Nursing Commons^™

Optimizing The Psychiatric Referral Pathway Between Community Health Center Primary Care Partner And An Academic Medical Center Psychiatric Practice: Baseline Assessment Of The Current State And Needs, Katherine Verdier

Doctor of Nursing Practice Scholarly Projects

Background

The shortage of mental health professionals and the stigma associated with seeking mental health care has contributed to the need for primary care to provide mental health services. While primary care providers are well-placed to offer mental health treatment, they may not feel comfortable prescribing psychotropic medication in their practice. In the absence of full collaborative care models, consulting with psychiatric specialists can help primary care providers to manage mental health conditions in primary care.

Local Problem

At a community health center (CHC) in Worcester County, Massachusetts, primary care providers (PCP) provide mental health treatment for patients and have …

Implementation Of A Health Care Transition Pathway For Children And Adults With Inborn Errors Of Metabolism: A Pilot Project, Brittany M. Murray

Doctor of Nursing Practice Scholarly Projects

Background: Children with medically complex diseases require highly specialized care by a highly specialized team. Those with rare disease, including inborn errors of metabolism (IEMs), are a medically complex population and face significant challenges undergoing the health care transition from a child/family-centered model to an adult/patient-centered model of care. The project site follows patients with IEMs in the Metabolism Program, but previously did not have a coordinated process and had insufficient resources for patients/families for the health care transition.

Methods: The Plan-Do-Study-Act (PDSA) method was utilized as the model for improvement. Due to the complexity of the population and time …

The Implementation Of A Blended Learning Course To Enhance Leadership And Management Capabilities In Liberian Student Nurse Anesthetists, Donnell Carter

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Leadership plays a crucial role in the functioning of a health system, particularly in resource-constrained settings like Liberia. Effective leadership is essential for identifying solutions and leading teams towards achieving important objectives. Improving leadership competencies among emerging Liberian nurse anesthetists is key to enhancing anesthesiaoutcomes in Liberia. The delivery of high-quality, safe anesthesia in Liberia is contingent on this.

METHODS: This quality improvement project (QI) implemented a transnational blended learning leadership andmanagement course to increase the knowledge, skills, and confidence of Liberian student nurse anesthetists. We used quantitative methods to organize and describe selected outcomes. We also used qualitative …

Implementation Of A Nurse Practitioner-Led Video Telehealth Program To Improve Triage For Pediatric Patients In An Ambulatory Intestinal Rehabilitation Center, Elizabeth Castle

Doctor of Nursing Practice Scholarly Projects

Background: Children with short bowel syndrome are medically complex, requiring specialized management and coordinated care to address acute triage issues between scheduled visits. Their risk for rapid decompensation and distance from specialty centers often necessitates telephone-based triage—a typically non-reimbursable method. At a leading Northeastern U.S. children’s hospital, the Intestinal Rehabilitation (IR) center manages high-risk telephone triage of these patients’ concerns using experienced nurse practitioners. The inability to directly visualize patients during telephone encounters, however, limits clinical assessment and decision-making, presenting challenges to efficient and safe care delivery. A systematic literature review indicated that telehealth can enhance parental confidence, improve clinician …

Enhancing Nurse Competency: Proper Application Of Chlorhexidine Gluconate Dressings To Prevent Central Line Associated Bloodstream Infections, Joseph Earich

Doctor of Nursing Practice Scholarly Projects

Central line-associated bloodstream infections (CLABSIs) pose a significant risk to patient safety and healthcare outcomes. The proposed Doctor of Nursing Practice (DNP) project addresses the knowledge gap among nurses regarding the correct procedures for changing chlorhexidine gluconate (CHG) dressings on central lines. The goal is to enhance nurse education and adherence to best practices, thereby reducing the incidence of CLABSIs. The project employs a quasi-experimental design with a pre-test and post-test methodology. Nurses will complete a pre-test to assess their baseline knowledge of CHG dressing changes. The nurse will participate in a hands-on educational session to improve their understanding and …

A Multicomponent Quality Improvement Initiative For The Early Identification, Prevention, And Management Of Delirium In The Medical-Surgical Setting, Sarah K. West

Doctor of Nursing Practice Scholarly Projects

Hospital-acquired delirium affects older adult patients, across the healthcare continuum. The incidence in frail older adults is high, costly, and often deemed preventable. Hospital-acquired delirium is associated with a multitude of short- and long-term complications, resulting in an increased rate of morbidity and mortality. The challenges of early recognition and management are prevalent in healthcare literature. While published guidelines exist, hospital systems continue to struggle with the standardization of geriatric delirium care. Given medical-surgical nursing is the cornerstone of hospital care, it is imperative to establish a standardized delirium prevention and management guideline, at this level of care, to optimize …

Enhancing Advanced Practice Nursing: Implementing A Simulation-Based Point-Of-Care Ultrasound Training Program, Brandy Younge, John Chovan, Bonnie Fagan, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

Nurse practitioners (NPs) are advanced practice nurses entrusted with diagnosing and treating illnesses, managing acute and chronic diseases, and engaging in continuous education to remain knowledgeable of evidence-based advancements. NPs offer a comprehensive range of healthcare services, catering to patients from wellness check-ups to those requiring complex care, such as individuals hospitalized with sepsis. One technological advancement that can support NPs in delivering optimal patient care is point-of-care ultrasound (POCUS). In the United States, over 385,000 NPs practice in patient care settings that may use POCUS. Numerous medical societies have issued position statements supporting the use of POCUS in the …

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Diabetes Self-Management Education For Older Adults In Primary Care, Makilah Rae Furlan

Doctor of Nursing Practice Scholarly Projects

Type 2 Diabetes (T2DM) is a chronic disease that impacts 27.2 million seniors 65 and older. Evidence-based care for T2DM includes a combination of medication and disease-management behaviors. Access to education to teach patients healthy behaviors to manage their disease is limited and even less accessible to geriatric patients with aging learning needs. The scholarly project addresses this gap in patient education by implementing evidence-based diabetes self-management education for geriatric patients to increase patient knowledge and confidence in implementing self-management behaviors. The scholarly project aims to assess health behaviors in patients aged 65 and older with established type 2 diabetes …

Evidence-Based Practice Guidelines For Perioperative Use Of Dexmedetomidine In Pediatric Congenital Cardiac Surgery, Kayla Thomsen

Doctor of Nursing Practice Scholarly Projects

Tachyarrhythmias are common postoperatively in the congenital cardiac surgery population. About 1% of the population is born with congenital heart disease (CHD), with 50% of patients undergoing surgery for CHD experiencing arrhythmias. Complications can arise from postoperative arrhythmias, including hemodynamic instability and myocardial depression, having catastrophic health repercussions. Despite the high prevalence and complications, there is no standard practice for postoperative tachyarrhythmia prevention in the chosen population, and prevention is at the provider's discretion. However, literature exploring the effects of dexmedetomidine notes promising results for using the drug for postoperative tachyarrhythmia prevention. The project aims to address the lack of …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler

Doctor of Nursing Practice Scholarly Projects

A pancreaticoduodenectomy, or Whipple procedure, is the only curative option for pancreatic cancer. For those eligible for tumor resection, the Whipple procedure is a difficult surgery for both the patient and provider. Complications following pancreaticoduodenectomy are numerous and include infection, delayed gastric emptying, high hospital costs, and pancreatic fistulas. Enhanced Recovery After Surgery (ERAS) protocols exist to provide evidence supporting standardization of practices that lead to the improvement of these patient outcomes. An ERAS protocol for the pancreaticoduodenectomy, first established in 2012, is inconsistently implemented in healthcare facilities. Researchers collected data involving the use of the Whipple procedure ERAS guidelines …

A Proposal: Gap Analysis On Novice Advanced Practice Provider Role Transition Within The Inpatient Setting, Erin Cornelius

Doctor of Nursing Practice Scholarly Projects

Background: Healthcare specialties are an integral part of patient care yet are briefly discussed throughout the academic journey of the advanced practice provider (APP). Hiring departments or facilities must provide further education on complex specialties. Due to a decline in practicing physicians, APPs will provide more patient care within specialties by 2032.

Purpose: To emphasize the importance of a high-quality onboarding program for the success of the APP, the department, and the hiring facility.

Method: Proposed data collection involves a two-part survey using the Novice Nurse Practitioner Role Transition (NNPRT) scale and an onboarding experiences survey.

Results: A literature thematic …

Development Of An Evidence Based Orientation Model For The Newly Graduated Nurse, Sandra L. Takach

Doctor of Nursing Practice Scholarly Projects

Healthcare in the acute hospital setting experienced a significant increase in highly acute patients with multiple comorbidities requiring competent, experienced clinicians who can provide high quality, safe care. The nursing shortage paired with the post pandemic hospital environment has altered the landscape of nurses entering the workforce and created a gap in competency of the bedside nurse. A loss of tenured nurses who typically onboard and mentor the novice nurse coupled with less than adequate clinical preparation of those graduating college led to elevated levels of stress and staggering turnover rates for the newly graduated nurse. Research validates efficient orientation …

Development Of Clinical Practice Guidelines For Incorporating Paravertebral Blockade For Thoracic Surgery Adult Patients, India Hutchison

Doctor of Nursing Practice Scholarly Projects

Thoracic surgery is considered one of the most painful surgical procedures due to its severity and the duration of the procedure. Pain is detrimental to the patient experience, and poor patient satisfaction results in revenue loss for hospitals. Maintaining adequate pain control after surgery is crucial in preventing pulmonary complications such as atelectasis and respiratory failure that prolong patient recovery. It is the responsibility of the anesthesia provider to ensure adequate pain control throughout the perioperative experience. Although current evidence-based data shows that regional anesthesia provides superior thoracic postoperative pain control, the current practice continues to be the utilization of …

Enhancing Postoperative Care For Vascular Patients: Pre- And Post-Test Clinical Knowledge Acquisition Of Early Mobilization Education For Interventional Healthcare Providers, Jennifer Wenger

Doctor of Nursing Practice Scholarly Projects

Peripheral vascular disease (PVD) is a chronic, systemic condition that often requires surgical intervention, presenting significant postoperative risks, including complications like thromboembolisms, pneumonia, and delayed functional recovery. Evidence-based practices (EBP), particularly early mobilization guidelines, have proven to improve recovery outcomes but remain inconsistently applied among interventional healthcare providers. The project addresses this critical issue by evaluating the impact of structured educational sessions on interventional healthcare providers’ knowledge and application of mobilization guidelines in postoperative vascular care. Using the John Hopkins Model of Evidence-Based Practice, a quasi-experimental design was adopted to assess the impact of the education. The project includes pre- …

Clinical Guidelines For The Perioperative Management Of Patients With Aortic Stenosis Undergoing Noncardiac Surgery, Owen Diehl

Doctor of Nursing Practice Scholarly Projects

Aortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine …

Implementation Guidelines For Total Hip And Total Knee Arthroplasty To Reduce The Incidence Of Deep Vein Thrombosis And Subsequent Pulmonary Embolism, Mitchell Mccorkle

Doctor of Nursing Practice Scholarly Projects

With patients living longer, the orthopedic sector has given rise to joint prostheses as a treatment for those experiencing osteoarthritis (OA). With the increase of these procedures, there is also an increased risk of deep vein thrombosis (DVT) and subsequent pulmonary embolus (PE) following these surgical procedures. The orthopedic medical community and anesthesia providers aim to decrease DVT and PE risk through multiple modalities. The anesthesia focuses on reducing DVT, and PE involves a multimodal approach to each anesthetic. Modalities used for the multimodal approach involve peripheral nerve blocks (PNB), neuraxial spinal anesthesia, early mobilization, postoperative nausea and vomiting (PONV) …

Implementation Of A Novice Charge Nurse Blended Learning Program In A Community Hospital, Asheley M. Davis

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: Charge nurses have a broad range of responsibilities that require skills beyond patient care. Unfortunately, these skills are not usually taught in nursing school or as part of continuing education for staff nurses. As a result, many new charge nurses feel unprepared for their role. This is compounded by the fact that a significant percentage of nurses in the workforce are novice nurses. These novice nurses who may not yet have the necessary experience are now leading staff without the guidance and support of experienced nurses.

Local Problem: Newly appointed charge nurses at the academically affiliated community hospital …

Patient Satisfaction With Telehealth To Access Psychiatric Health Services In Rural Outpatient Psychiatric Health Settings: A Project Proposal, Chimezie C. Onuchukwu

Doctor of Nursing Practice Scholarly Projects

Abstract

Telehealth competencies of the National Organization of Nurse Practitioner Faculties for Advanced Practice Registered Nurses (APRN) are fundamental in psychiatric health management. This project examined patient satisfaction with telehealth services through surveys and interviews, focusing on factors such as quality of care and provider-patient relationships, comparing satisfaction levels between in-person visits and telehealth services while evaluating how telehealth impacts overall service utilization.

Methodology: The project applied a mixed-methods approach. In structured interviews and surveys, patients were surveyed on satisfaction scores based on convenience, usability, provider-patient communication, and perceived care effectiveness. A comparative analysis was done between telehealth and …

Evidence-Based Practice Guidelines For Perioperative Insulin Pump Usage And Glycemic Control During The Perioperative Period, Duane Robinson

Doctor of Nursing Practice Scholarly Projects

According to the International Diabetes Federation, Diabetes Mellitus (DM) affects approximately 537 million people, representing approximately 10% of the worldwide population aged 20 to 79. Approximately 400,000 people with DM use continuous subcutaneous insulin infusion (CSII) pumps. CSII pump therapy mimics pancreatic insulin release, aiding in maintaining adequate insulin levels. Individuals with DM are more likely to require surgery than individuals without the disease. Among diabetics, people with Type 1 DM (T1D) are more likely to need medical interventions than individuals with Type 2 DM (T2DM). CSII therapy maintains blood glucose levels within a programmed range and decreases blood glucose …

Standardizing Heart Failure Discharges: Reducing 30-Day Readmission Rates, Angela Keziah

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Patients readmitted with heart failure (HF) suffer increased mortality, reduced quality of life, and heightened medical expenses, though most readmissions are preventable with a consistent HF discharge regimen.

Purpose: To determine if a consistent HF discharge regimen using an evidence-based HF discharge checklist tool, including standardized HF education and a scheduled follow-up appointment with their cardiologist within 7-10 days post-discharge, impacted HF 30-day readmission rates.

Methods: An evidence-based HF discharge checklist tool was placed on participants’ charts on the Progressive Care Unit (PCU) and utilized by the PCU nurses to standardize HF discharges.

Inclusion Criteria: The study included …

Evaluating The Effectiveness Of A Behavioral Emergency Response Team In An Emergency Department, Kim Jai

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The increasing incidence of occupational workplace violence (OWPV) in hospitals, especially in emergency departments (EDs), has become a significant concern in the United States. Given the increasing risk of the occurrence of workplace violence (OWPV) from patients and family members, hospitals have instituted the Behavioral Emergency Response Team (BERT) protocol, comprising trained staff members with expertise in acute psychiatric disorders and de-escalation techniques for managing assaultive behaviors.

Purpose: Evaluate a Behavioral Emergency Response Team (BERT) protocol implemented in an emergency department and make recommendations for improvement.

Methods: Using the Centers for Disease Control and Prevention's Logic Model, this …

Improving Health Literacy Related To Hypertension In A Minority Faith-Based Population, Kasaundra M. Beverly-Marshall, Kasaundra M. Beverly-Marshall

Doctor of Nursing Practice Scholarly Projects

Background: Insufficient research on health literacy related to cardiovascular disease highlights a gap in healthcare. Healthy People 2030 and local community health programs acknowledge gaps in research with future goals to improve health literacy.

Local Problem: The health literacy rate for Winnebago County, IL (41%) is higher than both the State of Illinois and national health literacy rates, which aligns with the results of a community needs assessment survey.

Methods: A community-based health promotion project using a pre-post study design uses the health promotion model to engage participants in advancing cardiovascular health outcomes.

Interventions: DNP student assisted participants in creating …

Optimizing Advance Care Planning: Leveraging An Electronic Medical Record Prompt To Impact Advance Directive Documentation, Annette L. Meares

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: Advance Directives (ADs) support patient-centered care by documenting preferences for future medical treatment. While the Centers for Medicare & Medicaid Services (CMS) incentivizes AD documentation through billing codes, national adoption remains low.

Local Problem: A rural Northern Illinois primary care practice had electronic referral capabilities for ACP; however, referrals remained low and inconsistent during Medicare Annual Wellness Visits (AWVs), limiting opportunities for AD completion.

Methods: This quality improvement project targeted Medicare AWV patients without ADs documented in the electronic medical record (EMR). During a 10-week pre-intervention period, baseline data were collected. In the subsequent 10-week intervention phase, an …

Implementation Of The Nurse-Driven Palliative Care Referral Protocol: A Quality Improvement Project, Khrystyna Lacombe

Doctor of Nursing Practice Scholarly Projects

Implementation of the Nurse-Driven Palliative Care Referral Protocol

Background and Purpose: Palliative care enhances quality of life, symptom management, and patient–family communication for individuals with serious illness. Despite strong evidence and national recommendations for early integration, referrals remain inconsistent and often occur late. At Advocate Sherman Hospital, only 17.9% of eligible oncology inpatients received palliative care consults. The absence of standardized referral criteria, reliance on provider discretion, and misconceptions equating palliative care with hospice contributed to delayed or missed consults. The purpose of this quality improvement (QI) project was to increase palliative care referrals by 20% within eight weeks through …

Reducing Acute Care Visits In Oncology: A Pilot Quality Improvement Project, Judy Metropulos

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: Patients receiving high-toxicity chemotherapy are at risk for post-infusion complications, which can result in unplanned hospital visits or admissions. Structured post-infusion follow-up may improve symptom management and reduce these events.

Local Problem: At North Region hospital, the 30-day post-infusion revisit rate was 31%, substantially exceeding the national average of 14.7%. A pilot program launched in 2021 reduced hospital visits by 7%; however, following its discontinuation due to staffing shortages and inadequate data collection, the rate subsequently increased, underscoring the need for sustainable interventions.

Methods: A quality improvement project was conducted in two, ten weeks phases. Phase 1 included …

Nurse's Satisfaction With The Implementation Of A Standardized Physical Assessment Template In Home Based Medical Care, Nicole Silvestri

Doctor of Nursing Practice Scholarly Projects

Background and Literature Review:
Home based medical care (HBMC), part of Optum’s UnitedHealth division, delivers in-home urgent care to medically complex patients at high risk for hospitalization. A nurse is dispatched to the home and a provider connects via telemedicine to conduct the visit. Currently, there is no standardized documentation tool to communicate physical assessment findings between the in-home nurse and the telemedicine provider. A literature review was conducted using PubMed and CINAHL with search terms including nursing satisfaction, physical assessment, EMR, template, standardized tool, and documentation. This revealed challenges in nursing documentation, communication, and physical assessment, particularly regarding …

Enhancing Inclusivity In Primary Care On A College Campus, Amanda Finkle Plyler

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Individuals who identify as lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) face higher health disparities and are less likely to seek healthcare due to fear of being misgendered or judged by staff. Purpose: The purpose of this DNP project was to implement an intervention for college students seeking care at Student Health Services (SHS) that includes a question addressing preferred pronouns during establishment of care, creating the opportunity for staff to address patients appropriately and to provide gender-affirming care. Method(s): A pre and post intervention patient satisfaction survey related to sexual orientation and gender identity (SOGI), …

Assessing The Impact Of Mindfulness-Based Stress Reduction (Mbsr) On Emergency Nurses' Absenteeism And Receptive Awareness Of And Attention To What Is Taking Place In The Present, Rachael Moore Drake

Doctor of Nursing Practice Scholarly Projects

Problem: The changing terrain of modern healthcare has made emergency nurses' well-being a top priority. Within the small community hospital where this project was conducted, the issue of employee work-related stress was identified through managers' feedback and employee surveys. Purpose: Leaders employ a comprehensive mindfulness program based on assessed employee needs to understand the practical interventions to address work-related stress. This project implemented mindfulness-based stress reduction (MSBR) interventions and assessed emergency nurses' absenteeism and receptive awareness of and attention to what is taking place in the present. Method: The project utilized the Mindful Attention Awareness Scale (MAAS) to assess emergency …