Nursing Commons^™

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, …

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 …

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 …

A Policy Analysis Of Adult Lead Exposure Screening In Michigan, Omoyemi A. Idowu

Doctoral Projects

A growing body of scientific literature suggests that even at low levels, lead is an important, but often overlooked risk factor for cardiovascular disease mortality in adults. Through an initial literature review and organizational assessment, the DNP student was able to identify a potential gap between current research and policy guidelines related to adult lead exposure screening in the state of Michigan. The purpose of this policy analysis project was to examine current literature and policy guidelines related to lead exposure screening in the adult population in order to identify and analyze a potential gap that may be amenable to …

Process Improvement To Improve Quality Measures In A Rural Primary Care Clinic, Lucille Yurko Vanderwoude

Doctoral Projects

Health disparities are differences in health that increase the amount of sickness in certain parts of the population, these inequalities in health are directly influenced by social, economic and environmental status (Healthy People 2020, 2008). Individuals living in poverty, violence, or disability have less opportunity for good healthcare and often have higher rates of chronic disease. Rural geographic locations additionally fall under this category (Healthy People 2020, 2008). These disparities can result from decreased exercise, violence in living situations, and unhealthy diet choices or options (CDC, 2018). Research has shown that health disparities increase with a reduction of individual’s income …

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 …

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, …

The Effect Of The Screening, Brief Intervention, Referral To Treatment (Sbirt) Model On Adult Depression In An Outpatient Setting, Genevieve E. Sweeney

Doctoral Projects

Depression is one of the most common chronic conditions in the world. Despite this, depression continues to be under-screened, inaccurately assessed and diagnosed, and poorly treated in outpatient settings. Many providers solely rely on clinical judgement instead of a screening tool or evidence-based toolkit when a patient presents with depression symptoms, resulting in underdiagnosis and inappropriate treatment. Utilization of resources can help a provider appropriately screen, diagnose and treat an individual with depression. Screening, Brief Intervention, Referral to Treatment (SBIRT) is an evidence-based model intended to improve these measures. Studies from the literature support the efficacy of the SBIRT model …

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 …

Improving Blood Pressure Control Among Patients Diagnosed With Hypertension In A Primary Care Setting, Eriko Apriliando

Doctoral Projects

Hypertension affects over 38% of adults or approximately 103 million Americans, costing around $131 billion annually in treatment and loss of productivity. It is also an independent risk factor for coronary events, heart failure, stroke, and end-stage renal disease contributing to 410,624 United States (U.S.) deaths in 2014. The American Heart Association (2016) has released the Measure Accurately, Act Rapidly, and Partner with Patient (MAP) protocol in order to address this issue. This project focused on implementing parts of the MAP protocol. The purpose was to improve blood pressure (BP) control of patients diagnosed with hypertension in a primary care …

Extraction And Analysis Of Data For Fragility Fracture Patients To Help Determine The Likelihood Of Follow-Up With A West Michigan Fragility Fracture Service, Michael Joseph Lamphere

Doctoral Dissertations

Fragility fractures and secondary fractures are a large physical, financial, and emotional drain on the individuals and families affected. Improving post fragility fracture care and increasing follow-up rates with specialty services, such as a fracture liaison service, may promote post-fracture recovery and help prevent future fractures. The purpose of this doctoral project was to increase and improve post osteoporotic fracture care by increasing appropriate referrals and follow-up care. Patient data was retrieved and analyzed on 60 fragility fracture patients referred to a local fracture liaison service. The analysis found that patient gender, fracture site, and history of a previous fracture …

Process Improvement To Reduce Route Of Medication Administration Errors In Patients With Enteral Feeding Tubes, Elizabeth Scott

Doctoral Projects

Advances in health information management in the form electronic health records, computerized provider order entry systems, and clinical decision support systems and tools have enhanced the productivity, effectiveness, and efficiency of healthcare. However, the cost of these positive effects does come at the expense of other factors. Along with the introduction of Clinical Provider Order Entry (CPOE) systems, organizations have experienced new possibilities for medication errors and risks to patient safety. Factors associated with these errors should be evaluated in detail in order to mitigate the causes of these types of errors and to plan strategies for prevention. Continued research …

A Simulation To Improve Nursing Students’ Understanding Of The Experience Of Middle Eastern Refugees, Ibtisam Matta

Honors Projects

A simulation was constructed with the aim of improving nursing students’ understanding of the needs of Middle Eastern refugees.

The research questions were: what are student nurses’ perceptions on the unique culture of the Middle Eastern refugee population after participating in a simulation of this populations’ experiences, and how will these influence the students’ interactions with this population in their nursing career?

Approval was granted from the Grand Valley State University (GVSU) Internal Review Board (IRB) to conduct the research. Student nurses were recruited through GVSU Kirkhoff College of Nursing (KCON) Student Nursing Association (SNA); the event was one of …

Examining Pediatric Tourette Syndrome, Alyssa Orlando

Honors Projects

Pediatric Tourette Syndrome is a complex neurological disorder. Many people associate it with swearing, however in reality it is very rarely associated with that. This paper entails my own personal experiene with Tourette Syndrome and examines potential treatment options in the pediatric population.

Exploration Of Naturopathic Medicine For Pregnant And Laboring Women, Megan Latreille

Honors Projects

Exploration of natural medicine has become increasingly common among individuals. With proper use, natural medicine can help treat many common ailments experienced during pregnancy, delivery, and postpartum. This paper serves to shed light on naturopathic medicinal techniques for expectant mothers and families, so that they may implement such in their own lives throughout pregnancy, during labor, and after birth. Yoga can be adapted and utilized during antenatal and postpartum periods to help with stress levels, depression, and physical health. Hypnosis, meditation, and hypnobirthing provide similar effects such as decreased stress and increased contentment; promoting a smoother and more effective labor …

Comparison Of A Self-Audit Tool To Accrediting Health Care Agencies’ Standards Of Care In A Corrections Setting, Matthew C. Widerman

Doctoral Projects

Millions of individuals enter correctional facilities each year and require health services. Inmates are bound to a set of rules, wherein they are thought of as objects of surveillance, punishment, or rehabilitation, rather than as patients. In addition to standards of care defined by national accrediting bodies and state boards of practice, correctional facilities also have state laws that define expected health services for incarcerated persons. All health care providers have a responsibility to provide the highest quality care, but in prisons, patients are still inmates bound to correctional rules. Policies and procedures guide health care practices in correctional facilities, …

A Review Of The Association Between Vitamin D And Postpartum Depression, Christa Fernando

Biomedical Sciences Undergraduate Research

Vitamin D (specifically vitamin D3) is a lipid soluble essential nutrient. It is found in few foods naturally but can be synthesized upon skin exposure to sunlight. Its intermediate structure in the blood is serum 25-hydroxyvitamin D, also called calcidiol, and is formed in the liver. Vitamin D receptors have been found in numerous areas of the brain that are involved in mood-related hormone production. It has also been found to be protective against the brain degradation of Alzheimer’s. Numerous studies have found a significant relationship between vitamin D and major depressive disorder. This review summarizes research on the connection …

An Interdisciplinary Framework For Impacting Older Adults Health And Physical Activity, Christopher J. Dondzila, Elaine Vandoren

Open Access Publishing Support Funded Articles

The exploration of feasible and cost-effective strategies is warranted to mitigate rising healthcare costs and lessen the impact of chronic diseases, functional decline, and disability in older adults. The overwhelming sedentariness of older adults is accompanied by a lack of expertise by healthcare professionals in exercise programming that acknowledge factors influencing physical activity (PA) patterns. We present a framework for a nursing/exercise science interdisciplinary effort to increase PA and improve health in older adults via the delivery of individually tailored exercise programming for an 8-week intervention. Results from this study will be integral in translating effective interdisciplinary efforts across diverse …

A Quality Improvement Project To Enact Evidence-Based Guidelines To Improve Documentation Of Hemoglobin A1c For Inpatient Diabetes Populations, Karyn C. Kinney

Master's Projects

The purpose of this paper is to describe a quality improvement project aimed to improve the documentation of hemoglobin A1c in the discharge instructions for patients with a diagnosis of diabetes prior to a transition from the acute care setting. Clinical practice guidelines from the American Diabetes Association and patient education recommendations from The Joint Commission are the impetus for this process improvement. The Plan-Do-Study-Act (PDSA) model was utilized to identify, design, and implement the process change in collaboration with an interprofessional team. The documentation rate of hemoglobin A1c was measured on two medical-surgical inpatient hospital units both pre- and …

Developing An Evidence-Based Discharge Process For Patients On A Cardiac/Renal Acuity-Adaptable Inpatient Unit, Tami Gallagher

Master's Projects

Introduction: Readmissions continue to negatively impact patient outcomes and create a significant financial burden. Regardless of efforts to reduce readmission rates, the cost of readmission continues to increase.

Clinical Problem: All-cause, 30-day readmission rates on a cardiac/renal acuity-adaptable inpatient nursing unit ranged from 11% to 33% from July to December 2018 for patients diagnosed with COPD, AMI, HF, and sepsis. The readmission rate for the organization was 16.2% in September 2018 with a target goal of 14.8%.

Project Aim: To use quality improvement tools and an interdisciplinary team to implement the teach-back method during discharge education and a discharge preparedness …

Introduction Of Auricular Acupuncture, Monica Lyons

Doctoral Projects

The overall purpose of this quality improvement project was to assess if there was an interest to add auricular acupuncture to a substance abuse program. The two guiding questions of the Doctor of Nursing Project were (a) how can auricular acupuncture be helpful when treating patients with substance abuse in a selected organization? (b) what information is needed for both staff and patients to make an informed decision regarding auricular acupuncture? The Promoting Action on Research Implementation in Health Services (PARiHS) framework was used as the theory framework for implementation of evidence-based research into an organization. The facilitator in the …

Evidence-Based Cardiac Monitoring: A Practice Change, Joseph Paul Urbanski

Doctoral Projects

Background: Overuse of cardiac monitoring (CM) in acute care settings contributes to increased healthcare spending and cost of services for patients. Additionally, inappropriate use of CM can contribute to wastefulness of healthcare resources, increases in hospital staff workloads, and can be improved with best evidence-based practice recommendations. A Midwest acute care hospital lacked an evidence-based, systematic method to define care for patients requiring CM.

Objective: The purpose of the project was to pilot an evidence-based CM change initiative, determine feasibility for sustainment, and propose next steps for adoption of the change initiative across non-emergency department, non-intensive care inpatient CM units …

Optimizing Clinical Processes Using The Electronic Health Record To Improve Patient Outcomes In Primary Care, Alex Jubril

Doctoral Projects

Background: The EHR has been used to leverage clinical processes for the improvement of patient outcomes. The average users of EHR limit its uses to the minimum level required to complete the daily tasks needed, regardless of the existence of features within the EHR that are readily available to optimize clinical processes for efficiency and effectiveness.

Objectives: The objective of this project was to improve the documentation in a nurse-managed health clinic related to the patient-centered medical home (PCMH) core criteria through enhancing the EHR to foster the quality improvement metrics and reporting.

Methods: This was a quality improvement project …

Prior Authorizations And Continued Treatment In Addiction Medicine, Wendy Hunting

Doctoral Projects

Introduction: Patients that require medication assisted treatment for opioid addiction can have their treatment delayed through the prior authorization process. A prior authorization is required by many insurance companies and can cause lengthy delays before the drug is approved. The two drugs that were considered for this project were Suboxone® (buprenorphine/naloxone) and Sublocade® (buprenorphine). These drugs are used for the treatment of opiate addiction. The proposed solution to the problem was to use quality improvement methods to implement a tracking and tickler system to improve the approval time from the insurance company.

Objectives: The project goal was to decrease the …

Adult Attention Deficit/Hyperactivity Disorder Quality Improvement Project, Danielle Miller

Doctoral Projects

Adults with Attention Deficit Hyperactivity Disorder (ADHD) vary widely in their symptom presentation and functional deficits, which can make management in the primary care setting challenging for providers (Morstedt, Corbisiero, Bitto, & Stieglitz, 2015). Measurement-based care is common in the management of medical disease, however is rarely used as standard practice in treatment of psychiatric disorders (Waldrop & McGuinness, 2017). As a result, treatment for psychiatric conditions, such as ADHD, may vary widely among clinicians and may result suboptimal treatment and patient outcomes (Waldrop & McGuinness, 2017). The proposed solution was to introduce the use of a standardized measurement tool …

Implementation Of An Evidenced-Based Intervention For Pain Management In Lumbar Spine Surgery, Mary R. Draper

Doctoral Projects

Introduction: Spinal surgeries are among the top procedures responsible for the highest degree of post-surgical pain. Opioids are the mainstay of current pain management practices in the post-operative period. In light of the opioid epidemic, increased opioid tolerance, and changes in legislation, there is a calling for alternative strategies in managing acute and chronic pain. The purpose of this project is to answer the following question: Does implementation of an evidence-based intervention for preoperative administration of gabapentin reduce patients’ perception of pain and reduce opioid consumption in those who experience lumbar spine surgery?

Objectives: The goal of this project is …

A Need For A Culturally Congruent Obesity Intervention At A Community Safety-Net Clinic, Claudia D. Rivera-Salas

Doctoral Projects

Background: Obesity is an epidemic in the United States which causes numerous chronic conditions and disproportionally impacts underserved populations. The removal of barriers that prevent active lifestyles such as unaffordable facilities and inaccessibility are of primary importance in promoting a healthy lifestyle.

Objectives: Collaboration with community organizations to increase access to culturally congruent nutrition and exercise classes for underserved Latino/Hispanic patients of a Midwestern safety-net clinic to reduce obesity, increase physical activity, and improve dietary habits.

Methods: Assessment of current practices revealed the need for project development. Six-week nutrition education class and exercise classes were held for eligible patients which …

Implementing Use Of The Moss (Michigan Opioid Safety Score) Tool And Interventions To Reduce Opioid-Related Overdose Events In High Risk Patients, Michelle J. Kloss

Doctoral Projects

Opioids are among the most common pharmacological class of therapeutic medications prescribed to alleviate pain across all healthcare settings. However, opioid-related adverse events are a growing problem contributing to an increase in morbidity and mortality. Current hospital practice does not utilize a pre-opioid administration screening tool to assess patient risk of adverse events related to opioid administration. The implementation of the Michigan Opioid Safety Score (MOSS), an evidence-based risk assessment tool which utilizes patient characteristics as well as respiratory assessment for the prediction and early detection of opioid-induced adverse events. This quality improvement project evaluated the effectiveness of the MOSS …