Nursing Commons^™

Implementation Of The Blunt Tip Cannula For Dermal Fillers To Decrease Adverse Events Intra And Post Treatment, Natalie Drone

Doctor of Nursing Practice Final Manuscripts

Abstract Title: Decreasing Adverse Events by Implementing Blunt Tip Cannula in the Administration of Dermal Fillers Intra and Post Treatment

Background: Dermal filler administration has become one of the most popular cosmetic procedures since dermal fillers were FDA approved in 1981. Although decreasing adverse events in dermal filler administration is a primary concern, aesthetic providers strive to provide patients with the most comfortable treatment experience possible without compromising aesthetic outcomes. Evidence has suggested that blunt tip cannulas provide a more comfortable delivery of dermal fillers and a lower risk of adverse events when compared with the standard practice …

Effects Of Telephone Follow-Up On Medication Adherence And Rapid Readmission Among Discharged Adults With Schizophrenia Spectrum Disorders (Ssds), Romilynn Danko, Madalyn Cosensci

Doctor of Nursing Practice Final Manuscripts

High rates of 30-day readmission after acute care discharge are a big concern for patients with psychiatric disorders. These high rates not only reflect poor patient outcomes, but also result in higher hospital costs. For adults with schizophrenia spectrum disorders (SSDs), a review of current research shows that non-adherence to medication has been significantly associated with rapid readmissions and that using an intervention such as follow-up telephone calls after discharge can help prevent readmission through increased medication adherence. Using the Iowa model framework as a guide, the purpose of this evidence-based practice project was to pilot a post discharge procedure …

Fall Risk Assessment And Intervention To Reduce Fall-Related Injuries And Hospitalization In Older Adults, Pittawat Emerson

Doctor of Nursing Practice Final Manuscripts

Falls among older adults is a major issue that has become a leading cause of injuries and deaths. This study is an evaluation of fall-risk assessment using the Stopping Elderly Accidents, Deaths & Injuries (STEADI) tool and physical activity intervention in older adults aged 65 and above during their annual wellness visits to reduce fall-related injuries and hospitalizations. The results showed a reduction of fall-related injuries by up to 11.8% after the 12-week intervention. Patients with moderate-to-high fall risk saw a decrease in injury by 12.9%. Patients with moderate-to-high fall risk scores saw a decrease by 12.9%, from 25.9% to …

The Power Of Proactive Referrals: An Evidence-Based Practice Project To Improve Smoking Cessation Rates At A Community Health Clinic, Kristin Mcmahon

Doctor of Nursing Practice Final Manuscripts

Tobacco use is the leading cause of preventable morbidity and mortality in the United States today. Twenty percent of adults in the United States use tobacco costing the healthcare system approximately $225 billion annually in disease treatment. Most smokers want to stop smoking and most visit a healthcare provider each year making access to cessation interventions feasible. The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to increase smoking cessation among patients at a community health clinic by proactively linking patients to cessation counseling and support through implementation of the Ask-Advise-Connect model of smoking cessation. During …

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 …

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 …

Evaluating The Effectiveness Of Education On The Misuse Of Corticosteroids And Antibiotics For Treatment Of Acute Pharyngitis, Samantha Kaikai

Doctor of Nursing Practice Final Manuscripts

Purpose: This evidence-based practice (EBP) project aims to pilot a nurse practitioner-driven education utilizing the American Family Physician guideline (AFP) “IDSA Updates Guideline for Managing Group A Streptococcal Pharyngitis.” Acute pharyngitis is a frequently observed condition in outpatient clinics, but its optimal management continues to be of concern due to the overuse of antibiotics and corticosteroid treatments. The AFP Guidelines for acute pharyngitis include using the Centor criteria to guide the plan of care and the evidence-based antibiotic therapy for patients who score >4 on the Centor criteria or test positive for the rapid point of care testing.

Background: In …

Forestalling: Decreasing Super-Utilizers In The Emergency Department Using Case Management Strategies, Kelly Chambers, Megan Gilmartin, Martha Narasimhan-Narayanan

Doctor of Nursing Practice Final Manuscripts

In 2019, it was estimated there were 18 million avoidable emergency department (ED) visits, totaling $32 billion in unnecessary healthcare spending. Super-utilizers (SU), individuals that seek care in the ED 3 or more times per year, account for a disproportionately large segment of healthcare consumption and costs. These patients inefficiently access the healthcare system and often fail to get the follow-up care that could prevent them from repeat ED visits.

This evidence-based project aimed to reduce unnecessary ED visits by at least 25% annually and have no use of the ED during the intervention period, by implementing social and medical …

Prediabetes Education To Prevent The Progression To Type 2 Diabetes, Peggy Mata

Doctor of Nursing Practice Final Manuscripts

This Evidenced-Based Project (EBP) aimed to decrease the incidence of patients diagnosed with prediabetes converting to Type 2 diabetes. By utilizing the Diabetes Self-Management Education and Support (DSMES) program, the project will enhance patient knowledge of diabetes and self-care practices. Education in patients diagnosed with prediabetes in a small community clinic in Tijuana, Mexico.

Background: The American Diabetes Association (ADA) recommends that patients diagnosed with prediabetes attend Diabetes Self-Management Education and Support (DSMES) classes. DSMES focuses on the lifestyle management of diabetes, and it facilitates knowledge, skills, and abilities necessary for optimal self-care. The focus is on supporting patient empowerment …

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 …

Implementation Of The Edinburgh Postpartum Depression Screening Tool To Screen Mothers For Postpartum Depression In The Pediatric Setting, Vera Nikolaychuk

Doctor of Nursing Practice Final Manuscripts

Postpartum depression (PPD) is a mood disorder affecting mothers after childbirth. Research estimates that approximately 11%-18% of mothers in the United States and one in seven women in California suffer from perinatal mood and anxiety disorder (PMAD) such as postpartum depression. Untreated postpartum depression not only costs United States billions of dollars in healthcare expenditure annually, but also leads to health complications for both mother and baby. The American Academy of Pediatrics (AAP) recommends screening for PPD at 1-,2-,4-, and 6- month well visits. A screening and referral program were implemented in a pediatric setting to identify mothers at risk …

Implementation Of Nola Pender’S “Clinical Assessment For Health Promotion Plan” To Increase Patient Self-Efficacy, Weight Loss And Health Promoting Behaviors Such As Improving Nutrition And Increased Physical Activity In Obese Women In A Weight Loss Clinic, Christine Ngwazini

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to review research-based studies on Nola Pender’s Health Promotion Model for weight loss and implement the evidence. The goal was to increase patient self-efficacy, weight-loss, and health promoting behaviors such as improved nutrition and increased physical activity among obese women in a weight loss clinic.

Background: Obesity leads to an increased risk of heart disease, stroke, type 2 diabetes, cancer, and premature death (CDC, 2020). From 2016 to 2017, 42.4% of people in the United States were obese (2020). Worldwide, over 650 million people were obese …

Screening People Experiencing Homelessness For Adverse Childhood Events (Aces), Priya Vishwanath

Doctor of Nursing Practice Final Manuscripts

The purpose of this project was to implement a screening tool identifying patients who have four or more Adverse Childhood Events (ACEs) and connecting them to resources to build protective resilience. Stress during the developmental years can lead to preventable health conditions that are costly and impede quality of life. Nine out of the ten leading causes of death are ACE related illnesses. These are caused by complications of toxic stress syndrome. During a 7-month period, 138 patients were screened; 45% had ACEs of four or more.

Smiling Mind: A Mobile Based Application To Reduce Stress, Agnes Rodrigues

Doctor of Nursing Practice Final Manuscripts

It has been recognized healthcare professionals experience high levels of stress at work with many working in environments characterized by high productivity targets, overtime, customer aggression, continuous organizational changes, and employee shortages. Mindfulness-based interventions such as mobile based meditation applications have gained popularity in the workplace given their potential benefits in decreasing workplace related stress, their ease of use, and cost-effectiveness. The purpose of this evidence based project (EBP) project was to reduce perceived workplace stress and to increase mindfulness using a mobile meditation application. Employees of an outpatient psychiatric clinic used the mobile meditation application Smiling Mind to meditate …

Screening For Childbirth-Related Posttraumatic Stress Disorder Using The City Birth Trauma Scale: A Pilot Project, Meredith Kazato

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project is to identify birthing people with childbirth-related posttraumatic stress disorder (CB-PTSD) symptoms using the City Birth Trauma Scale (CBTS). Once identified, at risk birthing people will receive verbal education about CB-PTSD and a social work consultation, if necessary.

Background: A birth is deemed traumatic, and thus fulfills one of eight criteria of posttraumatic stress disorder (PTSD), when during labor, delivery, and/or immediately postpartum, the birthing person perceives themselves and/or their baby’s life to be in danger and/or are at risk of being critically injured. These events include but are not limited to emergency cesarean …

Implementation Of Surgical Education Video To Burn Patients Before The Informed Consent Process, Brian Piatkowski

Doctor of Nursing Practice Final Manuscripts

Purpose: Before the initiation of this evidence-based Doctor of Nursing Practice (DNP) project, a systematic review of literature set forth by other researchers regarding the informed consent process was done. The literature showed patient satisfaction scores increased, while anxiety decreased regarding surgical procedures after using a multimedia educational tool. The first goal of the project was to determine any gaps in knowledge of the burn surgical patient population. The second goal of the project was to determine gaps in knowledge and comfort levels with providers obtaining informed consent. The third goal was to determine the efficacy of implementing a surgical …

Improved Monitoring Of Depression And Suicidal Ideation In Low-Income Adolescents Through Evidenced Based Provider Education, Sunday Adeyeye

Doctor of Nursing Practice Final Manuscripts

Background: Adolescents from low-income status experience more prevalent thoughts of suicide than their financially secure peers. Nearly 15% considered taking their own life. Suicidal ideation among adolescents in California ranges from 4% to 67%. Depression and suicidal thoughts are underdiagnosed among adolescents, with higher disparities among minority and lower socioeconomic backgrounds.

Purpose: This project involved consistent screening of high-risk adolescents for potential depression and suicidal ideation using a patient health questionnaire recommended by the U.S. Preventive Services Task Force screening.

Process: This project involved adolescents 12–18 years old who had visited a federally qualified healthcare center in San Bernardino, California. …

Increasing Covid-19 Vaccine Awareness Among Hispanic Families: A Policy Perspective, Allison Chico, Iris Vazquez, Claudia Aguayo, Jose Andres Rozo

Doctor of Nursing Practice Final Manuscripts

COVID-19 disproportionally affected Hispanic/Latinx populations exacerbating systemic health inequities. In San Diego County, 44.7% of COVID-19 cases are among Hispanic/Latinxs compared to 31.1% Whites. Community-centered, culturally tailored vaccine programs are essential to close the gap in COVID-19 disparities. This health policy project aimed to explore barriers to COVID-19 vaccination across Hispanics/Latinx in San Diego, communicate findings and seek assistance from elected officials, and collaborate with a community-based organization to provide vaccines utilizing the PRECEDE-PROCEED model. Our project utilized a multicomponent approach. We conducted a screening of 200 participants to identify common barriers for vaccine hesitancy among Hispanics/Latinx individuals across San …

Increasing Mental Health Literacy In The Black Church, Jonathan Allotey

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project was to increase mental health literacy, assess stigmatizing attitudes, and increase help seeking behavior in leadership within an African American church.

Background: The Black church has historically been a central institution for community support and leadership within these churches are often ill equipped to address the mental health needs of congregants. African Americans underutilize mental health services and are reported to have more chronic mental illnesses. Lack of mental health literacy may result in difficulty recognizing the risk factors, signs, symptoms, and treatments related to specific mental illnesses.

Evidence Based Intervention and Methods: Participating …

Lifestyle Modification Interventions On Hemoglobin A1c Level In Patients With Type Ii Diabetes Mellitus In An Underserved Community: A Pilot Project, Anniesatu Newland

Doctor of Nursing Practice Final Manuscripts

Type 2 diabetes mellitus (T2DM) is a pandemic of great concern among the nutrition-related non-communicable diseases. Its prevalence is mounting worldwide, particularly in underserved communities and minority groups. In 2019, 463 million people were diagnosed with T2DM, a number expected to increase to 578 million by 2030 globally. The prevalence of T2DM is increasing the mortality rate from cardiovascular complications. The social and health costs of treating this disease is currently 11% of the global health budget. This project aims to utilize an evidence-based approach to assess lifestyle interventions' effectiveness at decreasing the Hemoglobin A1c levels in T2DM individuals after …

Physician Orders For Life-Sustaining Treatment (Polst) Forms In A Primary Care Setting, Elena Johns

Doctor of Nursing Practice Final Manuscripts

Purpose: To increase completed POLST forms among elderly patients aged seventy-seven and older with chronic/debilitating illnesses, by at least 50% in a Primary Care clinic setting, from September 2021 to January 2022. Background: The government pays for over two-thirds of healthcare costs for the elderly aged sixty-five and older. Furthermore, by ages seventy to ninety, medical spending more than doubles. Many elderly and chronically ill patients report that they would prefer less aggressive treatment and more comfort care measures. However, patients also report a lack of knowledge about their end-of-life (EOL) wishes particularly when it comes to completing the Physicians …

Effects Of Diabetes Self-Management Education In The Primary Care Setting On Self-Efficacy And Glycosylated Hemoglobin Levels Among Adults With Type 2 Diabetes Mellitus, Colleen Harris

Doctor of Nursing Practice Final Manuscripts

Persons with uncontrolled type 2 diabetes, generally defined as having a hemoglobin A1c above target goal of 7% to 8%, have an increased risk for developing chronic diseases including renal disease, heart disease, strokes, and blindness. Lifestyle modifications play a significant role in mitigating these risks and improving glycemic control. The purpose of this evidence-based project (EBP) is to provide individualized diabetes self-management education to patients with type 2 diabetes to improve patient’s self-efficacy and glycemic control.

This EBP project is a continuation of a previously completed EBP by Nishita Patolia, DNP, FNP (2020), using wider inclusion criteria and optional …

Improving Discharge Outcomes: Telephone Follow Up For Heart Failure Patients, Ashley Fanjoy

Doctor of Nursing Practice Final Manuscripts

Congestive heart failure is one of the leading causes of hospitalization and readmission in the United States. The readmission rate at an acute care hospital in San Diego is 22%, and readmissions occur within an average of 6 days after discharge. The purpose of this pilot project is to improve discharge outcomes among heart failure patients using telephone follow up. The two objectives of this project are to reduce heart failure readmission rates over 3 months and improve patient knowledge to prevent decompensation, as rated by the Self Care of Heart Failure Index. Follow up calls were completed by the …

Improving Completion Rate Of Identifying Seniors At Risk (Isar) Screening Tool In Emergency Department (Ed) Setting, Ashley Clark

Doctor of Nursing Practice Final Manuscripts

Background: Patients age 65 and older are identified as being an at-risk population for readmissions to the hospital within 30 days. Evidence based practice has shown that completing the Identifying Seniors At Risk (ISAR) screening tool can help to identify the needs of these patients so they can age in place at home with the proper resources. The screening tool consists of 6 questions. A score of 3 or more on the ISAR is deemed high-risk and a consult with case management should be considered. The average completion rate in an emergency department was identified as being 33%. The goal …

Implementing Adverse Childhood Experience Screening In An Intensive Outpatient Mental Health Program, Bryan Amaro

Doctor of Nursing Practice Final Manuscripts

Adverse Childhood Experiences (ACES) are linked to damaging events which happen to people when we are young (0-18). ACEs are connected to a phenomenon known as the toxic stress response which can later become the root etiology for many mental health, substance abuse and chronic medical health complications our society faces. ACEs affect all populations and do not discriminate across socioeconomic, racial, ethnic, gender, or geographic lines. Roughly two thirds of Americans have experienced at least one ACE. This project seeks to perform ACE screening at an Intensive Outpatient behavioral health center by screening for ACEs upon all admissions into …

Screening For Suicide Risk In The Outpatient Electroconvulsive Therapy Population, Cerah Nagata

Doctor of Nursing Practice Final Manuscripts

TITLE: Screening for suicide risk in the outpatient electroconvulsive therapy population

BACKGROUND: Reducing risk for suicide continues to be a national hospital patient safety goal. Suicide is the 10th leading cause of death in the United States and suicide rates have increased 33% in the last decade. It has been found that 83% of those who die by suicide received healthcare services in their last year of life, thus healthcare providers are uniquely suited to play a role in identifying suicidality. The Columbia-Suicide Severity Rating Scale (C-SSRS) is a validated tool developed by Columbia University, University of Pennsylvania, and the …

Improving Vaccination Rates Through Community Partnership, Marissa Marquez

Doctor of Nursing Practice Final Manuscripts

IMPROVING VACCINATION RATES THROUGH COMMUNITY PARTNERSHIP

by

Marissa Marquez, DNP Student, FNP-C, MSN, MBA, RN, BSN

Clinical Mentor: Jill Milton, MSN, FNP-C

Joseph Burkard, DNSc, CRNA, AACN Health Policy Fellow

Purpose: The purpose of the quality improvement project is to improve the vaccination rates and vaccine series completion rates of school age children at Rosa Parks Elementary school through a targeted educational intervention.

Background: Under immunization among school-aged children is an ongoing challenge. Low rates of immunization can cause outbreaks of communicable disease, leading to preventable injury, loss of life, and burden to the healthcare system. Among other …

Identifying Elderly Patients At High Risk For Post-Operative Cognitive Dysfunction: A Clinical Perspective, Kelly Glas

Doctor of Nursing Practice Final Manuscripts

Background: The U.S. Census Bureau projects the number of Americans age 65 years and older will more than double between 2010 and 2050. The geriatric patient population will likely require the use of surgical services at a higher rate than ever before. To best care for the elderly undergoing procedures with anesthesia, it is imperative to follow the most up to date evidence to avoid post-operative complications, and more specifically post-operative cognitive dysfunction.

Purpose: The purpose of this DNP evidence-based practice project is to identify patients that are at high risk for post-operative cognitive dysfunction prior to undergoing anesthesia. Post-operative …

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 …

Econsent Forms On Ancillary Applications With Electronic Medical Record Integration – Reducing Consent Error, Lilian Chan

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The purpose of this project is to utilize electronic consents (eConsents) with ancillary applications as an evidence-based intervention to reduce consent errors.

Background: Studies show that paper-based handwritten forms have an error rate of up to 50%. Consent errors, especially in the preparation of surgery, are not merely documentation errors but patient safety pitfalls that allow for incorrect surgeries or financial loss due to aborted or delayed interventional cases. Internal organizational evidence indicates the implementation of an evidence-based opportunity as there was no use of electronic tools for consents utilized in the inpatient setting.

Methods: Inpatient departments …