Nursing Commons^™

Pediatric Delirium: Development Of A Standard Of Practice In A Cvicu And Picu Setting, Frances Gililand

DNP Projects

Pediatric delirium remains a significant cause of morbidity in pediatric critical care resulting in longer lengths of stay and increased healthcare costs that may extend beyond critical illness. Prevalence rates of pediatric delirium in pediatric intensive care settings are 20%. Not all children’s hospitals regularly assess for pediatric delirium. At the time of this project, the assessment of pediatric delirium was not a standard of practice at John Hopkins All Children’s Hospital (JHACH). Examining provider’s experience, knowledge and self-efficacy of pediatric delirium was the primary aim of this project. The secondary aim was to use information obtained through the first …

An Evaluation Of Provider Adherence To Acute Bronchitis Quality Measures In Adults, Rachel L. Lazar

DNP Projects

Background: Acute bronchitis management continues to be mistreated. Evidence based practice guidelines do not support antibiotic therapy for the treatment of acute bronchitis. Providers are encouraged to prescribe antitussives, suppressants and inhaler medications for the treatment of acute bronchitis symptoms, including cough.

Objective: The overall objective of this project is to evaluate the management of adults diagnosed with acute bronchitis in a limited services clinic.

Methods: A retrospective chart review was conducted on patients in a limited services clinic. The chart review assessed patients aged 18-64 with a diagnosis of acute bronchitis from July 1, 2016- June 30, 2017.

Results: …

Implementation Of The Stop Bang Screening Instrument For Obstructive Sleep Apnea Within The Intensive Care Unit And 5 East Cardiac Unit, Michael T. Lush

DNP Projects

BACKGROUND: Recent studies have found that OSA without the use of CPAP is an independent risk factor for cardiovascular disease and hypertension, which can lead to myocardial infarction (MI) and cerebral vascular accident (CVA) or stroke. This increases patient morbidity and mortality rates as well as medical costs. In those suffering from a myocardial infarction (MI) or cardiovascular accident (CVA), an important intervention is proper screening for the presence of OSA while in the acute care setting. The STOP BANG screening instrument is a simple yet effective tool in assessing for sleep apnea symptoms with a respective sensitivity of 93% …

Improving Fall Risk Assessment And Documentation: A Qi Project, Ashley N. Kohari

DNP Projects

BACKGROUND: Unintentional falls commonly arise and can cause significant harm including fractures, head injuries, and death. Assessing each patient for falls and performing a fall risk assessment is recommended by the American Geriatrics Society and the Center for Disease Control and Prevention, and is mandated for institutional reimbursement. Fall risk assessment has been shown to decrease the rate of falls and healthcare costs.

PURPOSE: The purpose of this quality improvement project was to improve compliance for fall risk screening and documentation to meet MACRA requirements in a family medicine clinic.

OBJECTIVES: The objectives for this project were: 1. Conduct PDSA …

Assessment Of Alcohol Withdrawal Syndrome Incidence And Identification Of Other Correlating Risk Factors In Patients Admitted Through The Emergency Department, Hannah Young

DNP Projects

PURPOSE: The purpose of this project was to measure adherence rates to the current alcohol use screening process, and identification of correlations of alcohol use and outcomes in patients admitted to Norton Hospital, via the emergency department.

METHODS: The study design is a retrospective descriptive evaluation, of adherence to the current alcohol use screening process, and associations among age, gender, ethnicity, length of stay, number of ICU days, restraint use days, level of care at admission (ICU, TCU, LLM/tele, MS), incidence of AWS/DTs, and activation of the CIWA protocol among the adult inpatient population of Norton Hospital’s downtown campus, admitted …

Intensive Care Admissions: Predicting Palliative Care Needs In The First 24 Hours, Ashton R. Miller

DNP Projects

PURPOSE: The purpose of this retrospective analysis was to determine the proportion of intensive care admissions that required palliative care services during the same admission assessed by an investigator-developed palliative care screening tool. This study also analyzed the screening tool for the number of criteria producing the highest sensitivity and specificity for a palliative care consult occurring during the same hospital stay.

METHODS: Retrospective data collection and analysis were performed by randomly selecting 110 patients records from a report obtained through the electronic health record, Epic. The sample was drawn from patients admitted to a medicine intensive care unit (2A) …

Scheduling Practices Of Acute Care Rn’S And Nurse Fatigue: Assessment And Development Of An Educational Program For Nurse Managers, Miranda Adkins

DNP Projects

PURPOSE: The purpose of this project is to develop an evidence-based organizational fatigue climate assessment to understand the current culture as it relates to nurse fatigue. This study includes the use of a fatigue measurement scale and the development of a fatigue reduction educational program for nurse managers.

METHODS: Using a cross-sectional survey design, data assessing organizational climate and actual fatigue levels among nurses employed at Saint Joseph East Hospital was obtained through an electronic questionnaire. Results were used to create a workplace fatigue educational program for nurse managers. The target sample consisted of 361 acute-care registered nurses for a …

Evaluation Of A Staff Resilience Program In A Pediatric Intensive Care Unit, Stacy Flanders

DNP Projects

Background: Compassion fatigue (CF) and secondary traumatic stress (STS) is prevalent in intensive care nurses, especially in pediatric intensive care nurses (PICU). CF/STS leads to burnout, reduced employee engagement, and nursing turnover.

Purpose: The purpose of this project was to evaluate the impact of a staff resilience program on nursing turnover, employee engagement and improved compassion satisfaction/ resilience among nurses in a PICU.

Methods: A retrospective pre-test and post-test design was used to evaluate the impact on turnover and engagement after implementation of the staff resilience program. Comparison of RN turnover and engagement results pre-implementation were compared to RN turnover …

Evaluating The Relationship Between Tobacco Use And Pain Perception Using The Global Pain Scale (Gps) In Opioid Dependent Adults: A Retrospective Analysis, Kristina Robinson

DNP Projects

Background: Chronic pain, smoking, and opioid use, contribute to a significant economic burden in the United States. Chronic pain affects all aspects of life, and is influenced by the use of cigarettes and opioids alike. Researchers suggest that there is a higher use of cigarettes and opioids in individuals with chronic pain. Chronic pain can promote smoking and smokers are more likely to use opioids. With the evidence that patients who smoke a higher number of cigarettes per day report higher pain, it is possible that smoking may be a stress-reducing behavioral response related to pain. Moreover, higher frequency and …

Impact Of Education On Provider Knowledge And Screening Practices Related To Childhood Obesity, Natalie B. Fulk

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effect of a provider education program on BMI screening practices and provider knowledge related to childhood obesity by implementing an educational intervention to advanced practice providers in a primary care clinic setting.

METHODS: A pretest/posttest design was used to examine changes in provider knowledge about BMI screening practices in children and adolescents, and lifestyle recommendations after a brief educational intervention was provided. A retrospective chart review was used to assess the screening and management practices for an elevated BMI percentile and provider documentation of lifestyle recommendations.

RESULTS: A total of …

Increasing Influenza Vaccination Rates In A Primary Care Clinic: A Quality Improvement Study, Cassandra R. Roshel

DNP Projects

Background

According to the most recent CDC statistics, the influenza virus kills between 12,000 and 56,000 people per year in the United States. Although influenza vaccination is recommended each year, only about half of all Americans are actually receiving the vaccine annually. The goal of this quality improvement project was to increase influenza vaccination rates at a large academic medical center in Kentucky. At baseline, there was no standardized screening protocol in place prior to this study.

Methods

This study implemented a pre-test post-test design to evaluate the impact of a process change intervention on vaccination status from September 1, …

An Evaluation Of The Effects Of A Diabetes Self-Management Education Program On The Hba1c In Patients With Type 2 Diabetes, Katherine Schoo

DNP Projects

Introduction

Diabetes has become an epidemic in the United States. More than 30.3 29 million Americans are living with the disease, while an additional 84.1 million Americans are living with prediabetes (Centers for Disease Control and Prevention [CDC], 2018). Standards set forth by the American Diabetes Association (ADA) describe comprehensive and individualized self-management education and treatment as part of their guidelines for the management of diabetes (ADA, 2018). The “Active Steps for Diabetes” program is an example of a diabetes self-management education (DSME) program that supports national recommendations made by the ADA.

Methods

This study was a retrospective descriptive pre- …

The Effect Of An American Heart Association Telephone Follow-Up Intervention On Knowledge And Self-Efficacy In Rural Heart Failure Patients, Haley Fuller

DNP Projects

Background: An increased national and local prevalence of heart failure fostered a review of the evidence to identify best practice interventions focusing on improving self-care and knowledge. Heart failure remains a leading cause of 30-day readmission in the United States and in Madisonville, Kentucky, the site of study. A review of the literature emphasized improving transitions from hospital to home with a multi-dimensional approach. Self-care and knowledge were identified as major determinants to adequately prepare a patient to manage this chronic disease. A pre- and post quasi experimental study was performed at a rural hospital in Kentucky. Objective: The goal …

Using Rapid Cycle Improvement To Improve Weight Management In Family Medicine, Kelly Mccormick

DNP Projects

PURPOSE: The purpose of this quality improvement project was to improve rates of nutrition screening and weight management in a Family and Community Medicine Clinic.

METHODS: This study was among several quality improvement projects being conducted at a Family and Community Medicine Clinic aimed at improving patient outcomes and quality measures for reimbursement beginning in 2019. Rapid cycle quality improvement was used to identify problems, implement changes, and evaluate workflow at the clinic in order to improve rates of compliance in BMI screening and documentation of weight management plans. Three PDSA cycles were completed. Activities included observation, staff education, visual …

Identifying Nurse’S Perspectives And Practices About Clinical Monitor Alarm Burden And Alarm Fatigue., Doreen M. Legere

DNP Projects

PURPOSE: To obtain insight into the nursing culture of the University of Kentucky Medical Center (UKMC) regarding alarm fatigue, measure nuisance alarm events, and identify the practices nurses at UKMC engage in to manage alarm pollution and mitigate alarm burden. Moreover, this practice improvement project identified how innovations like the introduction of a monitor watcher has impacted the rates of nuisance alarms and influenced nursing culture.

METHODS: A online survey based on the 2011 Healthcare Technology Foundation Alarms Survey (HTF) was sent to nurses in two intensive care units at UK Healthcare (UKHC). The results of the 2017 UKHC Alarm …

A Retrospective Comparative Analysis On The Effectiveness Of Pharmacologic Weight Loss, Emily Dunn

DNP Projects

PURPOSE:Obesity costs the U.S. roughly $147 billion in health care spending annually. There has been a call for healthcare providers to initiate all possible weight loss interventions. One treatment strategy not used to its fullest potential is that of prescribing antiobesity medications. The purpose of this project was to examine and evaluate the effectiveness of three common weight loss medications used in the treatment of obesity, including discussion and recommendations.

METHODS: This project was a single-center retrospective study comparing three different groups of patients seen at a rural weight loss clinic. The sample consisted of 84 patients seen between September …

Human Trafficking Awareness Pilot Project In Nursing Faculty And Senior Nursing Students In Western Kentucky, Kristin Reid

DNP Projects

PURPOSE: Human trafficking is an ongoing public health issue on a global and local platform. The care of victims is unique and multifaceted, with various physical and mental health care needs recognized. Human trafficking victims are often difficult to identify, as there have been reports that up to 88% of human trafficking survivors described encounters with healthcare professionals while they were being trafficked yet none were identified as victims (Office of Trafficking in Persons, 2017). This information places the healthcare provider at the forefront for advocating human trafficking victim identification and post identification care. The purpose of this project was …

Evaluation Of Risk Factors And Postoperative Outcomes In Surgical Laryngectomies With Intraoperative Hypothermia, Kristen V. Carter

DNP Projects

PURPOSE: The purpose of this study is to determine whether intraoperative hypothermia exposure would be identified as an independent risk factor for surgical laryngectomy patients’ rate of postoperative complications within their surgical admission. The findings would help to justify the institution of “pre-warming” laryngectomy patients to prevent detrimental effects postoperatively.

METHODS: Retrospective chart review of 245 patients who had laryngectomies at the University of Kentucky from 2010-2017. Rate of complication and variables predictability of postoperative complications was evaluated.

RESULTS: In the sample, 157 patients developed complications. Complications included 35 transpharyngeal fistulas, 29 free flap failures, 43 hematomas, 50 wound infections/ …

Evaluation Of Emergency Department Utilization Among Patients Who Have Primary Care Providers, Xin Zeng

DNP Projects

PURPOSE: High rates of emergency department (ED) use had little changes nationwide or in Kentucky after implementation of the Affordable Care Act. The Centers for Medicare and Medicaid Services have been calling for ways to reduce unnecessary ED usage. The purpose of this project is to identify factors associated with ED visits among adults in a primary care practice. The results are expected to serve as a needs assessment to determine ways for a primary care clinic to reduce inappropriate ED use.

METHODS A retrospective chart review was conducted to evaluate the ED use among 80 random selected adult patients …

Analysis And Evaluation Of Fall Incidence And Registered Nurse Documentation Of A Teach-Back Intervention At An Acute Care Hospital, Dawn M. Lechner

DNP Projects

PURPOSE: The purpose of this descriptive study was to examine the impact of a fall prevention quality improvement initiative on one unit of an acute care hospital (Hospital A). This multimedia initiative consisted of a video led fall prevention presentation with nurse-led scripted teach-back education on all newly admitted patients of one medical surgical oncology unit of Hospital A. Two objectives guided this study and included: Analyze adherence of a fall prevention education video and registered nurse led scripted teach-back intervention on newly admitted patients in the electronic health record; and Evaluate the impact of video education and registered nurse …

Impact Of A Nurse-Physician Communication Intervention On Psychological Empowerment And Effectiveness Of Collaboration Between Medical Staff And Critical Care Nurses, Kristen Wieder

DNP Projects

Background: Nurse-physician communication is an essential element of safe, effective patient care, nurse engagement and job satisfaction. Communication breakdowns can lead to poor patient outcomes and disengagement among nurses.

Purpose: The purpose of this project was to determine the impact of a nurse-physician communication intervention on psychological empowerment of critical care nurses. A second purpose of the study was to evaluate the effectiveness of communication between critical care nurses and members or the cardiothoracic surgery team and understand barriers and communication challenges.

Methods: A quasi-experimental pre-test/post-test design was utilized to evaluate the impact of a nurse-physician communication intervention …

The Effects Of A Nurse Manager System Collaborative Council On Job Satisfaction, Intent To Leave, & Resilience, Heather Oliver

DNP Projects

Abstract

PURPOSE: The purpose of this project was to create a Nurse Manager System Collaborative Council (NMSCC) at Norton Healthcare and to determine the impact of participation in the NMSCC on job satisfaction, intent to leave, and resilience.

METHODS: This study employed a quasi-experimental, pre-test, post-test design to assess the effectiveness of the NMSCC at Norton Healthcare. Job Satisfaction was measured using the Warshawsky scale, Intent to Leave was evaluated using the Houser scale, and resilience was assessed using the Connor-Davidson CD-RISC scale.

RESULTS: Resilience increased after participation in the NMSCC for 6 months. Job satisfaction and intent to leave …

The Effects Of A Mentor Program On Burnout, Resilience, Work Engagement, And Turnover Intentions Of New Nurse Managers, Jennifer Thomas

DNP Projects

BACKGROUND: The nurse manager position is an instrumental, critical role in healthcare organizations. However, nurse managers often enter the role lacking necessary leadership skills. Mentoring may add additional support and guidance in navigating the nurse manager role.

PURPOSE: The purpose of this study was to evaluate the effect of a nurse manager mentor program including focused, developmental classes on nurse manager burnout, resilience, work engagement, and turnover intention.

METHODS: A quasi-experimental study, utilizing a pre-test/post-test design was completed to evaluate the impact of a mentor program on new nurse manager burnout, resilience, work engagement, and turnover intention.

RESULTS: Nurse manager …

Pilot Of An Educational Module For An Adolescent Congenital Heart Transition Program In The Pediatric Setting, Katie J. Dust

DNP Projects

Abstract

PURPOSE:The purpose of this project was to pilot an educational module on a new congenital heart transition program to be instituted at a large Midwest medical system.The transition program is meant to assist pediatric cardiology patients in transferring from pediatric to adult care. An educational module was developed for inpatient health disciplines who will be involved in the transition program. Before offering the program throughout the medical system, a pilot was conducted to determine if the education was at the appropriate level. The educational module was modeled after the Got Transition Six Core Elements designed by the National Health …

Does A Nonstandardized Lactulose Administration Practice Affect Hepatic Encephalopathy In Patients With Liver Disease In The Acute Care Setting?, Mary Broadbent

DNP Projects

PURPOSE: The purpose of this study is to examine whether inpatients with liver disease at University of Kentucky Hospital receiving lactulose are meeting the protocol of 2-4 bowel movements per day. Research shows that lactulose is the medication of choice used to treat and prevent hepatic encephalopathy (HE). Additional lactulose interventions, a patient’s MELD score, and GCS score will be examined in this study as well. This information would be beneficial to providers and nurses because it would provide data on patients who might require more lactulose interventions than others.

METHODS: Retrospective chart reviews of 70 inpatients with liver disease …

The Effect Of A School-Based Health Center On Access To Care In A Rural Community, Macey Cornwell

DNP Projects

BACKGROUND: Lack of access to healthcare is a nationwide issue that affects underserved, minority, and rural populations. School-Based Health Centers (SBHCs) is one way to help increase access to care for students, staff, and family members.

PURPOSE: The purpose of this project was to provide preliminary data on the impact of a SBHC in a rural Kentucky community on access to care and school attendance.

METHODS: A univariate descriptive analysis was conducted to evaluate the perceived impact of the SBHC on access to care and demographic factors. Data was analyzed using Pearson’s Product Moment Correlation, two-sample t-tests, and The Wilcoxon …

Evaluation Of Aprn Transition To Practice Program, Frances Hines

DNP Projects

The purpose of this quality improvement project is to evaluate the newly implemented APRN Onboarding Model. The Onboarding pilot began in the summer of 2018. This project focused on the second offering (pilot) of the onboarding program which occurred in June of 2018. The APRN participants of the onboarding consisted of newly hired APRN’s into Norton Healthcare. Both Adult-Gerontology Acute Care Nurse Practitioners and Family Nurse Practitioners were included in this program evaluation. For this program evaluation a single survey instrument was developed to measure participants demographic, educational and work experience. Additionally perceptions of their level of confidence and self-efficacy …

Retrospective Chart Review Of Abnormal Lab Results In The Primary Care Setting, Derek Summers

DNP Projects

PURPOSE: The purpose of this project was to perform a needs assessment to determine if there was a delay in addressing abnormal lab results. The objectives were: 1) to determine the amount of time it takes for providers to address abnormal lab results in the ambulatory setting at an ambulatory setting within a Southeast Health Care System and 2) evaluate the alert and order set system for abnormal lab results of thyroid stimulating hormone, lipid panels, and hemoglobin A1C.

METHODS: A retrospective chart review was performed to determine the time it takes for primary care providers to address or follow …

An Assessment Of Potentially Inappropriate Medications Among The Elderly And The Effect Of An Educational Intervention On Provider Knowledge Of These Medications, Amanda Brown

DNP Projects

Objectives: The aims of this study were to assess potentially inappropriate medications (PIMs) or Beers medications among outpatient older adults within one Midwestern healthcare system, to determine rates of patient education on Beers medications, and to pilot an educational intervention for providers.

Methods: This study involved two parts. For part 1 of the study, a randomized retrospective chart review of 493 older adult patients seen in 2017 from four practices was conducted to assess Beers medication prescriptions and rates of patient education. Following the chart review, for part 2 of the study, an educational intervention was delivered to two providers …

Evaluating The Need For A Family Nurse Practitioner Fast Track As An Alternative To The Emergency Department, Anna Czartorski

DNP Projects

PURPOSE: Emergency Departments (ED) are a vital part of healthcare and they provide lifesaving services to patients that are acutely ill. However, the latest data shows that 42% of ED visits are related to medical complaints that can be managed by a primary care provider (PCP). The purpose of this study was to assess the need for a fast track within a midwestern suburban Emergency Department (ED) that is based upon the Family Nurse Practitioner (FNP) fast track model.

METHODS: This study was a descriptive study examining the usage of the ED for non-urgent medical complaints from January 1 …