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Articles 1 - 30 of 53
Full-Text Articles in Medicine and Health Sciences
Perioperative Advanced Directives, Derek Washer
Perioperative Advanced Directives, Derek Washer
Doctor of Nursing Practice Projects
Technology and surgical techniques continue to improve, resulting in more clients with advanced directives presenting to the operative suite for surgery or procedures requiring anesthesia. Anesthesia providers are in a critical position to discuss with the surgical patient or surrogate any alteration or reconsideration to their advanced directive. Unfortunately, patients and anesthesia provider discussions at a North Texas hospital were limited due to a knowledge deficit, an outdated hospital policy rescinding all directives perioperatively, and an inadequate consenting mechanism. The perioperative advanced directives project involved updating the hospital policy to current national guidelines and developing a “DNR Under Anesthesia” consenting …
Opioid Free Anesthesia, Sarah Medina
Opioid Free Anesthesia, Sarah Medina
Doctor of Nursing Practice Projects
Patients undergoing surgery are often given opioids intraoperatively. Administration of opioids is associated with untoward side effects that include nausea, respiratory depression, constipation, ileus, hyperalgesia, prolonged length of stay, and the potential for dependence (Garimella & Cellini, 2013). Emerging research on the topic of opioid-free anesthesia (OFA) is available and indicates several benefits of OFA, including reduction in postoperative pain, reduction in postoperative nausea and vomiting, reduction in postoperative shivering, and improved oxygen saturation levels (Mulier et al., 2018). This quality improvement project aimed to advance anesthesia providers' understanding of OFA by creating an OFA guideline and providing a learning …
Cultural Competency Training For U.S. Army Security Force Assistance Brigade (Sfab) Brigade Medical Teams, Jacob Blount
Cultural Competency Training For U.S. Army Security Force Assistance Brigade (Sfab) Brigade Medical Teams, Jacob Blount
Doctor of Nursing Practice Projects
The United States Army began standing up Security Force Assistance Brigades (SFAB) in February 2018. The Brigade Medical Team (BMT) is an 11-person, interdisciplinary Army National Guard team. National Guard Soldiers only have one weekend per month and two weeks of annual training per year to develop/maintain cultural competence. The researcher investigated the efficacy of the Cross-Cultural Competence Trainer (3CT) V2 course to develop and maintain cultural competency in BMT personnel. Pre-test results were obtained from three military medical personnel and a post-test immediately after the course. Participants completed a longitudinal test 28-31 days after the post-test. There was a …
Development And Implementation Of An Orthopedic Enhanced Recovery After Surgery Protocol, Beth Mccoy
Development And Implementation Of An Orthopedic Enhanced Recovery After Surgery Protocol, Beth Mccoy
Doctor of Nursing Practice Projects
Abstract
As life expectancy rates have grown and individuals desire a more active lifestyle the number of total hip arthroplasty and total knee arthroplasty surgeries performed has grown significantly. Enhanced recovery after surgery (ERAS) protocols have been shown to decrease the financial impact and improve patient outcomes in total joint surgeries. After a literature review a multidisciplinary team met and developed an ERAS protocol for total joint replacement surgeries to be implemented at a 250-bed community hospital in central Illinois. After an eleven-question pre-test was given to 34 participants consisting of perioperative nursing staff, anesthesia, and surgeons assessing their knowledge …
Improving Nurse Resilience, Brandon Hedgspeth
Improving Nurse Resilience, Brandon Hedgspeth
Doctor of Nursing Practice Projects
The national average nurse turnover rate was 18.2% in 2017 (Ackerson & Stiles, 2018). A contributing factor for nursing turnout rates was nurse burnout and compassion fatigue (Barratt, 2018; Cleary, Kornhaber, Thapa, West, & Visentin, 2018; Cope, Jones, & Hendricks, 2016; Magtibay, Chesak, Coughlin, & Sood, 2017; Delaney, 2018; Manomenidis, Panagopoulou, & Montgomery, 2019; Poulsen, 2015). Improvement in nurse resilience was revealed to reduce burnout and compassion fatigue in nurses (Ackerson & Stiles; Delaney). The primary goal of this quality improvement project was to evaluate the use and impact of resiliency education on the resiliency of nurses in the hospital …
Impact Of A Standardized Neurologic Exam On Diagnosis Of And Referral Pattern For Neurologic Disorder In Pediatric Toe Walking, Allison Hotze
Impact Of A Standardized Neurologic Exam On Diagnosis Of And Referral Pattern For Neurologic Disorder In Pediatric Toe Walking, Allison Hotze
Doctor of Nursing Practice Projects
Successful management of toe walking, a common patient complaint addressed by pediatric orthopedic providers, requires detection of concerning neurologic causes for toe walking. However, nurse practitioners in an outpatient orthopedic clinic were not following recommended guidelines for the history and physical exam for children who toe walk, resulting in delayed referrals and poorer patient outcomes. A performance improvement project was initiated that included an educational intervention, chart review, and data analysis. The goal was to improve the performance and documentation of neurologic exam when nurse practitioners saw patients for an initial visit for toe walking. A literature review provided evidence-based …
Implementation Of Enhanced Recovery After Surgery (Eras) Protocol After Cystectomy: A Quality Improvement Project To Evaluate Bowel Function With Implementation Of Eras Protocol, Weruche Agube
Doctor of Nursing Practice Projects
Abstract
The purpose of this Quality Improvement project was to develop and implement an enhanced recovery after surgery (ERAS) protocol for cystectomy patients at a regional hospital in central Illinois. Specific goals included reducing patient’s length of hospital stay, reducing occurrence of postoperative ileus after surgery as well as educating the nurses involved in patient care about effective implementation the protocol. An educational presentation and knowledge assessment via testing was developed and subsequently presented to the nurses both inpatient and outpatient at the host facility. A specific protocol was crafted after discussion with stakeholders and the ERAS protocol was finalized …
Evaluation Of Obstructive Sleep Apnea In Veterans With Coexisting Psychiatric Symptoms, Zenith Perpignani
Evaluation Of Obstructive Sleep Apnea In Veterans With Coexisting Psychiatric Symptoms, Zenith Perpignani
Doctor of Nursing Practice Projects
Abstract
There is a growing body of evidence that suggests a correlation between post-traumatic stress disorder (PTSD), nightmares with broken sleep, obstructive sleep apnea (OSA), and worsening of symptoms by OSA, Veterans who received treatment at a Midwest Veteran Affairs (VA) Center for Behavioral Health were often subject to variable wait times between scheduling of behavioral health and primary care providers (PCP). The purpose of the doctoral project was to reduce a Veteran's wait time for evaluation by a PCP after having been identified as at risk for OSA during routine psychiatric evaluation. The project examined Veteran's reports and measures …
Healthy Jacksonville, Erica Hunt, Alison Fornoff
Healthy Jacksonville, Erica Hunt, Alison Fornoff
Doctor of Nursing Practice Projects
Abstract
According to the Morgan County Community Needs Assessment, a significant opportunity for improvement exists in healthcare access among individuals in the northeast region of Jacksonville, Illinois. Tools to screen clients, interventions to identify the healthcare needs, and access to appropriate resources can promote improved health of individuals and the community. The Healthy Jacksonville Initiative was created to improve access to healthcare and community resources for the underserved people of Jacksonville, Illinois. The goal of this project was to implement a community resource registry and individualized needs assessment for community health care workers to use in order to better serve …
Steep Trendelenburg Associated Postoperative Vision Loss Prevention Education, Mitchell Coval
Steep Trendelenburg Associated Postoperative Vision Loss Prevention Education, Mitchell Coval
Doctor of Nursing Practice Projects
Postoperative vision loss (POVL) is a rare, but devastating complication that has been reported following robot-assisted laparoscopic surgeries that require prolonged steep Trendelenburg positioning. A central Illinois hospital had recently established a robot-assisted surgical program but lacked active interventions to reduce POVL risk due to a knowledge gap of the anesthesia providers. Following a comprehensive literature review, a PowerPoint educational program was provided at an anesthesia staff meeting. An evidence-based cognitive aid to provide a quick reference of POVL risk reduction strategies was created by the author in collaboration with the stakeholder. Once approved, the cognitive aid was attached to …
Patient Assessment And Provider Education Regarding Antibiotic Use In The Treatment Of Viral Uris In The Urgent Care Setting, Ashlee Schoby, Candra D. Hulskotter
Patient Assessment And Provider Education Regarding Antibiotic Use In The Treatment Of Viral Uris In The Urgent Care Setting, Ashlee Schoby, Candra D. Hulskotter
Doctor of Nursing Practice Projects
Improving Antibiotic Stewardship Through the Use of Patient Assessment and Provider Education Regarding Treatment of Viral URIs in the Urgent Care Setting
Candra Kronewitter and Ashlee Schoby
Date of Award
Spring 5-2020
Document Type
DNP Project
Project Team Faculty Member
Mary Zerlan, CRNA, DNP, APN
Project Team Faculty Member
Kay Gaehle, PhD
Keywords
Antibiotics, Antibiotic stewardship, URIs, Upper respiratory infections, Urgent care, ABUSE screening tool
Abstract
Antibiotic-resistant bacteria is a growing problem in the United States. The misuse or overuse of antibiotics is being considered the leading cause. Nearly 2-million individuals are infected with resistant bacteria yearly, and antibiotics prescribed …
Implementing Quality Into Practice: Nurse Driven Protocol To Reduce Unnecessary Telemetry Use, Richard Clapp
Implementing Quality Into Practice: Nurse Driven Protocol To Reduce Unnecessary Telemetry Use, Richard Clapp
Doctor of Nursing Practice Projects
Abstract
Background: As part of the American Board of Internal Medicine's Choosing Wisely initiative, the Society of Hospital Medicine issued the recommendation to reduce unnecessary use of continuous telemetry monitoring in the inpatient setting. Outside of its primary purpose continuous telemetry monitoring rarely positively impacts clinical decision making and overuse can lead to unnecessary and costly diagnostic work-ups, cause alarm fatigue, lead to emergency department congestion, and increase institutional financial burden.
Objective: Pilot an evidenced based nurse driven protocol for discontinuation of continuous telemetry monitoring to reduce unnecessary telemetry use among adult patients hospitalized outside of the intensive …
A Pilot Of Prenatal Transitional Care Services In The Urgent Care Setting, Alexandra Huddleston, Gloria Pryzgoda, Tiffany Hazel
A Pilot Of Prenatal Transitional Care Services In The Urgent Care Setting, Alexandra Huddleston, Gloria Pryzgoda, Tiffany Hazel
Doctor of Nursing Practice Projects
Established prenatal care leads to better outcomes and reduced healthcare expenditures. Inadequate prenatal care is associated with numerous risks. Many women face a variety of barriers that contribute to inadequate prenatal care. The purpose of this project was to create and pilot a new transitional care protocol to improve the referral rate of pregnant patients to establish prenatal care at a midwestern physician services (MPS) women’s health care clinic after a MPS express care visit. An extensive literature review was conducted, and a streamlined referral process linking pregnant patients to obstetric care was created to address identified barriers. The referral …
Development Of An Emergency Preparedness Protocol In An Office Setting, Amanda Burgesen
Development Of An Emergency Preparedness Protocol In An Office Setting, Amanda Burgesen
Doctor of Nursing Practice Projects
Office-based practices are not as stringently regulated as hospitals or ambulatory surgical centers. The lack of government oversight places the responsibility heavily on office-based practitioners to properly exercise their professional ethics to ensure their patients are receiving the highest quality of care while remaining safe. The purpose of this quality improvement project was to develop and implement an emergency activation protocol for a local gastroenterologist office in Southern Illinois that promotes emergency preparedness. The emergency activation protocol provided recommendations for staff training on emergency preparedness, mock codes, checking the crash cart, monitoring of the patient, medications available, and equipment that …
Laryngotracheal Stenosis, Kelsey Stuckey
Laryngotracheal Stenosis, Kelsey Stuckey
Doctor of Nursing Practice Projects
Laryngotracheal stenosis (LTS) is the luminal compromise at the laryngeal, subglottic, or tracheal level (Gelbard et al., 2014). Various etiologies for LTS exist. Endotracheal cuff over-inflation, inappropriately sized endotracheal tubes, and sudden movements of the tube contribute to injury, as well as anatomical differences(Cardillo et al., 2010; Divatia & Bhowmick, 2005; Medina et al., 2009; Miñambres et al., 2009; Nikolovski et al., 2019; Zaghi et al.,2016). The influence of estrogen may contribute to the development of LTS in women during the third through fifth decades Dedo & Catten, 2001; Poetker et al., 2006; Valdez & Shapshay, 2002). The project goal …
Trauma Informed Care: Paving The Way To Better Patient Outcomes, Sarah Halsey, Amy L. Armstrong
Trauma Informed Care: Paving The Way To Better Patient Outcomes, Sarah Halsey, Amy L. Armstrong
Doctor of Nursing Practice Projects
Trauma-informed care (TIC) is an approach that enables healthcare clinicians to understand the effects of trauma and create a safer environment. Providers acknowledge the pervasive nature of trauma but lack proper tools and training to implement. It has been suggested that trauma is the prime determinant of health outcomes. Therefore, providing training and cultivating a change towards a trauma-informed organization, has the capability to change health outcomes.
The purpose of this project was to establish a program at SIU Medicine in which new employees are trained on the importance of TIC. Working closely with the Director of Population and Community …
Reducing Emergence Delirium In Combat Veterans Through The Development Of A Decision-Tree Utilizing Ketamine And Precedex, Joseph Oldani, Russell Arendt
Reducing Emergence Delirium In Combat Veterans Through The Development Of A Decision-Tree Utilizing Ketamine And Precedex, Joseph Oldani, Russell Arendt
Doctor of Nursing Practice Projects
Emergence Delirium incidences in the combat veteran population warrant unique anesthetic considerations. Examples of these considerations include the exclusion of a benzodiazepine and the use of low dose Ketamine or Precedex infusions. Researching these considerations, an anesthetic decision tree coupled with a screening questionnaire was developed and implemented in a hospital in Southern Illinois. The tool was developed based on a thorough literature review and a need to condense this information into a working knowledge for clinical application. Implementation of the project included staff education on the tool and the management of Emergence Delirium by using Ketamine and Precedex. A …
Diabetes Management, Christina Varady
Diabetes Management, Christina Varady
Doctor of Nursing Practice Projects
Diabetes Self-Management Education and Support (DSMES) has been shown to improve diabetes management. A Midwest, private family practice did not offer formal diabetes education. The purpose of this project was to increase patient education for recently diagnosed patients with type 2 diabetes who had not yet reached their management goals. A second purpose was to develop quality educational material for the provider in this practice. These objectives were met by identifying patients who were not at the optimal goal of HgA1c of 7% per the American Diabetes Association (ADA) guidelines and providing quality diabetes education and follow up to these …
Safe Sleep Modeling In The Neonatal Intensive Care Unit, Barbara Garrison
Safe Sleep Modeling In The Neonatal Intensive Care Unit, Barbara Garrison
Doctor of Nursing Practice Projects
Abstract
Approximately 3,500 babies die each year due to sleep related deaths. The 2016 American Academy of Pediatrics Policy Statement clearly states that all health care workers should model safe sleep for infants less than 12 months of age prior to discharge from the hospital. However, at a large, Midwest, level IV, University-based neonatal intensive care unit (NICU), safe sleep was not being modeled. The purpose of this project was to increase adherence to the American Academy of Pediatrics recommendations by implementing a unit-based quality improvement project focusing on policy development, staff education, and parent education.
Although starting out as …
Preoperative Assessment Of Patients In An Enhanced Recovery Program, Edward Mitzelfelt
Preoperative Assessment Of Patients In An Enhanced Recovery Program, Edward Mitzelfelt
Doctor of Nursing Practice Projects
All patients undergoing surgery are at risk for perioperative morbidity and mortality (Gabriel et al, 2018) and a patient’s physical status plays a key role in patient outcomes (Hopkins et al, 2016). Enhanced recovery programs are intended to improve perioperative outcomes, facilitate postoperative recovery, and reduce loss of functional capacity (Feldheiser et al, 2016). Preoperative assessment allows for identification of risk factors which can be modified, with the aim of decreasing perioperative complications. A small community hospital had no standardized preoperative evaluation tool to use for their enhanced recovery patients. The purpose of this project was to create and implement …
Fascia Iliaca Blocks For The Treatment Of Hip Fractures In The Emergency Department, Megan Hahn
Fascia Iliaca Blocks For The Treatment Of Hip Fractures In The Emergency Department, Megan Hahn
Doctor of Nursing Practice Projects
Due to the aging population, the number of falls are increasing, leading to an increased number of individuals with hip fractures presenting in emergency departments (ED). Opioids are often administered for intraoperative pain related to hip fractures, which may result in a number of adverse effects, especially in the elderly. There is strong evidence suggesting that the use of fascia iliaca blocks (FIBs) in the ED can minimize opioid use, and improve patient outcomes and recovery. FIB is a compartment block that delivers local anesthetic around the lumbar plexus to provide analgesia associated with hip fractures.
The purpose of this …
Pain Control Options For The Parturient: Pamphlet Development For Patient Education, Alyssa R. Jimerson
Pain Control Options For The Parturient: Pamphlet Development For Patient Education, Alyssa R. Jimerson
Doctor of Nursing Practice Projects
Epidural analgesia has traditionally been requested by the parturient population as the primary choice of pain control during labor, despite the availability of other viable options (Pitter & Preston, 2001). Viable pain control options available during labor include, neuraxial anesthesia, peripheral nerve blocks, pharmacological, and non-pharmacological measures. Lack of education regarding the availability of various pain control options for parturient women is identified as a cause of missed pain relief opportunities (Vargens, Silva, & Progianti, 2013). The purpose of this project was to develop a pamphlet prototype for an obstetrics department at a tertiary care center in central Illinois, explaining …
Developing And Implementing Guidelines For Amniotic Fluid Embolism, Clayton Shick
Developing And Implementing Guidelines For Amniotic Fluid Embolism, Clayton Shick
Doctor of Nursing Practice Projects
Knowing that amniotic fluid embolism (AFE) is such a rare but harmful condition, a hospital in Metro-East St. Louis requested the creation of a checklist to ensure that all anesthesia providers quickly recognize and initiate appropriate management for AFE. The quality improvement project involved identifying the best evidence and collaborating with facility stakeholders to implement the use of an updated, evidence-based checklist to guide providers in the management of AFE. Via an open discussion PowerPoint presentation, CRNAs and anesthesiologists at the facility were provided education about AFE and the importance of using a checklist to facilitate management of AFE. The …
Improving Outcomes For Patients With Osa Receiving Anesthesia, Natalie Bram
Improving Outcomes For Patients With Osa Receiving Anesthesia, Natalie Bram
Doctor of Nursing Practice Projects
Obstructive Sleep Apnea (OSA) is a dangerous sleep disorder that is rising in prevalence, afflicting 29.4 million Americans or 12% of the U.S. population (AASM, 2017). Although OSA has the ability to negatively impact postoperative outcomes, numerous patients remain undiagnosed, unidentified, and improperly treated for OSA at the time of surgery (Baugh, 2013; Opperer et al., 2016). Evidence supports the STOP-BANG questionnaire as an effective, easy to use, and highly sensitive tool for screening patients for OSA (Chiu et al., 2016; Dolezal et al., 2011; Lakdawala, Dickey, & Alrawashdeh, 2018).
A 137-bed hospital had no standing preoperative protocol for the …
Tranexamic Acid Use, Jennifer Aumann
Tranexamic Acid Use, Jennifer Aumann
Doctor of Nursing Practice Projects
Bleeding is a risk associated with every surgery. The pediatric population represents unique challenges during surgery due to differences in anatomy and physiology when compared to the adult population. Historically, blood transfusions were the treatment for excessive surgical blood loss. Transfusion of blood products have associated risks: infection, volume overload, and immunological reactions (Fraser, Porte, Kouides, & Lukes, 2008; Porte & Leebeek, 2002; Yuan, Zhao, & Xu, 2016). Interventions to decrease blood loss are essential to improve surgical outcomes. Tranexamic acid (TXA) use decreases the number of required blood transfusions thereby decreasing transfusion-related morbidity (Lei, Xie, Xu, Xie, Huang, & …
Investigation And Evaluation Of Srna Barriers To Iana Engagement, Brittany Smith
Investigation And Evaluation Of Srna Barriers To Iana Engagement, Brittany Smith
Doctor of Nursing Practice Projects
The Illinois Association of Nurse Anesthetists (IANA) and American Association of Nurse Anesthetists (AANA) are professional organizations representing Certified Registered Nurse Anesthetists (CRNAs). While AANA membership has risen from 27,000 in 1994 to 45,000 in 2014, there was a 5% decline in CRNAs who are members of the AANA (Farina, Wilson, & FitzSimmons, 2016). Farina et al. (2016) reported that of 5,032 CRNAs who were not AANA members, 2,549 had been CRNAs for less than 10 years. This project involved the development and use of a 21-question survey to identify barriers to involvement in the IANA for student registered nurse …
Development Of A Propofol Administration Protocol For Soy Or Egg-Allergic Patients, Kayla Tisza
Development Of A Propofol Administration Protocol For Soy Or Egg-Allergic Patients, Kayla Tisza
Doctor of Nursing Practice Projects
The use of propofol for anesthesia and the prevalence of food allergies are both increasing. Propofol’s preparation contains soybean oil and egg lecithin, raising concerns about cross-sensitivity. No widely accepted practice protocol regarding the administration of propofol in soy or egg-allergic patients exists, and the evidence of anaphylactic reactions in this population is inconclusive. This project involved the creation of a protocol that details the use of propofol for soy or egg-allergic patients at a regional medical center in central Illinois.
Collaboration with clinical stakeholders and an extensive review of the literature guided the development of an algorithm based protocol …
Preventing Substance Use Disorder In Anesthesia Providers, Tyson Rogers
Preventing Substance Use Disorder In Anesthesia Providers, Tyson Rogers
Doctor of Nursing Practice Projects
Developing substance use disorder is considered one of the most serious occupational risk factors for anesthesia providers. The purpose of this project was to identify the prevalence and risk factors of substance use disorder within the anesthesia community and to signify the importance of early education and awareness to help prevent the development of substance use disorder through early education, identification, and awareness. The project consisted of an educational PowerPoint that was placed on Southern Illinois University Edwardsville’s (SIUE) wellness website within Black Board. The third-year nurse anesthesia students at SIUE were sent an email on how to access the …
Improving Perioperative Anxiety And Pain: Development Of A Music Therapy Protocol, Rhyz Wilson
Improving Perioperative Anxiety And Pain: Development Of A Music Therapy Protocol, Rhyz Wilson
Doctor of Nursing Practice Projects
Perioperative anxiety is strongly correlated with a higher incidence of post-surgery pain, an increase in the need for analgesics and anesthetics, and delayed recovery and discharge from the hospital (Jimenez-Jimenez et al., 2013; Kuhlmann et al., 2018). Finding multimodal approaches to ease anxiety and discomfort from unfamiliar hospital surroundings is necessary to reduce perioperative anxiety and subsequent physiological complications (Ni et al., 2011). A review of current evidence-based literature revealed that music therapy significantly decreases both perioperative anxiety and pain levels in adult patients undergoing surgery. For this quality improvement project, a music therapy protocol was developed in collaboration …
Computer Based Learning Module: Neuraxial And Peripheral Nerve Blocks, Altan Halici
Computer Based Learning Module: Neuraxial And Peripheral Nerve Blocks, Altan Halici
Doctor of Nursing Practice Projects
Neuraxial and peripheral nerve blocks (PNB) have been present for many years, but recently these pain management techniques are gaining popularity as an alternative to the use of opioids. Neuraxial and PNB reduce the opioid usage during and after the surgery and improve postoperative recovery in terms of pain relief, pain-related sleep disruption, and reduction of side effects, such as nausea and vomiting. Conversely, inadequate pain management after surgery may delay surgical recovery, decreased patient satisfaction, increased length of hospital stay, increased readmissions and healthcare costs (Patacsil, McAuliffe, Feyh, & Sigmon, 2016).
Perioperative nurses are instrumental during the post-operative period …