Nursing Commons^™

Successfully Spreading Improvement Work Using A Proven Framework, Rachel Lynn Wyatt

Doctor of Nursing Practice (DNP) Projects

Background: Hospital-acquired pressure injuries (HAPIs) are rising in the United States, increasing six percent between 2014 and 2017 alone (Agency for Healthcare Research and Quality [AHRQ], 2019). Approximately 60,000 patients die from complications related to HAPI annually (Padula & Delarmente, 2019).

Local Problem: In a Northern California Level II Trauma acute care hospital, HAPIs increased by 422% over two years, 2016-2018, with most of the HAPIs occurring in the Intensive Care Unit (ICU).

Context: This project sought to spread the Interventions by Braden Subscale protocol to seven medical-surgical units in the hospital using the Institute for Healthcare Improvement’s (IHI) Framework …

The Effects Of Naloxone Education Among Adults In Alameda County, Patricia Ronnica Tinglin

Doctor of Nursing Practice (DNP) Projects

Fatal opioid overdose is a growing concern in the United States (U.S.). The pharmaceutical companies assured the medical community that opioid pain relievers were not addictive. As a result, providers prescribed them at a significantly higher rate, which led to more extensive use of authorized and unauthorized opioid use before it was realized that they could be highly habit-forming (The U.S. Department of Health and Human Services [HHS], 2019). A growing body of evidence supports providing naloxone education as a means of harm reduction. The quality improvement project aims to implement educational sessions for adult patients seen at East Bay …

Using Simulation To Improve Covid-19 Code Blue Outcomes, Charity Shelton

Doctor of Nursing Practice (DNP) Projects

Background

Healthcare workers in the acute care setting must be ready to respond to emergencies at any given time. The recent COVID-19 pandemic put strains on the healthcare workforce that have brought challenges and new competencies for how healthcare workers safely respond to emergencies. To ensure healthcare workers maintain these competencies, specific training must occur to improve emergency response and outcomes. Specifically, there needs to be training for healthcare workers to respond to COVID-19 code blue emergencies safely and with skilled interventions.

Problem

A code blue in the acute care setting is a medical emergency that requires nurses, physicians, and …

Careless, Brenna Holland

Capstones

About This Project

I began working on this project six months ago, but my interest in the home care industry can be traced much further back. In the mid-aughts, my grandfather was diagnosed with Alzheimer’s. Hoping to live independently for as long as possible, he sought out the help of an in-home health aide. It was then that he learned he fell into a coverage gap; one that, even today, prevents many Americans from accessing home care services.

Faced with two options—father-son cohabitation or an institution—my grandfather moved in with my family, where he slipped into a catatonic depression prompted …

Program Evaluation Of Adolescent Intervention Program (Aip): Substance Abuse Education Program For At Risk Adolescents, Shanea Clancy

Doctor of Nursing Practice (DNP) Manuscripts

The purpose of this project is to evaluate the effectiveness of the Adolescent Intervention Program (AIP), a faith-based drug and alcohol recovery program for teens. This is an alternative to jail program. Nearly 1 in 10 Americans, 12 years or older (20.1 million people), have a substance use disorder (SUD), involving alcohol or illicit drugs (National Center for Drug Abuse Statistics, 2019). The average age of first-time alcohol or substance use is 13 years old and nine out of ten addictions start in the adolescent years (National Center for Drug Abuse Statistics, 2019). Adolescents with first-time drug and alcohol arrests …

Improving Lymphedema Self-Management And Screening In Newly Diagnosed Breast Cancer Clients Through The Use Of A Self-Management Lymphedema Toolkit, Kescia Gray

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: With breast cancer effecting women at much younger ages and modern treatments prolonging the life span, survivors are at increased risk of developing breast cancer-related lymphedema (BCRL), a chronic, progressive condition that can cause disability.

Purpose: The purpose of the project was to determine the level of knowledge and awareness of BCRL in newly diagnosed breast cancer clients; and to provided education on self-care after treatment, using of a self-management lymphedema toolkit (SMLT), to decrease risks of treatment-related lymphedema, improve self-efficacy, and enhance quality of life (QOL).

Methods: Newly diagnosed breast cancer clients (N=10) from the Breast …

Implementation Of Cervical Cancer Screening Protocol (Ccsp): A Quality Improvement Project, Emilee Lenhart Hawk

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Background and significance: Cervical cancer is the fourth most commonly occurring cancer in women and the eighth most commonly occurring cancer overall (WCRF, 2020). Papanicolaou (Pap) testing is the primary screening for cervical cancer. In the past 40 years the number of cases and deaths from cervical cancer has decreased significantly, resulting from cervical cancer screenings (CDC, 2021). Healthy People 2030 reports to increase the proportion of females ages 21-65 who receive a cervical cancer screening based on the most recent guidelines. The 2030 target is 84.3%. Human papillomavirus (HPV) is a virus that is transmitted through sexual contact …

Optimizing Postpartum Care By Ongoing Care Coordination Initiatives (Cci) In Screening And Management Of Postpartum Depression (Ppd) Among Clients In An Obgyn Practice: A Quality Improvement Project., Jennifer Broussard

Doctor of Nursing Practice (DNP) Manuscripts

Background: Postpartum depression (PPD) is defined as physical, emotional, and behavioral changes that occur after the birth of a child. Postpartum depression is complex and a mix of physical, emotional, and behavioral changes (Cleveland Medical Clinic, 2018). Postpartum depression screening is of high importance at a comprehensive postpartum visit. The consequences of a patient suffering postpartum depression can be serious and early recognition and interventions improve outcomes for the patient as well as the infant. Problem: There is a lack of screening for PPD among postpartum clients and this period is critical for the mother and the infant (American College …

Program Evaluation Of The Rapid Response System Prior To And During A Covid Surge, Sarah Born

Doctor of Nursing Practice (DNP) Manuscripts

Between the years 2004-2008, the Institute for Healthcare Improvement (IHI) and The Joint Commission made a recommendation for healthcare facilities nationwide to implement rapid response systems (RRS). Rapid response systems consist of four limbs: recognition and alert (afferent); response and providing timely patient management (efferent); delivering support and oversight (administrative), and monitoring the RRS patient outcome data (quality improvement). The intent of implementing RRS was to increase patient safety and outcomes within the acute care setting. The following question (PICO) formed the basis of the project: “How does the current rapid response system workflow compare to the rapid response system …

Reducing Opioid Related Deaths And Improving Rehabilitation Access Through The Elk Grove Village Cares Program: A Program Evaluation, Rebecca Barron

Doctor of Nursing Practice (DNP) Manuscripts

Abstract The goal of the Elk Grove Village Cares program is to decrease the deaths and overdoses of those who abuse opioids through harm reduction strategies and provide access to treatment. The article is a program evaluation of the Elk Grove Village Cares program. Surveys, interviews and the synthesis of program data is used to evaluate the efficacy of program activities. Results: The rate of death from opioid use has decreased an average of 1.7 deaths since program implementation in 2018. Law enforcement officers (LEO) and the community responded similarly to many survey questions regarding attitudes surrounding addiction. Within the …

Improving Care Of Children With Acute Decompensated Heart Failure (Adhf) Through Implementation Of A Heart Failure Communication Checklist & Discharge Plan, Dana M. Schneck

Doctor of Nursing Practice (DNP) Manuscripts

Background: Children admitted to the hospital with ADHF have been identified as a low volume high complexity population with high morbidity and mortality rates. Hospitalizations are fraught with prolonged lengths of stay and frequent readmissions prompting increased resource utilization and significant healthcare costs. Pediatric collaborative learning networks, such as the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) seek to close quality gaps by engaging multidisciplinary multi-institutional teams along with patients and caregivers to share expertise, experience, and data prompting translation of evidence into higher quality, safer, cost-effective care.

Methods: A13-item pediatric-specific Heart Failure Communication Checklist (HFcc) and Heart Failure Discharge …

Telehealth Appointments To Increase Therapy Compliance In Patients With Mosa, Tracy J. Partington

Doctor of Nursing Practice (DNP) Projects

Background: At the VA Puget Sound Healthcare System, care as usual for patients with a new diagnosis of mild obstructive sleep apnea (MOSA) is a letter directing the patient to call the continuous positive airway pressure (CPAP) clinic to establish ongoing care.

Local Problem: This model has resulted in low therapy compliance and does not afford patients the ability to discuss their diagnosis and treatment options with a licensed healthcare provider. A literature review showed telemedicine interventions increase therapy compliance in patients with MOSA.

Context: The Doctor of Nursing Practice project implemented an evidence-based practice change to improve therapy compliance …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Use Of Simulation To Improve Nurse's Response To Covid-19 Code Blue: A Literature Review, Charity Shelton

Doctor of Nursing Practice (DNP) Projects

Background

Healthcare workers in the acute care setting must be ready to respond to emergencies at any given time. The recent COVID-19 pandemic put strains on the healthcare workforce that have brought challenges and new competencies for how healthcare workers safely respond to emergencies. To ensure healthcare workers maintain these competencies, specific training must occur to improve emergency response and outcomes. Specifically, there needs to be training for healthcare workers to respond to COVID-19 code blue emergencies safely and with skilled interventions.

Problem

A code blue in the acute care setting is a medical emergency that requires nurses, physicians, and …

Transcatheter Aortic Valve Replacement: Implementation Of Shared Decision-Making, Liesel Buchner

Doctor of Nursing Practice (DNP) Projects

Background: The setting for this study is the structural heart program of a large healthcare organization in the Greater Sacramento area in California. Aortic stenosis (AS) is the most common cardiovascular valvular disease in the elderly. The treatment of AS is complex and over the last decade, the transcatheter aortic valve replacement (TAVR) procedure has changed the management of this high-risk group and has become the standard of care.

Problem: The structural heart team performs an average of 170 TAVR procedures annually. The program is relatively new, and although it is performing above the national averages for specific program outcome …

Patient Placement Matters: The Impact Of Unnecessary Lateral Movement On Patients, Jacqueline Strinden

Doctor of Nursing Practice (DNP) Projects

Patient Placement Matters: The Impact of Unnecessary Lateral Movement on Patients

Abstract

Background: National trends to decrease the number of licensed beds have created inpatient capacity constraints which have resulted in increased unnecessary lateral patient movement events, which contribute to decreased patient safety and quality of care. The incidence of adverse events increases significantly when multiple unnecessary lateral relocations result from secondary efforts to relieve hospital capacity constraints and improve efficiency.

Problem: At a 352 acute care hospital, 12,906 patient movement events were evaluated over a baseline period of three months resulting in an average of 1.48 unnecessary lateral patient …

Investigating Relationships Between Diabetes Distress, Diabetes Self-Care Behaviors, Intention To Use And Actual Use Of A Personal Health Record Within 30 Days Of Hospital Discharge In Persons With Type 2 Diabetes, Khaliah Fisher-Grace

Electronic Theses and Dissertations

Background: Diabetes distress (DD) is defined by emotional and behavioral challenges caused from diabetes and its management. Diabetes self-care behaviors can be compromised by DD. Personal Health Record (PHR) use has been associated with improvements in HbA1c, blood pressure, and LDL-C, but the relationship between DD and PHR use is unknown. Aims: 1) to determine differences between sociodemographic variables and intention to use and actual use of PHR in hospitalized persons with Type 2 Diabetes Mellitus (T2DM), 2) to investigate the relationship between DD, intention to use a PHR and actual use of a PHR within 30 days of hospital …

Influencing A Culture Of Quality And Safety Through Huddling, Tysa Ferguson, Natalia Mccain

Doctor of Nursing Practice Projects: College of Nursing

Not available

Intention To Breastfeed: Breastfeeding Attitudes, Norms, Self-Efficacy, Social Support Network And Community Resources Of African American, Low-Income, Emerging Adult Women, Pregnant For The First Time, Sara E. Brown

Theses & Dissertations

African American (AA) women continue to have the lowest rates of breastfeeding. This continues to create a health disparity even though breastfeeding is extensively recognized in the scientific and health care communities as the optimal feeding choice for infants. This study examined the relationship between the external variables (social support network and community resources) and the explanatory variables (attitudes, norms, and perceived self-efficacy) and intention to breastfeed, for the AA, first time, low-income, emerging adult pregnant woman. The Integrated Behavior Model (IBM) was used as the theoretical framework to guide this study in better understanding the variables influencing breastfeeding intention. …

Surgical Site Infections And Hand Hygiene Discharge Teaching, Jesus A. Rodriguez Hernandez

Master's Projects and Capstones

Problem: During the span of a nine-month period, the PACU of a perioperative unit in an acute care hospital in the East Bay Area saw an incidence of 13 surgical site infections (SSIs). SSIs have been associated with negative patient health outcomes, diminished quality of life, and increasing healthcare costs.

Context: The PACU consisted of 20 beds and a competent staff of registered nurses, medical assistants, patient care technicians (PCTs), and management staff. It served mostly adults from diverse backgrounds receiving elective and emergent surgeries.

Intervention: A Standardized 3-Step Hand Hygiene Discharge Teaching model with nurse self-audits for every surgical …

Preventing Maternal Falls, Blair Burkhart

Master's Projects and Capstones

Patient falls are unfortunate events in healthcare that are an essential quality improvement focus during patients’ hospital stays. At Hospital X, a private institution located in the suburbs of a large city, there had been 23 maternal falls within the last three years. This increase in maternal fall rate puts this hospital’s maternity unit above the average of other hospital’s fall rates according to the National Database of Nursing Quality Indicators. This quality improvement project aimed to reduce the rate of maternal falls on postpartum units through various forms of staff education. Education included Morse Fall Scale scoring, Sara Stedy …

Reducing Postpartum Maternal Falls: A Quality Improvement Project, Sarah L. Iroz

Master's Projects and Capstones

Falls are an unfortunate, common occurrence in the healthcare system and are often not thought to be a problem in the obstetrics population. Key stakeholders in a Northern California hospital brought the issue of maternal falls to leaders of the quality improvement team on the maternity unit. In the last three years, there have been 23 falls on the maternity floor, making their fall rate above the national average. It is the purpose of this project to aid the quality improvement team in reducing postpartum maternal falls over the next three years. After conducting a unit assessment, performing a literature …

Loneliness, Interpersonal Goals, Life Satisfaction, And Subjective Well-Being In Older Adults, Francesca C. Ezeokonkwo

Electronic Theses and Dissertations

Background: Loneliness is detrimental to health and is linked to numerous physiological and psychological problems. People across the age spectrum can be affected by loneliness at one point or another in their lives; however, older adults are disproportionally affected.

Aims: This study investigated the effect of interpersonal goals (compassionate and self-image goals), life satisfaction, and subjective well-being on loneliness in older adults and the influence of demographics and social support. The Ecosystem-Egosystem Theory of Social Motivation served as the theoretical framework.

Design and Method: This descriptive cross-sectional correlational study used the 2016 Health and Retirement Study. Participants were 65 years …

Implementation Of Maternal Fetal Triage Index To Improve Nurse Knowledge And Timeliness In Obstetric Triage: A Pilot Project, Emilie Long

Doctor of Nursing Practice Projects: College of Nursing

Objective: The objective of this project was to implement an obstetric triage acuity scale in a labor and delivery setting and study the effect on nurse knowledge and timeliness of care.

Design: A quasi-experimental pre and post-test design was used for this pilot project.

Setting: This project was conducted in an obstetric triage unit located within a fourteen-bed labor and delivery unit in the Midwest.

Methods: This pilot project was conducted over a two-month time period. Fifteen registered nurses qualified to care for obstetric triage patients were given education on the chosen triage acuity scale. A pre-test was administered before …

Decreasing Patient Fall Rates In The Microsystem, Kevin Dwayne Sanchez Camaya

Master's Projects and Capstones

Abstract

Problem: Falls are considered never events, yet continuously occur in the inpatient setting. Falls,

especially falls with injuries, impact the patients, the staff, and the hospital. Falls cause extended lengths of stay, affect the morale of the patients and the staff, and are non-reimbursable events.

Context: There have been an increased rate of falls within a medical/surgical/telemetry unit

microsystem at a Northern California hospital despite standardized screening and prevention tools. The unit can house up to 52 patients and is the designated Covid unit of the hospital at the time of this project.

Interventions: The interventions include optimizing the …

Motivated2move: Icu Liberation And Early Progressive Mobility In Ventilated Patients, Leslie S. Bigler

Master's Projects and Capstones

The Motivated2Move: ICU Liberation and Early Progressive Mobility in Ventilated Patients project was implemented in a 24-bed intensive care unit (ICU) in a 241-bed general care, stroke certified not-for-profit community hospital in northern California. The primary purpose of this project was to educate the nurses on the structure and implementation of the Society of Critical Care Medicine’s evidence-based ICU Liberation (ABCDEF) Bundle (Society of Critical Care Medicine, n.d.). A secondary purpose of this project was to coordinate an early progressive exercise and mobility protocol for all ventilated patients. The primary goal of the project is 100% compliance with the ICU …

Reducing Hospital Readmission Rate In Chf Patients Through Early Individualized Patient Discharge Education, Anthony Ensah

Master's Projects and Capstones

The term congestive heart failure (CHF) is a chronic condition that occurs in a person when the heart stops doing its normal activity of pumping blood to the rest of the body for the body. Heart failure normally occurs when the heart can no longer pump (systolic) or fills (diastolic) pressure adequately to the body. Because heart failure is one of the leading causes of death in the United States this project was conducted on one of the Northern California San Francisco Bay- Area hospitals to assess patients understanding and knowledge on the presenting signs and symptoms of heart failure …

Reducing The Postpartum Readmission Rate With Standardized Discharge Teaching, Darlene Day-Herzog

Master's Projects and Capstones

Problem: Hospital readmission rates are one of the quality metrics that matter for hospital reimbursements. In a large Northern California healthcare system, the postpartum readmission rate is often above the national average.

Context: The hospital designated as the main location for high-risk deliveries within a 30-mile radius has an Acute Care Obstetric postpartum population where twenty percent of the patients are at an increased risk for readmission.

Interventions: The project implemented the use of a standardized discharge teaching script and educational materials to be used by nursing staff throughout the patient’s hospital stay to see if multimodal standardization leads to …

Decreasing Maternal Breastfeeding Dissatisfaction During The Night Shift Related To Lactation Support, Robyn Caston

Master's Projects and Capstones

Abstract

Problem

This paper will discuss the Clinical Nurse Leader (CNL) project's specific aim: to decrease maternal dissatisfaction during the night shift related to lactation support in a high-risk maternal department.

Context

Research has shown that adding lactation support improves the decision to exclusively breastfeed and increases the duration. Breastfeeding for all infants starting at birth and continuing until at least 6 months of age has been recommended by the World Health Organization, UNICEF, and the American Academy of Pediatrics. Many studies about lactation support have demonstrated the health benefits to mothers and their infants.

Interventions

A baseline survey will …

Improving Medical-Surgical Nurses’ Confidence In Initiating The Code Blue Process, Moung Sui A. Lee

Master's Projects and Capstones

Lack of confidence in responding to codes can decrease patient outcomes, for any delay in care reduces the chances of revival. As codes occur less frequently in medical-surgical units, nurses who work in this specialty are not as equipped to respond to codes like their ICU or ER colleagues. To address this concern, a code blue readiness training was implemented in six different medical-surgical units of an East Bay hospital. Pre and post surveys were utilized for data comparison on nurses’ confidence in responding to various steps of a code. The results revealed an overall increase in confidence. For this …