Medicine and Health Sciences Commons^™

Dnp Final Report: Effects Of Open-Access Scheduling On Patient No-Show Rates In An Outpatient Clinic, Maria Aileen A. Wilkinson Msn, Mba, Rn

DNP Final Reports

No-show rates in a South Texas outpatient clinic have been as high as 16% to 20% which increases wait times to be seen in the clinic and decreases patient access to outpatient care. This no-show rate data has continued despite multiple interventions that have been implemented in an academic health science center. Physical, socio-economic, geographic, and health/lifestyle factors affecting no show or missed appointments are crucial to determining the most appropriate interventions to alleviate this issue. No-show rates are important metrics to improve because it directly affects the organization's revenue, access to care, and appointment wait times. Research evidence regarding …

Clinician Education Program: Promoting The Use Of Care Bundles In Reducing The Hospital Length Of Stay And Readmission Rates Of Adult Copd Patients, Nordita R. Bascon

MSN Capstone Projects

Management of COPD patients can cost hospitals approximately $308,502 per month. This is based on a single COPD readmission encounter costing $7,500 and estimated daily expenses of $2,883 (Davis, 2023; Hegwer, 2018). This executive summary outlines a clinician education program held at a community hospital in West Texas to promote patient quality care by encouraging healthcare professionals to use evidence-based chronic obstructive pulmonary disease (COPD) care bundles. Eighteen physicians and nurse practitioners attended the program. Then, a survey was conducted to assess the impact of the proposed program. Most attendees said they would incorporate care bundles in COPD care.

Internal …

Massive Transfusion And Shock Index, Kasey House

MSN Capstone Projects

Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.

While initiating an MTP …

Dedicated Vascular Access Team Benchmark Study, Rachel Davis

MSN Capstone Projects

Hospitals see a rise in the critically ill population. These patients present with multiple comorbidities resulting in frequent emergency department trips. Unfortunately, with each visit, these patients require a vascular access device. Over time their veins will no longer be easily accessible. Patients with veins that are no longer visible, palpable, or require special techniques to obtain access are considered to be difficult intravenous access (DIVA) patients. They will likely experience multiple attempts with each admission to the hospital, resulting in physical and emotional pain, not to mention being costly. The purpose of this paper is to compare the advantages …

Dnp Final Report: Developing Competence And Improving Patient Safety With Documentation Training In The Simulated Environment, Laura Zebreski

DNP Final Reports

With the advent of electronic health records, nursing documentation has declined in quality. Poor documentation exposes patients to safety risks. Nursing documentation is subject to legal standards set by the Texas State Board of Nursing. A DNP scholarly project was designed to create a learning and safety intervention to train student nurses to provide correct documentation before entering clinical settings. The goal of this project was to prepare nursing students to provide quality documentation that fulfills the legal standard to attempt to correct the current deficiencies seen in practice and promote patient safety. For this project, the students took a …

Nurse Efficiency & Ultrasound Guided Intravenous Access: Evidence Based Intervention Benchmark, Jacob D. Frost

MSN Capstone Projects

Gaining IV access is this first step into accurate, timely diagnosis and interventions of patients. Nurses are typically the first medical professional a patient sees. If the nurse can establish IV access as early as possible this will lead to faster interventions faster diagnostic results and better management for patients and ultimately better patient outcomes. Ultrasound guided IV can increase first attempt success rates leading to decreased painful IV insertions by multiple nurses. This would increase patient satisfactions scores leading to higher re-imbursement.

How Covid-19 Changed New Nurse Orientation, Lindsey Js Sanders

MSN Capstone Projects

Universities were no longer able to do in person learning for nursing students. Nursing students were being taught vital skills like inserting an IV catheter via online simulation. The number of hours nursing students had to participate in clinical hours at the hospital was diminished due to the hospitals not allowing in nursing students. This created a huge educational deficit in nursing students. The nursing students who graduated during the COVID-19 pandemic are arguably less skilled than their predecessors before them. To fill this educational gap, additional training and orientation time must be provided to allow for fully competent new …

Dnp Final Report: Executive Rounding And How It Affects The Completion Of A Quality Checklist And Quality Indicators: An Evidence-Based Practice Project, Ruben P. Castillo

DNP Final Reports

A question of inquiring led to the development of PICOT questions and a systematic search that recognized an executive leadership rounding process healthcare initiative need to improve the quality of care for patients, QI (quality improvement) initiatives such as reducing CAUTI (community-acquired urinary tract infections) and CLABSI (central-line associated bloodstream infections) in the medical floor population project was developed. The compelling internal and external evidence makes it vital to examine the following question, In acute care inpatients (P), how does an executive leaderships (manager &/or director), quality-indicator rounding plan (I) compare to no rounding plan (C) affect consistent completion of …

Dnp Final Report: Skilled Nursing Facility Readmissions: An Evidence-Based Telemedicine Innovation Project, Debra B. Graham

DNP Final Reports

Background: Nationally, 20% of patient readmissions occur within the first 48 hours after arrival to a skilled nurse facility (SNF), and 40-68% of these readmissions are potentially avoidable. Since 2016, the Centers for Medicare and Medicaid penalized SNFs when their return to hospital (RTH) percentages was above national benchmarks. The four SNFs in this project experienced rising transfer rates and diminished RTH percentages since 2017, despite using in-house providers Monday through Friday. Furthermore, there was no provision to address patients’ changes in conditions after hours.

Purpose: This evidence-based practice (EBP) project aimed to standardize the care provided to …

Dnp Final Report: Sane Finder: A Web-Based Mobile Solution To Identify The Location Of Currently Available Sexual Assault Nurse Examiners (Sane) For First Responders, Brenda D. Herrmann

DNP Final Reports

Society views sexual assault as one of the most horrific crimes committed by one human being against another, but the “rescue” has the potential to make the experience even more difficult for the victim, in essence re-traumatizing them (Nugent-Borakove et al., 2006). In the United States in 2018, almost 140,000 victims reported being sexually assaulted (U.S. Department of Justice - Federal Bureau of Investigation, 2019). In Texas, over 6 million individuals have been sexually assaulted in their lifetime (Busch-Armendariz et al., 2015). Getting victims to a specially trained sexual assault nurse examiner (SANE) as quickly as possible improves outcomes. SANEs …

Dnp Final Report: Psychosocial Screening For Oncology Patients, Robyn V. Beard

DNP Final Reports

Background: Patients with cancer often face severe distress related to fear of death, body disfigurement, financial stress, and lack of support system. This distress may lead to physical and emotional symptoms that bring patients to seek care at emergency departments, delay care or make poor health choices, and increase utilization of prescription drugs. With the already over burdened healthcare system, addressing these psychosocial needs is vital to improving patients outcomes as well as improving healthcare expenditure. Purpose: The purpose of this evidence based practice project was to improve perceived quality of life for oncology patients through detailed screening and behavioural …

Dnp Final Report: Mission Cyborg: An Ebp Project Integrating Hybrid Learning In An Undergraduate Nursing Course, Mary A. Thomas

DNP Final Reports

In modern times it is an expectation of students that technology be incorporated into how they receive their education. The COVID-19 pandemic brought to light how pure reliance on traditional face-to-face (F2F) learning can be detrimental to student learning. Many institutes of higher education had already implemented hybrid/blended learning prior to the pandemic and saw no difference in their NCLEX-RN pass rates. This evidence-based practice project gathered, reviewed, and synthesized evidence in order to determine if implementing different teaching strategies would maintain or improve student performance on both unit exams and end of course exit exams.

Health Literacy In Acute Care Benchmark Study, Micah Duke

MSN Capstone Projects

Poor health literacy levels directly correlate to poor patient discharge adherence and to an increase in repeat emergency department visits and healthcare costs. In addition, poor health literacy levels are directly correlated to a decrease in patient health outcomes. Studies clearly demonstrate that determining patient health literacy levels can be used to develop appropriate discharge instructions and education that will improve patient adherence and health outcomes, thus reducing emergency department readmissions and healthcare costs.

The purpose of this benchmark project is to implement procedures for consistently obtaining patient health literacy levels, along with language preferences, using the HLS-SF12 and to …

To Use Or Not To Use Oxygen For Mi Benchmark Study, Alexia Celaya

MSN Capstone Projects

It is a common practice for emergency personnel to administer oxygen for a patient diagnosed with a myocardial infarction. It is a well-known practice to place the patient on supplemental oxygen even if they are not hypoxic. The use of supplemental oxygen has been a cornerstone in the treatment of myocardial infarction. The rationale behind the administration of oxygen therapy is to increase oxygen delivery to the myocardium, therefore limiting the infarct size and future complications (Hofmann et al., 2017). The use of supplemental oxygen on normoxic patients has been challenged due to the possibility of causing further injury to …

Bedside Shift Reporting: A Benchmark Project, Clydea C. Hale

MSN Capstone Projects

Patient care is forever changing to improve satisfaction, safety, and overall treatment. Over the past few years, patients and their families are more invested in their overall care in the hospital and expect to be informed every step of the way. A common complaint from patients or their families is that one nurse or staff did not know the individuals care or treatment plan, there were no shift goals to work toward discharge, and the nurse did not update the patient/family with changes in care. All of these complaints along with the patient satisfaction scores and communication between the treatment …

Evidence-Based Individualized Discharge Educational Intervention For Coronary Artery Disease (Cad) Patients; A Benchmark Project, Sumita Thapa

MSN Capstone Projects

Coronary artery disease (CAD) is the leading cause of death worldwide, whereas, in the United States, 16,800,000 people are affected, resulting in 450,000 deaths annually. Patients’ perceptions of self-management related to treatment adherence, lifestyle modifications, and risk-factor management are significant indicators of outcomes following a cardiac event. To promote self-management in CAD patients, this benchmark project aims to determine the impact of individualized education interventions by establishing a standardized nurse-led educational intervention in the cardiac unit that emphasizes adherence to self-management and treatment regimen to improve quality of life and prevent rehospitalization due to worsening cardiac events. The evidence-based findings …

Cardiac Rehabilitation Benchmark Study, Catherine Cottle

MSN Capstone Projects

This benchmark study attempts to evaluate the effectiveness of cardiac rehabilitation in reducing mortality and hospital readmission rates of post-myocardial infarction patients. Several peer-reviewed articles were reviewed assessing the efficacy of cardiac rehabilitation. It was discovered that cardiac rehabilitation reduced several negative effects regarding heart disease, including the reduction of mortality and hospital readmission rates.

Dnp Final Report: Teamstepps For Nursing Students, Jennifer Matranga

DNP Final Reports

The purpose of this paper is to discuss the DNP project, which focused on improving communication skills for associate degree nursing students. The background and significance of this problem was identified, a systematic review of the literature was completed, and TeamSTEPPS, based on the body of evidence, was implemented in a clinical immersion setting. The project objectives were to implement communication techniques, using TeamSTEPPS, as recommended from the body of evidence. The anticipated outcomes were that nursing students would have increased confidence in asking questions in the clinical setting, reduced fear of communicating, and improved patient safety. A review of …

Dnp Final Report: Cultivating A Culture Of Civility In A Baccalaureate Nursing Program: A Doctor Of Nursing Practice Evidencebased Practice Project, Monica Sowell

DNP Final Reports

Incivility is a well-known issue in nursing, negatively impacting every aspect of the profession. In response to high incivility levels within a baccalaureate nursing program in central Texas, an incivility education module was created for use in adult medical-surgical courses. The module incorporated online preparatory learning followed by active classroom learning, roleplay practice, and faculty modeling to teach students to define, identify, and respond to incivility using evidence-based cognitive-behavioral strategies. Data was collected pre-education implementation and at three post-education time points to evaluate student self-efficacy changes in recognizing and responding to incivility. The COVID-19 pandemic necessitated changing the education delivery …

Dnp Final Report: The Impact Of Mindfulness Training On Stress, Burnout, And Mindfulness, Denise Mcnulty

DNP Final Reports

Stress and burnout are endemic in the health care profession, and the transition to practice is associated with even more stress and anxiety for new graduate nurses (Boehm & Tse, 2013). Researchers have demonstrated that mindfulness-based interventions mitigate stress and burnout and improve the workplace environment and patient outcomes (Perla et al., 2017; van den Riet et al., 2018). This scholarly evidence-based practice project assessed the impact of integrating mindfulness training into an existing nurse residency program. The team measured burnout, stress, and mindfulness via an online survey at the beginning of the February 2020 residency cohort with repeat measures …

Emergency Department Staffing And Overcrowding, Royce Hudgins

MSN Capstone Projects

Overcrowding in the emergency room (ER) is a decades old problem that can be caused by factors both internal and external to the (ER). The ripple effects from this problem can be seen throughout the hospital.

This change project seeks to identify and find solutions to patient flow problems that occur in the emergency room (ER) in order to: decrease patient wait times, reduce ER overcrowding, reduce costs, and to increase patient satisfaction and overall outcomes.

Dnp Final Report: Breaking The Cycle: Care Coordination Interventions And Sickle Cell Readmissions, Naphtali Edge

DNP Final Reports

Background

Approximately 100,000 people in the United States are affected by Sickle Cell Disease (SCD). Sickle Cell Disease represents the second highest readmitting diagnosis at Houston Methodist Hospital. The purpose of this study is to determine the impact of implementing care coordination interventions to reduce hospital readmissions of patients with SCD.

PICOT

In adult patients with SCD in the acute care hospital setting, how does care coordination intervention compared to no care coordination intervention affect the readmission rate for patients with SCD over a 3 – 6-month period?

Body of Evidence

Eleven studies were critical appraised and included in the …

The Relationship Between Early Discharge Planning And Length Of Stay, Kandiss Hearn

MSN Capstone Projects

Discharge planning (DCP) and early discharge intervention has proven to have a direct effect on reducing hospital length of stay (LOS), reducing readmissions, reducing patient morbidity, improving patient satisfaction and possibly reducing patient healthcare cost. This proposal specifically addresses hospital length of stay but with research it was found that early DCP also has the potential to improve outcomes in several areas adjacent to both the patient aspect and business aspect of health care. The proposed question is as follows: In adult hospitalized patients (P), how does discharge planning within the first 24 hours of admission (I) compared to late …

Increased Discharge Compliance Through Mental Health Follow-Up, Robert H. Kirby

MSN Capstone Projects

Emergency departments are being strained to their breaking points as a result of the recent COVID pandemic. These departments are in need of programs that can help to reduce stress on not only limited budgets but also reduce the strain on their overwhelmed staff. One such strain on emergency departments and their limited resources is the readmittance of mental health patients as a result of non-compliance of the discharge instructions. The change project looks to address whether following up 10 days post discharge can increase discharge instruction compliance and ultimately reduce readmissions. The aim of the project is through the …

Comparison Of Education Styles For Nursing Students: Team-Based Learning Versus Traditional Lecture, Hannah Gean

MSN Capstone Projects

Nursing graduates are coming into the workforce still lacking in important areas. Nurses need to have cultivated leadership, communication, and satisfaction skills before they start their first job. For this to occur, nursing students need to be prepared with these qualities while they are still in school. It is important for students to not only learn healthcare knowledge but to have practical skills in a variety of areas. When students learn through the traditional lecture method, it is not always possible to assess and support their learning in leadership, communication, and satisfaction. To ensure that students are receiving these values …

Huddle And Safety, Jaelynn Hall Bsn, Rn

MSN Capstone Projects

The purposed evidence-based practice (EBP) project focuses on a nursing intervention (team huddles) to increase safety and reduce inpatient fall rates. Negative outcomes to consider from an inpatient fall are harm and injury to the patient along with increased health care cost for the patient as well as hospital facility. Accrued cost associated with an in-patient injury resulting from a fall is not reimbursed according to the Centers for Medicare and Medicaid Services. The additional cost for hospital-acquired falls is estimated to be $6,694 (95% CI: -$1,277 to $14,665) (Agency for Healthcare Research and Quality, 2017). This was only related …

Oncology Nurse Compassion Fatigue Benchmark Project, Jessica R. Hayward

MSN Capstone Projects

Oncology nurses provide care to patients during some of the toughest times in their lives. This care places nurses at risk of developing compassion fatigue which can have negative long-term health impacts. There is currently no formal compassion fatigue education offered to oncology nurses. This lack of training leaves nurses vulnerable to the impacts of unmanaged stress, burnout, and compassion fatigue. This benchmark project was completed to bring awareness to the need for a mindfulness-based compassion fatigue course. This course will provide oncology nurses with the knowledge and skills necessary to manage these difficult emotions.

Patient Controlled Fluid Restriction Monitoring, Christina Tindel

MSN Capstone Projects

Patients are often placed under non-pharmacologic orders such as fluid restrictions during their hospital stay. The following article will discuss a plan to implement a change to have patients take a more active role in their plan of care by being the main ones to monitor their fluid intake.

Nurse Practitioner Occupational Burnout: A Focus On The Variables And Themes, Tanya G. Schlemmer

Nursing Faculty Publications and Presentations

Purpose: The prevalence of occupational burnout is high amongst service professionals and the nursing profession is no different. The rate of occupational burnout amongst nursing professionals and medical professionals is high. The themes or impact of occupational burnout amongst Nurse Practitioners is not well described in the literature. Herein this article describes the investigation into the issue of nurse practitioners and occupational burnout.

Data Sources: Scientific literature review, CINHAHL Complete and other online literature databases and resources. A State of the Science systematic review was conducted to further examine this issue to identify the prevalence of the problem amongst nurse …

Dnp Final Project: Implementing Teamstepps Training: Using Evidence To Impact Teamwork In An Acute Care Hospital, Nana Baah Adjei

DNP Final Reports

Background: Medical errors are the third leading cause of death in the United States. Patient morbidity and mortality will decrease when institutional efforts result in the implementation of action plans which reduce medical errors. Teamwork, education, and training through structured initiatives are the most effective mechanism to improve patient safety. Purpose: The project aims to impact the perception of communication among newly hired medical surgical nursing and support staff. The acute care hospital is a 200-bed tertiary care hospital. Intervention: The intervention consists of the registered nurses and support staff participating in an innovative, six-hour, interactive TeamSTEPPS fundamentals course. Results: …