Nursing Commons^™

Development Of A Heparin Dosing Guideline For Vascular Surgery, Brittany Bertoni, Anna Holdener

Doctor of Nursing Practice Projects

Unfractionated heparin is administered to provide anticoagulation for the prevention of thrombosis and ischemia during vascular surgery. The intraoperative goals of heparin administration are the achievement of adequate anticoagulation and maintaining a steady-state plasma concentration throughout the procedure to prevent thrombotic events. Due to patient variation in heparin sensitivity, the standard within vascular surgery is to obtain the intraoperative activated clotting time (ACT) as a means of monitoring heparin activity and guiding dosing regimens. Measuring the intraoperative ACT allows for evaluation of the intrinsic pathway to assist the provider in achieving a steady-state heparinization with high-dose heparin administration.

To reduce …

Mental Health Resources For The Pediatric And Adolescent Populations In The Rural Setting, Devon Shafer, Kyle Aldridge, Amy Lilly

Doctor of Nursing Practice Projects

Cognitive behavioral therapy (CBT) is a mainstay of treatment for problems such as anxiety and depression. However, access to this form of psychotherapy treatment is limited in rural areas, especially in pediatrics. The purpose of this project was to increase access to CBT through the use of smart phone CBT applications for patients at one rural midwest pediatric clinic. An extensive literature review revealed that mobile cognitive behavioral therapy (CBT) applications can be an effective option for adjunct therapy when provider access is limited. Two CBT mobile applications were selected for the project and training was provided to clinic providers. …

Integration Of The Svs Wifi Classification System For Ulcer Staging And Management In An Amputation Prevention Program, Allison Campos

Doctor of Nursing Practice Projects

Chronic limb-threatening ischemia is a significant problem with increased morbidity and mortality along with the risk of amputation. With the increased prevalence of diabetes worldwide, the population of patients presenting with nonhealing ulcers shifted from purely ischemic ulcers to a more complex picture for wound healing. Amputation prevention programs were developed to care for this heterogeneous population of patients. However, with multiple disciplines, there was no unified classification system in use. The historical classification systems were not inclusive to evaluate all aspects of wound healing, the extent of the wound, amount of ischemia, and the presence of infection. The Society …

Development Of A Protocol For Perioperative Management Of The Breastfeeding Mother, Kayla Nyseth, Kelsey Park

Doctor of Nursing Practice Projects

Facilitating breastfeeding is a public health priority, as disruption in lactation is associated with adverse health outcomes for the breastfeeding mother and child (ACOG, 2016). The need to take medication, maternal illness, and hospitalization are among the most common reasons women cite for ceasing breastfeeding before their projected goal (Odom, Li, Scanlon, Perrine, & Grummer-Strawn, 2013). Providing a healthcare team that encourages breastfeeding during the perioperative period can minimize interruptions in breastfeeding and optimize the benefits for both the mother and infant (Simon, Carabetta, Rieth & Barnett, 2018). Unfortunately, many anesthesia providers lack confidence related to breastfeeding and drug transfer. …

Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR).

Methods We conducted a retrospective chart review on patients …

Implementing Best Practices To Improve Veteran’S Primary Care: A Pilot Project For Suicide Screening, Assessment & Referral, Nathaniel Held

Doctor of Nursing Practice Projects

Problem Description: Suicide is an increasing problem within the United States, but an even greater problem among the veteran population. Veterans are twice as likely to commit suicide than individuals within the civilian population. El Paso County, Colorado has the highest veteran population in the state and the highest number of suicides. Despite numerous military mental health programs available. Studies have found that many veterans will visit a civilian primary care clinic (for various reasons) within a month of taking their own lives but rarely are mental health concerns noted. This can be due to a lack of awareness and …

Efficacy Of Integrating Cbt For Mental Health Care Into Substance Abuse Treatment In Patients With Comorbid Disorders Of Substance Abuse And Mental Illness, Laura U. Madu, Jacqueline Sharp, Bobby Bellflower

Doctor of Nursing Practice Projects

Abstract: Multiple studies have found that psychiatric disorders, like mood disorders and substance use disorders, are highly comorbid among adults with either disorder. Integrated treatment refers to the treatment of two or more conditions and the use of multiple therapies such as the combination of psychotherapy and pharmacotherapy. Integrated therapy for comorbidity per numerous studies has consistently been superior to the treatment of individual disorders separately. The purpose of this QI project was to identify the effectiveness of Cognitive Behavioral Therapy (CBT) instead of current treatment as usual for treating Substance Use Disorder (SUD) or mental health diagnosis independently. It …

Developing Organizational Support And Leadership Structures For Advanced Practice Nurses In The Hospital Setting, Andrea L. Childress

Doctor of Nursing Practice Projects

Background: Hospitals are increasing utilization of advanced practice nurses (APNs). APNs do not fit within the traditional nursing or medicine department structures. They are often hired by organizations without full evaluation and assessment of management issues and structures to support them.

Problem: APNs are employed to work throughout an acute care hospital. They report to medical leadership but have no voting rights or representation on medical committees. They lack connection to nursing staff and existing structures which impairs their ability to exhibit leadership and advance nursing practice.

Purpose: This project seeks to answer: What organizational support and leadership structures are …

Improving The Nurse Patient Assignment Process On A Medical Surgical Unit, Kevin K. Mcewan

Doctor of Nursing Practice Projects

Background: Nurse patient assignments on an adult medical surgical unit at a community hospital are often accomplished with inconsistent processes and rationales. Each charge nurse utilizes individualized processes to determine which patients will be best teamed-up and assigned to the available nurses. There are frequently no acuity measurements system or set criteria by which the number or types of patients can or should be assigned to any given nurse, nor are staff skill or competency considered in the assignment process.

Project Design: A pilot project was conducted on a medical/surgical unit. The project utilized the American Association of Critical Care …

Improving The Quality Of Care For Pediatric Psychiatric Patients In The Emergency Department, Joseph L. Greene

Doctor of Nursing Practice Projects

Pediatric patients (17 years and younger) in mental health crisis are arriving in the emergency department in increasing numbers because there is a lack of mental health crisis care in the community setting. The emergency department is crowded, lacks a dedicated area for psychiatric patients that is quiet and safe, and staff are inadequately trained in psychiatric competencies. A quality improvement project was approved by Boise State IRB to train RNs in psychiatric competencies. Telepsychiatry provided timely evaluation by a qualified psychiatric provider. Patients’ perceived meaning of the ED visit was evaluated using the Patient Evaluation of Emotional Comfort Experienced …

A Community-Based Pilot Prevention Program To Prevent Electronic Cigarette Use Among Teens, Rosanna Moreno

Doctor of Nursing Practice Projects

With over 3.6 million teens using tobacco, we have lost the opportunity to create the first tobacco-free generation. This pilot project presented the CATCH My Breath (CMB) E-Cigarette and JUUL prevention program to local teens experiencing a global pandemic. The program was condensed from a 4-week multi-session offering into a one-day seminar with an intense focus on student safety and engagement. While contextual factors significantly impacted the project implementation, the content remained largely the same. This accounted for the achievement of many of the project’s desired outcomes. Participants increased their baseline knowledge of the effects and dangers of e-cigarette use …

Mentorship For Newly Licensed Nurses: A Pilot Program, Michelle Doran, Rn, Dnp, Npd-Bc

Doctor of Nursing Practice Projects

Background: The turnover rate for newly licensed nurses is high, posing financial and resource challenges for healthcare organizations. Transition to practice programs are an effective means of supporting retention. Mentorship is a best practice within such programs as it promotes job satisfaction, professional growth and development, and retention.

Objectives: The purpose of this project was to implement and evaluate a pilot mentor program with new nurses. Outcomes were: development of a structured program, enhancement of mentees knowledge about the value of mentorship, and assessment of mentee and mentor satisfaction with the program through a final satisfaction survey.

Methods: Participants were …

The Effects Of Diabetes Self-Management Education Among African American Adults, Nkeiruka Muonagolu Msn, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Type II diabetes continues to be a pervasive issue among African American adults. Significant challenges in effective management have resulted in poor health outcomes that have disproportionately threatened the quality of life among this group and increased the risk of mortality. Diabetes Self-Management Education (DSME) has demonstrated success in improved patient management and its capacity to mitigate risks for complications. Although researchers and health institutions generally accept DSME as an effective tool for managing diabetes, limited studies exist on its efficacy for African Americans.

Purpose: This study aimed to examine the effects of DSME intervention on diabetes management among …

Interprofessional Approach To Medication Reconciliation In The Hospitalized Medicare Patient., Misty Robertson

Doctor of Nursing Practice Projects

Background

Poor medication reconciliation processes in acute care hospitals, combined with poor communication across the healthcare team, and a failure to bring specialized pharmacy resources to the team can be attributed to adverse drug events that in turn result in hospital readmissions within 30 days of discharge (Sutherland, David-Kasdan, Beloff, Mueller, Whang, Bleday, & Urman, 2016).

Project Design

The aims of project included: 1. Utilize an interprofessional team that included, nursing, pharmacy, RN care management, and physicians to develop hospital policy and procedures for medication reconciliation, 2. Develop a risk stratification method to identify patients at highest risk for medication …

Implementing Teamstepps® Training For An Interdisciplinary Healthcare Team To Improve Teamwork, Tina J. Dimarino, Msn, Rn, Cnor, Casc

Doctor of Nursing Practice Projects

Background: Ineffective teamwork and communication increase the risk of adverse patient outcomes. An evidence-based teamwork training intervention was implemented to improve teamwork and communication.

Aims /Objectives: The team participated in a TeamSTEPPS® training program. The aims and objectives were to improve the staff’s attitudes and perceptions of teamwork and communication; pre, post and sustained at 30-days, reduce the number of documented near misses and measure for daily use of the newly acquired skills.

Methods: This is a quality improvement project with a one group, pretest and posttest design. The TeamSTEPPS® intervention was presented to the healthcare team. Participants’ teamwork attitudes …

Mindfulness Training In Mitigating Implicit Bias: Improving Cultural Competency For Nurses Caring For Lgbt Individuals, Daniel Terrell, Msn, Rn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Equitable care remains a goal of the United States healthcare system, with cultural competency training used as one intervention to mitigate disparities. Cultural competency education is primarily based on racial and ethnic differences, often omitting other marginalized groups. Implicit bias consequences are not addressed in such training programs despite the association with health outcome disparities. Research related to implicit bias has demonstrated the ability to promote malleability in implicit associations.

Objectives: This project assessed a mindfulness meditation exercise intervention on nursing awareness in interacting with lesbian, gay, bisexual, and transgender (LGBT) patients. Additionally, an LGBT health education module that …

A Program Development And Evaluation Project For Provider Use Of Buprenorphine Maintenance, Kyle Olson, Aprn

Doctor of Nursing Practice Projects

Background: Buprenorphine (BNX) is used in Opioid Use Disorder (OUD) deterrence. Optimal long-term duration with BNX is unclear, but evidence shows that there is a high risk for relapse when medicine is discontinued even if maintenance has been stable for some time.

Outcomes: The purpose of this project was to decrease barriers for providers implementing BNX therapy for individuals diagnosed with OUD. Outcomes measured included: (1) knowledge of and barriers to implementing current guidelines, (2) factors preventing use of guidelines, (3) recommendations for BNX maintenance as per guidelines.

Methods: Using a pre-post intervention design, participant knowledge on BNX guidelines, factors …

Implementation Of Diabetic Foot Care Education Quality Improvement Project, Mitaliben R. Gor, Msn Aprn Fnp-C

Doctor of Nursing Practice Projects

Background: A diabetic foot ulcer is a major complication in diabetes mellitus that results in increased mortality, morbidity, costs, and reduced quality of life. In 2015, the prevalence of diabetic foot ulcers was estimated by the International Diabetes Federation to develop annually among 9.1 million to 26.1 million people with diabetes worldwide. Diabetic foot care has economic consequences due to the expenses related to the treatments that arise from prolonged and recurrent hospitalizations and social problems from employment losses.

Purpose: The purpose of this project was to implement diabetic foot care education among diabetes patients in the clinic as a …

Adoption Of Evidence-Based Practices In Stroke Transitions Of Care, Sabena Passarello, Rn, Msn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Stroke is a leading cause of mortality in the U.S. Individuals who suffer from stroke or transient ischemic attack are at risk for further cerebrovascular events. Prevention requires thorough diagnostic evaluation and care coordination, particularly from inpatient to outpatient settings. Transition of Care programs are effective methods for developing long-term treatment, establishing follow-up, and preventing further complications.

Aims/Objectives: The project purpose was to integrate evidence-based recommendations into a Transitions of Care program for patients with ischemic stroke or transient ischemic attack. The aims were to evaluate whether implementation of Stroke Transitions of Care improved outpatient follow-up and stroke readmission …

A Multi-Faceted Quality Improvement Project Amid A Global Pandemic: Improving Guideline-Consistent Cervical Cancer Screening Rates And Provider Knowledge Of Abnormal Cervical Cancer Screening Results During Reactivation Of A Metro Family Practice Clinic, Taylor Villwock, Agpcnp-Bc

Doctor of Nursing Practice Projects

Background: Despite the evidence-based value of cervical cancer screening, recent updates to guidelines, and general availability of the Papanicolaou (Pap) test, guideline-adherent screening rates remain low. The COVID-19 pandemic further impedes progress as preventive healthcare is delayed and patients are reluctant to enter healthcare facilities.

Objectives: The purpose of this project was to evaluate if provider education and patient reminder letters comprising written education and risk-mitigation efforts improved cervical cancer screening rates and increased providers’ knowledge of appropriate follow-up during reopening of a metro family practice clinic amid the COVID-19 pandemic.

Methods: A multi-faceted quality improvement project included a 3-month …

Increasing Mental Health Competency In School Nurses, Jennifer M. Walsh Msn, Cpnp, Cne

Doctor of Nursing Practice Projects

Background: Mental health concerns in the pediatric population have increased over recent years, even more so due to the COVID-19 pandemic. Time from onset of symptoms to treatment is over eight years, leaving less than 25% receiving care. Virginia ranks 47th for pediatric mental health care. School nurses spend a significant amount of workload on MH issues but often report being untrained to deal with these issues. Aims: Implement a quality improvement pilot program for school nurses designed to increase competency of identification, management, and referrals for students with mental health concerns. Outcomes measured domains of knowledge, attitude, and competency …

Prep Education Intervention, Kristina Jung Msn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: The nation’s HIV infection rate is alarming, yet only a small percentage of eligible individuals are prescribed pre-exposure prophylaxis (PrEP). This sluggish PrEP uptake may be related to lack of knowledge among non-HIV specialist providers. Thus, interventions toexpand providers’ use of PrEP as an HIV prevention strategy are needed.

Objectives: The project aim was to develop an intervention to improve retail nurse practitioners’ (NP) knowledge for PrEP clinical practice, comfort screening for “at-risk HIV” patients, confidence prescribing PrEP, and likeliness to prescribe PrEP in the next six months.

Methodology: An online PrEP tutorial was implemented for retail clinic NPs. …

Improving Nurse Manager Job Satisfaction: An Urban Academic Quality Improvement Project, Patricia A. Winston, Ms, Rn, Nea-Bc, Fache

Doctor of Nursing Practice Projects

Background: It is important that the nurse managers are able to contribute to organizational vision, mission, and goals by influencing others, sharing the vision, and implementing it (Boyce, 2018). They are pivotal to the successful accomplishments of the hospital mission. The issue of recruiting, developing and retaining nurse managers is one that challenges many health care institutions, hospitals, hospitals, and health systems. The literature regarding this concern was reviewed and the paucity of useful science in this regard led to question of how to improve the job satisfaction and job retention of nurse managers at urban academic medical centers.

Objective: …

Quality Improvement Initiative: Implementing A Nurse Peer Mentorship Program, Vepuka E. Kauari

Doctor of Nursing Practice Projects

Introduction: Formal mentoring programs are valuable experiences for the mentor and the mentee. They provide nurses with the ability to develop professional networks while refining their competency. Nurses should be properly mentored in focusing skills in addition to addressing their emotional needs. The purpose of this quality improvement project was to promote and evaluate the effectiveness of an existing mentoring program on intent to stay, perceived competency, and job satisfaction.

Methods: Institutional Review Board approval was obtained. A convenience sample of new nurses with less than 2 years’ experience in an academic medical center was recruited to assess their intent …

The Evaluation Of The Brøset Violence Checklist (Bvc) And Interventions To Reduce Patient Violence Incidents Occurring In The Emergency Department, Grace D. Yoon, Dnp, Rn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Patient violence in healthcare is an issue across many departments, but many staff members in the emergency department (ED) are directly affected by violent incidents.

Objectives: Three primary purposes determined the success of this Quality Improvement (QI) project: 1) to evaluate the effectiveness of utilizing the Brøset Violence Checklist (BVC) and implementing appropriate interventions to reduce the number of physical assault occurrences against healthcare providers in the ED; 2) to assess if there was an increase in reporting patient violence incidents; and 3) to assess for any improvements in perceived safety in the ED among the nurses.

Methods: Adult …

Implementation Of Capnography Monitoring To Improve Outcomes Among Intensive Care Unit Patients On Patient-Controlled Analgesia Or Opioids, Leslie Smith, Msn, Bmtcn, Aocns, Aprn-Cns

Doctor of Nursing Practice Projects

Background: Patient-controlled analgesia (PCA) administration of opioids is associated with risk for respiratory depression. Capnography is a non-invasive way to identify early respiratory depression and prevent adverse patient events.

Purpose: This project evaluated the effectiveness of capnography versus standard monitoring in reducing adverse events among patients admitted to an intensive care unit (ICU) who were prescribed PCA opioids and evaluated patients at high-risk for respiratory depression according to age, gender, diagnosis, co-morbidities, and type of opioid prescribed.

Methods: This project used a pre- and post-intervention design to compare differences in the number of adverse events among 20 adult patients …

A Quality Improvement Initiative To Engage Older Adults In The Discharge Process Using The Ideal Discharge Protocol, Ava D. Williams, Msn, Crnp Fnp-Bc

Doctor of Nursing Practice Projects

Background: Readmissions are costly and adversely affect patient outcomes. Readmissions significantly impact older adults’ ability to manage post-discharge. Older adults are more likely to have challenges with understanding newly prescribed medications after discharge and therefore are less compliant with medications. Older adults are also less likely to follow-up with their primary care physician after discharge. Engaging patients and families in a collaborative discharge process is a key foundational element needed to improve patient outcomes and reduce avoidable readmission rates.

Purpose: This quality improvement initiative engaged patients and families in an evidence-based discharge protocol to reduce avoidable readmission over three months. …

Design And Implementation Of A Nursing Peer Review Program In A Two-Hospital Setting, Joan L. Goss Ms, Rn, Acns-Bc

Doctor of Nursing Practice Projects

Background and Purpose: The Institute of Medicine’s (IOM) landmark publication To Err Is Human: Building a Safer Healthcare System measured the impact of medical error on the American public in both unnecessary human suffering and unsustainable financial cost to the US healthcare system. Nursing literature suggests that peer review of safety events can help mitigate the impact of medical errors by increasing nurse accountability for practice and empowerment for leading change.

Methods: Fourteen volunteers were selected from over 900 direct care nurses to participate in a four-month Nursing Peer Review Program (NPRP) pilot. Structure, process, and outcome measures of implementation, …

Effectiveness Of Community-Based Hemorrhage Control Education, Kristin Conti Dnp, Aprn, Fnp-C, Rn, Ccrn

Doctor of Nursing Practice Projects

Background: Rural residents are 14% more likely to die from an injury than their urban counterparts due to untimely and ineffective prehospital treatment, inequitable access to the most comprehensive trauma centers, and a lack of injury prevention programs. Although bystanders with bleeding control (BCon) knowledge and skills are vital to injury survival, only 0.5% of Idahoans have completed STOP THE BLEED®.

Purpose: Implement an evidence-based BCon course on how to identify and control life-threatening bleeding with pressure, packing, and tourniquets to increase willingness, confidence, and BCon knowledge, while decreasing concerns.

Methods: A pre-post same subject design was used. Participants were …

Heart Failure Management In A Skilled Nursing Facility, Leigh T. Simpkins

Doctor of Nursing Practice Projects

Background: Reducing heart failure hospital readmissions remains a priority for health systems and is a marker of quality for the Center for Medicare and Medicaid Services (CMS). Heart Failure is the most common cause of U.S. hospital admissions and an effective management program in the nursing home setting is crucial for quality and outcomes.

Purpose: The purpose of this project was to implement and evaluate a Nurse Practitioner/Physician supported heart failure management program in a skilled nursing facility that is able to be incorporated into facility staff workflow, enhances nursing staff knowledge of heart failure, improves identification of patients with …