Medicine and Health Sciences Commons^™

Identifying Nurse’S Perspectives And Practices About Clinical Monitor Alarm Burden And Alarm Fatigue., Doreen M. Legere

DNP Projects

PURPOSE: To obtain insight into the nursing culture of the University of Kentucky Medical Center (UKMC) regarding alarm fatigue, measure nuisance alarm events, and identify the practices nurses at UKMC engage in to manage alarm pollution and mitigate alarm burden. Moreover, this practice improvement project identified how innovations like the introduction of a monitor watcher has impacted the rates of nuisance alarms and influenced nursing culture.

METHODS: A online survey based on the 2011 Healthcare Technology Foundation Alarms Survey (HTF) was sent to nurses in two intensive care units at UK Healthcare (UKHC). The results of the 2017 UKHC Alarm …

A Retrospective Comparative Analysis On The Effectiveness Of Pharmacologic Weight Loss, Emily Dunn

DNP Projects

PURPOSE:Obesity costs the U.S. roughly $147 billion in health care spending annually. There has been a call for healthcare providers to initiate all possible weight loss interventions. One treatment strategy not used to its fullest potential is that of prescribing antiobesity medications. The purpose of this project was to examine and evaluate the effectiveness of three common weight loss medications used in the treatment of obesity, including discussion and recommendations.

METHODS: This project was a single-center retrospective study comparing three different groups of patients seen at a rural weight loss clinic. The sample consisted of 84 patients seen between September …

Human Trafficking Awareness Pilot Project In Nursing Faculty And Senior Nursing Students In Western Kentucky, Kristin Reid

DNP Projects

PURPOSE: Human trafficking is an ongoing public health issue on a global and local platform. The care of victims is unique and multifaceted, with various physical and mental health care needs recognized. Human trafficking victims are often difficult to identify, as there have been reports that up to 88% of human trafficking survivors described encounters with healthcare professionals while they were being trafficked yet none were identified as victims (Office of Trafficking in Persons, 2017). This information places the healthcare provider at the forefront for advocating human trafficking victim identification and post identification care. The purpose of this project was …

Evaluation Of Risk Factors And Postoperative Outcomes In Surgical Laryngectomies With Intraoperative Hypothermia, Kristen V. Carter

DNP Projects

PURPOSE: The purpose of this study is to determine whether intraoperative hypothermia exposure would be identified as an independent risk factor for surgical laryngectomy patients’ rate of postoperative complications within their surgical admission. The findings would help to justify the institution of “pre-warming” laryngectomy patients to prevent detrimental effects postoperatively.

METHODS: Retrospective chart review of 245 patients who had laryngectomies at the University of Kentucky from 2010-2017. Rate of complication and variables predictability of postoperative complications was evaluated.

RESULTS: In the sample, 157 patients developed complications. Complications included 35 transpharyngeal fistulas, 29 free flap failures, 43 hematomas, 50 wound infections/ …

Evaluation Of Emergency Department Utilization Among Patients Who Have Primary Care Providers, Xin Zeng

DNP Projects

PURPOSE: High rates of emergency department (ED) use had little changes nationwide or in Kentucky after implementation of the Affordable Care Act. The Centers for Medicare and Medicaid Services have been calling for ways to reduce unnecessary ED usage. The purpose of this project is to identify factors associated with ED visits among adults in a primary care practice. The results are expected to serve as a needs assessment to determine ways for a primary care clinic to reduce inappropriate ED use.

METHODS A retrospective chart review was conducted to evaluate the ED use among 80 random selected adult patients …

Analysis And Evaluation Of Fall Incidence And Registered Nurse Documentation Of A Teach-Back Intervention At An Acute Care Hospital, Dawn M. Lechner

DNP Projects

PURPOSE: The purpose of this descriptive study was to examine the impact of a fall prevention quality improvement initiative on one unit of an acute care hospital (Hospital A). This multimedia initiative consisted of a video led fall prevention presentation with nurse-led scripted teach-back education on all newly admitted patients of one medical surgical oncology unit of Hospital A. Two objectives guided this study and included: Analyze adherence of a fall prevention education video and registered nurse led scripted teach-back intervention on newly admitted patients in the electronic health record; and Evaluate the impact of video education and registered nurse …

Evaluating The Relationship Between Phq9 And Global Pain Scale (Gps) Scores In Opioid Dependent Adults: A Retrospective Correlational Study, Lori Nolan

DNP Projects

Background: Depression, chronic pain and opioid dependence are conditions commonly encountered in primary care settings. These comorbidities create treatment challenges while negatively influencing outcomes of care. The Patient Health Questionnaire (PHQ9) and Global Pain Scale (GPS) are valid screening tools used to score depression and pain symptoms. The purpose of this study was to determine the relationship between the PHQ9 and Global Pain Scale (GPS) scores in opioid dependent adults with chronic pain to determine whether both tools are necessary.

Methods: This was a descriptive study using a retrospective correlational research design. Data was obtained from the electronic medical records …

Impact Of A Nurse-Physician Communication Intervention On Psychological Empowerment And Effectiveness Of Collaboration Between Medical Staff And Critical Care Nurses, Kristen Wieder

DNP Projects

Background: Nurse-physician communication is an essential element of safe, effective patient care, nurse engagement and job satisfaction. Communication breakdowns can lead to poor patient outcomes and disengagement among nurses.

Purpose: The purpose of this project was to determine the impact of a nurse-physician communication intervention on psychological empowerment of critical care nurses. A second purpose of the study was to evaluate the effectiveness of communication between critical care nurses and members or the cardiothoracic surgery team and understand barriers and communication challenges.

Methods: A quasi-experimental pre-test/post-test design was utilized to evaluate the impact of a nurse-physician communication intervention …

The Effects Of A Nurse Manager System Collaborative Council On Job Satisfaction, Intent To Leave, & Resilience, Heather Oliver

DNP Projects

Abstract

PURPOSE: The purpose of this project was to create a Nurse Manager System Collaborative Council (NMSCC) at Norton Healthcare and to determine the impact of participation in the NMSCC on job satisfaction, intent to leave, and resilience.

METHODS: This study employed a quasi-experimental, pre-test, post-test design to assess the effectiveness of the NMSCC at Norton Healthcare. Job Satisfaction was measured using the Warshawsky scale, Intent to Leave was evaluated using the Houser scale, and resilience was assessed using the Connor-Davidson CD-RISC scale.

RESULTS: Resilience increased after participation in the NMSCC for 6 months. Job satisfaction and intent to leave …

The Effects Of A Mentor Program On Burnout, Resilience, Work Engagement, And Turnover Intentions Of New Nurse Managers, Jennifer Thomas

DNP Projects

BACKGROUND: The nurse manager position is an instrumental, critical role in healthcare organizations. However, nurse managers often enter the role lacking necessary leadership skills. Mentoring may add additional support and guidance in navigating the nurse manager role.

PURPOSE: The purpose of this study was to evaluate the effect of a nurse manager mentor program including focused, developmental classes on nurse manager burnout, resilience, work engagement, and turnover intention.

METHODS: A quasi-experimental study, utilizing a pre-test/post-test design was completed to evaluate the impact of a mentor program on new nurse manager burnout, resilience, work engagement, and turnover intention.

RESULTS: Nurse manager …

Provider Adherence And Influencing Factors To Implementation Of An Alcohol Withdrawal Protocol, Ashley Sellers

DNP Projects

Abstract

PURPOSE: The purpose of this study was to assess provider adherence of an initial alcohol withdrawal protocol among adult inpatients, correlate outcome variables with protocol initiation, and examine the factors influencing provider decisions to implement all parts of the protocol.

METHODS: This multi-center descriptive evaluation utilized a retrospective medical record review and qualitative survey. A convenience sample of 313 inpatients represented 395 separate admissions between January and June 2018 in the four adult hospitals of a large health care system. Twenty-four providers participated in an anonymous online survey.

RESULTS: The protocol was implemented in its entirety three times (1%) …

Pilot Of An Educational Module For An Adolescent Congenital Heart Transition Program In The Pediatric Setting, Katie J. Dust

DNP Projects

Abstract

PURPOSE:The purpose of this project was to pilot an educational module on a new congenital heart transition program to be instituted at a large Midwest medical system.The transition program is meant to assist pediatric cardiology patients in transferring from pediatric to adult care. An educational module was developed for inpatient health disciplines who will be involved in the transition program. Before offering the program throughout the medical system, a pilot was conducted to determine if the education was at the appropriate level. The educational module was modeled after the Got Transition Six Core Elements designed by the National Health …

Does A Nonstandardized Lactulose Administration Practice Affect Hepatic Encephalopathy In Patients With Liver Disease In The Acute Care Setting?, Mary Broadbent

DNP Projects

PURPOSE: The purpose of this study is to examine whether inpatients with liver disease at University of Kentucky Hospital receiving lactulose are meeting the protocol of 2-4 bowel movements per day. Research shows that lactulose is the medication of choice used to treat and prevent hepatic encephalopathy (HE). Additional lactulose interventions, a patient’s MELD score, and GCS score will be examined in this study as well. This information would be beneficial to providers and nurses because it would provide data on patients who might require more lactulose interventions than others.

METHODS: Retrospective chart reviews of 70 inpatients with liver disease …

The Effect Of A School-Based Health Center On Access To Care In A Rural Community, Macey Cornwell

DNP Projects

BACKGROUND: Lack of access to healthcare is a nationwide issue that affects underserved, minority, and rural populations. School-Based Health Centers (SBHCs) is one way to help increase access to care for students, staff, and family members.

PURPOSE: The purpose of this project was to provide preliminary data on the impact of a SBHC in a rural Kentucky community on access to care and school attendance.

METHODS: A univariate descriptive analysis was conducted to evaluate the perceived impact of the SBHC on access to care and demographic factors. Data was analyzed using Pearson’s Product Moment Correlation, two-sample t-tests, and The Wilcoxon …

Gait Ataxia And Posterior Circulation Stroke Recognition: Emergency Department Patients With Subjective Dizziness, Jessi Petty

DNP Projects

PURPOSE: The purpose of this study was to evaluate and describe any correlations between subjective dizziness, gait ataxia, and posterior circulation stroke in the setting of gait assessment as an evidence-based standard of care in the emergency department.

METHODS: This study was a two-center, descriptive, retrospective and prospective medical record review. The sample consisted of adult patients presenting to the emergency departments at two tertiary facilities within a large metropolitan healthcare system with chief complaints of subjective dizziness. The study period was February 1, 2018 through July 31, 2018. The data set was retrieved via data retrieval specialists.

RESULTS: A …

Evaluation Of Aprn Transition To Practice Program, Frances Hines

DNP Projects

The purpose of this quality improvement project is to evaluate the newly implemented APRN Onboarding Model. The Onboarding pilot began in the summer of 2018. This project focused on the second offering (pilot) of the onboarding program which occurred in June of 2018. The APRN participants of the onboarding consisted of newly hired APRN’s into Norton Healthcare. Both Adult-Gerontology Acute Care Nurse Practitioners and Family Nurse Practitioners were included in this program evaluation. For this program evaluation a single survey instrument was developed to measure participants demographic, educational and work experience. Additionally perceptions of their level of confidence and self-efficacy …

Retrospective Chart Review Of Abnormal Lab Results In The Primary Care Setting, Derek Summers

DNP Projects

PURPOSE: The purpose of this project was to perform a needs assessment to determine if there was a delay in addressing abnormal lab results. The objectives were: 1) to determine the amount of time it takes for providers to address abnormal lab results in the ambulatory setting at an ambulatory setting within a Southeast Health Care System and 2) evaluate the alert and order set system for abnormal lab results of thyroid stimulating hormone, lipid panels, and hemoglobin A1C.

METHODS: A retrospective chart review was performed to determine the time it takes for primary care providers to address or follow …

An Assessment Of Potentially Inappropriate Medications Among The Elderly And The Effect Of An Educational Intervention On Provider Knowledge Of These Medications, Amanda Brown

DNP Projects

Objectives: The aims of this study were to assess potentially inappropriate medications (PIMs) or Beers medications among outpatient older adults within one Midwestern healthcare system, to determine rates of patient education on Beers medications, and to pilot an educational intervention for providers.

Methods: This study involved two parts. For part 1 of the study, a randomized retrospective chart review of 493 older adult patients seen in 2017 from four practices was conducted to assess Beers medication prescriptions and rates of patient education. Following the chart review, for part 2 of the study, an educational intervention was delivered to two providers …

Appraisal Of Depression Among Individuals With T2dm Not On Insulin Therapy, Beverly Woods

DNP Projects

Abstract

BACKGROUND: Type 2 diabetes (T2DM) is a complicated disease process that affects more than 15 percent of adults in the state of Kentucky, with a national average of 9.4%. Individuals with diabetes are at increased risk for micro and macro neurovascular complications. Depression is a common co-morbidity and potentially affects their ability to manager this complex disease.

PURPOSE: The purpose of this study was to examine the prevalence of depression in a group of patients with T2DM, not on insulin therapy. Further, relationships between depression and blood glucose monitoring, Hgb A1c, other co-morbidities, number of medications taken, and demographics …

Evaluating The Need For A Family Nurse Practitioner Fast Track As An Alternative To The Emergency Department, Anna Czartorski

DNP Projects

PURPOSE: Emergency Departments (ED) are a vital part of healthcare and they provide lifesaving services to patients that are acutely ill. However, the latest data shows that 42% of ED visits are related to medical complaints that can be managed by a primary care provider (PCP). The purpose of this study was to assess the need for a fast track within a midwestern suburban Emergency Department (ED) that is based upon the Family Nurse Practitioner (FNP) fast track model.

METHODS: This study was a descriptive study examining the usage of the ED for non-urgent medical complaints from January 1 …

Assessing And Evaluating Health Literacy Practices In The Ambulatory Setting, Anne Marie Koch

DNP Projects

Purpose: The purpose of this study is to assess health literacy knowledge and practices among ambulatory care providers who care for patients with type 2 diabetes.

Methods: Healthcare professionals who provide diabetes care and education were invited to participate in a health literacy education session with a pre and post-intervention knowledge survey. A retrospective chart review was conducted to evaluate health literacy practices in three PCP and three endocrinology offices. An evaluation of health literacy practices was used to compare PCP and endocrinology practices and determine if health literacy practices correlated to controlled hemoglobin a1c values.

Results: …

Tne Effect Of In Our Own Voice On Stigma In Bsn Students, Stephanie Steele

DNP Projects

Stigma regarding mental illness is common throughout the world, and can lead to social isolation, low self-esteem, loss of income and employment, deterioration of life quality, impeded access to medical care, and a shorter lifespan for people diagnosed with a mental illness (Cleary, Deacon, Jackson, Andrew, & Chan, 2012; Corrigan et al., 2013). The purpose of this DNP project was to provide an evidence-based intervention called In Our Own Voice (IOOV) to first semester sophomore nursing students and assess its impact on their perceptions of mental illness stigma. Alterations in stigma were assessed through the Attribution Questionnaire-27 administered to students …

Dyslipidemia Screening In Children Between The Ages Of 9 And 11 Years: An Evidence-Based Approach, Meredith Toms

DNP Projects

PURPOSE: The purpose of this study is to examine the outcome of healthcare provider education on the incidence of dyslipidemia screening in a pediatric primary care clinic.

METHODS: The design of this study was a descriptive pre and post design to evaluate if dyslipidemia screening rates, knowledge, and self-efficacy of healthcare providers changed following an education series at a general pediatric clinic in Lexington, KY. The rates of dyslipidemia screening were calculated prior to providing provider education as well as afterwards to see whether there was an improvement in screening rates. Provider’s knowledge and confidence before the education series was …

An Assessment To Determine The Need For A Palliative Care Team To Improve Patient Satisfaction And Decrease Healthcare Costs, Nathalie Weis

DNP Projects

Abstract

Objective: The purpose of this project was to determine if there is a need for a palliative care team (PCT) to which primary care medical professionals can refer patients. The specific objectives of this project were: 1. To assess the knowledge of primary care providers regarding palliative care. 2. To assess the value and need for palliative care from the PCPs’ perspective. 3. To evaluate the current ED utilization data for adults with serious chronic illness.

Methods: This was a descriptive study that involved an analysis of ED visit data for chronic illness, and a survey all …

Evaluating The Effect Of A Nurse Navigator In Increasing Colorectal Screening, Christine Njogu

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a nurse navigator in increasing colorectal (CRC) screening in primary care setting.

METHODS: This was a descriptive retrospective study of the effect of nurse navigators in increasing colorectal screening in primary care settings within Jefferson county and its surrounding counties. The sample consisted of 200 patient chart reviews for the period of September 1st through December 31st, 2017. Rates of colorectal screening were compared in those who received a nurse navigator call and those who did not.

RESULTS: Overall screening rates were 44.6%. A distinct increase in screening …

The Evaluation Of The Impact Of Controlled Substance Patient Education In The After Visit Summary On Patient Knowledge Of Controlled Substance Medication, Marie Honeycutt

DNP Projects

The use of opioids is associated with risks for misuse, abuse, addiction and diversion, which are directly related to increased healthcare utilization, increased healthcare cost, and poor patient outcomes. The purpose of this study was to evaluate the impact of controlled substance (CS) patient education that was implemented into the electronic medical record. The objectives were to 1.) assess whether patients received the CS after visit summary (AVS) and 2.) assess differences in pain management knowledge between those who received the AVS and those who did not. Methods This descriptive correlational designed study examined the differences in pain management knowledge …

An Examination Of Primary Care Providers’ Assessment And Plan Of Care For Children And Adolescents Who Are Overweight Or Obese, Kevin Pinto

DNP Projects

Background: Childhood and adolescent obesity rates have more than tripled since the 1970s. Currently in the United States, one in five children is obese (6-19 years of age). It is important to identify children and adolescents who are overweight or obese because early intervention may help to reduce the long-term implications of obesity. The purpose of this project was to examine how often pediatric primary care providers diagnosed overweight or obesity and created a plan of care for children 6-17 years of age who were overweight or obese. Facilitators and barriers to diagnosing and creating a plan of care were …

A Process Improvement Project To Increase Referral And Documentation Rates For Diabetic Retinopathy Screening, Debra Ann Bryant Taylor

DNP Projects

Abstract

Background: Approximately 5.3 million Americans, aged 18 and over, carry a diagnosis of diabetic retinopathy (DR). By the year 2050 this number is expected to triple without effective healthcare intervention. Approximately 4.8% of the global blindness is attributable to DR, a silent, progressive, microvascular complication of diabetes. Best practice dictates immediate screening at time of diagnosis of Type II Diabetes Mellitus (T2DM) and biennial screenings thereafter, yet this need is often unmet.

Purpose: This study is a continuation of a process put into place by Dr. Michelle Campbell in October 2017 at the Norton Community Medical Associates Mount Washington …

Evaluation Of The Crafft Substance Use Screening Tool In Primary Care, Leanne Coleman

DNP Projects

PURPOSE: The purpose of this research study was to evaluate the use of the CRAFFT tool within a pediatric primary care setting. The specific objective was to assess the frequency of documentation of substance use screening, counseling, and/or intervention before and after the implementation of the CRAFFT tool.

METHOD: The practice site chose to implement an evidence based adolescent substance use screening tool (CRAFFT Tool) to improve practice. This practice improvement project utilized a descriptive design with a review of electronic medical records before and after a substance use screening tool was implemented. Two hundred medical records were reviewed, 100 …

The Effect Of A Provider Education Program On Tobacco Use In An Adult Population In The Primary Care Setting, Sunita Gurung

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effectiveness of an education session to promote adherence to the United States Preventive Services Task Force (USPSTF) recommendation and Clinical Practice Guidelines for Treating Tobacco Use and Dependence by providers.

METHODS: A retrospective and prospective record review was used to evaluate an education session for providers in tobacco use screening, providing cessation counseling, prescribing medication for tobacco cessation, and sending out referrals for tobacco cessation at one primary care clinic in Louisville, KY. Education sessions were held from August 1, 2018 to August 14, 2018. The sample consisted of 200 …