Medicine and Health Sciences Commons^™

Referral Patterns From Long-Term Care Services To Palliative Care: Perceptions Of Directors Of Nursing, Karen S. Sharrah, Dnp, Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: Palliative care referrals are important in long-term care facilities because they are the first step in generating the services that the patient may need. This study looked at the phenomena of how Directors of Nursing in long-term care facilities that had access to palliative care services determined if a referral was needed.

Objectives: The purpose of this study was to gain a deeper understanding of the decision- making process used by Directors of Nursing for referrals. The study’s aims were to determine what factors prompt a referral in long-term care settings. The primary research question was: How …

Differences In The Rothman Index Score In Evolving Emergent Events In Medical-Surgical Patients, Deborah Cardenas, Dnp, Msn, Rn, Paralegal

Doctor of Nursing Practice Projects

Background: The Rothman Index (RI), an early warning system using software integrated with the electronic medical record provides scores monitoring patient conditions. Minimal findings exist regarding RI scores in medical-surgical patients.

Objectives: Explore differences in the RI scores in medical-surgical patients who suffered rapid response, cardiopulmonary resuscitation or death events.

Methods: A retrospective comparative design of 75 subjects with a rapid response or cardiopulmonary resuscitation event on medical-surgical units over 12-months at an academic medical center using RI scores at admission, 48- and 24-hours before and at time of event. Deaths were identified immediately following the emergent events.

Results: The …

Transitioning Experienced General Care Float Pool Nurses To A Critical Care Float Pool, Troy T. Betts, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: A nationwide nursing shortage has resulted in a significant reduction in the number of qualified nurse applicants for critical care positions. Additional recruitment solutions for critical care staffing needed to be explored.

Purpose: The purpose of this project was to evaluate the effectiveness of an orientation program designed to transition experienced general care trained float pool nurses to a critical care float pool.

Methods: This descriptive study measured participants’ pre and post critical care orientation knowledge, and completion of core computerized competencies. Critical thinking questions, unit-based competencies, and measurement of participants’ individual perception of competence were also completed. Pre …

Differences In Preventable Cardiovascular-Related Versus Unavoidable Occupational Causes Of Firefighter Fatalities On Duty, Amy Goad, Dnp, Ms, Np-C

Doctor of Nursing Practice Projects

Background: Firefighters across the United States face high fatality rates in the line of duty of which many are likely related to preventable cardiovascular risk factors.

Objectives: To assess differences in firefighter cardiovascular-related versus unavoidable occupational-related fatalities by career status, age, smoking, obesity, and hypertension.

Methods: We used an exploratory, comparative secondary data analysis design. We extracted data from a national database of deceased firefighters over 14 years. Variables extracted were career status, age, smoking, obesity, and hypertension as well as the reason for death while on duty (i.e., cardiovascular-related or unavoidable occupational-related death). Data were analyzed using Chi-Square to …

The Impact Of Digital Education Delivery On Postoperative Pain Outcomes, Amber Stitz, Dnp, Ms, Aprn, Acns-Bc, Ocns-C

Doctor of Nursing Practice Projects

Background. Advances in technology and communication tools offer new, innovative methodologies for delivering information to patients. Research is needed to understand the clinical effectiveness of different education delivery methods on outcomes and comprehension.

Purpose. Compare the effects of digital education with conventional, written and verbal instructions on patients’ pain outcomes, knowledge attainment, and treatment participation.

Methods. A quasi-experimental design evaluated outcomes in 133 patients undergoing major hip (n=73) and knee (n=60) arthroplasty who received point-of-care pain education delivered via a dynamic mobile-computing (iPad) platform (n=65) or by conventional education (n=68). The significance level was set at 0.05. Person’s r and …

Identification Of Risk Factors Associated With Falls In The Long Term Care Setting, Jacqueline L. Patel, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Falls threaten the safety of older adults in long term care (LTC).

Objectives: To assess environmental, clinical and pharmacological causes of falls as well as compare Fall Risk Assessment Score, Brief Interview of Mental Status (BIMS) score, Activities of Daily Living (ADL) scores, age and gender of residents with one fall, recurrent falls, and no falls.

Methods: Using a descriptive-comparative design, we included a convenience sample of 290 adults ≥50 years old at our LTC facility. Fall and recurrent fall groups were matched to those with no falls. We assessed environmental, clinical and pharmacological variables, Fall Risk Assessment Scores, …

The Effect Of Palliative Care Nursing Education To Improve Knowledge In Palliative Care Of Hospital-Based Nurses Caring For Patients With Chronic, Serious Illness, Madelyn Rose Balicas, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Palliative care nursing provides care for the relief of pain and suffering throughout the course of a patient’s chronic, serious illness. Hospital-based nurses need to be equipped with palliative care nursing knowledge to provide optimal care for patients and their families to improve the quality of life. Lack of education in pain and symptom management and communication about goals of care can result in a suboptimal and high cost of care.

Objectives: To determine if a brief palliative care nursing education can improve the knowledge of hospital-based nurses about palliative care nursing.

Methods: A cross-sectional quantitative pre-posttest design used …

Effectiveness Of Residency Training Programs For Increasing Confidence And Competence Among New Graduate Nurse Practitioners, Heather Parkhill, Dnp, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Nurse practitioners (NPs) are enrolling in post-graduate residency programs that provide training and mentorship during transition to practice.

Objective: This project explored whether participation in NP residency improved feelings of confidence, competence, preparedness to provide care and job satisfaction among new graduate NPs who completed a residency program compared to new graduate NPs who did not complete a residency program.

Method: This mixed-methods study collected survey data from NPs who attended the 2017 AANP National Conference and two residency programs. A modified Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) (Misener & Cox, 2001) and Hart’s New Nurse Practitioner Preparedness …

Evaluating The Impact Of A Standardized Education Class On A Person Diagnosed With Chronic Kidney Disease, Stage Iv, Nancy K. Uhland, Dnp, Msn, Rn, Fnp-C

Doctor of Nursing Practice Projects

Background: Chronic kidney disease (CKD) is a complex, progressive, and costly disease impacting more than 26 million Americans. Providing effective education is necessary so the patient may actively participate in managing the disease process, but the effectiveness of the delivery of education to the patient with CKD is not well-known.

Objective: To evaluate the effectiveness of a standardized education class on the basic kidney knowledge of persons diagnosed with CKD, stage IV.

Method: This pilot study, using a one-group pre and post-test design, was conducted in an outpatient nephrology clinic located in Washington, D.C. The study participants, recruited using census …

Effects Of An Online Diabetes Self-Management Educational Class On Perceived Self-Efficacy In Patients With Type 2 Diabetes Mellitus, Samantha L. Sugarman, Dnp, Ba, Bsn, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Diabetes is a complex, chronic disease that, without adequate glycemic control, may result in avoidable complications. Without proper diabetes self-management education, achieving good glycemic control is difficult. Furthermore, lacking self-efficacy to perform such tasks may prevent even the most educated patients from achieving good glycemic control. Studies have shown that live diabetes education has improved self-efficacy in patients with diabetes, but few look at the effects of a lecture-style educational format in an online approach.

Objectives: The purpose of this study is to determine if an online, lecture-style diabetes self-management educational class will improve self-efficacy among patients with type …

Aerobic Physical Exercise Increases The Health-Related Quality Of Life In Older Adults, Patricia L. Parker

Doctor of Nursing Practice Projects

Abstract

Problem Description: Globally, the older adult population is expected to substantially increase in number throughout the next few decades. The aging process causes the body and mind to undergo many detrimental changes. Typically, older adults succumb to a more sedentary lifestyle due to factors such as decreased musculature and skeletal changes, chronic pain, socioeconomic and psychological stressors, and memory changes. Inevitably, health-related quality of life and overall independence dwindles in this population negating their perception of happiness and life satisfaction. There is significant research on preventing and/or managing cognitive disabilities in the older adult; however, Western medicine approaches, such …

An Evidence-Based Practice Assessment And Quality Improvement Initiative In Idaho's Critical Access Hospitals, Deena R. Rauch

Doctor of Nursing Practice Projects

Background: Health care providers and systems have been challenged to discard tradition-based care and outdated practices in lieu of evidence-based practice (EBP). Yet, little is known about the state of EBP, barriers and facilitators to EBP, and organizational readiness for EBP in Idaho’s Critical Access Hospitals (CAH). To affect positive change, it was necessary to understand whether providers in Idaho’s CAHs were using evidence as a foundation for practice—and, if not, what challenges existed in implementing EBP. Mitigating barriers and providing EBP education by way of webinar-based online technology has been proven to be practical and feasible. Providing EBP education, …

Implementing The Coordinated-Transitional Care Program To Reduce All Cause Readmissions, Tonya Page

Doctor of Nursing Practice Projects

Readmission to an acute care hospital are common, costly, and frequently avoidable. Transitions of care are critical to quality, safe patient care and increases effective prevention of readmissions. Although there is an abundance of knowledge related to causes of hospital readmissions and the effectiveness of preventative measures hospital readmission continue to plague healthcare organizations. A review of the literature was conducted, and 11 studies were reviewed and analyzed. The literature review showed evidence to support implementing a telephonic post-discharge follow-up protocol as an effective intervention to reduce hospital readmissions. The purpose of this project was to implement a telephonic, protocol-driven …

Implementing An Evidence Based Fall Prevention Program In A Long-Term Care Facility, Annie Schweikert

Doctor of Nursing Practice Projects

Falls among the elderly are a significant problem with severe consequences. Residents of long-term facilities account for twenty percent of fatal falls. It is imperative that evidence-based practices be implemented at this level of care to address this problem. A multifaceted evidence-based fall prevention program was implemented at a 70 bed, skilled nursing, long-term care facility located in Florida, whose fall rate of 7.14 is above than the national average (2.74-5.48). The fall prevention program included staff education, implementation of a checklist for universal fall precautions, post fall huddles, and the appointment of a falls champion. One-month post intervention results …

The Effect Of Ostomate-To-Ostomate Support On Psychosocial Adaptation To Stoma, Marjorie C. Summers

Doctor of Nursing Practice Projects

Approximately one million people in North America are living with an ostomy, and an additional 100,000 will undergo ostomy surgery annually. Persons living with ostomies, often referred to as ostomates, require specialized care and management to sustain physical health and quality of life. Fecal diversion ostomates, when compared to the general population, are more likely to experience psychological disturbance and higher levels of depression. These ostomates have reported increased loneliness, lowered self-esteem, decreased or absent libido, irritability, suicidal ideation, poor self-image, and symptoms of generalized anxiety disorder and social phobia. Being an ostomate has been associated with a reduction in …

The Effect Of Fall Prevention Education That Includes A Fall Safety Agreement On Fall Incident Rates, Rebecca Dotson

Doctor of Nursing Practice Projects

Patients experiencing falls while in the acute care setting is a challenge that plagues healthcare. In 2014, 29 million hospitalized patients fell causing 7 million injuries. Eighty-five percent or greater of unfavorable hospital occurrences are linked to falls. Falls occur regularly and can have detrimental effects both physically and psychologically. Literature reviews revealed encouraging results in relation to a reduction in falls with fall prevention education and the use of a fall safety agreement. The purpose of this project was to explore the effect of fall prevention education including a fall safety agreement on falls and falls with injury during …

Use Of The Coleman Transition Model To Reduce Copd Readmissions, Sara Briggs

Doctor of Nursing Practice Projects

This paper explores the use of the Coleman Transition Model as an evidenced based intervention to reduce 30-day readmissions of Chronic Obstructive Pulmonary Disease (COPD) patients on a pulmonary unit. Nearly 20% of Medicare beneficiaries are re-hospitalized within 30 days after discharge, resulting in an annual cost of approximately $17 billion. Hospitals can engage in activities to lower their rate of readmissions. The evidenced based intervention includes robust case management using The Coleman Transition Model in hospitalized COPD patients to reduce readmissions. COPD is a prevalent, complex, and costly condition to manage. COPD is now the third leading cause of …

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.