Medicine and Health Sciences Commons^™

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 …

Cultural Competency Training In Primary Care: A Pilot Project For Improving Culturally Competent Care, Diane F. Riff

Doctor of Nursing Practice Projects

As America grows increasingly diverse, there is a recognized need for increased cultural competence in Nurse Practitioners (NPs) and other healthcare workers. Research has shown that when health care providers are not attentive to providing culturally competent care, there is a subsequent negative impact on the quality, safety and cost of patient care. Cultural

competency is a recognized and popular approach to improving the provision of health

care to racial/ethnic minority groups in the community with the aim of reducing health disparities in racial/ethnic minorities. The project sought to improve NPs’ and other health care workers’ abilities to provide culturally …

Utilizing Simulation For Family Member Caregivers Of Nicu Infants: A Pilot Project, Brenda M. Seegmiller

Doctor of Nursing Practice Projects

According to the World Health Organization (WHO), there are approximately 15 million babies born prematurely every year. Family members of premature infants in the Neonatal Intensive Care Units (NICU) are overwhelmed and lack confidence with basic skills to care for their newborn. Simulation is an education modality used for adult learners that utilizes a hands-on method for education and allows application of knowledge and skill development in a safe environment. Although clinicians are frequently trained utilizing simulation, there is limited information on its use among family members and caregivers. The purpose of this DNP Project was to explore use of …

Colorectal Cancer Educational Program In A Community Senior Center, Cathy A. Catlett Dr.

Doctor of Nursing Practice Projects

Colorectal cancer (CRC) is a preventable cancer but prevention can only occur through screening. Screenings are recommended for those 50 to 75 years of age, however rates remain low with 25.6 percent having never been screened and 7.1 percent not up-to-date. The U.S. Preventive Services Task Force (USPSTF) recommends strategies such as education to increase screening rates. Education may be used to inform and motivate individuals to be screened. Research supports the use of educational activities in a community setting to increase CRC knowledge and increase CRC screening rates. A group educational program using the Centers for Disease Control’s (CDC) …

Mobile Video Monitoring To Reduce Falls And Sitter Usage, Jennifer L. Forman

Doctor of Nursing Practice Projects

In the United States between 700,000 to 1,000,000 people fall in hospitals each year. Reducing patient falls in the inpatient setting remains a challenge for many acute care hospitals. Inpatient falls can lead to serious injuries such as fractures and internal bleeding. Fall-related complications can lead to increased hospital stay, prolonged rehabilitation, and increased healthcare costs. Inpatient falls are considered preventable. One intervention commonly used to prevent falls and keep patients safe is the use of an in-person sitter or a patient safety companion (PSC). However, sitters are very costly and considered a variable staffing resource. The need for a …

The Impact Of A Revised Discharge Process From Acute Care To Home Care On Hospital Utilization In Children With Single Ventricle Heart Disease, Brian M. Stahulak

Doctor of Nursing Practice Projects

Problem Description: It is estimated that approximately ~0.5%, or ~400,000, of all U.S. children, are identified as having complex chronic conditions (CCC) and account for as much as one-third, or ~$100 billion, of health care spending for all children. The goal of this quality improvement (QI) project was to identify the impact of a revised discharge process for children with Single Ventricle Heart Disease (SVHD) on hospital utilization rates and the parent’s perception of discharge readiness during the interstage period. The QI project was conducted in a 44-bed cardiac care unit within a 336-bed freestanding pediatric, academic medical center in …

Awareness Matters: Improving Healthcare Workers’ Self-Efficacy, Knowledge, Skills And Attitudes Related To Mental Illness And Suicide Prevention, Carlana J. Coogle

Doctor of Nursing Practice Projects

Problem Description

Healthcare workers’ (HCWs) negative stigmas, poor attitudes, and lack of knowledge impact the care delivered to patients with a mental illness or who may be suffering with suicidal thoughts.

Rationale

Raising HCWs’ awareness, knowledge and skills have been linked to improving the negative stigmas, biases, and attitudes that impede the care required to achieve optimal health outcomes.

Intervention

Participants attended a 90-minute Question, Persuade, Refer (QPR) gatekeeper training, each participant received six bi-weekly emails about mental health issues, suicide prevention, and community resources. A pre/post survey design using the Mental Illness Clinicians’ Attitude Scale (MICA-4) and the Mental …

A Psychoeducational Support Group For Family Caregivers Of Elders With Major Neurocognitive Disorder/ Dementia, Brooke D. Katz

Doctor of Nursing Practice Projects

Background: Dementia is a major public health problem impacting an estimated 65.7 million people worldwide by 2030. It primarily occurs in the elderly population (over age 65) and also affects family caregivers, who often experience significant stress and burden. A psychoeducational support group may be an easy and cost-effective solution to caregiver stress and financial burden.

Objective: To determine whether or not there is an effect on self-reported stress and burden on family caregivers of elders with dementia (EWD) of a voluntary psychoeducational support group in the setting of Assisted Living, Memory Support, and Skilled Nursing led by a psychiatric …

Primary Care Panel Comanagement By A Physician And An Advanced Practice Clinician: Impact On Provider Burnout, Jennifer Strobel

Doctor of Nursing Practice Projects

Background: Levels of burnout have reached epidemic proportions among health care professionals, resulting in a number of negative consequences, including loss of productivity, increased turnover, and increased organizational costs. Advanced Practice Clinicians (“APCs”- a term that encompasses both ARNPs and PAs) were integrated into teams with physicians at a network of primary care clinics in a greater metropolitan area in the United States with the goal of reducing provider burnout. This approach has not yet been evaluated to determine whether there are benefits for reduction of burnout levels in clinicians. Few studies have been conducted to date about the …

Improving Sexual Orientation And Gender Identity Knowledge In Convenient Care Clinics: A Toolkit And Competency Training For Caregivers, Elizabeth M. Gallagher

Doctor of Nursing Practice Projects

It is well documented that transgender individuals experience higher rates of discrimination than non-transgender, also known as cis-gender, individuals (Scandurra, Amodeo, Valerio, Bochicchio, & Frost, 2017). This discrimination extends into the healthcare system, a place where all individuals should be treated with dignity and respect (Bauer, Scheim, Deutsch, & Massarella, 2014). Over the last few decades, cultural humility has been promoted in health care professional training (Fisher-Borne, Cain, & Martin, 2015; Tervalon & Murray-Garcia, 1998). However, transgender care is rarely included. This lack of training can lead to a decreased confidence in providing care to transgender individuals and poor experiences …

Improving Infection Management Of The Institutionalized Elderly, Jovel Angela Viloria Broqueza

Doctor of Nursing Practice Projects

Abstract

As the elderly population rapidly grows in the United States, the burden of managing infection in long-term care facilities (LTCF) escalates. The use of evidence-based infection identification algorithms for early recognition and treatment of pneumonia, urinary tract infections (UTI) and skin and soft tissue infections (SSTI) was evaluated at a Midwest suburban 110-bed long-term care facility. Focus group sessions were conducted at the facility with four nurse practitioners, the medical director, eight nurses and certified nursing assistants (CNAs) prior to an educational in-service which was provided to all staff at the facility. As criteria of infection were reported, nurses …

Overcoming Barriers For The Implementation Of Evidence-Based Practice Through Journal Clubs, Regina Thomas

Doctor of Nursing Practice Projects

Many barriers exist at a 134-bed rural hospital in southern Illinois that hinder generation, evaluation, and implementation of evidence-based research into practice. This DNP project was completed through a phase approach utilizing a modified version of Kotter’s Model of Change, the RNcEBP Survey to self-rate individual confidence in the EBP process, and the Iowa Model of Evidence-Based Practice to facilitate implementation of journal clubs. The RNcEBP survey revealed that nurses were familiar with the concept of EBP, have positive attitudes, and are confident that EBP changes can improve patient outcomes, but lack experience in evaluating literature to support implementing evidence-based …

Transitioning With Grace: Improving Quality Of Life For Comfort Care Patients In The Intensive Care Unit, Melissa Ashley

Doctor of Nursing Practice Projects

The primary aim of this project was to develop and execute a standard protocol of interventions for comfort care patients on a medical intensive care unit. Staff at a 15 bed MICU at a Midwest urban teaching hospital from June 1 until August 11, 2018 were trained to execute a standardized protocol of interventions for comfort care patients. Seventeen MICU patients who transitioned to comfort care were offered a standardized set of evidence-based interventions, after staff attended educational in-services on providing high quality end of life (EOL) care. Checklists were used to determine intervention compliance. Pre-project and post-project surveys were …

Implementation Of High Blood Pressure Guidelines In Clinical Practice, Jessica Walker

Doctor of Nursing Practice Projects

Abstract

This quality improvement project implemented 2017 Guidelines for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. An in-service education session on the 2017 High Blood Pressure Guidelines was provided to clinical staff. In addition, the AHA/ACC pooled cohort 10-year risk calculator was installed to computer desktops or smart phones, for providers. “Seven simple tips to get an accurate blood pressure reading” (American Medical Association, 2016) was posted in exam rooms and proper measurement and documentation techniques were reviewed with clinical staff. Review of recommended non-pharmacological treatment methods with proper patient education documentation was also conducted. …