Nursing Commons^™

Impact Of Opioid-Free Anesthesia On Postoperative Nausea & Vomiting: A Scoping Review, Madison Scholl, Miranda Morrison, Abbey Ramsey, Alexandria Sawicki, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose The purpose of this DNP Scoping Review is to compare the current literature regarding the incidence of postoperative nausea and vomiting (PONV) in adult patients who underwent general anesthesia when opioids are used intraoperatively versus a multimodal non-opioid-based intraoperative general anesthetic plan Specific Aims: Incidence of postoperative nausea & vomiting Postoperative rescue antiemetic administration Length of stay in postoperative anesthesia care unit (PACU) Incidence of intraoperative adverse events

Decreasing Postop Delirium With Dexmedetomidine Vs Propofol, Isabel Bannister, Rn, Bsn, Srna, Abigail Kurtz, Rn, Bsn, Srna, Abigail Banko, Rn, Bsn, Srna, Reid Blaylock, Rn, Bsn, Srna, Tracy Mcclinton, Dnp, Aprn, Agacnp-Bc, Epb-C, Caitlan Bradford, Rn, Bsn, Srna

Doctor of Nursing Practice Projects

Postoperative delirium (POD) is a common complication that contributes to increased length of hospital stay, impaired recovery, and can affect long-term outcomes. Recently, research has been conducted to determine if certain anesthetic agents decrease the likelihood of developing POD. However, no clear protocol for prevention exists. This scoping review aimed to analyze the current literature to determine the efficacy of dexmedetomidine versus propofol at preventing POD.

How Does School-Based Depression Education Effect Depression Scores: A Scoping Review, Hannah Kliewer Bsn, Rn, Grayson Sheley Bsn, Rn, Sally Humphrey Dnp, Aprn, Cpnp-Pc

Doctor of Nursing Practice Projects

Purpose:

The purpose of this scoping review is to provide a detailed look into depression education courses among adolescents, ages 10-19 years old, and determine if the adolescents’ knowledge, attitudes, and beliefs regarding depression are impacted.

Specific Aims: •Determine the impact of a school-based depression education program •Evaluate programs for early knowledge and prevention of depression •Compare the current school curriculum with the addition of depression education

Bi-Weekly Follow-Up Of Adult Patients Diagnosed With Schizophrenia To Increase Treatment Adherence: A Scoping Review, Garrett L. Seaton, Bsn, Rn, Michelle A. Conteh, Bsn, Rn, Shelia L. Jackson, Msn, Bsn, Rn, Sharon H. Little, Dnp, Fnp-Bc, Aprn

Doctor of Nursing Practice Projects

Purpose/Background

Schizophrenia is a complex psychiatric disorder that can significantly affect a patient’s psychological state. Because of this, medication nonadherence is reported as one of the most common causes of relapse and rehospitalization in patients diagnosed with schizophrenia. Although long-acting injectable (LAI) antipsychotics can help provide more continuous treatment, they do not address other factors that affect treatment adherence. This scoping review will evaluate existing literature to assess if a multimodal approach, such as increased patient follow-ups in addition to scheduled, current-practice LAI treatment and management, may increase treatment adherence in adult patients diagnosed with schizophrenia.

Methods

A database search …

Long-Acting Injectable Antipsychotics Vs. Oral Antipsychotics In Treatment Adherence: Efficacy And Equity Of Care, Jason P. Peter Msn, Aprn, Fnp-Bc, Ashley F. Walker Bsn, Rn, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Summary

Background: Compliance with oral antipsychotic medications (OAP) in the treatment of patients with schizophrenia has been a challenge. Challenges to OAP include medication side effects, lack of ability to obtain medications, and missing doses, among other factors. As a result of this non-compliance, those taking oral antipsychotic medication are at greater risk for exacerbation of their illness. The consequence of relapse carries considerable risks with each psychotic event. The study aims to compare if medication treatment adherence is greater in clients with schizophrenia using oral antipsychotics (OAPs) vs. long-acting injectable (LAI) antipsychotic medications.

Methods: In this scoping review, 15 …

Suicide Screening Among Adolescents With A History Of Mental Or Physical Abuse- Evaluating The Effectiveness Of Suicide Screening: A Scoping Review, Tiffany Nicole Jackson Bsn, Rn, Cody Tyler Cottrell Bsn, Rn, Allison Tucker Mcculley Bsn, Rn, Cen, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose The purpose of this scoping review is to gather evidence on best practice for the administration of pediatric suicide screening in a variety of healthcare settings.

Icu Delirium: Detection With And Without Cam-Icu Screening, Kiara Nicole Felix, Anita Larkin, Kathryn Lynn, Latoya Reed, Tracy Mcclinton Dnp, Ag-Acnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Delirium is a form of brain malfunction marked by abnormalities in cognition, disorientation, memory, and awareness. This scoping review's aim is to examine bodies of research on the effects of length of stay (LOS) in the ICU using Confusion Assessment Method-Intensive Care Unit (CAM-ICU).

Methods

Adults age 18 and older admitted to the ICU, of any race or ethnicity, and any gender were all included in the study articles. Nine articles satisfied the search criteria after publications underwent rapid critical appraisal. Results were evaluated for ICU LOS, hospital LOS, mortality, restraint use, medication use, delirium screening tool use, and …

Perioperative Corneal Abrasion: An Investigation Into Preventive Practices And Educational Interventions That Limit Corneal Abrasions In The Perioperative Setting, William Boyden

Doctor of Nursing Practice Projects

Corneal abrasions are the most common ophthalmic injuries that occur in the perioperative period. Corneal abrasions that occur while the patient is under anesthesia are the result of either physical trauma, exposure, or patient related factors. Anesthesiology departments rarely develop continuing education focusing on the reduction of corneal abrasion incidence. Evidenced-based guidelines for corneal abrasion prevention techniques were reviewed while developing an educational program focused on corneal abrasion prevention amongst a group of Certified Registered Nurse Anesthetists (CRNAs). An educational presentation was given to twenty-eight CRNAs. The goal of the presentation is to reduce corneal abrasions in the perioperative setting, …

Implementation Of A Glidescope Educational Program For Novice Student Registered Nurse Anesthesiologists, Joshua F. Snodgrass, Brian Bendel

Doctor of Nursing Practice Projects

GlideScope Video laryngoscopy carries a higher risk of injury to the pharyngeal cavity than direct laryngoscopy. Verathon is aware of this risk and has developed a proprietary “Four-step method” to mitigate it. This project aimed to reduce injuries related to GlideScope video laryngoscopy by providing first-year nurse anesthesiologists at Southern Illinois University Edwardsville with didactic and simulation education related to GlideScope video laryngoscopy and injury prevention. Didactic education was provided via a pre-recorded PowerPoint presentation. Simulation education was provided with the GlideScope and airway trainer manikins. The participants completed an identical 8-question pre-test and post-test to assess for knowledge gain …

Impact Of Mobile Text Reminders On Medication Compliance, Paul Weatherly, Haley Russell, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Purpose/Background

Patient noncompliance with medication leads to longer and more frequent infections and health issues. Using mobile reminders, patients can be prompted to take their medication, schedule their followup appointments, or fill their prescription to encourage compliance and better overall health.

Methods

A search of PubMed, LibKey, and EBSCO was conducted. Articles reviewed included meta-analysis, randomized controlled trials, and systematic reviews in the use of mobile reminders on patient compliance, specifically in medication adherence. Then, we reviewed the article methods and outcomes across various health issues addressed. The articles were then reviewed for criteria such as population size, length of …

Enhanced Recovery After Surgery (Eras) For Cardiothoracic Surgery, Emile Shaw, Samantha Schultz, Taylor Woods, Emma Zollmann, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Background/Purpose

Enhanced Recovery After Surgery (ERAS) protocols are multi-disciplinary approaches that optimize recovery and reduce surgical outcome variability. This scoping review compares surgical outcomes associated with traditional perioperative care to outcomes associated with an ERAS protocol for patients undergoing cardiothoracic surgery.

Methods

A literature review evaluating traditional perioperative care versus ERAS protocols in cardiothoracic surgical patients was performed to set inclusion and exclusion criteria based on current peer-reviewed journal articles for qualitative data. Group members selected 14 articles based on inclusion criteria and relevance to the PICOT question for review and placed findings in a synthesis table. Findings included compliance …

Telehealth By Certified Psychiatric Providers Compared To Emergency Department Healthcare Providers On Psychiatric Patient Outcomes: A Scoping Review, Lekisha C. Pride, Taylor B. Bradley, Michelle R. Porter, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Emergency department visits for mental health disorders have increased over the years due to insufficient mental health resources. The number of ED visits for mental health disorders rose from 1.4 to 2.5 million per year in the US. Therefore, mental health patients being seen by ED physicians are more likely to have longer lengths of stay, an increase in hospital admission, and high recidivism rates. Purpose: In this scoping review, we wanted to determine the role of telehealth on ED mental health patients. outcomes regarding how telehealth can reduce the number of admissions, length of stay in the ED, …

Effectiveness Of Perioperative Ketorolac Versus Opioids: A Scoping Review, Jamie Smith Bsn, Srna, Ashley Warner Bsn, Srna, Oran Tubre Bsn, Srna, Sherman Stauffer Bsn, Srna, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Abstract

Purpose

The purpose of this project will compare the effectiveness of ketorolac over opioids alone for pain management of patients 72 hours postoperatively.

Background

In recent years, there has been overwhelming evidence of opioid abuse and its adverse effects on patients’ lives. To combat this, significant attention has been paid to multimodal analgesia throughout the perioperative period to decrease patients’ exposure to opioids. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ketorolac, are being administered intraoperatively to reduce the need for opioids in patients' post-surgical procedures.

Methods

A literature review was done on articles that evaluated perioperative adult human patients undergoing …

The Effectiveness Of Increasing Frequency Of Central-Line Dressing Changes And Monitoring On Clabsi Rates: A Scoping Review, Jacob Schmidt, Bsn, Rn, Ccrn, Georgia Brown, Bsn, Rn, Laura Dickey, Agpcnp-C, Lauren Faulkner, Bsn, Rn, Margaret Harvey, Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Abstract

Purpose/Background

Central lines provide many benefits to critically ill patients; however, there are additional risks with them, including central line-associated bloodstream infections (CLABSIs). CLABSIs place patients at increased risk for morbidity and mortality, longer length of stay, and higher medical costs. Studies evaluating various methods of reducing CLABSIs have been performed. This scoping review was completed to determine the effectiveness of frequent central-line dressing changes and increased monitoring on the incidence of central-line associated blood stream infections in adults with central-lines.

Methods

An extensive database search through the University of Tennessee Health Science Center (UTHSC) Online Library was performed …

Teach-Back Method To Reduce Chf Readmissions: A Scoping Review, Briyanna Evans Bsn, Rn, Bre'yocha Dewalt Bsn, Rn, Ccrn, Jessica Mabry Bsn, Rn, Kailee Garrett Bsn, Rn, Crystal Stephens Bsn, Rn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background

The purpose of this scoping review is to evaluate the effectiveness of the teach-back method on education as it relates to congestive heart failure readmission rates. Congestive heart failure (CHF) is the most common cause of hospitalizations among those 65 years and older in the United States. CHF readmission rates in Tennessee are higher than the already elevated national average. The current literature suggests a need to reduce 30-day readmissions, improve patient outcomes, and enhance self-efficacy in patients with CHF. The research proposes a correlation between high readmission rates and poor knowledge retention of patients with CHF, but small …

Efficacy Of Distraction Therapy In Reducing Needlestick Pain In Pediatrics: A Scoping Review, Ashlan Ritchie Bsn, Rn, Anne Evans Bsn, Rn, Charlotte Isabel Bsn, Rn, Michelle Rickard Dnp, Cpnp-Ac, Chppn, Bmtcn

Doctor of Nursing Practice Projects

Purpose/Background

Pediatric pain management is often overlooked due to time constraints and lack of resources or education on interventions used, such as distraction or pharmacological therapy. Lack of pain management leads to patient and caregiver distress, as well as an increased number of attempts to perform the procedure. This scoping review evaluates the efficacy of distraction therapy compared to nonopioid pharmacological interventions for acute needlestick pain in children ages 6 to 12 years; patient and caregiver levels of distress were also evaluated in most studies.

Methods

The UTHSC (University of Tennessee Health Science Center) Library database was searched for full-text …

The Utilization Of Depression Screening Tools In Patients With Diabetes Type 2, Hanna Book, Kennedy Eldridge, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Artangela Henry Dnp, Agacnp-Bc, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Diabetes and depression are highly prevalent and concerning conditions impacting millions worldwide. Evidence-based guidelines recommend regular depression screening of individuals with type II diabetes (DM2) to appropriately diagnose and treat depression and proactively enhance clinical outcomes. The gold standard for determining depression in patients with chronic disease is the diagnostic clinical interview; however, many clinicians have turned to brief, self-reported screening tools such as the PHQ-2 and the PHQ-9 whose use are recommended by evidence-based guidelines. This study aims to assess the utilization of the PHQ-2 and PHQ-9 versus no screening on DM2 patients in a primary care setting. …

Improved Bonding & Maternal Self-Efficacy In The Nicu: A Scoping Review​, Alexandria Sneed Nauert Bsn, Rnc-Nic, Mckenleigh N. Hill Bsn, Rnc-Nic, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background

Mothers of infants admitted into the neonatal intensive care unit (NICU) are at risk for developing anxiety, depression, and post traumatic stress disorder (PTSD) related to their child’s hospitalization which impedes the mother-infant bonding and attachment process. Research shows that children of mothers suffering from these issues are more likely to develop their own behavioral, emotional and cognitive problems later in life. The purpose of this scoping review is to analyze the literature regarding methods to improve bonding and attachment between NICU patients and their mothers to improve long-term outcomes for the whole family.

Methods

The authors conducted a …

Barriers To Screening For Diabetic Retinopathy: A Scoping Review, Amy Cooper Rn, Bsn, Lajerica Bates Rn, Bsn, Julie Bridges Rn, Bsn, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

More than 34 million people in the United States have diabetes. Diabetic retinopathy (DR) is a major complication of diabetes and a leading cause of vision loss. Risk factors for diabetic retinopathy include Type 1 and Type 2 Diabetes, hypertension, smoking, and being African American or Hispanic/Latino. This scoping review seeks to analyze the current research on ways to increase vision screenings, thus reducing cases of diabetic retinopathy in adults.

Methods

Between September 2020 and November 2021, a search was conducted using PubMed, EBSCOhost, Medline, and CINAHL to identify articles using keywords such as diabetic retinopathy and ophthalmology. This …

Hepatitis C Virus Screening Strategies To Improve Early Identification And Treatment: ​ A Scoping Review​, Megan Elizabeth Lyons, Rn, Bsn, Ccrn, Thomas Tyler Bennett, Rn, Bsn, Ccrn, Felicia Ann Gray-Hamilton, Rn, Bsn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background

Hepatitis C virus (HCV) is the most common bloodborne infection in the United States (Ludden et al., 2022). Sadly, over half of the individuals living with chronic HCV are unaware of their condition (Halket et al., 2022). Due to rising numbers, HCV screening guidelines have been updated to recommend that every adult be screened at least once (Patel et al, 2021). Despite these guidelines, screening rates remain low. This scoping review aims to examine current research on HCV screening and strategies to improve early diagnosis and treatment.

Methods

This review began with a literature search using CINAHL and PubMed …

Improving Pediatric Medical Nurses’ Confidence In Caring For Pediatric Mental Health Patients: A Pilot Project Large Academic Pediatric Health System In The Pacific Northwest, Lauren Kalember

Doctor of Nursing Practice Projects

Problem Description

Pediatric mental and behavioral health care needs continue to increase across the nation. Approximately ten percent of pediatric hospitalizations are for a primary mental or behavioral health condition (Canvara & Johnson, 2020). With the increase in hospitalizations for mental health (MH) needs, pediatric psychiatric units are at capacity, and MH patients are admitted to pediatric general medical/surgical units for care. Most of the nurses that work on these units have not received pediatric mental health education outside of nursing school curricula and report a lack of confidence in their ability to care for pediatric MH patients. With the …

An Inpatient Fall Prevention Program Evaluation Using The Context, Input, Process And Product Model, Brittany Harker

Doctor of Nursing Practice Projects

Background/Context: Falls remain a substantial risk for patients and is reported that 1,000,000 patients fall each year and one-third result in injury to the patient.

Problem/Purpose: To evaluate the implementation of a fall prevention toolkit to determine if standards of care were followed and outcomes were met using the Context, Input, Process, and Product model.

Outcomes/Results: Fall risk assessment was occurring on admission (n=33) with opportunity for reassessment throughout stay. Required post-fall documentation was not completed per policy. 26% of staff responded to the feedback survey. The facility’s fall rate target was not met but reducing the …

Implementing Cognitive Behavioral Therapy For Insomnia With Motivational Interviewing In The Mental Health Setting, Kassandra E. Ransom

Doctor of Nursing Practice Projects

Can you imagine not sleeping well for weeks or months at a time? Insomnia impacts approximately one-third of adults and is considered the most prevalent of all sleep disorders. With a lack of consistent, quality sleep, insomnia has significant negative consequences that impact a person’s overall mental well-being, like increased anxiety, depression, chronic pain, and daily coping. Cognitive Behavioral Therapy for Insomnia (CBT-I) allows patients to reduce or eliminate insomnia or related symptoms without needing medication to obtain quality and consistent sleep. CBT-I is difficult, so partnering it with Motivational Interviewing (MI) techniques provides patient engagement and compliance to strike …

A Pilot Program To Address Nurse Leader Moral Distress Secondary To The Performance Evaluation Of Underperforming Personnel, Lisa Krening

Doctor of Nursing Practice Projects

Problem Description: First defined in 1984, as a nurse knowing the correct course of action but perceiving barriers that constrain the action, moral distress has evolved to include challenging situations associated with moral uncertainty, moral conflict, and ethical or moral dilemmas (Campbell et al., 2016; Fourie, 2015, 2016; Jameton, 1984). While the bulk of the moral distress literature has highlighted the challenges of direct care nurses, nurse leaders also grapple with ethical dilemmas that often lead to moral distress (Edmonson, 2010; Ganz et al., 2015; Prestia et al., 2017). Additionally, research indicates that nurse leaders lack experience in navigating ethical …

Implementing Best Practices To Improve Nurse-Patient Communication And The Ed Experience In A Small Suburban Hospital In The Northwestern U.S.: A Pilot Project, Kimberli Munn

Doctor of Nursing Practice Projects

As one measure of quality of care and patient satisfaction, healthcare systems now routinely evaluate the patient experience. Nurses at every level of care, especially those in the hospital, can directly impact the outcome of that experience (American Association of Colleges of Nursing [AACN], 2011; Natsui et al., 2018). Communication with the health care team during patient visits enhances overall patient satisfaction, and research has established a clear correlation between the patient experience and improved patient outcomes and quality of care (Hermann et al., 2019, Sonis et al., 2017; Tan et al., 2013). Quality care, a high standard, reflects the …

Opioid-Crisis Intervention: A Pilot To Moderate Patient’S Use Of Post-Operative Opioid Medications Using A Video-Based Perioperative Education Tool, Ahmed Alshaarawi

Doctor of Nursing Practice Projects

Problem Description

The opioid epidemic has been ravishing communities in the United States for nearly two decades, resulting in opioid misuse, dependence, and overdose-related deaths. Healthcare providers have inadvertently fueled the epidemic by overprescribing opioid medications contributing to 40% of the opioid overdose-related deaths. One in every 48 patients who receives an opioid medication for the first time will become a chronic user of these medications. Furthermore, 6% of all surgical patients will continue chronic use of opioid medications 90 days after their surgeries regardless of absence of pain. With over 50 million surgical cases performed each year in the …

Transformational Leadership And Structural Empowerment For Nurse Managers To Improve Nursing Job Satisfaction, Engagement, And Retention, Leah M. Gehri

Doctor of Nursing Practice Projects

Problem Description

Low nurse job satisfaction and engagement have historically been associated with high attrition. While it is too soon to fully quantify the impact of Covid-19 on nurse satisfaction, engagement, and turnover, evidence is emerging that high chronic fatigue and persistent feelings of being overwhelmed are causing nurses to either leave the bedside or quit nursing altogether, exacerbating existing nurse staffing challenges caused by a decades long nursing shortage that, pre-pandemic, predicted a national deficit of over one-half million nurses by 2030. The financial impact of competing for experienced nurses, and recruiting, hiring, and training new nurses to replace …

Improving Mental Wellness In Clinical Staff: Using Respite Rooms And Mindfulness Strategies In Ambulatory Care Settings, Whitney Hodges Shanley

Doctor of Nursing Practice Projects

Background: Diminished physical and mental wellness of clinical staff leads to poor patient health outcomes and high turnover rates. Providing designated quiet spaces to practice mindfulness can be beneficial to the overall health of healthcare workers, thus, improving compassion fatigue, job satisfaction, and retention of clinical staff.

Aim: This project implemented a respite room in an ambulatory care practice to improve clinical staff’s self-reported ratings of compassion fatigue, compassion satisfaction, and intent to leave their job.

Methods: This quality improvement project used a pre- and post-test design to compare clinical staff ratings of compassion fatigue (burnout and secondary traumatic stress), …

Depression Screening In Hematology/ Oncology Outpatient Clinic, Nikki Marshall Msn, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Oncology patients have multiple factors that can lead to depression, such as treatments, end-of-life decisions, stressors from home, pain, financial responsibilities, and transportation needs. If depression goes unaddressed, it can diminish the quality of life in oncology patients.

Objectives: (1) The purpose of this evidence-based practice (EBP) project is to improve Hematology/ Oncology (HEM/ONC) patient quality, with improved screening (PHQ-9 screening tool) and identification as well as referral for adult patients (18 and older). (2) Assess the knowledge, perception of depression, and confidence level of utilizing the PHQ-9 screening tool in the hem/onc outpatient clinic staff. (3) To increase …

The Oncology Clinical Trial Nurse Complex Design And Role Comprehension Training Evaluation Project, Pamela Herena Msn, Rn, Ocn

Doctor of Nursing Practice Projects

Background: The oncology Clinical Trial Nurse (CTN) plays a significant role in conducting clinical trials; however, the role comes with many challenges. These difficulties are related to the expanding landscape, advances in cancer research, complex trial designs, and the lack of role definition leading to role confusion and limited role comprehension.

Aims/Objectives: The project’s purpose was to develop a training program specific to complex clinical trial design, cancer disease overview and the oncology clinical trial nurse role. The aim focuses on the evaluation of the program by clinical trial research leaders.

Methods: A non-probability convenience snowball sampling method was used …