Nursing Commons^™

Why Won't This Heal?: Actinomyces And Wounds, Christina Wagener

Doctor of Nursing Practice Projects

Why Won’t This heal? Actinomyces and Wounds

Christina Wagener, MSN, Steve Kalish, MD, Mary Lee Barron, PhD, APRN, FNP-BC, FAANP

An incidental finding of Actinomyces europaeus in a refractory healing abscess presents an opportunity to close a knowledge and treatment gap. After finding Actinomyces species in multiple patients within a twenty-month period in an independent hospital in Chicago, IL, the probability exists that Actinomyces is becoming more prevalent in subcutaneous wounds. Chronic, non-healing wounds cause multiple negative consequences including financial, psychological and physical losses and possibly death.

Actinomyces is a Gram-positive, filamentous, non-acid-fast and anaerobic-to-microaerophilic bacteria first identified in 1997 …

Mindfulness-Based Stress Reduction Activities Via Smartphone In Advanced Practice Providers: A Pilot Quality Improvement Project To Reduce Perceived Stress, Burnout, And Intent To Leave, Cynthia L. Larsen-Bednarchik

Doctor of Nursing Practice Projects

Abstract

Burnout, attrition, and decreased work engagement among Advanced Practice Providers (APPs) are growing concerns and can have a negative influence on health care provider wellbeing. Chronic workplace stress is linked to various physical health problems, such as fatigue, insomnia, heart disease, depression, anxiety, and obesity. Chronic provider burnout is costly and extends to organizations and hospitals due to higher attrition, increased absenteeism, and decreased work engagement. Mindfulness-based stress reduction (MBSR) programs focus on the intent of practicing mindfulness to cultivate a state of being that is nonjudgmental, openhearted, friendly, curious, accepting, and compassionate. MBSR programs afford clinicians a way …

Physical Activity Group On An Inpatient Behavioral Health Unit, Patricia Brown

Doctor of Nursing Practice Projects

Physical activity is beneficial for the wellness of both the body and mind. Preventable physical diseases are the cause of the majority of deaths in individuals with severe mental illness (SMI) (Vancampfort et al., 2017). Motivation can be a barrier to regular physical activity. Learning by observation can facilitate maintaining behavior change. Thus, physical activity groups on an inpatient behavioral health unit were facilitated by exercise physiologists to improve mental health and physical health (Kaur et al., 2013; WHO, 2015). Lack of physical activity on inpatient behavioral health units is a common practice. The primary aim of this project was …

Implementation Of Provider Education For A Subanesthetic Ketamine Infusion For Acute Analgesia In Opioid Tolerant Postpartum Patients, Leah Baecht

Doctor of Nursing Practice Projects

The current opioid epidemic demands the development of new management policies and staff education to increase awareness of issues and improve care of patients with Opioid Use Disorder (OUD). A recent dramatic increase in OUD during pregnancy has paralleled the epidemic observed in the general population. The combination of OUD and cesarean delivery, place both the mother with OUD and neonate at risk for increased postoperative complications. The purpose of this project was to evaluate and increase staff knowledge regarding OUD in obstetrics. An analysis of staff knowledge was performed via surveys both pre and post dissemination of evidence. The …

Labor Management Protocol For Parturients On Buprenorphine, Erik Sanders

Doctor of Nursing Practice Projects

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Opioid dependence during pregnancy may lead to negative outcomes for both the parturient and the fetus. Opioid dependent parturients are often prescribed buprenorphine, a form of medication- assisted therapy. The use of buprenorphine within the parturient population is a relatively new practice and anesthesia providers are encountering difficulties in managing this population during the peripartum period. Literature has demonstrated anesthesia providers may best serve this population by utilizing a multimodal approach when providing analgesia (Jones et al., 2008; Meyer et al., 2010; Reddy et al., 2017). A combination of oral, intravenous and neuraxial modalities, in conjunction with the daily …

The Implementation Of A Behavioral Intervention Program In Obese Elderly Patients, Zandra Brown

Doctor of Nursing Practice Projects

Abstract

The prevalence of obesity is increasing in American and patients are living longer. Research suggests that behavioral lifestyle interventions help optimize elderly patient’s health and improve their quality of life. A successful behavioral weight loss program had been in place in one clinic within a large healthcare organization. The need at another metropolitan Midwest location seemed even greater due to having a patient population consisting of elderly, demographics, obesity trends, and high rates of obesity linked morbidities such a diabetes, hypertension, and heart disease. Thirteen elderly obese patients with ages ranging from 65-75 years old were enrolled in an …

Using An Electronic Health Record Alert System To Screen And Manage Patients With Diabetes Mellitus Type 2 In A Rural Primary Care Setting, Simon Katumu

Doctor of Nursing Practice Projects

Diabetes Mellitus type 2 is the 7th leading cause of death and affects nearly 10% of the US population. Early detection of this condition leads to the initiation of treatment and lowers the risk for complications and better outcomes. Frequent testing of hemoglobin A1Cs in those already diagnosed also leads to better management, glycemic control and improves health outcomes. This project utilized a feature in the electronic health record system of a rural primary care clinic to remind providers to screen at-risk patients and retest those who were either due or overdue for hemoglobin A1C testing. Hemoglobin A1C readings were …

Unraveling Sex Trafficking Through Screening And Referrals, Rebecca Sarabia

Doctor of Nursing Practice Projects

Abstract

Human trafficking is a form of modern-day slavery; sex trafficking is one form of human trafficking. Previous research has demonstrated that most trafficking victims encounter the healthcare system at some point during their trafficking experience. Patients who have been sex trafficked may experience profound psychological and physical trauma. Healthcare personnel are in key positions to screen for trafficking and to provide appropriate referrals; if an awareness of the problem exists. The purpose of this project was to increase OB/Gyn office staff confidence with sex trafficking screening and to complete appropriate referrals to address the identified needs. The project began …

Improving Perioperative Warming Of Surgical Patients: Implementation Of A Warming Protocol, Maghy Schrage

Doctor of Nursing Practice Projects

Despite the ample amount of knowledge and interventions available to keep patients warm in the operating room, the issue of inadvertent perioperative hypothermia continues to be a problem affecting surgical patients. Unfortunately, even a mild degree of hypothermia can increase a patient’s chance for negative outcomes such as surgical site infections, bleeding, and higher risk for mortality. The project involved development of a warming protocol/guideline for a small community hospital. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of warming patients, reimbursement initiatives, and appropriate interventions.

The project study …

Improving Emergence And Awaken Time In The Obese Population: Development Of A Desflurane Protocol In The Obese Population, Nikki Watson

Doctor of Nursing Practice Projects

Studies have shown that obese patients are at an increased risk for apnea and aspiration during the postoperative period due to comorbidities associated with obesity (Nason, 2015). Complications such as apnea and aspiration can increase the length of stay in the post-operative care unit (PACU). Slower emergence further increases the risk for apnea and aspiration because of delayed return of protective reflexes (Brousseau, Dobson, & Milne, 2014). Evidence-based research has shown Desflurane to have the fastest wake-up times in obese patients when compared to Sevoflurane, Isoflurane, and Propofol (Juvin, Vadam, Malek, Dupont, Marmuse, & Desmonts, 2000). The goal of this …

Popliteal Blocks For The Treatment Of Distal Injuries In The Lower Extremity In The Emergency Department, Jacob Turner

Doctor of Nursing Practice Projects

Opioid addiction in the United States has increased, and interventions needs to be put into place to manage pain with fewer opioids. Alternatives like peripheral nerve blocks can be used to aid in pain management for acute injuries like ankle and wrist fractures. The purpose of this project is to develop and create a regional anesthesia protocol for acute upper and lower extremity fractures in the emergency department (ED) at Passavant Hospital in Jacksonville, Illinois, with the long-term goal of a reduction in opioid administration. An educational Power Point presentation was provided for the ED and the anesthesia personnel on …

Implementation Of Crisis Checklists In The Operating Room, Gregory S. Feilner

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …

Introducing Enhanced Recovery After Surgery For Colorectal Procedures: Development Of An Enhanced Recovery After Surgery Protocol, Vincent Compton

Doctor of Nursing Practice Projects

Abstract

The prevalence of colorectal surgery is increasing due to the surgical demand of an aging population with various comorbidities (Ralph & Duff, 2017). Consequences include an increased burden on clinical and financial resources from perioperative costs, length of stay (LOS), complications, and readmissions (Nelson et al., 2016). Enhanced recovery programs were created to improve patient outcomes and decrease financial strain. Objectives of this practice project included researching current evidence-based literature to determine the effectiveness of ERAS implementation in open and laparoscopic colorectal procedures, developing a customized ERAS protocol, and introducing the pathway to members of anesthesia, pharmacy, and the …

Ethical Considerations In Short Term Global Health Experiences, Sheri Compton-Mcbride

Doctor of Nursing Practice Projects

Academically sponsored, short-term experiences in global health care (STEGH) have increased in popularity and accessibility among students originating from high-income countries (HIC) and enrolled in medical and health care programs. The populations served have socioeconomic, cultural, and/or geographic barriers to healthcare. Establishment of goals, clarity of expectations, and ethical awareness of services being provided are essential to achieve mutually agreeable outcomes for all involved. The project was designed to increase the knowledge of undergraduate nursing students scheduled to embark on a short term experience in global health. Module development and dissemination of evidence regarding the ethics of care and cultural …

Implementation Of A Medication Near-Miss Reporting System, Jamie Deubel

Doctor of Nursing Practice Projects

Faculty from a state university nurse anesthesia program requested a system to track medication near-miss events among their students. After a literature review, and in collaboration with faculty stakeholders, an electronic medication near-miss reporting system was developed and activated. A Likert scale evaluation survey was designed and reviewed by experts. This medication near-miss survey was auto-populated for all students who utilized the system. Students were happy with the anonymity, ease of use, and time it took to report the near-miss. Faculty stakeholders were given an open-ended question survey and results indicated faculty were pleased with the data they received. After …

Utilizing Team-Based Care To Improve Rural Cardiovascular Care, Amanda Clouser, Kastin Engeling, Kris Rhodes

Doctor of Nursing Practice Projects

Cardiovascular morbidity and mortality are significantly higher among individuals living in rural areas compared to urban and suburban settings. Some contributing factors include financial limitations, education level, and limited access to cardiovascular specialty healthcare. Using a team-based cardiovascular care approach in rural communities, including both nurse practitioners and physicians, could help improve access to cardiovascular health services. The purpose of this project was to conduct a focus group interview to evaluate a team-based care approach to cardiovascular services implemented in a rural clinic located in a medically underserved area. Based on the results of the focus group interview, an evidence …

Hand-Off Tool Implementation In Post-Anesthesia Care, Benjamin Nash

Doctor of Nursing Practice Projects

The issues surrounding the safety of patients and improving patient care outcomes in the pre-operative and post-operative environment, is one of ongoing focus and development. Post-operative, hand-off report is one aspect in the continuity of patient care that has affected patient outcomes. Clear, concise, and accurate communication concerning patients and their postoperative status is one way that providers and caregivers may ensure patient safety. There are many various organizations that emphasize the importance of clear, effective communication, in the form of a standardized hand-off tool to maximize patient safety. The purpose of the project was to standardize clear, concise, effective …

Improving Allergy Immunotherapy Adherence, Amy Branham

Doctor of Nursing Practice Projects

Allergen Immunotherapy (AIT) is an effective treatment for allergic rhinitis. However, at a Midwest teaching clinic, patients tend to not complete the entire course of immunotherapy. AIT adherence is suboptimal due to a multitude of reasons. The purpose of this project is to increase adherence to AIT by implementing the following evidence based interventions; a text message reminder, a communication/education template, and through increasing clinic accessibility. Initial implementation involved working with clinic personnel to develop the content of the reminder texts and of additional educational materials. Subsequently, the changes were executed at the beginning of fall. Over the following three …

Managing Chronic Back Pain In A Rural Primary Care Setting, Cassandra Chambers, Kaitlin E. Behnken

Doctor of Nursing Practice Projects

Chronic back pain management is complex and is often challenging for Primary Care Providers (PCPs). Rural PCPs are managing chronic back pain despite limited training and availability of pain management specialists. Pharmacological interventions are often used to treat chronic back pain despite current evidence suggesting physical therapy and aquatic therapy are first-line treatments. A directory of local therapy facilities offering physical and aquatic therapy and a review of clinical practice guidelines (CPG) were provided to three PCPs in a rural clinic in the Midwest. Use of the directory and the CPG was intended to help decrease reliance on pharmacological options …

Depression Screening In The Primary Care Setting, Colleen Dostal, Stephanie Boerding

Doctor of Nursing Practice Projects

Recent data reveals that approximately 17.3 million adults in the US population experience an episode of depression each year. Unidentified and untreated depression has many consequences leading to a poor quality of life, direct and indirect healthcare cost-related increases, and an increase in medical comorbidities. The U.S. Preventative Services Task Force recommends that all adults be screened for depression. The PHQ-2 and PHQ-9 are the most widely accepted screening tools in the preliminary detection of depression. The purpose of this project was to educate health care professionals regarding depression and the implementation of a new depression screening protocol: A positive …

Improving Acute Pain Management For Pediatric Patients: Development Of A Ketamine Infusion Protocol, Oksana Koeppen

Doctor of Nursing Practice Projects

Multimodal analgesia is a recommended approach for acute pain management for adults and children (ASA, 2012; Chou et al., 2016). This approach is becoming a prominent modality in pain control strategies in the pediatric population. An intravenous anesthetic, ketamine, may be a useful adjunct for acute pain management in children. Development of a pediatric ketamine infusion protocol and its subsequent introduction to the key stakeholders at the host facility in central Illinois were the focus of this project. Research has demonstrated the effectiveness of low-dose intravenous ketamine in acute pain management when used as an adjunct to other medications (Asadi …

Clinical Guideline Based Interventions To Increase Smoking Cessation Success In Primary Care, Chloe Marth

Doctor of Nursing Practice Projects

Current evidence indicates that providers play an integral role and are most successful in improving cigarette smoking cessation rates through a combination of counseling, patient follow up, and pharmacotherapy. In order to address high smoking rates among patients at a primary care clinic in an urban community, the Five A’s model for smoking cessation (Ask, Advise, Assess, Assist, and Arrange) was initiated. During clinic visits, patients were asked about their smoking status. For those who stated they smoked cigarettes, further evaluation was conducted using the Fagerstrom Test for Nicotine Dependence and the patient’s willingness to quit was assessed. Five of …

Implementing An Enhanced Recovery After Surgery Protocol In A Critical Access Hospital, Joseph Grazaitis

Doctor of Nursing Practice Projects

Enhanced recovery after surgery (ERAS) protocols provide numerous benefits for patients undergoing colorectal surgery. The goal of the protocol is to decrease surgical complications, patient’s length of hospital stay, recovery time, and increase patient satisfaction. The purpose of this doctoral project was to create and implement an ERAS protocol for a 25-bed critical access hospital. The findings obtained from the literature review were presented to the multi-disciplinary team. The specific needs of the surgical team were identified, and the ERAS protocol was created. Lastly, the ERAS protocol was finalized and implemented in the institution. The outcome measures examined were the …

Heart Failure Knowledge Among Cnas In A Skilled Nursing Facility: A Pilot Project, Amanda Mcdannald

Doctor of Nursing Practice Projects

Heart failure (HF) is one of the leading causes of hospitalization among patients over the age of 65 years. Many are transitioned to skilled nursing facilities (SNF) following hospital discharge. HF-specific SNF staff education was designed for early detection of changes and improved management of this patient population. Computer-based education modules and hands on skill demonstration stations were created to provide basic HF knowledge and specific guideline recommended care measures for the SNF environment. A pretest, post-test, and skill demonstration were implemented and included weight assessment, application of compression stockings, volume status monitoring, and low sodium diet recommendations. Pretest scores …

Supraclavicular Blocks For The Treatment Of Distal Injuries In The Upper Extremity In The Emergency Department, Patrick O'Brien

Doctor of Nursing Practice Projects

Opioid addiction in the United States has increased, and interventions needs to be put into place to manage pain with fewer opioids. Alternatives like peripheral nerve blocks can be used to aid in pain management for acute injuries like ankle and wrist fractures. The purpose of this project is to develop and create a regional anesthesia protocol for acute upper and lower extremity fractures in the emergency department (ED) at Passavant Hospital in Jacksonville, Illinois, with the long-term goal of a reduction in opioid administration. An educational Power Point presentation was provided for the ED and the anesthesia personnel on …

Utilizing Simulation To Implement Cognitive Aids In The Operating Room, Kaitlyn Brown

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …

Adequate Pain Control With Ofirmev To Minimize Narcotics Consumption And Its Side Effects, Gideon Nkrumah

Doctor of Nursing Practice Projects

Typically, perioperative pain has been managed with opioids, however, the extreme use of opioids has been associated with respiratory depression, excessive sedation, drowsiness, nausea, vomiting, ileus, severe constipation, prolonged hospital stay, addiction, and dependence. The American Society of Anesthesiologists Task Force on Acute Pain Management recommends that patients should always receive non-opioid analgesics like Acetaminophen and NSAIDs as first-line agents so that opioids can be used as adjunctive agents to minimize opioid-related side effects, addiction, and dependence (The American Society of Anesthesiologists, 2011).

A protocol was developed to help providers use Ofirmev effectively and efficiently. The goals of this project …

Development Of A Guideline To Reduce Spinal Induced Hypotension And Related Nausea And Vomiting In Patients Undergoing Scheduled Cesarean Section, Peter Gillen

Doctor of Nursing Practice Projects

Cesarean sections performed under spinal anesthesia frequently involve spinal-induced hypotension and can result in intraoperative nausea and vomiting for the patient. This project involved the development of a guideline to combat this problem using lower sequential devices, co-loading of crystalloid fluids, and prophylactic administration of intravenous ondansetron. The guideline was presented to anesthesia providers at a tertiary care facility in Southwestern Illinois. Evaluation of the project included pre and post-tests as well as post-implementation surveys of the providers. The pre-test results indicated a need for further education among providers to address the problem. The post-test scores achieved the goal of …

Implementing Routine Hiv Testing And Prevention In A Primary Care Setting, Michelle Bassett

Doctor of Nursing Practice Projects

Evidenced-based research has identified that routine HIV testing and education is pivotal in identifying new infections, providing access to treatment, and decreasing the rates of transmission. In 2006, the CDC implemented new guidelines recommending that all persons aged 13-64 years be tested yearly for HIV regardless of risk factors. Despite these recommendations, the CDC estimated that less than 37% of people were tested in 2017 and in the years prior. In this project, a protocol for routine testing and education was developed and implemented in a private Southern Illinois primary care practice. Providers and staff were educated on HIV and …

Improving Patient Education On Spinal Anesthesia: An Assessment Of A Patient Educational Program, Nicholas Raburn

Doctor of Nursing Practice Projects

Abstract

Spinal Anesthesia (SA) is a common type of anesthesia that is frequently used for surgeries of the lower abdomen, lower extremities, and perineal area. Spinal anesthesia offers fewer side effects and risks than General Anesthesia (GA). Patients usually recover their senses much faster with SA (MedlinePlus, 2017). Some patients often refuse SA due to fears and misconceptions. These misconceptions are related to a lack of education and resources available to patients. It is crucial that anesthesia providers learn to adequately educate patients preoperatively on the use of SA. Anesthesia providers in a community hospital in southern Illinois educated patients …