Nursing Commons^™

Implementing Distress Screening And Hospital Management Of Oncology Patients With Distress, Rhezarie Mae Agtarap

Doctor of Nursing Practice Projects

Of the nearly 2 million new cancer cases projected to occur in the United States in 2022, up to 65% of patients may be hospitalized in the first year of their diagnosis. Hospitalized oncology patients have been documented to experience psychological distress during their hospitalization related to physical and emotional challenges related to their disease. In ***, a tertiary hospital located in ***, Oregon, hospitalized cancer patients with hematologic malignancies and aggressive or advanced solid cancers have verbalized distress, including depression, anxiety, feelings of isolation, and fatigue during prolonged hospital stays. According to the National Comprehensive Cancer Network (NCCN), distress …

Improving Emergency Department Nurses Communication Self-Efficacy With Underrepresented Populations Through Cultural Humility Training, Nikki L. Graham

Doctor of Nursing Practice Projects

Problem Description: The chasm of health inequality for underrepresented populations in the United States is growing, despite advances in healthcare and increased life expectancy. Disparities span the age and healthcare continuum for underrepresented populations, with increased mortality and morbidity rates in nearly every category. Non-white residents in Cook County face the same challenges. Historical lack of trust creates a reluctance to seek healthcare among Black populations, but when they do, they are disproportionately dissatisfied with their care, receive less aggressive treatment, and report higher levels of uncontrolled pain. Nurses, as the largest body of healthcare professionals, are uniquely positioned …

Optimizing Digital Proficiency To Improve Perceived Self-Efficacy In Telehealth Nurses, Serena Young

Doctor of Nursing Practice Projects

The use of telehealth to provide care management services has increased as healthcare continues to evolve. Seven million Americans were predicted to use telehealth in 2020, which increased to over 35 million through the pandemic. These services have been shown to decrease healthcare disparities and promote positive health outcomes. Education and training for nurses providing telehealth services have not kept up with the increased demand. Nurses providing care management telehealth services in a large tertiary health system have low perceived self-efficacy for technology. Leaders in the organization believe this is causing a lack of digital proficiency in their workforce. This …

A Quality Improvement Project To Promote Awareness And Knowledge Of Nutrition As An Adjunctive Treatment Option For Chronic Insomnia, Sara J. Weelborg

Doctor of Nursing Practice Projects

Background

Insomnia is difficult to treat resulting in adverse outcomes. Traditional treatments are not always safe or accessible. Evidence, not readily available to providers, supports the adjunctive use of nutrition to ease symptoms.

Problem

Literature recommends the Mediterranean Diet for insomnia. A nutrition education module for psychiatric nurse practitioners (n=4) was created by a multidisciplinary committee to increase knowledge and comfort. Pre-post Likert-scale tool, multiple choice test, and interview questions were used to measure educational benefits.

Outcomes

All participants demonstrated knowledge acquisition (range 11% to 100%), increased intention to use information (range 9% to 43%), and positive feedback about nutrition …

A Pilot Project To Improve The Well-Being Of Inpatient Nurse Managers At An Academic Medical Center Through A Mindfulness-Based Intervention, Nancy Wiederhold

Doctor of Nursing Practice Projects

Purpose: To decrease inpatient nurse managers' burnout, stress, and compassion fatigue through attendance at a mindful, self-compassion intensive program.

Background/Significance: Nurse leaders and managers are indispensable pillars of the healthcare team, carrying the responsibility of shaping organizational success and ensuring quality patient care. Unfortunately, the current landscape of nursing leadership is clouded by sentiments of powerlessness, hopelessness, and guilt.

Description: Recognizing the practical challenges faced by nurse managers, a targeted intervention was implemented – a four-week, in-person mindfulness-based, self-compassion program. This initiative aimed to equip them with the tools to mitigate stress, burnout, and compassion fatigue. Led by a trained …

Implementation Of An Advanced Practice Provider Fellowship To Improve Transition To Practice, Breanne Hosford

Doctor of Nursing Practice Projects

Problem

Retention of advanced practice providers (APPs) is needed for ongoing high quality comprehensive care. Administrators at a large urban pediatric institute in the Midwest identified turnover and retention as an issue for APPs in the first one to two years of service. Even in years when turnover rates were not as high, the greatest number of APPs leaving the institution where those in their first five years of tenure. Without strategies aimed at improving transition to practice, new hire APPs will continue to be unprepared for their new role, therefore endangering job satisfaction, leading to continued turnover, and threatening …

A Patient Centered Quality Improvement Education Program Designed To Improve The Health Of Patients Living With Uncontrolled Hypertension In A Primary Care Setting, Alia Jamison-Dinowitz

Doctor of Nursing Practice Projects

Cardiovascular disease is the leading cause of death in the United States and it negatively contributes to poor health outcomes (Martinez-Garcia et al., 2018). Within the Antelope Valley in Lancaster California, 30.3 % of city residents have a hypertension diagnosis (Los Angeles County of Public Health, 2017). Much like the city at large, hypertension is a critical issue at AV Pediatrics and Family Medicine (AV Peds). This issue is driven by a variety of factors including a lack of understanding about hypertension and medication compliance, and a lack of understanding about healthy lifestyle choices. Providers at AV Peds have seen …

Improving The Culture Of Patient And Family-Centered Partnerships: A Quality Improvement Project, Nicole S. Ardres

Doctor of Nursing Practice Projects

Problem Description: In 2020, the coronavirus (COVID-19) impacted the world, changing the landscape of the nursing profession. The pandemic changed societal norms to reduce transmission and death rates by instituting social distancing requirements, stay-at-home policies, and mask mandates. Hospitals enacted crisis standards of care, changed orientation and training practices, and restricted family visitation policies. In addition, nursing programs temporarily halted in-person clinical training experiences and transitioned to online learning. These were challenging times to enter the nursing profession. The pandemic worsened the nursing shortage, contributing to burnout, turnover, and increased use of agency or travel nurses, resulting in a loss …

Implementing Best Practices To Improve Nurse-Patient Communication And The Ed Experience In A Small Suburban Hospital In The Northwestern U.S.: A Pilot Project, Kimberli Munn

Doctor of Nursing Practice Projects

As one measure of quality of care and patient satisfaction, healthcare systems now routinely evaluate the patient experience. Nurses at every level of care, especially those in the hospital, can directly impact the outcome of that experience (American Association of Colleges of Nursing [AACN], 2011; Natsui et al., 2018). Communication with the health care team during patient visits enhances overall patient satisfaction, and research has established a clear correlation between the patient experience and improved patient outcomes and quality of care (Hermann et al., 2019, Sonis et al., 2017; Tan et al., 2013). Quality care, a high standard, reflects the …

Improving Pediatric Medical Nurses’ Confidence In Caring For Pediatric Mental Health Patients: A Pilot Project Large Academic Pediatric Health System In The Pacific Northwest, Lauren Kalember

Doctor of Nursing Practice Projects

Problem Description

Pediatric mental and behavioral health care needs continue to increase across the nation. Approximately ten percent of pediatric hospitalizations are for a primary mental or behavioral health condition (Canvara & Johnson, 2020). With the increase in hospitalizations for mental health (MH) needs, pediatric psychiatric units are at capacity, and MH patients are admitted to pediatric general medical/surgical units for care. Most of the nurses that work on these units have not received pediatric mental health education outside of nursing school curricula and report a lack of confidence in their ability to care for pediatric MH patients. With the …

A Pilot Program To Address Nurse Leader Moral Distress Secondary To The Performance Evaluation Of Underperforming Personnel, Lisa Krening

Doctor of Nursing Practice Projects

Problem Description: First defined in 1984, as a nurse knowing the correct course of action but perceiving barriers that constrain the action, moral distress has evolved to include challenging situations associated with moral uncertainty, moral conflict, and ethical or moral dilemmas (Campbell et al., 2016; Fourie, 2015, 2016; Jameton, 1984). While the bulk of the moral distress literature has highlighted the challenges of direct care nurses, nurse leaders also grapple with ethical dilemmas that often lead to moral distress (Edmonson, 2010; Ganz et al., 2015; Prestia et al., 2017). Additionally, research indicates that nurse leaders lack experience in navigating ethical …

Transformational Leadership And Structural Empowerment For Nurse Managers To Improve Nursing Job Satisfaction, Engagement, And Retention, Leah M. Gehri

Doctor of Nursing Practice Projects

Problem Description

Low nurse job satisfaction and engagement have historically been associated with high attrition. While it is too soon to fully quantify the impact of Covid-19 on nurse satisfaction, engagement, and turnover, evidence is emerging that high chronic fatigue and persistent feelings of being overwhelmed are causing nurses to either leave the bedside or quit nursing altogether, exacerbating existing nurse staffing challenges caused by a decades long nursing shortage that, pre-pandemic, predicted a national deficit of over one-half million nurses by 2030. The financial impact of competing for experienced nurses, and recruiting, hiring, and training new nurses to replace …

An Inpatient Fall Prevention Program Evaluation Using The Context, Input, Process And Product Model, Brittany Harker

Doctor of Nursing Practice Projects

Background/Context: Falls remain a substantial risk for patients and is reported that 1,000,000 patients fall each year and one-third result in injury to the patient.

Problem/Purpose: To evaluate the implementation of a fall prevention toolkit to determine if standards of care were followed and outcomes were met using the Context, Input, Process, and Product model.

Outcomes/Results: Fall risk assessment was occurring on admission (n=33) with opportunity for reassessment throughout stay. Required post-fall documentation was not completed per policy. 26% of staff responded to the feedback survey. The facility’s fall rate target was not met but reducing the …

Implementing Cognitive Behavioral Therapy For Insomnia With Motivational Interviewing In The Mental Health Setting, Kassandra E. Ransom

Doctor of Nursing Practice Projects

Can you imagine not sleeping well for weeks or months at a time? Insomnia impacts approximately one-third of adults and is considered the most prevalent of all sleep disorders. With a lack of consistent, quality sleep, insomnia has significant negative consequences that impact a person’s overall mental well-being, like increased anxiety, depression, chronic pain, and daily coping. Cognitive Behavioral Therapy for Insomnia (CBT-I) allows patients to reduce or eliminate insomnia or related symptoms without needing medication to obtain quality and consistent sleep. CBT-I is difficult, so partnering it with Motivational Interviewing (MI) techniques provides patient engagement and compliance to strike …

Opioid-Crisis Intervention: A Pilot To Moderate Patient’S Use Of Post-Operative Opioid Medications Using A Video-Based Perioperative Education Tool, Ahmed Alshaarawi

Doctor of Nursing Practice Projects

Problem Description

The opioid epidemic has been ravishing communities in the United States for nearly two decades, resulting in opioid misuse, dependence, and overdose-related deaths. Healthcare providers have inadvertently fueled the epidemic by overprescribing opioid medications contributing to 40% of the opioid overdose-related deaths. One in every 48 patients who receives an opioid medication for the first time will become a chronic user of these medications. Furthermore, 6% of all surgical patients will continue chronic use of opioid medications 90 days after their surgeries regardless of absence of pain. With over 50 million surgical cases performed each year in the …

Optimizing Electronic Medication Prior Authorization: Reducing Prescription Delays, Arnold Butiu

Doctor of Nursing Practice Projects

Background: Within the United States, chronic disease in children has doubled over the last 20 years. Many diseases defined as chronic (attention deficit, epilepsy, and diabetes) require daily medication regimens for optimal management. To be covered by insurance, many of these medications require prior authorization (PA) from the patients’ pharmacy benefits policy. Delays in processing and receiving PA orders can lead to worsening disease and inadequate disease management.

In 2014, a pediatric academic medical center in the Midwest found that processing medications from prescription order to PA approval took nurses an average of over 90 hours. In August 2020, the …

Implementing An Evidence-Based Fall Prevention Plan To Address Unintentional Hospital Falls On A Medical/Surgical Unit, David Haskell

Doctor of Nursing Practice Projects

Background: Falling in the hospital setting is a leading cause of death and disability for patients. For many health care organizations, patient fall prevention strategies have become a priority focus to improve patient outcomes and associated costs.

Project Design: The project was designed to implement a quality improvement project on an adult medical/surgical unit, providing educational activities to nursing staff, and applying a standardized fall prevention plan of care “toolkit” for fall prevention interventions.

Results: Audits completed on 863 patient admits to a 36-bed Medical/Surgical unit during the three-month timeframe, showed the implementation of the project resulted in the creation …

Developing A Standardized Process For An Effective, Evidence-Based Fall Management Program To Reduce Falls In A Nursing Home Setting, Katrina K. Little

Doctor of Nursing Practice Projects

Background: Falls among the elderly population, aged 65 years and older, are a significantly growing public health problem. For elderly people residing in residential care facilities and facility administrators, falls are of great concern due to the post-fall associated consequences. Preventing resident falls in long-term care is a priority to reduce injuries and associated costs.

Project Design: This evidence-based quality improvement (EBQI) pilot project focused on fall prevention and was conducted on 1 unit (3 long-term care hallways) at a facility that provides both long-term care (LTC) and short-term rehabilitation services in Utah County, Utah. Interventions chosen for the Falls …

Mindfulness-Based Stress Reduction To Decrease Burnout In Emergency Nurses: A Quality Improvement Project At An Academic Medical Center, Desireé M. Mccue

Doctor of Nursing Practice Projects

Nursing burnout, categorized by increased emotional exhaustion (EE), depersonalization (DE), or decreased personal achievement (PA), is rising in the United States. Emergency Department (ED) nurses at an academic medical center in the western United States experience burnout related to workplace violence and trauma exposure exacerbated by a global pandemic. Burnout can lead to adverse health impacts for nurses, increased institutional costs, and adverse patient outcomes.

Improving mindfulness or awareness of the present can reduce burnout in ED nurses. A mindfulness pilot project was conducted with staff nurses (n=20) and nurse leaders (n=4) in the ED. Participants attended Mindfulness-Based Stress Reduction …

A Pilot Program To Improve Patient And Family Experience Scores And Quality Of Care Of The Hispanic Population In An Urban Pediatric Emergency Department., David C. Kruger

Doctor of Nursing Practice Projects

Problem Description: Emergency Department (ED) patients express decreased patient and family experience (PFE) scores when they feel disrespected (such as experiencing long wait times), experience ineffective communication, or have difficulty accessing care. These issues could lead to inequalities and adverse health care outcomes, especially among those of different races and ethnic backgrounds. The goal of this quality improvement (QI) project was to evaluate the PFE scores and the quality of care of the Hispanic population at a thirty-five-bed emergency department within a freestanding pediatric, academic medical center located in a large urban area.

Rationale: The theoretical framework guiding this QI …

A Chronic Obstructive Pulmonary Disease Pilot Using Risk Stratification To Improve Resource Allocation And Reduce Readmissions, Linda Gould

Doctor of Nursing Practice Projects

Background: Chronic Obstructive Pulmonary Disease (COPD) impacts 250 million people, is associated with high hospital readmission rates, and costs over $50 billion annually. Purpose: Apply risk stratification identifying higher risk patients to prioritize complex, time-consuming interventions and resources. Methods: Patients hospitalized with COPD were risk stratified using PEARL. Moderate-high risk patients were referred to specialty nurse practitioners, who used real-time interventions and motivational interviewing during intense weekly visits over 30 days targeting self-management, patient-specific risks, and resources. Results: No patients were readmitted or died during the pilot using risk stratification with patient-specific tertiary preventive care to …

Implementing Sexual Health Education For At-Risk High School Students In A Faith-Based Setting: A Pilot Project, Neva R. Fuentes

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STI) are a global issue that persist, causing significant negative health outcomes like cancer, adverse reproductive issues including infertility, and death (CDC, 2019a; Office of Women’s Health [OWH], 2019; WHO, 2019). In the United States, youth ages 15-24 years old make up 50% of the more than 20 million newly diagnosed STI’s each year (CDC, 2019a). Young women, adolescents (Slater & Robinson, 2014), minority populations (Mermelstein & Plax, 2016), and high school dropouts (Anderson & Pörtner, 2014) are even more disproportionately affected. Access to comprehensive health information and vaccines are well documented effective STI prevention methods …

Improving Access And Delivery Of Mental Health Care To Veterans Through A Care Coordination Pilot At A Texas Department Of Veterans Affairs Hospital, Jacqueline Buval

Doctor of Nursing Practice Projects

Background: Mental health (MH) disorders are among the leading cause of disabilities in adults, with an even greater prevalence among Veterans who served in combat. Forty percent of troops returning from combat zones report suffering from post-traumatic stress disorder (PTSD) or depression and 33% report trouble accessing MH care. Access to care is directly influenced by care coordination procedures in health care systems. If care coordination is poor or lacking, patients remain in settings that are inappropriate for their level of care. Implementing a care coordination program can improve care transitions, provide the necessary support for patients to successfully …

Deploying A Validated Postnatal Depression Screening Tool & Guideline To Improve Evidence Based Screening For Postpartum Depression In Ambulatory Care, Debbie Ketchum

Doctor of Nursing Practice Projects

Problem Description: Postpartum depression (PPD) is a significant public health problem that is potentially disabling and can be life-threatening. It is one of the most common diagnoses for maternal morbidity and mortality, affecting one in ten women in the United States. Currently, there is no universal process for the identification of PPD within the ambulatory clinics in this regional health system caring for obstetrical patients. A quality improvement project was developed and implemented with a pilot group in the ambulatory setting.

Rationale: Without a standard process for screening, patients and their newborns may be at increased risk for detrimental consequences …

Implementing Best Practices To Improve Veteran’S Primary Care: A Pilot Project For Suicide Screening, Assessment & Referral, Nathaniel Held

Doctor of Nursing Practice Projects

Problem Description: Suicide is an increasing problem within the United States, but an even greater problem among the veteran population. Veterans are twice as likely to commit suicide than individuals within the civilian population. El Paso County, Colorado has the highest veteran population in the state and the highest number of suicides. Despite numerous military mental health programs available. Studies have found that many veterans will visit a civilian primary care clinic (for various reasons) within a month of taking their own lives but rarely are mental health concerns noted. This can be due to a lack of awareness and …

Developing Organizational Support And Leadership Structures For Advanced Practice Nurses In The Hospital Setting, Andrea L. Childress

Doctor of Nursing Practice Projects

Background: Hospitals are increasing utilization of advanced practice nurses (APNs). APNs do not fit within the traditional nursing or medicine department structures. They are often hired by organizations without full evaluation and assessment of management issues and structures to support them.

Problem: APNs are employed to work throughout an acute care hospital. They report to medical leadership but have no voting rights or representation on medical committees. They lack connection to nursing staff and existing structures which impairs their ability to exhibit leadership and advance nursing practice.

Purpose: This project seeks to answer: What organizational support and leadership structures are …

Improving The Nurse Patient Assignment Process On A Medical Surgical Unit, Kevin K. Mcewan

Doctor of Nursing Practice Projects

Background: Nurse patient assignments on an adult medical surgical unit at a community hospital are often accomplished with inconsistent processes and rationales. Each charge nurse utilizes individualized processes to determine which patients will be best teamed-up and assigned to the available nurses. There are frequently no acuity measurements system or set criteria by which the number or types of patients can or should be assigned to any given nurse, nor are staff skill or competency considered in the assignment process.

Project Design: A pilot project was conducted on a medical/surgical unit. The project utilized the American Association of Critical Care …

Interprofessional Approach To Medication Reconciliation In The Hospitalized Medicare Patient., Misty Robertson

Doctor of Nursing Practice Projects

Background

Poor medication reconciliation processes in acute care hospitals, combined with poor communication across the healthcare team, and a failure to bring specialized pharmacy resources to the team can be attributed to adverse drug events that in turn result in hospital readmissions within 30 days of discharge (Sutherland, David-Kasdan, Beloff, Mueller, Whang, Bleday, & Urman, 2016).

Project Design

The aims of project included: 1. Utilize an interprofessional team that included, nursing, pharmacy, RN care management, and physicians to develop hospital policy and procedures for medication reconciliation, 2. Develop a risk stratification method to identify patients at highest risk for medication …

A Community-Based Pilot Prevention Program To Prevent Electronic Cigarette Use Among Teens, Rosanna Moreno

Doctor of Nursing Practice Projects

With over 3.6 million teens using tobacco, we have lost the opportunity to create the first tobacco-free generation. This pilot project presented the CATCH My Breath (CMB) E-Cigarette and JUUL prevention program to local teens experiencing a global pandemic. The program was condensed from a 4-week multi-session offering into a one-day seminar with an intense focus on student safety and engagement. While contextual factors significantly impacted the project implementation, the content remained largely the same. This accounted for the achievement of many of the project’s desired outcomes. Participants increased their baseline knowledge of the effects and dangers of e-cigarette use …

Improving The Quality Of Care For Pediatric Psychiatric Patients In The Emergency Department, Joseph L. Greene

Doctor of Nursing Practice Projects

Pediatric patients (17 years and younger) in mental health crisis are arriving in the emergency department in increasing numbers because there is a lack of mental health crisis care in the community setting. The emergency department is crowded, lacks a dedicated area for psychiatric patients that is quiet and safe, and staff are inadequately trained in psychiatric competencies. A quality improvement project was approved by Boise State IRB to train RNs in psychiatric competencies. Telepsychiatry provided timely evaluation by a qualified psychiatric provider. Patients’ perceived meaning of the ED visit was evaluated using the Patient Evaluation of Emotional Comfort Experienced …