Nursing Commons^™

Increasing Access To Primary Care Using Np’S: The Framework For An Academic Based Nurse-Managed Center In California, Prabjot (Jodie) Sandhu

Doctor of Nursing Practice (DNP) Projects

The dynamics of health care delivery and the role of health care providers is a changing canvas in the United States. The implementation of the Affordable Care Act (ACA), sets a goal to increase access to health care. The systems that support the ACA are constantly under scrutiny as failing to provide key answers to provider shortage and health care access issues. Nurse Practitioners (NPs) who are recognized by the ACA as a comprehensive part of this revolution are in a unique place to find opportunities to promote increased access to health and primary care services. While NPs in California …

Fnp Led Mobile Health Services For The Homeless Population, Tenzin D. Lama

Doctor of Nursing Practice (DNP) Projects

A small percentage of the U.S. population uses the greatest portion of the healthcare services. Homeless people are often such a group of “super-utilizers” of the healthcare system. Due to multiple medical and psychosocial conditions, people experiencing homelessness face numerous barriers to accessing healthcare, thus leading increased utilization of hospitals and emergency departments (EDs) services. Many of these events are preventable through improved primary care interventions. The literature on Respite/Recuperative Care, Transitional Care, and Mobile Health interventions have shown effectiveness in providing safe and quality care to homeless individuals during the critical transitional period post hospital discharge while also reducing …

Depression Screening And Early Intervention On The Post-Stroke Patient, Marco Oliver Dugan Lopez

Doctor of Nursing Practice (DNP) Projects

Statistics in the United States (US) have shown an increase in the prevalence of Cardiovascular Disease (CVD) or risk for developing CVD. Approximately 78 million American adults, 20 years and older, have hypertension, 31.9 million have elevated serum cholesterol levels, and 68.2 million use tobacco products. Within California, San Francisco (SF) was ranked 8th among counties with adult residents that have CVD. It is estimated that approximately 1.02% of these individuals will have a stroke each year and 16.25% will die from stroke. Of those that survive, it is estimated that at least half will develop neurologic deficits, and at …

Using A Strategic Model For Professional Development: The Importance Of Evidence-Based Competencies As A Foundation For Professional Practice., Peggi B. Winter

Doctor of Nursing Practice (DNP) Projects

Abstract

A nursing professional practice model (PPM) is designed to provide a framework for how nursing practices, communicates, leads, collaborates, and provides the highest quality of care as we navigate the complex healthcare system. An infrastructure for learning, competency, and performance needs to be integrated into this model as a foundation for accelerating business and clinical initiatives, promoting standardization, and sharing successful practices. It is now, more than ever, a necessity to have a well-trained, highly competent nursing workforce. Simply having the knowledge and the skill to do a job is insufficient; rather, it is implied that a competency has …

Development And Implementation Of A Violence Risk Assessment Tool, Mira Aidasani-Diwata

Doctor of Nursing Practice (DNP) Projects

The purpose of this quality improvement project was to provide a means to effectively assess patients as they are admitted to the hospitals and to effectively communicate a patient’s violent tendencies within the healthcare setting. Workplace violence is a serious problem that affects all healthcare professionals. Although serious assaults and homicides attract more media attention, the majority of workplace violence consists of non-fatal assaults. Nurses, aides, and patient care technicians suffer the most non-fatal assaults resulting in injury. Due to the growing incidence of assault and injury among healthcare workers, some states are calling for additional study on workplace violence. …

Building A Framework For Professional Nursing Practice Across The Continuum Of Care, Elizabeth S. Bigby

Doctor of Nursing Practice (DNP) Projects

Nursing professional practice models are designed to unite and align nurses under one vision, set of values, and a professional practice model. The goal of this project was to implement and enculturate a professional practice model of nursing with assistant nurse managers and leaders across the continuum of care at an urban medical center and associated ambulatory medical offices. Staff engagement has been shown to improve satisfaction and decrease turnover and implementation and enculturation of a professional practice model improves engagement. The target population was nurse managers and leaders as they needed to embrace professional practice before the project was …

Patient-Reported Outcomes Screening For Improved Patient Wellness: A Cancer Center Initiative, Alison Morris

Doctor of Nursing Practice (DNP) Projects

Background: People experiencing serious illness have significant unmet physical, emotional, social and spiritual needs. The Quality Oncology Practice Initiative (QOPI) requires patients to be screened for emotional wellbeing and pain by their second oncology visit. This project details one cancer center’s quality improvement initiative to (a) implement electronic screening of every cancer patient by their second oncology visit, (b) design processes for ongoing assessment and intervention of need(s), and (c) develop measurable and sustainable evaluation metrics to ensure that palliative care needs are met. Methods: In June 2015, we launched electronic collection of patient-reported outcomes (PROs) using the Patient Reported …

Improving The Patient Experience By Implementing Patient-Centered Care In A Community Hospital, Richard A. Billingsley Dnp, Mha, Rn

Doctor of Nursing Practice (DNP) Projects

Health care is a complex business currently undergoing extensive reform. These changes require new methods of care deliver and ways in which health care organizations are operating. At the forefront of this change effort is the 2010 Patient Protection and Affordable Care Act, which is transforming health care from a volume-based, fee-for-service process to the delivery of services that have value, improve quality outcomes, increase satisfaction, elicit greater efficiency, demonstrate improved safety outcomes, show cost-effectiveness, promote better access to services, and result in high reliability between providers and organizations. The goal of providing a more positive health care experience is …

Caution: Line-Of-Sight In Icu Designs, Diane C. Bartos

Doctor of Nursing Practice (DNP) Projects

It has been estimated that by the end of 2015, the U.S. will spend approximately $200 billion in new healthcare facilities construction. Infection prevention, patient and family satisfaction, and technologies influence contemporary designs of critical care units. All of these impacts have created larger patient care units, with a majority of single patient rooms. These larger spaces have created challenges for the clinicians to maintain the line-of-sight. The line-of-sight is one tool clinicians often use to maintain patient safety.

Since the seminal publication by the Institute of Medicine in 1999, patient safety concerns have escalated after revealing numerous deaths in …

The Role Of A Psychiatric Mental Health Nurse Practitioner As Part Of A Mobile Health Unit For The Homeless Population, Joan Alviar Fraino

Doctor of Nursing Practice (DNP) Projects

An estimated 2.3 to 3.5 million people are homeless in the U.S., often living with chronic medical and mental illnesses. The underserved population, such as the homeless, continues to experience gaps in services, resulting in poor healthcare outcomes and readmission to the hospital setting. They often present in crisis through the emergency room, contributing to an already overburdened healthcare system. Increased spending and overutilization of healthcare services continues to rise in the United States (U.S.). Due in part to advancements in technology and expanded health insurance coverage, American healthcare continues be one of the most expensive commodities in the U.S. …

Impetus To Transform: Essential Nursing Leadership Development Through Simulation, Mary J. Mette

Doctor of Nursing Practice (DNP) Projects

Abstract

A nurse manager’s ability to effect positive change and inspire others to higher levels of achievement is related to his or her leadership style in the practice setting, as well as the culture present in the organization as a whole. The aim of this Doctor of Nursing evidence-based change in practice project was to create an educational modality that supported training nurse leaders through innovation and creative problem solving in today’s acute healthcare setting.

A survey was administered to 48 frontline managers in a Northern California healthcare system to access the gaps and voids in their ability to integrate …

Preventing 30-Day Readmissions Of Clostridium Difficile Patients Utilizing Targeted Discharge Instructions, Keith A. Howard

Doctor of Nursing Practice (DNP) Projects

The Patient Protection and Affordable Care Act of 2010 ushered in a new era of fiscal accountability for healthcare organizations. Healthcare organizations and providers are now jointly held responsible for the improved quality of patient care and sustained reductions in patient care events termed healthcare-acquired conditions. To ensure compliance with this newly enacted legislation, the Centers for Medicare and Medicaid Services (CMS) began penalizing hospitals for targeted conditions leading to 30-day readmissions beginning in October 2012. Annually, CMS has focused attention on conditions that endanger patient health and welfare while secondarily attempting to reduce the excessive financial expenditures in …

A Quality Improvement Project To Increase Diabetes Self-Efficacy In A Rural Primary Care Clinic Through Patient Utilization Of A Diabetic Logbook, Margo D. Sutton

Doctor of Nursing Practice (DNP) Projects

The prevalence of type 2 diabetes mellitus (T2DM) has increased substantially in the United States in recent years. Teaching self-management to diabetic patients is essential to help them control their chronic disease. Albert Bandura’s theory of self-efficacy is commonly used in chronic disease self-management programs and is the theoretical framework upon which this Doctor of Nursing Practice (DNP) pilot project was built.

This evidence-based change in practice project took place in a rural primary care clinic in the central valley of California, and involved the development of a diabetes logbook, which was a tool for patients to use to learn …

Implementation Of An Evidence-Based Educational Workshop And Toolkit: Menopausal Women's Healthcare Needs For The Primary Care Provider, Pamela Doerr-Kashani Dnp, Rn

Doctor of Nursing Practice (DNP) Projects

This evidence-based change of practice project involved the development of an educational workshop for primary care providers (PCPs). The intent of the project was to improve PCP’s knowledge of menopausal health, and to create their comfort level when discussing menopausal healthcare with clients. The workshop Menopausal Women’s Healthcare Needs for the Primary Care Provider (Doerr-Kashani, 2014) was created in response to an identified gap in knowledge among PCPs nationally on menopause-related health issues. The workshop was designed as a resource to support PCPs to competently address women’s menopause-related health issues, and enable them to provide comprehensive, evidence-based care within the …

Improving Care Of Assisted Living Residents With Dementia Through A Competency-Based Behavioral Training Curriculum For Assisted Living Caregivers, Mary Ann Z. De Vera

Doctor of Nursing Practice (DNP) Projects

Behavioral and psychological symptoms of dementia (BPSD) are common among residents of assisted living facilities. Inadequately managed symptoms of BPSD can lead to problematic behaviors with significant consequences for patients and caregivers. Non-pharmacologic approaches to the management of problematic behaviors in individuals with dementia are the preferred management option. Caregiver training and education to enhance knowledge and skills in managing behavioral and psychological symptoms for assisted living caregivers is indicated to provide optimum care for patients with dementia. The purpose of this doctor of nursing practice (DNP) project was to develop and implement a caregiver-training workshop utilizing a competency-based behavioral …

Narrowing The Qsen Competency Gap In New Graduate Registered Nurses, Marty Mayhew

Doctor of Nursing Practice (DNP) Projects

This intervention is an evidence based, change of practice, quality improvement project that evaluates achievement of the six Quality and Safety Education for Nurses (QSEN) competencies of new registered nurse graduates. No intervention with a similar focus was found in an extensive review of the literature. The participants included 16 new graduate registered nurse hires enrolled in a new graduate RN residency program at Tucson Medical Center located in southern Arizona. The Nursing Quality and Safety Self Inventory^© (NQSSI^©) was used to identify practice gaps perceived by the new RN graduates related to the six QSEN competencies. …

Implementation Of Food Insecurity Screening In Clinical Setting, Florence Ngozi Soba

Doctor of Nursing Practice (DNP) Projects

This project used the Stetler model of research utilization framework to apply evidence-based findings to clinical settings screening adults with type II diabetes mellitus (T2DM) and low incomes for food insecurity. The project involved the review and critical appraisal of research studies and translation of research-based knowledge into a protocol for the Peach Tree Clinic with respect to the impact of food insecurity on diabetes outcomes in adults with T2DM and low incomes who were at risk of food insecurity. In addition, the proportion of screened at-risk patients who received nutritional counseling was calculated. The proportion of patients with T2DM …

Impact Of Improving Throughput In The Emergency Department, Katherine J. Edrington

Doctor of Nursing Practice (DNP) Projects

The purpose of this project was to evaluate the patient experience in the emergency department (ED) and in the inpatient setting while correlating increased throughput and patient outcomes at a suburban Acute Care facility in Ohio. The culture in the organization has lacked accountability and ownership of the patients. The ED admitted length of stay (ALOS) was 358 minutes in the beginning of 2013. For the first time in the organization’s history, the ED ALOS is now typically less than the recommended benchmark of 300 minutes. A report of findings among ED’s surveyed showed the ALOS best practice is 244 …

Implementing An Evidence Based Foot Assessment Protocol For Use By Nurses Caring For Adult Diabetic Patients Seeking Care In The Thanh Nhan Hospital Endocrinology Department, Amy Ly

Doctor of Nursing Practice (DNP) Projects

The purpose of this primary care nursing practice improvement project was to implement a diabetic evidence-based protocol for use by nurses caring for adult patients seeking care in the Thanh Nhan Hospital Endocrinology Department (TNH/ED) in Ha Noi, Vietnam.

Prior to project implementation, physicians performed all patient foot assessments. No standardized foot assessment tool existed.

The author made an on-site visit to the clinic to assess current practice. The author then recommended expanding nursing practice by using an evidence-based assessment tool. The author conceived an implementation approach, then designed, developed and presented the plan via an Internet-delivered fully interactive Virtual …

Specimen Labeling Improvement Project: Slip, Traci Hoiting

Doctor of Nursing Practice (DNP) Projects

Blood specimens are labeled at the time of acquisition in order to identify and match the specimen, label, and order to the patient. While the labeling process is not new, it is frequently laden with errors (Brown, Smith, & Sherfy, 2011). Wrong blood in tube (WBIT) poses significant risk. Multiple factors contribute to mislabeling errors, including lax policies, limited technological solutions, decentralized labeling processes, multi-tasking, distraction from the clinician, and insufficient education and training of staff. To reduce blood specimen labeling errors, a large academic medical center implemented an innovative technological solution for specimen labeling that integrates patient identification, physician …

Implementing And Evaluating A Clinical Information Interface Between An Electronic Medical Record And A Patient Classification System, Tanya Osborne-Mckenzie

Doctor of Nursing Practice (DNP) Projects

As a result of the Affordable Care Act and the Institute of Medicine’s initiatives, hospitals are challenged to improve outcomes as efficiently as possible. How does the national initiative of RNs partnering with other healthcare professionals to improve the quality of patient care at a lower cost, cascade down to individual organizations? One answer may come by focusing on nurse staffing in acute care hospitals. Considering the impact RNs have on patient quality outcomes and the bottom line of hospitals, appropriate management of the RN workforce is one of the most important areas hospitals can focus on in order to …

Transitional Care Services: A Nurse-Led Quality Improvement Project, Debra Conroy-Mccue

Doctor of Nursing Practice (DNP) Projects

With the implementation of the Patient Protection and Affordable Care Act of 2010 (PPACA) and a national requirement for health care providers and systems to deliver care that is safe, outcome driven, and cost effective, Dignity Health (DH) as part of the hospital engagement network (HEN) launched an initiative called the “No Harm” campaign to reduce all-cause avoidable hospital readmissions. The project, led by a Doctorate of Nursing Practice (DNP) student and readmission team, sought to achieve a 20% reduction in preventable readmissions by December 2014. After having achieved initial success in implementing transitional care services for patients with heart …

Improving Women’S Health Services By Adding Long-Acting Reversible Contraceptive Methods Into Primary Care-Focused Student Health, Shu-Chen Jennie Cheng

Doctor of Nursing Practice (DNP) Projects

Often resulting from inconsistent contraceptive use, unintended pregnancy among young women between ages 18-24 continues to be an issue in the United States. Long-acting reversible contraceptives, including intrauterine contraceptives and the subdermal contraceptive implant, are safe, effective, long-acting, easily reversible, and non-user dependent contraceptive methods, yet currently are greatly underutilized. Most of the contraceptive methods are provided at our student health services except for the highly effective long-acting reversible contraceptive methods. As family nurse practitioners and health care providers, it is essential to integrate this service into primary care-focused college student health clinics by providing evidence-based information to clinical providers …

Development And Implementation Of A Succession Plan For The Nursing Department In A Community Hospital, Nadine Mariotti

Doctor of Nursing Practice (DNP) Projects

This project identifies nursing leadership vacancies in a community nursing department and assisted in the planning and implementation of a succession framework to fill the gaps in the nurse leadership population. Aging nurse leaders are leaving the profession and thus are creating gaps which need to be filled (Stichler, 2008). The unavailability of respective schools and negative perceptions of nurses regarding the healthcare sector leads to the lack of interest in the nursing profession (Nelsey, Brownie, 2012). Factors contributing to burn-out in nursing departments affect the intentions of nurses to leave and lower satisfaction towards their profession. The proposed succession …

Using An Educational Module And Simulation Learning Experience To Improve Medication Safety, Barbara Lynn Durham

Doctor of Nursing Practice (DNP) Projects

The purpose of this evidence-based change in practice project was to provide nurses with an experiential learning opportunity, using simulation, to identify and report near miss events during the medication administration process related to patient-controlled analgesia (PCA) usage. Despite extensive in-service training on a Medical/Surgical (Med/Surg) floor in an acute care hospital, inconsistent, inaccurate and incomplete documentation with use of the new PCA pumps continued to be problematic. A conceptual framework of just culture was used with the quality improvement method of the Plan-Do-Study-Act (PDSA) cycle for testing change. Medication safety education was a valid andragogical strategy to decrease rates …

The Creation And Implementation Of A Transgender Cultural Competence Nursing Education Toolkit, James Bl Donovan

Doctor of Nursing Practice (DNP) Projects

Healthcare disparities in the transgender populations have been linked to lack of healthcare provider cultural competence (IOM, 2011; Bradford et al., Harbin et al., 2012; Eliason, Dibble, & DeJoseph, 2010; Lim, Brown, & Jones, 2013). Prior research has identified that healthcare providers receive little, if any, transgender cultural competence training during their formal education. A survey of nursing educators at the University of San Francisco School (USF) of Nursing and Health Professions suggested that few educators are providing transgender content or understand the unique healthcare needs of that population. A literature review concluded that little is known about the best …

Implementation And Evaluation Of An Oral Hygiene Program In Long-Term Care, Lawrence P. Lemos

Doctor of Nursing Practice (DNP) Projects

A review of the literature focusing on oral care within long-term care (LTC) suggests positive resident care outcomes occur when standardized practices are employed. Studies of staff education programs, trained oral hygiene aides, and dental hygienists working within LTC, have linked regular oral hygiene practices to decreased pneumonia rates. While these studies make the connection between good oral hygiene and reducing risk for pneumonia, best practices focused on implementing and sustaining an oral hygiene program in LTC facilities are lacking. The aim of this quality improvement project was to ensure that dependent residents in LTC receive assistance with daily oral …

Avoiding 30-Day Readmissions Of Acute Mi Patients Utilizing Cardiac Rehabilitation, Patricia T. Forsberg

Doctor of Nursing Practice (DNP) Projects

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more …

Overcoming Barriers To Screening For Anal Intraepithelial Neoplasia For Persons Living With Hiv, Brandon Hastings

Doctor of Nursing Practice (DNP) Projects

Screening has proven an effective strategy in the management of diseases that plague the population. This technique has proven to be most effective when screening is conducted with those who are most at risk for developing the targeted illness and when the frequency of screening follows set guidelines. Currently there are no nationally recognized screening guidelines for anal intraepithelial neoplasia (AIN). Screening for AIN stands to reduce overall incidence of anal squamous cell carcinoma through destruction of the dysplastic cells before they become cancerous. The goals of this project were to identify the patient population that stands to benefit the …

An Evidence-Based Approach To A Replacement Hospital Training Curriculum, Mark D. Beck

Doctor of Nursing Practice (DNP) Projects

Creation of a training and educational curriculum for a new or replacement facility is daunting in its own right, but without a repository of organizational knowledge cataloging the transfer of tacit to explicit knowledge from the organizations previous library of facility openings, the task becomes Herculean, with as many tasks and cast of characters as the original myths. Navigating the shoals, eddies and tides of the various aspects of this project revealed the need for a comprehensive knowledge management solution to training that is coupled with healthcare design principles and initiatives. This purpose of the DNP project is about the …