Medicine and Health Sciences Commons^™

Reducing Hospital-Acquired Pressure Injury In An Inpatient Medical-Surgical Telemetry Adult Unit By Educating And Encouraging Basic Wound Care Prior To Wound Care Consult, See Wai (Amy) Kong

Master's Projects and Capstones

Problem: A medical center in the Diablo Service Area had one of the highest rates in hospital-acquired pressure injury (HAPI), benchmarking with other facilities, with the project unit one of the top offenders. The patients and the medical center both suffered from the harm. Barriers to HAPI prevention included lack of patient turnings, skin assessment, and early standard wound care treatment.

Context: This project focused on the primary care team standardizing early wound care treatment to avoid wound progression.

Interventions: Interventions included re-educating the primary care team on early basic wound care using a standard wound care guideline created by …

Effects Of Preoperative Chlorhexidine Gluconate (Chg) Cloths Educational Intervention For Preoperative Staff On Chg Knowledge And Surgical Site Infection Rates: A Quality Improvement Initiative., Deven Leffler

Doctor of Nursing Practice Papers

Abstract

Background: Surgical site infections (SSIs) are the most common cause of a surgical complication and account for 38% of all hospital acquired infections (HAI). The cost of caring for SSIs in the United States can range from $3.5-$10 billion annually.

Purpose: The purpose of this DNP Quality Improvement (QI) initiative was to improve preoperative staff’s knowledge and application of the Food and Drug Administration (FDA) approved 3-minute application scrub time for the 2% CHG cloths and reduce SSIs for an acute care hospital located in Louisville, Kentucky.

Methods: Quality improvement was initiated using the Plan, Do, Study, Act (PDSA) …

Initiating A Childhood Obesity Screening Process In An Urban Pediatric Office, Kesha Thomas

Doctor of Nursing Practice Projects

Background: The benefit of identifying a pediatric patient with obesity is to prevent many chronic health conditions that can occur from diabetes. Pediatric patients can be at risk for prediabetes, low self-esteem, and musculoskeletal issues. The patients that are at higher risk for childhood obesity are African American and Hispanics.

Purpose: The Doctor of Nursing Practice project aims to identify a pediatric patient that is obese to make sure that the patient is assessed appropriately and to discuss an appropriate intervention for the patient. To make sure all pediatrics have an accurate height, weight, and A1C during their well-child visit. …

The Implementation Of The Pressure Injury Prevention Protocol To Reduce The Incidence Of Hospital-Acquired Pressure Injuries In A Va Medical Surgical Unit, Nekia Whitlow

Doctor of Nursing Practice Projects

Background: The clinical gap in service addressed in the DNP project was hospital-acquired pressure injuries. A hospital-acquired pressure injury (HAPI) is a local injury to the skin and underlying tissue during an inpatient hospital stay. The injury is caused by pressure, shear, or both (The Joint Commission (TJC), 2022). The development of a HAPI can result from other factors, such as advanced age, immobility, perfusion issues, nutritional status, illness severity, and chronic conditions (Rondinelli, Zuniga, Kipnis, et al., 2018). Immobile or sedated patients in the intensive care units are the most at risk because they have medical conditions that prevent …

Prevention Of Obesity-Related Morbidity & Mortality In Adults, Rachelle Virgin

Masters Theses/Capstone Projects

Poster presentation on the prevention of obesity related morbidity and mortality in adults.

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Implementation Of Cocare Help, Kara Marie Roman, Aaron Mestemaker

Culminating Experience Projects

Background: Delirium is a common disturbance in cognition among older adults in the hospital setting. It is associated with negative outcomes and high costs for patients, families, and hospital systems. Use of a reliable screening tool and evidence-based strategies such as CoCare: HELP demonstrates delirium prevention and functional decline in many geriatric hospitalized patients.

Objectives: This study examines the impact of implementing aspects of CoCare: HELP on two pilot units in an urban Midwestern hospital. Pre- and post-implementation measures of delirium rate, 30-day admission rate, length of stay, falls with injuries, safety attendant orders, restraint numbers, use of antipsychotics, and …

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Implementation Of Cocare Help, An Evidence-Based Intervention, Kara M. Roman, Aaron Mestemaker

Culminating Experience Projects

Background: Delirium is a common disturbance in cognition among older adults in the hospital setting. It is associated with negative outcomes and high costs for patients, families, and hospital systems. Use of a reliable screening tool and evidence-based strategies such as CoCare: HELP demonstrates delirium prevention and functional decline in many geriatric hospitalized patients.

Objectives: This study examines the impact of implementing aspects of CoCare: HELP on two pilot units in an urban Midwestern hospital. Pre- and post-implementation measures of delirium rate, 30-day admission rate, length of stay, falls with injuries, safety attendant orders, restraint numbers, use of antipsychotics, and …

Adult Post-Cardiac Surgery Deep Sternal Wound Infections, Samantha Porcher, Cole Gatzke

Nursing DNP Projects

ABSTRACT

Purpose and rationale: Deep Sternal Wound Infections (DSWI) are associated with morbidity rates and mortality rates as high as 10% -15% as well as significantly increased hospital costs. The purpose of this project is to decrease current rates of DSWIs in adults undergoing cardiac surgery at a large medical institution.

Synthesis of evidence: The literature shows a strong relationship between elevated HbA1C and DSWI. All articles reviewed for this proposal which implement a sternal vest intervention support its use to prevent DSWI.

Practice change and implementation strategies: The strategy used to implement these evidence-based practice interventions includes …

Pediatric Obesity In Primary Care, Lynne C. Liggins

Electronic Theses and Dissertations

The purpose of this evidence-based quantitative quasi-experimental research was to compare if providing the parents with information on the health risk associated with childhood obesity would cause the parents to make healthier food choices and encourage their children to be involved in a full hour of physical activity a day. Participants included parents and pediatric and adolescent children 5 to 18 years of age at a solo practice primary care office in a large city in Southern, California, which specializes in treating pediatric and adolescent patients. A pre- and postquantitative intervention design were used and analyzed using the paired t …

Decreasing Hospital Acquired Pneumonia In Adult Patients By Patient Care Technicians: Education With A Focus On Oral Care And Tooth Brushing, Amanda Nicole Lee

Master's Projects and Capstones

Hospital acquired pneumonia’s (HAPs) are unfortunate and preventable events quality improvement efforts should focus on. At a Northern California Hospital, there was an unmet HAP rate goal of 2.3 (20 out of 8795 patients) against a target goal of 2. This increase in HAP rates, both non-ventilated and ventilated was a call to action to reduce HAP to the target goal. The quality improvement project specifically aimed to reduce HAP rates on medical-surgical units through an ultra-brief refresher on the hospital validated and endorsed ROUTE bundle. The education focused on oral care completed by the patient care technicians (PCT’s). The …

Reducing Risk Factors Of Diabetes Mellitus Type Ii Development In Veterans Post Military Discharge Through The Patient Aligned Care Team Model And The Utilization Of Preventive Programs Involving Lifestyle Changes., Jeni Grundy

Doctor of Nursing Practice (DNP) Manuscripts

Diabetes Type II (T2DM) prevalence is rising in America, becoming a focus for disease prevention. The American Diabetes Association (ADA) has highlighted the need to tackle the increased T2DM precursor, prediabetes, which ultimately leads to T2DM if risk factors remain unaddressed. One group of the American population with a high rate of prediabetes is the 9/11 Veteran cohort. The Veterans Affairs (VA) system has numerous health promotion missions. This system has highlighted its initiatives to address the development of T2DM. Specific to the 9/11 group, their primary T2DM contributory risk factor is obesity paired with the low utilization of already …

The Emerging Epidemic Of Type 2 Diabetes And Obesity Amongst Young Children, Juliana Morales

Nursing | Senior Theses

Background:

In the past years childhood obesity has increased tremendously and currently ⅓ of children in the United States are obese today. Obesity and Type 2 Diabetes are illnesses that can later on lead to more severe health complications when as a child enters adulthood. Children who are obese have a greater risk of developing Type 2 diabetes, and currently more than 80% of children who already are diagnosed with Type 2 diabetes are obese. In school and often by health care providers we are told daily physical activity and healthy diet are the best ways to maintain optimal health, …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Chronic Obstructive Pulmonary Disease (Copd), Joseph Earich

Nursing Student Class Projects (Formerly MSN)

Background: Chronic Obstructive Pulmonary Disease (COPD) is an irreversible, preventable respiratory disease characterized by airflow limitation and obstruction that is usually progressive. COPD affects millions of people globally and over $7 billion dollars is spent on COPD related hospitalizations in the U.S. annually. This poster includes information focused on COPD, the underlying pathophysiology, clinical manifestations, diagnosis, nursing care implications, and treatment.

Methods: Research articles within the last five years were obtained using keywords such as COPD, pathophysiology, treatment, prevention, emphysema, and chronic bronchitis from databases EBSCO and PubMed. The data and quality of these articles were assessed and information compiled …

Acute Kidney Injury, Chelsey Benner

Nursing Student Class Projects (Formerly MSN)

Acute kidney injury (AKI) is a common complication of surgical procedures and can lead to increased morbidity and mortality. AKI can be described by a sudden decline in kidney function, evidenced by elevation of serum creatinine, elevated blood urea nitrogen levels, and a decreased glomerular filtration rate (McCance & Huether, 2018, p. 1360). Optimal perioperative management and recognition of patients at high risk for AKI is important in preventing the development of acute kidney injury.

Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith

Dissertations

Problem: CAUTIs (catheter-associated urinary tract infections) are a common hospital-acquired condition (HAC) that increase length of hospital stays, hospital costs, and risk for patient mortality. CAUTI rates in a PICU increased in 2021 from the year 2020. A rapid cycle PDSA revealed nurses were not using soap and water for foley catheter care, which is the recommended cleanser by the Centers for Disease Control and Prevention (CDC).

Methods: An observational descriptive design was used to evaluate foley catheter cleaning and CAUTI rates. PICU nurses completed behavior surveys regarding foley catheter cleaning practices. An education intervention occurred when nurses answered anything …

Improving Colorectal Cancer Screening In Primary Care, Bushra Iqbal

Doctor of Nursing Practice (DNP) Projects

Colorectal Cancer (CRC) is the second leading cause of cancer related deaths in the U.S., although it is preventable with adequate routine screening. Medically underserved minorities and immigrants require screening program awareness in their respective communities. The incidence of CRC remains markedly high despite the screening modalities among various populations. In the United States (U.S.), there were approximately 147,950 reported CRC diagnoses, 53,200 deaths, and over 35.2 cases per 100,000 in California alone reported in 2020 (Siegel et al., 2020). Healthcare providers can prevent colorectal cancer (CRC) through adequate routine screening. Various screening practices are widely implemented in primary cases …

Lifestyle Modification Interventions On Hemoglobin A1c Level In Patients With Type Ii Diabetes Mellitus In An Underserved Community: A Pilot Project, Anniesatu Newland

Doctor of Nursing Practice Final Manuscripts

Type 2 diabetes mellitus (T2DM) is a pandemic of great concern among the nutrition-related non-communicable diseases. Its prevalence is mounting worldwide, particularly in underserved communities and minority groups. In 2019, 463 million people were diagnosed with T2DM, a number expected to increase to 578 million by 2030 globally. The prevalence of T2DM is increasing the mortality rate from cardiovascular complications. The social and health costs of treating this disease is currently 11% of the global health budget. This project aims to utilize an evidence-based approach to assess lifestyle interventions' effectiveness at decreasing the Hemoglobin A1c levels in T2DM individuals after …

Save Lives And Sanitize: Prevention Of Surgical Site Infections Post-Cesarean Section Through Increased Hand Hygiene Compliance, Lindsay N. Nance

Master's Projects and Capstones

Problem: Surgical site infections (SSIs) occur in 3-15% of cesarean sections, making SSIs one of the most common hospital-acquired infections (HAIs). Surgical site infections (SSIs) have increased within a Labor & Delivery (L&D) unit in a large California teaching hospital for the past three years, affecting reimbursement and creating a range of adverse outcomes for patients. Performance of consistent and thorough hand hygiene practices is key to preventing infection, yet the unit’s hand hygiene compliance of 66.7% is well below the facility’s target goal of 90%. Based on recommendations from the organization’s Infection Prevention & Control (IPC) specialist, the …

Nutrition On The Prevention And Treatment Of Depression, Gracie Polen

Nursing | Senior Theses

Today, the general population consumes a diet high in sugars, saturated fats, incomplete protein sources, and the tendency to exceed the bodies caloric requirements. The trend of obesity due to poor dietary habits is alarming. Mental illness has increasingly risen over the past decade. Specifically, the incidence of depression has reached a startling rate. The relationship between poor dietary intake and depression have grown together and it is imperative that methods are introduced to aid in resolving this issue. The prevention and treatment of depression needs to be explored through alternative methods. Healthier dietary choices have been shown to have …

Multimodal Approach To Chronic Pain Management And Prevention Of Opioid Use Disorder, Hannah Elston

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background. Chronic pain (CP) is a major public health problem that affects one-third of the population and can interfere with the activities of daily life and cause decreased quality of life. Patients with CP have been increasingly prescribed opioids, contributing to the rise in the opioid epidemic. Due to the long-term nature of CP, the use of opioids as the sole treatment for CP can cause tolerance and increased dosages overtime which can lead to addiction and potentially overdose. Therefore, CP treatment should include multimodal approaches to treatment to prevent opioid misuse, opioid use disorder (OUD), and overdose. Multimodal treatments …

Implementation Of An Evidence-Based Bundle To Reduce Hospital Acquired Pressure Injury Harm Rates In The Intensive Care Unit: A Quality Improvement Project, Jessica Tripp

DNP Scholarly Projects

A pressure injury (PI) is a condition in which prolonged pressure or shear causes localized damage to the soft tissue and skin and is usually over a bony prominence (National Pressure Ulcer Advisory Panel (NPUAP), 2016). PIs can increase morbidity and mortality, increase length of stay, increase infection rates, increase healthcare costs and decrease quality of life (Agency for Healthcare Research and Quality (AHRQ), n.d.; Coyer et al., 2017). PIs are largely preventable yet continue to occur, despite the growing number of high-quality research articles that focus on this problem. Quality improvement initiatives are an effective way to translate evidence-based …

Increasing Utilization Of The Delirium Prevention Protocol In Post Cardiovascular Surgery To Improve Quality And Safety Of Healthcare, Kristin Luce

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Abstract:

Background and Objectives: Post-operative delirium (POD) is the most common complication seen following surgery in older adults. Two-thirds of delirium cases are diagnosed late or missed in everyday practice across health care settings which can lead to a variety of long-term complications. POD prevalence can be reduced within inpatient practice settings by utilizing established screening tools, such as the Confusion Assessment Method (CAM). This project aimed to increase nurse screening of delirium and provide education on POD to nursing staff on the post-cardiovascular surgery unit to increase utilization of the delirium prevention protocol.

Methods: Educational sessions provided to nursing …

Not A Phase: Lgbtq+ Teens -- How We Can Save A Life, Jennifer Carner

Doctor of Nursing Practice Projects

This DNP project was conducted to address suicide and risk-taking behaviors of LGBTQ teens and how adults can improve the long-term outcomes of LGBTQ teens by being supportive adults. LGBTQ+ teens are at 4 times higher risk of suicide than their non-LGBTQ+ peers (The Trevor Project, 2021). The Suicide Prevention Resource Center, 2008, found a teen having one caring adult in their lives decreases the risk of suicide. The project's goal was to educate adults to increase their comfort levels in terminology, their understanding of the developmental stages of teens, and how to provide protective factors to help reduce the …

Best Practices For The Prevention And Treatment Of Microcytic Hypochromic Anemia In Infancy, Janelle Paredes

Nursing | Senior Theses

Background: Microcytic hypochromic anemia is the most common nutritional deficiency in the world. This type of anemia is commonly found during infancy due to the lack of iron-fortified foods after six months of age. The effects linked to this deficiency can cause developmental delays and behavioral disturbances in infants if not treated immediately. Therefore, it is important for nurses to find the best practices to prevent microcytic hypochromic anemia to decrease its prevalence in infancy.

Objective: To find the best nursing practices for the prevention and treatment of microcytic hypochromic anemia in infancy.

Methods: This research will utilize …

Clinical Practice Guideline On Suicide Prevention Among Adolescents, Beltta Gangwab Tachi

Walden Dissertations and Doctoral Studies

AbstractIncreasing rates of suicide among adolescents in the United States is an unsettling problem whereby suicide is the second leading cause of mortality among adolescents. Although interventions exist to address this problem, there is a lack of clinical practice guidelines (CPGs) to assist healthcare providers to identify and prevent adolescent suicide. Guided by the zero-suicide model, the purpose of this project was to develop a CPG to address this gap in practice. A literature review on adolescent suicide prevention resulted in 24 peer-reviewed articles published in the past 5 years that were graded and arranged in a literature matrix. These …

Staff Education On Reducing Burnout In Mental Health Professionals Through Restorative Yoga Practice, Rina Buenaventura Vickery

Walden Dissertations and Doctoral Studies

Mental health professionals (MHPs) are at considerable risk for stress and burnout because of the nature of their work. Management and prevention of stress and burnout (e.g., through restorative yoga) may enable MHPs to avoid feelings of anxiety, depression, and apathy; lack of energy; and the development of unhealthy coping skills, such as substance and drug use. The purpose of this project was to create a staff education to assist MHPs in managing stress and burnout through yoga practice and mindfulness. The theoretical framework for the staff education was Kapp’s adult learning theory. An evidence-based PowerPoint presentation containing the staff …

Preventing Maternal Falls, Blair Burkhart

Master's Projects and Capstones

Patient falls are unfortunate events in healthcare that are an essential quality improvement focus during patients’ hospital stays. At Hospital X, a private institution located in the suburbs of a large city, there had been 23 maternal falls within the last three years. This increase in maternal fall rate puts this hospital’s maternity unit above the average of other hospital’s fall rates according to the National Database of Nursing Quality Indicators. This quality improvement project aimed to reduce the rate of maternal falls on postpartum units through various forms of staff education. Education included Morse Fall Scale scoring, Sara Stedy …

Hapi Prevention Bundle: An Initiative To Prevent Hospital-Acquired Pressure Injuries, Karla D. Penilla Lozano

Master's Projects and Capstones

Problem: Hospital-Acquired Pressure Injuries (HAPI) are a serious health problem as they increase patient morbidity and mortality. They are detrimental to patients, families, and healthcare systems. Context: Research supports HAPI prevention bundles are a way to standardize care processes and reduce the incidence of pressure injuries. This evidence-based practice intervention was initiated to develop a HAPI prevention bundle in an adult Medical-Surgical Telemetry unit. A literature review was conducted to identify the best HAPI prevention practices. Intervention: The evidence-based pressure injury preventive bundle includes interventions consistent with proper skin assessments and documentation, patient risk identification, development of Wound Care Champions, …

Reducing Postpartum Maternal Falls: A Quality Improvement Project, Sarah L. Iroz

Master's Projects and Capstones

Falls are an unfortunate, common occurrence in the healthcare system and are often not thought to be a problem in the obstetrics population. Key stakeholders in a Northern California hospital brought the issue of maternal falls to leaders of the quality improvement team on the maternity unit. In the last three years, there have been 23 falls on the maternity floor, making their fall rate above the national average. It is the purpose of this project to aid the quality improvement team in reducing postpartum maternal falls over the next three years. After conducting a unit assessment, performing a literature …