Nursing Commons^™

Promoting Self-Efficacy Among Head And Neck Cancer Patients, Lily Lam

Doctoral Projects

Current survivorship visits at the Stanford head and neck oncology program are not standardized to address ongoing post-treatment sequelae. The objectives of this study help to address whether current non-standardized visits actually help to empower patients to self-manage their chronic diagnosis of head and neck cancer by measuring their self-efficacy levels before and after their post-treatment survivorship visit.

Given the convenience sampling method, 17 patients were enrolled in this quasi-experimental pilot study. Demographic information was collected for each patient: gender, ethnicity, smoker status, and age. Head and neck cancer patients would first be surveyed before and after their follow up …

Adult Attention Deficit/Hyperactivity Disorder Quality Improvement Project, Danielle Miller

Doctoral Projects

Adults with Attention Deficit Hyperactivity Disorder (ADHD) vary widely in their symptom presentation and functional deficits, which can make management in the primary care setting challenging for providers (Morstedt, Corbisiero, Bitto, & Stieglitz, 2015). Measurement-based care is common in the management of medical disease, however is rarely used as standard practice in treatment of psychiatric disorders (Waldrop & McGuinness, 2017). As a result, treatment for psychiatric conditions, such as ADHD, may vary widely among clinicians and may result suboptimal treatment and patient outcomes (Waldrop & McGuinness, 2017). The proposed solution was to introduce the use of a standardized measurement tool …

Implementation Of An Evidenced-Based Intervention For Pain Management In Lumbar Spine Surgery, Mary R. Draper

Doctoral Projects

Introduction: Spinal surgeries are among the top procedures responsible for the highest degree of post-surgical pain. Opioids are the mainstay of current pain management practices in the post-operative period. In light of the opioid epidemic, increased opioid tolerance, and changes in legislation, there is a calling for alternative strategies in managing acute and chronic pain. The purpose of this project is to answer the following question: Does implementation of an evidence-based intervention for preoperative administration of gabapentin reduce patients’ perception of pain and reduce opioid consumption in those who experience lumbar spine surgery?

Objectives: The goal of this project is …

A Need For A Culturally Congruent Obesity Intervention At A Community Safety-Net Clinic, Claudia D. Rivera-Salas

Doctoral Projects

Background: Obesity is an epidemic in the United States which causes numerous chronic conditions and disproportionally impacts underserved populations. The removal of barriers that prevent active lifestyles such as unaffordable facilities and inaccessibility are of primary importance in promoting a healthy lifestyle.

Objectives: Collaboration with community organizations to increase access to culturally congruent nutrition and exercise classes for underserved Latino/Hispanic patients of a Midwestern safety-net clinic to reduce obesity, increase physical activity, and improve dietary habits.

Methods: Assessment of current practices revealed the need for project development. Six-week nutrition education class and exercise classes were held for eligible patients which …

Implementing Use Of The Moss (Michigan Opioid Safety Score) Tool And Interventions To Reduce Opioid-Related Overdose Events In High Risk Patients, Michelle J. Kloss

Doctoral Projects

Opioids are among the most common pharmacological class of therapeutic medications prescribed to alleviate pain across all healthcare settings. However, opioid-related adverse events are a growing problem contributing to an increase in morbidity and mortality. Current hospital practice does not utilize a pre-opioid administration screening tool to assess patient risk of adverse events related to opioid administration. The implementation of the Michigan Opioid Safety Score (MOSS), an evidence-based risk assessment tool which utilizes patient characteristics as well as respiratory assessment for the prediction and early detection of opioid-induced adverse events. This quality improvement project evaluated the effectiveness of the MOSS …

Follow-Up Among Homeless Patients At San Francisco General Hospital: Examining The Social Determinants Of Health, Robert Gnat

Doctoral Projects

The San Francisco General Hospital emergency department has a high occurrence of homeless patients that are lost to follow-up after discharge. This Doctor of Nursing Practice project conducted a survey to evaluate the social determinants of health among this population and how they influence the participant’s ability to follow-up. This is the first phase of a three-phase project involving assessment and evaluation. The second and third phases of this project will center on intervention and re-evaluation after intervention. The survey was administered to eligible participants who presented to the emergency department at San Francisco General Hospital. Fifty participants were surveyed …

Pediatric Patients With Diabetes Transition To Adult Care, Sara Jennings

Doctoral Projects

The purpose of this study was to identify the optimal age to target transition to adult care education for adolescent and young adults (AYA) with Type 1 and Type 2 Diabetes Mellitus (DM) as they transition from pediatric endocrinology providers to adult DM providers. A secondary purpose of this study was to identify if there was a relationship between attendance rate, age, gender, years diagnosed with DM, ethnicity, insurance type, Type of DM, and current county of residence with control of diabetes, measured by glycosylated hemoglobin (HgbA1c). A quantitative study through chart audits was conducted at Valley Children’s Healthcare, VCH, …

Providing Preventive Health Education And Developing A Referral Policy And Toolkit To Increase Access To Primary Care For Individuals With Mental Illness, Phaedra Mclin, Stephanie Myers

Doctoral Projects

Treatment rates in primary care for the mental health population is traditionally low. Individuals with mental illnesses were at a higher risk for the development of chronic health problems (Ross et al., 2015). Substance Abuse and Mental Health Services Administration (SAMHSA) indicated that many people with serious mental illness die from preventable diseases. People with serious mental illness also have a higher mortality rate than those in the general population (SAMHSA, 2017b).

The purpose of this Doctor of Nursing Practice (DNP) project was to determine if educational training regarding specific chronic disease conditions influenced the attitude and knowledge of the …

Actualizing Best Care Practices At A Psychiatric Treatment Center To Validate The Asset Of An On-Site Electrocardiogram, Pamela Metts

Doctoral Projects

Considerations to be contemplated in daily health delivery systems are complex and require varied approaches to deliver best-care processes that produce optimal patient outcomes. Specialty practice sites not only require the capability but also necessitate proficiency and dedication in meeting and exceeding essential healthcare competencies. A psychiatric treatment center specialty practice was the setting for this DNP project. The focus of this project included: (1) care resourcefulness, (2) safety initiatives, (3) increased privacy and confidentiality compliance, and (4) cost-efficiency measures.

Technology use beyond the security of the safety available within the treatment complex is a current policy at the psychiatric …

Complete Care Model Impact On Glycemic Control In California State Prisons, Diane M. O’Laughlin

Doctoral Projects

The Complete Care Model (CCM) is a health care delivery model based on the well-studied and internationally validated chronic care theory. Since the integration of the chronic care theory into California Department of Corrections and Rehabilitation (CDCR) patient care in 2008, steady improvement in health care related mortality has been seen, and there have been no unavoidable health care related deaths in CDCR since 2012 (Gransee, 2018). However glycemic control in CDCR diabetic patients has made no statistically significant change since the implementation of the CCM in 2015 when comparing the two years before and the two years after implementation …

Losing Weight And Improving A1c Level By Adding A 30-Minute Walk To Individuals' Daily Activities, Lobat Danehvar-Jahromi

Doctoral Projects

Overweight/obesity is a global health concern, as is the growing prevalence of type 2 diabetes mellitus. Health complications related to these two problems negatively affect individuals’ quality of life and the healthcare system. In the literature on controlling these two health issues and preventing their related health complications, few studies examine use of a simple and affordable method. This research investigated the possibility of improving BMI (body mass index) and lowering blood sugar level, as measured by A1c, by adding a 30-minute daily walk to individuals’ activities. Thirty patients classified as overweight or obese (BMI of 25-35) with type 2 …

Does Preoperative Ostomy Education Decrease Anxiety In The New Ostomy Patient?, Michelle Suzann Harris

Doctoral Projects

Background: There are approximately 100,000 patients with new ileostomies and colostomies created in the United States each year. These patients have specialized needs that include acceptance of altered body image, psychological stress, learning of difficult tasks, and occasionally an ominous diagnosis leading to the need for surgery. In addition to pre-surgical stoma site marking on the abdomen, ostomy nurses have identified early education to be an important factor in long-term success and management of the patient . Early education and stoma site marking may assist with a better-situated stoma leading to fewer complications related to appliance adherence and leakage. …

Is There A Relationship Between Limited English Proficiency (Lep), Medication Adherence Behaviors, And Adverse Asthma Outcomes In Hispanic Adults With Moderate To Severe Persistent Asthma?, Archana Kartik Chandra

Doctoral Projects

The effects of LEP are well documented in the literature. LEP decreases medication adherence, causes ineffective communication between patients and providers, and reduces health outcomes. Asthma is known to be misdiagnosed and under-treated in Hispanic adults. There are discrepancies in the literature about the effects of LEP in Hispanic adults with persistent asthma.

The purpose of this study was to determine if the presence of LEP is associated with medication adherence behaviors and adverse asthma outcomes in Hispanic adults with moderate to severe persistent asthma. Hispanic adults with LEP were assessed for asthma outcomes and medication adherence behaviors.

The results …

Nurse Managers: An Association Between Empowerment And Burnout, Sonja Lynn Avery

Doctoral Projects

The purpose of the study is to ascertain the presence of an inverse relationship between nurse managers’ feelings of structural empowerment and self-perception of burnout. Although research is available studying the effects of staff nurse empowerment and burnout, literature is sparse relative to evaluation of nurse manager empowerment and burnout. Of the studies available, there is supportive evidence pertaining to the negative implications associated with nurse manager burnout such as reduced staff nurse retention and morale, decrease in quality of patient care, and financial impact on organizational success. With such negative implications associated with a lack of empowerment and burnout, …

Addressing Disparities In Nurses’ Understanding Of Congestive Heart Failure, David Tomas Palecek

Doctoral Projects

Congestive heart failure (CHF) continues to affect millions of people a year and remains one of the leading causes of re-hospitalization in the US. Within the Central San Joaquin Valley (CSJV) the incidence of CHF remains significantly higher than the rest of California. In order to ensure appropriate patient care and outcomes registered nurses (RNs) must have a thorough and full understanding of the disease process and its associated symptomatology. This study aimed to find if the implementation of an interactive multimedia educational program focusing on all aspects of CHF could improve RNs education and understanding of CHF. It is …

Pathways To A Sustainable Community Health Worker Program In A Rural Native American Community, Hannah R. Duby

Doctoral Projects

Introduction: American Indian/Alaska Native (AI/AN) people have some of the greatest health disparities of any other citizen group in the U.S. (National Indian Health Board [NIHB], 2018). As liaisons between community members and health services, community health workers (CHWs) play an important role in reducing disparities in AI/AN communities (Indian Health Service [IHS], 2018). CHWs in the organization of interest are not being used to their full potential as the documentation of their care is not accessible to the primary care providers (PCPs) for care coordination and the program is threatened by issues related to sustainability.

Objectives: The purpose of …

Evaluation Of A Simulation-Based Nurse Residency Program, Cheri A. Van Wyngarden

Doctoral Projects

Upon completion of nursing school, new graduate nurses sit for licensure examination to demonstrate the minimal knowledge necessary to practice safely as an entry level nurse. Despite satisfactory completion of this examination, many new graduate nurses lack the competency and confidence to safely practice (Jung, Lee, Kang, & Kim, 2016 & Liaw, Palham, Chan, Wong & Lim, 2014). Traditional models of preceptorship with orientation are not adequately preparing new graduate nurses for practice. Nurse residency programs narrow the gap between demonstrated knowledge and competent practice. Varying types of nurse residency programs have successfully replaced traditional nursing orientation methods across the …

Improving Communication Of Asthma Related Care Between Pediatric Primary Care Providers And Schools, Jessica N. Heichel

Doctoral Projects

Introduction: Asthma is a life-altering chronic disease that affects many children throughout the state of Michigan. Evidence-based guidelines recommend a written asthma action plan (AAP) be given to all caregivers of children with asthma. This would include schools, but the plans are not making it there. This project focused on collecting school asthma data and designing a process change at a local clinic to send the plans directly to the schools.

Objectives: The goal of this project was to improve communication between healthcare providers and schools for children with asthma. The objectives were to increase the percentage of children with …

Interprofessional Collaboration During Discharge Planning For A Large Midwestern Hospital, Sarah Shepler

Doctoral Projects

Introduction: Interprofessional collaboration (IPC) improves the quality of healthcare delivery. IPC enhances communication during discharge planning, through use of structured daily rounds to reduce readmissions, length of stay (LOS), cost, and mortality. A $240 billion reduction in cost could be achieved with IPC. The Joint Commission, Institute of Medicine, and World Health Organization emphasize use of IPC to reduce errors, improve patient outcomes, and refine transitions of care for patients.

Objectives: The goal of this project was to determine how IPC within structured daily rounds during discharge planning impacts patient LOS and staff satisfaction.

Methods: This quality improvement project was …

Evaluating The Effectiveness Of Diabetes Class: A Project To Improve Quality Metric Measures, Miriam O. Russell

Doctoral Projects

Background: Diabetes is a significant health issue worldwide. Its increasing prevalence globally and regionally has been documented. Consequently, complications have resulted in higher morbidity and mortality in patients with diabetes (Martin & Lipman, 2013). The lack of education on self-managing diabetes can lead to serious complications. An effective approach, including evaluating and enhancing diabetes education, is necessary to improve diabetes self-management (Johnson & Raterink, 2009).

Objectives: To provide evaluation of a diabetes education class through quality measures and create a toolkit that will enhance the impact on the current diabetes education class.

Methods: A retrospective chart review that analyzes five …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Improving Patient Handover From The Pediatric Emergency Department To The Pediatric Intensive Care Unit, Kathryn Devinney

Doctoral Projects

Patient safety can be at risk during registered nurse handover, particularly when transitioning between high risk areas. According to The Joint Commission (2017), a standardized transition process should be implemented during patient handover. The purpose of this paper was to evaluate the effect of a standardized process with a cognitive aid on handover between a pediatric emergency department and an intensive care unit. Objectives of the project were to decrease conversion time in the emergency department, increase standardized process utilization, and improve patient outcomes, registered nurse perception and satisfaction, and patient proxy satisfaction. This evidence-based quality improvement project took place …

Improving Heart Failure Care Plan Coordination Across The Health Care Continuum, Amy Veltkamp

Doctoral Projects

Heart failure costs the United States 31 billion dollars each year, with much of those costs attributed to hospital admissions. Coordinating care across the health care continuum is a critical factor in improving heart failure care and reducing readmissions. An organizational assessment was conducted using the Burke and Litwin Causal Model of Organizational Performance and Change. The quality improvement project implemented a longitudinal plan of care (LPOC) across 10 hospitals and numerous ambulatory care sites at a large Midwestern health organization. Nurse care managers (NCMs) were the focus of this project due to their high-level of involvement in care coordination. …

Interprofessional Collaboration To Improve Discharge Planning, Erica L. Spalding

Doctoral Projects

Historically, health care professionals collaborated solely with other professionals within the same discipline. However, evidence shows collaboration between all disciplines involved in patient care leads to improved patient outcomes. Interprofessional collaboration can reduce costs and improve patient care, yet is used inconsistently in health care systems. Interprofessional collaboration was not fully used on two medical-surgical units in a large health system in the Midwest, particularly during the discharge planning process. This project aimed to standardize rounds on two units as part of a larger initiative to standardize rounds across all units within the system. The clinical question to be answered …

Developing An Evidence-Based Supportive Services Program For Cancer Survivors In A Private Oncology Practice, Joseph Ellul

Doctoral Projects

Improvements in cancer treatment have led to a rapidly increasing survivor population. In response, multiple side effects of cancer and cancer treatment as well as the various wellness needs of survivors have been recognized. Survivorship programs have been developed to care for survivors with residual effects of cancer and the side effects of treatment; however, additional support is needed. The purpose of the project was to highlight the need for a comprehensive supportive services program for the cancer survivor population and describe the steps that were required to successfully develop the program. The clinical question addressed by the project was: …

Improving Advance Care Planning Documentation In A Home Based Primary Care Program, Emily Radtke

Doctoral Projects

Advance care planning (ACP) is an importance process of reflection and communication regarding one’s preferences for future health care (Hagen et al., 2015). Findings from research indicate that advance care planning supports patient autonomy, improves quality of end-of-life, and increases patient and provider satisfaction (Bischoff at al., 2013; Brinkman-Stoppelenburg et al., 2014). To promote advance care planning discussion, the Centers for Medicare and Medicare Services (2016) made a decision to compensate health care providers for face-to-face conversations regarding future treatment associated with serious illness, offering two new current procedural terminology billing codes for ACP. The Plan-Do-Study-Act model (AHRQ, 2018) was …

Development Of A Depression Screening Protocol For At Risk Patients Based On The Adverse Childhood Experience Questionnaire, Brittany J. Taylor

Doctoral Projects

Background: Adverse childhood experiences (ACEs) are associated with increased risk for adult depression. Utilization of the Patient Health Questionnaire Nine (PHQ-9), in combination with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSMV) criteria, aids in the diagnosis of comorbid depression and assessment of severity.

Objectives: To standardize the process of screening new adult patients at a specialty care clinic for ACEs. Then, implement a depression screening protocol based on ACE criteria to identify adult patients with comorbid depression.

Methods: Demographic, ACE score, PHQ-9 score, and protocol implementation data collected and analyzed by the Doctor of Nursing Practice (DNP) …

Increasing Prevention And Recognition Of Delirium In A Non-Icu Acute Care Population, Anne Gembrowski

Doctoral Projects

Delirium is associated with increased mortality, nosocomial complications, increased length of hospital stay, and greater chance of readmission, increased hospital costs, and a need for skilled nursing aid after discharge from the hospital. In a hospital, delirium can affect up to 50 percent of older patient 65. The solution is to prevent delirium from occurring and to regularly screen for its presence. The purpose of this paper is to explore the best prevention strategies and screening tool for delirium and to successfully implement a delirium bundle on a medical surgical unit. The question this paper attempts to answer is if …

Management Of Distress In Adult Oncology Patients, Lauren Jongsma

Doctoral Projects

Cancer related distress has the potential to negatively impact the health of the patient and their treatment outcome (Grassi, Spiegel, & Riba, 2017). As identification and treatment of distress has a positive impact on patient outcomes; the Commission on Cancer (2016) required distress screening for accreditation. Key stakeholders within a Midwest hospital system expressed a desire for the improvement in the current state of the distress screening. Thus, the scholarly paper describes the key attributes of the organizational assessment, a literature review on evidence-based distress screening tool and a quality improvement project. The Promoting Action on Research Implementation in Health …

Improving Depression Screening And Follow-Up In Primary Care Through Implementation Of An Evidence-Based Protocol, Cheryl Fowler

Doctoral Projects

Depression is a leading cause of disability in adults and is a major contributor to burden of disease (World Health Organization [WHO], 2018). The United States Preventative Services Task Force (USPSTF) provides evidence-based recommendations to promote disease prevention. Among these, is the recommendation that all adults, regardless of risk factors, should be screened for depression in the primary care setting with adequate systems in place to allow for appropriate diagnosis and management (USPSTF, 2016). The purpose of this Doctor of Nursing Practice (DNP) student project was to develop and implement an evidence-based protocol in the primary care setting with aims …