Nursing Commons^™

A Quality Improvement Project: Streamlining The Post-Surgical Process In Total Knee And Hip Replacements With An Evidence-Based Guidance And Practice Protocol, Bianca Bullie

Doctoral Projects

ABSTRACT

The rates of total joint replacements, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA), are on the rise in the United States and are expected to rise further in the next 20 years (Singh et al., 2019). Implementing an ERAS protocol coupled with current orthopedic practices will decrease a vast number of postoperative issues such as length of hospital stays, the financial burden on the facility, and overall patient satisfaction. The DNP project proposed a multidisciplinary protocol to standardize the care of patients undergoing THA or TKA and identified if this surgical process would be adopted …

Improving Compliance With Treatments For End-Stage Renal Disease Patients On Hemodialysis, Susan Blakeney

Doctoral Projects

According to Blumrosen et al. (2020), the dialysis population cost expenditure is greater than “seven percent of the Medicare budget at nearly $40 billion a year” even though this population is “less than one percent of the Medicare population” (p. 1436). Additionally, the renal disease population is growing in the United States and internationally which contributes to rising healthcare costs around the globe (Levin, 2018).

The purpose of this Doctor of Nursing Practice (DNP) project was to identify the factors or reasons hemodialysis patients miss treatments or only stay for partial treatment. Hemodialysis patients are required to have treatments three …

Improving Readiness For Nursing Practice Via Simulation In Workplace Violence Mitigation, Paul J. Weingartner

Doctoral Projects

Workplace Violence (WPV), a significant problem in health care in the United States and worldwide, causes emotional and physical harm to nurses, negatively affects quality care delivery, and contributes to burn out, job dissatisfaction, and attrition. Clinical simulation was used to educate registered nursing students about WPV and train them in mitigation techniques in an effort to improve their awareness and readiness for professional nursing practice. Data from 37 students in their final semester of nursing school were collected anonymously prior to and after reviewing online materials about WPV and attending a 3-hour simulation experience in which two scenarios were …

Evaluating Pre-Anesthesia Telehealth Visit Outcomes In Cardiac Surgery Patients At A Tertiary-Level, Private, Academic Hospital, Ann Pan

Doctoral Projects

Telehealth is a dynamic, growing field in healthcare. Research has alluded to the potential of telemedicine in the pre-anesthesia area. With infection risk concerns brought to the forefront of healthcare due to the COVID pandemic, telemedicine offers an alternative evaluation method. Telehealth extends care to patients who otherwise would not have access to more comprehensive pre-anesthetic care and surveillance. Although studies show telemedicine's potential and positive effects, institutions have not extended virtual visits for all cardiac surgery pre-anesthesia patients. This retrospective evaluation study aimed to assess the impacts of telehealth on cardiac surgery pre-anesthesia assessments in a tertiary-level, private, academic …

How Implementing A Digital Competency Management System Reduced Nurse Training Cost And Improved Npd Practitioner Satisfaction In A Pediatric Hospital, Dionne Margallo

Doctoral Projects

Healthcare organizations must have high-quality nursing staff to deliver optimal patient care. Educators and managers evaluate nurses by their performance through nursing competencies, or “knowledge, skills, [and] abilities” (KSA) (American Nurses Association, 2015, p. 86). Traditional competency evaluations and manual tracking posed a problem within one pediatric hospital. Leaders did not have a transparent way to see the knowledge and skills of their nursing staff. This resulted in increased organizational costs due to retraining and increased workload and job dissatisfaction among educators. The purpose of this quality improvement (QI) project was to evaluate how implementing a digital competency management system …

Evaluating The Impact Of An Evidence Based Practice Education Program In A Nurse Residency Program On Evidence Based Practice Beliefs, Implementation And Competency, Amy Hu

Doctoral Projects

For organizations to ensure that they are providing safe and quality patient care, they must promote a culture of care based on Evidence Based Practice (EBP). To improve healthcare quality nurses must make care decisions based on the most current scientific evidence. In fact the Institute of Medicine set a goal that 90% of clinical decisions be evidence based by 2020 (Institute of Medicine, 2008). Unfortunately it can take up to 15-20 years for newly discovered treatments to be implemented into patient care (Institute of Medicine, 2001). Healthcare providers continue to base healthcare decisions on outdated practices derived from tradition …

Implementing High-Intensity Trauma-Informed Sexual Behavior Risk Reduction In Justice-Involved Women, Lakisha M. Holton

Doctoral Projects

Sexually transmitted infections continue to be a source of significant morbidity in people with a history of incarceration, particularly women. Justice-involved women are at exceptionally high risk of long-lasting and severe health consequences of contracting an STI. This evidence-based practice implementation project used a repeated measures design to compare sexually transmitted infection knowledge acquisition and condom use self-efficacy in a group of incarcerated women before, immediately after, and three weeks following participation in the Safer Sex Self-Efficacy Workshop. Of the participants (N= 21), 100% demonstrated a significant increase in sexually transmitted infection knowledge and condom use self-efficacy between pre- and …

Preparing Nurses For The Transition To Practice With Virtual Simulation, Jennifer Holm

Doctoral Projects

This project assessed the clinical reasoning objectives of first-semester nursing students who had up to 75% of their clinical time using virtual simulations compared to those who primarily had traditional direct-care clinical experiences with up to 12% of their time in simulation. The principal investigator reviewed clinical reasoning measures within student evaluations from the Fall 2019 and Fall 2021 cohorts of an Associate Degree in Nursing (ADN) program. The results of a two-tailed independent samples t-test demonstrated a slight reduction in the clinical reasoning abilities of the cohort with a higher proportion of simulation. However, there were several possible confounding …

A Retrospective Evaluation Of Pain Management Of The Postpartum Inpatient After Birth, Ronda Harden

Doctoral Projects

A multimodal plan of care to manage pain can effectively help reduce the risk of opioid dependency and addiction. The concerns about the rise in the rate of new persistent opioid use among women exposed in postpartum indicate a need for a practice change in managing pain after birth. This retrospective study evaluated the impact of implementing a multimodal plan of care in treating the pain of the postoperative postpartum patient. A notable finding was that fewer milligrams of opioids were administered after a practice change. The mean total was significantly different between the pre-and post-group, with a higher percentage …

Implications Of Educational Counseling On Prep Uptake In Msm At A Community Health Clinic, Thanh T. Dinh

Doctoral Projects

HIV pre-exposure prophylaxis (PrEP) medication is 99% effective at preventing HIV acquisition if used daily (CDC, 2020; FDA, 2019). Despite its effectiveness and wide availability, PrEP uptake and adherence remained low, especially among MSM of color (Bradley et al., 2019; Kuhns et al., 2017). Prior studies have shown that participants exposed to PrEP information, counseling, and education were more likely to show interest in PrEP and uptake of PrEP. Although various studies support the effectiveness of educational interventions in increasing PrEP uptake, it has not been widely implemented in the practice setting in communities that would benefit from it. The …

Asthma Care By Unlicensed Personnel In The Elementary School Setting: A Training Program, Teresa Eligio

Doctoral Projects

This Quality Improvement project (QI) aims to improve the competence and confidence of unlicensed school health staff in identifying asthma symptoms, reading an asthma action plan, asthma care, emergency response, medication delivery tools, and trigger reduction in the school setting. The QI project transpired in an Elementary School District in Los Angeles County, CA. The Project Manager, an asthma instructor trained by the American Lung Association, provided evidence-based Asthma-Basics training for health clerks (HCs), substitute health clerks (SHCs), licensed vocational nurse health clerks (LVN HCs), school office coordinators (SOCs), school office attendance clerks (SOAs), and substitute school office staff (SDO). …

Game-Based Refresher Training For Registered Nurse Providers Of Neonatal Resuscitation, Renee Billner-Garcia

Doctoral Projects

Based on evidence suggesting resuscitation provider knowledge and skill decay can occur as soon as four weeks post-training, the American Heart Association (AHA) recommends more frequent resuscitation refresher training. While current resuscitation training and education practices center on simulation training, its cost in terms of supplies, equipment, and personnel may be creating barriers to increasing the frequency of refresher training. This quality improvement project implemented a game-based, refresher training for registered nurse providers of neonatal resuscitation with a focus on improving the time to initiation of positive pressure ventilation (PPV) per Neonatal Resuscitation Program (NRP) guidelines. Using commonly available free …

Tiered Centralized Education In The Transition-To-Practice Program To Improve Nurses' Level Of Confidence On Nursing Sensitive Indicators Outcomes, Froiland Agana Ascaño

Doctoral Projects

A tiered Centralized Education in the Transition-to-Practice (TTP) Program is crucial to improving nurses' Level of Confidence on nursing-sensitive quality indicators. The benefits of a structured orientation program taught by trained content experts are evident in the literature. In addition, training transition-to-practice RNs during onboarding with training and assessment sessions throughout the orientation program to increase frequency provides skills acquisition. This study examined the impact of a house-wide education program on the nurses' confidence levels of CLABSI prevention, a measured nursing-sensitive quality indicator. This quasi-experimental quality improvement study measured the confidence and comfort levels of transition-to-practice RNs and identified that …

Full Practice Authority: Determining Readiness Among Nurse Practitioner Students In Mississippi, Betty Hoffman

Doctoral Projects

Full practice authority has been granted to nurse practitioners by many states. These practitioners are educated and trained as full primary providers of health care. Full practice authority for nurse practitioners is not granted in Mississippi, which currently ranks in the lowest positions for health care in the United States. The low ranking can be attributed to a lack of providers and access to services.

This project seeks to explore attitudes and understanding of nurse practitioner students in the State of Mississippi regarding full practice authority. A survey will be electronically distributed to determine what is already known and understood …

Improving The Process Of Pain Management By Implementing Best Practices In A Nursing Home, Sukhjit Dhillon

Doctoral Projects

Pain is often untreated or undertreated among older adults living in nursing homes. The lack of standardized pain management protocols makes it difficult to address pain in this population. Deficiencies in pain management and documentation were identified in a nursing home and a performance improvement project was implemented with the aim to improve pain management, pain documentation, and staff knowledge of pain management. A pre-and post-intervention study design was used, and data analysis included descriptive statistics and a paired samples t-test. Participants (n=12) included seven registered nurses and five licensed vocational nurses who provide direct care to the residents in …

Educational Intervention With Visual Cues To Increase Compliance With Postoperative Warming, Michael J. Domingo

Doctoral Projects

Millions of operations are performed annually in the United States. However, postoperative hypothermia still affects surgical patients who are not thermoregulated and can occur among them during the postoperative period. Postoperative warming compliance rates across countries and institutions are generally poor (Koh et. al, 2021). Therefore, the focus of the DNP project was to assess how providing education on postoperative warming and providing visual cues to the PACU RNs would increase postoperative warming compliance. The PACU RN participants were provided postoperative warming education with visual cues. Specifically reviewed with the PACU RNs was taking the patient’s temperature, connecting the patient …

Impact Of Mindfulness Practice On Compassion Fatigue In Pediatric Cardiovascular Critical Care Nurses: A Quality Improvement Project, Kendy Luu

Doctoral Projects

Background: A considerable proportion of the extant literature on healthcare has documented compassion fatigue (CF) as a major factor that contributes to poor job performance, satisfaction, and negative patient outcomes (Figley, 2002). CF is well known to negatively impact patient care and outcome, relationships, and job satisfaction among pediatric cardiovascular intensive care (CVICU) nurses. Developing interventions to reduce burnout and CF bear the potential to reduce costs and improve quality care; one particularly promising approach in this regard is the practice of mindfulness-based stress reduction (MBSR). Purpose: This quality improvement project aimed to determine the impact of an abbreviated MBSR …

Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach

Doctoral Projects

The lack of preoperative warming has a direct relationship to perioperative hypothermia complications which include, but are not limited to: increased infection rate, coagulopathies, and increased myocardial oxygen consumption; all contributing to poor patient and facility outcomes. Implementation of an evidence-based educational module with visual aid can potentially increase the utilization of active warming techniques in the preoperative setting by perioperative staff. The DNP Project investigated barriers to preoperative warming by perioperative staff at a large teaching hospital in the southeastern United States. Barriers were assessed by a voluntary survey sent to 87 perioperative staff members. Twenty-two surveys were completed …

Implementation Of A Pre-Anesthesia Take-Home Evaluation (Pathe) As A Means Of Process Improvement: A Best Practice Recommendation, Russell Gray, Hunter Brown, Trey Galloway

Doctoral Projects

The pre-anesthesia evaluation (PAE) is a vital component to anesthesia providers when choosing an appropriate anesthetic plan for patients requiring surgery. The PAE, pre-anesthesia risk-factor assessment, and provision of pre-anesthesia instructions are standards of care implemented in order to assess the patient’s likely outcome of surgery and anesthesia as well as stratify any known risk factors to optimize surgical/anesthetic outcomes. Any disruption in this process could potentially lead to decreased patient/provider satisfaction, reduced patient compliance with pre-anesthetic instructions, reduced patient safety, and unnecessary financial burden.

After the completion of a literature review, the need for a best practice recommendation was …

Implementation And Evaluation Of A Registered Nurse Pre-Eclampsia Education Program Within A Women's Urgent Care Center, Amber Vetter

Doctoral Projects

Pre-eclampsia can be a serious development for both mother and fetus during pregnancy. Increased mortality and morbidity rates have been shown in women diagnosed with pre-eclampsia. Higher education for registered nurses on a Women’s Urgent Care (WUC) center will help diagnose the mother more quickly and inevitably receive treatment sooner leading to better outcomes for the birth of her newborn. The educational tools used in the study were a pre-and post-test and an educational video for the registered nurses to watch. A retrospective chart review before and after the intervention will help to see if there is any decrease in …

Evidence-Based Update In Practice Development Of A Nursing Checklist For Documentation Of Pediatric Pre-Operative Fall Safety Measures, Susan Shemper

Doctoral Projects

ABSTRACT

Fall safety is an important component of patient care in the healthcare setting. Communication and implementation of fall safety measures are a critical part of the plan of care for each patient. Pre-operative pediatric patients have an increased risk of falls due to sedation, under-developed motor skills, and fall safety education. It is important for the pre-operative nursing staff to evaluate and implement a plan of care, including fall safety measures, according to each patient’s needs. The Joint Commission, (additionally known as TJC), is a United States based nonprofit, tax-exempt 501(c)(3) organization that accredits more than 22,000 U.S. healthcare …

Objective Structured Clinical Evaluation For Supraclavicular And Femoral Nerve Blocks Utilizing Ultrasound Guidance For Student Nurse Anesthetists, Mitchell Fowler, Christopher Bond

Doctoral Projects

The purpose of this DNP project was to create a tool to teach and evaluate student registered nurse anesthetists (SRNAs) at TheUniversity of Southern Mississippi (USM) on supraclavicular and femoral nerve blocks to promote safety in the clinical setting. An objective structured clinical evaluation (OSCE) for ultrasound-guided supraclavicular and femoral nerve blocks was created as the basis for this project. Best-practice techniques as identified by the AANA’s 14^thstandard of nurse anesthesia practice were researched and used in the development of the OSCE to promote a culture of safety for SRNAs and patients (AANA, 2019).

A culture of safety …

Best Practice Recommendation On Anesthesia Involvement In Preoperative Interdisciplinary Rounding On Surgical Inpatients, Elizabeth Davis

Doctoral Projects

Healthcare professionals are always seeking methods to improve patient care and patient outcomes and increase efficiency while reducing errors. By improving communication through the implementation of interdisciplinary communication, improved care quality, fewer variations in care, and enhanced collaboration among the healthcare team may be an outcome (Hoke & Falk, 2012). While anesthesia is involved in patient care throughout the perioperative period, their expertise may impact the patient’s outcome and quality of surgical care. With the involvement of anesthesia in interdisciplinary rounding, the patient may be optimized, and the plan of care may be more appropriate and individualized.

The potential for …

Increasing Knowledge Of Fibromyalgia Diagnostic Criteria Using A Screening Tool In Primary Care, Diane Morris

Doctoral Projects

ABSTRACT

Fibromyalgia (FM) is a chronic pain condition that is second only to osteoarthritis. Fibromyalgia dramatically impacts the quality of life, with its many symptoms requiring a multidisciplinary approach to treatment. The recommendation is that patients with fibromyalgia are treated in primary care, as are other chronic diagnoses such as hypertension and diabetes, with referrals to other disciplines as needed. However, some primary care providers may not recognize fibromyalgia as a valid diagnosis, have received inadequate formal training in fibromyalgia, and have limited awareness of diagnostic criteria.

According to the research, as many as 3 out of 4 people with …

A Safety Net: Early Assessment Of Multiple Social Determinants Of Health Risk Factors In The Pediatric Inpatient Population, Emily Caroline Brister

Doctoral Projects

A lack of protocol for screening of social determinants of health (SDH), specifically for pediatric patients, despite national endorsement, is setting a basis for increased rates of negative health outcomes that can follow individuals into adulthood. The PRAPARE tool, or the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences, is a guided national effort to assist healthcare centers in the collection of the necessary social data required to care for patients and act upon their social determinants of health (The National Association of Community Health Centers [NACHC], 2019). This project acted to identify if the early assessment …

The Effects Of Telehealth On Patient Satisfaction And Information Recall For Breast Cancer Survivors During Covid-19, Stacey Teicher

Doctoral Projects

The coronavirus (COVID-19) pandemic has changed how cancer survivorship care is delivered. (Al‐Shamsi, 2020). To protect vulnerable breast cancer patients, health care providers are moving towards telecommunication such as telephone, video, and secure messaging (electronic mail) versus in-person visits to connect with their patients (Segelov et al., 2020) during this pandemic. Breast cancer survivorship visits can be safely deferred from in-person visits to telehealth visits (Dietz et al., 2020). This doctoral project examines the impact of transitioning from in-person to telehealth (telephone or video) visits on patient satisfaction and recall of information for breast cancer survivors reviewing their Survivorship …

Michigan Physician Orders For Scope Of Treatment: Development Of A Nationally Recognized Program, Megan Owens

Doctoral Projects

Background: Advance directives are well intentioned, but fail to promote patient autonomy in emergent situations.

Objective: To develop a sustainable portable medical order program consistent with national standards through an evidence-based toolkit.

Methods: A literature review and policy analysis were conducted to develop toolkit. Interviews were conducted with content experts to validate toolkit.

Results: The final toolkit consisted of five components: educational materials for healthcare providers, a policy brief, strategies for fund development, strategies for quality monitoring, and a cost savings exemplar.

Conclusions: An evidence-based toolkit tailored to state-specific barriers is critical to development of a portable medical order program.

Improving Adolescent Risk Assessment And Provider Follow-Up In Primary Care, Darby R. Disselkoen

Doctoral Projects

Purpose: The purpose of this quality improvement project was to improve preventive care for adolescent patients by implementing standardized, routine screening for risk-taking behaviors and improving provider response to identified risks using the Rapid Assessment for Adolescent Preventive Services tool and resources for providers to reference during discussions about risk.

Methods: Quality improvement methodology was utilized at a midwestern pediatric primary care office to implement a practice workflow for staff to follow during annual, adolescent wellchild exams beginning at age thirteen.

Results: Analysis of project results demonstrated a significant increase in routine screening for adolescent risk behaviors compared to the …

Evaluating The Impact Of Nurse Server Standardization On Patient Safety, Megan L. Priebe

Doctoral Projects

Aim: The aims of nurse server (supplies at bedside) standardization program evaluation were to: (1) examine supply costs; (2) identify staff efficiency; (3) evaluate patient safety; (4) identify staff satisfaction and acceptance.

Background: A healthcare facility in the Midwest implemented standardization of the nurse server. Standardization was done to improve patient safety and staff efficiency

Methods: The literature provided metrics for evaluating standardized nurse servers to determine the impact on patient safety. Specific measures used in this quality improvement project were: census data, costs analysis, supply room observations, semi-structured interviews, and data from the VOICE reporting system (system for adverse …

Evaluation Of A Chewing Gum Protocol For Postoperative Spinal Patients, Lauren E. Vachon

Doctoral Projects

Aims and objectives: The purpose of this project was to evaluate if the implementation of a chewing gum protocol improved bowel motility, decreased ileus rate, length of stay, bowel and pain medication use, and hospital costs in post-surgical spinal patients in a suburban hospital.

Background: Postoperative bowel dysfunction is a major source of health problems, including abdominal pain, ileus, increased length of stay, pain medication use, and healthcare costs.

Design: Retrospective cohort study with a focus on program evaluation of the previously implemented chewing gum protocol. An audit of the electronic health record compared outcomes in patients five months before …