Incorporation Of Mindfulness Application Use In Doctoral Nurse Anesthesia Curricula For Mitigation Of Stress And Anxiety In Student Registered Nurse Anesthetists, Kerrie Rodgers

Doctor of Nursing Practice Scholarly Projects

The nurse anesthesia specialty is highly stressful, with educational training being no exception. High didactic demands and intensive clinical experiences are placed on student registered nurse anesthetists (SRNAs), increasing stress and anxiety in their personal and professional lives. High levels of psychological distress can lead to inadvertent consequences in students’ mental, emotional, and physical health and can contribute to illness, burnout, substance use, and compromise in patient safety. Some degree of stress is necessary for motivation to succeed and perform at high levels, and encountering stress while enrolled in a doctoral nurse anesthesia program is expected and unavoidable. A search …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Evaluating Nurses’ Turnover Intention And Organizational Commitment Following Stroke Unit Staffing Changes: An Evidence-Based Quality Initiative, Heather Tatusko

Doctor of Nursing Practice Scholarly Projects

Nurses are known to be overworked, overwhelmed, undervalued, and understaffed at dangerous levels throughout various inpatient hospital units across the United States (U.S.). Hospital registered nurse (RN) turnover is a significant issue that has accelerated since the COVID-19 pandemic, resulting in economic impacts and other burdens for organizations, individuals, and communities. Evidence suggests that evaluating Registered Nurses’ Turnover intention (NTI) and Organizational Commitment (OC) can help maintain a ready and capable team of skilled RNs; however, most healthcare organizations (HCOs) do not collect or analyze NTI and OC data and focus on staffing numbers and monetary incentives to get adequate …

Evaluating Nurses’ Turnover Intention And Organizational Commitment Following Stroke Unit Staffing Changes: An Evidence-Based Quality Initiative, Heather M. Tatusko Phiri

Doctor of Nursing Practice Scholarly Projects

Nurses are known to be overworked, overwhelmed, undervalued, and understaffed at dangerous levels throughout various inpatient hospital units across the United States (U.S.). Hospital registered nurse (RN) turnover is a significant issue that has accelerated since the COVID-19 pandemic, resulting in economic impacts and other burdens for organizations, individuals, and communities. Evidence suggests that evaluating Registered Nurses’ Turnover intention (NTI) and Organizational Commitment (OC) can help maintain a ready and capable team of skilled RNs; however, most healthcare organizations (HCOs) do not collect or analyze NTI and OC data and focus on staffing numbers and monetary incentives to get adequate …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Implementing Universal Adult Depression Screening In A Rural Maine Free Medical Clinic, Karen Hussion

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Depression in adults is a leading cause of disability, morbidity and mortality worldwide with an estimated prevalence of 20% in the US population. Despite estimates that one out of every five Americans suffers from depression, less than 50% of adult primary care patients with depression are identified, and less than 5% of all adult primary care patients are screened. To increase early detection and management of depression, the United States Protective Service Task Force (USPSTF) recommends routine depression screening for adults older than 18 years in primary care settings.

LOCAL PROBLEM: This project site was a rural, free, …

Final Scholarly Project: Clinical Guidelines For The Perioperative Management Of Patients With Opioid Use Disorder Requiring Anesthesia, Jessica Kayla Joos

Doctor of Nursing Practice Scholarly Projects

Opioids have highly addictive properties that allow for high levels of misuse. Since the early 1990s, the misuse and deaths rates related to narcotics have steadily risen in the United States. Efforts to identify individuals using opioids prior to surgery have proven difficult. The number of patients misusing opioids and reporting for surgery can only be estimated due to under-reporting related to fear and self-stigma. With 50 million surgeries in the U.S. annually and 3.32 million people misusing opioids monthly, the chances of a patient with Opioid Use Disorder (OUD) presenting for anesthesia are exceptionally high. Moreover, patients who rate …

Enhancing Srna Confidence: Simulation-Based Crm Training For The Management Of Intraoperative Cardiac Arrest, Melissa Lee

Doctor of Nursing Practice Scholarly Projects

Intraoperative emergencies in the operating room (OR) are rare but necessitate early recognition and intervention.

Enhancing Srna Confidence: Integrating Simulation-Based Crm Training With Didactic Education To Improve Intraoperative Recognition, Communication, And Management Of Intraoperative Cardiac Arrest, Melissa Lee

Doctor of Nursing Practice Scholarly Projects

Within the operating room (OR), the ability to identify deteriorating patient conditions and effectively communicate, is essential to delivering safe and efficient care. Although rare, the critical nature of emergent events necessitates early recognition and prompt intervention by an experienced anesthesia provider. The complexity of emergency management is often related to diagnostic ambiguity, individual provider experience, and disruptions of the fast-paced OR environment, requiring appropriate training methods for proficient execution. However, student registered nurse anesthetists (SRNAs) often lack sufficient exposure to emergent clinical scenarios, leading to delayed intervention and diminished confidence during crisis management. An evidence-based simulation education guideline for …

Evidence-Based Strategy To Improve Delirium Detection In Elderly Postsurgical Patients, Aimee Baker

Doctor of Nursing Practice Scholarly Projects

Postoperative delirium (POD) is a serious adverse outcome that frequently affects older adults. Patients experiencing POD are at greater risk for postoperative mortality, increased length of hospital stay, functional decline, and increased cost of care. Current global population trends indicate that the population of adults over the age of 60 years old will double over the next thirty years. Recent guidelines call for hospitals to implement routine delirium assessment to improve early intervention. Nursing delirium assessment tools are a critical resource for early delirium identification. Nursing delirium assessment tools are often highly sensitive and specific for delirium when used in …

Implementation And Evaluation Of A Structured Mentorship Program, Cary Bedinghaus, Caroline Hillman

Doctor of Nursing Practice Scholarly Projects

The project addresses mentorship in a graduate nursing anesthesia program. The goal is to improve the existing mentorship program and to implement a durable and consistent system that gathers and responds to feedback from the students. Two literature reviews form the underpinnings of the structure and evaluation components of the project. Three structural components were identified in the review as highly effective in multiple studies of diverse mentorship programs. The first component is establishing an effective dyad matching scheme. The second component is establishing clear goals. The third component is maintaining the relationship and achieving goals through frequent and consistent …

Adoption Of Ventilator-Associated Event Bundle In Adult Critical Care Population, Renee Christine Hayes

Doctor of Nursing Practice Scholarly Projects

Problem: The utilization of mechanical ventilatory support is a periodic necessity within critical care. One significant aspect of mechanical ventilatory health management focuses on preventing the sequela of ventilator-associated events (VAE). The societal impact of VAE occurrences weighs heavily on the already burdened registered nurse (RN), health care providers including physicians and advanced practice providers, healthcare system, and overall patient and family wellbeing. Purpose: This project examined if the addition of a ventilator associated event bundle (VB) reduces the occurrence of VAE within the adult patient population requiring mechanical ventilation for longer than 48 hours. Methods: Metric review of VAE …

Post-Discharge Follow-Up Call To Impact Heart Failure Re-Admission Rates, Regina Mitchell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The clinical setting for this project, a 321-bed southeastern hospital in South Carolina, has an elevated re-admission rate for CHF patients of 22.67% (Ferguson, B. V.P. Quality, personal communication, October 21st, 2022), 1.57% above the Centers for Medicare Services (CMS) benchmark of 21.1% for payment reduction penalties. Purpose: Determine if post-discharge interview phone calls decrease CHF re-admission rates. Methods: A two-group pretest-posttest design will be used. Data will be collected during retrospective unit chart review, weekly chart review of patient participants, and structured post-discharge phone interviews. Inclusion Criteria: English-speaking, adult (>18 years of age) patients with …

Evaluating The Impact Of Rapid Response Electroencephalogram In Post-Cardiac Arrest Patients, Lauren Lee Steffen

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Timely diagnosis and treatment of nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) are critical for improving patient outcomes after a cardiac arrest. However, NCSE can only be confirmed with an electroencephalogram (EEG), which is either considerably delayed or unavailable in the Emergency Department and Intensive Care Unit (ICU). Purpose: This project aimed to describe the impact of a rapid response electroencephalogram (rrEEG) brain monitor on improving time- to- acquisition and length of stay in the Intensive Care Unit for post-resuscitated cardiac arrest survivors; additionally, does rrEEG increase nurse's knowledge and confidence in managing complex seizure patterns? Method(s): …

The Impact Of Brief Electronic Guided Mindfulness Meditation On Anxiety Scores, Sierra King

Doctor of Nursing Practice Scholarly Projects

In the United States, anxiety rates are on the rise for the general population (Goodwin et al., 2020a). Prolonged and frequent anxiety can become unprompted and problematic (American Psychiatric Association, 2021). Management of anxiety is crucial for overall wellbeing. Access to treatment and resources for anxiety may be limited in rural geographical locations (Morales et al., n.d.). This DNP project sought to determine whether a brief intervention of electronic guided mindfulness meditation (MM) by Insight Timer is effective in decreasing anxiety in a rural populous. Convenience sampling recruited a final total of 11 rural participants who participated in seven sessions …

Standardizing The Discharge Process To Reduce Copd Readmission Rates, Kristine Doligosa

Doctor of Nursing Practice Scholarly Projects

Background: Frequent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can lead to unfavorable patient outcomes and costly readmissions. Inadequate patient support during discharge and an inconsistent discharge process are factors contributing to high readmissions in this population.

Purpose: This quality improvement project aimed to reduce COPD-related hospital readmissions by standardizing the discharge process for patients admitted with AECOPD and identify patient risk factors for readmission.

Methods: Following a quantitative and quasi-experimental design, this project standardized the discharge process for patients admitted with AECOPD using the Re-Engineered Discharge Toolkit components and a discharge care bundle. The project was …

Implementation Of The Stop The Bleed Program At A Local Park District, Emily J. Minerva

Doctor of Nursing Practice Scholarly Projects

Background: Fifty percent of people who suffer from an acute bleeding event die before arriving to the hospital due to lack of receiving care in a timely manner.

Local Problem: Increased emergency response times could prove fatal to someone experiencing a large bleed, highlighting the need for increased emergency preparedness in the community.

Methodology: This implementation pilot project utilized quantitative tools (pre- and post-multiple-choice test and Likert scales) and a qualitative narrative approach (inductive content analysis).

Interventions: A certified Stop the Bleed instructor provided Stop the Bleed education with an animated presentation, hands-on skills training session, and a …

Improving Utilization Of Nonpharmacological Interventions In Adult Oncology Patients, Alison Keck

Doctor of Nursing Practice Scholarly Projects

Background: Anxiety is one of the most prevalent symptoms oncology patients experience and clinical guidelines support the use of nonpharmacological interventions (NPI) as a primary method for managing anxiety.

Local Problem: At a suburban, community hospital, a nurse perception survey revealed staff were “always” offering medications 69% of the time but NPIs were “never” used anywhere between 38-81% of the time. In a sampling of patients, only 33% recalled they had used NPIs. A Patient Reported Outcomes Measurement Information System (PROMIS) tool revealed that 69% of patients had higher than average levels of anxiety on the unit.

Methods: This quality …

Full Plate Living-Teaching Kitchen: A Sustainable Approach To Employee Health, Amy M. Daniel

Doctor of Nursing Practice Scholarly Projects

Abstract

Insufficient fiber intake is a key contributor to diet-related chronic diseases (DRCD) such as obesity, hypertension, and diabetes. This evidence-based health promotion program evaluated integrating a teaching kitchen with the Full Plate Living Plan (FPL-TK) to increase daily fiber intake. Grounded in the Social Cognitive Theory, the 8-week employee health promotion program included hands-on culinary demonstrations, a structured FPL nutrition curriculum, and fiber tracking tools to help participants engage and participate in weekly health and wellness changes. The program successfully achieved high engagement rates, with 80% of participants reporting high satisfaction with the program and 100% of participants stating …

Implementation Of A Protocol To Improve The Intake Assessment And Treatment With Suboxone Among Patients’ Dependent On Opioids On Two Mental Health Crisis Units, Maeghan Dillon

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: In 2021,106,699 people died from a drug overdose and of these deaths, over 75% were related to illicit or prescription opioids (Centers for Disease Control, 2023). At two in-patient community crisis stabilization units for psychiatric care, many patients have a comorbid diagnosis of a substance use disorder and another mental illness. Treatment with Buprenorphine/naloxone (Suboxone) is associated with decreased opioid overdoses and related deaths; however, Suboxone inductions have not been a part of admission treatment.

Methods: This quality improvement (QI) project initiated a Suboxone protocol for eligible patients on two crisis in-patient stabilization units. The outcomes …

Implementation Of Evidence Based Practices To Reduce Postoperative Sore Throat, Anthony Brusadin

Doctor of Nursing Practice Scholarly Projects

An estimated 15 million endotracheal tube (ETT) intubations occur annually in the United States. In addition to pain and nausea, one of the leading complaints by patients after intubation is a sore throat. Postoperative sore throat (POST) is caused by increased pressure on the trachea from the ETT during intubation and after the ETT cuff has been inflated. To prevent the occurrences of POST many options were explored, including cuff material, shape, filling media, and ETT tube size. Through research one of the ways to reduce POST is by monitoring the cuff pressure of the ETT against the tracheal. Typically, …

Impact Of Discharge Teaching On 30-Day Readmission Rates In The Incarcerated Patient Population, Natasha P. Walker

Doctor of Nursing Practice Scholarly Projects

Problems Statement: Current incarcerated patient policy prohibits communicating discharge information to the patient on day of discharge to mitigate elopement risk. Purpose: The purpose of this DNP project is to improve hospital quality metric 30-day readmission rates in the incarcerated patient population by implementing a trial period of discharge teaching the day of discharge. Method: Implementation of discharge teaching utilizing the Krames patient education standardized discharge teaching tool integrated within the health system’s electronic health record. Analysis: The project’s initial plan to use the Pearson correlation coefficient to evaluate relationship between 30-day readmission rates and standardized discharge teaching on the …

Use Of A Palliative Care Trigger Tool In A Surgical-Trauma Intensive Care Unit, Courtney Thomas

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Patients are not habitually screened for palliative care consultations, and there is no protocol for initiating communication with palliative care. Not only is this a problem at the local and state level, but only about 5% of acute care patients nationally are estimated to utilize palliative care services. This delay in specialty care that palliative consultations could provide negatively impacts patients. Purpose: This evidence-based practice (EBP) project aimed to determine if a palliative care trigger tool in an intensive care unit (ICU) would increase the number of palliative care consultations. Methods: A pre-implementation survey was distributed to ICU …

Integration Of Problem-Solving Therapy To Address Mental Health Needs Of Family Medicine Patients, Robert M. Sutter

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Patients in Family Medicine at an academic medical center in the Southeast who show signs and symptoms of depression are being referred to behavioral health to manage their depression symptoms. Long waiting lists, which delay the patient’s time to see behavioral health and a lack of patient education about the need for mental health services led to delays in patient care and poor appointment adherence.

Purpose: The purpose of this project was to determine if providing Problem Solving Therapy (PST) in a one-time setting, after referral from the primary care provider (PCP), with psychoeducation, decreases depression scores for …

Implementation Of A Pcp Referral In Urgent Care For Patients With Hypertension, Teri Alesha Scott

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adult patients with uncontrolled hypertension at Saluda Pointe Urgent Care (SPUC) do not have an established primary care provider (PCP) for follow-up.

Purpose: To improve access to care by establishing patients with uncontrolled hypertension (>140/90) with a PCP.

Method: Implement a PCP referral at SPUC for patients with uncontrolled hypertension. The Primary Care Connection Center (PCCC) contacted the referred patients within 72 hours to schedule an appointment. An Organizational Change Management (OCM) Solutions survey measured provider attitude and readiness for change before and after implementation.

Inclusion Criteria: Adult patients 18 and older, without an …

A Response Team Approach To Reducing Restraint Use In The Emergency Department, Sarah Place

Doctor of Nursing Practice Scholarly Projects

Assaults on staff are doubling in the healthcare field, and due to the urgent need to secure the environment, the use of restrictive measures is at times, the safest choice. The following project examined the implementation of a Behavioral Emergency Response Team approach in an Emergency Department, and the effects it had, on reducing the use of violent restraints, assaults on staff, and increase confidence of staff in managing difficult situations. An anonymous survey was used to measure staff confidence while handling agitated patients, and an event report was used that identified if de-escalation techniques were employed to assist in …

Improving The Discharge Process In A Post-Acute Care, Skilled Nursing Facility To Decrease Hospital Readmissions, Shantoria W. Parker

Doctor of Nursing Practice Scholarly Projects

Problem: Older adults recently discharged from a skilled nursing facility (SNF) (often referred to as short-stay facilities) experience a period of vulnerability while transitioning back into the community, placing them at increased risk of adverse events, including hospital readmissions (Anderson et al., 2021). Completing a timely appointment (within 7 days) with primary care providers following discharge into the community reduces patients’ risk of preventable hospital readmissions (RHI, 2023) through interventions aimed at promoting coordinated care and safe transitions (Patel et al., 2019). However, more than 50% of readmitted patients failed to visit a primary care provider's (PCP) office between SNF …

Early Palliative Care Screening Among Solid Tumor Oncology Patients, Kaitlin Lothe

Doctor of Nursing Practice Scholarly Projects

While there are extensive benefits of integration of early palliative care, referral to this specialty tends to occur late in the disease course after some form of suffering has already occurred (Hausner et al., 2021). The purpose of this DNP student’s quality improvement project was to improve care coordination and increase rate of palliative care referrals of solid tumor oncology patients through implementation of an evidence-based trigger tool for palliative care screening. Participants were recruited from a 36-bed inpatient adult medical oncology unit where identified patients meeting criteria were included in the study. Data for this study included participant demographics, …

Implementation Of “The Pause” To Promote Clinician Wellness, Aishia Shonta Jennings

Doctor of Nursing Practice Scholarly Projects

Clinicians experience work-associated trauma after unsuccessful resuscitation efforts and may internalize the trauma unless it is addressed. The purpose of this DNP project was to conduct a pilot to determine whether “The Pause” is a practice that could be adopted throughout the organization to promote clinician well-being after patient resuscitation efforts, often called a “code blue” event. The model for this evidence-based practice change is the six-step Rosswurm and Larrabee (1999) model. Data analysis included six measures: the number of code blue events that occurred during the implementation period, the number of code blue events that were unsuccessful in patient …