Medicine and Health Sciences Commons^™

Implementing Ethics Education For Nurse Managers, Mona L. Lateyice, Rachel E. Marzec

Doctor of Nursing Practice Scholarly Projects

Background: Every day, nurses are faced with making decisions for patient care and may come across complicated ethical decisions. Ethical practice is essential in every health care organization in providing care and how they conduct themselves (ANA, 2015). Nurse managers are responsible for ensuring ethical standards are met by nursing staff.

Problem: Nurse managers are faced with ethical problems more than fifty percent of their work time (Aitamaa, 2019). There are studies that show nurse managers and nurses have difficulty solving ethical problems because they lack understanding of ethical principles (Huang, et al., 2020). Evidence shows nurses are deficient in …

Referral Triage To Improve Neurology Access, Melinda Mata

Doctor of Nursing Practice Scholarly Projects

The demand for neurology consultation far outweighs the number of specialists, thus causing long wait-times for consultation. Other contributing factors to obtaining timely consultation include, quality of information sent with the referral, insurance authorization, triage process, and appointment availability. This retrospective quality improvement study explored the effects of a referral triage process on reducing appointment wait time. All referrals were sent to one fax number and a new standard referral and triage process was implemented with specific operators with defined roles and responsibilities. The initial results following intervention implementation did not show improvement in wait times. Comparing the new triage …

Telehealth Monitoring For Non-Hospitalized Covid-19 Positive Patients In A Rural Setting, Rebekah Leann French

Doctor of Nursing Practice Scholarly Projects

Purpose

This quality improvement project evaluates the efficacy of an outpatient COVID-19 telehealth monitoring program intended to increase access to care, decrease emergency room/urgent care visits, and hospital admissions among telehealth observed adult patients in a rural area while providing safe home monitoring during acute illness.

Rationale/Background

Prior to COVID-19 pandemic, healthcare systems within the United States encountered several challenges including healthcare inequality and decreased healthcare access, particularly in rural communities. These gaps became more apparent when a novel COVID-19 pandemic emerged straining healthcare systems in the United States and throughout the world. Challenges ranged from overwhelmed emergency room (ER) …

Evaluation Of An Educational Intervention For Patients Undergoing Radical Cystectomy, Lisa D. Hendle

Doctor of Nursing Practice Scholarly Projects

Preoperative anxiety can increase stress and cause complications for patients who have upcoming surgery. This project evaluated the effectiveness of an educational intervention of a 4-minute video and opportunity to ask questions after had on the patient’s preoperative anxiety levels prior to radical cystectomy with ileal conduit creation surgery. This project had a small sample size of 5 but found that the educational intervention did create a significant decrease in the average anxiety score reported by the patients scheduled for radical cystectomy with ileal conduit creation surgery (p=0.018). It is unclear whether the intervention itself or the extra time spent …

Perceptions Of Nursing Staff On Restraint Alternatives, Adelia S. Perea

Doctor of Nursing Practice Scholarly Projects

Physical restraint is often used as a nursing intervention for patients with behavioral issues despite current evidence that indicates their use is actually more harmful than helpful. Nursing staff at UNMH are required by policy to use other methods such as restraint alternatives before placing patients in restraint. However, they do not have the necessary resources or tools to comply with the policy. The NPCU conducted a quality improvement project that introduced 5 restraint alternatives followed by a survey focused on nursing perceptions. The results revealed 2 alternatives (Gamewright GoPOP sensory toy & Playtivity sensory disc) were perceived by nursing …

Do-Not-Hospitalize Orders In Assisted Living Facilities: Perspectives From Direct Care Workers, Alanna Kates Dancis Dr.

Doctor of Nursing Practice Scholarly Projects

Context: Do-not-hospitalize (DNH) orders in assisted living facilities (ALFs) are often misunderstood, ignored, or countermanded by direct care workers (DCWs), potentially leading to residents being sent to the hospital against their wishes.

Objectives: The primary purpose of this study was to gather sufficient qualitative data to create an intervention that would help prevent DCWs from sending residents with DNH orders to the hospital against their wishes. To accomplish this goal, the study centered on three research objectives: 1) to understand more fully how DCWs interpret DNH orders; 2) to determine if carrying out DNH orders causes moral distress for DCWs; …

Does Nurses Confidence Improve After Attending A Training For Teaching Home Infusion Patients?, Carol Menorah Young Dnp

Doctor of Nursing Practice Scholarly Projects

Discharge can be a difficult step for patients and their families and a challenging task for nurses. Poor instructions have a negative impact on the patient population. In addition, improper and incomplete discharge information negatively affects the posthospital recovery period and may cause the patient to return to the hospital for the same episode of care. Returning to the hospital emergency room or readmission for the same episode of care will increase the dangers to the patient’s health and recovery plan and increase the cost of individual healthcare. The patient population ranks the quality of discharge information via their responses …

The Use Of Appreciative Inquiry In Identifying Pueblo Core Values, Kristyn N. Yepa

Doctor of Nursing Practice Scholarly Projects

This study used appreciative inquiry to identify core values or concepts essential to the Jemez Pueblo community to inform an evaluation framework used by community strength-based programs in Jemez Pueblo. Key informant interviews and a focus group were conducted in Jemez Pueblo with key program staff and tribal leaders. The audio recordings were transcribed and analyzed using inductive reasoning to identify core values. In addition, grounded theory was used to develop a conceptual model from the themes generated from the analysis. The PICOT question was, "Can the Appreciative Inquiry method help uncover core values of a Pueblo community?"

Nurse Driven Antibiotic Stewardship, Dr. Judy Liesveld R. White

Doctor of Nursing Practice Scholarly Projects

Abstract

Antibiotic use has increased tremendously and has led to antimicrobial resistance. Because it is a growing problem across healthcare systems around the world, healthcare systems and organizations must combat the detrimental effects of inappropriate use of antibiotics. The development of antibiotic stewardship programs is crucial to providing high quality, safe patient care. The work ofthis project intends to form a basic understanding ofa nurses' role as a member of the antibiotic team. Most healthcare systems have operated by a pharmacy driven antibiotic team concept and have just recently included nurses as a missing component to a full functioning team. …

Nurses In New Mexico: Their Awareness Of Safe Harbor As Reflected In A Survey During A Time Of Covid-19, Ashley R. Gonzales

Doctor of Nursing Practice Scholarly Projects

The healthcare industry is highly regulated to ensure patients receive safe, high-quality, patient-centered care. Even with these regulations, patient outcomes remain poor, given the high expenditure and percentage of the gross domestic product that healthcare comprises in the United States. Nurses make up the largest proportion of the healthcare field and are often overlooked when it comes to policies to ensure their practice remains safe and licenses protected. Nurses are the eyes and ears of their board-certified providers and detect subtle changes in a patient’s condition. However, such attention to detail can be executed only when the nurses can care …

Nurse Job Satisfaction In The Midst Of A Pandemic, Reynaldo Gonzales

Doctor of Nursing Practice Scholarly Projects

Strategies and intervention for nursing recruitment and retention are critical needs at the hospital unit management level especially during this time of coronavirus disease of 2019 (COVID-19) pandemic.

Research Question: What are the unit-levels of nurse job satisfaction among eight satisfaction dimensions (i.e., satisfaction with extrinsic rewards, scheduling, family/work balance, co-workers, interaction, professional opportunities, praise/recognition, and control/responsibility) in an acute medical-surgical unit?

Objectives The objective of this project is to systematically obtain unit-level input to explore nurses’ views and experiences as it relates to job satisfaction.

Methodology: This is a descriptive cross-sectional convenience study measuring job satisfaction among Registered Nurses …

Hepatitis C Screening, Confirmation, And Referral Improvement Project, Maria E. Mcmahon

Doctor of Nursing Practice Scholarly Projects

Hepatitis C is an illness caused by the blood-borne Hepatitis C virus (HCV), and usually becomes a chronic condition. Left untreated, HCV can lead to severe liver disease and liver failure. Newer treatments are effective and well tolerated, but most people with chronic HCV are not accessing treatment due to several factors that will be discussed. The primary objectives of this quality improvement project were to improve the treatment cascade, provide education to providers and patients, and facilitate screening, virus confirmation, and referral to treatment, in a Federally Qualified Health Center.

The Effects Of A Formal Organizational Program On Nursing Supervisor Self-Perception Of Leadership, Jonathan Allen Judy-Del Rosario

Doctor of Nursing Practice Scholarly Projects

Nursing house supervisors oversee hospital operations during evenings, nights, weekends, and holidays, yet many feel disconnected from others in the nursing leadership team. These individuals work as the sole leader on duty, having limited interaction with the daytime leaders and often lack formal leadership development. This quantitative, quasi-experimental study explored the effects of implementing a formal educational and team building program on the perception of the supervisor’s leadership skills as well as collaboration with the leadership team. The Leadership Practices Inventory and the Collaborative Behavior Scale – Shortened were the two surveys administered to assess the effects of this program. …

Trauma Center Development Improved New Mexico Trauma System By Decreasing Inappropriate Air Medical Transport And Increasing System Revenue, Nikki L. May

Doctor of Nursing Practice Scholarly Projects

Before 2016 in southern New Mexico, the closest trauma center for patients was El Paso, Texas. Las Cruces, New Mexico, in Doña Ana County began developing its first trauma center in 2016 and became designated in 2017. The development of this trauma center changed trauma triage destination protocols for trauma patients. The improved collaboration and teamwork with prehospital personnel, surrounding hospitals, and existing trauma centers led to the development of trauma triage and transport guidelines. These protocols categorized trauma patients and constituted a guide for emergency personnel. Developing a trauma center in Doña Ana County improved the New Mexico Trauma …

Limiting Potentially Inappropriate Medications In Long-Term Care, Clare M. Ironside

Doctor of Nursing Practice Scholarly Projects

Aim: This project aimed to assess the effectiveness of the STOPP/START tool in identifying and reducing potentially inappropriate medications among multi-morbid, older, long-term care residents in a metropolitan area of a Southwestern state.

Design: In this quality improvement project, seven prescribers working within four long-term care facilities were trained to assess for potentially inappropriate medications using the STOPP/START tool. The medication lists for long-term care residents (n =45) over age 65 were collected at baseline and again at three months post-intervention and assessed for overall medication use, psychotropics, and proton pump inhibitors. The project also assessed prescribers’ comfort and …

Comparing An Evidence-Based Screening Tool To Standard Substance Abuse Screening Questions In Identifying Pregnant Women At Risk For Substance Abuse, Nicole Y. Romero

Doctor of Nursing Practice Scholarly Projects

The purpose of the study project was to compare a nonspecific substance screening questionnaire with a well validated, evidence-based substance screening tool designed specifically for the pregnant population Evidence has shown use of an evidence-based screening tool improves maternal and fetal outcomes and reduces the risk of missed cases, stereotyping, and stigma. This study project utilized the social learning theory model, which defines human behavior as a reciprocal, continuous interaction among cognitive, behavioral, and environmental determinants. A pilot observational study project was conducted within a focal organization in a specified women’s health clinic over a 12-week period comparing their currently …

Chemotherapy Instruction Improvement Project, Lori A. Lelii

Doctor of Nursing Practice Scholarly Projects

Purpose

The project aimed to evaluate nursing satisfaction after implementing a standardized chemotherapy patient education program. The project tracked patient satisfaction scores on the Press Ganey® survey to identify changes.

Rationale/Background

Patients receiving chemotherapy for the first time have significant educational needs. Nurses are concerned about their patients because of the complexity of chemotherapy treatment and potential for complications related to inadequately managed side effects. There is limited information available to guide nurses on best approaches to prepare clients for chemotherapy.

Theoretical framework

This project was conducted using a Plan, Do, Study, Act approach under the modern change theory.

Methodology …

Biopsychosocial Multidisciplinary Treatment Impact On Risk Of Opioid Misuse, Michael A. Palacio

Doctor of Nursing Practice Scholarly Projects

From 1999 to 2014, over 165,000 persons in the United States died from an overdose related to prescription opioids (Centers for Disease Control and Prevention [CDC], 2016). In response, the CDC released guidelines that propose nonpharmacologic and nonopioid pharmacologic therapy as preferred methods for chronic pain control (Dowell et al., 2016). The purpose of this project was to examine the biopsychosocial multidisciplinary treatment impact on risk of opioid medication misuse among adult chronic opioid-dependent noncancer pain clinic patients with and without a psychiatric disorder. Engel’s (1977) biopsychosocial model was used to evaluate whether multidisciplinary treatment impacted the risk of opioid …

Attitudes Towards Treating Injured Patients In Urgent Care, Erin Beverly

Doctor of Nursing Practice Scholarly Projects

There has been published literature on the topic of clinician bias and the effects of bias on patient care, however, a review of the literature did not yield any research on the topic of clinician bias towards treating patients injured in motor vehicle accidents (MVA’s). There has been concern about clinicians not preferring to see patients injured in MVA’s however this is only anecdotal. If this topic is to be addressed through quality improvement efforts, there should first be scholarly evidence to support these efforts. This study employed a prospective survey of a convenience sample of clinicians who practice in …

Identification Of Variables For Hemoglobin A1c Prediction, Erica A. Richards

Doctor of Nursing Practice Scholarly Projects

An evolution in healthcare is taking place throughout our country. Healthcare providers are required to achieve an ever-growing number of regulatory and metric-driven standards. This transformation aims to improve both the quality and cost of healthcare in the United States. Diabetes mellitus (DM) is one of the most costly chronic diseases in the United States. Since DM has high mortality, high morbidity, and low quality of life rates, it is no wonder that DM is one of the focuses of the National Committee for Quality Assurance performance improvement tools known as the Healthcare Effectiveness Data and Information Set (HEDIS). In …

Nurse Educators Influence On Student Success, Callie Whittington

Doctor of Nursing Practice Scholarly Projects

Passing nursing licensure exams is important to promising nurses. The number of times a graduating nursing student must take The National Council Licensure Examination-Registered Nurse (NCLEX-RN), reflects upon the institution of higher education as a gauge of the quality of their training programs and preparation. Student outcomes are very important to overall standing of the nursing programs, as the first attempt NCLEX-RN pass rates affect status of the nursing program. The nurse educator’s role in student success is vital and the level of education for the nurse educator can play a valuable part in this as well.

The researcher of …

Understanding The Prevalence Of Compassion Fatigue, Compassion Satisfaction, And Resilience In Primary Care, Christina M. O'Connell

Doctor of Nursing Practice Scholarly Projects

Compassion fatigue (CF), its components of burnout (BO) and secondary traumatic stress (STS), and compassion satisfaction (CS) affect healthcare providers and staff and can dramatically influence patient care and access to primary care services. Resilience is a tool which serves as a protective factor that can mitigate CF and enhance CS. There is a gap in research regarding the relationship between compassion fatigue, compassion satisfaction, and resilience among primary care providers and frontline staff. Additionally, the current COVID-19 pandemic has revealed healthcare’s deficits related to staff and provider burnout, a myriad of workforce safety issues, disparities in care, and a …

Perceived Critical Success Factors For Native American And Non-Native American Pre-Licensure Nursing Students In Northern New Mexico, Karen E. Nielsen

Doctor of Nursing Practice Scholarly Projects

Considering the consistent healthcare system load demands, nursing shortages persist, especially in remote areas of the United States. It is vital that students interested in attending nursing school and working in their home communities have expanded nursing program access and supports in order to supply the necessary nursing workforce in remote areas. Lack of diversity in the nursing profession weakens healthcare delivery. Native Americans are underrepresented as nursing students and employed nurses. Measures to provide a more diverse workforce should concentrate on recruitment, retention, and graduation rates of underrepresented minority nursing students. Limited research is available surrounding Native American nursing …

Standardizing Assessment And Management Of Ankyloglossia, Marcia Nicole Cowen

Doctor of Nursing Practice Scholarly Projects

Ankyloglossia, which is characterized by a short, tight or thick lingual frenulum, can negatively impact breastfeeding. It has been recognized as a problem for centuries. Frenotomies have traditionally been performed to remove the lingual frenulum when indicated. The use of frenotomies and a focus on ankyloglossia fell out of favor in the twentieth century with renewed attention in the past several decades. Limited high-quality studies have been undertaken on ankyloglossia. There remains no standardized diagnosis or management recommendations. In efforts to promote a standardized approach that is based on current knowledge, this study will involve an educational in-service on ankyloglossia, …

Improving End-Of-Life Care On Navajo Through Education, Johanna G. Bahe

Doctor of Nursing Practice Scholarly Projects

End-of-life care (EOLC) is an essential component of comprehensive healthcare and has been shown to improve the quality of life of patients and their families by preventing and relieving pain caused by physical, psychosocial, and spiritual complications. Many rural communities lack access to EOLC, specifically certified palliative and hospice services. The lack of this specialty in rural areas directly affects the experience of healthcare staff. The absence of education for rural healthcare staff and the importance of culturally sensitive care among indigenous people are key concepts in this study.

The purpose of this study was to measure the knowledge, confidence, …

Value-Based Purchasing: Does Educating Direct Care Nurses Result In Value-Based Care?, Ryan Levi

Doctor of Nursing Practice Scholarly Projects

The United States health care system is undergoing the greatest transformation in the country’s history. Health care is rapidly moving away from volume-based reimbursement towards value-based models. The Hospital Value-Based Purchasing (VBP), a Center for Medicare and Medicaid pay-for-performance program, makes Medicare reimbursement contingent on performance in four quality categories. Clinical care, person and community engagement, safety, and efficiency determine an organization’s total performance score (TPS), which is used to impose positive, negative, or neutral payment adjustments. Nursing, more than any other health care profession, impacts hospitals’ TPS and subsequently Medicare reimbursement under VBP. While the literature indicates nurses should …

Transitioning From Experienced Nurse To Resident In Blended Cohort Transition-To-Specialty Nurse Residency Programs, Rachael Frija

Doctor of Nursing Practice Scholarly Projects

Recommendations from the Institute of Medicine promote nurse residency programs for experienced nurses (EN) transitioning to new areas of specialty. A large non-profit healthcare system in the Southwest implemented three Transition-to-Specialty (TtS) residency programs using a blended cohort approach consisting of graduate nurses (GNs) and ENs. Upon review of program outcomes, ENs reported to have higher attrition rates than their GN counterparts. Given the substantial pecuniary loss related to EN turnover, understanding the ENs’ perspectives to achieve successful role transition to a new area of specialty is critical to a successful program. This qualitative descriptive study sought to describe the …

Gastrostomy Tube Complications And Management, Deborah J. Garcia

Doctor of Nursing Practice Scholarly Projects

The avoidable complications of clogging and dislodgement of gastrostomy tubes (g-tubes) place a tremendous burden on patients, caregivers, healthcare providers, and the entire medical system. These complications are associated with $130 million in healthcare utilization each year. Insufficient education of patients and personal caregivers regarding the prevention of complications of clogging and dislodgement of g-tubes is identified as a major barrier. Preintervention and postintervention education program models were established, which include a preprocedure clinic visit with education as well as scheduled follow-up phone calls. A chart review and follow-up phone call was used to evaluate the effect of providing consistent …

Identify The Qualifications, Major Duties, Responsibilities And Expected Outcomes For The Chief Experience Officer Among Health Care Systems In The United States, Kathleen D. Davis

Doctor of Nursing Practice Scholarly Projects

The Chief Experience Officer (CXO) role has emerged in health care in the last five to ten years. There is an absence of role descriptions, qualifications, duties, expected outcomes and reporting structures available in the literature. Most of the available information are reports from private organizations like the Experience Innovation Network, The Beryl Institute (TBI), Catalyst Healthcare Research (CHR) and The Health Care Advisory Board (Boehm, 2015; Boehm & Petty, 2016; Lauing & Woods, 2015; Palmer & Prince, 2013; The State of the Patient Experience, 2015; Wolf, 2015; Wolf & Prince, 2014) who produce information for members and are not …

The Costs And Benefits Of Outsourcing Marketing, Student Recruitment And Retention Services In An Online Rn-To-Bsn Program, Jacqueline M. Wuellner

Doctor of Nursing Practice Scholarly Projects

ABSTRACT

In 2010, the Institute of Medicine advised that by 2020, 80% of working nurses should have at minimum a baccalaureate degree. Across the country, the profession will fall short of that goal. In New Mexico, the numbers of associate degree nurses and baccalaureate degree nurses are nearly equal. As the flagship university for the state, the University of New Mexico has offered a program for baccalaureate degree completion for registered nurses for over 55 years. Wishing to fulfill the IOM mandate, the University of New Mexico, College of Nursing desires to grow its RN-to-BSN program by expanding its marketing, …