Nursing Commons^™

Improving Adolescent Risk Assessment And Provider Follow-Up In Primary Care, Darby R. Disselkoen

Doctoral Projects

Purpose: The purpose of this quality improvement project was to improve preventive care for adolescent patients by implementing standardized, routine screening for risk-taking behaviors and improving provider response to identified risks using the Rapid Assessment for Adolescent Preventive Services tool and resources for providers to reference during discussions about risk.

Methods: Quality improvement methodology was utilized at a midwestern pediatric primary care office to implement a practice workflow for staff to follow during annual, adolescent wellchild exams beginning at age thirteen.

Results: Analysis of project results demonstrated a significant increase in routine screening for adolescent risk behaviors compared to the …

Evaluation Of A Chewing Gum Protocol For Postoperative Spinal Patients, Lauren E. Vachon

Doctoral Projects

Aims and objectives: The purpose of this project was to evaluate if the implementation of a chewing gum protocol improved bowel motility, decreased ileus rate, length of stay, bowel and pain medication use, and hospital costs in post-surgical spinal patients in a suburban hospital.

Background: Postoperative bowel dysfunction is a major source of health problems, including abdominal pain, ileus, increased length of stay, pain medication use, and healthcare costs.

Design: Retrospective cohort study with a focus on program evaluation of the previously implemented chewing gum protocol. An audit of the electronic health record compared outcomes in patients five months before …

A Budget Impact Analysis Of A Tobacco Control Program In A Community Mental Health Clinic, Thuy-Nhi Nguyen

Doctoral Projects

Objectives: This project evaluation aimed to determine if the tobacco cessation program, American Lung Association’s Freedom From Smoking (ALAFFS), within the designated community mental health organization (CMHO) is affordable and sustainable through a budget impact analysis.

Methods: The study modeled the impacts on the costs of facilitator training, staff salaries/time, program workbooks, program supplies, bus passes, and other supplies and materials. The Medicaid reimbursement rate used for tobacco cessation group therapy was included. The budget impact analysis projected financial consequences of the presence of training costs and number of smokers with severe mental illness who attended the program.

Results: The …

Improving The Screening And Care Of Hospitalized Adults With Obstructive Sleep Apnea Through Standardized Workflow Processes, Elizabeth Henschel

Doctoral Projects

BACKGROUND: Adults can be screened for obstructive sleep apnea in acute care settings using the validated STOP-BANG questionnaire. Healthcare providers can treat patients with confirmed or suspected obstructive sleep apnea to reduce risk for complications during hospitalization or after surgery.

PURPOSE/ RELEVANCE TO HEALTHCARE QUALITY: To determine if the standardization of obstructive sleep apnea screening and patient care workflows improves process efficiency saving nursing time and healthcare expenses.

METHODS: Quality improvement project included an organizational assessment of healthcare system setting to define clinical problem; determined appropriate evidence-based interventions; and implemented strategies guided by quality improvement models.

INTERVENTION: Updated inpatient units …

Utilization Of Home Blood Pressure Monitoring In Adult Patients With Hypertension, Justin R. Crow

Doctoral Projects

Hypertension is one of the most prevalent conditions in the United States, affecting roughly 45% of adults in the country (Centers for Disease Control and Prevention [CDC], 2020). The CDC (2020) reports that only an estimated 24% of patients have controlled blood pressure, which is defined as blood pressure less than 130/80 mm Hg. In 2017, the American Heart Association (AHA) and American College of Cardiology (ACC) released a comprehensive set of guidelines that aimed to assist providers with hypertension management. The Measure Accurately, Act Rapidly, and Partner with Patients (MAP) protocol was formulated as an evidence-based strategy to improve …

Addressing Social Determinants Of Health In Community-Based Palliative Care, Mary D. Chenge

Doctoral Projects

Background and Objectives: Addressing social determinants of health (SDOH) in the medical community has recently started; however, there is yet to be a standardized format for addressing the social needs of patients. Consequently, a protocol was developed to address SDOH to increase screening rates, social work referrals, and capture depression reimbursement.

Methods: The quality improvement project was implemented using the Plan-Do-Study-Act framework at an urban Community-Based Palliative Care organization in the Midwestern United States. Participants included office staff and 140 patients (two separate sets of 70 randomly selected patients pre/post-implementation). A protocol was developed for screening 11 SDOH using an …

Improving Handover Process For Stroke Patients Transferring From Emergency Department To Interventional Radiology: A Quality Improvement Project, Megan Buchman

Doctoral Projects

Background: A standardized handover process is needed for stroke patients transferring from the Emergency Department to Interventional Radiology.

Local Problem: Emergency Department and Interventional Radiology had different handover processes.

Methods: A quality improvement project was conducted in a large Magnet® designated midwestern health system. Participants included emergency department and interventional radiology nurses and stroke patients. Pre/post-quality and post implementation measures were obtained.

Interventions: The interventions included utilizing a standardized handover tool between departments, calling report prior to patient transfer, and turning in handover tool following stroke case to ensure compliance. Two cycles of the Plan-Do-Study-Act Cycle were completed.

Results: No …

“Warm Handoff” To Increase Enrollment In A Maternal Infant Health Program, Samantha Worthem

Doctoral Projects

Introduction: In a Midwest Health Department’s (HD) Maternal Infant Health Program (MIHP), infant death rate has been on a steady incline at 4.8 deaths per 1,000 in 2019 (Michigan Department of Community Health, 2020). Implementation of a “warm handoff” between the local HD and Michigan Department of Health and Human Services (MDHHS) was created to increase enrollment and visits. During warm handoffs, health care providers work together within the same setting to provide evaluation and care to patients and clients (Musselman et al., 2018).

Methods: This program evaluation reviewed data retrospectively from March 31 to September 30, for 2019 and …

Enteral Nutrition Protocol For Pediatric Burn Patients: A Quality Improvement Initiative, Margaret Tepe

Doctoral Projects

Objective: This quality improvement project was conducted to determine the efficacy of an enteral feeding protocol to improve nutrition supplementation in pediatric burn patients.

Methods: Non-ICU patients with >10% total burn surface area requiring enteral nutrition supplementation were fed within 12 hours of admission or with the first sedated dressing change, whichever took place first. Pre (n = 3) and post (n = 5) implementation of the enteral feeding protocol data were obtained. Data were collected via chart audit and survey.

Results: Patients and nurses had similar characteristics; and nurses had similar nutrition practices. Total intake of calories (93.8%) and …

Evaluating The Impact Of Nurse Server Standardization On Patient Safety, Megan L. Priebe

Doctoral Projects

Aim: The aims of nurse server (supplies at bedside) standardization program evaluation were to: (1) examine supply costs; (2) identify staff efficiency; (3) evaluate patient safety; (4) identify staff satisfaction and acceptance.

Background: A healthcare facility in the Midwest implemented standardization of the nurse server. Standardization was done to improve patient safety and staff efficiency

Methods: The literature provided metrics for evaluating standardized nurse servers to determine the impact on patient safety. Specific measures used in this quality improvement project were: census data, costs analysis, supply room observations, semi-structured interviews, and data from the VOICE reporting system (system for adverse …

Improving Care Coordination For The Homeless Population Using Systematic Quality Improvement, Rutendo Nyasvisvo

Doctoral Projects

Background and Objectives: Care coordination for the homeless population is challenging due to the complexity of healthcare and the uncertain life circumstances of the homeless individual. Objectives were developed to guide care coordination for the homeless by utilization of the free clinic to create PCP referrals, appointments and tracking follow-up care to increase appointment attendance and improve health outcomes for the homeless individual.

Design: A quality improvement project.

Setting: A faith-based non-profit homeless shelter organization in the Midwestern United States.

Participants: Participants include 25 homeless guests, 5 staff members including a clinic coordinator, 3 registered nurses and 1 licensed practical …

Enhancing Medication Adherence Behaviors Among Ambulatory Pediatric Hematology & Oncology Patients: A Quality Improvement Project, Desiree Palmer

Doctoral Projects

Introduction: Researchers have found that pediatric patients with acute lymphoblastic leukemia and adolescent patients with sickle cell disease struggle to adhere to medication treatment requirements. Because of this trend, there is a clear need to address medication adherence. The purpose of this quality improvement project was to enhance medication adherence behaviors among pediatric hematology and oncology patients and their families within an ambulatory hematology and oncology clinic.

Methods: The project included a systematic literature review to identify evidence-based interventions, an organizational assessment, and a three-phase multifaceted quality improvement process. To increase patients bringing medications to appointments, 32 medication transportation bags …

Utilizing Educational Materials To Change Vaccine Compliance In Children Under 24 Months Of Age, Kelsey M. Arnold

Doctoral Projects

Background: Childhood vaccinations are critical to preventative care for the pediatric population. The goal for the clinic’s combination 10 insurance quality measure, which reflects the number of fully vaccinated children by 24 months of age, is to be greater than 68%.

Purpose: This quality improvement project sought to implement evidence-based interventions to improve childhood vaccine compliance by increasing the parent/caregiver’s knowledge about vaccines and increasing the communication with their healthcare provider.

Methods: A parent friendly vaccine schedule, information pamphlet, interactive video, and survey were given to parents/caregivers during well-child visits. A total of 117 parent/caregiver surveys were collected. Vaccine compliance …

Sickle Cell Disease: Development Of An Acute Pain Management Program In A Hematology/Oncology Practice, Elizabeth Pohl

Doctoral Projects

Background: Patients with sickle cell disease experience can experience acute episodes of severe pain that require prompt pain medication. Treating uncomplicated, acute sickle cell disease pain in the emergency department setting has been shown to be costly and lead to higher rates of hospitalization than similar care in a dedicated outpatient setting.

Objectives: The aim of this article is to outline the program development efforts undertaken to apply current literature findings and evidence-based practice guidelines to create a program development toolkit and business plan for a sickle cell disease acute pain management program in an outpatient hematology practice.

Methods: A …

Creating Equal Opportunities Through Developmental Screening At A Rural Health Clinic, Allison Honderd

Doctoral Projects

Background: 17% of United States children have a developmental delay, but only 2-3% receive early intervention referrals (Rice et al., 2014; Zablotsky et al., 2019). Standardized developmental screening improves developmental delay identification and early intervention referrals (Guervara et al., 2013; Lipkin et al., 2020).

Objectives: This project aimed to implement standardized developmental screening, refer positive screenings, and generate revenue through proper billing.

Methods: A 12-week quality improvement project was implemented with the M-CHAT and Ages and Stages Questionnaire (ASQ) through four PDSA cycles at a rural health clinic for 9, 18, and 24-month well-child checks. Data were analyzed through a …

Program Evaluation Of Parent Engagement Activities In The Pediatric Cardiac Intensive Care Unit, Cheryl A. Bos

Doctoral Projects

Introduction: Leaders of a six-bed pediatric cardiac critical care unit identified the need to evaluate family engagement in patient care activities prior to implementing quality improvement initiatives. This program evaluation identified staff and family perception of barriers and facilitators to parent engagement in the Pediatric Cardiac Intensive Care Unit.

Methods: Data were collected through quantitative and qualitative methods. Surveys collected staff baseline and parent pre-/post-hospital perception of the role of family engagement in caring for the child.

Results: The Questionnaire of Factors That Influence Family Engagement survey of 58 registered nurses indicated the nurse workflow (τb = .579, p = …

A Standardized Unit Based Process For Obtaining Heart Failure Patient Weights, Lesli E. Teed

Master's Projects

Introduction: A CNL student-led process improvement process improvement project was proposed to help improve the accuracy of Heart Failure patient weights on a geriatric specialty unit. Cardiology voiced a preference for patients to be weighed using electronic standing scales rather than in-bed scales to improve accuracy. A literature review revealed that in-bed scale weights were less accurate due to inconsistencies in zeroing the bed prior to obtaining the weight, not removing excess patient care equipment and bed linens, and not ensuring that the patient was wearing a minimal amount of clothing.

Methods: Electronic standing scales were purchased, current practice state …

Implementing Purposeful Rounding As A Quality Improvement Project To Improve Patient Satisfaction In The Emergency Department, Kersten O'Brien

Master's Projects

Purpose: The purpose of this paper is to describe a quality improvement project to develop and implement a purposeful rounding protocol to improve patient satisfaction and call light rates which affect both patient and nursing staff satisfaction in the emergency department (ED). Importantly, patient satisfaction scores in the ED tend to be low but high scores are related to improved competitive advantage, reimbursement rate, patient outcomes, and nursing staff interruptions.

Methods: A literature review was conducted to determine best practices. Using the lean process and the Plan-Do-Study-Act (PDSA) model, this information was used to identify opportunities for improvement and to …

Advance Care Planning Barriers For Young Adults, Emily K. Songer

Honors Projects

According to the CDC, 40.6% of young adult deaths occur from unintentional injuries, which is the leading cause of death for this age group (Heron, 2019). When accidents occur, they sometimes result in a loss of the ability to make medical decisions, and young adults most likely have never had the opportunity state their wishes regarding their medical care. This is why advance care planning is important, because it allows the opportunity to express those desires before it is too late. Many people often confuse advance care planning as a process that is only needed for the elderly and those …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

Video Education For Improved Education Of Newly Diagnosed Multiple Sclerosis Patients, Theresa Mccrumb

Doctoral Projects

Anxiety and depression are prevalent in multiple sclerosis (MS) patients, especially those newly diagnosed. Receiving a diagnosis of MS can be overwhelming and impact patients in multiple areas including physical issues, cognitive changes and anxiety and depression (Kantor, Bright & Burtchell, 2017). This anxiety and depression can cause patients to be less engaged in their plan of care and thereby reduce their quality of life (Rieckmann, et al., 2015). According to the Multiple Sclerosis Association of America (MSAA), four of 10 MS patients are diagnosed with depression and anxiety, with the highest incidence at diagnosis (Multiple Sclerosis Association of America, …

Insight Into Student Perceptions Of Lgbtqia+ Content Inclusion In Bsn Education, Kenny Sullivan, Jae Basiliere

Honors Projects

Previous research has indicated that LGBTQIA+ clients continue to receive discriminatory care from healthcare professionals. Undergraduate nursing students (n = 24) completed a survey inquiring about their perceptions of knowledge of this vulnerable population, their preparedness to provide care, and the education they received from their BSN program. Twenty-two students’ responses, 91.67%, indicate a need for further education on the provision of care to LGBTQIA+ patients. These students demonstrated discrepancies in their perceptions and the application of their knowledge. As such, nursing programs should begin to consider providing more thorough education on this vulnerable population to prepare student nurses with …

Evidence-Based Policy And Procedure Review System, Meredith A. Stokes

Doctoral Projects

Policies and procedures guide practice and the care of patients in every field of healthcare. Incorporating best practice evidence into clinical practice is a critical step towards providing safer patient care and improved patient outcomes. The challenge has been finding a way to incorporate best practice evidence into policies and procedures. Accordingly, an evidence-based project to answer the following clinical practice question was proposed: What is an evidence-based strategy for reviewing, updating, and disseminating policies and procedures for office staff at a cancer treatment organization? Through the use of Donabedian’s Model for Quality Improvement, student created tools, and an evidence-based …

Psychological Distress In General Undergraduate Students And Baccalaureate Nursing Students, Kersten O'Brien

Student Scholars Day Posters

Background/Significance: Psychological distress in undergraduate college students is a significant concern in the U.S. Many stressors, such as academics and finances, are associated with high levels of reported stress, depression and anxiety. Nursing students face additional stressors, such as meeting program requirements, practicing in clinical environments and preparing for their licensure exam.

Purpose: The purpose of this review is to describe psychological distress levels in baccalaureate nursing students compared to general undergraduate students and what interventions help relieve student distress.

Methods: A literature review was conducted using CINAHL and PubMed databases.

Findings: While general undergraduate college students report high psychological …

Recruitment Strategies For Cognitively Impaired Older Adults In Assisted Living Communities, Paige Greer, Elizabeth Hill, Katelyn Ware

Student Scholars Day Posters

It is well documented that recruiting persons with dementia for research in long term care settings is challenging (Lam, et. al. 2018). The purpose of this study is to explore recruitment techniques suggested by the National Institute on Aging (2018), including the use of brochures, community contact introductions (CCI), presentations, event tables, 1:1 interactions and activity events. We examined the success of each method of recruitment in two recruitment waves based on the number recruited in relation to the number of hours spent on that recruitment method. Of the 119 people that were screened, 47% were enrolled in the study. …

The Impact Of Study Abroad On Cultural Competence, Megan Minix

Student Scholars Day Posters

No abstract provided.

Exploration Of The Effectiveness Of Naprotechnology In Women’S Healthcare, Cecilia Cerven

Student Scholars Day Posters

Many women today struggle with abnormal menstrual cycles and the painful symptoms of reproductive disorders. The standard approach to treatment of irregular menses, PCOS, endometriosis, hormonal abnormalities, PMS, and other conditions is the prescription of a pill for symptom management. A relatively new and innovative method to fertility care is drawing the attention of healthcare providers and prospective clients alike, which offers an alternative approach. NaProTechnology, or Natural Procreative Technology, works with Fertility Awareness-Based Methods (FABMs) to detect and treat various reproductive disorders. This project will assist in bridging the gaps in education and overall awareness of treatment options available …

Safe Sleep, Jenna Czart

Student Scholars Day Posters

Many parents and healthcare providers are either unsure of safe sleep practices or fail to implement them. This presentation will display safe sleep guidelines that are recommended by the American Academy of Pediatrics.

The Healing Power Of Music, Kathleen Szczesny

Student Scholars Day Posters

The value of holistic and individualized care in honoring a patient’s story and promoting their quality of life is of the highest importance when providing nursing care. Nursing is more than just a profession, it is an art that is consistently changing and adapting, requiring critical and creative thinking to deliver high quality, safe care that is evidenced-based. Nurses must continuously seek innovative ways to enrich lives and enhance the healing process through interventions strongly supported by research. The purpose of this project was to explore music as an alternative form of medicine that can be utilized as a therapeutic …

The Significance Of Transient Elastography In The Prevention And Early Detection For Individuals With Nonalcoholic Fatty Liver Disease (Nafld), Emmalee Peck

Student Scholars Day Posters

Early detection and intervention are key to reverse Nonalcoholic Fatty Liver Disease (NAFLD). Newer imaging modalities such as the transient elastography (FibroScan) is a method in which healthcare providers can detect fibrosis and cirrhosis, as measured by the amount of liver stiffness, in individuals with NAFLD. The purpose of this review was to synthesize the literature comparing transient elastography to invasive and noninvasive diagnostic techniques for the detection of liver fibrosis in people with NAFLD. Thirty articles met the inclusion criteria and were included in this review. Overall, transient elastography was found to be a sufficient tool in conjunction and …