Medicine and Health Sciences Commons^™

Evaluating Patient Outcomes When Adding Licensed Practical Nurses To The Staffing Mix, Isabel C.M. Shephard, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: An incorporation of licensed practical nurses (LPNs) in the RN staffing mix was made in a small community hospital. Research shows that RNs at the bedside equates to less adverse patient outcomes such as falls, pressure ulcers and an increase on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Objectives: To evaluate the effects of incorporating LPNs in the staffing mix on the number of patient falls, pressure ulcers and HCAHPS survey results.

Methods: A Pre and Post study design was used to compare baseline data obtained four months prior to implementing and four months during …

Nurse Managers And Hospital Nurse Educators’ Views Related To The Knowledge, Skill And Attitude Requirements Of Newly Licensed Nurses In The Las Vegas And Salt Lake Valleys, Delos Jones, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: In 2017, approximately 230,569 new Registered Nurses (RNs) were licensed in the United States. Of these, over a quarter will leave their first position in less than a year. While 90% of academic leaders feel nursing graduates are ready for practice, only 10% of clinical leaders agree. Recent changes in health care, and an intensifying theory-practice gap hint that newly licensed nurses (NLNs) may not be equipped for today’s workplace.

Objective: This qualitative project asked, “What do nurse managers and hospital educators perceive as required knowledge, skills and attitudes (KSAs) for NLNs to ensure successful and safe orientation or …

Identification Of Risk Factors Associated With Falls In The Long Term Care Setting, Jacqueline L. Patel, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Falls threaten the safety of older adults in long term care (LTC).

Objectives: To assess environmental, clinical and pharmacological causes of falls as well as compare Fall Risk Assessment Score, Brief Interview of Mental Status (BIMS) score, Activities of Daily Living (ADL) scores, age and gender of residents with one fall, recurrent falls, and no falls.

Methods: Using a descriptive-comparative design, we included a convenience sample of 290 adults ≥50 years old at our LTC facility. Fall and recurrent fall groups were matched to those with no falls. We assessed environmental, clinical and pharmacological variables, Fall Risk Assessment Scores, …

Effectiveness Of Residency Training Programs For Increasing Confidence And Competence Among New Graduate Nurse Practitioners, Heather Parkhill, Dnp, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Nurse practitioners (NPs) are enrolling in post-graduate residency programs that provide training and mentorship during transition to practice.

Objective: This project explored whether participation in NP residency improved feelings of confidence, competence, preparedness to provide care and job satisfaction among new graduate NPs who completed a residency program compared to new graduate NPs who did not complete a residency program.

Method: This mixed-methods study collected survey data from NPs who attended the 2017 AANP National Conference and two residency programs. A modified Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) (Misener & Cox, 2001) and Hart’s New Nurse Practitioner Preparedness …

Associations Between Nurse Experience, Clinical Specialty Setting, And Level Of Nursing Education With Adherence To Clinical Practice Guidelines For Inpatient Influenza And Pneumococcal Vaccination Administration, Amy C. Alsante, Dnp, Ms, Rn, Ne-Bc, Chep

Doctor of Nursing Practice Projects

Background: This research project examines associations between years of nursing practice and compliance with clinical practice guidelines for inpatient influenza/pneumococcal vaccination administration. Previous research demonstrates novice nurses are at higher risk for errors of omission and face challenges with critical thinking.

Objectives: 1) Identify associations between years of practice and compliance with clinical practice guidelines for inpatient influenza/pneumococcal vaccination administration and 2) to identify associations among independent variables including levels of education, and specialty setting.

Methods: A retrospective chart review was conducted to identify associations between years of practice and compliance with clinical practice guidelines for inpatient influenza/pneumococcal vaccination administration. …

Shelburne And Clark’S Harbour Quit Smoking: A Community-Based Smoking Cessation Initiative Process Evaluation, Georgeann Lois Macdonald Mn: Dnp, Anp, Rn, Accn, Np

Doctor of Nursing Practice Projects

Background: The prevalence of Canadian smokers is 14.6%. Clark’s Harbour and Shelburne’s rate of smoking increased from 15.6% in 2012 to 19.4% in 2015 (Propel Centre for Population Health Impact, 2015). It was imperative that innovative ways be found to reduce the smoking prevalence.

Objectives: 1) Identify a difference in the participants’ Stages of Change before and after completing the smoking cessation program. 2) Determine whether the participants quit smoking 3) Assess whether there was satisfaction with the program.

Methods: In this one group pre and post-test design, the participants completed a series of pre and post program questionnaires. The …

Effects Of An Online Diabetes Self-Management Educational Class On Perceived Self-Efficacy In Patients With Type 2 Diabetes Mellitus, Samantha L. Sugarman, Dnp, Ba, Bsn, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Diabetes is a complex, chronic disease that, without adequate glycemic control, may result in avoidable complications. Without proper diabetes self-management education, achieving good glycemic control is difficult. Furthermore, lacking self-efficacy to perform such tasks may prevent even the most educated patients from achieving good glycemic control. Studies have shown that live diabetes education has improved self-efficacy in patients with diabetes, but few look at the effects of a lecture-style educational format in an online approach.

Objectives: The purpose of this study is to determine if an online, lecture-style diabetes self-management educational class will improve self-efficacy among patients with type …

Variables Related To Colon Cancer Screening Rates Among Male Veterans, Patricia D. Dotson, Dnp, Msn, Aprn

Doctor of Nursing Practice Projects

Background/Problem: The Center for Disease Control & Prevention (CDC) recommends colon cancer screening colonoscopy beginning at age 50 years and every 10 years thereafter. The purpose of this study was to compare differences in meeting the colorectal cancer (CRC) screening recommendations between male Veterans and non-Veterans and identifying any association among Veterans social economic status (SES).

Methods: A descriptive-comparative design was used to address the study question, aims and hypotheses, using the 2014 Behavioral Risk Factor Surveillance System (BRFSS) data. A national representative sample of 20,360 Veterans and 36,183 non-Veterans between 50-74 years, were included in analysis. The associations between …

Effects Of A Formal Educational Class On The Quality Of Life In Patients Diagnosed With Hypothyroidism, Tahimina Popal, Dnp, Bsn, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Hypothyroidism is a chronic disease that requires self-care skills such as healthy diet, exercise, and a daily medication regimen where timing of food intake is essential. Adequate education is essential for patients with hypothyroidism to be able to manage their disease, and to live with the best quality of life possible. Many studies have been conducted to assess the perceived health status of patients with hypothyroidism, but few have examined the effects of a formal educational program on the quality of life.

Objectives: The purpose of this study is to determine if a formal hypothyroidism educational class will improve …

Educating Oncology Nurse Practitioners To Provide Basic Palliative Care, Lynn Adams, Dnp, Ms, Anp-Bc, Aocn

Doctor of Nursing Practice Projects

Background: Approximately 1.66 million Americans are diagnosed with cancer each year and another 589,430 die from the disease. As treatment options have expanded, many cancer patients are living longer with worsening symptoms and disabilities and an increased illness burden. These patients are ideal candidates for palliative care. Palliative care involves care delivered by a team of clinicians with specialty training and a focus on improving the quality of life for patients with serious illnesses. A number of major organizations have made formal recommendations regarding the integration of palliative care into comprehensive cancer care including the American Society of Clinical Oncology …

Evaluation Of The Carestarttm Glucose-6-Phosphate Dehydrogenase (G6pd) Rapid Diagnostic Test At Community And Health Center Level, Cambodia, Bertha Nyagaya-Wojnarski, Dnp, Fnp-Bc, Mph

Doctor of Nursing Practice Projects

Background: Primaquine (PQ) is the only FDA-approved drug for radical cure of Plasmodium vivax (P.v) malaria, but treatment can result in life-threatening hemolysis if given to a glucose-6- phosphate dehydrogenase deficient (G6PDd) patient. Therefore, the G6PD status of the patient with P.v must be known prior to prescribing PQ. However, patient G6PD status in rural malaria endemic settings is generally unknown, illuminating the need for reliable point of care G6PD diagnostic tests as a prerequisite to safely administer PQ. To increase community PQ access in Cambodia, performance of CareStartTM G6PD rapid diagnostic tests (RDTs) needs to be evaluated in healthcare …

Incorporating Just Culture Principles Into Clinical Learning Experiences, Paula Gendreau, Dnp, Msn, Rn, Cne

Doctor of Nursing Practice Projects

Background: Although nursing student’s confidence regarding patient safety is influenced by both clinical faculty and environments in which they learn, faculty seemed to have the most influence in shaping student’s attitudes surrounding a culture of safety. Objectives: To explore and support faculty culture of safety practices that promote meaningful learning experiences for students surrounding patient safety in clinical learning environments.

Methods: An embedded mixed method design was utilized for this pilot study. Quantitative data was collected both pre- and post-semester utilizing an adapted Health Professional Education in Patient Safety Survey, and post-semester qualitative data further expanded on faculty perceptions and …

Effects Of A Phase Ii Cardiac Rehabilitation Program On Patient Depression, Michael R. Legal, Dnp, Msn-Ed, Rn, Ccrn-K

Doctor of Nursing Practice Projects

Background: Screening for depression upon intake and completion of a Phase II cardiac rehabilitation (CR) program may influence the type of interventions implemented by CR staff and reduce depression.

Objectives: We examined patients before and after a Phase II CR program who self-reported as depressed using the CES-D score and also assessed scores by procedure, gender and age. We further identified the types of interventions used for those who were depressed.

Methods: We conducted a pre-post intervention study. Using a convenience sample, data were collected on CES-D scores before and after the program and by type of procedure, gender, and …

Implementing The Coordinated-Transitional Care Program To Reduce All Cause Readmissions, Tonya Page

Doctor of Nursing Practice Projects

Readmission to an acute care hospital are common, costly, and frequently avoidable. Transitions of care are critical to quality, safe patient care and increases effective prevention of readmissions. Although there is an abundance of knowledge related to causes of hospital readmissions and the effectiveness of preventative measures hospital readmission continue to plague healthcare organizations. A review of the literature was conducted, and 11 studies were reviewed and analyzed. The literature review showed evidence to support implementing a telephonic post-discharge follow-up protocol as an effective intervention to reduce hospital readmissions. The purpose of this project was to implement a telephonic, protocol-driven …

Implementing An Evidence Based Fall Prevention Program In A Long-Term Care Facility, Annie Schweikert

Doctor of Nursing Practice Projects

Falls among the elderly are a significant problem with severe consequences. Residents of long-term facilities account for twenty percent of fatal falls. It is imperative that evidence-based practices be implemented at this level of care to address this problem. A multifaceted evidence-based fall prevention program was implemented at a 70 bed, skilled nursing, long-term care facility located in Florida, whose fall rate of 7.14 is above than the national average (2.74-5.48). The fall prevention program included staff education, implementation of a checklist for universal fall precautions, post fall huddles, and the appointment of a falls champion. One-month post intervention results …

Using An On-Line Educational Module To Increase Nurses' Conviction And Confidence In The Use Of The Teach-Back Method For Discharge Instructions, Allison S. Morrison

Doctor of Nursing Practice Projects

Health literacy status can affect an individual’s ability to self-monitor and manage chronic conditions. It is not uncommon for patients to have difficulty comprehending key patient instructions. The role of the nurse in the hospital setting encompasses many facets which include patient teaching. Providing effective patient teaching is one role that many nurses do not feel confident in implementing. A sample of (N=18) nurses participated in on-line educational program to improve conviction and confidence in use of the teach-back method for delivery of discharge instructions. A pretest-posttest design was utilized and measured nurses’ conviction and confidence using the Conviction and …

The Effect Of Ostomate-To-Ostomate Support On Psychosocial Adaptation To Stoma, Marjorie C. Summers

Doctor of Nursing Practice Projects

Approximately one million people in North America are living with an ostomy, and an additional 100,000 will undergo ostomy surgery annually. Persons living with ostomies, often referred to as ostomates, require specialized care and management to sustain physical health and quality of life. Fecal diversion ostomates, when compared to the general population, are more likely to experience psychological disturbance and higher levels of depression. These ostomates have reported increased loneliness, lowered self-esteem, decreased or absent libido, irritability, suicidal ideation, poor self-image, and symptoms of generalized anxiety disorder and social phobia. Being an ostomate has been associated with a reduction in …

The Effect Of Fall Prevention Education That Includes A Fall Safety Agreement On Fall Incident Rates, Rebecca Dotson

Doctor of Nursing Practice Projects

Patients experiencing falls while in the acute care setting is a challenge that plagues healthcare. In 2014, 29 million hospitalized patients fell causing 7 million injuries. Eighty-five percent or greater of unfavorable hospital occurrences are linked to falls. Falls occur regularly and can have detrimental effects both physically and psychologically. Literature reviews revealed encouraging results in relation to a reduction in falls with fall prevention education and the use of a fall safety agreement. The purpose of this project was to explore the effect of fall prevention education including a fall safety agreement on falls and falls with injury during …

Use Of The Coleman Transition Model To Reduce Copd Readmissions, Sara Briggs

Doctor of Nursing Practice Projects

This paper explores the use of the Coleman Transition Model as an evidenced based intervention to reduce 30-day readmissions of Chronic Obstructive Pulmonary Disease (COPD) patients on a pulmonary unit. Nearly 20% of Medicare beneficiaries are re-hospitalized within 30 days after discharge, resulting in an annual cost of approximately $17 billion. Hospitals can engage in activities to lower their rate of readmissions. The evidenced based intervention includes robust case management using The Coleman Transition Model in hospitalized COPD patients to reduce readmissions. COPD is a prevalent, complex, and costly condition to manage. COPD is now the third leading cause of …

Patient Deterioration Simulation Education And New Graduate Nurses' Self-Confidence And Competence, Heather B. Norris

Doctor of Nursing Practice Projects

Inconsistent identification and intervention for patient deteriorations has been identified as a global healthcare issue that has a profound effect on patient outcomes. Failure to rescue (FTR) rates are influenced by the quality of care a hospital provides in the event of patient deterioration. Rapid Response Teams (RRTs) are summoned to the bedside in the event of a patient deterioration to assess the patient and intervene quickly. Efficient use of RRTs prevents cardiopulmonary arrests and decreases hospital mortality, thirty-day morality, and length of stay. Patient deterioration simulation education can improve the use of RRTs and positively influence patient outcomes. New …

A Process Improvement For Depression Screening And Management In A University Health Clinic, Margaret H. Zoellers

Doctor of Nursing Practice Projects

Research indicates that among college students, there is a high prevalence of depression that is frequently undiagnosed and untreated, placing students at risk of impaired academic performance and suicidal behavior. The purpose of the evidence-based process improvement was: a) establish a depression screening and management protocol in the university health clinic, and b) increase university health clinic providers’ knowledge of evidence-based depression screening and management. Family nurse practitioner providers in the university health clinic (n=6) participated in a depression screening and management education program. Knowledge of evidence-based depression screening and management was measured prior to and after the program. A …

Care Coordination: Using A Nurse Navigator In An Endoscopy Unit, Judith L. Poe

Doctor of Nursing Practice Projects

Compliance with colorectal cancer (CRC) screening in Kentucky is low. This is substantiated by Kentucky having the highest rate of new CRC cases in the nation and being the fourth highest in CRC-related mortality. Kentucky’s colorectal screening rate in 2012 was 62.9%. The incidence rate for colorectal cancer in Kentucky is 49.2 per 100,000 which is the highest rate in the United States. Patient navigation has shown promise in increasing compliance with CRC screening and reducing health disparities. The adoption of a patient navigation model in an endoscopy unit can increase efficiency, reduce patient cancellations and same day no show …

Best Practices For Screening, Identification, And Referral Of Female Collegiate Athletes With Disordered Eating, Brenda Caudill

Doctor of Nursing Practice Projects

Eating disorders have the highest mortality rate of any mental illness, including depression. Female collegiate athletes are at greater risk compared to the non-athlete population. Athletic personnel should be prepared to screen, identify, and refer female athletes for eating disorders. However, most staff are not familiar with common signs and symptoms of disordered eating, which could delay recognition of unhealthy behavior and ultimately long-term health risks. Appropriate screening protocols can assist with early identification. The purpose of this DNP project was improve the knowledge of the athletic staff regarding eating disorder recognition, awareness of university policy for identification and referral …

Designing A Nurse Residency Program For Cultural Fit: A Pilot Project, Melinda Blair

Doctor of Nursing Practice Projects

New graduate registered nurse (NGRN) turnover in an acute care setting is estimated between 35% - 61% nationally and is costly to an organization. Costs are estimated between $60,000 – $90,000 dollars to replace one NGRN. A smooth transition from student nurse to professional nurse is fraught with problems, including increased job stress and pressures imposed on the NGRN from a high-paced, uncertain health care environment. The purpose of this project was to design a customized nurse residency program (NRP) curriculum to increase NGRN retention. NRP curriculum elements were identified using findings from the Casey Fink Graduate Nurse Experience Survey …

A Nurse Mentor Program In A Long Term Acute Care Hospital, Regina Masters

Doctor of Nursing Practice Projects

Nurse turnover is a national problem with the potential to affect quality of care and patient outcomes. A Long Term Acute Care Hospital (LTACH) with nurse turnover rates above the national average as high as 28% sought to address this problem. A review of the literature identified nurse mentor programs increasing registered nurse (RN) satisfaction and decreasing turnover. Therefore, the purpose of this project was to implement a mentor program for newly hired RNs. Mentors were paired with new RNs for a four-week program. Pre and post intervention data were collected via the McCloskey Mueller Nurse Satisfaction Survey (MMSS) and …

Medication Error Reporting To Improve Patient Safety, Dianna Madden

Doctor of Nursing Practice Projects

In 2006, the Institute of Medicine estimated that 1.5 million preventable adverse drug events occur in healthcare facilities annually (Institute of Medicine, 2006). Each ADE adds approximately $8,750 per hospital stay (Institute of Medicine, 2006). In 2017, the Food and Drug Administration (FDA) estimated that 1.3 million people are injured annually from medication errors (Agency for Healthcare Research and Quality, 2017). For the purposes of this project, all Registered Nurse staff on the Medical-Surgical unit were mandated to participate in an education targeted at medication error reporting, the importance of reporting, and a demonstration of inputting an error into the …