Nursing Commons^™

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 …

A Quality Improvement Initiative: Addressing Workplace Violence Toward Nurses To Promote A Culture Of Safety In An Inpatient Psychiatric Facility, Ernestina Danso

DNP Scholarly Projects

This quality improvement initiative aimed to address workplace violence against nurses in inpatient psychiatric facilities and promote a culture of safety. The QI project involved 27 participants, including inpatient psychiatric nurses and mental health counselors from Cahill 4 and 7 West units at the Cambridge Campus. The primary objective was to identify challenges that hindered the effective utilization of the Broset Violence Checklist (BVC) tool for referring patients to sensory modulation rooms.

Pre- and post-intervention surveys were conducted to assess participants' self-reported knowledge and barriers to BVC and sensory room utilization. Educational sessions covering workplace violence, debriefing techniques, and the …

Improving Patient Access To Gastroenterology Through A Nurse-Practitioner-Led Clinic: A Quality Improvement Project, Kayla Northam

DNP Scholarly Projects

The United States has a critical healthcare access issue for gastroenterology patients. Delays in treatment can lead to expensive complications, including emergency room visits, hospitalization, and surgery. Creating a rapid-access clinic (RAC) for gastroenterology so that patients can obtain a quick and efficient evaluation of their symptoms in a shorter appointment time can help decrease the delay in care and generate more revenue for the hospital. Over 8 weeks in 2023, Dartmouth Hitchcock Medical Center Department of Gastroenterology used a telemedicine-only RAC to see patients for 20 minutes rather than the traditional 60-minute period. As a result, the RAC saw …

Facilitating Palliative Care In A Critical Access Hospital System: Implementation Of Screening And Educational Interventions, Michele Lovell

DNP Scholarly Projects

BACKGROUND: The United States health care system faces the dual challenge of an aging population with a concomitant increase in the presence of chronic and serious illness, the care of which accounts for the nation’s largest expenditure of burgeoning healthcare costs. Palliative care is specialized care for people with serious illness aimed at reducing suffering, optimizing quality of life, and enhancing medical decision making. An ample evidence base demonstrates that palliative care increases both quality of care and patient and family satisfaction while also reducing associated costs. The aim of this quality improvement project was to facilitate palliative care services …

Decreasing Post-Operative Ventilator Time In The Cardiovascular Surgical Patient: A Nursing Education Quality Initiative, Amanda J. Bruno Roberts

DNP Scholarly Projects

Extended mechanical ventilation times after open heart surgery can contribute to complications prolonging recovery and length of stay, as well as increasing mortality. Standardized staff education of immediate post-open-heart recovery and ventilator weaning protocols, combined with the use of ABCDE and VAP bundles can reduce these complications. At Hospital X during summer of 2022, the average length of time patients remained mechanically ventilated after open heart surgery increased. After an initial needs survey was distributed to nursing staff, a set of novel QR codes was created to simplify and centralize training for staff in the ICU to facilitate early extubation …

A Comparison Of Outcomes For Lipid Emulsions In Total Parenteral Nutrition Among Home Infusion Patients, Gregory W. Wesley-Lynch

DNP Scholarly Projects

This quality improvement project aimed to compare the outcomes of lipid emulsions used in total parenteral nutrition among home infusion patients. The quality improvement project included 45 patients who received four weeks or more of either Intralipid or SMOFlipid. Paired t-tests were used to compare SMOFlipid and Intralipid regarding three liver function test (LFTs) values; (Alkaline Phosphate (ALP), Aspartate transaminase (AST,) and Alanine transaminase (ALT). Results demonstrated that SMOFlipid was superior to Intralipid, resulting in lower LFTs for ALP, AST, and ALT. This study provides evidence to support the use of SMOFlipid over Intralipid in total parenteral nutrition for home …

Utilizing Outpatient Telehealth As A Treatment Approach For Patients With Substance Use Disorder: A Quality Improvement Project, Veronica Kwegyir-Afful

DNP Scholarly Projects

Background: The issue of substance use disorder (SUD) has demonstrated a growing prevalence both in the United States (U.S.) and globally. Effective treatment modalities have been devised for individuals afflicted by SUD, thereby enabling their post-treatment prognosis to be parallel to that of patients with other chronic diseases, such as diabetes. However, several factors or barriers impede individuals with SUD from assessing treatment. These barriers encompass financial constraints stemming from inadequate insurance coverage and high cost, the stigma surrounding SUD, which results in patient's hesitancy to seek treatment treat, adverse societal attitudes, collateral social percussions like work hour losses and …

Increasing Access And Adherence To Cognitive Behavioral Therapy For Insomnia (Cbti) For Adults: A Quality Improvement Project, Kristen Newell

DNP Scholarly Projects

BACKGROUND: Insomnia is a sleep disorder that is becoming more prevalent. It can significantly impact a person's quality of life and it contributes to a substantial economic financial burden. Cognitive behavioral therapy for insomnia (CBTi) is the primary treatment for insomnia, but patients are rarely referred for this treatment. This quality improvement project focused on implementing motivational interviewing to increase patient utilization of CBTi. It also encouraged utilization of CBTi Coach, a free phone application that has all of the CBTi components, a rigid sleep behavioral plan and frequent follow-up appointments to improve sleep quantity and quality.

INTERVENTION: Patients that …

A Quality Improvement Initiative To Improve Access And Patient Flow In A Non-Emergency Walk-In Care Clinic, Renee J. Broze

DNP Scholarly Projects

Background: A community-based non-emergency walk-in clinic in Southern New Hampshire experienced high volume and inefficient workflows during the pandemic, causing delays in care, long visit times, and low net promoter scores.

Purpose: Institute an evidence-based approach to improve work efficiency through innovative models of care.

Methods: A literature review on best practices for workflow redesign guided the project. The project instituted an on-demand telemedicine service and a clinic fast-track workflow. A mixed methods approach analyzed pre /post cycle times, net promoter scores, and themes from staff interviews. Pre/post cycle times analyzed 12,767 completed appointments.

Results: There was a statistically significant …

Exploring & Mitigating Workplace Incivility At A Rural Community Hospital, Jacquelyn Ethier

DNP Scholarly Projects

Workplace Incivility (WI) is a well-known challenge in healthcare, with decades of mounting evidence showing the effects on workplace culture, healthcare worker retention and patient safety. The nursing workforce has become increasingly vulnerable to all stressful elements of the work environment. Organizational leadership must develop and deploy mitigation strategies to minimize the negative consequences of these behaviors for nurses, and the entire healthcare team. The purpose of this quality improvement project is to assess the current state of nurse perceptions of WI at a rural community hospital and deploy evidence-based education on strategies to address and mitigate WI. The method …

Strengthening New Hampshire’S Primary Care Workforce Pipeline: Utilization Of Alternative Scheduling Models, Elizabeth Harrison

DNP Scholarly Projects

Abstract

BACKGROUND: Traditional clinical scheduling coupled with the current reimbursement system have created systematic barriers leading to decreased clinical education opportunities. Alternative scheduling models such as longitudinal integrated clerkships, one preceptor to two students and wave scheduling have the potential to eliminate these barriers and provide financial gains and increased access to care.

INTERVENTION: Interventions to meet this quality improvement project's objectives included (1) pre-intervention planning (2) focus groups, (3) video presentations and (4) a pilot program of alternative scheduling models in clinical practice.

RESULTS: A pilot program utilizing the alternative scheduling models increased the relative value units (RVU) of …

Implementation Of A Standardized Process To Increase Promotion Of Family Presence During Resuscitation, Eileen Hollis

DNP Scholarly Projects

BACKGROUND: Family Presence During Resuscitation (FPDR), has been studied and recommended as an important and relevant practice for decades, yet it remains controversial with frequent barriers to implementation. The benefits of this practice are numerous; and to truly embrace shared decision making, nurses and providers must encourage patients and families to participate in all aspects of care, even during resuscitation events. As evidence supporting the emotional and psychological benefits of FPDR began to grow, however, a global pandemic brought family presence to an abrupt halt.

METHODS: This quality improvement project’s focus was to standardize a process for offering and allowing …

Improving Patient Safety And Emergency Department Staff Efficiency In Barcode Medication Administration By Using The Rover™ Mobile Application, Ian Kirit

DNP Scholarly Projects

BACKGROUND: The Emergency Department (ED) is one of the busiest areas in the hospital. Patients are often acute, and it can get chaotic at times. Such a complex environment requires an effective and efficient system to increase staff efficiency and elevate patient safety. Patient and medication scanning has been a continuing issue with the current barcoding process using the in-room scanners and workstations on wheels (WOWs). In reviewing the Barcode Medication Administration (BCMA) weekly audit report, scanner broken and scanner not available are the most frequently used reasons for not scanning patients and medications. Additionally, WOWs can be hard to …