Nursing Commons^™

A Program Evaluation To Assess Readiness For The National Committee For Quality Assurance’S Patient Centered Medical Home Model Application, Alida M. Semrinec

Doctoral Projects

The Patient Centered Medical Home Model is associated with enhanced patient experience and quality improvement outcomes. The Model has the capacity to guide primary care practices to enhance quality, provide more comprehensive, patient centered care, and increase practice revenue. An urban, nurse managed community health center that has recently implemented the nurse care manager role (a Model requirement) desires to apply for recognition. A program evaluation was conducted to assess current practice, policies, and procedures in place at a Community Health Center through the lens of the National Committee for Quality Assurance’s forty Patient Centered Medical Home Model core competencies. …

Utilization Of Home Blood Pressure Monitoring In Adult Patients With Hypertension, Justin R. Crow

Doctoral Projects

Hypertension is one of the most prevalent conditions in the United States, affecting roughly 45% of adults in the country (Centers for Disease Control and Prevention [CDC], 2020). The CDC (2020) reports that only an estimated 24% of patients have controlled blood pressure, which is defined as blood pressure less than 130/80 mm Hg. In 2017, the American Heart Association (AHA) and American College of Cardiology (ACC) released a comprehensive set of guidelines that aimed to assist providers with hypertension management. The Measure Accurately, Act Rapidly, and Partner with Patients (MAP) protocol was formulated as an evidence-based strategy to improve …

Enhancing Medication Adherence Behaviors Among Ambulatory Pediatric Hematology & Oncology Patients: A Quality Improvement Project, Desiree Palmer

Doctoral Projects

Introduction: Researchers have found that pediatric patients with acute lymphoblastic leukemia and adolescent patients with sickle cell disease struggle to adhere to medication treatment requirements. Because of this trend, there is a clear need to address medication adherence. The purpose of this quality improvement project was to enhance medication adherence behaviors among pediatric hematology and oncology patients and their families within an ambulatory hematology and oncology clinic.

Methods: The project included a systematic literature review to identify evidence-based interventions, an organizational assessment, and a three-phase multifaceted quality improvement process. To increase patients bringing medications to appointments, 32 medication transportation bags …

Promoting Civility In The Workplace: Addressing Bullying In New Graduate Nurses Using Simulation And Cognitive Rehearsal, Sandy Phan

Doctoral Projects

Bullying continues to be a widespread, devastating problem in nursing. Research indicates that bullying has a negative, rippling impact on nurses, organizations, and patient care. This evidence-based practice project aimed to enhance new graduate nurses’ abilities to identify and respond to bullying behaviors. The intervention used a mixed educational methodology of didactic, simulation role-play, and cognitive rehearsal. The project was implemented at a large academic healthcare system in Northern California. Outcomes were evaluated using Kirkpatrick levels 1-4 and the Clark Workplace Civility Index (CWCI). Participants reported that the educational intervention met intended learning objectives, enabled them to apply learned behaviors …

The Effects Of Virtual Reality On Symptom Distress In Patients Undergoing Hematopoietic Stem Cell Transplant, Colleen Vega, Robin Whitney, Josef Hannah, Grant Smith

Doctoral Projects

The purpose of this QI project was to evaluate the effects of virtual reality (VR) on symptom distress experienced by individuals receiving an allogenic stem cell transplant. Allogenic transplants are associated with a moderate to high risk for distressing symptoms such as depression, anxiety, and pain. VR targets multiple sensory modalities, including auditory, visual or haptic experiences, by using computer-generated scenarios, which can interact with an individual and possibly diminish unpleasant symptoms. Twenty individuals aged 19 to 70 years (median age of 56.5 years) who were hospitalized in an academic setting received VR up to two sessions a week for …

Improving Handover Process For Stroke Patients Transferring From Emergency Department To Interventional Radiology: A Quality Improvement Project, Megan Buchman

Doctoral Projects

Background: A standardized handover process is needed for stroke patients transferring from the Emergency Department to Interventional Radiology.

Local Problem: Emergency Department and Interventional Radiology had different handover processes.

Methods: A quality improvement project was conducted in a large Magnet® designated midwestern health system. Participants included emergency department and interventional radiology nurses and stroke patients. Pre/post-quality and post implementation measures were obtained.

Interventions: The interventions included utilizing a standardized handover tool between departments, calling report prior to patient transfer, and turning in handover tool following stroke case to ensure compliance. Two cycles of the Plan-Do-Study-Act Cycle were completed.

Results: No …

“Warm Handoff” To Increase Enrollment In A Maternal Infant Health Program, Samantha Worthem

Doctoral Projects

Introduction: In a Midwest Health Department’s (HD) Maternal Infant Health Program (MIHP), infant death rate has been on a steady incline at 4.8 deaths per 1,000 in 2019 (Michigan Department of Community Health, 2020). Implementation of a “warm handoff” between the local HD and Michigan Department of Health and Human Services (MDHHS) was created to increase enrollment and visits. During warm handoffs, health care providers work together within the same setting to provide evaluation and care to patients and clients (Musselman et al., 2018).

Methods: This program evaluation reviewed data retrospectively from March 31 to September 30, for 2019 and …

Enteral Nutrition Protocol For Pediatric Burn Patients: A Quality Improvement Initiative, Margaret Tepe

Doctoral Projects

Objective: This quality improvement project was conducted to determine the efficacy of an enteral feeding protocol to improve nutrition supplementation in pediatric burn patients.

Methods: Non-ICU patients with >10% total burn surface area requiring enteral nutrition supplementation were fed within 12 hours of admission or with the first sedated dressing change, whichever took place first. Pre (n = 3) and post (n = 5) implementation of the enteral feeding protocol data were obtained. Data were collected via chart audit and survey.

Results: Patients and nurses had similar characteristics; and nurses had similar nutrition practices. Total intake of calories (93.8%) and …

Improving The Screening And Care Of Hospitalized Adults With Obstructive Sleep Apnea Through Standardized Workflow Processes, Elizabeth Henschel

Doctoral Projects

BACKGROUND: Adults can be screened for obstructive sleep apnea in acute care settings using the validated STOP-BANG questionnaire. Healthcare providers can treat patients with confirmed or suspected obstructive sleep apnea to reduce risk for complications during hospitalization or after surgery.

PURPOSE/ RELEVANCE TO HEALTHCARE QUALITY: To determine if the standardization of obstructive sleep apnea screening and patient care workflows improves process efficiency saving nursing time and healthcare expenses.

METHODS: Quality improvement project included an organizational assessment of healthcare system setting to define clinical problem; determined appropriate evidence-based interventions; and implemented strategies guided by quality improvement models.

INTERVENTION: Updated inpatient units …

A Budget Impact Analysis Of A Tobacco Control Program In A Community Mental Health Clinic, Thuy-Nhi Nguyen

Doctoral Projects

Objectives: This project evaluation aimed to determine if the tobacco cessation program, American Lung Association’s Freedom From Smoking (ALAFFS), within the designated community mental health organization (CMHO) is affordable and sustainable through a budget impact analysis.

Methods: The study modeled the impacts on the costs of facilitator training, staff salaries/time, program workbooks, program supplies, bus passes, and other supplies and materials. The Medicaid reimbursement rate used for tobacco cessation group therapy was included. The budget impact analysis projected financial consequences of the presence of training costs and number of smokers with severe mental illness who attended the program.

Results: The …

Improving Care Coordination For The Homeless Population Using Systematic Quality Improvement, Rutendo Nyasvisvo

Doctoral Projects

Background and Objectives: Care coordination for the homeless population is challenging due to the complexity of healthcare and the uncertain life circumstances of the homeless individual. Objectives were developed to guide care coordination for the homeless by utilization of the free clinic to create PCP referrals, appointments and tracking follow-up care to increase appointment attendance and improve health outcomes for the homeless individual.

Design: A quality improvement project.

Setting: A faith-based non-profit homeless shelter organization in the Midwestern United States.

Participants: Participants include 25 homeless guests, 5 staff members including a clinic coordinator, 3 registered nurses and 1 licensed practical …

Sickle Cell Disease: Development Of An Acute Pain Management Program In A Hematology/Oncology Practice, Elizabeth Pohl

Doctoral Projects

Background: Patients with sickle cell disease experience can experience acute episodes of severe pain that require prompt pain medication. Treating uncomplicated, acute sickle cell disease pain in the emergency department setting has been shown to be costly and lead to higher rates of hospitalization than similar care in a dedicated outpatient setting.

Objectives: The aim of this article is to outline the program development efforts undertaken to apply current literature findings and evidence-based practice guidelines to create a program development toolkit and business plan for a sickle cell disease acute pain management program in an outpatient hematology practice.

Methods: A …

Utilizing Educational Materials To Change Vaccine Compliance In Children Under 24 Months Of Age, Kelsey M. Arnold

Doctoral Projects

Background: Childhood vaccinations are critical to preventative care for the pediatric population. The goal for the clinic’s combination 10 insurance quality measure, which reflects the number of fully vaccinated children by 24 months of age, is to be greater than 68%.

Purpose: This quality improvement project sought to implement evidence-based interventions to improve childhood vaccine compliance by increasing the parent/caregiver’s knowledge about vaccines and increasing the communication with their healthcare provider.

Methods: A parent friendly vaccine schedule, information pamphlet, interactive video, and survey were given to parents/caregivers during well-child visits. A total of 117 parent/caregiver surveys were collected. Vaccine compliance …

Addressing Social Determinants Of Health In Community-Based Palliative Care, Mary D. Chenge

Doctoral Projects

Background and Objectives: Addressing social determinants of health (SDOH) in the medical community has recently started; however, there is yet to be a standardized format for addressing the social needs of patients. Consequently, a protocol was developed to address SDOH to increase screening rates, social work referrals, and capture depression reimbursement.

Methods: The quality improvement project was implemented using the Plan-Do-Study-Act framework at an urban Community-Based Palliative Care organization in the Midwestern United States. Participants included office staff and 140 patients (two separate sets of 70 randomly selected patients pre/post-implementation). A protocol was developed for screening 11 SDOH using an …

Improving Nurses’ Provision Of Neuroprotective Care In The Nicu: A Quality Improvement Project, Tammi Reeves-Messner

Doctoral Projects

Infants born prematurely (less than 37 weeks’ gestation) require specialized medical and nursing care to survive. Most of these babies require some form of respiratory, cardiovascular, thermal, and nutritional support as their bodies are not yet physiologically mature enough to handle these basic functions on their own. These supports include basic care such as diaper changes and feeding as well as life-saving interventions which include ventilation, intravenous nutrition, thermal regulation, and vasoactive medications. Depending on their gestational age or their diagnoses, they may require higher levels of support, such as nitric oxide gas delivered via a ventilator (Lai et al, …

Creating Equal Opportunities Through Developmental Screening At A Rural Health Clinic, Allison Honderd

Doctoral Projects

Background: 17% of United States children have a developmental delay, but only 2-3% receive early intervention referrals (Rice et al., 2014; Zablotsky et al., 2019). Standardized developmental screening improves developmental delay identification and early intervention referrals (Guervara et al., 2013; Lipkin et al., 2020).

Objectives: This project aimed to implement standardized developmental screening, refer positive screenings, and generate revenue through proper billing.

Methods: A 12-week quality improvement project was implemented with the M-CHAT and Ages and Stages Questionnaire (ASQ) through four PDSA cycles at a rural health clinic for 9, 18, and 24-month well-child checks. Data were analyzed through a …

Program Evaluation Of Parent Engagement Activities In The Pediatric Cardiac Intensive Care Unit, Cheryl A. Bos

Doctoral Projects

Introduction: Leaders of a six-bed pediatric cardiac critical care unit identified the need to evaluate family engagement in patient care activities prior to implementing quality improvement initiatives. This program evaluation identified staff and family perception of barriers and facilitators to parent engagement in the Pediatric Cardiac Intensive Care Unit.

Methods: Data were collected through quantitative and qualitative methods. Surveys collected staff baseline and parent pre-/post-hospital perception of the role of family engagement in caring for the child.

Results: The Questionnaire of Factors That Influence Family Engagement survey of 58 registered nurses indicated the nurse workflow (τb = .579, p = …

Apneic Oxygenation: An Adjunctive Therapy For Laryngoscopy During Anesthesia Induction, Yaro Hoffman

Doctoral Projects

Endotracheal intubation is an essential component within the skill set of anesthesia providers. Rapid arterial desaturation remains a primary risk factor during laryngoscopy and intubation. The risk for hypoxemia exists because during endotracheal intubation, patients are apneic or hypo-ventilating (Wong et al., 2017). Apneic oxygenation (AO) has been advocated to attenuate hypoxemia during endotracheal intubation (Pavlov et al., 2017).

The aim of this project was to assess for any knowledge deficits regarding AO among anesthesia providers and assess the willingness of these providers to include AO into their current practice. The project investigator conducted an education session involving the …

Using Collaborative Objective Simulation Clinical Evaluation With Undergraduate Nursing Students And Nurse Anesthesia Students Labor Epidural Placement In An Active Labor Patient, Chaka K. Jackson, Aisha Pierre

Doctoral Projects

Developing interdisciplinary teamwork and patient communication skills are essential for the student registered nurse anesthetist (SRNA) to provide quality patient care when administering epidural anesthesia. The synthesis of the evidence revealed limited available information on simulation use for SRNA epidural administration and collaboration. This doctoral project examined the effectiveness of learning through traditional simulation to enhance communication and collaboration between the Bachelor of Science in Nursing (BSN) and the Nurse Anesthesia Program (NAP) students. The BSN and NAP students were provided with a simulation environment to care for a laboring patient while improving patient safety and quality outcomes. The project …

A Best Practice Recommendation: Decreasing Perioperative Fentanyl Used Through The Utilization Of Dexmedetomidine Prior To Surgical Incision, Shelby Harriel, Amy Houck

Doctoral Projects

Upon anesthesia induction, patients often receive fentanyl, an opioid medication that is linked to addiction, dependence, morbidity, and mortality (Stanley, 2014). The goal of this practice recommendation was to propose an alternative way of managing pain and the increased sympathetic response in the perioperative setting, specifically during the induction phase, through evaluating published research. A possible substitute for fentanyl is a drug called dexmedetomidine (Precedex™). Through a comparison of pharmacology, indications, risks, and benefits, one can conclude that if Precedex™ is given prior to induction, in the place of large doses of fentanyl, it can potentially achieve a smoother intraoperative …

Improving Door To Transfer Times For St Segment Elevation Myocardial Infarction In Small Emergency Departments: A Quality Performance Improvement Project, Amber Ryals

Doctoral Projects

Heart disease is a leading cause of death in the United States (Centers for Disease Control [CDC], 2020). ST-elevation myocardial infarctions are around 38% of all coronary syndrome patients that present to the emergency department (Akbar et al., 2020). Smaller, outlying facilities can be at a disadvantage due to the lack of readily available specialties and services, such as a cardiac catheterization laboratory, which has the potential to cause a delay in inpatient care. With standardized cardiac protocols in place at many facilities, initial identification and treatment of myocardial infarctions are begun long before a patient enters a facility, often …

Educating Student Registered Nurse Anesthetist On Malignant Hyperthermia Using An Objective Structured Clinical Examination, Ednita Street Fountain, Faith Sherman

Doctoral Projects

Malignant hyperthermia (MH) is a low-frequency, high-impact event that many student registered nurse anesthetists (SRNA) may be unprepared to manage due to limited exposure in clinical practice (Hackl et al., 1990). Lack of preparation for dealing with such low frequency, high impact events can lead to unfortunate adverse events resulting in death (Hackl et al., 1990). Thus, students should be are prepared to handle these situations if an event should occur.

An objective structured clinical examination (OSCE) is a structured method used to assess certain skills and underpinning knowledge required for practice (Harden & Gleeson, 1979). Students are allowed to …

Ultrasound-Guided Peripheral Venous Access: An Objective Structured Clinical Examination (Osce), Christopher Smith

Doctoral Projects

Intravenous (IV) access is essential to anesthetic practice as it allows the provider to administer fluids, sedative agents, and resuscitation medications. There is, however, a large subset of patients in which IV access can be difficult to obtain due to confounding factors such as preexisting disease, body habitus, and volume status (Sabado & Pittiruti, 2019). Bedside ultrasonography is an effective tool that can be used to gain IV access in these difficult patient populations. The downside to this technology is that there is a learning curve associated with its use, and proper training in ultrasound-guided venous access techniques is crucial …

Developing An Interdisciplinary Team Checklist To Assess Readiness For Appropriate Medical Removal Of Central Venous Catheter (Cvc), Miranda Harper

Doctoral Projects

Healthcare-associated infections are not a new concept in health care. Many different health-care-associated infections have been established over the years including but not limited to healthcare-associated pneumonia, catheter-associated urinary tract infection, and central line-associated bacterial infection. While these infections are common in healthcare facilities, the rates of these infections are still prevalent in hospitals across the United States. This DNP project focused on central line-associated bacterial infections.

An interdisciplinary team checklist to assess readiness for appropriate medical removal of central venous catheter (CVC) was developed to assess intensive care unit patients for early appropriate medical CVC removal. The interdisciplinary team …

Cultural Competence Objective Structured Clinical Examination For Student Nurse Anesthetists, Ashley Nicole Minor, Loryn Elise Jamison

Doctoral Projects

The landscape of ethnicity is growing increasingly diverse. In 2017, the U.S. Census Bureau estimated that by the time the 2020 Census is conducted, over half of the nation’s children will be of a minority group (U.S. Census Bureau, 2017). With this evolution in cultural variety comes a necessity to incorporate exposure and training of cultural competency into professional health programs. Student registered nurse anesthetists (SRNAs) are a key demographic to professional growth within the realms of cultural competence as related to the field of nurse anesthesia. Along with clinical skills and advanced knowledge, cultural competence should be equally developed. …

Mindful Matters: Addressing Barriers To Classroom-Based Mindfulness, Kirsten Munk

Doctoral Projects

A growing body of research suggests that incorporating classroom-based mindfulness interventions in elementary schools is associated with improvements in student behavior, self-regulation, and measures of mental health. However, the adoption of teacher-led mindfulness programs in California’s public schools has not been widely embraced. This doctoral project explored the impact of an educational intervention on pre-service teachers’ perceptions, attitudes, and intentions to implement mindfulness interventions in their classrooms. A brief educational intervention and website resource were provided to multidisciplinary teaching credential students in a 2-year graduate credential program. Participants completed a pre- and post-intervention survey to evaluate their intentions to implement …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

Video Education For Improved Education Of Newly Diagnosed Multiple Sclerosis Patients, Theresa Mccrumb

Doctoral Projects

Anxiety and depression are prevalent in multiple sclerosis (MS) patients, especially those newly diagnosed. Receiving a diagnosis of MS can be overwhelming and impact patients in multiple areas including physical issues, cognitive changes and anxiety and depression (Kantor, Bright & Burtchell, 2017). This anxiety and depression can cause patients to be less engaged in their plan of care and thereby reduce their quality of life (Rieckmann, et al., 2015). According to the Multiple Sclerosis Association of America (MSAA), four of 10 MS patients are diagnosed with depression and anxiety, with the highest incidence at diagnosis (Multiple Sclerosis Association of America, …

Willingess To Use Telehealth For Diabetes Management In The Rural Healthcare Setting, Andrew Kim

Doctoral Projects

Diabetes is a disease that has far reaching physically and financially consequences. This disease has shown to increase morbidity and mortality, along with increasing overall healthcare costs. Optimal management of diabetes may require a multidisciplinary approach across the span of multiple encounters with the diabetic patient. Considering the nature of diabetes, integration of telehealth has the opportunity to improve diabetes management by improving healthcare outcomes, along with potential cost savings. However, the use of novel technology like telehealth is only as useful if patients are willing to use it. Thus, this survey aimed to determining whether patients within a rural …

Evidence-Based Policy And Procedure Review System, Meredith A. Stokes

Doctoral Projects

Policies and procedures guide practice and the care of patients in every field of healthcare. Incorporating best practice evidence into clinical practice is a critical step towards providing safer patient care and improved patient outcomes. The challenge has been finding a way to incorporate best practice evidence into policies and procedures. Accordingly, an evidence-based project to answer the following clinical practice question was proposed: What is an evidence-based strategy for reviewing, updating, and disseminating policies and procedures for office staff at a cancer treatment organization? Through the use of Donabedian’s Model for Quality Improvement, student created tools, and an evidence-based …