Nursing Commons^™

Patient Outcomes Following The Implementation Of A Cardiogenic Shock Algorithm, Alana E. Hall

Doctor of Nursing Practice Scholarly Projects

Problem Statement: ST-elevated myocardial infarction (STEMI) is one of the leading causes of cardiogenic shock (CS) associated with increased in-hospital mortality. Despite multiple efforts to improve outcomes, mortality remains high.

Purpose: This quality improvement project aimed to analyze the impact of a cardiogenic shock algorithm on survival to discharge for STEMI patients.

Methods: A CS algorithm was implemented at a cardiac catheterization laboratory on October 3, 2022. Using the Plan-Do-Study-Act quality improvement framework, data was retrospectively collected on patients presenting with a STEMI who meet CS criteria to determine if there was improved survival to discharge after implementing …

Impact Of A Toolkit On Fall Prevention In An Acute Midsized Rehabilitation Facility In The Southeast, Shantai D. Allen

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Older people in hospitals may face a greater risk of falls due to the use of medication, lower body weakness, and some difficulty with balance and walking. Over the past five years, there has been a steady increase in the prevalence of falls with the targeted unit reporting over 5 falls per 1000 patient days, which is higher than the national average. Purpose: The purpose of this project was to decrease falls and decrease falls with injuries in this patient population. Methods: The project employed a pre-post intervention design that measured fall incidence in the targeted unit after …

Implementation Of A Nurse Driven Urinary Catheter Protocol: A Quality Improvement Project For Adult Patients, Jamie H. Dagenhart

Doctor of Nursing Practice Scholarly Projects

Introduction: Studies have shown a relationship between management and use of indwelling urinary catheters on catheter days and catheter-associated urinary tract infections (CAUTIs), in adult patients in intensive care units (ICUs). Globally, increases in catheter days and CAUTI rates have led to poor patient outcomes, increased lengths of hospital stay, and increased hospital costs. In efforts to inhibit these adverse effects, institutions have developed protocols specific to reducing CAUTIs in hospitalized patients. This paper argues that a multifaceted nurse driven indwelling urinary catheter protocol will positively influence number of catheter days and change in practice, in the proposed institutional settings. …

Assessing Organizational Readiness For Evidence-Based Practice (Ebp) Change For The Implementation Of A Postoperative Neuropathic Mastalgia (Pnm) Scale Among General Surgery Ambulatory Practices, Jessica Terry Gonzalez

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Assessing postoperative neuropathic mastalgia (PNM) among oncology breast surgical patients is not commonly performed using a surgery specific pain scale at large South Carolina healthcare organization and is historically misdiagnosed, mismanaged, despite representing a common and significant complication (Gong et al., 2020; Humble et al., 2015; Mejdahl et al., 2019). Studies show that early identification of patients with neuropathic-specific pain following breast cancer-related surgery facilitates better pain management and patient outcomes (Pereira et al., 2017; Sipilä et al., 2012). Assessing organizational readiness to adopt Evidence-Based Practice change is recommended to facilitate the identification of potential barriers to implementation …

Increasing Hpv Vaccination Uptake In Female College Students Aged 18-26, Gabrielle B. Scott

Doctor of Nursing Practice Scholarly Projects

Human papillomavirus (HPV) is the most common sexually transmitted infection in the world. Most people infected with HPV remain asymptomatic, but infections may result in several types of cancer. Three HPV vaccines are available with the recommended initiation of vaccination between 11–12 years, but the vaccine may be administered to females through 45 years old. Despite HPV vaccine efficacy, vaccination rates among college-age students remain low, particularly in certain geographical areas such as the Southeastern United States. This project aimed to increase HPV vaccination uptake among females between the ages of 18-26 in the Women’s Health Clinic through patient education …

Michigan Appropriateness Guideline For Intravenous Catheters And The Impact On Utilization And Infection Ratios In Peripherally Inserted Central Catheters, Kasey Smith Bustamante

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adult patients are at increased risk for central line-associated bloodstream infections when central line utilization rates are increased and are inserted inappropriately, based on patient criteria. Purpose: Determine if utilization of the Michigan Appropriateness Guidelines for Intravenous Catheters (MAGIC) will reduce central line utilization ratios (focusing on peripherally inserted central catheters (PICC)) and reduce risk of central line-associated bloodstream infections among an adult population in the Trauma Surgical Care Unit (TSCU) and Medical Intensive Care Unit (MICU) at a tertiary care center in the South Carolina Pee Dee Region. Methods: The Plan Do Study Act (PDSA) quality improvement …

Hpv Vaccine Hesitancy: Improving Vaccination Rates In The Pediatric Primary Care Setting, Stephanie Meltzer Carper

Doctor of Nursing Practice Scholarly Projects

Problem statement: The Human Papillomavirus (HPV) vaccine protects against carcinogenic strains of HPV and is administered during childhood to provide maximum protection during peak risk for exposure and HPV disease. Despite demonstrated efficacy, HPV vaccine hesitancy leads to decreased vaccination rates in the pediatric primary care setting. Purpose: This quality improvement project aims to improve HPV vaccination rates at SouthernMED Pediatrics, Summerville, South Carolina. Methods: A pre-intervention survey was administered to identify parental concerns regarding the HPV vaccine to create a customized educational handout. Health care providers systematically used motivational interviewing, presumptive approach communication techniques, and a customized educational handout …

Retrospective Analysis Of Benzodiazepine And Sedative Use In The Surgical-Trauma Intensive Care Unit, Ronelle Guinyard Goodwin

Doctor of Nursing Practice Scholarly Projects

Problem Statement: There has been an increase in benzodiazepine use and delirium occurrences in the surgical-trauma intensive care unit (STICU). Purpose: This Doctor of Nursing (DNP) project aimed to explore the current practice of benzodiazepine and sedative use for adult patients admitted to the STICU who developed alcohol withdrawal syndrome (AWS) or delirium. Method: A retrospective chart review with descriptive analysis was completed for all adult patients admitted to the STICU at a regional community level 1 adult and level 2 pediatric trauma center, diagnosed with AWS or delirium, and treated with benzodiazepines during their intensive care unit (ICU) stay. …

Improving Communication And Workflow Among Advanced Practice Providers And Nurses On Nightshift In An Intensive Care Unit, Chelsey Alise Durr Massey

Doctor of Nursing Practice Scholarly Projects

Problem Statement: There is often a lack of streamlined communication on nightshift among the reduced care team in acute care settings. The absence of organized collaboration and shared decision-making contributes to strained professional relationships between the advanced practice provider (APP) and the nurse. Purpose: Nightly provider-nurse bedside rounds were implemented in a 21-bed cardiovascular intensive care unit (CVICU) using a goal sheet to improve communication among the APPs and nurses. Methods: A pretest-posttest design in which surveys were used in this quality improvement (QI) project to determine perceptions of communication between APPs and nurses. Inclusion Criteria: All APPs and rotating …

Impact Of A Standardized Checklist On Post Discharge Appointment Attendance And Readmission Rates Of Veterans With A Mental Health Diagnosis, Henretta N. Milton-Williams

Doctor of Nursing Practice Scholarly Projects

Inpatient readmissions are among the most severe problems facing hospitals. Readmissions are most common in the first two to five days after discharge, especially among veterans with mental illnesses at the Columbia Veteran Administration Hospital System (CVAHS) inpatient units. The discharge planning process should begin as soon as a patient is admitted and should be updated throughout the inpatient stay to ensure a safe transition of care from inpatient to outpatient. This Doctor of Nursing Practice (DNP) quality improvement project is aimed to develop and implement a standardized checklist to streamline and organize the discharge planning for all veterans admitted …

Using The Buzzy Device To Decrease Pain, Fear, And Anxiety With Venipunctures And Injections, Lisa Santiago Sauls

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Anxiety, fear, and pain related to initiating peripheral venous access or injections are a high priority in the ambulatory infusion clinic setting for both children and adult populations.

Purpose: To determine if the Buzzy device will decrease anxiety, fear, and pain related to adult patients undergoing peripheral venous access or injections in ambulatory infusion clinics.

Methods: Age, sex, route of medication the patient is receiving. A post-procedure questionnaire assessed the participant's satisfaction with the Buzzy device. Pain, fear, anxiety, and patient satisfaction were all measured using a visual analog scale.

Inclusion Criteria: Patients aged eighteen and above receive …

Implementation Of A Peer To Peer Concussion Management Program And Its Effect On Concussion Knowledge And Reporting Behaviors In Collegiate Club Sports Athletes, Brian Wallace Stefan

Doctor of Nursing Practice Scholarly Projects

Problem: Concussions continue to be a common injury in both athletes and non-athletes across the world. In college, symptoms and recovery time from concussion injuries can lead to loss of social interaction, class time, and participation in school events such as sports. For collegiate club athletes at the University of Pittsburgh, there is currently no mandated concussion protocol, making injury management more difficult. Purpose: This project's purpose was to determine whether a peer-to-peer concussion education tool is a viable implementation option to improve the concussion environment for this population compared to their current structure with no protocol. Method(s): A five-step …

Implementation Of Daily Multidisciplinary Rounding Audits Of Adherence To An Indwelling Catheter Protocol Impact On Catheter-Associated Urinary Tract Infections, Jacqueline April Wright

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Catheter-associated urinary tract infections (CAUTIs) among critical care patients negatively impact the trajectory of the patient’s hospitalization through increased mortality, morbidity, length of stay, and cost. To combat this, hospitals have implemented bundles in compliance with evidence-based practice models to reduce CAUTIs. Purpose: Determine if implementing a daily multidisciplinary rounding audit of established CAUTI prevention protocol decreases the occurrence of CAUTIs in critical care patients with indwelling urinary catheters. Methods: Participants in this quality improvement project included critical care nurses and providers participating in daily multidisciplinary rounds on all critical care patients with indwelling urinary catheters admitted to …

Implementing Ethics Education For Nurse Managers, Mona L. Lateyice, Rachel E. Marzec

Doctor of Nursing Practice Scholarly Projects

Background: Every day, nurses are faced with making decisions for patient care and may come across complicated ethical decisions. Ethical practice is essential in every health care organization in providing care and how they conduct themselves (ANA, 2015). Nurse managers are responsible for ensuring ethical standards are met by nursing staff.

Problem: Nurse managers are faced with ethical problems more than fifty percent of their work time (Aitamaa, 2019). There are studies that show nurse managers and nurses have difficulty solving ethical problems because they lack understanding of ethical principles (Huang, et al., 2020). Evidence shows nurses are deficient in …

Implementation Of A Decision Aid To Increase The Rate Of Routine Breast Cancer Screening Among Women Between 50 To 74 Years Old At A Federally Qualified Health Center, Dana Mars

Doctor of Nursing Practice Scholarly Projects

Background: Breast cancer is the most prevalent form of cancer in the U.S. Cancer screenings can result in prompt treatments and positive health outcomes. Disparities in screening rates are prevalent among vulnerable populations. At a Federally Qualified Health Center (FQHC), where the project occurred, the rate of breast cancer screening in 2021 (64%) was lower than the target set by the Healthy People 2030 (77%). This quality improvement project aimed to increase the rate of routine breast cancer screening among women aged 50-74 years old in the FQHC.

Methods: Previous studies have reported that decision aids on breast cancer screening …

Implementation Of Readmission Prevention Pathway To Reduce Skilled Nursing Facility Readmission, Bina Darai

Doctor of Nursing Practice Scholarly Projects

Background: Individuals admitted to Skilled Nursing Facilities (SNFs) are at risk of preventable hospital readmissions due to complex medical issues. Evidence indicates that many residents are transferred from SNFs to the hospital at least once. The Centers for Medicare & Medicaid Services penalizes facilities with high rehospitalization rates. Implementing an evidence-based strategy could reduce 30-day readmission rates in this setting.

Local problem: This project was conducted in a 34-bed Sub-Acute Care Unit in an SNF. The unit's 30-day readmission rate was high compared to the average rate at the SNF and the national benchmark, identifying a need to reduce readmission. …

Referral Triage To Improve Neurology Access, Melinda Mata

Doctor of Nursing Practice Scholarly Projects

The demand for neurology consultation far outweighs the number of specialists, thus causing long wait-times for consultation. Other contributing factors to obtaining timely consultation include, quality of information sent with the referral, insurance authorization, triage process, and appointment availability. This retrospective quality improvement study explored the effects of a referral triage process on reducing appointment wait time. All referrals were sent to one fax number and a new standard referral and triage process was implemented with specific operators with defined roles and responsibilities. The initial results following intervention implementation did not show improvement in wait times. Comparing the new triage …

Telehealth Monitoring For Non-Hospitalized Covid-19 Positive Patients In A Rural Setting, Rebekah Leann French

Doctor of Nursing Practice Scholarly Projects

Purpose

This quality improvement project evaluates the efficacy of an outpatient COVID-19 telehealth monitoring program intended to increase access to care, decrease emergency room/urgent care visits, and hospital admissions among telehealth observed adult patients in a rural area while providing safe home monitoring during acute illness.

Rationale/Background

Prior to COVID-19 pandemic, healthcare systems within the United States encountered several challenges including healthcare inequality and decreased healthcare access, particularly in rural communities. These gaps became more apparent when a novel COVID-19 pandemic emerged straining healthcare systems in the United States and throughout the world. Challenges ranged from overwhelmed emergency room (ER) …

Implementation Of A Comprehensive Diabetic Foot Care Program In Primary Care, Peguy Sylvain

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Diabetes Mellitus is a growing health problem in America. Uncontrolled diabetes can result in vascularcomplications. One of the most common complications of diabetes is diabetic peripheral neuropathy. Early foot carescreening can help prevent Diabetic peripheral neuropathy and other complications such as skin injuries, burns, falls,infection, lower- extremity amputations, and peripheral arterial disease. Interventions that have been shown to improve theidentification of diabetes foot complications include staff education, screening and assessment, use of monofilament,tuning fork for diabetic foot assessment, patient education/ self-care, standardization, and use of electronic medical records(EMR)/electronic reminders.

METHODS: The Plan Do Study Act method of quality improvement …

Introduction Of Hiv Point-Of-Care Testing In Adolescent Primary Care: A Quality Improvement Project, Jennifer Quinn Belfry

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: HIV, first identified in 1981, remains a persistent public health problem affecting 1.1 million Americans today. Detection is a critical first step to ending the HIV epidemic and the CDC recommends universal HIV screening for all patients 13-64 years of age regardless of risk factors. HIV screening rates are suboptimal especially in adolescent and young adult populations who face unique barriers to screening. The aim of this project was to improve HIV screening rates in adolescent and young adult patients at a large, urban FQHC.

LOCAL PROBLEM: In the state of Rhode Island, 1 in 10 persons living with …

Perceptions Of Nursing Staff On Restraint Alternatives, Adelia S. Perea

Doctor of Nursing Practice Scholarly Projects

Physical restraint is often used as a nursing intervention for patients with behavioral issues despite current evidence that indicates their use is actually more harmful than helpful. Nursing staff at UNMH are required by policy to use other methods such as restraint alternatives before placing patients in restraint. However, they do not have the necessary resources or tools to comply with the policy. The NPCU conducted a quality improvement project that introduced 5 restraint alternatives followed by a survey focused on nursing perceptions. The results revealed 2 alternatives (Gamewright GoPOP sensory toy & Playtivity sensory disc) were perceived by nursing …

Implementation Of A Standardized Universal Protocol Process At A Large Academic Medical Center, Lisa Ann Heard

Doctor of Nursing Practice Scholarly Projects

Background: Decreasing the risk of wrong site, wrong procedure and wrong patient surgery is an essential healthcare safety initiative. The Joint Commission’s Universal Protocol along with the World Health Organization (WHO) Safe Surgery Checklist were designed to aid in this patient safety effort and have been implemented in hospitals worldwide.

Local Problem: Perioperative and procedural areas at the project hospital areas have adopted the Universal Protocol and Safe Surgery Checklist. Despite agreement in their importance, there is a lack of uniform application of all components. This leads to variation in practice which may impact team compliance with the protocol and …

Implementing An Augmented Perioperative Obstructive Sleep Apnea Pathway For Improvement Of Perioperative Management In Patients Undergoing Elective Orthopedic Surgery, Michelle Dwyer

Doctor of Nursing Practice Scholarly Projects

Background: Obstructive sleep apnea (OSA) in the perioperative period is a frequently encountered complex clinical challenge that increases the risk for post-operative complications. Patients undergoing elective orthopedic surgery may be untreated for OSA or unaware of an increased risk for OSA at the time of scheduling an elective surgical procedure. Appropriate intervention for these patients is needed to decrease the risk of postoperative complications and increased morbidity and mortality.

Methods: The objective of this improvement project was to improve the care across the perioperative experience for patients with obstructive sleep apnea or at a high risk for obstructive sleep apnea …

Implementation Of A Peer Mentoring-Network Initiative In Outpatient Psychiatry To Improve Psychiatric Advanced Practice Nurses' Job Satisfaction, Maria Romanoff Rand

Doctor of Nursing Practice Scholarly Projects

Background: Post-pandemic rates of mental illness have increased, resulting in a rise in demand for psychiatric services. At the same time, a growing shortage of psychiatric providers is occurring. This combination has given rise to an expanding mental health crisis where strengthening and stabilizing the psychiatric workforce is paramount. Psychiatric Advanced Practice Nurses are uniquely qualified to staff this shortage. Therefore, positive job satisfaction for Psychiatric Advanced Practice Nurses is vital to increase and retain psychiatric healthcare providers available to address this critical need for mental health services.

Methods: At the project site, the shift to telehealth, changing leadership, and …

Introduction Of Probiotics To Improve Eczema Symptoms In Children In One Pediatric Primary Care Practice: A Quality Improvement Project, Christie Potter

Doctor of Nursing Practice Scholarly Projects

Background: There is emerging interest in alternative approaches to treating children with eczema because there is currently no allopathic cure. Non-pharmacological approaches are regarded as generally safe, well tolerated, and cost effective. Eczema is a chronic, relapsing inflammatory, itchy skin condition that adversely affects quality of life in many individuals, including children. Eczema interferes with sleep, leads to secondary skin infections, and causes intractable itching. Topical steroids are the current standard of practice in treating patients but, evidence suggests that they can cause unwanted side effects and can lead to serious systemic reactions. The purpose of this quality improvement project …

Communication Assessment Tools For Emergency Department Nurses Who Interact With Individuals With Intellectual And Developmental Disabilities, Holly Hunt

Doctor of Nursing Practice Scholarly Projects

Abstract/Executive Summary

Problem Statement: Communication is an essential part of every nurse-patient interaction. During the best of times the patient and nurse can clearly understand each other and engage in successful interaction with positive patient outcomes. Individuals with intellectual and developmental disabilities (IDD) often use nontraditional ways of communicating that can complicate the ideal nurse-patient interaction. When a patient presents with a different method of communicating, the nurse must possess tools available to facilitate a successful interaction. Identifying such a tool or if one cannot be found building a sample tool is vital for positive patient outcomes for individuals with …

The Effectiveness Of Targeted Education On Improving Nurses’ Self-Efficacy In Caring For Psychiatric Patients On Medical Surgical Units, Rachel Shirey

Doctor of Nursing Practice Scholarly Projects

Individuals with mental illness are occasionally hospitalized on medical units, specifically medical-surgical units. Nurses working on medical-surgical units may find patients with mental illness more challenging due to the complexity of care they sometimes require. Nurses’ perceived ability to provide quality care for these patients is reduced in comparison to their perceived ability to care for patients without mental illness. Consequently, low self-efficacy can result in the provision of a lower quality of care for this population. The purpose of this quality improvement project was to improve the care that patients with mental illness receive while hospitalized on medical-surgical units. …

Breastfeeding After Maternal Anesthesia: A Guideline Development, Megan Berens

Doctor of Nursing Practice Scholarly Projects

Postoperative breastfeeding recommendations for lactating mothers by anesthesia providers are inconsistent and often inaccurate. Inappropriate recommendations have led to withholding of breastmilk to the infant, unnecessary disposal of breastmilk, surgical delay, exposure of an infant to high levels of drugs in breastmilk, and early cessation of breastfeeding. The purpose of the scholarly project was to develop a set of evidenced-based practice guideline recommendations and a proposed implementation plan for anesthesia providers to use in support of breastfeeding mothers who recover from surgery. Many studies in the literature indicate that there are inconsistencies in postoperative breastfeeding recommendations by anesthesia providers. When …

Development And Implementation Of An Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Program For Student Registered Nurse Anesthetists, Nicholas Colangelo, Zachary Wise

Doctor of Nursing Practice Scholarly Projects

The American Association of Nurse Anesthetists (AANA) has defined the scope of nurse anesthesia practice to include services in acute, chronic, and interventional pain management, as well as the use of ultrasound (U/S) and other diagnostic technologies. However, there are no standard curriculum requirements in place that mandate graduate programs to educate student nurse anesthetists in U/S-related modalities. In addition to the AANA, the use of U/S in nurse anesthesia practice has recently been adopted by The Council on Accreditation of Nurse Anesthesia Educational Programs (COA), which characterizes U/S use by its clinical impact on the reduction in complications, increased …

Ohio Forensic Nurse Examiners: Readiness To Care For Victims Of Sexual Assault With Disability, Deanna Nicole Smith

Doctor of Nursing Practice Scholarly Projects

Forensic nurse examiners (FNEs) care for crime victims in acute care settings. These nurses are specifically trained in trauma-informed care and evidence collection in cases of sexual assault, domestic violence, abuse, and human trafficking (RAINN, 2022). The scholarly project focuses on the care of victims of sexual assault living with disability, as this population is three times more likely to be victimized than any other population (NSVRC, 2022). The project literature review reveals a lack of data on preparation standards for FNEs on caring for victims with disability and providing accommodations during forensic examination. Currently, it is unknown if FNEs …