Nursing Commons^™

A Pilot Program To Improve Patient And Family Experience Scores And Quality Of Care Of The Hispanic Population In An Urban Pediatric Emergency Department., David C. Kruger

Doctor of Nursing Practice Projects

Problem Description: Emergency Department (ED) patients express decreased patient and family experience (PFE) scores when they feel disrespected (such as experiencing long wait times), experience ineffective communication, or have difficulty accessing care. These issues could lead to inequalities and adverse health care outcomes, especially among those of different races and ethnic backgrounds. The goal of this quality improvement (QI) project was to evaluate the PFE scores and the quality of care of the Hispanic population at a thirty-five-bed emergency department within a freestanding pediatric, academic medical center located in a large urban area.

Rationale: The theoretical framework guiding this QI …

Developing A Standardized Process For An Effective, Evidence-Based Fall Management Program To Reduce Falls In A Nursing Home Setting, Katrina K. Little

Doctor of Nursing Practice Projects

Background: Falls among the elderly population, aged 65 years and older, are a significantly growing public health problem. For elderly people residing in residential care facilities and facility administrators, falls are of great concern due to the post-fall associated consequences. Preventing resident falls in long-term care is a priority to reduce injuries and associated costs.

Project Design: This evidence-based quality improvement (EBQI) pilot project focused on fall prevention and was conducted on 1 unit (3 long-term care hallways) at a facility that provides both long-term care (LTC) and short-term rehabilitation services in Utah County, Utah. Interventions chosen for the Falls …

Implementing Sexual Health Education For At-Risk High School Students In A Faith-Based Setting: A Pilot Project, Neva R. Fuentes

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STI) are a global issue that persist, causing significant negative health outcomes like cancer, adverse reproductive issues including infertility, and death (CDC, 2019a; Office of Women’s Health [OWH], 2019; WHO, 2019). In the United States, youth ages 15-24 years old make up 50% of the more than 20 million newly diagnosed STI’s each year (CDC, 2019a). Young women, adolescents (Slater & Robinson, 2014), minority populations (Mermelstein & Plax, 2016), and high school dropouts (Anderson & Pörtner, 2014) are even more disproportionately affected. Access to comprehensive health information and vaccines are well documented effective STI prevention methods …

Preventing Failure To Rescue: Implementation Of An Early Warning Score System, Caitlyn Holloway Msn Rn Ccrn-Cmc Pccn Tcrn

Doctor of Nursing Practice Projects

Background: Hospitalized patients are at inherent risk of complications and further clinical deterioration, even in the presence of advanced medical interventions and expert caregivers, with the most significant risk being failure to rescue. Early Warning Score (EWS) systems allow for earlier, more effective identification of clinical deterioration than traditional medical emergency team (MET) systems and provide an opportunity to reduce failure to rescue events and improve patient outcomes.

Objective: The purpose of this quality improvement project was to implement an EWS system that allowed bedside caregivers to improve patient outcomes through reduction of failure to rescue events and improvement of …

Mental Health First Aid (Mhfa): Implementing An Evidence-Based Practice Change Initiative In A School Setting, Kate Wachutka Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: School-aged children with unidentified mental illnesses experience poor health outcomes and increased medical costs. Successful management of this public health threat requires a collaborative community approach with a focus on enhancing adults’ mental health literacy (MHL) to improve outcomes.

Objectives: The objectives of this project were to implement an evidence-based mental health education (utilizing MHFA) and sustainment program within a school setting for staff and parents supervising children to optimize the adults' MHL over a three month period.

Methods: A pretest-posttest design was used. Participants were recruited from a school in the Western United States. Inclusion criteria consisted of: …

Implementing Sskin Bundle For Pressure Ulcer Prevention In Long-Term Care Facility, Funmilayo Oni

Doctor of Nursing Practice Projects

Background: Pressure ulcers are a major challenge in long-term care (LTC) facilities. Adult patients in LTC setting are at risk for developing pressure ulcers due to chronic medical conditions and comorbidities. Preventing the onset of these wounds is more cost-effective than treating pressure ulcers.

AIM/Objectives: The primary objective was to decrease the number of pressure ulcers by 50% within a three-month period. Secondary objectives were to achieve 100% compliance with completion of mandatory staff education, score on the posttest questionnaire, and compliance with mandatory staff documentation as instructed by the SSKIN protocol.

Methods: This DNP Project used a pretest and …

Antibiotic Stewardship For Asymptomatic Bacteriuria In Older Adults Residing In Long-Term Care At End-Of-Life, Kimberly Madison Agpcnp-Bc

Doctor of Nursing Practice Projects

Background: Differentiating between asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) in older adults is challenging due to their atypical presentation. There is a critical gap in practice to adhere to clinical guidelines advising against treating ASB with antibiotics.

Objectives: The purpose of this Quality Improvement project was to implement an antibiotic stewardship program at a hospice organization to standardize judicious use of antibiotics at the end-of-life. The outcome measures were designed to evaluate clinician knowledge, prescribing policies and practice changes, the completeness of documentation, the appropriate usage of antibiotics, and clinician antibiotic use attitudes and beliefs.

Methods: Hospice clinicians …

Structured Type 2 Diabetes Education To Improve Self-Monitoring Blood Glucose, Self-Care Management, And Diabetes Knowledge In A Multicultural Family Practice Clinic, Deedee Foster Fnp-C

Doctor of Nursing Practice Projects

Background: The family practice providers at the family medicine residency clinic (FMRC) have neither sufficient time nor continuity of care to provide diabetes education to effectively reduce A1c levels. The FMRC has 500 multicultural type 2 diabetes patients with an A1c >7% that has increased by 23.2% in the previous five months. Multiple studies have demonstrated that structured diabetes education can significantly decrease blood glucose readings, improve self-care management, and diabetes knowledge to attain optimal glycemic control.

Objectives: To implement an evidence-based practice (EBP) project in the FMRC to improve participants blood glucose readings, self-care management, and diabetes knowledge.

Methods: …

Effect Of A Web-Based Educational Intervention In Improving Depression Knowledge And Help-Seeking Behaviour In Women, Chibuzo Efuribe Rn Msn Fnp-Bc

Doctor of Nursing Practice Projects

Background: Depression is of global concern and one of the leading causes of disability in the United States. Based on a needs assessment conducted in a faith-based organization, we noticed a gap in depression knowledge, an unwillingness to seek help, and a lack of open dialogue among the women. Studies have shown that low depression literacy impedes early recognition, prevention, and willingness to seek help (Brijnath et al., 2016; Reavley et al., 2014).

Aims: This study aimed to evaluate the effects of web-based educational intervention in improving depression knowledge and help-seeking behavior among women in a faith-based organization.

Methods: Using …

Program Evaluation Of Leader Rounding In Emergency And Trauma, Allen Fasnach Msn, Rn

Doctor of Nursing Practice Projects

Background: Patient satisfaction scores are an area of priority for hospitals throughout the United States because of their association with quality outcomes for the patients (Davenport, O'Connor, Szychowski, Landry, & Hernandez, 2017). This healthcare organization implemented the practice of nurse leader rounding over the last five years with the goal of leaders rounding on 75% or greater of the units' populations without any organizational sustainment or achievement of upper decile patient satisfaction scores.

Aims: The aim of this project was to utilize the Centers for Disease Control Framework for a Program Evaluation to evaluate the redesigned leadership rounding program for …

Effectiveness Of Provider Education To Improve Screening, Diagnosis, And Management Of Postpartum Depression, Gina M. Tytula

Doctor of Nursing Practice Projects

Background: Postpartum depression (PPD) effects approximately 15% of new mothers after the birth of their child which results in feelings of anger, fear and being overwhelmed. In the practice setting for this project there were low rates of PPD screening, leading to missed diagnoses and inadequate management of PPD.

Purpose: The purpose of this project was to implement and evaluate the effectiveness of an education program to increase providers’ perceived knowledge and improve screening, diagnosis and management of PPD for a multicultural patient population at an urban obstetrics practice.

Methods: This pre-post design project evaluated the effectiveness of an educational …

Evaluating Telehealth As A Means Of Communicating With Living Donors And Its Effect On Quality Of Care, Ashley Anne Hamby Rn Msn

Doctor of Nursing Practice Projects

Background: Despite the advantages of living donor kidney transplantation (LDKT), there are barriers that potential donors face that make living donation less appealing. Research supports the use of telehealth as an effective method of enhancing access to care and building efficiencies.

Aims/Objectives: To evaluate access to care, effectiveness, financial impact, and experience after implementing telehealth as a means of communicating with living donors.

Methods: Utilizing a pretest-posttest design, an analysis was performed among medically cleared donors evaluated in-person between January 1, 2019 to December 31, 2019 (Control Group; N=64) and donors evaluated via telehealth (Zoom®) between January 1, 2021 to …

Implicit Bias Training: Improving Racial/Ethnic Disparities In Maternal Care, Marilyn Mapp

Doctor of Nursing Practice Projects

Background: Racial and ethnic disparities persist in the United States leading to adverse maternal outcomes. Nationally, the maternal mortality rates in black women are two to three times higher than white women. Implementing implicit bias training, recommended by the Council on Patient Safety in Women’s Health, is a key intervention that may help to reduce these disparities.

Objectives: This quasi-experimental/mixed methods project evaluated the effectiveness of training on implicit bias to increase awareness of implicit bias among a convenience sample of registered nurses in labor and delivery and postpartum units at two community hospitals.

Methods: Quantitative data was analyzed with …

A Community Educational Intervention To Improve Firearm Safety Behavior In Families, Elizabeth G. Choma Msn, Rn, Cpnp-Pc

Doctor of Nursing Practice Projects

Background: Every day in America children, are injured or killed from the accidental shooting of firearms. Additionally, few households with children report storing all guns unloaded and locked up. Recent evidence supports education on safe firearm storage as an effective intervention in promoting firearm safety in families with children. However, Pediatric healthcare providers often do not have enough time for firearm education during well visits.

Objective: This Quality Improvement (QI) project aimed to use an educational intervention with statistics on firearms in children and implemented the Asking Saves Kids (ASK) campaign to assess and improve firearm safety behaviors in families …

A Certified Nurse Program: Mitigating Barriers To Certification, Kymberlee Cox Msn, Rn, Npd-Bc, Pccn-K

Doctor of Nursing Practice Projects

Background: Certification recognizes a nurse's specialized knowledge, skill, and expertise. It has been linked to positive patient, nurse, and organizational outcomes. Recognizing these advantages, the nursing department set a goal to increase certification rates. However, perceived barriers to certification existed, and rates remained unchanged. A program was needed to overcome these obstacles.

Aims/Objectives: To develop and evaluate a Certified Nurse Program that addresses the perceived barriers to certification by proactively supporting, preparing, and recognizing nurses who pursue and maintain a specialty certification.

Methodology: A 200-bed Maryland suburban hospital adopted the program. Initiatives for certification support, preparation, and recognition were implemented. …

A Telehealth Blood Pressure Education Program On Hypertension Knowledge, Selfcare, And Behavior, Cheynnie N. Burnett Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: Hypertension poses a significant risk for morbidity and mortality. Regular blood pressure monitoring, medication compliance, and/or lifestyle modifications have shown to improve control. Digital communication in healthcare, such as telemedicine provides patients and primary care offices an opportunity to improve access to care and education.

Objectives: This Quality Improvement (QI) Project aimed to answer the question: In adult patients with a diagnosis of hypertension, what is the effectiveness of implementing an evidence- based telehealth blood pressure management program in a primary health care setting, when compared to baseline, on blood pressure knowledge, management, and self-care over a nine- week …

The Impact Of Mentorship On Nurses’ Level Of Self-Efficacy And Motivation To Pursue Board Leadership Positions, Amy K. Mccarthy Msn, Rnc-Mnn, Ne-Bc

Doctor of Nursing Practice Projects

Background: Nurses comprise the largest component of the healthcare workforce and possess a unique understanding of healthcare operations and patient care. On average, the proportion of nurses serving on hospital boards range from 2 to 6%, with the proportion of physicians averaging 20%. Over the last decade, much attention has been placed on emphasizing the importance of a nurse’s presence on boards. Despite these initiatives, nurses continue to display an overall hesitancy towards board service.

Objectives: The aim of this project was to implement an evidence-based mentorship program to address barriers to board leadership and increase overall self-efficacy and motivation …

Implementation Of A Standardized Handoff Tool For The Transition Of Care Of Adult Liver Transplant Patients, Suzanne Robertazzi Msn, Anp-Bc

Doctor of Nursing Practice Projects

Background: The transfer of care of the adult liver transplant patient from the inpatient to the outpatient setting has increased in complexity and has the potential to lead to errors and adverse events.

Objective: This pre-post design quality improvement project implemented a hand-off communication tool to improve adult liver transplant patient outcomes when transitioning from the inpatient to outpatient setting.

Methods: The hand-off tool was based on Illness severity, Patient summary, Action list, Situation awareness, and Synthesis (I-PASS). An EMR chart review was completed on discharged liver transplant patients 3 months (N=28) prior and 4 months (N=36) after I-PASS implementation. …

Intrathecal And Epidural Dexmedetomidine For Obstetric Patients, Sarah Tobias, Addison Hohner

Doctor of Nursing Practice Projects

The use of dexmedetomidine in spinals and epidurals can be beneficial for obstetric patients. The combination of dexmedetomidine with local anesthetics for neuraxial anesthesia potentiates the effect of the blockade while eliminating the undesirable side effects associated with opioid administration. This project used a non-experimental, pre-test/post-test design to assess key stakeholders' current use and intended future use of dexmedetomidine in neuraxial anesthesia for obstetrical patients. The goal of this project was to review current evidence-based literature regarding the use of dexmedetomidine as a neuraxial adjunct for obstetric anesthesia. The aim of this project was to summarize the results of the …

Addressing Tobacco Use With Improved Utilization Of 5as Framework In Primary Care, Binta Bojang

Doctor of Nursing Practice Projects

Abstract

Identifying and treating tobacco use disorder through screening and evidence-based intervention is necessary to assist all tobacco users to quit and or to decrease typical tobacco-linked health risks. The findings from the literature review suggested that the implementation of the technology-enhanced 5As model (asking, advising, assessing, assisting and arranging for follow up) approach might serve as a reminder to clinicians to assess tobacco use, and improve patient outcomes in tobacco cessation care. The purpose of this DNP project was to improve the treatment of tobacco use disorder among adults in a primary care. The objective of this project was …

Bridging The Gap In Education For Patients On Oral Chemotherapy: A Qi Project, Lindsay Rodriguez

Doctor of Nursing Practice Projects

Abstract

Oral chemotherapy and intravenous (IV) chemotherapy share many of the same side effects. However, at community General Hospital Medical Center oral chemotherapy patients were not receiving equitable monitoring and education like their IV chemotherapy counterparts. To bridge the gap, a quality improvement (QI) initiative to improve education, documentation and follow-up between visits was proposed to increase compliance and understanding. The QI project consisted of patients taking oral chemotherapy within the first 12 weeks of starting treatment. Patients were contacted weekly via nurse lead follow up calls and the Oral Chemotherapy Template was discussed with the patient to identify concerns …

Complete Health Improvement Program To Implement Lifestyle Medicine, Robert Hobbs Jr

Doctor of Nursing Practice Projects

The health of many Americans continues to worsen. Over the past 20 years there has been a fifty percent increase in the incidence of Type 2 Diabetes Mellitus in the US. America has an increase in obesity rates, and lower mortality rates compared to other countries that spend less per capita. Currently the US healthcare system only contributes about 20% of the overall care of patients. Provider burned out is increasing and many remain uneducated regarding lifestyle medicine. Since up to 90% of chronic diseases are lifestyle related, a different approach to chronic disease care is needed. The Complete Health …

Decreasing Falls: Communicating Safety With Patient-Directed Visual Cues, Signs, And Symbols, Lizelle Hill

Doctor of Nursing Practice Projects

Patient falls during hospitalization are a major clinical problem that occurs frequently. It is estimated that between 700,000 and 1,000,000 patients fall in hospitals each year. Between 30% and 50% of patients who fall in hospitals are injured. Consequently, falls with serious injury are among the most frequent hospital-reported sentinel events. Hospitals also suffer from patient falls as the Centers for Medicare and Medicaid Services no longer reimburse for costs related to preventable falls or fall-related injuries. Given the significant negative impact of falls on patients and healthcare organizations, hospitals continue to look for interventions to decrease falls. Research strongly …

Online Support For Families Affected By Opioid Use Disorder, Sharonda Hill

Doctor of Nursing Practice Projects

Families who care for children with neonatal abstinence syndrome (NAS) face many challenges and may be lacking support. The purpose of this project was to provide evidence-based information to families caring for NAS children through an established online support group, To the Moon and Back. Nola Pender’s Health Promotion Model was the theoretical model used to guide this project. An intervention to deliver support and information was implemented through three sessions. During these sessions participants were educated on evidenced-based tools to help their children with behavioral self- regulation and communication with providers. Data was collected through pre and post assessments …

Use Of Academic Detailing To Improve Reporting Of Peri-Operative Events, Allyn Sara Miller-James

Doctor of Nursing Practice Projects

Problem: Four million people worldwide die within thirty days of surgery. The EPIC Corporation has created the opportunity to collect and analyze data on the peri-operative care of patients. Initially, implementation of the program has identified barriers to event reporting by anesthesia providers. Barriers identified in the literature and in semi-structured interviews are fear of liability and retribution by patients, employers, and governing bodies. Significance: Despite national efforts to increase the reporting of medical errors, they remain grossly under- reported. The integration of the National Anesthesia Clinical Outcomes Registry (NACOR) events data collection tool into the EHR for anesthesia providers …

Simulation To Improve Dementia-Related Care Of Veterans, Brandy Wardrip

Doctor of Nursing Practice Projects

Millions of Americans, including Veterans, are diagnosed with dementia. Healthcare staff may benefit from dementia-related training. This Doctorate in Nursing Practice (DNP) project evaluated the effectiveness of the Virtual Dementia Tour (VDT) as a learning tool to improve staff’s knowledge of dementia, enhance their empathy and attitudes when interacting with Veterans diagnosed with the disease, and increase awareness that behaviors commonly seen with dementia may be forms of communication. Interprofessional healthcare staff (N=33) at a Veterans hospital participated in the experiential simulation. A pre-and post-test design utilized the Dementia Knowledge Assessment Scale (DKAS) and the Dementia Attitude Scale …

Providing Mbsr Tools To First Year Adn Nursing Students: A Dnp Project, Katherin Brandt

Doctor of Nursing Practice Projects

Abstract

As part of the educational training provided to nursing students it is important to not only provide information regarding stress management, but also to give them tools that they can use to handle stressful situations more effectively. Literature supports the use of mindfulness techniques practiced regularly to decrease stress and anxiety. This DNP project developed, implemented, and evaluated the addition of Mindfulness-Based Stress Reduction (MBSR) techniques into the curriculum of the first-year Medical Surgical nursing course in a prelicensure Associate Degree Nursing program. The project was guided by Watson’s Theory of Human Caring and the Model for Improvement (PDSA …

Streamlining The Referral Process For A Mental Health Clinic: A Dnp Project, Ashley Barr

Doctor of Nursing Practice Projects

Abstract

Mental health providers are in short supply in the United States. Access to mental health is impacted by the process used to refer patients. To bridge this gap, this DNP Project sought to increase mental health referrals to the partnering organization through strategic outreach to primary care and an online social media presence. After IRB approval, outreach to twenty-one primary care providers across eleven clinics was completed, a social media campaign was conducted, and the intake form for the partnering organization was updated for tracking the source of the referral. Results of the interventions included high satisfaction on the …

"Healthy Skills 4 Life" Program: A Pilot Study And Program Evaluation, Wendy Hines

Doctor of Nursing Practice Projects

This project piloted and evaluated “The Healthy Skills 4 Life” (HS4L) program within a middle school population. HS4L is an innovative holistic health curriculum focusing on four key areas of healthy behavior: nutrition, physical activity, stress management, and sleep hygiene. A middle school physical education teacher was supplied with the HS4L instructional materials and support needed to independently implement the program. The HS4L program allowed the students to self-assess wellness behaviors and create an action plan for improvement focusing on healthy lifestyle concepts. The implementation was evaluated utilizing the "Healthy Skills 4 Life" Feedback survey. The total average …

The Use Of A Code Lavender Space To Promote Self-Care, Em Toe

Doctor of Nursing Practice Projects

The nursing shortage has been an ongoing issue across the nation. The workforce has lost valuable employees, especially in rural areas, due to staff shortages and lack of self-care. Implementing therapeutic interventions such as a Code Lavender Room aims to implement self-care during working hours to increase nursing retention in the long term. The goal of this quality improvement project was to provide a safe place for employees to go to relax and reset during working hours. A survey was used to analyze the Code Lavender Room's effectiveness in self-care and how likely the staff are to continue to use …