Nursing Commons^™

Evaluation Of Obstructive Sleep Apnea In Veterans With Coexisting Psychiatric Symptoms, Zenith Perpignani

Doctor of Nursing Practice Projects

Abstract

There is a growing body of evidence that suggests a correlation between post-traumatic stress disorder (PTSD), nightmares with broken sleep, obstructive sleep apnea (OSA), and worsening of symptoms by OSA, Veterans who received treatment at a Midwest Veteran Affairs (VA) Center for Behavioral Health were often subject to variable wait times between scheduling of behavioral health and primary care providers (PCP). The purpose of the doctoral project was to reduce a Veteran's wait time for evaluation by a PCP after having been identified as at risk for OSA during routine psychiatric evaluation. The project examined Veteran's reports and measures …

Healthy Jacksonville, Erica Hunt, Alison Fornoff

Doctor of Nursing Practice Projects

Abstract

According to the Morgan County Community Needs Assessment, a significant opportunity for improvement exists in healthcare access among individuals in the northeast region of Jacksonville, Illinois. Tools to screen clients, interventions to identify the healthcare needs, and access to appropriate resources can promote improved health of individuals and the community. The Healthy Jacksonville Initiative was created to improve access to healthcare and community resources for the underserved people of Jacksonville, Illinois. The goal of this project was to implement a community resource registry and individualized needs assessment for community health care workers to use in order to better serve …

Steep Trendelenburg Associated Postoperative Vision Loss Prevention Education, Mitchell Coval

Doctor of Nursing Practice Projects

Postoperative vision loss (POVL) is a rare, but devastating complication that has been reported following robot-assisted laparoscopic surgeries that require prolonged steep Trendelenburg positioning. A central Illinois hospital had recently established a robot-assisted surgical program but lacked active interventions to reduce POVL risk due to a knowledge gap of the anesthesia providers. Following a comprehensive literature review, a PowerPoint educational program was provided at an anesthesia staff meeting. An evidence-based cognitive aid to provide a quick reference of POVL risk reduction strategies was created by the author in collaboration with the stakeholder. Once approved, the cognitive aid was attached to …

Patient Assessment And Provider Education Regarding Antibiotic Use In The Treatment Of Viral Uris In The Urgent Care Setting, Ashlee Schoby, Candra D. Hulskotter

Doctor of Nursing Practice Projects

Improving Antibiotic Stewardship Through the Use of Patient Assessment and Provider Education Regarding Treatment of Viral URIs in the Urgent Care Setting

Candra Kronewitter and Ashlee Schoby

Date of Award

Spring 5-2020

Document Type

DNP Project

Project Team Faculty Member

Mary Zerlan, CRNA, DNP, APN

Project Team Faculty Member

Kay Gaehle, PhD

Keywords

Antibiotics, Antibiotic stewardship, URIs, Upper respiratory infections, Urgent care, ABUSE screening tool

Abstract

Antibiotic-resistant bacteria is a growing problem in the United States. The misuse or overuse of antibiotics is being considered the leading cause. Nearly 2-million individuals are infected with resistant bacteria yearly, and antibiotics prescribed …

A Pilot Of Prenatal Transitional Care Services In The Urgent Care Setting, Alexandra Huddleston, Gloria Pryzgoda, Tiffany Hazel

Doctor of Nursing Practice Projects

Established prenatal care leads to better outcomes and reduced healthcare expenditures. Inadequate prenatal care is associated with numerous risks. Many women face a variety of barriers that contribute to inadequate prenatal care. The purpose of this project was to create and pilot a new transitional care protocol to improve the referral rate of pregnant patients to establish prenatal care at a midwestern physician services (MPS) women’s health care clinic after a MPS express care visit. An extensive literature review was conducted, and a streamlined referral process linking pregnant patients to obstetric care was created to address identified barriers. The referral …

Implementing Quality Into Practice: Nurse Driven Protocol To Reduce Unnecessary Telemetry Use, Richard Clapp

Doctor of Nursing Practice Projects

Abstract

Background: As part of the American Board of Internal Medicine's Choosing Wisely initiative, the Society of Hospital Medicine issued the recommendation to reduce unnecessary use of continuous telemetry monitoring in the inpatient setting. Outside of its primary purpose continuous telemetry monitoring rarely positively impacts clinical decision making and overuse can lead to unnecessary and costly diagnostic work-ups, cause alarm fatigue, lead to emergency department congestion, and increase institutional financial burden.

Objective: Pilot an evidenced based nurse driven protocol for discontinuation of continuous telemetry monitoring to reduce unnecessary telemetry use among adult patients hospitalized outside of the intensive …

Development Of A Propofol Administration Protocol For Soy Or Egg-Allergic Patients, Kayla Tisza

Doctor of Nursing Practice Projects

The use of propofol for anesthesia and the prevalence of food allergies are both increasing. Propofol’s preparation contains soybean oil and egg lecithin, raising concerns about cross-sensitivity. No widely accepted practice protocol regarding the administration of propofol in soy or egg-allergic patients exists, and the evidence of anaphylactic reactions in this population is inconclusive. This project involved the creation of a protocol that details the use of propofol for soy or egg-allergic patients at a regional medical center in central Illinois.

Collaboration with clinical stakeholders and an extensive review of the literature guided the development of an algorithm based protocol …

Improving Perioperative Anxiety And Pain: Development Of A Music Therapy Protocol, Rhyz Wilson

Doctor of Nursing Practice Projects

Perioperative anxiety is strongly correlated with a higher incidence of post-surgery pain, an increase in the need for analgesics and anesthetics, and delayed recovery and discharge from the hospital (Jimenez-Jimenez et al., 2013; Kuhlmann et al., 2018). Finding multimodal approaches to ease anxiety and discomfort from unfamiliar hospital surroundings is necessary to reduce perioperative anxiety and subsequent physiological complications (Ni et al., 2011). A review of current evidence-based literature revealed that music therapy significantly decreases both perioperative anxiety and pain levels in adult patients undergoing surgery. For this quality improvement project, a music therapy protocol was developed in collaboration …

Developing And Implementing Guidelines For Amniotic Fluid Embolism, Clayton Shick

Doctor of Nursing Practice Projects

Knowing that amniotic fluid embolism (AFE) is such a rare but harmful condition, a hospital in Metro-East St. Louis requested the creation of a checklist to ensure that all anesthesia providers quickly recognize and initiate appropriate management for AFE. The quality improvement project involved identifying the best evidence and collaborating with facility stakeholders to implement the use of an updated, evidence-based checklist to guide providers in the management of AFE. Via an open discussion PowerPoint presentation, CRNAs and anesthesiologists at the facility were provided education about AFE and the importance of using a checklist to facilitate management of AFE. The …

Laryngotracheal Stenosis, Kelsey Stuckey

Doctor of Nursing Practice Projects

Laryngotracheal stenosis (LTS) is the luminal compromise at the laryngeal, subglottic, or tracheal level (Gelbard et al., 2014). Various etiologies for LTS exist. Endotracheal cuff over-inflation, inappropriately sized endotracheal tubes, and sudden movements of the tube contribute to injury, as well as anatomical differences(Cardillo et al., 2010; Divatia & Bhowmick, 2005; Medina et al., 2009; Miñambres et al., 2009; Nikolovski et al., 2019; Zaghi et al.,2016). The influence of estrogen may contribute to the development of LTS in women during the third through fifth decades Dedo & Catten, 2001; Poetker et al., 2006; Valdez & Shapshay, 2002). The project goal …

Tranexamic Acid Use, Jennifer Aumann

Doctor of Nursing Practice Projects

Bleeding is a risk associated with every surgery. The pediatric population represents unique challenges during surgery due to differences in anatomy and physiology when compared to the adult population. Historically, blood transfusions were the treatment for excessive surgical blood loss. Transfusion of blood products have associated risks: infection, volume overload, and immunological reactions (Fraser, Porte, Kouides, & Lukes, 2008; Porte & Leebeek, 2002; Yuan, Zhao, & Xu, 2016). Interventions to decrease blood loss are essential to improve surgical outcomes. Tranexamic acid (TXA) use decreases the number of required blood transfusions thereby decreasing transfusion-related morbidity (Lei, Xie, Xu, Xie, Huang, & …

A Difficult Vascular Access Algorithm Using Intraosseous Devices In The Elective Pediatric Surgical Population, Cory R. Austin

Doctor of Nursing Practice Projects

In pediatric patients undergoing elective surgery, anesthesia is commonly induced via mask inhalation followed by peripheral IV placement before proceeding to airway management. However, IV access is often unpredictable and difficult to obtain in pediatric patients, with attempt success between 35% to 74%. During IV attempts, many dangerous clinical situations can occur amid limited options to deliver necessary medications. Failure to attain IV access may ultimately require extremes such as CVC placement or procedure cancellation. In this project, a difficult vascular access algorithm including intraosseous devices as an alternative was developed based on current evidence, existing algorithms, and implementation site …

Improving Outcomes For Patients With Osa Receiving Anesthesia, Natalie Bram

Doctor of Nursing Practice Projects

Obstructive Sleep Apnea (OSA) is a dangerous sleep disorder that is rising in prevalence, afflicting 29.4 million Americans or 12% of the U.S. population (AASM, 2017). Although OSA has the ability to negatively impact postoperative outcomes, numerous patients remain undiagnosed, unidentified, and improperly treated for OSA at the time of surgery (Baugh, 2013; Opperer et al., 2016). Evidence supports the STOP-BANG questionnaire as an effective, easy to use, and highly sensitive tool for screening patients for OSA (Chiu et al., 2016; Dolezal et al., 2011; Lakdawala, Dickey, & Alrawashdeh, 2018).

A 137-bed hospital had no standing preoperative protocol for the …

Pain Control Options For The Parturient: Pamphlet Development For Patient Education, Alyssa R. Jimerson

Doctor of Nursing Practice Projects

Epidural analgesia has traditionally been requested by the parturient population as the primary choice of pain control during labor, despite the availability of other viable options (Pitter & Preston, 2001). Viable pain control options available during labor include, neuraxial anesthesia, peripheral nerve blocks, pharmacological, and non-pharmacological measures. Lack of education regarding the availability of various pain control options for parturient women is identified as a cause of missed pain relief opportunities (Vargens, Silva, & Progianti, 2013). The purpose of this project was to develop a pamphlet prototype for an obstetrics department at a tertiary care center in central Illinois, explaining …

Preoperative Assessment Of Patients In An Enhanced Recovery Program, Edward Mitzelfelt

Doctor of Nursing Practice Projects

All patients undergoing surgery are at risk for perioperative morbidity and mortality (Gabriel et al, 2018) and a patient’s physical status plays a key role in patient outcomes (Hopkins et al, 2016). Enhanced recovery programs are intended to improve perioperative outcomes, facilitate postoperative recovery, and reduce loss of functional capacity (Feldheiser et al, 2016). Preoperative assessment allows for identification of risk factors which can be modified, with the aim of decreasing perioperative complications. A small community hospital had no standardized preoperative evaluation tool to use for their enhanced recovery patients. The purpose of this project was to create and implement …

Preventing Substance Use Disorder In Anesthesia Providers, Tyson Rogers

Doctor of Nursing Practice Projects

Developing substance use disorder is considered one of the most serious occupational risk factors for anesthesia providers. The purpose of this project was to identify the prevalence and risk factors of substance use disorder within the anesthesia community and to signify the importance of early education and awareness to help prevent the development of substance use disorder through early education, identification, and awareness. The project consisted of an educational PowerPoint that was placed on Southern Illinois University Edwardsville’s (SIUE) wellness website within Black Board. The third-year nurse anesthesia students at SIUE were sent an email on how to access the …

Fascia Iliaca Blocks For The Treatment Of Hip Fractures In The Emergency Department, Megan Hahn

Doctor of Nursing Practice Projects

Due to the aging population, the number of falls are increasing, leading to an increased number of individuals with hip fractures presenting in emergency departments (ED). Opioids are often administered for intraoperative pain related to hip fractures, which may result in a number of adverse effects, especially in the elderly. There is strong evidence suggesting that the use of fascia iliaca blocks (FIBs) in the ED can minimize opioid use, and improve patient outcomes and recovery. FIB is a compartment block that delivers local anesthetic around the lumbar plexus to provide analgesia associated with hip fractures.

The purpose of this …

Investigation And Evaluation Of Srna Barriers To Iana Engagement, Brittany Smith

Doctor of Nursing Practice Projects

The Illinois Association of Nurse Anesthetists (IANA) and American Association of Nurse Anesthetists (AANA) are professional organizations representing Certified Registered Nurse Anesthetists (CRNAs). While AANA membership has risen from 27,000 in 1994 to 45,000 in 2014, there was a 5% decline in CRNAs who are members of the AANA (Farina, Wilson, & FitzSimmons, 2016). Farina et al. (2016) reported that of 5,032 CRNAs who were not AANA members, 2,549 had been CRNAs for less than 10 years. This project involved the development and use of a 21-question survey to identify barriers to involvement in the IANA for student registered nurse …

Computer Based Learning Module: Neuraxial And Peripheral Nerve Blocks, Altan Halici

Doctor of Nursing Practice Projects

Neuraxial and peripheral nerve blocks (PNB) have been present for many years, but recently these pain management techniques are gaining popularity as an alternative to the use of opioids. Neuraxial and PNB reduce the opioid usage during and after the surgery and improve postoperative recovery in terms of pain relief, pain-related sleep disruption, and reduction of side effects, such as nausea and vomiting. Conversely, inadequate pain management after surgery may delay surgical recovery, decreased patient satisfaction, increased length of hospital stay, increased readmissions and healthcare costs (Patacsil, McAuliffe, Feyh, & Sigmon, 2016).

Perioperative nurses are instrumental during the post-operative period …

Development And Implementation Of An Enhanced Recovery After Surgery Screening Tool For Orthopedic Patients, Katie O'Rourke

Doctor of Nursing Practice Projects

Enhanced Recovery After Surgery (ERAS) protocols are evidence-based programs utilized by hospitals to improve patient outcomes and decrease perioperative opioid administration, generally associated with abdominal surgeries. With over 850,000 orthopedic surgeries performed in 2016, the volume of operations alone indicates a need for adoption of ERAS protocols within the orthopedic patient population. A review of literature was completed to gather the most current, evidence-based non-opioid components to be included in an ERAS protocol for orthopedic patients at a 460-bed hospital in Missouri. The results showed that Acetaminophen, Celebrex, Gabapentin, and regional anesthesia techniques are the most utilized ERAS adjuncts. With …

Development Of An Emergency Preparedness Protocol In An Office Setting, Amanda Burgesen

Doctor of Nursing Practice Projects

Office-based practices are not as stringently regulated as hospitals or ambulatory surgical centers. The lack of government oversight places the responsibility heavily on office-based practitioners to properly exercise their professional ethics to ensure their patients are receiving the highest quality of care while remaining safe. The purpose of this quality improvement project was to develop and implement an emergency activation protocol for a local gastroenterologist office in Southern Illinois that promotes emergency preparedness. The emergency activation protocol provided recommendations for staff training on emergency preparedness, mock codes, checking the crash cart, monitoring of the patient, medications available, and equipment that …

Improving Emotional Intelligence Skills In Student Registered Nurse Anesthetists, Kathryn M. Gratza

Doctor of Nursing Practice Projects

Becoming a certified registered nurse anesthetist (CRNA) involves didactic and clinical course work that challenges the student’s cognitive, mental, and emotional well-being. Standardized cognitive factors, such as grade point average, are utilized for nurse anesthesia program admission, but those factors do not take into account the student’s emotional intelligence. The ability to manage one’s emotions has a positive correlation with academic success (Beauvais, Stewart, DeNisco, & Beauvais, 2014) and has been correlated with greater success in nurse anesthesia programs (Collins, 2013).

The goal of this doctoral project was to increase the emotional intelligence of first-year students in the nurse anesthesia …

Discharge Opioid Guidelines For The Postpartum Woman, Chelsea Marie Pierce

Doctor of Nursing Practice Projects

In spite of the alarming opioid abuse epidemic, the number of opioids prescribed to women who give birth has been overlooked and underregulated. In a large metropolitan hospital that has over 3,500 deliveries a year, this problem was identified through first-hand encounter and data collection from an electronic medical record. Women in the postpartum period were prescribed an unnecessary number of opioids upon discharge. The goal of this project was to create guidelines that would decrease opioid use and increase the overall well-being of postpartum women. Guidelines were based off of type of delivery and women were not allotted more …

Addressing Hypertension Health Literacy In Black Individuals Who English Is Their Second Language, Uche Olateru

Doctor of Nursing Practice Projects

Hypertension is a primary preventable risk factor for cardiovascular disease. Despite advances in preventive and treatment measures, related to blood pressure control, the prevalence of hypertension in the United States remains high among Black People of immigrant and non immigrant communities. Healthcare is increasingly complex, and health literacy problems have increased due to demands by healthcare stakeholders for patients to assume a more independent role in taking charge of their health. A quality improvement project was conducted in a Faith based community to improve the knowledge of participants about hypertension. The objective of this project was to enhance lifestyle management …

Diabetes Management, Christina Varady

Doctor of Nursing Practice Projects

Diabetes Self-Management Education and Support (DSMES) has been shown to improve diabetes management. A Midwest, private family practice did not offer formal diabetes education. The purpose of this project was to increase patient education for recently diagnosed patients with type 2 diabetes who had not yet reached their management goals. A second purpose was to develop quality educational material for the provider in this practice. These objectives were met by identifying patients who were not at the optimal goal of HgA1c of 7% per the American Diabetes Association (ADA) guidelines and providing quality diabetes education and follow up to these …

Cvd Screening Protocol For History Of Hypertension In Pregnancy, Wendy E. Rodgers, Marissa P. Mahan, Jamie Y. Welty

Doctor of Nursing Practice Projects

The American College of Obstetricians and Gynecologists (ACOG) and the American Heart Association (AHA) recommend women with a history of hypertension during pregnancy receive annual blood pressure monitoring, weight check, and lipid screening; remain in the optimal body mass index (BMI) range; and obtain education on future risks for cardiovascular disease (CVD). At a small, Midwestern primary care clinic, there is not a current process in place to ensure patient education and screenings are provided for patients who meet this criterion. For this project, two check boxes were added to the providers’ annual exam template in the electronic health record …

Trauma Informed Care: Paving The Way To Better Patient Outcomes, Sarah Halsey, Amy L. Armstrong

Doctor of Nursing Practice Projects

Trauma-informed care (TIC) is an approach that enables healthcare clinicians to understand the effects of trauma and create a safer environment. Providers acknowledge the pervasive nature of trauma but lack proper tools and training to implement. It has been suggested that trauma is the prime determinant of health outcomes. Therefore, providing training and cultivating a change towards a trauma-informed organization, has the capability to change health outcomes.

The purpose of this project was to establish a program at SIU Medicine in which new employees are trained on the importance of TIC. Working closely with the Director of Population and Community …

Implementation Of The Edinburgh Postnatal Depression Scale In A Midwest Primary Care Clinic, Amanda Lee

Doctor of Nursing Practice Projects

Recent data from the World Health Organization reveals that the prevalence of postpartum depression is about 13%. Research portrays that untreated postpartum depression can have a detrimental impact on maternal and child outcomes. The American Academy of Pediatrics recommends integrating postpartum depression screening at the 1-, 2-, 4-, and 6-month well-child visits. The purpose of this project was to increase early identification of women with postpartum depression (PPD) by increasing the frequency of the Edinburgh Postpartum Depression Scale (EPDS) and evaluating the adherence of the recommended protocol at a Midwestern Primary Care clinic. The healthcare staff received training that included …

Increasing The Completion Of Advance Directives In Patients With Chronic Obstructive Pulmonary Disease In The Primary Care Setting, Cynthia Davis

Doctor of Nursing Practice Projects

When considering patients with COPD, current evidence indicates that discussions related to prognosis, illness trajectory, and goals of care between the provider and patient do not happen as they should. Consequently, without any advanced directives, the default in crisis is “do everything”. This gap in practice supported the need to implement an evidence-based assessment protocol regarding advance care planning needs in patients with COPD. The purpose of this project was to increase the number of COPD patients having advanced directives in a mid-western primary care clinic. The protocol included a chart review to assess for completed advanced directives among patients …

Efforts To Improve Breast Cancer Screening In A Rural Primary Care Clinic, Michelle Voudrie, Simi Dhillon

Doctor of Nursing Practice Projects

Breast cancer is the second-leading cause of cancer-related deaths among women in the United States. The American College of Obstetricians and Gynecologists (ACOG) recommend women at average risk of breast cancer to begin screening mammography starting at age 40. Mammography has been recognized as the most substantial tool to detect breast cancer. However, many rural organizations have seen a decrease in mammography compliance rates. The goal of this project was to create an evaluation and follow-up protocol for women in a rural primary care clinic who meet the criteria for ACOG’s guidelines for breast cancer screening which promotes increased compliance …