Medicine and Health Sciences Commons^™

Implementation Of Written Discharge Instructions For Common Diagnoses In The Urgent Care Setting, Melissa Kulp, Kristin Elmore

Doctor of Nursing Practice Projects

Abstract

Discharge instructions are an important tool providers use to communicate information to patients about their medical diagnosis after they return to their home environments. When patients understand and follow discharge instructions there are improved outcomes, fewer callbacks, and decreased return visits. The purpose of this quality improvement project were (a) to develop and distribute discharge instructions at or below a sixth-grade reading level, (b) on common diagnoses appropriate for a rural community, (c) decreased the need for subsequent office visits, and (d) decreased call volumes at a rural walk-in clinic. A large-scale literature review was conducted to determine the …

Increasing Hpv Vaccination In Adolescents, Emily Martin, Emily Hartmann

Doctor of Nursing Practice Projects

Human papillomavirus virus (HPV) is a sexually transmitted disease that can negatively affect both males and females by leading to cervical, vaginal, vulvar, anal, penile, and oropharyngeal cancer. Vaccinating against HPV using the Gardasil vaccine is an effective method to prevent HPV, however, vaccination rates are still unacceptably low in adolescents ages 11 to 14. Pediatric providers should encourage and strongly recommend HPV vaccines to all adolescents. Addressing and easing parental hesitancy is a key component to improving vaccine acceptance. The setting for the project was a rural pediatric office in southern Illinois where HPV vaccination rates are lower than …

Retention Of New Nurses In The Cardiovascular Operating Room, Hannah Shufeldt

Doctor of Nursing Practice Projects

Background

In January of 2020, a hospital in Springfield, Illinois started the year with seven full-time circulating nurses in the cardiovascular operating room (CVOR). Three of those nurses left before the end of the year and an additional four nurses were hired. In January of 2021, the CVOR began the year with eight nurses. Five of these nurses left by the end of the year and seven more were hired, one of which left before the end of 2021. This department has struggled to retain nurses, with a turnover rate of 42.9% in 2020 and 62.5% in 2021.

Purpose

The …

Dexmedetomidine As An Adjunct Therapy To Neuraxial Anesthesia In Labor And Delivery, Anthony Nungesser

Doctor of Nursing Practice Projects

In 2011, the Centers for Disease Control (CDC) declared the opioid crisis an epidemic, and in 2017 it was declared a public health emergency. In labor and delivery, neuraxial anesthesia has been used for over a hundred years to provide pain relief for parturients. Although many alternatives have been studied, opioids are the most frequently used local anesthetic adjuvants, and their use in neuraxial blocks has evolved over the last 50 years (Swain et al., 2017). While neuraxial opioids have proven to be an effective adjunct for pain relief, they are associated with undesirable side effects as well as the …

Assessment Of Caregiver Burden In A Memory Loss Clinic, Andrea Perkins

Doctor of Nursing Practice Projects

Background: Over 131,000 people in Illinois identify themselves as caregivers of someone with memory loss. The family caregiver may provide care including, but not limited to, assistance with activities of daily living, financial responsibilities, behavior management, and scheduling, and transportation to medical appointments. The care provided by the caregivers may lead to caregiver burden symptoms of depression, anxiety, and perceived stress. Purpose: Health care providers at a central Illinois memory clinic are not currently completing formal assessments of caregiver burden. This quality improvement project was done to determine if the current memory loss program services provide enough support …

Empowering Nurses To Recognize Post-Stroke Depression In The African American Community, Deidra Frisbie, Robin Simon

Doctor of Nursing Practice Projects

African Americans (AA) have the highest prevalence of stroke and death compared to other racial groups in the United States. Post-stroke depression (PSD) affects approximately 1/3 of all stroke patients and is underdiagnosed in the African American community.

Aim: By using a mHealth mobile app and a Psychiatry provider list at discharge, PSD can be identified, and interventions initiated, thus decreasing the sequela of PSD in AA.

Methods: Nurses were provided education on PSD, expressions of depression in African-Americans, cultural humility, implicit bias, and the importance of the nurse's role in developing a therapeutic relationship.

Results: Quantitative analysis revealed the …

Screening For Social Determinants Of Health To Improve Care In Pediatric Patients With Recurrent Urinary Tract Infections: A Scoping Review, Emily Gray Msn, Fnp-C, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Purpose: To describe what is known about how SDoH screening impacts adherence to treatment in pediatric patients with recurrent UTIs.

Depression Awareness Programs For Adolescents: A Scoping Review, Kincharska N. Freeman Msn, Aprn, Fnp-C, Cnor, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

The purpose of this DNP project is to determine if receiving school-based depression awareness education affects the depression scores of adolescents between 10 and 19 years of age.

Improving Intravenous Fluid Resuscitation Compliance Of Severe Septic And Septic Shock Adults In A Rural Emergency Room, Alison Douglas

Doctor of Nursing Practice Projects

Background: The Doctor of Nursing Practice (DNP) project focused on the delay in intravenous fluid (IVF) resuscitation of sepsis and septic shock patients in the emergency room (ER) before inpatient admission.

Purpose: The purpose of this project was to improve the time-sensitive administration of IVF resuscitation of adult patients diagnosed with sepsis or septic shock by enhancing ER nurses’ end-user knowledge of and adherence to evidence-based sepsis treatment recommendations over approximately six weeks (42 days).

Methods: Retrospective chart reviews were performed in December 2021 and focused on IVF resuscitation times. Pre-intervention questionnaires were completed, assessing baseline nursing knowledge. Nurse education …

Implementing The Use Of The Emergency Severity Index Triage Tool In Urgent Care, Sakeena Spencer

Doctor of Nursing Practice Projects

Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has …

Empowering Emergency Department Nurses To Utilize The Steadi Program For Fall Prevention, Edmond M. Woods

Doctor of Nursing Practice Projects

Background: A fall is defined as an event that results in a person coming to rest inadvertently on the ground, floor, or other lower levels (World Health Organization, 2022). Nationally the incidence of falls among older adults has steadily increased over the last ten years. According to the Centers for Disease Control and Prevention (CDC), "Falls among older adults aged 65 years and older caused over 34,000 deaths in 2019, making it the leading cause of injury contributing to death for that group" (CDC, 2019, para 1). These individuals who fall for the first time often have another fall unless …

Implementation Of Routine Screening To Detect Early Cases Of Depression And Anxiety In Hispanic Adolescents In The Primary Care Setting, Latoya Hayward

Doctor of Nursing Practice Projects

Depression and anxiety are among the leading causes of illness and disability in adolescents and are two of the most prevalent mental health conditions in Latino youth. If left unrecognized and untreated, these conditions can lead to decreased quality of life and increased rates of suicide. Researchers recommend early mental health screening to occur in the primary care setting. Through routine screening using evidence-based screening tools (PHQ-9 and GAD-7), the primary goal of this quality improvement project was to increase early detection of depression and anxiety in primary care and initiate early treatment. Project methods included implementation of new workflow, …

Implementation Of An E-Learning Module To Increase Rn Knowledge And Skills Of Emergency Preparedness, Kaitlyn Hope Chung

Doctor of Nursing Practice Projects

Background

By failing to prepare, you are preparing to fail. —Benjamin Franklin, writer, philosopher, politician. Having education initiatives for mass casualty incidents and disaster preparedness that are concise and organized is of high importance. This issue is pertinent to the midwestern medical center where this project took place because in the event of a true mass casualty or disaster scenario, many lives could be saved if registered nurses (RNs) in the emergency department (ED) were better prepared. For a hospital to provide adequate and effective care during a crisis, healthcare workers must be effectively trained to do so. However, many …

Occupational Stress In Psychiatric Nurses And The Impact Of Self-Care Activities, Jacqueline Lowe

Doctor of Nursing Practice Projects

Background

The nursing profession is an extremely stressful occupation. Psychiatric nurses face many of the general stressors that are inherent within the profession as well as unique challenges in taking care of psychiatric patients. Prolonged exposure to stress can impact the quality of the nurses' lives as well as the quality of patient care. Engagement in self-care activities can promote the well-being of psychiatric nurses.

Purpose

To investigate the level of occupational stress in psychiatric nurses and offer them a guided six-week program on self-care activities. This intervention was measured for any change in the level of occupational stress that …

A Clinical And Community Linkage Benefitting Patients With Chronic Conditions, David B. Clapp

Doctor of Nursing Practice Projects

Background: Connecting healthcare clinics and community resources can improve the health of patients. It is shown that this type of linkage is an effective approach to addressing health concerns and to potentially prevent long-term health issues.

Purpose: The purpose of the DNP project is to promote and provide a clinical-community linkage at a local specialty clinic to determine if the providers find that offering community resources to patients increases their perception of quality of care provided.

Methods: Utilizing a guideline set forth by the CDC, providers within a specialty clinic were provided with a pre-test to determine if their current …

Improving Workflow Efficiency In A Medical Clinic Utilizing A Competency Evaluation Tool With Skills Checklist, Jillian England Johnson

Doctor of Nursing Practice Projects

Background: Checklists are commonly used in many healthcare settings to validate one’s competency in a skill or task. Competency is essential to help reduce human errors and prevent patient harm, improving patient outcomes while carrying out evidence-based care.

Purpose: The purpose of this DNP project was to improve patient care, patient care outcomes, and workflow efficiency in a charitable clinic by identifying strengths and opportunities for growth among the staff and volunteers through a competency evaluation tool utilizing a skills checklist.

Methods: This quality improvement project included implementing a competency evaluation tool with a skills checklist for staff and volunteers …

Addressing Polypharmacy: Implementing The Medication Appropriateness Index Clinical Tool To Increase Deprescribing By Healthcare Providers, Lori Floyd

Doctor of Nursing Practice Projects

Background: Polypharmacy is a national and local issue of concern within healthcare. Deprescribing medications has been identified as a plausible solution for patients experiencing polypharmacy. However, many healthcare providers are unaware of the practice of deprescribing and, if aware, may not be implementing clinical tools for deprescribing effectively. The family medicine clinical site supplies an opportunity for healthcare providers to utilize an evidence-based clinical tool to review medications, identify if inappropriate, and deprescribe if indicated.

Purpose: The purposes of the Doctor of Nursing Practice (DNP) project were to increase deprescribing activity among prescribing healthcare providers and to increase prescribing healthcare …

Implementing A Pressure Injury Prevention Bundle To Decrease Hospital-Acquired Pressure Injuries In An Adult Medical-Surgical Unit, Laura Brock

Doctor of Nursing Practice Projects

Background: Pressure injuries affect approximately 2.5 million people in the United States and cost the American healthcare system more than $11.6 billion annually. Healthcare organizations have sanctions placed on them by government agencies to minimize the occurrence of pressure injuries to reduce financial burdens and poor patient outcomes.

Purpose: The project aimed to evaluate the effectiveness of reducing the incidence of hospital-acquired pressure injuries after implementing a pressure injury prevention bundle over eight weeks in a medical-surgical unit in a rural hospital in Alabama.

Methods: This quality improvement project consisted of three key components: educating nurses to …

Providing Education To Staff Members On Implementing Follow-Up Education At Discharge To Patients With Low Heart Scores, Daniel Burton

Doctor of Nursing Practice Projects

Background: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) provides accreditation to hospitals, including “heart certification.” The facility was successful at meeting the four measures previously assigned to them. As a result, they were given four new measures. One of these standards is providing discharge education based on “heart scores.”. Only 35% of patients are receiving discharge/follow-up education at discharge from the emergency department (ED).

Purpose: The purpose of this study is to increase the number of patients receiving chest pain education and follow-up instructions in the ED as evidenced by the improvement in documentation of the interventions.

Methods: …

Clabsi’S: Reducing The Rates In An Urban Intensive Care Unit By Consistent Use Of The Central Line Maintenance Evaluation Tool (Clmet), Bridget Smith

Doctor of Nursing Practice Projects

Background: Quality improvement efforts from an urban facility have observed a need for staff education on the central line maintenance bundle and consistent surveillance with the Central Line Maintenance Evaluation Tool (CLMET).

Purpose: To address the practice gap of central line maintenance bundle usage at the bedside by utilizing the CLMET consistently.

Methods: A voluntary didactic program offered to staff and encouraging daily utilization of the CLMET that included real-time feedback by the supervisors.

Results: Pretest grade for the unit (n=13, 82.06) and the post-test grade (n=13, 86.33), which is + 4.27 points after education. Pre-implementation, January 1st through 31st, …

Training Sexual Assault Nurse Examiners (Sane) And Patient Advocates To Improve Utilization Of The Alabama Crime Victims Compensation Commission (Acvcc) Program For Sexual Assault Victims, Erica Starling

Doctor of Nursing Practice Projects

Background: Sexual assault is a nationwide problem that often goes unreported. According to the Rape, Abuse and Incest National Network (RAINN), every 68 seconds an American is sexually assaulted. One out of every six women has been a victim of sexual assault in their lifetime. Sexual violence has long-term effects on victims including post-traumatic stress disorder, suicidal ideations and/or attempted suicide, substance use disorder, work and/or family life struggles, unplanned pregnancy, and/or sexually transmitted infections (STI).

Purpose: The purpose of this project is to improve the utilization of the Alabama Crime Victims Compensation Commission Program (ACVCC) for victims …

Project Ankle-Brachial Index: Implementation Of An Evidence-Based Peripheral Artery Disease Protocol, Melaney Banks

Doctor of Nursing Practice Projects

Background: Peripheral artery disease (PAD) is a narrowing or blocking of the arteries due to plaque buildup, which prevents oxygen, blood, and other nutrients from getting to the legs. When this buildup reaches a certain point, it becomes atherosclerosis, which is more prevalent in a smoker. Smoking intensifies the problem of plaque buildup if an individual already suffers from PAD. When an individual smokes, the nicotine causes the arteries to constrict and narrow, reducing blood flow further. The ankle-brachial index (ABI) is a simple, cost-effective diagnostic test to identify the presence of PAD which will improve patient outcomes.

Purpose: This …

Implementation And Evaluation Of A Syphilis Screening Tool To Increase Patient Testing For Syphilis Among Adults 18 Years And Older In A Rural Primary Care Clinic, Valeria S. Wiggins

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STIs) are an increasing epidemic in the United States (U.S.) that need immediate interventions to reverse the effects of syphilis on the sexual health of adults in rural populations. Many are unaware of the growing rate of syphilis and the overall impact it causes nationally. When syphilis is detected early, it can be easily treated and cured. Rural primary care providers are ideal candidates for implementing education, screening, testing, and treatment.

Purpose: The Doctor of Nursing Practice (DNP) project aims to increase the frequency of screening patients in rural primary care clinics for high-risk sexual behaviors. …

Implementing Antimicrobial Stewardship For Healthcare Providers In An Urgent Care Setting To Reduce Antibiotic Misuse For Respiratory Infections, Ashley Pauldin

Doctor of Nursing Practice Projects

Background: Antimicrobial resistance has been identified as a major threat by the World Health Organization (WHO), and antimicrobial stewardship is a key strategy to overcome resistance. A major contributing factor to this crisis is the inappropriate use of antibiotic prescriptions in outpatient settings. Although evidence-based guidelines on appropriate treatment for acute upper respiratory infections (URIs) have been developed, the need for improving provider and patient awareness and knowledge in the urgent care setting is critical.

Purpose: The purpose of the DNP project was to implement antimicrobial stewardship guidelines in the urgent care facility to decrease the misuse of antibiotic prescribing …

Implementing Hand Hygiene Protocol For Direct Care Staff In An Inpatient Psychiatric Facility To Improve Hand Hygiene Compliance, Juliet Mkpuechina

Doctor of Nursing Practice Projects

Background: Handwashing with soap and running water is one of the most effective ways to prevent diseases and infections spread through touch. Hand hygiene refers to handwashing with soap, water, and other disinfecting agents to prevent infection. According to Chassin et al. (2017), hand hygiene compliance reduces healthcare-associated infections (HAI). Studies show that an increase in handwashing compliance can be correlated to a decrease in healthcare-associated infections. Studies have proven that though it is challenging to link hand hygiene to a reduction in healthcare-associated infections directly to improved hand hygiene compliance, many hospitals have seen a decline in HAIs as …

Increasing Medical-Surgical Nurses' Skills And Knowledge On Wound Assessment And Documentation Through An Educational Approach, Jewels Knight

Doctor of Nursing Practice Projects

Background: Hospital acquired pressure injury rates are increasing while other hospital acquired condition rates are decreasing. Pressure injuries are expensive and place patients at a higher risk of death. Accurate wound assessment and documentation to satisfy the present on admission indicator could positively affect hospital acquired pressure injury rates.

Purpose: The purpose of this process improvement project was to increase nurses’ skills and knowledge towards proper wound assessment and documentation and to increase nurses’ knowledge on why comprehensive skin assessments and documentation of the observations are important for positive patient outcomes.

Method: This project consisted of offering an educational …

Using The Cdc’S Healthcare Personnel And First Responders: How To Cope With Stress And Build Resilience During The Covid-19 Pandemic Education Resources To Reduce Burnout Of Intensive Care Nurses At An Urban Acute Care Hospital, Elizabeth Gilbert

Doctor of Nursing Practice Projects

Background: Nurse burnout is a serious problem, as documented by many studies. Burnout has been shown to lower quality of life, performance level, and organizational commitment while also increasing a nurses' desire to leave the job. Despite this knowledge, nurse burnout continues to be present, especially among nurses who work in intensive care units (ICUs). Hospitals need ICU nurses to care for critically ill patients; therefore, it is essential to educate ICU nurses on burnout and initiate measures to decrease burnout in this vulnerable population.

Purpose: The goals of this study are to explore nurse burnout in the medical intensive …

Education Regarding Advance Directives Improves The End-Of-Life Choices Documentation In Heart Failure Patients, Phebe Hagins Wright

Doctor of Nursing Practice Projects

Background: Heart failure affects the lives of more than 6 million people in the United States and outpatient heart failure clinics offer an opportunity to educate patients while providing evidence-based care. A needs analysis revealed that many heart failure patients do not have an advance directive (AD) on file.

Purpose: The DNP project aims to implement an educational program that provides the tools and knowledge to heart failure patients to assist patients in determining their end-of-life care goals and allow them to document these goals in the Five Wishes document.

Methods: This quality improvement project consisted of a didactic educational …

Utilizing Multimodal Education To Impact Provider Documentation Of Post-Anesthesia Evaluation In A Rural Hospital, Jennifer Coffman

Doctor of Nursing Practice Projects

Background: Hospital policy, Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (TJC) require a post-anesthesia evaluation to be completed and documented no later than forty-eight hours following surgery or any other procedure requiring anesthesia. This evaluation is required any time general, regional, or monitored anesthesia has been administered to the patient and must be completed by a certified anesthesia provider. One rural hospital facility’s post-anesthesia documentation compliance has declined to 79%, compared to the previous quarter’s report of 95%.

Purpose: The Doctor of Nursing Practice (DNP) project aimed to improve post-anesthesia documentation through a multimodal educational intervention. …

Implementation Of A Diabetes Self-Management Education Program In The Rural Health Care Setting To Improve Glycemic Control In The African American Adult Population, Patricia Jackson

Doctor of Nursing Practice Projects

Background: According to the Center for Disease Control (CDC), Type 2 Diabetes Mellitus (T2DM) is a significant epidemic health problem worldwide. Furthermore, with the generality of T2DM-associated complications increasing, individuals living with chronic diseases must be competent in self-management to prevent long-term complications (CDC, 2021). Therefore, this Project Investigator aims to decrease the reported home glycemic control and improve diabetes self-management education among African American individuals in rural healthcare using the DSMEP tool.

Purpose: The purpose of the DNP project was to implement and assess the Diabetes Self-Management Education Program (DSMEP) effect on African American individuals in the rural health …