Medicine and Health Sciences Commons^™

Community Education: Impact On Earlier Recognition Of Stroke, Lauren Kahn

Doctor of Nursing Practice Projects

Cerebrovascular disease was identified as the fourth leading cause of death in Cleveland County, North Carolina from 2014 to 2018 (Cleveland County Public Health Center, 2020). Community education was identified as a potential solution to decreasing the number of community members affected by cerebrovascular disease and resulting death and disability. Five community classes were taught with 97 participants. Pre-, post-, and 1-week post-class surveys were distributed to assess baseline knowledge, knowledge gain, and knowledge retention, with 74 pre-class, 72 post-class, and 28 1-week post-class surveys returned. Of these surveys, after exclusionary criteria were used, 40 pre-class, 53 post-class, and 22 …

Fostering Relationships Between New Graduate Nurses And Leadership To Increase Retention, Michelle Cotton

Doctor of Nursing Practice Projects

Objective: To implement weekly one-on-one touch bases between nursing leaders, such as managers and directors, with newly hired, new graduate nurses, up to 1 year after graduation to improve retention of those employees. The intent is to improve retention from a baseline of 23% in 2022.

Results: 35.8% of the newly hired nurses plan to remain in their current role for the next 2-3 years.

Conclusions: Almost 55% said that they strongly agreed with the touch base contributing to development/growth. This was the lowest scoring question and the most concerning related to retention. An overwhelming majority felt …

A Review Of The Effects Of Different Types Of Stigmas On The Retention Rates Of Patients In Medication-Assisted Treatment And How To Combat The Problem, Pamela Cox

Doctor of Nursing Practice Projects

It is difficult to turn on the news without hearing about the opioid epidemic or a recent opioid overdose. There is hope because there is a treatment to help prevent this epidemic. That treatment is known as medication-assisted therapy (MAT), where patients can present and, if they meet the criteria, can be given a prescription for buprenorphine/naloxone combination medication. Treatment with buprenorphine/naloxone has been shown to be highly effective treatment for substance use disorder (SUD). Even though it has been proven that this combination works, less than 20% of patients diagnosed with SUD present for treatment. This study focused on …

Implementing A Strategic Reporting Model Among Public Health Nurse Consultants To Increase Communication, Heather Willis

Doctor of Nursing Practice Projects

Public health has seen a drastic amount of turnover post-pandemic. There was an estimated 44% turnover rate for public health registered nurses, with a vacancy rate that doubled from 12.7% in March 2020 to 23.2% in July 2022 (Skinner, 2022). With this high turnover rate, many nurses are new to North Carolina (NC) public health departments and health districts. Public Health Nurse Consultants (PHNCs) are expected to train and guide these new nursing staff members. With the turnovers continuing at the local health departments (LHDs), new nurses are not given the recommended training because of communication breakdowns. This project helped …

The Use Of Diaphragmatic Breathing Techniques To Reduce Stress In Pre-Licensure Nursing Students, Amy Naugle

Doctor of Nursing Practice Projects

Research supports the idea that pre-licensure nursing students experience higher levels of stress than their general education-focused peers. This DNP project focused on stress related to nursing exams in the first semester of nursing school and promoted the adoption of diaphragmatic breathing techniques. The use of stress management techniques has been explored in those with intense job experiences and has proven to alleviate stress and promote improved coping. This cohort of pre-licensure nursing students was asked to identify stressors that affected them within the preceding 6 months while attending the first semester of a 2-year nursing program. The cohort was …

Medication Reconciliation: Preventing Harm To The Senior Living Population, Charles (Chuck) Jennings

Doctor of Nursing Practice Projects

This project was designed to address the risk of medication errors occurring when geriatric adults return to a senior living setting following an acute care stay. In addition to a primary care physician (PCP), the health care of geriatric adults is often managed by medical specialists and subspecialists. The engagement of multiple providers poses significant communication challenges, as these providers often work in separate offices and are limited in their information sharing. Consequently, following a hospital discharge, reconciling medication orders amongst all providers can be challenging. This challenge is further complicated, as PCPs oftentimes do not interface with the specialists …

Initial Refugee Health Assessment Educational Session, Yolondra Cochnan

Doctor of Nursing Practice Projects

The initial refugee health assessment presents an excellent opportunity to identify communicable diseases in newly arriving refugees. As the number of refugee arrivals increases, so will the need for nurses who possess the skills necessary to conduct the initial refugee health assessment. Prior to the pandemic, the United States was facing a nursing shortage. The impact of the pandemic devastated the nursing community, leaving them exhausted and burnt out, which led many nurses to retire and leave the field of nursing (National Council of State Boards of Nursing [NCSBN], 2023). Skilled nurses are needed to prevent the spread of communicable …

Incorporating Simulation Experiences Into The Nurse Aide Curriculum To Improve Clinical Judgment, Tonya A. May

Doctor of Nursing Practice Projects

This DNP Project was designed to strengthen clinical judgment skills in nurse aide students. Incorporating simulation-based learning opportunities into the nurse aide curriculum supports the development of clinical judgment skills. Four simulation scenarios were designed to focus on the student's ability to respond within the nurse aide’s scope of practice. Pre-test and post-test surveys were developed with a 5-point Likert scale (1 = strongly agree, 2 = agree, 3 = neither agree nor disagree, 4 = disagree, 5 – strongly disagree) to assess the student's perception of their ability to perform, notice, interpret, respond, and reflect on patient care. A …

Improving Access To Early Interventions For Prediabetic Patients, Kimberleigh M. Telling

Doctor of Nursing Practice Projects

Approximately 88 million Americans, or nearly one-third of the population, have prediabetes. This condition has a high rate of progression to type 2 diabetes, reaching 70%. However, early identification, diagnosis, and participation in lifestyle interventions can effectively reduce the risk and promote euglycemia. Regrettably, 85% of those with prediabetes are unaware. The goal of this quantitative quality improvement project was to enhance the use of the prediabetes diagnosis code by primary care providers, who play a crucial role in preventing type 2 diabetes. The purpose was to improve access to early intervention for individuals with prediabetes, following the guidelines of …

How Simulation Influences Self-Confidence In First Semester Nursing Students, Veronica Arredondo

Doctor of Nursing Practice Projects

First-semester nursing students lack confidence and competency in performing nursing skills and providing direct patient care. Nursing students are expected to be prepared before going to the clinical setting to provide direct patient care. The purpose of this quality improvement project is to examine the confidence levels of first-semester nursing students before and after the application of high-fidelity simulation (HFS). A controlled environment using HFS where nursing students can safely practice and achieve the understanding needed to develop their critical thinking skills is a potential solution. Using simulation education can increase the ability of an individual to complete nursing skills …

The Introduction Of A Low-Fidelity Simulation With An Electronic Health Record To Increase Clinical Judgment In Pre-Licensure Bachelor Of Science In Nursing Students, Tammy Rogers

Doctor of Nursing Practice Projects

The National Council of State Boards of Nursing (NCSBN) lists clinical judgment (CJ) as a critical skill for nurses to promote patient safety (Barner et al., 2023). The purpose of this quality improvement project was to increase CJ through low-fidelity simulation and an authentic electronic health record (EHR) with the aim of improving patient safety. The clinical partners of the school of nursing provided the EHR making it an innovative, cost-effective approach to guide students in interpreting evidence to make safe clinical decisions (Barner et al., 2023). Forty-five Bachelor of Science in Nursing (BSN) students participated in the project, which …

Impact Of Self-Management Education On The Self-Efficacy Of People With Chronic Pain, Tanya Jones

Doctor of Nursing Practice Projects

Self-efficacy is a critical element in the self-management of chronic pain. Despite the traditional approaches to managing chronic pain, such as opioids, traditional methods have proven ineffective and often lead to addiction and misuse, contributing to the overwhelming and devastating opioid crisis. This quality improvement project aimed to reduce the knowledge gap among individuals between the ages of 18 and 75 who have chronic pain by producing data that illustrates that providing individuals with self-management education empowers them to understand and self-manage their pain. The concept of self-management education is grounded in Bandura's Social Cognitive Theory, which highlights the role …

Implementing A Foot Screening Project For Diabetic Patients In An Assisted Living Facility, Beatrice L. Bailey

Doctor of Nursing Practice Projects

Diabetes impacts around 422 million individuals globally, resulting in 1.5 million reported annual deaths. Type 2 diabetes affects approximately 35.4% of the population in the United States, with 1.4 million new cases identified each year. When not managed properly, diabetes can spiral into a long list of complications. Among the various challenges in diabetes management, foot complications stand out as significant and often avoidable. Without proper attention, these complications can lead to severe health issues. To address this concern, this project focuses on resolving standard foot inspection practices within an assisted living facility in central Mississippi. The goal is to …

Improving Outcomes For Women Following Gynecological Surgery Through Implementation Of Multimodal Analgesia As Part Of An Enhanced Recovery After Surgery (Eras) Protocol, Shannan M. Case

Doctor of Nursing Practice Projects

The opioid epidemic in the United States has been a continuous public health crisis, as opioid-associated overdose has become one of the leading causes of death. The risk of opioid misuse increases following exposure to opioids perioperatively. As a result, anesthesia providers are facing a significant shift in practice to decrease opioid administration while adequately managing perioperative pain. While opioids have historically been the mainstream for perioperative pain management, multimodal analgesic (MMA) regimens as part of Enhanced Recovery After Surgery (ERAS) programs are being utilized as alternative methods. With these programs, opioids are reduced by administering non-opioids with neuraxial and …

The Effects Of Diet And Exercise On Menopause Symptoms And Symptom Severity, Nicole Crowder

Doctor of Nursing Practice Projects

Menopause is a phase of life that occurs between the ages of 45-50 years and can last from 7-10 years or longer. The purpose of this quality improvement project was to develop a clinical protocol of assessments not currently completed to decrease the common symptoms of menopause such as hot flashes by implementing dietary changes and exercise as a weekly routine to decrease menopause symptoms. Participation was solicited at a private primary care clinic to women aged 40 and older over a 6-week period. BMI was calculated, documented, and completed surveys were retuned at check-out, with no identifiers and deposited …

Sepsis Criteria On Triage (Scot): Sepsis Alert, Kristie Givens

Doctor of Nursing Practice Projects

Sepsis is a serious life-threatening condition that kills hundreds of thousands of patients every year and is a major leading cause of death. Sepsis is a medical emergency where early identification and prompt treatment are crucial for survival. Despite assessment tools for early recognition, a delay in antibiotic therapy remains. A sepsis alert (Code Sepsis) in the emergency department could improve sepsis care, spare countless lives, and save billions of dollars nationwide, annually. The implementation of a Code Sepsis will trigger a team to deliver immediate treatment and ensure one hour antibiotic administration times. The John Hopkins Nursing Evidence-Based Practice …

Conflict Resolution In Healthcare: The Vital Role Of Developing Conflict Management Skills Among Nurse Leaders, Kris Maddalena

Doctor of Nursing Practice Projects

Nurse leaders at the unit level play a vital and indispensable role in acute care settings. Their influence extends beyond administrative tasks, as they significantly impact crucial factors such as nurse retention rates, patient outcomes, and the overall work environment of the unit-level teams. Effective unit-level leadership has been consistently associated with improved outcomes, increased job satisfaction, and decreased turnover among nurses (Aiken et al., 2011). This DNP project is focused on enhancing conflict management skills among unit-level nurse leaders in an acute care setting. The project followed a quality improvement sequence, which included obtaining a needs assessment for unit-level …

Empowering New Ob Nurses To Combat Racial Disparities Through Education, Tabitha Poole

Doctor of Nursing Practice Projects

Minority patients are experiencing maternal morbidity and mortality at rates three to four times higher than white patients in America (Valerio et al., 2023). The project aims to measure the impact of anti-racism training on new OB nurses' understanding of racial disparities and their impact on maternal health outcomes. A three-hour educational course, in alignment with evidence-based practices, was provided to the participants. Utilizing a Likert Scale, pre- and post-intervention assessments were administered via Microsoft Forms to measure participants' perception of knowledge of implicit bias and structural racism. Gender, age range, and race/ethnicity were also collected to allow for further …

Analysis Of Phlebotomy Training Implementation To Reduce Lab Errors In The Clinical Setting, Sandy King

Doctor of Nursing Practice Projects

The primary responsibility of a laboratory technician is to obtain patient blood samples through venipuncture as well as collect, transport, and store other clinical specimens. Poor blood collection can lead to erroneous and misleading results for the provider in addition to the annoyance of repeat testing for the patient. The lack of formal phlebotomy training provided to nurses could be contributing to laboratory rejections. For patients receiving lab services, how effective is an implementation of formal phlebotomy training for nurses compared to non-formal phlebotomy-trained nurses, in reducing failed lab results? The purpose and aim of this quality improvement project are …

Medication Overrides In Emergency Departments Defy Safety Culture, Jennifer Holt

Doctor of Nursing Practice Projects

Medication errors are a growing problem in healthcare systems. Emergency Departments (ED) are especially susceptible to this. Automated dispensing cabinets (ADC) help promote patient safety, but ED nurses commonly override the safety steps built into that workflow. This quality improvement project aims to reduce the number of medication overrides in three rural emergency departments. Data was compiled for the six months before the education and then for the four-week time frame post-education. Education was developed concerning the effects of medication override and errors were presented to all ED nursing staff at the three facilities. Implementation occurred over four weeks and …

The Implementation Of A Diabetic Foot Screening Tool Into A Primary Care Practice, Joanna P. Barnett

Doctor of Nursing Practice Projects

Inconsistent guidelines and nonadherence to diabetic foot screening recommendations are ongoing problems. This project aimed to promote the prevention of diabetic foot complications by detecting complications early and determining who is at high risk. An educational intervention provided for clinicians addressing the importance of foot assessments and the use of a diabetic foot screening tool was provided. After the education was provided, a pre-and post-test comparison was assessed for increased knowledge. Due to a small sample size and the need to assess results quickly, the plan-do-study-act method guided the project. Post-intervention, the goal was to have four providers increase the …

Reducing Test-Taking Anxiety In Transitional Associate Degree Nursing Students, Diane L. Hare

Doctor of Nursing Practice Projects

Test-taking anxiety causes physical, emotional, and psychological harm that can influence the results of the test takers' performance on an examination (Fletcher, 2022). Reducing test anxiety in nursing students can increase the number of students achieving success in nursing programs, therefore increasing the number of nurses entering the workforce. The United States estimates there will be a shortage of 12.9 million nurses by 2035 (Tamata & Mohammadnezhad, 2022). The aim of the quality improvement project was to reduce test-taking anxiety in nursing students with relaxation techniques. A convenience sample of forty-six students was chosen. The students attended three educational sessions …

Medication-Assisted Therapy And First Episode Psychosis: Evaluating Treatment And Readmission Rates: A Scoping Review, Whitney Nichole Trotter Ms, Bsn, Rdn/Ldn, Rn, Margaret Carrie Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background:

There is limited research aimed at addressing the reoccurrence of admission rates for first-episode psychosis. Research shows that early interventions for first-episode psychosis lead to remissions and prevention of relapses. Research also estimates that approximately one-half of first-episode clients have a history of cannabis abuse or dependence and one-third have a current cannabis use disorder (Wisdom et al., 2011). This study looks to determine whether Medication-assisted therapy (MAT) impacts readmission rates for patients who have substance use disorder and first-episode psychosis within six months of discharge.

Methods:

A comprehensive literature search was conducted using several electronic databases, including PubMed, …

Evaluation Of A Revised Clinical Ladder Program In Addressing Clinical Competence And Performance, Accountability, Professional Growth, Rewards And Benefits, Job Satisfaction And Engagement, And Autonomy And Decision Making, Vaughn Hansen Msn, Rn, Ne-Bc

Doctor of Nursing Practice Projects

Background: The surge of nurses leaving the profession has increased in recent years raising concerns that unless systemwide changes are implemented this trend will increase exponentially for years to come. Healthcare organizations struggle to retain an experienced, competent nursing workforce and seek ways to keep them from leaving. A clinical ladder program is one potential method being implemented in which healthcare organizations mitigate the exodus of nurses and create a healthier work environment.

Objectives: This doctoral project aimed to measure the perceptions of how well a revised clinical ladder program influenced the nursing workforce satisfaction in the following areas: clinical …

The Effects Of Postpartum Hemorrhage Simulation, Kera Olson

Doctor of Nursing Practice Projects

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. Evidence supports the importance and impact simulation has had on preparation for postpartum hemorrhage. Preparation with hands-on education is imperative for a safe outcome during a real-life hemorrhage situation. Lack of frequent education and simulation can equate to negative outcomes for all involved. The purpose of this project was to increase exposure to a safe environment to explore knowledge and skills during a postpartum hemorrhage event. This quality improvement project surveyed postpartum nurses pre and post-mock postpartum hemorrhage simulation. The setting allowed for mistakes, discussion, and open …

Implementation Of A Comprehensive Diabetic Foot Care Protocol In A Primary Care Clinic, Kakecha Taylor

Doctor of Nursing Practice Projects

Diabetes-related complications are significant in the diabetic patient population in the United States. Appropriate measures must be implemented to ensure that diabetic foot disease is prevented. One suggested approach to stopping the progression of complications is to ensure comprehensive diabetic foot exams and foot care education are performed and documented by providers, as recommended by the American Diabetes Association (ADA) annually. Diabetes poses a public health challenge requiring the implementation of evidence-based guidelines in primary care. This quality improvement project aimed to implement a comprehensive diabetic foot care protocol to impact providers' documentation and performance of foot exams in diabetic …

Simultaneous Family Planning Counseling During Visits For Chronic Conditions That Increase Preeclampsia Risk, Jessica Cotton

Doctor of Nursing Practice Projects

Treatment plans are incomplete until providers address a condition’s impact on a potential pregnancy. Primary care providers (PCPs) routinely treat hypertension (HTN), diabetes (DM), chronic kidney disease (CKD), lupus (LP), and antiphospholipid syndrome (APL), which all increase preeclampsia in pregnancy. PCPs may be more prone to overlook pregnancy potential in the context of diseases than those specializing in obstetrics. This quality improvement (QI) project aimed to see if this was true in a small nurse practitioner-owned and run family practice clinic in Oklahoma. A 2022 retrospective chart review for non-pregnant reproductive-age adult females confirmed that no ICD-10 codes for HTN, …

Increasing Provider Confidence With Expedited Partner Therapy In Rural Health, Keisha Fox

Doctor of Nursing Practice Projects

The amount of gonorrhea and chlamydia cases reported in the state of Arkansas over the past four years has gradually increased. Expedited partner therapy (EPT) offers secure, reliable treatment for heterosexual individuals exposed to gonorrhea or chlamydia by their sexual partner without a physical exam but is not commonly offered by providers at Lee County Cooperative Clinic. This quality improvement used CDC guidelines and Arkansas legal statutes to implement EPT education for the providers in a rural health clinic in Arkansas. The goal was to increase provider knowledge and comfort in prescribing EPT. Recruitment of four providers involved discussion of …

Implementation Of High-Fidelity Simulation: Raising The Stakes For Registered Nursing Students, Brittany T. Allen-Marshall

Doctor of Nursing Practice Projects

Critical thinking is a necessary skill for a nurse to possess to be safe and competent. The problem identified for this Doctor of Nursing Practice (DNP) project is the lack of utilization of high-fidelity simulation (HFS) at the University of Arkansas Community College at Morrilton (UACCM)—the DNP project aimed to implement HFS and reduce the critical thinking gap between RN students and practice. The DNP student evaluated student critical thinking with pre-and post-tests. The pre-and post-test results containing Next Generation (NGN) test items showed no statistical significance (p=0.25). The Nursing Anxiety and Self-Confidence with Clinical Decision Making© (NASC-CDM©) scale pre- …

Evaluating The Effectiveness Of The Clinical Care Of The Pediatric Patient Course: A Quality Improvement Project, Cassandra Elliot

Doctor of Nursing Practice Projects

The Clinical Care of the Pediatric Patient (CCPP) is a two-day course held monthly as part of the onboarding process. This mandatory course is intended to prepare onboarding clinical staff for the provision of evidence-based care to pediatric patients. CCPP contains over 17 hours of didactic and hands-on instruction in the assessment, management, and treatment of pediatric conditions. The goal of this quality improvement project was to determine the perceived effectiveness of the CCPP course and its impact on the confidence level of clinical staff as pediatric providers during their first few months of employment. A regression analysis was used …