Nursing Commons^™

Decreasing Preoperative Anxiety In Cataract Patients, Virginia Baltz

Doctor of Nursing Practice Projects

Several studies show that patients present with anxiety before surgical procedures. Preoperative anxiety may cause unwanted sympathetic nervous system (SNS) responses which can result in nervousness, anger, or sadness. Hypertension and tachycardia are often present, along with unwanted postoperative complications including increased pain perception and decreased patient satisfaction. Understanding that anxiety is both an emotional and physiological response, emphasizes the need to alleviate anxiety preoperatively (Aust et al., 2016). This Quality Improvement project aims to manage patient surgical expectations with cataract surgery through positive preoperative education. Patients were given written education and the opportunity to discuss the information before cataract …

Does Urgent Care Depression Screening Lead To Increased Depression Diagnosis?, Eric Haertling

Doctor of Nursing Practice Projects

There is a knowledge gap in the administering of depression screening within the urgent care setting. The Patient Health Questionnaire (PHQ) depression screening can identify patients with depression, but evidence has been limited in identifying an increase in depression diagnosis with the implementation of depression screening. This project aims to determine if routine depression screening with the PHQ increases depression diagnosis in the urgent care setting. The translational science project was performed in a rural urgent care in north-central Arkansas between January 2022 to February 2022. A total of 2,135 records were included in the project, with eight ICD-10 codes …

Discharge Process Optimization, Erin M. O’Neal

Doctor of Nursing Practice Projects

As the demands of the nurse become increased with higher acuity and documentation requirements, the delivery of discharge instructions is often one of the most, and at times, only, formal education opportunities between the nurse and the patient. It is imperative to modify the discharge process to ensure patients have the ability to confidently care for themselves after they leave the hospital. The aim of this project was to create a nursing discharge workflow that meets the educational needs of the patients. This project was a quality improvement project designed to change the nursing workflow to provide a better discharge …

Diabetic Education In An Uninsured Patient Population, Amanda Whistler

Doctor of Nursing Practice Projects

Abstract

Patient education is an important factor in the management of Type 2 Diabetes. Successful outcomes can be causally related to proper patient education. Many times, patients are left with more questions than answers about their newly diagnosed condition. Some groups of patients are affected by prediabetes and diabetes more than other groups. Differences in health status or access to health care among racial, ethnic, geographic, and socioeconomic groups are referred to as health disparities. This is a major concern in the United States for health care providers.

A spreadsheet was used to record the blood glucose levels of each …

Increasing Low-Dose Ct Screening In Primary Care, Bethany Huelskoetter

Doctor of Nursing Practice Projects

Abstract

Lung cancer was ranked as the second most common cancer diagnosed in 2020 and had the highest death rate compared to all other cancers, excluding nonmelanoma skin cancers (ACS). Early detection is key in decreasing the mortality of lung cancer. A low dose CT (LDCT) is a yearly screening tool developed to detect lung cancer early in high-risk patients yet is much underutilized in primary care. The purpose of this project is to increase the number of LDCT orders placed for qualified patients to decrease the lung cancer mortality rate. There were two main methods for this project: education …

Mindfulness And Meditation To Reduce Test And Evaluation Anxiety In Doctoral Nurse Anesthesia Students, Jenna L. Tebbenkamp

Doctor of Nursing Practice Projects

Abstract

Mindfulness and Meditation to Reduce Test and Evaluation Anxiety in Doctoral Nurse Anesthesia Students

Background/Information

A significant number of university students report experiencing test anxiety. Extreme anxiety has been reported as a cause of withdrawal from university studies. Certified Registered Nurse Anesthetists are required to complete an intense curriculum with tests and evaluations prior to passing a national board certifying exam, which is anxiety provoking.

Purpose

The primary objective of this project was to provide mindfulness intervention information to be utilized by the DNP students and assess desires of having a mindfulness meditation practice to alleviate academic anxiety.

Methods …

Inpatient Observation Safety Assistant Practices, Jennifer Knight

Doctor of Nursing Practice Projects

Abstract

Introduction. Sitter usage is a patient safety practice used across healthcare organizations and the world. Sitters go by many other names, such as patient safety assistants, patient care assistants, care partners, and observation partners. There is literature that supports different variations of practices in healthcare facilities. A scoping review of the literature revealed multiple initiatives to reduce sitter cost and observation through nurse empowerment.

Purpose of Root Cause Analysis. The purpose of this root cause analysis is to determine why personnel inconsistently use the sitter policy. The appraised data will be used to improve the sitter process at this …

Implementation Of A Risk Assessment Tool To Increase Screening For Extragenital Gonorrhea And Chlamydia In Men Who Have Sex With Men, Andrew P. Tharp

Doctor of Nursing Practice Projects

INTRODUCTION: Gonorrhea and chlamydia account for the majority of sexually transmitted infections (STIs) in the United States and are often thought to infect only the urogenital tract. Infections can also be harbored at extragenital sites (rectum and oropharynx), and these infections can increase susceptibility to HIV. Extragenital screening recommendations exist for populations deemed high risk, including men who have sex with men (MSM); yet, routine screening is not consistently completed.

PURPOSE: To improve screening rates for extragenital gonorrhea and chlamydia in MSM within a primary care setting by using an STI risk assessment tool.

METHODS: Clinicians completed a baseline knowledge …

Short Term Medical Mission Antibiotic Protocol, Greg Jennings

Doctor of Nursing Practice Projects

Background/Introduction: Short term medical mission trips are growing in popularity and with this growth the level of care provided must remain evidenced based. Mission groups traveling to developing countries consist primarily of volunteers. And while many of those serving on mission trips are medically trained, some have minimal healthcare knowledge. Pharmacists are not always available to dispense medications on mission trips and therefore it is common for registered nurses in the pharmacy to dispense the medications prescribed by the providers. Because the medications available on mission trips are limited, often times substitutions must be made, especially when it comes …

Improving Access To Reproductive Life Planning Following Implementation Of One Key Question® In Practice, Ashley Wittler

Doctor of Nursing Practice Projects

Abstract

Inadequate reproductive life planning (RLP) education is a widespread problem for women in the United States. This deficit leaves women without necessary guidance regarding contraceptive choices and maximizing pre-conception health. Use of RLP is endorsed by the American College of Obstetricians & Gynecologists (ACOG) and the Center for Disease Control (CDC). Lack of use of an RLP tool in a large, multi-site obstetrical and gynecological practice located in the Metro East is an issue that greatly impacts the patient population. The goal was to initiate the use of an evidence-based RLP tool, known as One Key Question®. The use …

Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn

Doctor of Nursing Practice Projects

Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use.

Methods A literature review was …

Medicated-Assisted Treatment And 12-Step Programs: Evaluating The Referral Process, Candace S. Brown, Chudney Williams, Ryan E. Stephens, Jacqueline Sharp, Bobby Bellflower, Martinus T. Zeeman

Doctor of Nursing Practice Projects

Purpose/Background Overdose deaths in the U.S. from opioids have dramatically increased since the COVID-19 pandemic. Although medicated-assisted treatment (MAT) programs are widely available for sufferers of opiate addiction, many drop out of treatment prematurely. Twelve-step programs are considered a valuable part of treatment, but few studies have examined the effect of combining these approaches. We aimed to compare abstinence rates among patients receiving MAT who were referred to 12-step programs to those only receiving MAT.

Methods In this prospective study, a cohort of participants from a MAT clinic agreeing to attend a 12-step program was compared to 15 controls selected …

Policy Analysis Of The Illinois Nurse Practice Act (Aprn Title Section 65/65-50), Sara Kim

Doctor of Nursing Practice Projects

Background

Physician groups claim allowing nurses to use the title "doctor" confuses patients. Nurses assert that the title is common to many disciplines, and nurses should be trusted like other professionals to identify their specialty to patients. Currently, qualified nurses in Illinois using the title "doctor" in clinical areas must introduce themselves to each patient in the following way: "Hi, I'm Dr. Smith, the nurse practitioner taking care of you today. I do not have a degree in medicine, and I am not a physician or medical doctor” (225 ILCS § 65/65-50).

Purpose

This project aimed to evaluate Illinois Nurse …

Utilization Of Telephone Outreach And Telemedicine To Improve Diabetic Outcomes, Nicolas Yemm

Doctor of Nursing Practice Projects

Diabetic adherence is paramount to achieving adequate glycemic control. Telephone outreach and utilization of telemedicine can improve diabetic adherence through closer monitoring and removing barriers to access for care. The goal of the project was to improve the dashboard HbA1c quality metric within the IM office. The office dashboard HbA1c metric initially was in the “red threshold”, which means <70% of patients aged 18-75 years old with diabetes had a HbA1c <8%. This project involved performing telephone outreach to contact diabetic patients who were due for office follow-up to offer telemedicine as a convenient option for patient evaluation. In addition, the secondary goals of the project included identifying social determinants presenting barriers to diabetic care plan adherence. The results indicated telephone outreach and telemedicine use may help achieve better glycemic control in diabetic patients. This project demonstrated improvement in HbA1c dashboard metrics to the “yellow threshold”, indicating 71% of patients (18-75 years old) in the office with diabetes had a HbA1c <8%. Several limitations were identified, including a short implementation window (6 weeks), lack of ability to assess whether providers were instituting project recommendations, staff engagement, and internet bandwidth/technology literacy issues when using telemedicine. From a long-term implementation perspective, the project showed telephone outreach and telemedicine are useful tools that can positively impact poorly controlled diabetic patients to improve glycemic control. However, the limitations of the project will likely need to be addressed to achieve long-term implementation of the project methods.

Adverse Childhood Experiences And Urinary Incontinence In Elementary School Aged Children, Amanda Jill Travis Msn, Fnp-C, Margaret C. Harvey Phd, Aprn, Acnp-Bc, Chfn, Michelle Rickard Dnp, Apnp-C

Doctor of Nursing Practice Projects

Purpose/Background: Adverse Childhood Experiences (ACEs) have an impact on health throughout the lifespan (Filletti et al., 1999; Hughes et al., 2017). These experiences range from physical and mental abuse, substance abuse in the home, parental separation or loss, financial instability, acute illness or injury, witnessing violence in the home or community, and incarceration of family members (Hughes et al., 2017). Understanding and screening for ACEs in children with urinary incontinence can help practitioners identify psychological stress as a potentially modifiable risk factor.

Methods: A 5-month chart review was performed identifying English speaking patients ages 6-11 years presenting to the outpatient …

Development And Implementation Of An Enhanced Recovery After Surgery Protocol For Thoracic Surgery Procedures, Nicholas Collier

Doctor of Nursing Practice Projects

A high prevalence of lung and esophageal cancers leads to significant healthcare dollars utilized for treatment and management. Surgical resection is regarded as a key component for multidisciplinary treatment and management of these cancers. By standardizing multidisciplinary patient care and utilizing evidence-based practice, Enhanced Recovery After Surgery (ERAS) protocols for thoracic surgery have offered better outcomes with fewer complications and reduced healthcare costs. The anesthesia providers at the host facility were deficient in basic knowledge related to ERAS protocols and best practice management of thoracic surgery patients. The purpose of this project was to educate anesthesia providers on ERAS principles …

Transversus Abdominis Plane Block: A Scoping Review, Liam Maher, Leanne Orians, Gabrielle Pappas, Lanny Coker Dnsc, Crna

Doctor of Nursing Practice Projects

The purpose of this project is to provide an overview of the literature on the analgesic effects of transverse abdominal plane (TAP) block and its effectiveness in reducing opioid consumption.

Intraoperative Administration Of An Nsaid And An Opioid Vs. An Opioid Alone Effect On Postoperative Ileus Development, Brooke H. Ulsh, Delaney N. Vedros, Rebekah G. Whaley, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

The purpose of this DNP project is to examine what is known from existing literature about postoperative ileus development in the adult surgical patient population after receiving intraoperative opioids versus a combination of intraoperative opioids and NSAIDs.

Intraoperative Dexmedetomidine For Reduction Of Postoperative Delirium In The Elderly: A Scoping Review, Gregory B. Harris Bsn, Rn, Srna, Brooke N. Hatchell Bsn, Rn, Srna, Davelin D. Woodard Bsn, Rn, Srna, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain.

Methods: The authors developed eligibility criteria for inclusion of articles and performed a …

Pain Control: Opioid Vs. Nonopioid Analgesia During The Immediate Postoperative Period, Shamsie M. Lumpkin Bsn, Srna, Isaac W. Parrish Bsn, Srna, Austin S. Terrell Bsn, Srna, Dwayne S. Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to …

Dexmedetomidine Vs Fentanyl In Attenuating The Sympathetic Surge During Endotracheal Intubation: A Scoping Review, Alexandra Schwieger, Kaelee Shrewsbury, Paul Shaver, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 …

Postoperative Nausea And Vomiting Implications In Neostigmine Versus Sugammadex, Corey Lee Johnson, Colton Bradley James, Sarah Grace Traughber, Charles Anthony Walker, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Purpose/Background: Postoperative nausea and vomiting (PONV) is a frequent complaint in the postoperative period, which can delay discharge, result in readmission, and increase cost for patients and facilities. Inducing paralysis is common in anesthesia, as is utilizing the drugs neostigmine and sugammadex as reversal agents for non-depolarizing neuromuscular blockers. Many studies are available that compare these two drugs to determine if neostigmine increases the risk of PONV over sugammadex. Sugammadex has a more favorable pharmacologic profile and may improve patient outcomes by reducing PONV.

Methods: This review included screening a total of 39 studies and peer-reviewed articles that looked at …

Opioid Free Anesthesia To Prevent Post Operative Nausea/Vomiting, Aleksander Acred, Milena Devineni, Lindsey Blake, Cindi Dabney Dnp, Crna

Doctor of Nursing Practice Projects

Purpose The purpose of this study is to compare the incidence of post-operative nausea and vomiting (PONV) in opioid-utilizing and opioid-free general anesthesia. Background PONV is an extremely common, potentially dangerous side effect of general anesthesia. PONV is caused by a collection of anesthetic and surgical interventions. Current practice to prevent PONV is to use 1-2 antiemetics during surgery, identify high risk patients and utilize tracheal intubation over laryngeal airways when indicated. Current research suggests minimizing the use of volatile anesthetics and opioids can reduce the incidence of PONV, but this does not reflect current practice.

Methods In this scoping …

Increasing Referrals To School Counselors By Integrating An Evidence-Based Program For Educators Identifying Adolescents At Risk For Suicide In A Rural High School, Wendy Holloway

Doctor of Nursing Practice Projects

Background: Addressing suicide in America's youth is imperative. Teachers play an essential role in identifying and intervening with adolescents experiencing psychological distress leading to suicide. Teachers and staff lack professional development addressing the identification of students in psychological distress.

Purpose: This project aimed to increase referrals to school counselors by integrating an evidence-based program for educators identifying adolescents at risk for suicide in a rural high school.

Design Method: This was a quantitative quality improvement project with a pre-/post-test design. Additionally, referrals to the school guidance counselors before implementing the program and after the completion of the program were …

Improving Medication Communication Hospital Consumer Assessment Of Healthcare Providers And Systems (Hcahps) Score, Danyel Weldon Munster

Doctor of Nursing Practice Projects

Nurses provide education on medication purposes and side effects to hospitalized patients. Patient satisfaction surveys measure this intervention with the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). HCAHPS determines a portion of hospital reimbursement and star rating. By improving patient satisfaction through effective medication communication, the hospital’s star ratings and reimbursements increase. Various clinical settings utilize the teach-back method to improve patient understanding and participation in their medication education. This quality improvement project aims to improve HCAHPS medication communication-specific scores through scripted, nurse-delivered teach-back interventions. The student DNP educated the staff nurses on an adult medical-surgical unit, …

Reducing Incidence Of Contrast-Induced Acute Kidney Injury Through Nursing Education, Hilarie Rankin

Doctor of Nursing Practice Projects

Contrast-induced acute kidney injury (CI-AKI) occurs commonly in patients following percutaneous coronary intervention (PCI) and has been linked to increased patient morbidity, higher risk for cardiovascular mortality, and a large burden of annual healthcare costs. The implementation of evidence-based care standards by nursing staff has been shown to reduce incidence of CI-AKI. Current discrepancies in nursing care have been linked to increased incidence of CI-AKI; therefore, the need for enhanced nurse buy-in with evidence-based protocols is paramount. The primary investigator sought to increase knowledge of CI-AKI and nursing compliance with an established evidence-based protocol at a single center hospital. After …

Unifying Vision: Strategies That Influence Nurse Self-Care Practices, Nancy Weaver

Doctor of Nursing Practice Projects

Background: Self-care is about physical health and includes the individual's emotional, mental, and spiritual aspects. Self-care behaviors are tailored to an individual's perceptions and values. Stress among nurses has been linked to high turnover rates and nursing shortages. When nurses experience job-related stress, effectively managing a patient's care becomes difficult.

Purpose: This project aimed to create a website presenting creative strategies that encourage a healthy lifestyle and teach nurses how to engage in self-care practices. Through interviews with executives at a privately owned, multi-specialty physician clinic, stakeholders identified the need for easy access to information supporting nurses' ability to …

Implementing Stop The Bleed In Schools, Tonya Bright

Doctor of Nursing Practice Projects

Background: An emergency or disaster can strike at any time, even during the day, while numerous students are in school. This paper will discuss how an educational program initiating Stop the Bleed (StB) in public schools prepares and equips school nurses to respond to a bleeding emergency in the school setting.

Design method: Initiate StB as a "train-the-trainer" course for school nurses. School nurses will have knowledge, training, and supplies to train the employees at their schools. Conduct pre- and post-surveys to assess learning objectives and attitudes toward training and readiness.

Conclusion: The StB educational intervention effectively improved knowledge by …

Sepsis Initiative: Champion Series, Ashlie Barnes

Doctor of Nursing Practice Projects

Sepsis is defined as a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a higher risk of mortality than with sepsis alone. Each year, more than 1.7 million people are diagnosed with sepsis in the United States, and at least 270,000 Americans die. There is no confirmatory diagnostic test to diagnose sepsis. Therefore, clinical judgment based on evidence of infection and organ dysfunction is key.

Despite thousands of articles and hundreds of trials, sepsis plays …

Improving Health Literacy For Diabetics In A Rural Community, Elissa Purvis

Doctor of Nursing Practice Projects

Adults with type II diabetes mellitus need to understand the disease and manage their chronic condition to live a healthy and comfortable life. This project aimed to educate adults with type II diabetes mellitus in self-management of their chronic illness to increase their health literacy to improve their heart health, kidney health, nutrition, and exercise. The project utilized a Doctor of Nursing Practice (DNP) approach to education for adults with type II diabetes mellitus on the disease process.

METHODS: This project is a quality improvement project focused on educating adults with type II diabetes mellitus in managing their chronic conditions …