Nursing Commons^™

Trauma Center Development Improved New Mexico Trauma System By Decreasing Inappropriate Air Medical Transport And Increasing System Revenue, Nikki L. May

Doctor of Nursing Practice Scholarly Projects

Before 2016 in southern New Mexico, the closest trauma center for patients was El Paso, Texas. Las Cruces, New Mexico, in Doña Ana County began developing its first trauma center in 2016 and became designated in 2017. The development of this trauma center changed trauma triage destination protocols for trauma patients. The improved collaboration and teamwork with prehospital personnel, surrounding hospitals, and existing trauma centers led to the development of trauma triage and transport guidelines. These protocols categorized trauma patients and constituted a guide for emergency personnel. Developing a trauma center in Doña Ana County improved the New Mexico Trauma …

Limiting Potentially Inappropriate Medications In Long-Term Care, Clare M. Ironside

Doctor of Nursing Practice Scholarly Projects

Aim: This project aimed to assess the effectiveness of the STOPP/START tool in identifying and reducing potentially inappropriate medications among multi-morbid, older, long-term care residents in a metropolitan area of a Southwestern state.

Design: In this quality improvement project, seven prescribers working within four long-term care facilities were trained to assess for potentially inappropriate medications using the STOPP/START tool. The medication lists for long-term care residents (n =45) over age 65 were collected at baseline and again at three months post-intervention and assessed for overall medication use, psychotropics, and proton pump inhibitors. The project also assessed prescribers’ comfort and …

Comparing An Evidence-Based Screening Tool To Standard Substance Abuse Screening Questions In Identifying Pregnant Women At Risk For Substance Abuse, Nicole Y. Romero

Doctor of Nursing Practice Scholarly Projects

The purpose of the study project was to compare a nonspecific substance screening questionnaire with a well validated, evidence-based substance screening tool designed specifically for the pregnant population Evidence has shown use of an evidence-based screening tool improves maternal and fetal outcomes and reduces the risk of missed cases, stereotyping, and stigma. This study project utilized the social learning theory model, which defines human behavior as a reciprocal, continuous interaction among cognitive, behavioral, and environmental determinants. A pilot observational study project was conducted within a focal organization in a specified women’s health clinic over a 12-week period comparing their currently …

Analysis Of Clinical Outcomes And Cost-Effectiveness Of Neuromuscular Blocking Drug Reversal In Patients With Obstructive Sleep Apnea, Samantha Kinglsey, Aaron "Mitch" Corn

Doctor of Nursing Practice Scholarly Projects

Non-depolarizing neuromuscular blockers are used during many surgical procedures to induce muscle relaxation for tracheal intubation and improve surgical conditions for surgeons. The use of these medications requires an agent to be given to fully reverse the effects of the neuromuscular blocking drug. Historically, neostigmine has widely been used as the primary reversal agent. However, sugammadex, a recently FDA approved drug, is also available for the reversal of common neuromuscular blocking drugs, rocuronium and vecuronium. In the literature, sugammadex is widely regarded as a clinically superior reversal agent. But its use is commonly limited to emergent situations due to the …

The Impact Of Early Goal Directed Sepsis Bundle Sets In The Emergency Department And The Impact Of Sep-1 Compliance Rates, Christie L. Ferrari

Doctor of Nursing Practice Scholarly Projects

Sepsis is a medical emergency that is prevalent throughout hospitals everywhere. Due to the growing crisis, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Surviving Sepsis Campaign (SSC) adopted core measures for sepsis (SEP-1) which aim at improving overall compliance of evidence-based treatment standards for sepsis. The purpose of this Doctor of Nursing Practice (DNP) project was to determine if incorporating early goal directed sepsis bundles in a rural Midwestern ED was effective in increasing compliance with SEP-1 rates. The secondary purpose evaluated how nursing knowledge, awareness, and compliance with sepsis bundles affects SEP-1 compliance rates. …

Implementation Of An Evidence-Based Bundle To Reduce Hospital Acquired Pressure Injury Harm Rates In The Intensive Care Unit: A Quality Improvement Project, Jessica Tripp

Doctor of Nursing Practice Scholarly Projects

A pressure injury (PI) is a condition in which prolonged pressure or shear causes localized damage to the soft tissue and skin and is usually over a bony prominence (National Pressure Ulcer Advisory Panel (NPUAP), 2016). PIs can increase morbidity and mortality, increase length of stay, increase infection rates, increase healthcare costs and decrease quality of life (Agency for Healthcare Research and Quality (AHRQ), n.d.; Coyer et al., 2017). PIs are largely preventable yet continue to occur, despite the growing number of high-quality research articles that focus on this problem. Quality improvement initiatives are an effective way to translate evidence-based …

Evaluation Of A Hands-On Cooking Class And Its Effects On Self-Efficacy In Relation To Healthy Eating In Type 2 Diabetics, Codi A. Jenshak-Gorzinski

Doctor of Nursing Practice Scholarly Projects

The prevalence of Type 2 diabetes is alarming and poses a great threat to U.S. national health. Chronic diabetes can lead to serious conditions such as heart attack and stroke, and can result in premature mortality (World Health Organization, 2018). Diabetes can be prevented or treated by eating a healthy diet. Cooking classes are a potential way to improve American’s knowledge of nutritional principles and help them become confident that they have the capacity to eat a healthy diet. The purpose of this DNP project was to determine if participation in cooking classes enhanced self-efficacy as it pertains to healthy …

Utilization Of The Calm Apparatus To Adult Men And Women With Atrial Fibrillation To Decrease Emergency Department Visits For Atrial Fibrillation, Ami Klein

Doctor of Nursing Practice Scholarly Projects

The purpose of this project is two-fold. The first is to determine if the CALM APP use by adult men and women with atrial fibrillation (AF) will decrease anxiety. The second is to determine if decreased anxiety utilizing the CALM APP will deter admissions to the emergency department (ED) for AF in the first month post-catheter ablation of AF. The Zung SAS was used to determine the pre- and post-anxiety scores. The Seven Days of Calm (free app) was used to teach deep breathing and meditation. This study showed a moderate decrease in ED visits with use of the Calm …

Chemotherapy Instruction Improvement Project, Lori A. Lelii

Doctor of Nursing Practice Scholarly Projects

Purpose

The project aimed to evaluate nursing satisfaction after implementing a standardized chemotherapy patient education program. The project tracked patient satisfaction scores on the Press Ganey® survey to identify changes.

Rationale/Background

Patients receiving chemotherapy for the first time have significant educational needs. Nurses are concerned about their patients because of the complexity of chemotherapy treatment and potential for complications related to inadequately managed side effects. There is limited information available to guide nurses on best approaches to prepare clients for chemotherapy.

Theoretical framework

This project was conducted using a Plan, Do, Study, Act approach under the modern change theory.

Methodology …

Spiritual Care: The Overlooked Need In End-Of-Life Care, Michael Howard Vrmeer

Doctor of Nursing Practice Scholarly Projects

Background: A number of studies have validated the use of the FICA tool to evaluate a patient’s spirituality. FICA has been helpful in many palliative care settings to screen for spiritual problems that influence the patient's overall health. Aim: The project was a quality improvement initiative with the purpose of implementing the FICA tool as part of the admission assessment to increase chaplain referrals for inpatient palliative care services. Methods: The staff received an in-service on using the FICA questions on admission, and a prompt to complete the screen was placed at each work station in the project setting. Results: …

The Impact Of Nurse Leader Learning Labs On Nurse Managers' Perception Of Leadership Competency In The Acute Care Setting, Carolyn Rivers Swinton

Doctor of Nursing Practice Scholarly Projects

Problem Statement: It is critically important that our nurse managers (NMs) have the leadership skills to support the care team in providing safe care to patients. Historically, nurse managers have received minimal training in the leadership role. Failure to address NMs’ coaching needs can compromise the organization's ability to achieve operational goals. Purpose: The project's primary aim was to improve NMs’ perceptions of leadership competency in the acute care setting through experiential nurse leader learning labs. The secondary aim was to demonstrate that the confident and prepared nurse manager can achieve organizational goals in the acute care setting. Method: There …

The Effects Of Debriefing On Nurse Distress After Perinatal Loss, Russin Marie Kelly

Doctor of Nursing Practice Scholarly Projects

Labor and delivery nurses are the first-line caregivers for women suffering a perinatal loss which involves miscarriage, stillbirth, and infant death. This loss of life can cause nurses’ distress. This project proposes using the PEARLS healthcare debriefing tool as an intervention to decrease distress and improve nurse satisfaction. Before and after the debriefing intervention, a survey allowed the nurse to rate their distress from zero to ten using the distress thermometer and answer questions about job satisfaction. The data analyzed shows that the debriefing intervention decreased nurse distress after perinatal loss compared to the prior practice of no debriefing after …

Expanding The Discharge Bundle To Reduce Preventable Readmission Among Adult Patients With Heart Failure, Leah Caccam Ramos

Doctor of Nursing Practice Scholarly Projects

Individuals with a heart failure (HF) diagnosis have a high risk of readmission following hospital discharge, increasing care costs. In an academic medical center (AMC) in Charleston, SC, the all-patient-related DRG of HF had 576 30-day readmissions for FY 2020, equivalent to a 26.3% readmission rate. This project aimed to decrease the readmission rate of adult patients diagnosed with HF admitted to cardiac units in the AMC by expanding the discharge bundle. The current discharge process is not bundled. The discharge bundle elements include HF education, pharmacy medication reconciliation, medication counseling, and appointment to the HF clinic prior to discharge. …

Improving Hand Hygiene In A Rural Critical Access Hospital, Katherine H. Miller

Doctor of Nursing Practice Scholarly Projects

Hand hygiene adherence is the single most important infection control practice among healthcare workers in United States hospitals. Hand hygiene is cost effective and adherence to protocols can reduce hospital acquired infections and employee illness. While hand hygiene adherence has been shown through research to improve patient safety and reduce hospital acquired infections, adherence to hand hygiene protocols among healthcare workers is poor and improvement efforts lack sustainability. A potential barrier to performing hand hygiene includes failure of healthcare workers to realize they are carrying microbes on their hands and what proper hand hygiene is, whether using soap and water …

Post-Discharge Phone Calls In The Emergency Department: Do Follow-Up Calls Increase Patient Satisfaction And Reduce Post-Discharge Complications?, Saraann K. Fagan

Doctor of Nursing Practice Scholarly Projects

Improvements in discharge instructions are necessary in emergency departments (EDs) across the United States (US). Multiple factors, such as the fast-paced environment and varying levels of acuity in the ED, contribute to inadequate discharge instructions and change is necessary to further prevent negative outcomes. The purpose of the evidence-based practice project was to implement post-discharge follow-up phone calls to ED patients to improve patient satisfaction scores regarding discharge instructions for at-home care and to reduce post-discharge complications. The project was implemented over a three-month period in early 2021 in the ED of a local hospital in Charleston, South Carolina (SC). …

Biopsychosocial Multidisciplinary Treatment Impact On Risk Of Opioid Misuse, Michael A. Palacio

Doctor of Nursing Practice Scholarly Projects

From 1999 to 2014, over 165,000 persons in the United States died from an overdose related to prescription opioids (Centers for Disease Control and Prevention [CDC], 2016). In response, the CDC released guidelines that propose nonpharmacologic and nonopioid pharmacologic therapy as preferred methods for chronic pain control (Dowell et al., 2016). The purpose of this project was to examine the biopsychosocial multidisciplinary treatment impact on risk of opioid medication misuse among adult chronic opioid-dependent noncancer pain clinic patients with and without a psychiatric disorder. Engel’s (1977) biopsychosocial model was used to evaluate whether multidisciplinary treatment impacted the risk of opioid …

Attitudes Towards Treating Injured Patients In Urgent Care, Erin Beverly

Doctor of Nursing Practice Scholarly Projects

There has been published literature on the topic of clinician bias and the effects of bias on patient care, however, a review of the literature did not yield any research on the topic of clinician bias towards treating patients injured in motor vehicle accidents (MVA’s). There has been concern about clinicians not preferring to see patients injured in MVA’s however this is only anecdotal. If this topic is to be addressed through quality improvement efforts, there should first be scholarly evidence to support these efforts. This study employed a prospective survey of a convenience sample of clinicians who practice in …

Eastern European Orthodox Christian Immigrant Women: A Pilot Study And Needs Assessment, Kimberly A. Babich-Speck

Doctor of Nursing Practice Scholarly Projects

The healthcare perceptions of the Eastern European Orthodox Christian immigrant women (EEOCIW) to the United States (U.S.) are under-represented in the literature. Although they appear similar to Americans, their cultural and religious traditions are outside the mainstream American culture. This pilot study and health needs assessment examines the women’s healthcare perceptions of 14 EEOCIW and identifies similarities and differences with 25 U.S. born Orthodox Christian women (USOCW). Between September and November 2020, interviews were conducted with Orthodox Christian immigrant women from Eastern Europe and Orthodox Christian women born in the U.S. Questions covered the perceptions of women’s healthcare, factors influencing …

An Examination Of The Impact Of Health Literacy Assessment On Incarcerated Individuals With A Diagnosis Of Type 2 Diabetes, Josi Rotunno

Doctor of Nursing Practice Scholarly Projects

Low health literacy levels limit healthcare outcomes in a variety of diagnoses. Having a low health literacy level can significantly impact an individual’s ability to manage their condition. Among these individuals are incarcerated individuals, who are especially vulnerable to low health literacy levels. Due to regulations of the correctional facility, along with the vulnerability of the population, it is often difficult to get approval for studies and to make changes within this setting[TMD1] . The stigma of incarceration, along with the difficulty in navigating the correctional setting regulations, often create barriers to making changes that could improve the health …

Nitroglycerin Safety In Inferior St Elevation Myocardial Infarction (Stemi) Patients: A Retrospective Review, Olivia Montgomery

Doctor of Nursing Practice Scholarly Projects

Nitroglycerin (NTG) is medication used to reduce chest pain (Boden et al., 2015) and is the suggested analgesic for angina associated with ST elevation myocardial infarction (STEMI) (de Alencar Neto, 2018). Due to the potential for right ventricular (RV) infarct and hemodynamic collapse in inferior STEMI patients (Nagam, Vinson, & Levis, 2017), the American Heart Association (AHA) recommends avoidance of NTG in patients with suspected RV infarct (Antman et al., 2004). The purpose of this DNP project was to explore the safety of NTG use in the treatment of patients diagnosed with STEMI by evaluating the effects of NTG on …

Evaluating Va Nurse Acceptance Of Virtual Healthcare Technology During The Coronavirus Outbreak, Francesca Bryan-Couch

Doctor of Nursing Practice Scholarly Projects

At a regional Veterans Administration (VA) hospital, nurses performing case management were unable to perform face-to-face visits with patients due to coronavirus. Care coordination and discharge planning efforts occurred through telephonic case management to preserve personal protective equipment and reduce transmission rates through social distancing. Trust and rapport between patients and nurses were reduced without personal contact. Peplau’s theory of interpersonal relations described six nurse roles and three phases of relationship development required to create therapeutic nurse-patient relationships. Connectedness was a key concept considered to be the path to a successful meaningful therapeutic nurse-patient relationship (Hrabe, 2005).

To evaluate current …

Professional Quality Of Life Indicators And Turnover Intention In Forensic Nurses, Leigh Anne Meyer

Doctor of Nursing Practice Scholarly Projects

Background/Significance: Significant barriers to forensic nurse workforce development exist, affecting patient access to care. Retention of forensic nurses is a persistent problem. Turn-over of forensic nurses can be attributed to many factors related to professional quality of life, including compassion satisfaction (CS), burnout (BO) and secondary traumatic stress (STS).

Methods: A convenience sample of forensic nurse program coordinators was used to identify the effect of an educational session on professional quality of life and strategies for reducing stressors within the role on ProQOL-5 and TIS-6 scores using a pre- post-test quasi-experimental survey design. Correlation between professional quality of life indicators …

Implementation Of A Perioperative Pathway For Individuals With Or At High Risk For Obstructive Sleep Apnea, Kimberly Claude

Doctor of Nursing Practice Scholarly Projects

Background At the Veterans Affairs Boston, pre-operative screening for obstructive sleep apnea using the STOP-Bang questionnaire and referral to pulmonary service for those who fail screening is not reliably completed. For patients identified as having OSA or at high risk for OSA, advice on how to reduce postoperative risk may not be adequately communicated through the perioperative process. The project aim is to construct and implement a perioperative pathway to ensure surgical patients with OSA or suspected OSA receive evidence-based care throughout the perioperative period.

Methods The intervention for this quality improvement project was an evidence-based perioperative pathway which includes …

Implementing Telemental Health To Improve Access To Mental Healthcare In Rural Vermont, Julia Mcdougal Ronconi

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Mental health access in rural areas is a national problem. Of strategies to increase access, telemental health has the highest level of evidence.

PURPOSE: This project aimed to implement a telemental health program in rural Vermont to: (a) increase the number of rural-dwelling patients who enter treatment for anxiety and depression, (b) evaluate the effectiveness of telemental health for depression, anxiety, and overall functioning, and (c) evaluate patient satisfaction with the accessibility, quality, and affordability of the service.

METHODS: Adult psychiatric diagnostic evaluation, medication management and psychotherapeutic interventions were delivered via telemental health. The service was marketed to Health …

Identification Of Variables For Hemoglobin A1c Prediction, Erica A. Richards

Doctor of Nursing Practice Scholarly Projects

An evolution in healthcare is taking place throughout our country. Healthcare providers are required to achieve an ever-growing number of regulatory and metric-driven standards. This transformation aims to improve both the quality and cost of healthcare in the United States. Diabetes mellitus (DM) is one of the most costly chronic diseases in the United States. Since DM has high mortality, high morbidity, and low quality of life rates, it is no wonder that DM is one of the focuses of the National Committee for Quality Assurance performance improvement tools known as the Healthcare Effectiveness Data and Information Set (HEDIS). In …

Nurse Educators Influence On Student Success, Callie Whittington

Doctor of Nursing Practice Scholarly Projects

Passing nursing licensure exams is important to promising nurses. The number of times a graduating nursing student must take The National Council Licensure Examination-Registered Nurse (NCLEX-RN), reflects upon the institution of higher education as a gauge of the quality of their training programs and preparation. Student outcomes are very important to overall standing of the nursing programs, as the first attempt NCLEX-RN pass rates affect status of the nursing program. The nurse educator’s role in student success is vital and the level of education for the nurse educator can play a valuable part in this as well.

The researcher of …

Perceived Critical Success Factors For Native American And Non-Native American Pre-Licensure Nursing Students In Northern New Mexico, Karen E. Nielsen

Doctor of Nursing Practice Scholarly Projects

Considering the consistent healthcare system load demands, nursing shortages persist, especially in remote areas of the United States. It is vital that students interested in attending nursing school and working in their home communities have expanded nursing program access and supports in order to supply the necessary nursing workforce in remote areas. Lack of diversity in the nursing profession weakens healthcare delivery. Native Americans are underrepresented as nursing students and employed nurses. Measures to provide a more diverse workforce should concentrate on recruitment, retention, and graduation rates of underrepresented minority nursing students. Limited research is available surrounding Native American nursing …

Feasibility And Acceptability Of A Process Change For Patients With Medicaid To Receive Larc In A Private Obgyn Office, Laura Mills

Doctor of Nursing Practice Scholarly Projects

Background and Review of Literature: Long-acting reversible contraception (LARC) is an effective form of contraception that has been shown to have high rates of satisfaction and few contraindications for patients. However, patients with Medicaid coverage may face barriers and challenges in obtaining LARC. Often, providers in small obstetrics and gynecology (OBGYN) private practices are unable or unwilling to provide LARC placement due to financial burdens as a result of limited Medicaid reimbursement. Regardless of insurance carrier or size of practice, patients should have access to the contraception method of their choice.
Purpose: This project aims to determine the feasibility and …

Mentorship Experience Among Nurse Practitioners, Chelsea L. Noble

Doctor of Nursing Practice Scholarly Projects

Background and Review of Literature: The current literature provides the context of mentorship and its benefits across various disciplines. Nursing and medicine use mentorship frequently to guide each new generation of healthcare providers. There is a current lack of research focusing on nurse practitioners as it relates specifically to mentorship.
Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate mentorship in nurse practitioners and across subspecialties.
Methods: A descriptive correlational study was conducted. Data were collected using the Mentor Evaluation Tool (MET) and the National University Hospital Mentorship Evaluation (NUH ME) tool that were administered …

Evaluating The Impact Of A Mindfulness Intervention On Mindful Attention And Awareness, Resilience To Stress, And Perceived Stress In Newly Licensed Nurses In A Nurse Residency Program, Vicki L. Washington

Doctor of Nursing Practice Scholarly Projects

Background: A career in the healthcare profession of nursing provokes significant stress in newly licensed nurses. Previous studies suggested that mindful practice enhanced well-being by bringing awareness to thinking and living in the present moment (being mindful), decreased stress, and enhanced resilience to stress. Purpose: The purpose of this study was to evaluate the impact of a mindfulness intervention on mindful attention and awareness, resilience to stress, perceived stress, and health status in newly licensed nurses in a nurse residency program (NRP).
Methods and Procedure: This mixed-methods quasi-experimental study used a pretest-posttest design with an intervention and comparison group. Surveys …