Nursing Commons^™

Improving Adolescent Risk Behavior Screening: Implementation Of The I-Cloud Rapid Assessment Adolescent Preventive Screening (Raaps) Tool, Donna L. Rinker

Doctoral Projects

Adolescents are engaging in risky behaviors earlier contributing to 75% of adolescent morbidity and mortality with unintentional injuries listed as the most common cause of death among this population in the United States. It is reported that engaging in more than one risk behavior will lead to other risk behaviors resulting in the rise of indirect and direct costs in society today. The scholarly project was conducted in response to a midwestern Michigan primary care clinic need to improve the early identification and documentation of adolescent risk behaviors with evidence-based technology screening. The purpose of this quality improvement project was …

An Evaluation Of Implementing Enhanced Recovery After Surgery Protocol Throughout The Perioperative Phase: A Quality Improvement Initiative To Enhance Patient Outcomes After Colorectal Surgery, Jerica Hill Dnp

Doctoral Projects

Abstract: The Enhanced Recovery After Surgery protocol (ERAS) is a multimodal collaborative approach implemented throughout the perioperative phase to enhance patient outcomes. The key mechanism for effectiveness in the ERAS protocol is the attenuation of the surgical stress response combined with treatments that support the return of functions that delay recovery in traditional methods. The purpose of this scholarly project was to evaluate the results of the ERAS Pilot program currently initiated at Baptist Memorial Hospital to improve patient outcomes undergoing major abdominal surgery. Prior to the implementation of the ERAS protocol there was no standardized method in place at …

Implementation Of A Multimodal Hand Hygiene Intervention At A Rural Critical Access Hospital, Amy J. Hopp

Doctoral Projects

Healthcare acquired infections are the most common complication of hospital care in the United States, with subsequent negative implications on the healthcare system. While hand hygiene has long been considered the single most important and cost-effective way of reducing healthcareacquired infections, compliance among healthcare professionals is low, and most efforts to improve it fail. When compared to single-component hand hygiene interventions, research demonstrates that tailored multimodal interventions are an effective way to improve compliance with hand hygiene practices among healthcare professionals. This Doctor of Nursing Practice project focused on implementing a multimodal hand hygiene intervention, tailored to fit the specific …

Evaluation Of A Health System’S Community Targeted Program For Individual’S With Increased Risk For Cardiovascular Disease And Diabetes, Phallon Lovelady

Doctoral Projects

Introduction: Lack of a program evaluation plan for a community targeted primary prevention program poses a risk for undefined program effectiveness. Conducting a systemic program evaluation helps determine program effectiveness and value. The purpose of this paper is to discuss the process of implementing a program evaluation during a Doctorate of Nursing Practice (DNP) scholarly project.

Objectives: The objectives of this project were to apply a scholarly approach to program evaluation utilizing evidence-based practice tools, demonstrate DNP Essentials and health systems leader competencies, and describe the steps taken during the process.

Methods: The CDC Framework for Program Evaluation (2011) was …

Use Of A Vietnamese Pain Scale And Report Of Pain Or Discomfort In Vietnamese Patients With Limited English Proficiency During The Post-Operative Period, Kristine Ho

Doctoral Projects

Language and the ability to communicate with the patient are foundational for effective anesthesia/patient relationships (Rosse, Bruijne, Suurmond, Essink-Bot, &Wagner, 2015). The burgeoning population of Vietnamese people in the United States demands implementation of procedures to ensure adequate communication and safe care. The present project sought to determine if the Wong-BakerVietnamese Pain Rating® Scale assisted Vietnamese patients with limited English proficiency to adequately report pain or discomfort relief during the post-operative period. A convenience sample of adults (N = 25) that meet inclusion criteria constituted the sample. Inclusive criteria were patients who were Vietnamese, between the ages of 30 …

Intraoperative Ketamine Administration: An Adjunctive Therapy That Reduces Postoperative Pain For Patients Undergoing Spinal Surgery, Brittany Pierce

Doctoral Projects

In 2017, the United States Department of Health and Human Services declared that the country was experiencing an opioid crisis (U.S. Department of Health and Human Services, 2018). As a result of this phenomenon, healthcare providers are examining how they are managing pain and researching new avenues for the treatment of pain. Anesthesia providers are in a unique position to help reduce postoperative pain and ultimately the development of chronic pain. This doctoral project was conducted in order to write an evidence-based policy that directs and educates anesthesia providers in the administration of intraoperative ketamine to reduce postoperative pain in …

Laryngeal Mask Airway: A Postoperative Sore Throat Clinical Practice Guideline, Logan Williams

Doctoral Projects

One of the most common and preventable complications experienced by patients undergoing general anesthesia is a postoperative sore throat (POST). Up to 70% of patients who receive a laryngeal mask airway (LMA) during anesthesia suffer from POST. Despite its regular occurrence and designation as a minor complication, POST has proven to be a distressing complication for patients afflicted. Consequently, a perceived minor complication can, in fact, play a major role in a patient’s perception of their care, the skill of their anesthesia provider, and their overall satisfaction with their experience.

Evidence shows that inflation of LMA cuffs beyond the recommended …

Utilizing The Stop-Bang Questionnaire As A Preoperative Assessment Tool In Patients Undergoing Endoscopic Procedures, Emily Randle

Doctoral Projects

In the world of anesthesia, obstructive sleep apnea (OSA) can cause a conglomeration of post-operative complications. One of the best ways to avoid these complications is to alter one’s anesthetic to accommodate the needs of a patient with OSA. The current issue with altering one’s anesthetic is that a majority of patients with OSA still remain undiagnosed. My project that will showcase just how many patients have undiagnosed OSA.

The goal of this project was to recognize how many patients were at moderate to high risk for OSA. I did this by providing an in-service on OSA and the STOP-Bang …

Implementation Of A Sustainable Peer Mentor Program In Student Registered Nurse Anesthetists (Srnas)”, Kristin Cox

Doctoral Projects

Evidence has shown that Student Registered Nurse Anesthetist’s (SRNAs) stress is perceived as above average and is correlated with substandard patient care during clinical courses (Chipas et al., 2012). Some studies have indicated SRNAs experience low self-efficacy during clinical, which could lead to difficulty in thinking clearly or responding to clinical situations (Imus, Burns, & Weglarz, 2017). Peer mentoring has shown to result in stress reduction and improvement in self-efficacy in students (Barker et al., 2012; Giordana & Wedin, 2010). Despite the current evidence, a nurse anesthesia program in the southeastern United States did not have an organized peer mentor …

A Quality Improvement Project To Increase Hand Hygiene Opportunities For Anesthesia Providers, Brad Margherio

Doctoral Projects

Hand hygiene is considered to be the far more superior method for preventing the spread of bacteria from a patient care provider to the patient (Allegranzi & Pittet, 2009; Rowlands et al., 2014; Tartari & Mamo, 2011). The addition of easily accessible hand hygiene devices to the anesthesia carts in the operating room may help to improve the opportunities for the anesthesia providers to perform hand hygiene. Hand sanitizer devices were placed on each of the eight anesthesia carts located in the surgery department of a rural hospital in south Mississippi. The devices were measured weekly for a two-week period …

Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell

Doctoral Projects

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at …

Best Practice Policy: Utilizing A Standardized Handoff Tool Postoperatively In An Intensive Care Unit For Patients Undergoing Cardiac Surgery, Alexandra Bradley

Doctoral Projects

Communication is a key aspect of care in the health care setting. Handoff communication occurs between medical provider’s numerous times a day. Each patient handoff performed has the potential for ineffective communication, leading to poor patient outcomes. The Joint Commission has recognized handoff communication as one of the main causes of sentinel events, or unexpected events that results in patient harm or death, in the health care setting (Joint Commission on Accreditation of Health care Organizations [JCAHO], 2012). The Joint Commissions National Patient Safety Goal requires “a standardized approach” for provider handoffs. The introduction of a checklist or handoff tool …

A Quality Protocol For A Federally Qualified Health Center: A Pilot Project, John K. Dekock

Doctoral Projects

Federally Qualified Health Centers (FQHCs) have become a vital part of access to care for low socioeconomic status individuals. The federal government has allocated funds to be distributed to FQHCs via Medicare and Medicaid reimbursement based on insurance claims and through the Health Resources and Service Administration (HRSA) via grants and incentives based on Uniform Data System (UDS) reporting. Federally Qualified Health Centers must complete annual uniform data system (UDS) reporting on quality indicator metrics to receive grants and incentives from HRSA. The Health Resources and Service Administration (HRSA) funded health centers are expected to have ongoing quality assurance and …

Barriers To Providing Quality Care For Pediatric Patients With Autism Spectrum Disorder As Identified By Baccalaureate Prepared Registered Nurses: A Basis To Enhance Professional Practice, Ugo Ndubaku

Doctoral Projects

The increased prevalence of autism spectrum disorder (ASD) foretells that this sector of the population will be accessing health care services in greater numbers; thus, it behooves healthcare providers to prepare for their impending needs. This qualitative study describes the experiences of baccalaureate prepared registered nurses caring for children and adolescents with ASD in order to identify challenges that hinder providing comprehensive and individualized care. A purposive sample of 10 baccalaureate degreed registered nurses (RNs) who have worked or work in the pediatric unit was used to gather rich descriptive experiences. The qualitative data analyses were based on an interpretive …

Can Using A Smartphone Application Improve The Ability Of Law Enforcement Officers To Recognize Commercially Sexually Exploited Children And Report Them To Child Welfare Authorities?, Sheree Goldman

Doctoral Projects

The commercial sexual exploitation of children (CSEC) is a crime of abuse that is frequently unrecognized because mandated reporters may be unfamiliar with the indicators. Commercially sexually exploited minors participate in sex acts in exchange for money, goods, or services. At least 200,000 American children are believed to be victims of this crime each year (County Welfare Director Association of California, 2015). Victims often go undiscovered and experience significant health issues. A public health model is used to explain the context of victimization and the need for interdisciplinary collaboration to discover victims and connect them with needed services. A randomized …

Patient Perceptions Of Google Glass In The Outpatient Dermatology Setting, Sandra Odenheimer

Doctoral Projects

Background: The ubiquitous use of electronic health record (EHRs) during medical office visits using a computer monitor and keyboard can be distracting and disrupt patient-healthcare provider (HCP) non-verbal eye contact cues, which are integral to effective communication. Provider use of a remote medical scribe with face-mounted eyeglass technology, such as Google Glass (GG), may preserve patient-HCP communication in the healthcare setting by allowing providers to access other parts of the patient’s EHR (e.g. laboratory results, current medications, immunization records) all while maintaining direct eye contact with their patients. The medical scribe is able to chart patient encounters in real-time working …

Retrospective Analysis Of Obstetric Sepsis Screening, Holly A. Champagne

Doctoral Projects

This project was designed to evaluate outcomes following implementation of routine screening for sepsis in the obstetric population. A retrospective analysis of the electronic medical record of 204 women who met sepsis criteria using obstetric-adjusted systemic inflammatory response syndrome (SIRS) criteria and a source of infection was the method used. Outcomes were evaluated for neonates born to the women who developed sepsis during labor. The incidence of sepsis was 0.401 per1,000 and included those with antepartum, intrapartum, or postpartum admissions. The setting was a tertiary center with 5,075 deliveries over the study period. There were 92 (45.2%) who had sepsis, …

Perceptions Of Caring In The Pediatric Medically Complex Population, Ivette Becerra-Ortiz

Doctoral Projects

In a hospital system that transitioned from a non-caring science model to a professional practice model based on the Theory of Human Caring/Caring Science, it is important to measure the outcomes of the care delivery transition. In a non-experimental, cross-sectional, correlational, quantitative study the aim was to compare a pre/post-Caring Science model implementation at a pediatric and obstetric medical center, by assessing perceptions of caring in the medically complex pediatric population and in the nurses that care for them.

This study used a convenience sample of 102 pediatric families enrolled in a complex care program, and 23 nurses providing care …

Evidence-Based Study Of Medication Compliance Project In Hiv Prevention Using Pre-Exposure Prophylaxis (Prep) Antivirals For Hiv-Negative Males, Ming-Chun Ho

Doctoral Projects

In 2012, emtricitabine/tenofovir was the only Food and Drug Administration-approved medication for pre-exposure prophylaxis (PrEP) used in human immunodeficiency virus (HIV) prevention. To date, there is little research on open-label and mixed-payer characteristics supporting medication compliance of men who have sex with men (MSM). The purpose of this research was to describe individual demographic variables associated with PrEP medication adherence and to examine the effect of a follow-up phone call from a nurse once a month for 3 months. A total of 30 MSM were recruited and data were collected using a demographic questionnaire, medication adherence tool and follow-up phone …

Sexually Transmitted Infection Risk Reduction For College Students, Mary Kathryn Dowling

Doctoral Projects

University students have been assessed through many sexual health lenses, but there is a paucity of research on the sexual health of community college students. This population may provide good access to at-risk youth, and opportunity to reverse steep climbs in sexually transmitted infection (STI) rates. This research project pilot tests a theory-based intervention employing social facilitation to reduce STI risk among college students. Fifty students were recruited from Human Sexuality courses to participate in a 60-minute workshop. Pre- and post-testing measured for change in STI knowledge, attitude towards safer sex, and self-efficacy for engaging in safer sex practices.

A …

The Effectiveness Of Insulin Pump Therapy After Transition From Multiple Daily Insulin Injections In Type 1 Diabetes, Sima Sapkota

Doctoral Projects

The population of patients who have been diagnosed with diabetes mellitus (Type 1 or Type 2) has been increasing in the United States. Patients with type 1 diabetes may receive insulin through delivery via insulin pump therapy (IPT) or multiple daily insulin injections (MDII). In addition to requiring insulin, other management regimens have included frequent blood glucose monitoring, checking laboratory values hemoglobin A1c (A1C), maintaining normal body mass index (BMI), keeping a balanced diet, carbohydrate counting, and exercise. The purpose of the study was to compare the retrospective data of A1C and BMI of patients with type 1 diabetes after …

Assessment Of Nurse Behaviors That Influence Care And Maintenance Of Pediatric Oncology Central Venous Catheters, Susan Elizabeth Mckenna

Doctoral Projects

Central venous catheters (CVC) are devices necessary to medically treat pediatric patients diagnosed with conditions such as cancer. Central line associated bloodstream infection (CLABSI) is a complication associated with utilizing a central line. Nurses are responsible for maintaining and complying with strict prevention protocols. The aims of this quality improvement project are to: (a) gain an understanding of perceptions of CLABSI prevention, (b) observe adherence to the CLABSI prevention bundle, (c) measure adherence to the current CLASBI prevention bundle (post-training), (d) identify ways to improve adherence to the CLASBI bundle, and (e) ascertain potential strategies for further compliance efforts. Three …

Improving Teen And Pediatric Provider Communication Through Education And Technology, Kathy A. Connor-Prows

Doctoral Projects

Navigating healthcare can be daunting as an adult, but doing so as a teenager can seem virtually impossible. Until the age of eighteen, parents of children of all ages initiate, schedule, and accompany their children to see their pediatrician for virtually all appointments. Over time, children and their parents develop a special bond with their pediatrician and too frequently, this relationship becomes abruptly severed as their teen turns eighteen years old and is thrust into adult medicine. As healthcare providers, we expect healthcare consumers (including teens) to know how and when to initiate, schedule, and get themselves to an appointment. …

Obstetric Nurses’ Perceived Barriers To Immediate Skin To Skin Contact After Cesarean Birth, Joelene Sarmiento Balatero

Doctoral Projects

Despite the strong evidence supporting immediate skin to skin contact (SSC) after birth, research suggests that patients who undergo cesarean births do not have the same opportunities for SSC as patients who undergo vaginal births. There are limited studies regarding provider attitudes surrounding the practice of immediate SSC after cesarean birth. The aim of this research was to understand obstetric nurses’ perceived barriers to immediate SSC after cesarean section.

An exploratory qualitative design was used for the project. The semi-structured, open-ended interviews were conducted via video conferencing. Conventional content analysis methods were used to analyze the data, which yielded the …

Adolescent Sexual Health: Provider Evaluation Of A Sexual History Tool At A School-Based Health Clinic, Gillian Marie Williams

Doctoral Projects

There is a growing concern within the United States in regard to sexual behavior within our adolescent population. Sexually transmitted infections (STIs) have always been a concern, however, there has been a steady increase since 2014 in the three nationally reportable diseases of chlamydia, gonorrhea, and syphilis. According to the CDC (2017), 15-24 years old account for half of all the new STI s. There is a need to provide more sexual health to adolescents during their health visits. It is also imperative to understand the beliefs and attitudes of providers with providing these types of exams and asking questions …

Improving Adolescent Risk Assessment In A Primary Care Setting, Kristin N. Vanderwell

Doctoral Projects

Adolescent risk-taking behaviors contribute significant risk to the current and future health of adolescent patients and have a significant annual cost to society. A primary care practice in western Michigan had no standardized practice related to the screening, evaluation, and response to adolescent-risk taking behaviors. As a result, only three of the fourteen providers were consistently following national guidelines for screening, evaluating, and responding to adolescent risk-taking barriers. The providers cited lack of time and lack of knowledge as barriers to following guidelines. The purpose of this quality improvement project was to address the health care needs of the adolescent …

Implementation Of Standardized Heart Failure Educational And Documentation Processes Within An Outpatient Heart And Vascular Clinic, Mallory Myslenski

Doctoral Projects

Heart failure is a prevalent, high-risk condition associated with high mortality and frequent hospitalizations. Heart failure is characterized by acute exacerbations of signs and symptoms, and affects almost six million Americans leading to one of the most costly illnesses in the United States. Management of heart failure is complex and individualized relying on appropriate education, self-care management, medications, and adequate follow-up to succeed in treatment. Many organizations have initiated evidence-based heart failure management or educational programs that provide easy-to-learn education on diagnosis, medication, and self-care behaviors. Research has shown that these programs help patients to better manage their symptoms at …

An Education Intervention To Increase Rounding And Toileting And Reduce Falls In A Hospital Acute Care Of The Elderly (Ace) Unit, Amelia Grayson

Doctoral Projects

Introduction: Falls are the most common accident reported in acute care hospitals and patients who are 65 and older are the most vulnerable. Falls can lead to physical and emotional injury, reduced mobility and functioning, increased length of hospital stay, increased healthcare costs, and admission to long-term care facilities. In 2008, the Center for Medicare & Medicaid Services (CMS) has eliminated reimbursement to hospitals for treatment of injuries resulting from a fall during hospitalization. Research on fall prevention in adult acute care found multifactorial interventions that address multiple risk factors for falls are the most successful at prevention. This …

Increasing Post-Acute And Long Term Care Coding For Advance Care Planning In An Outpatient Setting, Emily M. Mccloskey

Doctoral Projects

Today’s healthcare landscape is saturated with an aging U.S. population that is living longer and with more chronic conditions. One way to manage care for this aging population, especially those with chronic conditions, is through advance care planning (ACP). Healthcare providers are capable of engaging patients in these important healthcare discussions, yet use of methods to appropriately document and code for these services are lacking. There are Current Procedural Terminology (CPT) codes in existence that would be applicable for these services; however, they are not widely understood nor routinely used in clinical practice. Administrators at a large Midwestern healthcare organization’s …

Prevention Of Central Line-Associated Bloodstream Infection (Clabsi) In Adult Oncology Patients, Christina Winkelman

Doctoral Projects

Central Line-Associated Bloodstream Infection (CLABSI) is a preventable issue in healthcare. CLABSI contributes to negative patient outcomes and increased healthcare cost. Research demonstrates that many interventions are effective in reducing the rate of CLABSI. The implementation of CLABSI bundles can significantly reduce the occurrence of CLABSI. This quality improvement project implemented a CLABSI bundle that specifically targeted identified areas of weakness in CLABSI prevention at an organization with a focus on adult oncology care. The three part CLABSI prevention bundle focused on: (a) registered nurses (RN) changing and documenting endcaps in the electronic health record after blood administration, (b) RNs …