Nursing Commons^™

Improving Adherence To Annual Diabetes Guidelines In Rural Primary Care, Ashley Barney

Masters Projects

Background: The American Diabetes Association (ADA) (2022) identifies comorbidity risk assessments and treatment planning as key health maintenance components for diabetic patients. However, many providers do not adhere to the recommended national guidelines (Brenner et al., 2020).

Objectives: At a rural primary care clinic, the effectiveness of implementing a checklist was evaluated to improve provider adherence to the annual diabetes guidelines set by the ADA.

Methods: A quality improvement project was initiated and guided by the Lean Six Sigma framework. The checklist was implemented to assess if providers adhered to the recommended annual diabetes guidelines. The project …

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Implementation Of Cocare Help, An Evidence-Based Intervention, Kara M. Roman, Aaron Mestemaker

Masters Projects

Background: Delirium is a common disturbance in cognition among older adults in the hospital setting. It is associated with negative outcomes and high costs for patients, families, and hospital systems. Use of a reliable screening tool and evidence-based strategies such as CoCare: HELP demonstrates delirium prevention and functional decline in many geriatric hospitalized patients.

Objectives: This study examines the impact of implementing aspects of CoCare: HELP on two pilot units in an urban Midwestern hospital. Pre- and post-implementation measures of delirium rate, 30-day admission rate, length of stay, falls with injuries, safety attendant orders, restraint numbers, use of antipsychotics, and …

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Implementation Of Cocare Help, Kara Marie Roman, Aaron Mestemaker

Masters Projects

Background: Delirium is a common disturbance in cognition among older adults in the hospital setting. It is associated with negative outcomes and high costs for patients, families, and hospital systems. Use of a reliable screening tool and evidence-based strategies such as CoCare: HELP demonstrates delirium prevention and functional decline in many geriatric hospitalized patients.

Objectives: This study examines the impact of implementing aspects of CoCare: HELP on two pilot units in an urban Midwestern hospital. Pre- and post-implementation measures of delirium rate, 30-day admission rate, length of stay, falls with injuries, safety attendant orders, restraint numbers, use of antipsychotics, and …

Trauma And Resiliency, Madelyn Ferguson

Honors Projects

Life is a series of events, some overwhelmingly positive and others devastatingly negative. Because of the inevitability of adversity, one must learn to adapt to negative circumstances. However, people react to trauma in different ways with some seeking to take their own lives and others finding a healthy outlet. What causes such a difference in our reactions to trauma? Is it simply the power of thought or is there a genetic component? What can I do to build my own resilience and promote the resilience of others around me? The purpose of this paper is to explore the relationship between …

Interprofessional Education Lab Manual And Workbook, Geraldine Terry

Open Textbooks

This laboratory manual was designed to educate and develop integrated healthcare practices essential in delivering person-centered care. Participants will develop their ability to distinguish the role of their own profession and other healthcare professionals collaborating in the care coordination and case management of patients. The content and team-oriented activities in this manual provide guidance on advancing leadership and communication principles necessary for effective interprofessional communication and team collaboration. The well-researched material is tailored to build on the strengths of participants, while also identifying and encouraging areas for improvement.

Engaging Caregivers To Use An Evidence‑Based Intervention For Medicaid Benefciaries With Alzheimer’S Disease: A Pilot Study, Sandra Lee Spoelstra, Alla Sikorskii, Monica Schueller, Viktoria Basso, Autumn Baldwin

Peer Reviewed Articles

Background This pilot study aimed to adapt an intervention, engaging informal caregivers to help clinicians with providing care to improve (or maintain) physical function of individuals with Alzheimer’s Disease or other dementias. To the best of our knowledge, for the frst time, we report on use of the intervention in those with Alzheimer’s Disease or other dementias.

Methods This was a 5-month mixed methods cohort study in a convenience sample of clinicians, caregivers, and benefciaries at 3-Medicaid Home and Community-based Service sites in Michigan. Two content experts and 5 caregivers modifed the intervention. We trained 116 clinicians to engage caregivers …

Results Of A Multi-Site Pragmatic Hybrid Type 3 Cluster Randomized Trial Comparing Level Of Facilitation While Implementing An Intervention In Community-Dwelling Disabled And Older Adults In A Medicaid Waiver, Sandra Spoelstra, Monica Schueller, Viktoria Basso, Alla Sikorskii

Peer Reviewed Articles

Background: Evidence-based interventions that optimize physical function for disabled and older adults living in the community who have difficulty with daily living tasks are available. However, uptake has been limited, particularly in resource-constrained (Medicaid) settings. Facilitation may be an effective implementation strategy. This study’s aim was to compare internal facilitation (IF) versus IF and external facilitation (EF) on adoption and sustainability of an intervention in a Medicaid home and community-based waiver.

Methods: In a hybrid type 3 trial, waiver sites (N = 18) were randomly assigned to implement the intervention using a bundle of strategies with either IF or IF …

Formalized Diabetes Education In A Safety-Net Clinic, Haley N. Wanic

Doctoral Dissertations & Projects

Uncontrolled diabetes mellitus in a Hispanic population can be helped through a quality improvement project focused on progressive verbal and written diabetes self-management education (DSME) Purpose of this article is to review the background, an organizational assessment, a literature review, results of the quality improvement project that took place at a safety-net clinic in the Midwest. This project included four patients and data was analyzed through descriptive statistics. Results include improved hemoglobin (Hg) A1c, minimal workflow adjustments for providers, completed microalbumins, and written education given to patients. In conclusion, the quality improvement project showed positive trends in outcome measures over …

End The Stigma: Strategies To Improve Mental Health, Alexia M. Frantzeskakis

Honors Projects

The project discusses coping strategies that students can utilize to improve their mental health. A paper, along with five fliers that will be distributed to incoming freshmen were developed. Each flier discusses a different coping strategy on the following topics: physical activity, mindfulness, social media use, routines, and resources available to students in the community.

Know The Signs Of An Allergic Reaction: Anaphylaxis, Sarah R. Remillard

Honors Projects

The purpose of this project was to develop a food allergy informational poster for use in the classroom. The Center for Disease Control has estimated that an average of two children in each public school classroom in the United States struggled with a food allergy. Meanwhile, other researchers found that 25% of first-time anaphylaxis episodes occurred in classrooms. This Honors Project was developed to address the informational gap concerning anaphylaxis that occurs at schools. The methodology was literature review. The Honor Project's outcome was the informational poster, Know the Signs of an Allergic Reaction: Anaphylaxis, as well as the supplemental …

Improving Provider Adherence To Ada Clinical Practice Guidelines: A Qi Project In A Patient Centered Medical Home, David H. Kamp

Masters Projects

Background and purpose: Diabetes is the leading cause of kidney failure, lower limb amputations, and adult blindness. The American Diabetes Association recommends timely screenings to reduce complications. Flowsheets facilitate improved outcomes. The project implemented an electronic flowsheet to promote staff adherence to select screenings.

Methods: Screenings included foot exam, eye exam, glycohemoglobin, microalbumin creatinine ratio, lipid profile, and anti-hypertensive medication. Staff viewed the flowsheet to determine screening eligibility per ADA guidelines. Quantitative and qualitative data analyzed.

Results: Quantitative results: 40% improvement among medical assistants (MAs) completing foot exams and 75.53% improvement among providers ordering eye exams. No statistical significance among …

Nur 621: Clinical Pathophysiology Oer Curation, Chealsye Bowley

Curated OER Collections

This OER curation is an annotated bibliography of prospective OER for the GVSU course NUR 621: Clinical Pathophysiology, assembled by request from the instructor.

Nur 265: Introduction To Nursing Research And Evidence-Based Practice Oer Curation, Chealsye Bowley

Curated OER Collections

This OER curation is an annotated bibliography of prospective OER for the GVSU course NUR 265: Introduction to Nursing Research and Evidence-based Practice.

Development Of A Point-Of-Care Ultrasonography Workflow Within A Rural Clinic, Lauren Myers

Masters Projects

Abstract

Background and Objectives: Healthcare has revolutionized with advancements in ultrasound technology. Among these advancements and the increasing availability of imaging modalities is point-of-care ultrasonography (POCUS) technology.

Problem: While POCUS has gained considerable ground in primary care, infrastructure to support its utility is deficient. The purpose of this project was to design, pilot, and evaluate a POCUS workflow to facilitate technology utilization and increase access to care.

Methods: Program development and evaluation involves the design, implementation, and evaluation of an evidence-based workflow for POCUS technology. The project was intended to address the needs of individuals in a rural setting. Participants …

Improving Patient Portal Enrollment Through Education And Technology At Rural Family Practice, Kelsey Crampton

Doctoral Dissertations & Projects

Background: Patient portals are available through many healthcare offices. They offer the opportunity to improve patient engagement and quality of patient care, but few patients enroll. At a small rural primary care office, less than 20% of the patients were enrolled in the patient portal.

Objective: The purpose of this quality improvement project was to address the barriers reported by patients at this clinic and determine whether changes in portal enrollment volume occurred. Reported barriers included a lack of knowledge about the portal and difficulties with the sign-up process.

Methods: Over three months, strategies included the development of a …

Development Of A Care Management Program Within An Urban Health Center, April M. Butler

Masters Projects

Abstract

Care management (CM) services offered in primary care settings are used to increase patient engagement in self-care and improve communication between patients and health care providers. The aim of this article is to describe the creation of an evidenced-based toolkit within an urban health center that addresses the structures, processes, and outcome measures necessary for the development of a sustainable CM program. Based on the findings from an organizational assessment and comprehensive literature synthesis, several policies, procedures, and workflow diagrams of processes within the health center were created to guide the implementation of a CM program.

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Pre-Implementation Of Cocare Help, Thomas D. Finn, Autumn Baldwin, Elizabeth Hill

Doctoral Dissertations & Projects

Background: Delirium is a change in consciousness characterized by rapid onset and fluctuating attention, causing impairment in the ability to process and recall information, occurring in 30% of hospitalized older adults. Delirium can increase falls, length-of-stay, mortality, and cost. The CoCare Hospital Elder Life Program® (HELP) is an evidence-based bundle of interventions targeting cognitive impairment, sleep deprivation, immobility, visual/hearing impairment, and dehydration, embedding geriatric principles in care to prevent delirium.

Objectives: To further analyze the pre-implementation of the HELP in order to optimize success of program administration.

Methods: Mixed methods were used to collect retrospective/prospective data (interviews (N=25], surveys [N=25], …

Adverse Childhood Experiences: Effects Of Covid-19, Evan Guo

Honors Projects

The evaluation of an adult's health status consists of several entities. These factors can include physical, mental, and emotional health in an individual's history contributing to their overall health. When studying such factors, some researchers emphasize the importance of recognizing events experienced during a person's childhood that affect their development, and therefore, their adult health status. Today, as people continue adapting to the COVID-19 pandemic and changes in regulation of standards for socialization, it is becoming apparent to healthcare researchers how these new modifications are highly impactful to the development of children and adolescents. When studying the various factors that …

Evidence-Based Recommendations For Assistive Technologies For Safety In Dementia Care, Lee A. Diener

Masters Projects

A Quality Improvement (QI) project in a Midwestern Continuing Care Residential Community (CCRC) was designed to examine the evidence-base of four assistive technology platforms marketed as safety platforms as means to improve outcomes for older adults residing in memory care environments. Using the Evidence-Based Design Model Socio-Technical Systems Theory, survey data and observational data collected from the organization were considered with respect to the evidence-base supporting each technology. Ten organizational priorities derived from collected data were used to develop an Evidence-Based Assistive Technology Fitness score for each of the AT platforms reviewed. This methodology provides a means to evaluate planning …

Michigan Physician Orders For Scope Of Treatment: Development Of A Nationally Recognized Program, Megan Owens

Doctoral Projects

Background: Advance directives are well intentioned, but fail to promote patient autonomy in emergent situations.

Objective: To develop a sustainable portable medical order program consistent with national standards through an evidence-based toolkit.

Methods: A literature review and policy analysis were conducted to develop toolkit. Interviews were conducted with content experts to validate toolkit.

Results: The final toolkit consisted of five components: educational materials for healthcare providers, a policy brief, strategies for fund development, strategies for quality monitoring, and a cost savings exemplar.

Conclusions: An evidence-based toolkit tailored to state-specific barriers is critical to development of a portable medical order program.

Faces Of Aces For Nursing Education, Kelsey Bredeweg, Angela Raterink

Honors Projects

Adverse childhood experiences (ACEs) are traumatic events that occur in childhood. They include children experiencing violence, abuse, neglect, or witnessing violence in the home. ACEs also incorporate environmental factors that threaten a child's stability and safety, such as having family members struggle with substance abuse, mental health, or instability due to parental separation or absent family members. There is significant evidence that ACEs are related to negative health outcomes in adulthood including chronic health problems, mental illness, and substance misuse. ACEs are common and experienced by many. According to the Centers for Disease Control and Prevention, 1 in 6 adults …

Compassion Fatigue In Nursing: How Can It Be Prevented?, Megan J. Vlahos

Honors Projects

A literature review paper that discusses the prevalence of compassion fatigue among acute care nurses and interventions that can be implemented to prevent it from occurring.

Registered Nurses’ Images Of Nursing During A Pandemic, Abigail Slaktowski

Honors Projects

The purpose of this research study was to discover any new or transformed images of nursing during the COVID-19 pandemic in the United States. The research question was “What are Registered Nurses’ images of nursing while working during a pandemic?” Registered nurses submitted an image and a brief narrative of the image through REDCap ©, a secure database, describing how the image and culture of nursing is impacted by the COVID-19 pandemic. Using Leininger’s Four Phases of Data Analysis (1991), the five submitted photos and narratives were analyzed. Data analysis revealed fourteen categories, then five patterns, then two final themes: …

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 …

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 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 …

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 …

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 …

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 …