Medicine and Health Sciences Commons^™

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 …

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 …

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.

Acceptability Of Telepsychiatry In A Rural Kentucky Community Mental Health Clinic, Leslie Brauner

Doctor of Nursing Practice Projects

While telepsychiatry has been championed as a method to improve access to care and health care delivery to remote regions, the willingness of rural patients to receive psychiatric treatment via telehealth technology remains uncertain (Rohland, Saleh, Rohrer, & Romitti, 2000). Published studies concerning general patient satisfaction with telemedicine are available; however, there is little focus on satisfaction of specialized telepsychiatric care to rural mentally ill adults. A capstone project was conducted to examine the acceptability and satisfaction of telepsychiatry in a rural Kentucky mental health clinic. Patient satisfaction with the modality was assessed using the Telemedicine Satisfaction and Usefulness Questionnaire …

The Nurse Manager's Leadership And Nurse Satisfaction, Deborah Bryant

Doctor of Nursing Practice Projects

Nurse managers face many challenges in today's healthcare environment including how to retain staff. The purpose of this capstone was to give tools to nurse managers on specific units to develop techniques for shaping a positive culture making a difference for the nursing staff, patients, families and others on the nursing units. Culture-shaping tools were taught to five nurse managers after completion of a pre-assessment survey by bedside nurses to determine if the behaviors of the nurse managers could impact the nurse satisfaction and improve retention. Nursing staff were queried for effectiveness in nurse satisfaction after the nurse managers had …

Implementation And Evaluation Of A Team Simulation Training Program, Yvonne Rice

Doctor of Nursing Practice Projects

Trauma care, characterized by complex, shifting priorities, presents many challenges to providers. Traditionally, immediate trauma care has been provided in emergency departments. It has recently been recognized that severely injured patients receive better care with improved outcomes when they bypass the emergency department and are admitted directly to the trauma surgical intensive care unit (TSICU). To assure that TSICU nurses and interprofessional staff are prepared to handle such patients, all new registered nurses in the TSICU of a Level I Trauma Center participate in a one-day Trauma Boot Camp. Originally, the focus of the Trauma Boot Camp was solely on …

Bordered Silver Foam Dressings For Colorectal Surgical Patients, Jessica Maynard

Doctor of Nursing Practice Projects

Although a surgical site infection (SSI) is a risk of an operative procedure, most are preventable (Health Protection Agency, 2009). The Joint Commission National Patient Safety Goal 7 stipulates the implementation of evidence-based practice for SSI prevention in acute care facilities. The purpose of this pilot project was to implement a bordered silver foam dressing protocol for post-operative colorectal surgical patients. Using a pre- and post-comparison design, the new dressing protocol was implemented for a two-month pilot for colorectal surgical patients meeting the specified criteria at Cabell Huntington Hospital. SSI rate following the protocol was compared to the SSI rate …

The Effect Of A Facilitated Educational Program And Experiential Learning On Nursing Workplace Incivility, Nancy E. Armstrong

Doctor of Nursing Practice Projects

Workplace incivility is a well-documented issue in nursing. It has the potential to cause emotional and physical distress in victims, and potentially affect the quality of care provided. Research in acute care settings found that facilitated educational training sessions related to workplace incivility, in combination with experiential learning activities, assisted nurses in improving their understanding of workplace incivility and their communication skills. It has also been found to reduce workplace incivility. The purpose of this Capstone Project was to implement a civility training program that included education about incivility through facilitated discussions, as well as teambuilding exercises and experiential learning …

Evaluating The Effectiveness Of A Heart Improvement Toolkit Program: A Pilot Project, Cheryl L. Mitchell

Doctor of Nursing Practice Projects

Heart failure (HF) is a chronic, debilitating disease resulting in over one million hospitalizations with an estimated 30.7 million dollars in total health care cost per year (Go et al., 2014). Evidence shows that HF education programs that promote adherence to pharmacological and non-pharmacological provider recommendations are effective in reducing 30-day HF recidivism rates, increasing self-care behavior, and decreasing adverse clinical events. The purpose of this evidence-based project was to implement the Heart Improvement Toolkit (HIT) Program which is a one-on-one, comprehensive HF-specific education program, for patients with a HF diagnosis who have been admitted to non-cardiac specialty units. Program …

Improving A Fall Prevention And Management Program In An Acute Care Setting, Ashlee D. Gallion

Doctor of Nursing Practice Projects

In-patient falls are common but preventable adverse events. A patient fall has become a targeted event that hospitals across the country are trying to prevent by implementing new evidence-based strategies and techniques. The purpose of this capstone project was to implement a valid and reliable fall risk assessment tool and a post-fall huddle process. Following a 30-day pilot of the new fall prevention protocol on a medical-surgical unit at the Cabell Huntington Hospital, the documentation of fall risk and post-fall huddles was examined. Fall rates during the pilot were compared to pre-implementation rates. During this project, the new fall risk …

Simulation In Assisting Nurses To Better Recognize Early Signs Of Clinical Deterioration Of Patients, Loretta Elder

Doctor of Nursing Practice Projects

The need to enhance the knowledge and skills of nurses caring for patients who exhibit signs of clinical deterioration has been validated in the literature. The literature has further supported the registered nurse as the key individual expected to recognize signs of clinical deterioration in the patient. The use of simulation as an effective teaching strategy has been well documented in the literature. The purpose of the project was to use simulation as an educational intervention to increase nurse knowledge, self-confidence, and competency when caring for patients exhibiting signs of clinical deterioration. The findings of this project are supported by …

Creating Opportunities For Personal Empowerment For Adolescent Students In A Rural High School, Sharon A. Edwards

Doctor of Nursing Practice Projects

BACKGROUND: With the incidence of 3% of children and 6% of adolescents diagnosed with depression, treatment appropriate for this population is needed. Provision of mental health care is limited due to barriers of access such as transportation, parental consent, and availability of services in the adolescent’s environment such as the school setting. OBJECTIVES: To decrease the depressive symptoms and increase the self-confidence perceptions of adolescents in a high school setting utilizing a cognitive-behavioral skills enhancing, seven-session intervention called COPE (Creating Opportunities for Personal Empowerment).

STUDY DESIGN: The project was an evidence-based nurse practitioner project utilizing pre- and …

Utilization Of Cope In The College Population, Rachael Hovermale

Doctor of Nursing Practice Projects

Background: College is a major transition in the lives of many young adults. As early as 1997, Sax reported that stress and depression were on the rise among college students and that 9.7% of college freshmen experienced depressive symptoms. Mental health treatments are often geared to children or older adults.

Objective: The objectives of this project were to (a) assess levels of anxiety and depression in identified at risk college students; (b) implement a new cognitive behavioral therapy (CBT)-based intervention; and (c) evaluate the effectiveness of the intervention on students’ levels of anxiety and depression and satisfaction with the intervention. …