Nursing Commons^™

Preoperative Fasting Policy Updated For Healthy Patients, Janet Dewees

Doctor of Nursing Practice Final Manuscripts

Preoperative fasting of solids and liquids for 8 hours prior to surgeries requiring anesthesia has been the standard for decades. Guidelines developed in 1999 by the American Society of Anesthesiologists (ASA) allow clear liquids up to 2 hours prior to elective surgery in healthy patients. These guidelines were evaluated and endorsed by the ASA in 2011 and 2017. However, after two decades, this policy is still not standard in many facilities. This evidence-based project aims to change the current fasting policy at a surgery center in Southern California to allow clear liquids up to 2 hours prior to elective procedures …

Management Of Mild Abscesses In Adult Patients, Liliana Pittman

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project was to improve the management of purulent skin and soft tissue infections (SSTIs) among male inmates incarcerated within a detention facility in Southern California. Standardizing the use of the Infectious Diseases of America (IDSA) guidelines could ensure improved management of mild abscesses. The IDSA guideline supported the use of incision and drainage of mild abscesses without the use of broad-spectrum antibiotics when clinically appropriate. Over the past decade, the emergence of multi-resistant pathogens has contributed to an increase in the incidence of SSTIs. In 2012, the total cost of SSTIs in the United States …

The Second Victim: Knowledge For The Healthcare Team, Charisse Lyn Tabotabo

Doctor of Nursing Practice Final Manuscripts

Adverse patient events can have lasting and traumatic effects on members of the healthcare team. In 2019, a Southern California healthcare organization developed a peer support program for second victims (SVs). Despite this program being available to all staff, many nurses in the neonatal intensive care unit (NICU) of a metropolitan area entity did not know the program existed. The purpose of this study was to provide education to NICU nurses about second victims and the organization’s peer support program through an online learning module. Participants completed a survey upon module completion. The survey used a simultaneous pre-post survey on …

Standardized Education On Physician Orders For Life Sustaining Treatment (Polst) Conversations, Venessa Oteniya

Doctor of Nursing Practice Final Manuscripts

According to research literature, 15% of Medicare beneficiaries spend more than 7 days in the intensive care unit before they die. These Medicare beneficiaries receive aggressive, life-prolonging medical treatments that might not be in agreement with their wishes. Approximately 13% of SNF residents have improperly completed POLST forms that can result in intensive treatments that patients did not want. One barrier to the lack of POLST completion in SNFs is staff difficulty with understanding and explaining the form, a result of inadequate education.

In August 2020, the San Diego Coalition for Compassionate Care formed an education program to provide virtual …

Removal Of Ana Language To Increase Access To Vaccination Compliance, Steven G. Pochop Jr.

Doctor of Nursing Practice Final Manuscripts

Background: In 2015, the American Nurses Association (ANA) revised their immunization and vaccine policy statement to address the culture of vaccines that was prevalent in 2015. Due to evolving climate and growth in vaccination noncompliance as evidenced by recent outbreaks of vaccine preventable illnesses.

Purpose of Project: It is my recommendation that the ANA remove their endorsement of religious exemption from vaccinations in their policy statement, considering misapplications for which the exemption was not designed and that compromises the safety of the public. Additionally, annual medical exemption recertification signed by a qualified provider will become the recommended standard of practice. …

Proper Utilization Of The Canadian C-Spine Rule For Mild C-Spine Injury, Lizbeth Velazquez

Doctor of Nursing Practice Final Manuscripts

Abstract

The aim of this evidence-based project was to implement the Canadian C-Spine Rule guideline for low-risk c-spine injury in a urban urgent care in order to reduce unnecessary imaging (cervical X-ray), radiation exposure, and to identify patients requiring ED referral for computed tomography (CT) scans. The use of imaging can help to identify life-threatening neck injuries when clinically appropriate; however, unnecessary imaging without the use of a clinical decision tool is associated with an annual cost of $6.8 million-$9.6 million in the United States. Encouraging providers to increase patient engagement and to use other valuable diagnostic tests is part …

Achieving Advance Care Planning In Diverse Populations Via Teleconferencing With Skilled Nursing Facility Residents, Tania Huezo

Doctor of Nursing Practice Final Manuscripts

Background: Advance care planning (ACP) has always been a priority in healthcare, and even more crucial during the COVID-19 pandemic. It has been extremely challenging for ACP to occur in the skilled nursing facility (SNF) population once social distancing restrictions were put in place to protect residents and staff.

Purpose: The purpose of this evidence-based project was to assess the effectiveness of ACP via teleconferencing with skilled nursing facility (SNF) residents in the hope of increasing completion of high-quality Physician’s Orders for Life-Sustaining Treatment (POLST) forms.

Methods: The San Diego Coalition for Compassionate Care developed an ACP community outreach program …

Addressing Vaccine Hesitancy With Motivational Interviewing: A Pilot Study, Olivia Ball

Doctor of Nursing Practice Final Manuscripts

Statement of the problem: The unprecedented 2019 Measles outbreaks in the US and the current COVID 19 global pandemic highlight the necessity of addressing vaccine hesitancy. Improving vaccine confidence requires strategic communication approaches that focus on addressing the complex reasons for vaccine hesitancy.

Purpose: The purpose of this project was to improve both provider’s understanding of the complex factors involved in vaccine hesitancy and confidence in using motivational interviewing to address vaccine hesitancy.

Intervention: An educational presentation for advanced practice nurses was conducted with the purpose of highlighting the benefits of using motivational interviewing in vaccine hesitant patients.

Results: The …

Pediatric Primary Care Depression Screening Using Phq-9 Modified For Teens, Aksel Narvaez

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project is to improve depression screening among adolescents between the ages of 12 and 18 using the PHQ-9 Modified Scale for Teens in a rural pediatric primary care clinic in Southern California. Depression is a cause of considerable morbidity and mortality among the pediatric population. The literature supports the use of depression screening tools in a variety of settings, including pediatric primary care; their use has shown an improvement in detection of depression in adolescents. The American Academy of Pediatrics (AAP) and the U.S. Preventive Services Task Force (USPSTF) both recommend the use of tools …

Increasing Physical Activity In Children And Adolescents During The Covid-19 Pandemic, Alyssa Plisic

Doctor of Nursing Practice Final Manuscripts

Exercise benefits physical and mental health, prevents chronic disease, and improves overall quality of life. Most children and adolescents do not meet daily physical activity recommendations (Child and Adolescent Health Measurement Initiative, 2019). The COVID-19 pandemic created large barriers for engagement in exercise and further decreased levels of activity in this population (Dunton et al., 2020; Moore et al., 2020; Sekulic et al., 2020). This project evaluates the effects of the COVID-19 pandemic on physical activity in youth 8-17 years old. An exercise journal increased activity in all participants and promoted attention to daily activity. Overall activity and participation in …

Improving Identification Of Seniors At Risk Tool Adherence To Identify Emergency Department Readmissions In Older Adults, Joy Gao

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project (EBP) is to improve the emergency department (E.D.) staff adherence in completing the Identifying Seniors at Risk (ISAR) screening tool. The specific aim is to improve electronic health record (EHR) data collection to enhance the identification of older adults that are frequent utilizers of the E.D. at a local community hospital in Southern California. Based upon the most recent National Hospital Ambulatory Medical Care Survey, patients ages 65 and older make up 32% of all E.D. admissions. These patients also represent 50% of the moderate to severely ill patients seen in the E.D. …

Efficacy Of Telehealth Modalities In Medication Adherence For Older Adults, Mitchell Adrian C. Siy

Doctor of Nursing Practice Final Manuscripts

About half of the geriatric population who take at least one medication find medication adherence challenging. Average adherence of an elderly patient taking one medication a day is about 80%. This adherence decreases to about 50% for patients taking medications four times a day. Nonadherence can lead to a myriad of preventable adverse effects that can reduce the quality of life and even result in death. In the United States, $100-300 billion could be saved in health care costs due to adverse effects of poor medication adherence. The purpose of this evidence-based project (EBP) is to improve medication adherence in …

A Guide To Vaccine Policy Change At A National Level, Janelle Bird

Doctor of Nursing Practice Final Manuscripts

Abstract

Health policy is in a near constant state of improvement. In order to solidify those improvements, health policy requires assistance from the upcoming generations of healthcare workers to push for those changes. Due to the outdated vaccination policy in the American Nurses Association (ANA), many states continued to issue exemptions based upon unsupported religious preferences. This helped to worsen the outbreak of measles in 2018-2019. The Previous ANA Policy on Vaccinations as of July 21, 2015 stated the ANA supports immunization exemptions only for the following reasons: Medical contraindications and Religious beliefs. Educate and train future health care professionals …

Impact Of Psychotropic Medications On Electrical Cardiac Conduction In The Emergency Department: A Best Practice Review, Juliann Hatt

Doctor of Nursing Practice Final Manuscripts

Abstract Background: The effects of psychotropic drugs on cardiac repolarization have increasingly gained attention in research and clinical practice over the last 2 decades. The absolute risk of cardiac arrhythmia, such as the polymorphic ventricular tachycardia, Torsades de Pointes (TdP), is low (14 per 10,000 patients/year) and sudden cardiac death as a consequence of all cardiac arrhythmias is less frequent (Braillon et al., 2017). TdP can occur at therapeutic doses of second-generation antipsychotics and antidepressants and with a corrected Q-T (QTc) interval >500 ms. Many psychotropic medications can delay cardiac repolarization thereby producing prolonged QTc in the electrocardiogram (ECG). Emergency …

Introducing Trauma-And Resiliency-Informed Care In A Residential Treatment Setting, Connie Quach

Doctor of Nursing Practice Final Manuscripts

Background: The link between trauma exposure and substance use is well established. Seventy-five percent of individuals in substance use treatment report histories of abuse and trauma. Early traumatic experiences or repetitive trauma exposure disrupts a person’s ability to self-regulate which may demonstrate as disruptive behavior or present as physiological symptoms.

Purpose: The purpose of this project was to introduce and increase awareness of trauma and resiliency informed definitions, techniques, and provide resources for staff in a residential treatment setting.

Evidence-based Intervention and Methods: Participating nurses and resident assistants received a one hour presentation on trauma, resiliency, and its associated interventions. …

Identifying Opportunities For Implementing Home Blood Pressure Monitoring In Newly Diagnosed Or Worsening Hypertension At A Family Health Clinic, Catherine Liikala

Doctor of Nursing Practice Final Manuscripts

Abstract

The literature is clear that the diagnosis, treatment, and plan of care for hypertension in adults should rely, at least in part, on ambulatory blood pressure. Using in-office blood pressures alone risks inaccurate measurements and can result in inappropriate treatments. Many clinics, however, do not adhere to this recommendation and will fall back on clinic readings which puts the patient at risk of mismanaged hypertension and polypharmacy. This project was formulated to identify the extent to which hypertensive patients were diagnosed and managed without the use of home blood pressure monitoring in a small local community clinic. This …

Screening For Postmenopausal Osteoporosis In Women Between Age 30-64 In Primary Care: A Policy Perspective With Recommendations, Shenwan Wang

Doctor of Nursing Practice Final Manuscripts

Osteoporosis is a silent disease leading to osteoporotic fractures and even death. Postmenopausal women are extremely susceptible to osteoporosis because of estrogen deficiency. But less than 1 in 4 women with an osteoporotic fracture was screened or treated for osteoporosis. Postmenopausal women have been proven to benefit from early osteoporosis detection and treatment. However, there is no current national policy on screening for postmenopausal osteoporosis before age 65. Nurse practitioners can play an important role in screening for postmenopausal osteoporosis in primary care to prevent osteoporotic fractures and improve quality of life.

Optimizing Best Telehealth Practices Among Advanced Practice Registered Nurses, Karen Swafford

Doctor of Nursing Practice Final Manuscripts

Abstract

Optimizing best clinical telehealth practices among APRNs

Abstract Title: Optimizing best clinical telehealth practices among APRNs through a survey that gauges their preparedness in core competencies and their recommendations.

Background: In April 2020, about half of all Medicare primary care visits were done through telehealth due to the COVID-19 pandemic. Telehealth evoked a strong positive response among patients, which created a new niche in healthcare. To effectively leverage its value, one of its key goals is the promotion of best clinical practices (Agrawal, 2020). However, very little information was found about programs that address NP training in telehealth. …

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

Strategies For The Improvement Of Healthcare Through Simulation, Roger Lankheet

Dissertations

Title:Strategies for the improvement of healthcare through simulation

Background: Medical errors continue to plague the healthcare industry. The annual rates of morbidity are approximately 2.69 million (AHRQ, 2019), while mortality rates exceed 400,000 per annum (Makary & Daniel, 2016). There may be no panacea to combat these egregious rates. However, simulation of patient care events may better prepare healthcare professionals to prevent medical errors as it has been proven to be an effective learning strategy (Kirkham, 2018), enhancing skills while gaining experiential knowledge, without risk to actual patients.

Purpose: The purpose of this qualitative study was to gain a …

Obesity Prevention Toolkit To Combat Weight Gain Related To Sedentary Behavior And Dietary Habits In College Students: An Evidence-Based Project, Maria Amos, Martha Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Forty percent of the US population ages 20-39 are categorized as obese,

their BMI is over 30, and 35% of college age students are obese or overweight. Issues related to obesity cost the US $147 billion annually. Between 40%-50% of college students are reported to be inactive. Inactivity can lead to increased morbidity and mortality related to increased risks of cardiovascular disease, diabetes, hypertension, musculoskeletal issues, and depression. Providing dietary and physical activity education and access to nutritional information promotes behavior change in young adults.

Aims of Service Change: This evidence-based project proposal aims to provide a toolkit …

Motivational Interviewing And Frequent Follow-Up In A Pediatric Primary Care Setting To Improve Diet And Activity In Adolescents, Celeste Armenta, Kathy James

Doctor of Nursing Practice Final Manuscripts

Background: Adolescent obesity is a serious health concern with increased worldwide prevalence. Excess weight gain can affect adolescent’s physical and emotional health. The adolescent with excess weight can involve acute and chronic long-term health complications that continue into adulthood.

Methods: Health care providers screened for overweight and obese adolescents during annual physicals and follow-up visits. Thirty adolescents at the 85th - 95th percentile and above on the growth chart received a pre and post clinical-screening questionnaire for eating behaviors and exercise. Individualized education with parent involvement and motivational interviewing (MI) was implemented with monthly follow-ups for 4 months.

Findings: Data …

Utilizing Post Graduate Residency Program In New Graduate Nurse Practitioners To Improve Clinical Outcomes, Lashaunda Jethro

Doctor of Nursing Practice Final Manuscripts

Utilizing Post Graduate Residency Program in New Graduate Nurse Practitioners to Improve Clinical Outcomes.

by LaShaunda R Jethro

The Advanced Practice Registered Nurse (APRN) role across the continuum of patient care continues to evolve, and the APRN continues to play a significant part in sustaining the current healthcare system and controlling the rising incidence of mortality and medical cost. While a substantial amount of evidence demonstrates that Nurse Practitioners (NPs) are expert healthcare providers, some studies also report that many new NPs fail to be confident in their capability to undertake the NP role and attend to increasing patient loads. …

Screening For Resilience In Pediatric Primary Care, Kaitlin Phelan, Martha Grant Fuller

Doctor of Nursing Practice Final Manuscripts

Introduction: Adversity in childhood increases risk for physical and mental health problems. Children who undergo adverse events can still flourish, due to the concept of resilience. Literature shows that resilience influences health more than adversity, and screening for resilience may improve practice.

Method: A valid screening tool for resilience, The CD-RISC, was given to children twelve and above during their well visit during February 2021 at a clinic in Oceanside, CA. Scores were categorized into four quartiles. Children responding in the lowest two quartiles received provider follow up.

Results: 97 surveys were scored: 39 scoring in the lowest quartile, 19 …

Neonatal Toxic Stress And Long-Term Neurodevelopment In Premature Infants, Rachelle Sey

Dissertations

Background: Evidence suggests the presence of complex biologic connections between the social environment, neurologic development, and long-term health. Premature infants spend many months in the Neonatal Intensive Care Unit (NICU) often separated from their parent(s). Decrease in the age of viability threshold allows extremely preterm infants to benefit from lifesaving therapies; however, they are frequently exposed to significant stressors that increase their risk for adverse neurodevelopmental outcomes.

Purpose: The purpose of this study is to examine the relationship among socio-demographic factors, exposure to stressors in the NICU environment, stress modifiers/buffers, neonatal morbidities at discharge, and 1. 2-year neurodevelopmental outcomes and …

Suicide Mortality Of Emergency Department Patients, Briony Marie Dubose Mhi, Rn, Lss, Bb

Dissertations

Purpose The purpose of this retrospective comparative study is to describe relationships among biological, psychological, sociocultural factors and emergency department (ED) care among discharged ED patients and describe the association of these variables with subsequent suicide mortality.

Rationale Identifying patients who are most at risk of suicide mortality post ED discharge can focus resources, refine interventions, and prevent suicide. Additionally, recognizing patterns of ED care including ordering of a psychiatric evaluation and disposition status can provide data for potential practice changes.

Background Suicide is the 10th leading cause of death in the United States and has been since 2008. Suicide …

Timing Of Therapeutic Hypothermia & Short-Term Infant Outcomes, Brooke Rakes

Dissertations

Background: Hypoxic-ischemic encephalopathy (HIE) can result in devastating long-term neurological morbidity and/or death. Current evidence recommends initiating Therapeutic Hypothermia (TH), as early as possible, however, research specifically describing TH timing in relation to short-term infant outcomes is limited with mixed results.

Purpose: Examine TH timing (TH initiation time & time to target temperature) on short-term outcomes (neonatal seizure; brain injury) of infants >35weeks, with suspected HIE, born at a large urban women’s medical center.

Methodology: Retrospective, cross-sectional, correlational design examining data extracted from electronic health record from November 1, 2012- March 31, 2020. Descriptive and inferential statistics were performed.

Results …

Life Satisfaction: Aging Female Informal Caregivers Of Persons With Dementia, Deborah Ann Monson

Dissertations

Purpose/Aims

The purpose of this study was to describe the relationship between aging female informal caregivers of persons with dementia (PWD) and care recipients’ PWD demographic factors, aging female informal caregivers of PWD social support factors, positive and negative feelings, a sense of flourishing, stress, and life satisfaction.

Background/Rationale

Older adults with dementia are living longer and the majority are receiving care by aging female informal caregivers. Dementia incrementally worsens over time impacting informal caregiver life satisfaction. Most studies have focused on negative aspects of informal caregiving. Therefore, this study investigated both positive and negative aspects of caregiving.

Conceptual Basis …

Health Disparities Associated With Pre-Existing Cardiovascular Disease And Telemedicine Interventions During Covid-19 Pandemic: Best Practice Review With Recommendations, Barbara Mae Madriaga

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to review research-based evidence brought forth by other researchers and scientists. The first goal was to determine current health care disparities associated with COVID-19 and pre-existing cardiovascular disease. The second goal was to determine current recommendations of COVID-19 and pre-existing cardiovascular disease. The third goal was to determine the use of telemedicine during this pandemic for cardiovascular interventions.

Background: In the United States, heart disease has been the leading cause of death for most racial and ethnic groups. The COVID-19 pandemic has revealed deeply rooted inequities …

Time To Medical Help-Seeking For Adults Who Experience Symptoms Of Stroke In A California-Mexico Border Region, Jean Rockwell

Dissertations

Background: Acute thrombolytic therapy for ischemic stroke must be administered within 4.5 hours of stroke symptom onset. Despite its proven efficacy fewer than 12% of those suffering acute ischemic stroke receive this treatment. The most common reason for low utilization is late medical help-seeking. Though the relationship among predictor variables and time to medical help-seeking have been explored in previous studies, it stills remains uncertain which predictors are most influential. The aim of this study was to identify factors associated with time to medical help-seeking for patients who experienced symptoms of stroke within a U.S. Southern California-Mexico border region. This …