Medicine and Health Sciences Commons^™

Media Use Management With Toddlers And Preschoolers: Introducing Screen Time Recommendations In Pediatric Primary Care, Kaitlyn Mcgough

Doctor of Nursing Practice Projects

As the field of technology has advanced, screens have become easier than ever to access both for adults and their children in the form of smartphones, tablets, laptops, televisions, and more. This advancement has brought on unforeseen challenges for families as they grapple with understanding and implementing healthy boundaries between their children and technology. By their second year of life, 50% of children will have interacted with some form of media, and research is beginning to reflect that there is a measurable effect of screen time on toddler development. The need for intervention has continued to grow, as children are …

Developing An Educational Pamphlet For Patients Undergoing Interscalene Blocks With Liposomal Bupivacaine Exparel, Steve Fankam

Doctor of Nursing Practice Projects

There are over one million shoulder arthroscopies and arthroplasties performed worldwide each year, with interscalene blocks (ISBs) the typical treatment choice for postoperative analgesia (Etkin & Springer, 2017). In 2018, Exparel® was FDA approved for use in ISBs and educational materials currently are scarce (Pacira Pharmaceuticals, 2019). The effectiveness of pamphlets in the clinical setting has been well established (Sustersic, Gauchet, Foote, & Bosson, 2017). Pamphlets improve health literacy by providing patients a tool to aid in recall and adherence to postoperative instructions (Sustersic et al., 2017). This project reviewed the available literature on Exparel® ISBs, health literacy, and pamphlet …

Improving Skin Cancer Screening In Primary Care, Jaclyn Barnhouse, Rebecca Baietto

Doctor of Nursing Practice Projects

Skin cancer is one of the most common forms of cancer in the United States, with melanoma having the highest rate of mortality of all forms of skin cancer (CDC, 2019). However, there is hesitancy among primary care providers to perform skin cancer screenings (Oliveria et al., 2011). Prevention and early detection of melanoma is key. Melanoma has been known to be highly curable when found early. This makes early detection even more important in order to prevent metastasis and potential mortality (Bruce et al, 2017). The use of targeted screening tools can potentially save lives when utilized in primary …

Interventional Techniques For Chronic Low Back Pain And Migraine Headaches: Development Of Educational Pamphlets​, Muhidin Abukar, Mathew Schilling

Doctor of Nursing Practice Projects

Keywords

Chronic low back pain, migraine headaches, radiofrequency ablation, greater occipital nerve blocks, sphenopalatine blocks, botox injections.

Abstract 

Chronic low back pain and migraine headaches affect millions of adults in the United States. Traditionally, opioid and non-opioid pain medications were the mainstay pharmacological treatment of choice. However, due to the highly addictive nature of opioids, practitioners are seeking alternatives for pain management.  Radiofrequency ablation (RFA), a minimally invasive technique has been shown to alleviate chronic back pain while botox injections and other non-invasive opioid sparing techniques, such as greater occipital nerve blocks and sphenopalatine blocks have been found to be …

Physical Well-Being And Healthy Lifestyle Options, Michael Perkins

Doctor of Nursing Practice Projects

Background

The AANA has identified stress management or wellness as a priority for all CRNA programs. The Health and Wellness Initiative put in place by the AANA in 2004 is a model designed for all SRNA programs and intended to address students’ participation in wellness events in order to combat stressors.

The primary purpose of this project was to gain information about the stress faced by SRNAs enrolled at a Midwestern University and to evaluate strategies that could help students properly deal with stress.

Methods and Evaluation

Fifty-five students participated in the survey, data were compared by year in the …

Voyage: A Passage Through Orientation, Patricia Eppel

Doctor of Nursing Practice Projects

Dedication

This DNP project is dedicated to my husband, Jim who carried my school bags to and from the car on every hockey trip, dance competition trip, camping trip, and every other trip, just so I could say I had my homework in case I found time to study. Thank you for making dinners, doing dishes, vacuuming, and providing unwavering support for me through these past years. I also dedicate this project to my children Jacob and Sophia, who always seemed to migrate their way into the dining room late at night for talks when I was up studying. No …

Continuing Education Preferences Amongst Crnas, Jamie Nichting

Doctor of Nursing Practice Projects

The Illinois Association of Nurse Anesthetists (IANA) is a professional organization representing Certified Registered Nurse Anesthetists (CRNAs). To ensure compliance with high standards of care in the profession, CRNAs are required to obtain continuing education units (CEUs) for each 4-year certification period. The IANA offers conferences in both fall and spring, however, a loss in attendance and revenue at state meetings concerns the board members as to how state members are complying with the educational requirements to remain certified. It was imperative that the IANA needed to implement new educational opportunities that actively engaged CRNAs resulting in an increase in …

Virtual Cadaver Dissection Prior To Clinical Experiences In Nurse Anesthesia, Hannah Ruholl, Kyle Smith

Doctor of Nursing Practice Projects

Anatomy and physiology (A&P) courses are the foundation of anesthesia training. Student registered nurse anesthetists (SRNAs) must be A&P experts as they perform clinical skills for the first time. Traditionally, cadaver dissection has been used to enhance comprehension of A&P. However, not all facilities can allocate the time, space, or financial resources for cadaver dissection within their programs of study, especially at institutions that lie outside of major medical centers. Despite the presence of a virtual cadaver at a nurse anesthesia program in the Midwest, its introduction to SRNAs as a resource had not been fully employed. The goals of …

Identifying Barriers To Keeping Appointments In Mental Health, Shontel Ray

Doctor of Nursing Practice Projects

Abstract

Accessing healthcare for mental illness is important but has been challenging to resolve. Due to barriers, individuals are missing appointments leading to long-term negative effects of poor patient outcomes, such as homelessness and suicide. Understanding why individuals cancel or do not show up to their appointments is crucial to resolve this nationwide problem. Further investigation is needed to identify what barriers cause individuals to miss appointments so interventions can be created to resolve it and improve patient care. For this study, those who did not attend their first or second appointments were called and given an eight-question survey. The …

Standardizing Evaluation Methods For Simulation, Jessica Antisdel, Leslie Artinger

Doctor of Nursing Practice Projects

Background: Evidence suggests that student registered nurse anesthetists (SRNAs) benefit from simulation in the educational curriculum (Turcato, Roberson, & Covert, 2008). When simulation is implemented into coursework, it is important to evaluate student learning and perceptions (Adamson & Kardong-Edgren, 2012), however, there are few standardized instruments available (Adamson et al., 2012; Doolan et al., 2016).

Objectives: The goal of this project was to provide the foundation for standardizing simulation evaluation tools within a midwestern university’s school of nurse anesthesia.

Methods: A presentation on the Value Analysis Model was developed through extensive use of the literature and collaboration with a content …

Compassion Fatigue And Burnout During The Covid-19 Pandemic, Gabrielle Giamanco, Tyler Tanzyus

Doctor of Nursing Practice Projects

Abstract

The COVID-19 pandemic has pushed nurses to exhaustion while leaving them with compassion fatigue (CF) and burnout (BO). Compassion fatigue is secondary to traumatic stress and exposure, while burnout is the state of exhaustion of one’s ability to manage with their work and personal everyday stressors. This study aimed to determine whether a daily use of a meditation app could change quality of life indicators amongst front-line nurses affected by COVID-19. With the help of the ProQol assessment tool, along with a pre and post intervention surveys, participants’ awareness and personal experiences were evaluated. The study consisted of nurses …

Evaluating Unexpected Outcomes With A Change In Practice, Justin Trexler

Doctor of Nursing Practice Projects

Abstract

Quality improvement projects improve processes for delivering safe and effective care to patients. Most protocols can be implemented successfully, but what factors lead to an unexpected outcome? This project sought feedback from anesthesia providers after a protocol for administering intranasal midazolam instead of intravenous midazolam in older adults during cataract removal had unfavorable results. Using the concepts developed by Proctor et al. (2010) to analyze the feedback from the anesthesia providers, this project sought to understand why this change in practice elicited these unfavorable results.

The goal of the change in practice was to improve turnover times and reduce …

Development Of A Heparin Dosing Guideline For Vascular Surgery, Brittany Bertoni, Anna Holdener

Doctor of Nursing Practice Projects

Unfractionated heparin is administered to provide anticoagulation for the prevention of thrombosis and ischemia during vascular surgery. The intraoperative goals of heparin administration are the achievement of adequate anticoagulation and maintaining a steady-state plasma concentration throughout the procedure to prevent thrombotic events. Due to patient variation in heparin sensitivity, the standard within vascular surgery is to obtain the intraoperative activated clotting time (ACT) as a means of monitoring heparin activity and guiding dosing regimens. Measuring the intraoperative ACT allows for evaluation of the intrinsic pathway to assist the provider in achieving a steady-state heparinization with high-dose heparin administration.

To reduce …

Mental Health Resources For The Pediatric And Adolescent Populations In The Rural Setting, Devon Shafer, Kyle Aldridge, Amy Lilly

Doctor of Nursing Practice Projects

Cognitive behavioral therapy (CBT) is a mainstay of treatment for problems such as anxiety and depression. However, access to this form of psychotherapy treatment is limited in rural areas, especially in pediatrics. The purpose of this project was to increase access to CBT through the use of smart phone CBT applications for patients at one rural midwest pediatric clinic. An extensive literature review revealed that mobile cognitive behavioral therapy (CBT) applications can be an effective option for adjunct therapy when provider access is limited. Two CBT mobile applications were selected for the project and training was provided to clinic providers. …

Integration Of The Svs Wifi Classification System For Ulcer Staging And Management In An Amputation Prevention Program, Allison Campos

Doctor of Nursing Practice Projects

Chronic limb-threatening ischemia is a significant problem with increased morbidity and mortality along with the risk of amputation. With the increased prevalence of diabetes worldwide, the population of patients presenting with nonhealing ulcers shifted from purely ischemic ulcers to a more complex picture for wound healing. Amputation prevention programs were developed to care for this heterogeneous population of patients. However, with multiple disciplines, there was no unified classification system in use. The historical classification systems were not inclusive to evaluate all aspects of wound healing, the extent of the wound, amount of ischemia, and the presence of infection. The Society …

Development Of A Protocol For Perioperative Management Of The Breastfeeding Mother, Kayla Nyseth, Kelsey Park

Doctor of Nursing Practice Projects

Facilitating breastfeeding is a public health priority, as disruption in lactation is associated with adverse health outcomes for the breastfeeding mother and child (ACOG, 2016). The need to take medication, maternal illness, and hospitalization are among the most common reasons women cite for ceasing breastfeeding before their projected goal (Odom, Li, Scanlon, Perrine, & Grummer-Strawn, 2013). Providing a healthcare team that encourages breastfeeding during the perioperative period can minimize interruptions in breastfeeding and optimize the benefits for both the mother and infant (Simon, Carabetta, Rieth & Barnett, 2018). Unfortunately, many anesthesia providers lack confidence related to breastfeeding and drug transfer. …

Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR).

Methods We conducted a retrospective chart review on patients …

Implementing Best Practices To Improve Veteran’S Primary Care: A Pilot Project For Suicide Screening, Assessment & Referral, Nathaniel Held

Doctor of Nursing Practice Projects

Problem Description: Suicide is an increasing problem within the United States, but an even greater problem among the veteran population. Veterans are twice as likely to commit suicide than individuals within the civilian population. El Paso County, Colorado has the highest veteran population in the state and the highest number of suicides. Despite numerous military mental health programs available. Studies have found that many veterans will visit a civilian primary care clinic (for various reasons) within a month of taking their own lives but rarely are mental health concerns noted. This can be due to a lack of awareness and …

Efficacy Of Integrating Cbt For Mental Health Care Into Substance Abuse Treatment In Patients With Comorbid Disorders Of Substance Abuse And Mental Illness, Laura U. Madu, Jacqueline Sharp, Bobby Bellflower

Doctor of Nursing Practice Projects

Abstract: Multiple studies have found that psychiatric disorders, like mood disorders and substance use disorders, are highly comorbid among adults with either disorder. Integrated treatment refers to the treatment of two or more conditions and the use of multiple therapies such as the combination of psychotherapy and pharmacotherapy. Integrated therapy for comorbidity per numerous studies has consistently been superior to the treatment of individual disorders separately. The purpose of this QI project was to identify the effectiveness of Cognitive Behavioral Therapy (CBT) instead of current treatment as usual for treating Substance Use Disorder (SUD) or mental health diagnosis independently. It …

Developing Organizational Support And Leadership Structures For Advanced Practice Nurses In The Hospital Setting, Andrea L. Childress

Doctor of Nursing Practice Projects

Background: Hospitals are increasing utilization of advanced practice nurses (APNs). APNs do not fit within the traditional nursing or medicine department structures. They are often hired by organizations without full evaluation and assessment of management issues and structures to support them.

Problem: APNs are employed to work throughout an acute care hospital. They report to medical leadership but have no voting rights or representation on medical committees. They lack connection to nursing staff and existing structures which impairs their ability to exhibit leadership and advance nursing practice.

Purpose: This project seeks to answer: What organizational support and leadership structures are …

Improving The Nurse Patient Assignment Process On A Medical Surgical Unit, Kevin K. Mcewan

Doctor of Nursing Practice Projects

Background: Nurse patient assignments on an adult medical surgical unit at a community hospital are often accomplished with inconsistent processes and rationales. Each charge nurse utilizes individualized processes to determine which patients will be best teamed-up and assigned to the available nurses. There are frequently no acuity measurements system or set criteria by which the number or types of patients can or should be assigned to any given nurse, nor are staff skill or competency considered in the assignment process.

Project Design: A pilot project was conducted on a medical/surgical unit. The project utilized the American Association of Critical Care …

Improving The Quality Of Care For Pediatric Psychiatric Patients In The Emergency Department, Joseph L. Greene

Doctor of Nursing Practice Projects

Pediatric patients (17 years and younger) in mental health crisis are arriving in the emergency department in increasing numbers because there is a lack of mental health crisis care in the community setting. The emergency department is crowded, lacks a dedicated area for psychiatric patients that is quiet and safe, and staff are inadequately trained in psychiatric competencies. A quality improvement project was approved by Boise State IRB to train RNs in psychiatric competencies. Telepsychiatry provided timely evaluation by a qualified psychiatric provider. Patients’ perceived meaning of the ED visit was evaluated using the Patient Evaluation of Emotional Comfort Experienced …

A Community-Based Pilot Prevention Program To Prevent Electronic Cigarette Use Among Teens, Rosanna Moreno

Doctor of Nursing Practice Projects

With over 3.6 million teens using tobacco, we have lost the opportunity to create the first tobacco-free generation. This pilot project presented the CATCH My Breath (CMB) E-Cigarette and JUUL prevention program to local teens experiencing a global pandemic. The program was condensed from a 4-week multi-session offering into a one-day seminar with an intense focus on student safety and engagement. While contextual factors significantly impacted the project implementation, the content remained largely the same. This accounted for the achievement of many of the project’s desired outcomes. Participants increased their baseline knowledge of the effects and dangers of e-cigarette use …

Mentorship For Newly Licensed Nurses: A Pilot Program, Michelle Doran, Rn, Dnp, Npd-Bc

Doctor of Nursing Practice Projects

Background: The turnover rate for newly licensed nurses is high, posing financial and resource challenges for healthcare organizations. Transition to practice programs are an effective means of supporting retention. Mentorship is a best practice within such programs as it promotes job satisfaction, professional growth and development, and retention.

Objectives: The purpose of this project was to implement and evaluate a pilot mentor program with new nurses. Outcomes were: development of a structured program, enhancement of mentees knowledge about the value of mentorship, and assessment of mentee and mentor satisfaction with the program through a final satisfaction survey.

Methods: Participants were …

The Effects Of Diabetes Self-Management Education Among African American Adults, Nkeiruka Muonagolu Msn, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Type II diabetes continues to be a pervasive issue among African American adults. Significant challenges in effective management have resulted in poor health outcomes that have disproportionately threatened the quality of life among this group and increased the risk of mortality. Diabetes Self-Management Education (DSME) has demonstrated success in improved patient management and its capacity to mitigate risks for complications. Although researchers and health institutions generally accept DSME as an effective tool for managing diabetes, limited studies exist on its efficacy for African Americans.

Purpose: This study aimed to examine the effects of DSME intervention on diabetes management among …

Interprofessional Approach To Medication Reconciliation In The Hospitalized Medicare Patient., Misty Robertson

Doctor of Nursing Practice Projects

Background

Poor medication reconciliation processes in acute care hospitals, combined with poor communication across the healthcare team, and a failure to bring specialized pharmacy resources to the team can be attributed to adverse drug events that in turn result in hospital readmissions within 30 days of discharge (Sutherland, David-Kasdan, Beloff, Mueller, Whang, Bleday, & Urman, 2016).

Project Design

The aims of project included: 1. Utilize an interprofessional team that included, nursing, pharmacy, RN care management, and physicians to develop hospital policy and procedures for medication reconciliation, 2. Develop a risk stratification method to identify patients at highest risk for medication …

Implementing Teamstepps® Training For An Interdisciplinary Healthcare Team To Improve Teamwork, Tina J. Dimarino, Msn, Rn, Cnor, Casc

Doctor of Nursing Practice Projects

Background: Ineffective teamwork and communication increase the risk of adverse patient outcomes. An evidence-based teamwork training intervention was implemented to improve teamwork and communication.

Aims /Objectives: The team participated in a TeamSTEPPS® training program. The aims and objectives were to improve the staff’s attitudes and perceptions of teamwork and communication; pre, post and sustained at 30-days, reduce the number of documented near misses and measure for daily use of the newly acquired skills.

Methods: This is a quality improvement project with a one group, pretest and posttest design. The TeamSTEPPS® intervention was presented to the healthcare team. Participants’ teamwork attitudes …

Mindfulness Training In Mitigating Implicit Bias: Improving Cultural Competency For Nurses Caring For Lgbt Individuals, Daniel Terrell, Msn, Rn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Equitable care remains a goal of the United States healthcare system, with cultural competency training used as one intervention to mitigate disparities. Cultural competency education is primarily based on racial and ethnic differences, often omitting other marginalized groups. Implicit bias consequences are not addressed in such training programs despite the association with health outcome disparities. Research related to implicit bias has demonstrated the ability to promote malleability in implicit associations.

Objectives: This project assessed a mindfulness meditation exercise intervention on nursing awareness in interacting with lesbian, gay, bisexual, and transgender (LGBT) patients. Additionally, an LGBT health education module that …

A Program Development And Evaluation Project For Provider Use Of Buprenorphine Maintenance, Kyle Olson, Aprn

Doctor of Nursing Practice Projects

Background: Buprenorphine (BNX) is used in Opioid Use Disorder (OUD) deterrence. Optimal long-term duration with BNX is unclear, but evidence shows that there is a high risk for relapse when medicine is discontinued even if maintenance has been stable for some time.

Outcomes: The purpose of this project was to decrease barriers for providers implementing BNX therapy for individuals diagnosed with OUD. Outcomes measured included: (1) knowledge of and barriers to implementing current guidelines, (2) factors preventing use of guidelines, (3) recommendations for BNX maintenance as per guidelines.

Methods: Using a pre-post intervention design, participant knowledge on BNX guidelines, factors …

Implementation Of Diabetic Foot Care Education Quality Improvement Project, Mitaliben R. Gor, Msn Aprn Fnp-C

Doctor of Nursing Practice Projects

Background: A diabetic foot ulcer is a major complication in diabetes mellitus that results in increased mortality, morbidity, costs, and reduced quality of life. In 2015, the prevalence of diabetic foot ulcers was estimated by the International Diabetes Federation to develop annually among 9.1 million to 26.1 million people with diabetes worldwide. Diabetic foot care has economic consequences due to the expenses related to the treatments that arise from prolonged and recurrent hospitalizations and social problems from employment losses.

Purpose: The purpose of this project was to implement diabetic foot care education among diabetes patients in the clinic as a …