Nursing Commons^™

Implementing Cards As A Tool To Expand End-Of-Life Conversations, Amanda Caldwell

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Starting an end-of-life conversation can be daunting for a healthcare provider. These conversations are often challenging and bring up complex emotions for the patient. The aging population is growing immensely, leading to an increased need for advanced care planning in the coming years. Advanced care planning and the discussions surrounding it are commonly limited to issues of cardiopulmonary resuscitation measures. In addition to this, the conversation needs to be focused on values and goals at the end-of-life. Current research shows that value-based end-of-life conversations allow patients to express issues that are important to them. This will allow each patient to …

The Implementation Of A Validated Csec Screening Tool For Youth Age 11 - 17 In A Pediatric Emergency Room, Julie Clark, Josie Doss, Krystal E. Canady, Yameika Head Md

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Youth are a vulnerable population due to their age, developmental level, and dependability on others. Child abuse is a public health issue that addresses a broad range of inflicted harm ranging from neglect to physical and sexual maltreatment. A severe form of child sexual abuse is the Commercial Exploitation of Children (CSEC), also known as Child Sex Trafficking (CST), and Human Minor Sex Trafficking (HMST). For purposes of this paper, CSEC is used for CSEC, CST, and HMST. Commercial sexual exploitation of children includes sexual crimes involving children and adolescents for gain. Due to the child being less than 18 …

Implementation And Evaluation Of An End-Of-Life Standardized Participant Simulation Into An Adult/Gerontology Acute Care Nurse Practitioner Program, Shannon Daly

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Palliative care interventions are in high demand due to patients living longer with chronic, life-limiting conditions. Nursing professionals are instrumental in the care of patients across their lifespan, and it is imperative that they receive end-of-life care training in their respective curriculums. The aims of this project were to 1) implement end-of-life content into an AGACNP program using the ELNEC curriculum and 2) to determine if the simulated environment affects the AGACNP students’ self-confidence and anxiety levels when making clinical decisions for end-of-life patients. As a result of the standardized participant (SP) end-of-life simulation, AGACNP students experienced an increase in …

Perceptions Of Integrating Immersive Virtual Reality Simulation As A Teaching Methodology In A Hospital Setting, Ladonna Christy

Dissertations and Theses (Open Access)

Introduction As newly licensed nurses enter the workforce with limited experience and limited clinical reasoning skills, nursing educators must employ innovative strategies to teach graduate nurses how to identify and manage clinical deterioration – skills which are vital to saving lives and improving outcomes. Fully immersive Virtual Reality (VR), (also defined as Immersive VR) is one effective educational strategy available for hospital educators to use for preparing newly licensed nurses to recognize and manage clinical deterioration.

Objective The purpose of this study was to explore perceptions of hospital-based nurse educators, simulation specialists, and nursing leaders with respect to integrating immersive …

Postpartum Depression Screening In The Neonatal Intensive Care Unit: Maternal And Provider Perspectives, Candice Triulzi

Dissertations and Theses (Open Access)

Objective: Although mothers of preterm infants are at increased risk for postpartum depression (PPD), PPD screening conducted by neonatal providers in the Neonatal Intensive Care Unit (NICU) is currently not a standard of care. The purpose of this study was to explore maternal and provider perceptions of neonatal providers conducting PPD screening in the NICU.

Design: This study was conducted with a qualitative approach.

Setting: A 24-bed Level III NICU in Houston, TX acted as the study site.

Participants: Participants were purposively sampled (N=31) and included mothers of NICU infants (n=15) and NICU providers (n=16).

Methods: Semi-structured individual and paired …

Factors Associated With Advance Care Planning Engagement In Healthy Young Adults, Pablo J. Vasquez

Dissertations and Theses (Open Access)

Background: Advance care planning (ACP) is a process that supports individuals at any stage of health in understanding and sharing their personal values and goals pertaining current or future medical needs with their families and healthcare providers. Although ACP is applicable to adults of any age and any stage of the health continuum, it is widely associated with older or terminally ill populations, and the need for end-of-life (EOL) planning in healthy young adults is generally found unnecessary. The National Institutes of Health supports the expansion of ACP research in understudied populations. Investigating ACP in healthy young adults support such …

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

Doctoral Projects

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

Integrating Mental Health Into Primary Care, Lori Hopwood, April Schmidt

Doctor of Nursing Practice Projects

BACKGROUND: The purpose of this project was to examine the effects of a newly integrated collaborative mental health care model. The primary goal of the integrated behavioral health program was designed to increase the ability of primary care providers to provide mental health services with the support and expertise of a consulting psychiatrist and behavioral health specialist. Additional goals were to improve access to care and improve mental health outcomes.

AIMS: The aim of this project was to evaluate a new way of integrating mental health services in a rural health, primary care practice in central Illinois.

METHODS: Measures …

Implementation Of Phq-2 Screening Tool In A Telemedicine Based Setting, Joanna Luong

Doctor of Nursing Practice Projects

Background Major depression is one of the most common mental health disorders in the United States, affecting nearly 17.3 million of the population. As cases continue to rise throughout the ongoing pandemic of COVID-19, telemedicine has become a popular modality for accessibility to mental health care. Adequate screening, availability of resources and services, prompt treatment, and simple follow ups can contribute to treatment success rates and higher positive outcomes.

Theoretical Framework

The expanded collaborative chronic care model theoretical framework translates to this project in that it approaches management of patients with a team approach for those who screen positive for …

Establishing A Neonatal Peripherally Inserted Central Catheter (Picc) Team, Rebecca Hunt

Doctor of Nursing Practice Projects

Infants admitted to the neonatal intensive care unit (NICU) have a plethora of diagnoses, including prematurity and newborns with genetic, neurological, surgical, and cardiac problems. The nature of these disease processes usually precludes enteral feedings and providing the infant with appropriate nutrition and hydration is a priority. This requires central venous access and peripherally inserted central catheter (PICC) placement allows for a reliable route of administration for intravenous nutrition and medications. The purpose of this project was to develop a nurse-led neonatal PICC team to provide timely placement of PICC lines while maintaining cost-effectiveness and maintaining a minimal number of …

Neuraxial Anesthesia For Total Joint Arthroplasty, Katherine Pozzo

Doctor of Nursing Practice Projects

This quality improvement doctoral nursing project sought to provide a sustainable and data-driven change process at a critical access hospital in Illinois. The main objective of this project was an improvement in postoperative pain scores and implementation of best practice guidelines regarding total joint arthroplasty. Total joint arthroplasty is one of the most common surgical procedures performed in the United States. Future figures predict exponential growth due to our aging patient population, the obesity epidemic, and continued improvements in technique. Despite advances, orthopedic surgeries continue to be taxing on the body and can produce significant complications. General anesthesia for these …

The Use Of Point Of Care Ultrasound To Assess Gastric Contents And Determine Aspiration Risk In The Obese Patient Presenting For Elective Surgery, Harry Senaldi, Mary Zerlan

Doctor of Nursing Practice Projects

Pulmonary aspiration of gastric content is a potentially injurious and fatal complication of anesthesia. Obese patients with a BMI ≥ 35 presenting for elective surgery are at an increased risk of aspiration due to increased gastric pressure, delayed gastric emptying, and higher gastric volumes. Point of care ultrasound (POCUS) is a tool that allows the nurse anesthetist to assess gastric content and assign aspiration risk based on the scan results. A knowledge improvement project in the form of a lecture and hands-on tutorial focused on using POCUS to assess gastric content and assign aspiration risk was designed. This project was …

Physician Use Of The Rapid3 To Guide Rheumatology Follow-Up: A Retrospective Examination, Karen Howard

Doctor of Nursing Practice Projects

Abstract

The Quality Improvement Team of a rheumatology clinic was seeking ways to deal with the long intervals for an available follow-up appointment. The use of standardized disease activity assessment tools as a part of patient care is an evidence-based practice that is not employed by over one third of rheumatologists. One of the many uses of these tools is to guide treat-to- target care. Treat-to-target care uses the disease assessment tool score to guide treatment decisions and follow up interval. This project examined the use of a standardized disease assessment tool, the Routine Assessment of Patient Index Data 3 …

The Development Of An Evidenced-Based Guideline For The Anesthetic Management Of Surgical Cases Utilizing Evoked Potential Monitoring, Brent Hitchens, Darrell Risinger

Doctor of Nursing Practice Projects

Recent increases in the prevalence of neuromonitoring cases have contributed to the utilization of evoked potential (EP) monitoring during surgery. Evoked potentials are electrical signals measured in response to a stimulus. Intraoperative neuromonitoring is used to alert the surgeon, anesthesia provider, and neuromonitoring technician of changes before permanent nerve injury occurs. There are many factors that can affect neuromonitoring quality including hypothermia, hypotension, positioning, anemia, and anesthesia medications. The latter is especially important since certain anesthetic medications can have a profound inhibitory effect on the nervous system, leading to decreased amplitude and prolonged latency of EP signals. As a result, …

Introduction Of Enhanced Recovery After Cesarean Section (Erac) Protocol, Kwame Adu-Affum

Doctor of Nursing Practice Projects

Cesarean section is one of the most performed in-patient surgeries worldwide (Wilson et al., 2018; Liu et al., 2020). Births by cesarean section have been increasing globally. Cesarean birth rate has remained above 31% in the United States, even with the consistent two percent decrease in birth rate per year (Martin et al., 2019). Illinois has also maintained a high cesarean birth rate above 30% (Hamilton et al., 2021). Cesarean patients experience inflammatory and neurohormonal changes with many adverse effects in direct response to surgical stress (Mullman et al., 2020). The post-cesarean physiological effects, including pain, reduced gastric motility, pulmonary …

Computer-Based Learning Module: Local Anesthetic Systemic Toxicity, Nhan Nguyen

Doctor of Nursing Practice Projects

Local anesthetic systemic toxicity (LAST) is the result of rapid absorption of local anesthetics (LAs) into the systemic circulation resulting in toxic plasma levels of the drugs. With the advent of ultrasound-guided regional anesthesia and improvements in injection techniques, the incidence of LAST has decreased significantly over the years. Even though LAST is rare, it is a potential, life-threatening complication associated with any administration of LAs. Providers and staff members taking care of patients receiving LAs should be astutely aware of potential complications so that LAST signs and symptoms can be recognized, and treatments can be implemented as swiftly as …

Difficult Labor Epidural: Intrathecal Catheter Management, Andrew Screnchuk

Doctor of Nursing Practice Projects

Labor epidural analgesia is the most common method used to control pain associated with labor and vaginal delivery in the United States. However, the epidural catheter placement can cause accidental dural puncture in about 1 to 6% of laboring patients. Initiation of continuous intrathecal analgesia provides a good alternative to another attempt of epidural placement in certain types of the laboring population. While other countries have published referral guidelines of managing accidental dural puncture, the United States lacks such practice standards. The application of Accidental Dural Puncture Management with Intrathecal Catheter (ADPMIC) guidelines, used in other countries for difficult epidural …

Perioperative Tube Feeding Guidelines For The Pediatric Burn Patient, Jordan Swanberg

Doctor of Nursing Practice Projects

Pediatric burn patients require an astronomical amount of nutritional support to promote wound healing and prevent unwanted side effects. These patients often require multiple surgeries, and consequently, when following standard NPO guidelines, these patients go for hours without any nutritional support. For this reason, a protocol was implemented on how to administer tube feedings throughout the perioperative process safely. The purpose of this project was to give a PowerPoint presentation to the providers that tested their current knowledge on how to manage tube feedings in the operative setting best. A single group design consisting of CRNA’s and an anesthesiologist was …

Creating A Guideline For Sti Testing In The Pediatric Population, Alexandria Molaro, Alexandra Evans, Alex Niebrugge

Doctor of Nursing Practice Projects

Sexually transmitted infection (STI) prevention, education, screening, and management in pediatric primary care settings are of importance due to the increasing number of cases yearly. Almost half of the 26 million new STIs that occurred in 2018 were among young people 15-24. An opportunity existed in a rural pediatric primary clinic, for improved adherence to Centers for Disease Control and Prevention (CDC) or American Academy of Pediatrics (AAP) recommendations to screen/test patients. An evidence-based project (EBP) was developed to address this concern. Project objectives included: developing STI screening guidelines for pre-teen to young adults, developing a screening algorithm, providing alternative …

Critical Care Orientation Escape Room, Leah Deaton

Doctor of Nursing Practice Projects

Newly licensed nurses often feel unprepared and lack confidence as they transition from academia to practice. Education Specialists who oversee training programs for newly graduated nurses are challenged to create education modalities that are meaningful, engaging, and promote critical thinking. The purpose of this project was to create an Educational Escape Room to reinforce principles of safe medication administration for new nurses entering critical care areas in a large pediatric hospital. Escape Rooms engage learners through gamification and active-learning principles to improve knowledge synthesis and retention. Eighty-three newly hired critical care RNs participated in the Educational Escape Room during house-wide …

Improving Healthcare Team Communication With Limited English Proficiency Families In The Nicu, Ivonne Mandell

Doctor of Nursing Practice Projects

Language barriers are common in healthcare settings, creating disparities in care between individuals with limited English proficiency and those with English proficiency. In the NICU setting, professional medical interpreters have been shown to improve parent/staff communication and increase parent satisfaction by allowing parents to ask questions and form trusting relationships with staff. Solid parent-provider communication can result in better health outcomes by increasing parental empowerment and participation in their child’s care. Despite the acknowledged advantages of using professional interpreters in healthcare settings, they are frequently under-utilized, even when readily available. The purpose of this project was to improve communication with …

Implementation Of Depression Screening In A Nursing Home, Titilayo Raji

Doctor of Nursing Practice Projects

Abstract

Background/Introduction

Unidentified and untreated depression among nursing home residents leads to poor quality-of-life and substantial healthcare dollars are utilized for care management. Use of validated instruments and routine screening provides opportunity for early detection and treatment.

Purpose

The purpose of this project was to educate employees of a nursing home on the use of the Geriatric Depression Screening (GDS) tool, implement it on two units of the nursing home, and evaluate the feasibility and acceptability of this quality improvement project.

Method

An educational presentation was delivered to introduce the implementation plan, GDS screening tool, and protocol for data collection. …

Best Practice In The Perioperative Anesthetic Management Of Infants With Gastroschisis, Emily R. Lester

Doctor of Nursing Practice Projects

Gastroschisis, a severe abdominal wall defect, occurs in approximately 1 in every 2,000 fetuses. Despite care advancements, gastroschisis is associated with significant morbidity and mortality including prolonged time to tolerance of enteral feeds, prolonged ventilator support, and increased intensive care unit length of stay and hospital costs. A recent practice change in the care of infants with gastroschisis at a tertiary care facility in central Illinois lead to the request for an integrative review of the available literature and subsequent development of a comprehensive guideline discussing best-practice perioperative recommendations pertinent to the care of infants with gastroschisis. Through review of …

Pediatric Distraction Methods For The Perioperative Period, Jennifer L. Ashton, Katherine M. Rosner

Doctor of Nursing Practice Projects

Abstract

Most pediatric patients will experience anxiety to some degree during the perioperative period. Unrecognized and untreated anxiety can lead to complications during induction of anesthesia and may manifest as maladaptive behaviors that can last up to 6 months postoperatively. Multiple modalities are typically utilized to provide the greatest amount of anxiety relief with minimal side effects. Nonpharmacological methods of distraction have been proven effective when used in combination with pharmacological agents, as well as when used alone. The goal of this project was to create and present an educational resource tool regarding pharmacological and nonpharmacological distraction methods for pediatric …

Anticipatory Guidance For Parents/Caregivers Of Pediatric Patients Ages 0-12 Months, Cody Palmer, Anna Hagnauer

Doctor of Nursing Practice Projects

Anticipatory guidance is defined as proactive counseling for caregivers regarding various aspects of childcare and development. This project sought to improve the process and delivery of anticipatory guidance for infants aged 0-12 months at one rural pediatric primary care clinic. An extensive literature review was undertaken to determine current recommendations for anticipatory guidance topics pertinent to pediatric patients aged 0-12 months. Additional research explored the efficacy of various educational formats to provide teaching. Written educational materials were updated and edited to be visually appealing and understandable, and educational videos were created. Written materials and educational videos were provided to parents/caregivers …

Development Of A Protocol To Manage Postdural Puncture Headache, Ashley M. Shulman, Lynexis P. Mcvey

Doctor of Nursing Practice Projects

In obstetric laboring patients, neuraxial anesthesia is a common form of analgesia. However, neuraxial procedures are not without risk. Accidental dural puncture (ADP) is a potential risk with any epidural procedure. Patients who experience ADP are at a greater risk of developing postdural puncture headache (PDPH). The presentation of PDPH is commonly described as a dull, throbbing, headache worsening upon standing and relieved with supine positioning (Patel et al., 2020). Symptoms of PDPH may range from mild to debilitating and develop within five days of ADP. A variety of treatment options exist for PDPH ranging from conservative to invasive. The …

Improving Staff Education On Lung Cancer Screening At The Illinois Correctional Facilities For The Justice-Involved Individuals, Natalie Bethel, Jillian Youngquist

Doctor of Nursing Practice Projects

Justice-involved individuals are at an increased risk of developing chronic health conditions, including lung cancer. Literature supports the practice of using an annual low-dose CT scan to screen for lung cancer. Illinois Correctional Facilities lacked a lung cancer screening protocol for justice-involved individuals. Lung cancer screening guidelines were approved for the facilities, however, the time frame for implementation was unclear. This DNP project focused on evidenced based guidelines for lung cancer screening with education tools for staff members to prepare them for implementation. Staff was presented with a pre-test, PowerPoint presentation, and a post-test to evaluate lung cancer screening knowledge. …

Establishing Care With A Primary Care Provider, Ashley Whitlatch

Doctor of Nursing Practice Projects

Established primary care leads to continuity of care, improved patient outcomes, and increased quality of life. There is also an improvement in the unnecessary usage of urgent care resources. The purpose of this project was to pilot a new process within the urgent or emergent care setting to ensure that patients who are not established with a primary care provider (PCP) have an appointment set before they are discharged. Staff were educated and trained in how to schedule primary care appointments for at-large patients. There are a high number of individuals who do not have a primary care provider. When …

Implementation Of Routine Screening With Patient Health Questionnaire 9 (Phq-9) Of Adults With Crohn’S Disease, Jo A. Muller-Krause

Doctor of Nursing Practice Projects

Introduction: Mild levels of depression have been measured with screening tools at rates of 15-24% in adults with Crohn’s disease (CD). The spectrum of the impact of depressive symptoms is measurable and documented for those with CD. Patient perspectives support the integration of psychological care, and the Patient Health Questionnaire 9 (PHQ-9) is a well validated tool for the measurement of depressive symptoms.

Purpose: Increase depression screening of adult CD patients in the outpatient gastroenterology clinic and evaluate the provider perspectives regarding PHQ-9, depression, and CD.

Conceptual Framework: The Johns Hopkins Nursing Evidence Based Practice (JHNEBP) Model was selected as …

Increasing Obesity Education In An Underserved Latino Population, Morgan Lippert, Kelsey Beard

Doctor of Nursing Practice Projects

Obesity is a rapidly growing health problem in the United States. Certain populations are at high risk for developing obesity including the Latino population and underserved communities. This Quality Improvement project aimed to develop a more patient centered approach for primary care providers use to deliver obesity education to an at-risk Latino population. The project was completed at a clinic in southern Illinois where the majority of the population is underserved and Spanish speaking. Obesity education tools in both Spanish and English were given to the patients in order to decrease the language barrier and improve patient education and understanding …