Medicine and Health Sciences Commons^™

Increasing Adult Influenza Vaccination Rates In The Primary Care Setting, Leah Prescott Msn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Provision of vaccinations is one of the most basic interventions aimed at health promotion and disease prevention in the primary care setting. Despite increased public awareness and improved access to vaccinations through minute-clinic settings, health fairs, and employer-offered vaccination clinics, adults in the United States continue to fall short of national goals. Literature demonstrates vaccination rates among adults vary widely and may be affected by a multitude of factors, however vaccination rates may be greatly improved with increased provider engagement.

Objectives: The purpose of this project was to develop, implement, and evaluate a program to improve immunization rates in …

Alcohol Screening, Brief Intervention, And Referral To Treatment Protocol In The Emergency Department, Malvis Ndips Achonduh Tamon, Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: The impact that results from inappropriate alcohol consumption poses challenges to public health. The rate of alcohol-related visits to the Emergency Department (ED) has increased, which has resulted in an increased annual cost of alcohol-related visits. ED serves as a common portal of entry into the healthcare system for many patients and offers a unique opportunity to impact drinking behaviors.

Objectives: To increase the number of alcohol screenings and brief interventions when indicated to adult patients who visit the ED and increase ED nurses' knowledge regarding alcohol misuse and indications for brief interventions.

Methods: An educational module was delivered …

The Effect Of Hypertension Education On Knowledge, Lifestyle Behaviors And Blood Pressure Management Among Parishioners In A Faith-Based Setting, Lynda N. Goodfriend, Msn, Rn

Doctor of Nursing Practice Projects

Background: Hypertension (HTN) is a major risk factor for life threatening events. Although evidence supports using faith-based settings to provide health education to better manage chronic conditions and prevent complications, HTN education is underutilized in this setting.

Aims/Objectives: This project aimed to assess the effectiveness of HTN education on knowledge, self-reported lifestyle behaviors and blood pressure (BP) management among parishioners in a suburban church.

Method: A pre-post educational intervention was used in this evidence-based project. BP screening identified 56 eligible adults and a convenience sample of 44 parishioners with HTN were enrolled. Participants received two 45-minutes educational sessions. Pre- and …

A Nurse Led Pre-Operative Patient Education Intervention And Its Effect On Anxiety Levels In General Surgical Patients, Elisabet C. Harms Ms, Rn, Cmsrn, Cnecl

Doctor of Nursing Practice Projects

Background: Substantial research has shown anxiety can negatively affect patients during the surgical period. Healthcare staff have limited time to educate.

Objectives: This study assessed the effect of pre-operative patient education on general surgical patients’ level of state anxiety. Also, compared the differences of pre and post intervention anxiety scores between patients undergoing different types of surgery and anticipating varied length of hospital stay.

Methods: A one-hour educational class, either in-person or online, provided information about surgery and recovery phase to 20 pre-operative patients. Participants’ anxiety levels before and after the class were measured using the State Anxiety Inventory questionnaire. …

Mitigating Delirium For The Elderly Post-Operatively Without Medication, Ann Lo Basso

Doctor of Nursing Practice Projects

Background: Often occurring after surgery, or hospitalization, the development of delirium in older adults, initiates a cascade of events culminating in loss of independence, increased morbidity and mortality, and high health care costs (Oh, et al., 2017).

Objective: The purpose of this quality improvement (QI) project was to adapt and implement best practices using HELP for managing older patients with postoperative delirium through the existing 1:1 observation structure and implementing cognitive care strategies. The 1:1 sitter roles and responsibilities were redesigned to include non-pharmacological, multicomponent interventions.

Methods: The QI project used a pre-test post-test intervention design comparing groups before and …

Time For Quiet Reducing Nighttime Interruptions In The Icu (Turn In-Icu): Evaluation And Implementation Of A Nonpharmacological Sleep Bundle To Improve Sleep Quality, Delirium, And Nighttime Sedation Requirements, Christina Junker, Msn, Rn, Ccrn

Doctor of Nursing Practice Projects

Background: Undisturbed, restful sleep is essential for physiological as well as psychological well-being. For critically ill patients, sleep deprivation caused by frequent nighttime interruptions is associated with poor sleep quality and negative patient outcomes.

Objectives: The purpose of this Quality Improvement (QI) project was to promote uninterrupted sleep between the hours of 10 PM and 5 AM. Outcomes for evaluation consisted of the following three components: (1) sleep quality, (2) incidence of delirium, and (3) nighttime sedation requirements. Except for sleep quality, these variables were compared before and after the intervention.

Methods: A descriptive, before and after design for data …

Implementing The Ami Readmits Risk Assessment Score Within A Referral Protocol To Increase Referrals For Follow-Up Among Patients With Type I Myocardial Infarction, Nailya Muganlinskaya, M.S.N., M.P.H., Acnp-Bc, Dnp Graduate

Doctor of Nursing Practice Projects

Background: The hospital’s post- myocardial infarction (MI) referral protocol does not address patient risk characteristics. Referrals to a post- MI clinic have been lower than expected. Evidence suggests the AMI READMITS score can predict readmissions within 30 days after discharge among patients with acute MI.

Aim: This quality improvement study evaluated a referral protocol that integrated the AMI READMIT score to increase appropriate referrals after discharge.

Methods: Patient chart data was analyzed to assess changes in referrals and timely follow-up from pre-intervention to intervention. A survey assessed providers’ satisfaction with the new referral protocol.

Results: Among 57 patients (n=29 pre-intervention; …

The Development, Implementation And Evaluation Of An Evidence-Based Biohazard Training Program Within A Pediatric Ambulatory Practice, Lakeshia L. Evans Mba, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Communicable disease(s) such as Ebola or Coronavirus can cause a catastrophic health crisis within the United States healthcare system, especially among the pediatric and elderly population. Lack of knowledge, skills and confidence among health care professionals in the pediatric setting regarding these infectious organisms can affect early identification, proper isolation, early treatment, and increased risk of a possible pandemic and/or fatalities.

Aims/Objectives: The aim of this study was to develop, implement and evaluate an evidence-based biohazard training program-using the Identify, Isolate and Inform (3I) tool within a pediatric urgent care center to increase the staff’s knowledge, skills and confidence …

Implementing A Digital Imaging Platform Using Tissue Analytics In A Level 1 Trauma Center, Victoria Donaldson, Msn, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: More than 2.5 million people develop pressure ulcers (PUs) annually. PUs cost the U.S. $9.1-11.6 billion per year and add about $43,180 to a hospital stay. The Centers for Medicare Medicaid Services (CMS) stopped reimbursement for hospital-acquired pressure ulcers (HAPUs). Documentation of PUs must indicate if they are present on admission (POA) and include accurate stages and treatment plan of PUs. Aims/Objectives: To use Digital Imaging platform using Tissue Analytics (TA) along with the standard care protocol. The objectives of this study were to (1) Improve identification of PUs, (2) Increase accuracy of PU staging and (3) Improve documentation …

Nurse’S Perception Of Safety Culture And Patient Safety Following Implementation Of A Handoff Communication Process Between Pre-Operative And Operating Room Nurses, Tracy Willett, Msn, Mba, Rn, Nea-Bc, Cnor

Doctor of Nursing Practice Projects

Background: In a hospital environment the care of the patient is transferred multiple times during his or her stay. Current needs assessment indicates that nurses’ perception of safety culture with handoff communication and patient safety is an area of focus for the practice site.

Objectives: This study aimed to improve the Pre-operative and Operating Room nurses’ perception of safety culture measured with four valid and reliable survey questions. The second study’s aim was to improve patient safety with the handoff process, measured by the number of adverse events reported by the practice site.

Methods: Pre-implementation data was collected. Nurses worked …

Improving Patient And Provider Engagement By Utilizing Ask Me 3®, Joseph G. Smith, Msn, Arnp, Fnp Bc

Doctor of Nursing Practice Projects

Background: Patient and provider engagement in healthcare has an impact on health outcomes.

Purpose: To study the implementation of the Ask Me 3 (AM3) tool, a tool that encourages patients to ask three questions about their health to their care provider. The aim of the project is to explore the level of patient and provider engagement by patients` reports of their perception of engagement with their provider and in understanding their diagnosis.

Methods: The setting was a small urban family practice in the Pacific Northwest. Every patient that checked in for their appointment, excluding pediatric and younger than 18 years …

Utilizing A Mentorship Approach To Address The Underrepresentation Of Ethnic Minorities In Senior Nursing Leadership, Kimberly Jean-Louis, Msn, Mpa, Rn, Nea-Bc

Doctor of Nursing Practice Projects

Many healthcare institutions have acknowledged the benefits of and the need for a workforce that reflects the diverse patient populations they serve. However, few healthcare organizations have made progress in increasing the diversity of their leadership teams. The American Hospital Association’s Institute for Diversity in Healthcare Management (2016) found that while minorities represent 32% of hospital patient populations across the nation, they only account for 11% of executive leadership. The objective of this DNP project was to implement a 4-month mentorship program that empowered minority nurse leaders who desire career advancement to executive leadership roles and provide them with realistic …

Does Use Of A Mobile App And Telephone Support Promote Improved Self-Care Of Heart Failure?, April Christine Chew

Doctor of Nursing Practice Projects

Background

Heart failure is a complex disease and a growing global epidemic. Symptoms and multiple comorbidities contribute to the overwhelming burden of heart failure, and support people make an important contribution to self-care. Effective self-care maintenance behaviors along with confidence and support can help people living with heart failure to effectively self-manage the disease.

Purpose

This project aimed to determine if use of a mobile app with telephone support calls was an effective intervention to promote improved self-care of heart failure and caregiver contribution to self-care of heart failure compared to the standard of care where the intervention was not …

Implementing Feno Testing Protocol In A Pulmonary Clinic: A Dnp Project, Herbert "Allen" Nolan

Doctor of Nursing Practice Projects

Airway inflammation is a common condition seen in the pulmonary clinic and can be present in patients with chronic obstructive pulmonary disease, asthma, chronic cough and asthma chronic obstructive overlap syndrome. Utilization of fractional exhaled nitric oxide testing is a quick means of identifying airway inflammation in patients who visit the pulmonary clinic with the diagnoses listed above. Fractional Exhaled Nitric Oxide testing along with Asthma Control Testing were used in the pulmonary clinic to aid in the identification of airway inflammation along with traditional spirometry testing. The results reflected an increase in the identification of patients with airway inflammation …

The Impact Of Nursing Staff Responsiveness On Patient Satisfaction: A Pilot Project, Lisa Wallace

Doctor of Nursing Practice Projects

Timeliness of healthcare staff responsiveness to patient requests is multifactorial. Inadequate responsiveness to patient requests may lead to increased patient injury, increased cost, and patient dissatisfaction which may impact stakeholders and profit margin. Evidence supports that proactive, timely, staff responsiveness to patient requests and call lights may lead to improved patient safety, higher patient satisfaction, and better healthcare outcomes. Bundled staff responsiveness interventions may be implemented to improve patient safety, patient and staff satisfaction. Examples of interventions include engaging staff project buy-in with formation of a patient experience team, hardwiring hourly safety rounding, providing staff education on the importance of …

A Diabetes Crash Course In A Primary Care Setting To Improve Diabetes Self-Care: A Pilot Project, Michelle L. Macdonald

Doctor of Nursing Practice Projects

Diabetes (DM) is a deadly disease affecting millions. Lack of proper DM self-care management can lead to numerous complications and even death. The American Diabetes Association (ADA) recommends lifestyle change as a first-line treatment along with diabetes self-management education (DSME). However, according to the Centers for Disease Control and Prevention (CDC) only a fraction of those diagnosed attend. The purpose of this project was to improve DM self-management behaviors following a patient focused unique DMSE designed to meet community needs. A customized crash course style DM educational session was offered to all DM patients in a rural primary care clinic. …

Checklist Utilization To Reduce Cauti Rates: A Dnp Project, Christina Jah

Doctor of Nursing Practice Projects

Catheter-associated urinary tract infections (CAUTIs) are preventable events with significant ramifications for both patients and hospitals. Proper training on evidence-based practices for catheter management is a vital component of preventing and decreasing CAUTIs. Following a review of the literature, evidence supports that CAUTI education with the use of a standard urinary catheter checklist for registered nurses (RNs) has the potential to ensure that knowledge is applied, thus decrease CAUTIs. This doctoral project developed, implemented, and evaluated an educational program and checklist to reduce CAUTI among patients at a Veterans Administration (VA) hospital. This project utilized a mixed-method data collection with …

Implementation Of An Educational “Boot Camp” To Increase Nurses’ Confidence, Knowledge And Use Of Evidence-Based Practice In A Veterans Affairs Medical Center, Anita S. Dahl

Doctor of Nursing Practice Projects

Evidence-based practice (EBP) can be used to promote quality patient care, improve population health, decrease healthcare costs, improve work-life balance of health care professionals, increase job satisfaction, and decrease staff turnover. Barriers to implementing EBP include perceived lack of autonomy and authority to change patient care processes; and knowledge deficits related to EBP implementation. Limited access to research materials and inadequate leadership support also stifles implementation of EBP. The purpose of this project was to increase confidence, knowledge, and use of EBP by nurses through implementation of an intense, structured educational “Boot Camp”. A convenience sample of 27 nurses participated …

An Organizational Readiness Assessment And Patient Survey For Adoption Of An Opioid De-Escalation Protocol In Curative Oncology Patients, Adria Myers

Doctor of Nursing Practice Projects

Since 2012, statistics illustrate an explosion in the number of Americans admittedly misusing prescription opioids which increase the risk of long-term adverse effects. By 2016, individuals admitting to taking opioids for non medical reasons exceeded eleven million and 1.9 million of these individuals met the mental health guidelines for opioid abuse. Oncology patients represent a target population with an unmet met need for opioid reduction. Goals for de-escalation or tapering opioids for non-cancer pain have gained increasing attention across healthcare. Evidence-based opioid de-escalation guidelines specific for curative oncology patients are lacking in the literature. The aim of this DNP project …

Effectiveness Of De-Escalation Training To Medical-Surgical Nurses, Tammy L. Sullivan

Doctor of Nursing Practice Projects

Nurses are the most common victims of workplace violence and typically are not equipped deliver appropriate prevention interventions. Although most violent episodes occur in the emergency department and mental health units, violence towards nurses on the medicalsurgical units is on the rise. Patient perpetrated aggression and violence is positively correlated with poor patient outcomes and length of stay. In addition to the physical effects on the nurse, there are psychological effects that can impact their career and personal life. The direct and indirect cost for an organization includes decreased productivity, increased absenteeism, and turnover. In potentially violent situations, nurses must …

Simulation Based Learning To Increase Competency And Self-Confidence In Novice Nurses, Veronica Eubank

Doctor of Nursing Practice Projects

New nursing graduates lack competency and confidence in failure to rescue situations could result in failure to rescue (FTR). High-fidelity simulation (HFS) is a potential solution to ensure a controlled environment in which new graduates can practice safely and gain the knowledge they need to develop critical thinking skills. Utilizing simulation education to improve an individual’s ability to recognize deterioration early, communicate, prioritize, delegate, and provide role clarity can foster confidence and competence in new graduate nurses. The project evaluated the effectiveness of using HFS for novice nurses to increase knowledge, competency, and confidence when a patient status deteriorates. The …

Preparing For Obstetrical Emergencies In The Emergency Department, Tracy Littlehale

Doctor of Nursing Practice Projects

Emergency Department nurses must maintain the skills to manage OB emergencies in the ED, especially in hospitals with no OB unit. Limited contact with OB patients diminishes the self-confidence, knowledge and skill of ED nurses, which may minimize their ability to recognize OB problems in a timely manner. As increasing numbers of patients with OB emergencies are expected to seek care in rural EDs due to closure of rural OB units and rising OB risk factors, maintenance of OB skills by ED nurses is critical. Simulation has been identified in the literature as an effective strategy to help nurses advance …

Preparing Ambulatory Care Leaders For Service: Onboarding To Mentorship, Kara Simpson

Doctor of Nursing Practice Projects

At a large academic medical center in the Southeastern United States, a gap was identified in the process for onboarding and mentorship new leaders in the ambulatory care setting. Based on the evidence in the literature, a standardized onboarding and mentorship program can improve job satisfaction and retention of leaders. A program was developed to bridge this gap and provide educational support for new leaders. Participants completed surveys at the onset and conclusion of the program with a validated survey tool. While the quantitative results were not statistically significant, the feedback from the participants indicated the time spent in the …

Using Simulation To Improve Skills, Confidence, And Satisfaction Related To Diabetes Education, Greshin M. Markwell

Doctor of Nursing Practice Projects

Diabetes mellitus is the seventh leading cause of death in the U.S. and affects 30.3 million people (Centers for Disease Control and Prevention [CDC], 2019). Research suggests that patients often have a limited knowledge and insight into self-management of diabetes mellitus (DM). Acceptance of the disease, insufficient knowledge, and noncompliance are the examples of key factors that affect the progress of the disease. Nurses play a key role in the delivery of diabetes education which can improve compliance. Simulation can be used to improve the nursing skill sets for diabetes education. The purpose of this project was to implement evidence-based …

Minimizing Antipsychotic Medication Side Effects In Adults Diagnosed With Mental Illness Through Psychoeducation: An Evidence-Based Approach, Sarah A. Yao

Doctor of Nursing Practice Projects

Adherence to antipsychotic medication has demonstrated significant impact in decreasing symptom exacerbation among patients diagnosed with mental illness. Antipsychotic medications have several benefits including the management of psychotic and mood disorders; however, they could cause unwanted medication side effects with metabolic and cardiovascular risks. This issue is one of the commonly linked side effects resulting in nonadherence among mentally ill patients. The purpose of this project was to implement a psychoeducational intervention using the SIMPLE program to address metabolic and cardiovascular risks associated with antipsychotic medications among adult patients diagnosed with mental illness. A sample size of sixteen adult patients …

Suicidal Risk Education In Hospice Care, Shannon Jones

Doctor of Nursing Practice Projects

It is well-documented that oncology patients experience greater rates of suicidality including suicidal ideation, actions, or completions, as compared to the general population. The small, rural county which was the setting for this project has a higher rate of lung and colon cancers as compared to regional, state, and national rates. A review of the literature revealed best practices for suicide screening including universal education and screening and targeted education and screening for at-risk populations. The rate for suicides in the county is also higher than the rates for the region, state, and nation. The purpose of this project was …

Improving Workplace Incivility By Educating Frontline Nurse Leaders: The Charge Nurse, Temika Ford

Doctor of Nursing Practice Projects

The term workplace incivility is often replaced interchangeably with workplace bullying, horizontal/lateral violence, psychosocial harassment, intimidating behavior, and/or aggression (micro/macro). Workplace incivility in nursing has lasting effects on the profession through worsening the nursing shortage, contributing to low morale, negative working environments, safety issues for staff and patients, stress-related health problems, absenteeism, and decreased quality of patient care. Incivility can be from a variety of sources including: Nurse managers, clinical team leads, unit coordinators, physicians, patients, and other healthcare professionals. Buy-in by nursing executive leadership and evidence-based education for nurses is mandatory to address organizational incivility.

The purpose of this …

Implementing Safeplan: A Communication Template For Emergency Nurses Caring For Psychiatric Patients, Michele Leigh Rudisill

Doctor of Nursing Practice Projects

This DNP Project explored the impact of introducing a communication template for emergency department (ED) nurses to use during handoff when caring for psychiatric patients. This need was identified as ED nurses are now caring for psychiatric patients for longer periods of time in the ED setting, sometimes weeks to months, due to limited inpatient mental health resources and resources in the community. ED nurses’ perceptions were surveyed and the need for a standardized, yet flexible communication template was identified. The literature was reviewed, and no such template was identified specific to ED nurses caring for the psychiatric patient population. …

Assessment Of Intensive Care Family Satisfaction, Jami Burnette

Doctor of Nursing Practice Projects

There continues to be an unknown factor in knowing true patient and family satisfaction within the intensive care unit (ICU) setting. Current literature reveals surveys used to measure patient satisfaction do not pertain to the ICU setting. Patients often do not remember the ICU stay due to critical illness and are unable to actively participate with care. Families act as surrogates, are included in patient care, and collaborate with nursing and medical teams to help make care decisions. Families are integral in the patient care process and are vital members of the health care team. Even though families are included …

Work Well: Promoting Health Behaviors And Self-Care Amongst Public School Faculty, Staff, & Administrators, Sherri Smith

Doctor of Nursing Practice Projects

Workplace wellness is a critical aspect within an organization. Failure to encourage and meet the wellness needs of staff can lead to increased absenteeism, decreased productivity, as well as increased stress levels. Improved workplace wellness in an academic setting has not only potential positive impact on employees but also the students they teach. Evidence shows that implementing wellness initiatives in academic settings has the potential to improve the overall wellbeing of teachers as well as students. Interventions include a Walkabout Challenge, a Caring Peer Group, and education. The interventions are an effort to improve self-care habits amongst faculty and staff …