Nursing Commons^™

Self-Reliance And Self-Efficacy As Determinants Of Mental Health Treatment Seeking Intention In A Sample Of Student Service Members/Veterans, Leigh Holdsambeck

DNP Projects

Problem Statement: High rates of mental illness and poor treatment seeking have plagued the military for decades. As an organization that demands resilience, sacrifice, strength, and courage from its members, many servicemembers develop deep-seated self-reliance and self-efficacy. Though essential in many critical situations, these traits often complicate a servicemember's willingness to seek care for a mental health concern. Student servicemembers/veterans (SSM/Vs) are at an increased risk for poor mental health outcomes owing to the compounded stressors of military service and academia. Purpose: To measure the impact of elements of military service, namely self-reliance and self-efficacy, on mental health …

Exploring The Impact Of Care Delivery On Families Of Children With Medical Complexity, Shelby Pawlowski

DNP Projects

Background: Children with medical complexity (CMC) are considered most medically fragile and require the most health care needs. Medical care for CMC is described as fragmented, uncoordinated, and crisis-driven with a tendency to over-medicalize the child and under-support the family. The intimate link between caregiver and child health supports further exploration of factors that may influence family health-related quality of life (FHRQOL) in families of CMC. Purpose: The purpose was description of the population of CMC receiving rehabilitation services in the community setting and exploration of the impact of a comprehensive outpatient rehabilitation facility (CORF) on FHRQOL. Review of Evidence: …

A Quality Improvement Project To Improve Communication And Reduce Hospital Readmissions, Mackenzie Thomas

DNP Projects

Background: More than 25 million people are readmitted to the hospital within 30 days of nursing home admission. With most nursing home patients receiving Medicare, Medicaid, or other publicly funded services, readmissions significantly burden the healthcare system. Poor communication within nursing homes may contribute to poor health outcomes and unplanned hospital readmissions. Purpose: To reduce readmission rates at two skilled nursing facilities by improving staff communication through consistent use of the INTERACT STOP AND WATCH (SW) tool. Design: The quality improvement project reviewed all admissions, transfers, and readmissions occurring before and during the project to determine the impact of the …

Rn Perception Of Resources, Communication, And Leadership During Covid-19 And The Impact On Rn Satisfaction And Turnover In A Multi-Hospital System, Gina Bullington

DNP Projects

Abstract

While RN retention has been a perennial challenge, COVID-19 has exacerbated the problem. The project’s purpose was to study RNs’ perception of communication, resources, and leadership during COVID-19, and the impact on RN turnover in a multi-hospital system. 3280 RNs’ engagement survey responses and turnover percentages from pre-COVID-19 (November 2019) were compared to engagement survey responses and turnover percentages 12 months later (November 2020). 90% (n = 2963) were female and 43% (n = 1396) were between the ages of 25 and 39 years. The majority of RN respondents were employed 1-9 years (59%, n = 1934). …

The Health Impact Of Intensive Case Management On Women With Oud And Their Infants, Shannon Rappe

DNP Projects

Postpartum women with an opioid use disorder (OUD) are at high risk for treatment disengagement, leaving them vulnerable to overdose and death between seven and twelve months postpartum. Intensive case management programs have been proposed as an effective strategy to reduce barriers and increase treatment engagement among postpartum women. The purpose of this study was to evaluate program outcomes of postpartum women with OUD and the health outcomes of their infants when engaged in an intensive case management program postpartum. The study was a retrospective review of secondary data collected on 221 postpartum mothers and 225 infants of mothers who …

Implementing The Quality Of Care Partnership To Reduce The Cost Of Screenings For Sexually Transmitted Infections On A Southeastern College Campus, Amy Guidera

DNP Projects

College students are a priority preventative healthcare population that can engage in high risk behaviors which may concurrently increase the potential for unsafe sexual practices, including contracting sexually transmitted infections (STIs). Early education, screening, treatment, and partner notification are important interventions for breaking the chain of transmission and recurrence in relation to preventing poor health outcomes and mitigating college dropout rates. The aim of this quality improvement project was to determine if the reduction in STI screening costs for college students (aged 18-30 years old) would increase the amount of STI screenings conducted at a university health center over the …

Examining Health Disparities Among Lesbian, Gay, Bisexual, Transgender, And Queer/Questioning Adults In Davidson County, Tennessee, Samantha Anticuar

DNP Projects

Background: Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) individuals experience increased risks for health disparities and discrimination compared to non-LGBTQ individuals, yet there is limited research in southern populations. Purpose: The purpose of this scholarly project was to examine if LGBTQ individuals had increased health disparities compared to non-LGBTQ individuals in Davidson County, Tennessee (TN). Methods: A quasi-experimental design (N = 1,704) used the 2019 Nashville Community Health and Well-being Survey for analysis. Results: Findings suggested LGBTQ individuals had increased odds of not having health insurance (p = .009, adjusted odds: 6.84), poor mental health (p …

Decreasing Clabsi Among Cancer Patients: Daily Observed Chlorhexidine Gluconate Baths, Cody Tripp

DNP Projects

Background: Research suggests that daily bathing with chlorhexidine gluconate (CHG) among cancer patients can decrease rates of central line-associated bloodstream infections (CLABSI). Literature supports the premise that the highest rates of patient compliance using CHG baths occurs with direct RN assistance or observation of the bath. Methods: Nurses employed on a hematology/oncology unit in Middle Tennessee were surveyed about their perception of how many CHG bath were not occurring on a given day and then educated via an online module, on the efficacy of daily CHG baths. Approximately two months after the preliminary survey and educational module, RNs were surveyed …

Debriefing Among Hospice Professionals During A Pandemic, Holly Knott

DNP Projects

Abstract

Background: Because hospice professionals are repeatedly exposed to death, they are at a higher risk of developing compassion fatigue (Alkema et al., 2008). Over time, compassion fatigue may result in burnout, potentially causing a depletion of professionals in the hospice field (Gallagher, 2013; Haddad & Toney-Butler, 2020). While the hospice industry cannot afford to lose professionals to burnout, stress from a rapidly growing elderly population and work challenges related to the COVID-19 pandemic potentially place hospice professionals at an increased risk. Reflective debriefing has been recommended to provide emotional support to battle job dissatisfaction, compassion fatigue, and burnout (McIntosh, …

Triage Process In Primary Care Clinics, Ashley Vasilik

DNP Projects

Skillfully applied triage techniques can make the difference between rapid, appropriate, cost effective care and poor outcomes at increased cost. While triage has been well documented in emergency departments, military, and natural disasters, it is far less well-understood in the primary care setting. Appropriate, accurate triage and disposition in primary care can improve patient outcomes and reduce unnecessary emergency department visits. This may have an impact on emergency department over-crowding. This exploratory, qualitative, descriptive study examines the triage process of six primary care clinics in Tennessee and Alabama. Interviews with participants were conducted between September and November 2020. Donabedian’s SPO …

Assessment Of Postpartum Nurses' Knowledge And Teaching Habits Of Maternal Morbidity And Mortality, Mikayla Dodson

DNP Projects

The postpartum period is a joyous time of mother-infant bonding, but it can also be a risky time for women. Despite the education that is provided to postpartum women after birth, many women are still questioning whether or not the signs and symptoms they are experiencing are sufficiently alarming to alert a health care provider. Any delay in seeking care can contribute to poor health outcomes and even maternal mortality. Registered nurses oftentimes provide the bulk of discharge education to postpartum patients. When their knowledge or confidence levels regarding specific topics are low, this can negatively impact the education they …

Decreasing Test Anxiety In Nursing Students Using Cute/Funny Animal Videos, Lynn Kelso

DNP Projects

Abstract

Background: Stress, test anxiety and worry continue to increase in nursing students. As successful completion of course exams is required for nursing students to complete their program of study, these increased levels of stress, anxiety and worry can hinder their ability to perform at their best. Purpose: The aim of this project is to show that using cute/funny animal videos prior to an exam can decrease test anxiety (TA) and improve performance. Project Improvement Framework: The plan-do-study-act, PDSA, quality improvement framework was used for the final, modified project. Method: A video was embedded into three of …

The Outcomes Of Cope, A Cognitive Behavioral Therapy Program, In Patients Awaiting Lvad Implantation, Aaron G. Harris

DNP Projects

PURPOSE: The purpose of the Doctor of Nursing Practice (DNP) project was to pilot Creating Opportunities for Personal Empowerment (COPE), an evidence based cognitive behavioral therapy (CBT) intervention, with patients diagnosed with advanced heart failure who are awaiting Left Ventricular Assist Device (LVAD) implantation or those who have had one recently implanted before they are discharged home. METHODS: A cross-sectional study design was used for this Pilot project. Patients were identified for potential participation by LVAD coordinators and represent a convenience sample. The patients were screened for anxiety and depression using the GAD-7 and PHQ-9 screening tools. If patients scored …

The Evaluation Of An Amino Acid- Oral Re-Hydration Solution (Enterade®) To Improve Quality Of Life In Solid Tumor Cancer Patients By Reduction Of Chemotherapy Related Diarrhea, Holly Chitwood

DNP Projects

Background: Chemotherapy related diarrhea (CRD) is a common adverse effect of many chemotherapy agents used to treat cancer. CRD negatively affects quality of life (QOL) for cancer patients and often results in treatment delays, hold, dose reductions, and hospitalizations affecting morbidity and mortality. Proper management of CRD with novel therapeutics is needed to improve the quality of life and patient outcomes for this population.

Purpose: The purpose of this study was to evaluate the use of a proprietary amino acid-oral rehydration solution (AA-ORS) known as Enterade® to reduce the severity of CRD, to improve patient reported QOL among patients over …

The Associations Among Parental Emotional States, Adolescent Emotional States, And A1c In Adolescents With Type 1 Diabetes, Jennifer L. Yenke

DNP Projects

Background: This study examined depression and diabetes distress (DD) in adolescents with type 1 diabetes (T1D) and in their parents. Depressive symptoms and DD are associated with poor glycemic control.

Objectives: To describe the prevalence of parental and adolescent depressive symptoms and DD in the sample and to evaluate correlations among depressive symptoms, DD, and A1c in parent-adolescent dyads in which the adolescents have T1D.

Methods: Thirty-two parent-adolescent dyads completed measures assessing depressive symptoms (Patient Health Questionnaire-9) and DD (Problem Areas in Diabetes- Parent of Teen and Teen versions), self-reported socio-demographic and clinical variables, and responded to questions about living …

Evaluation Of The Effectiveness Of Emergency Department Through-Put Based On Provider Type In A Critical Access Hospital, Deanna Faye Dingus Hamilton

DNP Projects

Abstract

Purpose: To evaluate effectiveness and timeliness of through-put in the emergency department based on provider type in a rural critical access hospital in eastern Kentucky.

Design: A retrospective, observational review was conducted at a small critical access hospital. Descriptive statistics including Mann Whitney and Chi square were performed to evaluate significance.

Methods: Pre-intervention 552 charts were abstracted and 1656 post-intervention charts were abstracted. Arrival time to triage, triage to provider and provider to disposition times in minutes were collected. A prospective survey regarding comfort level with performing advanced practice skills was given to the advanced providers who were working …

Promotion Of Most Forms Through Education About Importance Of Advance Care Planning In Seriously Ill Patients, Nidhi More

DNP Projects

Abstract

Purpose: To establish the importance of early Advance Care Planning (ACP) and improve the utilization of Medical Orders for Scope of Treatment (MOST) forms in seriously ill patients by educating providers and nurses to identify patients who meet specified criteria. The goals of this intervention are reduction of readmissions and better quality of life for this patient population.

Methods: A quasi-experimental design was used for evaluation of an Educational intervention to promote MOST forms, Advance Directives (AD) and Palliative Care (PC) consults. A retrospective and prospective chart review was conducted to determine the number of patients who met criteria …

Improving Multidisciplinary Adherence To A Daily Goals Checklist In The Icu: A Quality Improvement Initiative, Chelsea Mccarty

DNP Projects

Abstract

Background: In November 2019, the University of Louisville Hospital merged and assumed operations of all KentuckyOne facilities. During the transition, a spike in hospital acquired infection rates ensued at Jewish Hospital, notably amongst the critical care units. In January 2020, a daily checklist was introduced to the critical care department. A Daily Checklist is a tailored communication tool designed to reduce communication error and improve adherence to patient safety measures. There continues to be a gap in adherence to the U of L daily checklist from both nurses and providers. Purpose: The purpose of this project was to improve …

The Effect Of An Acuity Adaptable Unit On Efficiency In Non-Critical Trauma Patients, Rebecca Charles

DNP Projects

Problem Statement: It was observed a large academic medical center is experiencing impeding congestion of non-critical care patients due to challenges with bed availability and high patient volumes. Delays in transferring patients to an appropriate level of care can impose safety risks and prolong length of stay. Implementation of an acuity adaptable unit may be a cost-effective approach to a growing problem.

Background: A fixed bed model limits the acuity of patients admitted to a specific space. Using the Iowa Model of Evidence Based Practice as the framework for design, moving to an acuity adaptable unit could facilitate patient …

Care Coordination Of The Geriatric Traumatic Fracture Patient: A Multimodal Approach To Pain Management, Alexandra Keough

DNP Projects

Introduction: Traumatic fractures are increasing in incidence across the country, particularly in the aging population. Geriatric patients who are admitted to the acute care setting for traumatic fractures are a unique population that require acute pain management, while also managing other comorbidities. While there are several guidelines on pain management for patients who are admitted to the acute care setting, there are no specific guidelines on the best practices to manage acute pain in the geriatric traumatic fracture population. Evidence supports a multimodal pain management strategy using pharmacologic and non-pharmacologic means as the best way to care for this population. …

A Multi-Faceted Intervention To Reduce Low Value Diagnostic Studies In A Medical Intensive Care Unit., Jessica Caicedo

DNP Projects

Routine daily chest x-rays (CXRs) and laboratory studies have been identified as low-value care practices that contribute to the rising cost of healthcare without improving quality or outcomes. There is a large body of evidence as well as recommendations from multiple professional organizations for providers to not order unnecessary daily or routine diagnostic studies. Rather, these should be ordered in an on-demand fashion as a response to a specific clinical query. Despite the strength of recommendations, practice remains variable across the U.S. The reasons for resistance to practice change as well as the most effective strategies for implementing sustainable change …

Improving Human Papillomavirus Vaccination Rates Among Kentucky Adolescents, Cori Arena

DNP Projects

Background: The Human Papillomavirus (HPV) is a significant factor associated with the development of HPV-associated cancers in the United States. The administration of the HPV vaccination is a critical prevention strategy in reducing HPV-related cancers in the United States. The state of Kentucky has lower than average HPV vaccination rates compared to the national average. There is a significant amount of evidence exploring barriers and facilitators of the HPV vaccination administration. There are several multi-level barriers associated with low uptake of the HPV vaccination in adolescents. Multiple sources of evidence have indicated that parents who receive a provider recommendation are …

Home Point Of Care Inr Testing In Left Ventricular Assist Device Patients: A Clinical Evaluation, Emily Corsentino

DNP Projects

Purpose: The purpose of this project was to evaluate the complications and adverse events in left ventricular assist device (LVAD) patients when comparing those using home point of care (POCT) international normalized ratio (INR) testing versus lab testing. Additionally, the time in therapeutic window for both these groups was studied. A cost benefit analysis was performed. All this data was compiled into a provider education evaluated by a pre and post-survey design.

Methods: The project is a single-center study that will occur at the University of Kentucky Chandler Medical Center. It is a cross-sectional, pre/post-test design. Data will be collected …

The Impact Of Identifying And Addressing The Social Needs Of Patients With Type 2 Diabetes Mellitus In A Primary Care Clinic, Shelby Roberts

DNP Projects

BACKGROUND: A key aspect of successful Diabetes management is addressing social needs. Patients prefer individualized care that is tailored to their specific needs.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to screen patients regarding their diabetes distress and social needs requirements to develop and implement individualized social needs interventions.

METHODS: Patients were included in the study if they had a Hemoglobin A1C >9. Patients were screened, provided additional check in points and social needs were addressed in conjunction with the patient’s primary care provider and onsite social worker. Post intervention …

Anxiety Screening In Children & Adolescents With Type 1 Diabetes Using The Gad-7 Tool, Allison B. Reynolds

DNP Projects

BACKGROUND: Children and adolescents with type 1 diabetes (T1DM) can encounter a variety of factors that affect proper management of their diabetes, including mental health. Youth with diabetes have significantly higher rates of depression, anxiety, and mental health problems compared to the general population. Anxiety is especially prevalent. PURPOSE: The objective of this project was to evaluate anxiety screening of children and adolescents with T1DM during their routine diabetes visits. Specifically, to assess for any trends in anxiety levels and patient characteristics including demographics, insulin regimen and A1C levels. METHODS: A cross- sectional, retrospective review of ambulatory electronic health records …

The Impact Of A Change In Leadership, Taylor Collins

DNP Projects

Abstract

Background: Unmitigated stress in nursing results in moral distress, burnout, turnover and poor patient outcomes. Authentic leaders can improve the nurses’ work environment and satisfaction by improving communication and implementing supportive measures.

Purpose: The purpose of this study was to determine whether a change in executive leadership at BSW Grapevine Medical Center reduced nursing job stress as evidenced by improved nurse satisfaction, nurse retention, nurse engagement, patient satisfaction and care outcomes.

Conceptual Framework: Watson’s Theory of Human Caring

Design: This study is a quantitative, descriptive retrospective measurement of two points in time, before and after …

Evaluation Of A Spontaneous Breathing Trial Extubation Protocol On Patient Outcomes, Joshua Caldwell

DNP Projects

Background: Evidence correlates better patient outcomes with shorter ventilator days therefore, without contraindications, patients should be removed from continuous mechanical ventilation as soon as safely possible. Exactly how to assess readiness to extubate and when to extubate is still up in the air.

Purpose: Evaluation of a 30-minute spontaneous breathing trial extubation protocol on patient outcomes and to also evaluate staff education of the 30-minute spontaneous breathing trial extubation protocol on adherence and patient outcomes

Methods: This is a retrospective and prospective evidence-based quality improvement project comparing patient outcomes before and after staff education as well as patient outcomes between …

S.A.F.F.E.R. Airway Management: Evaluating The Effectiveness Of Checklist Implementation On Reducing Peri-Intubation Complications In An Air Medical Transport Service, Rachael M. Croley

DNP Projects

Background: Advanced airway management via endotracheal tube placement in the critically ill and injured is tenuous and presents a multitude of challenges that threaten patient safety. The potential for procedure-associated hypoxia, hypotension, and cardiac arrest during the peri-intubation period can be detrimental to overall patient outcomes. Purpose: The purpose of this project is to evaluate the effectiveness of the Standardized Airway Flow For Engineered Resuscitation (S.A.F.F.E.R.) checklist in reducing peri-intubation complications and provider perception of checklist implementation when performing advanced airway procedures.

Methods: A case-control analytical observational design study which included retrospective and prospective electronic medical record review to determine …

End-Of-Life Nursing Consortium To Improve The Gap In Palliative Care, Emma Kroger

DNP Projects

Abstract

Objective: The purpose of this project is to implement a palliative care education intervention with a pre- and post-survey to assess knowledge, emotional preparedness, and confidence in undergraduate nursing students at the University of Kentucky.

Aim: The aim of this project is to address the gap in palliative care education by increasing professional knowledge, emotional preparedness, and confidence levels in regards to palliative care of future nurses at the University of Kentucky.

Background: The terms “hospice” and “palliative” are often used interchangeably in the healthcare setting. However, palliative care focuses on symptom management in all stages of acute, chronic, …

Sustainability Of A Dnp Qi Project On Bmi Screening And Weight Management Documentation In Primary Care, Assal Moori Shir Mohammadi

DNP Projects

Background: Nurses with a Doctor of Nursing (DNP) degree are prepared at the highest level of expertise to provide safe and efficient health care to patients and help bridge the gap between research and evidence-based health care. Although DNP students invest significant effort, time and resources to implement quality improvement (QI) projects, the sustainability of the outcomes of these is not well studied and empirical evidence on sustainability of quality improvement interventions is very limited.

Objective: To assess the sustainability of the QI project titled: “Using Rapid Cycle Improvement to Improve Weight Management” over time and evaluate the characteristics of …