Care Of The Critically Ill Nontrauma Patient: Improving Emergency Department Readiness And Patient Care Through The Implementation Of A Dedicated Resuscitation Bay, Martha H. Buck Rn, Bsn, Tcrn, Joseph F. Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Current best practice among emergency departments worldwide includes the maintenance of a dedicated resuscitation space. This practice allows for team members and equipment to be ready at a moment’s notice to provide care to a patient in need of lifesaving interventions. This evidence-based performance improvement project seeks to implement this standard of care in a busy, urban emergency department in Southern California.

Prior to this study, patients at this facility were placed in the next available care space, without the maintenance of a dedicated resuscitation area for critically ill patients. Survey data evaluating staff levels of perceived readiness to care …

Atrial Fibrillation Management In Hispanic Adults, Tania Borja

Dissertations

Background: Research has found atrial fibrillation (AF) to be the primary or a contributing cause of death on 183,321 death certificates, and an underlying cause of death for 26,535 Americans in 2019. Findings indicate an increased AF diagnosis in White people compared to racial and ethnic minorities, contrasting widespread findings of increased prevalence of cardiovascular disease and ischemic strokes in minorities. Significant disparities—by race and socioeconomic status in disease distribution and access to testing and lifesaving treatments—have been documented, specifically associated with social determinants of health (SDOH); i.e., the conditions in which people are born, grow, live, work, and age. …

Better Sleep, Brighter Mornings: A Sleep Hygiene Protocol For Older Adults As A Quality-Of-Life Enhancement, Melissa Baltazar

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to emphasize the importance of and educate patients on primary prevention techniques for sleep hygiene to use as a tool to enhance quality of life by increasing patient’s self-reported sleep quality.

Background: Sleep patterns change as we age, however, aging itself is not necessarily a cause of sleep problems. Sleep is one of the most important activities for a person’s health and overall well-being. A growing body of literature shows that not enough sleep and poor sleep quality is associated with hypertension, heart disease, stroke, diabetes, …

Implementation Of The Generalized Anxiety Disorder 2-Item Screening Tool For Adult Patients In An Underserved Outpatient Cardiology Clinic, Leila Joint

Doctor of Nursing Practice Final Manuscripts

Background: 11.7% of adults aged 18 and over have regular feelings of worry, nervousness, or anxiety. Anxiety can often present with somatic symptoms. The rates of misdiagnoses are high with symptoms often attributed to physical etiologies. Early recognition and treatment of anxiety can improve quality of life, prevent complications and reduce health care costs.

Purpose of Project: Implementation of the Generalized Anxiety Disorder 2-item (GAD-2) screening tool in a fast-paced underserved outpatient cardiology clinic for adult patients presenting with chest pain and/or palpitations without documented history of anxiety. The purpose of this project is to improve the utilization …

Treatment Evaluation Of Iron Deficiency Anemia In Women Of An Underserved Community, Bukola Olusanya

Doctor of Nursing Practice Final Manuscripts

Background/Purpose: Iron deficiency anemia (IDA) is the most common micronutrient deficiency globally. More than 20% of women experience IDA during the reproductive year. As the first-line treatment in IDA, oral iron supplement (IOS) is associated with gastrointestinal side (GI) effects, and it is often a barrier to achieving normal hemoglobin (Hb) and serum ferritin (SF) levels. Ineffective treatment fueled by a lack of guidelines increases the dilemma of dosing frequency in primary care, leads to poor quality of life, and increases the burden of anemia.

Intervention: Evidence showed that intermittent OIS is as effective as daily dosing. It is associated …

Improving Same Day Surgery Patient Outcomes Through A Nurse Practitioner Led Telephone Follow-Up Call, Jessica Cooke, Kamila Zasowska

Doctor of Nursing Practice Final Manuscripts

Background: On average, patients experience one to seven problems post-hospital discharge leading to increased unplanned emergency room visits, hospital readmission, and worse outcomes. The average cost of a single hospital admission is $15,477, an emergency room visit $1,389, and treatment for a surgical site infection $10,443-$25,546. Additionally, the Center for Medicare and Medicaid Services (CMS) imposes fines on hospital systems with high readmission rates. Currently, the Southern California hospital this project was implemented at has a 15.5% hospital-wide unplanned 30-day readmission rate with a national average of 15.2%.

Purpose: The purpose of this evidence-based practice project was to implement a …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …

Cardiology Implications Of Ed Covid-19 Patients In An Underserved Rural Health Care Environment, Pedro Colio

Dissertations

Background/Purpose: Positive COVID-19 patients with chronic comorbidities have been associated with severe cardiac complications (e.g., STEMI, NSTEMI, myocarditis, pericarditis, AF) specifically among underserved communities. Acute STEMI and NSTEMI are cardiac conditions associated with ruptured atherosclerotic plaque leading to significant myocardial injury. AF, the most common arrhythmia leading to cerebrovascular accidents, is also common in hospitalized patients with severe illnesses. Myocarditis and pericarditis are inflammatory heart conditions associated with acute viral infections. According to the literature, these cardiac issues have been linked as complications of COVID-19. COVID 19 is an emerging, complex, and costly public health challenge globally with potential lifelong …

Does Comfort Care Make You Uncomfortable? Use Of The Cares Tool For End-Of-Life Symptom Assessment And Management, Christina Covington

Doctor of Nursing Practice Final Manuscripts

Acute care nurses caring for end-of-life (EOL) patients often feel unprepared for and undereducated about this high-need population. According to current literature, many nurses lack adequate training in providing EOL care. This project aimed to improve symptom management of dying patients by providing acute care nurses education about EOL symptom assessment and medication use for symptom management. The revised Iowa model, which emphasizes clinician involvement, guided this evidence-based practice project. Sixteen acute care nurses received 30-minute in-person education, consisting of instruction in EOL symptom assessment and management via use of the CARES (comfort, airway, restlessness, emotional, self-care) tool and basic …

Enriching The Perioperative Enhanced Recovery After Surgery (Eras) Program For Patients Undergoing Whipple Procedure For Pancreatic Cancer, Natalie E. Fisher

Doctor of Nursing Practice Final Manuscripts

Pancreatic cancer remains one of the most complex and lethal diseases worldwide with surgical resection as a major treatment choice. Although surgery may be one of the only options for advanced pancreatic cancer, it is not without a lengthy hospital stay, a long list of possible postoperative complications, and an increased risk for readmission after discharge. Enhanced recovery after surgery (ERAS) programs have been implemented for years in other surgical services for cancer care. These programs have now been extended and researched to include patients undergoing surgery for pancreatic cancer. These programs are designed to assist patients and their families …

Biomarkers And Factors Related To Risk Of Acute Kidney Injury, Mary Ann David

Dissertations

Background: Acute kidney injury (AKI) is associated with increased mortality, morbidity, length of hospital stay, and in-hospital cost. Timely intervention is needed to prevent disease progression, but the delay in diagnostic process often results in delayed treatment. Recent studies show a significant increase in novel urine biomarkers (UB), TIMP-2 and IGFBP7, has been linked to an increased risk of AKI.

Objectives: The purpose of this study was to examine the relationships among participants’ sociodemographic and clinical characteristics, including select biomarkers, care management processes, treatments, and patient outcomes in a sample of hospitalized critically ill patients in southern California.

Findings: Study …

Interventional Radiology Procedures Without Sedation: The Nurse Experience, Catherine De Leon

Dissertations

Background: Many IR procedures offer a less invasive and economical alternative to some open or laparoscopic surgeries. Patients undergoing a procedure without moderate sedation are awake, alert, with heightened sensory perceptions, and vulnerable to their surroundings. There is a gap in the current body of literature relating to the IR nurse’s experience of caring for patients during procedures without the use of moderate sedation.

Purpose/Aims: The purpose of this study was to explore the lived experience of Interventional Radiology (IR) nurses caring for conscious patients undergoing a procedure without the use of sedation. This phenomenological study aimed to describe the …

Development Of A Nurse Practitioner Driven Program For Cardiology Providers To Increase Knowledge And Awareness Of Neurodevelopmental Assessment Needs In Children With Congenital Heart Defects, Michele Readman

Doctor of Nursing Practice Final Manuscripts

Children diagnosed with congenital heart defects are at increased risk for neurodevelopmental delays. Timely referral of patients to a neurodevelopmental clinic for initial evaluation and referrals to support services can improve learning outcomes, provide early intervention for neurodevelopmental disorders, and mediate factors affecting low quality of life. Nationally, a substantial proportion of pediatric cardiologists are not referring children for neurodevelopmental evaluation. A review of patient referrals to a Cardiac Neurodevelopmental Clinic within an urban children’s hospital demonstrated an opportunity to improve provider awareness and knowledge of referral recommendations. Using the Iowa Model of Evidence-Based Practice to Promote Quality Care, an …

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project, Alison Cusmano

Doctor of Nursing Practice Final Manuscripts

Hypertension is a public health issue estimated to affect 112 million adults by 2030. Primary care patients in an outpatient clinic in Southern California with elevated blood pressure readings in the office did not have an organized system for close follow-up. The purpose of this evidence-based project (EBP) was to educate patients on self-measured blood pressure monitoring (SMBP), Dietary Approaches to Stop Hypertension (DASH), diet interventions, and healthy weight loss to improve hypertension rates. Through these interventions, patients developed an understanding of their systolic and diastolic blood pressure goals. Nurse practitioners, medical assistants, and licensed vocational nurses screened for high …

Deprescribing In The Hospice Population, Who Is Eligible And Who Is Agreeable: A Quality Improvement Project, Ashlee Nicole Smith

Doctor of Nursing Practice Final Manuscripts

Current evidence recommends and supports deprescribing medications to reduce polypharmacy in the hospice population. The project aim was to determine accurate percentages of deprescribing at three time periods: before hospice admission, at hospice enrollment, and four weeks post hospice enrollment. This project was a retrospective review of the medication administration record (MAR) of patients admitted into Sharp Hospice from a Sharp Healthcare facility. Sharp Hospice, in California, USA, admitted 164 patients during August 2020. Of those, 34 patients were eligible for inclusion in this retrospective quality improvement review. Prior to discharge from a Sharp facility, the percentage of target medications …

Identifying Opportunities For Implementing Home Blood Pressure Monitoring In Newly Diagnosed Or Worsening Hypertension At A Family Health Clinic, Catherine Liikala

Doctor of Nursing Practice Final Manuscripts

Abstract

The literature is clear that the diagnosis, treatment, and plan of care for hypertension in adults should rely, at least in part, on ambulatory blood pressure. Using in-office blood pressures alone risks inaccurate measurements and can result in inappropriate treatments. Many clinics, however, do not adhere to this recommendation and will fall back on clinic readings which puts the patient at risk of mismanaged hypertension and polypharmacy. This project was formulated to identify the extent to which hypertensive patients were diagnosed and managed without the use of home blood pressure monitoring in a small local community clinic. This …

Sunscreen Use And Screening In College Athletes: An Evidence-Based Pilot Project, Nicole Brustkern Bsn, Rn, Cpn, Sharon Boothe-Kepple Phd, Msn, Fnp-C, Phn (Chickasaw)

Doctor of Nursing Practice Final Manuscripts

Background: Melanoma is the third most common cancer in individuals ages 15 – 29. The greatest risk for melanoma is ultraviolet (UV) radiation from the sun. Collegiate athletes are exposed to 1,000 more sun hours per year than the average adult, placing them at higher risk for melanoma. Evidence supports sunscreen education and screening to promote protective behaviors in young adults.

Objective: This evidence-based pilot project implements the standardized screening of sunscreen use and sun protective behaviors in women’s soccer players ages 18 to 21 years old at the University of San Diego.

Methods: The Sun Exposure and Protection Index …

Managing Pediatric Atopic Dermatitis In The Allergy Clinic: Use Of An Eczema Action Plan To Improve Caregiver Understanding And Self-Efficacy, A Pilot Study, Danielle Hubacek

Doctor of Nursing Practice Final Manuscripts

Eczema, or atopic dermatitis, is a complex and chronic condition that affects approximately 10% of children throughout the United States (Brown et al., 2018). The American Academy of Allergy Asthma & Immunology (AAAAI) (2017) estimates the average cost of eczema management for each patient is approximately $3,302 per year. The complex nature of atopic dermatitis indicates a need for individualized treatment plans. Research has shown that standardized patient teaching, written education materials, and Eczema Action Plans (EAP) reinforce patient teaching, parental understanding, and improve quality of life. This evidence-based practice (EBP) project introduces the use of a written Eczema Action …

Weight Reduction Motivation In Osteoarthritis Patients Through Nurse Practitioner Driven Education And Follow-Up: A Pilot Project, Caoilfhionn Mulvey, Martha Fuller Phd

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The ultimate goal of this short-term pilot project is for

overweight or obese osteoarthritis patients to increase their knowledge on the benefits of

weight loss and physical activity. Research shows that for every kilogram of weight lost,

2.2–4.0 kilograms of weight is taken off of the joint and could reduce joint pain up to

thirty to fifty percent and improve quality of life. Following education from the provider,

patients will understand the correlation of osteoarthritis symptom management with

weight loss.

EBP Model/Frameworks: This project utilizes the Iowa Model of Evidence-Based

Practice to Promote Quality Care. This addresses …

Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel

Doctor of Nursing Practice Final Manuscripts

Abstract

Background

Congenital heart disease (CHD) is the most common birth defect and affects almost 1% of all live births. Treatment anxiety is common among children with CHD who undergo multiple procedures early in their lifetime. Dramatically increased life spans for this cardiac population has led to a shift from focusing on survival to their long-term health outcomes.

Methods:

Administration of the Peds QL Cardiac Module 3.0 assesses health related quality of life (HRQOL) during annual visits to a Cardiac Neurodevelopmental (ND) Clinic by evaluating the level of Treatment Anxiety a patient experiences during healthcare appointments. The questionnaire scores are …

Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht

Doctor of Nursing Practice Final Manuscripts

Advanced Care Planning (ACP) is an essential part of providing adequate care in the primary care setting. Discussing end of life with patients can be a tedious and uncomfortable conversation for many providers, however, its continued avoidance contributes to the stigma of end of life care and may also result in significant healthcare cost expenditure with the use of unwanted invasive treatments. All providers should engage in consistent advanced care planning in order to improve patient and provider communication, improve patient satisfaction, increase advanced directives on file, reduce the stigma of the topic, and improve quality of life.

Improving Identification Of Seniors At Risk Tool Adherence To Identify Emergency Department Readmissions In Older Adults, Joy Gao

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project (EBP) is to improve the emergency department (E.D.) staff adherence in completing the Identifying Seniors at Risk (ISAR) screening tool. The specific aim is to improve electronic health record (EHR) data collection to enhance the identification of older adults that are frequent utilizers of the E.D. at a local community hospital in Southern California. Based upon the most recent National Hospital Ambulatory Medical Care Survey, patients ages 65 and older make up 32% of all E.D. admissions. These patients also represent 50% of the moderate to severely ill patients seen in the E.D. …

Efficacy Of Telehealth Modalities In Medication Adherence For Older Adults, Mitchell Adrian C. Siy

Doctor of Nursing Practice Final Manuscripts

About half of the geriatric population who take at least one medication find medication adherence challenging. Average adherence of an elderly patient taking one medication a day is about 80%. This adherence decreases to about 50% for patients taking medications four times a day. Nonadherence can lead to a myriad of preventable adverse effects that can reduce the quality of life and even result in death. In the United States, $100-300 billion could be saved in health care costs due to adverse effects of poor medication adherence. The purpose of this evidence-based project (EBP) is to improve medication adherence in …

Impact Of Psychotropic Medications On Electrical Cardiac Conduction In The Emergency Department: A Best Practice Review, Juliann Hatt

Doctor of Nursing Practice Final Manuscripts

Abstract Background: The effects of psychotropic drugs on cardiac repolarization have increasingly gained attention in research and clinical practice over the last 2 decades. The absolute risk of cardiac arrhythmia, such as the polymorphic ventricular tachycardia, Torsades de Pointes (TdP), is low (14 per 10,000 patients/year) and sudden cardiac death as a consequence of all cardiac arrhythmias is less frequent (Braillon et al., 2017). TdP can occur at therapeutic doses of second-generation antipsychotics and antidepressants and with a corrected Q-T (QTc) interval >500 ms. Many psychotropic medications can delay cardiac repolarization thereby producing prolonged QTc in the electrocardiogram (ECG). Emergency …

Chronic Pain, Sleep Disruption, And Work Performance In The Military, Jeffrey Ransom

Dissertations

Abstract

Background and Significance: Managing pain is a challenge for many organizations, including the U.S. military. The added complication of managing sleep disruption compounds the issue. Examining pain and sleep disruption in the context of work performance within the military is critical to understanding the impact of these conditions on our nation’s fighting forces.

Purpose: Examine the associations of chronic pain and sleep disruption in the context of work performance among active duty military service members.

Research Aims: 1) Describe sociodemographic characteristics, military service characteristics, clinical characteristics, and work performance of active duty service members, 2) Examine relationships between these …

Utilization Of Evidence-Based Telehealth For Routine Follow-Up Visits In Outpatient Palliative Care, Nienke Sahelijo Bsn, Rn, Dnp-Fnp Student, Kori Fitzgerald Dnp, Fnp-C, Joseph F. Burkard Dncs, Crna

Doctor of Nursing Practice Final Manuscripts

Objectives: Palliative care services constitute a vital part of the oncology treatment plan. Much of the suffering associated directly with cancer itself or as a result of treatments can be mitigated with the early incorporation of palliative services. Unfortunately, access to palliative care remains elusive due to a lack of qualified providers. This evidence-based project was implemented in an effort to address gaps in care for advanced cancer patients. The goal was to provide telehealth visits for follow-up of stable patients to manage symptoms and psychosocial challenges with equivalent or improved satisfaction as compared to their last in-office visit …

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and represents a …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Optimizing Dry Skin Management Utilizing Np Led Phone Follow-Up, Christine Vazquez Bsn, Rn, Dnp - Fnp/Agnp Student

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project is to evaluate the impact of a healthcare provider-led standardized dry skin protocol for outpatient geriatric patients to promote overall well-being and improve quality of life.

Background: Current literature supports using the dry skin protocol to help primary care teams identify patients that require xerosis cutis skin care, particularly of the lower extremities. The primary focus of this project will be timely detection of patients with the dry skin condition that will be identified with the standardized Overall Dry Skin (ODS) scale. When the patient meets the ODS criteria, a timely discussion will be …

Skin And Soft Tissue Infections In The Emergency Department, Nicole Martinez

Dissertations

Background/Purpose: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.

Theoretical/Conceptual Framework: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus …