Medicine and Health Sciences Commons^™

Neuraxial Anesthesia For Total Joint Arthroplasty, Katherine Pozzo

Doctor of Nursing Practice Projects

This quality improvement doctoral nursing project sought to provide a sustainable and data-driven change process at a critical access hospital in Illinois. The main objective of this project was an improvement in postoperative pain scores and implementation of best practice guidelines regarding total joint arthroplasty. Total joint arthroplasty is one of the most common surgical procedures performed in the United States. Future figures predict exponential growth due to our aging patient population, the obesity epidemic, and continued improvements in technique. Despite advances, orthopedic surgeries continue to be taxing on the body and can produce significant complications. General anesthesia for these …

The Use Of Point Of Care Ultrasound To Assess Gastric Contents And Determine Aspiration Risk In The Obese Patient Presenting For Elective Surgery, Harry Senaldi, Mary Zerlan

Doctor of Nursing Practice Projects

Pulmonary aspiration of gastric content is a potentially injurious and fatal complication of anesthesia. Obese patients with a BMI ≥ 35 presenting for elective surgery are at an increased risk of aspiration due to increased gastric pressure, delayed gastric emptying, and higher gastric volumes. Point of care ultrasound (POCUS) is a tool that allows the nurse anesthetist to assess gastric content and assign aspiration risk based on the scan results. A knowledge improvement project in the form of a lecture and hands-on tutorial focused on using POCUS to assess gastric content and assign aspiration risk was designed. This project was …

Physician Use Of The Rapid3 To Guide Rheumatology Follow-Up: A Retrospective Examination, Karen Howard

Doctor of Nursing Practice Projects

Abstract

The Quality Improvement Team of a rheumatology clinic was seeking ways to deal with the long intervals for an available follow-up appointment. The use of standardized disease activity assessment tools as a part of patient care is an evidence-based practice that is not employed by over one third of rheumatologists. One of the many uses of these tools is to guide treat-to- target care. Treat-to-target care uses the disease assessment tool score to guide treatment decisions and follow up interval. This project examined the use of a standardized disease assessment tool, the Routine Assessment of Patient Index Data 3 …

The Development Of An Evidenced-Based Guideline For The Anesthetic Management Of Surgical Cases Utilizing Evoked Potential Monitoring, Brent Hitchens, Darrell Risinger

Doctor of Nursing Practice Projects

Recent increases in the prevalence of neuromonitoring cases have contributed to the utilization of evoked potential (EP) monitoring during surgery. Evoked potentials are electrical signals measured in response to a stimulus. Intraoperative neuromonitoring is used to alert the surgeon, anesthesia provider, and neuromonitoring technician of changes before permanent nerve injury occurs. There are many factors that can affect neuromonitoring quality including hypothermia, hypotension, positioning, anemia, and anesthesia medications. The latter is especially important since certain anesthetic medications can have a profound inhibitory effect on the nervous system, leading to decreased amplitude and prolonged latency of EP signals. As a result, …

Introduction Of Enhanced Recovery After Cesarean Section (Erac) Protocol, Kwame Adu-Affum

Doctor of Nursing Practice Projects

Cesarean section is one of the most performed in-patient surgeries worldwide (Wilson et al., 2018; Liu et al., 2020). Births by cesarean section have been increasing globally. Cesarean birth rate has remained above 31% in the United States, even with the consistent two percent decrease in birth rate per year (Martin et al., 2019). Illinois has also maintained a high cesarean birth rate above 30% (Hamilton et al., 2021). Cesarean patients experience inflammatory and neurohormonal changes with many adverse effects in direct response to surgical stress (Mullman et al., 2020). The post-cesarean physiological effects, including pain, reduced gastric motility, pulmonary …

Computer-Based Learning Module: Local Anesthetic Systemic Toxicity, Nhan Nguyen

Doctor of Nursing Practice Projects

Local anesthetic systemic toxicity (LAST) is the result of rapid absorption of local anesthetics (LAs) into the systemic circulation resulting in toxic plasma levels of the drugs. With the advent of ultrasound-guided regional anesthesia and improvements in injection techniques, the incidence of LAST has decreased significantly over the years. Even though LAST is rare, it is a potential, life-threatening complication associated with any administration of LAs. Providers and staff members taking care of patients receiving LAs should be astutely aware of potential complications so that LAST signs and symptoms can be recognized, and treatments can be implemented as swiftly as …

Difficult Labor Epidural: Intrathecal Catheter Management, Andrew Screnchuk

Doctor of Nursing Practice Projects

Labor epidural analgesia is the most common method used to control pain associated with labor and vaginal delivery in the United States. However, the epidural catheter placement can cause accidental dural puncture in about 1 to 6% of laboring patients. Initiation of continuous intrathecal analgesia provides a good alternative to another attempt of epidural placement in certain types of the laboring population. While other countries have published referral guidelines of managing accidental dural puncture, the United States lacks such practice standards. The application of Accidental Dural Puncture Management with Intrathecal Catheter (ADPMIC) guidelines, used in other countries for difficult epidural …

Perioperative Tube Feeding Guidelines For The Pediatric Burn Patient, Jordan Swanberg

Doctor of Nursing Practice Projects

Pediatric burn patients require an astronomical amount of nutritional support to promote wound healing and prevent unwanted side effects. These patients often require multiple surgeries, and consequently, when following standard NPO guidelines, these patients go for hours without any nutritional support. For this reason, a protocol was implemented on how to administer tube feedings throughout the perioperative process safely. The purpose of this project was to give a PowerPoint presentation to the providers that tested their current knowledge on how to manage tube feedings in the operative setting best. A single group design consisting of CRNA’s and an anesthesiologist was …

Creating A Guideline For Sti Testing In The Pediatric Population, Alexandria Molaro, Alexandra Evans, Alex Niebrugge

Doctor of Nursing Practice Projects

Sexually transmitted infection (STI) prevention, education, screening, and management in pediatric primary care settings are of importance due to the increasing number of cases yearly. Almost half of the 26 million new STIs that occurred in 2018 were among young people 15-24. An opportunity existed in a rural pediatric primary clinic, for improved adherence to Centers for Disease Control and Prevention (CDC) or American Academy of Pediatrics (AAP) recommendations to screen/test patients. An evidence-based project (EBP) was developed to address this concern. Project objectives included: developing STI screening guidelines for pre-teen to young adults, developing a screening algorithm, providing alternative …

Critical Care Orientation Escape Room, Leah Deaton

Doctor of Nursing Practice Projects

Newly licensed nurses often feel unprepared and lack confidence as they transition from academia to practice. Education Specialists who oversee training programs for newly graduated nurses are challenged to create education modalities that are meaningful, engaging, and promote critical thinking. The purpose of this project was to create an Educational Escape Room to reinforce principles of safe medication administration for new nurses entering critical care areas in a large pediatric hospital. Escape Rooms engage learners through gamification and active-learning principles to improve knowledge synthesis and retention. Eighty-three newly hired critical care RNs participated in the Educational Escape Room during house-wide …

Improving Healthcare Team Communication With Limited English Proficiency Families In The Nicu, Ivonne Mandell

Doctor of Nursing Practice Projects

Language barriers are common in healthcare settings, creating disparities in care between individuals with limited English proficiency and those with English proficiency. In the NICU setting, professional medical interpreters have been shown to improve parent/staff communication and increase parent satisfaction by allowing parents to ask questions and form trusting relationships with staff. Solid parent-provider communication can result in better health outcomes by increasing parental empowerment and participation in their child’s care. Despite the acknowledged advantages of using professional interpreters in healthcare settings, they are frequently under-utilized, even when readily available. The purpose of this project was to improve communication with …

Implementation Of Depression Screening In A Nursing Home, Titilayo Raji

Doctor of Nursing Practice Projects

Abstract

Background/Introduction

Unidentified and untreated depression among nursing home residents leads to poor quality-of-life and substantial healthcare dollars are utilized for care management. Use of validated instruments and routine screening provides opportunity for early detection and treatment.

Purpose

The purpose of this project was to educate employees of a nursing home on the use of the Geriatric Depression Screening (GDS) tool, implement it on two units of the nursing home, and evaluate the feasibility and acceptability of this quality improvement project.

Method

An educational presentation was delivered to introduce the implementation plan, GDS screening tool, and protocol for data collection. …

Best Practice In The Perioperative Anesthetic Management Of Infants With Gastroschisis, Emily R. Lester

Doctor of Nursing Practice Projects

Gastroschisis, a severe abdominal wall defect, occurs in approximately 1 in every 2,000 fetuses. Despite care advancements, gastroschisis is associated with significant morbidity and mortality including prolonged time to tolerance of enteral feeds, prolonged ventilator support, and increased intensive care unit length of stay and hospital costs. A recent practice change in the care of infants with gastroschisis at a tertiary care facility in central Illinois lead to the request for an integrative review of the available literature and subsequent development of a comprehensive guideline discussing best-practice perioperative recommendations pertinent to the care of infants with gastroschisis. Through review of …

Pediatric Distraction Methods For The Perioperative Period, Jennifer L. Ashton, Katherine M. Rosner

Doctor of Nursing Practice Projects

Abstract

Most pediatric patients will experience anxiety to some degree during the perioperative period. Unrecognized and untreated anxiety can lead to complications during induction of anesthesia and may manifest as maladaptive behaviors that can last up to 6 months postoperatively. Multiple modalities are typically utilized to provide the greatest amount of anxiety relief with minimal side effects. Nonpharmacological methods of distraction have been proven effective when used in combination with pharmacological agents, as well as when used alone. The goal of this project was to create and present an educational resource tool regarding pharmacological and nonpharmacological distraction methods for pediatric …

Anticipatory Guidance For Parents/Caregivers Of Pediatric Patients Ages 0-12 Months, Cody Palmer, Anna Hagnauer

Doctor of Nursing Practice Projects

Anticipatory guidance is defined as proactive counseling for caregivers regarding various aspects of childcare and development. This project sought to improve the process and delivery of anticipatory guidance for infants aged 0-12 months at one rural pediatric primary care clinic. An extensive literature review was undertaken to determine current recommendations for anticipatory guidance topics pertinent to pediatric patients aged 0-12 months. Additional research explored the efficacy of various educational formats to provide teaching. Written educational materials were updated and edited to be visually appealing and understandable, and educational videos were created. Written materials and educational videos were provided to parents/caregivers …

Development Of A Protocol To Manage Postdural Puncture Headache, Ashley M. Shulman, Lynexis P. Mcvey

Doctor of Nursing Practice Projects

In obstetric laboring patients, neuraxial anesthesia is a common form of analgesia. However, neuraxial procedures are not without risk. Accidental dural puncture (ADP) is a potential risk with any epidural procedure. Patients who experience ADP are at a greater risk of developing postdural puncture headache (PDPH). The presentation of PDPH is commonly described as a dull, throbbing, headache worsening upon standing and relieved with supine positioning (Patel et al., 2020). Symptoms of PDPH may range from mild to debilitating and develop within five days of ADP. A variety of treatment options exist for PDPH ranging from conservative to invasive. The …

Improving Staff Education On Lung Cancer Screening At The Illinois Correctional Facilities For The Justice-Involved Individuals, Natalie Bethel, Jillian Youngquist

Doctor of Nursing Practice Projects

Justice-involved individuals are at an increased risk of developing chronic health conditions, including lung cancer. Literature supports the practice of using an annual low-dose CT scan to screen for lung cancer. Illinois Correctional Facilities lacked a lung cancer screening protocol for justice-involved individuals. Lung cancer screening guidelines were approved for the facilities, however, the time frame for implementation was unclear. This DNP project focused on evidenced based guidelines for lung cancer screening with education tools for staff members to prepare them for implementation. Staff was presented with a pre-test, PowerPoint presentation, and a post-test to evaluate lung cancer screening knowledge. …

Establishing Care With A Primary Care Provider, Ashley Whitlatch

Doctor of Nursing Practice Projects

Established primary care leads to continuity of care, improved patient outcomes, and increased quality of life. There is also an improvement in the unnecessary usage of urgent care resources. The purpose of this project was to pilot a new process within the urgent or emergent care setting to ensure that patients who are not established with a primary care provider (PCP) have an appointment set before they are discharged. Staff were educated and trained in how to schedule primary care appointments for at-large patients. There are a high number of individuals who do not have a primary care provider. When …

Implementation Of Routine Screening With Patient Health Questionnaire 9 (Phq-9) Of Adults With Crohn’S Disease, Jo A. Muller-Krause

Doctor of Nursing Practice Projects

Introduction: Mild levels of depression have been measured with screening tools at rates of 15-24% in adults with Crohn’s disease (CD). The spectrum of the impact of depressive symptoms is measurable and documented for those with CD. Patient perspectives support the integration of psychological care, and the Patient Health Questionnaire 9 (PHQ-9) is a well validated tool for the measurement of depressive symptoms.

Purpose: Increase depression screening of adult CD patients in the outpatient gastroenterology clinic and evaluate the provider perspectives regarding PHQ-9, depression, and CD.

Conceptual Framework: The Johns Hopkins Nursing Evidence Based Practice (JHNEBP) Model was selected as …

Increasing Obesity Education In An Underserved Latino Population, Morgan Lippert, Kelsey Beard

Doctor of Nursing Practice Projects

Obesity is a rapidly growing health problem in the United States. Certain populations are at high risk for developing obesity including the Latino population and underserved communities. This Quality Improvement project aimed to develop a more patient centered approach for primary care providers use to deliver obesity education to an at-risk Latino population. The project was completed at a clinic in southern Illinois where the majority of the population is underserved and Spanish speaking. Obesity education tools in both Spanish and English were given to the patients in order to decrease the language barrier and improve patient education and understanding …

Identifying Facilitators And Barriers For A Successful Student Registered Nurse Anesthetist’S Clinical Experience, James Clancy, Adam Bruinius

Doctor of Nursing Practice Projects

Student registered nurse anesthetists experience a wide variety of barriers and facilitators to their clinical education; often rotating through several clinical sites during their nurse anesthesia educational program (NAEP) tenure. Existing evidence suggests SRNAs must be proficient in seeking, accepting, and utilizing feedback from clinical preceptors (Algiraigri, 2014). Accepting constructive criticism may be challenging for SRNAs as they are highly skilled, competent nurses who are now entering rigorous NAEPs as novices. Reverting from preceptor to preceptee can be a difficult transition for SRNAs. This project aimed to identify barriers and facilitators to a successful SRNA clinical education through a literature …

Utilizing A Personal Health Coach In The Management Of T2dm, Emily Killebrew, Matthew Huelsman, Verah Bonareri, Terri Furfaro

Doctor of Nursing Practice Projects

Management of type 2 diabetes mellitus (T2DM) can reduce hemoglobin a1c values and ultimately reduce the risk of morbidity and mortality. Many adults live with uncontrolled T2DM due to a lack of knowledge of disease management. The purpose of this project was to evaluate the implementation of a personal health coach for the management of T2DM in adult patients. An extensive literature review was conducted, and the use of the Diabetes Management Self-Efficacy Scale (DMSES) was chosen to evaluate participants’ self-efficacy regarding their T2DM. Adult patients aged 21-75 with a diagnosis of T2DM and a hemoglobin a1c >7 in a …

Development Of Evidence-Based Rubrics And Instructional Videos For Anesthesia Induction Sequences, James P. Canny, Nathan M. Carroll

Doctor of Nursing Practice Projects

Safe and effective induction of anesthesia is a vital component of any anesthesia provider’s skill set. Although both typical sequence and rapid sequence induction are common procedures, much variance in technique exists among providers. Clear, standardized rubrics are an important element in teaching these skills. The purpose of this project was to update the typical and rapid sequence induction rubrics for the Southern Illinois University Edwardsville Nurse Anesthesia Program with the current best practice recommendations. To utilize and reinforce observational learning, instructional videos were also created to accompany the updated rubrics. These materials were presented to the student registered nurse …

Conducting A Root Cause Analysis To Improve Intake Processes And Record Review In Home Health, Christina Guerrero

Doctor of Nursing Practice Projects

Minimization of adverse events, reduction of inpatient admissions, and prevention of polypharmacy within home health are of importance due to the increasing number of Medicare beneficiaries. In 2019, CMS reported 5,266,931 patients were served by home health agencies, accounting for 7,439,849 episodes of care. It is projected that the number of beneficiaries will rise from 54 million to more than 80 million by the year 2030. Medical errors are now the third-leading cause of death in the United States, surpassing diabetes, Alzheimer’s, and stroke. The Agency for Healthcare Research and Quality identifies a lack of institutional intake processes as the …

Establishing Guidelines To Promote Best Practice For Common Ailments In School-Based Health Clinics, Kaitlin Sweeney, Rachael Schaefer

Doctor of Nursing Practice Projects

The COVID-19 pandemic exposed the gap in access to medical care of school-age children and identified a need for community-based health clinics to aid in its minimization. Evidence shows the creation of school-based health clinics (SBHCs) in public school districts provides a pathway for students to receive high-quality care in an easily accessible manner. Therefore, patient care guidelines for common ailments seen in SBHCs for a local federally qualified healthcare center (FQHC) were developed in conjunction with the FQHC goal to build and operate a SBHC located in southern Illinois. Eight guidelines were created to analyze the most common chief …

The Implementation Of A Mental Health Screening Protocol In An Occupational Health Setting, Chandra A. Pierson-Rye

Doctor of Nursing Practice Projects

Background

Occupational injuries are disturbingly common and can occur regardless of employment industry, given that virtually every job in every industry has some degree of risk. Literature suggests that once an injury has occurred, psychosocial factors such as depression can play a pivotal role in the progression of pain, determine whether a subsequent disability develops, and the length of time an employee is off work.

Theoretical Framework

Both pain and depression are hypothesized to follow the same descending pathway in the CNS and have the same biochemical basis, serotonin and norepinephrine. The Biophysical Model of Pain can be used to …

Improving Depression Surveillance At The We Care Clinic, Kaitlin Springer, Emma Hanney

Doctor of Nursing Practice Projects

Depression is one of the most underdiagnosed and untreated disorders affecting more than 16 million people in the United States each year (Henry et al., 2020). Unmanaged depression can lead to emotional suffering, decreased productivity, reduced income, impaired relationships, and an increased risk for comorbidities (Sinisalchi et al., 2020). It can affect anyone, however, individuals who are non-white, female, undereducated, disabled, pregnant or postpartum, have low socioeconomic status, or lack social support are at an increased risk (United States Preventative Services Task Force, 2019). The Southern Illinois University Edwardsville We Care Clinic provides primary care to minority patient populations who …

Implementation Of Prep Protocol In Primary Care, Myia Harper, Catalina West

Doctor of Nursing Practice Projects

Human immunodeficiency virus (HIV) is an incurable condition that continues to be a public health threat. Approximately 38 million people live with the disease worldwide, and one out of seven are unaware they have the disease. Pre-exposure prophylaxis (PrEP) is a medication that can be prescribed to individuals at risk of acquiring HIV. PrEP can be prescribed by any healthcare provider who deems a patient at risk for HIV. However, a primary care practice in central Illinois previously had no protocol for initiation of PrEP. This quality improvement (QI) project aimed to implement a PrEP protocol in the department of …

Implementation Of Childhood Trauma Questionnaire In A Primary Care Setting, Michele Hartke

Doctor of Nursing Practice Projects

Background

Childhood abuse, neglect and unusual stressful or traumatic conditions are common pediatric issues, with most Americans having experienced one kind of these adverse childhood experience (ACE) resulting in mental and physical issues in adulthood (Centers for Disease Control, 2010). Implementing a routine screening for patients will assist in identifying health concerns and can improve outcomes for the patient.

Aim

The aim of this project was to implement the use of a brief screening tool in a primary care medical office setting to assess for traumatic childhood experiences that have impact on a patient’s current morbidities.

Theoretical Framework

This quality …

Hypertension Management In Primary Care Using Target:Bp; Meeting Patient Goals And Quality Measures, Hollie Yoder

Doctor of Nursing Practice Projects

Hypertensive disease is a global problem impacting millions of individuals aged 18 years and above. Uncontrolled hypertension management can lead to significant complications and death . Primary care providers are challenged to improve patient outcomes in patients with hypertensive disease while complying with clinical quality measures for high blood pressure as outlined by the Center for Medicare and Medicaid Services Merit-based Incentive Payment System (MIP) performance measures. The purpose of this project was to improve high blood pressure in patients diagnosed with primary hypertension utilizing the American Heart Association (AHA) and the American Medical Association (AMA) Target: Blood Pressure (BP) …