Nursing Commons^™

Simultaneous Family Planning Counseling During Visits For Chronic Conditions That Increase Preeclampsia Risk, Jessica Cotton

Doctor of Nursing Practice Projects

Treatment plans are incomplete until providers address a condition’s impact on a potential pregnancy. Primary care providers (PCPs) routinely treat hypertension (HTN), diabetes (DM), chronic kidney disease (CKD), lupus (LP), and antiphospholipid syndrome (APL), which all increase preeclampsia in pregnancy. PCPs may be more prone to overlook pregnancy potential in the context of diseases than those specializing in obstetrics. This quality improvement (QI) project aimed to see if this was true in a small nurse practitioner-owned and run family practice clinic in Oklahoma. A 2022 retrospective chart review for non-pregnant reproductive-age adult females confirmed that no ICD-10 codes for HTN, …

Evaluating The Effectiveness Of The Clinical Care Of The Pediatric Patient Course: A Quality Improvement Project, Cassandra Elliot

Doctor of Nursing Practice Projects

The Clinical Care of the Pediatric Patient (CCPP) is a two-day course held monthly as part of the onboarding process. This mandatory course is intended to prepare onboarding clinical staff for the provision of evidence-based care to pediatric patients. CCPP contains over 17 hours of didactic and hands-on instruction in the assessment, management, and treatment of pediatric conditions. The goal of this quality improvement project was to determine the perceived effectiveness of the CCPP course and its impact on the confidence level of clinical staff as pediatric providers during their first few months of employment. A regression analysis was used …

Weight Loss And The Effects On Blood Pressure, Ashiqua Jackson

Doctor of Nursing Practice Projects

Obesity and hypertension directly contribute to cardiovascular disease, which is modifiable and preventable with lifestyle modification. Blood pressure (BP) control directly impacts mortality from heart disease. The literature suggests that weight reduction is associated with a decrease in BP. The project’s purpose is to assess the effect of a weight management plan on obese or overweight adults with hypertension. The best practice identified was the DASH diet for weight loss and BP reduction, followed by a medication regimen such as Semaglutide. The inclusion criteria comprised adults >18 years with a BMI > 25 and exclusion criteria of < 18 years old, BMI < 25, and a diagnosis of diabetes. Based on the inclusion criteria, a convenience sample of 27 patients was obtained from an outpatient clinic through a retrospective chart review. Obesity, hypertension, and DASH diet education were provided to the clinic staff. During the initial weight management consultation, the provider educated patients about the DASH diet. A baseline BP and weight were obtained and compared four weeks later. A two-tailed Wilcoxon and paired t-test revealed a significant systolic and diastolic BP reduction. The results were statistically significant, indicating that a comprehensive weight management plan is essential to reducing both BP and weight in overweight, obese, and hypertensive patients.

Early Identification Of Postpartum Depression Symptoms During The Antenatal Period Through The Utilization Of The Edinburgh Postnatal Depression Scale, Cherie Didier

Doctor of Nursing Practice Projects

Postpartum depression (PPD) is a prevalent mental health disorder that negatively impacts maternal behavior and infant development. Despite a global incidence of around 12% (Ti & Curtis, 2019), current screening practices are inadequate. The American College of Obstetricians and Gynecologists (ACOG, 2018) recommends universal screening using the Edinburgh Postnatal Depression Scale (EPDS) at least once during pregnancy. However, the project site in an obstetrical clinic currently does not screen during pregnancy. This quantitative quality improvement project in a Memphis, TN, obstetrical clinic used systematic data collection of EPDS scores of pregnant women and analysis to investigate the effectiveness of implementing …

Improving Timeliness Of Nursing Documentation, Anthony S. Morgan

Doctor of Nursing Practice Projects

Nursing documentation is a critical element of the patient's medical record and contains essential information relied upon to create and implement the plan of care. Despite the understood importance of timely documentation, nurses in this community hospital inpatient medical/surgical unit still struggle to complete data entry promptly. This quality improvement project aimed to improve the efficiency and timeliness of nursing documentation in this unit by deploying the EMR on a mobile application as an adjunct to desktop and laptop PC devices. EMR reporting tools were used to collect timestamps of flowsheet documentation observation time and observation entry time. Time in …

Impact Of Anxiety In School Aged Children And Adolescents In Rural Settings, Jasmine Smith

Doctor of Nursing Practice Projects

The widespread prevalence of youth anxiety has a strain on rural communities lacking screening access. The Screen for Child Anxiety Related Emotional Disorders (SCARED) Tool is widely validated to assess anxiety. The project’s purpose analyzed clinician’s adherence to screening youth with a chief complaint of anxiety or as a behavioral referral at Shaw Medical. The principal investigator implemented a SCARED educational protocol which consisted of SCARED handouts, mock training interviews, a post-educational survey, and chart audits. A descriptive research design using a retrospective chart review examined SCARED screenings in 100 youth aged 8-18 listing sociodemographic statuses of gender, race, and …

Mindfulness Training To Reduce Perceived Stress Among Manufacturing Employees: An Evidence-Based Project, Ijeoma Okoro

Doctor of Nursing Practice Projects

Background: Stress, a state of emotional or physical tension, is experienced by individuals for various reasons. The American Psychological Association identifies money, work, and the economy as the most frequently cited sources of stress. Workers in manufacturing settings are particularly susceptible to increased levels of perceived stress due to the demanding nature of their work. To reduce stress levels, some manufacturing companies have begun implementing different interventions, including mindfulness-based stress reduction.

Objectives: The aim of this project was to implement a weekly 30-minute mindfulness training program over six weeks to reduce perceived stress levels among manufacturing employees at a company …

Rn To Bsn End-Of-Program Evaluation Revision, Nichol Tate

Doctor of Nursing Practice Projects

The data in an end-of-a-program student survey are crucial for maintaining a high-quality program and meeting accreditation standards. This quality improvement project aims to formulate a revised end-of-program evaluation survey for graduates to use to provide feedback to make necessary improvements to the program and employ better communication and access to educators for students to feel connected and important. After the item analysis method was used to review the questions and revise the survey, the revision of the survey was sent to the current summer RN to BSN students to complete and provide data about the overall program. Another method …

Utilization Of Modified Early Warning Scores (Mews) To Decrease In-Hospital Cardiac Arrests (Ihca), Ashley Bryan

Doctor of Nursing Practice Projects

Background: Less than 25% of patients survive to discharge after an in-hospital cardiac arrest (IHCA). The American Heart Association (AHA) aimed to increase the survival to discharge after IHCA to 35%, according to the AHA Get with the Guidelines (GWTG). Pre-implementation of MEWS-based rapid response rounding the facility had a 24% survival to discharge rate after IHCA.

Purpose: The Doctor of Nursing Practice (DNP) project aimed to improve the survival to discharge percentage after IHCA by implementing MEWS-based rapid response rounding on all patients with a MEWS of four or greater.

Methods: The quality improvement project consisted of having rapid …

The Use Of Two Nurses, Four Eyes On Skin Assessments To Reduce The Incidence Of Pressure Injuries In Medical-Surgical Patients, Tiffany Bass

Doctor of Nursing Practice Projects

Background: Hospital-acquired pressure injuries (HAPIs) adversely affect at-risk patient populations and hospital settings. HAPIs increase the risk of death in vulnerable patient populations (Wassel et al., 2020). In addition, HAPIs cost healthcare agencies $9 to $11 billion annually (Padula & Pronovost, 2018). Inconsistent completion and documentation of the patient’s skin assessments both upon admission and daily throughout their hospital stay are identified barriers to improving patient outcomes. Implementing a Two Nurses, Four Eyes on Skin Assessment model upon admission and daily during the patient’s stay will decrease the incidence of hospital-acquired pressure injuries.

Purpose: The purpose of this Doctor of …

Implementation Of A Nurse-Driven Early Mobility Protocol In Critical Care To Reduce Intensive Care Unit Acquired Weakness (Icuaw), Wendy Key

Doctor of Nursing Practice Projects

Background: Intensive care unit acquired muscle weakness (ICUAW) is a syndrome of general weakness that occurs while a patient has a critical illness. Almost half of all ICU patients develop ICUAW. The most common occurrence of ICUAW is seen in patients diagnosed with prolonged mechanical ventilation, severe sepsis, or difficulty weaning from mechanical ventilation (MV). Bedrest is the number one risk factor for the development of ICUAW and the elderly are at higher risk. The best treatment for ICUAW is early mobility which has shown positive effects for decreasing ventilator days and intensive care unit (ICU) length of stay (LOS). …

Improving Initial Lactic Acid Compliance Of Suspected Septic Adults In A Rural Emergency Department, Nataleigh Jones

Doctor of Nursing Practice Projects

Background: Sepsis remains one of the leading causes of death in hospital settings. The doctor of nursing practice (DNP) project demonstrated areas that the hospital is doing satisfactorily with compliance and many areas for improvement within the organization regarding sepsis compliance. The DNP project demonstrated the effectiveness of the sepsis best practice advisory (BPA) tool in increasing sepsis bundle compliance in the emergency department (ED).

Purpose: The purpose of this DNP project is to help aid in the early recognition of sepsis and improve initial lactic acid compliance in a local emergency department. Many tools help with the early recognition …

Reducing The Incidence Of Opioid-Induced Unintended Advanced Sedation And Respiratory Depression In Hospitalized Patients, Angel Elliott

Doctor of Nursing Practice Projects

Background: Opioids are commonly administered to hospitalized patients to treat acute pain and can cause serious adverse events such as unintended advanced sedation and respiratory depression, also known as opioid-induced respiratory depression (OIRD). Post-surgical patients are at increased risk of unintended advanced sedation and respiratory depression due to anesthesia and pre-and post-opioid administration. They have a greater risk because they have less monitoring than those in the intensive care unit because their care teams, typically nurses, have higher staff-to-patient ratios. The use of enhanced interventions, such as the use of sedation evaluation tools, can decrease the risk of OIRD.

Purpose: …

Use Of Evidence-Based Telehealth To Reduce Complications In Adults With Type 2 Diabetes In A Rural Health Facility, Joni Kelley

Doctor of Nursing Practice Projects

Background: Formal education for type 2 diabetes mellitus (T2DM) patients is essential, especially in rural areas where diabetes is approximately 17% higher than in urban areas (Bolin & Ferdinand, 2018). In 2019, diabetes was listed as the direct cause of 1.5 million deaths, and 48% of all deaths due to diabetes occurred before 70 years (American Diabetes Association, 2021). According to the American Diabetes Association (2021), approximately 550,149 people in Alabama, or 14.1% of adults, have been diagnosed with diabetes. An additional 119,000 people in Alabama have diabetes but are unaware, significantly increasing their risk of complications (American Diabetes Association, …

Implementation Of A Perinatal Depression Screening Protocol, Michele Fuller

Doctor of Nursing Practice Projects

Background: Perinatal depression (PD), leading to suicide, ranked as a high cause of maternal mortality and was found to affect one out of 7 women in 2018, according to the American College of Obstetrics and Gynecology (ACOG) (2018). PD screening at the start of pregnancy care aims to achieve early referral to behavioral health resources (ACOG, 2018).

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to implement an evidenced-based PD screening protocol by presenting the Edinburgh Postpartum Depression Scale (EPDS) to each initial prenatal visit patient (IPV).

Methods: Qualitative pre-data was collected, followed by qualitative post-data …

Implementing An Evidence-Based Pressure Injury Bundle To Reduce Acquired Pressure Injuries In A Long-Term Care Facility, Latecia Rhoden

Doctor of Nursing Practice Projects

Background: Pressure injuries in the United States affect between 1-3 million people. Of the percentage of patients affected by pressure injuries, a range from 2% to 28% of those patients are in long-term care facilities. In Alabama, the pressure injury rate in long-term care facilities ranges from 2.3% to 18.4%. According to this long-term care facility's November 2022 quality improvement report, the acquired pressure rate rose from 2.2% to 8.3% in a year. A total of nineteen newly acquired pressure injuries were reported. Eleven of the nineteen pressure injuries occurred in the long-term stay unit, accounting for almost 58% of …

Utilizing A Multidisciplinary Team Approach To Opioid Stewardship At An Interventional Pain Clinic, Georgemarie Garber

Doctor of Nursing Practice Projects

Background: The opioid epidemic is a preventable health threat that is a recognized national problem by the Centers for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS). The evidence-based Opioid Stewardship (OS) toolkit is essential in the opioid epidemic because it supports identifying patients at risk for opioid aberrancy. However, at the Interventional Pain Management Clinic (IPMC), a chart review on the completion rates of the OS toolkit components for new patients admitted in June 2022 revealed that providers were not consistently completing components of the OS toolkit such as Opioid Risk Tool (ORT), the Morphine …

Implementation Of A Postpartum Depression Screening Protocol, Samantha Abercrombie

Doctor of Nursing Practice Projects

Background: Postpartum depression (PPD) is a major depressive disorder that can occur after having a baby and anytime during the first year postpartum (Centers for Disease Control and Prevention [CDC], 2021). Symptoms of PPD may include anger, crying more than usual, withdrawing from family, inability to bond with the baby, feelings of anxiousness, or thoughts of the mother harming herself or the baby. PPD can yield many challenges and hinder daily living activities. Recent research by the CDC (2021) estimates that 1 in 8 women experience manifestations of PPD. Findings also suggest that 1 in 5 women were not …

Implementation Of A Patient Care Specialist Role To Enhance The Patient Experience In A Pediatric Emergency Department, Jillian Brodeur

Doctor of Nursing Practice Projects

Background: Patient-centered care (PCC) has been an emerging trend in healthcare for the past two decades (Walsh et al., 2022). PCC and the patient experience have become essential measures of the quality of care provided and are linked to reimbursement dollars and improved patient outcomes (Rapport et al., 2019).

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to improve the patient experience in the Emergency Department (ED) of a metropolitan hospital. The DNP project focused on the benefit of a patient advocate in the ED to improve the patient experience. The project sought to improve …

Reducing The Incidence Of Hospital Acquired Pressure Injuries With An Interprofessional Collaboration Using Range Of Motion Exercises, Angela Johnson

Doctor of Nursing Practice Projects

Background: Hospital - Acquired Pressure Injuries (HAPIs) are an enormous problem for healthcare institutions and patients. HAPIs are painful, can lead to additional infections, increase the length of stay, and even cause death. Hospitals around the country are experiencing increases in the number of HAPIs. This project was implemented in a medical-surgical unit of a local urban hospital in the southeastern United States. The medical-surgical unit reported an increase in the number of HAPIs that exceeded the national average of 3%.

Purpose: The purpose of this quality improvement project was to apply an interprofessional approach to reduce HAPIs using a …

Improving Influenza Vaccination Rates In A Primary Care Clinic: A Quality Improvement Crusade, Janet Lowe

Doctor of Nursing Practice Projects

Background: Research consistently shows that influenza vaccines prevent medical appointments, treatments, and disabilities. In the United States (U.S.), 25-49 million individuals contracted influenza from October 2022 through January 2023. However, despite a greater community consciousness regarding viral contagions and the improved availability of vaccinations through primary care settings, ambulatory clinics, and local pharmacies, adults in the U.S. continue to miss the national influenza vaccination goals of 70%.

Purpose: This Doctor of Nursing Practice (DNP) project aimed to boost influenza immunization rates and comprehension of vaccination benefits among patients in a primary care setting during the influenza season. The DNP student …

Improving Door-To-Balloon Times In Adult Patients With St-Elevation Myocardial Infarction By Utilizing A Stemi-Rn, Amanda Hunter

Doctor of Nursing Practice Projects

Background: Heart disease is the leading cause of death in Alabama. The national estimated annual incidence of myocardial infarction (MI) is 605,000 new and 200,000 recurrent attacks, of which approximately 170,000 are silent (Tsao et al., 2022). Roughly every 40 seconds, an American will have an MI (Tsao et al., 2022). An ST-elevation myocardial infarction (STEMI) occurs when one or more of the coronary arteries supplying the heart with blood occlude, leading to myocardial injury (Akbar et al., 2021). Clinical practice guidelines for STEMI recommend Door to Balloon (D2B) intervention in 90 minutes or less (O'Gara et al., 2013), while …

Utilization Of A Simulation Electronic Documentation Model For Healthcare Providers To Reduce Documentation Errors In A Hospital Setting, Icy Moton-Hale

Doctor of Nursing Practice Projects

Background: Electronic health records (EHRs) are commonly used within healthcare systems across the United States. Although EHRs were developed to provide safe delivery of care, poor documentation quality remains a problem. Poor HER documentation can negatively affect many patients’ health outcomes.

Purpose: The purpose of the DNP project was to determine the degree to which using a simulated electronic documentation model to train nurses in an acute care unit would decrease documentation errors and missed care and decrease missed opportunities for patient education in EHRs.

Methods: The theoretical framework was underpinned by the Donabedian model, positing that factors associated with …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

Promoting Wellness With Medical-Surgical Nurses In An Urban Medical Center Through Mindfulness-Based Stress Reduction, Shemeka Leonard

Doctor of Nursing Practice Projects

Background: Due to their position on the forefront lines of the healthcare system, nurses are more likely to experience stress at work. Job-related stress can cause increased anxiety, emotional turmoil, depression, and other mental issues. Nurses commonly deal with elevated distress due to workload demands such as passing medication, checking for errors, ensuring patient safety, and charting—mindfulness-based stress reduction (MBSR) is a useful means of reducing psychological distress.

Purpose: The DNP project objectives were to reduce stress, encourage well-being, and show how effective an MBSR program works in a hospital setting. The aim is to reduce stress/improve wellness.

Methods …

Improving Early Sepsis Recognition And Treatment By Utilizing The Surviving Sepsis Campaign In Emergency Department Patients, Rebecca Smith

Doctor of Nursing Practice Projects

Background: Sepsis is a physical reaction to infection that can cause bodily injury, organ deterioration, and death (Sepsis Alliance, 2022). Early sepsis identification and intervention requires staff engagement in quick recognition and implementation of care (Jorgensen, 2019). Septic patients require prompt initiation of intravenous fluids, hemodynamic observation, and appropriate laboratory testing (Evans & Rhodes, 2021). Rapid detection of sepsis can prevent patients from progressing to severe sepsis and septic shock, increasing the risk of mortality (Jorgensen, 2019). As a result of the high mortality rates and complications associated with this health disparity, evidenced-based care bundles were developed to improve care …

Using The 2as And R Method To Encourage Referral To Smoking Cessation Counseling In An Urban Pulmonary Clinic, Jennifer Holloway

Doctor of Nursing Practice Projects

Background: Smoking is a habit of millions of Americans despite the associated preventable health issues and death that it produces. Smoking cessation programs, particularly those using pharmacotherapy, are effective in increasing smoking cessation rates. However, smoking cessation programs remain underutilized.

Purpose: The purpose of the DNP project is to educate providers on using the 2As and R (ask, advise, and refer) of smoking cessation to assess a patient’s readiness to quit and refer to smoking cessation counseling. For providers working in an urban pulmonary clinic, does education regarding the use of the 2As and R method as a standardized intervention …

Evaluation Of A Peer Support Group Implementation To Reduce Burnout In Nursing Staff On An Acute Inpatient Mental Health Unit, Marilyn Scott

Doctor of Nursing Practice Projects

Background: Burnout is feeling emotionally overwhelmed and exhausted due to stress in the workplace. Caring for acute psychiatric patients can impact the mental health of nursing staff and contribute to high-stress levels. Nursing burnout contributes to staffing shortages and increased risk for adverse patient safety events in an acute inpatient mental health unit.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) Quality Improvement (QI) project was to evaluate the impact of a peer support group on burnout reduction in the nursing staff working in an acute inpatient mental health unit.

Methods: A peer support group was implemented …

Stress Reduction In Correctional Healthcare Workers: A Survey Of Healthcare Staff Stress Levels In A Tennessee Correctional Facility Using The Perceived Stress Scale, Lashelle Melton

Doctor of Nursing Practice Projects

Background: Correctional nurses’ function in a high-stress environment due to the nature of their clients and the importance of environmental security. Job stress and satisfaction are theorized relational concepts that influence intent to stay, and turnover as described in the anticipated turnover model. Acute stress can occur in correctional nurses when faced with unexpected or intense situations, such as a medical emergency, a violent incident, or a suicide attempt. Several factors can contribute to acute stress in correctional nurses, leading to overwhelming feelings and making it difficult for nurses to provide quality care.

Purpose: The DNP project aims …

Physical Exercise As A Lifestyle Modification To Lower Blood Pressure In Hypertensive Females With A Body Mass Index Greater Than 25, Kacee Pee

Doctor of Nursing Practice Projects

Background: Hypertension affects many Americans nationwide and, if untreated, can cause heart attack, stroke, and chronic kidney disease. Hypertension (HTN) accounts for about 1 in 5 deaths of U.S. women and is a greater burden for women than men (Wenger et al., 2018). Women who are overweight increase their risk of developing hypertension. Lifestyle modifications, such as diet and exercise, are the first-line treatment for hypertension. Physical exercise is a crucial component of lifestyle therapy for the primary prevention and treatment of hypertension. Several studies consistently demonstrate the beneficial effects of exercise on hypertension, with reductions in both systolic and …