Nursing Commons^™

Evidenced-Based Practice Competency Assessment For Competency-Based Orientation Protocol To Improve Competency Level Among Medical-Surgical Nurses, Maryann Ornelas

Student Scholarly Projects

Practice Problem: Within a 12-month period, high incidences of severe post-spinal surgical complications resulted in a host of concerns in this clinical site when patients either returned to the operating room for spine revision or increased the length of stay.

PICOT: The PICOT question that guided this project was: "In Medical Surgical (Med-Surg) nurses (P), how would a Competency-Based Orientation (CBO) protocol with the inclusions of four critical elements of postoperative spinal care [POSC] (I) compared to the usual postoperative practice (C) enhance competency level in Med-Surg nurses when delivering postoperative practice at an inpatient setting (O) over 10 weeks …

My Happy Baby Is Back: Zero Balancing, Craniosacral Therapy And A Baby’S Journey To Becoming Mobile, Veronica Quarry

Journal of Transformative Touch

Alison began receiving ZB and CST at 13 months of age due to gross motor delays: at that age she was only able to sit somewhat rigidly. After the first session, Alison changed` from being very unhappy and seemingly frustrated to being happy and more calm. Within one month of weekly sessions, Alison was able to be on her tummy, began to crawl, became more agile in seated play, was squatting and standing and took her first steps.

A Multi-Stakeholder Perspective On Quality Of Care Among Residents, Family Members And Nursing Staff In Nursing Homes: A Balanced Centricity Approach, Sil Aarts, Erica De Vries, Hilde Verbeek, Gaby Odekerken, Katya Y. J. Sion

Patient Experience Journal

The objective of this study was to use a Balanced Centricity (BC) approach to describe how personal values related to experienced quality of care are defined for residents, family and nursing staff in nursing homes. Capturing the values from a multi-stakeholder perspective, a qualitative approach was conducted in which the stakeholders’ (e.g., residents, family members of residents and nursing staff; a triad) experiences, opinions and values were explored. Participants were recruited from ten nursing homes within the Living Lab in Ageing & Long-Term Care Limburg, the Netherlands. The audio recording of every interview was transcribed verbatim. The analysis made use …

Identifying Sources Of Patient Dissatisfaction When Seeking Care For A Chronic And Complex Disease, Katharine J. Head, Anna K. Forster, Amanda Harsin, Rebecca J. Bartlett Ellis

Patient Experience Journal

Patients’ evaluations of healthcare often rely on patient satisfaction and encounter-specific approaches. Instead, valuable information can be gained by focusing on patient dissatisfaction with healthcare over time. This study examined patients’ sources of care dissatisfaction when seeking healthcare for a long-term chronic and complex disease (CCD). Participants with a CCD called polycystic kidney disease (N=387) completed an online questionnaire with an open-ended question about dissatisfying experiences. Content analysis was used to analyze responses. The coded data resulted in conceptual codes related to dissatisfaction with information, support, and care management. Analysis revealed the type of healthcare provider is often …

Standardizing Congestive Heart Failure Education To Decrease Readmissions, Cyntia Boter

Master's Projects and Capstones

Background: The setting of this project took place in a small 100-bed community hospital that is a part of a larger healthcare organization in Northern California. The focus of the project was the implementation of standardized education for patients with congestive heart failure (CHF) to lead to an outcome of decreased readmissions. Readmissions to hospitals are costly and effective discharge planning can impact and decrease readmissions.

Problem: The facility in which this project took place has 35 readmissions a year for CHF. It is the third highest DRG and reason for readmissions in 2022. Although there is work in place …

Transformational Leadership Training For Middle Management To Reduce Turnover And Improve Job Satisfaction, Andrea Huntsinger, Andrea Huntsinger

Master's Projects and Capstones

Reduce Turnover and Improve Job Satisfaction

Abstract

Background: The medical center’s Maternal Child Health Department comprises 10 labor and delivery beds, 22 postpartum beds, and a 16-bed Level II NICU. The unit is overseen by six ANMs, a manager, and a director. The unit comprises approximately 160 employees, most being bedside registered nurses (RNs). The hospital prioritizes achieving Magnet status, where nurse job satisfaction is prioritized. The concern is that the department’s culture is not aligning with Magnet guidelines due to a lack of leadership within the unit.

Problem: A review of the department’s ANM team showed an unstable turnover …

Use Of Electronic Health Record Reminders To Improve Primary Care Providers’ Colorectal Cancer Screening Recommendations., Terra Renee Schrembs

Doctor of Nursing Practice Papers

Background: Colorectal cancer (CRC) is the third most common worldwide cause of cancer morbidity and mortality. CRC mortality is preventable through regular screening. Electronic health record (EHR) reminders for providers can increase providers’ CRC screening recommendations and lead to earlier CRC diagnosis. According to the National Cancer Institute’s Screening and Risk Factors Report for Kentucky by County 2008-2010, 62.7% of adults in a rural Kentucky county aged 50-75 had completed a home based FOBT in the past two years or have ever had a colorectal endoscopy.

Purpose: The purpose of this DNP project was to implement and evaluate an …

Evaluation Of Sensory Room Education To Promote Usage In An Inpatient Psychiatric Setting: A Quality Improvement Project., Breanna M. Coulardot

Doctor of Nursing Practice Papers

Seclusion and restraints are intended to be used as a last resort intervention if a patient presents as harmful to themself or others. However, the use of seclusion and restraints in mental health practice has been questioned for several decades. A 26-year study that researched restraint-related fatalities among children and adolescents in the United States from 1993 to 2018 disclosed 79 deaths (Nunno et al., 2022). Seclusion and restraints also restrict autonomy which can cause retraumatization if a patient was previously neglected or abused (Hammer et al., 2011). Many patients presenting to the project site are survivors of neglect and …

A Program Evaluation Of Domestic Violence Screening At A Large Urban Hospital., Taylor L'Heureux

Doctor of Nursing Practice Papers

Domestic violence has been deemed a direct invasion and violation of human rights by the World Health Organization (2021). Due to the continuous rise in cases of domestic violence, national organizations like the United States Preventative Services Task Force (USPSTF) have recommended that healthcare providers screen patients for this abuse. The purpose of this study was to reinforce the current screening procedure and protocol to ensure that each patient was screened for domestic violence before being discharged from the hospital. This study evaluated a quality improvement project formed to promote the completion of a preexisting domestic violence screening form that …

Implementation Of A Mindfulness Intervention To Increase Adolescent Resilience In An After-School Program: A Quality Improvement Project., Katie Thomas

Doctor of Nursing Practice Papers

Background: Globally, fourteen percent of adolescents ages 10 to 19 years old suffer from mental health problems (World Health Organization, 2021). Resilience is a fundamental concept of the mental health promotion framework (CAMH, 2022).The WHO (2020) “Guidelines on Mental Health Promotive and Preventive Interventions for Adolescents” includes the recommendation that universal interventions to promote mental health and reduce mental disorders should include social and emotional learning (SEL), such as emotional regulation, mindfulness, stress management, problem solving, and interpersonal skills. Mindfulness-based interventions (MBIs) are one evidence-based method of accomplishing this goal (Sapthiang et al., 2018). Purpose: The purpose of …

Implementation Of An Initiative To Standardize Abdominal Binder Use In Postoperative Cesarean Section Patients: A Program Evaluation., Sarah Cohron

Doctor of Nursing Practice Papers

A cesarean section is a major abdominal surgery with a unique recovery profile. The patient must recover from surgery while simultaneously coping with a major life event: the birth of a new baby. The utilization of pain management techniques with as few side effects as possible is paramount to ensure optimal maternal and newborn outcomes (Karlström et. al., 2007; Eisenach et. al., 2008). On an inpatient mother/baby unit at a high-risk urban hospital in Louisville, Kentucky approximately 66 babies are born via cesarean section every month (Mattingly, 2021). However, in the fall of 2021, it was discovered that there was …

Introduction Of A Policy Adherence Plan In An Outpatient Buprenorphine Treatment Clinic., Stacie Switzer Cheney

Doctor of Nursing Practice Papers

Abstract

Background: Medication-Assisted Treatment (MAT) is one of the most effective pharmacological therapies for opioid dependence. Regular urine drug screening to include random urine drug screens at least once a month is a key factor in improving quality care for those receiving treatment in an outpatient MAT clinic.

Problem: A rural outpatient MAT clinic has a current random urine policy that is not being utilized when treating clients with Opioid Use Disorder (OUD). This increases the risk of diversion and misuse of buprenorphine/naloxone (Suboxone), thus increasing the risk of overdose and death for OUD patients.

Environment: This project was implemented …

Effects Of Preoperative Chlorhexidine Gluconate (Chg) Cloths Educational Intervention For Preoperative Staff On Chg Knowledge And Surgical Site Infection Rates: A Quality Improvement Initiative., Deven Leffler

Doctor of Nursing Practice Papers

Abstract

Background: Surgical site infections (SSIs) are the most common cause of a surgical complication and account for 38% of all hospital acquired infections (HAI). The cost of caring for SSIs in the United States can range from $3.5-$10 billion annually.

Purpose: The purpose of this DNP Quality Improvement (QI) initiative was to improve preoperative staff’s knowledge and application of the Food and Drug Administration (FDA) approved 3-minute application scrub time for the 2% CHG cloths and reduce SSIs for an acute care hospital located in Louisville, Kentucky.

Methods: Quality improvement was initiated using the Plan, Do, Study, Act (PDSA) …

The Impact Of Social Determinants Of Health And Acculturation On Quality Of Life In Older Chinese American Adults With Chronic Pain: A Quantitative Study, Chi Lam

Dissertations

Despite a rapid increase in the older Chinese American adult population, there are very few research studies examining the impact of social determinants of health and acculturation on the quality of life in older Chinese American adults. The purpose of the study was to determine the impact of social determinants of health and acculturation on quality of life in older Chinese American adults with chronic pain. This quantitative, descriptive correlational study utilized Madeleine Leininger’s Transcultural Theory as its theoretical framework. Two research questions guided this study: (1) Was there a difference in the quality of life in older Chinese American …

Improving Central Line-Associated Bloodstream Infection Prevention Bundle Compliance To Reduce Infection Rates In A Pediatric Cardiac Intensive Care Unit., Aubree Croghan

Doctor of Nursing Practice Papers

Background: Central line-associated bloodstream infection (CLABSI) is the most common healthcare-acquired infection in pediatrics. A pediatric acute care facility in Kentucky created a specialized care team in an effort to track CLABSI bundle compliance and reduce central line infections. While rates of infection decreased, a significant number of infections still occurred and staff adherence to facility evidence-based policies and infection prevention interventions remained low.

Purpose: To reach the facility’s goal of zero central line-associated bloodstream infections, a quality improvement (QI) project was developed to improve staff knowledge of care and increase staff adherence to policy.

Methodology: To create the QI …

Improving Prediabetes Screening, Diagnosis, And Referral To A Diabetes Prevention Program In The Primary Care Setting., Brittany Morguelan

Doctor of Nursing Practice Papers

Improving Prediabetes Screening, Diagnosis, and Referral to a Diabetes Prevention Program in the Primary Care Setting

Table of Contents

Abstract……………………………………………………………………………………………4

Background………………………………………………………………………………………..5

Purpose…………………………………………………………………………………………...10

Literature Review……………………………………………………………………………...…10

Conceptual Framework…………………………………………………………………………..15

Setting………………………………………………………………………………………...….17

Context…………………………………………………………………………………………..18

Procedures/Intervention…….……………………………………………………………………19

Ethical Considerations…..……………………………………………………………………….20

Measures…………………………………………………………………………………………20

Data Analysis……………………………………………...……………………………………..22

Results……………………………………………………………………………………………23

Discussion……………………………………………………………………………...………...26

References……………………………………………………………………………………….33

Appendix A: Implementation Timeline…………………………………………………………40

Appendix B: IROC Quality Improvement Leadership Approval Letter………………………...41

Appendix C: PCP Referral Process and Diabetes Prevention Program Referral Order………...42

Figure 1: Monthly Number of N-DPP EHR Referrals by PCPs…………………………………….43

Figure 2: Monthly Total PCP Screening HbA1c/FBG Orders vs. Monthly Results HbA1cs……44

Figure 3: Demographic Analysis: Patients with a Documented Prediabetes ICD-10 (R73.03/R73.0)………………………………………………………………………………………….45

Abstract

Background: Prediabetes is a …

Utilizing A Reminder Tool To Improve Post-Hypoglycemia Recheck Rates On A Medical Surgical Unit., Laken Heitz

Doctor of Nursing Practice Papers

Diabetes is a growing epidemic with profound implications on the healthcare system. One of many possible complications is hypoglycemia, which is any value below 70 mg/dL. Inpatient hypoglycemia is a patient safety concern, and its treatment requires nursing adherence to strict protocols including a recheck within 15 to 30 minutes after treatment. However, evidence from the literature and project site demonstrated low rates of timely post-hypoglycemia rechecks. The purpose of this project was to provide education to all MIPS nurses regarding the utilization of a reminder tool for post-hypoglycemia rechecks. The intervention plan included reviewing the current hospital-wide hypoglycemia policy, …

Remote Blood Pressure Monitoring Program: Program Evaluation., Brittany Walker

Doctor of Nursing Practice Papers

The prevalence of hypertension is high at the local, state, and national levels. In 2021, 39% of Kentucky adults were diagnosed with high blood pressure (CDC, 2021). Primary care providers are utilizing remote blood pressure monitoring (RBPM) to assist with the management of hypertension. Literature reveals that remote BP monitoring alone, without the use of other interventions such as counseling and education, may not effectively control blood pressure (Uhlig K, et al, 2013). This project evaluated the RBPM program utilized at a federally qualified health center in Louisville, KY. Patient engagement within the RBPM program includes BP measurement, communication with …

A Quality Improvement Project: Implementing Safe Sleep Practice In A Neonatal Intensive Care Unit., Morgan Demyer

Doctor of Nursing Practice Papers

Significance: The American Academy of Pediatrics (AAP) recommends safe sleep practices (SSP) to reduce infant sleep-related deaths. Annually 3,500 babies die due to improper sleeping conditions, and Kentucky is among the lower-performing states for infant sleep safety. The AAP recommends initiating SSP with infants in neonatal intensive care units (NICU) and recently expanded recommendations in 2022. Presently, there is no regulation of healthcare clinician education regarding SSP or role-modeling behavior in the in-patient setting.

Purpose: This scholarly project aimed to improve knowledge and awareness of SSP by improving clinician knowledge and behavior of SSP use in NICU and …

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Guide And Algorithm Creation For Hepatitis B Vaccination And Tuberculosis Testing Requirements For A Nursing Program., Jumoke Owolabi

Doctor of Nursing Practice Papers

This project developed a guide and algorithm for hepatitis B vaccination and tuberculosis (TB) testing requirements for nursing students at the University of Louisville [UofL] School of Nursing [SON] before clinical placement. Clarifying the requirements for hepatitis B vaccination, testing, and tuberculosis testing was paramount for clinical compliance because the current policy was determined to be ambiguous. The literature review revealed discrepancies with policies for hepatitis B and TB among countries and with individual institutions confirming the need for aligning with evidence-based vaccination guidelines. Based on these findings, an evidence-based guide and algorithm were created. Feedback from the clinical compliance …

Improving Maternal And Infant Health: A Quality Improvement Initiative To Recognize Postpartum Depression In The Neonatal Intensive Care Unit., Amy Barry

Doctor of Nursing Practice Papers

BACKGROUND: While postpartum depression (PPD) is a significant problem in the postpartum population, emerging literature suggests that PPD is disproportionately concentrated and underdiagnosed among mothers of infants admitted to the neonatal intensive care unit (NICU).

PURPOSE: The purpose of this project was to institute a PPD screening protocol within a Level III NICU to identify mothers exhibiting signs of distress and initiate social work referrals.

METHODS: A quality improvement project implemented utilizing the Plan-Do-Study-Act (PDSA) framework and a pre-and-posttest design.

INTERVENTION: Staff education regarding PPD symptoms and the project’s protocol occurred via electronic means. Mothers of NICU infants who remained …

Perceptions And Experiences Of Nursing Students And Faculty Members Regarding Implementation Of The Bs-Nursing Program, Abdul Karim, Yasmin Amarsi, Yasmin Parpio, Laila Akber Cassum, Munira Amirali, Shakir Rehman

School of Nursing & Midwifery

Objective: To explore the perceptions and experiences of nursing students and faculty members regarding the implementation of the baccalaureate nursing programme in public-sector setting.
Methods: The descriptive, exploratory, qualitative study was conducted at the Khyber Medical University, Peshawar, Pakistan, from April 15, 2020 to April 15, 2021, and comprised undergraduate nursing students and faculty members. Because of the coronavirus disease-2019 pandemic, the subjects were interviewed through telephonic call using a semi-structured interview guide. Data was analysed using the Creswell's analysis approach.
Results: Of the 15 subjects, 10(66.6%) were students aged 21-24 years; 7(70%) males and 3(30%) females. The remaining 5(33.3%) …

Self-Care Narratives: Life Stories Of Rural Adults Managing Chronic Illness Without Insurance, Jean E. Montgomery

Nursing Dissertations - Archive

Uninsured rural adults with chronic illness are more likely to experience worse outcomes than insured individuals. Without access to healthcare or insurance, self-care is an important variable in the management of chronic illness in this rural population. Although rural safety-net programs have been implemented for decades, research on the effectiveness of these programs and self-care is rare and limited. Rural health disparity persists while voices from this marginalized population have gone unheard. The purpose of this study was to give them a voice by capturing first person storied accounts of self-care from chronically ill, uninsured, rural non-elderly adults and to …

The Relationship Between Nurse Professional Development Practitioners’ Perceptions Of Empowerment In The Workplace And Intent To Stay Post Covid-19 Pandemic, Tashiana Roberts-Jackson

Nursing Dissertations - Archive

Nurse Professional Development (NPD) practitioners in the acute care hospital setting are often undervalued despite their crucial role. During the COVID-19 pandemic, they demonstrated adaptability by rapidly transitioning to virtual formats for onboarding nursing staff, while also shouldering the responsibility of ensuring staff competency in caring for COVID-19 patients. Additionally, NPD practitioners faced heavy workloads, having to retrain nursing staff who worked in indirect patient care roles, while also filling in during critical staffing shortages. To date, no studies have been found that explored key factors that predict intent to stay in the NPD practitioner population pre- or post-pandemic. Thereby, …

Nurses’ Education, Knowledge And Perceptions Of Peripheral Intravenous Catheter Management: A Web-Based, Cross-Sectional Survey, Debbie Massey, Marie Cooke, Gillian Ray-Barruel, Nicole Marsh, Amanda J. Ullman, Alison Craswell, Marianne Wallis

Research outputs 2022 to 2026

Background: Peripheral intravenous catheters (PIVCs) are the most used invasive medical device. Unfortunately, PIVCs fail for a variety of reasons and failure often results in serious adverse events leading to patient discomfort, infection, delays in treatment, increased healthcare costs, and even death. In Australia, qualified nurses assess, manage, and remove a PIVC as part of their clinical role. To date, no study has described the current state of knowledge and confidence (self-efficacy) about PIVCs from the perspectives of qualified nurses working in Australian hospital settings. Aims: To describe the current state of knowledge and confidence (self-efficacy) about PIVC management from …

The Journey From Drug Addiction To Drug Withdrawal: A Christian Gospel Rehabilitation Program In Taiwan, Pi-Ming Yeh

ETSU Faculty Works

Background

World Drug Report estimates the number of opioid users at 53 million and identifies opioids as responsible for two thirds of the 585,000 people who died as a result of drug use in 2017.

Purpose

The purpose of this study was to analyze the testimonies of 30 people regarding their journeys from drug addiction to drug withdrawal in Taiwan.

Methods

This was a qualitative research design. The sample inclusion criteria were as follows: (a) being a drug abuser, (b) completed the Christian Gospel Drug Withdrawal Program or church-sponsored program, and (c) shared their related testimony on the Good TV …

Increasing Job Satisfaction Of Nurses Using A Mindfulness-Based Program: A Quality Improvement Project, Melissa A. Haggerty

DNP Projects

Significance and Background

Job dissatisfaction among critical care nurses can result in poor mental health, increased incidences of burnout, increased stress levels, and lower quality patient care. Evidence supports mindfulness practices and their ability to improve job satisfaction by promoting calmness, decreasing stress, and reducing anxiety. In a cardiothoracic intensive care unit (CTICU) in a large teaching hospital in the New York metro area, there was no strategy in place to address low job satisfaction among nurses.

Purpose

Implement a Mindfulness-Based program for CTICU nurses to engage in mindfulness exercises during their shifts and at home. Compare reported job satisfaction …

Exploring The Lived Experiences Of Dysphoric Milk Ejection Reflex During Postpartum Breastfeeding: A Phenomenological Study, Stephanie Herr, Jessica Devido, Richard Zoucha, Jill Demirci

Electronic Theses and Dissertations

This study sought to explore the lived experiences of Dysphoric Milk Ejection Reflex (D-MER) during postpartum breastfeeding. A phenomenological method based on Giorgi’s phenomenological underpinnings was used. The setting for this study was virtual interviews in a secure online platform. The sample consisted of 13 participants, self-identifying as experiencing D-MER. Semi-structured interviews, with thematic analysis of transcription were conducted. Four major themes were identified: 1) Breastfeeding concessions and toleration; 2) Something does not feel “normal”; 3) I remember a feeling like this before 4) This is real, and recognition is validating. Conclusions were that women of this study value the …

The Use Of Mindfulness-Based Stress Reduction To Reduce Stress And Burnout In Nurses, Sherri Foreman

MSN Capstone Projects

The Mindfulness-Based Stress Reduction Program (MBSR) has been used effectively in multiple clinical settings to reduce workplace stress and burnout in nurses. The MBSR’s cost-effective approach to stress management can be implemented into any healthcare facility’s policy. The topic of MBSR’s effect on stress and burnout has been identified as essential due to nurses working in fast-paced, stressful work environments. These work environments lead to increased stress and burnout. The International Council of Nurses surveyed nurses before and after the pandemic. There were 40% of nurses that reported symptoms of burnout before the pandemic compared to 70% of nurses after …