Medicine and Health Sciences Commons^™

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patients and anesthesia provider discussions at a North Texas hospital were limited due to a knowledge deficit, an outdated hospital policy rescinding all directives perioperatively, and an inadequate consenting mechanism.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

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

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

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

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

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 …

Heart Failure 30-Day Readmission Frequency, Rates, And Hf Classification, Yolanda R. Brown, Twonia M. Goyer, Margaret C. Harvey

Doctor of Nursing Practice Projects

30 Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure

Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who …

Increasing Nurse Knowledge Using A Formal Lung Transplant Education Program, Amy M. Stoddard, Donna Lynch-Smith, Kate Carlson Wrammert, Bobby Bellflower

Doctor of Nursing Practice Projects

This quality improvement project was completed to show that a formal lung transplant education course for nurses caring for lung transplant patients increased their knowledge. An eight-hour education course was developed by experts in the field of lung transplantation. A pretest was administered before the education course. A posttest was administered to determine if knowledge was improved. A three-month follow-up test was administered to determine knowledge retention. Based on the data analysis, nurse knowledge improved after formal education. Item analysis determined what areas of educational content need to be the focus of quarterly education. The education course was adopted as …

2020 Graduates Project Abstracts By Cizik School Of Nursing At Uthealth, Dnp Program

Doctor of Nursing Practice Projects

The Cizik School of Nursing at UTHealth proudly presents the DNP Project abstracts for the 2020 Class of DNP Graduates.

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 …

The Effect Of An Online Mental Health Promotion Program During Covid-19, Juliana Maldonado

Doctor of Nursing Practice Projects

Background

The negative impact of Coronavirus 19 (COVID-19) on mental health has been observed through the pandemic. People have had to adapt to a new norm of social distancing, wearing a mask, and abstaining from big group gatherings. These changes have impacted all levels of society and the rise of mental health care continues to grow as COVID-19 continues at this time. Mental health promotion strategies may be enhanced through the use of telehealth.

Purpose

To determine if a six-week online mental health promotion intervention would improve the GAD-7 scores of participants.

Methods

This project utilized a quantitative quasi-experimental pre-test/post-test …

The Effect Of An Online Educational Intervention On The Community Knowledge Of Physical Health, Mental Health And Self-Efficacy During The Covid-19 Pandemic, Kerstin Ashby Ferguson

Doctor of Nursing Practice Projects

Background

Community health education during times of pandemic is of utmost importance to disseminate information regarding safety precautions, educate the public regarding the disease process, and provide accurate health information during a time when individuals are specifically vulnerable to inaccurate sources of information. During the COVID-19 pandemic, physical gatherings were highly restricted; therefore, it became important to incorporate technology into the educational process.

Purpose

The purpose of this project was to determine if a thirty-day, online community health education program would increase the health knowledge and self-efficacy of participants.

Methods

This project utilized a quantitative quasi-experimental pre-test/post-test design from a …

Nurse Champions For Medication Reconciliation: Making A Difference, Stacey Waters

Doctor of Nursing Practice Projects

Background: Medication reconciliation creates a significant safety risk when patients transition from one care environment to another. This is especially true for older adults who may have multiple medications, poor health literacy, or multiple providers. During care transitions, collecting accurate information about previous medication regimens can be a challenge. If providers are unskilled at eliciting the needed information, discrepancies can result, leading to medication errors, poorer outcomes, or patient harm. These discrepancies, if unresolved, can follow the patient throughout hospitalization and back into the outpatient setting, leaving patients unable to manage their care at home safely.

Purpose: The objective …

Increasing Long-Term Care Employee Influenza Compliance Through An Educational Approach, Shyandrea H. Brazil

Doctor of Nursing Practice Projects

Influenza (flu) is a highly contagious respiratory illness caused by several influenza viruses (Centers for Disease Control, 2019). The CDC estimates that there have been approximately 42.9 million flu incidents, 20.1 million flu medical visits, 647,000 flu related hospitalizations and 61,200 deaths from October 1, 2018 through May 4, 2019. Individuals who contract this illness may have symptoms varying from mild to severe. This project focused on the elderly population because these individuals fall into the high-risk category. Individuals 65 and older are more likely to experience flu-related complications, which could ultimately lead to hospitalizations and in some cases, death. …

Protecting The Integument: Changing Nursing Practice To Prevent Pressure Injuries, Latonya Lawery

Doctor of Nursing Practice Projects

The purpose of this project is to assess and improve nurses’ knowledge of pressure injuries and pressure injury preventions using evidence-based guidelines and a southeastern United States hospital’s skin integrity policy. My population of focus is direct care professional nurses caring for adults and geriatric patients in the acute care setting.

Design and Methods: The DNP student’s project is a quality improvement project using a Quasi-experimental design, which includes using a pre-test (Appendix A) and post-test (Appendex B). FADE (Appendix C) is the quality improvement method chosen for this project. FADE (Appendix C) is an acronym representing focus, analyze, develop, …

Improving The Accuracy Of Temporal Artery Thermometry In Pediatric Direct Care Providers: A Performance Improvement Project, Kimberly L. Bell

Doctor of Nursing Practice Projects

Purpose: The purpose of the project was to improve the accuracy of temporal artery thermometry (TAT) measurements compared to axillary, rectal, and oral thermometry readings on a Pulmonary Pediatric Care Unit.

Design and Methods: A pre-educational and post-educational competency tests and skill performance test of obtaining accurate TAT results with an Exergen 5000 Temporal Scanner were implemented after the pediatric nursing staff participated in a 60-minute educational program. Of the 32 participants, most were RNs (84%) followed by certified nursing assistants (9%) and LPNs. Most participants worked the 12-hour day shift 7a-7p (59%), followed by the 7a-3p shift (38%) and …

The Effect Of A Provider Education Program On Antibiotic Overuse In Acute Sinusitis, Shawna Berg

Doctor of Nursing Practice Projects

Background: Acute sinusitis is a typical patient diagnosis encountered in the outpatient setting. Inappropriate antibiotic prescribing is a well-documented concern. The overprescribing of antibiotics is associated with increased antibiotic resistance, cost, and adverse side effects. Despite the research, improper prescribing of antibiotics continues to be problematic.

Purpose: A provider education program was implemented at three separate urgent care centers for healthcare providers concerning antibiotic stewardship. The objective was to evaluate the effectiveness of a provider education program to examine changes in the immediate antibiotic prescribing habits.

Design Method: A pretest-posttest quasi-experimental design with provider educational intervention was implemented concerning antibiotic …

The Evolution Of Nursing Leadership: Novice To Expert, Yolanda Chandler

Doctor of Nursing Practice Projects

The nurse leader is critical in staff development, contentment, retention, patient safety, quality of care, and achievement of organizational goals. Nurse leaders in a managerial role must lead, oversee, delegate, guide, and support staff nurses. They are expected to demonstrate clinical competence, make decisions, communicate effectively, be visible and approachable, and empower others. Some skills learned as a charge nurse can help the new manager adapt to the role, but many healthcare organizations offer a novice nurse manager a limited orientation.

Purpose: Effective nursing leadership requires nurse managers to have clinical experience, think critically, motivate others, communicate and delegate constructively, …

A Multifocused Intervention To Reducing Antibiotic Prescribing In Uncomplicated Upper Respiratory Infections In The Urgent Care Setting, Chelsea Popp

Doctor of Nursing Practice Projects

Background: Upper respiratory infections (URIs) comprise a large amount of Urgent Care visits. Though certain patients with URIs may require antibiotic intervention, the majority of patients are considered uncomplicated. Inappropriate prescribing of antibiotics has a direct association to antibiotic resistant bacteria and increased patient mortality (Harris, et al., 2016). Antibiotics are prescribed for more than half of URI’s presenting to Urgent Care clinics.

Purpose: The purpose of this quality improvement project is to determine if proper education on current evidence-based practice guidelines for both the patient and provider will result in a reduction in the number of antibiotics prescribed for …

Improving Skin Tears Healing Time Is Demonstrated By The Staff Rn Who Performs Early Initiation Treatment Of The Skin Tear Protocol, Sharon Brazile

Doctor of Nursing Practice Projects

Skin tears create numerous challenges for managing skin integrity for our aging population. Skin tears result from trauma, such as a patient bumping into a doorknob or rubbing against the wheelchair; they also occur because the epidermis and dermis lose elasticity and rub against each other, causing a shearing process that separates the outer skin layers from their protective under layers. Skin tears not only look terrible but can be painful and lead to infection if treatment is not initiated early by the nurse.

Purpose: The Chief Nursing Officer chose to focus on skin tear treatment at a southeast urban …

Improving School Attendance Rates Utilizing A School-Based Clinic, Tameka Minter Hines

Doctor of Nursing Practice Projects

Student attendance and good health are two essential concepts that correlate with procuring students' academic success. Students can gain knowledge with the ability to be present in the class setting. Any disruption in the student's ability to attend class can have long-lasting negative consequences. Chronic health conditions are the primary obstacles in student attendance. Chronic health conditions such as asthma, sickle cell, childhood cancers, type 2 diabetes, and mental health issues or defects are significant barriers to school attendance. School administrators, parents, and community health partners are task with developing viable options for managing student healthcare along with access to …

Purposeful Hourly Rounding And Reduction Of Patient Falls, Iesha S. Bell

Doctor of Nursing Practice Projects

Falls are a pervasive and persistent problem in all healthcare settings, with adverse clinical, social, and economic outcomes for patients, staff, and institutions involved. The systematic process of purposeful rounding is an intentional act conducted with a clear purpose for the patient's benefit. Prevention of inpatient falls remains a challenge for nurses. Despite fall prevention efforts by nurses, the rate of patient falls in the acute care setting is a major safety concern. A Doctor of Nursing Practice project was crafted and implemented to educate nursing staff on purposeful hourly rounding and apply the 4 P's (pain, positioning, possessions, and …

Can We Talk? Bridging The Communication Gap Between Nurses And Providers, Jolie Wildinger

Doctor of Nursing Practice Projects

Background: Effective communication is the key to successful relationships and improving patient care. Effective and efficient communication is also essential in producing a healthy self-confidence and knowledge base, which is needed by nurses and physicians who are providing daily care to patients.

Purpose: The purpose of this performance improvement project is to increase the communication competence and self-awareness of staff nurses during intraprofessional interactions with the healthcare providers.

Methods: A quasi-experimental quality improvement process that included a pre and post-survey alongside an educational program to arm nurses with information and communication techniques needed to help build relationships to foster effective …

Improving Patient Follow-Up For Laboratory Testing Using Telephone Calls As An Intervention: A Quality Improvement Project, Jill Gray

Doctor of Nursing Practice Projects

Background: Today, in the United States, 74,273 individuals are actively waiting for an organ transplant. Of those, approximately 8,000 need a liver transplant. With the increased need for an organ transplant, the use of increased risk donors is on the rise. In these patients, it is imperative to monitor for the transmission of HCV, HBV, and HIV.

Purpose: Increase compliance for monitoring transplant recipients who receive organs from increased risk donors for HCV, HBV, and HIV.

Design method: In order to measure the outcomes of this project, the following instruments were used: parametric testing and paired t-test. Parametric …

Improving Hypoglycemia Protocol Compliance Through Nursing Education, Concepta Onyatta

Doctor of Nursing Practice Projects

Nurses hold a vital role in glucose management in order to ensure safety and quality outcome for hospitalized patients.

Background: Assessing serum and point of care glucose results and bringing abnormal results to the attention of the healthcare team can help maintain optimal management. Despite challenges to hypoglycemic protocol compliance, informed nurses can advocate effectively for their patients. Understanding insulin action and the effective use of evidence-based guidelines/protocols can help nurses promote optimal patient outcomes. Common barriers to glucose control and education of current best practices in the acute care setting were reviewed.

Purpose: To improve hypoglycemic protocol compliance …

A Quality Improvement Pilot To Reduce Caregiver Burden In Caregivers Of Hematopoietic Stem Cell Transplant (Hsct) Patients In A Hsct Program In The Northwest, Jody Acheson

Doctor of Nursing Practice Projects

Background: Hematopoietic stem cell transplant (HSCT) is an intensive and complex treatment for certain blood cancers. Caregivers are required for patients receiving this treatment. Caregivers frequently experience caregiver burden. Providing an intervention to alleviate caregiver burden can positively impact patient and caregiver health outcomes.

Project Design: The following was the project design: 1) review the literature to understand the best practices to prevent caregiver burden for caregivers of patients undergoing HSCT, 2) development a pilot quality improvement program based on the evidence, 3) implementation of the pilot, and 4) obtaining feedback from facilitators and participants to optimize intervention for ongoing …

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

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

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

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 …