Medicine and Health Sciences Commons^™

Increasing Hpv Vaccination In Adolescents, Emily Martin, Emily Hartmann

Doctor of Nursing Practice Projects

Human papillomavirus virus (HPV) is a sexually transmitted disease that can negatively affect both males and females by leading to cervical, vaginal, vulvar, anal, penile, and oropharyngeal cancer. Vaccinating against HPV using the Gardasil vaccine is an effective method to prevent HPV, however, vaccination rates are still unacceptably low in adolescents ages 11 to 14. Pediatric providers should encourage and strongly recommend HPV vaccines to all adolescents. Addressing and easing parental hesitancy is a key component to improving vaccine acceptance. The setting for the project was a rural pediatric office in southern Illinois where HPV vaccination rates are lower than …

Retention Of New Nurses In The Cardiovascular Operating Room, Hannah Shufeldt

Doctor of Nursing Practice Projects

Background

In January of 2020, a hospital in Springfield, Illinois started the year with seven full-time circulating nurses in the cardiovascular operating room (CVOR). Three of those nurses left before the end of the year and an additional four nurses were hired. In January of 2021, the CVOR began the year with eight nurses. Five of these nurses left by the end of the year and seven more were hired, one of which left before the end of 2021. This department has struggled to retain nurses, with a turnover rate of 42.9% in 2020 and 62.5% in 2021.

Purpose

The …

Implementation Of Written Discharge Instructions For Common Diagnoses In The Urgent Care Setting, Melissa Kulp, Kristin Elmore

Doctor of Nursing Practice Projects

Abstract

Discharge instructions are an important tool providers use to communicate information to patients about their medical diagnosis after they return to their home environments. When patients understand and follow discharge instructions there are improved outcomes, fewer callbacks, and decreased return visits. The purpose of this quality improvement project were (a) to develop and distribute discharge instructions at or below a sixth-grade reading level, (b) on common diagnoses appropriate for a rural community, (c) decreased the need for subsequent office visits, and (d) decreased call volumes at a rural walk-in clinic. A large-scale literature review was conducted to determine the …

Dexmedetomidine As An Adjunct Therapy To Neuraxial Anesthesia In Labor And Delivery, Anthony Nungesser

Doctor of Nursing Practice Projects

In 2011, the Centers for Disease Control (CDC) declared the opioid crisis an epidemic, and in 2017 it was declared a public health emergency. In labor and delivery, neuraxial anesthesia has been used for over a hundred years to provide pain relief for parturients. Although many alternatives have been studied, opioids are the most frequently used local anesthetic adjuvants, and their use in neuraxial blocks has evolved over the last 50 years (Swain et al., 2017). While neuraxial opioids have proven to be an effective adjunct for pain relief, they are associated with undesirable side effects as well as the …

Empowering Nurses To Recognize Post-Stroke Depression In The African American Community, Deidra Frisbie, Robin Simon

Doctor of Nursing Practice Projects

African Americans (AA) have the highest prevalence of stroke and death compared to other racial groups in the United States. Post-stroke depression (PSD) affects approximately 1/3 of all stroke patients and is underdiagnosed in the African American community.

Aim: By using a mHealth mobile app and a Psychiatry provider list at discharge, PSD can be identified, and interventions initiated, thus decreasing the sequela of PSD in AA.

Methods: Nurses were provided education on PSD, expressions of depression in African-Americans, cultural humility, implicit bias, and the importance of the nurse's role in developing a therapeutic relationship.

Results: Quantitative analysis revealed the …

Assessment Of Caregiver Burden In A Memory Loss Clinic, Andrea Perkins

Doctor of Nursing Practice Projects

Background: Over 131,000 people in Illinois identify themselves as caregivers of someone with memory loss. The family caregiver may provide care including, but not limited to, assistance with activities of daily living, financial responsibilities, behavior management, and scheduling, and transportation to medical appointments. The care provided by the caregivers may lead to caregiver burden symptoms of depression, anxiety, and perceived stress. Purpose: Health care providers at a central Illinois memory clinic are not currently completing formal assessments of caregiver burden. This quality improvement project was done to determine if the current memory loss program services provide enough support …

Implementation Of Routine Screening To Detect Early Cases Of Depression And Anxiety In Hispanic Adolescents In The Primary Care Setting, Latoya Hayward

Doctor of Nursing Practice Projects

Depression and anxiety are among the leading causes of illness and disability in adolescents and are two of the most prevalent mental health conditions in Latino youth. If left unrecognized and untreated, these conditions can lead to decreased quality of life and increased rates of suicide. Researchers recommend early mental health screening to occur in the primary care setting. Through routine screening using evidence-based screening tools (PHQ-9 and GAD-7), the primary goal of this quality improvement project was to increase early detection of depression and anxiety in primary care and initiate early treatment. Project methods included implementation of new workflow, …

Implementation Of A Tele-Triage Protocol In An Emergency Department Setting, Megan Tuetken, Sierra Hamlin, Sydney Spaulding

Doctor of Nursing Practice Projects

Nationwide, the volume of emergency department (ED) visits has steadily increased over the last several decades. This steady increase in volume frequently causes ED crowding and considerable delays in patient evaluation and treatment. Recently, teletriage has been used in emergency departments to evaluate less emergent patient needs while freeing up in-house providers to care for more critical patients. The goal of this DNP project was to develop a protocol for the utilization of teletriage in an Emergency Department in a level 1 trauma center in central Illinois using nurse practitioners to assess patients in the waiting room and order appropriate …

Assessing Provider Confidence Of Acute Otitis Media Diagnosis And Treatment With An Optical Coherence Tomography Device In The Urgent Care Setting, Meghan Weber, Susan Wolf

Doctor of Nursing Practice Projects

Acute otitis media (AOM) is one of the most common causes of pediatric infection worldwide at approximately 350 million visits per year, as well as one of the most challenging illnesses to diagnose for providers (Tong et al., 2018). This dilemma leads to antibiotics being inappropriately prescribed, at a rate of approximately 75% (Islam & Hassinger, 2018). This project sought to explore the impact of implementing an optical coherence tomography (OCT) device in an urgent care setting when assessing otalgia in patients 0 to 17 years of age. The three main objectives of the project were to increase provider confidence …

Development And Evaluation Of Enhanced Recovery After Surgery Protocols For General Abdominal And Orthopedic Surgery With Focus On Preoperative Hydration And Multimodal Management In Preoperative And Postoperative Phases, Kristin Wolff, Sadie Spilker

Doctor of Nursing Practice Projects

Enhanced Recovery After Surgery (ERAS) is described as an evidence-based, patient-centered, interdisciplinary team developed protocol utilized to decrease the patient’s stress response to surgery, maintain preoperative physiologic function, and expedite recovery (American Association of Nurse Anesthetists [AANA], 2017). Existing evidence displayed the benefits of utilizing ERAS protocols in various surgical procedures, including general and orthopedic cases. Studies showed one must employ the preoperative, intraoperative, and postoperative components of the ERAS protocols to achieve maximum benefits. A critical access hospital in Illinois utilized some components of ERAS protocols, mainly the intraoperative portions, but lacked the full utilization. Goals of the review …

Controlling Hypertension: A Self Blood Pressure Monitoring Program Plus Health Coaching Compared To Health Coaching Alone, Jordan Joynt, Alex Watson

Doctor of Nursing Practice Projects

While nearly half of adults in the United States have hypertension, only about one quarter of those adults have adequately controlled hypertension. Providing a nurse-led coaching program in combination with home blood pressure monitoring (HBPM) has been shown to improve blood pressure control. A rural family practice clinic in the Illinois Metro East area proposed a clinical trial to test a nurse-led coaching program in combination with home blood pressure monitoring (HBPM) in decreasing blood pressure long-term. Both intervention and control groups received nurse-led hypertension coaching, while the intervention group also received a home blood pressure cuff. The results showed …

The Development Of An Evidenced-Based Guideline For The Anesthetic Management Of Surgical Cases Utilizing Evoked Potential Monitoring, Brent Hitchens, Darrell Risinger

Doctor of Nursing Practice Projects

Recent increases in the prevalence of neuromonitoring cases have contributed to the utilization of evoked potential (EP) monitoring during surgery. Evoked potentials are electrical signals measured in response to a stimulus. Intraoperative neuromonitoring is used to alert the surgeon, anesthesia provider, and neuromonitoring technician of changes before permanent nerve injury occurs. There are many factors that can affect neuromonitoring quality including hypothermia, hypotension, positioning, anemia, and anesthesia medications. The latter is especially important since certain anesthetic medications can have a profound inhibitory effect on the nervous system, leading to decreased amplitude and prolonged latency of EP signals. As a result, …

Perioperative Tube Feeding Guidelines For The Pediatric Burn Patient, Jordan Swanberg

Doctor of Nursing Practice Projects

Pediatric burn patients require an astronomical amount of nutritional support to promote wound healing and prevent unwanted side effects. These patients often require multiple surgeries, and consequently, when following standard NPO guidelines, these patients go for hours without any nutritional support. For this reason, a protocol was implemented on how to administer tube feedings throughout the perioperative process safely. The purpose of this project was to give a PowerPoint presentation to the providers that tested their current knowledge on how to manage tube feedings in the operative setting best. A single group design consisting of CRNA’s and an anesthesiologist was …

Creating A Guideline For Sti Testing In The Pediatric Population, Alexandria Molaro, Alexandra Evans, Alex Niebrugge

Doctor of Nursing Practice Projects

Sexually transmitted infection (STI) prevention, education, screening, and management in pediatric primary care settings are of importance due to the increasing number of cases yearly. Almost half of the 26 million new STIs that occurred in 2018 were among young people 15-24. An opportunity existed in a rural pediatric primary clinic, for improved adherence to Centers for Disease Control and Prevention (CDC) or American Academy of Pediatrics (AAP) recommendations to screen/test patients. An evidence-based project (EBP) was developed to address this concern. Project objectives included: developing STI screening guidelines for pre-teen to young adults, developing a screening algorithm, providing alternative …

Computer-Based Learning Module: Local Anesthetic Systemic Toxicity, Nhan Nguyen

Doctor of Nursing Practice Projects

Local anesthetic systemic toxicity (LAST) is the result of rapid absorption of local anesthetics (LAs) into the systemic circulation resulting in toxic plasma levels of the drugs. With the advent of ultrasound-guided regional anesthesia and improvements in injection techniques, the incidence of LAST has decreased significantly over the years. Even though LAST is rare, it is a potential, life-threatening complication associated with any administration of LAs. Providers and staff members taking care of patients receiving LAs should be astutely aware of potential complications so that LAST signs and symptoms can be recognized, and treatments can be implemented as swiftly as …

Improving Staff Education On Lung Cancer Screening At The Illinois Correctional Facilities For The Justice-Involved Individuals, Natalie Bethel, Jillian Youngquist

Doctor of Nursing Practice Projects

Justice-involved individuals are at an increased risk of developing chronic health conditions, including lung cancer. Literature supports the practice of using an annual low-dose CT scan to screen for lung cancer. Illinois Correctional Facilities lacked a lung cancer screening protocol for justice-involved individuals. Lung cancer screening guidelines were approved for the facilities, however, the time frame for implementation was unclear. This DNP project focused on evidenced based guidelines for lung cancer screening with education tools for staff members to prepare them for implementation. Staff was presented with a pre-test, PowerPoint presentation, and a post-test to evaluate lung cancer screening knowledge. …

Best Practice In The Perioperative Anesthetic Management Of Infants With Gastroschisis, Emily R. Lester

Doctor of Nursing Practice Projects

Gastroschisis, a severe abdominal wall defect, occurs in approximately 1 in every 2,000 fetuses. Despite care advancements, gastroschisis is associated with significant morbidity and mortality including prolonged time to tolerance of enteral feeds, prolonged ventilator support, and increased intensive care unit length of stay and hospital costs. A recent practice change in the care of infants with gastroschisis at a tertiary care facility in central Illinois lead to the request for an integrative review of the available literature and subsequent development of a comprehensive guideline discussing best-practice perioperative recommendations pertinent to the care of infants with gastroschisis. Through review of …

Increasing Obesity Education In An Underserved Latino Population, Morgan Lippert, Kelsey Beard

Doctor of Nursing Practice Projects

Obesity is a rapidly growing health problem in the United States. Certain populations are at high risk for developing obesity including the Latino population and underserved communities. This Quality Improvement project aimed to develop a more patient centered approach for primary care providers use to deliver obesity education to an at-risk Latino population. The project was completed at a clinic in southern Illinois where the majority of the population is underserved and Spanish speaking. Obesity education tools in both Spanish and English were given to the patients in order to decrease the language barrier and improve patient education and understanding …

Establishing Guidelines To Promote Best Practice For Common Ailments In School-Based Health Clinics, Kaitlin Sweeney, Rachael Schaefer

Doctor of Nursing Practice Projects

The COVID-19 pandemic exposed the gap in access to medical care of school-age children and identified a need for community-based health clinics to aid in its minimization. Evidence shows the creation of school-based health clinics (SBHCs) in public school districts provides a pathway for students to receive high-quality care in an easily accessible manner. Therefore, patient care guidelines for common ailments seen in SBHCs for a local federally qualified healthcare center (FQHC) were developed in conjunction with the FQHC goal to build and operate a SBHC located in southern Illinois. Eight guidelines were created to analyze the most common chief …

Improving No Show Rates In A Gi Endoscopy Outpatient Lab, Mark Mcateer

Doctor of Nursing Practice Projects

No show rates in outpatient health care settings can negatively impact patient outcomes as well as physician and nursing practice. Many procedural areas face an average no show rate between 14%-16% annually. Insufficient procedure preparation, socioeconomical issues including lack of transportation, illness on the day of the day of the procedure, and lack of educational awareness surrounding the importance of needing the procedure have been linked to patient’s canceling scheduled procedures. High no show rates contribute to significant financial losses as well as unused resources for procedural departments. The negative impact of these losses can create issues with staff department …

Physician Use Of The Rapid3 To Guide Rheumatology Follow-Up: A Retrospective Examination, Karen Howard

Doctor of Nursing Practice Projects

Abstract

The Quality Improvement Team of a rheumatology clinic was seeking ways to deal with the long intervals for an available follow-up appointment. The use of standardized disease activity assessment tools as a part of patient care is an evidence-based practice that is not employed by over one third of rheumatologists. One of the many uses of these tools is to guide treat-to- target care. Treat-to-target care uses the disease assessment tool score to guide treatment decisions and follow up interval. This project examined the use of a standardized disease assessment tool, the Routine Assessment of Patient Index Data 3 …

Pediatric Distraction Methods For The Perioperative Period, Jennifer L. Ashton, Katherine M. Rosner

Doctor of Nursing Practice Projects

Abstract

Most pediatric patients will experience anxiety to some degree during the perioperative period. Unrecognized and untreated anxiety can lead to complications during induction of anesthesia and may manifest as maladaptive behaviors that can last up to 6 months postoperatively. Multiple modalities are typically utilized to provide the greatest amount of anxiety relief with minimal side effects. Nonpharmacological methods of distraction have been proven effective when used in combination with pharmacological agents, as well as when used alone. The goal of this project was to create and present an educational resource tool regarding pharmacological and nonpharmacological distraction methods for pediatric …

The Implementation Of A Mental Health Screening Protocol In An Occupational Health Setting, Chandra A. Pierson-Rye

Doctor of Nursing Practice Projects

Background

Occupational injuries are disturbingly common and can occur regardless of employment industry, given that virtually every job in every industry has some degree of risk. Literature suggests that once an injury has occurred, psychosocial factors such as depression can play a pivotal role in the progression of pain, determine whether a subsequent disability develops, and the length of time an employee is off work.

Theoretical Framework

Both pain and depression are hypothesized to follow the same descending pathway in the CNS and have the same biochemical basis, serotonin and norepinephrine. The Biophysical Model of Pain can be used to …

The Use Of Point Of Care Ultrasound To Assess Gastric Contents And Determine Aspiration Risk In The Obese Patient Presenting For Elective Surgery, Harry Senaldi, Mary Zerlan

Doctor of Nursing Practice Projects

Pulmonary aspiration of gastric content is a potentially injurious and fatal complication of anesthesia. Obese patients with a BMI ≥ 35 presenting for elective surgery are at an increased risk of aspiration due to increased gastric pressure, delayed gastric emptying, and higher gastric volumes. Point of care ultrasound (POCUS) is a tool that allows the nurse anesthetist to assess gastric content and assign aspiration risk based on the scan results. A knowledge improvement project in the form of a lecture and hands-on tutorial focused on using POCUS to assess gastric content and assign aspiration risk was designed. This project was …

The Effectiveness Of Using The Anatomage Table As A Learning Adjunct To Peripheral Nerve Blocks Among Student Registered Nurse Anesthetists, Paige Dickey, Melissa Gerlach, Mary Zerlan

Doctor of Nursing Practice Projects

Abstract

In anesthesia programs across the country, learning advanced level human anatomy and physiology concepts provides a large foundation for which skills used in clinical application are learned. Student registered nurse anesthetists (SRNAs) are clinically trained to perform a variety of invasive procedures in practice including peripheral nerve blocks (PNBs). This project aimed to implement a supplemental, hands-on learning activity to improve overall PNB education, ultimately improving patient care and safety. A series of guided lessons were created to help the students walk through the anatomy of PNBs utilizing the Anatomage table (AT). SRNAs attended a workshop where they went …

Improving Healthcare Team Communication With Limited English Proficiency Families In The Nicu, Ivonne Mandell

Doctor of Nursing Practice Projects

Language barriers are common in healthcare settings, creating disparities in care between individuals with limited English proficiency and those with English proficiency. In the NICU setting, professional medical interpreters have been shown to improve parent/staff communication and increase parent satisfaction by allowing parents to ask questions and form trusting relationships with staff. Solid parent-provider communication can result in better health outcomes by increasing parental empowerment and participation in their child’s care. Despite the acknowledged advantages of using professional interpreters in healthcare settings, they are frequently under-utilized, even when readily available. The purpose of this project was to improve communication with …

Establishing A Neonatal Peripherally Inserted Central Catheter (Picc) Team, Rebecca Hunt

Doctor of Nursing Practice Projects

Infants admitted to the neonatal intensive care unit (NICU) have a plethora of diagnoses, including prematurity and newborns with genetic, neurological, surgical, and cardiac problems. The nature of these disease processes usually precludes enteral feedings and providing the infant with appropriate nutrition and hydration is a priority. This requires central venous access and peripherally inserted central catheter (PICC) placement allows for a reliable route of administration for intravenous nutrition and medications. The purpose of this project was to develop a nurse-led neonatal PICC team to provide timely placement of PICC lines while maintaining cost-effectiveness and maintaining a minimal number of …

Neuraxial Anesthesia For Total Joint Arthroplasty, Katherine Pozzo

Doctor of Nursing Practice Projects

This quality improvement doctoral nursing project sought to provide a sustainable and data-driven change process at a critical access hospital in Illinois. The main objective of this project was an improvement in postoperative pain scores and implementation of best practice guidelines regarding total joint arthroplasty. Total joint arthroplasty is one of the most common surgical procedures performed in the United States. Future figures predict exponential growth due to our aging patient population, the obesity epidemic, and continued improvements in technique. Despite advances, orthopedic surgeries continue to be taxing on the body and can produce significant complications. General anesthesia for these …

Establishing Care With A Primary Care Provider, Ashley Whitlatch

Doctor of Nursing Practice Projects

Established primary care leads to continuity of care, improved patient outcomes, and increased quality of life. There is also an improvement in the unnecessary usage of urgent care resources. The purpose of this project was to pilot a new process within the urgent or emergent care setting to ensure that patients who are not established with a primary care provider (PCP) have an appointment set before they are discharged. Staff were educated and trained in how to schedule primary care appointments for at-large patients. There are a high number of individuals who do not have a primary care provider. When …

Anticipatory Guidance For Parents/Caregivers Of Pediatric Patients Ages 0-12 Months, Cody Palmer, Anna Hagnauer

Doctor of Nursing Practice Projects

Anticipatory guidance is defined as proactive counseling for caregivers regarding various aspects of childcare and development. This project sought to improve the process and delivery of anticipatory guidance for infants aged 0-12 months at one rural pediatric primary care clinic. An extensive literature review was undertaken to determine current recommendations for anticipatory guidance topics pertinent to pediatric patients aged 0-12 months. Additional research explored the efficacy of various educational formats to provide teaching. Written educational materials were updated and edited to be visually appealing and understandable, and educational videos were created. Written materials and educational videos were provided to parents/caregivers …