Medicine and Health Sciences Commons^™

Fascia Iliaca Blocks For The Treatment Of Hip Fractures In The Emergency Department, Megan Hahn

Doctor of Nursing Practice Projects

Due to the aging population, the number of falls are increasing, leading to an increased number of individuals with hip fractures presenting in emergency departments (ED). Opioids are often administered for intraoperative pain related to hip fractures, which may result in a number of adverse effects, especially in the elderly. There is strong evidence suggesting that the use of fascia iliaca blocks (FIBs) in the ED can minimize opioid use, and improve patient outcomes and recovery. FIB is a compartment block that delivers local anesthetic around the lumbar plexus to provide analgesia associated with hip fractures.

The purpose of this …

Investigation And Evaluation Of Srna Barriers To Iana Engagement, Brittany Smith

Doctor of Nursing Practice Projects

The Illinois Association of Nurse Anesthetists (IANA) and American Association of Nurse Anesthetists (AANA) are professional organizations representing Certified Registered Nurse Anesthetists (CRNAs). While AANA membership has risen from 27,000 in 1994 to 45,000 in 2014, there was a 5% decline in CRNAs who are members of the AANA (Farina, Wilson, & FitzSimmons, 2016). Farina et al. (2016) reported that of 5,032 CRNAs who were not AANA members, 2,549 had been CRNAs for less than 10 years. This project involved the development and use of a 21-question survey to identify barriers to involvement in the IANA for student registered nurse …

Computer Based Learning Module: Neuraxial And Peripheral Nerve Blocks, Altan Halici

Doctor of Nursing Practice Projects

Neuraxial and peripheral nerve blocks (PNB) have been present for many years, but recently these pain management techniques are gaining popularity as an alternative to the use of opioids. Neuraxial and PNB reduce the opioid usage during and after the surgery and improve postoperative recovery in terms of pain relief, pain-related sleep disruption, and reduction of side effects, such as nausea and vomiting. Conversely, inadequate pain management after surgery may delay surgical recovery, decreased patient satisfaction, increased length of hospital stay, increased readmissions and healthcare costs (Patacsil, McAuliffe, Feyh, & Sigmon, 2016).

Perioperative nurses are instrumental during the post-operative period …

Development And Implementation Of An Enhanced Recovery After Surgery Screening Tool For Orthopedic Patients, Katie O'Rourke

Doctor of Nursing Practice Projects

Enhanced Recovery After Surgery (ERAS) protocols are evidence-based programs utilized by hospitals to improve patient outcomes and decrease perioperative opioid administration, generally associated with abdominal surgeries. With over 850,000 orthopedic surgeries performed in 2016, the volume of operations alone indicates a need for adoption of ERAS protocols within the orthopedic patient population. A review of literature was completed to gather the most current, evidence-based non-opioid components to be included in an ERAS protocol for orthopedic patients at a 460-bed hospital in Missouri. The results showed that Acetaminophen, Celebrex, Gabapentin, and regional anesthesia techniques are the most utilized ERAS adjuncts. With …

Development Of An Emergency Preparedness Protocol In An Office Setting, Amanda Burgesen

Doctor of Nursing Practice Projects

Office-based practices are not as stringently regulated as hospitals or ambulatory surgical centers. The lack of government oversight places the responsibility heavily on office-based practitioners to properly exercise their professional ethics to ensure their patients are receiving the highest quality of care while remaining safe. The purpose of this quality improvement project was to develop and implement an emergency activation protocol for a local gastroenterologist office in Southern Illinois that promotes emergency preparedness. The emergency activation protocol provided recommendations for staff training on emergency preparedness, mock codes, checking the crash cart, monitoring of the patient, medications available, and equipment that …

Improving Emotional Intelligence Skills In Student Registered Nurse Anesthetists, Kathryn M. Gratza

Doctor of Nursing Practice Projects

Becoming a certified registered nurse anesthetist (CRNA) involves didactic and clinical course work that challenges the student’s cognitive, mental, and emotional well-being. Standardized cognitive factors, such as grade point average, are utilized for nurse anesthesia program admission, but those factors do not take into account the student’s emotional intelligence. The ability to manage one’s emotions has a positive correlation with academic success (Beauvais, Stewart, DeNisco, & Beauvais, 2014) and has been correlated with greater success in nurse anesthesia programs (Collins, 2013).

The goal of this doctoral project was to increase the emotional intelligence of first-year students in the nurse anesthesia …

Discharge Opioid Guidelines For The Postpartum Woman, Chelsea Marie Pierce

Doctor of Nursing Practice Projects

In spite of the alarming opioid abuse epidemic, the number of opioids prescribed to women who give birth has been overlooked and underregulated. In a large metropolitan hospital that has over 3,500 deliveries a year, this problem was identified through first-hand encounter and data collection from an electronic medical record. Women in the postpartum period were prescribed an unnecessary number of opioids upon discharge. The goal of this project was to create guidelines that would decrease opioid use and increase the overall well-being of postpartum women. Guidelines were based off of type of delivery and women were not allotted more …

Addressing Hypertension Health Literacy In Black Individuals Who English Is Their Second Language, Uche Olateru

Doctor of Nursing Practice Projects

Hypertension is a primary preventable risk factor for cardiovascular disease. Despite advances in preventive and treatment measures, related to blood pressure control, the prevalence of hypertension in the United States remains high among Black People of immigrant and non immigrant communities. Healthcare is increasingly complex, and health literacy problems have increased due to demands by healthcare stakeholders for patients to assume a more independent role in taking charge of their health. A quality improvement project was conducted in a Faith based community to improve the knowledge of participants about hypertension. The objective of this project was to enhance lifestyle management …

Diabetes Management, Christina Varady

Doctor of Nursing Practice Projects

Diabetes Self-Management Education and Support (DSMES) has been shown to improve diabetes management. A Midwest, private family practice did not offer formal diabetes education. The purpose of this project was to increase patient education for recently diagnosed patients with type 2 diabetes who had not yet reached their management goals. A second purpose was to develop quality educational material for the provider in this practice. These objectives were met by identifying patients who were not at the optimal goal of HgA1c of 7% per the American Diabetes Association (ADA) guidelines and providing quality diabetes education and follow up to these …

Cvd Screening Protocol For History Of Hypertension In Pregnancy, Wendy E. Rodgers, Marissa P. Mahan, Jamie Y. Welty

Doctor of Nursing Practice Projects

The American College of Obstetricians and Gynecologists (ACOG) and the American Heart Association (AHA) recommend women with a history of hypertension during pregnancy receive annual blood pressure monitoring, weight check, and lipid screening; remain in the optimal body mass index (BMI) range; and obtain education on future risks for cardiovascular disease (CVD). At a small, Midwestern primary care clinic, there is not a current process in place to ensure patient education and screenings are provided for patients who meet this criterion. For this project, two check boxes were added to the providers’ annual exam template in the electronic health record …

Trauma Informed Care: Paving The Way To Better Patient Outcomes, Sarah Halsey, Amy L. Armstrong

Doctor of Nursing Practice Projects

Trauma-informed care (TIC) is an approach that enables healthcare clinicians to understand the effects of trauma and create a safer environment. Providers acknowledge the pervasive nature of trauma but lack proper tools and training to implement. It has been suggested that trauma is the prime determinant of health outcomes. Therefore, providing training and cultivating a change towards a trauma-informed organization, has the capability to change health outcomes.

The purpose of this project was to establish a program at SIU Medicine in which new employees are trained on the importance of TIC. Working closely with the Director of Population and Community …

Implementation Of The Edinburgh Postnatal Depression Scale In A Midwest Primary Care Clinic, Amanda Lee

Doctor of Nursing Practice Projects

Recent data from the World Health Organization reveals that the prevalence of postpartum depression is about 13%. Research portrays that untreated postpartum depression can have a detrimental impact on maternal and child outcomes. The American Academy of Pediatrics recommends integrating postpartum depression screening at the 1-, 2-, 4-, and 6-month well-child visits. The purpose of this project was to increase early identification of women with postpartum depression (PPD) by increasing the frequency of the Edinburgh Postpartum Depression Scale (EPDS) and evaluating the adherence of the recommended protocol at a Midwestern Primary Care clinic. The healthcare staff received training that included …

Increasing The Completion Of Advance Directives In Patients With Chronic Obstructive Pulmonary Disease In The Primary Care Setting, Cynthia Davis

Doctor of Nursing Practice Projects

When considering patients with COPD, current evidence indicates that discussions related to prognosis, illness trajectory, and goals of care between the provider and patient do not happen as they should. Consequently, without any advanced directives, the default in crisis is “do everything”. This gap in practice supported the need to implement an evidence-based assessment protocol regarding advance care planning needs in patients with COPD. The purpose of this project was to increase the number of COPD patients having advanced directives in a mid-western primary care clinic. The protocol included a chart review to assess for completed advanced directives among patients …

Efforts To Improve Breast Cancer Screening In A Rural Primary Care Clinic, Michelle Voudrie, Simi Dhillon

Doctor of Nursing Practice Projects

Breast cancer is the second-leading cause of cancer-related deaths among women in the United States. The American College of Obstetricians and Gynecologists (ACOG) recommend women at average risk of breast cancer to begin screening mammography starting at age 40. Mammography has been recognized as the most substantial tool to detect breast cancer. However, many rural organizations have seen a decrease in mammography compliance rates. The goal of this project was to create an evaluation and follow-up protocol for women in a rural primary care clinic who meet the criteria for ACOG’s guidelines for breast cancer screening which promotes increased compliance …

Safe Sleep Modeling In The Neonatal Intensive Care Unit, Barbara Garrison

Doctor of Nursing Practice Projects

Abstract

Approximately 3,500 babies die each year due to sleep related deaths. The 2016 American Academy of Pediatrics Policy Statement clearly states that all health care workers should model safe sleep for infants less than 12 months of age prior to discharge from the hospital. However, at a large, Midwest, level IV, University-based neonatal intensive care unit (NICU), safe sleep was not being modeled. The purpose of this project was to increase adherence to the American Academy of Pediatrics recommendations by implementing a unit-based quality improvement project focusing on policy development, staff education, and parent education.

Although starting out as …

Implementation Of A Depression And Domestic Violence Screening Protocol In An Internal Medicine Setting, Laurie Hopper

Doctor of Nursing Practice Projects

Depression is a widespread problem in the United States, yet only 35% of sufferers seek help for their symptoms. Additionally, almost 25% of women and 14% of men report experiencing some form of domestic violence. Both of these conditions can impact short-term and long-term health and overall function. Early detection, treatment, services, and support can improve patient outcomes.

This project initiated the use of two standardized screening tools, the PHQ-2 for depression and the PVS for domestic violence, in an internal medicine practice where no formal screening process had been in place. During the 3-month implementation period, patients of the …

Sharp Safety And Supply Containment In Procedural Areas, Ariel Wright

Doctor of Nursing Practice Projects

To improve safety in procedural areas, a Midwest hospital piloted supply and sharps counts to reduce both sharp injuries and patient retained supplies. Supply counts are a standard of practice for decades within surgical-operational departments. Despite improved standards within surgical-operational departments, safety measures within procedure areas are limited. With current recommendations for sharp and supply counts and reported sharp injuries in the procedural area, the need to develop and implement a supply count and sharp containment policy was evident. A four-week doctoral project was implemented within the electrophysiology studies (EP) procedural area. EP staff reported using non-standardized techniques to count …

Managing, Mitigating And Minimizing Patient Violence In The Emergency Department, Denise Thompson

Doctor of Nursing Practice Projects

Patient violence in the Emergency Department (ED) is common, varied, and has lasting effects on nurses. Survey and questionnaire responses from 18 nurses in a Midwestern hospital ED revealed mindsets and perceptions of short and long term effects of potential and realized patient violence situations. Patient verbal and physical abuse directed at nurses is generally viewed as an acceptable job risk by the general public, hospital administrators, and nurses. Nurse surveys indicated daily anticipation of physical harm, a sense of helplessness from lack of administrative support, and emotional stress related to acts of patient violence. Support from Occupational Safety and …

Dedicated Preceptors Improve Nurse Residency, Anne Hustad

Doctor of Nursing Practice Projects

Research and evidence support the use of dedicated preceptors during new nurse residency programs to increase nurse retention after the orientation period. A small rural Illinois hospital introduced a nurse internship program in 2017 without the use of dedicated preceptors. The program continued throughout 2018 and nurse retention did not improve as anticipated by the hospital leadership. In early 2019, this author collaborated with the education department to implement a new nurse orientation program that introduced the use of dedicated preceptors. An education bundle was developed and presented to the dedicated preceptors outlining expectations and an orientation checklist. Pre-implementation focus …

Optimizing Data Accessibility To Impact Bcma Compliance, Lucy A. Bischof, Margott Montesinos

Doctor of Nursing Practice Projects

Background: The integration of health information technology (HIT) is an expectation during the healthcare delivery process to ensure quality and accuracy. Data generated from HIT can help facilitate quality initiatives. HIT such as Barcode Medication Administration (BCMA) has been successfully introduced in the healthcare industry with a demonstrated positive impact on patient safety. A small test of change was implemented on a Medical Surgical (MS) and Intensive Care Unit (ICU) which included automated daily BCMA compliance reports sent to leadership compared to the current standard process.

Objectives: To examine impact of reports on the BCMA compliance data. To examine leadership …

Reducing Emergence Delirium In Combat Veterans Through The Development Of A Decision-Tree Utilizing Ketamine And Precedex, Joseph Oldani, Russell Arendt

Doctor of Nursing Practice Projects

Emergence Delirium incidences in the combat veteran population warrant unique anesthetic considerations. Examples of these considerations include the exclusion of a benzodiazepine and the use of low dose Ketamine or Precedex infusions. Researching these considerations, an anesthetic decision tree coupled with a screening questionnaire was developed and implemented in a hospital in Southern Illinois. The tool was developed based on a thorough literature review and a need to condense this information into a working knowledge for clinical application. Implementation of the project included staff education on the tool and the management of Emergence Delirium by using Ketamine and Precedex. A …

Developing The Pedis Pediatric Obstructive Sleep Apnea Screening Tool, Steven Sumpter

Doctor of Nursing Practice Projects

Obstructive sleep apnea (OSA) is the most common type of apnea in the pediatric population. Its prevalence is 0.7%-3.0% (Garcia et al., 2016). The dangers of OSA are multiplied in conjunction with anesthesia because anesthesia resembles a state of sleeping, relaxing the airway, and requiring more intense airway monitoring. Childhood OSA includes increased risk for developing neurocognitive impairment, behavioral problems, failure to thrive, hypertension, cardiac dysfunction, systemic inflammation, and increased healthcare costs (Kothare et al., 2015). A perioperative pediatric OSA screening tool is necessary to reduce airway risks. The PEDIS screening tool is a brief, efficient, and evidence-based tool capable …

Implementing A Health Promotion Physical Activity Program For Middle School Youth In A Rural, Faith-Based Organization, Karmin Maher-Hasse

Doctor of Nursing Practice Projects

Problem: Childhood obesity is more prevalent in rural areas, and these areas have fewer resources to address it. Geographic distance to available resources, health care provider shortages, parental obesity, and poverty contribute to higher prevalence of obesity in rural children compared to urban children.

Rationale: Obesity prevention and treatment often requires long-term healthy lifestyle behavior changes including nutrition counseling and physical activity (PA). It is likely an obese pre-adolescent will have obesity as an adult, and the likelihood increases if obesity continues into adolescence. Pre-adolescence provides a window of opportunity to influence healthier PA habits to prevent overweight (OW) and …

A Faith-Based Quality Improvement Project To Increase Awareness, Prevention, And Management Of Coronary Heart Disease In African Immigrants, Temitope S. Okpebho

Doctor of Nursing Practice Projects

Problem Description: Coronary heart disease (CHD) affects people globally, and it is the leading cause of death in the United States. Despite increased CHD awareness, evidence shows the increased prevalence and low CHD awareness among African Immigrants. According to Boateng et al. (2017), African immigrants are more likely to have CHD risk factors and be unaware. This may be due to changes in eating habits, lack of physical activity, increased stress level, and the adaptation of the Western diet.

Rationale: This project included implementing a culture care theory in a faith-based organization to increase awareness, management, and prevention of CHD …

Improving The Process Of Making Preoperative Home-Medication Recommendations, Andrew Standefer

Doctor of Nursing Practice Projects

Improving the Process of Making Preoperative Home-Medication Recommendations

Many patients presenting for surgery have a list of prescribed medications they take daily to treat various comorbidities. Even though prescription drugs may offer patients therapeutic benefits during the perioperative period, they may also cause adverse effects when used in conjunction with anesthesia during surgery (Marley, Calabrese, & Thompson, 2014). Therefore, identification of medications for the preoperative patient to take or withhold is necessary.

Research indicates that clinicians often make inappropriate decisions regarding preoperative medication management in settings where no guideline exists (Renew, Bolton, Alvarado, & De Ruyter, 2015; Symons & McMurry, …

Implementation Of Crisis Checklist For Local Anesthetic Systemic Toxicity (Last) In The Parturient Patient, Annelise Contino

Doctor of Nursing Practice Projects

The chief anesthesiologist at a large hospital in Illinois requested education and a checklist on the treatment of Local Anesthetic Systemic Toxicity for the medical team involved in the care of parturient patients. The implementation of The Stanford Anesthesia Cognitive Aid Group checklist for LAST and an educational session was completed for all staff involved in the care of the parturient patient. A PowerPoint presentation was utilized to educate on the early recognition and treatment of LAST. The presentation was implemented at the obstetrics department staff meetings and the monthly anesthesia department meeting. A pretest was completed prior to education …

Crna To Cvicu Rn: Implementation Of A Standardized Patient Handoff Checklist For Post-Surgical Heart Patients, Ashley Mcgrath

Doctor of Nursing Practice Projects

Patient handoffs occur when the information and responsibility of the patient is transferred from one health professional to another. Ineffective communication during the critical postoperative phase of the transfer of care (TOC) has been associated with extended hospital stays, increased healthcare costs and patient dissatisfaction. In 2007, the Joint Commission National Patient Safety Goals proclaimed the importance of a standardized handoff process for effective handoffs. The purpose of this quality improvement doctoral project was to assess if the utilization of a standardized TOC checklist from the operating room to the cardiac intensive care unit (CVICU) for post-heart patients improved communication …

Dnp Project: Improving No-Show Rates In Primary Care, Mai-Linh T. Nguyen, Sarah M. Kuzara

Doctor of Nursing Practice Projects

Abstract

This paper explores the factors that contribute to no-show rates in the primary care setting and effective interventions to improve no-show rates. The average no-show rate in the primary care setting is 23%, (Dantas, Fleck, Olivaria, & Humacher 2018). In 2018, the no-show rate at the WeCare Clinic was 50-60%. A literature review was conducted to gather information regarding why patients choose to no-show their appointments, the common causes of high no-show rates, and effective interventions found to decrease no-show rates. We investigated the primary causes of a high no-show rate at the WeCare Clinic by interviewing staff and …

Improving Health Insurance Literacy Within Our Community Through The Use Of Local Libraries, Bonnie Gregg, Jenny Lieu

Doctor of Nursing Practice Projects

Low health literacy is associated with a poorer ability to understand medical information leading to disparities among all ages. Communities play a role in supporting efforts to improve health literacy. Libraries are trusted institutes that offer an environment for all members of the community and serve as places of lifelong learning. A needs assessment approach determined a gap in knowledge regarding health literacy and insurance, specifically the Affordable Care Act (ACA). This project was an exploratory, community improvement project. Information was presented in educational sessions at two local libraries. Participants were also given an informative brochure to accompany the presentation. …

Hepatitis C Screening Protocol In A Rural Primary Care Setting, Katie C. Wollerman, Mackenzie M. Bowers

Doctor of Nursing Practice Projects

Current evidence indicates a need for Hepatitis C Virus (HCV) screening, as the virus can lead to complications if not detected early. Screening is determined by population-based risks, behavioral-based risks, and healthcare-based risks. After criteria are met, patients can be screened by a venous laboratory test. A gap existed in a rural primary healthcare clinic, as providers were not following Centers for Disease Control and Prevention (CDC) or U.S. Preventative Services Task Force (USPSTF) recommendations to screen patients. An HCV screening protocol was developed and implemented in this healthcare facility. The providers opted to only implement screening for population-based risk …