Nursing Commons^™

The Effects Of Compassion Fatigue On Burnout Among Inpatient Psychiatric And Intensive Care Unit Nurses, Amita Madan Neidlinger

DNP Projects

PURPOSE: This DNP project is relevant to nurses of the psychiatric and Intensive Care Unit (ICU) setting, as high stress environments may produce higher rates of compassion fatigue and burnout. Investigation of these areas may help illuminate unnecessary healthcare costs that are associated with these phenomena. This DNP project is important to the University of Kentucky’s healthcare system, its patients, and nurses. Increased absenteeism and increased medication errors are positively associated with the prevalence of compassion fatigue and burnout in nurses. Outcomes from this project will allow identification of unnecessary healthcare costs and encourage administrators to focus on reducing nurse …

Increasing Smoking History Documentation And Lung Cancer Screening Orders In A Primary Care Clinic, Tabitha M. Caudill

DNP Projects

BACKGROUND: In 2018, there were approximately 234,030 new lung cancer diagnoses and 154,500 lung cancer deaths in the United States. Kentucky leads the nation in new lung cancer cases each year. The USPSTF estimates that 10% to 12% of lung cancers detected by routine screening would not have been detected until the cancer advanced; therefore, the USPSTF recommends yearly lung cancer screenings using low dose CT (LDCT) scans of the chest for patients 55 to 80 years old who have a 30 pack-year smoking history and are currently smoking or have quit within the last 15 years.

PURPOSE: …

Evaluating The Feasibility Of Outpatient Iv Diuretic Therapy For Patients With Decompensated Heart Failure, Christina Thompson

DNP Projects

Heart failure is a prevalent chronic disease that contributes to many hospitalizations that may not always be necessary. Evidence supports that patients who present to the Emergency Department in fluid overload can be treated in the outpatient setting when only IV diuretic is warranted. Both decreases in costs and improved outcomes have been reported, yet there has been little movement toward providing outpatient diuresis versus hospitalization. The purpose of this DNP project was to evaluate the feasibility of an outpatient option for IV diuretic therapy for patients with acute decompensated heart failure experiencing symptoms of fluid overload. This descriptive study …

An Analysis Of Factors Which Affect Self-Management In Language-Diverse Patients With Type 2 Diabetes, Sarah Hayden

DNP Projects

Purpose: The purpose of this scholarly project was twofold: 1) To identify the impact that health literacy, diabetes knowledge, self-efficacy, and illness perception have on diabetes self-management behaviors and 2) To assess differences in project variables between English and Spanish-speaking participants. The Individual and Family Self-Management Theory was used as a guiding theoretical framework. Methods: Thirty-three English-speaking and twenty-eight Spanish-speaking adults with Type 2 diabetes (n=61) were recruited from a diabetes private-practice in the Southeastern United States. Patients completed a cross-sectional composite survey composed of demographic information, the Brief Health Literacy Screener, Diabetes Knowledge Questionnaire (DKQ-24), Diabetes Management Self-Efficacy Scale …

Fear-Avoidance Beliefs In Patients With Acute Low Back Pain, Kayla Heldman

DNP Projects

Low back pain affects over 80% of the population impacting their quality of life and causing both disability and loss of work productivity. Acute low back pain is seen as a “favorable” prognosis yet many patients continue to suffer from chronic low back pain. Psychological barriers such as fear-avoidance beliefs have been shown to be a contributing factor in low back pain rehabilitation and chronicity. This project was designed to evaluate if fear-avoidance was a health determinant that affects how primary care providers create treatment plans and to explore the relationship between fear-avoidance beliefs with physical therapy outcomes. Specifically, the …

The Impact Of In-Home Lactation Support On Breastfeeding Self-Efficacy, Duration, And Exclusivity, Kristian Beach

DNP Projects

While there is evidence to suggest that hospital lactation support impacts rates of breastfeeding initiation by new mothers, women may benefit from additional lactation support and intervention to meet Healthy People 2020 goals for breastfeeding duration and exclusivity. Breastfeeding self-efficacy can be targeted by lactation counselors to improve breastfeeding outcomes. The purpose of this study was to determine how in-home lactation support influences breastfeeding self-efficacy, duration, and exclusivity. A descriptive, cross-sectional, survey-based design with convenience sampling was used in the study, in which a one-time, voluntary, electronic survey with a retrospective pretest-posttest was emailed to postpartum women who received in-home …

Evidence-Driven Diagnosis And Treatment Of Acute Urinary Tract Infections In Long-Term Care, Morgan K. Clouse

DNP Projects

Misdiagnosis of asymptomatic bacteriuria as a urinary tract infection continues to occur, leading to the overuse of antibiotics. Due to the growing elderly population in long-term care facilities (LTCFs), LTCFs can play a critical role in antimicrobial stewardship. Urinary tract infections are a starting point for moving toward antimicrobial stewardship, since urinary tract infections are common in LTCFs. A retrospective chart review of 156 cases with suspected urinary tract infections (UTIs) was completed in a LTCF. The purpose of the scholarly project was to assess diagnostic and treatment practices for UTIs and compare them to a diagnostic and treatment algorithm. …

Subclinical Atherosclerosis Vascular Evaluation (Save): Nurse Practitioner Barriers To And Facilitators Of Research Utilization Regarding Screening For Subclinical Atherosclerosis, Gina Pritchard

DNP Projects

The project identified factors affecting implementation of evidence-based non-invasive screening tests to identify early stage cardiovascular disease (CVD). The use of coronary artery calcium scores and carotid intima media thickness testing improves accuracy of risk stratification over risk factor scoring systems alone. The purpose of this project was to identify NP’s perceived barriers to and facilitators of utilization of evidence-based non-invasive CVD screening tests and to make recommendations for improvements in implementation. The SAVE project consisted of a cross-sectional survey of 64 nurse practitioners, recruited using a multi-pronged strategy, using Funk’s barriers instrument plus two additional qualitative questions regarding intent …

Comparing The Effects Of Immersion Service Learning And Local Service Learning In Pre-Licensure Health Care Students’ Transcultural Self-Efficacy, Kimberly Johnson

DNP Projects

Local and immersion service learning methods prepare pre-licensure health care professionals to deliver culturally competent care to diverse populations- an important need because of the rapid racial and ethnic diversity growth in the U.S. A mixed-methods approach compared the effect of local and immersion service learning methods on multiple disciplines of pre-licensure health care students’ confidence in delivering care to diverse populations. Guided by Jeffreys (2016) CCC Model, the Transcultural Self Efficacy Tool (TSET) was used to compare pre-licensure health care students’ (n=34) transcultural self-efficacy perceptions following local or immersion service learning experiences. Secondary source, qualitative data obtained from …

Simulation As A Clinical Remediation Strategy For Undergraduate Nursing Students, Sara Camp

DNP Projects

Given the imperative of success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) examination, academic proficiency rather than clinical competence remains the primary focus of nursing education. It is imperative that nursing programs have an intentional remediation plan to provide resources designed to monitor, evaluate and improve clinical competence, distinct from those necessary for academic success. Simulation is an established nursing pedagogy in the development of clinical competency, as it facilitates and grounds the application and reinforcement of abstract and theoretical concepts. and may be useful as a formative strategy when students show faltering clinical proficiency. Clinical and …

Compassion Fatigue As It Relates To Nurse Turnover In Oncology Nurses At An Urban Hospital, Diana Wells-English

DNP Projects

According to Stamm (2010), Compassion fatigue (CF) refers to the negative aspects of caring and compassion satisfaction (CS) refers to the positive aspects. Compassion fatigue is well documented in oncology nurses. It is a concept incorporating both burnout (BO) and secondary traumatic stress (STS). Nurses working with patients who have cancer are exposed to a multitude of stressors that may contribute to CF and ultimately high turnover rates. The purpose of this study is to explore the relationships between CS, STS, BO, and turnover intention in a sample of oncology nurses. The study is a correlational study utilizing survey methodology …

Evaluation Of Intimate Partner Violence Screening In A Metropolitan Public Health Department, Niani Conerly

DNP Projects

Routine intimate partner violence (IPV) screening has been recommended for all health care settings to prevent subsequent short and long term health consequences of survivors. However, provider adherence remains low. The purpose of this quality improvement project is to evaluate current screening practices, identify the needs of, and provide resources to three family planning clinics within a metropolitan public health department. The project utilized Donabedian’s Structure, Process, and Outcomes Model to map current protocols within three family planning clinics to identify current practices. A chart review including 105 patient charts was done to identify documentation of IPV screening/discussion as well …

Foster Youth Transition To Adulthood: Effects Of Housing Stability And Social Support On Mental Health, Elizabeth Gray Kaiser

DNP Projects

Foster care adolescents have a more difficult time transitioning to adulthood, compared to non-foster care peers, due to the maltreatment and uprooting they often experience prior to entering the foster care system. Although foster care protects children from harmful environments, literature supports that multiple placement changes and lack of stable family and social support contributes to higher likelihood of housing instability, such as homelessness, and mental health problems, including stress, anxiety, and depression, in adulthood. Independent living programs, such as YVLifeSet, facilitate more successful transitions to adulthood by offering support in the form of mentors, life-skills training, and counseling. These …

Exploring The Perceived Barriers To Long-Acting Reversible Contraception In Women Who Are In Treatment For Opioid Addiction, Carleigh Smith

DNP Projects

The rise in rates of opioid addiction among women of childbearing age, alongside the consistent rates of unintended pregnancy, has changed the landscape for the public health risks and outcomes of unintended pregnancies in the United States. Concurrently, uptake of long-acting reversible contraception (LARC) remains low among all women, particularly those with substance use disorder. This project explores the perceived barriers to LARC among women enrolled in medication-assisted treatment (MAT) for opioid addiction. A mixed methods, cross-sectional survey design was used to capture how women in MAT access care, their reproductive planning and intention, contraceptive knowledge and behavior, and their …

The Impact Of Antibiotic Stewardship Education On Parental Care Satisfaction And Follow-Up, Paige Ferguson

DNP Projects

Parental satisfaction with antibiotic stewardship has been investigated extensively in pediatric inpatient settings; however, there has been relatively little research in pediatric outpatient settings. In 2014 upper respiratory infections were the most common infections seen among the general population with children having an average of 3 to 8 viral respiratory illnesses per year and receiving 34.6% of all antibiotic prescriptions. Escalating antibiotic resistance and increased emphasis on patient/parental satisfaction necessitates the exploration of a method to improve antibiotic stewardship while maintaining parental satisfaction. The purpose of this project was to assess parental satisfaction with care and follow-up visits after antibiotic …

Defining The Health Of A Work Environment: An Assessment And Evaluation, Jennifer Thornsberry

DNP Projects

PURPOSE: The purpose of this study was to ascertain nursing leaders and direct care nurses’ perceptions of the health of the work environment in medical-surgical, intermediate care, and progressive care units at an acute care hospital located in central Kentucky. METHODS: This study employed a descriptive, correlational design. Bivariate statistical procedures were utilized to determine the relationship between the perceptions of the health of the work environment and nursing turnover and engagement. RESULTS: Direct care nurses and nurse leaders both scored effective decision making/skilled communication as the healthiest attribute of the work environment, while genuine teamwork was scored as the …

Evaluation Of Self-Efficacy And Confidence Levels Among Newly Graduated Nurses Exposed To An End-Of-Life Simulation: A Comparison Study, Catherine Edwards

DNP Projects

Purpose: The purpose of this project is to compare self-efficacy and confidence levels among a cohort of newly graduated nurses (defined as nurses who have had no nursing experience and are participating in a new graduate nursing residency) who will participate in an EOL simulation with another cohort of nurses who have been practicing for a year or more, but have not participated in an end-of-life simulation.

Methods: The study included two parts. The first portion included a pre and post-test evaluation of an end-of-life (EOL) simulation intervention with newly graduated nurses (Group One, n= 22), as part of their …

Identifying Rates, Barriers And Facilitators For Hpv Vaccines In Children Ages 11-14 In A Kentucky Primary Care Clinic, Sarah J. King

DNP Projects

Background: Among all of the pediatric vaccinations recommended by the CDC, the HPV vaccination has consistently had lower adherence rates than the goal set by Healthy People 2020. The CDC recommends that adolescents start receiving the human papillomavirus (HPV) vaccine at the ages 9-11 to provide protection against certain strains of HPV that can cause cancer. The goal is to administer the HPV vaccine before the adolescent would be exposed to the virus. However, there has been much resistance and non-adherence to the HPV vaccination. Purpose: The purpose of this study was to identify the current rates of HPV vaccination …

Provider Adherence To Recommendations For Hpv Vaccination In A Family Practice And Pediatric Clinic, Kara Saling

DNP Projects

Background: The HPV vaccination has consistently had lower adherence rates than the goal set by Healthy People 2020. The Advisory Committee on Immunizations Practices (ACIP) now recommends that children (both male and female) 11 to 12 years of age should start to receive the HPV vaccine before exposure to the virus. However, even with the change in the new guidelines, the HPV vaccine administration rates still trail other adolescent vaccinations.

Purpose: The purpose of this project is to identify pediatric and family practice provider adherence to ACIP/CDC recommendations on HPV vaccinations in a Southeastern United States health system in …

An Examination Of The Knowledge And Screening Practices For Child Maltreatment Among Primary Care Providers, Nicole Cirincione

DNP Projects

Background: Child maltreatment can affect any race, economic status, gender, and age. Primary care providers have contact with children and their caretakers daily and develop bonds that encourage open communication. Screening for child maltreatment risk factors can help discover those in danger and decrease abuse rates. Purpose: The purpose of this study was to examine provider’s knowledge of child maltreatment risk factors and assess screening and documentation practices. Methods: This was a descriptive study that included an electronic survey to primary care providers to assess current knowledge and practices for child maltreatment risk factors. Second, a retrospective chart review was …

Nurse Manager Span Of Control And The Impact On Employee Engagement, Jene' M. Kendall

DNP Projects

PURPOSE: The purpose of this study was to assess nurse manager span of control in medical- surgical, intermediate care, and progressive care units at Norton Healthcare and determine correlations between nurse manager span of control and employee engagement.

METHODS: For this descriptive, correlational study, the researcher analyzed data to identify relationships in span of control and employee engagement data for 19 nurse managers leading 23 inpatient care units. A survey to evaluate the role of the nurse manager and the assistant nurse manager also was done.

RESULTS: The average span of control for nurse managers was 52.2 full time equivalent …

The Evaluation Of Advanced Practice Providers Practice Patterns And Delivery Of Care Models In The Specialty Practice Environment, Katherine W. Rogers

DNP Projects

Background: Advanced Practice Providers (APPs), specifically Nurse Practitioners (NP) and Physician Assistants (PA), have been utilized in healthcare for decades to improve access to care for patients. Norton Healthcare’s largest population of APPs is in specialty practices. The expansion of APPs into the medical group has been rapid and without evaluation of value and role identification.

Purpose: The purpose of this study is to evaluate Advanced Practice Provider (APP) practice patterns and care delivery models within specialty practices in a large medical group. The outcome of the study will help to identify trends in practice and areas where …

The Effect Of An Educational Intervention On The Blood Culture Contamination Rate In Acutely Ill Adults, Kandace Vanhoozer

DNP Projects

PURPOSE: The purpose of this project was to assess the knowledge of nurses that collect blood culture specimens at University of Louisville Hospital and to implement an educational intervention among those nurses. It was expected that the educational intervention implemented for this project would increase nurses’ knowledge regarding the proper technique for blood culture specimen collection and decrease in the rate of contaminated blood cultures.

METHODS: This study included a prospective pre- and post-test of nursing knowledge followed by an educational intervention as well as a retrospective comparison of the pre- and post-education blood culture contamination rates.

RESULTS: Of the …

Impact Of Kamishibai Card Process On Central Venous Line Maintenance Bundle Compliance, Julia B. Frith

DNP Projects

Background: Central venous line (CVL) maintenance “bundles” have been developed and implemented at Norton Healthcare to decrease central line-associated bloodstream infections. While maintenance bundle audits are performed and compliance scores are reported to frontline providers and institutional leaders, the traditional audit process does not capture the factors underlying noncompliance.

Methods: A retrospective evaluation of the implementation of the Kamishibai Card process for CVL maintenance bundle compliance in the NCH PICU was performed using a pre- and post-test design. Pre-implementation and post-implementation data was compared to assess the change in compliance with the individual CVL maintenance bundle components as well …

Impact Of A Leadership Development Program On Perceptions Of Structural Empowerment, Leadership Self-Efficacy, And Staff Nurse Clinical Leadership, Matthew E. Proud

DNP Projects

BACKGROUND: In order to serve as full partners on the interdisciplinary health care team: nurses at all levels must develop essential leadership competencies Organizations need to identify the essential leadership competencies required for bedside nursing staff and develop programs to enhance these competencies. Leadership competencies in areas such as managing change can help bedside nursing staff improve care delivery and quality outcomes.

PURPOSE: The purpose of this project was to evaluate the impact of an established leadership development program on participants’ perceptions of structural empowerment, leadership self-efficacy, and staff nurse clinical leadership in one university health system.

METHODS: The pilot …

Evaluation Of A Critical-Care Pain Observation Tool Quality Initiative, Caissy A. Goe

DNP Projects

Background: Patients unable to self-report pain are at increased risk for inadequate pain management and less than optimal outcomes. The implementation of behavioral pain scales, such as the Critical-Care Pain Observation Tool (CPOT), have demonstrated an improvement in pain management and patient outcomes.

Local Problem: A lack of the routine use of behavioral pain scales for mechanically ventilated patients unable to self-report pain was identified as a significant barrier to optimal pain and agitation management.

Methods: A retrospective pre and post design was used to evaluate the effectiveness and impact of a CPOT quality initiative on the management of pain, …

Antibiotic Prescribing For Treatment Of Acute Pediatric Illnesses By Advanced Practice Nurses, Deborah J. Whitehurst

DNP Projects

Antibiotic over-prescribing by physicians for the treatment of acute respiratory tract illnesses have been examined in a variety of settings. Different studies have examined nurse practitioner (NP) prescribing practices both in the United States and various international settings. There have been limited studies specifically examining antibiotic prescribing practices in the pediatric population. However, no studies were found which compared population specific NP groups. The purpose of this study was to understand differences in antibiotic prescribing practices among advanced practice pediatric providers.

The goal of this project was to describe and compare antibiotic prescribing practices of pediatric nurse practitioners (PNP) and …

Health Literacy In A Primary Care Setting, Ashley Newman

DNP Projects

BACKGROUND: Low health literacy is prevalent in the United States. As a result, the Agency for Healthcare Research and Quality (AHRQ) developed universal health literacy precautions to improve patient understanding of health information. Using universal precautions and specific tools, such as teach-back, has been shown to decrease morbidity and improve patient outcomes.

PURPOSE: The purpose of this quality improvement project is to assess provider knowledge of health literacy in a primary care setting. A secondary purpose is to assess the use of patient education material for patients with diabetes, hypertension, and hyperlipidemia that meet universal precautions.

METHODS: This study was …

Assessment Of The Need For Provider Education On Screening For Depression In Patients With Select Dermatologic Problems, Sarah B. Zerhusen

DNP Projects

PURPOSE: The purpose of this project is to evaluate the knowledge, attitudes, perceptions, skills, and self-efficacy of dermatology providers’ assessment of depression in patients with chronic skin disease to determine the need for continuing education programs.

METHODS: This is a single practice, multi site, quantitative correlational design study to assess provider use, comfort, and proficiency of screening and discussion of depression in patients suffering from plaque psoriasis and atopic dermatitis. Data was collected through the use of a questionnaire dispensed in January of 2018. The sample consisted of 23 dermatology providers in a dermatology practice with clinics in Louisville, Lebanon, …

The Evaluation Of A Multi-Hospital System Nurse Residency Program On New Graduate Nurse Retention And Engagement, Julie N. Wolford

DNP Projects

PURPOSE: The purpose of this evaluation project was to determine the effectiveness of the Norton Healthcare new graduate nurse residency program on retention and engagement of newly- licensed registered nurses.

METHODS: This study was a retrospective pre-test, post-test design of the impact of the nurse residency program on turnover and engagement for the participants in the first year of the Norton Healthcare Nurse Residency Program. Engagement was evaluated using the Utrecht Work & Well-being Survey (UWES). Return on investment was also evaluated for the first year of the program. The sample included 791 newly-licensed registered nurses hired between January 2014 …