Nursing Commons^™

"Salir Adelante": Improving The Quality Of School Entrance Physicals For Immigrant Minors, Jennifer Sternberg, Elizabeth Morse

DNP Projects

The purpose of this QI project was to improve the delivery of school physicals in the setting of an -friendly non-profit safety-net clinic by creating a patient-centered clinical pathway to improve focused screening and referrals for newly arrived migrant children and their families by routinely assessing and addressing behavioral health care (BH) and social determinants of health needs (SDoH).

Using QI methodology and Donabedian’s Structure Process Outcomes framework, the project team implemented a clinical pathway that included an immigration-focused history of present illness, systematic behavioral health (BH), and social determinants of health (SDoH) screenings embedded within an electronic health record …

Advancing Health Equity On Campus A Minority Health Promotion Quality Improvement Initiative, Natasha Wilson

DNP Projects

Abstract Background: Minority students at predominantly white institutions face unique stressors due to their minority status, impacting their health. Initiatives promoting community engagement, diversity, equity, and inclusion can help reduce minority stress and foster health equity and success in higher education Method: This project employed a Community-Based Participatory Research (CBPR) framework to enhance minority student involvement in sexual and mental health services both on campus and in the wider community. It involved forming partnerships between minority student organizations, faculty, and community partners to organize wellness events focusing on sexual and mental health during the fall semester of 2023. The events …

Introducing An Evidence-Based Copd Care Bundle To Reduce Readmission Rates: A Quality Improvement Project, Michael Distasio

DNP Projects

Background

Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating lung condition, and a leading cause of readmission following an acute exacerbation. The Centers for Medicare and Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP) determines reimbursement penalties to hospitals when patients admitted with acute exacerbation of COPD are readmitted for any reason within 30 days of discharge. A regional medical facility (MF) identified 30-day readmission rates for COPD patients as a key improvement metric. Several gaps in the standardized care of patients with COPD on a pulmonary-focused medical-surgical unit (MSU) identified by key unit stakeholders provided impetus for …

Increasing Faculty Knowledge Of Competency-Based Education: A Quality Improvement Project, Lindsay O'Sullivan

DNP Projects

Background: The nursing academic-to-practice knowledge gap creates systems-based and patient outcomes issues. The changing demands of healthcare require the advancement of the discipline of nursing through the improvement of nursing education. The American Association of Colleges of Nursing (AACN) requires all nursing programs to implement Competency-Based Education (CBE) evaluations and assessments into existing nursing curricula to respond to changing healthcare demands. The aim of this project was to improve the knowledge of nursing educators regarding the use of CBE at a mid-sized university in the southeast.

Methods: The Diffusion of Innovation Theory was used as a framework for this project. …

The Impact Of An Educational Video On Physician Confidence And Comfort Level In Discussing Autopsies, Joy N. Owings, Laura Gray, David Phillippi

DNP Projects

Background: Autopsy rates have declined since the 1970s despite the procedure's benefit to families and medical science. Two well-documented reasons for the declining autopsy rate are physicians’ lack of knowledge about autopsies and lack of confidence in offering them. Objective: The primary aim of this study was to evaluate the impact of a brief educational video on physicians' comfort level, confidence, and knowledge regarding autopsy discussions. The objective was to address the declining autopsy rates by enhancing physicians' confidence and comfort level in offering autopsies to families. In addition, this study aimed to investigate physicians’ practices of consenting for an …

Implementing The Phq-9 Tool To As A Standard Of Practice In A Mental Health Setting: A Quality Improvement Project, Gabriella Laferriere

DNP Projects

The objective of this project was to implement the Patient Health Questionaire-9 (PHQ-9) tool as a standardized protocol for depression screening on patients being treated at an outpatient mental health facility in Central Connecticut, where there was no depression screening protocol in place. The clinical question being asked was, is there any correlation between use of the PHQ-9 tool and changes being made to a patient’s depression treatment plan?

Methods: A data collection form was completed by the psychiatric nurse practitioner on each patient who met the following criteria: Depression and/or anxiety was the patient’s primary diagnosis and patient was …

Playing It Sun Safe: A Quality Improvement Project, Sarah P. Tarr, Kathryn K. Dambrino, R. David Phillippi, Ashley Karpinos

DNP Projects

Background: Athletes who play outdoor sports have multiple risk factors for the development of skin cancer. Literature highlights the need for the use of evidence-based strategies to improve the knowledge and utilization of sun protection practices in this high-risk population. Methods: Playing it Sun Safe was a multifaceted skin cancer prevention initiative implemented in a population of collegiate soccer athletes in collaboration with a university athletic department and campus health clinic. Evidence-based interventions were designed through application of the Health Belief Model (HBM) and were implemented using the Institute for Healthcare Improvement (IHI) quality improvement framework. Purpose: The two-fold aim …

Implementing Directed Security Rounding With The Brøset Violence Checklist: A Quality Improvement Project, Jacqueline Ortiz

DNP Projects

Significance and Background: Violence against healthcare workers is an international issue. The rates of workplace violence (WPV) have been steadily increasing over the last few years. The practice setting implemented the use of the Brøset Violence Checklist (BVC) system-wide in July 2022, following the Joint Commission’s new standards for WPV prevention. The BVC is a checklist of six behaviors (confusion, irritability, boisterousness, physical threats, verbal threats, and attacking objects) that the nurses score as a 1 (present) or 0 (absent), and the higher the sum of the scores the greater the risk of violence. A score of three or greater …

African American Women’S Perceptions Of A Group Based, Diabetic Medical Nutritional Therapy Intervention: A Qualitative Study, Megan Mcmahon, Laura Gray

DNP Projects

Background: African American women exhibit lower rates of attaining recommended diabetes management goals such as optimal blood sugar, cholesterol, and blood pressure numbers compared to other racial and gender groups. As a result, they bear a disproportionate burden of the adverse outcomes associated with poorly managed type 2 diabetes, including increased complications and mortality rates compared to other demographic groups. Despite favorable qualitative findings regarding group-based interventions for African American women with other chronic diseases, a notable gap in the literature exists regarding the women’s perceptions of a group-based medical nutritional therapy tailored to type 2 diabetes. Purpose: This scholarly …

Optimization Of A Push Notification System To Improve First Case Delays: A Quality Improvement Project, Chelsea Secondino, Samantha Tortora

DNP Projects

Background

Delayed first case on time starts (FCOTS) in the operating room (OR) have a trickle-down effect throughout the day leading to wasted resources, patient dissatisfaction, and healthcare staff stress and burnout. In the local practice setting the mean FCOTS was 65%, well below the national target of 83%. Surgeons being late and missing electronic health record documentation were the most common reasons for delays. A push notification system had been implemented to improve FCOTS however few surgeons and nurses were using this technology.

Project Goals

1. Develop a process and training for a push notification system for surgeons and nurses. …

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …

Enhancing Primary Care With Progressive Muscle Relaxation For Anxiety, Depression, And Acute Stress: A Quality Improvement Project, Andrew Dudley

DNP Projects

Introduction

Depression affects 1 in 5 individuals during their lifetime (Hidalgo et al., 2021), with 23 million Americans seeking mental health treatment annually (Parish et al., 2023). While guidelines from the AAFP and APA advocate comprehensive care approaches, medication prescriptions for anxiety and depression remain prevalent, particularly among children aged 6-18 (Lester et al., 2022). Direct observation identified a need to bridge gaps in adjunctive therapies between the primary care setting and counseling services for patients who presented with mild or mild to moderate anxiety or depression. Feedback analysis by staff in the setting identified a gap in knowledge and …

Implementing A Depression Screening Protocol In Primary Care To Improve Utilization Rates: A Quality Improvement Project, Stella Lemel

DNP Projects

Significance and Background: Depression is a widespread and debilitating mental health condition that is often underdiagnosed and undertreated, especially in primary care settings. The importance of early detection and intervention for depression in preventing adverse outcomes and improving patient well-being is not consistently recognized. This DNP project addresses this gap by implementing a standardized depression screening protocol in primary care.

Purpose: This project aims to assess the achievability and efficiency of implementing a depression screening protocol in a primary care clinic to improve the identification and management of depression among patients.

Methods: Plan-Do-Study-Act. Plan: A depression screening protocol was developed …

Dnp Project Proposal: Toolkit For Transition Of Young Adults With Autism Spectrum Disorder (Ya-Asd) To Primary Care, Dawn Boal

DNP Projects

Significance and Background: Young adults (YA) with autism spectrum disorder (ASD) transitioning from pediatric to adult care may have more difficulty finding a primary care clinician trained to address their unique medical and mental health needs. Transition resources need to be developed to help these patients and their caregivers while they are still being cared for by their pediatrician.

Purpose: To develop an ASD resource toolkit with resources designed to help YA-ASD and their caregivers with the transition from pediatric care to adult primary care.

Methods: The Model for Healthcare Improvement guided this evidence-based quality improvement project. An evidence …

Implementing A Skin Care Bundle On Hypoperfusion Skin: A Quality Improvement Project, Emily O'Connor

DNP Projects

Significance and Background: Pressure injury rates have increased within the critical care population. Pressure injuries are known to increase pain, infection risk, length of stay leading to decreased quality of life. Thermal imaging cameras highlight areas of hypoperfusion, allowing staff to target these areas as high likelihood to progress to a pressure injury. Foam dressings have been shown to help decrease pressure injury acquisition. Prevention methods should utilize evidence-based skin care bundles and focus on known information and target areas. Combining knowledge from thermal cameras, foam dressings, turning every two hours and accurate use of documentation scale (Braden Scale), a …

Implementing Continuous Glucose Monitoring: A Quality Improvement Project, Molly Suydam

DNP Projects

Significance and Background: Continuous glucose monitoring (CGM) devices are beneficial for assessing blood glucose measurements throughout the day by simply waving a smartphone over the sensor that’s attached to the back of a patient’s arm. Patients with T2DM who check blood glucose measurements via finger-sticks, have to undergo numerous daily finger-sticks. Over time, this action can grow very cumbersome while CGM offers real-time blood glucose measurements without having to pierce the skin repeatedly. CGM use in patients with T2DM may help to improve overall blood glucose measurements.

Purpose: To trial CGM in patients with T2DM and monitor blood glucose measurements …

The Effect Of Skin Tone Inclusive Dermatology Education On Diagnostic Accuracy And Self-Confidence In Graduate Nursing Students, Kaylyn Bourne, Laura Gray

DNP Projects

Abstract

BACKGROUND: People with skin of color face worse health outcomes than their light-skinned peers. According to the literature, graduate nursing programs lack skin tone inclusive curricular content (Shue-McGuffin & Powers, 2022). This contributes to disproportionate racial and ethnic health disparities. Skin tone inclusive online dermatology modules have been shown to improve diagnostic accuracy and self-confidence among medical students and residents in primary care specialties (Trinh et al., 2021; Salava & Salmela, 2022; Wang et al., 2020). Similar models may be an effective approach for graduate nursing students as they prepare to evaluate skin disease across the skin tone …

Implementation Of A Risk Stratification Foot Screening Tool At A Free Outpatient Clinic: A Quality Improvement Project, Joni-Kay Johnson

DNP Projects

Background: Foot conditions and disorders are prevalent concerns for the medically underserved population, that can manifest through chronic illnesses like diabetes, peripheral vascular disease, and hypertension, especially if these conditions go undetected or unmanaged for periods of time. This population is faced with complex challenges and are at risk of illness due to inequities and disparities in access to health care services. They are known to suffer from poor health and can be reluctant to seek healthcare except in crisis. Walking is a common mode of transportation among underserved individuals and increased risks of physical injury, poor hygiene, and inadequate …

Implementing Teach Back Heart Failure Education To Improve Self-Care And Reduce Re-Hospitalization: A Quality Improvement Project, Sweata Patel

DNP Projects

Heart failure (HF) is a major health concern. External evidence supports the use of the teach-back method for patient education to promote self-care behaviors in patients with HF which may also reduce rehospitalizations. Patients with HF at one home health agency in New England participated in the quality improvement project which consisted of delivering 20 minute weekly standardized teach-back educational sessions covering topics of HF self-care over six weeks. The existing patient education materials and two new resources, Medication Tracker and Self-Check Plan for HF management, were reviewed. Three questions from the Self-Care of Heart Failure Index were asked during …

Improving Provider Ordered Annual Breast Cancer Screening In Primary Care, Alexis Manzella

DNP Projects

Significance and Background: Breast cancer is the most common cancer in women throughout the United States. Specifically, the state of Connecticut has one of the highest rates of breast cancer in the country. Multiple evidence-based organizations have developed specific guidelines for screening in clinical practice. These guidelines specify when a woman should be screened and how frequently. A project was put in place at a FQHC in Connecticut to increase the number of breast cancer screenings ordered, based on clinical guidelines. Evidence supported the use of provider education to increase the number of mammograms ordered (Marks,2022).

Purpose: Increase the number …

Postoperative Discharge Opioid Education Including Narcan Kit Access To Prevent Overdose: A Quality Improvement Project, Arezo Aziz

DNP Projects

Significance and Background: Opioid related overdoses are considered a public health epidemic and emergency in recent years within the United States. With a staggering number of opioid related deaths which have continued to rise, steps have been taken to decrease risk within local communities through programs including personalized patient education during provider visits, the dispensing of Naloxone with opioid prescriptions and encouraging the use of alternative pain management strategies. Most recently, New York State passed a recommendation encouraging all healthcare providers to prescribe Naloxone with the first opioid prescription of each year for patients deemed high risk for overdose. A …

Support Program For Dnp/Fnp Students: A Quality Improvement Project, Catie Pernice

DNP Projects

Significance and Background: Peer support programs in graduate studies can help students in a multitude of ways. Peer support programs can improve student satisfaction and decrease stress levels among students. Some graduate nursing programs offer a peer support program for students but not all. The university where this project was conducted does not offer a peer support program for Doctorate of Nursing Practice/Family Nurse Practitioner students.

Purpose: To increase student satisfaction and decrease the stress of DNP/FNP students in their first year of graduate college.

Methods: The project’s implementation and evaluation were guided by The Iowa Model Revised: Evidence-Based Practice …

Implementation Of A Human Trafficking Screening Tool In An Immigrant Services Organization, Cassandra Cooper

DNP Projects

Background

Human trafficking (HT) is a public health problem that advances the spread of disease and mental health issues and affects vulnerable populations including immigrants. HT screening tools are more reliable than clinical judgment in identifying HT victims, as even victims themselves are sometimes unaware of their own victimhood. To reduce the instances of victims being missed, HT screening tools have been validated to identify victims without the influence of personal bias.

Project Goals

1. Choose and implement a HT education module for staff.

2. Implement the AHTST for all new arrivals and from the months of November 2023 through …

Smoking Cessation In Primary Care Using The 5 A’S Model Of Motivational Interviewing: A Quality Improvement Project, Lauren M. Violette

DNP Projects

Significance and Background: Tobacco use is one of the leading causes of preventable death in the United States, greatly contributing to morbidity and mortality. Motivational Interviewing (MI), a counseling style, has been shown to increase motivation for change in people. Successful intervention for behavior modification starts with identifying a person’s readiness for change. The 5 A’s model is an established form of motivational interviewing that addresses the five major steps of intervention: Ask, Advise, Assess, Assist, and Arrange. The Center for Disease Control (CDC) endorses the use of the 5 A’s brief tobacco intervention to protect the public’s health from …

Implementing Hourly Rounding In Reducing The Rate Of Falls Among Older Adults In Long-Term Care Facilities, Alfred Amaechi

DNP Projects

Background

Falls are events with a resultant effect of an individual accidentally or unintentionally coming to rest on the floor, ground, or other lower level; also, injuries sustained from falls may be fatal or non-fatal depending on the severity of the fall (World Health Organization [WHO], 2021). Falls are the second leading cause of unintentional injury deaths globally; each year, an estimated 684 000 individuals die from falls globally, of which over 80% are in low- and middle-income countries; adults older than 60 years of age suffer the greatest number of fatal falls, and 37.3 million falls that are severe …

Empowering Caregivers In The Prevention Of Clinical Delirium For At Risk Older Adults Boarding In The Emergency Department Setting, Danielle Brewer

DNP Projects

Background: Emergency Department (ED) overcrowding is a global healthcare crisis documented in the literature for more than a decade, impacting patient outcomes and resource availability. While awaiting delayed transfer to an inpatient room, older adults in the ED remain vulnerable to developing acute delirium. Boarding potentiates the risk for worsening health outcomes, which are further compounded by delirium. Scarcity of resources and time constraints delay delirium detection and increase risk for down-stream hospital-acquired complications, higher cost, and prolonged length of stay. Current ED models do not prioritize caregiver partnership or involvement in delirium-conscious care, which is a holistic approach to …

Increasing Awareness Of Implicit Bias And Systemic Racism Among Clinical Staff Caring For Non-Hispanic Black Maternal Patients, Melissa Courtney

DNP Projects

Background: Kentucky is ranked 17^th in the nation for the highest maternal mortality rate in the U.S. with a rate of 22.9 per 100,000, and 78 percent of those maternal deaths were considered preventable. The Non-Hispanic Black maternal death rate in the U.S. and Kentucky is 2.9 times higher than that of the Non-Hispanic White maternal counterparts (Kentucky Department of Public Health Division of Maternal and Child Health (KDPHDMCH), 2022). The fundamental cause of maternal health inequities is structural racism, which leads to poor treatment and experiences in the healthcare system (Chinn et al., 2020). Structural racism and implicit …

Veterans Direct Admission Reassessment Tool Validation For The Reduction Of Rapid Response Code Blue, And Code Stroke Team Activations In Newly Arrived Direct Admission Veterans, Joshua Monroe Wells

DNP Projects

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified …

Bridging The Gap In Health Literacy: A Quality Improvement Project, Sunny Rana

DNP Projects

Background: Health literacy is an important factor for healthcare outcomes. Measuring healthcare outcomes continues to be traditionally performed after implementation of interventions, however, the aspect of healthcare literacy pertaining to these outcomes is not always measured or evaluated. Understanding the patient’s health literacy can assist the provider to create and include individualized education at the patient’s knowledge level to increase comprehension, compliance, medication adherence and ultimately increase positive health outcomes.

Project Goals

1. Assess baseline literacy for the patients who appear in the practice for a visit over a three-month period.

2. Implementing the measurable METER tool which can provide …

Implementation Of Unit-Based Preceptor Orientation: The Effects On Perceived Orientee Competence And Self-Confidence Of The Precepting Cvicu Nurse, Laura K. Marcum

DNP Projects

Purpose: The purpose of this study was to assess how unit-specific preceptor training impacted the perceived readiness of new graduate nurses, self-confidence of preceptors, and the correlated job satisfaction.

Background: The nurse attrition rate is resulting in inexperience at the bedside. Nursing inexperience leads to lower quality patient care. If improving the efficiency of training and education can improve perceived readiness, then in turn we can increase the longevity of our new nurses. Improving the longevity of nurses has significant implications on the budget of each hospital, the patient outcomes, and the staff’s resulting job satisfaction.

Methods: New graduate nurse …