Nursing Commons^™

Development Of A Process For Adoption And Attainment Of Pcmh Recognition Requirements For An Urban Primary Care Clinic, Jamie L. Hendricks

Doctoral Projects

The Centers for Disease Control and Prevention (2017) reported that in 2016, healthcare expenditures in the United States totaled 17.9% of the gross domestic product. Unfortunately, care quality is not reflective of the high costs of care. Models of care delivery like the patient centered medical home (PCMH) have shown promise in addressing these concerns.

This project focused on program development for PCMH adoption at an urban clinic in an effort to improve financial stability and remain competitive. The purpose was to propose a plan for adoption and attainment of PCMH recognition requirements for an urban primary care office.

The …

Nonalcoholic Fatty Liver Disease And The Pnpla3 Gene, Lori Houghton-Rahrig, Debra Schutte, Jenifer I. Fenton, Jennifer Awad

Peer Reviewed Articles

Nonalcoholic fatty liver disease (NAFLD) is a rapidly emerging worldwide public health concern strongly associated with obesity, insulin resistance/diabetes type 2, and the metabolic syndrome (Younossi et al., 2011). It is the most common cause of liver disease in the world (World Gastro - enterology Organisation [WGO], 2012). Defined as a total liver weight comprised of more than 5% fat, NAFLD can progress from simple fatty liver disease to nonalcoholic steatohepatitis with or without fibrosis, liver cirrhosis, liver cancer, or liver failure resulting in premature death (Levene & Goldin, 2012). The development and progression of NAFLD is influenced by genetic …

An Evaluation Of A Nerve Block Protocol In Patients With Hip Fractures, Jenna Buchman

Doctoral Projects

BACKGROUND/PURPOSE: Pain management for hip fracture patients in the time before surgery is crucial. Literature highlights the success of local, single injection nerve blocks to aid in preoperative pain management. A local hospital implemented a preoperative, single injection nerve block protocol in March 2018. This quality improvement project investigated: (1) organization protocol compliance, and (2) if the preoperative single injection nerve block protocol reduces hip fracture pain, use of systemic opioid analgesics, decreases incidence of adverse opioid effects, and reduces cost of care.

SUBJECTS: Patients ages 18 and older admitted with the primary diagnosis of an operable isolated hip fracture …

Identifying Gaps In Care In The Geriatric Trauma Patient With Rib Fractures, Kathy A. Crystal

Doctoral Projects

Introduction: Rib fractures in the geriatric patient can be life altering. Across the country trauma centers are caring for an increased volume of geriatric patients aged 65 years and older (Ali-Osman et al., 2018). The geriatric patient with thoracic injury has the second highest mortality rate among the trauma population in the United States (Mentzer et al., 2017). The assessment of the patient is key to identify critical changes due to high risk of adverse events from rib fractures. Despite efforts to standardize the assessment and care provided to the patient with rib fractures, a lot of variation occurs. Research …

An Implementation Toolkit For Increasing Breastfeeding Sustainability, Regina Kirwin

Doctoral Projects

Introduction: African American women have the lowest rates of breastfeeding in the United States compared to other racial and ethnic groups (DHHS, 2016). Peer support increases breastfeeding rates (Shakya, 2017). An evidence-based implementation toolkit will provide key stakeholders the information and skill development needed to successfully implement and sustain peer support programs geared toward increasing breastfeeding rates for African American women in West Michigan. The purpose of this paper is to disseminate the quality improvement process used to develop an evidence-based toolkit guided by a secondary data analysis from research data collected in a previously implemented peer mentor program.

Objective: …

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

Care Of Adult Cancer Survivors, Kelsey Kloosterman

Doctoral Projects

As innovative cancer treatments emerge, more people are surviving cancer. Cancer survivors have multiple and unique healthcare needs due to their cancer and cancer treatments. Communication among those treating the cancer, primary care providers, and cancer survivors is necessary to coordinate care once treatment is finished. The development of a survivorship care plan that is reviewed with the cancer survivor is intended to facilitate communication among all stakeholders. This quality improvement project examined current practice in a survivorship clinic in a Midwestern health system cancer center that cares for a variety of types of cancer patients. By reviewing evidence in …

Evaluation Of Short Term Cognitive Behavioral Therapy Intervention In A Primary Care Setting, Kevin Hengeveld

Doctoral Projects

Introduction: Depression and anxiety are chronic recurring medical conditions that impact all aspects of health. When depression and anxiety are present with other comorbid diseases, mortality and health care costs are higher. Children and young adults are particularly vulnerable to mental health issues. Suicide is the 2nd leading cause of death for this demographic. Depression is common in adolescents with an incidence of 8 to 20 percent. Primary care provides 70 percent of mental health care in the United States, and the primary intervention offered is pharmacological. Evidence suggests that a combination of medication and psychotherapy provide superior relief of …

Improving Adolescent Risk Behavior Screening: Implementation Of The I-Cloud Rapid Assessment Adolescent Preventive Screening (Raaps) Tool, Donna L. Rinker

Doctoral Projects

Adolescents are engaging in risky behaviors earlier contributing to 75% of adolescent morbidity and mortality with unintentional injuries listed as the most common cause of death among this population in the United States. It is reported that engaging in more than one risk behavior will lead to other risk behaviors resulting in the rise of indirect and direct costs in society today. The scholarly project was conducted in response to a midwestern Michigan primary care clinic need to improve the early identification and documentation of adolescent risk behaviors with evidence-based technology screening. The purpose of this quality improvement project was …

Mindfulness’S Effects On Undergraduate Nursing Students' Negative Mental Health Symptoms: A Systematic Review, Erin Sartorius

Honors Projects

Undergraduate nursing students endure unique stressors that potentiate negative consequences to their mental health. Mindfulness-based interventions may improve these negative mental health symptoms in nursing students. The objective of this review is to assess available research regarding the effects of mindfulness-based interventions on the negative mental health symptoms of undergraduate nursing students. The databases CINAHL Complete, PubMed, and PsycINFO were searched for relevant research. Search terms were brainstormed and individually assessed to determine relevancy to the research question. In order to be incorporated into this systematic review, all assessed studies needed to include (1) an intervention rooted in mindfulness, (2) …

Creating And Conducting Intergenerational Learning In Higher Education, Andrea Lauren Holt

Honors Projects

The creation, conduction and revision of a one of a kind intergenerational course taught in the Grand Valley State University Fredrick Meijer Honors College. Elders and Traditional Honors College Freshman came together in a mixed classroom in order to bridge the gaps of communication and misunderstanding between generations.

Implementation Of A Multimodal Hand Hygiene Intervention At A Rural Critical Access Hospital, Amy J. Hopp

Doctoral Projects

Healthcare acquired infections are the most common complication of hospital care in the United States, with subsequent negative implications on the healthcare system. While hand hygiene has long been considered the single most important and cost-effective way of reducing healthcareacquired infections, compliance among healthcare professionals is low, and most efforts to improve it fail. When compared to single-component hand hygiene interventions, research demonstrates that tailored multimodal interventions are an effective way to improve compliance with hand hygiene practices among healthcare professionals. This Doctor of Nursing Practice project focused on implementing a multimodal hand hygiene intervention, tailored to fit the specific …

Evaluation Of A Health System’S Community Targeted Program For Individual’S With Increased Risk For Cardiovascular Disease And Diabetes, Phallon Lovelady

Doctoral Projects

Introduction: Lack of a program evaluation plan for a community targeted primary prevention program poses a risk for undefined program effectiveness. Conducting a systemic program evaluation helps determine program effectiveness and value. The purpose of this paper is to discuss the process of implementing a program evaluation during a Doctorate of Nursing Practice (DNP) scholarly project.

Objectives: The objectives of this project were to apply a scholarly approach to program evaluation utilizing evidence-based practice tools, demonstrate DNP Essentials and health systems leader competencies, and describe the steps taken during the process.

Methods: The CDC Framework for Program Evaluation (2011) was …

An Enhanced Actualized Dnp Model To Improve Dnp Project Placements, Rigor, And Completion: A Research Brief, Marie Vanderkooi, Dianne Conrad, Sandra Spoelstra

Open Access Publishing Support Funded Articles

Doctor of nursing practice (DNP) projects are summative evaluations of enactment of the DNP Essentials. However, information about structure, process, and outcomes of DNP projects is scarce. Guided by an enhanced actualized DNP model, this study tested the effect of a PhD-DNP-site mentor model to guide DNP projects. Time-to-complete assignments, defense, and graduation improved; high satisfaction for students, mentors, and faculty were found; and a strengthened academic-practice partnership occurred, leading to additional student placements. Broader testing of the enhanced model in various size and types of academic-practice settings is needed prior to use.

Improving A Discharge Process To Decrease Readmission Rates, Erni Ensing

Master's Projects

No abstract provided.

Increasing Use Of A Tobacco Cessation Quitline In A Rural Prenatal Population, Rachel T. Schleenbaker

Master's Projects

This paper addresses prenatal smoking rates within in a rural northern Michigan district health department (HD) through a Master of Science in Nursing (MSN) quality improvement project. The paper provides a detailed microsystem assessment of the Maternal Infant Health Program (MIHP) at the district HD describing the clinical problem and identifying a practice gap in care of prenatal smokers. The literature review describes the three most effective prenatal smoking cessation interventions: counseling, incentives, and feedback. The literature review also addresses the effectiveness of and barriers to smoking quitlines. The clinical protocol followed the Model for Improvement framework with the completion …

Hospital Acquired Pressure Injury Gap Analysis, Mary Lou Hall

Master's Projects

Hospital acquired pressure injuries (HAPIs) were identified as an area for a quality improvement (QI) project in a progressive care unit (PCU) in a Midwestern Hospital. In order to reduce HAPIs and provide the best possible preventative care, a gap analysis between the current care practices on the progressive care unit and the best evidence-based practice recommendations for HAPI prevention in the areas of risk/skin assessment, surface support, nutrition and hydration, repositioning/movement, moisture management, and prophylactic dressings was conducted. The Model for Improvement (MFI) was the QI framework that guided this pressure injury gap analysis.

The goals of this gap …

Implementing Evidence-Based Fall Reduction Interventions In An Urban Emergency Department, Nichole L. Schmidt

Master's Projects

The patient population that is falls in the emergency department (ED) tends to differ from population that falls on inpatient units. However, there is no validated fall risk assessment for the ED setting. In an ED in a western Michigan hospital a fall reference card was designed and trialed by a small group of ED nurses on twenty-five ED patients. The fall reference card was created as a quick-reference guide for the assessment of fall risk, and the implementation of evidence-based fall risk interventions. The card utilized interventions supported by literature as the most common reasons for ED falls. The …

A Quality Protocol For A Federally Qualified Health Center: A Pilot Project, John K. Dekock

Doctoral Projects

Federally Qualified Health Centers (FQHCs) have become a vital part of access to care for low socioeconomic status individuals. The federal government has allocated funds to be distributed to FQHCs via Medicare and Medicaid reimbursement based on insurance claims and through the Health Resources and Service Administration (HRSA) via grants and incentives based on Uniform Data System (UDS) reporting. Federally Qualified Health Centers must complete annual uniform data system (UDS) reporting on quality indicator metrics to receive grants and incentives from HRSA. The Health Resources and Service Administration (HRSA) funded health centers are expected to have ongoing quality assurance and …

Applying Process Standardization And Health Literacy Precautions To Increase Older Adult Patient Satisfaction With Medication Teaching, Casie N. Sultana

Master's Projects

The purpose of this paper is to describe a quality improvement (QI) project with the goal of creating an evidence-based, standardized process for nurses to teach older adult patients about newly prescribed medications.

Improving Adolescent Risk Assessment In A Primary Care Setting, Kristin N. Vanderwell

Doctoral Projects

Adolescent risk-taking behaviors contribute significant risk to the current and future health of adolescent patients and have a significant annual cost to society. A primary care practice in western Michigan had no standardized practice related to the screening, evaluation, and response to adolescent-risk taking behaviors. As a result, only three of the fourteen providers were consistently following national guidelines for screening, evaluating, and responding to adolescent risk-taking barriers. The providers cited lack of time and lack of knowledge as barriers to following guidelines. The purpose of this quality improvement project was to address the health care needs of the adolescent …

Implementation Of Standardized Heart Failure Educational And Documentation Processes Within An Outpatient Heart And Vascular Clinic, Mallory Myslenski

Doctoral Projects

Heart failure is a prevalent, high-risk condition associated with high mortality and frequent hospitalizations. Heart failure is characterized by acute exacerbations of signs and symptoms, and affects almost six million Americans leading to one of the most costly illnesses in the United States. Management of heart failure is complex and individualized relying on appropriate education, self-care management, medications, and adequate follow-up to succeed in treatment. Many organizations have initiated evidence-based heart failure management or educational programs that provide easy-to-learn education on diagnosis, medication, and self-care behaviors. Research has shown that these programs help patients to better manage their symptoms at …

An Education Intervention To Increase Rounding And Toileting And Reduce Falls In A Hospital Acute Care Of The Elderly (Ace) Unit, Amelia Grayson

Doctoral Projects

Introduction: Falls are the most common accident reported in acute care hospitals and patients who are 65 and older are the most vulnerable. Falls can lead to physical and emotional injury, reduced mobility and functioning, increased length of hospital stay, increased healthcare costs, and admission to long-term care facilities. In 2008, the Center for Medicare & Medicaid Services (CMS) has eliminated reimbursement to hospitals for treatment of injuries resulting from a fall during hospitalization. Research on fall prevention in adult acute care found multifactorial interventions that address multiple risk factors for falls are the most successful at prevention. This …

Increasing Post-Acute And Long Term Care Coding For Advance Care Planning In An Outpatient Setting, Emily M. Mccloskey

Doctoral Projects

Today’s healthcare landscape is saturated with an aging U.S. population that is living longer and with more chronic conditions. One way to manage care for this aging population, especially those with chronic conditions, is through advance care planning (ACP). Healthcare providers are capable of engaging patients in these important healthcare discussions, yet use of methods to appropriately document and code for these services are lacking. There are Current Procedural Terminology (CPT) codes in existence that would be applicable for these services; however, they are not widely understood nor routinely used in clinical practice. Administrators at a large Midwestern healthcare organization’s …

Prevention Of Central Line-Associated Bloodstream Infection (Clabsi) In Adult Oncology Patients, Christina Winkelman

Doctoral Projects

Central Line-Associated Bloodstream Infection (CLABSI) is a preventable issue in healthcare. CLABSI contributes to negative patient outcomes and increased healthcare cost. Research demonstrates that many interventions are effective in reducing the rate of CLABSI. The implementation of CLABSI bundles can significantly reduce the occurrence of CLABSI. This quality improvement project implemented a CLABSI bundle that specifically targeted identified areas of weakness in CLABSI prevention at an organization with a focus on adult oncology care. The three part CLABSI prevention bundle focused on: (a) registered nurses (RN) changing and documenting endcaps in the electronic health record after blood administration, (b) RNs …

Structure, Process, And Outcomes: The Foundation For Continuous Quality Improvement In Primary Care, Mark A. Contreras

Doctoral Projects

Healthcare within the United States is notoriously fragmented and inefficient. Contemporary innovations for policy, reimbursement, and care delivery are consistently directed towards the promotion of value based care (Bates, 2010). These initiatives routinely coalesce around the promising potential of a robust primary care system. The Patient-Centered Medical Home (PCMH) model is increasingly becoming the standard of quality care and use of this model by healthcare providers is poised to bring about a paradigm shift towards value-based care (Henderson, Princell & Martin, 2012).

This scholarly project incorporated an evidence based approach to establishing continuous quality improvement in a primary care office …

Implementation Of Evidence-Based Culturally Adapted Interventions, Collaborative Care, And Change Management For Improved Mental Health Outcomes In A Community-Based Safety-Net Clinic, Laura E. Hall

Doctoral Projects

Mental health disorders are prominent and devastating in the United States. They are more prevalent in low-socioeconomic and minority groups with lower rates of diagnosis and treatment in these populations. Primary care settings are the foremost location for screening, diagnosis, and treatment for common mental health disorders but do not always provide adequate care due to limitations of time, knowledge, and resources. Evidence has shown that collaborative care models can provide more effective treatment for behavioral health services through a team-based approach to holistic patient care. This project focused on implementing culturally adapted, collaborative care models to improve mental health …

Nursing Student Perceptions Of Study Abroad, Emma Branch

Honors Projects

Following the author's own study abroad in Cusco, Peru in May 2017, a literature review was conducted on nursing students who studied abroad and its effect on their ability to provide culturally competent care. Based on that review, the author created a standardized survey tool to be used on other nursing students who study abroad. This tool includes pre-travel and post-travel questions. It collects demographic data, data on the logistics of the trip, and open-ended questions about the experience. The tool was distributed to the GVSU nursing students who went to Ghana, Africa in March 2018. The data from that …

Improving The Patient Handoff From Or To Picu In Children Who Have Undergone Cardiac Surgery Using A Standardized Handoff Tool, Amanda Taylor

Doctoral Projects

Inpatient hospitalizations for children are often costly. Children often transition from one setting to the next while hospitalized, therefore their provision of care is also transferred from one care team to the next. This transition presents a vital time for the child, that may be associated with adverse events and medical error. Adverse events can lead to poor outcomes for the child. Despite efforts to improve patient handoffs, communication failures are still abundant in healthcare. Research indicates that the use of a standardized handoff tool from one setting to the next is an effective method for improving the patient’s transition. …

Effect On Opioid Use Following The Implementation Of Evidence-Based Pain Management, Kathryn L. Ellens

Doctoral Projects

Pain is the most common reason people seek healthcare. Initiatives to prevent the undertreatment of pain have resulted in overreliance on opioids to treat pain. Despite significant increases in opioid use, pain is more prevalent than ever. Additionally, devastating consequences from opioid use have resulted, such as dependence, addiction, and increasing opioid-related deaths. Research demonstrates multimodal analgesic therapy is an effective alternative to the overreliance on opioids to treat pain. Multimodal analgesia is the synergistic use of two or more analgesics with different mechanisms of action. Multimodal analgesia produces significantly more effective and efficient pain management than opioid-only therapy. This …