The Creation And Implementation Of A Transgender Cultural Competence Nursing Education Toolkit, James Bl Donovan

Doctor of Nursing Practice (DNP) Projects

Healthcare disparities in the transgender populations have been linked to lack of healthcare provider cultural competence (IOM, 2011; Bradford et al., Harbin et al., 2012; Eliason, Dibble, & DeJoseph, 2010; Lim, Brown, & Jones, 2013). Prior research has identified that healthcare providers receive little, if any, transgender cultural competence training during their formal education. A survey of nursing educators at the University of San Francisco School (USF) of Nursing and Health Professions suggested that few educators are providing transgender content or understand the unique healthcare needs of that population. A literature review concluded that little is known about the best …

Impact Of Improving Throughput In The Emergency Department, Katherine J. Edrington

Doctor of Nursing Practice (DNP) Projects

The purpose of this project was to evaluate the patient experience in the emergency department (ED) and in the inpatient setting while correlating increased throughput and patient outcomes at a suburban Acute Care facility in Ohio. The culture in the organization has lacked accountability and ownership of the patients. The ED admitted length of stay (ALOS) was 358 minutes in the beginning of 2013. For the first time in the organization’s history, the ED ALOS is now typically less than the recommended benchmark of 300 minutes. A report of findings among ED’s surveyed showed the ALOS best practice is 244 …

Avoiding 30-Day Readmissions Of Acute Mi Patients Utilizing Cardiac Rehabilitation, Patricia T. Forsberg

Doctor of Nursing Practice (DNP) Projects

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more …

Using An Educational Module And Simulation Learning Experience To Improve Medication Safety, Barbara Lynn Durham

Doctor of Nursing Practice (DNP) Projects

The purpose of this evidence-based change in practice project was to provide nurses with an experiential learning opportunity, using simulation, to identify and report near miss events during the medication administration process related to patient-controlled analgesia (PCA) usage. Despite extensive in-service training on a Medical/Surgical (Med/Surg) floor in an acute care hospital, inconsistent, inaccurate and incomplete documentation with use of the new PCA pumps continued to be problematic. A conceptual framework of just culture was used with the quality improvement method of the Plan-Do-Study-Act (PDSA) cycle for testing change. Medication safety education was a valid andragogical strategy to decrease rates …

Implementation And Evaluation Of An Oral Hygiene Program In Long-Term Care, Lawrence P. Lemos

Doctor of Nursing Practice (DNP) Projects

A review of the literature focusing on oral care within long-term care (LTC) suggests positive resident care outcomes occur when standardized practices are employed. Studies of staff education programs, trained oral hygiene aides, and dental hygienists working within LTC, have linked regular oral hygiene practices to decreased pneumonia rates. While these studies make the connection between good oral hygiene and reducing risk for pneumonia, best practices focused on implementing and sustaining an oral hygiene program in LTC facilities are lacking. The aim of this quality improvement project was to ensure that dependent residents in LTC receive assistance with daily oral …

Overcoming Barriers To Screening For Anal Intraepithelial Neoplasia For Persons Living With Hiv, Brandon Hastings

Doctor of Nursing Practice (DNP) Projects

Screening has proven an effective strategy in the management of diseases that plague the population. This technique has proven to be most effective when screening is conducted with those who are most at risk for developing the targeted illness and when the frequency of screening follows set guidelines. Currently there are no nationally recognized screening guidelines for anal intraepithelial neoplasia (AIN). Screening for AIN stands to reduce overall incidence of anal squamous cell carcinoma through destruction of the dysplastic cells before they become cancerous. The goals of this project were to identify the patient population that stands to benefit the …

The Design And Implementation Of A Grief Support Program In A Faith-Based Setting, Susan Mortell

Doctor of Nursing Practice (DNP) Projects

Although grief itself is not a pathological condition, adequate support before and after loss can prevent grief becoming unresolved or complicated. Complicated grief (CG) is often diagnosed when severe bereavement symptoms persist over six months following a loss, and it affects an estimated 3-25% of the general population (Fujisawa, Kato, Miyashita, Nakajima, Ito, & Kim, 2010). Complicated grief can result in longstanding psychological issues such as depression and substance abuse.

One group that is at particular risk for CG is older lesbian, gay, bisexual and transgender (LGBT) individuals. This population is significantly represented in Most Holy Redeemer Catholic Church (MHR) …

Implementing And Evaluating A Clinical Information Interface Between An Electronic Medical Record And A Patient Classification System, Tanya Osborne-Mckenzie

Doctor of Nursing Practice (DNP) Projects

As a result of the Affordable Care Act and the Institute of Medicine’s initiatives, hospitals are challenged to improve outcomes as efficiently as possible. How does the national initiative of RNs partnering with other healthcare professionals to improve the quality of patient care at a lower cost, cascade down to individual organizations? One answer may come by focusing on nurse staffing in acute care hospitals. Considering the impact RNs have on patient quality outcomes and the bottom line of hospitals, appropriate management of the RN workforce is one of the most important areas hospitals can focus on in order to …

Implementation Of Food Insecurity Screening In Clinical Setting, Florence Ngozi Soba

Doctor of Nursing Practice (DNP) Projects

This project used the Stetler model of research utilization framework to apply evidence-based findings to clinical settings screening adults with type II diabetes mellitus (T2DM) and low incomes for food insecurity. The project involved the review and critical appraisal of research studies and translation of research-based knowledge into a protocol for the Peach Tree Clinic with respect to the impact of food insecurity on diabetes outcomes in adults with T2DM and low incomes who were at risk of food insecurity. In addition, the proportion of screened at-risk patients who received nutritional counseling was calculated. The proportion of patients with T2DM …

Specimen Labeling Improvement Project: Slip, Traci Hoiting

Doctor of Nursing Practice (DNP) Projects

Blood specimens are labeled at the time of acquisition in order to identify and match the specimen, label, and order to the patient. While the labeling process is not new, it is frequently laden with errors (Brown, Smith, & Sherfy, 2011). Wrong blood in tube (WBIT) poses significant risk. Multiple factors contribute to mislabeling errors, including lax policies, limited technological solutions, decentralized labeling processes, multi-tasking, distraction from the clinician, and insufficient education and training of staff. To reduce blood specimen labeling errors, a large academic medical center implemented an innovative technological solution for specimen labeling that integrates patient identification, physician …

Transitional Care Services: A Nurse-Led Quality Improvement Project, Debra Conroy-Mccue

Doctor of Nursing Practice (DNP) Projects

With the implementation of the Patient Protection and Affordable Care Act of 2010 (PPACA) and a national requirement for health care providers and systems to deliver care that is safe, outcome driven, and cost effective, Dignity Health (DH) as part of the hospital engagement network (HEN) launched an initiative called the “No Harm” campaign to reduce all-cause avoidable hospital readmissions. The project, led by a Doctorate of Nursing Practice (DNP) student and readmission team, sought to achieve a 20% reduction in preventable readmissions by December 2014. After having achieved initial success in implementing transitional care services for patients with heart …

Implementing An Evidence Based Foot Assessment Protocol For Use By Nurses Caring For Adult Diabetic Patients Seeking Care In The Thanh Nhan Hospital Endocrinology Department, Amy Ly

Doctor of Nursing Practice (DNP) Projects

The purpose of this primary care nursing practice improvement project was to implement a diabetic evidence-based protocol for use by nurses caring for adult patients seeking care in the Thanh Nhan Hospital Endocrinology Department (TNH/ED) in Ha Noi, Vietnam.

Prior to project implementation, physicians performed all patient foot assessments. No standardized foot assessment tool existed.

The author made an on-site visit to the clinic to assess current practice. The author then recommended expanding nursing practice by using an evidence-based assessment tool. The author conceived an implementation approach, then designed, developed and presented the plan via an Internet-delivered fully interactive Virtual …

Development And Implementation Of A Succession Plan For The Nursing Department In A Community Hospital, Nadine Mariotti

Doctor of Nursing Practice (DNP) Projects

This project identifies nursing leadership vacancies in a community nursing department and assisted in the planning and implementation of a succession framework to fill the gaps in the nurse leadership population. Aging nurse leaders are leaving the profession and thus are creating gaps which need to be filled (Stichler, 2008). The unavailability of respective schools and negative perceptions of nurses regarding the healthcare sector leads to the lack of interest in the nursing profession (Nelsey, Brownie, 2012). Factors contributing to burn-out in nursing departments affect the intentions of nurses to leave and lower satisfaction towards their profession. The proposed succession …

Narrowing The Qsen Competency Gap In New Graduate Registered Nurses, Marty Mayhew

Doctor of Nursing Practice (DNP) Projects

This intervention is an evidence based, change of practice, quality improvement project that evaluates achievement of the six Quality and Safety Education for Nurses (QSEN) competencies of new registered nurse graduates. No intervention with a similar focus was found in an extensive review of the literature. The participants included 16 new graduate registered nurse hires enrolled in a new graduate RN residency program at Tucson Medical Center located in southern Arizona. The Nursing Quality and Safety Self Inventory^© (NQSSI^©) was used to identify practice gaps perceived by the new RN graduates related to the six QSEN competencies. …

Improving Women’S Health Services By Adding Long-Acting Reversible Contraceptive Methods Into Primary Care-Focused Student Health, Shu-Chen Jennie Cheng

Doctor of Nursing Practice (DNP) Projects

Often resulting from inconsistent contraceptive use, unintended pregnancy among young women between ages 18-24 continues to be an issue in the United States. Long-acting reversible contraceptives, including intrauterine contraceptives and the subdermal contraceptive implant, are safe, effective, long-acting, easily reversible, and non-user dependent contraceptive methods, yet currently are greatly underutilized. Most of the contraceptive methods are provided at our student health services except for the highly effective long-acting reversible contraceptive methods. As family nurse practitioners and health care providers, it is essential to integrate this service into primary care-focused college student health clinics by providing evidence-based information to clinical providers …

An Evidence-Based Approach To A Replacement Hospital Training Curriculum, Mark D. Beck

Doctor of Nursing Practice (DNP) Projects

Creation of a training and educational curriculum for a new or replacement facility is daunting in its own right, but without a repository of organizational knowledge cataloging the transfer of tacit to explicit knowledge from the organizations previous library of facility openings, the task becomes Herculean, with as many tasks and cast of characters as the original myths. Navigating the shoals, eddies and tides of the various aspects of this project revealed the need for a comprehensive knowledge management solution to training that is coupled with healthcare design principles and initiatives. This purpose of the DNP project is about the …

Evidence-Based Change In Practice: Development And Implementation Of Type Ii Diabetic Flow Sheet, Kathryn Grimleybaker

Doctor of Nursing Practice (DNP) Projects

Ten percent of the National Health Service annual budget goes to treat complications from diabetes (Lancet, 2010). The American Diabetes Association® (ADA, 2013) estimated that diabetics in the United States incur $176 billion annually in direct medical costs for treatment with hospitalization being the main component of the expenditures. California has the largest population of diabetics and the highest annual cost at $27.6 billion (ADA, 2013). The Healthcare Cost and Utilization Project (HCUP, 2008) found that the average cost of hospitalization in 2008 for a patient with diabetes was $10,937 in contrast to $8,746 for a patient without diabetes. The …

Advantages And Limitations Of Anesthesia And Sedation Practices Used Among Acute Ischemic Stroke Patients During Endovascular Revascularization Therapy, Margaret Korzewski

Doctor of Nursing Practice (DNP) Projects

In order to safely and efficiently perform endovascular revascularization procedures among acute ischemic stroke (AIS) patients, general anesthesia or sedation is often required. However, anesthesia management during these procedures varies significantly worldwide and the procedural logistics have not been established yet. At some institutions AIS patients are intubated and paralyzed, while at other facilities, there is no routine protocol. In 2011 the University Hospital used “action nurses” (critical care float pool nurses) to provide pharmacological paralysis with sedation for intubated AIS patients under direct supervision of the neurointerventionalist. However, clinical outcomes among AIS patients undergoing endovascular procedures were poor. Exclusive …

Motivational Interviewing Education For San Mateo County’S Adolescent Healthcare Providers: Focus On Healthy Diet And Physical Activity, Emilie J. Gruhl

Doctor of Nursing Practice (DNP) Projects

Motivational interviewing has been endorsed by San Mateo County as an evidence-based effective form of behavior change counseling. Eighty percent of pediatric healthcare providers in San Mateo County have been trained in motivational interviewing, however 70% of the providers use it less than 50% of the time. The goal of this project was to reeducate the adolescent providers of San Mateo County in motivational interviewing with an emphasis on individualized training and feedback, directed toward healthy diet and exercise. Results of the quality improvement project showed an average 2.5-point increase in provider confidence on a zero to ten-point scale, and …

Design And Implementation Of A Sustainable, University-Based, Emergency Medical Response Service, Octavia A. Mandel Struve

Doctor of Nursing Practice (DNP) Projects

Collegiate-based emergency medical services (EMS), designed primarily to provide pre-hospital basic life support and emergency services, are venues by which nurses and other healthcare professionals, with an understanding of community health and social network issues, can maximize health promotion objectives for university and college campus communities. These EMS systems also provide vital support to city and county emergency services and promote positive community relationships with neighboring areas. They can provide excellent opportunities for students to develop critical skills for success in the healthcare and business world. The sustainability and vibrancy of collegiate-based EMS systems are primarily related to impact, benefit …

A Novel Psychotropic Risk Assessment To Enhance Medical Management Of Patients With Behavioral And Psychological Symptoms Of Dementia, Nancy C. Trego

Doctor of Nursing Practice (DNP) Projects

There is growing evidence and concern documenting the risks of antipsychotic use, and psychotropic medication burden in general, for older adults with behavioral and psychological symptoms of dementia (BPSD). Yet nearly 25 percent of all long term care residents take antipsychotics for behavioral disturbances associated with dementia as “off-label” use, despite their modest efficacy and FDA black box warnings (CMS, 2013). Expert consensus calls for non-pharmacological strategies as the first line treatment, yet some patients with BPSD may require a combination of non-pharmacological interventions and pharmacological treatments for symptom reduction (AGS, 2011). The relief of debilitating symptoms aims to improve …

Preventing Dysfunctional Behaviors Of Those With Dementia Based On The Progressively Lowered Stress Threshold Model, Mary Chrabaszcz

Doctor of Nursing Practice (DNP) Projects

Abstract

Dementia is a disease that impacts millions of people worldwide. Amongst the complications of this disease are behaviors that affect not only the individual with dementia but also their caregivers. These behaviors can be challenging especially for formal caregivers and it is important that they are taught how to prevent them. Long-term care facilities are the perfect settings for this type of education. For this reason, an educational program, including a needs assessment, PowerPoint presentation, and on-site support, was brought to a locked, assisted-living unit of Jewish Geriatric Services in Longmeadow, Massachusetts. The educational program was inspired and supported …

Evaluation Of A Continued Safe Patient And Handling Program, Mary K. Daily

Doctor of Nursing Practice (DNP) Projects

Nursing staff have a high risk of on the job injury from patient handling and movement. Safe Patient Handling and Movement programs help reduce injury through education and training to employees. Programs need to be evaluated regularly to determine if the goals are being met. When a program is not meeting its projected goals, modifications are needed to improve the program and its outcomes. The purpose of this project was to evaluate a continued safe patient handling program. The goals were to provide best evidence from research. Use best evidence to enhance the program. Promote positive behaviors from employees. Reduce …

Improving Discharge Planning And Education Of Nursing Students: A Collaborative Approach, Lea Dodge

Doctor of Nursing Practice (DNP) Projects

Nurses require training to provide discharge teaching yet nursing students are often not assigned the task of discharge teaching and are overwhelmed by the task once they enter the workforce (London, 2004). Few nursing programs provide opportunities for nursing students to participate in quality improvement projects. In an attempt to decrease post-discharge adverse events (AE) and increase exposure to discharge teaching and quality improvement by nursing students, 13 nursing students in a baccalaureate undergraduate nursing program assigned to a DEU in a sub-acute rehabilitation facility were provided with instruction utilizing the evidenced-based teach-back method. The nursing students conducted the discharge …

Improving Nurses’ Pain Management In The Post Anesthesia Care Unit (Pacu), Amelia D. Madenski

Doctor of Nursing Practice (DNP) Projects

Pain after surgery is distressing to patients and is a significant problem in post anesthesia care unit (PACU). Ineffective pain management in the immediate postoperative period can prolong the patient’s length of stay in the PACU which may lead to increased cost of care. The nurses’ lack of knowledge regarding pain management and ineffective team communication are barriers to effective pain management. An educational intervention based on the Knowledge- to-Action Model was implemented to 22 nurses in the recovery room at an urban hospital. A one group pre-test and post-test measure design was used to evaluate educational program. The data …

Improving The Transition Of Care From The Hospital To Primary Care Providers For Patients With Heart Failure, John Blake

Doctor of Nursing Practice (DNP) Projects

The goal of this quality improvement project was to enhance the transition of care from the hospital to primary care providers for patients with heart failure at one acute care hospital in Tampa, Florida. A literature review revealed that discharge summaries have a pivotal communication role in the transition of care. Consequently, the electronically recorded discharge summaries relating to a random sample of 60 patients discharged from this hospital were audited for a trial period of six months (three months before and three months after an intervention by the DNP candidate to encourage the attending physicians to improve the transition …

Copd Dyspnea Palliation Project: Dyspnea Palliation In End-Stage Copd Patients, Kaveri M. Roy

Doctor of Nursing Practice (DNP) Projects

Chronic Pulmonary Obstructive Disease (COPD) is a chronic and incurable disease that affects over 12 million Americans. The number of people with COPD is rising, and it is the third leading cause of death in the United States. Management and palliation of COPD symptoms has become a public health issue. The capstone project, the COPD Palliation Project, was a pilot study that combined nursing case management and patient education to provide optimal patient dyspnea palliation and self-efficacy of dyspnea management to end-stage COPD hospice patients. For the intervention, end-stage COPD patients were taught to use a dyspnea algorithm to palliate …

Non-Pharmacological Management Of The Behavioral And Psychological Symptoms Of Dementia, Chito O. Uyanwune

Doctor of Nursing Practice (DNP) Projects

The focus of this change in practice implementation project is to emphasize and encourage the use of non-pharmacological interventions as the first line intervention in managing the Behavioral and Psychological Symptoms of Dementia (BPSD) among nursing home residents. A sample of nurses (N = 14) and nursing assistants (N = 11) working in two local nursing homes participated in an educational intervention about dementia care. Two hundred and one charts were reviewed of the residents of both homes for antipsychotic use. Regardless that one home seems very organized, is using less antipsychotic than the other home compared to their bigger …

Eat Well, Live Actively: A Primary Care Interventional Program For The Treatment Of Childhood Obesity, Julianne M. Randlemon

Doctor of Nursing Practice (DNP) Projects

Over the last thirty years, childhood obesity has become one of the presiding diseases in the pediatric population. Last year the CDC (2012) reported that 12.5 million children under the age of five were not only overweight but also obese. This growing trend has been inadequately addressed by the United States preventive healthcare system. The pandemic has continued to spread: America’s obese children have substantially contributed to the ever-growing fiscal demands of health care in the United States. Olshansky et al. (2005) suggest this will in turn translate into the first generation of American adults that will be sicker and …

Evaluation Of Radiation Exposure From Computed Tomography Of The Head, Nelly Vega-Woo

Doctor of Nursing Practice (DNP) Projects

In an effort to reduce radiation exposure from computed tomography (CT), practitioners and facilities need to monitor radiation exposure while delivering high-quality diagnostic exams. Computed tomography scanners have a range of pre-programmed protocols for different examination types, with set values for tube potential, tube current, and rotation time (American Association of Physicists in Medicine, 2007). One way to minimize a patient’s exposure to radiation from CT is the use of an automatic exposure control (AEC) device. Current research is focusing on these devices and their actual benefits to patients. To assess the effectiveness of such a device, analysis of radiation …