Nursing Commons^™

Evaluation Of The Implementation Of The Munro Pressure Ulcer Risk Assessment Scale To Mitigate Pressure Ulcers In The Perioperative Setting, Sherry Lynn Grandison

Doctor of Nursing Practice Projects

Background: The process of implementing appropriate skin assessment and documentation throughout the patient’s operative experience assists in the early detection of pressure ulcers.

Purpose: This Doctor of Nursing Practice (DNP) project had two goals. The first was to determine a practical tool that would ensure that surgical nurses demonstrate competence and comply with the process of identifying compromised skin integrity, and the second goal was to effectively communicate the findings with other clinical team members.

Methods: The DNP project focused on the use of the Munro Pressure Ulcer Risk Scale Assessment Tool to identify pressure ulcers and to promote collaboration …

Increasing Medical-Surgical Nurses' Skills And Knowledge On Wound Assessment And Documentation Through An Educational Approach, Jewels Knight

Doctor of Nursing Practice Projects

Background: Hospital acquired pressure injury rates are increasing while other hospital acquired condition rates are decreasing. Pressure injuries are expensive and place patients at a higher risk of death. Accurate wound assessment and documentation to satisfy the present on admission indicator could positively affect hospital acquired pressure injury rates.

Purpose: The purpose of this process improvement project was to increase nurses’ skills and knowledge towards proper wound assessment and documentation and to increase nurses’ knowledge on why comprehensive skin assessments and documentation of the observations are important for positive patient outcomes.

Method: This project consisted of offering an educational …

Using The Cdc’S Healthcare Personnel And First Responders: How To Cope With Stress And Build Resilience During The Covid-19 Pandemic Education Resources To Reduce Burnout Of Intensive Care Nurses At An Urban Acute Care Hospital, Elizabeth Gilbert

Doctor of Nursing Practice Projects

Background: Nurse burnout is a serious problem, as documented by many studies. Burnout has been shown to lower quality of life, performance level, and organizational commitment while also increasing a nurses' desire to leave the job. Despite this knowledge, nurse burnout continues to be present, especially among nurses who work in intensive care units (ICUs). Hospitals need ICU nurses to care for critically ill patients; therefore, it is essential to educate ICU nurses on burnout and initiate measures to decrease burnout in this vulnerable population.

Purpose: The goals of this study are to explore nurse burnout in the medical intensive …

The Effectiveness Of A Virtual Shared Medical Appointment On Opioid Safety Education Participation In The Veteran Population Within A Va Health Care System, Jana Falkner

Doctor of Nursing Practice Projects

Background: From 2019 to 2021, there has been an increase in opioid prescribing, leading to the current death rate of 136 Americans per day from an opioid overdose (Centers for Disease Control and Prevention [CDC], 2021). In response to these shocking statistics, a Veterans Administration (VA) health care system initiated a face-to-face interdisciplinary opioid safety shared medical appointment (SMA). Although the face-to-face Opioid Safety SMA was successful in increasing opioid safety awareness, participation, and attendance for the SMA have declined over the last year.

Purpose: The purpose of the DNP project was to improve attendance for veterans participating in the …

Reducing Hospital Readmissions Through A Standardized Heart Failure Educational Program For Community Based Nurse Case Managers, Greta Abernathy

Doctor of Nursing Practice Projects

Background: Heart failure is a high-risk health condition that impacts a patient's heart, causing it to pump at a weaker pace than a healthier person's heart (Mayo Clinic, 2020). Associated with frequent hospital admissions, heart failure affects millions of Americans in the United States (Fleg, 2018) and results in repeated readmissions, costing thousands of dollars per admission and decreased quality of life.

Purpose: This DNP project aims to implement an evidence-based educational model of care for nurse case managers within a community setting focused on Heart Failure (HF) that will improve the heart failure patient's ability to self-manage their disease …

The Use Of The Centers For Disease Control (Cdc) Outpatient Antibiotic Stewardship Program To Reduce Unnecessary Antibiotic Prescriptions Written For Sinusitis In A Rural Urgent Care Clinic Setting, Melanie Maddox

Doctor of Nursing Practice Projects

Background: The discovery of antibiotics has been a significant success in fighting bacterial infections. According to the Centers for Disease Control (CDC), in 2018, inappropriate prescribing of antibiotics contributed to antibiotic-resistant conditions, which led to 2 million infections, and has killed about 23,000 Americans annually (Chaney, 2018: CDC, 2019). By 2050, 10 million people are expected to die globally due to bacterial resistance, with the cost potentially reaching $100 trillion (WHO, 2019).

Purpose: The purpose of the DNP Project is to decrease unnecessary antibiotic prescriptions for the diagnosis of sinusitis in a rural urgent care clinic and increase provider awareness …

A Multi-Modal Strategy To Activate Pronation For Acute Respiratory Distress Syndrome Patients, Meredith Mccrorie

Doctor of Nursing Practice Projects

Background: Acute Respiratory Distress Syndrome (ARDS) is an acute pulmonary process that compromises the health of patients in the Intensive Care Unit (ICU). ARDS can progress to irreversible fibrosis causing the lungs to become noncompliant, adversely affecting ventilation or gas exchange (Buckley et al., 2019). An ARDS diagnosis accounts for 30-40% mortality rate which is an improvement from 60% in the last two decades. The clinical course of this disease is highlighted by Acute Hypoxic Respiratory Failure (AHRF) evidenced by chest radiographs revealing bilateral dense consolidations. Manual pronation of ARDS patients has shown an increase in alveolar function with end …

Utilizing Multimodal Education To Impact Provider Documentation Of Post-Anesthesia Evaluation In A Rural Hospital, Jennifer Coffman

Doctor of Nursing Practice Projects

Background: Hospital policy, Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (TJC) require a post-anesthesia evaluation to be completed and documented no later than forty-eight hours following surgery or any other procedure requiring anesthesia. This evaluation is required any time general, regional, or monitored anesthesia has been administered to the patient and must be completed by a certified anesthesia provider. One rural hospital facility’s post-anesthesia documentation compliance has declined to 79%, compared to the previous quarter’s report of 95%.

Purpose: The Doctor of Nursing Practice (DNP) project aimed to improve post-anesthesia documentation through a multimodal educational intervention. …

Prenatal Education For Black Mothers And Their Support Persons As An Intervention For Improving Initiation Of Breastfeeding, Sandra King

Doctor of Nursing Practice Projects

Background: The benefits of breastfeeding are commonly known; however, the rates of exclusive breastfeeding among the Black community are less than those of other ethnic groups. Providing breastmilk or formula to an infant is an individual decision. Influential factors such as cultural background, employment status, socioeconomic status, level of education, and availability of support from family members and health care providers correlate with the method a mother chooses to feed her infant. Increasing breastfeeding initiation immediately after birth is a necessary precedent for uptake in the exclusivity of breastfeeding.

Purpose: This Doctor of Nursing Practice project aims to improve prenatal …

Implementation Of A Diabetes Self-Management Education Program In The Rural Health Care Setting To Improve Glycemic Control In The African American Adult Population, Patricia Jackson

Doctor of Nursing Practice Projects

Background: According to the Center for Disease Control (CDC), Type 2 Diabetes Mellitus (T2DM) is a significant epidemic health problem worldwide. Furthermore, with the generality of T2DM-associated complications increasing, individuals living with chronic diseases must be competent in self-management to prevent long-term complications (CDC, 2021). Therefore, this Project Investigator aims to decrease the reported home glycemic control and improve diabetes self-management education among African American individuals in rural healthcare using the DSMEP tool.

Purpose: The purpose of the DNP project was to implement and assess the Diabetes Self-Management Education Program (DSMEP) effect on African American individuals in the rural health …

Stroke Care: Achieving Recommended Door To Computed Tomography Times In Ambulatory Patients Presenting To The Emergency Department Of A Rural Hospital Through The Application Of American Stroke Association Guidelines, Ricardo Paitz

Doctor of Nursing Practice Projects

Background: Time matters in stroke care, and every second counts because the extent of irreversible neuronal damage increases over time (Saver, 2006). Therefore, the American Stroke Association (ASA) recommends a door to computed tomography time of 20 minutes or less for patients presenting with signs of acute ischemic stroke. This time metric in stroke care is often not met, resulting in the delay of care of patients which translates to poorer outcomes, including death and a decreased quality of life in patients who have suffered an acute ischemic stroke (Kamal, Sheng, et al., 2017).

Purpose: The purpose of this DNP …

Utilization Of Staff Education To Improve The Management Of Aggression And Violence In The Rural Inpatient Psychiatric Setting, Clara Ugwuibe-Ogunseye

Doctor of Nursing Practice Projects

Background: Workplace violence (WPV) is a global concern and an occupational hazard faced by healthcare professionals worldwide. Aggression and violence can result in serious injury to the patient, healthcare professional, other patients, or visitors and cause stress to healthcare workers, and increase work absences (Picot, 2021).

Purpose: This DNP process improvement project aim was to utilize an educational training program on violence risk assessment, therapeutic communication, and verbal de-escalation techniques, to improve the confidence of mental health nursing staff in using early intervention to manage aggressive, violent patients. This education and early intervention reduced rates of aggression and violence escalation, …

Reducing Admissions Of Adult Congestive Heart Failure Patients In The Acute Care Setting, Jamekia Calhoun

Doctor of Nursing Practice Projects

Background: Heart failure (HF) is a clinical diagnosis that affects about 1 to 2% of the population worldwide. Poor education regarding self-care behaviors after discharge has contributed to increased readmissions after acute hospitalization. Hospital readmissions cost is approximately one hundred thousand dollars. This increase in cost has forced the Centers for Medicare and Medicaid Service (CMS) to place penalties on organizations with high readmission rates. The organization may be penalized for increases in readmission rates by decreasing the percentage of the combined total Medicare payments received from the CMS (Centers for Medicare and Medicaid Services [CMS], 2021)

Purpose: …

Implementation And Evaluation Of A Post-Op Coronary Artery Bypass Graft Extubation Checklist To Reduce Prolonged Intubation In The Intensive Care Unit, Melissa Bailey

Doctor of Nursing Practice Projects

Background: Total intubation time of post-op coronary artery bypass graft (CABG) patients is set by the Society of Thoracic Surgeons (STS) guidelines. STS states that post-op CABG patients need to be extubated within twelve hours of end anesthesia time with a recommendation of fewer than six hours. The project site had a total intubation time of greater than seventeen hours before removing the outliers. The current process does not result in a total intubation time of fewer than six hours. Implementation of an extubation checklist was chosen as the intervention for this DNP project.

Purpose: This DNP project aims to …

Implementation Of A Tele-Triage Protocol In An Emergency Department Setting, Megan Tuetken, Sierra Hamlin, Sydney Spaulding

Doctor of Nursing Practice Projects

Nationwide, the volume of emergency department (ED) visits has steadily increased over the last several decades. This steady increase in volume frequently causes ED crowding and considerable delays in patient evaluation and treatment. Recently, teletriage has been used in emergency departments to evaluate less emergent patient needs while freeing up in-house providers to care for more critical patients. The goal of this DNP project was to develop a protocol for the utilization of teletriage in an Emergency Department in a level 1 trauma center in central Illinois using nurse practitioners to assess patients in the waiting room and order appropriate …

Assessing Provider Confidence Of Acute Otitis Media Diagnosis And Treatment With An Optical Coherence Tomography Device In The Urgent Care Setting, Meghan Weber, Susan Wolf

Doctor of Nursing Practice Projects

Acute otitis media (AOM) is one of the most common causes of pediatric infection worldwide at approximately 350 million visits per year, as well as one of the most challenging illnesses to diagnose for providers (Tong et al., 2018). This dilemma leads to antibiotics being inappropriately prescribed, at a rate of approximately 75% (Islam & Hassinger, 2018). This project sought to explore the impact of implementing an optical coherence tomography (OCT) device in an urgent care setting when assessing otalgia in patients 0 to 17 years of age. The three main objectives of the project were to increase provider confidence …

Dexmedetomidine To Reduce Ponv, Amanda Johnson Srna, Joshua Lawrence Srna, Staci Martinez Srna, Taylor Mayberry Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative nausea and vomiting (PONV) contribute to patient dissatisfaction, discomfort, adverse outcomes, and increased healthcare costs. Despite current protocols that aim to reduce PONV by prevention/antiemetic administration, PONV continues to be a common manifestation in many postoperative patients (Elvir-Lazo et al., 2020). This scoping review aimed to analyze available research on the efficacy of dexmedetomidine to reduce perioperative opioid requirements and PONV.

Methods Synthesis of this scoping review began with a systematic approach to search databases and identify eligibility criteria articles. Of the 21 articles that met criteria, a synthesis table was formed to visualize the qualitative (smoking status, …

Development And Evaluation Of Enhanced Recovery After Surgery Protocols For General Abdominal And Orthopedic Surgery With Focus On Preoperative Hydration And Multimodal Management In Preoperative And Postoperative Phases, Kristin Wolff, Sadie Spilker

Doctor of Nursing Practice Projects

Enhanced Recovery After Surgery (ERAS) is described as an evidence-based, patient-centered, interdisciplinary team developed protocol utilized to decrease the patient’s stress response to surgery, maintain preoperative physiologic function, and expedite recovery (American Association of Nurse Anesthetists [AANA], 2017). Existing evidence displayed the benefits of utilizing ERAS protocols in various surgical procedures, including general and orthopedic cases. Studies showed one must employ the preoperative, intraoperative, and postoperative components of the ERAS protocols to achieve maximum benefits. A critical access hospital in Illinois utilized some components of ERAS protocols, mainly the intraoperative portions, but lacked the full utilization. Goals of the review …

Controlling Hypertension: A Self Blood Pressure Monitoring Program Plus Health Coaching Compared To Health Coaching Alone, Jordan Joynt, Alex Watson

Doctor of Nursing Practice Projects

While nearly half of adults in the United States have hypertension, only about one quarter of those adults have adequately controlled hypertension. Providing a nurse-led coaching program in combination with home blood pressure monitoring (HBPM) has been shown to improve blood pressure control. A rural family practice clinic in the Illinois Metro East area proposed a clinical trial to test a nurse-led coaching program in combination with home blood pressure monitoring (HBPM) in decreasing blood pressure long-term. Both intervention and control groups received nurse-led hypertension coaching, while the intervention group also received a home blood pressure cuff. The results showed …

Integrating Mental Health Into Primary Care, Lori Hopwood, April Schmidt

Doctor of Nursing Practice Projects

BACKGROUND: The purpose of this project was to examine the effects of a newly integrated collaborative mental health care model. The primary goal of the integrated behavioral health program was designed to increase the ability of primary care providers to provide mental health services with the support and expertise of a consulting psychiatrist and behavioral health specialist. Additional goals were to improve access to care and improve mental health outcomes.

AIMS: The aim of this project was to evaluate a new way of integrating mental health services in a rural health, primary care practice in central Illinois.

METHODS: Measures …

Implementation Of Phq-2 Screening Tool In A Telemedicine Based Setting, Joanna Luong

Doctor of Nursing Practice Projects

Background Major depression is one of the most common mental health disorders in the United States, affecting nearly 17.3 million of the population. As cases continue to rise throughout the ongoing pandemic of COVID-19, telemedicine has become a popular modality for accessibility to mental health care. Adequate screening, availability of resources and services, prompt treatment, and simple follow ups can contribute to treatment success rates and higher positive outcomes.

Theoretical Framework

The expanded collaborative chronic care model theoretical framework translates to this project in that it approaches management of patients with a team approach for those who screen positive for …

Establishing A Neonatal Peripherally Inserted Central Catheter (Picc) Team, Rebecca Hunt

Doctor of Nursing Practice Projects

Infants admitted to the neonatal intensive care unit (NICU) have a plethora of diagnoses, including prematurity and newborns with genetic, neurological, surgical, and cardiac problems. The nature of these disease processes usually precludes enteral feedings and providing the infant with appropriate nutrition and hydration is a priority. This requires central venous access and peripherally inserted central catheter (PICC) placement allows for a reliable route of administration for intravenous nutrition and medications. The purpose of this project was to develop a nurse-led neonatal PICC team to provide timely placement of PICC lines while maintaining cost-effectiveness and maintaining a minimal number of …

Neuraxial Anesthesia For Total Joint Arthroplasty, Katherine Pozzo

Doctor of Nursing Practice Projects

This quality improvement doctoral nursing project sought to provide a sustainable and data-driven change process at a critical access hospital in Illinois. The main objective of this project was an improvement in postoperative pain scores and implementation of best practice guidelines regarding total joint arthroplasty. Total joint arthroplasty is one of the most common surgical procedures performed in the United States. Future figures predict exponential growth due to our aging patient population, the obesity epidemic, and continued improvements in technique. Despite advances, orthopedic surgeries continue to be taxing on the body and can produce significant complications. General anesthesia for these …

The Use Of Point Of Care Ultrasound To Assess Gastric Contents And Determine Aspiration Risk In The Obese Patient Presenting For Elective Surgery, Harry Senaldi, Mary Zerlan

Doctor of Nursing Practice Projects

Pulmonary aspiration of gastric content is a potentially injurious and fatal complication of anesthesia. Obese patients with a BMI ≥ 35 presenting for elective surgery are at an increased risk of aspiration due to increased gastric pressure, delayed gastric emptying, and higher gastric volumes. Point of care ultrasound (POCUS) is a tool that allows the nurse anesthetist to assess gastric content and assign aspiration risk based on the scan results. A knowledge improvement project in the form of a lecture and hands-on tutorial focused on using POCUS to assess gastric content and assign aspiration risk was designed. This project was …

Physician Use Of The Rapid3 To Guide Rheumatology Follow-Up: A Retrospective Examination, Karen Howard

Doctor of Nursing Practice Projects

Abstract

The Quality Improvement Team of a rheumatology clinic was seeking ways to deal with the long intervals for an available follow-up appointment. The use of standardized disease activity assessment tools as a part of patient care is an evidence-based practice that is not employed by over one third of rheumatologists. One of the many uses of these tools is to guide treat-to- target care. Treat-to-target care uses the disease assessment tool score to guide treatment decisions and follow up interval. This project examined the use of a standardized disease assessment tool, the Routine Assessment of Patient Index Data 3 …

The Development Of An Evidenced-Based Guideline For The Anesthetic Management Of Surgical Cases Utilizing Evoked Potential Monitoring, Brent Hitchens, Darrell Risinger

Doctor of Nursing Practice Projects

Recent increases in the prevalence of neuromonitoring cases have contributed to the utilization of evoked potential (EP) monitoring during surgery. Evoked potentials are electrical signals measured in response to a stimulus. Intraoperative neuromonitoring is used to alert the surgeon, anesthesia provider, and neuromonitoring technician of changes before permanent nerve injury occurs. There are many factors that can affect neuromonitoring quality including hypothermia, hypotension, positioning, anemia, and anesthesia medications. The latter is especially important since certain anesthetic medications can have a profound inhibitory effect on the nervous system, leading to decreased amplitude and prolonged latency of EP signals. As a result, …

Introduction Of Enhanced Recovery After Cesarean Section (Erac) Protocol, Kwame Adu-Affum

Doctor of Nursing Practice Projects

Cesarean section is one of the most performed in-patient surgeries worldwide (Wilson et al., 2018; Liu et al., 2020). Births by cesarean section have been increasing globally. Cesarean birth rate has remained above 31% in the United States, even with the consistent two percent decrease in birth rate per year (Martin et al., 2019). Illinois has also maintained a high cesarean birth rate above 30% (Hamilton et al., 2021). Cesarean patients experience inflammatory and neurohormonal changes with many adverse effects in direct response to surgical stress (Mullman et al., 2020). The post-cesarean physiological effects, including pain, reduced gastric motility, pulmonary …

Computer-Based Learning Module: Local Anesthetic Systemic Toxicity, Nhan Nguyen

Doctor of Nursing Practice Projects

Local anesthetic systemic toxicity (LAST) is the result of rapid absorption of local anesthetics (LAs) into the systemic circulation resulting in toxic plasma levels of the drugs. With the advent of ultrasound-guided regional anesthesia and improvements in injection techniques, the incidence of LAST has decreased significantly over the years. Even though LAST is rare, it is a potential, life-threatening complication associated with any administration of LAs. Providers and staff members taking care of patients receiving LAs should be astutely aware of potential complications so that LAST signs and symptoms can be recognized, and treatments can be implemented as swiftly as …

Difficult Labor Epidural: Intrathecal Catheter Management, Andrew Screnchuk

Doctor of Nursing Practice Projects

Labor epidural analgesia is the most common method used to control pain associated with labor and vaginal delivery in the United States. However, the epidural catheter placement can cause accidental dural puncture in about 1 to 6% of laboring patients. Initiation of continuous intrathecal analgesia provides a good alternative to another attempt of epidural placement in certain types of the laboring population. While other countries have published referral guidelines of managing accidental dural puncture, the United States lacks such practice standards. The application of Accidental Dural Puncture Management with Intrathecal Catheter (ADPMIC) guidelines, used in other countries for difficult epidural …

Perioperative Tube Feeding Guidelines For The Pediatric Burn Patient, Jordan Swanberg

Doctor of Nursing Practice Projects

Pediatric burn patients require an astronomical amount of nutritional support to promote wound healing and prevent unwanted side effects. These patients often require multiple surgeries, and consequently, when following standard NPO guidelines, these patients go for hours without any nutritional support. For this reason, a protocol was implemented on how to administer tube feedings throughout the perioperative process safely. The purpose of this project was to give a PowerPoint presentation to the providers that tested their current knowledge on how to manage tube feedings in the operative setting best. A single group design consisting of CRNA’s and an anesthesiologist was …