Medicine and Health Sciences Commons^™

Factors Affecting Student Success In Oregon Associate Degree Nursing Programs, Tracy Fawns

Doctor of Nursing Practice Projects

Background: Multiple factors contribute to student retention and attrition rates in undergraduate nursing programs. Attrition rates are rising, which affects society as the population is aging and there is a need for more nurses. Identifying attrition risk as a method to increase student success is imperative in order to produce more nurses. The purpose of this project was to analyze and evaluate predictive factors and academic issues that affect student success at Oregon Consortium of Nursing Education (OCNE) schools in order decrease attrition rates in the science courses and increase associate degree of nursing (ADN) program completion.

Methods: This records-based …

Educating Mothers Of Obese Hispanic Preschoolers To Create Lifelong Healthy Habits, Lynette Marshall

Doctor of Nursing Practice Projects

Problem and Background: Childhood obesity has doubled in children and quadrupled in adolescents in the past 3 decades, increasing from 5% to 17% in one generation. The highest rates of childhood obesity are among Mexican Americans. Obesity can increase health morbidities, and as obese children continue to grow, these health concerns progress to adulthood. In spite of enhanced education and communication between mothers of obese children and their primary care providers, minimal improvement has taken place in terms of outcomes and lifestyle changes.

Methods: Fourteen obese Hispanic 2- to 5-year-olds and their mothers participated in the study. The children’s BMIs …

Increasing Primary Care Hepatitis C Screening In The 1945-1965 Birth Cohort, Maria M. Shimizu

Doctor of Nursing Practice Projects

Background: Over 3.2 million American citizens have been infected with the Hepatitis C virus (HCV). It is estimated three fourths of this population are from the birth cohort born between 1945 and 1965, otherwise known as Baby Boomers. Despite the Centers for Disease Control and Prevention (CDC; 2014) recommendations to screen this population at least one-time regardless of risk factors, screening practices in the primary care setting have been suboptimal (American Association for the Study of Liver Diseases [AASLD], 2015).

Aim: The aim of this project was to identify barriers to HCV screening of the Baby Boomer population in the …

A Comparative Study Of Cde Utilization Rates And Hospital Admissions For Foot Ulcerations Between Two Hospitals, Amber Toombs

Doctor of Nursing Practice Projects

One of the nine standards of diabetes self-management education declares that education should be performed by an instructor with expertise in diabetes education and management or a certified diabetes educator (CDE). The purpose of the study is to measure the prevalence of referrals to CDEs upon discharge for patients admitted with diabetic foot ulcers compared between two hospital populations, Baptist Hospital in Memphis, TN and NEA Baptist in Jonesboro, AR. Data was collected and reviewed to identify the number of patients who received a referral upon discharge and readmissions rates for these patients. Eighty-six patients were included in the study. …

Development And Implementation Of A Nurse Driven Protocol To Increase Palliative Care Consults In Patients With Advanced Heart Failure, Amber Calendar

Doctor of Nursing Practice Projects

Heart failure creates a significant economic burden for the United States (Ambrosy et al., 2014). In an effort to better coordinate care for patients with advanced heart failure, the American College of Cardiology and American Heart Association developed guidelines for the management of heart failure and suggest integration of palliative care services (Yancy et al., 2013). Palliative care is defined as specialized medical care for patients with serious illness to improve quality of life by focusing on symptom control (Hospice and Palliative Care Association, 2017). The aim of this scholarly project was to translate research into practice by developing a …

Impact Of A Sepsis Coordinator On Patient Outcomes Of Adult Patients With Sepsis, Angela B. Smith

Doctor of Nursing Practice Projects

The impact of sepsis is a significant health problem with estimations of 3 million cases of severe sepsis annually and a resultant 750,000 deaths in the United States (Gaieski, Edwards, Kallan & Carr, 2013). The implementation of a Sepsis Coordinator was developed at a local acute care facility to identify areas of opportunities in the care of sepsis patients, facilitate processes to identify patients at risk for sepsis, educate the multidisciplinary team on new and existing evidence and measure and monitor outcome data. This study evaluates the impact of a Sepsis Coordinator on hospital mortality, length of stay and evidence-based …

Does Intensive Behavioral Therapy Result In Greater Weight Loss Among Patients With Obesity At A 12-Week Interval, Angela Jones

Doctor of Nursing Practice Projects

Purpose: To examine the efficacy of Intensive Behavioral Therapy (IBT) in adult, obese patients at a 3-month interval conceptually consistent with the Centers for Medicare and Medicaid (CMS) measures of 6.6 pounds in six months as determinant of weight loss success. Method: A convenience sample of 42 patients in the NEA Baptist Weight Management Program with a BMI of 30 kg/m2 or greater and active participation in the program for a minimum of 12 weeks. Patients pregnant, currently treated for cancer, or other body surface restricting conditions were excluded. Active participation entailed face-to-face visits with APRN, nurse weigh-ins, weekly group …

Development Of A Sexual Assault Legal Education (Sale) Certification Program For Advanced Healthcare Providers Precepting Novice Sexual Assault Nurse Examiners In Arkansas, Heather Dawn Thompson

Doctor of Nursing Practice Projects

Caring for victims of sexual violence requires evidence based didactic education combined with clinical preceptorship by a qualified advanced practice provider. With less than twenty certified sexual assault nurse examiners in the state of Arkansas, it is imperative to increase access to qualified examiners. Despite available didactic courses, access to qualified clinical preceptors/mentors is an obstacle that has yet to be addressed. To assess the interest of advanced providers in completing a certification course in forensics that would qualify them as a preceptor for novice sexual assault nurse examiners, a pilot study was conducted. Majority of respondents (80%) were interested …

Validation Of An Evaluation Tool For Simulation To Test Competency In Diagnosis And Management Of Anaphylaxis By Nurse Anesthesia Students, Christie Black

Doctor of Nursing Practice Projects

Nurse Anesthesia students must demonstrate required core competencies prior to graduation and entry into practice. High-fidelity medical simulation can be used for performance evaluation and assessment of these competencies. However, in order to effectively evaluate student performance, a valid and reliable evaluation tool must be utilized. The goal of this experimental study was to create a simulation evaluation tool for recognition, diagnosis, and management of anaphylaxis in a patient under general anesthesia and determine if it was both valid and reliable. Ten 3rd level Arkansas State University (A-State) Nurse Anesthesia students were recruited to participate in a critical event simulated …

Early Identification And Screening Of Adolescent Depression In Primary Care, Ladonna Williams

Doctor of Nursing Practice Projects

Depression is a major concern affecting all population groups across the world, yet little attention has been directed to adolescents despite high incidence rates. The inadequacy or limited mental health facilities have seen primary care clinics take up the role of screening for depression. Thus, this study investigated the rate of depression screening within primary care settings for adolescents. A descriptive research design was carried out and data collected using retrospective chart review of 100 charts. The study targeted adolescents within the age group of 11 and 14 who had sought primary care services from 2015 onwards. It excluded participants …

Identifying Factors That Impact Provider Adherence With Current Asthma Guidelines, Tammi Martinez

Doctor of Nursing Practice Projects

The objective of this descriptive study is to identify factors that may impact adherence for providing patients enrolled in a rural primary care practice with an asthma action plan (AAP) as recommended by The National Heart, Lung and Blood Institute (NHBLI). The AAP, developed by the provider and care team in partnership with the patient, describes explicit instructions for long-term control and quick relief-medication tailored to the literacy and cultural beliefs of the patient. Currently; the rate of adherence for this standard practice at the primary care site is 20%. The plan is to be updated at every patient visit …

In Patients With End-Stage Renal Disease, How Does Intentional Screening For Depression Compared To Current Screening Practice Affect Mental Health Referrals?, Sara Beth Culbreath

Doctor of Nursing Practice Projects

Depression remains poorly diagnosed and treated in the general population as well as in patients with chronic illness including end-stage renal disease. Referrals to mental health providers and treatment for patients with depressive symptoms are suboptimal leading to decreased adherence to dialysis treatments, increased hospitalizations, and increased mortality. A review of the literature supports intentional screening for depression in the chronically ill population that can easily be incorporated into routine health examinations or, in the case of maintenance hemodialysis patients, the patient’s treatment time. The purpose of this study was to determine if intentional screening for depression in end stage …

Investigating The Incidence Of Postoperative Mild Cognitive Impairment In Cognitively Intact Patients Aged 65-80 Years Undergoing General Anesthesia For Surgery, Bryon Ward

Doctor of Nursing Practice Projects

The purpose of this prospective, descriptive pilot study is to establish a baseline measure for mild cognitive impairment (MCI) in patients aged 65-80 years following elective surgery with general anesthesia (GA). Older adults scheduled for elective surgery routinely undergo GA with a combination of volatile and intravenous anesthetic agents. Current literature shows that patients aged 65-80 who receive GA agents are at increased risk for MCI postoperatively. Data also suggests that further studies are necessary in order to more completely evaluate alternative anesthesia techniques and agents that may prove to reduce the risk and incidence of MCI associated with anesthesia …

Evaluation Of A Competency-Based Interprofessional Diabetes Management Education Module For Health Professions Students: A Multi-Modular Approach, Bilinda Norman

Doctor of Nursing Practice Projects

The purpose of this study was to evaluate the effectiveness of a competency-based interprofessional diabetes education module, using a multi-modular approach. The results of a needs assessment of health professionals revealed few opportunities for interprofessional diabetes education, other than through “on-the-job” training. A nurse-led, comprehensive diabetes education program was developed to support achievement of interprofessional competencies for health professions students prior to graduation for the improvement of population health for clients with diabetes, following the needs assessment. The program included didactic education and simulation experience encompassing the use of the Alphabet Strategy for diabetes education, addressing the need for interprofessional …

Developing Psychiatric Nursing Competencies On An In-Patient Hospital-Based Psychiatric Unit, Beverly J. Sedlacek

Doctor of Nursing Practice Projects

Problem Statement

Offering staff development training for psychiatric nurses has not kept pace with the advances in psychiatric knowledge and skills in nursing. Purpose: The purpose of this quality improvement doctor of nursing (DNP) project was to implement a competency-based staff development program on a community hospital-based inpatient psychiatric unit to determine if the psychiatric/mental health nursing knowledge, nurse patient relational skills, and attitudes of the nurses would improve or change.

Methods

A mixed method of quasi-experimental, non-randomized pre-test/post-test and semi-structured interview design was used, which utilized a convenience sampling approach. Data were collected in two phases. Three domains of …

Faith Community Nurse Care Transitions Intervention Feasibility Project, Jennifer Palagi

Doctor of Nursing Practice Projects

Background: A major national-to-local healthcare quality and safety goal is to reduce hospital readmissions, which are considered preventable patient harm. While the literature shows the impact of using care transitions programs to reduce readmissions, few studies have utilized faith community nurses (FCNs) within care transition programs. An FCN-integrated care transitions program potentially could help fill the gap in community clinical support for chronic illness care. Saint Alphonsus Regional Medical Center (SARMC), a Catholic hospital in Boise, Idaho, sponsors an FCN network within many Southwest Idaho faith communities. This presented a local opportunity to create and test the feasibility of an …

Facilitating The Sustainability Of Health Behaviors In The Phase Iii (Graduated) Cardiac Rehabilitation Population, Andrea C. Lambe

Doctor of Nursing Practice Projects

Cardiovascular disease (CVD) develops in the setting of poor health behaviors often secondary to hypertension, dyslipidemia and hyperglycemia or diabetes (Spring et al., 2013). In the United States, it is estimated that health care costs associated with CVD management will triple to $818 billion in 2030 (Spring et al., 2013). Cardiac rehabilitation (CR) is a secondary/ tertiary prevention program aimed at reducing modifiable risk factors for CVD in a patient population who has already experienced a “qualifying” cardiac event and may be at an increased risk for sustaining another, possibly life-threatening, event (Lucan, 2010). Existing evidence points to a 45-47% …

Prehabilitation Impact On Post-Operative Risk, Readmission Rates And Patient Satisfaction, Pamela Fields

Doctor of Nursing Practice Projects

Background: Prehabilitation programs may improve 30-day readmission rates, post-operative infections and patient satisfaction in obese total joint replacement (TJR) patients. Joint replacement patients who participate in prehabilitation have improved physical function and patient satisfaction. In an effort to improve TJR patients’ mobility and recovery, a prehabilitation performance improvement project was implemented at a local wellness center.

Method: The Institute of Healthcare Improvement, Triple Aim Initiative (IHI, TAI) and Centers for Medicare and Medicaid (CMS) performance improvement goals provided the project foundation (IHI, 2015; CMS; 2015). The physical exercise routine utilized in this program was identified as appropriate for use with …

Simulation As Staff Development For Competency In Nursing Care Of Patients With Chest Tubes, Jennifer Dent

Doctor of Nursing Practice Projects

There is an estimated 98,000 to 400,000 hospital errors that result in patient harm or death annually (David, Gunnarsson, Waters, Horblyuk and Kaplan, 2013; James 2013). As a member of the health care team nurses coordinate and provide continual care to the hospitalized patient (American Association of Colleges of Nursing, 2011; Parker, 2014). Patient safety is promoted when nurses are competent in their knowledge, skills, attitude, and performance related to evidence-based practice, protocols, and standards of care (; American Nurses Association, n.d; Schroeter, 2009). The purpose of this evidence-based project was to promote patent safety by developing and maintaining competency …

Implementation Of Community-Based Education To Promote Colorectal Cancer Knowledge And Screening Rates, Marsha Woodall

Doctor of Nursing Practice Projects

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second-leading cause of cancer death for both men and women in Kentucky and in the US. Although early detection and diagnosis greatly affect survival rates, only about half (58.2%) of the US population participates in screening (Screening Rates, 2016). Two of the previously reported barriers with colorectal cancer screening are provider neglect to fully educate patients on the need for screening and patient compliance with screening recommendations. The purpose of this capstone project was to implement community-based CRC education and screening. Watson’s Human Caring Theory and Prochaska and …

Bone Health Promotion For Youth: A Primary Care Intervention, Kay G. Wilson

Doctor of Nursing Practice Projects

Obese youth have high rates of vitamin D and calcium deficiencies and are at risk for developing osteoporosis. Clinical guidelines are needed in primary pediatric care services to promote bone-healthy behaviors. The aim of this project was to: a) implement the infrastructure and processes for physiological monitoring, consistent parameter-based vitamin D & calcium supplementation, family education, and coaching, and b) evaluate the impact of bone promotion changes on patients and parents and the primary care delivery system. The project outcomes included modest gains in bone health awareness among staff, patients, and families. In addition, modifications to clinical pathways and related …

Establishing A Nurse Mentor Program To Improve Nurse Satisfaction And Intent To Stay, Sara Jane Jones

Doctor of Nursing Practice Projects

Retention of new graduate registered nurses (RNs) is a problem within the healthcare system negatively impacting patient safety and health care outcomes. The problem of retention of qualified RNs is compounded by the potential shortage of RNs, the aging RN workforce and the aging US population. During a period of transition, a novice RN requires the guidance of others to learn to apply theoretical knowledge to real life clinical experiences. In the linear progression of Benner’s levels of clinical competency, the beginning two levels of nurses need a resource person to guide their progression in clinical practice. A mentoring relationship …

Community Acquired Pneumonia Project, Patricia Heaney

Doctor of Nursing Practice Projects

There is an increasing number of microorganisms that are becoming resistant to antimicrobial medications. This growing number of resistant organism poses a serious health threat, not only in this nation, but throughout the world. The Center for Disease Control and Prevention (CDC) estimates that there are greater than 2 million people who acquire serious infections that are resistant to one or more antimicrobial agents that were made to treat those organisms (CDC, 2013). Streptococcus pneumonia (S. pneumoniae or pneumococcus) is one such organism that has been identified by the CDC (2013) as becoming increasingly resistant to drugs that were once …

Follow-Up Telephone Contact Following Discharge From Long-Term Acute Care Hospitals, Tonja Williams

Doctor of Nursing Practice Projects

Readmissions to acute care hospitals within 30 days post discharge are a burden to healthcare economy. Medicare Payment Advisory Commission (2007) estimated a cost of $12 billion dollars is spent each year on Medicare patients who are readmitted to an acute care hospital within 30 days post discharge. MedPAC (2007) estimated that 75% of those readmissions are avoidable. A review of the literature was conducted. Thirteen studies were reviewed and analyzed and the results of the literature review indicated there is evidence supportive of implementing telephone follow-up contact with patients discharged from the LTACH to assess for additional needs and …

Implementing An Intervention To Reduce Seclusion And Restraints In An Inpatient Psychiatric Hospital, Amanda B. Lykins

Doctor of Nursing Practice Projects

The need to enhance nursing staff’s knowledge, perceptions and attitudes around alternatives to seclusion and restraint has been well validated in the literature. Seclusion and restraint use in the inpatient psychiatric setting are highly dangerous physical interventions, used to control the behavior of a mentally ill patient who is a danger to self or others. Seclusion and restraint events have the potential to cause emotional trauma, physical injury to patients or staff and the possibility of patient death. The purpose of the capstone project was to implement an evidence-based education program to, improve nursing staff’s (RN, LPN, MHA and SRNA) …

Stress Reduction Program In A Military Clinic, Hyun-Ju Kang

Doctor of Nursing Practice Projects

Occupation-related stress has been a long-standing concern of the health care industry. Studies indicate that health care workers have higher rates of substance abuse and suicide than other professionals and elevated rates of depression and anxiety linked to job stress. In addition to psychological distress, other outcomes of job stress include burnout, absenteeism, employee intent to leave, reduced patient satisfaction, and diagnosis and treatment errors. Mindfulness interventions, such as practicing yoga on a regular basis, have been found to be effective in reducing work-related stress by multiple researchers. The overall level of stress, anxiety and depression decreased after implementation of …

Process Evaluation On Crisis Services In Northern Idaho, Claudia G. Miewald

Doctor of Nursing Practice Projects

Background: Idaho ranks last of all states for per capita spending on mental health treatment (Kaiser Family Foundation, 2014). In Idaho, individuals in crisis who suffer from mental illness or Substance Use Disorder (SUD) have few options for care. They often utilize the most expensive treatment through the emergency department, inpatient services, or by going to jail. Idaho has the 7^th highest suicide rate in the nation (Suicide Prevention Action Network of Idaho, 2015), while Region 1 of Idaho has the second highest suicide rate in the state from 2010-2014 (Suicide Prevention Action Network of Idaho, 2015).

Methods: This …

The Development And Implementation Of Hospital-Based Clinical Guidelines To Enhance Nursing Staff Efficacy In Glycemic Management At A Large Psychiatric Teaching Hospital, Cherno Bah

Doctor of Nursing Practice Projects

Background: This quality improvement project was conducted at the Colorado Mental Health Institute at Pueblo (CMHIP) in order to improve glycemic management. In psychiatric inpatient settings, proper glycemic management is inadequate which increases metabolic risk and poor patient outcomes. One way to address this problem is by using practice guidelines and education, which enhances nurses’ efficacy.

Purpose: The purpose of this project was to develop and implement a glycemic management guideline to enhance clinical nursing staff knowledge and confidence.

Method: Fifty-five clinical nursing staff attended an in-service and were asked to fill out a survey before and after the in-service …

Identifying And Accommodating Education And Research Barriers Of Rural Nursing Staff In The Mississippi River Delta, Anna Watkins

Doctor of Nursing Practice Projects

The purpose of this cross sectional descriptive study is to identify, by survey, what education and research barriers exist for operating room and post anesthesia care nursing staff in the rural hospitals of the Mississippi River Delta.

Identifying And Accommodating Education And Research Barriers Of Rural Nursing Staff In The Mississippi River Delta, L. Todd Hammon

Doctor of Nursing Practice Projects

Nearly 20% of the nursing workforce practice in rural settings. The literature suggest rural nursing staff do not have the same opportunities for continuing education or the implementation of research in their practice as do nursing staff of larger urban hospitals. Rural nursing staff face unique barriers in obtaining the needed continuing education and research. Identifying and accommodating these barriers is needed. The purpose of this study was to identify by survey, what education and research barriers exist for operating room and post anesthesia care nursing staff in the rural hospitals of the Mississippi River Delta.