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 …

Defining Success In Patient Care Technician Development, Ferrol A. Thomas

DNP Scholarly Projects

The national nursing shortage has created a need for unique staffing models in healthcare organizations that incorporate unlicensed assistive personnel such as, patient care technicians (PCT). As part of the healthcare team, PCTs provide support to registered nurses contributing to positive patient outcomes. Recruitment and training for PCTs is successful in workforce development programs through employer academic partnership programs. The Success Case Method (SCM) was used to evaluate a local workforce development program for PCT at Nashville State Community College. Participants were evaluated to gain demographic data (n=25) and qualitative interviews (n=6) to provide insight about what made the program …

Implementation Of A Rounding Tool To Promote Compliance With Central Line Dressing Changes In An Adult Intensive Care Unit, Fabiola Demuth

DNP Scholarly Projects

Abstract

Evidence supports implementing central line (CL) maintenance bundles and nurse-led rounding interventions to prevent central line-associated bloodstream infections (CLABSIs). In a Tennessee intensive care unit (ICU), increased CLABSI rates were associated with inconsistent CL dressing maintenance and documentation. This Doctor of Nursing Practice scholarly project was implemented to improve ICU CLABSI rates and reinforce nursing standard practices for CL dressing care. This quality improvement project used the Institute for Healthcare Improvement (IHI) model for improvement, which used the plan, do, study, act (PDSA) cycles as part of the framework to implement a daily nurse-led rounding tool in the ICU, …

Increasing Colorectal Cancer Screening Uptake Among Hispanic/Latino Patients: A Quality Improvement Initiative, Erick Hernandez Campos, Elizabeth Morse, David Phillippi

DNP Scholarly Projects

Background: In 2021, cancer (CRC) screening rates for Latino men (42%) and women (47.5%) remain well below the Health People 2020 target (70.5%). Extensive documentation of barriers for screening include language, insurance status, and other sociocultural barriers which contribute to delays in diagnosis and/or diagnosis at advanced stages of the disease, and worse health outcomes. Latinos need culturally and linguistically appropriate health promotion interventions aimed to increase CRC screening rates with any modality (FIT, Cologuard, or Colonoscopy).

Methods: The Donabedian Structure-Process-Outcome (S-P-O) Model for quality improvement was used to develop and target a provider-driven, language-concordant communication interventions for …

Learn, Reflect, Practice, Discuss: A Professional Development Pilot For Clinical Nurse Educators, Jessica Savage, Linda Wofford Dr., David Phillippi Dr.

DNP Scholarly Projects

Abstract

AIM: The aim of this project was to assess the effect of a professional development pilot on the self-efficacy among clinical nurse educators toward evaluation and assessment of students in the clinical setting.

BACKGROUND: Nursing schools employ clinical nurse faculty with varied levels of experience and formal education in teaching. Positive student outcomes are dependent on the competency of their nursing faculty, yet best practices to train and support the professional growth of clinical faculty have not yet been identified.

METHOD: A multi-modal professional development pilot including online-learning modules, self-reflection, practice-learning, and peer-mentoring components was designed and implemented with …

Women's Stories Of Reaching A Diagnosis Of Endometriosis: A Qualitative Study, Susan C. Debolt

DNP Scholarly Projects

Endometriosis is a chronic gynecological condition affecting 10% of reproductive-aged women worldwide. Women with endometriosis often experience a decreased quality of life compared to women without endometriosis. The average time to diagnosis is greater than six years for adult women and greater than 11 years for adolescents. Yet, there is little research investigating the pre-diagnostic experiences of women with endometriosis. This study aims to inform healthcare providers of patients' pre-diagnostic experiences of endometriosis in an effort to improve patient care. Using one-on-one, semi-structured online interviews and a qualitative design, this study explored six women's pre-diagnostic experiences of endometriosis. The main …

Culturally Sensitive Emergency Care For Sexual And Gender Minority Youth, Kaysi Goodall

DNP Scholarly Projects

There is substantial evidence of disparities in access to healthcare and health outcomes affecting sexual and gender minority youth (SGMY). However, evidence of SGMY cultural sensitivity training for pediatric emergency health professionals is limited. This quality improvement research project in an urban pediatric emergency department (PED) used a cross-sectional, pre-test post-test design to improve health professionals’ knowledge, attitudinal awareness, and clinical preparedness in caring for this population. It was informed by the Institute for Healthcare Improvement’s Model for Improvement and completed in four Plan-Do-Study-Act (PDSA) cycles. Evidence-based pedagogical strategies were utilized for a 60-minute staff training session, including introducing foundational …

Exploring Factors Influencing Nursing Engagement In 4ms Initiatives On An Inpatient Older Adult Unit, Sarah Nelson

DNP Scholarly Projects

Background: The older adult population is growing, and these individuals often have health challenges that require complex nursing care. On an older adult unit in Tennessee, a 4Ms (What Matters, Medication, Mentation, and Mobility) Age-Friendly care initiative was implemented to improve care and outcomes. Early data showed inconsistent nursing engagement with 4Ms initiatives and qualitative data on engagement factors was needed to increase nursing support and improve patient outcomes. Purpose: Therefore, this scholarly project explored factors influencing nursing staff engagement with the 4Ms initiative on an older adult unit. Methods: Nurses and …

Early Progressive Mobility In The Micu: A Qi Project, Kenneth Johnson

DNP Scholarly Projects

Abstract

Background: Immobility causes grave harm to ICU patients. There is not a body system that bedrest does not affect negatively. The MICU has an early mobility protocol; however, patients are often left in bed, PT/OT is underutilized, and nurses are unfamiliar with the current early mobility protocol.

Methods: The Plan Do Study Act quality improvement method was used for this project which ran from September 1 to November 30, 2022, and involved the MICU RN staff. This QI project evaluated the current early mobility protocol, assessed barriers, determined the nurse’s perceptions, and offered recommendations for sustainability.

Intervention: The project …

Impact Of Teamstepps On Team Performance In An Oral And Maxillofacial Surgery Practice, Katherine E. Lee

DNP Scholarly Projects

Effective communication and teamwork skills among oral and maxillofacial surgery (OMS) teams are essential for quality and safe patient care. As some in the profession assert that the team model for delivering anesthesia care is integral to their history of safety, the model continues to be scrutinized by professional groups whose members seek to limit oral surgeons’ ability to provide anesthesia services in the office setting. This quality improvement project assessed how introducing the TeamSTEPPS Office-Based Care (OBC) program in an OMS clinic impacted team dynamics. The impact of TeamSTEPPS OBC training on attitudes and perceptions of teamwork was evaluated …

Exploring Hapi Incidence In Patients Admitted Through The Ed: A Quality Improvement Initiative, Alexa L. Tietgens

DNP Scholarly Projects

Each year in the U.S., pressure injuries, or PIs, are responsible for more than 60,000 patient deaths and billions of dollars’ worth of treatment costs. Research shows that roughly 95% of all PIs are preventable by following evidence-based practice guidelines which include early identification of patients at risk, frequent skin assessments, and implementation of prevention strategies. However, the ED environment creates unique risks for PI development due to the routine use of hard surfaces (i.e., stretchers, backboards, exam tables) and frequent hospital overcrowding. Although nurses play a pivotal role in PI prevention, frequent staffing shortages, high patient acuity levels, and …

Perceptions Of Preparedness Among New Graduate Nurses: Traditional Curriculum Versus Concept-Based Curriculum, Ashley A. Wheeler, Steven Busby, David Phillippi, Tammy Legge

DNP Scholarly Projects

Concept-based curriculum (CBC) is a newer trend in nursing education curriculum aimed at preparing new graduates to enter the workforce as generalist nurses better suited to care for a more medically complex population. Using CBC, students are introduced to concepts in order to build conceptual understandings as they engage in knowledge and skill learning, as opposed to a traditional nursing curriculum that is taught in sections grouped by patient population and medical complexity. At a nursing school housed within a private university in the southeast, the traditional nursing curriculum was replaced with CBC in 2016. To better understand the preparedness …

Implementation Of Point-Of-Care Tick-Borne Disease Powerplan™ And Algorithm For Early Detection And Treatment Of Tick-Borne Diseases, Ashley Pinkham

DNP Scholarly Projects

Abstract

Local Problem: The Concord Hospital system, serving 30+ communities, is situated in the heart of New Hampshire surrounded by densely wooded forests, lakes, and mountains and is a mecca for camping, vacationing, and sightseeing, doubling its population of 1.6 million residents during spring, summer, and fall months. Despite the serenity, there is a predator that lingers among the hiking trails and lake shorelines. From January 2021 through August 2022 there were a total of 41 hospitalizations from tick-borne diseases, some with life threatening symptoms. Unfortunately, nearly half (43%) of patients presented to their primary care provider first where the …

Implementation Of Virtual Reality For The Laboring Patient: A Quality Improvement Project, Chantal Cole

DNP Scholarly Projects

BACKGROUND: Having a baby can be one of the most challenging and painful experiences a woman has in their lifetime. Being able to choose between a variety of pharmacological and non-pharmacological pain-control methods is important to improve the patient experience and outcomes. This quality improvement project aimed to introduce a virtual reality device into the labor and delivery setting as a non-pharmacological pain control method. The goal was to decrease pain and anxiety levels, decrease the rate of epidural anesthesia use, and decrease the length of time epidural anesthesia medication was running before delivery.

METHODS: The four key components of …