Nursing Commons^™

Stroke Symptom Identification Tool For Hospitalized Patients In A Rural Setting, Cheryl Ann Henderson

Doctoral Dissertations and Projects

Thousands of persons in the United States yearly suffer acute large vessel occlusion stroke (LVO). Caring for these individuals with strokes and the ensuing issues increases healthcare dollars. In underserved, rural communities, there is a dire need for improved methods to access care for these individuals. A 3-month evidence-based practice (EBP) project was conducted in a small rural town in Virginia with one of the state’s highest rates of acute stroke. Nurses in the rural hospital voluntarily participated in an educational program on recognizing acute stroke and utilizing the Vision, Aphasia, Neglect (VAN) assessment tool. The participants (N-15) were asked …

Strategies To Prevent And Manage Peri Wound Skin Complications Associated With Compression Bandages Application In Patients With Venous Leg Ulcers: An Integrative Literature Review, Judith D. Plummer- Morgan

Doctoral Dissertations and Projects

Skin maceration, pressure injury, skin-stripping, as well as less common dermatological problems, are frequently noted in patients treated for venous ulcers with compression bandages. Ongoing issues with infection can lead to unwanted effects, including hospitalization and unexpected expenses. This integrative review was synthesized using Whittemore and Knafl’s five-stage methodological framework. A systematic search was conducted through the following online databases: CINAHL, MEDLINE, PubMed, and ScienceDirect for articles available in English and available in full text. This integrative review aims to review, synthesize, and critique the current literature to determine what strategies have been implemented to prevent or manage dermatological problems …

Assessment And Documentation Of Social Determinants Of Health Among Health Care Providers: Qualitative Study, Brooks Yelton Ma, Lmsw, Jancham Rachel Rumthao, Mayank Sakhuja, Mark M. Macauda, Lorie Donelle Phd, Rn, Fcan, Michelle Angelique Arent, Xueying Yang, Xiaoming Li, Samuel Noblet, Daniela B. Friedman

Publications

BACKGROUND: Research clearly demonstrates social determinants of health (SDOH) impact health outcomes. Provider consideration of patient SDOH in prevention and treatment planning is critical for improved health care quality and health equity. Despite awareness of the connections between SDOH and improved population health, research demonstrates few providers document patient SDOH. OBJECTIVE: This qualitative study aimed to better understand the barriers and facilitators of SDOH assessment, documentation, and referral in different health care settings and roles. METHODS: Individual semistructured interviews were conducted with practicing health care providers in South Carolina between August 25, 2022, and September 2, 2022. Participants were recruited …

Improving Interprofessional Value-Based Care For Residents In Skilled Nursing Facilities., Alisha Mitchell

Doctor of Nursing Practice Papers

Background/Significance: Providers may unknowingly impede residents’ equitable treatment without understanding ethnocultural diversity and values, thus preventing residents and their families from receiving care consistent with residents’ values and beliefs.

Purpose: This project aimed to improve equitable healthcare with spiritual and ethnocultural congruence integrated into care processes and workflow in a skilled nursing facility.

Methods: The Institute of Healthcare Improvement model for improvement (MFI) and an adapted evidence-based practice guideline guided the quality improvement project, implemented in one section of a 60-bed long-term care unit at a skilled nursing facility.

Practice Change: Process and care delivery workflow …

Proactive Toileting: Strengthening Purposeful Hourly Rounding's Influence On Patient Falls., Brittany Pollock

Doctor of Nursing Practice Papers

The purpose of this DNP quality improvement project was to decrease patient falls on a 21-bed step-down telemetry unit in a Kentucky metropolitan hospital. This project implemented proactive toileting in conjunction with purposeful hourly nursing rounds. A pre-education survey was given one week before the education module, and a post-education survey was provided six weeks after the education module was opened. Pre- and post-survey scores were compared to assess any changes in staff’s understanding of proactive toileting and project goals. Falls were measured, and compliance with proactive toileting was monitored in the electronic health record over an 8-week course. Compared …

Decreasing Restraint Times On An Inpatient Psychiatric Unit., Maria Siegel

Doctor of Nursing Practice Papers

Restraints are widely used on inpatient psychiatric units when psychiatric patients exhibit escalating behaviors. Physical restraints, including seclusion, increase patients’ risk for injury and psychological trauma. Acute inpatient psychiatric units should aim to use restraints only as a last resort and for as little time as possible to keep the patient and others safe. The literature suggests that ways to decrease restraint rates on inpatient psychiatric units include risk assessment for early identification and proper use of alternative measures. Nursing staff education has been proven to play an important role in decreasing overall restraint times on inpatient psychiatric units. The …

Implementation Of A Progressive Muscle Relaxation Intervention To Decrease Cancer Patients' Distress: A Quality Improvement Project., Theresa Thomas

Doctor of Nursing Practice Papers

Background: People affected by cancer often experience psychological distress that ultimately decreases their health, adherence to treatment, overall well-being, and quality of life. Research has shown that MBIs can reduce psychological distress, depression, and anxiety and increase quality of life. A needs assessment conducted within a local cancer support organization, Gilda’s Club Kentuckiana, has expressed the need for providing a more comprehensive range of accessible MBIs in their programming to meet their psychosocial goals by reducing psychological distress in their members. PMR is an MBI not currently used by GCK that has been proven effective at reducing anxiety, depression, and …

Evaluating The Effectiveness Of A Standardized Mobile Vaccination Clinic Training Program For Team Leaders In Reducing Vaccination Administration Errors., Valenchia Brown

Doctor of Nursing Practice Papers

In response to the urgent need for mobile COVID-19 vaccination clinics, the Kentucky Nurses Association (KNA) developed a standardized training program aimed at equipping nurse leaders with the necessary tools and resources for safe and efficient vaccine administration, free of vaccination errors, during mobile vaccination clinics. The purpose of this study was to assess the process effectiveness of the training program as perceived by team leaders and evaluate the number and types of vaccination errors during these clinics. The CDC’s Logic Model served as the framework for this project. The interventions included team leaders undergoing standardized training outlined in the …

Increasing Music Therapy Referrals In A Surgical Intensive Care Unit., Brandi Cecil

Doctor of Nursing Practice Papers

Medications have been the primary intervention in intensive care unit patients due to the fact that the patients are often unconscious, critically medically ill, or unable to actively participate in nonpharmacological treatment. Researchers have found the integration of music therapy in patient care has helped ease pain, anxiety, and stress, and has been useful in vital control, such as decreasing heart rate and respiration count. A study was conducted in a surgical intensive care unit (SICU) to examine the benefits of increasing music therapy consults. Critical care nurses were educated on the advantages of utilizing interdisciplinary care by consulting music …

Intention To Change Lifestyle Behaviors In 10- To 14-Year-Old Children With Obesity., Mallory Swanson

Doctor of Nursing Practice Papers

Background: Pediatric obesity is a multifaceted disease that affects 19.7% of children. Obesity increases the risk of long-term health morbidity and costs billions of dollars annually for the United States healthcare system.

Purpose: The objective of this quality improvement project was to utilize the 5210 Healthy Children Campaign to facilitate behavior change in obese children. Potential outcomes include fostering health promotion and disease prevention, improving patient outcomes, decreasing morbidity and mortality, and easing the healthcare burden.

Methods: Intervention took place at Growing Kids Pediatrics and was conducted through four educational sessions involving the obese child and at least one caregiver. …

Improving Catheter-Associated Urinary Tract Infections In The Intensive Care Unit: Implementation Of A Rounding Tool To Enhance Communication And Collaboration., Bethany Carol Risen

Doctor of Nursing Practice Papers

Background/Significance: Catheter-associated urinary tract infections (CAUTIs) are avoidable and costly healthcare-associated infections (HAIs) and are associated with high morbidity and mortality. A rise in CAUTIs at the project site, and the need for a standardized CAUTI prevention communication process, prompted this quality improvement project.

Purpose: The purpose of this quality improvement project was to decrease CAUTIs through improved communication and collaboration amongst the critical care team.

Methods: Twelve nurses completed the Collaboration and Satisfaction about Care Decisions (CSACD) questionnaire pre- and post- intervention which, evaluated communication and collaboration. Nurses also assessed IUC indication and removal during interdisciplinary rounds.

Intervention: This …

Effectiveness Of An Electronic Health Record Embedded Evidence-Based Testing Algorithm For Clostridioides Difficile Infection., Sarah Marie Bishop

Doctor of Nursing Practice Papers

Background: Clostridioides difficile infection (CDI) commonly impacts hospitalized patients with almost half a million cases reported in the United States annually. C. difficile colonization is more common than infection. Identifying true infection versus colonization is critical to avoiding inappropriate treatment, unnecessary exposure to antibiotics, and increased cost of care. Implementation of evidenced-based CDI testing criteria can help reduce inappropriate CDI testing and avoid the misidentification of colonized patients as true CDI.

Purpose: The purpose of this project was to evaluate the effectiveness of an evidence-based electronic health record (EHR) integrated CDI testing algorithm in reducing inappropriate CDI testing among adult …

Improving Postoperative Breast Augmentation Patient Education Delivery., Madison Callery

Doctor of Nursing Practice Papers

Background: Effective patient education promotes successful postoperative outcomes. Nurses in an outpatient surgery center lacked consistent patient education practices and materials.

Purpose: The purpose of the project was to implement an evidence-based multimodal educational strategy for patients who undergo breast implant surgeries.

Methods: At an outpatient plastic surgery center, pre- and post-intervention phone calls were tracked; post-intervention education, documentation, and patient satisfaction data were recorded. Nurses were educated on the new materials, delivery procedures, and electronic health record (EHR) documentation. All patients undergoing breast implant surgery received multimodal education at each postoperative appointment. Outcomes included (1) the number of patient …

Recognizing And Reporting Of Child Maltreatment In A Pediatric Primary Care Setting., Jennifer L. Dumey

Doctor of Nursing Practice Papers

Child abuse and neglect, together known as child maltreatment, is a global problem with grim lifelong consequences (WHO, n.d.). Education and confidence in reporting child maltreatment are imperative for medical providers who are responsible for the evaluation of children during routine visits with pediatric providers. Research continues to link child maltreatment with adverse health outcomes that span throughout a person's lifetime. For this reason, medical providers must be provided with continued education on early recognition and reporting of concerns for child maltreatment.

The purpose of this project is to increase provider knowledge on the identification and reporting of child maltreatment. …

New Ways To Impact Primary Palliative Care Practices Using Online Continuing Education, Charlene Barke, Sarah Mollman, Amy Skoglund, Brandi Pravecek, Mari Perrenoud, Carol Stewart

College of Nursing Faculty Publications

Background: Healthcare professionals trained in palliative care (PC) improve satisfaction and decrease healthcare overutilization for patients with serious illness and their families. A continuing education (CE) series on primary PC aligned to the National Clinical Practice Guidelines for Quality PC was developed by local, interdisciplinary experts for a target audience of rural, primary care healthcare professionals. The modules were accessed on an online learning management system platform.
Objective: The study objectives were to assess differences in participants’ knowledge, competence, performance, and ability to improve patient care as well as commitment to change practice after taking each of the CE modules. …

Utilization Of Modified Early Warning Scores (Mews) To Decrease In-Hospital Cardiac Arrests (Ihca), Ashley Bryan

Doctor of Nursing Practice Projects

Background: Less than 25% of patients survive to discharge after an in-hospital cardiac arrest (IHCA). The American Heart Association (AHA) aimed to increase the survival to discharge after IHCA to 35%, according to the AHA Get with the Guidelines (GWTG). Pre-implementation of MEWS-based rapid response rounding the facility had a 24% survival to discharge rate after IHCA.

Purpose: The Doctor of Nursing Practice (DNP) project aimed to improve the survival to discharge percentage after IHCA by implementing MEWS-based rapid response rounding on all patients with a MEWS of four or greater.

Methods: The quality improvement project consisted of having rapid …

Utilizing Mhealth To Increase Follow-Up In Latinx Adults With Hyperlipidemia., Jessica Raymond Richards

Doctor of Nursing Practice Papers

Background: Management of hyperlipidemia (HLD) is crucial to the prevention and management of cardiovascular disease cardiovascular disease (CVD), a leading cause of death in the United States (US) and Latinx adults (Centers for Disease Control and Prevention (CDC), 2019). The main difficulty affecting monitoring of lipid levels in patients diagnosed with HLD is lack of adherence to follow-up appointments.

Purpose: The purpose of this Quality Improvement (QI) project is to evaluate the impact of culturally competent translated short message service (SMS) texts to increase adherence follow-up on a Latinx population served at the Kentucky Racing Services Health Center (KRSHC).

Intervention: …

Improving Post-Stroke Dysphagia Screening In The Intensive Care Unit., Chelsea Bills

Doctor of Nursing Practice Papers

Background: Dysphagia screening is a critical aspect in the care of patients experiencing acute stroke and dysphagia may often determine life or death following a stroke event. Inconsistent nurse dysphagia assessment and documentation were identified in the Medical/Surgical Intensive Care Unit project organization.

Purpose: The purpose of this project was to explore the impact of an educational program on stroke nurse dysphagia screening and nursing self-efficacy in the ICU.

Methods: Fifteen nurses completed a modified General Self-Efficacy Scale survey which measured nurse perceptions of change in their own self-efficacy to perform dysphagia screenings; dysphagia screening rates and rates of dysphagia …

The Use Of Two Nurses, Four Eyes On Skin Assessments To Reduce The Incidence Of Pressure Injuries In Medical-Surgical Patients, Tiffany Bass

Doctor of Nursing Practice Projects

Background: Hospital-acquired pressure injuries (HAPIs) adversely affect at-risk patient populations and hospital settings. HAPIs increase the risk of death in vulnerable patient populations (Wassel et al., 2020). In addition, HAPIs cost healthcare agencies $9 to $11 billion annually (Padula & Pronovost, 2018). Inconsistent completion and documentation of the patient’s skin assessments both upon admission and daily throughout their hospital stay are identified barriers to improving patient outcomes. Implementing a Two Nurses, Four Eyes on Skin Assessment model upon admission and daily during the patient’s stay will decrease the incidence of hospital-acquired pressure injuries.

Purpose: The purpose of this Doctor of …

An Unaddressed Role Of Nurses: Barriers In Promoting Reproductive Health In Pakistan: A Commentary Paper, Rabab Vadivala, Arisha Amin, Sahar Jessani, Sara Hudani

Journal of Asian Midwives (JAM)

Reproductive health has a significant impact on a person’s overall wellbeing. Despite this, it is not given major attention. Many people are still unaware of the importance of reproductive health, and one reason for this is the often-overlooked role of nurses in sexual and reproductive health. Nurses, midwives and lady health visitors are the healthcare professionals that play a pivotal role in promoting reproductive health. However, due to several factors, such as burnout among nurses and a lack of educational preparedness, this role of nurses remains unaddressed. This article discusses the general determinants that contribute to the underutilization of nurses …

Implementation Of A Nurse-Driven Early Mobility Protocol In Critical Care To Reduce Intensive Care Unit Acquired Weakness (Icuaw), Wendy Key

Doctor of Nursing Practice Projects

Background: Intensive care unit acquired muscle weakness (ICUAW) is a syndrome of general weakness that occurs while a patient has a critical illness. Almost half of all ICU patients develop ICUAW. The most common occurrence of ICUAW is seen in patients diagnosed with prolonged mechanical ventilation, severe sepsis, or difficulty weaning from mechanical ventilation (MV). Bedrest is the number one risk factor for the development of ICUAW and the elderly are at higher risk. The best treatment for ICUAW is early mobility which has shown positive effects for decreasing ventilator days and intensive care unit (ICU) length of stay (LOS). …

Fostering Patient Safety: Importance Of Nursing Documentation, Shamsa Samani, Salma Amin Rattani

School of Nursing & Midwifery

Background: Nurses are professionally accountable for assessing and documenting patients’ vital signs. Nurses failing to fulfill this responsibility position their patients at risk. This paper presents two real-life cases pertaining to patients’ safety resulting in fatal outcomes, leading to the professional, legal, and ethical liability of nurses as the providers of patient care.
Objective: This paper focuses on the role of organizational culture in fostering patient safety specifically in monitoring and documentation of patients’ vital signs and early recognition of warning signs.
Methodology: A comprehensive literature search was conducted using various databases, examining the significance of vital signs monitoring and …

Oxygen Therapy Education To Improve Oxygen Safety In The Emergency Department: A Quality Improvement Project, Latania Wolfe

DNP Projects

Background and Significance: Oxygen is often administered in emergency departments (ED) in US without the nurses and other healthcare staff inputting orders for this medication. This gap in placing orders poses a risk to patient safety and poses a regulation issue.

Purpose: The goal of this quality improvement project is to increase the rate of orders placed for patients using oxygen in ED staff by 12% from March 1, 2023 to May 31, 2023.

Methods: The Model for Improvement guided this quality improvement project. Two PDSA cycles were completed.

Results: PDSA #1 Completed SWOT analysis and used information to …

Michigan Appropriateness Guideline For Intravenous Catheters And The Impact On Utilization And Infection Ratios In Peripherally Inserted Central Catheters, Kasey Smith Bustamante

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adult patients are at increased risk for central line-associated bloodstream infections when central line utilization rates are increased and are inserted inappropriately, based on patient criteria. Purpose: Determine if utilization of the Michigan Appropriateness Guidelines for Intravenous Catheters (MAGIC) will reduce central line utilization ratios (focusing on peripherally inserted central catheters (PICC)) and reduce risk of central line-associated bloodstream infections among an adult population in the Trauma Surgical Care Unit (TSCU) and Medical Intensive Care Unit (MICU) at a tertiary care center in the South Carolina Pee Dee Region. Methods: The Plan Do Study Act (PDSA) quality improvement …

Hpv Vaccine Hesitancy: Improving Vaccination Rates In The Pediatric Primary Care Setting, Stephanie Meltzer Carper

Doctor of Nursing Practice Scholarly Projects

Problem statement: The Human Papillomavirus (HPV) vaccine protects against carcinogenic strains of HPV and is administered during childhood to provide maximum protection during peak risk for exposure and HPV disease. Despite demonstrated efficacy, HPV vaccine hesitancy leads to decreased vaccination rates in the pediatric primary care setting. Purpose: This quality improvement project aims to improve HPV vaccination rates at SouthernMED Pediatrics, Summerville, South Carolina. Methods: A pre-intervention survey was administered to identify parental concerns regarding the HPV vaccine to create a customized educational handout. Health care providers systematically used motivational interviewing, presumptive approach communication techniques, and a customized educational handout …

Retrospective Analysis Of Benzodiazepine And Sedative Use In The Surgical-Trauma Intensive Care Unit, Ronelle Guinyard Goodwin

Doctor of Nursing Practice Scholarly Projects

Problem Statement: There has been an increase in benzodiazepine use and delirium occurrences in the surgical-trauma intensive care unit (STICU). Purpose: This Doctor of Nursing (DNP) project aimed to explore the current practice of benzodiazepine and sedative use for adult patients admitted to the STICU who developed alcohol withdrawal syndrome (AWS) or delirium. Method: A retrospective chart review with descriptive analysis was completed for all adult patients admitted to the STICU at a regional community level 1 adult and level 2 pediatric trauma center, diagnosed with AWS or delirium, and treated with benzodiazepines during their intensive care unit (ICU) stay. …

Improving Communication And Workflow Among Advanced Practice Providers And Nurses On Nightshift In An Intensive Care Unit, Chelsey Alise Durr Massey

Doctor of Nursing Practice Scholarly Projects

Problem Statement: There is often a lack of streamlined communication on nightshift among the reduced care team in acute care settings. The absence of organized collaboration and shared decision-making contributes to strained professional relationships between the advanced practice provider (APP) and the nurse. Purpose: Nightly provider-nurse bedside rounds were implemented in a 21-bed cardiovascular intensive care unit (CVICU) using a goal sheet to improve communication among the APPs and nurses. Methods: A pretest-posttest design in which surveys were used in this quality improvement (QI) project to determine perceptions of communication between APPs and nurses. Inclusion Criteria: All APPs and rotating …

Impact Of A Standardized Checklist On Post Discharge Appointment Attendance And Readmission Rates Of Veterans With A Mental Health Diagnosis, Henretta N. Milton-Williams

Doctor of Nursing Practice Scholarly Projects

Inpatient readmissions are among the most severe problems facing hospitals. Readmissions are most common in the first two to five days after discharge, especially among veterans with mental illnesses at the Columbia Veteran Administration Hospital System (CVAHS) inpatient units. The discharge planning process should begin as soon as a patient is admitted and should be updated throughout the inpatient stay to ensure a safe transition of care from inpatient to outpatient. This Doctor of Nursing Practice (DNP) quality improvement project is aimed to develop and implement a standardized checklist to streamline and organize the discharge planning for all veterans admitted …

Using The Buzzy Device To Decrease Pain, Fear, And Anxiety With Venipunctures And Injections, Lisa Santiago Sauls

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Anxiety, fear, and pain related to initiating peripheral venous access or injections are a high priority in the ambulatory infusion clinic setting for both children and adult populations.

Purpose: To determine if the Buzzy device will decrease anxiety, fear, and pain related to adult patients undergoing peripheral venous access or injections in ambulatory infusion clinics.

Methods: Age, sex, route of medication the patient is receiving. A post-procedure questionnaire assessed the participant's satisfaction with the Buzzy device. Pain, fear, anxiety, and patient satisfaction were all measured using a visual analog scale.

Inclusion Criteria: Patients aged eighteen and above receive …

Implementation Of A Peer To Peer Concussion Management Program And Its Effect On Concussion Knowledge And Reporting Behaviors In Collegiate Club Sports Athletes, Brian Wallace Stefan

Doctor of Nursing Practice Scholarly Projects

Problem: Concussions continue to be a common injury in both athletes and non-athletes across the world. In college, symptoms and recovery time from concussion injuries can lead to loss of social interaction, class time, and participation in school events such as sports. For collegiate club athletes at the University of Pittsburgh, there is currently no mandated concussion protocol, making injury management more difficult. Purpose: This project's purpose was to determine whether a peer-to-peer concussion education tool is a viable implementation option to improve the concussion environment for this population compared to their current structure with no protocol. Method(s): A five-step …