Medicine and Health Sciences Commons^™

Patient Deterioration Simulation Education And New Graduate Nurses' Self-Confidence And Competence, Heather B. Norris

Doctor of Nursing Practice Projects

Inconsistent identification and intervention for patient deteriorations has been identified as a global healthcare issue that has a profound effect on patient outcomes. Failure to rescue (FTR) rates are influenced by the quality of care a hospital provides in the event of patient deterioration. Rapid Response Teams (RRTs) are summoned to the bedside in the event of a patient deterioration to assess the patient and intervene quickly. Efficient use of RRTs prevents cardiopulmonary arrests and decreases hospital mortality, thirty-day morality, and length of stay. Patient deterioration simulation education can improve the use of RRTs and positively influence patient outcomes. New …

A Process Improvement For Depression Screening And Management In A University Health Clinic, Margaret H. Zoellers

Doctor of Nursing Practice Projects

Research indicates that among college students, there is a high prevalence of depression that is frequently undiagnosed and untreated, placing students at risk of impaired academic performance and suicidal behavior. The purpose of the evidence-based process improvement was: a) establish a depression screening and management protocol in the university health clinic, and b) increase university health clinic providers’ knowledge of evidence-based depression screening and management. Family nurse practitioner providers in the university health clinic (n=6) participated in a depression screening and management education program. Knowledge of evidence-based depression screening and management was measured prior to and after the program. A …

Care Coordination: Using A Nurse Navigator In An Endoscopy Unit, Judith L. Poe

Doctor of Nursing Practice Projects

Compliance with colorectal cancer (CRC) screening in Kentucky is low. This is substantiated by Kentucky having the highest rate of new CRC cases in the nation and being the fourth highest in CRC-related mortality. Kentucky’s colorectal screening rate in 2012 was 62.9%. The incidence rate for colorectal cancer in Kentucky is 49.2 per 100,000 which is the highest rate in the United States. Patient navigation has shown promise in increasing compliance with CRC screening and reducing health disparities. The adoption of a patient navigation model in an endoscopy unit can increase efficiency, reduce patient cancellations and same day no show …

Best Practices For Screening, Identification, And Referral Of Female Collegiate Athletes With Disordered Eating, Brenda Caudill

Doctor of Nursing Practice Projects

Eating disorders have the highest mortality rate of any mental illness, including depression. Female collegiate athletes are at greater risk compared to the non-athlete population. Athletic personnel should be prepared to screen, identify, and refer female athletes for eating disorders. However, most staff are not familiar with common signs and symptoms of disordered eating, which could delay recognition of unhealthy behavior and ultimately long-term health risks. Appropriate screening protocols can assist with early identification. The purpose of this DNP project was improve the knowledge of the athletic staff regarding eating disorder recognition, awareness of university policy for identification and referral …

Designing A Nurse Residency Program For Cultural Fit: A Pilot Project, Melinda Blair

Doctor of Nursing Practice Projects

New graduate registered nurse (NGRN) turnover in an acute care setting is estimated between 35% - 61% nationally and is costly to an organization. Costs are estimated between $60,000 – $90,000 dollars to replace one NGRN. A smooth transition from student nurse to professional nurse is fraught with problems, including increased job stress and pressures imposed on the NGRN from a high-paced, uncertain health care environment. The purpose of this project was to design a customized nurse residency program (NRP) curriculum to increase NGRN retention. NRP curriculum elements were identified using findings from the Casey Fink Graduate Nurse Experience Survey …

A Nurse Mentor Program In A Long Term Acute Care Hospital, Regina Masters

Doctor of Nursing Practice Projects

Nurse turnover is a national problem with the potential to affect quality of care and patient outcomes. A Long Term Acute Care Hospital (LTACH) with nurse turnover rates above the national average as high as 28% sought to address this problem. A review of the literature identified nurse mentor programs increasing registered nurse (RN) satisfaction and decreasing turnover. Therefore, the purpose of this project was to implement a mentor program for newly hired RNs. Mentors were paired with new RNs for a four-week program. Pre and post intervention data were collected via the McCloskey Mueller Nurse Satisfaction Survey (MMSS) and …

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 …

Transitional Care Medical House Call: A Pilot Project, Ron B. Ordona

Doctor of Nursing Practice Projects

Problem Description: Vulnerable, homebound older adults are highly susceptible to unplanned 30-day hospital readmissions, which is costly for the healthcare system. As a result, health care expenditures for this population continue to rise. Studies have shown that transition of care programs, when complemented with home-based primary care delivery, may improve health care outcomes for this population.

Purpose: The purpose of this quality improvement pilot project was to implement medical house calls as a component of transitional care management (TCM) and measure patient outcomes such as unplanned 30-day readmission rates and correlate predictors of readmission. As a secondary outcome, the project …

Improving Care For Adult Clinic Patients With A History Of Poor Glycemic Control, Bonnie M. Clark

Doctor of Nursing Practice Projects

Problem Description: Patients of one internal medicine clinic were found to have nearly twice the rate of diagnosed diabetes and poor glycemic control, when compared with national rates. Given this, certain aspects of the patient-provider dyad system, such as inadequate provider time, knowledge, and resources; may have contributed to the ability of some patients to adapt to a lifestyle with consistent diabetes self-care.

Intervention: An evidence-based diabetes protocol was developed, a diabetes self-management training (DSMT) curriculum was adapted to local context, and three cycles of patient-centered DSMT classes were delivered to provide individual and group-based support to participants. Completion of …

Using An On-Line Educational Module To Increase Nurses' Conviction And Confidence In The Use Of The Teach-Back Method For Discharge Instructions, Allison S. Morrison

Doctor of Nursing Practice Projects

Health literacy status can affect an individual’s ability to self-monitor and manage chronic conditions. It is not uncommon for patients to have difficulty comprehending key patient instructions. The role of the nurse in the hospital setting encompasses many facets which include patient teaching. Providing effective patient teaching is one role that many nurses do not feel confident in implementing. A sample of (N=18) nurses participated in on-line educational program to improve conviction and confidence in use of the teach-back method for delivery of discharge instructions. A pretest-posttest design was utilized and measured nurses’ conviction and confidence using the Conviction and …

Education And Enhanced Support To Improve Breastfeeding Success: A Quality Improvement Project In A Rural Community, Amberlyn Kay Gentry

Doctor of Nursing Practice Projects

Abstract

Problem Description: Breastfeeding continuation rates fall below the Healthy People 2020 goal of 60.6% for any breastfeeding at six months postpartum. In Navajo County, Arizona the breastfeeding rate for WIC participants was 36.9%. Breastfeeding provides health benefits to babies and women and decreased health care costs. A quality improvement project was developed and implemented with a pilot group of participants in a rural Northeastern Arizona community.

Interventions: After a thorough literature review, four interventions were selected. These included: development of a community health coalition, prenatal breastfeeding education, administration of a new baby tea event, and extended support …

Implementation Of A Nurse Visit Model For Patients With Congestive Heart Failure In A Federally Qualified Health Center, Heather Brantley

Doctor of Nursing Practice Projects

Background: Chronic congestive heart failure is the primary cause for hospitalizations among people 65 and over in the United States, resulting in two-thirds of all heart failure costs .Congestive heart failure (CHF) continues to be one of the most prevalent and expensive chronic illnesses to treat throughout the world in a time when cost-effectiveness, improved quality, and care based on outcomes is a requirement . Chronic heart failure is the primary cause for hospitalizations among people 65 and over in the United States, resulting in two-thirds of all heart failure costs (Lambrinou, Kalogirou, Lamnisos, & Sourtzi, 2012). Traditional approaches …

Evidence-Based Guidelines And Protocol Implementation In A Primary Care Clinic To Improve Chronic Asthma Care, Jo E. Cote

Doctor of Nursing Practice Projects

The aim of this project was to pilot the implementation of evidence-based guidelines and protocols for chronic asthma care in a rural primary care clinic system. Asthma is under-diagnosed and under-treated, resulting in significant burden of disease. Achieving asthma control requires collaborative care between the patient and healthcare clinicians. Education on evidence-based guidelines was provided to healthcare clinicians. Effectiveness of education and integration of altered workflow was measured. Integration of evidence-based guidelines and protocols was demonstrated by clinicians. The results support expanding the project to the remaining five clinics in the clinic system.

Are Education And Work Process Redesign Effective In Increasing Documentation Of Annual Retinal Exams Among Diabetic Patients?, Stacy Screws

Doctor of Nursing Practice Projects

Annual retinal eye exams are one of the key strategies in controlling vision loss due to diabetes. The American Diabetes Association (ADA) states that in order to “provide high-quality diabetes care, practitioners need information systems that help them track patient progress toward goals, as well as tools to help them meet those goals.” The electronic medical record (EMR) is a mainstay of healthcare today but the basic utilization of a EMR does not necessarily change the quality of care that patients receive. The purpose of this project was to determine if education and work process redesign are effective in increasing …

Improved Outcomes Associated With An Early Mobilization Protocol Among Hip And Knee Replacement Patients, Emily Emma, Dnp, Rn-Bc, Onc

Doctor of Nursing Practice Projects

Background: According to the National Association of Orthopedic Nurses (NAON), research indicates that evidence-based practice for post-operative hip and knee replacement patients includes early mobilization several hours following surgery. Findings indicate that early mobilization on the day of surgery directly correlates to decreased pain, increased distance ambulated and decrease in length of stay (LOS) in the hospital. Objectives: The aim of this research was to validate findings in the literature indicating that improved patient outcomes (pain, distance ambulated and LOS) are associated with implementation of an Early Mobilization Protocol among post-operative total hip and knee replacement patients. Methods: The study …

A Retrospective Analysis Of Surgeon Estimated Time And Actual Operative Time To Develop An Efficient Operating Room Scheduling System, Pearly T. Brown, Dnp, Rn, Cnor

Doctor of Nursing Practice Projects

Problem: Surgical departments account for sizable budgets in hospitals. To ensure efficiency, optimal processes need to be maintained. The current practice for posting a surgical case is using surgeon estimated times (SETs), which only includes the reporting points of component 2 (C2) “incision” to “dressing.”

Objective: To analyze if there was a significant difference in minutes between actual operative times (AOT) and SET in patients undergoing outpatient general laparoscopic and inpatient orthopedic total joint surgery.

Methods: The facility is a level one trauma teaching center, with 371 beds, and a yearly surgical volume of 17,000 cases. This retrospective …

Effects Of A Comprehensive Bariatric Program Implementation On 30-Day Readmission And 30-Day Er/Infusion Clinic Visit Rates Due To Dehydration, Azra Kukic, Dnp, Rn, Cbn, Acm

Doctor of Nursing Practice Projects

Background: Program accreditation requires adherence to MBSAQIP standards to assist patient in making needed changes to his/her diet and lifestyle. However, literature provides conflicting information regarding the value of a comprehensive bariatric program accreditation and its effects on 30-day readmission and 30-day ER/infusion clinic visit due to dehydration development.

Objectives: To examine the effects of implementing a comprehensive bariatric surgical program on 30-day readmission rates, and 30-day emergency room (ER) and infusion clinic visit rates due to dehydration for bariatric surgical patients.

Methods: Our study was a retrospective separate sample pre-post intervention chart review. The data were collected before and …

Variables Associated With Overweight/Obesity Among African-American Women With Hypertension And/Or Diabetes, Monica A. Hamilton, Dnp, Rn, Acns-Bc

Doctor of Nursing Practice Projects

BACKGROUND

Obesity is the second leading cause of preventable death next to tobacco use. Although it is prevalent in all populations, it disproportionately affects AA women. Overweight/obesity increases AA women’s chances of developing chronic illnesses such as diabetes, hypertension, heart disease, and decreases their life expectancy. The purpose of this study was to explore variables associated with overweight/obese AA women with hypertension and/or diabetes.

METHODS

A secondary data analysis was conducted using a descriptive-correlational design to analyze cross-sectional data obtained from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). The sample consisted of AA women (n =1823). The dependent variable …

An Assessment Of Errors And Near-Misses From Pre-Licensure Student Nurses, Megan Wolfe, Dnp, Fnp-C, Ms Ed., Rd, Rn, Cne

Doctor of Nursing Practice Projects

Background: Approximately one-half of new nurses with less than one year of experience who were involved in adverse patient events identified that their formal education preparation was a causal factor in their error (Saintsing, Gibson & Pennington, 2011). An examination of quality and safety measures of a current hospital based associate degree nursing (ADN) educational program provided data regarding errors committed by prelicensure students. Tracking and analysis of frequency and type of student clinical errors provided for identification of similarities and an opportunity for system evaluation and improvements.

Objectives: To identify the number, types and categories of Student …

A Comparison Of Influenza & Tdap Vaccination Rates By Characteristics Of Child-Bearing-Aged Women, Francis Connor, Dnp, Msn, Mph, Fnp-Bc

Doctor of Nursing Practice Projects

Background

The Advisory Committee on Immunization Practices recommend childbearing-aged women receive an annual influenza vaccine, one dose of Tdap instead of TD after 18 years of age, and one dose of Tdap during the 3^rd trimester of each pregnancy. Despite these recommendations, influenza and Tdap vaccination rates remain lower than current goals.

Objectives

The purpose was to assess influenza and Tdap vaccination rates among women of childbearing age by pregnancy status, age group, and race/ethnicity.

Methods

The retrospective secondary data analysis included a nationally representative sample of women aged 18 to 44 years from the 2014 Behavioral Risk Factors …

Teamstepps Training And Vital Signs Chart To Improve Situational Monitoring For Clinical Deterioration, Rosemarie A. Patrick

Doctor of Nursing Practice Projects

Failure to monitor early warning signs of patient deterioration can result in cardiopulmonary arrests and patient death. Implementation of team building programs emphasizing vital sign data, with consistent monitoring and trending have demonstrated positive outcomes in multiple health care environments. This project implemented TeamSTEPPS© education for 23 registered nurse (RN) residents in an acute care medical center. Specific aims included: (a) increased knowledge of team communication techniques; (b) improved attitudes towards vital sign monitoring, especially respiratory rate assessment; and (c) improved attitudes towards early rapid response system activation. The education program included support tools, behavioral-modeling, simulation exercises based on de-identified …

Motivational Interviewing In Primary Care To Improve Lifestyle Choices For School Age Children, Angela D. Wood

Doctor of Nursing Practice Projects

Childhood obesity is an epidemic in the United States placing children at risk for immediate and long-term health problems. Primary care providers are optimally placed to address this high-priority health issue. The purpose of the project was to implement a practice change in the delivery of nutrition and physical activity information during well child visits. The 5-2-1-0 healthy habits message was delivered via motivational interviewing to the parent/guardian of overweight/obese children. A sample of seven parents/guardians participated in the educational program, which included an initial visit, two-week follow-up phone call, and one-month follow up visit. An initial assessment of family …

Internet-Based Cognitive Behavior Therapy For College Students With Symptoms Of Depression, Sandra Robertson

Doctor of Nursing Practice Projects

College students have high rates of depression, but do not always receive appropriate mental health care. Internet-based cognitive behavior therapy (ICBT) has the potential to provide students rapid access to an evidence-based treatment for depression. This project examined the acceptability and effectiveness of the ICBT program MoodGYM for college students with significant symptoms of depression. Nineteen college students with scores of 10 or higher on the Patient Health Questionnaire-9 (PHQ-9) depression scale were enrolled in the project. Attrition, defined as failing to complete any MoodGYM modules, was high at 31.6% (n=6). Only 26.3% of participants (n=5) completed all five modules. …

Perioperative Preceptor Education In An Agency Preceptor Workshop, Kimberly N. Crawford

Doctor of Nursing Practice Projects

There is a critical shortage of perioperative nurses and the demand in the United States (US) is growing steadily by 1% to 2% each year. It is estimated that nearly 20% of registered nurses (RNs) currently working in the perioperative area will retire in the next five years. In the perioperative area, when using the 6 to 12-month orientation time frame, as outlined in the Association of PeriOperative Registered Nurses (AORN) orientation calculator, the cost of orienting a new RN can exceed $100,000. A preceptorship workshop is one strategy that has been shown as an evidence-based intervention to decrease RN …

Development Of A Leadership Program For Hospital Employees:, Diana Marie Beckman

Doctor of Nursing Practice Projects

Healthcare leader’s ability to respond to the dynamic environment of healthcare is essential for positive health care outcomes. Leaders set the strategic direction for healthcare organizations, and this requires that leaders assess themselves and their employees to develop effective education programs needed to meet any knowledge gaps limiting the workforce ready to respond to the new demands. The purpose of this project is to implement and assess a revised curriculum of a leadership development program by measuring gained self-identified development of leadership practices.

Organizational Improvement Readiness Assessment (Oira) Tool Evaluation, Leslie Hough Falk

Doctor of Nursing Practice Projects

Background: Research shows that despite an increase in the number of organizational improvement initiatives there is a lack of consistent, sustained outcomes. Organizations struggle with how to reliably and accurately measure their readiness to drive and sustain outcomes. A search of the literature failed to identify a comprehensive, evidence-based tool that has been developed or evaluated to assess organizational improvement readiness. The objective of this project was to evaluate a newly developed Organizational Improvement Readiness Assessment (OIRA) Tool.

Project Design: Guided by two theoretical models, Delphi-Based Systems Architecting Framework (DB-SAF) and the Rogers Diffusion of Innovation Model, a 3-round, modified …

Creating A Rural Nursing Workforce, Heidi Johnston

Doctor of Nursing Practice Projects

Background: Nursing students living in rural areas often encounter barriers, real or perceived, to receiving education. These students may be unable to leave home to obtain higher education due to expectations, financial issues, and geography (Robert Wood Johnson Foundation, 2010), thus contributing to a shortage of qualified nurses in rural communities. Great Basin College (GBC) recently implemented synchronized distance education Synchronized Distance Education (SDE) for the (AAS) nursing program, and there was a need to conduct a program evaluation in order to maintain/improve program quality. One goal of Healthy People 2020 (2014) is improving access to comprehensive, quality healthcare services. …

Geriatric Competency Training For Staff Providing Chronic Care Management Services, Brigette C. Holleran

Doctor of Nursing Practice Projects

Americans 65 and older are the growing at an unprecedented rate. Older adults with complex needs are outpacing the number of healthcare providers equipped to care for them. In preparation for implementation of Chronic Care Management (CCM) service, it will be important to engage staff and motivate participation through planned education and training. The purpose of this project was to implement a staff training that included increasing basic knowledge of the CCM program and participant knowledge of age-based competency principles. A pretest posttest design evaluated participants (N=31) who attended the Older Adult Sensitivity Training (OAST) program. Knowledge was measured using …

Evaluating Adn Faculty Job Satisfaction, Karen M. Thies

Doctor of Nursing Practice Projects

Background

The U.S. is facing a critical shortage of nurses as the aging baby boomer generation is requiring more nursing care. Contributing to the nursing shortage is the inability to educate larger numbers of nurses, attributable to a lack of nursing faculty. Insufficient numbers of nursing faculty results in qualified applicants being turned away from nursing programs.

Project Design

This project evaluated faculty job satisfaction in 703 accredited Associate Degree Nursing (ADN) programs in the U.S. The Index of Work Satisfaction (IWS) (Stamps, 1997), was designed to measure specific factors of nurses' job satisfaction and was emailed to all full …

A Quality Improvement Project: Adopting The Standards Of Best Practice In Simulation: Debriefing With Pearls, Rebecca Lea Hooper Keesee

Doctor of Nursing Practice Projects

Background

There is evidence the best practices of simulation, specifically, the use of debriefing, will assist the new graduate nurse’s transition into the profession by increasing their clinical judgment. This quality improvement (QI) project explored the pedagogy of High Fidelity Simulation and Debriefing as a solution for the lag in New Graduate Nurse (NGN) practice readiness. The specific aims of this project were: 1) to teach the NGN residency educators how to implement Standard: Debriefing of the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practices: Simulation^SM by focusing on the role of the debriefer; …