Medicine and Health Sciences Commons^™

Improving The Mental Health And Wellness Of Middle School Educators Post-Covid19, April Pearson

Doctor of Nursing Practice Projects

U.S. public school teachers of all educational levels were challenged during the COVID-19 pandemic to provide education to students in alternative ways; face-to-face, hybrid model, or remote learning. This resulted in teacher stress, dissatisfaction, and turnover. Locally, after the 2020-2021 school year at East Iredell Middle School, 9 out of 22 educators resigned or transferred due to the stress and fatigue of teaching students in a hybrid model during the COVID-19 pandemic. The purpose of this project was to promote the health and wellness of middle school educators. The PICOT statement is, what is the effect of an educational program …

The Use Of A Code Lavender Space To Promote Self-Care, Em Toe

Doctor of Nursing Practice Projects

The nursing shortage has been an ongoing issue across the nation. The workforce has lost valuable employees, especially in rural areas, due to staff shortages and lack of self-care. Implementing therapeutic interventions such as a Code Lavender Room aims to implement self-care during working hours to increase nursing retention in the long term. The goal of this quality improvement project was to provide a safe place for employees to go to relax and reset during working hours. A survey was used to analyze the Code Lavender Room's effectiveness in self-care and how likely the staff are to continue to use …

Dnp Project Active Anson, Melissa C. Griffin

Doctor of Nursing Practice Projects

Objectives: To implement and evaluate the effectiveness of using a mobile app to encourage hospital workers to increase their physical activity.

Methods: Project was open and advertised to all hospital employees in a small rural community hospital in the south-eastern United States through flyers, bulletin boards, emails, banners and in-person registration assistance. Registered participants completed a 30-day walking challenge and recorded their daily step counts. Participants received a gift bag with fitness items such as water bottles. The three highest step count participants were awarded prizes. Weekly prize drawings were conducted for participants with 10,000 steps per day. Post challenge …

Not A Phase: Lgbtq+ Teens -- How We Can Save A Life, Jennifer Carner

Doctor of Nursing Practice Projects

This DNP project was conducted to address suicide and risk-taking behaviors of LGBTQ teens and how adults can improve the long-term outcomes of LGBTQ teens by being supportive adults. LGBTQ+ teens are at 4 times higher risk of suicide than their non-LGBTQ+ peers (The Trevor Project, 2021). The Suicide Prevention Resource Center, 2008, found a teen having one caring adult in their lives decreases the risk of suicide. The project's goal was to educate adults to increase their comfort levels in terminology, their understanding of the developmental stages of teens, and how to provide protective factors to help reduce the …

The Impact Of Mindful Breathing On Stress Of Employees Working From Home, Lindsey Goldberg

Doctor of Nursing Practice Projects

This DNP project was designed to decrease stress among employees working from home (WFH) by educating them on mindful breathing practices. Through the implementation of a mindful breathing activity, the intended project outcome was to improve stress levels of employees working from their homes. Mindful breathing is an evidence-based strategy that has demonstrated decreased stress levels. Mindful breathing was implemented among two companies employing an estimate of 170 WFH employees to improve health and well-being with potential long-term positive impact on sustainability of organizations in the post-COVID, work from home environment. The participants were invited to perform 8-minutes of daily …

Smartphrases: Optimizing Discharge Education In Limited English Proficiency (Lep) Spanish-Speaking Patient Encounters, Somer Knight

Doctor of Nursing Practice Projects

Health inequities due to communication barriers exist at a high rate for those who identify with limited English proficiency. This quality improvement project aimed to decrease these inequities by providing pre-translated discharge instructions (AVS) to patients who receive surgical services and recover in the pediatric post anesthesia care unit (PACU) of a state hospital. Specifically, this project examined if the availability of pre-translated instructions (SmartPhrases) increased nurse and interpreter satisfaction with the discharge process, and improved their perceived level of equitable care they are able to provide. Discharge instructions were gathered from the participating surgical and interventionist teams, and the …

Improving Utilization Of Palliative Care For Heart Failure Patients, Devin Tilley

Doctor of Nursing Practice Projects

The purpose of this program was to educate providers regarding palliative care for heart failure patients. Palliative care is underutilized in conjunction with usual heart failure management despite proven benefits of decreased symptom burden, reduced hospitalizations, and improved overall quality of life. Provider education has the ability to improve provider knowledge of palliative care for heart failure patients. A brief education session was given to hospital providers in an acute care setting to evaluate the benefits of provider education on palliative care utilization for heart failure patients. Findings included improved provider confidence in referring heart failure patients to palliative care. …

Implementation Of Lean Principles During Operating Room Turnovers, Makenzie Marshall

Doctor of Nursing Practice Projects

Background

Many operating rooms across the country face the daunting task of making their turnovers between surgical patients quicker and more efficient. Turnover time is defined as the time it takes to clean an operating room and set up the next sterile field between surgical patients. The time begins when the patient leaves the operating room suite and stops when the next patient enters the same suite. Running an operating room is a complex and costly endeavor, and even small shortfalls can have a snowball effect, leading to delays, wasteful spending, and substandard patient outcomes; therefore, it is imperative to …

Enhancing The Accuracy And Effectiveness Of The National Institute Of Health Stroke Scale In A Rural Emergency Departmennt, Emily Nicole Addington

Doctor of Nursing Practice Projects

A rural facility in the foothills of North Carolina found a need for process improvement regarding the emergency department and completion of the NIHSS. The DNP student and the Stroke Coordinator along with the Quality Improvement Coordinator agreed with the need for education of staff concerning accurate assessment and documentation of the NIHSS. The DNP project implemented additional training for the emergency department nurses and paramedics in the form of face-to-face classes with a PowerPoint. A pre-and post-survey was conducted to gauge the comfort level of staff with the NIHSS and stroke processes of the rural emergency department. The Stroke …

Using A Deterioration Index Score To Improve Patient Outcomes, Amanda Doub

Doctor of Nursing Practice Projects

Quick recognition and response to clinical deterioration have a significant impact on patient mortality and outcomes. Nurses’ confidence in their ability to recognize signs and symptoms of deterioration and activate rapid response teams (RRT) is vital in preventing code blues and transfers to a higher level of care. The objective of this project was to determine the effect of an educational intervention on nurse acknowledgment of the deterioration index score and nurse confidence in intervening to improve patient outcomes by alerting the Rapid Response Team (RRT) within two months for adult patients on a medical-surgical unit. Findings from the project …

Thinking Inside The Food Pantry Box, Elizabeth Shoaf

Doctor of Nursing Practice Projects

Background: Prior research has indicated a varying relationship between food security and obesity risk. Food insecurity is a known complication of men and women’s underlying health issues, such as hypertension and diabetes, because of altered food choices.

Objective: Provide healthier food options to the food insecure within the facility’s food distribution boxes, as available, for the two most common health issues (diabetes and high blood pressure).

Methods: Clients at a local food pantry were interviewed individually to learn more about food insecurity and complicating health issues, such as obesity, diabetes, and high blood pressure (hypertension) while simultaneously offering alternative food …

Implementation Of New Teaching Strategies By Psychosocial Rehabilitation Center Staff To Increase Member Participation And Retention Of Newly Referred Members, Joseph Warren Ledesma Perez

Doctor of Nursing Practice Projects

Non-profit organizations like psychosocial rehabilitation centers operate largely on reimbursements and funding from government agencies and charitable organizations, respectively. Since reimbursements are based on units of service provided, the center’s operations rely heavily on the attendance and participation of its members in the provided sessions. Charitable institutions, also require fund recipients to provide a report of outcomes and the impact the funds have on the recipients or the community at large. Members’ participation at the chosen site was reported to be low, which led to a projected unsustainability of operations if the numbers did not improve. Equipping the staff facilitating …

Incentive Spirometer Use In Trauma Patients 65 Years And Older With Rib Fractures/Chest Trauma, Sharon F. Ali

Doctor of Nursing Practice Projects

Geriatric patients 65 years old and older admitted to the medical surgical trauma unit with rib fractures had increased readmission rates to the trauma ICU, due to respiratory insufficiency within the last 12 months. This DNP project followed all patients admitted to the trauma service of a Level I trauma hospital with rib fractures/blunt chest trauma during the months of February 2-April 30, 2022. The focus was on the nurse-driven protocol, which included providing incentive spirometer education to the trauma patient for aggressive pulmonary hygiene and documenting patients’ achievements and goals into the medical record. Registered nurses (RN) were asked …

Increasing Cancer Survivorship Knowledge Through Individualized Cancer Survivorship Packets, Ashley Atkins

Doctor of Nursing Practice Projects

This project was developed with the aim of formulating an individualized educational packet that would improve patients’ knowledge of their initial cancer diagnosis and provide additional information to facilitate a smooth transition from treatment to remission. Using a pretest and posttest, quantitative data was collected pertaining to 10 different types of patient education. The pretest survey collected eight questions that related to gathering information about their cancer diagnosis, resources, and knowledge level. The DNP Project Leader secured a Cancer Survivorship Guide through the American Society of Clinical Oncology that was added to the initial cancer survivorship education for all patients. …

Discharge Process Optimization, Erin M. O’Neal

Doctor of Nursing Practice Projects

As the demands of the nurse become increased with higher acuity and documentation requirements, the delivery of discharge instructions is often one of the most, and at times, only, formal education opportunities between the nurse and the patient. It is imperative to modify the discharge process to ensure patients have the ability to confidently care for themselves after they leave the hospital. The aim of this project was to create a nursing discharge workflow that meets the educational needs of the patients. This project was a quality improvement project designed to change the nursing workflow to provide a better discharge …

Diabetic Education In An Uninsured Patient Population, Amanda Whistler

Doctor of Nursing Practice Projects

Abstract

Patient education is an important factor in the management of Type 2 Diabetes. Successful outcomes can be causally related to proper patient education. Many times, patients are left with more questions than answers about their newly diagnosed condition. Some groups of patients are affected by prediabetes and diabetes more than other groups. Differences in health status or access to health care among racial, ethnic, geographic, and socioeconomic groups are referred to as health disparities. This is a major concern in the United States for health care providers.

A spreadsheet was used to record the blood glucose levels of each …

Increasing Low-Dose Ct Screening In Primary Care, Bethany Huelskoetter

Doctor of Nursing Practice Projects

Abstract

Lung cancer was ranked as the second most common cancer diagnosed in 2020 and had the highest death rate compared to all other cancers, excluding nonmelanoma skin cancers (ACS). Early detection is key in decreasing the mortality of lung cancer. A low dose CT (LDCT) is a yearly screening tool developed to detect lung cancer early in high-risk patients yet is much underutilized in primary care. The purpose of this project is to increase the number of LDCT orders placed for qualified patients to decrease the lung cancer mortality rate. There were two main methods for this project: education …

Mindfulness And Meditation To Reduce Test And Evaluation Anxiety In Doctoral Nurse Anesthesia Students, Jenna L. Tebbenkamp

Doctor of Nursing Practice Projects

Abstract

Mindfulness and Meditation to Reduce Test and Evaluation Anxiety in Doctoral Nurse Anesthesia Students

Background/Information

A significant number of university students report experiencing test anxiety. Extreme anxiety has been reported as a cause of withdrawal from university studies. Certified Registered Nurse Anesthetists are required to complete an intense curriculum with tests and evaluations prior to passing a national board certifying exam, which is anxiety provoking.

Purpose

The primary objective of this project was to provide mindfulness intervention information to be utilized by the DNP students and assess desires of having a mindfulness meditation practice to alleviate academic anxiety.

Methods …

Inpatient Observation Safety Assistant Practices, Jennifer Knight

Doctor of Nursing Practice Projects

Abstract

Introduction. Sitter usage is a patient safety practice used across healthcare organizations and the world. Sitters go by many other names, such as patient safety assistants, patient care assistants, care partners, and observation partners. There is literature that supports different variations of practices in healthcare facilities. A scoping review of the literature revealed multiple initiatives to reduce sitter cost and observation through nurse empowerment.

Purpose of Root Cause Analysis. The purpose of this root cause analysis is to determine why personnel inconsistently use the sitter policy. The appraised data will be used to improve the sitter process at this …

Implementation Of A Risk Assessment Tool To Increase Screening For Extragenital Gonorrhea And Chlamydia In Men Who Have Sex With Men, Andrew P. Tharp

Doctor of Nursing Practice Projects

INTRODUCTION: Gonorrhea and chlamydia account for the majority of sexually transmitted infections (STIs) in the United States and are often thought to infect only the urogenital tract. Infections can also be harbored at extragenital sites (rectum and oropharynx), and these infections can increase susceptibility to HIV. Extragenital screening recommendations exist for populations deemed high risk, including men who have sex with men (MSM); yet, routine screening is not consistently completed.

PURPOSE: To improve screening rates for extragenital gonorrhea and chlamydia in MSM within a primary care setting by using an STI risk assessment tool.

METHODS: Clinicians completed a baseline knowledge …

Short Term Medical Mission Antibiotic Protocol, Greg Jennings

Doctor of Nursing Practice Projects

Background/Introduction: Short term medical mission trips are growing in popularity and with this growth the level of care provided must remain evidenced based. Mission groups traveling to developing countries consist primarily of volunteers. And while many of those serving on mission trips are medically trained, some have minimal healthcare knowledge. Pharmacists are not always available to dispense medications on mission trips and therefore it is common for registered nurses in the pharmacy to dispense the medications prescribed by the providers. Because the medications available on mission trips are limited, often times substitutions must be made, especially when it comes …

Improving Access To Reproductive Life Planning Following Implementation Of One Key Question® In Practice, Ashley Wittler

Doctor of Nursing Practice Projects

Abstract

Inadequate reproductive life planning (RLP) education is a widespread problem for women in the United States. This deficit leaves women without necessary guidance regarding contraceptive choices and maximizing pre-conception health. Use of RLP is endorsed by the American College of Obstetricians & Gynecologists (ACOG) and the Center for Disease Control (CDC). Lack of use of an RLP tool in a large, multi-site obstetrical and gynecological practice located in the Metro East is an issue that greatly impacts the patient population. The goal was to initiate the use of an evidence-based RLP tool, known as One Key Question®. The use …

Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn

Doctor of Nursing Practice Projects

Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use.

Methods A literature review was …

Medicated-Assisted Treatment And 12-Step Programs: Evaluating The Referral Process, Candace S. Brown, Chudney Williams, Ryan E. Stephens, Jacqueline Sharp, Bobby Bellflower, Martinus T. Zeeman

Doctor of Nursing Practice Projects

Purpose/Background Overdose deaths in the U.S. from opioids have dramatically increased since the COVID-19 pandemic. Although medicated-assisted treatment (MAT) programs are widely available for sufferers of opiate addiction, many drop out of treatment prematurely. Twelve-step programs are considered a valuable part of treatment, but few studies have examined the effect of combining these approaches. We aimed to compare abstinence rates among patients receiving MAT who were referred to 12-step programs to those only receiving MAT.

Methods In this prospective study, a cohort of participants from a MAT clinic agreeing to attend a 12-step program was compared to 15 controls selected …

Policy Analysis Of The Illinois Nurse Practice Act (Aprn Title Section 65/65-50), Sara Kim

Doctor of Nursing Practice Projects

Background

Physician groups claim allowing nurses to use the title "doctor" confuses patients. Nurses assert that the title is common to many disciplines, and nurses should be trusted like other professionals to identify their specialty to patients. Currently, qualified nurses in Illinois using the title "doctor" in clinical areas must introduce themselves to each patient in the following way: "Hi, I'm Dr. Smith, the nurse practitioner taking care of you today. I do not have a degree in medicine, and I am not a physician or medical doctor” (225 ILCS § 65/65-50).

Purpose

This project aimed to evaluate Illinois Nurse …

Utilization Of Telephone Outreach And Telemedicine To Improve Diabetic Outcomes, Nicolas Yemm

Doctor of Nursing Practice Projects

Diabetic adherence is paramount to achieving adequate glycemic control. Telephone outreach and utilization of telemedicine can improve diabetic adherence through closer monitoring and removing barriers to access for care. The goal of the project was to improve the dashboard HbA1c quality metric within the IM office. The office dashboard HbA1c metric initially was in the “red threshold”, which means <70% of patients aged 18-75 years old with diabetes had a HbA1c <8%. This project involved performing telephone outreach to contact diabetic patients who were due for office follow-up to offer telemedicine as a convenient option for patient evaluation. In addition, the secondary goals of the project included identifying social determinants presenting barriers to diabetic care plan adherence. The results indicated telephone outreach and telemedicine use may help achieve better glycemic control in diabetic patients. This project demonstrated improvement in HbA1c dashboard metrics to the “yellow threshold”, indicating 71% of patients (18-75 years old) in the office with diabetes had a HbA1c <8%. Several limitations were identified, including a short implementation window (6 weeks), lack of ability to assess whether providers were instituting project recommendations, staff engagement, and internet bandwidth/technology literacy issues when using telemedicine. From a long-term implementation perspective, the project showed telephone outreach and telemedicine are useful tools that can positively impact poorly controlled diabetic patients to improve glycemic control. However, the limitations of the project will likely need to be addressed to achieve long-term implementation of the project methods.

Adverse Childhood Experiences And Urinary Incontinence In Elementary School Aged Children, Amanda Jill Travis Msn, Fnp-C, Margaret C. Harvey Phd, Aprn, Acnp-Bc, Chfn, Michelle Rickard Dnp, Apnp-C

Doctor of Nursing Practice Projects

Purpose/Background: Adverse Childhood Experiences (ACEs) have an impact on health throughout the lifespan (Filletti et al., 1999; Hughes et al., 2017). These experiences range from physical and mental abuse, substance abuse in the home, parental separation or loss, financial instability, acute illness or injury, witnessing violence in the home or community, and incarceration of family members (Hughes et al., 2017). Understanding and screening for ACEs in children with urinary incontinence can help practitioners identify psychological stress as a potentially modifiable risk factor.

Methods: A 5-month chart review was performed identifying English speaking patients ages 6-11 years presenting to the outpatient …

Development And Implementation Of An Enhanced Recovery After Surgery Protocol For Thoracic Surgery Procedures, Nicholas Collier

Doctor of Nursing Practice Projects

A high prevalence of lung and esophageal cancers leads to significant healthcare dollars utilized for treatment and management. Surgical resection is regarded as a key component for multidisciplinary treatment and management of these cancers. By standardizing multidisciplinary patient care and utilizing evidence-based practice, Enhanced Recovery After Surgery (ERAS) protocols for thoracic surgery have offered better outcomes with fewer complications and reduced healthcare costs. The anesthesia providers at the host facility were deficient in basic knowledge related to ERAS protocols and best practice management of thoracic surgery patients. The purpose of this project was to educate anesthesia providers on ERAS principles …

Transversus Abdominis Plane Block: A Scoping Review, Liam Maher, Leanne Orians, Gabrielle Pappas, Lanny Coker Dnsc, Crna

Doctor of Nursing Practice Projects

The purpose of this project is to provide an overview of the literature on the analgesic effects of transverse abdominal plane (TAP) block and its effectiveness in reducing opioid consumption.

Intraoperative Administration Of An Nsaid And An Opioid Vs. An Opioid Alone Effect On Postoperative Ileus Development, Brooke H. Ulsh, Delaney N. Vedros, Rebekah G. Whaley, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

The purpose of this DNP project is to examine what is known from existing literature about postoperative ileus development in the adult surgical patient population after receiving intraoperative opioids versus a combination of intraoperative opioids and NSAIDs.