Nursing Commons^™

Impact Of Opioid-Free Anesthesia Versus Opioid-Based Anesthesia On Time To Extubation: A Scoping Review, Mary K. Connor Rn, Bsn, Srna, Dexter Browning Rn, Bsn, Srna, Ariel Clark Rn, Bsn, Srna, Erica B. Gates Rn, Bsn, Srna, Madison T. Mccaskill Rn, Bsn, Srna, Dwayne L. Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Opioids during surgery have been clinically proven to lengthen the time between intubation and post-op extubation. Increased time to extubation is associated with negative patient outcomes. This scoping review aims to evaluate the use of ketamine with opioid free analgesia (OFA) versus traditional opioid usage and its outcomes on extubation times.

Methods

From September 2021 to November 2021, we conducted a literature search using the University of Tennessee Health Science Center’s (UTHSC) online library. Through the PubMed, CINAHL, Medline, and Cochrane databases, we identified seventy-one articles that matched our criteria. Of those articles, we selected twenty-five to undergo rapid …

Evaluating The Efficacy Of Medication-Assisted Treatment For First Episode Psychosis: A Scoping Review, Chanel Thomas Msn, Aprn, Fnp-Bc, Rn-Bc, Alexandra Wittenberg Bsn, Rn-Bc, Anttrenika Anderson Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that individuals with substance use disorder (SUD) receive medicated-assisted treatment (MAT), as a complete approach to substance use treatment (SAMHSA, 2019). However, treatment measures using combination treatment for SUD in individuals experiencing first episode psychosis (FEP) are seldom used. This scoping review assesses the efficacy of MAT in conjunction with antipsychotics compared to the use of antipsychotic monotherapy for FEP individuals on hospital readmission rates.

Methods

The authors conducted a literature review utilizing PubMed, EBSCO, Elsevier, Google Scholar, PsychINFO, and Medline from August 2020 to November 2022. Key phrases …

The Jackson/Cubbin Skin Risk Assessment Tool: Implementing An Evidence-Based Practice Change Initiative In The Intensive Care Unit, Andrew Riddle Msn, Rn, Npd-Bc, Ccrn-K

Doctor of Nursing Practice Projects

Background: Pressure injuries in acute care patients cause thousands of deaths and billions of losses annually. The Braden Scale has been an American standard of pressure injury risk assessment yet demonstrates poor predictability in the Intensive Care Unit (ICU) population. Recent evidence indicates that the Jackson/Cubbin Scale performs similarly or superiorly to the standard.

Purpose: To compare the Jackson/Cubbin Scale to the Braden Scale in assessing ICU patients’ risk for pressure injuries and resulting nursing interventions. Methods: Using a pretest-posttest and comparative design, trained nurses in two ICUs applied both Jackson/Cubbin Scale and Braden Scale to assess patients’ risks twice …

Impact Of An Automated Text And Phone Call Post-Discharge Follow-Up Program On Patient Satisfaction Scores And 30-Day Hospital Readmission Among Adult Patients, Michael Clarke

Doctor of Nursing Practice Projects

Background: The Center for Medicare & Medicare (CMS) withholds reimbursement from hospitals that fail to meet established benchmarks for the rate of 30-day hospital readmission and patient satisfaction.

Objective: This project aimed to improve patient satisfaction scores and decrease 30-day hospital readmissions among adult patients at the project hospital by implementing an automated phone call and text message post-discharge follow-up program.

Methods: This quality improvement project utilized a Plan-Do-Study-Act (PDSA) method. Program participants’ 30-day readmission data and patient satisfaction scores were collected and analyzed throughout the 90-day project and up to 30 days after the project ended. Program participants received …

Roadmap To Reduce Barriers To Medical Aid In Dying For Rural Coloradans: A Health Policy Analysis And Advocacy Campaign, Ashley D. Fry Msn, Apn, Agacnp-Bc, Achpn

Doctor of Nursing Practice Projects

Background: Medical aid in dying (MAID) is a process by which a terminally ill adult with a prognosis of six months or less can request prescription medications to end their life. Colorado’s End-of-Life Options Act requires that two physicians participate in the process to certify terminal illness and prescribe medications. Nearly all rural and frontier counties face shortages of medical professionals. These conditions challenge rural residents who want to access MAID. Advanced practice registered nurses and physician assistants can address gaps in rural and frontier counties; on average, they outnumber physicians in these communities.

Aims: The aims of this health …

Cultivating Unit-Based Leaders Through A Tiered, Structured Mentorship Program, Brittney Daley Msn, Rn, Ccrn

Doctor of Nursing Practice Projects

Background: Succession planning and mentorship is an essential need in developing future nursing leaders. The IOM and published literature strongly support the importance of mentorship programs in nursing (IOM, 2021). The current succession plan and mentorship program is not sufficient.

Purpose: The purpose of this project was to create and implement an evidence-based, 3-tiered unit-based leadership mentorship program (LMP) for bedside registered nurses to support growth and professional development between tiers over a 4-month period.

Aims/Objectives: Using the completion of a pre and post survey the mentee was assigned a tier from novice to experienced leaders. Through the program, the …

Impacts Of Emotional Intelligence Skill Development Training On Nurse Leaders, Denise A. Holyoak Dnp, Rn, Ccrn-K, Nea-Bc

Doctor of Nursing Practice Projects

Background: Emotional intelligence (EI) skills are recognized as an essential tool for leaders’ success in their organization. Research shows that an EI skill development training program is effective at improving this skill set of nurse leaders and thus positively influence individual and organizational outcomes.

Aims: The purpose of this evidence-based practice (EBP) project was to design an EI skill development curriculum for frontline inpatient nurse managers and to evaluate its impact on three aims: EI skill scores of nurse managers, patient satisfaction scores related to nurse communication and nurse manager leadership communication scores.

Methods: Eleven inpatient nurse managers from a …

Addressing Verbal Aggression To Reduce Workplace Violence Against Nurses, Rebecca Harris

Doctor of Nursing Practice Projects

Background: Almost three-quarters of non-fatal workplace violence-related injuries requiring time away from the workplace occur in the healthcare and social services sector. More than 90 percent of assaults against nurses are from patients. Verbal aggression was correlated with physical violence and could contribute to nurses’ stress and dissatisfaction and compromise patient care. Policies and guidelines addressing verbal aggression against nurses are often unclear and not well-supported by evidence. This can leave nurses unprepared to recognize and respond to verbal aggression or threats of physical harm without compromising their safety.

Aim: This health policy analysis aimed to explore a range of …

Management Of Stage I And Stage Ii Labor Arrest Disorder To Reduce Primary Cesarean Section Birth Rate For African American Women, Ariam Yitbarek Mha, Bsn, Rn, Nea-Bc

Doctor of Nursing Practice Projects

Background: Cesarean section delivery rate in the United States has reached an alarming rate of over 30%. African American women experience a higher cesarean birth rate compared to Caucasian Women. The repeat c-section rate for all patients is greater than 80%. These findings underscore the need for intervention to reduce primary cesarean section deliveries in African American Women.

Objective: This quality improvement project aimed to implement caregiver education on the ACOG/SMFM definition of the first and second-stage labor arrest disorder to reduce primary cesarean section birth for African American women.

Method: This pre-and post-intervention quality improvement project was conducted on …

The Impact Of Nurse-To-Nurse Change Of Shift Report At The Bedside On Patient Satisfaction Scores And Patient Safety, Tonya Washington

Doctor of Nursing Practice Projects

Background: Nursing shift report is an essential part of the clinical practice. It allows nursing staff to exchange necessary patient information to ensure continuity of care and patient safety. Traditionally, nursing shift report was done at the nurses’ station or behind closed doors and did not involve the patient.

Objective: This project aims to implement an evidenced-based bedside shift report (BSR) on two medical and two surgical inpatient units to improve patient safety and patient satisfaction scores in the Communication with Nurses domain of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Methods: The project utilized a …

The Impact Of Remote Video Monitoring On Costs And Patient Outcomes, Karen Wyche Latham Msn, Rn, Nea-Bc, Cenp

Doctor of Nursing Practice Projects

Background: Reducing patient falls remains a challenge for many acute care hospitals. Sitters (1:1 observation) are often utilized as an intervention to mitigate this. This costly intervention has drained both personnel and financial resources, forcing hospitals to find less costly alternatives to achieve the same safety outcomes. Remote video monitoring technology (RVM) is an innovative technology that supports the monitoring of multiple patients by one observer from a remote location and is an effective alternative in reducing patient falls and/or injury and associated costs.

Aim: The goal of this evidence-based practice initiative was to evaluate the effectiveness of RVM compared …

Implementation Of Collaborative Care Intervention Within A Fqhc To Achieve Uniform Data System (Uds) Measure Of Depression Remission, Rasha A. Kafi Msn, Rn, Fnp-C

Doctor of Nursing Practice Projects

Background: Depression is one of the most common and treatable mental health conditions. Untreated depression causes emotional suffering, reduced productivity, lost wages, increased comorbidity risks, and increased healthcare costs.

Purpose: The purpose of this project was to implement Collaborative Care Interventions (CCI) to achieve the Uniform Data System (UDS) Measure of Depression Remission.

Aims: The AIMS of this project were: (a) Increases the percentage of nursing staff compliance and completion of the educational training; (b) increases nursing staff knowledge of recognition of depression signs and symptoms, early identification of depression, and administration to all adult patients; (c) Increase the percentage …

Perioperative Pain Control: Evaluating Best Practices In Perioperative Pain Measures, Lisa M. Malakowsky

Doctor of Nursing Practice Projects

Background

Postoperative pain is contributing to the nation's opioid epidemic. Pain is an unpleasant sensation felt by the patient. When it is experienced postoperatively, it is a result of the surgical process. Patients up to 80% worldwide state that their pain is not controlled to their satisfaction. When postoperative pain is not treated adequately, it can contribute to chronic pain.

Purpose

Perioperative pain assessment and treatment policy at a rural critical access hospital and compare it to evidence-based guidelines for best practice. The project assessed the patient's pain treatment effectiveness compared to the pain management policy by using the CDC …

Effects Of Hope Intervention On Hope And Quality Of Life In Senior People Who Live Alone, Sophia Abraham

Doctor of Nursing Practice Projects

Background

In the United States, there is a growing number of seniors who frequently present with increased risk for reduced hope and quality of life (QOL). Quality of life in the senior population is a world-wide concern and it is believed to be directly associated with their well-being. Senior people living alone experience a higher degree of depression, reduced hope, isolation, falls, and increased mortality. The literature indicates that there is a significant relationship between the level of hope and QOL. Hope is an inner source that plays a vital part in how an individual think and behaves. Hope shapes …

Effects Of A 12-Week Plant-Based Diet Program On Obese And Overweight Adults In Rural Michigan, Nadine Larcher

Doctor of Nursing Practice Projects

Background

Overweight and obesity among adults are a rising epidemic in the U.S. Obesity is a risk factor for many chronic diseases and impacts morbidity and mortality. Despite our high-tech medical care system in the U.S., we are losing the war on obesity due to not addressing the underlying problems. These include unhealthy lifestyles and an unhealthy diet. A growing body of research studies has shown that adopting a low-fat whole food plant-based diet (WFPBD) regime consisting of whole grains, fruits, vegetables, legumes, and no animal-based products is an effective measure to counteract the rising pandemic of chronic diseases related …

Effects Of A Mindfulness Intervention On Nurse Burnout, Sandra Elanges

Doctor of Nursing Practice Projects

Background

Before the COVID-19 pandemic, nurse retention was a known issue; current nurse retention has worsened. This project examined the burnout of nurses and offered some potential interventions to assist in retaining nurses in the field of nursing.

Purpose

To determine whether a six-week online mindfulness intervention improved the Oldenburg Burnout Inventory (OLBI) scores of nurse participants.

Methods

This project used a convenience snowball sample of participants recruited through social media platforms including Reddit, Twitter, Facebook, TikTok, AllNurses, and word of mouth. This quantitative quasi-experimental design utilized pre- and post-testing to measure baseline burnout and evaluate the intervention’s efficacy. The …

Faith-Based Collaboration To Improve Depression & Self-Compassion In The Elderly: A Dnp Project, Julita Cinguina

Doctor of Nursing Practice Projects

Abstract

Faith-based organizations are in a position to improve mental health outcomes for the elderly. With the help of the Community Wellness Center at Our Lady of Fatima (OLF) Catholic Church in Wilton, Connecticut, a new action plan was implemented to accomplish this goal. The proposed DNP Project was an evidence-based, multi-factorial intervention to improve self-compassion and reduce risk for depression for the elderly in the community. It consisted of four structured group sessions over a 6-week period with each session lasting 45 minutes. The group meetings offered evidence-based strategies to improve mental health including: (1) purposeful spiritual counseling utilizing …

Implementing A Covid 19 Policy For Telehealth, Ashley M. Morello

Doctor of Nursing Practice Projects

The proposed DNP Project explored the implementation of a COVID-19 telehealth policy to clarify evidence-based practice, promote use of safe medications, and reduce hospitalizations. Providers were recruited from a telehealth organization, educated on current guidelines, and given a pocket card for reference and re-enforcement of training. Data was collected to examine guideline utilization, confidence in treating COVID-19, and efficacy of pocket card. COVID-19 patients also received follow up calls to determine if hospitalization was required post treatment. Chart audits were then completed to review compliance with guidelines. The results indicated both objective and clinical improvement in provider confidence treating COVID-19. …

Addressing Gaps In Respiratory Assessments: A Dnp Project, Kristin Quakenbush

Doctor of Nursing Practice Projects

Respiratory assessments by healthcare workers, particularly counting the respiratory rates, have been found to be inadequate and ineffective. As a result, patient care may be delayed, reimbursement may be inaccurate, and the nurse may risk legal consequences. The purpose of this project was to fully examine the current accuracy of respiratory rate counts and documentation on two identified units within an acute care hospital, offer evidence-based solutions in the accurate count and documentation of respiratory rates, and perform follow-up chart audits to evaluate if application of learning occurred. Baseline audits demonstrated that respiratory rate counts were not even skewed and, …

Improving Asthma Management Behaviors In School Nurses Through Facilitator Training And Supported Implementation, Mary D. Hacker-Taylor

Doctor of Nursing Practice Projects

Uncontrolled asthma in middle school age children and adolescents results in increased morbidity and often impairs a student’s ability to participate in school activities. School absenteeism is an unintended consequence which in turn can impact academic success. School nurses can improve student asthma outcomes through effective asthma management behaviors (AMB’s). The purpose of this multi-phase quality improvement DNP project was to improve both knowledge and confidence, and thereby improve AMB’s in Kentucky school nurses. A convenience sample of twelve nurses participated in the project. The American Lung Association’s (ALA) Kickin’ Asthma training was extended to all Kentucky school nurses who …

Intimate Partner Violence Screening In The Veteran Affairs' Ambulatory Care Clinics: A Quality Improvement Project, Stephanie Ralston

Doctor of Nursing Practice Projects

Intimate Partner Violence is a type of Domestic Violence (DV), referring to physical, verbal, emotional, or sexual violence, or stalking between current or former intimate partners. Veterans may be at higher risk than those identified in the civilian population. The rate of IPV across military populations ranges from 13.5% to 58% with rates among female Veterans ranging from 29% to 74% (Veterans Affairs, 2023). This project's purpose was to evaluate the effectiveness of an awareness campaign on IPV screening and referral rates in a federal healthcare facility. Results from this DNP project indicate that ongoing training and education are vital …

Mock Drills To Improve Inpatient Stemi Performance And Self-Confidence, Samantha Miniard

Doctor of Nursing Practice Projects

STEMI care can be challenging for med-surg telemetry nurses to recognize among inpatients because it is a high-risk low volume population. Frequently these patients’ present with atypical acute coronary syndrome (ACS), and not the classic chest pain seen when someone calls 911. However, the same treatment and care out-of-the hospital patients receive when calling 911 should be the same gold standard for in-hospital patients. More studies have been conducted to perfect the out-of-hospital STEMI care versus the in-hospital STEMI care. Mock drills can help improve knowledge, self-confidence, and performance with inpatient STEMI care. This DNP project was an evidenced-based quality …

Impact Of Accessible Training For Providers On Continuous Glucose Monitoring Utilization, Shana Cunningham

Doctor of Nursing Practice Projects

Continuous Glucose Monitor (CGM) use can improve blood glucose control, reduce the risk of hypoglycemia, and assist healthcare providers with medical management of diabetes mellitus. CGM therapy for patients with diabetes may not be fully utilized because of a provider's lack of knowledge or confidence in using the technology. The DNP project aimed to increase the utilization of continuous glucose monitors by providing accessible training with ongoing implementation support for providers through electronic learning. The goal was to increase CGM implementation and ultimately improve outcomes for a person with diabetes. The intervention included recorded modules, live interactive session, resources, handouts, …

Application Of Preceptorship Bundle To Enhance New Graduate Rn Success, Joann R. Nardoni

Doctor of Nursing Practice Projects

New graduate Registered Nurses (RN) are experiencing a difficult transition to practice. In turn it causes increased stress and job dissatisfaction. The quality improvement project focused on a bundled intervention to bridge this gap. It involved a preceptorship enhancement bundle to improve training with an emphasis on intentional pairing of preceptor/preceptee and use of the One-Minute Preceptor Model. People of like temperament were paired using the Ntrinsx personality profile to enhance the learning relationship. The One-Minute Preceptor Model was used to train preceptors how to engage critical thinking and clinical reasoning in the new RN. The actions of intentionally pairing …

Improving Self-Management Of Diabetes With Culturally Sensitive Interventions, Janet O. Makori

Doctor of Nursing Practice Projects

Abstract

Adult Latino patients with diabetes may require education and skills that are culturally appropriate to achieve optimum results. The purpose of this DNP project was to improve diabetes self-management among Latino and other at-risk adults. The project used an intervention bundle to streamline screening, education, and improve patients’ self- confidence. Adult patients were screened during triage to obtain vital signs and blood glucose levels per the routine at the clinic and via phone to discuss management of diabetes. Implementation of the project included provision of culturally sensitive diabetes education material, culturally sensitive “traffic light” food guide in English and …

Implementation Of A Psychiatric Mental Health Nurse Practitioner Transition To Practice Survival Kit Series: A Dnp Project, Dera Harvey

Doctor of Nursing Practice Projects

It is imperative that new graduate PMHNPs successfully traverse the gap from student to prescriber of care to meet these needs. Currently, a transition to practice gap exists for PMHNPs who are often left alone to navigate the beginnings of their new career. Additionally, the transition has not been analyzed extensively in literature (Barnes, 2015). The purpose of this DNP project is to implement a transition to practice survival kit series. The proposed DNP project is a mixed methods design focused on program evaluation. The project will assess the effect of a 6-session transition to practice survival kit series on …

Therapeutic/Expressive Writing And Resilience Promotion For Nurses To Reduce Burnout Syndrome, William D. Wagner Mr.

Doctor of Nursing Practice Projects

COVID-19 accelerated the rate in which nurses were unable to maintain resilience and reduce burnout. This evidence-based DNP project obtained data from a therapeutic/expressive writing intervention and group resilience discussion with Women’s Care Center (WCC) nurses to improve resilience acuity and reduce symptoms associated with burnout syndrome. A review of previous studies indicated therapeutic/expressive writing and group resilience discussions have been beneficial in improving resilience and reducing burnout. A demographic and two preintervention surveys were completed by WCC nurses in the hospital relaxation room or skills lab. The Connor-Davidson RISC-25© was used to determine resilience scores for morning and evening …

Improving Self-Management Of Diabetes With Culturally Sensitive Interventions, Janet O. Makori

Doctor of Nursing Practice Projects

Abstract

Adult Latino patients with diabetes may require education and skills that are culturally appropriate to achieve optimum results. The purpose of this DNP project was to improve diabetes self-management among Latino and other at-risk adults. The project used an intervention bundle to streamline screening, education, and improve patients’ self- confidence. Adult patients were screened during triage to obtain vital signs and blood glucose levels per the routine at the clinic and via phone to discuss management of diabetes. Implementation of the project included provision of culturally sensitive diabetes education material, culturally sensitive “traffic light” food guide in English and …

Improving Early Utilization Of Palliative Care Services To Impact Quality Of Life, April Mcdonald

Doctor of Nursing Practice Projects

Despite studies indicating the benefits of palliative care, many barriers remain that prevent individuals from accessing this specialty service. Palliative care needs improved utilization. The purpose of this quality improvement project was to improve the utilization of palliative services and increase general knowledge and confidence among nursing staff within one nursing home facility. In the intervention bundle, training was provided on the use of a Palliative Referral Flowchart and the Palliative Performance Scale (PPS) along with evidence-based materials made available to residents and families. Data was collected pre and post intervention. Knowledge was improved by 26 %. Confidence was improved …

Improving Hepatitis C Virus Screening Through Bundle Interventions, Jennifer West

Doctor of Nursing Practice Projects

Abstract

Hepatitis C (HCV) is estimated to impact 57,500 people in the US and is a leading infectious disease worldwide. The purpose of this DNP Project is to increase provider confidence in screening, early detection rates and ultimately timely treatment for patients at risk for HCV served within a rural Federal Qualified Health center (FQHC).

Interventions for this project included bundle steps consisting of provider and staff training of Hepatitis C guidelines for screening, use of an Electronic Medical Records (EMR) HCV flowsheet and lab template, revision of preventative health form, and self-efficacy survey to evaluate provider and nursing confidence …