Nursing Commons^™

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

Doctoral Projects

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

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

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

Doctoral Projects

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

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

Methods: A …

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

Doctoral Projects

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

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

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

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

Doctoral Projects

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

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

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

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

Doctoral Projects

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

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

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

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

Doctoral Projects

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

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

A Program Evaluation To Assess Readiness For The National Committee For Quality Assurance’S Patient Centered Medical Home Model Application, Alida M. Semrinec

Doctoral Projects

The Patient Centered Medical Home Model is associated with enhanced patient experience and quality improvement outcomes. The Model has the capacity to guide primary care practices to enhance quality, provide more comprehensive, patient centered care, and increase practice revenue. An urban, nurse managed community health center that has recently implemented the nurse care manager role (a Model requirement) desires to apply for recognition. A program evaluation was conducted to assess current practice, policies, and procedures in place at a Community Health Center through the lens of the National Committee for Quality Assurance’s forty Patient Centered Medical Home Model core competencies. …

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

Doctoral Projects

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

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

Doctoral Projects

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

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

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

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

Doctoral Projects

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

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

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

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

Honors Projects

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

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

Master's Projects

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

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

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

Master's Projects

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

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

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

Doctoral Projects

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

Objectives: Five of the …

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

Doctoral Projects

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

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

Honors Projects

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

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

Doctoral Projects

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

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

Student Scholars Day Posters

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

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

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

Findings: While general undergraduate college students report high psychological …

The Impact Of Vaccination On Grand Rapids Public Schools' Students, Kayeleigh Eder, Jeremy Abreo, Jordyn Francis

Student Scholars Day Posters

Central Focus: The focus of this paper is to analyze the amount of children vaccinated in the Kent County School District. After determining the percentage of vaccinated children, we plan to implement an intervention to promote vaccination education to parents in the Grand Rapids area as well as increase awareness of the detrimental complications of refusing vaccinations. We are going to interview administrators in the school districts in Kent County, along with school nurses and Primary Care Providers to determine what they believe the issues surrounding the vaccination rates in this area are. After obtaining this information, we are going …

The Healing Power Of Music, Kathleen Szczesny

Honors Projects

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

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

Honors Projects

Many women today struggle with abnormal menstrual cycles and the painful symptoms of reproductive disorders. The standard approach to treatment of infertility, irregular menses, polycystic ovarian syndrome (PCOS), endometriosis, hormonal abnormalities, premenstrual syndrome (PMS), and other pathophysiologic reproductive conditions is the prescription of a pill for symptom management or implementation of assisted reproductive technologies. However, many women may not feel comfortable with this treatment strategy due to ethical concerns or apprehension about potential side effects. The purpose of this paper is to assist in bridging the gaps in education to increase overall awareness of a new approach to women’s healthcare, …

The Impact Of Vaccination On Grand Rapids Public Schools’ Students, Jeremy Abreo, Kayeleigh Eder, Jordyn Francis

Honors Projects

The focus of our project was to analyze the amount of children vaccinated in Grand Rapids Public Schools. After determining the percentage of vaccinated children, we planned to implement an intervention to promote vaccination education to parents in the Grand Rapids area as well as increase awareness of the detrimental complications of refusing vaccinations.

As one of the focuses of our project, we decided to create a set of pamphlets. We focused on two main vaccines: the MMR vaccine and the Influenza Vaccine. After we gathered information about the two different vaccines, we compiled this information into an organized manner …

Utilization Of Patient Toolkit And Discharge Algorithm For Providers To Reduce Readmission Due To Repeat Ground Level Fall, Sara Karl

Doctoral Projects

Introduction. Falls are the leading cause of injury and injury death in adults over the age of 65. A retrospective examination at Level 1 trauma center in the Midwest found that 19.4% (118/605) of older adults admitted with a ground level fall were readmitted with a subsequent fall and injury. The aim of this quality improvement initiative is to determine if the implementation of an evidenced based patient toolkit and a discharge algorithm for providers will reduce outpatient falls. The objective was to reduce hospital readmission due to repeat fall.

Methods: The design of this project was mixed methods, observational, …

Honoring Patient Do Not Resuscitate Wishes And Reducing Harm During Transitions Of Care: A Quality Improvement Project, Emily L. Kraus

Doctoral Projects

Objectives: The quality improvement project objectives were to honor documented Do Not Resuscitate wishes in emergency departments by examining and improving workflow during primary care to emergency department transitions. A location for advance care planning documentations was designated for advanced directives, yet not utilized.

Methods: Mixed method, pre-/post-comparison, and thematic design examined clinicians and patients in a primary care office and two emergency departments in a Midwest healthcare system. Data was collected from patient records, clinician surveys, and observation of workflow. Descriptive statistics, frequency counts and non-parametric tests were used to analyze data.

Results: Patient charts were audited (N=261 [pre=124; …

The Impact Of A Pediatric Nurse Residency Program On Newly Licensed Registered Nurses At Six Months, Amy Rohn

Doctoral Projects

Background: Newly licensed registered nurses (NLRNs) face challenges as they transition from the academic setting to professional practice. These challenges can leave NLRNs feeling dissatisfied and vulnerable in their new positions. Nurse residency programs (NRPs) are an effective way to provide support for the NLRN.

Objectives: The purpose of this project was to evaluate the impact of a newly implemented NRP on NLRNs at six months related to their perception of support, patient safety, stress, communication/leadership, and professional satisfaction.

Methods: The project setting was a large midwestern children’s hospital. The sample consisted of twenty-six NLRNs who participated in the NRP …

Developing Lactation Support In A Primary Care Pediatric Office, Charlotte Minnema

Doctoral Projects

Background: Breast milk is known to be the best nutrition for infants, and experts recommend to exclusively breastfeed through the first six months of life and provide breastmilk through at least the first year of a child’s life (American Academy of Pediatrics, 2012). The United States is currently not achieving its breastfeeding goals set out in Healthy People 2020 by the US Department of Health and Human Services (U.S. Department of Health and Human Services, 2014). The integration of Internationally Board-Certified Lactation Consultants (IBCLC) into primary care pediatrics offices has been shown to increase all breastfeeding rates (Witt, Smith, Mason, …

Implementation Strategies To Reduce Hospital Readmission Rates In Adults With Sepsis: A Quality Improvement Project, Erin Kucharek

Doctoral Projects

Background: Sepsis is a concern in healthcare, as patients are 2 to 3 times more likely to be readmitted to the hospital than those with other illnesses. Readmitted patient with sepsis costs the healthcare system $3.5 billion dollars per year. Effective care coordination is a tool that decreases readmission rates in other illnesses and is likely applicable to those with sepsis. The purpose of this quality improvement project was to determine if primary care provider follow-up appointments, increased home care utilization, and patient education would reduce sepsis readmissions.

Methods: The Transitional Care Model guided project design and The Kotter Model …

Creating Opportunities For Personal Empowerment: A Project Evaluation, Ann L. Cudney

Doctoral Projects

Introduction: 66% of individuals in the United States who experienced a major depressive episode in the last year saw a general practitioner or family doctor and not a psychiatrist or psychotherapist (Center for Behavioral Health Statistics and Quality, 2018). Many primary care providers treat with medication, however, a combination of medication and psychotherapy is associated with better results (Anxiety and Depression Association of America, n.d.). A Midwestern faith-based healthcare organization implemented a pilot cognitive behavioral therapy program at a family medicine residency clinic to improve mental health care.

Objectives: The purpose of this project was to evaluate if the implementation …

Increasing Annual Retinal Exams Among Patients With Type 2 Diabetes, Afokoghene H. Odhu

Doctoral Projects

The Center for Disease Control and Prevention (CDC, 2017) reports that approximately 30 million people in the United States (US) have diabetes. Approximately 8 million have diabetes retinopathy (DR) (CDC, 2018). DR is the leading cause of vision impairment in type 2 diabetes patients. Left untreated, DR can result in loss of vision and blindness (Hernández, Simó-Servat, Bogdanov, & Simó, 2017). The US spends approximately $500 million dollars annually in the treatment of diabetes-related blindness (CDC, n.d.). Early detection and management of DR through tight glycemic control, aggressive blood pressure and lipid management is essential to preventing complications of the …

Self-Monitoring Of Blood Pressure In Community – Dwelling Senior Adults, Laura N. Love

Doctoral Projects

Unregulated hypertension is a public health concern. Hypertension is a chronic disease affecting adults across the lifespan. Although hypertension is easy to diagnose and treat, rates of blood pressure control continue to be low (AHA, 2017). Because of this, it is imperative to employ novel strategies for blood pressure control; especially in high risk populations. The purpose of this evidence-based, project was to determine whether self-monitoring of blood pressure (SMBP) improves knowledge about hypertension, while also increasing the frequency of SMBP. Another outcome of interest was a reduction in mean systolic blood pressure for the cohort. The project enrolled participants …