Nursing Commons^™

Addressing A Crisis In Nursing Practice: Exploring The Impact Of Multimedia Case-Based Learning On The Clinical Judgment Of Undergraduate Nursing Students, Macy Jenette Bennett

Theses and Dissertations

Clinical judgment is a priority nursing skill to ensure the delivery of safe and effective nursing care. New graduate nurses and nursing students lack the clinical judgment skills that are necessary for entry-level nursing practice. Nurse educators must therefore implement teaching strategies that facilitate clinical judgment. This study evaluated the clinical judgment of undergraduate nursing students after the implementation of multimedia case studies related to the concept of perfusion. Two research questions guided this study: (a) in what ways do undergraduate nursing students demonstrate clinical judgment after completing a series of perfusion-related multimedia case studies and (b) to what extent …

Implementing The 5a’S Of Obesity Management In Primary Care, Holly H. Rowell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The prevalence of obesity continues to increase globally, with greater prevalence in the southern United States, resulting in higher costs to the healthcare system and greater risks for the development of other chronic diseases. Purpose: Determine if implementing the 5A’s of Obesity Management among primary care providers in a rural, low-income healthcare setting will increase the diagnosis of obesity and result in a subsequent decrease in weight among patients who are obese. Methods: An educational session was held to familiarize providers with the 5A’s of Obesity Management and the importance of obtaining and documenting proper height …

Implementation Of Shared Decision Making To Impact Decisional Conflict In Advancing Chronic Kidney Disease, Margaret Mcannar Sorkin

Doctor of Nursing Practice Scholarly Projects

Problem Statement: A notable phenomenon in nephrology is indecision regarding treatment for End Stage Renal Disease (ESRD). Indecision regarding treatment for ESRD can lead to suboptimal dialysis starts, creating poorer health outcomes, decreased quality of life, and higher healthcare costs. Purpose: This project aimed to determine if participation in a shared decision-making (SDM) program decreases decisional conflict in patients with advancing renal disease deciding between ESRD treatment options. Methods: A pretest-posttest design was used. Participants were recruited from a private nephrology practice. Inclusion Criteria: English-speaking patients, over the age of 20, with Chronic Kidney Disease Stages 4 or 5 (estimated …

Impact Of The Blaylock Risk Assessment Screening Score On Inpatient Length Of Stay On Inpatient Psychiatric Units Within An Acute Care Hospital, Princess P. Minter

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Insufficient discharge planning at the time of patient admission can result in increased hospitalization length of stay and poor clinical outcomes, including a rapid deterioration of stabilized patients’ mental status while unnecessarily waiting for discharge arrangements to be put in place at the time of discharge. Purpose: To determine if completing the Blaylock Risk Assessment Screening Score (BRASS) index tool to identify barriers to discharge at the time of patient admission impacts the length of stay for patients admitted to general psychiatric inpatient units. Methods: Patient admission and discharge data collected using the BRASS index within 48 hours …

Human Papillomavirus Vaccination Rates Among Adolescents In South Carolina, Rebecca Jane Morrison

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Among adolescents 11-17 years of age in South Carolina, low rates of human papillomavirus (HPV) vaccination can negatively impact health outcomes through increased risk of acquiring HPV-associated cancers.

Purpose: To determine if the 4 Pillars™ Immunization Toolkit increased HPV vaccination rates among adolescent patients.

Methods: The 4 Pillars™ Immunization Toolkit was the framework for this bundled intervention. Pillar 1, convenience and easy access, included after-school HPV express clinics. Pillar 2, communication, utilized staff motivational interviewing skills, campaign promotion materials, documentation of declination, and second-dose callback appointments. Pillar 3, enhanced vaccination systems, was designed to use …

Reducing Wait Times For Psychiatric Intakes, Ryan Brad Carsten

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Early intervention for mental illness is vital to a swift recovery and extended wait times for mental health treatment have proven to be a barrier to early intervention. Purpose: The purpose of this quality improvement project was to determine if wait times for psychiatry intakes at the University of South Carolina (USC) Student Health Center Psychiatry Services can be reduced and kept under 1 week by utilizing the Specific Timely Appointments for Triage (STAT) model. This model consists of clinicians scheduling a specified number of intake appointments based on the typical demand for service. Students were booked in …

Improving Dementia Symptoms Through Personalized Music, Lindsay Grainger

SC Upstate Research Symposium

Alzheimer's disease and related dementia (ADRD) is a prevalent, costly, and complicated disease. With over 6 million Americans affected and the cost of treatment soaring to over $320 billion dollars annually, there is a growing need for low-cost interventions to treat symptoms. Routinely listening to personalized music selections has been shown to reduce agitation—the most common symptom of Alzheimer’s disease and related dementia. The purpose of this study was to provide a personalized music listening (PML) intervention of thirty minutes to 10 nursing home residents with dementia. Thirty-minute PML sessions occurred multiple times a week over six weeks. The inclusion …

Hgs-3 The Influence Of A Tandem Cycling Program In The Community On Physical And Functional Health, Therapeutic Bonds, And Quality Of Life For Individuals And Care Partners Coping With Parkinson’S Disease, Leila Djerdjour, Jennifer L. Trilk

SC Upstate Research Symposium

Purpose Statement: Several studies have shown that aerobic exercise can have a positive impact on alleviating symptoms experienced by individuals with Parkinson's disease (PD). Despite this evidence, the potential benefits of exercise for both PD patients and their care partners (PD dyad) remain unexplored. This research project investigates the effectiveness, therapeutic collaborations, and physical outcomes of a virtual reality (VR) tandem cycling program specifically designed for PD dyads.

Methods: Following approval from the Prisma Health Institutional Review Board, individuals with PD were identified and screened by clinical neurologists. The pre-testing measures for PD dyads (N=9) included emotional and cognitive status …

Post-Discharge Follow-Up Call To Impact Heart Failure Re-Admission Rates, Regina Mitchell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The clinical setting for this project, a 321-bed southeastern hospital in South Carolina, has an elevated re-admission rate for CHF patients of 22.67% (Ferguson, B. V.P. Quality, personal communication, October 21st, 2022), 1.57% above the Centers for Medicare Services (CMS) benchmark of 21.1% for payment reduction penalties. Purpose: Determine if post-discharge interview phone calls decrease CHF re-admission rates. Methods: A two-group pretest-posttest design will be used. Data will be collected during retrospective unit chart review, weekly chart review of patient participants, and structured post-discharge phone interviews. Inclusion Criteria: English-speaking, adult (>18 years of age) patients with …

Use Of A Palliative Care Trigger Tool In A Surgical-Trauma Intensive Care Unit, Courtney Thomas

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Patients are not habitually screened for palliative care consultations, and there is no protocol for initiating communication with palliative care. Not only is this a problem at the local and state level, but only about 5% of acute care patients nationally are estimated to utilize palliative care services. This delay in specialty care that palliative consultations could provide negatively impacts patients. Purpose: This evidence-based practice (EBP) project aimed to determine if a palliative care trigger tool in an intensive care unit (ICU) would increase the number of palliative care consultations. Methods: A pre-implementation survey was distributed to ICU …

Implementation Of A Pcp Referral In Urgent Care For Patients With Hypertension, Teri Alesha Scott

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adult patients with uncontrolled hypertension at Saluda Pointe Urgent Care (SPUC) do not have an established primary care provider (PCP) for follow-up.

Purpose: To improve access to care by establishing patients with uncontrolled hypertension (>140/90) with a PCP.

Method: Implement a PCP referral at SPUC for patients with uncontrolled hypertension. The Primary Care Connection Center (PCCC) contacted the referred patients within 72 hours to schedule an appointment. An Organizational Change Management (OCM) Solutions survey measured provider attitude and readiness for change before and after implementation.

Inclusion Criteria: Adult patients 18 and older, without an …

A Response Team Approach To Reducing Restraint Use In The Emergency Department, Sarah Place

Doctor of Nursing Practice Scholarly Projects

Assaults on staff are doubling in the healthcare field, and due to the urgent need to secure the environment, the use of restrictive measures is at times, the safest choice. The following project examined the implementation of a Behavioral Emergency Response Team approach in an Emergency Department, and the effects it had, on reducing the use of violent restraints, assaults on staff, and increase confidence of staff in managing difficult situations. An anonymous survey was used to measure staff confidence while handling agitated patients, and an event report was used that identified if de-escalation techniques were employed to assist in …

Improving The Discharge Process In A Post-Acute Care, Skilled Nursing Facility To Decrease Hospital Readmissions, Shantoria W. Parker

Doctor of Nursing Practice Scholarly Projects

Problem: Older adults recently discharged from a skilled nursing facility (SNF) (often referred to as short-stay facilities) experience a period of vulnerability while transitioning back into the community, placing them at increased risk of adverse events, including hospital readmissions (Anderson et al., 2021). Completing a timely appointment (within 7 days) with primary care providers following discharge into the community reduces patients’ risk of preventable hospital readmissions (RHI, 2023) through interventions aimed at promoting coordinated care and safe transitions (Patel et al., 2019). However, more than 50% of readmitted patients failed to visit a primary care provider's (PCP) office between SNF …

Early Palliative Care Screening Among Solid Tumor Oncology Patients, Kaitlin Lothe

Doctor of Nursing Practice Scholarly Projects

While there are extensive benefits of integration of early palliative care, referral to this specialty tends to occur late in the disease course after some form of suffering has already occurred (Hausner et al., 2021). The purpose of this DNP student’s quality improvement project was to improve care coordination and increase rate of palliative care referrals of solid tumor oncology patients through implementation of an evidence-based trigger tool for palliative care screening. Participants were recruited from a 36-bed inpatient adult medical oncology unit where identified patients meeting criteria were included in the study. Data for this study included participant demographics, …

Patient Outcomes Following The Implementation Of A Cardiogenic Shock Algorithm, Alana E. Hall

Doctor of Nursing Practice Scholarly Projects

Problem Statement: ST-elevated myocardial infarction (STEMI) is one of the leading causes of cardiogenic shock (CS) associated with increased in-hospital mortality. Despite multiple efforts to improve outcomes, mortality remains high.

Purpose: This quality improvement project aimed to analyze the impact of a cardiogenic shock algorithm on survival to discharge for STEMI patients.

Methods: A CS algorithm was implemented at a cardiac catheterization laboratory on October 3, 2022. Using the Plan-Do-Study-Act quality improvement framework, data was retrospectively collected on patients presenting with a STEMI who meet CS criteria to determine if there was improved survival to discharge after implementing …

Implementation Of A Nurse Driven Urinary Catheter Protocol: A Quality Improvement Project For Adult Patients, Jamie H. Dagenhart

Doctor of Nursing Practice Scholarly Projects

Introduction: Studies have shown a relationship between management and use of indwelling urinary catheters on catheter days and catheter-associated urinary tract infections (CAUTIs), in adult patients in intensive care units (ICUs). Globally, increases in catheter days and CAUTI rates have led to poor patient outcomes, increased lengths of hospital stay, and increased hospital costs. In efforts to inhibit these adverse effects, institutions have developed protocols specific to reducing CAUTIs in hospitalized patients. This paper argues that a multifaceted nurse driven indwelling urinary catheter protocol will positively influence number of catheter days and change in practice, in the proposed institutional settings. …

Michigan Appropriateness Guideline For Intravenous Catheters And The Impact On Utilization And Infection Ratios In Peripherally Inserted Central Catheters, Kasey Smith Bustamante

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adult patients are at increased risk for central line-associated bloodstream infections when central line utilization rates are increased and are inserted inappropriately, based on patient criteria. Purpose: Determine if utilization of the Michigan Appropriateness Guidelines for Intravenous Catheters (MAGIC) will reduce central line utilization ratios (focusing on peripherally inserted central catheters (PICC)) and reduce risk of central line-associated bloodstream infections among an adult population in the Trauma Surgical Care Unit (TSCU) and Medical Intensive Care Unit (MICU) at a tertiary care center in the South Carolina Pee Dee Region. Methods: The Plan Do Study Act (PDSA) quality improvement …

Hpv Vaccine Hesitancy: Improving Vaccination Rates In The Pediatric Primary Care Setting, Stephanie Meltzer Carper

Doctor of Nursing Practice Scholarly Projects

Problem statement: The Human Papillomavirus (HPV) vaccine protects against carcinogenic strains of HPV and is administered during childhood to provide maximum protection during peak risk for exposure and HPV disease. Despite demonstrated efficacy, HPV vaccine hesitancy leads to decreased vaccination rates in the pediatric primary care setting. Purpose: This quality improvement project aims to improve HPV vaccination rates at SouthernMED Pediatrics, Summerville, South Carolina. Methods: A pre-intervention survey was administered to identify parental concerns regarding the HPV vaccine to create a customized educational handout. Health care providers systematically used motivational interviewing, presumptive approach communication techniques, and a customized educational handout …

Retrospective Analysis Of Benzodiazepine And Sedative Use In The Surgical-Trauma Intensive Care Unit, Ronelle Guinyard Goodwin

Doctor of Nursing Practice Scholarly Projects

Problem Statement: There has been an increase in benzodiazepine use and delirium occurrences in the surgical-trauma intensive care unit (STICU). Purpose: This Doctor of Nursing (DNP) project aimed to explore the current practice of benzodiazepine and sedative use for adult patients admitted to the STICU who developed alcohol withdrawal syndrome (AWS) or delirium. Method: A retrospective chart review with descriptive analysis was completed for all adult patients admitted to the STICU at a regional community level 1 adult and level 2 pediatric trauma center, diagnosed with AWS or delirium, and treated with benzodiazepines during their intensive care unit (ICU) stay. …

Improving Communication And Workflow Among Advanced Practice Providers And Nurses On Nightshift In An Intensive Care Unit, Chelsey Alise Durr Massey

Doctor of Nursing Practice Scholarly Projects

Problem Statement: There is often a lack of streamlined communication on nightshift among the reduced care team in acute care settings. The absence of organized collaboration and shared decision-making contributes to strained professional relationships between the advanced practice provider (APP) and the nurse. Purpose: Nightly provider-nurse bedside rounds were implemented in a 21-bed cardiovascular intensive care unit (CVICU) using a goal sheet to improve communication among the APPs and nurses. Methods: A pretest-posttest design in which surveys were used in this quality improvement (QI) project to determine perceptions of communication between APPs and nurses. Inclusion Criteria: All APPs and rotating …

Impact Of A Standardized Checklist On Post Discharge Appointment Attendance And Readmission Rates Of Veterans With A Mental Health Diagnosis, Henretta N. Milton-Williams

Doctor of Nursing Practice Scholarly Projects

Inpatient readmissions are among the most severe problems facing hospitals. Readmissions are most common in the first two to five days after discharge, especially among veterans with mental illnesses at the Columbia Veteran Administration Hospital System (CVAHS) inpatient units. The discharge planning process should begin as soon as a patient is admitted and should be updated throughout the inpatient stay to ensure a safe transition of care from inpatient to outpatient. This Doctor of Nursing Practice (DNP) quality improvement project is aimed to develop and implement a standardized checklist to streamline and organize the discharge planning for all veterans admitted …

Using The Buzzy Device To Decrease Pain, Fear, And Anxiety With Venipunctures And Injections, Lisa Santiago Sauls

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Anxiety, fear, and pain related to initiating peripheral venous access or injections are a high priority in the ambulatory infusion clinic setting for both children and adult populations.

Purpose: To determine if the Buzzy device will decrease anxiety, fear, and pain related to adult patients undergoing peripheral venous access or injections in ambulatory infusion clinics.

Methods: Age, sex, route of medication the patient is receiving. A post-procedure questionnaire assessed the participant's satisfaction with the Buzzy device. Pain, fear, anxiety, and patient satisfaction were all measured using a visual analog scale.

Inclusion Criteria: Patients aged eighteen and above receive …

Implementation Of A Peer To Peer Concussion Management Program And Its Effect On Concussion Knowledge And Reporting Behaviors In Collegiate Club Sports Athletes, Brian Wallace Stefan

Doctor of Nursing Practice Scholarly Projects

Problem: Concussions continue to be a common injury in both athletes and non-athletes across the world. In college, symptoms and recovery time from concussion injuries can lead to loss of social interaction, class time, and participation in school events such as sports. For collegiate club athletes at the University of Pittsburgh, there is currently no mandated concussion protocol, making injury management more difficult. Purpose: This project's purpose was to determine whether a peer-to-peer concussion education tool is a viable implementation option to improve the concussion environment for this population compared to their current structure with no protocol. Method(s): A five-step …

Implementation Of Daily Multidisciplinary Rounding Audits Of Adherence To An Indwelling Catheter Protocol Impact On Catheter-Associated Urinary Tract Infections, Jacqueline April Wright

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Catheter-associated urinary tract infections (CAUTIs) among critical care patients negatively impact the trajectory of the patient’s hospitalization through increased mortality, morbidity, length of stay, and cost. To combat this, hospitals have implemented bundles in compliance with evidence-based practice models to reduce CAUTIs. Purpose: Determine if implementing a daily multidisciplinary rounding audit of established CAUTI prevention protocol decreases the occurrence of CAUTIs in critical care patients with indwelling urinary catheters. Methods: Participants in this quality improvement project included critical care nurses and providers participating in daily multidisciplinary rounds on all critical care patients with indwelling urinary catheters admitted to …

Unlocking Population-Specific Treatments To Render Equitable Approaches And Management In Cardiovascular Disease (Upstream Cvd): African American Emerging Adults, Shannon Bright Smith

Theses and Dissertations

Cardiovascular disease (CVD) is the leading cause of death in America. African American people have disparate CVD outcomes, and African American emerging adults (AAEAs) aged 18-25 have CVD risk factors. This study aimed to examine the state of CVD risk factors in AAEAs, assess upstream and population factors in AAEAs attending a southeastern historically black college/university (HBCU), compare their perceived and objective CVD risk, explore their level of CVD knowledge, and examine responses when they learn their objective CVD risk.

Chapter 1 presents background literature on CVD in AAEAs and the research plan. Chapter 2 presents a newly synthesized situation-specific …

Reducing Falls Among Adult Psychiatric Inpatients Using K-Cards With The Epi, Epfrat Factors, And Nursing Judgment, Katelyn Dunn

Doctor of Nursing Practice Scholarly Projects

In the United States, the highest rates of falls are in the psychiatric inpatient population. Fall reduction was as an organizational goal of the project site, a 352-bed hospital in the Southeastern United States. The Epic Predictive Index (EPI), an automated fall risk assessment tool, had recently been adopted. This project evaluated the impact of an enhanced fall reduction strategy involving the use of Kamishibai Cards (K-Cards), which are a compliance reminder for healthcare staff, to support additional evidence-based identification of fall risk among adults receiving inpatient psychiatric care at the facility. The use of K-Cards with each patient’s current …

Substance Use Disorder Treatment Among African American Men Living In The Rural South Of The United States, Serge Raoul Wandji

Theses and Dissertations

Substance use disorders (SUD) affect more than 40 million Americans. African American (AA) men are disproportionally affected by the negative health and social consequences of SUD, and men in rural areas may be particularly at risk due to disadvantaged socioeconomic conditions and persistent race-related stressors such as perceived discrimination. The overall purpose of this study is to advance the understanding of factors associated with SUD treatment acceptance and relapse potential among Southern rural AA men.

This purpose was achieved by determining differences in treatment acceptance and relapse potential by race and gender among rural residents admitted in a SUD treatment …

Nurse Perceptions Of Caring And Professional Governance, Lan Angela Nguyen

Theses and Dissertations

Background: Caring, a characteristic of an effective work environment, and clinical nurse control over the professional governance of nursing practice results in higher nursing retention and better patient outcomes. Although the concepts of caring and professional governance of nursing practice, and their discrete associations with patient outcomes, are widely studied, little to no research is published on the nature of the relationship between caring and professional governance of nursing practice. Without understanding this relationship, it is challenging to explore the impact of this relationship on nursing practice and patient outcomes.

Aims: The purpose of this study was to describe nurse …

Gh-06 Human Trafficking Simulation With Senior Nursing Students, Stephanie Barnhill, Monique Jones

SC Upstate Research Symposium

This poster shares information on a human trafficking simulation that can be used in healthcare courses. It includes an overview of human trafficking, risk factors for victims, and a script that students follow to make decisions as a victim and see the choices this vulnerable population must make.

Thought-provoking quotations from victims involved in human trafficking are shared, as well as resources for debriefing and discussion of healthcare worker roles, biases, and human tracking choices.

Implementation Of A Bowel Management Care Bundle On The Spinal Cord Injury Patient Population During Acute Recovery, Jessica Rene Baldwin

Doctor of Nursing Practice Scholarly Projects

Over 17,000 Americans suffer from spinal cord injuries (SCI) annually. Although the loss of motor function is a blatantly obvious sequela, the loss of autonomic nervous system control, and its direct effects on various body systems, is scarcely understood. The most frequently reported impairment associated with SCI-related bowel dysmotility is Neurogenic Bowel Dysfunction (NBD), affecting approximately 20-60% of the SCI population. NBD is defined as slow colonic time and is hallmarked by constipation and often impaction, leading to life-threatening complications, such as bowel obstruction, fecal impaction, autonomic dysreflexia, and even death. Identifying dysmotility within the SCI patient population and early …