Nursing Commons^™

Palliative Care Referral Protocol: Best Practice Toolkit For Improving Early Referral Rate For Adult Cancer Patients, Linda Dinh Nguyen

Student Scholarly Projects

Despite the benefits of palliative care being well-documented in studies and early palliative care services being strongly recommended by reputable organizations, such as the American Society of Clinical Oncology, many patients did not receive or received late referrals (Pigni et al., 2022). This mainly occurs because oncologists commonly base their referrals on perceived needs and clinical judgment (Smith et al., 2017). Thus, this program development project aimed to create a toolkit to improve early identification and referral to palliative care for adult patients who would benefit from palliative care services. The PICO question that guides this program is: In ambulatory …

Impact Of Self-Management Education On The Self-Efficacy Of People With Chronic Pain, Tanya Jones

Doctor of Nursing Practice Projects

Self-efficacy is a critical element in the self-management of chronic pain. Despite the traditional approaches to managing chronic pain, such as opioids, traditional methods have proven ineffective and often lead to addiction and misuse, contributing to the overwhelming and devastating opioid crisis. This quality improvement project aimed to reduce the knowledge gap among individuals between the ages of 18 and 75 who have chronic pain by producing data that illustrates that providing individuals with self-management education empowers them to understand and self-manage their pain. The concept of self-management education is grounded in Bandura's Social Cognitive Theory, which highlights the role …

Benchmark Study Of Early Palliative Care In End-Stage Liver Disease, Pebble Ward

MSN Capstone Projects

Patients with ESLD in general have high rates of healthcare utilization, resulting in more than 250,000 hospitalizations at $9.8 billion annually in the United States (Ufere et al., 2019). Liver disease is a rising cause of death worldwide, affecting younger people, but palliative care is largely absent for these patients (Kimball et al. 2018). Early readmissions are common for patients with ESLD and in the U.S. alone, over 25% of patients are readmitted within 30 days of their initial diagnosis, rates that now exceed those seen for patients with CHF and COPD (Ufere et al. 2019). Evidence shows that early …

The Effects Of Diet And Exercise On Menopause Symptoms And Symptom Severity, Nicole Crowder

Doctor of Nursing Practice Projects

Menopause is a phase of life that occurs between the ages of 45-50 years and can last from 7-10 years or longer. The purpose of this quality improvement project was to develop a clinical protocol of assessments not currently completed to decrease the common symptoms of menopause such as hot flashes by implementing dietary changes and exercise as a weekly routine to decrease menopause symptoms. Participation was solicited at a private primary care clinic to women aged 40 and older over a 6-week period. BMI was calculated, documented, and completed surveys were retuned at check-out, with no identifiers and deposited …

Sepsis Criteria On Triage (Scot): Sepsis Alert, Kristie Givens

Doctor of Nursing Practice Projects

Sepsis is a serious life-threatening condition that kills hundreds of thousands of patients every year and is a major leading cause of death. Sepsis is a medical emergency where early identification and prompt treatment are crucial for survival. Despite assessment tools for early recognition, a delay in antibiotic therapy remains. A sepsis alert (Code Sepsis) in the emergency department could improve sepsis care, spare countless lives, and save billions of dollars nationwide, annually. The implementation of a Code Sepsis will trigger a team to deliver immediate treatment and ensure one hour antibiotic administration times. The John Hopkins Nursing Evidence-Based Practice …

Conflict Resolution In Healthcare: The Vital Role Of Developing Conflict Management Skills Among Nurse Leaders, Kris Maddalena

Doctor of Nursing Practice Projects

Nurse leaders at the unit level play a vital and indispensable role in acute care settings. Their influence extends beyond administrative tasks, as they significantly impact crucial factors such as nurse retention rates, patient outcomes, and the overall work environment of the unit-level teams. Effective unit-level leadership has been consistently associated with improved outcomes, increased job satisfaction, and decreased turnover among nurses (Aiken et al., 2011). This DNP project is focused on enhancing conflict management skills among unit-level nurse leaders in an acute care setting. The project followed a quality improvement sequence, which included obtaining a needs assessment for unit-level …

Organizational Methods Of Reducing Burnout: The Impact Of Self-Rostering On Work-Life-Integration, Cory Authement

MSN Capstone Projects

With burnout being at an all-time high, organizations must find new ways to prioritize staff wellbeing and promote work-life balance. According to the Emergency Nurses Association (ENA) turnover in emergency departments ranges from 15-30% within the first year of nursing, and 43% within the first three years (Roncallo et al., 2020). These turnover rates cost a 300-bed facility approximately four million dollars in annual expenditure (Hesse, 2016). This level of loss and expenditure is unsustainable for the future of nursing and diverts resources away from our patients.

In recent studies, it was shown that burnout leads to difficulties for nurses …

Improving Clinical Competence With Electronic Medical Record Training In Nursing Students: A Benchmark Study, Ashley Reddock

MSN Capstone Projects

Nursing students are required to do many clinical hours based on their program, the Board of Nursing and their accrediting body. During these clinicals, students are faced with challenges that cause safety concerns due to lack of exposure or knowledge regarding policies and procedures. What seems like a simple task, could be life altering because of inadequate competency.

Performing at an expected level of education and demonstrating integration of knowledge, skills, abilities, and judgement defines competency according to the American Nurses Association (ANA) (2018). Nursing programs are expected to produce competent students, and competent nurses upon graduation. Displaying competency in …

Improving The Mental Health Of Nursing Students By Utilizing A Serenity Room: A Benchmark Study, Megan E. Taylor

MSN Capstone Projects

Research findings consistently show that even though improvements have been made through the years, there is much more work to be done concerning mental health nationwide, especially in nursing. Nurses are the front-line workers in healthcare and face challenging times daily. Mental health-related issues in nursing have increased on a national level since the COVID-19 pandemic (Xiong et al., 2022). A more significant nursing shortage will likely occur without drastic change and support for nurses’ well-being.

The purpose of this paper is to describe a benchmark Capstone project. This benchmark study was conducted with the goal of improving nursing students …

Benchmark: Reducing Surgical Plume Output With Smoke Evacuation, Kaitlynn Olano

MSN Capstone Projects

This project focuses on addressing the critical issue of surgical smoke exposure in operating rooms through the strategic implementation of smoke evacuation systems. The primary objective is twofold: to prioritize the safety and well-being of healthcare professionals and to ensure that patient care remains uncompromised. It strives to reshape the operating room environment, making surgical plume exposure a thing of the past.

Extensive research forms the core of this project. A comprehensive literature synthesis, including systematic reviews, randomized control trials, prospective and cohort studies, and qualitative research, underscores the occupational safety concerns related to surgical plume exposure. This synthesis strongly …

Green Tea Supplementation: An Effective Lifestyle Modification For Cholesterol Management, Samuel J. Nemati

MSN Capstone Projects

Hypercholesterolemia is an insidious disease and the leading factor to the deadliest killer in the United States – cardiovascular disease (Centers for Disease Control and Prevention, 2023a). Over 85 million American adults suffer from elevated cholesterol, and treatment can prove challenging and may require multiple modalities outside just pharmaceutical intervention – such as dietary and other lifestyle changes (Centers for Disease Control and Prevention, 2023b; Goldman, 2023). Green tea – among the most common teas consumed worldwide – exerts a uniquely antihyperlipidemic and cardioprotective effect that suggests its consideration as a potentially-viable nonpharmacological option for hypercholesterolemia (Harvard Health Publishing, 2012; …

Effect Of Doula Care Education On Cesarean Section Rates: A Benchmark Study, Elena Rubio-Mcdonald

MSN Capstone Projects

A cesarean section (CS) is a vital maternal care intervention when necessary; however, the surgical procedure places childbearing women at direct risk for infection, hemorrhage, thromboembolism, injury to bladder or bowel, post-surgical pain, and complications from anesthesia. The risk of mortality associated with CS is four to five times more likely compared to vaginal delivery. Severe nursing shortages, high patient volumes, and patients with complex pregnancy related health concerns create barriers to the provision of continuous labor support (CLS) by labor and delivery (L&D) nurses. Partnering with certified doulas and implementing the CLS methods they employ may promote spontaneous vaginal …

Cardio-Pulmonary Resuscitation Without The Pulmonary? A Benchmark Project, Fernando A. Rios

MSN Capstone Projects

Cardiac Arrest occurs outside of the hospital setting more than you think. According to MyCares.net, 15% of OHCA happened in a public setting in 2020. Even if you are a trained healthcare professional, it may not be accessible at times in these situations due to different factors such as equipment availability, trained assistance, etc... Having an alternative option to conventional mouth-to-mouth rescue breath CPR would encourage trained and untrained bystanders to perform life-saving interventions to patients until local EMS responders can arrive. The covid pandemic affected everyone inside and outside the medical world. The general population got a real …

Implementation Of Coping Strategies For Compassion Fatigue Through Counseling, Caleb R. Turner

MSN Capstone Projects

Many healthcare organizations are struggling to retain nurses due to the recent COVID-19 pandemic. Understanding common reasons for decreased retention in nursing begins with evaluating job satisfaction and how it can be affected (Cuartero-Castañer, 2021). Compassion Fatigue (CF) and Burnout (BO) are two leading causes of decreased job satisfaction (Compassion Satisfaction (CS)). The Professional Quality of Life Scale (PROQoL) (see Appendix C) is designed to identify individuals at higher risk of CF and BO. Using this scale in conjunction with the Peer-Support coaches in the hospital setting allows nurses to have conversations and communicate effectively with coaches trained to have …

A Provider In Triage To Decrease “Left Without Being Seen”: A Benchmark Project, Taylor B. Weathers

MSN Capstone Projects

As Emergency Departments (ED) continue to fill and become crowed, the attention to care of each patient can be delayed or missed. Back flow into the ED can cause a bottleneck effect for patients coming in, which can lead to an increase in the number of patients who leave without being seen (LWBS). In order to combat the challenges of patient throughput that result in patients leaving prior to care, I am proposing the implementation of a provider in triage (PIT). By placing a provider, either physician or mid-level practitioner, in the triage area will allow patients to been seen …

Evidence-Based Pain Management With Inclusion Of Music Therapy For Post-Surgical Patients: A Benchmark Study, Ashleigh Rowan

MSN Capstone Projects

Improper pain management in the postsurgical patient can delay proper healing, increase frustration for the patient, and prolong hospital stays (Córcoles-Jiménez et al., 2021). Moderate to severe pain can pose a greater risk for complications such as deep vein thrombosis, pneumonia, and delayed recovery (Kolaczko et al., 2019). Music therapy is an underutilized pain intervention in the PACU environment. Music therapy has been shown to lower pain and anxiety scores in many different clinical settings (Lee et al., 2017). Pain management can radically improve a patient’s outlook and recovery (Luo & Min, 2017). Patients who return to wakefulness and receive …

Pre-Shift Mindfulness: An Evidence Based Practice Benchmark Project, Whitney Turner

MSN Capstone Projects

Although a nursing shortage has existed for some time, it seems there is currently a flight of both experienced and young clinicians from the bedside. Over the course of the Covid-19 pandemic, healthcare organizations have seen dramatic increases in turnover and vacancy rates, leading to severe staffing shortages and compromised patient care. Historically, nursing has been a caring, service driven profession, and a calling for millions of professionals. However, nurses are increasingly concerned with their personal wellbeing.

The term “burnout” appeared in the 1970s to describe the consequences of severe stress in “caring” professions, and include symptoms such as exhaustion, …

Massive Transfusion And Shock Index, Kasey House

MSN Capstone Projects

Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.

While initiating an MTP …

Perceptions And Awareness Of Operating Room Staff Regarding Surgical Smoke: Implications For Safety And Health, Karla Flores

MSN Capstone Projects

In the ever-evolving landscape of modern medicine, surgical procedures have become increasingly complex and reliant on energy-based devices, leading to the ubiquitous presence of surgical smoke in ORs. This phenomenon, while a byproduct of technological advancement, poses significant concerns regarding the health and safety of OR personnel, including surgeons, nurses, anesthesiologists, surgical technicians, and ancillary staff. This paper presents a meticulous examination of the multifaceted impacts of surgical smoke, emphasizing the urgency for comprehensive intervention and systemic change.

The Effects Of Non-Pharmacological Interventions For Behavior And Psychological Symptoms Of Dementia: A Benchmark Study, Rachel R. Williams

MSN Capstone Projects

The management of behavioral and psychological symptoms of dementia (BPSD) in patients who reside in nursing homes can be challenging. These neuropsychiatric behaviors can include but are not limited to aggression, agitation, delirium, depression, and psychosis (Cloak & Al Khalili, 2022). Patients with BPSD often have difficulty expressing their needs due to the disease process, resulting in further complexity when managing behaviors. There are no psychotropic medications to treat BPSD specifically, but many are often prescribed to treat the symptoms or behaviors exhibited by patients. The use of psychotropics, especially long-term can cause a myriad of adverse effects and should …

The Effects Of Education On Influenza Vaccination Uptake, Jazzlyn Lawson

MSN Capstone Projects

Influenza is a viral illness that occurs internationally and peaks in prevalence during the months of October to May. There are several types of influenza viruses: Influenza A, B, C, and D (CDC, 2023). Vaccines are available in the United States as early as the start of the flu season to those who wish to receive it. The influenza virus types covered by the annual flu vaccine include Influenzas A and B types (CDC, 2023). The influenza vaccine is recommended by the CDC with the intent to limit the occurrence and spread of influenza each year. Symptoms of influenza consist …

America Heart Association Guidelines On Telemetry Monitoring To Reduce Alarm Fatigue And Improve Patient Outcomes, Rekike Aster Ehrenberg

MSN Capstone Projects

The excessive use of telemetry monitoring in healthcare has become a widespread concern, leading to increased healthcare costs and alarm fatigue among providers. These issues threaten patient safety and negatively impact patient outcomes. To address these issues, the American Heart Association (AHA) has published guidelines for telemetry monitoring to reduce alarm fatigue and improve patient outcomes.

A three-month benchmark project was conducted using evidence-based methods to implement the AHA guidelines for telemetry monitoring in a medical-surgical unit. The project aimed to serve as a model for others with similar issues. By following the AHA guidelines, patient safety can be enhanced, …

The Impact Of Shared Governance On Work Engagement And Job Satisfaction, Mikayla Adkins

MSN Capstone Projects

In 2023, the National Council of State Boards of Nursing revealed that 100,000 nurses left the workforce during the COVID-19 pandemic and another 900,000 plan to leave by 2027 due to stress, burnout, and retirement. Identifying and implementing practical strategies to reduce voluntary turnover as a result of stress and burnout is a top priority for nursing leaders across the country. Work engagement and job satisfaction have well been documented in the literature as antidotes to occupational stress and burnout in the nursing profession (Schaufeli & Bakker, 2004; Pressley & Garside, 2022). Evidence suggests that implementing shared governance is a …

Empowering New Ob Nurses To Combat Racial Disparities Through Education, Tabitha Poole

Doctor of Nursing Practice Projects

Minority patients are experiencing maternal morbidity and mortality at rates three to four times higher than white patients in America (Valerio et al., 2023). The project aims to measure the impact of anti-racism training on new OB nurses' understanding of racial disparities and their impact on maternal health outcomes. A three-hour educational course, in alignment with evidence-based practices, was provided to the participants. Utilizing a Likert Scale, pre- and post-intervention assessments were administered via Microsoft Forms to measure participants' perception of knowledge of implicit bias and structural racism. Gender, age range, and race/ethnicity were also collected to allow for further …

Wellness Review 2023, Part 1, Brian A. Ferguson, Martin Huecker

Journal of Wellness

Introduction: The 2023 Part 1 summary reviews research on wellness in healthcare professionals published outside of JWellness from January 1, 2023 to June 30, 2023.

Methods: Editors conducted a Boolean search of titles and abstracts in PubMed utilizing keyword identifiers pairing healthcare personnel (providers, nurses, and other staff) with a well-being metric. Of 416 relevant articles, an intriguing and innovative 30 were selected for inclusion, with two additional articles manually curated.

Literature in Review: This sample of the recent literature into healthcare professional wellness included multiple targeted interventions and studies of resilience. Main themes that emerged include: positive systematic healthcare …

Analysis Of Phlebotomy Training Implementation To Reduce Lab Errors In The Clinical Setting, Sandy King

Doctor of Nursing Practice Projects

The primary responsibility of a laboratory technician is to obtain patient blood samples through venipuncture as well as collect, transport, and store other clinical specimens. Poor blood collection can lead to erroneous and misleading results for the provider in addition to the annoyance of repeat testing for the patient. The lack of formal phlebotomy training provided to nurses could be contributing to laboratory rejections. For patients receiving lab services, how effective is an implementation of formal phlebotomy training for nurses compared to non-formal phlebotomy-trained nurses, in reducing failed lab results? The purpose and aim of this quality improvement project are …

Medication Overrides In Emergency Departments Defy Safety Culture, Jennifer Holt

Doctor of Nursing Practice Projects

Medication errors are a growing problem in healthcare systems. Emergency Departments (ED) are especially susceptible to this. Automated dispensing cabinets (ADC) help promote patient safety, but ED nurses commonly override the safety steps built into that workflow. This quality improvement project aims to reduce the number of medication overrides in three rural emergency departments. Data was compiled for the six months before the education and then for the four-week time frame post-education. Education was developed concerning the effects of medication override and errors were presented to all ED nursing staff at the three facilities. Implementation occurred over four weeks and …

Palliative Care And Quality Of Life Improvement: A Benchmark Study, Rebecca Daniels

MSN Capstone Projects

This project provides an overview of the standard and regular implementation of palliative care versus early implementation of palliative care in patients with chronic or terminal illnesses. Palliative care is an essential component of healthcare that focuses on improving the quality of life and providing support to patients through holistic elements to patients and their families facing chronic and terminal illnesses. With evidence-based research, many articles have been published with implementation of early palliative care showing improvement in patient and even caregiver quality of life. This project includes evidence gathered from mixed methods of systematic review of existing literature, randomized …

Fostering Critical Thinking Through Simulation: An Integrative Review, Sarah Knapp, Raymonta Green

Master of Science in Nursing Final Projects

Over the past decade simulation has become a staple of nursing education with increasing use during the COVID-19 pandemic. Both manikin-based and virtual simulation are used to increase the preparedness of nursing students for their roles at the bedside. With the increasing experience-complexity gap, it is important that students enter the workforce prepared to effectively care for patients. Simulation allows students to work with a patient scenario without the possibility of injury; in simulation, mistakes are opportunities instead of harm. This integrative review searched the literature questioning if in pre-licensure Bachelor of Science in Nursing students, do virtual simulation and …

Advance Care Planning: Best Practice Toolkit For Improving Access To Advance Care Planning Using Telehealth Visits, Jae Jackson

Student Scholarly Projects

Advance care planning (ACP) predominately occurs during a life-threatening crisis or during an inpatient admission. The primary care provider (PCP) is generally not the healthcare provider addressing ACP at the time of a crisis or during an inpatient admission. Being proactive in limiting ACP decisions with unfamiliar providers, uncomfortable environments, and increasing access to ACP discussions with PCPs are supportive reasons to utilize an ACP telehealth toolkit in primary care. Patients risk having ACP discussions with random providers, environments that don’t provide comfort when having such personal discussions, or not having the peaceful death they deserve without having an ACP …