Nursing Commons^™

Reducing Preoperative Anxiety In Adolescents Facing Spinal Fusion Surgery, Anna Gayle Parke

DNP Projects

Reducing preoperative anxiety for adolescents facing spinal fusion surgery for the treatment of scoliosis has significant implications for clinical practice and patient outcomes for this specific population. The reality of a pending surgery creates a difficult, uncomfortable, and exhausting state of being that can lead to increased postoperative pain, sleep disturbances, and maladaptive behaviors. This final capstone project inquiry report presents three manuscripts which focus on the reduction of preoperative anxiety in adolescents facing spinal fusion surgery. The first manuscript is a literature review examining current evidence related to preoperative anxiety, adolescents undergoing spinal fusion surgery, and teaching programs aimed …

Adult Acute Sinusitis Antimicrobial Stewardship Program In A Primary Care Setting, Katelyn M. Hellman

DNP Projects

BACKGROUND: Inappropriate antibiotic prescribing is a well-documented global health crisis (Centers for Disease Control, CDC, 2013). Antimicrobial stewardship (AS) is the purposeful selection of the correct drug, dose, route and duration of antimicrobial treatment to decrease microbial resistance, adverse drug effects and cost while improving patient outcomes (Dellit et al., 2007; CDC, 2016). Antimicrobial Stewardship Programs (ASP) are multidisciplinary programs designed to improve AS.

PURPOSE: To describe baseline prescribing patterns and evaluate the effect of an antimicrobial stewardship program (ASP) for adult acute sinusitis on provider knowledge and antibiotic prescribing practice. among primary care providers in an internal medicine clinic …

Family Rounds In The Medical Intensive Care Unit: An Intervention To Enhance Communication, Travis R. Klein

DNP Projects

Background: In the Intensive Care Unit (ICU) family member satisfaction is an important element of quality patient care. Families of ICU patients value communication with care providers and involvement in their relative’s care.

Objectives:

1. To determine if scheduled family rounds each day can improve the satisfaction and feelings of support with decision-making for family members of ICU patients?

2. Evaluate any associations between patient characteristics (hospital length of stay, ICU length of stay, and ventilator days) and family satisfaction?

Methods: This pilot project was conducted in a 12-bed medical ICU led by advanced practice nurses (APRN-MICU). Using the family …

Assessment Of Horizontal Violence And Healthy Work Environments Of Two Nursing Units, Rebekah Dailey

DNP Projects

PURPOSE: Horizontal Violence plagues the health of nursing work environments. In order to diminish this phenomenon and establish healthy work environments as established by the AACN, assessments must be completed to identify strengths and weaknesses and determine the proper interventions to employ. However, there is a lack of evidence in actionable interventions. The purpose of this project was to assess healthy work environments of two nursing units by examining horizontal violence, civility, teamwork, and satisfaction, and identify interventions to strengthen the health of the work environment.

METHODS: This study was a descriptive study using an electronic survey of two nursing …

Searching For A Common Thread: A Retrospective Chart Review Of Child And Adolescent Restraints And Seclusions, Mary Koziura

DNP Projects

Child and Adolescent psychiatry is an increasingly frequented area of research. The project leader believes violence in an inpatient psychiatry setting is an underrepresented topic of research and discussion. Close quarters among patients of varying diagnoses and backgrounds, coupled with varying culture and attitudes of staff make for a teetering point—a fine line—between therapeutic interaction and safety concerns. Particularly, in the case of patients under 18, one hopes to establish an environment of nurturing, as opposed to a police state. With the fact established that children and their parents should always come first, many of the staff are often exposed …

Can The Cdc's Get Smart Program And A Decision Tree Alter Clinician Guideline Adherence For Abrs And Avrs?, Tracy R. Wilson

DNP Projects

In previous bodies of work, researchers have not evaluated clinicians’ treatment of AVRS and ABRS by examining the impact of a national education toolkit and a decision tree tool. It is the intent of this scholarly project to determine whether an educational program based on a national education toolkit plus a decision tree tool offered to health care providers in a Middle Tennessee walk-in clinic, promoted an increase in treatment guideline adherence when diagnosing and treating acute bacterial rhinosinusitis and acute viral rhinosinusitis.

Effect Of Dietary Self-Monitoring In Caucasian And African-American Women, Julianne Tondreau

DNP Projects

Purpose: The purpose of the study is 1) to assess the effect of dietary self-monitoring on weight loss in a population of Caucasian and African-American women and men; and 2) to determine if there is a difference in African Americans’ and Caucasians’ use of self-monitoring in weight loss.

Review of the Literature: Previous studies demonstrated increased weight loss with dietary self-monitoring; however, these studies’ samples are 70-80% Caucasian women and cannot be generalized to African-Americans or men. Studies confirming the effectiveness of dietary intake self-monitoring in non-Caucasian women and men are needed.

Methodology: Using a cohort design with prospective and …

Educating Providers: A Pilot Study On The Impact Of Standard Days Method Education In Northern Haiti, Jennifer Quigley

DNP Projects

Preventing unintended pregnancy is a topic of global and domestic importance. In 2013, almost 290,000 maternal deaths occurred due to complications of pregnancy or child-birth; 99% of these deaths were in developing countries (World Health Organizations, 2014). Additionally, more than 4 million infants died before reaching their first birthday, a large number being attributed to multiple factors related to unhealthy timing of pregnancy (World Health Organization, 2012). The World Health Organization (2012) asserts the ability of women to adequately control the timing and spacing of pregnancy can dramatically decrease maternal mortality due to pregnancy complications and unsafe abortions, decrease infant …

Breastfeeding Intention Within A Rural Postpartum Population: Does Education Matter?, Brooke Hawkins

DNP Projects

Purpose: The purpose of this scholarly project was to determine breastfeeding intention in a rural population after receiving education from a certified lactation consultant.

Review of the Literature: The benefits of breastfeeding for both mother and child are clearly stated in the literature. Despite the known benefits, rates of breastfeeding are decreased within rural populations. Previous research suggests education about breastfeeding benefits is beneficial in increasing these rates. In particular, previous studies focused on the contributing factors affecting a mother’s decision to breast or formula feed. However, few studies were found strictly evaluating breastfeeding intention after receiving formal …

Public Access To Naloxone: Exploring Intention To Prescribe Among Tennessee Nurse Practitioners, Kathryn L. Dambrino

DNP Projects

Background

Drug overdose deaths have become an escalating epidemic in the U.S. and surpassed motor vehicle collisions as the leading cause of accidental death. To combat opioid overdose, naloxone distribution to the public has been initiated in some states as a harm reduction strategy. Naloxone has been used for many years among hospital professionals as a life-saving antidote to reverse the respiratory depression effects of opioids, and the FDA has approved take-home naloxone devices for layperson use. Though legislation has been introduced in many states, such as Tennessee, to allow provider prescription of naloxone to laypersons, minimal data have been …

Medication Adherence After Post Percutaneous Coronary Intervention: An Educational Intervention, Rebecca Shelton Thomas

DNP Projects

Purpose: The purpose of this evidenced-based education project was (i) assess current barriers and determining factors associated with medication adherence and how this coincides with health outcomes, (ii) assess whether medication adherence and hospital re-admission rates were improved with a comprehensive medication discharge educational plan.

Setting: The project took place on a 35 bed post interventional care unit (4IC) located in a 433 bed community care hospital in Central Kentucky.

Population: The population for this study was a sample of 10 acute myocardial infarction patients post percutaneous coronary intervention. Thirty percent of participants were female and 60% were male. Mean …

Patient Characteristics Associated With Inpatient Psychiatric Re-Admissions And The Utility Of The Readmit Clinical Risk Index, Autumn P. Roque

DNP Projects

In response to the problem of frequent 30 day re-admissions to inpatient psychiatric facilities, Vigod and colleagues (2015) developed the READMIT clinical risk index to identify risk factors for psychiatric inpatient re-admissions. The question addressed in this study was: Can the READMIT clinical risk index be used to identify patients that are at high risk for 30 day inpatient psychiatric re-admissions at Eastern State Hospital? This project used a descriptive retrospective design. Data were extracted from the discharge summaries of patients discharged from Eastern State Hospital between September 2013 and December 2014. Data collected included patient demographic variables (age, gender, …

Piloting An Intervention To Improve Continuity In Lung Cancer Patients, Stacy L. Richey

DNP Projects

Purpose: Kentuckians facing a lung cancer diagnosis are at greater risk for care fragmentation due to the complexities associated with the diagnosis, staging and treatment of the disease combined with multiple health disparities such as advanced age, multiple comorbid conditions, low socioeconomic status, geographic isolation, and low literacy levels. Transitioning from primary to specialist care can be especially difficult for these patients. The main purpose of this paper was to determine the feasibility and effect of a nurse-led, multidimensional intervention designed to improve relational (RC), informational (IC), and management continuity (MC) across the primary to secondary care interface, as well …

Impact Of Health Information Technology Patient Education With "Teach-Back" On Patient Satisfaction And Hospital Readmissions, Judi Dunn

DNP Projects

Background: With the advances in medical care, patients are being asked to manage more complicated self-care regimens, and there is often a gap between what the nurse teaches and what the patient understands. This can lead to re-hospitalizations that are burdensome for patients and are costly to the American healthcare system. The Department of Health and Human Services (DHHS) challenged healthcare organizations to leverage technology that engages patients in self-management support and encourages clinician use of patient-centered communication techniques, such as teach-back.

Purpose: The purpose of this project is to evaluate the use of health information technology along with an …

A Practice Improvement Project To Improve Knowledge And Perceptions Of Palliative Care Among Patients With Heart Failure And Cancer In The Acute Setting Using Video Enhanced Education, Crystal F. Spellman

DNP Projects

Background: Clear communication of the purpose and benefits of palliative care can reduce barriers to acceptance of such services for patients and families. The purpose of this practice improvement project was to assess and improve knowledge and perceptions of palliative care among patients with a diagnosis of heart failure and cancer in the acute setting using a video enhanced education intervention. Methods: This practice improvement project took place at a 555 bed teaching hospital. 18 patients referred to an inpatient palliative care consult service in the acute care setting with a diagnosis of either heart failure or cancer participated. …

Evaluation Of Central Line Insertion Bundle Practices In A Trauma/Surgical Intensive Care Unit, Margaret A. Moore

DNP Projects

Central venous catheters, also known as central lines, serve an essential role in critical care settings across the globe. However, these lines put patients at an increased risk for hospital-acquired infections in the form of central line-associated bloodstream infections (CLABSI). In an effort to prevent these infections, evidence-based nursing interventions in the form of insertion and maintenance bundle are undertaken. It is the focus of this practice inquiry project to evaluate nurse adherence to central line insertion bundles before and after implementation of routine reporting of adherence rates within an ICU. The evaluation will provide insight to the degree of …

Assessment Of Obesity Management In A Primary Care Setting, Katie Diffenderfer

DNP Projects

Purpose: The purpose of this study was to evaluate the current practices related to obesity in the primary care setting in University of Kentucky’s Healthcare System. The specific aims were to: 1) Determine the proportion of obese patients who had an ICD-9/10 diagnosis code for obesity, 2) Determine the proportion of obese patients who received interventions related to their obesity, 3) Determine whether obesity diagnosis and interventions varied based on patient demographics, and 4) Compare actual obesity interventions to those outlined in the clinical practice guidelines.

Methods: A retrospective chart review of male and female patients between the ages of …

Improving The Identification, Delivery Of Care, And Outcomes Of Hospital-Acquired Sepsis, Nicholas James Welker

DNP Projects

Sepsis syndromes that develop among a hospital inpatient population can be difficult to differentiate from other disease processes that share systemic inflammatory response syndromes. A bedside nurse-driven screening process was developed at Baptist Health Lexington to aid with early sepsis identification and foster prompt goal-directed therapy. This retrospective study of 26 patients identified over a 6 month period measures intensive care length of stay, mortality, and sepsis severity. Exclusion criteria were pregnancy and Do Not Resuscitate orders.

Screening compliance was poor at 23.1 percent (n=6). Complete compliance with goal directed therapy was 7.7 percent, though some components of therapy such …

Evaluating Provider Knowledge Of The Hpv Vaccine In Kentucky, Madeline A. Wilson

DNP Projects

According to the CDC, about 79 million Americans are currently infected with Human papillomavirus (HPV) with an additional 14 million infected annually, most of which are teenagers and young adults. Of these 14 million newly diagnosed cases, approximately 27,000 are diagnosed with a cancer caused by HPV. Kentucky’s HPV vaccination initiation and completion rates are below national estimates.

In 2013, Kentucky’s vaccine completion rate for girls age 13 to 17 was 26.8 percent compared to United States completion rate of 37.6 percent. Kentucky vaccine completion rate for boys age 13 to 17 was 19 percent compared to a United States …

Effect Of Enteral Feeding Timing In Septic Shock Patients, Shane D. Slone

DNP Projects

The goal of this research project was to identify the effect of the timing of enteral nutrition (EN) initiation timing on in-hospital mortality, ICU LOS and hospital LOS among patients with septic shock requiring norepinephrine. The study design was a cross-sectional analysis of retrospective electronic health record data. Patients who had received norepinephrine for septic shock were divided into early EN initiation (within 48 hours of ICU admission) and late EN initiation (Greater than or equal to 48 hours after ICU admission) groups. 680 subjects were included; 469 in the early group and 211 in the late group. Demographics, comorbidities, …

An Evaluation Of Childhood Overweight And Obesity Screening And Management In The Primary Care Setting, Stephanie Horning

DNP Projects

Background-In Kentucky, 19.7% of children ages 6-11 years old are obese ("Center for Disease Control and Prevention (CDC)," 2013). Approximately 50% of these children will become obese adults (Lazarou & Kouta, 2010). It is imperative that interventions are initiated to normalize weight in childhood to offset the long term physical and psychosocial risks associated with obesity.

Purpose-The purpose of this gap analysis was to evaluate the screening and management of childhood overweight and obesity in one of Norton’s healthcare primary care setting.

Methods-The electronic medical records of 35 children aged 10 to 11, who had BMIs > 85 …

Use Of High-Fidelity Simulation Training For New Cardiothoracic Intensive Care Unit Nurses, Bryan Boling

DNP Projects

Critical care nursing is one of the most challenging, high-stress fields in healthcare. This is especially true for nurses in the highly specialized environment of the cardiothoracic intensive care unit (CTICU). The experience level of nurses in critical care is positively linked with patient outcomes; however, with older nurses retiring or moving away from the bedside and younger nurses increasingly moving into advanced practice or management and leadership roles it is becoming more difficult to maintain a high degree of nursing experience in the ICU. Simulation training has been used to provide safe, effective training, and it is even possible …

Evaluation Of Nurses' Knowledge Of "Period Of Purple Crying" Program: Shaken Baby Syndrome Prevention, Cynthia L. Brubaker-Vincent

DNP Projects

Shaken baby syndrome (SBS) and pediatric abusive head trauma (PAHT) continue to be the leading cause of child abuse death and most common causes of mortality and morbidity due to the physical child abuse in the United States (Barr, 2014). According to the CDC of the nearly 2,000 children who die from abuse each year, PAHT and SBS are responsible for 10-12% of those fatalities (CDC, 2015). There are 1450-1700 cases of reported shaken injuries to infants and children reported in the United States each year (Barr, 2014). Shaken Baby Syndrome is 100% preventable through the proper education to our …

Evaluation Of Serum Vitamin D Levels In Older Adults Who Fall And Sustain A Fracture: A Retrospective Chart Review, Suzanne L. Pilon

DNP Projects

Purpose: This practice inquiry project was designed to (i) evaluate serum vitamin D levels in individuals aged 65 years and older who had fallen and sustained a fracture and (ii) identify if the serum vitamin D levels were within therapeutic range.

Background: Older adults are at increased risk of falling and sustaining a fracture as a result of falls. Vitamin D has been shown to be effective in fall prevention yet vitamin D is deficient in the older population worldwide. Evaluating current serum vitamin D levels in older adults who fall and sustain a fracture may provide additional insight in …

Assessment Of Blood Pressure Control In Patients Diagnosed With Hypertension In A Primary Care Setting, Lauren Prince

DNP Projects

Purpose: To evaluate provider adherence to the current hypertension management guideline, JNC 8, by assessing blood pressure control in individuals diagnosed with hypertension in an internal medicine clinic.

Methods: A retrospective chart review was conducted to assess the percentage of patients diagnosed with essential hypertension meeting the blood pressure goals set forth in JNC 8. In the absence of blood pressure control, provider intervention was assessed. Data collected included blood pressure, use of home blood pressure log, documentation of blood pressure medication compliance, and provider interventions in the absence of blood pressure control across three office visits. In addition, current …

Prediction Screening To Identify Heart Failure Patients At High Risk For Readmission, Kelly L. Taylor

DNP Projects

Background: There is an increased need to identify factors associated with higher risk for excessive HF re-hospitalizations due to hospitals receiving financial penalties related to these re-hospitalizations and poorer patient outcomes. Identifying HF patients at highest risk for re-hospitalization with a screening instrument upon admission to the hospital would allow for early implementation of interventions tailored around reducing risk factors for re-hospitalization.

Objectives: The specific aims of this study were to 1) identify characteristics that were predictive of HF re-hospitalization; and 2) use those characteristics to create a screening instrument.

Methods: A total of 158 patients (age=63±13; 50.6% female; 73.4% …

Outcomes Experienced By Patients Presenting With Ventral Hernias And Morbid Obesity In A Surgical Clinic, Margaret A. Plymale

DNP Projects

Surgeons generally agree that morbid obesity is a contraindication to ventral hernia repair surgery due to risk of adverse outcomes. The purpose of this study was to describe the experience of patients with ventral hernia complicated by morbid obesity by reviewing a population of patients that were seen by a surgical service to determine the characteristics of those patients that had favorable and unfavorable outcomes. A retrospective medical record review was conducted of new patients with ventral hernias and morbid obesity (body mass index (BMI ) ≥ 40 kg/m²) seen by one surgical service over a two and …

Compliance With The 2015 American Diabetes Association Screening Guidelines For Diabetes Mellitus Type 2 In Primary Care, Krista L. Johnson

DNP Projects

Purpose: The purpose of this project was to evaluate provider use of hemoglobin (HgA1c) measurement as a method of screening for Type Two Diabetes Mellitus (T2DM) per the 2015 American Diabetes Association screening guidelines in a multidisciplinary primary care clinic in Kentucky.

Methods: A retrospective electronic medical record review was conducted in a large ambulatory care clinic. A master list was compiled of all patients aged 45-89 years who were seen for any reason the first week of November 2015. A total of 127 records that met inclusion criteria were randomly selected. The proportion of patients who were appropriately screened …

A Study Of Provider Practices In The Screening, Diagnosis, And Treatment Of Childhood Overweight And Obesity In A Rural Eastern Kentucky Clinic, Ashley R. Healy

DNP Projects

Objectives: The purpose of this study is to assess the current practices of providers for overweight and obese children at well visits, and how the demographics of age, sex, race, ethnicity, primary language spoken, insurance type, and provider type influence the care provided to overweight and obese children at the study site, which is a rural primary care clinic in eastern Kentucky.

Methods: This study is a retrospective design auditing well child charts (n = 571) from the study site over a two year period. Charts were audited for the data points of age, sex, race, ethnicity, primary spoken language, …

The Effect Of Nurse Dose On Breastfeeding Exclusivity - A Patient Level Analysis, Gwen Moreland

DNP Projects

Background: Breastfeeding is strongly associated with health benefits for children and their mothers. Despite this knowledge, breastfeeding rates in the United States have increased only slightly. Current research examines the relationship between nurse characteristics and patient outcomes in adult intensive care and acute care settings. To date there is very limited research examining nurse variables and outcomes in women and children, and very little knowledge regarding the characteristics of the nurse in relation to patient’s breastfeeding success.

Purpose: The purpose of this practice inquiry project was to evaluate the relationship between the attributes of nurse dose and the immediacy and …