Nursing Commons^™

The Effect Of Transition Readiness Interventions On Adolescents With Diabetes When Transitioning From Pediatric To Adult Clinic, Kimberly Walker

DNP Projects

PURPOSE: The purpose of this study was to initiate a transition readiness program which uses motivational interviewing at the Pediatric Endocrinology Clinic located within the UK HealthCare Kentucky Clinic. An evaluation of this program was conducted by assessing participant outcomes related to readiness for transitioning.

METHODS: This study was a quasi-experimental one group pretest posttest design to assess the effectiveness of transition readiness interventions on adolescent readiness and confidence in transition of care at the Pediatric Endocrinology Clinic located at the Kentucky Clinic. The sample consisted of 14 patients.

RESULTS: No statistical significance was found in the TRAQ tool and …

Screening For Sleep Apnea In Patients With Hypertension Using The Stop-Bang Tool In A Primary Care Setting, Natalie R. Jennette

DNP Projects

Obstructive sleep apnea (OSA) is a common cause of high blood pressure but often undetected in patients with hypertension. Screening tools for OSA exist but are underutilized. This project aimed to identify current practices and perceptions related to screening for OSA in patients with hypertension and improve primary care provider knowledge of OSA and screening rates using the STOP-BANG screening tool. The providers acknowledged the importance of screening patients with hypertension but there was no increase in screening after education was provided. Effective screening tools exist but effective strategies to bring this evidence to practice need to be explored further.

Evaluation Of Depression Screening Implementation In The Adult Inpatient Heart Failure Population: A Process Outcomes Evaluation, Jennifer Sustek

DNP Projects

BACKGROUND: Extensive study has found depression in heart failure (HF) patients to be a significant risk factor which has been associated with poor outcomes and increased medical cost for this population. It is highly recommended to screen HF patients for depression to identify this important risk factor. The PHQ-9 depression screening instrument (sensitivity 70% specificity 92%) has been identified as a valid measure to detect depression in the HF population. Implementing a depression screening protocol in an inpatient environment requires education of providers to establish awareness of best practice and foster confidence in their application of the screening instrument. OBJECTIVE: …

An Evaluation Of An Innovative Weight Management Program In A Primary Care Setting, Susan Peak

DNP Projects

Background- Kentucky ranks third in the nation for childhood overweight and obesity. . Consumption of high dietary fat, excessive use of electronics, low levels of physical activity and consumption of sugar filled drinks are modifiable behaviors believed to be the biggest culprits behind these statistics.

Purpose- The purpose of this evaluation was to assess the implementation of the 5-2-1-0 plan in the management of childhood overweight or obesity within an urban primary care clinic.

Methods- After initiation of the program by the clinic focused interviews with the primary care providers were conducted to evaluate barriers and benefits to …

The Impact Of Nursing Staff Adherence With Chlorhexidine Gluconate Bathing On Intensive Care Unit Patient Outcomes, Tara M. Jones

DNP Projects

Purpose: The purpose of this study is to evaluate nursing staff adherence to a chlorhexidine gluconate (CHG) bathing protocol in the intensive care unit at Norton Brownsboro Hospital.

Methods: This study utilized a single-site, quasi-experimental, retrospective electronic medical record review format. The sample consisted of 200 patient records post CHG bathing protocol initiation from the Norton Brownsboro Hospital Intensive Care Unit during the period of March, 2015 to May, 2017.

Results: The sample was divided into adherent and non-adherent groups. No significant differences in age, sex, race, ICU length of stay (LOS), BMI, or mortality scores, presence of indwelling medical …

Effect Of A Parent Empowerment Program On Length Of Stay And Parental Stress In The Neonatal Intensive Care Unit, Holly L. Nieves

DNP Projects

PURPOSE: Research surrounding topics in the Neonatal Intensive Care Unit have long been focused on mortality and morbidity of this population. However, consideration of the parent-infant relationship and subsequently adverse outcomes that could be formed during the intensive care stay should be examined. Parent empowerment programs in the NICU have been shown to decrease length of stay, parental stress, and depression. The purpose of this study was to evaluate the impact of the COPE for HOPE parent empowerment program on length of stay, parental stress, maternal depression, and parent satisfaction in the Neonatal Intensive Care Unit with parents of infants …

Perceptions About Cognitive Enhancement Therapy Among Regional Mental Health Providers: A Mixed Methods Analysis, Adam A. Loose

DNP Projects

Cognitive Enhancement Therapy (CET) is a program, developed at the University of Pittsburgh, to improve cognitive deficits experienced by people diagnosed with schizophrenia. Since its implementation in various settings, CET has demonstrated positive outcomes for patients in many cognitive domains. This study took a mixed methods approach to assess the interest and knowledge of mental health providers at a regional level and a local mental health facility in particular, about beginning a CET program. The quantitative study obtained data from evaluations administered during two CET training events at a local mental health facility. Digitally recorded qualitative interviews were conducted with …

A Retrospective Chart Review On The Effects Of Cam On Pain And/Or Anxiety In The Oncology And Bone Marrow Transplant Population, Cherry Nelson

DNP Projects

PURPOSE: The purpose of this study was to promote integrative medicine by evaluating the efficacy of Complementary Alternative Medicines (CAM) on pain and/or anxiety reduction in the oncology and bone marrow transplant population. The four modalities of CAM were massage, Jin Shin Jyutsu (JSJ), aromatherapy and narrative medicine.

METHODS: The design was a single center retrospective chart review, focusing on medications for pain and anxiety, self-reported pain levels, self-reported anxiety levels, chronicity of pain and acuity of pain prior to and after the CAM modality/s implementation.

RESULTS: Due to the lack of electronic documentation of massage, aromatherapy and narrative medicine, …

Evaluation Of A Nurse Navigator Program On The 30-Day Readmission Rate In Heart Failure Patients, Katie A. Winiger

DNP Projects

PURPOSE: The purpose of this study was to evaluate the impact of a registered Nurse Navigator (NN) on hospital 30-day readmissions for patients with heart failure at Norton Healthcare (NHC) in Louisville, Kentucky.

METHODS: This study involved two phases. Phase I was a retrospective descriptive design utilizing a medical record review of 159 patient charts. Group 1, 54 charts, included patients with heart failure who were discharged from NHC for heart failure related illnesses and were seen in a primary care clinic that utilized a NN after discharge from the hospital. Group 2, 105 charts, included patients with heart failure …

Evaluation Of A Primary Care Based Diabetes Education Program, Claire Pfister

DNP Projects

The improved management of diabetes is a critical clinical and economic challenge facing our healthcare system. Educating patients with diabetes to self-manage their disease is a vital component of diabetes care. The purpose of this DNP practice improvement project was to evaluate an innovative health care delivery method of individualized diabetes self-management education (DSME) in primary care. The approach combined individual DSME with a registered dietician and routine diabetes care with the primary care provider into one patient appointment. System data was reviewed to compare referral and attendance patterns of group and individual methods. Changes in clinical indicators of A1C, …

Exploring Barriers To Primary Care In The Lgbt Community, Desiree R. Price

DNP Projects

Purpose: The specific aim of this study was to identify the LGBT patient’s perspective of what factors could contribute to a more responsive primary care environment.

Methods: The study was a non-experimental, descriptive study utilizing an anonymous, internet based electronic survey. A survey/questionnaire tool, developed for the study, was disseminated among a social media site and a listserv for two organizations with strong connections to the LGBT community.

Results: Eighty-one responses were received. Participants: 60% identified as female, 95% were Caucasian, with 84% never having a Pap smear, and only 6.6% having recommended breast cancer screenings. The incidence of …

Evaluation Of An Enhanced Recovery After Surgery (Eras) Pathway In Two Hospitals, Jennifer A. Janes

DNP Projects

OBJECTIVE: The purpose of this study is to evaluate the Enhanced Recovery After Surgery (ERAS) pathway utilized at two Norton Healthcare facilities for colorectal and gynecological surgeries. The specific aim is to examine the impact on patient outcomes, clinical effectiveness, and costs.

METHODS: This was a multi-center, pre-post implementation retrospective study of the impact of ERAS pathways on colorectal surgery patients at Norton Audubon Hospital (NAH) and gynecological surgery patients at Norton Women’s and Children's Hospital (NWCH). The sample included 399 patients including patients from both hospitals, pre- and post-ERAS.

RESULTS: The ERAS pathway lead to a significant reduction in …

Screening For Alcohol Use/Abuse In The Primary Care Setting Using The Audit-C And Sbirt (Screening, Brief Intervention, Referral To Treatment), Whitney D. Spear

DNP Projects

PURPOSE: The purpose of this study was to examine the feasibility of alcohol screening in the primary care setting to detect alcohol abuse or misuse using the AUDIT-C standardized screening tool and SBIRT.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected via retrospective chart review from the electronic medical records by the type of office visit; either new patient initial visit or annual well visit. The patient sample consisted of 25 participants for the study period of September 19^th through October 10^th, 2017.

RESULTS: There were 37 patients eligible to participate …

Getting The Most Out Of Pediatric Screenings, Carly R. Oliver

DNP Projects

Purpose: The purpose of this study was to compare the results of the Ages and Stages Questionnaire to the Survey of Well-Being of Young Children to determine if they produced the same outcomes. The Survey of Well-Being of Young Children offers additional screening tools that address risk factors for child abuse, that the Ages and Stages does not include. This project also surveyed the caregivers completing the questionnaires to determine which questionnaire they found more beneficial.

Background and Significance: In the United States, approximately 15% of children ages 3 to 17 years of age have at least one developmental disability. …

Post Evaluation Of A Nurse Driven Early Mobility Program, Paula Halcomb

DNP Projects

The goal of this study was to evaluate the effectiveness of a recently implemented nurse driven early mobility program on patients in two Trauma Surgical Intensive Care Units at the University of Kentucky HealthCare (UKHC). The purpose of this study was to evaluate the effectiveness of a recently implemented nurse driven early mobility program (NDEMP) on patients in two Trauma Surgical Intensive Care Units at the University of Kentucky HealthCare (UKHC). Nursing staff are responsible for mobilizing patients to their maximum ability twice daily in addition to any therapy provided by Physical and Occupational Therapists. The study was an uncontrolled …

Evaluating Utilization Of An Early Mobility Protocol In An Adult Icu In The Veterans Administration System, Julie Duffy

DNP Projects

Purpose: To evaluate ICU staff’s adherence to a new progressive mobility protocol as part of a quality improvement project in an adult medical-surgical intensive care unit (ICU).

Background: Bedrest can lead to complications for hospitalized patients and current literature supports that mobility within the ICU is safe and feasible for critically ill patients. Current evidence based literature identifies barriers to patient mobilization which can be addressed through implementation of a mobility protocol. Utilization of mobility protocols is one way to improve quality of care and prevent common bedrest complications in the critically ill patient population.

Methods: Retrospective medical record reviews …

Comparison Of Pain Management Modalities In The Development Of Postoperative Respiratory Failure, Amanda Carney

DNP Projects

BACKGROUND: This paper outlines the steps taken for a quality improvement study that investigated the development of postoperative respiratory failure (PORF) at University of Kentucky Chandler Medical Center (UKCMC). The first paper describes the influence of an interprofessional education (IPE) pilot program on doctoral nursing students and the experiences gained while working on a process improvement project. The second paper is a literature review on predictors for PORF. The third paper is a case control study that investigated the effects of pain management modalities on the development of PORF.

OBJECTIVES: To outline the process for developing a practice improvement project. …

Evaluation Of The Healthy-Heart, Healthy-Brain Program, Sooksai Kaewbua

DNP Projects

Purpose: The purpose of this study was to evaluate the effects of a group-based, psychoeducational program on the knowledge of healthy diet and eating behaviors of adults with mental-health diagnoses in an inpatient psychiatric setting.

Background and Significance: In a given year, adults with mental-health diagnoses have a higher risk of mortality relative to the general population. Mortality from natural causes among individuals with mental-health disorders is similar to the leading causes of death found nationwide, including cardiovascular diseases. There is a growing body of evidence showing a relationship between the health of clients’ hearts and brains. Thus, it is …

A Gap Analysis On Vaccine Administration For Average And High-Risk Adults, Whitney Pack Metcalfe

DNP Projects

Background: Nationally adult immunization rates continue to fall below the current benchmark goals. It is estimated adult vaccinations range from 20 to 60 percent, depending on the vaccine. There are different vaccine schedules for those of average-risk compared to those with high-risk conditions. Providers are being encouraged to explore their administration of vaccines as preventable, communicable diseases continue to be seen. Objectives: In a primary care clinic, a gap analysis was conducted to: 1.) Determine adult immunization rates, 2.) Compare vaccine administration rates of the Tdap, PCV13, PPSV23, and influenza vaccines between average and high-risk adults, 3.) Determine if specific …

Assessing Provider And Staff Knowledge Of Health Literacy And Satisfaction With A Health Literacy Assessment Tool In A Primary Care Practice, Whitney J. Lynn

DNP Projects

PURPOSE: The purpose of this quality improvement project was to assess provider and staff knowledge about health literacy. Specifically, the knowledge of health literacy and perceived importance, current usage, and benefits of the use of a health literacy assessment tool at a primary care clinic was evaluated pre-intervention. The perceived importance of health literacy as well as satisfaction with, frequency of use, and recommendation of the chosen health literacy assessment tool for future use was evaluated post-intervention.

METHODS: This project used surveys pre- and post-intervention at an urban primary care clinic in the southeastern United States from January to March …

An Evaluation Of Provider Adherence To Adult Sinusitis Quality Measures And Guideline, Caitlin A. Davidson

DNP Projects

Purpose

The purpose of this project is to evaluate adherence to Physician Quality Reporting System (PQRS) Measures #331 (delaying antibiotic treatment until at least seven days of symptoms) and #332 (prescribing amoxicillin or amoxicillin/clavulanate) on adult sinusitis treatment. Data was collected from patient encounters at the University of Kentucky College of Nursing Community Health Center (UKCONCHC) in Wilmore, Kentucky. To adhere to these quality measures would foster antibiotic stewardship. Further statistical analysis was completed to determine if gender or age bias was present in prescribing practices.

Methods

A retrospective chart audit was conducted to determine adherence to the quality measures. …

Safe Prescribing Of Combined Hormonal Contraceptives Using The U.S. Medical Eligibility Criteria For Contraceptive Use Guideline, Morgan E. Thomas

DNP Projects

Safe prescribing of combined hormonal contraceptives is important to prevent unplanned pregnancies and adverse effects including thrombotic events. Combined hormonal contraceptives can be taken safely but this relies on appropriate prescribing techniques by the healthcare provider. Prior to prescribing any type of contraception, health care providers should perform a risk assessment to anticipate and prevent patient complications. The Centers for Disease Control and Prevention created the United States Medical Eligibility Criteria (U.S. MEC) for contraceptive use guideline to help direct healthcare providers to assess patient risk factors, prescribe the safest form of contraception, and provide necessary teaching and follow-up. This …

Efficacy Of The Adherence To An Evidence-Based Early Mobilization Protocol On Patient Outcomes Post Thoracic Surgery, Blair Eberhardt

DNP Projects

Background: Immobilization is a commonly observed problem for adults in the intensive care unit (ICU) that may lead to ICU delirium, ICU associated weakness, increased length of hospital stay, and increased mortality¹⁷. Therefore, early mobilization has become an increasingly imperative priority regarding the treatment plan for patients in the ICU. Mobilization is often delayed or completed on a subjective provider basis due to scarcity of resources and outdated evidence-based knowledge⁷. This examination of adherence to an evidence-based protocol helps to assess efficiency of therapeutic outcomes regarding early ambulation of surgical thoracic patients in the critical care …

Use Of The Afix Model To Improve Adolescent Hpv Vaccination: A Pilot Research Study, Emily Messerli

DNP Projects

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines.

Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX …

Improving Screening For Alcohol Use Amongst Women In Primary Care, Sarah K. Bell

DNP Projects

Purpose: The purposes of this practice inquiry project were to examine the effect of the addition of a standardized screening tool (AUDIT-C) within the ambulatory electronic health record (AEHR) and the effect of an education session with primary care providers on documentation of alcohol screening and counseling within the AEHR. Furthermore, provider confidence with Screening, Brief Intervention, and Referral to Treatment (SBIRT) was compared before and after the educational session.

Methods: A quasi-experimental one-group pretest posttest design was utilized via chart review prior to and following the educational intervention for patients seen for an annual wellness exam. Data extracted included …

Implementing & Evaluating A Nurse-Led Educational Intervention For Bone Marrow Transplant Patients In The Acute Care Setting, Tia T. Wheatley

DNP Projects

Objective: The Bone Marrow Transplant (BMT) Basics Class is a nurse-led educational program dedicated to preparing patients and their caregivers of the treatment outline and self-care behaviors associated with receiving a BMT. The purpose of this project is to evaluate the effectiveness of this intervention in order to support the needs of the BMT patient and promote patient-centered care.

Study Design: Retrospective review to evaluate a quality improvement project.

Participants & Methods: As of July 2016, the BMT Basics Class became a standard of care at an NCI-designated academic cancer center in the southeastern United States. Between July 20, 2016 …

A Secondary Analysis Of Survey Data Evaluating The Lifelines Suicide Prevention Program Among Middle School Students, Nicki Sullivan

DNP Projects

PURPOSE: The purpose of this study was to evaluate student feedback of the 2015 Lifelines Suicide Prevention Program at Jessie Clark Middle School. Student feedback was examined by assessing students’ knowledge of suicide, attitudes toward suicide, knowledge of when and from whom to seek help if feeling suicidal or told by a friend that they are suicidal, and impressions of the educational presentation following participation in the Lifelines Suicide Prevention Program.

METHODS: In this secondary analysis, anonymous student responses (N=269) from a 2015 middle school survey were examined by using a mixed method design with the quantitative study measures being …

Incidence Rate Of Delirium After Cardiac Surgery And Feasibility Of A Delirium Prediction Rule, Kelly Bohl

DNP Projects

Delirium is an acute, temporary cognitive disorder that is characterized by a change in mental status, altered level of judgement, and changes in perception and behavior. Elderly patients who undergo open cardiac surgery are particularly at risk for developing delirium postoperatively. Although it is a temporary disorder, there are many consequences associated with delirium after cardiac surgery, including a longer length of stay in the hospital, long term functional decline, a greater use of health care resources and an increase in mortality risk. The purpose of this project was to identify the one-year incidence of postoperative delirium after cardiac surgery …

The Use Of Magnets As Patient Appointment Reminders And Hpv Vaccination Rates, Hayden Kelley

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a patient reminder alert system implemented at a public health department in rural Indiana in an attempt to increase the facility’s human papillomavirus (HPV) vaccination rates.

METHODS: This study was a secondary data analysis utilizing the Children and Hoosiers Immunization Registry Program (CHIRP) database to compare HPV vaccination rates before and after the implementation of an HPV magnet reminder program. The sample consisted of 122 adolescents; 31 patients for the pre-implementation period, July 1, 2015- June 30, 2016 and 91patients for the post-implementation period, July 1, 2016- Jan …

Evaluation Outcomes Of Delirium And Abrupt Discontinuation Of Psychiatric Medications Of The Adult Acute Care Patient, Latoya Lee

DNP Projects

PURPOSE: Delirium remains a common consequence of critical illness and is known to cause negative patient outcomes during an intensive care unit (ICU) stay. Hence, the purpose of this project is to evaluate the outcomes of patients taking psychiatric medications whose medications are abruptly discontinued upon admission to an ICU. Specifically, the outcomes of interest will be altered mental status, length of hospital stay, restraint use and mortality.

METHODS: A correlational analysis using a retrospective chart audit was conducted on 602 patients admitted to the Neurological/ Neurosurgical ICUs at the University of Kentucky Chandler Hospital from January 2015 to December …