Improving Nursing Comfort In Relation To Difficult Conversations, Sarah Clifton

DNP Projects

Abstract

Background/Purpose

Conversations between care providers and patients are integral to medicine and are the most performed “procedure” (Luff et al., 2016). In Pediatric Intensive Care Units (PICUs) and Pediatric Cardiac Intensive Care Units (PCICUs), children of all ages with diverse diagnoses and needs are treated for critical illnesses and traumatic events. Therefore, providers frequently have difficult conversations with patients and their families. Pediatric critical care nurses are often invited to participate in these discussions. However, their role during, and after, these conversations is not always clear. The goal of this project was to evaluate the impact of an educational …

Implementation Of A Death Anxiety Screening Protocol Specific To Patients With Advanced Cancer In An Outpatient Palliative Care Setting, Olivia M. Sasdi

DNP Projects

Abstract

Background: Recent studies have shown that upwards of 80% of patients with advanced cancer suffer from death anxiety resulting in increased physical and psychological suffering. Despite death anxiety’s ubiquitous nature and negative impact, the literature regarding this condition consistently indicates that it remains under-identified and undertreated in patients with advanced cancer. The “Death and Dying Distress Scale” (DADDS) is a clinically validated tool used to identify, measure, and guide effective treatment modalities for death anxiety specifically in patients with advanced cancer, but is scarcely used routinely in practice. Incorporating this screening tool to be used regularly could improve identification …

Effectiveness Of A Multimodal Educational Program In Increasing Understanding And Utilization Of Tele-Icu Resources By Critical Care Nurses: A Pilot Study, Olga Vulakh

DNP Projects

Background. Integration of tele-intensive care units (tele-ICUs) into healthcare systems is associated with improved patient outcomes and organizational performance. Inadequate bedside nurses’ knowledge about tele-ICU is associated with poor communication and lack of trust between bedside and tele-ICU teams. These problems might diminish tele-ICU’s ability to maximally impact patient outcomes.

Purpose. The purpose of this project was to create a multimodal educational program with the goal of improving knowledge, attitudes, and skills related to tele-ICU among critical care nurses and to assess the effect of the educational intervention on tele-ICU utilization among bedside nurses as evidenced by the number of …

Relationship Between Number Of Mechanical Ventilation Days Prior To Ecmo Initiation And Outcomes In Covid-19 Patients, Brittany Bergman

DNP Projects

Background: Since the start of the pandemic, there has been over 16,000 COVID-19 positive patients placed on Extracorporeal Membrane Oxygenation (ECMO). Little is known about the effect of long mechanical ventilation prior to ECMO initiation. Purpose: The first purpose of this project is to evaluate whether a longer mechanical ventilator time (ten or more days) prior to ECMO initiation is associated with increased mortality and longer total lengths of time on ECMO in patients with COVID-19, as opposed to being on a ventilator for under ten days prior to being placed on ECMO. The second purpose is to increase provider …

Evaluation Of A Discharge Clinic Implemented For Patients Without A Primary Care Provider Or Access To Their Primary Care Provider, Jessica Sass

DNP Projects

Background: Patients transitioning from an inpatient hospital stay to self-care responsibilities post-discharge are at risk for readmission resulting in increased cost and resource utilization. Care transition programs can result in cost avoidance and decreased resource utilization.

Purpose: The purposes of this project were to: (a) determine if implementation of a Discharge Clinic affected 30-day readmission rates in patients without a primary care provider, (b) ascertain if a visit by a paramedicine program paramedic impacted 30-day readmission rates in patients who missed their Discharge Clinic appointment, and (c) find out whether a second post-discharge phone call influenced 30-day readmission rates.

Method: …

Utilizing Podcast Education To Improve Nurse Knowledge, Confidence, And Behaviors Related To Palliative Care Conversations In The Intensive Care Unit, Brittany Estridge

DNP Projects

Background: The personal connection that Registered Nurses (RNs) build with patients and their families puts them at the forefront of many conversations during the patient’s stay in the intensive care unit (ICU). Some of the most difficult conversations are related to palliative care (PC). It can be challenging to know how to respond to the complex questions posed in palliative care conversations (PCC) when patients and their caregivers are making decisions that will alter the course of the patient’s treatment, as well as affect the quality and length of their life.

Purpose: Nurses receive inadequate training in PCC. The purpose …

Addressing The Inpatient Penicillin Allergy And Antibiotic Stewardship: The Effect Of Education On Compliance Rates Of The Nurse Driven Penicillin Allergy Assessment Tool, Alexandria Bassler

DNP Projects

Background: Penicillin allergies are the most frequently reported drug allergy but less than 1% of the total population has a true immune-mediated allergy. Patients who are labeled as having a penicillin allergy may receive drugs that are less effective, more costly, and more toxic. The nurse driven penicillin allergy assessment tool strives to increase penicillin allergy de-labeling rates by pharmacists and providers.

Objective: The purposes of this study were to (1) perform a retrospective and prospective chart review to determine compliance rates with the nurse driven penicillin allergy assessment tool, (2) provide an education module on antibiotic stewardship …

Modified Early Warning Scoring (Mews) Versus Epic Deterioration Index (Edi): Battle Royale For Which Has The Best Patient Outcomes In The Inpatient Setting, Dirk A. Church

DNP Projects

Abstract

Background: The increased workload bedside nurses face today requires new tools to assist with the identification of deteriorating patients during hospitalization. The Modified Early Warning Score (MEWS) tool has formed the background of early warning tools. Newer, more complex tools, like Epic’s Deterioration Index (EDI), have been developed to identify patient deterioration earlier. There is lack of evidence in the literature comparing different early warning tools, implementation, and patient outcomes.

Objective: The purpose of the study was to examine models for EWS notification for RRT and patient outcomes between the use of the MEWS and EDI in an adult, …

Examining Perceived Stress And Diet Quality Among Low-Income Families Engaged With A Nutrition-Based Food Assistance Program, Kelsey R. Wolfe, Kathryn L. Dambrino, David Phillippi, Laura Gray

DNP Projects

Abstract

Introduction: Evidence suggests poor-quality diets and high levels of stress have negative impacts on health, especially in low-income families in the southern United States. Nutrition-based food assistance programs were developed to meet nutritional needs of food insecure clients. The purpose of this scholarly project was to explore the relationship between perceived stress and diet quality among low-income families engaged with a nutrition-based food assistance program.

Methods: A retrospective and observational design was used to analyze previously collected survey responses from clients participating in a nutrition-based food assistance program in Nashville, TN (N = 425). Descriptive statistics and Spearman’s …

Increasing Adherence Of Chg Bathing: An Evidence-Based Practice Quality Improvement Project, Melissa Benedetto

DNP Projects

Introduction

Patients admitted to hospitals are at risk for developing Healthcare-acquired Infections (HAIs). Evidence suggests that these infections, including Central Line Associated Infections (CLABSIs), increase the cost of patient care and have a negative impact on patient outcomes. Daily chlorhexidine (CHG) bathing has been identified to help decrease HAIs in the hospital for patients in the Intensive Care Unit (ICU), those with Multi-drug Resistant Organisms (MDROs), and/or patients with a Central Venous Catheter (CVC).

Purpose

The purpose of this project is to implement an intervention to assess and improve CHG bathing adherence for hospitalized patients. Patients targeted include those at …

Reducing Medication Non-Adherence With Improved Health Literacy Interventions: An Evidence-Based Practice Quality Improvement Project, Unity Wiles

DNP Projects

Introduction

Health literacy is the ability to obtain, process, and understand basic health information and services needed to make appropriate healthcare decisions and follow instructions for treatment. Patients with low health literacy have been predicted to have poor health outcomes. The inclusion of the single-item literacy tool into the admission process of this project involved the patient-centered-care characteristics of improved patient experience, lower health cost, improved clinical experience, and better outcomes.

Purpose

The National Action Plan to improve Health Literacy seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a linked multi-sector effort to improve health literacy. Low …

Operating Room Nurses Sleep Health: An Evidence-Based Practice Sleep Health Education Project, Gabriella M. Castignoli

DNP Projects

Background: "Sleep Health" is a new Healthy People 2023 priority due to notable poor sleep health across the nation, with more than 25% of U.S. adults reporting insufficient sleep. Adequate sleep is necessary to work effectively and safely, with operating room (OR) nurses at high risk for inadequate sleep due to atypical work schedules.

Purpose: This project aims to establish the importance of sleep health for OR nurses at a community-based hospital and improve sleep health perception and sleep health through sleep health education with staff.

Methods: The IOWA model for evidence-based practice and quality improvement tools, Plan-Do-Study-Act, and the …

Increasing Opioid Abuse Screening In Primary Care Clinic: An Evidence-Based Quality Improvement Project, Carlos Milla

DNP Projects

Introduction

To address substance abuse multiple organizations recommend increase drug abuse screening as part of routine health care. CAGE AID is five-question tool used to screen for drug and alcohol use, answering yes to two or more questions indicates further assessment is advised. Unfortunately, most primary care centers do not use screen for substance abuse using validated instrument tools such as the CAGE-AID tool.

Purpose

The purpose of this evidence-based practice (EBP) project is to implement the CAGE-AID Substance abuse screening tool by nurse practitioners students in a family clinic located in Bridgeport in order to increase to number of …

Implementation Of A Nurse Driven Palliative Care Consult: A Quality Improvement Project, Socnite Sebourne-Francis

DNP Projects

Background: Palliative care consult (PCC) is an approach that can improve the quality of life and symptom management of patients facing life-threatening illnesses. At a 20-bed medical oncology unit in Connecticut, patients with poor prognosis and worsening symptoms have high re-admission rates within 30 days of post-hospital discharge; yet healthcare providers fail to initiate PCC.

Purpose: This project hypothesizes how implementing a nurse-driven PCC on admission or hospital stays compared to the timing of a physician to a physician PCC improves a plan of care for oncology patients? Will it result in a decrease in 30-day re-admission rates? The …

Improving Specialist Referrals In Outpatient Primary Care: An Evidence-Based Practice Quality Improvement Project, Kimberly Gaznabie

DNP Projects

Background: In the United States, more than a third of patients receive specialty referrals per year, constituting more than half of outpatient visits. Patients require efficient, immediate referrals for specialty-based treatment plans and the prevention of worsening conditions.

Purpose: This evidence-based practice improvement project aimed to improve the specialty-provider referral system for a community-based outpatient primary care clinic.

Increasing The Utilization Of A Cardiovascular Risk Assessment & Screening Tool Through Education In A Primary Care Setting: A Quality Improvement Project, Taylor A. Massey

DNP Projects

Background and Significance: The World Health Organization (WHO) (2021) reports that 55.4 million people died worldwide in 2019; cardiovascular diseases due to ischemic heart disease and stroke were the top two leading causes of these deaths. Experts predict that by the year 2030, more than 22.2 million people will die annually from cardiovascular disease (Ruan et al., 2018). Noninvasive cardiovascular screening tests, such as the "Pulse4Pulse" screening tool, are a way to help providers identify patients at high-risk for cardiovascular disease and initiate treatment to reduce future risk.

Purpose: To increase provider utilization of the "Pulse4Pulse" screening test in a …

Increasing Awareness Of Hereditary Fructose Intolerance: An Evidence-Based Practice Implementation Project, Jacqueline M. Bridge

DNP Projects

Background: Hereditary Fructose Intolerance (HFI) is an inborn error of metabolism which results in the absence of an effective Aldolase B enzyme. Without this enzyme, ingestion of fructose and metabolic precursors leads to acute illness, multiorgan damage, and possible death. The increased presence of these sugars results in earlier onset of symptoms and more difficulty for those with HFI.

Purpose: The project’s aim is to increase awareness of HFI in healthcare providers using a learning module and assessments of knowledge at three different points in time.

Methods: The IOWA model for evidence-based practice projects was applied during the development and …

Implementing A Patient Reported Outcome Measure For Patient With Anemia Of Chronic Kidney Disease (Ckd) In The Outpatient Setting, Marissa Finger

DNP Projects

Introduction: Chronic kidney disease (CKD) is a growing public health concern in the United States. People with CKD suffer from many symptoms that cause distress and low quality of life (QoL). Research has found an association between symptom burden in patients with CKD and the disease's worsening progression. There is little data on ways to monitor and address CKD symptoms routinely.

Purpose: The purpose of this project was to identify symptoms related to advancing kidney disease using patient-reported outcome measures (PROMs) through IPOS-Renal survey and implement a nurse-driven protocol to manage patient reported symptoms.

Interventions/Setting: Over a three-month period at …

No Pass Zone: A Quality Improvement Project, Casey St. John

DNP Projects

Introduction: Patient call-bell lights are a means for communication from a hospitalized patient's room to staff members. This DNP project involves staff and patients on a 28-bed pediatric medical-surgical unit. The aim was to implement a No pass Zone for patient call bell lights. Additionally, this project served to aid in increasing staff responsiveness to answer patients' questions and concerns.

Methods: Staff completed a Cornerstone education on the No Pass Zone. Data was collected from pre/post-implementation staff surveys and pre/post-implementation Press Ganey scores. Weekly staff audits on direct observation of staff response to patients' call-bell lights.

Results: A total of …

Improving The Quality Of Burn Care Through Implementation Of The American Burn Association Competencies, Laura Ritter

DNP Projects

Background and Significance: Specialty certification is an important method to demonstrate that nurses possess training, expert knowledge, and skill in a specialty field. The American Burn Association (ABA) and the Burn Nurse Competency Initiative (BNCI) developed 11 competencies that specify the training, expert knowledge, and skills that nurses require for all aspects of burn nursing practice. The ABA and Board of Certification of Emergency Nurses are in the process of developing a burn certification for nurses. They suggest that all burn units begin to adopt these competencies to ensure consistent and competent care.

Purpose: To adopt the ABA …

Increasing Patient Satisfaction Of Post-Cesarean Mothers: An Evidence-Based Practice Quality Improvement Project, Amanda Jones

DNP Projects

Introduction: The first hour after delivery, referred to as the “Golden Hour” or “Sacred Hour,” is when the mom, baby, and the support person get 1-hour of uninterrupted bonding time together. This time is critical because it promotes neonatal thermoregulation, decreases newborn stress levels, improves mother–newborn attachment, and encourages breastfeeding. Unfortunately, most cesarean births do not receive the Golden Hour and instead experience delayed bonding time.

Purpose: The purpose of this Evidence-Based Practice (EBP) project was to incorporate the Golden Hour for post-cesarean section mothers in a mid-sized community-based hospital in XXX, CT in order to increase patient satisfaction post-c-section; …

Implementation Of 3-Minute Diabetic Foot Exam For At Risk Diabetic Patients In Urban Primary Care Setting, Suzana Alvarez

DNP Projects

Background: Healthcare providers manage chronic health concerns by reducing the risk of diabetic complications among their patient population. In 2017, diabetes was the seventh leading cause of death in the United States and Connecticut. In Connecticut, there are 19,500 newly diagnosed diabetics and four Connecticut cities have higher occurrence of diabetes: Waterbury, New Britain, Hartford, and Bridgeport. Bridgeport Primary Care (BPC) had no policy or procedure in place to require the providers to complete a routine diabetic foot exam. The aim of this project was to promote and implement a tool to assist the BPC providers in evaluating adult …

Pain Assessment Policy Update And Nursing Education On Best Practices For Pain Assessment: A Quality Improvement Project, Jennifer Zhang

DNP Projects

Significance and Background: Chronic pain assessment should focus on patients' functional status, quality of life (QOL), and pain control. A tool to assess pain intensity and biopsychosocial impacts of pain for patients with chronic pain was needed in a Federally Qualified Health Center (FQHC). The Defense and Veterans Pain Rating Scale (DVPRS) incorporates a numeric rating scale with four functional questions on pain interference on ADLs. DVPRS design stimulates communication between patients and providers about their pain, its impact on function, and state of mind. Treatments are focused on making the pain tolerable and optimizing patient function while avoiding unwanted …

Psychological Safety In Pre-Licensure Nursing Simulation, Lauren Rickman

DNP Projects

Background

Simulation-based experiences (SBEs) allow learners to use clinical decision-making, clinical judgment, and hands-on skills to analyze and respond to realistic clinical situations in a controlled, interactive environment. Psychological safety (PS) is essential for increasing a learner's engagement in an SBE. Psychologically safe learning environments allow students to feel valued and comfortable speaking up and taking risks without consequences to themselves or others, promoting learning and innovation. Measuring PS may help simulation faculty improve their learning environment by supporting learning-oriented behavior and boosting students' clinical competency.

Purpose

The purpose of this Doctor of Nursing Practice (DNP) scholarly project was to …

Compassion Satisfaction, Burnout, And Secondary Traumatic Stress Among Heart Transplant Nurses In A Hospital Setting, Marissa Potts

DNP Projects

Abstract

Purpose: The purpose of this study was to assess whether or not, and the degree to which compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) are present among inpatient acute-care heart transplant nurses. Perceived presence of other contributing factors that contributed to CS, BO, and STS was also assessed.

Design: A cross-sectional survey-based mixed methods study with an explanatory sequential design was used to assess baseline levels of CS, BO, and STS and identify any other factors at work or home that may impact these constructs.

Methods: A Qualtrics survey was sent to potential participants. A convenience …

Adverse Childhood Experiences Screening In Adulthood: Knowledge, Attitudes, And Self-Efficacy Among Tennessee Nurse Practitioners, Megan M. Wanca

DNP Projects

Despite the prevalence of adverse childhood events (ACEs) and the relationship with negative health outcomes in adults, research shows clinical use of ACE screening is low among healthcare providers including nurse practitioners (NPs). The scholarly project’s purpose was to examine how Tennessee NP knowledge, attitudes, and self-efficacy influence intentions to screen for ACEs related to childhood trauma or abuse in adult patients. Using the Information-Motivation-Behavioral Skills Model as the theoretical framework, a cross-sectional and exploratory design assessed the association of NPs’ ACE screening knowledge, attitudes, and self-efficacy on the NPs’ intention to screen for ACEs in adult patients. A reliable …

A Quality Improvement Project To Examine The Impact Of The Use Of Structured Diabetes Educational Materials For Medical Personnel, Alina Jaffer

DNP Projects

With the immigrant population increasing in the United States, the demand for healthcare providers who can provide culturally appropriate care and intracultural communication has increased. Compared to individuals born in the United States, immigrants with diabetes are less likely to meet the standardized targets for diabetes management, resulting in disparities in diabetes-related complications. The problem is the lack of evidence-based patient education for all people, including immigrants who do not speak English as a first language. The purpose of this project was to assess whether or not language-specific structured diabetes educational material for healthcare personnel use would increase the efficacy …

Examining Nurse Engagement In Antimicrobial Stewardship At Long-Term Care Facilities, Mosam S. Patel, Kathryn L. Dambrino, Olivia Bahemuka, David Phillippi

DNP Projects

Background: The World Health Organization stated that antimicrobial resistance is one of the top 10 threats to global health. To combat antimicrobial resistance, antimicrobial stewardship (AMS) programs were developed. Efforts to engage nurses in stewardship efforts have been limited. Bedside nurses are in an optimal position to help decrease antimicrobial use, which is especially relevant in long-term care facilities where up to 75% of antibiotic use is deemed unnecessary or inappropriate. The purpose of this Doctor of Nursing Practice scholarly project was to examine factors that influence nurse engagement in AMS at long-term care facilities in Tennessee. Methods: A …

Interprofessional Socialization Of Nursing Students After Participating In Interdisciplinary Rounds In An Intensive Care Unit, Ashlyn S. Upshaw

DNP Projects

Background: Nursing engagement in interprofessional collaboration leads to safe and quality healthcare for patients. In order to effectively engage in interprofessional collaboration, nursing students must socialize among healthcare providers from various disciplines. Purpose: The purpose of this project was to examine pre-licensure nursing students’ beliefs and attitudes towards interprofessional socialization and collaboration following their participation in interdisciplinary rounds in an intensive care unit (ICU) setting. Methods: A mixed-methods, cross-sectional design was used to collect data from undergraduate nursing students at a private university. Following an ICU clinical rotation, participants completed the Interprofessional Socialization and Valuing Survey-21 (ISVS-21) …

A Peer-Led Evidence-Based Contraceptive Counseling Initiative, Megan K. Tenbarge

DNP Projects

The experience of sexual health and wellness varies for newly independent college freshman. For reproductive-age women, gaps in knowledge and self-efficacy overlap with barriers accessing contraception and reproductive health care contributing to high-risk behavior and poor sexual health outcomes. Community-based participatory research was used to develop and implement a peer-education program targeting sorority women on a college campus in the Southeastern United States in the fall semester of 2021. Two senior nursing majors completed continuing education to be empowered as peer-educators using The University of California San Francisco Beyond the Pill framework. They engaged directly with nursing faculty stakeholders and …