Nursing Commons^™

Mortality And Length Of Stay In Patients With Covid-19 On Ecmo: A Retrospective Before And After Quality Improvement Study, Chantal Branco

DNP Scholarly Projects

The use of extracorporeal membrane oxygenation as a supportive modality for patients with COVID-19 pneumonia emerged as the gold standard of care for those who do not respond to traditional therapies. The primary aim of this 10-month, quantitative, retrospective, quality improvement project was to identify if V-V ECMO treatment guidelines, implemented in the treatment of COVID-19 pneumonia, led to decreased mortality rates and lengths of stay. A total of 27 patients met inclusion criteria during queried time frames (n = 14 in Wave 1 and n = 13 in Wave 2). Data collected demonstrated no significant difference (p = .385) …

Development Of A Resilience Program To Combat Burnout In Nursing Practice, Maggie Lynch

DNP Scholarly Projects

Burnout has been identified as a national health crisis, with implications for the retention and health of critical healthcare workers. Acknowledging the innate stressors of providing healthcare it is the responsibility of leaders in the industry to mitigate burnout to sustain the workforce critical to healthcare in the United States. Understanding resilience and how to foster it in nurses will contribute to burnout prevention and consequently improve the quality of health care provided Americans. Resilience training has been identified as a valuable approach to retention of the workforce. This scholarly project developed a resilience training program for newly licensed registered …

Evaluating Advanced Nurse Clinicians’ Readiness To Use Augmented Reality For Delivery Of Simulated Teaching Sessions, Kelly Carbone

DNP Scholarly Projects

Background

Since the start of the COVID-19 pandemic, nurses have adapted numerous new processes and procedures. Keeping patients safe is dependent on the education and experience of providers caring for them. By utilizing the capabilities of augmented reality (AR), clinical nurse educators (CNEs)/advanced nurse clinicians (ANCs) can provide real-time learning while providing feedback to nurses during simulated instructional experiences. AR instructional methods hold promise for educators due to staff shortages, time constraints, and inadequate facility space for in-person teaching sessions.

Purpose

The purpose of this doctoral project was to evaluate the ANCs readiness to adopt new AR technology, the Microsoft …

Effectiveness Of An Instructional Program On Decreasing Fall Incidents In Geriatric Patients With Psychiatric Disorders, Maurice Washington

DNP Scholarly Projects

Falls occur in 25% of older adults, resulting in over 8 million fatal and nonfatal injuries. In addition to the human suffering, associated medical and legal costs amount to over 50 billion dollars a year. This study examines the impact on fall rates of an evidence-based fall prevention program provided to a multidisciplinary staff on a psycho geriatric unit in Philadelphia, Pennsylvania. Staff knowledge of effective fall prevention interventions was measured before and after their participation in an evidence-based instructional workshop provided by the Project Director using the Falls Prevention Knowledge Test by Dykes et al. (2019). While there were …

Effect Of A Community Hospital’S Sustainable And Enhanced Fall Prevention Quality Improvement Program On Inpatient Falls And Falls With Injury: A Before And After Study, Anne Catino

DNP Scholarly Projects

The frequency of hospital falls is a significant clinical problem and directly related to patient safety. Failure to identify potential risk factors and to implement individualized measures for fall prevention can threaten patients’ safety and lead to increased hospital length of stay, increased hospital cost, and reduced quality of life for patients. The purpose of this project was to enhance an evidence-based, fall prevention program to effect a reduction in falls and falls injury. The project is supported by a multidisciplinary hospital team and builds on a community hospital’s fall reduction program. Falls and falls with injury frequencies for 6 …

An Evidence-Based Teaching Plan For Preventing Wrong-Site Block Placement During Regional Anesthesia, Mark A. Michetti, Kristen E. Newbrough

DNP Scholarly Projects

Wrong-site regional anesthetic block placement is a threat to patient safety and quality perioperative care. The adverse outcomes for patients, providers, and institutions demonstrate safety risks that are linked to inconsistent use of comprehensive guidelines in clinical practice. The purpose of this Doctor of Nursing Practice Project is to create a comprehensive evidence-based Teaching Plan for preventing wrong-site block (WSB) placement during regional anesthetic induction and for use in institutions by anesthesia providers to prevent wrong-site anesthetic block placement. The teaching plan focuses on four main constructs to prevent WSBs, which include the incidence of WSBs, the consequences of WSBs, …

Cognitive Aid For Anesthesia Providers Caring For Lactating Mothers, Danielle Pantella, Dana Lawrence

DNP Scholarly Projects

Evidence on the transfer of medications into breastmilk during the administration of anesthesia and sedation medications may not be well known by anesthesia providers. As they teach lactating mothers, anesthesia clinicians may not be comfortable explaining details about breastfeeding, such as the effects of anesthesia on breast milk and when mothers can safely resume breastfeeding. Lack of provider knowledge may be a safety threat that can be decreased by an evidence-based cognitive aid. The purpose of this patient safety project is to develop a cognitive aid that includes anesthetic agents and knowledge components to structure the provision of care to …

An Evidence-Based Teaching Plan For Anesthesia Providers On Intraoperative Blood Glucose Monitoring In Diabetic Patients Undergoing Noncardiac Surgery, Brian Sabec, Christopher Mcmichael

DNP Scholarly Projects

As the incidence of diabetes continues to rise both locally and nationally, anesthesia providers must be prepared to manage diabetic patients intraoperatively during the administration of anesthesia. Literature suggests that blood glucose levels are not adequately monitored in the operating room, potentially contributing to many postoperative complications. Therefore, this doctoral project aims to develop an evidence-based teaching plan for monitoring intraoperative glucose levels in the diabetic patient population to enhance anesthesia provider knowledge.

Evidence-Based Interprofessional Education For The Labor And Delivery Team On Nitrous Oxide Anesthesia For Laboring Mothers, Amanda Rota, Jessica Stoffey

DNP Scholarly Projects

Pain management in the laboring patient continues to arise with challenges of safety, efficacy and comfort. Nitrous oxide is an option for managing laboring women’s pain. However, the lack of education for perinatal teams across the United States regarding nitrous oxide administration in the labor patients omits a successful pain management option. The purpose of this Doctor of Nursing Practice project is to create an evidence-and theoretically-based education module for the labor and delivery team, incorporating an instructional video to build knowledge on the use of nitrous oxide in the laboring mother.

Performance Improvement Project Implementing Rapid Cycle Deliberate Practice Simulation To Improve Team Performance During Administration Of Moderate Sedation By Non-Anesthesia Providers In The Interventional Platform, John Kost, Matthew Snyder

DNP Scholarly Projects

A steady increase in procedures in interventional platforms has required the administration of moderate sedation and analgesia by non-anesthesia providers. Of concern is managing the delicate balance between different levels of sedation on a continuum to ensure safe and effective care. Moderate sedation achieves suppression of consciousness while maintaining a patent airway and intrinsic respiratory drive compared to deep sedation where airway patency and respiratory function can be compromised. Administration of moderate sedation by non-anesthesia providers in interventional platforms leads to a higher rate of procedural complications. Rapid Cycle Deliberate Practice (RCDP) simulation will be utilized to educate non-anesthesia providers …

An Evidence-Based Teaching Plan For Anesthesia Providers On The Patient Safety Aspects And Pharmacoeconomic Advantages Associated With Sugammadex Use, Amanda Cruz, Courtney Keil

DNP Scholarly Projects

Anesthesia providers are often required to administer neuromuscular blockade during surgical procedures to optimize both surgical conditions and allow for mechanical ventilation. Reversal of neuromuscular blockade at the conclusion of surgery assists anesthesia providers in preventing adverse events and optimizing patient safety. Current literature supports the use of sugammadex as the safest neuromuscular blockade reversal agent in many cases, but also shows a lack of provider education regarding its use. The hesitancy of anesthesia providers and medical institutions to utilize sugammadex as a standard of care despite evidence-based literature supporting its regular use implies that there is either a knowledge …

An Evidence-Based Teaching Plan For An Anesthesia Crisis Resource Management Simulation Targeting Malignant Hyperthermia, Jacqueline Dowe, Michael Reynaltti

DNP Scholarly Projects

Most medical errors in health care are preventable and result from lack of communication and teamwork among health care workers. Despite health care providers’ training on preventing medical errors and managing medical crises, patient care services may be compromised and result in patient harm when teamwork and communication decrease among clinicians. Anesthesia Crisis Resource Management (ACRM) was designed to help anesthesia providers effectively manage crises by working in multidisciplinary teams to improve and develop both teamwork and technical skills. The purpose of the Doctor of Nursing Practice project is to design an evidence-based teaching plan for a ACRM simulation targeting …

Differences In Anxiety In New-To-Practice Traditional And Non-Traditional Registered Nurses In Clinical Practice, Sharon Mingo

DNP Scholarly Projects

New-to-practice RNs experience anxiety during licensure preparation and orientation. Such anxiety is anticipated to linger for approximately 6 months as the RN transitions to practice and adapts to professional nursing. Many new-to-practice RNs report feelings of anxiety. Their anxiety can negatively affect the quality and safety of nursing care and increase nurse turnover. Unfortunately, the literature on anxiety in traditional post-licensure in new-to-practice RNs in clinical practice lacks information on non-traditional post-licensure new-to-practice RNs' experiences when starting professional practice roles in health care settings. This descriptive comparative study compares differences in anxiety in new-to-practice RNs of traditional and non-traditional Bachelor …

Development Of An Evidence-Based Process For Implementing Stanford Cognitive Aids In Offsite Anesthesia Practice Facilities, Christopher Delaney, Jennalise Eiswerth

DNP Scholarly Projects

Failure to rescue patients during medical emergencies often results in significant morbidity and mortality outcomes in outpatient surgical settings. The purpose of this Doctor of Nursing Practice project is to develop an implementation process with the Stanford Anesthesia Cognitive Aid manual (Stanford Anesthesia Cognitive Aid Group) for perioperative critical events in outpatient surgical sites to increase emergency preparedness for the surgical team, including anesthesia and other direct care providers. An educational intervention will be used for the surgical team, including anesthesia and other direct care providers, at outpatient surgical sites on utilization of the Stanford Anesthesia Cognitive Aid manual (Stanford …

Evidence-Based Educational Modules On Applying The Aana Infection Control Guidelines, Rachel Bassett, Keli Costa

DNP Scholarly Projects

Inadequate hand hygiene and contamination of the anesthesia workstation have resulted in pathogen transmission and subsequent healthcare-associated infections. This clinical problem poses a significant safety threat as healthcare-associated infections are one of the leading causes of preventable patient harm and death. Research literature and the American Association of Nurse Anesthetists illustrate the need for universal infection prevention precautions and standardized anesthesia workstation cleaning practices to decrease workstation contamination and healthcare-associated infections. The purpose of this project will be to create a teaching plan based on research literature and the American Association of Nurse Anesthetists infection prevention and control guidelines to …

Development Of An Evidence-Based Teaching Module Using Educational Videos For The Novice Crna Simulation Educators, Alexis Bishop, Ashley Frugoli

DNP Scholarly Projects

Research has emphasized the benefits of incorporating a well-structured pre-brief and debrief into a simulation learning experience. Current themes in the literature suggest a lack of resources offered to simulation instructors, resulting in inconsistent pre-briefing and debriefing approaches amongst instructors. Ultimately, the learner suffers, compromising the knowledge and skills taken into the clinical setting. The primary purpose of this Doctor of Nursing Practice (DNP) project was to create an educational intervention for novice certified registered nurse anesthetists (CRNA) who are new to being a simulation educator. The intervention will utilize a self-paced teaching module with embedded videos and active learning …

Evidence-Based Educational Modules On The Safe Delivery Of Anesthesia In Mri Suites, Mandy Cesco-Cancian, Taylor Crofoot

DNP Scholarly Projects

Few citations were located on the formal education on MRI patient safety for anesthesia providers administering anesthesia services in MRI suites. Consequently, patients and staff may be at risk for injury or death during MRI procedures and health care institutions can be threatened with financial loss secondary to legal exposure, equipment damage and resultant morbidity and mortality associated with MRI patient safety events. This doctoral project will create three evidence-based continuing education modules to educate anesthesia providers on the operation of the MRI unit, potential MRI associated risks and complications, and specific anesthesia considerations for providers assigned to the MRI …

An Evidence-Based Teaching Plan To Increase Awareness Of Certified Registered Nurse Anesthetists To Patient Safety Threats Due To Provider Fatigue And To Offer Effective Strategies To Mitigate Fatigue, Tieneasha Hines, Lisa Alexander

DNP Scholarly Projects

The mental, physical, and emotional effects of stress and fatigue pose significant patient safety risks resulting from impaired concentration, coordination, and overall productivity in certified registered nurse anesthetists. Fatigue is commonly experienced by nurse anesthetists. Fatigue is an occupational hazard that affects not only nurse anesthetists but also patients, colleagues, and other healthcare stakeholders. Certified registered nurse anesthetists are most affected by fatigue due to the prolonged duration of extensive patient monitoring during surgical and complex medical procedures. Due to their central role in ensuring patient safety and comfort during surgery and other procedures requiring anesthesia, certified registered nurse anesthetists …

Quality Of Care Improvement: A Process To Standardize Handoff Communication Between Anesthesia Providers And Post-Anesthesia Care Unit Nurses, Maria Chernyak, Courtney Posten

DNP Scholarly Projects

Introduction: Transition of care is the process in which sending provider teams and receiving provider teams release the care of the patient from one provider team to the next utilizing a communication process. Review of the literature has identified several different protocols in place to systematize communication among providers, however, there is no standardized instrument or process that encompasses the post-anesthesia transfer of care process. Our project goal is to develop a standardized evidence-based handoff communication instrument to be utilized during the transition of care process between anesthesia care teams to the post-anesthesia care (PACU) teams to improve quality of …

Educational Modules On Pediatric Cardiac Care For Host Nurse Training During Surgical Mission Trips: A Quality Improvement Project, Maria Arlene Gapac Lemin

DNP Scholarly Projects

Numerous health care organizations conduct international surgical mission trips to treat pediatric patients with congenital cardiac disorders in countries unable to provide complex surgical interventions locally without support. This doctoral student’s experience on numerous mission trips provided the opportunity to evaluate the expertise of circulating and scrub nurses in host countries. Based on this assessment, a knowledge and skill gap was identified and suggested that an educational intervention might benefit host nurses. The purpose of this doctoral project was to develop evidence- and theoretically-based educational modules for local nurses to improve perioperative nursing practice in meeting the needs of their …

Early Intervention Referral Process Improvement In Primary Care Pediatrics: An Evidence-Based Algorithm, Katherine G Mcmahon Thompson

DNP Scholarly Projects

Early Intervention programs provide evidence-based services to children with developmental delay from 0 to 3 years of age. Many children eligible for Early Intervention programs are not successfully referred to services provided by health care professionals for evaluations. The purpose of this doctoral project is to describe the evidence-based steps in a referral algorithm for early intervention evaluation to increase referrals by primary care health care providers and to increase evaluation rates of referred children. A draft algorithm was based on content analysis of empirical and theoretical literature. Experts in early intervention primary care services reviewed the draft algorithm, rank …

Educational Plan For Certified Nursing Assistants In Long-Term Care Facilities On Assessing Pain Of Residents With Dementia, Rachel Lynn Spoon

DNP Scholarly Projects

Certified nursing assistants employed in long-term care agencies may have little education on the assessment of pain experienced by residents with dementia. The purpose of the Doctor of Nursing Practice Project was to develop an evidenced-based teaching plan for certified nursing assistants caring for residents with dementia in long-term care settings. The plan includes content on dementia, dementia symptoms, pain indicators, and pain assessment in residents with dementia, non-medicinal management strategies, and communication strategies for referring assessment findings to licensed practical and registered nurses. Supplemental PowerPoint™ slides were developed that match the teaching plan. The draft teaching plan was judged …

An Evidence-Based Questionnaire To Assess Influenza Vaccine Adherence In Young Adults Ages 19 To 25 Years, Tricia A. Gill

DNP Scholarly Projects

Young adults ages 19 to 25 years in the United States are at increased risk for influenza because their annual flu shot adherence is the lowest out of all age groups. Their non-adherence and increased potential for illness have a very great impact on contacts, including family, friends, coworkers, their children, and people in the community. The purpose of this Doctor of Nursing Practice Project is to create an evidence- and theoretically-based questionnaire aimed at assessing flu vaccine adherence in young adults ages 19 to 25 years in a primary care practice with the future objective of reducing the overall …

Evidence-Based Trigger Videos Related To Distractions And Safety Threats To Anesthesia Care In The Operating Room, Alexandra Kendall, Dominique Sturdivant, Lynne Miller

DNP Scholarly Projects

Intraoperative distractions are considered exceedingly detrimental to the quality of anesthesia care. Distractions in the operating room (OR) cause an array of negative effects for healthcare providers and can represent major patient safety risks. At this time, there is no formal training for anesthesia providers targeting the impact of distractions or educating providers about the risks to their patients.

The primary aim of this project was to develop four trigger videos that will be utilized in future research to increase anesthesia providers’ awareness of the threats to patient care and quality of care that result from disruptions secondary to distractions. …

Improving Medication Education On An Infectious Disease Unit For Hospitalized Patients At Discharge: A Quality Improvement Project, Kristin L. Pilong

DNP Scholarly Projects

Medication education by nurses during patients’ hospital stay is an important component of patient care. Nurses’ knowledge of specific medications and the resources that support teaching patients about medications may play a key role in increasing their satisfaction with the hospitalization experience. This quality improvement doctoral project created and validated evidenced-based cognitive aids for nurses to support this process. The project is part of a quality improvement initiative at a hospital in South Jersey to create and validate cognitive aids for 5 high frequency medications prescribed for patients prior to discharge from the hospital The cognitive aids focused on three …

Educational Process Improvement Program For Novice Anesthesia Providers Learning Safe Management Of The Anesthesia Workstation, Robert M. Vitale, James Mahon

DNP Scholarly Projects

Patient safety is at the cornerstone of the delivery of quality anesthesia. A historically pervasive patient safety threat related to the field of anesthesia has been the anesthesia workstation. Although anesthesia delivery improvements are based on refining physical engineering principles, they are also based on preventing human error. This DNP project uses an educational process improvement design to generate an evidence-based simulation educational activity for novice anesthesia providers to better prepare themselves for the reality of anesthesia workstation malfunction and human error.

The Creation Of An Evidence-Based Educational Intervention For Preceptor Development Of The Novice Certified Registered Nurse Anesthetist, Kathleen Yoka, Nathalie Anderson

DNP Scholarly Projects

Novice certified registered nurse anesthetists (CRNA) are responsible for precepting student registered nurse anesthetists (SRNA) while simultaneously caring for patients in the operating room (OR). SRNAs rely on CRNAs for the majority of clinical training by preceptorship. Well-defined best precepting practices do not exist. The ability to teach others is a learned skill, and the lack of such skill can lead to undue stress for both the novice CRNA and the SRNA. This may lead to reduced job satisfaction of the CRNA and diminished educational experience of the SRNA. The primary purpose of this Doctor of Nursing Practice (DNP) project …

Perioperative Protocol To Prevent Emergence Delirium In Patients With Post-Traumatic Stress Disorder, Audrianna Bustos, Roxanne Sambuca

DNP Scholarly Projects

Introduction: Ten percent of adults will experience post-traumatic stress disorder (PTSD) at some point during their lifetime, 50% of which remain untreated and undiagnosed. Perioperative management of the patient with PTSD may create significant challenges for the anesthesia provider. Patients with PTSD are more likely to experience emergence delirium (ED), which poses a significant safety threat to patients and staff. Screening for PTSD is routine in the veteran population but has not yet translated into common practice. To our knowledge, no protocol currently exists for anesthetic management of patients with PTSD. Routine screening for PTSD in the preoperative period and …

An Evidence-Based Teaching Plan For Novice Certified Registered Nurse Anesthetists On Medication Shortage Safety Threats And Management, Daniel Worley, Beata Zimmerman

DNP Scholarly Projects

Shortages of anesthesia medications pose significant risks to patient safety. Despite this, no standardized educational program was located to regularly update practicing anesthesia providers nor was this topic identified by the Council on Accreditation of Nurse Anesthesia Educational Programs as a requirement for nurse anesthesia training programs. The purpose of this project was to develop an evidence-based Teaching Plan for novice certified registered nurse anesthetists. A directed content analysis identified key themes from relevant literature. Themes included counts and patterns of medication shortages, lack of alternatives, impact on patient safety, professional concerns related to changes in practice, quality concerns, characteristics, …

Multimodal Analgesia: Educating Postoperative Nursing, Ira Woodruff, James Keenan

DNP Scholarly Projects

Abstract

Background: Although anesthesia professionals are familiar with this multimodal analgesia, a need remains in educating nurses who will take care of the patients postoperatively so that multimodal techniques may be continued while minimizing opioid use.

Purpose: The purpose of this scholarly doctorate of nursing practice (DNP) project is to validate components of an educational program detailing multimodal analgesia so that postoperatively, nurses may continue to utilize similar techniques for patients to minimize opioid exposure.

Design: A quality improvement project using cross sectional data collection with a focus on provider education was conducted.

Instrumentation: Survey quantitative …