Medicine and Health Sciences Commons^™

Impact Of Spontaneous Breathing Trials On Reducing Ventilator-Associated Pneumonia In Adult Intubated Patients: A Scoping Review, Jireh R. Johnson Bsn, Rn, Hamzha Aysheh Bsn, Rn, Keianna Luckett Bsn, Rn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background For ventilated patients in the intensive care unit, ventilator-associated pneumonia (VAP) is a major source of morbidity. It is difficult to diagnose due to many of the diagnostic criteria being subjective, its clinical signs that are broad, and its association with various respiratory disorders. Hospitals have developed varying ventilator bundles in expectation to prevent the incidence of Ventilator-associate pneumonia. We performed scoping review to determine the impact of spontaneous breathing trials (SBT) on reducing VAP.

Methods From August to November of 2021, using the MEDLINE, ScienceDirect, and Scopus databases and MeSH search terms, we identified over 20,000 articles containing …

Prophylactic Administration Of Steroids And The Effect On Post-Extubation Stridor: A Scoping Review, Chelsey Benson Bsn, Rn, Karlene Ferraro Bsn, Rn, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl

Doctor of Nursing Practice Projects

Purpose/Background Stridor occurs due to laryngeal edema which arises when a patient has been intubated for an extended period of time. There are several factors that affect the degree of swelling. Post-extubation stridor signals that a patient requires reintubation because the airway is no longer patent. Corticosteroids, such as dexamethasone, can be used prior to extubation to minimize complications and overall length of stay if a patient is at high risk for stridor. This scoping review will evaluate the literature and the association between the use of prophylactic steroids on mechanically ventilated adult patients and the occurrence of post-extubation stridor. …

Optimizing Electronic Medication Prior Authorization: Reducing Prescription Delays, Arnold Butiu

Doctor of Nursing Practice Projects

Background: Within the United States, chronic disease in children has doubled over the last 20 years. Many diseases defined as chronic (attention deficit, epilepsy, and diabetes) require daily medication regimens for optimal management. To be covered by insurance, many of these medications require prior authorization (PA) from the patients’ pharmacy benefits policy. Delays in processing and receiving PA orders can lead to worsening disease and inadequate disease management.

In 2014, a pediatric academic medical center in the Midwest found that processing medications from prescription order to PA approval took nurses an average of over 90 hours. In August 2020, the …

A Chronic Obstructive Pulmonary Disease Pilot Using Risk Stratification To Improve Resource Allocation And Reduce Readmissions, Linda Gould

Doctor of Nursing Practice Projects

Background: Chronic Obstructive Pulmonary Disease (COPD) impacts 250 million people, is associated with high hospital readmission rates, and costs over $50 billion annually. Purpose: Apply risk stratification identifying higher risk patients to prioritize complex, time-consuming interventions and resources. Methods: Patients hospitalized with COPD were risk stratified using PEARL. Moderate-high risk patients were referred to specialty nurse practitioners, who used real-time interventions and motivational interviewing during intense weekly visits over 30 days targeting self-management, patient-specific risks, and resources. Results: No patients were readmitted or died during the pilot using risk stratification with patient-specific tertiary preventive care to …

Improving Access And Delivery Of Mental Health Care To Veterans Through A Care Coordination Pilot At A Texas Department Of Veterans Affairs Hospital, Jacqueline Buval

Doctor of Nursing Practice Projects

Background: Mental health (MH) disorders are among the leading cause of disabilities in adults, with an even greater prevalence among Veterans who served in combat. Forty percent of troops returning from combat zones report suffering from post-traumatic stress disorder (PTSD) or depression and 33% report trouble accessing MH care. Access to care is directly influenced by care coordination procedures in health care systems. If care coordination is poor or lacking, patients remain in settings that are inappropriate for their level of care. Implementing a care coordination program can improve care transitions, provide the necessary support for patients to successfully …

Implementing An Evidence-Based Fall Prevention Plan To Address Unintentional Hospital Falls On A Medical/Surgical Unit, David Haskell

Doctor of Nursing Practice Projects

Background: Falling in the hospital setting is a leading cause of death and disability for patients. For many health care organizations, patient fall prevention strategies have become a priority focus to improve patient outcomes and associated costs.

Project Design: The project was designed to implement a quality improvement project on an adult medical/surgical unit, providing educational activities to nursing staff, and applying a standardized fall prevention plan of care “toolkit” for fall prevention interventions.

Results: Audits completed on 863 patient admits to a 36-bed Medical/Surgical unit during the three-month timeframe, showed the implementation of the project resulted in the creation …

Mindfulness-Based Stress Reduction To Decrease Burnout In Emergency Nurses: A Quality Improvement Project At An Academic Medical Center, Desireé M. Mccue

Doctor of Nursing Practice Projects

Nursing burnout, categorized by increased emotional exhaustion (EE), depersonalization (DE), or decreased personal achievement (PA), is rising in the United States. Emergency Department (ED) nurses at an academic medical center in the western United States experience burnout related to workplace violence and trauma exposure exacerbated by a global pandemic. Burnout can lead to adverse health impacts for nurses, increased institutional costs, and adverse patient outcomes.

Improving mindfulness or awareness of the present can reduce burnout in ED nurses. A mindfulness pilot project was conducted with staff nurses (n=20) and nurse leaders (n=4) in the ED. Participants attended Mindfulness-Based Stress Reduction …

Deploying A Validated Postnatal Depression Screening Tool & Guideline To Improve Evidence Based Screening For Postpartum Depression In Ambulatory Care, Debbie Ketchum

Doctor of Nursing Practice Projects

Problem Description: Postpartum depression (PPD) is a significant public health problem that is potentially disabling and can be life-threatening. It is one of the most common diagnoses for maternal morbidity and mortality, affecting one in ten women in the United States. Currently, there is no universal process for the identification of PPD within the ambulatory clinics in this regional health system caring for obstetrical patients. A quality improvement project was developed and implemented with a pilot group in the ambulatory setting.

Rationale: Without a standard process for screening, patients and their newborns may be at increased risk for detrimental consequences …

A Pilot Program To Improve Patient And Family Experience Scores And Quality Of Care Of The Hispanic Population In An Urban Pediatric Emergency Department., David C. Kruger

Doctor of Nursing Practice Projects

Problem Description: Emergency Department (ED) patients express decreased patient and family experience (PFE) scores when they feel disrespected (such as experiencing long wait times), experience ineffective communication, or have difficulty accessing care. These issues could lead to inequalities and adverse health care outcomes, especially among those of different races and ethnic backgrounds. The goal of this quality improvement (QI) project was to evaluate the PFE scores and the quality of care of the Hispanic population at a thirty-five-bed emergency department within a freestanding pediatric, academic medical center located in a large urban area.

Rationale: The theoretical framework guiding this QI …

A Quality Improvement Initiative To Redefine Nurse-Led Discharge Interventions In A Skilled Nursing Facility (Snf) On All-Cause 30-Day Re-Admission Rates Using The Re-Engineered Discharge (Red) Program, Ruby Panju-Merali Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: The growing population of people over the age of 65 years with surmounting medical complexities resulting in hospital re-admissions poses significant challenges for the healthcare system. Re-Engineered Discharge (RED) has demonstrated interventions inclusive of nursing driven discharge planning to successfully decrease hospital readmissions in Skilled Nursing Facilities (SNF).

Purpose: This aim of this quality improvement initiative was to improve discharge efficiency by implementing a modified version of RED to evaluate the effect of centralizing nursing in education and discharge processes and influence on all-cause 30-day readmission rates.

Methods: A pre and post intervention design was utilized for patient chart …

Developing A Standardized Process For An Effective, Evidence-Based Fall Management Program To Reduce Falls In A Nursing Home Setting, Katrina K. Little

Doctor of Nursing Practice Projects

Background: Falls among the elderly population, aged 65 years and older, are a significantly growing public health problem. For elderly people residing in residential care facilities and facility administrators, falls are of great concern due to the post-fall associated consequences. Preventing resident falls in long-term care is a priority to reduce injuries and associated costs.

Project Design: This evidence-based quality improvement (EBQI) pilot project focused on fall prevention and was conducted on 1 unit (3 long-term care hallways) at a facility that provides both long-term care (LTC) and short-term rehabilitation services in Utah County, Utah. Interventions chosen for the Falls …

Implementing Sexual Health Education For At-Risk High School Students In A Faith-Based Setting: A Pilot Project, Neva R. Fuentes

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STI) are a global issue that persist, causing significant negative health outcomes like cancer, adverse reproductive issues including infertility, and death (CDC, 2019a; Office of Women’s Health [OWH], 2019; WHO, 2019). In the United States, youth ages 15-24 years old make up 50% of the more than 20 million newly diagnosed STI’s each year (CDC, 2019a). Young women, adolescents (Slater & Robinson, 2014), minority populations (Mermelstein & Plax, 2016), and high school dropouts (Anderson & Pörtner, 2014) are even more disproportionately affected. Access to comprehensive health information and vaccines are well documented effective STI prevention methods …

Preventing Failure To Rescue: Implementation Of An Early Warning Score System, Caitlyn Holloway Msn Rn Ccrn-Cmc Pccn Tcrn

Doctor of Nursing Practice Projects

Background: Hospitalized patients are at inherent risk of complications and further clinical deterioration, even in the presence of advanced medical interventions and expert caregivers, with the most significant risk being failure to rescue. Early Warning Score (EWS) systems allow for earlier, more effective identification of clinical deterioration than traditional medical emergency team (MET) systems and provide an opportunity to reduce failure to rescue events and improve patient outcomes.

Objective: The purpose of this quality improvement project was to implement an EWS system that allowed bedside caregivers to improve patient outcomes through reduction of failure to rescue events and improvement of …

Mental Health First Aid (Mhfa): Implementing An Evidence-Based Practice Change Initiative In A School Setting, Kate Wachutka Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: School-aged children with unidentified mental illnesses experience poor health outcomes and increased medical costs. Successful management of this public health threat requires a collaborative community approach with a focus on enhancing adults’ mental health literacy (MHL) to improve outcomes.

Objectives: The objectives of this project were to implement an evidence-based mental health education (utilizing MHFA) and sustainment program within a school setting for staff and parents supervising children to optimize the adults' MHL over a three month period.

Methods: A pretest-posttest design was used. Participants were recruited from a school in the Western United States. Inclusion criteria consisted of: …

Implementation Of A Transitional Care Model To Decrease Readmissions For Ischemic Stroke And Tia Patients, Sarah Baskind Msn, Fnp-Bc, Cnrn, Scrn

Doctor of Nursing Practice Projects

Background: Poor continuity of care after hospitalization can increase the risk of adverse health outcomes such as unplanned readmissions for stroke and transient ischemic attack (TIA) patients. Transitional care models (TCMs) can be used to improve the coordination of care post-discharge.

Objectives: The purpose of this doctoral Quality Improvement (QI) project was to develop, implement, and evaluate a TCM for ischemic stroke/TIA patients over a 3-month period. This project had four aims: 1) to decrease the unplanned 30-day readmission rate, 2) for all eligible patients to be enrolled after discharge, 3) to have all enrolled participants receive all components, and …

Implementing Sskin Bundle For Pressure Ulcer Prevention In Long-Term Care Facility, Funmilayo Oni

Doctor of Nursing Practice Projects

Background: Pressure ulcers are a major challenge in long-term care (LTC) facilities. Adult patients in LTC setting are at risk for developing pressure ulcers due to chronic medical conditions and comorbidities. Preventing the onset of these wounds is more cost-effective than treating pressure ulcers.

AIM/Objectives: The primary objective was to decrease the number of pressure ulcers by 50% within a three-month period. Secondary objectives were to achieve 100% compliance with completion of mandatory staff education, score on the posttest questionnaire, and compliance with mandatory staff documentation as instructed by the SSKIN protocol.

Methods: This DNP Project used a pretest and …

Antibiotic Stewardship For Asymptomatic Bacteriuria In Older Adults Residing In Long-Term Care At End-Of-Life, Kimberly Madison Agpcnp-Bc

Doctor of Nursing Practice Projects

Background: Differentiating between asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) in older adults is challenging due to their atypical presentation. There is a critical gap in practice to adhere to clinical guidelines advising against treating ASB with antibiotics.

Objectives: The purpose of this Quality Improvement project was to implement an antibiotic stewardship program at a hospice organization to standardize judicious use of antibiotics at the end-of-life. The outcome measures were designed to evaluate clinician knowledge, prescribing policies and practice changes, the completeness of documentation, the appropriate usage of antibiotics, and clinician antibiotic use attitudes and beliefs.

Methods: Hospice clinicians …

Structured Type 2 Diabetes Education To Improve Self-Monitoring Blood Glucose, Self-Care Management, And Diabetes Knowledge In A Multicultural Family Practice Clinic, Deedee Foster Fnp-C

Doctor of Nursing Practice Projects

Background: The family practice providers at the family medicine residency clinic (FMRC) have neither sufficient time nor continuity of care to provide diabetes education to effectively reduce A1c levels. The FMRC has 500 multicultural type 2 diabetes patients with an A1c >7% that has increased by 23.2% in the previous five months. Multiple studies have demonstrated that structured diabetes education can significantly decrease blood glucose readings, improve self-care management, and diabetes knowledge to attain optimal glycemic control.

Objectives: To implement an evidence-based practice (EBP) project in the FMRC to improve participants blood glucose readings, self-care management, and diabetes knowledge.

Methods: …

Effect Of A Web-Based Educational Intervention In Improving Depression Knowledge And Help-Seeking Behaviour In Women, Chibuzo Efuribe Rn Msn Fnp-Bc

Doctor of Nursing Practice Projects

Background: Depression is of global concern and one of the leading causes of disability in the United States. Based on a needs assessment conducted in a faith-based organization, we noticed a gap in depression knowledge, an unwillingness to seek help, and a lack of open dialogue among the women. Studies have shown that low depression literacy impedes early recognition, prevention, and willingness to seek help (Brijnath et al., 2016; Reavley et al., 2014).

Aims: This study aimed to evaluate the effects of web-based educational intervention in improving depression knowledge and help-seeking behavior among women in a faith-based organization.

Methods: Using …

Program Evaluation Of Leader Rounding In Emergency And Trauma, Allen Fasnach Msn, Rn

Doctor of Nursing Practice Projects

Background: Patient satisfaction scores are an area of priority for hospitals throughout the United States because of their association with quality outcomes for the patients (Davenport, O'Connor, Szychowski, Landry, & Hernandez, 2017). This healthcare organization implemented the practice of nurse leader rounding over the last five years with the goal of leaders rounding on 75% or greater of the units' populations without any organizational sustainment or achievement of upper decile patient satisfaction scores.

Aims: The aim of this project was to utilize the Centers for Disease Control Framework for a Program Evaluation to evaluate the redesigned leadership rounding program for …

Effectiveness Of Provider Education To Improve Screening, Diagnosis, And Management Of Postpartum Depression, Gina M. Tytula

Doctor of Nursing Practice Projects

Background: Postpartum depression (PPD) effects approximately 15% of new mothers after the birth of their child which results in feelings of anger, fear and being overwhelmed. In the practice setting for this project there were low rates of PPD screening, leading to missed diagnoses and inadequate management of PPD.

Purpose: The purpose of this project was to implement and evaluate the effectiveness of an education program to increase providers’ perceived knowledge and improve screening, diagnosis and management of PPD for a multicultural patient population at an urban obstetrics practice.

Methods: This pre-post design project evaluated the effectiveness of an educational …

Evaluating Telehealth As A Means Of Communicating With Living Donors And Its Effect On Quality Of Care, Ashley Anne Hamby Rn Msn

Doctor of Nursing Practice Projects

Background: Despite the advantages of living donor kidney transplantation (LDKT), there are barriers that potential donors face that make living donation less appealing. Research supports the use of telehealth as an effective method of enhancing access to care and building efficiencies.

Aims/Objectives: To evaluate access to care, effectiveness, financial impact, and experience after implementing telehealth as a means of communicating with living donors.

Methods: Utilizing a pretest-posttest design, an analysis was performed among medically cleared donors evaluated in-person between January 1, 2019 to December 31, 2019 (Control Group; N=64) and donors evaluated via telehealth (Zoom®) between January 1, 2021 to …

Implicit Bias Training: Improving Racial/Ethnic Disparities In Maternal Care, Marilyn Mapp

Doctor of Nursing Practice Projects

Background: Racial and ethnic disparities persist in the United States leading to adverse maternal outcomes. Nationally, the maternal mortality rates in black women are two to three times higher than white women. Implementing implicit bias training, recommended by the Council on Patient Safety in Women’s Health, is a key intervention that may help to reduce these disparities.

Objectives: This quasi-experimental/mixed methods project evaluated the effectiveness of training on implicit bias to increase awareness of implicit bias among a convenience sample of registered nurses in labor and delivery and postpartum units at two community hospitals.

Methods: Quantitative data was analyzed with …

Ventilator-Associated Pneumonia Bundle Compliance: A Quality Improvement Project, Keesha L. Holmes Msn, Fnp, Ne-Bc

Doctor of Nursing Practice Projects

Background: In many hospitals, patients requiring mechanical ventilation are managed in an intensive care unit (ICU) or a unit that requires a higher level of care compared to a medical-surgical unit. Patients on mechanical ventilation are susceptible to acquiring ventilator-associated pneumonia (VAP) if precautionary measures are not taken.

Aims/Objectives: The purpose of this quality improvement project was to assess if after an identified group of critical care registered nurses (RN) participated in an education session on ventilator-associated pneumonia and ventilator-care bundle (VCB) interventions, would their knowledge be enhanced, would the RNs implement the knowledge learned into their practice, and if …

A Community Educational Intervention To Improve Firearm Safety Behavior In Families, Elizabeth G. Choma Msn, Rn, Cpnp-Pc

Doctor of Nursing Practice Projects

Background: Every day in America children, are injured or killed from the accidental shooting of firearms. Additionally, few households with children report storing all guns unloaded and locked up. Recent evidence supports education on safe firearm storage as an effective intervention in promoting firearm safety in families with children. However, Pediatric healthcare providers often do not have enough time for firearm education during well visits.

Objective: This Quality Improvement (QI) project aimed to use an educational intervention with statistics on firearms in children and implemented the Asking Saves Kids (ASK) campaign to assess and improve firearm safety behaviors in families …

A Certified Nurse Program: Mitigating Barriers To Certification, Kymberlee Cox Msn, Rn, Npd-Bc, Pccn-K

Doctor of Nursing Practice Projects

Background: Certification recognizes a nurse's specialized knowledge, skill, and expertise. It has been linked to positive patient, nurse, and organizational outcomes. Recognizing these advantages, the nursing department set a goal to increase certification rates. However, perceived barriers to certification existed, and rates remained unchanged. A program was needed to overcome these obstacles.

Aims/Objectives: To develop and evaluate a Certified Nurse Program that addresses the perceived barriers to certification by proactively supporting, preparing, and recognizing nurses who pursue and maintain a specialty certification.

Methodology: A 200-bed Maryland suburban hospital adopted the program. Initiatives for certification support, preparation, and recognition were implemented. …

A Telehealth Blood Pressure Education Program On Hypertension Knowledge, Selfcare, And Behavior, Cheynnie N. Burnett Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: Hypertension poses a significant risk for morbidity and mortality. Regular blood pressure monitoring, medication compliance, and/or lifestyle modifications have shown to improve control. Digital communication in healthcare, such as telemedicine provides patients and primary care offices an opportunity to improve access to care and education.

Objectives: This Quality Improvement (QI) Project aimed to answer the question: In adult patients with a diagnosis of hypertension, what is the effectiveness of implementing an evidence- based telehealth blood pressure management program in a primary health care setting, when compared to baseline, on blood pressure knowledge, management, and self-care over a nine- week …

The Impact Of Mentorship On Nurses’ Level Of Self-Efficacy And Motivation To Pursue Board Leadership Positions, Amy K. Mccarthy Msn, Rnc-Mnn, Ne-Bc

Doctor of Nursing Practice Projects

Background: Nurses comprise the largest component of the healthcare workforce and possess a unique understanding of healthcare operations and patient care. On average, the proportion of nurses serving on hospital boards range from 2 to 6%, with the proportion of physicians averaging 20%. Over the last decade, much attention has been placed on emphasizing the importance of a nurse’s presence on boards. Despite these initiatives, nurses continue to display an overall hesitancy towards board service.

Objectives: The aim of this project was to implement an evidence-based mentorship program to address barriers to board leadership and increase overall self-efficacy and motivation …

Improving Screening For Sleep Disturbance In Patients With Parkinson’S Disease, Jenny Nguyen Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Sleep disturbance (SD) is one of the most common and debilitating non-motor manifestations of Parkinson’s disease (PD). SD intensifies the disease-related disabilities of motor and non-motor symptoms. In spite of this, it is often under-recognized and underaddressed by healthcare professionals. The Movement Disorder Society recommends the Parkinson’s disease Sleep Scale (PDSS – 2) be used to screen and measure severity of overall sleep problems in this patient population.

Objectives: The purpose of this quality improvement (QI) project is to increase the utilization of the PDSS-2, a standardized approach to assessment of sleep difficulties. This can facilitate identification of individual …

Implementation Of A Standardized Handoff Tool For The Transition Of Care Of Adult Liver Transplant Patients, Suzanne Robertazzi Msn, Anp-Bc

Doctor of Nursing Practice Projects

Background: The transfer of care of the adult liver transplant patient from the inpatient to the outpatient setting has increased in complexity and has the potential to lead to errors and adverse events.

Objective: This pre-post design quality improvement project implemented a hand-off communication tool to improve adult liver transplant patient outcomes when transitioning from the inpatient to outpatient setting.

Methods: The hand-off tool was based on Illness severity, Patient summary, Action list, Situation awareness, and Synthesis (I-PASS). An EMR chart review was completed on discharged liver transplant patients 3 months (N=28) prior and 4 months (N=36) after I-PASS implementation. …