Nursing Commons^™

Development Of An Evidence Based Orientation Model For The Newly Graduated Nurse, Sandra L. Takach

Doctor of Nursing Practice Scholarly Projects

Healthcare in the acute hospital setting experienced a significant increase in highly acute patients with multiple comorbidities requiring competent, experienced clinicians who can provide high quality, safe care. The nursing shortage paired with the post pandemic hospital environment has altered the landscape of nurses entering the workforce and created a gap in competency of the bedside nurse. A loss of tenured nurses who typically onboard and mentor the novice nurse coupled with less than adequate clinical preparation of those graduating college led to elevated levels of stress and staggering turnover rates for the newly graduated nurse. Research validates efficient orientation …

Quality Improvement Initiative: Implementing Wellness Visit (Wv) Education To Improve Staff Self-Efficacy, Preston T. Holifield

Doctor of Nursing Practice Projects

Preventive care delivery is a cornerstone of value-based primary care, yet non-provider staff often lack the confidence and training to engage patients in Medicare Annual Wellness Visits (AWVs). Non-provider staff included Registered Nurses (RN’s), Licensed Practical Nurses (LPN/LVN’s), Secretaries, Medical Aids (MA’s), and Practice Managers (PM’s). This quality improvement project aimed to evaluate whether a brief educational intervention could improve self-efficacy among non-provider staff related to AWV discussions and workflow. Conducted in two primary care clinics in Southeast Missouri, this one-group pretest-posttest study involved six participants and utilized the General Self-Efficacy Scale (GSES) and Learning Self-Efficacy Scale (LSES) to measure …

Development Of Clinical Practice Guidelines For Incorporating Paravertebral Blockade For Thoracic Surgery Adult Patients, India Hutchison

Doctor of Nursing Practice Scholarly Projects

Thoracic surgery is considered one of the most painful surgical procedures due to its severity and the duration of the procedure. Pain is detrimental to the patient experience, and poor patient satisfaction results in revenue loss for hospitals. Maintaining adequate pain control after surgery is crucial in preventing pulmonary complications such as atelectasis and respiratory failure that prolong patient recovery. It is the responsibility of the anesthesia provider to ensure adequate pain control throughout the perioperative experience. Although current evidence-based data shows that regional anesthesia provides superior thoracic postoperative pain control, the current practice continues to be the utilization of …

Enhancing Postoperative Care For Vascular Patients: Pre- And Post-Test Clinical Knowledge Acquisition Of Early Mobilization Education For Interventional Healthcare Providers, Jennifer Wenger

Doctor of Nursing Practice Scholarly Projects

Peripheral vascular disease (PVD) is a chronic, systemic condition that often requires surgical intervention, presenting significant postoperative risks, including complications like thromboembolisms, pneumonia, and delayed functional recovery. Evidence-based practices (EBP), particularly early mobilization guidelines, have proven to improve recovery outcomes but remain inconsistently applied among interventional healthcare providers. The project addresses this critical issue by evaluating the impact of structured educational sessions on interventional healthcare providers’ knowledge and application of mobilization guidelines in postoperative vascular care. Using the John Hopkins Model of Evidence-Based Practice, a quasi-experimental design was adopted to assess the impact of the education. The project includes pre- …

Pulmonary Embolism Response Team In Acute Care Settings: A Scoping Review Of The Evidence, Tia Glover Bsn, Rn, Leslie Asplund Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Pulmonary embolism (PE) is a critical cardiovascular emergency associated with high morbidity and mortality. Despite its prevalence, traditional PE management often lacks cohesion, leading to suboptimal outcomes. Pulmonary Embolism Response Teams (PERTs) offer a multidisciplinary approach aimed at improving patient outcomes by streamlining diagnosis, facilitating timely interventions, and promoting evidence-based treatment. This scoping review evaluates the evidence supporting PERT efficacy across various clinical and resource-related outcomes with the aim to decrease mortality rates, shorten inpatient length of stay, improve cost efficacy, and minimize adverse events from treatment modalities.

Methods

A comprehensive literature search was conducted using PRISMA guidelines across …

Development Of A Clinical Pathway For Acute Pain Management As An Element Of The Prevention Of Delirium In Older Adult Trauma Surgery Patients, Stacey Mermigos

Doctoral Scholarly Projects & Capstones

For hospitalized patients, delirium is prevalent and associated with poor outcomes including increased mortality, morbidity, hospital length of stay, and healthcare costs. Although past studies have identified effective interventions to both prevent and manage delirium in critically ill patients, the most widely used evidence is not easily generalized to non-critically ill patients, specifically trauma patients who experience acute pain, serial surgical procedures, and other notable precipitating and predisposing factors. Clinical pathways are structured plans that are useful for encouraging consistent, evidence-based interventions for various medical conditions and situations. At this time, there is no clinical pathway for the prevention of …

A Four-Year Longitudinal Study Of Effectiveness Of Evidence-Based Bundle Practices For Preventing Catheter-Associated Urinary Tract Infections In An Academic Health Care Center, May Mei-Sheng Riley

Doctoral Projects

Catheter-associated urinary tract infections (CAUTIs) significantly contribute to morbidity, prolonged hospitalization, and elevated healthcare costs, underscoring the crucial need for prevention to ensure patient safety. Despite ongoing mitigation efforts, CAUTI prevalence remained a concern in our facility at the time of this study. Catheter insertion and maintenance bundles, a recognized framework utilizing teamwork, collaboration, and focused interventions, were implemented to reduce CAUTIs and improve patient safety. This study evaluated the effectiveness of these bundles in reducing CAUTIs and catheter utilization to identify best practices for enhanced catheter management and care quality.

Preserving What Matters: A Multimodal Approach To Maintaining Fat-Free Mass During Anti-Obesity Medication Based Weight Loss, Sarah Gore

Evidence-Based Practice Project Reports

Weight loss is often associated with reductions in fat-free mass (FFM), which can negatively impact metabolic rate, thermoregulation, bone density, functional capacity, and overall quality of life (Roth et al., 2022; Sedlmeier et al., 2021). This Evidence-Based Practice project aimed to reduce FFM loss in adults prescribed anti-obesity medications (AOMs) for weight management through a targeted, multimodal intervention. Twenty-two patients beginning AOM treatment at a family practice in northwest Indiana were invited to participate, with 19 consenting to enroll. Each participant received personalized guidance, including tailored calorie and protein intake goals to support a hypocaloric, high-protein diet, alongside evidence-based aerobic …

Clinical Guidelines For The Perioperative Management Of Patients With Aortic Stenosis Undergoing Noncardiac Surgery, Owen Diehl

Doctor of Nursing Practice Scholarly Projects

Aortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine …

Impact Of Implementing An Updated Cervical Cancer Screening Protocol In The Primary Care Setting, Teri A. Koch

Evidence-Based Practice Project Reports

Cervical cancer is one of the most common types of cancer among women globally. Current screening methods by clinicians include cytology sampling, high-risk human papillomavirus sampling, or co-testing with both methods. These tests may detect cell changes before they become cancerous, yet the uptake of these methods has decreased in recent years (Aginga, 2022; Office of Disease Prevention and Health Promotion, 2023; Popalis et al., 2022; Sung et al., 2021). The primary purpose of this evidence-based practice project was to determine if the implementation of an updated cervical screening protocol improved the linkage of abnormal results to appropriate clinical follow-up …

A Multi-Modal Intervention To Improve Identification, Management, And Prevention Of Early Childhood Caries In The Primary Care Setting, Rieley M. Hull

Evidence-Based Practice Project Reports

Early childhood caries (ECC) is the most prevalent chronic childhood disease and, if untreated, can lead to significant long-term health and social consequences, posing a substantial healthcare burden (AAPD, 2023; ADA, 2023; USPSTF, 2021; WHO, 2022). This evidence-based practice (EBP) project aimed to implement a multi-modal intervention to reduce ECC risk factors, prevent new dental caries, and halt the progression of existing dental caries. Conducted in a pediatric primary care setting in West Michigan, the project included patients five and under who received an oral examination and dental caries risk assessment following the AAP’s guidelines. Based on their oral health …

Improving Communication And Job Satisfaction: Utilizing Team Strategies And Tools To Enhance Performance And Patient Safety (Teamstepps) For Interventional Service Areas, Sukhbinder Kaur Sangha

Doctoral Projects

Purpose: Improved communication and job satisfaction among staff are essential for those working in high-stress critical care environments like the cardiac catheterization laboratory (Cath Lab). The purpose of this investigation was to utilize the quality improvement initiative Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to improve attitudes and job satisfaction in the Cath Lab. Method: A total of 30 subjects participated in a TeamSTEPPS educational intervention. After obtaining informed consent, a demographic survey, a pre- and post-test TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and Job Satisfaction Survey (JSS) were administered. The post-test included open-ended questions for feedback …

Smoking Cessation Education In Caregivers Of Pediatric Patients Hospitalized With Asthma Exacerbation, Maya Emptage, Kaitlynn Lineberry, Suzanne Kayali, Bobby Bellflower Dnsc, Nnp-Bc, Faanp, Michelle Rickard Dnp, Pnpac-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Pediatric asthma is rising globally, currently affecting over 300 million individuals and projected to reach 400 million by 2025. This scoping review aims to summarize existing evidence on the impact of providing smoking education to caregivers during hospitalization on reducing pediatric asthma exacerbations, with the goal of encouraging further research.

Methods

The search spanned from August 2022 to November 2024, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria focused on studies involving human participants and caregivers of children receiving smoking cessation education in relation to asthma exacerbation and hospital admission. Databases searched included …

Addressing Gaps In The Continuum Of Care: A Quality Improvement Project Focused On Adolescent Youth With Depression Symptoms At A School-Based Health Clinic, Leah Nigon

Theses and Graduate Projects

This Doctor of Nursing Practice (DNP) quality improvement project aimed to address gaps in the continuum of care for adolescents experiencing depression symptoms at a school-based health clinic (SBHC) within an alternative learning community school (ALCS) in southeast Minnesota. Adolescent depression rates are on the rise and are only exacerbated by systemic barriers and social determinants of health, requiring improved mental health care access. Guided by Madeleine Leininger’s Culture Care Theory, the project focused on improving follow-up care for students with elevated depression scores on the Patient Health Questionnaire-9 (PHQ-9-M). A tracking system was developed, and the SBHC nurse contacted …

Implementing Lean Methodology To Decrease Wait Times In A Psychiatric Emergency Department, Kristina S. Baxter

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement project aimed to implement Lean strategies to optimize the intake process in a psychiatric emergency department, thereby reducing patient wait times, minimizing left-without-being-seen (LWBS) occurrences, and improving access to timely psychiatric care.

Background

The project was conducted in a hospital-based psychiatric emergency department in Southeast Texas, serving adults and children six years and older.

Methodology

Lean methodology and PDSA cycles were employed to refine the intake process and eliminate inefficiencies. Key interventions included patient transport by technicians to minimize delays, using tele-clinicians for assessments to reduce staff burden, and restructuring nursing assessments to prioritize telehealth consultations …

Evaluation Of The Library Session In A Health System Rn Research Fellowship Program, Frances Chu, Basia Delawska-Elliott, Carrie Grinstead, Dana Kopp, Heather Martin

Articles, Abstracts, and Reports

No abstract provided.

Dnp Final Report: Improving Adherence With Cms Sep-1 Sepsis Bundle In The Emergency Department, Emmanuel Bernards

DNP Final Reports

Adherence to the CMS SEP-1 Sepsis bundles is critical to sepsis management and leads to lower sepsis mortality, lower incidence of readmission, reduced length of hospital stay, and improved patient outcomes. This medical center has struggled to meet the required 71% adherence rate set by the Center for Medicaid and Medicare, representing the benchmark of acceptable care of sepsis patients. Therefore, the following PICOT question arises: among the hospitals’ ED physicians and nursing staff (P), how does a multimodal approach consisting of education, visual reminders, and audit and feedback (I) compared to a single approach (education) (C) affect adherence to …

The Impact Of Mentorship On Burnout Among Novice Nurse Faculty, Lucas Gless

Doctor of Nursing Practice Projects

Burnout among novice nurse educators contributes to increased rates of faculty turnover and vacancies in nursing education. This is especially significant in rural settings. This quality improvement project aimed to determine the impact of mentorship on novice nurse educators’ perception of burnout at a rural community college in East Texas. Utilizing a mixed methods design, novice nurse educators with less than two years of academic nurse education experience were assigned experienced faculty mentors over an eight-week period. The Maslach Burnout Inventory-Educators Survey (MBI-ES) measured emotional exhaustion, depersonalization, and personal accomplishment, both before and after the intervention. Data analysis, using the …

Quality Improvement Project Prevention Of Perioperative Pressure Injury Utilizing Scott Triggers Education, Assessment, And Interventions, Lisette Miller

Doctor of Nursing Practice Projects

Abstract

The quality improvement project was initiated to educate perioperative staff on the evidence-based practice of Scott Triggers to reduce perioperative hospital-acquired pressure injuries (HAPIs). The purpose of the project was to provide Scott Trigger’s education to perioperative nurses for the reduction of perioperative HAPIs utilizing Scott Trigger's risk assessment tool and recommended interventions. Using a quantitative quasi-experimental design, the project consisted of two separate three-month data collection sets, one set collected pre-educational intervention, and the second set collected post-educational intervention. The project proved the use of the Scott Triggers high-risk assessment tool and utilization of the recommended interventions to …

Quality Improvement Project Impact Of Multidisciplinary Patient Education On Heart Failure 30-Day Readmission Rate, Jeanne P. Williams

Doctor of Nursing Practice Projects

Patients diagnosed with heart failure are at an increased risk for readmission to the hospital within 30 days of discharge, and their care costs are projected to continue to increase. This Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to implement an evidence-based initiative to mitigate the increased heart failure 30-day readmission rate on a 30-bed medical-surgical telemetry unit in an acute care facility. Using the teach-back communication method, multidisciplinary patient education was implemented to prepare patients diagnosed with heart failure to manage their condition once discharged home. The theoretical and implementation frameworks used were Lewin’s Change Model, …

Second Language Acquisition For Adults, Sara Santos Costa

Seton Hall University Dissertations and Theses (ETDs)

The process of Second Language Acquisition (SLA) has been explored by several scholars, who start with fundamental questions such as: “Does second language acquisition work in the same way as first language acquisition?” “What are the differences in the processes each individual experiences?” “Is it possible to become fluent in a second language at an older age?” This paper aims to show some key research conducted on this topic and provide a clear understanding of the processes that second language learners face.

This paper will delve into three main approaches to SLA: Behaviorist Theory, Universal Grammar (UG) and Interactionist Theory. …

Executive Summary: Development Of An Evidence-Based Prevention Bundle To Reduce Falls On An Inpatient Psychiatric Detoxification Unit, Ramatu Dougrey Jalloh

Walden Dissertations and Doctoral Studies

Following a 16% increase in patient falls from 2023 to 2024 in an inpatient psychiatric detoxification unit, a quality improvement education project was implemented to assess the impact of an evidence-based fall prevention bundle on fall rates and nursing compliance. Nurses received education through a PowerPoint presentation to enhance understanding and implementation of the bundle, which included Edmonson reassessments after high-risk medication administration, ISHAPED bedside shift handoffs, care plan updates, and SWIFT daily safety huddles. Posttests identified that the objective score of 80% knowledge for nurses was met. During the 10-week implementation, the goal was 100% compliance with all bundle …

Dexmedetomidine As An Adjunct To Local Anesthetics In Neuraxial Anesthesia: A Scoping Review, Meaghan Elrod, Jacob Flake, Sarah Eggers, Kieraney Coston, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Neuraxial anesthesia is key for pain management and comfort during surgery. While local anesthetics and opioids have notable side effects, Dexmedetomidine (DEX) offers a promising alternative. Early studies suggest DEX improves pain control, prolongs anesthesia duration, and reduces opioid-related side effects. This review explores the benefits of incorporating DEX into neuraxial anesthesia for better patient safety and comfort

Methods

This scoping literature review took place from August 2023 to April 2024, utilizing PubMed, CINAHL, Cochrane Library, and Google Scholar for sources. After reviewing over 2,000 abstracts, 25 articles met the inclusion criteria, with nine selected as most relevant. Four …

Enhancing Hospital Throughput With The Power Of Reminders: Implementing A Discharge Before Noon Strategy At An Urban Teaching Hospital, Jessie Ventura

Doctoral Projects

The doctoral project deploys a "Discharge Before Noon" strategy at an urban teaching hospital to resolve discharge delays and improve patient throughput efficiency. Hospitals experiencing overcrowding must prioritize timely patient discharges to enhance clinical results and operational performance. The project adopted the PARIHS framework to steer implementation through its emphasis on evidence-based practices, contextual factors, and facilitation strategies. The research gathered discharge data and team coordination results before and after the intervention period. The findings revealed elevated discharge numbers before noon and substantial progress in interdisciplinary team collaboration. The initiative indicated an optimizing trend for discharge procedures, even though statistical …

A Multimodal Intervention To Improve Treatment And Clinical Outcomes In Children With Recurrent Otitis Media, Daniel Courtaney

Evidence-Based Practice Project Reports

Acute otitis media is the number one cause for primary health care visits and antibiotic prescriptions in the pediatric population (El Feghaly & Jackson, 2023). Upwards of 27% of children experience multiple episodes of otitis media (OM) that meet recurrent otitis media (ROM) diagnosis criteria (Pelton & Marchisio, 2023). Guided by the Iowa Model (Iowa Model Collaborative, 2017), the project’s purpose was to implement a multimodal intervention to decrease recurrent OM and repeat clinic visits. A comprehensive literature search of 5 databases yielded 16 sources ranging from levels I-IV (Melnyk & Fineout-Overholt, 2023). Using the AGREE II and JBI Critical …

Staff Education On Medication Reconciliation, Ivana Priscilla Adwoa Antwiwaa Buamah

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice education project focused on improving staff knowledge of medication reconciliation through an evidence-based educational intervention in an outpatient clinic. Medication reconciliation is crucial for ensuring accurate and consistent medication lists across care transitions, helping to prevent errors, such as omissions, duplications, dosing mistakes, and drug interactions. The project’s central question was whether staff education on an evidence-based approach to medication reconciliation would improve staff knowledge. A pre- and post-education survey was used to measure changes in staff knowledge after a PowerPoint presentation. Results showed a significant increase in staff knowledge after the intervention; the participants’ …

Staff Education For Infection Control Prevention, Beatrice I. Cesar

Walden Dissertations and Doctoral Studies

This project was a quality improvement staff education program to address the increase in hospital-acquired infections in the project facility. The hospital administrator identified that staff were overwhelmed and may not be consistently implementing appropriate infection control practices. If infection control practices are not addressed in hospitals system, there would be a much higher rate of hospital-acquired diseases among hospitalized patients and the staff. A staff education program about evidence-based strategies relating to infection control prevention was implemented to increase the nurses’ knowledge about strategies to decrease the spread of infection in the project facility. Eleven registered nurses participated in …

Staff Education To Enhance The Diagnosis Of Depression In Older Adults, Abiola Oyenwen Izekor

Walden Dissertations and Doctoral Studies

The aim of this staff education project was to improve provider knowledge on using the Geriatric Depression Scale (GDS) for screening depression in older adults. Geriatric depression is often underdiagnosed due to atypical symptoms and reliance on generalized tools such as the Patient Health Questionnaire-9 (PHQ-9), leading to delays in treatment and increased health care costs. To address this gap, I collaborated with a librarian to conduct a literature search, initially identifying 149 articles and refining them to 20 for review. I followed the analysis, design, development, implementation, and evaluation (ADDIE) model to structure the educational intervention. The training included …

Staff Education To Improve Staff Knowledge And Attitudes Regarding Aggressive Patient Behaviors, Roya Khoshbakht

Walden Dissertations and Doctoral Studies

Aggressive behavior among psychiatric patients threatens safety and quality in healthcare, causing physical and psychological harm to staff and contributing to burnout and high turnover rates. This Doctor of Nursing Practice (DNP) project addressed gaps in staff knowledge and attitudes, particularly among nurses, regarding aggression management and de-escalation techniques through a comprehensive education program on the causes of aggression, warning signs, and effective strategies. The evidence-based practice (EBP) question was, Will staff education on evidence-based strategies for preventing and managing aggressive behavior improve staff knowledge and attitude? Project team members used the Johns Hopkins Evidence-Based Practice (JHEBP) model to develop …

Exploring Metacognitive Interventions To Enhance Pre-Licensure Nursing Student Academic Performance: A Mixed-Methods Perspective, Angela Christian, Kara Delafosse

The Journal of Advancing Education Practice

rigorous demands of nursing school and the high expectations for critical thinking. Situating students for success requires implementing effective study strategies. Metacognition is the ability of students to manage their studying and learning tactics, while recognizing how and when to employ various strategies to master content (Chang et al., 2021). Metacognition directly correlates with enhanced critical thinking, clinical judgment, effective communication skills, and problem-solving capabilities which are critical in the nursing profession (Chang et al., 2021). Incorporating these skills to assist students as they matriculate through their academic journey situates them for success in the nursing profession. Using metacognitive awareness …