Nursing Commons^™

National Early Warning Score (News) For Covid-19 Infected Patients: A Clinical Guidance Tool, Robert Villegas

Doctor of Nursing Practice Final Manuscripts

Background: Coronavirus 2019 (COVID-19) presents with variable clinical manifestations from asymptomatic to life-threatening organ dysfunction. The National Early Warning Score, also known as NEWS, was initially developed to detect adult inpatient deterioration using existing physiological data and adverse clinical outcomes from 35,585 medical admissions. The NEWS guideline consists of six parameters: respiratory rate, pulse, oxygen saturation, temperature, systolic blood pressure, and level of consciousness.

Purpose: This project implemented NEWS guidelines to identify patients at high risk for deterioration with COVID-19.

Evidence-Based Interventions: The project included retrospective-prospective chart reviews for 100 patients diagnosed with COVID-19 from October 2020 to December 2020. …

Transitioning Eating Practices Of Older Adults, Michelle Lajoy Jackson

Dissertations

Purpose: The purpose of this descriptive qualitative study was to explore what factors may have influenced the transition of an individual older adult’s eating practices over a lifespan and the impact participants perceived those factors currently had upon their nutritional health in older adulthood.

Background: The older adult population is recognized as one of the fastest growing populations in the United States. One of many growing concerns for this population is the impact of dietary practices on the morbidity and mortality of this aging population. There is limited research to date that has explored the transitioning of appetite …

Development Of A Nurse Practitioner Driven Program For Cardiology Providers To Increase Knowledge And Awareness Of Neurodevelopmental Assessment Needs In Children With Congenital Heart Defects, Michele Readman

Doctor of Nursing Practice Final Manuscripts

Children diagnosed with congenital heart defects are at increased risk for neurodevelopmental delays. Timely referral of patients to a neurodevelopmental clinic for initial evaluation and referrals to support services can improve learning outcomes, provide early intervention for neurodevelopmental disorders, and mediate factors affecting low quality of life. Nationally, a substantial proportion of pediatric cardiologists are not referring children for neurodevelopmental evaluation. A review of patient referrals to a Cardiac Neurodevelopmental Clinic within an urban children’s hospital demonstrated an opportunity to improve provider awareness and knowledge of referral recommendations. Using the Iowa Model of Evidence-Based Practice to Promote Quality Care, an …

Biomarkers And Factors Related To Risk Of Acute Kidney Injury, Mary Ann David

Dissertations

Background: Acute kidney injury (AKI) is associated with increased mortality, morbidity, length of hospital stay, and in-hospital cost. Timely intervention is needed to prevent disease progression, but the delay in diagnostic process often results in delayed treatment. Recent studies show a significant increase in novel urine biomarkers (UB), TIMP-2 and IGFBP7, has been linked to an increased risk of AKI.

Objectives: The purpose of this study was to examine the relationships among participants’ sociodemographic and clinical characteristics, including select biomarkers, care management processes, treatments, and patient outcomes in a sample of hospitalized critically ill patients in southern California.

Findings: Study …

Interventional Radiology Procedures Without Sedation: The Nurse Experience, Catherine De Leon

Dissertations

Background: Many IR procedures offer a less invasive and economical alternative to some open or laparoscopic surgeries. Patients undergoing a procedure without moderate sedation are awake, alert, with heightened sensory perceptions, and vulnerable to their surroundings. There is a gap in the current body of literature relating to the IR nurse’s experience of caring for patients during procedures without the use of moderate sedation.

Purpose/Aims: The purpose of this study was to explore the lived experience of Interventional Radiology (IR) nurses caring for conscious patients undergoing a procedure without the use of sedation. This phenomenological study aimed to describe the …

When "First, Do No Harm" Fails: A Restorative Justice Approach To Workgroup Harms In Healthcare, Pedro L. Flores

Dissertations

In healthcare, workgroup mistreatment is a pervasive problem that begins during medical education (medical and nursing school) and becomes embedded in the “hidden curriculum of professionalism,” which dissuades and even punishes learners for talking about abuse they witness. Furthermore, the mistreatment of healthcare providers (HCPs) pervades all disciplines in the healthcare delivery chain due to a combination of cultural factors, systemic pressures, dysfunctional hierarchies, and leadership’s tolerance of intimidating and disruptive behaviors. Not surprisingly, 18% of U.S. HCPs have left the medical field since the start of the COVID-19 pandemic, and burnout, stress, anxiety, and increased workloads have been identified …

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project, Alison Cusmano

Doctor of Nursing Practice Final Manuscripts

Hypertension is a public health issue estimated to affect 112 million adults by 2030. Primary care patients in an outpatient clinic in Southern California with elevated blood pressure readings in the office did not have an organized system for close follow-up. The purpose of this evidence-based project (EBP) was to educate patients on self-measured blood pressure monitoring (SMBP), Dietary Approaches to Stop Hypertension (DASH), diet interventions, and healthy weight loss to improve hypertension rates. Through these interventions, patients developed an understanding of their systolic and diastolic blood pressure goals. Nurse practitioners, medical assistants, and licensed vocational nurses screened for high …

A Qualitative Exploration Of The Patient Care Experience As Perceived By Hispanic Patients Receiving Care At A Safety-Net Facility, Silvinia Cuizon

Dissertations

Purpose: The purpose of this study was to understand how English- and Spanish-speaking Hispanic patients seeking kidney and liver transplant care at a safety-net facility perceive and interpret the care experience with the goal of generating a grounded theory model to guide care delivery and improve perception of care for this population.

Background/Rationale: The patient experience is the current federally mandated hospital quality indicator that measures the range of interactions patients have with their hospital admission, which has fiscal and clinical implications for the delivery of care. Many safety-net health care delivery systems, which primarily serve traditionally underserved populations, and …

Deprescribing In The Hospice Population, Who Is Eligible And Who Is Agreeable: A Quality Improvement Project, Ashlee Nicole Smith

Doctor of Nursing Practice Final Manuscripts

Current evidence recommends and supports deprescribing medications to reduce polypharmacy in the hospice population. The project aim was to determine accurate percentages of deprescribing at three time periods: before hospice admission, at hospice enrollment, and four weeks post hospice enrollment. This project was a retrospective review of the medication administration record (MAR) of patients admitted into Sharp Hospice from a Sharp Healthcare facility. Sharp Hospice, in California, USA, admitted 164 patients during August 2020. Of those, 34 patients were eligible for inclusion in this retrospective quality improvement review. Prior to discharge from a Sharp facility, the percentage of target medications …

Emergency Department Visits And Hospital Admissions For Adult Cancer Patients Post Outpatient Chemotherapy: Does The Oncology Nurse Navigator Make A Difference?, Sunny L. Stirling

Dissertations

Background: Cancer is the second leading cause of death in the United States and worldwide. Oncology related hospital visits account for over $88 billion annually; 35% of this cost is attributable to inpatient hospital stays even though most cancer treatments are given outpatient. The Centers for Medicare and Medicaid Services introduced the Chemotherapy Measure which tracks Emergency Department visits and hospitalization within 30 days of any outpatient chemotherapy treatment. The Oncology Nurse Navigator (ONN) has offered some benefit in cancer care, but its role in ED visits and hospital admissions is unknown for adult patients with cancer post outpatient …

Food Insecure Copd Patients And Healthcare Utilization: A Retrospective Study, Kristine Mendoza

Dissertations

Abstract

Purposes/Aims: Despite advances in the recognition and treatment of high-cost users of health care, the incidence of healthcare utilization remains high. Rates of hospital admissions and emergency room visits among chronic disease like COPD have become a targeted group for health management. COPD patients have multiple and complex health and social needs, but the impact of their unmet food needs is not well understood and warrants further investigation. The purpose of this study is to explore the relationships between COPD food insecure patients and healthcare utilization in San Diego County.

Background/Rationale: Government programs targeting patients with high healthcare costs …

Identifying Gaps In Follow-Up Care Among Adults In An Occupational Health Setting: A Retrospective Ebp Pilot, Ginny Meyerhuber, Msn, Rn

Doctor of Nursing Practice Final Manuscripts

The Aim of this Evidence-Based Project (EBP) was to find a gap in care among adults working in a large financial institution who had the presence of elevated blood pressure at an onsite health clinic visit in the previous 3 years. Background: Screening for elevated blood pressure in an occupational health setting identified adults with one of the most common chronic medical conditions. Additionally, almost one-half of all adults in the United States have hypertension (HTN); a preventable risk factor for strokes and heart disease (Office of the Surgeon General, 2020). This Surgeon General’s report revealed that HTN control …

Implementation Of The Center For Disease Control (Cdc) Prediabetes Risk Test In The Medical Weight Loss Setting, Gabriela Miller, Rn, Bsn

Doctor of Nursing Practice Final Manuscripts

Background: Prediabetes is a serious health condition where blood sugars are higher than normal which increases risk of developing type 2 diabetes mellitus (T2DM), heart disease and stroke. One in three US adults have prediabetes and 90% of them do not know. Losing 5-7% of body weight and regular physical activity can lower the risk of developing T2DM by more than half.

Methods: Screening patients for prediabetes at a medical weight loss clinic using the evidence-based Centers for Disease Control (CDC) Prediabetes Risk Test. A score of five or higher on the screening tool indicates the patient is at risk …

Establishment Of Best Practice Skills For Advanced Practice Nurses, Leslie Kendrick, Tara Hughes, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Over the past two decades, nursing researchers have defined nurses’ perceptions of evidence-based practice as well as facilitators and barriers to its implementation . This project seeks to take the next step through a current assessment of registered and advanced-practice nurses’ assimilation of evidence-based practice as well as a current literature review of the research to clinical use gap. This is a cross-sectional, retrospective project. Through analysis of two self-administered questionnaires to both registered and advanced-practice clinical nurses as well as literature review findings, five recommendations for advanced-practice nurses were created. Ultimately, the goal of this project seeks to establish …

Sunscreen Use And Screening In College Athletes: An Evidence-Based Pilot Project, Nicole Brustkern Bsn, Rn, Cpn, Sharon Boothe-Kepple Phd, Msn, Fnp-C, Phn (Chickasaw)

Doctor of Nursing Practice Final Manuscripts

Background: Melanoma is the third most common cancer in individuals ages 15 – 29. The greatest risk for melanoma is ultraviolet (UV) radiation from the sun. Collegiate athletes are exposed to 1,000 more sun hours per year than the average adult, placing them at higher risk for melanoma. Evidence supports sunscreen education and screening to promote protective behaviors in young adults.

Objective: This evidence-based pilot project implements the standardized screening of sunscreen use and sun protective behaviors in women’s soccer players ages 18 to 21 years old at the University of San Diego.

Methods: The Sun Exposure and Protection Index …

Transitioning From Onsite To Online Psychotherapy Visits During The Covid-19 Crisis, Michael Angello Negron, Dnp

Doctor of Nursing Practice Final Manuscripts

Background: On March 19, 2020, the governor of the State of California, Gavin Newsom, issued executive stay-at-home order due to the coronavirus disease (COVID-19) pandemic (State of California, 2020). In a private psychiatric practice in southern California treating patients with anxiety and depression, psychotherapy treatment was abruptly affected by that order. The purpose of this project was to transition from onsite to online psychotherapy visits to ensure the continuity of care and facilitate patients’ progress in dealing with mental illnesses during the COVID-19 crisis.

Aims: The proposed solution to the problem of decreased access to care during the pandemic was …

Managing Pediatric Atopic Dermatitis In The Allergy Clinic: Use Of An Eczema Action Plan To Improve Caregiver Understanding And Self-Efficacy, A Pilot Study, Danielle Hubacek

Doctor of Nursing Practice Final Manuscripts

Eczema, or atopic dermatitis, is a complex and chronic condition that affects approximately 10% of children throughout the United States (Brown et al., 2018). The American Academy of Allergy Asthma & Immunology (AAAAI) (2017) estimates the average cost of eczema management for each patient is approximately $3,302 per year. The complex nature of atopic dermatitis indicates a need for individualized treatment plans. Research has shown that standardized patient teaching, written education materials, and Eczema Action Plans (EAP) reinforce patient teaching, parental understanding, and improve quality of life. This evidence-based practice (EBP) project introduces the use of a written Eczema Action …

Telehealth Breastfeeding: Best Practice Guideline, Laura Amabile

Doctor of Nursing Practice Final Manuscripts

Background: Only 24.9% of United Stated infants are exclusively breastfed through six months. Healthy People 2020 breastfeeding goals include increasing the proportion of infant breastfed through six months to 60.6%. The Surgeon General’s Call to Action identified increasing access to International Board-Certified Lactation Consultants as a priority to improve breastfeeding percentages.

Purpose: Implementation of an evidence-based telehealth breastfeeding guideline, will provide mothers with consistent education regarding breastfeeding practices and guidance to overcome common obstacles, which will then result in increased confidence levels regarding breastfeeding and increase breastfeeding durations.

Study and Design: The Iowa model was utilized to guide this project. …

Identifying Adverse Childhood Experiences (Aces) In A Federally Qualified Health Center Using The Pediatric Aces And Related Life Events Screener, Melody Albarran-Slovin, Bsn, Rn

Doctor of Nursing Practice Final Manuscripts

Background: Evidence links adverse childhood experiences (ACEs) to health issues later in life. Most research has been conducted in adults but there is a lack of recent research on the impact of ACEs in the pediatric population particularly in relation to mental health conditions. Utilizing the Pediatric ACEs Screener (PEARLS) health care providers can screen for ACEs at earlier ages.

Purpose: The aim of this evidence-based project is to determine if there is an increase of newly diagnosed mental health related disorders when using PEARLS compared to not using PEARLS in the previous months before implementation.

Methods: ACEs were identified …

Weight Reduction Motivation In Osteoarthritis Patients Through Nurse Practitioner Driven Education And Follow-Up: A Pilot Project, Caoilfhionn Mulvey, Martha Fuller Phd

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The ultimate goal of this short-term pilot project is for

overweight or obese osteoarthritis patients to increase their knowledge on the benefits of

weight loss and physical activity. Research shows that for every kilogram of weight lost,

2.2–4.0 kilograms of weight is taken off of the joint and could reduce joint pain up to

thirty to fifty percent and improve quality of life. Following education from the provider,

patients will understand the correlation of osteoarthritis symptom management with

weight loss.

EBP Model/Frameworks: This project utilizes the Iowa Model of Evidence-Based

Practice to Promote Quality Care. This addresses …

Balancing Provider Stress And Resilience In The Time Of Covid, Zachary Love

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project is to improve secondary traumatic stress (STS), compassion satisfaction, and burnout amongst providers—physicians, residents, and nurse practitioners—within the acute psychiatry units of the La Jolla Veterans Health Administration (VHA) through a one-time educational training session.

Background: Mental health providers at the VHA acute psychiatry units experience one of the highest risks for the development of STS, CF, and burnout amongst all professions due to a number of individual and institutional factors. STS is characterized by secondhand traumatization with symptoms similar to that of Post-Traumatic Stress Disorder—difficulty sleeping, mood changes, upsetting images appearing …

Improving Pediatric Provider Preparedness For Postpartum Depression Screening, Samantha Shafer, Martha G. Fuller

Doctor of Nursing Practice Final Manuscripts

Background: Postpartum depression (PPD) is one of the most common complications of childbirth, affecting approximately 10-20% of mothers within the child’s first year of life with negative impact on both mother and child. . Pediatric primary care providers have frequent contact over the infant’s first year of life. The American Academy of Pediatrics (AAP) recommends screening mothers for PPD at the 1, 2, 4, and 6-month well-baby visits, yet due to barriers, pediatric providers are not consistently screening for PPD. Barriers include lack of preparedness and knowledge of resources and inadequate time.

Aims of Service Change: To improve pediatric provider …

Reducing Obesity Rates Among Adults In A Primary Care Setting: An Evidence-Based Practice Project, Raxita Neupane

Doctor of Nursing Practice Final Manuscripts

Background: Over 60% of adults in the United States meet the criteria for being overweight or obese. The estimated obesity-related health care costs are as high as $147 billion per year. Despite the alarming health risks and increasing health care costs, the rates of screening and counseling for obesity in the primary care setting are merely 30%. This project outlines weight-management counseling strategies.

Purpose of Project: The purpose of the evidence-based practice project was to implement patient-tailored evidence-based nutritional assessment tools and intensive behavioral counseling. The ultimate goal was to reduce body mass index (BMI) among overweight and obese …

Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel

Doctor of Nursing Practice Final Manuscripts

Abstract

Background

Congenital heart disease (CHD) is the most common birth defect and affects almost 1% of all live births. Treatment anxiety is common among children with CHD who undergo multiple procedures early in their lifetime. Dramatically increased life spans for this cardiac population has led to a shift from focusing on survival to their long-term health outcomes.

Methods:

Administration of the Peds QL Cardiac Module 3.0 assesses health related quality of life (HRQOL) during annual visits to a Cardiac Neurodevelopmental (ND) Clinic by evaluating the level of Treatment Anxiety a patient experiences during healthcare appointments. The questionnaire scores are …

Sun Protection Behaviors In Patients With Actinic Keratosis, Madison Molotky

Doctor of Nursing Practice Final Manuscripts

The purpose of this project was to increase sun protection discussion and education in patients with actinic keratosis at a dermatology clinic. Actinic keratosis is one of the most common dermatologic diagnoses in patients 45 and older. Fifty-eight million Americans have one or more actinic keratoses and they are caused by years of UV sun exposure without sun protection. They are often a precursor to squamous cell carcinoma and adequate sun protection can prevent future lesions from developing and slow or stop the progression of current lesions. The Sun Exposure and Protection Index was implemented for patients with actinic keratosis …

Implementing Ebp Guidelines To Optimize Human Donor Milk Usage In The Hospital Setting, Kimberly Carriker

Doctor of Nursing Practice Final Manuscripts

Purpose statement and rationale: The purpose of the project was to implement a donor milk workflow for an academic hospital so that babies who qualify for donor milk receive it instead of formula. It aimed to improve adherence to the protocol and increase the percentage of babies who received breast milk in the hospital setting and followed The Iowa Model for implementation.

Synthesis of evidence: Top regulating agencies and healthcare entities all support breastfeeding and breast milk use. Studies have been performed to address formula use versus human milk use in infants and show that babies have better outcomes when …

Bridging The Gap: Utilization Of Telehealth For Heart Failure Patients To Reduce Hospital Readmissions: Best Practice And Recommendations, Shalaine Corbilla

Doctor of Nursing Practice Final Manuscripts

Background: Heart failure is a leading cause of morbidity and mortality in the United States and accounts for a vast number of 30-day hospital readmissions. Within the first 30 days of discharge, patients and caregivers often misinterpret discharge instructions or lack access to providers. During this period, some modifiable symptoms become too difficult to tolerate and patients return to the emergency department for assessment and ultimately readmission for high-risk complications. The Sars-CoV-2 pandemic has added additional barriers for patients to receive care after a hospital discharge.

Purpose: To identify current best practices used for outpatient follow up with …

Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht

Doctor of Nursing Practice Final Manuscripts

Advanced Care Planning (ACP) is an essential part of providing adequate care in the primary care setting. Discussing end of life with patients can be a tedious and uncomfortable conversation for many providers, however, its continued avoidance contributes to the stigma of end of life care and may also result in significant healthcare cost expenditure with the use of unwanted invasive treatments. All providers should engage in consistent advanced care planning in order to improve patient and provider communication, improve patient satisfaction, increase advanced directives on file, reduce the stigma of the topic, and improve quality of life.

Family Bereavement Implications For Military Personnel: A Policy Proposal, Dehussa Urbieta

Doctor of Nursing Practice Final Manuscripts

Introduction: The death of a child is a devastating tragedy. Evidence demonstrates a link between bereavement and increased mortality risks and decrements in physical and mental health. Factors are compounded in active-duty service members through arduous duty environments, deployments, relocations, and inadequate support systems.

Methods: A focused literature search of bereavement specifically concentrated on child loss and the sequela on survivor mental health and functioning was conducted. The quality of the evidence was assessed using the Melnyk Evidence-Based Practice Model. The Evidence-Based Public Health Model was used as a guide for policy development.

Evidence-Based Intervention: Draft a military parental bereavement …

Substance Use Screening, Brief Intervention, And Referral To Treatment (Sbirt) In Pregnant Women Living With Hiv, Whitney Markowitz

Doctor of Nursing Practice Final Manuscripts

Abstract

TITLE: Substance Use Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Pregnant Women Living with Human Immunodeficiency Virus (HIV)

BACKGROUND: According to the 2018 National Survey on Drug Use and Health, 5.4%, 9.9%, and 11.1% of pregnant women reported use of illicit drugs, alcohol, and tobacco, respectively, in the past month. In the same year, Centers for Disease Control reported 19% of new HIV diagnoses were among women. Substance use in pregnant women living with HIV increases risk of adverse outcomes for both mother and child including neonatal viral transmission and obstetrical complications. Universal screening for substance use …