Health and Medical Administration Commons^™

Implementation Of A Smoking Cessation Program In A Multidisciplinary Clinic, Lori Prewitt Moore, Shannon Harris

DNP Manuscripts

Tobacco use remains the solitary, most preventable cause of death and secondary disease among patients in the United States (US). Health-related smoking costs are in an excess of $300 billion yearly (CDC, 2018). Addressing this global, public health concern is vital in order to attempt to reduce unnecessary smoking-related comorbid conditions and death. This project is important to scholarly nursing practice in order to reduce smoking-related Chronic Obstructive Pulmonary Disease (COPD) exacerbations, reduce carbon monoxide (CO) levels, and reduce dyspnea on exertion (DOE) among current primary care smokers. The expectations of this project are for the doctoral of nursing practice …

Work-Life Balance: Combating Nurse Practitioner Burnout And Primary Care Provider Shortages Utilizing Telehealth, Jennifer O'Dell

Graduate Research Projects

No abstract provided.

Understanding Language Barriers And Its Implications On Patient Outcomes In The Urgent Care Situation, Nicolo Co

Nursing | Senior Theses

Background

A common goal for healthcare is healthcare for all, through which can be achieved when communication between the client and healthcare team is established. There are millions of immigrants worldwide who are not granted the healthcare that they deserve simply because of a lack of understanding in a country’s dominant language.

Patients with a limited language proficiency in a new country can have difficulty in understanding the care that they receive, which leads them to toil with understanding their healthcare options, let alone establishing expectations. This issue also stretches onto the risks of patient safety, in which urgent needs …

Application Of A Secondary Opioid Risk Tool In The Management Of Patients On Opioids In The Adult Pain Management Clinic: A Quality Improvement Project, Monica Kastanaras

DNP Projects

Introduction—Significance and Background: Aggressive opioid prescription practices play the biggest role in opioid-related behaviors and contribute to an epidemic of abuse. If started on long-term opioid therapy without screening, patients who are high risk for opioid abuse could overdose on their prescribed opioids. Current practice does not follow guidelines on monitoring opioid misuse behaviors utilizing a secondary screening tool for patients on long-term therapy.

Purpose: The purpose of this project is to help clinicians identify whether a patient, currently on long-term opioid therapy, may be exhibiting aberrant behaviors associated with misuse of opioid medications, using the Current Opioid Misuse Measure …

Implementation Of A Probiotic Intervention Among Medical-Surgical Patients: An Evidence-Based Practice Quality Improvement Project, Moncia Bonvicini

DNP Projects

Introduction: Clostridium difficile infection (CDI) is the most prevalent nosocomial infection pathogen responsible for antibiotic associated diarrhea. CDI is a significant cause of morbidity and mortality rates of medical patients and has increased due to frequent broad spectrum antibiotic usage. CDI is associated with a mortality rate of 25% amongst medical patients. At this catholic hospital in the Northeast of the United States, there is currently no official intervention implemented to prescribe a probiotic when patients are started on antibiotics. Evidence supports that probiotics agents have demonstrated modest success in the risk reduction of CDI to patients receiving antibiotic therapy. …

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis

Nursing | Student Research Posters

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care based training, with …

Improving Patient Access To Gastroenterology Through A Nurse-Practitioner-Led Clinic: A Quality Improvement Project, Kayla Northam

DNP Scholarly Projects

The United States has a critical healthcare access issue for gastroenterology patients. Delays in treatment can lead to expensive complications, including emergency room visits, hospitalization, and surgery. Creating a rapid-access clinic (RAC) for gastroenterology so that patients can obtain a quick and efficient evaluation of their symptoms in a shorter appointment time can help decrease the delay in care and generate more revenue for the hospital. Over 8 weeks in 2023, Dartmouth Hitchcock Medical Center Department of Gastroenterology used a telemedicine-only RAC to see patients for 20 minutes rather than the traditional 60-minute period. As a result, the RAC saw …

Effectiveness Of Speech Intervention Methods In Children With Speech Delays, Andrea Noel, Rachel Windemuth, Brett Porter

Williams Honors College, Honors Research Projects

Speech delays in children is a common issue that can be treated by a wide variety of interventions. Our PICOT question is, in children, ages six months to thirteen years, with speech/language delays, how does the addition of innovative and supplemental interventions, compared with standard interventions alone, effect improvements in the delays. All three group members have known someone who has suffered from a speech delay, and we want to research the best possible methods to overcome that obstacle to answer our questions, we will begin to take on the task of creating and writing a systematic review. This review …

Patient Characteristics And Telehealth Visits In A Hepatology Clinic, Maria E. Walters

DNP Projects

BACKGROUND: In an attempt to decrease significant no-show rates amongst telehealth patients in a Hepatology outpatient clinic, a clinic-specific intervention was executed, which was efficient in decreasing no-show rates, however could not continue to be financially supported.

PURPOSE: The purpose of this study was to evaluate correlations between demographic data and social determinants of health with patients who showed and did not show for their telehealth appointments, with an overall goal of determining if there is a need for targeted support for telehealth appointments to decrease no-show rates.

METHODS: Electronic health records of telehealth patients were reviewed in an …

Electronic Cigarettes And Young Adults: Use Of Screening Tools And Provider Knowledge, Kayla Erin Chelf

DNP Projects

Background: Electronic Cigarette (e-cigarette) use is now more common than traditional cigarette use in adolescents and young adults (Dinardo & Rome, 2019). There is concern that the lack of screening for use and knowledge about the health consequences of e-cigarette use is driving this growth.

Objective: The purposes of this project were to (1) assess baseline e-cigarette knowledge and screening practices from healthcare professionals, and (2) evaluate changes in knowledge after delivery of an educational intervention about e-cigarettes.

Methods: In this quasi-experimental study a seven-question survey on screening practice and knowledge concerning e-cigarettes in young adults was posted on the …

Evaluation Of A Discharge Clinic Implemented For Patients Without A Primary Care Provider Or Access To Their Primary Care Provider, Jessica Sass

DNP Projects

Background: Patients transitioning from an inpatient hospital stay to self-care responsibilities post-discharge are at risk for readmission resulting in increased cost and resource utilization. Care transition programs can result in cost avoidance and decreased resource utilization.

Purpose: The purposes of this project were to: (a) determine if implementation of a Discharge Clinic affected 30-day readmission rates in patients without a primary care provider, (b) ascertain if a visit by a paramedicine program paramedic impacted 30-day readmission rates in patients who missed their Discharge Clinic appointment, and (c) find out whether a second post-discharge phone call influenced 30-day readmission rates.

Method: …

Modified Early Warning Scoring (Mews) Versus Epic Deterioration Index (Edi): Battle Royale For Which Has The Best Patient Outcomes In The Inpatient Setting, Dirk A. Church

DNP Projects

Abstract

Background: The increased workload bedside nurses face today requires new tools to assist with the identification of deteriorating patients during hospitalization. The Modified Early Warning Score (MEWS) tool has formed the background of early warning tools. Newer, more complex tools, like Epic’s Deterioration Index (EDI), have been developed to identify patient deterioration earlier. There is lack of evidence in the literature comparing different early warning tools, implementation, and patient outcomes.

Objective: The purpose of the study was to examine models for EWS notification for RRT and patient outcomes between the use of the MEWS and EDI in an adult, …

Impact Of Pulmonary Embolism Response Teams On Patient Quality Ratings, Sabrina Renee' Simpkins-Morris

Walden Dissertations and Doctoral Studies

AbstractLeaders of health care organizations have limited evidence of the impact of pulmonary embolism response teams (PERTs) on quality outcomes for patients with an intermediate and high-risk pulmonary embolism (PE). The purpose of this quantitative study was to determine whether there was any significant difference in patient HCAHPS linear mean scores for instructions given about medication and overall care between acute care hospitals with and without PERT teams. Donabedian’s framework for assessing health care quality was used as the theoretical foundation for this research. Survey data collected by the Centers for Medicare and Medicaid, as part of its Hospital Consumer …

Perioperative Nurses' Perceptions And Barriers To Implementing The Colorectal Surgery Care Bundle, Kaydian Kerry-Ann Grant

Walden Dissertations and Doctoral Studies

AbstractDespite evidence that surgical care bundle usage prevents surgical site infections (SSIs) in colorectal surgeries, there is a consistent increase in SSIs. Perioperative nurses are in a unique position to provide insight into the process for colorectal surgical care bundle usage, yet little is known about how perioperative nurses view the process. The perioperative patient focused model was used in this qualitative interpretative phenomenological study to examine the perceptions of perioperative nurses regarding the use of colorectal surgery care bundle and its role in preventing SSIs in patients undergoing colon and rectal surgeries. Sixteen perioperative nurses who were members of …

The Investigation Of Resilience As A Moderating Factor On Burnout And Intention To Stay In Nursing Professionals., Florina Karasik

Walden Dissertations and Doctoral Studies

The intention to stay in nursing staff working with adult patients in a hospital setting is a major concern for healthcare organizations because of its effect on patient health outcomes. Grounded in the social cognitive career theory, the purpose of this quantitative correlational study was to investigate resilience as a moderating factor in the relationship between burnout and intention to stay for licensed registered nurses with BSN degrees working with adults in a hospital setting. The participants were 80 licensed registered nurses with BSN degrees working with adults in a hospital setting in the United States of America. The results …

Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr

Walden Dissertations and Doctoral Studies

AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …

Factors Influencing Newly Licensed Nurse Position Selection And Retention, Melinda S. Kidder

Walden Dissertations and Doctoral Studies

Newly licensed nurse turnover can be costly, causing a mismatch between supply and demand for nurse staffing needs, lowering quality outcomes, and decreasing patient satisfaction. This quantitative study was conducted to identify the relationship between why newly licensed nurses selected their first position and their retention in that initial position. Other factors examined in relation to retention were unit most worked, age, race, sex, and education level. Irvine and Evans’s theory of job satisfaction and Maslow’s hierarchy of needs guided the analysis of the data. Secondary data used were the Newly Licensed Registered Nurse New Cohort 3 Survey from 2016 …

Relationship Between Nurse Managers’ Cultural Humility Practices And Nurse Retention, Jessica Scharfenberg

Walden Dissertations and Doctoral Studies

Some hospital administrators experience yearly loss of human capital, resulting in economic and noneconomic consequences that require resource reallocation to sustain operations. Grounded in the cultural humility theory, the purpose of this quantitative correlational study was to examine the relationship between nurses’ perceptions of their nurse managers’ (a) openness, (b) self-awareness, (c) egolessness, (d) self-reflection and critique, (e) supportive interaction, and nurse turnover intention. Participants included 142 registered nurses working in the Midwest United States. Data were collected using Foronda’s Cultural Humility Scale and the Michigan Organizational Assessment Questionnaire. Results of multiple regression analysis indicated the model could significantly predict …

Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr

Walden Dissertations and Doctoral Studies

AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …

Strategies To Mitigate Nurse Turnover, James Edward Cooper Jr

Walden Dissertations and Doctoral Studies

Registered nurse turnover is a severe problem for all healthcare organizations because it negatively affects financial growth, patient care, and reputation, ultimately resulting in financial losses. Grounded in Herzberg’ two-factor theory, the purpose of this qualitative multiple-case study was to explore strategies hospital leaders use to mitigate RN turnover. The participants included three hospital leaders from three different hospitals in the southeastern United States who mitigated RN turnover. Data were collected from semistructured interviews and company documents and analyzed using Yin’s five-phase data analysis process. Three themes emerged: nurse engagement, job satisfaction, and trust in leadership mitigated RN turnover. A …

Relationship Between Nurse Managers’ Cultural Humility Practices And Nurse Retention, Jessica Scharfenberg

Walden Dissertations and Doctoral Studies

Some hospital administrators experience yearly loss of human capital, resulting in economic and noneconomic consequences that require resource reallocation to sustain operations. Grounded in the cultural humility theory, the purpose of this quantitative correlational study was to examine the relationship between nurses’ perceptions of their nurse managers’ (a) openness, (b) self-awareness, (c) egolessness, (d) self-reflection and critique, (e) supportive interaction, and nurse turnover intention. Participants included 142 registered nurses working in the Midwest United States. Data were collected using Foronda’s Cultural Humility Scale and the Michigan Organizational Assessment Questionnaire. Results of multiple regression analysis indicated the model could significantly predict …

Support Their Sleep: Enhancing Nurses' Knowledge And Implementation Of Non-Pharmacological Sleep Protocols To Improve Patient Rest, Recovery, And Reduce Cognitive Impairment., David C. Barry

Master's Theses and Capstones

Background: Sleep and rest play an influential role in promoting recovery and healing in humans. Hospitalized patients are at risk for altered sleep from hospitalization, illness, and stimulation from a hospital environment. Non-pharmacologic interventions preformed by nurses can help to improve sleep and sleep environment for patients.

Local problem: There was no protocol or available information regarding patient sleep promotion for nurses to references when caring for patients.

Methods: Nurses in the microsystem (n=8) were administered a pre/post questionnaire containing Likert scales and a short quiz containing knowledge-based questions. Questionnaires were distributed to nurses prior to and after …

Strategies To Mitigate Nurse Turnover, James Edward Cooper Jr

Walden Dissertations and Doctoral Studies

Registered nurse turnover is a severe problem for all healthcare organizations because it negatively affects financial growth, patient care, and reputation, ultimately resulting in financial losses. Grounded in Herzberg’ two-factor theory, the purpose of this qualitative multiple-case study was to explore strategies hospital leaders use to mitigate RN turnover. The participants included three hospital leaders from three different hospitals in the southeastern United States who mitigated RN turnover. Data were collected from semistructured interviews and company documents and analyzed using Yin’s five-phase data analysis process. Three themes emerged: nurse engagement, job satisfaction, and trust in leadership mitigated RN turnover. A …

Doctoral Study Effects Of Mandatory Staffing Requirements On Quality Indicators In Long-Term Care, Melissa Reed

Walden Dissertations and Doctoral Studies

Long term care facilities continue to struggle to improve the quality of care, which affects publicly reported data and reimbursement. The purpose of this study was to evaluate if state-mandated staffing ratios affected Centers for Medicare and Medicaid Services (CMS) survey ratings for CMS Region 7, which consisted of Iowa, Kansas, Missouri, and Nebraska. The theoretical framework was grounded by Donabedian’s quality theory, which described quality is made up of the elements of structure, process, and outcomes. This study included two research questions evaluating if there was a correlation between minimum staffing ratios and quality of care in long-term care …

Factors Influencing Newly Licensed Nurse Position Selection And Retention, Melinda S. Kidder

Walden Dissertations and Doctoral Studies

Newly licensed nurse turnover can be costly, causing a mismatch between supply and demand for nurse staffing needs, lowering quality outcomes, and decreasing patient satisfaction. This quantitative study was conducted to identify the relationship between why newly licensed nurses selected their first position and their retention in that initial position. Other factors examined in relation to retention were unit most worked, age, race, sex, and education level. Irvine and Evans’s theory of job satisfaction and Maslow’s hierarchy of needs guided the analysis of the data. Secondary data used were the Newly Licensed Registered Nurse New Cohort 3 Survey from 2016 …

A Novel Use Of Bar Code Medication Administration Data To Assess Nurse Staffing And Workload, Melissa K Knox, Paras D Mehta, Lynette E Dorsey, Christine Yang, Laura A Petersen

Faculty, Staff and Students Publications

OBJECTIVE: The aim of the study is to introduce an innovative use of bar code medication administration (BCMA) data, medication pass analysis, that allows for the examination of nurse staffing and workload using data generated during regular nursing workflow.

METHODS: Using 1 year (October 1, 2014-September 30, 2015) of BCMA data for 11 acute care units in one Veterans Affairs Medical Center, we determined the peak time for scheduled medications and included medications scheduled for and administered within 2 hours of that time in analyses. We established for each staff member their daily peak-time medication pass characteristics (number of patients, …

The Heart And Soul Of Engagement In The Float Pool Team, Kymberly Dexter

Master's Projects and Capstones

Problem: The assistant nurse manager (ANM) role is considered an entry-level management position and is not intended as a permanent career role. The unintended consequence is that there is a high rate of organizational turnover, making it challenging to build and retain a solid, cohesive, and productive team.

Context: A new manager of a float pool team in a 166-bed community hospital found that with little financial investment, a significant impact is made by holding a safe space for listening to the ANM team and designing education and training around what is most important to frontline managers.

Interventions: A baseline …

Improving Access For Medicare Inpatient Psychiatric Patients: A Health Policy Analysis, Malinda B. Whitfield

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The Medicare Inpatient Psychiatric Services (IPS) policy, originally developed in the 1960s and without any significant or meaningful updates since the 1980’s, is physician specific, does not reflect the current model of care for psychiatric inpatients, and is restrictive for psychiatric mental health nurse practitioner (PMHNP) practice. The policy is complex, consists of outdated regulations, and results in millions of dollars in compliance costs for Inpatient Psychiatric Facilities (IPFs) annually (NABH, 2019). Although clearly an important part of the inpatient psychiatric services team, PMHNPs are not identified or defined in the policy (Center for Medicare and Medicaid Services [CMS], 2019). …

Improving Glycemic Control During The Covid-19 Pandemic: A Quality Improvement Project, Megan Henderson

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Diabetes is a costly, chronic health condition. The COVID-19 pandemic has significantly impacted the delivery of health care and exacerbated chronic health conditions, such as diabetes. Diabetes is one of the most significant comorbid conditions associated with poor COVID-19 outcomes (Cariou et al., 2020). Control of blood glucose levels during the COVID-19 pandemic has proved challenging to maintain. The purpose of this quality improvement project is to identify gaps in diabetic self-care and then implement a diabetic toolkit to improve self-efficacy of diabetes self-management. According to the American Diabetes Association (2022), self-management of diabetes, education, and support from providers is …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …