Medicine and Health Sciences Commons^™

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; …

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 …

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 …

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 …