Nursing Commons^™

Identifying Adolescent Depression In The Public School System, Laura Lee Griffith

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Twenty percent of United States adolescents experience major depression at some point. Elevated school dropout rates, substance abuse, chronic disease, mortality and morbidity rates, and impaired growth remain because 60 % of adolescents with unidentified depression do not receive treatment. Purpose: This evidence-based project identified adolescents aged 16-19 in a South Carolina high school who had symptoms of depression. Counseling and resource information were provided for students with scores of 10 or greater, or thoughts of self-harm on the PHQ-9. Method: Students were screened using the PHQ-9. Data was organized in Excel and analyzed using the T-tests and …

The Impact Of A Visual Remote Patient Monitoring Device (Leaf) On Hospital-Acquired Pressure Injuries (Hapi), Tyler Andrew Gunther

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The Critical Care Department at a large academic hospital in the Southeast has experienced a significant increase in healthcare-acquired pressure injuries (HAPIs), contributing to elevated mortality rates. Factors such as insufficient adherence to turning protocols and resource limitations impact patient safety, thus increasing the potential for adverse outcomes and increased costs. Purpose: The purpose of this DNP scholarly project was to evaluate the impact of a turn monitoring device, specifically the LEAF system by Smith and Nephew, on HAPI incidence in the critical care setting. The project aimed to address the identified barriers to compliance, enhance patient safety, …

Implementation Of Eat Sleep Console For Neonatal Abstinence Syndrome: A Quality Improvement Project, Harley Addison Kennington

Doctor of Nursing Practice Scholarly Projects

Problem Statement: A level III NICU and mother-baby unit within an inpatient hospital in the Southeast United States transitioned from the Finnegan Neonatal Abstinence Scale (FNASS) to the Eat, Sleep, Console (ESC) for treating Neonatal Abstinence Syndrome (NAS). Prior to ESC implementation, there was limited nursing education of ESC practice guidelines or consideration for proper implementation protocol. Purpose: The purpose of this evidence-based quality improvement project was to reintroduce nursing staff to the ESC NAS Care Tool and ESC charting guidelines within the NICU and mother-baby units. Methods: This project followed the PDSA process – Plan, Do, Study, Act, underscored …

Increasing Pre-Procedure Communications To Decrease Colonoscopy Cancellations, Natalie Brooke Midkiff

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Colonoscopies play a vital role in early colorectal disease detection and prevention. Yet, the field of gastroenterology faces a persistent challenge - frequent procedure cancellations and incomplete examinations due to suboptimal bowel preparation. This not only compromises the effectiveness of colonoscopies but also poses potential health risks.

Purpose: This project aimed to reduce procedure cancellations and incomplete examinations by regularly communicating pre-procedure instructions and reminders through text messages and phone calls.

Inclusion Criteria: The criteria were clearly defined, targeting patients aged 18 and older who needed colonoscopies. This focus ensured the project's relevance to specialized gastrointestinal intervention. Establishing …

Identification Of Obstructive Sleep Apnea Symptoms Among Veterans In The Primary Care Setting, John Dominic Rosella Iv

Doctor of Nursing Practice Scholarly Projects

Untreated obstructive sleep apnea (OSA) has long-term cardiovascular and metabolic health implications, impacting quality of life and increasing health expenditures. Veterans have a higher prevalence rate of OSA attributed to an aging population and higher rates of comorbid conditions. The problem of under recognition of OSA symptoms partly relates to clinicians needing to elicit relevant symptoms routinely. At the same time, the lack of primary-care-based screening protocols contributes to the percentage of undiagnosed OSA. The purpose of this evidence-based project was to implement routine screening to identify OSA risk among veterans in primary care settings in South Carolina. The method …

Depression In Individuals With Chronic Liver Disease: Improving Screening In The Outpatient Setting, Kayla Corine Wright

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Individuals with chronic conditions such as chronic liver disease experience higher rates of depression, often underdiagnosed and placing high risk demographics in jeopardy of adverse outcomes, including worsening prognosis, decreased quality of life, and increased symptomatology.

Purpose: Evidence advocates for routine depression screening within high-risk patient populations. This paper outlines the implementation of a quality improvement initiative aimed at enhancing depression screening at a selected outpatient liver clinic within an extensive hospital system by implementing the PHQ-9 questionnaire during patient clinic visits, where no standardized screening protocol was previously in place.

Methods: The Plan-Do-Study-Act cycle guided the implementation …

Increasing Breast Cancer Screening Rates Among Women Ages 40 To 74 In An Urban Safety Net Primary Care Clinic: A Quality Improvement Project, Wilder Pinnock

Doctor of Nursing Practice Scholarly Projects

Background and Problem Description: Breast cancer continues to be the most common and second most lethal form of cancer among women in the U.S. Although there have been improvements in breast cancer screening in the US, major disparities persist. The national breast cancer screening rate for the year 2021 was 75.6%; the rate for the underserved and minority population was 54%. This QI project took place at a Federally Qualified Health Center that provides medical care to medically underserved and vulnerable populations.

Purpose and Aim: This project aimed to increase breast cancer screening at the proposed site to optimize early …

Implementation Of Synchronous And Asynchronous Car-T Education For Emergency Room And Intensive Care Unit Nurses In Non-Oncology Units, Kylie Kuck

Doctor of Nursing Practice Scholarly Projects

Background: Chimeric antigen receptor T cell (CAR-T) therapy is a novel and promising cancer treatment for hematologic malignancies. This treatment is highly regulated by the Food and Drug Administration (FDA) and The Foundation for the Accreditation of Cellular Therapy (FACT) because of the known toxicities associated with treatment.

Local problem: In 2022, FACT published guidelines requiring formal education for both oncology and non-oncology nurses who care for these patients, including emergency room and intensive care unit nurses.

Methods: This quality improvement project provided education to emergency room and intensive care unit care nurses who are caring for CAR-T cell therapy …

Online Diabetes Program Improving Nurses' Competency In School-Age Diabetes Care, Kristina Donovan

Doctor of Nursing Practice Scholarly Projects

Background: Diabetes affects over 280,000 children under 20 in the US, requiring specialized knowledge and skills for management. In a large urban school district with 54,000 students, 159 have diabetes, cared for by 158 school nurses. These nurses often struggle with the complexities of diabetes care and lack standardized training, leading to potential suboptimal care. An online diabetes education program was implemented to improve their competency, knowledge and skills, and confidence in managing diabetes in school-age children.

Methods: An asynchronous online competency-based diabetes education program to improve nurses’ competency to care for school-age children with diabetes was implemented in an …

Development And Implementation Of An Emergency Preparedness Policy And Procedure, Educational Intervention, And In-Situ Simulation In A Pediatric Primary Care Office: A Quality Improvement Project, Kaitlin Patel

Doctor of Nursing Practice Scholarly Projects

Background. Pediatric primary care offices are frequently unprepared to respond to clinical emergencies that may present to or occur at their site. The purpose of this project was to improve office emergency preparedness at a pediatric primary care office to align with the American Academy of Pediatrics policy statement for pediatric office emergency preparedness.

Methods. A PRISMA-guided literature review found support for both educational interventions and in-situ simulation to improve aspects of emergency preparedness. The aim of this project was to develop a practice-specific emergency preparedness policy and procedure and implement a training and in-situ simulation to increase medical and …

Implementation Of A Standardized Acute Care Plan For Complex Care Medicine Service Patients: A Quality Improvement Initiative, Tracy Markwell

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Care transition plans, locally called Acute Care Plans (ACPs), are created specifically for super utilizers of the Complex Care Medicine Service (CCMS) and are a target for improvement. The purpose of this project was to improve care for CCMS patients by developing, implementing, and evaluating a standardized CCMS ACP. A multidisciplinary approach was chosen to facilitate the transitions of care process during an admission or discharge from the hospital.

LOCAL PROBLEM: The purpose of the ACP is to get a quick summary of how to treat a patient when they come to the hospital. The ACPs are …

Implementing Pain Screening In A Parkinson’S Disease Clinic: A Quality Improvement Initiative, Anne Marie Desmond

Doctor of Nursing Practice Scholarly Projects

Background: Pain is a multifaceted, non-motor symptom often unnoticed and undertreated in Parkinson's disease (PD). PD pain is associated with decreased quality of life (QOL) and is found in 30-85% of PD patients. The effective diagnosis and treatment of PD pain could improve patient QOL. Barriers to appropriate diagnosis and treatment include a valid and reliable PD pain assessment tool. There was an opportunity to improve the assessment of PD-related pain at the movement disorder clinic in this suburban clinic of a tertiary safety net hospital. The local movement disorder clinic did not have a standardized PD-specific tool to assess …

Evaluation Of A Team-Based Model Of Nursing Care In The Acute Care Setting, Vanetta W. White

Doctor of Nursing Practice Scholarly Projects

Problem: The current nursing shortage is much different than the ones we have experienced in previous years. It is predicted that it will have long-lasting effects. With this shortage of nurses, especially in the acute care setting, alternative methods to deliver patient care beyond the current use of primary care models need to be explored. These alternative models of care which include team-based nursing must maintain quality and safety for patients cared for.

Purpose: This project will evaluate the outcomes of returning to a team-based nursing model of care on a medical-surgical unit while continuing to provide safe, quality care …

Implementation And Evaluation Of A Neonatal Resucitation Program Protocol In Stand-Alone Emergency Department, Hannah Collins Walden

Doctor of Nursing Practice Scholarly Projects

Problem statement: Within nursing there are some skills that hold a significant amount of risk. This includes neonatal resuscitation within stand-alone emergency departments. Due to the low frequency of opportunities to practice neonatal resuscitation, nurses must utilize alternative methods to maintain current evidence-based practice. Purpose: The purpose of this project was to evaluate the effectiveness of a protocol incorporating Neonatal Resuscitation Program (NRP) preparedness and simulation to increase stand-alone emergency department nurses’ perceived clinical competence to performing neonatal resuscitation. Methods: The development and implementation of a protocol that defines and incorporates NRP roles, provides a maintenance checklist for …

Measurement-Based Mental Health In Adolescents, Ayzia Lynn Taylor

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adolescent mental health is a growing concern. Children and adolescents are commonly diagnosed with Attention Deficit Hyperactive Disorder (ADHD), anxiety, and depression. Some youth may also experience co-occurring symptoms that their primary healthcare provider must distinguish to appropriately diagnose and treat.

Purpose: The project aimed to implement measurement-based care for adolescents between the ages of 12 to 18 in a pediatric outpatient facility that is not currently utilizing post-assessment screening tools. The project seeks justification for treatment options utilizing pre-assessment screening tools and therapeutic relief with medication intervention determined by post-assessment screening results.

Methods: Adolescents between the ages …

Implementation Of Shared Decision Making To Impact Decisional Conflict In Advancing Chronic Kidney Disease, Margaret Mcannar Sorkin

Doctor of Nursing Practice Scholarly Projects

Problem Statement: A notable phenomenon in nephrology is indecision regarding treatment for End Stage Renal Disease (ESRD). Indecision regarding treatment for ESRD can lead to suboptimal dialysis starts, creating poorer health outcomes, decreased quality of life, and higher healthcare costs. Purpose: This project aimed to determine if participation in a shared decision-making (SDM) program decreases decisional conflict in patients with advancing renal disease deciding between ESRD treatment options. Methods: A pretest-posttest design was used. Participants were recruited from a private nephrology practice. Inclusion Criteria: English-speaking patients, over the age of 20, with Chronic Kidney Disease Stages 4 or 5 (estimated …

Implementing The 5a’S Of Obesity Management In Primary Care, Holly H. Rowell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The prevalence of obesity continues to increase globally, with greater prevalence in the southern United States, resulting in higher costs to the healthcare system and greater risks for the development of other chronic diseases. Purpose: Determine if implementing the 5A’s of Obesity Management among primary care providers in a rural, low-income healthcare setting will increase the diagnosis of obesity and result in a subsequent decrease in weight among patients who are obese. Methods: An educational session was held to familiarize providers with the 5A’s of Obesity Management and the importance of obtaining and documenting proper height …

Impact Of Hydrogen Peroxide Wipes Disinfecting Clostridioides Difficle On High-Touch Surfaces, Tyler Wolf Ramirez

Doctor of Nursing Practice Scholarly Projects

Clostridioides difficile is the leading cause of nosocomial diarrheas worldwide (Centers for Disease Prevention and Control [CDC], 2022). 15% of all hospitalized patients in the United States develop antibiotic-associated diarrhea (AAD), with 15-25% of cases caused by C. difficile (CDC, 2022). C. difficile costs the United States Healthcare system $5.4-6.3 billion annually (Balsells et al., 2019). The project’s purpose was to see if implementing hydrogen peroxide (H2O2) wipes using an interprofessional team leads to the following expected outcome(s): reduction in hospital-acquired C. difficile infections and comparable disinfection rates to sodium hypochlorite. An interprofessional team consisting of the primary lead, Clinical …

Human Papillomavirus Vaccination Rates Among Adolescents In South Carolina, Rebecca Jane Morrison

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Among adolescents 11-17 years of age in South Carolina, low rates of human papillomavirus (HPV) vaccination can negatively impact health outcomes through increased risk of acquiring HPV-associated cancers.

Purpose: To determine if the 4 Pillars™ Immunization Toolkit increased HPV vaccination rates among adolescent patients.

Methods: The 4 Pillars™ Immunization Toolkit was the framework for this bundled intervention. Pillar 1, convenience and easy access, included after-school HPV express clinics. Pillar 2, communication, utilized staff motivational interviewing skills, campaign promotion materials, documentation of declination, and second-dose callback appointments. Pillar 3, enhanced vaccination systems, was designed to use …

Impact Of The Blaylock Risk Assessment Screening Score On Inpatient Length Of Stay On Inpatient Psychiatric Units Within An Acute Care Hospital, Princess P. Minter

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Insufficient discharge planning at the time of patient admission can result in increased hospitalization length of stay and poor clinical outcomes, including a rapid deterioration of stabilized patients’ mental status while unnecessarily waiting for discharge arrangements to be put in place at the time of discharge. Purpose: To determine if completing the Blaylock Risk Assessment Screening Score (BRASS) index tool to identify barriers to discharge at the time of patient admission impacts the length of stay for patients admitted to general psychiatric inpatient units. Methods: Patient admission and discharge data collected using the BRASS index within 48 hours …

Assessing Readiness To Quit As An Intervention For Tobacco Cessation In Oncology Patients, Victoria Gabriela Maddox

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Smoking and tobacco use is the leading cause of preventable death in the United States. Twenty percent of all cancer diagnoses are directly linked to smoking, and tobacco-related diseases and cancers contribute to one in every five deaths annually in the United States. Less than one in ten smokers are successful at quitting. Smokers attempting to quit are more successful in cessation programs after evaluation of self-efficacy, such as the readiness to quit.

Purpose: This evidence-based practice project aimed to evaluate the impact of motivational interviewing with the 5A’s model on smoking cessation efforts in patients at an …

Use Of An Audit And Feedback Tool And Sglt-2 Inhibitors To Delay Progression Of Chronic Kidney Disease, Megan Elaine Lanpher

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adults with Type 2 diabetes mellitus and chronic kidney disease experience a higher risk for progression to end-stage kidney disease, which negatively impacts health, increases medical costs, and decreases quality of life. Purpose: Determine if an audit and feedback intervention in a local nephrology clinic can increase provider adherence to a clinical practice guideline that supports the prescription of sodium glucose cotransporter-2 (SGLT-2) inhibitors. Methods: A pretest-posttest design was used to determine if an audit and feedback tool delivered to providers at three-week intervals would increase prescription of SGLT-2 inhibitors in adults with Type 2 diabetes and chronic …

Appropriate Policies For Patients Utilizing Insulin Pumps With Continuous Glucose Monitoring During Hospital Admission, Mary Elizabeth Holiday

Doctor of Nursing Practice Scholarly Projects

Problem Statement: A growing number of patients with diabetes are using advanced diabetes management technology with an integrated insulin pump and continuous glucose monitor (CGM); however, multiple concerns surround their use during hospitalization, ranging from patient safety risks to nursing comfort in overseeing these devices.

Purpose: This project aimed to determine if an accurate, reformed inpatient policy supporting specific automated insulin pump use during admission maintained patient glucose control, improved patient satisfaction, and increased nursing comfort levels.

Methods: Pre- and post-policy nursing knowledge surveys, retrospective admission glucose metrics, and patient experience narratives were evaluated.

Inclusion Criteria: Patients and nurses were …

Reducing Wait Times For Psychiatric Intakes, Ryan Brad Carsten

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Early intervention for mental illness is vital to a swift recovery and extended wait times for mental health treatment have proven to be a barrier to early intervention. Purpose: The purpose of this quality improvement project was to determine if wait times for psychiatry intakes at the University of South Carolina (USC) Student Health Center Psychiatry Services can be reduced and kept under 1 week by utilizing the Specific Timely Appointments for Triage (STAT) model. This model consists of clinicians scheduling a specified number of intake appointments based on the typical demand for service. Students were booked in …

Using Visual Thinking Strategies To Increase Empathy Levels In Inpatient Psychiatric Nurses: A Quality Improvement Project, Katharine E. Harding

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Research indicates that empathy is declining in today’s behavioral health nursing workforce. Purpose: The aim of this quality improvement project was to apply an evidence-based Visual Thinking Strategies intervention to the clinical problem and increase empathy levels from pre-survey measurement among psychiatric nurses. Method: VTS methodology was employed through in-person interviews where participants viewed art-based images pertaining to mental health. Feedback from semi-structured questions was shared among participants. Pre and post-test interventional quantitative data via The Jefferson Scale of Empathy-Health Provider version (JSE-HP) and The Interpersonal Reactivity Index (IRI) instruments were collected. Inclusion Criteria: Participants were voluntarily recruited …

An Evidence-Based Strategy For The Use Of Simulation To Assess Situation Awareness In Applicants To Nurse Anesthesia Programs, Angela Lee

Doctor of Nursing Practice Scholarly Projects

Medical errors are considered one of the top causes of patient death. Closed claims analysis reveals an estimated 50% of claims are associated with preventable events by the anesthesia provider. Errors in anesthesia leading to critical incidents are associated with errors in situation awareness (SA). Identification of human factor variables, such as SA, provides an analysis of observable behavior and intuition necessary to guide crisis management, maintain clinical performance, and mitigate errors in patient safety. The human factor components of human error and SA play critical roles in patient safety and overall clinical anesthesia practice. The viability of simulation assessment …

Evidence Based Practice Guidelines For The Pediatric Autistic Spectrum Disorder Population, Calvin Sparks

Doctor of Nursing Practice Scholarly Projects

Children with autism spectrum disorder (ASD), as well as caregivers, experience significant challenges in their interactions with healthcare providers in a clinical setting. This is primarily due to their issues with communication, social interaction, and sensory sensitivities to anesthetic treatment during premedication or preoperative environments. Due to these characteristics, it is important to maintain and update the current standards of care for children with ASD while utilizing evidence-guided strategies to provide a pre-operative assessment effectively. The pre-operative assessment is a critical component that renders impact throughout the surgical experience with the purpose of risk stratification, preparation of altering the normal …

Development And Implementation Of An Evidence Based Practice Guideline Related To The Management Of Adult Angioedema, Megan Przybysz

Doctor of Nursing Practice Scholarly Projects

Angioedema (AE) is a potentially life-threatening medical condition that occurs with a higher frequency than medical providers may expect, with the emergency department (ED) serving as the usual first point of medical contact for patients. Any hesitation in recognizing AE or inconsideration of the disease process in differential diagnoses may lead to a dangerous delay of care. Due to the potential rapid progression of airway obstruction in AE, inexperienced providers should not attempt intubation, instead deferring to providers experienced in alternative airway techniques (i.e., anesthesia providers). The primary goal of this project is to develop an evidencebased practice guideline for …

Preprocedural Ultrasound For Labor Neuraxial Anesthesia: Evidence-Based Practice Recommendations, Nicholas Anderson

Doctor of Nursing Practice Scholarly Projects

Central neuraxial blockade (CNB) is the most widely used method of anesthesia provided to laboring patients and includes epidural, spinal, combined spinal-epidural, and caudal techniques. Studies have shown that using preprocedural ultrasound is a safe and effective tool to facilitate the placement of neuraxial needles, especially in patients with predicted difficulty. With the prevalence of obesity increasing, laboring patients with predicted difficulty of neuraxial needle placement is increasing as well. In addition, the traditional method of palpation and visualization of anatomical landmarks to place neuraxial needles can produce inaccurate results due to inconsistencies between patients. Use of preprocedural ultrasound to …

Development Of An Evidence-Based Crna Preceptor Training Program, Emmanuel Mensah

Doctor of Nursing Practice Scholarly Projects

A preceptor is an experienced clinician who is expected to facilitate a student's learning experience. Preceptorship is the relationship between a staff nurse and student, focusing on the development of clinical skills and knowledge. Initially introduced by Florence Nightingale in the 1800s, the concept was quickly adopted by nurse anesthetists and is a staple of the anesthesia practice today. As it stands, many Certified Registered Nurse Anesthetists (CRNA) preceptors do not receive formal training in their role, which may lead to a decrease in teaching ability and confidence to face broad teaching-learning issues. A lack of preparation hinders preceptor outcomes …