Medicine and Health Sciences Commons^™

Update Of Blood Transfusion Protocols At A Regional Hospital In Rural Illinois, Kendra Tracy

Doctor of Nursing Practice Projects

The chief nursing officer (CNO) at a small regional hospital in rural Illinois requested an update to their blood transfusion policy and protocol based on current evidence-based information. These documents were updated with current information on safe assembly and delivery, identification of transfusion reactions, and appropriate responses to these reactions. In collaboration with the CNO and Quality Improvement Committee (QIC), drafts of a new policy and protocol and a Blood Transfusion Skills Checklist were developed. These documents were presented at a hospital-wide Skills Lab Day to registered nurses employed at the facility. A Likert Scale evaluation survey was presented to …

Treating Acute Bronchitis In Primary Care, Haylie Patterson, Stacy Wieland

Doctor of Nursing Practice Projects

There has been a significant rise in inappropriate antibiotic prescribing in the United States with at least 30 percent of antibiotics prescribed deemed unnecessary (Fiore, Fettic, Wright, & Ferrara, 2017). Overprescribing antibiotics for viral illnesses such as acute bronchitis leads to antimicrobial resistance. Based on current treatment guidelines, most upper respiratory infections do not respond to antibiotics but rather require supportive measures. Antibiotic prescribing trends for a Midwestern rural clinic were obtained through a retrospective and prospective chart review. Patients were frequently receiving antibiotics for acute bronchitis. To approach the problem a quality improvement (QI) evidence-based project was proposed. A …

Improving Acute Pain Management: Development Of An Adult Dexmedetomidine Infusion Protocol, Timothy Denney

Doctor of Nursing Practice Projects

Studies have revealed over 80% of surgical patients experience acute postoperative pain: 75% of patients describe pain levels as moderate, severe, or extreme (Chou et al., 2016). Opioids continue to be the mainstay of most postoperative analgesia regimens (Tan, Law, & Gan, 2015). While effective for the treatment of severe pain, opioid use also prolongs length of hospital stay and places patients at greater risk for higher adjusted mean costs due to dose-related side effects. Multimodal analgesia is a concept that continues to gain momentum to improve perioperative analgesia while reducing the incidence of opioid-related adverse events (Buvanendran & Kroin, …

Integration Of Mental Heath Screening Protocol In Primary Care For Patients Who Have Experienced Traumatic Events, Karra N. Adams

Doctor of Nursing Practice Projects

Mental health status is not always assessed in patients involved in a physically traumatic event unless the patient expresses concern. Often times, orthopedic injuries are a result from a traumatic event. Routine mental health screening in the primary care orthopedic setting can help identify mental health care needs early so that adequate interventions can be implemented in a more effective manner. The goal of this project was to evaluate the feasibility of incorporating the use of a brief mental health screening tool in a primary care setting to assess the psychological needs of patients who have been involved in a …

Implementation Of Emergency Severity Index Training To Improve Accuracy Of Triage Levels, Erinn Hileman, Douglas Mckain

Doctor of Nursing Practice Projects

This quality improvement project was created to help increase knowledge of the Emergency Severity Index (ESI) in the Emergency Department (ED), a form of triage used to categorize patients by their acuity. Proper ESI use shortens the length of stay times, door to provider times and reduces the number of patients that leave without being seen.

The goal of this project was to develop an online learning module that would increase the nurses’ knowledge of triage to enhance triage accuracy. Nineteen (19) emergency department nurses were given a pretest, an ESI educational presentation, and a follow-up post-test.

Data analysis indicated …

Development And Evaluation Of A Malignant Hyperthermia Computer Based Learning Project, Andrew Miller

Doctor of Nursing Practice Projects

Malignant hyperthermia (MH) is a potentially fatal, inherited disorder of muscle hypermetabolism that occurs after a person is exposed to commonly used volatile anesthetic agents (sevoflurane, desflurane, isoflurane) and/or the depolarizing muscle relaxant, succinylcholine (Diu & Mancuso, 2012). The MH mortality rate has decreased from 80% in the 1960s to less than 5% in 2006 due to increased clinical awareness of manifestations, pathophysiology, and improvement in perioperative monitoring (Rosenberg, Pollock, Schiemann, Bulger, & Stowell, 2015). Therefore,continuing education of perioperative staff is an integral part of proper MH preparedness. Computer-based learning (CBL) modules have been shown to be efficient, inexpensive forms …

Increasing Utilization And Awareness Of An Existing Patient Portal Application, Amanda Graham, Jessica L. Schnebly

Doctor of Nursing Practice Projects

Patient portal applications (PPAs) are secure website or computer/mobile device applications that allow 24-hour access to a patient’s electronic health record (EHR). Patient portal applications are intended to improve quality and access to health care by engaging patients to be more active in managing and monitoring their health. A large Midwest multispecialty organization’s Follow My Healthpatient portal application (FMH app) is underutilized by patients and providers. While evidence supports the use of web-based patient portal applications, only 17% of this organization’s patients use the FMH app, and even less use its direct messaging capabilities.

The purpose of this project …

Assessing Palliative Care Needs In Residents With Alzheimer's, Emily Yarnell

Doctor of Nursing Practice Projects

Current evidence indicates a lack of assessment protocols focusing on palliative care needs for patients with Alzheimer’s disease. This gap in practice supported the need to implement an evidence-based assessment protocol for early identification of palliative care needs in patients with Alzheimer’s disease residing in a long-term care facility. The protocol included using the patient’s Global Deterioration Scale (GDS) score to determine the patient’s palliative care needs according to the Dementia Progression Prioritization of Goals model. If the score indicated moderate to severe Alzheimer’s disease, then their goal was maximization of comfort, indicating a need to begin palliative care plans. …

Improving Acute Postoperative Pain Management For The Pediatric Patient: Guidelines On The Use Of Intravenous Dexmedetomidine, Jenna Winters

Doctor of Nursing Practice Projects

Inadequately treated surgical pain in children leads to risky complications, such as longer recovery times, infection, prolonged hospitalizations, readmissions, altered pain sensitivity, neurophysiological changes, and cognitive-behavioral abnormalities (Campbell, 2013; Ibrahim, Jones, Lai, & Tan, 2016). Review of the literature indicated intravenous dexmedetomidine, as an adjunct, may lead to improved outcomes and a reduction in postoperative pain in children undergoing surgical intervention. An evidenced-based educational presentation introduced intravenous dexmedetomidine in children to anesthesia professionals, pharmacy staff, and the pediatric care team at a tertiary care center. Concluding the educational presentation, participants completed a voluntary survey evaluating the effectiveness of the presentation. …

Hepatitis C Virus Screening And Treatment, Dani Loftus, Emily Machens, Crista Jamous

Doctor of Nursing Practice Projects

Hepatitis C Virus (HCV) is classified as a contagious liver disease that can be either acute or chronic, and the illness ranges in severity from mild to lifelong. It is estimated that 2.7 million people in the United States (US) have HCV, but only half are diagnosed. The CDC recommends testing by birth-cohort, focusing on adults born between 1945 and 1965. Three main objectives for this project included implementation of a clinical decision support system (CDSS) for providers, increasing HCV screening by providing education to the support staff in primary care clinics of a local hospital which would increase the …

Transitioning Pediatric Patients With Special Needs, Dimi Resch

Doctor of Nursing Practice Projects

Transitional care, which encompasses both the sending and receiving aspects, is essential for pediatric patients with complex care needs.A provider in a small, Midwest pediatric primary care clinic agrees with researchers that transitional guidelines are needed for consistency among pediatric and adult providers. This clinic currently has no process in place to guide the transition of patients with special needs. The primary goal of this project was to develop a communication tool that aids in the transition of patients with special needs into the adult primary care setting. The literature reviewed provided a variety of tools used to communicate healthcare …

Transition Of Care From Pediatrics To Adult Health Care, Heather Mahsman, Holly J. Henderson

Doctor of Nursing Practice Projects

Transition planning is essential for continuity of healthcare for adolescents approaching adulthood. Transition of care should start in early adolescence to help pediatric patients find and establish an adult healthcare provider. The purpose of this project was to assess and increase awareness of transition planning and assess the feasibility of instituting a transition program in a rural health pediatric clinic. Staff and providers were educated about transition of care planning and current recommendations from the American Academy of Pediatrics. Pre and post surveys were collected. Staff reported the program as beneficial to their patients and would like to see further …

The Hemoglobin A1c Of African-Americans/Blacks With Diabetes Mellitus Type Two Using Low-Fat Diabetes Plate Diet, Ednah K. Makori

Doctor of Nursing Practice Projects

Diabetes Mellitus type two (DMT2) is a chronic disease that leads to high blood sugar in the body and if not corrected over a period of time, it leads to development of complications. Some of those complications include blindness, kidney failure, and retinopathy, among others. DMT2 continues to affect many people in the USA, especially African-Americans/Black who have the highest prevalence as compared to other races. Proper diet management especially the Low-Fat diabetes diet helps to decrease Hemoglobin A1c, which could result in reduction of risk of developing complications and morbidity related to DMT2. This project was done to educate …

Quality Improvement: Developing A Hospital Program To Reduce Staff Injury Associated With The Care Of The Patient With Dementia, Kimiko Krutz

Doctor of Nursing Practice Projects

Problem Description

Hospital clinical staff injuries can occur while caring for patients with dementia. Clinician injury is a concern because it can be career-ending for the clinician and costly to the hospital ($80,000) to replace a nurse. A reliable estimate of the numbers of staff injuries by patients does not exist in the academic literature. Occupational Safety and Health Administration (OSHA) now require hospitals to provide data on clinician injuries related to patient care. This project explored the use of dementia patient-centered care education to increase clinician self-efficacy to ultimately decrease clinician injury.

Intervention

This quality improvement project provided 20 …

Implementation Of A Nurse-Led Transitional Care Model For Older Adults With Copd Admitted To Home Health, Michelle Ryan Hunt

Doctor of Nursing Practice Projects

Problem Description: The importance of management of chronic disease and preventing rehospitalization has been identified at national and local levels. Chronic obstructive pulmonary disease (COPD) is one of the chronic diseases with notable rates of emergency department use and recurrence of hospitalizations.

Rationale: Implementation of transitional care models have been successful for health care organizations in chronic disease management.

Interventions: The health-social partnership transitional care management program (HSTCMP) was used to design a transitional care model process pilot for a home health agency (HHA) within a health system. This process used a multidisciplinary team led by a registered nurse for …

Increasing Physical Activity In Hispanic Adults To Reduce Complications Of Type 2 Diabetes, Linda C. Valenzuela

Doctor of Nursing Practice Projects

Problem Description: Adults in the United States do not exercise sufficiently to meet the specifications outlined in the 2018 Physical Activity Guidelines (U.S. Department of Health and Human Services, 2018). The Office of Disease Prevention and Health Promotion’s (2018) Healthy People 2020 aims to eliminate health disparities and achieve health equity among all population groups in the United States. However, statistics from the U.S. Office of Minority Health (2014) indicate that Hispanics are twice as likely to be diagnosed with type 2 diabetes as non-Hispanic whites. According to a Centers for Disease Control and Prevention (CDC) report in 2015, …

The Association Of Modified Early Warning Score On Patient Outcomes In Medical-Surgical Units In An Academic Medical Center, Gerundio Ursolino Iii, Msn, Mba, Ccrn-K

Doctor of Nursing Practice Projects

Background: A nationwide problem that has been regularly overlooked is poor recognition of deteriorating patients which can lead to increased severity of illness. One way to avoid adverse events is early detection of clinical deterioration using vital signs via Modified Early Warning Score (MEWS). However, the majority of the hospitals across the United States are not utilizing this. MEWS implementation can minimize adverse events by early recognition, which will lead to early intervention and improved patients’ outcomes.

Objective: The aim of this quasi-experimental study was to determine if MEWS implementation will reduce the number of adverse outcomes.

Methodology: …

Improving Nursing Staffing Methodology And Nursing Sensitive Outcomes With The Addition Of A Patient Centered Acuity Measure, Douglas C. Howard Rn, Ms, Ne-Bc

Doctor of Nursing Practice Projects

Background: Assigning the correct nursing resources to hospitalized patients positively impacts patient outcomes. The current process for matching nurses to patients is highly variable and involves a combination of simple ratios, historical workload data, and expert opinion but lacks objective measurement of the patient’s condition.

Objectives: This project evaluated change in selected quality indicators and the daily unit-level management of nursing resources after implementing the Troubled Outcome Risk (TOR) into existing nursing staffing methodology in a Department of Veterans Affairs hospital.

Methods: TOR provides objective measurement of individual patient allostatic load. Daily calculation of TOR scores for each patient on …

Opioid Dosing’S Impact On Numeric Pain Rating Scale And Urine Toxicology Results, Christine Couperus–Mashewske Fnp-Bc, Rn

Doctor of Nursing Practice Projects

Background: Concerns about opioid prescribing in the United States have been rising (Centers for Disease Control and Prevention [CDC], 2016). Assessing pain scores, along with urine toxicology screenings can provide information to both patients and providers about prescription opioids.

Objectives: The purpose of this retrospective chart review study was to compare numeric pain scores and urine toxicology results between two different groups of patients who were being prescribed daily≥ 90mg opioid dosing.

Methods: This retrospective chart review sample was of 134 adult chronic pain patients at one pain management clinic. Patients’ average numeric pain rating while using opioids for a …

Evaluation Of Patient Throughput In An Outpatient Pediatric Hematology, Oncology, And Bone Marrow Transplant Clinic, Samantha Depadova Msn, Rn, Anp-C, Ocn

Doctor of Nursing Practice Projects

Background: Outpatient oncology clinics are complex environments. The multi-step, sequential nature of oncology treatment contributes to delays. Prolonged wait time impacts patient compliance, satisfaction, and staff satisfaction.

Objectives: To assess throughput in the outpatient pediatric oncology clinic and explore staff’s assessment of throughput and their opinions of what might be improved.

Methods: Our descriptive-comparative study used retrospective reviews to measure four time intervals for 312 visits at our mid-Atlantic outpatient clinic. Patient and appointment factors were explored. Mean interval times were calculated and differences impacting throughput were analyzed using ANOVA. Prospective survey data were obtained from 22 clinic staff …

Analysis Of Parental Attitudes Of Adolescent Vaccinations In The Retail Health Care Setting, Patrick William Denning Mph, Msn

Doctor of Nursing Practice Projects

Background: The tetanus-diphtheria-acellular pertussis, meningococcal, and human papillomavirus vaccines have been recommended for adolescents since 2005. Retail health clinics can increase the delivery of vaccinations by reaching patients outside the traditional healthcare system.

Objectives: To measure parental attitudes of adolescent vaccinations utilizing the Vaccine Confidence Scale (VCS) and assess reasons parents decided to vaccinate or not. Attitudes were compared to previous studies. Our long-term purpose was to develop targeted interventions to increase adolescent vaccinations.

Methodology: A descriptive survey design measured the parental attitudes of adolescent vaccinations from total VCS scores and subscale scores of benefits, harms, and trust. A qualitative …

Effects Of Teach-Back Method Of Education On Knowledge Of Heart Failure Self-Care Management And Post-Discharge Knowledge Retention, Ama Awuah-Asamoah Msn, Rn, Acnp

Doctor of Nursing Practice Projects

Background: Approximately forty to eighty percent of patient education is immediately forgotten, and about fifty percent of retained information is inaccurate; knowledge is an essential bridge between patient teaching, comprehension and knowledge retention by using the teach- back method (Farris, 2015; Rouse et al., 2016; Stamp et al., 2014).

Objectives: The purpose of this study was to compare teach-back education method versus standard education and care, on knowledge of heart failure (HF) self-care management at discharge and retention of knowledge at three to ten days post discharge.

Methods: A non-probability convenience sampling of 22 HF patients, 65 years and older, …

Improving Nursing Students’ Attitudes And Beliefs About Transgender Clients Through The Use Of A Simulated Clinical Experience, J. Alex Thompson Msn, M.Ed., Rn, Cne

Doctor of Nursing Practice Projects

Background: Negative healthcare experiences may lead to poor health outcomes for transgender individuals, but nursing curricula give little attention to transgender healthcare. This study engaged nursing students in a simulated clinical experience (SCE) which featured a young adult transgender male in an acute care setting to determine whether participation would have a significant impact on student nurses’ attitudes and beliefs about transgender individuals.

Methods: The convergent parallel mixed-methods design used a one group pretest-posttest and a post-case debriefing interview to examine undergraduate nursing student attitudes and beliefs toward transgender individuals. Participants (N=27) reported their feelings via the Transgender Attitudes and …

Online Sexual Health Education With Rural Independent Study Charter School Students, Crystal L. Gardner Msn, Phn, Rn

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STIs) and unwanted pregnancies continue to be public health problems in the United States. Each year there are about 20 million new STIs in the United States with about half of the infections occurring in people 15 to 24 years old (The Centers for Disease Control and Prevention, 2016).

Objectives: The purpose of this descriptive pre- and post-test study was to determine if an online STI prevention program increased knowledge about STIs, STI related resources, and lowered STI risk-taking behaviors in rural northern California students attending an alternative high school.

Methodology: “Positive Prevention PLUS” curriculum and …

Self-Efficacy In Emerging Nurse Leaders: The Effects Of A Virtual Community Of Practice On Nurse Educators In A New Practice Role, Kevin Daugherty Hook Msn, Ma, Ms, Agpcnp-Bc, Crnp

Doctor of Nursing Practice Projects

Background: Clinical nurse educators in long-term and skilled nursing facilities have an opportunity to exercise new leadership skills in bridging the gap between education and practice.

Objective: To assess the effects of a virtual Community of Practice (CoP) on the self-efficacy of clinical nurse educators who work in newly developing leadership roles in a large long-term and skilled nursing organization operating in multiple sites across the United States.

Methodology: The exploratory pilot study used a one group pre-test/posttest method. A convenience sample was used to enroll participants with newly created roles in clinical education. The Leader Efficacy Questionnaire (LEQ) was …

A Pre/Post Intervention Study To Assess Social Capital Through Bonding And Bridging Among Federal Nurse Teleworkers, Carrie Jeffries Mph, Ms, Rn, Anp-Bc, Aacrn, Aahivs, Nea-Bc, Fache

Doctor of Nursing Practice Projects

Background: The social capital components of bonding (within groups) and bridging (between external groups) are essential to building healthy and effective teleworking relationships that are required to retain staff.

Objectives: To identify if delivering a relationship building educational intervention to federal nurse teleworkers who used the internet daily would improve their total Internet Social Capital Scale (ISCS) scores and bonding and bridging subscale scores.

Methods: Our study employed a pre/post intervention design, aiming for a convenience sample of 75% (n=41/55) of federal nurse teleworkers. We delivered, via webinar, a 45-minute educational session on telework and techniques to increase bonding and …

Effects Of A Patient Progression Coordinator On Hospitalized Patient Progression Times, Amy C. Wright Msn, Rn

Doctor of Nursing Practice Projects

Background: Since 2005, the Joint Commission required moving patients through the hospital quickly. Previous efforts at our hospital improved Emergency Department throughput but hospital-wide congestion of patients remained.

Objectives: To examine the effects of implementing a patient progression coordinator (PPC) on hospital length of stay (LOS) for patients with ST-elevated myocardial infarction (STEMI), ischemic stroke, knee replacement, and hip replacement.

Methods: We used a separate sample, pre- post- intervention design conducted in a southern California community hospital. The intervention was implementation of a PPC to facilitate movement of patients through the hospital. LOS, from time of admission to discharge, was …

Improving Nurse-To-Nurse Handoff Communication At The Bedside Through Simulation-Based, Lisa Thornsberry Mrs.

Doctor of Nursing Practice Projects

Communication among nursing staff is crucial to the outcome of patient care. Poor handoff and communication among professionals can have a negative impact on the safety of patients. The systemic nature of the problem with miscommunication among healthcare clinicians supports the necessity of standardization of communication among nursing as a handoff of care.

Change of shift report, or nurse-to-nurse report ensures the transfer of critical information to promote patient safety and best practices. Transferring and communicating pertinent information from one shift to the next is one factor in providing continuity of care. Bedside Shift Report (BSR) is an opportunity to …

Increasing Medication Error Reporting To Improve Patient Safety, Dianna Madden

Doctor of Nursing Practice Projects

In 2006, the Institute of Medicine estimated that 1.5 million preventable adverse drug events occur in healthcare facilities annually (Institute of Medicine, 2006). Each ADE adds approximately $8,750 per hospital stay (Institute of Medicine, 2006). In 2017, the Food and Drug Administration (FDA) estimated that 1.3 million people are injured annually from medication errors (Agency for Healthcare Research and Quality, 2017). For the purposes of this project, all Registered Nurse staff on the Medical-Surgical unit were mandated to participate in an education targeted at medication error reporting, the importance of reporting, and a demonstration of inputting an error into the …

Streamlining The Nursing Approach To Newborns With Neonatal Abstinence Syndrome, Gail A. Reichert

Doctor of Nursing Practice Projects

Newborns may suffer from withdrawal symptoms after exposure to maternal substance abuse while in-utero, resulting in negative outcomes for the patient, family, and healthcare system. Neonatal Abstinence Syndrome (NAS) has increased by 300% in the United States. Non-pharmacological interventions such as rooming in, breastfeeding, and parent education are nursing activities which can improve the outcomes for NAS patients. However, a formal protocol to identify, assess, and treat the patients with non-pharmacologic evidence-based interventions is lacking. The purpose of this project was to develop, implement, and evaluate a sustainable policy to incorporate evidence-based strategies into nursing care at a rural community …