Nursing Commons^™

Improving Self-Efficacy In Heart Failure Care, Tracy Bennett Mcleod

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Heart Failure contributes significantly to the morbidity and mortality of the adult population and is one of the leading causes of 30-day readmissions. The cost of heart failure is a substantial healthcare burden. Purpose: The purpose of this project was to determine if implementing the “Rise Above Heart Failure” educational program would improve heart failure knowledge, weight monitoring, and reduced re-admission rates in heart failure patients. Methods: A pre-test and post-test survey named The Dutch Heart Failure Knowledge Scale was utilized. Van der Wal, Jaarsma, Moser, and Van Veldhuisen (2005) developed this questionnaire to evaluate patients' knowledge. The …

The Use Of A Clinical Pathway To Increase Child Abuse Screenings Of Young Children With Fractures, Stephanie Li Schaller

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Nationally, infants and young children who present to emergency departments with fractures are not being screened adequately for possible physical abuse with a skeletal survey (Paine & Wood, 2018; Shelmerdine et al., 2014; Wood et al., 2019). Without universal screenings, implicit bias along racial and socioeconomic lines becomes a factor in deciding which children with fractures get screened, resulting in either under-or over-utilization of skeletal survey screenings (Kim et al., 2017; Paine & Wood, 2018). When child abuse is not diagnosed correctly, further abusive injuries or death can occur (Ravischandiran et al., 2010). Purpose: This evidence-based practice project …

Pediatric Patients In Diabetic Ketoacidosis: A Pathway To Improvement, Rebecca Russell Vincent

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Pediatric patients in diabetic ketoacidosis (DKA) frequently present to non-pediatric specific care centers initially for medical management where providers may or may not be familiar with standards and treatment guidelines particular to this specialty population. Purpose: The purpose of this project was to establish a pediatric DKA clinical pathway (CPW). Pediatric patients require precise treatments tailored to age and weight specifications. A pediatric DKA CPW identifies treatment order sets, goals, and outcomes customized to the patient’s metabolic demand. Commonalities within a predictable course of treatment for patients with a shared clinical diagnosis result in accelerated care, improved patient …

Patient Activation In Individualized Coaching For Congestive Heart Failure Patients, Jessica Marie Thomas

Doctor of Nursing Practice Scholarly Projects

Adult patients diagnosed with congestive heart failure suffer from high hospitalization rates, recurrent readmissions, decreased quality of life, increased healthcare expenditures, and increased mortality. This project aimed to determine if individualized coaching plans based on patients’ activation scores impacted emergency room visits and hospital readmissions. A pretest-posttest design was used. The 13-item Patient Activation Measure® (PAM®) tool was administered before and after completing 30-day individualized coaching. Seventy-five participants were recruited from referrals to the outpatient Continuum Case Management (CCM) program. Inclusion criteria included English-speaking adult patients diagnosed with congestive heart failure 18 years of age. The intervention consisted of individualized …

The Impact Of Nurse-Patient Engagement With Health Information Technology On Patient Portal Usage, Quyen Thuy Vo

Doctor of Nursing Practice Scholarly Projects

The patient portal, a Health Information Technology (HIT) tool, was created to promote patient engagement with available health information to improve health outcomes. Low patient portal use of available educational interventions with a HIT tool is an identified problem at a rural hospital in North Carolina. Low usage could be related to nurses’ unfamiliarity with HIT tools. This DNP project provided nursing staff with a flipped classroom learning module on utilizing available HIT tools within the hospital setting, increasing nurses’ engagement with the patient portal. A sample of Registered Nurses (RNs) from two units who were previously taught to utilize …

Bridging The Gap: Improving Hypertension In African American Women And Preventing Cardiovascular Disease, Latoshia Danielle Williams

Doctor of Nursing Practice Scholarly Projects

Problem Statement: There is a disproportionate number of African American women (AAW) diagnosed with hypertension (HTN) with modifiable health and behavior risk factors that contribute to cardiovascular disease (CVD). Purpose: The purpose of this DNP project was aimed at evaluating if a 12-week educational program using Life Simple 7 guidelines from the American Heart Association (AHA) within a primary care facility for adults diagnosed with hypertension and who are overweight would reduce blood pressure, body mass index, and increase knowledge regarding hypertension. Methods: A pretest and posttest intervention design was utilized to determine the outcomes of this study. The setting …

Implementation Of A Primary Care Toolkit To Improve Dementia Diagnosis And Management In A Rural Setting, Meredith George-Wieland

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: There are six million people with dementia living in the United States and this number is expected to rise exponentially due to the aging population. In the United States, it is estimated that only two thirds of dementia cases are recorded during primary care visits and an estimated, one third of cases have been either missed or disregarded.

LOCAL PROBLEM: In a remote primary care clinic on Kodiak Island, off the southeastern coast of Alaska, there is a lack of dementia and related cognitive diagnoses in the primary care setting due to patients’ and families lack access to the …

A Competence-Based Online Learning Video And In-Situ Simulation To Improve Perioperative Anesthesia Nurse Practitioner Self-Efficacy In Responding To Anesthesia Emergencies, Sara Durgerian

Doctor of Nursing Practice Scholarly Projects

Background: Nurse Practitioners (NPs) are broadly educated to the population-based role in which they practice. Further education in subspecialties is essential as more NPs are working autonomously in highly specialized care areas.

Problem: In the Department of Anesthesia at a large urban hospital, perioperative anesthesia NPs lack formal training in the subspecialty of anesthesia, which contributed to a lack of self-efficacy when responding to anesthesia emergencies.

Methods: An asynchronous multimodal brief instructional video accompanied by an in-situ simulation of an anesthesia emergency was developed to increase knowledge and confidence in perioperative anesthesia nurse practitioner response to anesthesia emergencies.

Results: A …

Mentorship In Retail Health - A Quality Improvement Project Initiative, Judith Thigpen

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Nurse practitioners (NPs) practicing in retail health face issues that complicate provision of care including isolation, lack of support staff, and non-clinical administrative and business duties. To address this, a national retail health company implemented a mentorship program for newly graduated, newly hired NPs. This quality improvement project will facilitate the implementation and evaluation of this mentorship program in one of the company’s regions in Georgia.

AVAILABLE KNOWLEDGE: Literature suggests that NPs believe that a mentor can help contribute to professional development, counter stress and anxiety, provide support, increase job satisfaction, and guide in critical decision making.

AIMS: 1. …

Revision And Deployment Of An Oral Anticancer Medication Adherence Toolkit, Kristine Lefebvre

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Oral anticancer medications offer state-of-the-art cancer treatment with the convenience and autonomy of self-care in the home. Professional organizations often provide expert guidance and resources to support the provision of high quality, safe, evidence-based care. LOCAL PROBLEM: Many institutions lack a formal oral anticancer medication program, including a process to assess and monitor adherence. Nurses and their colleagues look to the literature, training, collaboration with colleagues, and through practice tools and programs available through their specialty associations for support in their adherence work. The Oral Adherence Toolkit released in 2016 needed updating to reflect current best practices. METHODS: The …

Does Nurses Confidence Improve After Attending A Training For Teaching Home Infusion Patients?, Carol Menorah Young Dnp

Doctor of Nursing Practice Scholarly Projects

Discharge can be a difficult step for patients and their families and a challenging task for nurses. Poor instructions have a negative impact on the patient population. In addition, improper and incomplete discharge information negatively affects the posthospital recovery period and may cause the patient to return to the hospital for the same episode of care. Returning to the hospital emergency room or readmission for the same episode of care will increase the dangers to the patient’s health and recovery plan and increase the cost of individual healthcare. The patient population ranks the quality of discharge information via their responses …

Nurse Driven Antibiotic Stewardship, Dr. Judy Liesveld R. White

Doctor of Nursing Practice Scholarly Projects

Abstract

Antibiotic use has increased tremendously and has led to antimicrobial resistance. Because it is a growing problem across healthcare systems around the world, healthcare systems and organizations must combat the detrimental effects of inappropriate use of antibiotics. The development of antibiotic stewardship programs is crucial to providing high quality, safe patient care. The work ofthis project intends to form a basic understanding ofa nurses' role as a member of the antibiotic team. Most healthcare systems have operated by a pharmacy driven antibiotic team concept and have just recently included nurses as a missing component to a full functioning team. …

The Use Of Appreciative Inquiry In Identifying Pueblo Core Values, Kristyn N. Yepa

Doctor of Nursing Practice Scholarly Projects

This study used appreciative inquiry to identify core values or concepts essential to the Jemez Pueblo community to inform an evaluation framework used by community strength-based programs in Jemez Pueblo. Key informant interviews and a focus group were conducted in Jemez Pueblo with key program staff and tribal leaders. The audio recordings were transcribed and analyzed using inductive reasoning to identify core values. In addition, grounded theory was used to develop a conceptual model from the themes generated from the analysis. The PICOT question was, "Can the Appreciative Inquiry method help uncover core values of a Pueblo community?"

Increasing School Personnel Knowledge And Self-Efficacy Of Allergy Management, Sabrina Monzione

Doctor of Nursing Practice Scholarly Projects

Introduction: School-aged children with allergies is a growing population. Allergies are a leading cause of chronic illnesses, are costly to the healthcare system, and can result in death. Allergic reactions in schools negatively impact student outcomes. The sites for this improvement project were four urban, public schools in Suffolk County, Massachusetts that did not have standardized school personnel allergy education.

Methods: The project took place in four, urban public schools in Suffolk County, Massachusetts. The four schools are comprised of three middle schools and one high school serving over 1,400 students. Over 240 teachers and supporting staff members provide instruction …

Implementing Universal Depression Screening In A College Health Clinic, Marilyn J. Grabau

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: College students are at high risk for depression, and this carries a considerable burden. The American College Health Association supports depression screening on college campuses recognizing that early identification leads to better outcomes.

LOCAL PROBLEM: The project site is a public university located in New England. The college campus health center incorporates medical and counseling services. From August 2019 to December of 2019, 67% of students seen in the counseling center described depressed mood as the presenting concern. Currently there is no routine depression screening in place.

METHODS: This QI project implemented universal depression screening at the student health …

Nurses In New Mexico: Their Awareness Of Safe Harbor As Reflected In A Survey During A Time Of Covid-19, Ashley R. Gonzales

Doctor of Nursing Practice Scholarly Projects

The healthcare industry is highly regulated to ensure patients receive safe, high-quality, patient-centered care. Even with these regulations, patient outcomes remain poor, given the high expenditure and percentage of the gross domestic product that healthcare comprises in the United States. Nurses make up the largest proportion of the healthcare field and are often overlooked when it comes to policies to ensure their practice remains safe and licenses protected. Nurses are the eyes and ears of their board-certified providers and detect subtle changes in a patient’s condition. However, such attention to detail can be executed only when the nurses can care …

Using The Whole School, Whole Child, Whole Community Approach To Improve An Urban Early Learning Center Students’ Social, Emotional, And Physical Health And Wellness, Joelle Chateauneuf

Doctor of Nursing Practice Scholarly Projects

Background: Integrating school-based health education and models of healthy lifestyles in early childhood provides a foundation for lifelong health learning. Many chronic may be prevented or mitigated through early childhood health education. Early learning centers (ELCs) may be a perfect setting to enable young children to achieve their full potential.

Problem: In Boston, Massachusetts, there are differences in health experience across population groups. Children of color and lower socioeconomic challenges experience higher rates of chronic conditions.

Available Knowledge: Search of literature showed that school-based healthy lifestyle interventions improve healthy behaviors and can be taught to children as young as preschool. …

Improving The Coordination Of Care For Periprocedural Antithrombotic Medication Management In Patients Undergoing Elective Surgery, Joyce Larson

Doctor of Nursing Practice Scholarly Projects

Background: Arranging periprocedural antithrombotic medication (ATM) management is a frequently encountered complex clinical challenge. Often, there is limited time between the pre-admission clinic visit and the surgical date to coordinate ATM management and communicate the plan to the patient. This increases the risk of perioperative adverse events, case delays and cancellations, and is a patient safety concern. A quality improvement project was undertaken to address improving ATM periprocedural care coordination for patients taking ATM undergoing elective surgery. A review of the literature found clinical decision support system (CDSS) alerts to be an effective strategy. The aim of the project was …

Health Equity & Obesity Management: An Improvement Project In A Federally Qualified Healthcare Center In Central Harlem, Brianna Bouchez

Doctor of Nursing Practice Scholarly Projects

Description of the problem: Obesity is a growing healthcare problem worldwide with extraordinary costs to the individual's health and the healthcare system. Individuals most affected by obesity include socioeconomically disadvantaged individuals, often with limited resources to seek specialized care.

Available knowledge: Various weight-loss interventions exist but access and success rates vary. Weight loss is often modest and additional factors such as social determinants of health, health literacy, and patient motivation are all factors important to the success of an intervention.

Specific Aims: The purpose of this quality improvement project was to improve self-regulatory weight loss behaviors and increase weight loss …

Improving Access To Non-Pharmacologic Integrative Pain Management Modalities In Sickle Cell Disease (Scd) Inpatients, Nicole Lincoln

Doctor of Nursing Practice Scholarly Projects

Background: Evidence suggests that non-pharmacologic therapies complement and work synergistically alongside traditional pharmacologic therapies for chronic pain and have a beneficial impact on the intensity of pain, improved quality of life and functional status. Sickle Cell Patients have complex pain and often feel stigmatized due to pain seeking behaviors. This project evaluates the effect of a clinical initiative stewarded by nurses and managed in the electronic health record. The project aims to improve access to preferred modalities for integrative pain management among hospitalized Sickle Cell Disease (SCD) inpatients.

Methods: The nurses received e-learning and in-person training on the use of …

Implementation Of Delirium Bundle On A Hospital Medical/Surgical Unit To Help Decrease The Prevalence Of Delirium, Sanusi Mohammed

Doctor of Nursing Practice Scholarly Projects

Description of the Problem: Delirium is defined as a constellation of symptoms that includes disturbance in attention or awareness, change in cognition, language and perceptual disturbances that develops over a short period of time. Delirium mostly affects adult patients with risk factors including history of dementia, early cognitive impairment, dehydration, and infections. This quality improvement project was implemented on one hospital unit at a large tertiary hospital in the Boston area. This unit has one highest rate of delirium in the entire hospital system. Delirium is associated with high rate of morbidity and mortality. Also, this syndrome leads to longer …

Nurse Job Satisfaction In The Midst Of A Pandemic, Reynaldo Gonzales

Doctor of Nursing Practice Scholarly Projects

Strategies and intervention for nursing recruitment and retention are critical needs at the hospital unit management level especially during this time of coronavirus disease of 2019 (COVID-19) pandemic.

Research Question: What are the unit-levels of nurse job satisfaction among eight satisfaction dimensions (i.e., satisfaction with extrinsic rewards, scheduling, family/work balance, co-workers, interaction, professional opportunities, praise/recognition, and control/responsibility) in an acute medical-surgical unit?

Objectives The objective of this project is to systematically obtain unit-level input to explore nurses’ views and experiences as it relates to job satisfaction.

Methodology: This is a descriptive cross-sectional convenience study measuring job satisfaction among Registered Nurses …

Effects Of Evidence-Based Discharge Instructions On Follow-Up With A Healthcare Provider In Patients Presenting With Mtbi-Like Symptoms To A Health Clinic At A Rural Sports Camp In The Pacific Northwest In The U.S., Eva G. Bergner

Doctor of Nursing Practice Scholarly Projects

Mild traumatic brain injury (mTBI) is a major public health burden affecting both children and adults in the U. S. (Sarmiento et al., 2019; Schuchat, Houry, & Baldwin, 2018). The management of mTBI at summer camps is not well characterized in the literature. Epidemiologic studies on summer camps have reported that 25% of all injuries were to the head, face and/or neck (Kolberg et al., 2020; Robinson, Arbogast, Garst & Corwin 2019). The purpose of this project was to evaluate the impact of evidence-based instructions for follow-up with a healthcare provider in patients presenting with mTBI-like symptoms to a health …

Safety Measures In The Epilepsy Monitoring Unit: An Organizational Assessment, Tina Yates

Doctor of Nursing Practice Scholarly Projects

Long-term video-electroencephalography (EEG) monitoring in the epilepsy monitoring unit (EMU) is an elective procedure and generally safe. Clinical experts determined the EMU protocols at a level-4 comprehensive epilepsy center were not followed correctly. The project is a retrospective chart audit incorporating Ray’s Bureaucratic Caring theoretical framework with Donabedian’s conceptual model. The project objective is to evaluate if safety measures protocols are implemented appropriately in the EMU and determine whether a need exists for quality improvements.

The project reviewed patients admitted to the EMU from September 2021 through November 2021 who developed a generalized tonic clonic (GTCs) seizure with electrographic epileptiform …

Evidence-Based Practice Guideline Development: Selection Of Local Anesthetics And The Additive Dexamethasone In Brachial Plexus Blocks, Alexandra Mcguire

Doctor of Nursing Practice Scholarly Projects

Brachial plexus blocks (BPB) are a type of regional anesthesia that inhibits the sensory and motor function of the upper extremity. The efficacy of a BPB depends on the type and dose of local anesthetics (LA), as well as the use of any additive agent. The selection of LA depends on the type, concentration, and volume of LA. Certain additives, such as dexamethasone, when added to BPB, were shown to increase motor and sensory block duration.

A chart audit conducted by the pharmacy and anesthesia departments revealed a significant variability of clinical practice in the use of LA and additives …

Hepatitis C Screening, Confirmation, And Referral Improvement Project, Maria E. Mcmahon

Doctor of Nursing Practice Scholarly Projects

Hepatitis C is an illness caused by the blood-borne Hepatitis C virus (HCV), and usually becomes a chronic condition. Left untreated, HCV can lead to severe liver disease and liver failure. Newer treatments are effective and well tolerated, but most people with chronic HCV are not accessing treatment due to several factors that will be discussed. The primary objectives of this quality improvement project were to improve the treatment cascade, provide education to providers and patients, and facilitate screening, virus confirmation, and referral to treatment, in a Federally Qualified Health Center.

Evidenced-Based Practice Guideline Development: Selection Of Local Anesthetics And The Additive Dexamethasone In Brachial Plexus Blocks, Sabina Lamichhane Wagle

Doctor of Nursing Practice Scholarly Projects

Brachial plexus blocks (BPB) are a type of regional anesthesia that inhibits the sensory and motor function of the upper extremity. The efficacy of a BPB depends on the type and dose of local anesthetics (LA), as well as the use of any additive agent. The selection of LA depends on the type, concentration, and volume of LA. Certain additives, such as dexamethasone, when added to BPB, were shown to increase motor and sensory block duration.

A chart audit conducted by the pharmacy and anesthesia departments revealed a significant variability of clinical practice in the use of LA and additives …

Evaluating The Impact Of A Team-Based Model Of Primary Care On Provider Burnout And Patient Experience, Kimberly A. Moreland

Doctor of Nursing Practice Scholarly Projects

Background: To assure high quality, safe, affordable, and accessible health care, organizations are embarking on quality improvement initiatives to work toward the triple aim of patient satisfaction, improving the health of populations, and reducing the cost of care.

Description of the Problem: Primary care is the backbone of the health care system, but it is a challenging environment with high rates of clinician burnout. Clinician burnout undermines the ability of organizations to meet the triple aim. Innovative new care delivery models are needed that can meet the triple aim while also mitigating burnout.

Available Knowledge: A PRISMA review of the …

Implementation Of A Polypharmacy Deprescribing Protocol Among Older Adults In A Community-Based Care Organization, Johanne Cazeau

Doctor of Nursing Practice Scholarly Projects

Background: Polypharmacy, defined as the use of five or more medications, has the potential to increase morbidity, mortality and decrease quality of life. Older adults are disproportionately affected by polypharmacy. Decreasing polypharmacy could prevent morbidity and mortality while saving millions of dollars annually. The use of the ARMOR tool has been shown to decrease polypharmacy and the prescribing of inappropriate medications among the elderly.

Local problem: There is a high prevalence of polypharmacy among older adult patients at the managed care organization where this quality improvement project was implemented. Among a panel of 30 members, almost all (n=29) were taking …

The Effects Of A Formal Organizational Program On Nursing Supervisor Self-Perception Of Leadership, Jonathan Allen Judy-Del Rosario

Doctor of Nursing Practice Scholarly Projects

Nursing house supervisors oversee hospital operations during evenings, nights, weekends, and holidays, yet many feel disconnected from others in the nursing leadership team. These individuals work as the sole leader on duty, having limited interaction with the daytime leaders and often lack formal leadership development. This quantitative, quasi-experimental study explored the effects of implementing a formal educational and team building program on the perception of the supervisor’s leadership skills as well as collaboration with the leadership team. The Leadership Practices Inventory and the Collaborative Behavior Scale – Shortened were the two surveys administered to assess the effects of this program. …