Medicine and Health Sciences Commons^™

Intraoperative Dexmedetomidine For Reduction Of Postoperative Delirium In The Elderly: A Scoping Review, Gregory B. Harris Bsn, Rn, Srna, Brooke N. Hatchell Bsn, Rn, Srna, Davelin D. Woodard Bsn, Rn, Srna, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain.

Methods: The authors developed eligibility criteria for inclusion of articles and performed a …

Pain Control: Opioid Vs. Nonopioid Analgesia During The Immediate Postoperative Period, Shamsie M. Lumpkin Bsn, Srna, Isaac W. Parrish Bsn, Srna, Austin S. Terrell Bsn, Srna, Dwayne S. Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to …

Dexmedetomidine Vs Fentanyl In Attenuating The Sympathetic Surge During Endotracheal Intubation: A Scoping Review, Alexandra Schwieger, Kaelee Shrewsbury, Paul Shaver, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 …

Postoperative Nausea And Vomiting Implications In Neostigmine Versus Sugammadex, Corey Lee Johnson, Colton Bradley James, Sarah Grace Traughber, Charles Anthony Walker, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Purpose/Background: Postoperative nausea and vomiting (PONV) is a frequent complaint in the postoperative period, which can delay discharge, result in readmission, and increase cost for patients and facilities. Inducing paralysis is common in anesthesia, as is utilizing the drugs neostigmine and sugammadex as reversal agents for non-depolarizing neuromuscular blockers. Many studies are available that compare these two drugs to determine if neostigmine increases the risk of PONV over sugammadex. Sugammadex has a more favorable pharmacologic profile and may improve patient outcomes by reducing PONV.

Methods: This review included screening a total of 39 studies and peer-reviewed articles that looked at …

Opioid Free Anesthesia To Prevent Post Operative Nausea/Vomiting, Aleksander Acred, Milena Devineni, Lindsey Blake, Cindi Dabney Dnp, Crna

Doctor of Nursing Practice Projects

Purpose The purpose of this study is to compare the incidence of post-operative nausea and vomiting (PONV) in opioid-utilizing and opioid-free general anesthesia. Background PONV is an extremely common, potentially dangerous side effect of general anesthesia. PONV is caused by a collection of anesthetic and surgical interventions. Current practice to prevent PONV is to use 1-2 antiemetics during surgery, identify high risk patients and utilize tracheal intubation over laryngeal airways when indicated. Current research suggests minimizing the use of volatile anesthetics and opioids can reduce the incidence of PONV, but this does not reflect current practice.

Methods In this scoping …

Increasing Referrals To School Counselors By Integrating An Evidence-Based Program For Educators Identifying Adolescents At Risk For Suicide In A Rural High School, Wendy Holloway

Doctor of Nursing Practice Projects

Background: Addressing suicide in America's youth is imperative. Teachers play an essential role in identifying and intervening with adolescents experiencing psychological distress leading to suicide. Teachers and staff lack professional development addressing the identification of students in psychological distress.

Purpose: This project aimed to increase referrals to school counselors by integrating an evidence-based program for educators identifying adolescents at risk for suicide in a rural high school.

Design Method: This was a quantitative quality improvement project with a pre-/post-test design. Additionally, referrals to the school guidance counselors before implementing the program and after the completion of the program were …

Improving Medication Communication Hospital Consumer Assessment Of Healthcare Providers And Systems (Hcahps) Score, Danyel Weldon Munster

Doctor of Nursing Practice Projects

Nurses provide education on medication purposes and side effects to hospitalized patients. Patient satisfaction surveys measure this intervention with the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). HCAHPS determines a portion of hospital reimbursement and star rating. By improving patient satisfaction through effective medication communication, the hospital’s star ratings and reimbursements increase. Various clinical settings utilize the teach-back method to improve patient understanding and participation in their medication education. This quality improvement project aims to improve HCAHPS medication communication-specific scores through scripted, nurse-delivered teach-back interventions. The student DNP educated the staff nurses on an adult medical-surgical unit, …

Reducing Incidence Of Contrast-Induced Acute Kidney Injury Through Nursing Education, Hilarie Rankin

Doctor of Nursing Practice Projects

Contrast-induced acute kidney injury (CI-AKI) occurs commonly in patients following percutaneous coronary intervention (PCI) and has been linked to increased patient morbidity, higher risk for cardiovascular mortality, and a large burden of annual healthcare costs. The implementation of evidence-based care standards by nursing staff has been shown to reduce incidence of CI-AKI. Current discrepancies in nursing care have been linked to increased incidence of CI-AKI; therefore, the need for enhanced nurse buy-in with evidence-based protocols is paramount. The primary investigator sought to increase knowledge of CI-AKI and nursing compliance with an established evidence-based protocol at a single center hospital. After …

Unifying Vision: Strategies That Influence Nurse Self-Care Practices, Nancy Weaver

Doctor of Nursing Practice Projects

Background: Self-care is about physical health and includes the individual's emotional, mental, and spiritual aspects. Self-care behaviors are tailored to an individual's perceptions and values. Stress among nurses has been linked to high turnover rates and nursing shortages. When nurses experience job-related stress, effectively managing a patient's care becomes difficult.

Purpose: This project aimed to create a website presenting creative strategies that encourage a healthy lifestyle and teach nurses how to engage in self-care practices. Through interviews with executives at a privately owned, multi-specialty physician clinic, stakeholders identified the need for easy access to information supporting nurses' ability to …

Implementing Stop The Bleed In Schools, Tonya Bright

Doctor of Nursing Practice Projects

Background: An emergency or disaster can strike at any time, even during the day, while numerous students are in school. This paper will discuss how an educational program initiating Stop the Bleed (StB) in public schools prepares and equips school nurses to respond to a bleeding emergency in the school setting.

Design method: Initiate StB as a "train-the-trainer" course for school nurses. School nurses will have knowledge, training, and supplies to train the employees at their schools. Conduct pre- and post-surveys to assess learning objectives and attitudes toward training and readiness.

Conclusion: The StB educational intervention effectively improved knowledge by …

Sepsis Initiative: Champion Series, Ashlie Barnes

Doctor of Nursing Practice Projects

Sepsis is defined as a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a higher risk of mortality than with sepsis alone. Each year, more than 1.7 million people are diagnosed with sepsis in the United States, and at least 270,000 Americans die. There is no confirmatory diagnostic test to diagnose sepsis. Therefore, clinical judgment based on evidence of infection and organ dysfunction is key.

Despite thousands of articles and hundreds of trials, sepsis plays …

Improving Health Literacy For Diabetics In A Rural Community, Elissa Purvis

Doctor of Nursing Practice Projects

Adults with type II diabetes mellitus need to understand the disease and manage their chronic condition to live a healthy and comfortable life. This project aimed to educate adults with type II diabetes mellitus in self-management of their chronic illness to increase their health literacy to improve their heart health, kidney health, nutrition, and exercise. The project utilized a Doctor of Nursing Practice (DNP) approach to education for adults with type II diabetes mellitus on the disease process.

METHODS: This project is a quality improvement project focused on educating adults with type II diabetes mellitus in managing their chronic conditions …

Early Antibiotic Administration For Sepsis, Joseph Hooks

Doctor of Nursing Practice Projects

Sepsis is a life-threatening organ dysfunction caused by the body's response to an infection causing systemic inflammation. Timely intervention with broad-spectrum antibiotics is linked to improved outcomes, reversal of organ failure, and decreased hospital length of stay. Studies show that the incidence of sepsis is increasing, while mortality related to sepsis has declined over the past several decades. Effective treatment of the source of infection is key to improving sepsis recovery and preventing septic shock. Epidemiologic studies are showing startling increases in sepsis cases with falling mortality rates. Sepsis awareness is a primary focus of quality improvement initiatives in hospitals …

Increasing Colorectal Cancer Screening Rates Through Education, Kayla Metz

Doctor of Nursing Practice Projects

Colorectal cancer is the second leading cause of cancer deaths in the United States. Adenomatous polyps cause 90% of colorectal cancer. These polyps can be identified before they become cancerous through numerous colorectal cancer screenings. There are many ways to help cover the cost of screenings or to make them no cost to patients, but the number of individuals who have ever been screened or who are current with screening recommendations remains low. This DNP project aims to provide education to providers and individuals regarding the various type of colorectal cancer screening options. A reduction in fears and improved knowledge …

Using Infographics To Improve Completion Rates Of The Sepsis Protocol Bundle, Stephen Newbern

Doctor of Nursing Practice Projects

Hospitals have sepsis protocols that must be implemented when a patient shows positive signs and symptoms of a septic infection. Nurses learn about sepsis in nursing school and rarely further their education beyond this basic understanding of the disease. So, when nurses fail to comply with organizational instructions outlined within a defined sepsis protocol bundle, this often leads to a progression of severe sepsis in a patient and, most likely, increased cost for the healthcare facility. Multiple sepsis protocol bundle failures negatively impact organizational ratings established by The Joint Commission for patient care and are highly associated with increased sepsis …

Re-Educating Healthcare Workers In Long-Term Care Facilities To Improve Hand Hygiene Compliance, Jennifer A. Ukeje

Doctor of Nursing Practice Projects

Hand hygiene is one of the most significant measures for protecting nursing home residents from healthcare-associated infections (HAIs). An estimated 1.6 million to 3.8 million infections occur each year; of these infections, 32% of all healthcare-associated infections (HAIs) are urinary tract infections (UTI), 15% are pneumonia (lung infection), and 14% are bloodstream infections. The high incidence of HAIs in nursing homes is due to multiple factors such as understaffing, inadequately trained staff, staff to resident ratio, lack of antibiotics stewardship, and the increasing clinical complexity of the average nursing home. In addition, most long- term care (LTC) residents are older …

Increasing Compliance On Pain Reassessment At A Rural Hospital Swing Bed Unit, Stephanie Melson

Doctor of Nursing Practice Projects

The overarching goal of this project is to ensure patient pain reassessment is completed on all patients in accordance with the facility and The Joint Commission (TJC) standards after the intervention. The last four surveys of the rural critical access hospital yielded subpar results showing noncompliance with pain reassessment. Utilizing quality improvement measures such as staff education and charting reminders, gaps in practice were found and utilized to optimize the care to patients related to pain and reassessment. The study seeks to improve the pain reassessment skills and compliance of nursing staff at a rural critical access hospital. Initial non-compliance …

Mentoring New Graduate Nurses To Promote Staff Retention, Elsie Anwah

Doctor of Nursing Practice Projects

Nursing mentoring programs promote professional socialization in new graduates to increase patient safety, enhance clinical competency, improve job satisfaction, and reduce turnover. A structured mentoring program helps the new graduate experience a more controlled and intentional learning experience. Implementing a well-designed experience helps to increase job satisfaction and decreased turnover. The mentorship program utilized Patricia Benner’s theory ‘From Novice to Expert model.’ The project design was based on quality improvement which followed the focus, analyze, develop, execute, and evaluate (FADE) methodology. The goal of the project was to measure the intent to stay of new graduate nurses through Intent to …

Improving Suicide Risk Assessment Through Educational Program Implementation, Timothy Booth

Doctor of Nursing Practice Projects

Background: Unsustainable behavioral health education focused on comprehensive suicide risk assessment performance contributes to decreased registered nurses’ perceived self-efficacy in assessing and caring for suicidal patients.

Purpose: To educate medical-surgical and progressive care registered nurses in assessing patients for suicide risk factors and warning signs comprehensively.

Design Method: A quasi-experimental designed quality improvement project with evidence-based suicide educational program implementation. Project results yielded a 56.7% increase in registered nurses’ perceived self-efficacy in assessing and caring for suicidal patients. Future DNP work will focus on sampling a larger population (N) to decrease opportunities for the skewness of project results …

Can Provision Of Additional Education For Nursing Staff Increase Breastfeeding Knowledge And Feelings Of Self-Efficacy?, Akeba Deqwan Thompson

Doctor of Nursing Practice Projects

Background: Post-partum nurses are responsible for preparing new mothers with the necessary skills to feed and care for their infants and need proper education to effectively and confidently discuss feeding options with their patients.

Purpose: This quality improvement project aims to increase nursing knowledge of breastfeeding and their feeling of self-efficacy in promoting breastfeeding as an option to new mothers.

Design Methods: A quasi-experimental design including a pre-test/post-test used to quantify the effect of education on therapeutic communication, nursing responsiveness, and feelings of self-efficacy.

Conclusion: An overall increase in feelings of self-efficacy and knowledge of breastfeeding was noted amongst nursing …

Implementing An Antibiotic Stewardship Education Program To Decrease Antibiotic Prescriptions In An Urgent Care Clinic, James Gramling

Doctor of Nursing Practice Projects

Antibiotics are often prescribed for respiratory infections. These infections often have a viral rather than a bacterial source. Overuse of antibiotics is associated with increased potential for adverse effects, increased healthcare costs, and increasing antibiotic resistance. The purpose of this DNP project was to determine if implementing an antibiotic stewardship program at an urgent care clinic would decrease the number of antibiotic prescriptions written for acute respiratory tract infections. An educational session consisting of didactic and PowerPoint presentations was provided to each provider at the urgent care clinic. Medical records were reviewed for four weeks after completion of the session …

A Quality Improvement Project To Improve The Management Of Patients At Risk For Falls, Crystal Medici

Doctor of Nursing Practice Projects

Background: Falls are one of the most common adverse events in the hospital. Falls can result in injury, increased hospital length of stays, increased costs and use of hospital resources, and death. The risk of falling is even higher for hospitalized patients due to unfamiliar environments, new medications and treatments, acute illness symptoms, surgery, bed rest, lines, tubes, and catheters.

Purpose: This quality improvement project aimed to increase awareness of the importance of fall prevention in the hospital setting and educate nursing staff on fall prevention to decrease patient falls.

Methods: This project utilized a quasi-experimental study design that includes …

Differences In Student Perceptions With Virtual Clinical Simulation, Melissa Wheeles

Doctor of Nursing Practice Projects

Background: Simulation has been a part of nursing education since its inception, with virtual clinical simulation gaining expanded use since the Coronavirus Pandemic. Once considered only a supplemental teaching method, this form of education has become an imperative means of program progression for nursing students when hospital clinical spaces are limited.

Purpose: The purpose of the study is to evaluate potential differences in nursing student perceptions of anxiety and self-confidence with clinical decision making in virtual clinical simulation compared to traditional face-to-face clinicals.

Design Methods: A descriptive, quantitative study using the NASC-CDM© tool completed by 5th (final) semester …

Fall Prevention: The First Line Of Defense. Integration Of Innovated Strategies To Decrease Falls For The Hospitalized Patient, Milledge Smalls

Doctor of Nursing Practice Projects

Background: Falling is defined as an accidental encounter with the ground or other surfaces. Individuals with dementia are at a greater risk for falls due to conditions such as neurological impairments in perception or cognition. Presently, 50 million people live with dementia worldwide, which is projected to increase to 152 million by 2050 because of a rise in life expectancy and an aging population. The incidence of falls has rapidly become a major public health problem around the world. Approximately 30% of people older than 65 years of age fall each year, and patients with dementia cost the nation $236 …

Preventing Complications Of Undiagnosed Diabetic Peripheral Neuropathy In Rural Healthcare Settings, Kendra Ward Harris

Doctor of Nursing Practice Projects

Background: Diabetic peripheral neuropathy (DPN) affects the lives of approximately 50% of all persons diagnosed with diabetes. Patients who are minorities, residents of rural communities, low income, or non-compliant with treatment, have a higher risk of developing DPN. The long-term effects interfere with the patient’s abilities to carry out activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Patients incur debt from medical expenses, depression from the inability to perform self- care, and became withdrawn because of their distorted body image.

Purpose: The purpose of this project was to use the Michigan Neuropathy Screening Instrument (MNSI) …

Efficacy Of Handoff Education For Icu Nurses When Transferring Patients To The Operating Room, Sandra Ruth Horace

Doctor of Nursing Practice Projects

Background: The transition of care from the Surgical Intensive Care Unit (SICU) to the Anesthesia team in the Operating Room (OR) is a vulnerable time for patients. There is currently no formal process for the patient transitioning from the Surgical ICU to the OR. The disarray of this transition can lead to serious omissions in communication and be harmful to the patient.

Purpose: Currently, there is no formalized or universal process for handoff communication between the SICU team and the Anesthesia team. This project aimed to provide handoff education for SICU nurses when sending a patient from the OR. This …

Effect Of Increased Confusion Assessment Method For The Intensive Care Unit Delirium Assessments On Patients In The Surgical Intensive Care Unit, William Lemon

Doctor of Nursing Practice Projects

Delirium is an acute syndrome of the central nervous system (CNS) that affects patients of all ages and all hospital areas. Furthermore, delirium can lead to frequent complications for these patients, especially those in intensive care units (ICU) (Kanova, Sklienka, Burda, & Janoutova, 2017). Nationally delirium affects 20-80% of patients that require ICU care (American Nurses Association, 2019). In the Surgical intensive care unit (SICU) at the acute care hospital used in the project, the average number of patients suffering from delirium is about 23%. The purpose of this project was to provide a more in-depth analysis of delirium, and …

Hypertension Education And Management Intervention (Hemi) In The Urgent Care Setting, Conrad L. Cash

Doctor of Nursing Practice Projects

Background: Hypertension, being a very prominent disease, is a common problem found during urgent care visits. By beginning in the urgent care setting, hypertension management can be started early; thereby preventing complications from uncontrolled hypertension.

Purpose: This DNP project aimed to improve patient knowledge of hypertension and overall blood pressure readings by providing one-to-one provider-patient education.

Design Method: This DNP quality improvement project was a pre- and post-test design using quantitative data. The goal was to access if there was a change in patient education pre, post, and three months follow-up along with a change in blood pressure.

Results: …

Increasing Staff Awareness And Screening Practices For Adverse Childhood Experiences At A Primary Care Clinic, Kayla Wright

Doctor of Nursing Practice Projects

Adverse childhood experiences (ACEs) are present in approximately 60% of the adult population in the United States. There is a correlation between adverse childhood experiences and chronic health conditions as adults. Despite the evidence showing this correlation, there is a lack of screening for ACEs in the primary care setting. Many primary care providers and staff are unaware of ACEs or the correlation with chronic health conditions and substance abuse and, therefore, do not understand how to or recognize the benefits of screening in primary care. With education for providers and staff, primary care is the ideal setting to perform …

Preventing Unplanned Pregnancies: The Impact Of Prevention Education, Eliza Dudley

Doctor of Nursing Practice Projects

Teenage pregnancy and unplanned parenthood are social issues in many communities, states, and developed and undeveloped countries. The impact of early, unplanned pregnancy is detrimental to the adolescent's health, mental health, and physical well-being. Teenage pregnancy may be considered a social issue that is often the result of inadequate sexual and reproductive education, both in adult parents and teenagers. Despite recent reductions in teenage pregnancies, in recent years, more than 20 million teenagers experienced parenthood before graduating from high school. Programs are needed to prevent the possible stigma, physical and emotional risks of unplanned teenage pregnancy, lower adolescent pregnancy rates, …