Medicine and Health Sciences Commons^™

Obstructive Sleep Apnea: A Staff Educational Program And Protocol, Aaron Michael Quach

Doctor of Nursing Practice Projects

Obstructive sleep apnea (OSA) is a common sleep breathing disorder. Despite its prevalence, OSA often goes undiagnosed. This can result in negative sequelae. By educating healthcare providers about OSA, screening patients, and altering the plan of care, better outcomes will arise and complications can be minimized.

The purpose of this project was to develop an obstructive sleep apnea educational program and protocol based on available current literature for anesthesia providers at a community hospital. The educational project and protocol consisted of an informational PowerPoint, pretest and posttest surveys, an OSA screening tool and identification of a high risk OSA patient …

Fascia Iliaca Compartment Block Protocol For Hip Fracture, M. Ray Nordyke

Doctor of Nursing Practice Projects

Fascia iliaca compartment block (FICB) is a volume based block used to treat pain associated with hip fractures. An anesthesia group at a central Illinois hospital expressed interest in the creation of an evidenced-based protocol for FICB. After an extensive literature search an evidence-based protocol was designed. The initial implementation of the protocol was a presentation of an informational PowerPoint which discussed the aspects of the protocol presented to the anesthesia staff and the registered nursing staff who assist the anesthesia providers. The protocol was then evaluated with a Likert scale survey completed by the staff. The results from the …

Impact Of Motivational Interviewing On Body Mass Index, Tajsier L. Thompson

Doctor of Nursing Practice Projects

Introduction

Being overweight and obese has become a common lifestyle. More than half of American adults are overweight and more than a quarter of overweight adults are obese. Despite this overwhelming statistic, weight-loss coaching by primary care providers is usually disregarded due to time constraints and lack of skills to motivate patients to reach weight-loss goals. Motivational interviewing (MI) focuses on helping people investigate and overcome ambivalence toward healthy lifestyle modifications by helping them to explore their weaknesses, strengths, and preferences in an effort to facilitate behavioral changes.

Objective

The primary objective of this project is to assess the effectiveness …

Improving Acute Postoperative Pain Management For Opioid-Tolerant Patients: Development Of A Postoperative Ketamine Infusion Protocol, Jeri Dockins

Doctor of Nursing Practice Projects

Anesthesia providers are encountering a growing number of opioid-tolerant patients. To date, the treatment for acute pain has been the administration of opioids. The administration of opioids leads to postsurgical complications. This project’s purpose was to improve acute pain management for opioid-tolerant patients by creating a postoperative ketamine infusion protocol. Ketamine is a noncompetitive antagonist at N-methyl-D-aspartate receptor sites involved in nociceptive and inflammatory pain transmission (Radvansky et al., 2015; Vandivelu et al., 2016). Research has demonstrated ketamine administered as a bolus dose or a continuous low-dose infusion for 24 to 48 hours postoperatively often results in a decrease in …

Introduction Of Enhanced Recovery After Surgery For Colorectal Surgical Patients: A Quality Improvement Project, Amanda R. Mcvey

Doctor of Nursing Practice Projects

The purpose of this practice project was to develop and introduce an enhanced recovery after surgery (ERAS) protocol for colorectal surgical patients at a tertiary care center in southern Illinois. Project aims included reviewing available literature and study outcomes to develop an evidenced-based ERAS protocol for colorectal surgery and educating anesthesia providers about ERAS to introduce the evidenced-based ERAS protocol for colorectal surgery. An educational presentation and learning assessment tool were developed and subsequently presented to the anesthesia providers at the host facility. The first step toward implementing the protocol is education, as such, the results of the assessment questions …

The Implementation Of A Health Blog At A Community College, Colin M. Solomon, Roxanne Strohbeck

Doctor of Nursing Practice Projects

This projects details the implementation of a health blog at a Midwestern community college family health clinic. The literature review examines issues regarding benefits of college health clinics to students, health dangers college students face, social media usage for health education, how enhanced awareness of college health clinics can lead to increased usage, social media intervention design, and ethics of social media use for health promotion. A theoretical nursing framework is applied to the project of designing the blog. Clinical relevance for nurse practitioner practice is established with supporting literature review. Methods of project implementation are delineated including possible improvements, …

Protocol Development In The Or: Lessons Learned, Megan Sims

Doctor of Nursing Practice Projects

The management of pain in those undergoing a laparoscopic cholecystectomy is complex and challenging. There have been advances in the understanding of the physiology of pain and a wide variety of treatment options are now available. Establishing a preventative multi-modal protocol with different types of pain medications that work on a variety of receptors along the pain pathway is imperative. Through an exhaustive literature review, a preventative multi-modal approach was established and introduced at a small hospital in Central Illinois available for all laparoscopic cholecystectomy patients undergoing surgery over a 10 week implementation period. There was only one completed case …

Improving Perioperative Management Of Patients Experiencing Local Anesthetic Systemic Toxicity: An Assessment Of A Staff Educational Program, Sarah O'Leary

Doctor of Nursing Practice Projects

Local anesthetic systemic toxicity (LAST) is a rare but life-threatening complication occurring after administration of local anesthetics. With the increasingly widespread use of local anesthetics (LAs), healthcare providers must be educated on safe administration, as well as recognition and treatment of LAST. This project involved the development of a computer-based learning (CBL) module for staff at a tertiary care center in central Illinois with a focus on the definition, characteristics, prevention, symptoms, and treatment of LAST.

Knowles’ adult learning theory served as the primary foundation and theoretical framework for the development of the CBL. A comprehensive review of the literature …

Training Plan For Anesthesia Information Management Systems (Aims), Omololu Kaffy Kafisanwo

Doctor of Nursing Practice Projects

The federal government has set a mandate for healthcare facilities to adopt electronic health records (EHR) or be penalized through reimbursement cut. A SIH has plans to install Epic in November 2017, a survey completed by anesthesia providers at SIH revealed staff resistance to the Epic transition. Since this resistance has the potential to disrupt patient care and anesthesia workflow, the chief anesthesiologist at SIH and the author devised a training plan to reduce resistance and facilitate smooth transition. The author utilized the results from the completed survey to coordinate with the chief anesthesiologist and IT training specialist to develop …

Evaluating Transfer Of Continuing Education To Practice: A Retrospective Mixed-Methods Study, Tiffany Bryant, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: Continuing education (CE) is an essential component of building and maintaining the competence and performance of health professionals. Evidence of its impact on practice is lacking. Organizations need evidence of CE transfer to the practice setting to demonstrate its value and inform CE practice.

Objectives: The purpose of this study was to provide evidence of CE’s impact on practice by analyzing nurses’ reports of intent to change practice, actual practice change, and examples of practice change. Research assessing the effects of CE on nursing practice across multiple courses involving different topics, levels of nursing practice and location supports generalizability. …

Cancer Screening Practices Among Sexual Orientation Groups, Scott Kilgore, Dnp, Msn, Bs, Rn

Doctor of Nursing Practice Projects

Background: Increasing cancer screening testing is a national health initiative to decrease the mortality rates of all Americans; however, cancer screening practices among sexual minorities have been understudied.

Objectives: To assess and compare breast, cervical, prostate, and colorectal cancer screening practices among straight, lesbian, gay, and bisexual individuals.

Methods: A descriptive-correlational study was conducted using data from the Center for Disease Control and Prevention 2014 Behavioral Risk Factor Surveillance System survey. Respondents who answered questions about their cancer screening practices and sexual orientation were included.

Results: This study identified disparities in breast cancer screening practices with bisexual women (81.9%) meeting …

The Effects Of A Structured Teaching Session On Perceived Self-Efficacy Among Mental Health Nursing Supervisors, Pamela Fess, Dnp, Msn

Doctor of Nursing Practice Projects

Background: Specific factors that contribute to nursing supervisors perceived self-efficacy remains unclear. Although several studies have examined the relationship between self-efficacy and mental health nursing supervision most have focused on the impact of client care. To date, there is a dearth of studies to assess the impact of a leadership focused teaching session on the perceived self-efficacy of mental health nursing supervisors. Equipping nurses who are responsible for the supervision of others with the skills needed to fulfill their role responsibilities has the potential to improve their job performance, the work satisfaction, and well-being of staff nurses they supervise as …

Differences In The Rothman Index Score In Evolving Emergent Events In Medical-Surgical Patients, Deborah Cardenas, Dnp, Msn, Rn, Paralegal

Doctor of Nursing Practice Projects

Background: The Rothman Index (RI), an early warning system using software integrated with the electronic medical record provides scores monitoring patient conditions. Minimal findings exist regarding RI scores in medical-surgical patients.

Objectives: Explore differences in the RI scores in medical-surgical patients who suffered rapid response, cardiopulmonary resuscitation or death events.

Methods: A retrospective comparative design of 75 subjects with a rapid response or cardiopulmonary resuscitation event on medical-surgical units over 12-months at an academic medical center using RI scores at admission, 48- and 24-hours before and at time of event. Deaths were identified immediately following the emergent events.

Results: The …

Differences In Preventable Cardiovascular-Related Versus Unavoidable Occupational Causes Of Firefighter Fatalities On Duty, Amy Goad, Dnp, Ms, Np-C

Doctor of Nursing Practice Projects

Background: Firefighters across the United States face high fatality rates in the line of duty of which many are likely related to preventable cardiovascular risk factors.

Objectives: To assess differences in firefighter cardiovascular-related versus unavoidable occupational-related fatalities by career status, age, smoking, obesity, and hypertension.

Methods: We used an exploratory, comparative secondary data analysis design. We extracted data from a national database of deceased firefighters over 14 years. Variables extracted were career status, age, smoking, obesity, and hypertension as well as the reason for death while on duty (i.e., cardiovascular-related or unavoidable occupational-related death). Data were analyzed using Chi-Square to …

Outcomes Of Allogeneic Hematopoietic Stem Cell Transplantation For Gata2 And Dock8 Immunodeficiencies: Demographics And Transplantation Variables, Kristen M. Cole, Dnp, Msn, Rn, Bmtcn, Ocn

Doctor of Nursing Practice Projects

Background/Purpose: GATA2 and Dedicator-of-Cytokinesis-8 (DOCK8) deficiencies are two recently described genetic immunodeficiency diseases for which allogeneic hematopoietic stem cell transplant (HSCT) represents the only definitive therapy. The patient characteristics and HSCT variables that relate to the outcomes in these two diseases following HSCT remain unclear. Therefore, we described these variables in these two patient populations and explored their relationships with HSCT outcomes.

Methods: Data were obtained from retrospective chart reviews of all patients with GATA2 deficiency and DOCK8 deficiency who underwent HSCT on clinical research protocols at the National Cancer Institute. The outcomes included overall and disease-free survival status, graftversus-host …

Transitioning Experienced General Care Float Pool Nurses To A Critical Care Float Pool, Troy T. Betts, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: A nationwide nursing shortage has resulted in a significant reduction in the number of qualified nurse applicants for critical care positions. Additional recruitment solutions for critical care staffing needed to be explored.

Purpose: The purpose of this project was to evaluate the effectiveness of an orientation program designed to transition experienced general care trained float pool nurses to a critical care float pool.

Methods: This descriptive study measured participants’ pre and post critical care orientation knowledge, and completion of core computerized competencies. Critical thinking questions, unit-based competencies, and measurement of participants’ individual perception of competence were also completed. Pre …

Measuring Nursing Students’ Perceptions Of Teamwork In A Multiple Patient Simulation, Christine Seaton, Dnp, Msn

Doctor of Nursing Practice Projects

Background: Simulation based education offers safe, reflective learning opportunities. However, data had not been obtained of nursing students’ perceptions of teamwork performed during Virtual Hospital (VH), a multiple patient simulation.

Objectives: This evaluation gap was addressed using the Agency for Healthcare Research and Quality’s (AHRQ) TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ). The validated survey measures self-reported perceptions of teamwork in communication, mutual support, and situational awareness on a Likert scale from 1 to 5 (AHRQ, 2014).

Methods: A pre-and post, one group design was used to measure perceptions of teamwork. Twenty participants were recruited from students, enrolled in a second-degree undergraduate …

Evaluating The Impact Of A Standardized Education Class On A Person Diagnosed With Chronic Kidney Disease, Stage Iv, Nancy K. Uhland, Dnp, Msn, Rn, Fnp-C

Doctor of Nursing Practice Projects

Background: Chronic kidney disease (CKD) is a complex, progressive, and costly disease impacting more than 26 million Americans. Providing effective education is necessary so the patient may actively participate in managing the disease process, but the effectiveness of the delivery of education to the patient with CKD is not well-known.

Objective: To evaluate the effectiveness of a standardized education class on the basic kidney knowledge of persons diagnosed with CKD, stage IV.

Method: This pilot study, using a one-group pre and post-test design, was conducted in an outpatient nephrology clinic located in Washington, D.C. The study participants, recruited using census …

The Impact Of Digital Education Delivery On Postoperative Pain Outcomes, Amber Stitz, Dnp, Ms, Aprn, Acns-Bc, Ocns-C

Doctor of Nursing Practice Projects

Background. Advances in technology and communication tools offer new, innovative methodologies for delivering information to patients. Research is needed to understand the clinical effectiveness of different education delivery methods on outcomes and comprehension.

Purpose. Compare the effects of digital education with conventional, written and verbal instructions on patients’ pain outcomes, knowledge attainment, and treatment participation.

Methods. A quasi-experimental design evaluated outcomes in 133 patients undergoing major hip (n=73) and knee (n=60) arthroplasty who received point-of-care pain education delivered via a dynamic mobile-computing (iPad) platform (n=65) or by conventional education (n=68). The significance level was set at 0.05. Person’s r and …

Assessing Employee Needs To Enhance A Workplace Wellness Program, Paige Herschend, Dnp, Msn, Bsn, Ba

Doctor of Nursing Practice Projects

Background: Workplace wellness programs are increasingly prevalent, but their designs vary dramatically. While successful programs differ, those that are coordinated, comprehensive, and planned intentionally to address specific workplace needs have been found most beneficial.

Objective: This project assessed the perceived health status and wellness needs of employees at one company to determine whether its workplace wellness program could be enhanced.

Methods: This project focused on one site of a large, multi-state company. A retrospective review of data from an employees’ health and wellness survey was performed. Univariate and bivariate statistics were used to analyze the relationships among …

The Effect Of Palliative Care Nursing Education To Improve Knowledge In Palliative Care Of Hospital-Based Nurses Caring For Patients With Chronic, Serious Illness, Madelyn Rose Balicas, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Palliative care nursing provides care for the relief of pain and suffering throughout the course of a patient’s chronic, serious illness. Hospital-based nurses need to be equipped with palliative care nursing knowledge to provide optimal care for patients and their families to improve the quality of life. Lack of education in pain and symptom management and communication about goals of care can result in a suboptimal and high cost of care.

Objectives: To determine if a brief palliative care nursing education can improve the knowledge of hospital-based nurses about palliative care nursing.

Methods: A cross-sectional quantitative pre-posttest design used …

A Retrospective Study: Diagnosis And Treatment Of Depression In Breast Cancer Patients, Cheryl Ann Thaxton, Dnp

Doctor of Nursing Practice Projects

Background: One issue related to breast cancer diagnosis and treatment is the risk of depression.

Objectives: The purpose of this study is to examine ethnic differences and commonalties in the method of diagnosis and treatment of depression for female breast cancer patients.

Specific Aims: The study aims to examine the method of diagnosis and treatment of depression in Caucasian, Latino, and African American breast cancer patients.

Questions/Hypothesis: 1. Does the method of diagnosis and treatment of depression differ based on ethnicity? Hypothesis: Method of diagnosis and treatment will differ for Minorities as compared to Caucasians; 2. What percentage of patients …

Improving Primary Care Utilization For Transgender Patients At An Fqhc, Timothie J. Rochon, Dnp, Rn, Cnm

Doctor of Nursing Practice Projects

Background: Transgender and Gender-Nonconforming (TGNC) populations comprise approximately 6% of the U.S. population. Socially and within the medical treatment system TGNC individuals face widespread stigmatization and discrimination which negatively impacts their mental, physical, and emotional health and contributes to health disparities. Real and perceived barriers to safe and effective healthcare are worsened by the scarcity of primary care providers knowledgeable in caring for these populations.

Objectives: The aim of this quality improvement project was to examine the impact of inclusive gender-affirming integration on the utilization of preventive and primary care services.

Methods: A one group pre- and post-intervention design was …

Referral Patterns From Long-Term Care Services To Palliative Care: Perceptions Of Directors Of Nursing, Karen S. Sharrah, Dnp, Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: Palliative care referrals are important in long-term care facilities because they are the first step in generating the services that the patient may need. This study looked at the phenomena of how Directors of Nursing in long-term care facilities that had access to palliative care services determined if a referral was needed.

Objectives: The purpose of this study was to gain a deeper understanding of the decision- making process used by Directors of Nursing for referrals. The study’s aims were to determine what factors prompt a referral in long-term care settings. The primary research question was: How …

Missed Nursing Care Reported By Medical-Surgical Rns In A Community Hospital, Anne Schmidt, Dnp, Msn, Rn, Aprn-Bc, Cenp

Doctor of Nursing Practice Projects

Background: Missed nursing care is defined as any lapse in essential patient care. It is a previously studied, persistent phenomenon. If unrecognized, it can compromise patients’ recoveries, trigger adverse events, and increase healthcare costs.

Objectives: To examine the prevalence of missed nursing care reported by medical-surgical registered nurses (RNs) and contributing factors for its occurrence.

Methods: The project used a cross-sectional, correlational design. A convenience sample of 96 RNs, recruited from three medical-surgical units, completed the MISSCARE Survey between September and October 2017. An analysis of survey responses quantified the frequency, nature, and common contributing factors for care omissions. The …

Evaluation Of Disparities In Healthcare Experiences Between Racial Identities And Age Cohorts, Christopher Ruckman, Dnp, Mba, Msn, Rn, Cen

Doctor of Nursing Practice Projects

Background: Healthcare consumers have their own perspectives and expectations of what should occur during an encounter of care; these unmet expectations create healthcare disparities. However, there is limited data regarding healthcare experiences among racial and aging groups.

Objectives: To compare the physical and emotional responses of healthcare experiences among racial/ethnic and aged cohorts in the United States.

Methods: Applying a descriptive-correlational design, secondary data from the 2014 Behavioral Risk Factor Surveillance System related to healthcare experiences among racial groups (White, Black, Hispanic, and Asian) and aged cohorts (18-39, 40-54, and 55- 69 years) were assessed.

Results: In the sample, there …

Moral Distress In Registered Nurses, Yvonne Mcmillan, Dnp, Bsn, Msn, Np-C

Doctor of Nursing Practice Projects

Background: Moral distress occurs when one knows the ethically correct action to take but feels powerless or is unable to take that action. Although various sources and common clinical scenarios that often induce distress among registered nurses have been studied, most of the research was qualitative and there was limited evidence regarding moral distress and nursing practice factors.

Objectives: To assess the frequency and intensity of moral distress and compare critical care nurses vs. non-critical care nurses' total moral distress scores.

Methods: A cross sectional survey of 97 registered nurses was conducted through survey monkey. The MDS-R was used to …

Evaluation Of The Associations Between Unplanned Readmissions And The Lace Index And Other Variables, Cathy Stankiewicz, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: Unplanned readmissions, within 30 days following an inpatient hospital admission, are common and costly. Research has identified factors that predict readmissions, and predictive algorithms, such as the LACE index, have been studied and widely adopted by hospitals despite demonstrated variability in predictive ability.

Objectives: To examine the associations between unplanned readmissions and the LACE index, and other variables that reflect patient- and encounter-level factors not currently incorporated in the LACE index.

Methods: A retrospective analysis was conducted utilizing data from electronic health records of inpatients discharged from a large quaternary hospital located in the southeastern United States between January …

Pilot Study Of Anxiety, Depression, And Quality Of Life In Patients With The Diagnosis Of Metastatic Uveal Melanoma, Regine Nshimiyimana, Dnp, Bpharm, Fnp-Bc, Agacnp-Bc, Ocn, Aocnp

Doctor of Nursing Practice Projects

Background: Awareness of a patient’s anxiety, depression, and quality of life (QOL) in those with metastatic uveal melanoma (MUM) can influence care that meets patients’ bio-psychosocial-spiritual needs.

Objectives: To measure the level of anxiety, depression, and QOL in patients with MUM and explore differences by gender, age range, time to metastatic disease, and duration of illness since metastasis.

Methods: We used a descriptive-comparative survey design. Over three months, a convenience sample of 70 patients with MUM aged ≥ 18 years, treated at a Mid-Atlantic hospital were invited to complete a combined survey of the Hospital Anxiety and Depression Scale and …

Peer To Peer Review: Professional Development To Improve Feedback Skills And Self-Efficacy, Brittany H. Gnilka, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: Peer to peer review is the most essential form of peer review as it encourages nurses to evaluate the quality, safety, and effectiveness of nursing care amongst peers. Poor communication skills for providing feedback during peer review is a barrier identified in the literature, which can be addressed in professional development training.

Objectives: The purpose of this study was to evaluate the effect of communication-focused professional development sessions on the ambulatory care nurses’ perceived self-efficacy to successfully provide meaningful feedback during peer to peer review.

Results: The results showed a statistical significance difference between the mean pre and postGSES …