed at an acute care pediatric facility to increase EBP utilization via the implementation of a virtual EBP educational program. The findings from this project describe the establishment of an EBP educational program with the intent to create a critical mass of EBP …

Improving The Competency Of Nurse Educators In The Use Of Simulation, Pricilla H. Wyatt

Electronic Theses and Dissertations

Simulation in nursing education programs is widely used as an active clinical learning strategy. This teaching methodology is a standard supplement to clinical experiences for nursing students to meet the requirements of clinical components within their degree program; however, the faculty of a small liberal arts-based Bachelor of Science in Nursing program was not using simulation to its fullest potential. Therefore, the purpose of this DNP project was to introduce the use of evidence-based practice simulation guidelines recommended by the National Council of State Boards of Nursing. The study sample of 16 included 10 full-time faculty, five part-time adjunct faculty, …

The Effect Of A Standardized Handoff Tool On Communication, Interunit Transitions, And Wait Time: A Quality Improvement Project, Silvia N. Myndresku

Graduate Theses, Dissertations, and Problem Reports

This project sought not only to improve the communication and interunit transitions of care between emergency department providers (EDPs) and inpatient providers (IPs) using a standardized handoff tool, but also to reduce the Emergency Room (ED) wait time for patients admitted to the community hospital. The project employed a quantitative quasi-experimental pre-test/post-test design to explore provider satisfaction with an evidence-based standardized handoff tools and wait time. Forty-eight providers completed the survey before the I-PASS implementation, and 43 providers completed the survey post I-PASS implementation. Though not statistically significant, data indicates that wait time increased for the post-implementation months of December, …

Development And Implementation Of An Evidence-Based Practice Mentor Fellowship, Stacy L. Alves

Doctor of Nursing Practice (DNP) Projects

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017).

Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation.

Context: …

Formulating Well-Written Clinical Practice Questions And Research Questions, Natalie Bermudez

Nursing & Health Sciences Research Journal

Implementation of evidence-based practices is an expectation in healthcare and nursing, requiring knowledge and understanding of evidence-based practice (EBP) and research. Recent evidence shows that nurses' lack of knowledge contributes to nurses' lack of participation in EBP and research and their ability to differentiate between the two posing challenges with writing clinical questions and research questions. The purpose of this article is to provide foundational education on the differences, similarities, and relationship between EBP and research, and provide guidance for writing clinical practice and research questions.

Improving Patient Outcomes With Post-Op Education For Nurses Caring For Patients Undergoing Total Joint Replacement, Amanda Collier

Doctor of Nursing Practice Projects

Background: Surgical site infections (SSI) are the third most reported nosocomial infection causing an increased length of stay, increased healthcare cost, and a substantial increase in morbidity. A SSI is an infection developing within 30 days of surgery without using an implant and within one year of surgery utilizing any form of implant. Typically SSI occurs at the time of incision. However, poor postoperative wound care can lead to an SSI.

Purpose: This project aims to educate nursing staff on care of the total joint replacement (TJR) patient to reduce readmission rates for postoperative SSI.

Design Methods: This …

It’S Their Lifeline: Preventing Central Line Associated Blood Stream Infection In An Adult Intensive Care Unit, Jacenda Lee Rangel

Master's Projects and Capstones

Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm.

Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of …

The Effect Of Implementing A Generalized Anxiety Disorder Protocol For Anxiety And Depression Symptoms In The Primary Care Setting, Bailey J. Hinman

Evidence-Based Practice Project Reports

Generalized anxiety disorder (GAD) is very prevalent in the United States with 5.7% of citizens affected (National Institute of Mental Health [NIMH], 2017). This number is expected to be even higher because individuals avoid care due to stigma of mental illness (Andrews et al., 2018). GAD can have significant implications such as decreased ability to function, decreased quality of life and increased risk of suicide (Fong, 2018; Lizarondo, 2018). The purpose of this project was to improve outcomes for adult patients with GAD in the primary care setting by improving treatment to follow best practice recommendations. The Johns Hopkins Evidence …

The Emerging Global Tobacco Treatment Workforce: Characteristics Of Tobacco Treatment Specialists Trained In Council-Accredited Training Programs From 2017 To 2019, Christine E. Sheffer, Abdulmohsen Al-Zalabani, Andrée Aubrey, Rasha Bader, Claribel Beltrez, Susan Bennett, Ellen Carl, Caroline Cranos, Audrey Darville, Jennifer Greyber, Maher Karam-Hage, Feras Hawari, Tresza Hutcheson, Victoria Hynes, Chris Kotsen, Frank Leone, Jamie Mcconaha, Heather Mccary, Crystal Meade, Cara Messick

Nursing Faculty Publications

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist …

Exploring The Usability Of The Com-B Model And Theoretical Domains Framework (Tdf) To Define The Helpers Of And Hindrances To Evidence-Based Practice In Midwifery, Annemarie De Leo, Sara J. Bayes, Dianne Bloxsome, Janice Butt

Research outputs 2014 to 2021

Background Despite the advancement of scientific research in the field of maternity care, midwives face challenges translating latest evidence into evidence-based practice (EBP) and express reticence towards leading practice change in clinical areas. This study aimed to explore midwifery leaders’ views on what factors help or hinder midwives’ efforts to translate latest evidence into everyday practice and consider them in relation to both the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Methods This qualitative study formed part of a larger action research (AR) project that was designed to improve midwives’ EBP implementation capability. Data were …

Increasing Fall Awareness Through Nursing Staff Education, Evelyn Ahiante Dennis

Walden Dissertations and Doctoral Studies

Patient falls are a significant healthcare concern, with the highest risk being among older adults aged 65 and older. A lack of nursing knowledge can contribute to patient falls. This DNP project was conducted in the medical-surgical trauma unit of a 137-bed local rehabilitation center in Northern Georgia. The intention of the project was to understand if a nursing staff education program would increase knowledge regarding falls prevention. Kurt Lewin’s change theory provided the framework for the project. The project participants were nine medical surgical nurses. Using the analysis, design, development, implementation (ADDIE) model, a falls prevention education program was …

Beliefs About Evidence-Based Practice Among New Graduate Nurses, Julie Bane

Walden Dissertations and Doctoral Studies

It is an expectation that new graduate nurses (NGNs) use evidence-based practices (EBP) in patient care; however, studies indicated that NGNs lack confidence in, belief in, and a full understanding of EBP processes and implementation. The doctoral project practice-focused question addressed whether immersion in EBP education and completion of an EBP project through a quality-improvement pilot program would enhance NGNs’ beliefs about the benefits and processes of EBP as well as increase confidence in their ability to implement EBP in the clinical setting. Knowles’ adult learning theory and Rogers’ diffusion of innovation theory guided the project’s motivation and examination of …

Context Matters: Evaluating The Influence Of Patient Demographics And In-Patient Care Parameters On Breastfeeding Outcomes Associated With The Baby Friendly Hospital Initiative, Sarah Vivian Martin

Doctor of Nursing Practice Projects

Objective: Evaluate the effectiveness of the global Baby Friendly Hospital Initiative (BFHI) as an intervention to improve breastfeeding outcomes and to explore factors that are most supportive and predictive of exclusive breastfeeding.

Design: Program evaluation of the BFHI using a retrospective pre and post implementation electronic health record chart review.

Setting: A tertiary level hospital in WA. BFHI designation was achieved in November 2017.

Participants: Patients with a low-risk pregnancy, who gave birth (vaginal or cesarean) to a healthy term infant in Quarter one of 2015 (N=145) and Quarter four of 2018 (N=131).Patient and infant must have been discharged home …

Medication Error Prevention Strategies, Shana L. Brown

MSN Capstone Projects

The fundamental purpose of every healthcare organization is to enhance patient quality of life through the provision of superior healthcare to produce the best patient outcomes. In the pre-hospital practice setting of helicopter emergency medical service (HEMS) the desire of system leaders and medical staff is to be primarily patient-centered, focused on the safety and wellbeing of patients while at the same time managing the business finances and budget of the organization. Maintaining a healthy environment with safe patient practices is the responsibility of organization administrators, physicians, nurses, paramedics, and all healthcare providers.

One of the primary duties that healthcare …

A Multimodal Analgesic Virtual Reality Program To Reduce Opioid Exposure, Jessica Hovland

Student Scholarly Projects

The opioid crisis continues to be a public health concern. Traditionally, an opioid-centric approach treats postoperative pain.

The following PICOT question guided this project: Will initiating a multimodal analgesic virtual reality quality improvement program (I) compared to current practice (C) decrease opioid requirements (O) in robotic hysterectomy patients (P) during the postoperative period (T)? Several articles promote non-opioid analgesia and non-pharmacological interventions, such as multimodal analgesia and virtual reality (VR) for pain management.

This project reviewed pre- and post-implementation data after implementing new evidence-based multimodal analgesia and VR protocols. The project captured a total of 64 patients in the pre-implementation …