Nursing Commons^™

Using An American Sign Language Video Intervention To Improve Advance Care Planning Engagement Among Deaf Adults, Colleen Ann Manning Dnp, Aprn, Fnp-C

Doctor of Nursing Practice Final Project Abstract

PURPOSE This quality improvement (QI) project was intended to increase ACP engagement by 25% from baseline by implementing an ASL video intervention. The project was conducted at a Deaf community organization in Houston, Texas.

BACKGROUND Literacy and language barriers negatively impact access to healthcare and health information among the Deaf population. ASL video interventions aimed at improving health equity are supported in the literature.

METHODOLOGY The Plan-Do-Study-Act (PDSA) quality improvement methodology was used to create a video for the Deaf community about ACP using ASL and captioning. The PREPARE™ ACP Engagement Survey measured changes in ACP behavior due to a …

Implementation Of A Standardized Process To Increase Referrals To The Tobacco Quitline In An Underserved General Oncology Cancer Survivorship Clinic, Kristyn-Mae Rosales

Doctor of Nursing Practice Final Project Abstract

PURPOSE The purpose of this scholarly project was to implement a standardized process to increase referral rates to the tobacco quitline among cancer survivors in an outpatient center. The intent was to promote the usage of tobacco cessation resources for this vulnerable population.

BACKGROUND “Cigarette smoking remains the leading cause of preventable disease, disability, and death in the United States” (CDC, 2023). This project was implemented in an ambulatory clinic among the Harris County population, Houston, Texas. The aim of this project was to increase the number of quitline referrals by 20% in six months.

METHODOLOGY Interventions were implemented to …

Effectiveness Of A Positive Psychotherapy Tool In Reducing Burnout And Increasing Morale Of Night Shift Mental Health Workers On An Acute Pediatric Psychiatric Floor, Esther Gatonye

Doctor of Nursing Practice Final Project Abstract

Purpose: This scholarly project's purpose was to enhance the well-being of mental healthcare workers on the night shift in an acute pediatric mental health unit by implementing the Three Good Things (3GT) positive psychotherapy tool. The project intended to address the issue of high burnout rates among healthcare workers and improve employee well-being and patient care.

Background: The project was implemented in a 16-bed Mental Health Unit within a pediatric hospital located in the Austin Metroplex.

Methodology: The project employed a non-randomized pre-, mid, and post-design and utilized surveys to evaluate burnout, well-being, and coping skills. Burnout was measured using …

Improving Fall Rates And Satisfaction Through Implementation Of Bedside Shift Report Protocol., Olive Atsafack Tieumo

Doctor of Nursing Practice Final Project Abstract

PURPOSE

Implementing BSR Protocol to improve patient fall rates and satisfaction in an adult medical surgical unit in Texas aims to decrease the patient fall rates by 10%, increase patient satisfaction rates by 7%, and improve the completion of nursing BSR and fall checklists by 10% with the implementation of a standardized BSR tool and a fall TIPS checklist within 16 weeks.

BACKGROUND

High fall-risk patients are found on the unit, and about 86.1% of inpatient falls occur at the bedside. The average unit fall rates exceed the target of 2.3 and HCAHPS scores stay below 65%. Inconsistencies in shift …

Prognostic Values Of Serum Lactate-To-Bicarbonate Ratio And Lactate For Predicting 28-Day In-Hospital Mortality In Children With Dengue Shock Syndrome, Thanh Nguyen Tat, Nhu Vo Hoang-Thien, Dat Nguyen Tat, Phuc Hoang Nguyen, Lien Thi Ho, Duong Hung Doan, Dung Tuan Phan, Yen Nguyen-Hoang Duong, Truc Huynh Nguyen, Tuyet Kim Nguyen, Ha Thi-Thu Dinh, Thuy Thi-Diem Dinh, Anh Thi-Mai Pham, Viet Do Chau, Tung Huu Trinh, Luan Vo Thanh

Faculty, Staff and Student Publications

This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of …

Implementing Fall Prevention Safety Agreement And Fall Tips To Improve Patient Safety With Postoperative Cancer Patients, Marguerite Ndoko

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement project aimed to implement targeted fall prevention interventions within an oncology surgical unit to reduce the rate of patient falls by 30%.

BACKGROUND

Hospital patient falls are a major safety concern, particularly in oncology surgical patients due to postoperative weakness and altered mobility. Consistent high fall rates in the unit prompted targeted interventions to address this risk.

METHODOLOGY

Two interventions were implemented over 14 weeks using PDSA cycles. Patient Fall Safety Agreements (PFSA) were initiated between patients and bedside nurses upon admission, while fall Tailoring Interventions for Patient Safety (TIPS) were posted in patient rooms to …

A Dnp Project: Improving Clinical Alarm Management Through An Alarm Management Bundle: A Quality Improvement Project, Mary I. Alejo

Doctor of Nursing Practice Final Project Abstract

The purpose is to increase nurses' perception toward clinical alarm management by implementing an alarm management bundle and educational skills in a Cardiovascular Intensive Care Unit (CVICU). The project was implemented in a 31- bed CVICU at a teaching facility in the Texas Medical Center. The Plan-Do-Study-Act was the chosen quality improvement model for the DNP project. Paper-based surveys were used to assess baseline data on competency and confidence levels of alarm management on the Philips monitor with the Healthcare Technology Foundation (HTF) Survey and the Nurse Competence on Philips Physiologic Monitors Use Survey. Active rounds were conducted to ensure …

Neonatal Outcomes In The Surgical Management Of Placenta Accreta Spectrum Disorders: A Retrospective Single-Center Observational Study From 468 Vietnamese Pregnancies Beyond 28 Weeks Of Gestation, Phuc Nhon Nguyen, Anh Dinh Bao Vuong, Xuan Trang Thi Pham

Faculty, Staff and Student Publications

BACKGROUND: Placenta accreta spectrum disorders (PASDs) increase the mortality rate for mothers and newborns over a decade. Thus, the purpose of the study is to evaluate the neonatal outcomes in emergency cesarean section (CS) and planned surgery as well as in Cesarean hysterectomy and the modified one-step conservative uterine surgery (MOSCUS). The secondary aim is to reveal the factors relating to poor neonatal outcomes.

METHODS: This was a single-center retrospective study conducted between 2019 and 2020 at Tu Du Hospital, in the southern region of Vietnam. A total of 497 pregnant women involved in PASDs beyond 28 weeks of gestation …

Use Of A Shared Decision-Making Approach To Improve Blood Pressure Readings In A Hispanic Population With Hypertension, Narayani Koirala

Doctor of Nursing Practice Final Project Abstract

Background: Hypertension is a major risk factor for cardiovascular disease morbidity and mortality with over half of all cardiovascular deaths attributed to it (CDC, 2022). “It is estimated that one-third of adults are hypertensive worldwide. Predictions indicate that one billion individuals will be hypertensive by 2025” (Eghbali et al., 2022). Non-adherence to prescription medication and lifestyle changes is a significant problem and prevalent in the Hispanic population due to various factors related to social determinants of health.

Aim: This project aimed to increase patient adherence to hypertension treatment therapy in Hispanic adults with hypertension for improved blood pressure control and …

Reducing Hemoglobin A1c Using Diabetes Self-Management Education And Support (Dsmes) For Hispanic Adults In A Primary Care Setting, Gita Gyawali Sedai

Doctor of Nursing Practice Final Project Abstract

Background: Members of the Hispanic population have a 50% or higher chance of developing diabetes and often do so at a younger age than other adults in the United States (CDC, 2022a). Diabetes complications also impact the Hispanic population harder, with higher rates of kidney failure caused by diabetes, along with diabetes-related vision loss and blindness (CDC, 2022a). DSMES programs have shown significant improvements in A1C and blood sugar control in different settings (Powers et al., 2020). However, it has not been implemented in many primary care settings.

Purpose: The purpose of this project was to implement and evaluate …

Breastfeeding Initiation, Duration, And Associated Factors Among People With Hepatitis C Virus Infection, Jennifer L Grasch, Jessica A De Voest, George R Saade, Brenna L Hughes, Uma M Reddy, Maged M Costantine, Edward K Chien, Alan T N Tita, John M Thorp, Torri D Metz, Ronald J Wapner, Vishakha Sabharwal, Hyagriv N Simhan, Geeta K Swamy, Kent D Heyborne, Baha M Sibai, William A Grobman, Yasser Y El-Sayed, Brian M Casey, Samuel Parry, Eunice Kennedy Shriver National Institute Of Child Health And Human Development (Nichd) Maternal-Fetal Medicine Units (Mfmu) Network

Faculty, Staff and Student Publications

OBJECTIVE: To characterize breastfeeding behaviors and identify factors associated with breastfeeding initiation among people with hepatitis C virus (HCV) infection.

METHODS: We conducted a secondary analysis of a multicenter observational cohort of pregnant people with singleton gestations and HCV seropositivity. This analysis includes individuals with data on breastfeeding initiation and excludes those with human immunodeficiency virus (HIV) co-infection. The primary outcome was self-reported initiation of breastfeeding or provision of expressed breast milk. Secondary outcomes included duration of breastfeeding. Demographic and obstetric characteristics were compared between those who initiated breastfeeding and those who did not to identify associated factors. Univariable and …

Increasing Code Blue Education For Staff Nurses To Reduce Stress And Increase Competency, Haris Ali

Doctor of Nursing Practice Final Project Abstract

PURPOSE The goal for this project is to increase code blue education and knowledge for staff registered nurses during new employee orientation at a psychiatric teaching hospital. An educational video will be created consisting of code blue procedures. The goal of this video is to better educate registered nurses on code blue medical emergencies before their time on the unit floor begins.

BACKGROUND A code blue or rapid response team is critical for patients to receive proper medical care. The education of nurses has been shown to increase the knowledge and understanding of medical emergency teams and increase the utilization …

Improving Patient Engagement Post-Percutaneous Coronary Intervention Using The Systematic Introduction Of A Cardiac Rehabilitation Bundle In A Community Hospital: A Quality Improvement Project, Rebecca Vela

Doctor of Nursing Practice Final Project Abstract

PURPOSE This quality improvement project aimed to increase patient participation and program completion rates in cardiac rehabilitation (CR) following percutaneous coronary intervention (PCI) by 10% of the historical baseline within 3 months.

BACKGROUND Heart disease is the leading cause of death in the United States. PCI is a standard treatment for symptomatic heart disease. CR is a post-PCI secondary strategy proven to reduce mortality and improve quality of life. The project addressed below-average CR attendance at a community hospital in the greater Houston area.

METHODOLOGY An evidence-based, multidisciplinary bundle that included education, signage, defined quality metrics and dashboard, patient-centered care, …

Decreasing Compassion Fatigue In Inpatient Nurses Using Debriefing And Group Care Program, Hanh Nguyen

Doctor of Nursing Practice Final Project Abstract

Purpose: The quality improvement project's purpose was to use a group care program to decrease compassion fatigue (work-related stress) in nurses. The project aimed to reduce compassion fatigue in nurses by 25% and nurse turnover rates by 10% post-intervention.

Background: The project was implemented on two inpatient units in Texas. Decrease in compassion fatigue can help improve nurse well-being and nurse retention, promoting safe quality nursing care.

Methodology: The Professional Quality of Life Scale (ProQOL) survey measured compassion satisfaction and burnout pre-intervention. Twelve weekly program sessions were completed using strategies: debriefing, breathing exercise, and muscle relaxation. A …

Implementation Of Same Day Cervical Cancer And Chlamydia Screening In A University Clinic Setting, Amanda Rodriguez

Doctor of Nursing Practice Final Project Abstract

Implementation of same day cervical cancer and chlamydia screening in a university clinic setting

PURPOSE The purpose of this quality improvement project was to implement a screening questionnaire in a university student health center to increase the rates of up-to-date cervical cancer and chlamydia screening.

BACKGROUND The project was implemented at a university-based student health center with a student population of 31,559 with 60.3% of the population being female.

METHODOLOGY A screening questionnaire regarding pap smear results and last chlamydia testing was developed for all female students age 18-65 to complete at check in for their appointments. Medical staff were …

Impact Of A Nurse Manager Development Program On Manager Competency And Intent To Leave, Yashamika Short

Doctor of Nursing Practice Final Project Abstract

PURPOSE The purpose of this Quality Improvement Project is to create an evidence-based onboarding and orientation process for novice and assistant nurse managers that positively impacts nurse manager competency and intent to leave.

BACKGROUND Many organizations don’t provide formal leadership training for their nurse managers. Nurse managers are typically selected for their positions based on clinical expertise rather than leadership and management competency.

METHODOLOGY American Organization for Nursing Leadership Manager Competency Assessment tool and Dr. Nora Warshawsky Nurse Manager Intent to Leave Survey were utilized pre/post training. The framework has 3 domains: the science (managing the business), the art (leading …

Enhancing Medication Safety Through Standardized Protocols And Skills Competency Checklist: A Quality Improvement Project In Group Homes For Individuals With Intellectual Disabilities, Mary Chilaka

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement (QI) project aimed to enhance medication safety in group homes for individuals with intellectual disabilities by implementing standardized protocols and a skills competency checklist for Unlicensed Assistive Personnel (UAPs).

BACKGROUND

Medication errors in group homes often result from inconsistent training and oversight among UAPs. This project addressed these gaps by introducing structured training, a competency checklist, and workflow improvements to enhance adherence to best practices.

METHODOLOGY

Using the Plan-Do-Study-Act (PDSA) cycle, key interventions included bi-weekly training, hands-on shadowing, competency assessments, and "do not disturb" signage to minimize distractions. Data collection included pre- and post-training surveys, weekly …

Improving The Self-Efficacy And Self-Management Of Adult Patients With Type Ii Diabetes (T2dm) Through A Telehealth Program At An Outpatient Clinic, Uchechukwu N. Iwuorie

Doctor of Nursing Practice Final Project Abstract

Purpose

This eight-week quality improvement project implemented a cellphone-based reminder text intervention to improve self-efficacy and self-management practices among adults diagnosed with T2DM at an outpatient clinic in Tomball, Texas.

Background

The clinic serves underserved populations in Tomball. Over 20% of diabetic patients have a Hemoglobin A1c (HbA1c) above 9%. There is no program for T2DM self-management due to resources and staffing.

Methodology

Informed participants completed a recruitment packet and a self-efficacy survey before and after the intervention. Thirteen patients received two text messages biweekly from the clinic, on self-care reminders, recommended by the American Diabetes Association, along with an …

Rising Prevalence Of Mild Chronic Gastritis In Children: A Single Center Experience, Rohit Josyabhatla, Mary Lauren Wood, Amber Gafur, Nina Tatevian, Amanda S Tchakarov, Syed Shahrukh Hashmi, Jon Marc Rhoads, Melissa Renee Van Arsdall

Faculty, Staff and Student Publications

OBJECTIVES AND METHODS: We analyzed upper endoscopic and histological findings in 3 cohorts of children undergoing upper gastrointestinal endoscopy over a 10-year period. Five hundred seventy-nine patients were identified, with 244 (42%), 199 (35%), and 136 (23%) in the 2011, 2015, and 2019 cohorts, respectively. The most common symptoms and signs were abdominal pain, vomiting, failure to thrive, and diarrhea.

RESULTS: The number of patients who had histological evidence of chronic gastritis increased from 2011 (n = 70, 29%) to 2015 (n = 106, 53%) and 2019 (n = 92, 68%;

CONCLUSIONS: There has been a significant rise in the …

Feasibility And Measurement Of Bedside Pumping In The Nicu: A Mixed Methods Study, Jessica Gomez

Dissertations and Theses (Open Access)

Abstract

Background: Supporting preterm infants with mother’s own milk (MOM) can improve health outcomes and decrease mortality.¹ Freshly pumped MOM, within four hours of expression, has the highest availability of bioactive components versus stored MOM. However, fresh milk is often not readily available due to the disconnected process of breastfeeding that occurs with preterm infants in the NICU. One convenient solution to improve access to fresh MOM is for the mother to pump at the infant's bedside. This intervention could improve the mother's pumping experience and provide the infant access to fresh MOM.

Purpose: This study aimed to evaluate …

Metformin Plus Insulin For Preexisting Diabetes Or Gestational Diabetes In Early Pregnancy: The Mompod Randomized Clinical Trial, Kim A Boggess, Arielle Valint, Jerrie S Refuerzo, Noelia Zork, Ashley N Battarbee, Kacey Eichelberger, Gladys A Ramos, Gayle Olson, Celeste Durnwald, Mark B Landon, Kjersti M Aagaard, Kedra Wallace, Christina Scifres, Todd Rosen, Wadia Mulla, Amy Valent, Sherri Longo, Laura Young, M Alison Marquis, Sonia Thomas, Ashley Britt, Diane Berry

Faculty, Staff and Student Publications

IMPORTANCE: Insulin is recommended for pregnant persons with preexisting type 2 diabetes or diabetes diagnosed early in pregnancy. The addition of metformin to insulin may improve neonatal outcomes.

OBJECTIVE: To estimate the effect of metformin added to insulin for preexisting type 2 or diabetes diagnosed early in pregnancy on a composite adverse neonatal outcome.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial in 17 US centers enrolled pregnant adults aged 18 to 45 years with preexisting type 2 diabetes or diabetes diagnosed prior to 23 weeks' gestation between April 2019 and November 2021. Each participant was treated with insulin and …

The Effectiveness Of Implementing Nurse-Driven Mobility Protocol To Reduce Los, Delirium And Ventilator Days, Sajani Abraham

Doctor of Nursing Practice Final Project Abstract

The effectiveness of implementing a nurse-driven mobility protocol to reduce LOS, ventilator days, and delirium

PURPOSE

The purpose of this scholarly project was to implement the effectiveness of a nurse- led mobility program in enhancing patient ambulation rates, thereby reducing the length of stay, delirium, and ventilator days in an intermediate care unit.

BACKGROUND

The project was implemented in an 18 bed IMU in the academic center in the Texas Medical Center, Houston, Texas.

METHODOLOGY

The project utilizes AHRQ nurse-driven mobility protocols to enhance patient mobility. The staff were educated on the use of the tool prior to implementation and …

Impact Of Preparing Nursing Students To Deliver A Parent-Based Sexual Health Intervention On Attitudes And Intentions For Sexual Health Education And Parent Communication Counseling: A Mixed Methods Study, Deidra Carroll Coleman, Anitra Frederick, Stanley Cron, Christine Markham, Vincent Guilamo-Ramos, Diane Santa Maria

Faculty, Staff and Student Publications

BACKGROUND: Nurses are well positioned to promote sexual health but are not adequately prepared in their nursing programs to engage families on this topic and often lack the knowledge and confidence necessary to counsel families about sexual health communication. The purpose of this study was to determine how facilitating a parent-based sexual health intervention would impact nursing students' attitudes and intentions about sexual health education and parent communication counseling.

METHODS: Using an embedded mixed-methods design, which integrated a quasi-experimental framework, we examined the impact of participation in a parent-based sexual health intervention among 126 baccalaureate nursing students enrolled in a …

Understanding The Gap Between Nursing Workforce In The United States And Population Needs-A Policy Brief, Mayar Al Mohajer

Faculty, Staff and Students Publications

Purpose  This report is intended to analyze the root causes for the current gap between the nursing workforce and population needs in the United States. It aims to consolidate what is known about these contributing reasons and provide evidence-based recommendations for action.

Methods  The report utilized the Sample, Phenomenon of Interest, Design, Evaluation, Research type framework to develop the research question and the 5 Whys methodology for the root cause analysis.

Results  This report highlighted six major causative problems, including workforce market mismatch, poor financing design, inadequate governance, flawed technologies, insufficient research, and suboptimal service delivery. A detailed evaluation of …

Nurse Leader Perceptions Of Data In The Veterans Health Administration: A Qualitative Evaluation, Janine J Wong, Richard P Sorelle, Christine Yang, Melissa K Knox, Sylvia J Hysong, Lynette E Dorsey, Patrick N O'Mahen, Laura A Petersen

Faculty, Staff and Students Publications

Healthcare systems and nursing leaders aim to make evidence-based nurse staffing decisions. Understanding how nurses use and perceive available data to support safe staffing can strengthen learning healthcare systems and support evidence-based practice, particularly given emerging data availability and specific nursing challenges in data usability. However, current literature offers sparse insight into the nature of data use and challenges in the inpatient nurse staffing management context. We aimed to investigate how nurse leaders experience using data to guide their inpatient staffing management decisions in the Veterans Health Administration, the largest integrated healthcare system in the United States. We conducted semistructured …

Mental Health And Parenting Among Young Adults Experiencing Homelessness With And Without Their Children, Rebecca Bergh

Dissertations and Theses (Open Access)

Background: Parent-child separation and custody loss are common among parenting young adults experiencing homelessness (YAEH). These experiences may be traumatic for YAEH, a population already vulnerable to mental health disorders and high levels of trauma. Little is known about how YAEH who have their children with them compare to YAEH separated from their children in terms of mental health and risk and resilience factors. Further evidence is needed to better understand the parenting and mental health support needs among YAEH, particularly surrounding parent-child separation.

Aims: This study aimed to examine the characteristics of (1) parenting YAEH living with their children …

Exploring The Novice Nurses’ Perceptions Of Communication Dynamics In The Operating Room, Lasandra Brown

Dissertations and Theses (Open Access)

Background: Communication among the multidisciplinary team members in an operating room setting is essential for effective and safe patient care. Studies have previously addressed communication breakdowns among team members, and miscommunications have been demonstrated to significantly challenge efficiency in the operating room. Novice nurses play an integral role in the success of operating room procedures and must possess strong communication skills that facilitate optimal patient outcomes.

Purpose: The aim of this study was to explore novice nurses’ perceptions of factors that influence the dynamics of team communication in the operating room setting.

Methods: An inductive thematic, qualitative analysis of 11 …

Baby Boomer Gay Men’S Lived Experiences With Primary Healthcare: A Qualitative Study, Aaron J. Loeb

Dissertations and Theses (Open Access)

Background: Baby boomer gay men have experiences discrimination in healthcare settings. Members of the LGBTQIA+ population are often studied as a single entity, which fails to account for the distinct cultural and social generational differences within this population that may affect their experiences of health care. A paucity of research is available on baby boomer gay men’s perspectives about primary healthcare experiences. Such knowledge is necessary to improve inclusiveness in healthcare settings and health outcomes.

Purpose: The purpose of this study was to describe baby boomer gay men’s lived experiences with primary healthcare. The specific aims are to describe: (1) …

Symptom Experience Of Patients With Advanced Melanoma Undergoing Immune Checkpoint Inhibitor Therapy, Natalie Jackson-Carroll

Dissertations and Theses (Open Access)

Background: Immune checkpoint inhibitors (ICIs) are novel therapeutic agents utilized in the management of advanced melanoma. Though generally well-tolerated, patients receiving ICIs experience treatment-related toxicities at varying onset and intensity. Assessment and evaluation of these toxicities and their impact on a quality of life is essential to comprehensive cancer care. Patient-reported outcomes (PRO) contribute vital data to a clinical assessment, supporting clinicians in their ability to improve outcomes. To date, there is no melanoma-specific or ICI-specific PRO measure of symptom burden available.

Purpose: The purpose of this study was to describe the symptom experience from the patient's perspective and how …

A Nurse-Led Telehealth Program For Diabetes Foot Care: Feasibility And Usability Study, Hsiao-Hui Ju, Rashmi Momin, Stanley Cron, Jed Jularbal, Jeffery Alford, Constance Johnson

Faculty, Staff and Student Publications

BACKGROUND: Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide.

OBJECTIVE: The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-care, and foot care behaviors before and after participating in the program.

METHODS: The study used a single-arm, pre-post design in 2 large family …