Nursing Commons^™

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Spencer Forest

Master's Projects and Capstones

Problem: This quality improvement project aims to increase SEP-1 sepsis bundle compliance among nursing staff at a 16-bed emergency department through targeted continual staff education on sepsis screening and best practices. Currently, the unit is experiencing cases of sepsis fallout and is not meeting the 90% threshold on three treatment metrics as defined by the institutional sepsis bundle time goals. Bundle compliance that adheres to the time goals decreases incidences of sepsis fallout and overall days in the hospital, while increasing positive patient health outcomes.

Context: A microsystem assessment was completed along with a staff gap survey to determine areas …

Improving Depression Screening Completion Rates For Medicare Patients In A Primary Care Setting, Kenneth J. Haluska

Evidence-Based Practice Project Reports

The United States Preventative Services Task Force recommends screening the general adult population for depression (Siu et al., 2016). Despite increasing clinical practice guidelines recommending depression screening, only 40-50% of depressed older adults are recognized and treated (Phoh et al., 2017). The purpose of this evidence-based practice (EBP) project was to implement a medical assistant (MA) depression screening protocol, using the PHQ-9 and staff education, to improve depression screening completion rates in Medicare patients in a primary care setting. An exhaustive literature search of eight databases yielded 14 pieces of evidence that made recommendations for best practice. The evidence was …

Hepatitis C Virus Screening Strategies To Improve Early Identification And Treatment: ​ A Scoping Review​, Megan Elizabeth Lyons, Rn, Bsn, Ccrn, Thomas Tyler Bennett, Rn, Bsn, Ccrn, Felicia Ann Gray-Hamilton, Rn, Bsn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background

Hepatitis C virus (HCV) is the most common bloodborne infection in the United States (Ludden et al., 2022). Sadly, over half of the individuals living with chronic HCV are unaware of their condition (Halket et al., 2022). Due to rising numbers, HCV screening guidelines have been updated to recommend that every adult be screened at least once (Patel et al, 2021). Despite these guidelines, screening rates remain low. This scoping review aims to examine current research on HCV screening and strategies to improve early diagnosis and treatment.

Methods

This review began with a literature search using CINAHL and PubMed …

Building A Community-Academic Partnership To Improve Screening For Intimate Partner Violence: Integrating Advocates In Healthcare Clinic Settings, Erin C. Schubert, Colleen M. Galambos, Teresa Jerofke-Owen, Erica Arrington, Greer C. Jordan, Nilanjan Lodh, Heidi Paquette, Gisela Chelimsky, Linda B. Piacentine

College of Nursing Faculty Research and Publications

Aims

To develop an innovative community-academic partnership to advance, test and promote intimate partner violence screening and referral protocols by comparing the effect of integrating intimate partner violence advocates versus enhancing medical training in medical clinic settings serving women from vulnerable populations. Detecting intimate partner violence in healthcare settings allows for survivors to connect to safety and referral resources prior to violence escalating. Screening for intimate partner violence and connecting patients to referral resources requires creating a safe and trusting relationship between healthcare providers and patients. Developing screening and referral protocols responsive to survivors' needs requires involvement of clinic staff, …

Screening For Social Determinants Of Health In The Primary Care Setting: A Quality Improvement Project, Winifred Ann Shouse

Graduate Theses, Dissertations, and Capstones

Social determinants of health are the conditions in which individuals are born, age, work, and live that affect health status and outcomes (Rivich et al., 2019). These social and environmental factors can create barriers to patients being able to access and adhere to recommendations for chronic disease management (Gold, et al., 2019). Communication gaps between patients and primary care providers make it challenging for healthcare providers to be completely aware of the financial burdens their patients encounter (Patel et al., 2016). Research supports that identifying and addressing the barriers related to social determinants of health can improve the management of …

Implementation Of Evidence-Based Multiple Focus Integrated Intensified Tb Screening To End Tb (Exit-Tb) Package In East Africa: A Qualitative Study, Kahabi Isangula, Doreen Philbert, Florence Ngari, Tigest Ajeme, Godfather Kimaro, Getnet Yimer, Nicholaus P. Mnyambwa, Winters Muttamba, Irene Najjingo, Aman Wilfred

School of Nursing & Midwifery, East Africa

Introduction Tuberculosis (TB) remains a major cause of morbidity and mortality, especially in sub-Saharan Africa. We qualitatively evaluated the implementation of an Evidence-Based Multiple Focus Integrated Intensified TB Screening package (EXIT-TB) in the East African region, aimed at increasing TB case detection and number of patients receiving care.

Objective We present the accounts of participants from Tanzania, Kenya, Uganda, and Ethiopia regarding the implementation of EXIT-TB, and suggestions for scaling up.

Methods A qualitative descriptive design was used to gather insights from purposefully selected healthcare workers, community health workers, and other stakeholders. A total of 27, 13, 14, and 19 …

Improving Hepatitis C Virus Screening Through Bundle Interventions, Jennifer West

Doctor of Nursing Practice Projects

Abstract

Hepatitis C (HCV) is estimated to impact 57,500 people in the US and is a leading infectious disease worldwide. The purpose of this DNP Project is to increase provider confidence in screening, early detection rates and ultimately timely treatment for patients at risk for HCV served within a rural Federal Qualified Health center (FQHC).

Interventions for this project included bundle steps consisting of provider and staff training of Hepatitis C guidelines for screening, use of an Electronic Medical Records (EMR) HCV flowsheet and lab template, revision of preventative health form, and self-efficacy survey to evaluate provider and nursing confidence …

Early Identification Of Barriers To Medication Adherence In The Elderly Population Through The Use Of A Modified Screening Tool, Miranda Joyner, Blake Meranto

Doctoral Projects

Medication nonadherence (MNA) is a major contributor to hospitalizations and accounts for billions of dollars spent every year on health care. Despite medications being prescribed in nearly 75% of healthcare interactions, it is estimated that 33 to 50% of Americans do not take their medications as prescribed, if at all (Bartlett Ellis et al., 2020; Kleinsinger, 2018). The COM-B (Capability, Opportunity, Motivation, Behavior) Model used in this DNP project suggests that an individual must have the capability, opportunity, and motivation to enact a certain behavior, and should any of these areas be lacking, the behavior is unlikely to occur. This …

Education To Increase Nurse Knowledge And Compliance With Social Determinants Of Health Screening, Bonnie Rieger

Walden Dissertations and Doctoral Studies

To provide holistic care and ensure positive patient health outcomes, the social determinants of health (SDOH) must be addressed. Research demonstrates that while medical care is a contributor to wellness, the SDOH serve an influential role in patient health outcomes. There is limited literature describing how to best educate practicing nurses about SDOH concepts. The purpose of this DNP project was to provide an educational intervention to increase inpatient staff nursing knowledge of the SDOH. Sources of evidence used to create the education module included scholarly literature describing the SDOH concepts and their application to patient, community, and population health. …

Quality Improvement Project To Assist In Implementation Of Prediabetes Screen Protocol, Kyai Forney

Doctoral Projects

Prediabetes is a reversible condition that causes blood glucose levels to be higher than normal, but not high enough to be diagnosed as type 2 diabetes. When one has prediabetes, the cells in the body do not respond normally to insulin, and insulin acts like a key to letting blood sugar into cells to use energy. The pancreas produces insulin to try to get the cells to respond, but eventually, the pancreas has a challenging time keeping up, and the blood sugar level rises causing prediabetes (Lehrman, 2021). A person can have prediabetes for years with no obvious symptoms, so …

Education To Increase Nurse Knowledge And Compliance With Social Determinants Of Health Screening, Bonnie Rieger

Walden Dissertations and Doctoral Studies

To provide holistic care and ensure positive patient health outcomes, the social determinants of health (SDOH) must be addressed. Research demonstrates that while medical care is a contributor to wellness, the SDOH serve an influential role in patient health outcomes. There is limited literature describing how to best educate practicing nurses about SDOH concepts. The purpose of this DNP project was to provide an educational intervention to increase inpatient staff nursing knowledge of the SDOH. Sources of evidence used to create the education module included scholarly literature describing the SDOH concepts and their application to patient, community, and population health. …

Mental Health Services: Improving Utilization In Homeless Populations, Gurdeep Mann

DNP Qualifying Manuscripts

Emergency shelters provide a unique location to offer easily accessible services for unhoused individuals experiencing mental distress and serious mental illness. Housing First interventions do not improve mental health or social integration. It is important to consider alternative approaches to providing care for homeless individuals. This integrated review was undertaken to evaluate existing evidence of interventions that improve mental health awareness and utilization of mental health services among unhoused populations living in shelters. Assertive outreach is an important strategy that was shown to improve effectiveness of mental health programs in shelters; reconnect individuals with family; and help with psychological integration. …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Toolkit For Screening Older Adults Desiring To Age In Place In Independent Living, Sister Raymond Marie Labonte

Seton Hall University Dissertations and Theses (ETDs)

The world is experiencing an increase in the aged population. This increase stimulated the popular theme of aging in place. Much time, effort and research have been channeled into exploring this model as an alternative to assisted living or skilled nursing settings for senior citizens worldwide. Elders desire to age in place. Current, recent, and decades old literature identifies this preferential option of the elderly and supports the need to develop plans and tools to assist elders to be able to successfully age in place. This quality assurance project is the venture to create both a congregate living community and …

Implementing A Diabetes Risk Screening Protocol In The Primary Care Setting., Anna Marks

Doctor of Nursing Practice Papers

Abstract

Background: Over one-third of the United States population, approximately 86 million individuals, are estimated to have prediabetes (CDC, 2021a). If left untreated, prediabetes will progress to type II diabetes mellitus (T2DM) in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop T2DM within their lifetime (Hostalek, 2019).

Purpose:The purpose of this quality improvement project was to implement and evaluate the American Diabetes Association MyChart Diabetes Risk Assessment tool in a primary care clinic to optimize the early identification of prediabetes and T2DM in non-pregnant adults ages 18 to 70 …

Screening For Social Determinants Of Health In A Comprehensive Pediatric Sickle Cell Disease Clinic, Marie Turner

Dissertations

Problem: Social determinants of health (SDOH) affect health outcomes across the lifespan. The American Academy of Pediatrics recommends routine screening for SDOH. Poverty is a SDOH affecting health outcomes in children, especially in children with a chronic disease such as sickle cell disease (SCD). Children with sickle cell disease have a high burden of SDOH. This project sought to describe the SDOH barriers experienced by pediatric patients with SCD.

Methods: A descriptive survey/observational design, using a convenience sample of pediatric patients ages 0-19 years old in a comprehensive SCD clinic at a large, urban, Midwestern academic medical center was utilized …

Addressing Perceived Barriers To Screening For Adverse Childhood Experiences In Primary Care, Trenton Conway

Dissertations

Problem: Inconsistent screening for Adverse Childhood Experiences (ACEs) in primary care settings leads to fewer appropriate behavioral health (BH) referrals and may increase risk for and incidence of chronic health conditions.

Methods: This quality improvement (QI) project used a descriptive observational design with prospective and retrospective data collection. The CDC’s ACE screening tool was administered to patients 18 years and older presenting to primary care. Data collection included number of ACE screenings completed and the number of BH referrals made following the screening. In additional, information was collected from medical assistants (MAs) and providers about the ACE screening process.

Results: …

The Use Of A Clinical Pathway To Increase Child Abuse Screenings Of Young Children With Fractures, Stephanie Li Schaller

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Nationally, infants and young children who present to emergency departments with fractures are not being screened adequately for possible physical abuse with a skeletal survey (Paine & Wood, 2018; Shelmerdine et al., 2014; Wood et al., 2019). Without universal screenings, implicit bias along racial and socioeconomic lines becomes a factor in deciding which children with fractures get screened, resulting in either under-or over-utilization of skeletal survey screenings (Kim et al., 2017; Paine & Wood, 2018). When child abuse is not diagnosed correctly, further abusive injuries or death can occur (Ravischandiran et al., 2010). Purpose: This evidence-based practice project …

Implementation And Evaluation Of A Syphilis Screening Tool To Increase Patient Testing For Syphilis Among Adults 18 Years And Older In A Rural Primary Care Clinic, Valeria S. Wiggins

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STIs) are an increasing epidemic in the United States (U.S.) that need immediate interventions to reverse the effects of syphilis on the sexual health of adults in rural populations. Many are unaware of the growing rate of syphilis and the overall impact it causes nationally. When syphilis is detected early, it can be easily treated and cured. Rural primary care providers are ideal candidates for implementing education, screening, testing, and treatment.

Purpose: The Doctor of Nursing Practice (DNP) project aims to increase the frequency of screening patients in rural primary care clinics for high-risk sexual behaviors. …

Diagnosis And Initial Management Of Acute Stress Disorder And Post-Traumatic Stress Disorder In The Primary Care Setting, Lindsay Leonard, Blaine Winters

Student Works

Purpose: The purpose of this paper is to equip nurse practitioners (NPs) with resources and tools that will help with the early recognition and treatment of Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD) in patients following a traumatic accident.

Background: According to the Centers for Disease Control and Prevention (2019), trauma, or unintentional injury, is the leading cause of death for individuals under the age of 45 and the third leading cause of death for all ages of people in the United States. Patients involved in traumatic accidents often develop adverse psychological sequelae such as PTSD and ASD. …

Improving Colorectal Cancer Screening In Primary Care, Bushra Iqbal

Doctor of Nursing Practice (DNP) Projects

Colorectal Cancer (CRC) is the second leading cause of cancer related deaths in the U.S., although it is preventable with adequate routine screening. Medically underserved minorities and immigrants require screening program awareness in their respective communities. The incidence of CRC remains markedly high despite the screening modalities among various populations. In the United States (U.S.), there were approximately 147,950 reported CRC diagnoses, 53,200 deaths, and over 35.2 cases per 100,000 in California alone reported in 2020 (Siegel et al., 2020). Healthcare providers can prevent colorectal cancer (CRC) through adequate routine screening. Various screening practices are widely implemented in primary cases …

Implementing A Diabetic Foot Care Program In A Virtual Primary Care Clinic, Zahra Naderi Asiabar

Doctor of Nursing Practice (DNP) Projects

Abstract

Background

Healthcare professionals (HCPs) have a key responsibility in delivering preventative and early intervention diabetes foot management within primary care. Diabetic foot ulcers (DFUs) are a major complication of diabetes and can lead to amputations and other wound issues.

Comprehensive care and treatment of diabetes are most effective when patients can access a supportive connection with providers. Before the pandemic, there were many reasons to utilize a technology-based distance approach to health care. The coronavirus pandemic in 2019 prompted additional reasons for the transition to distant care.

Problem

The yearly screening of a virtual foot exam on patients with …

Implementing Universal Depression Screening In A College Health Clinic, Marilyn J. Grabau

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: College students are at high risk for depression, and this carries a considerable burden. The American College Health Association supports depression screening on college campuses recognizing that early identification leads to better outcomes.

LOCAL PROBLEM: The project site is a public university located in New England. The college campus health center incorporates medical and counseling services. From August 2019 to December of 2019, 67% of students seen in the counseling center described depressed mood as the presenting concern. Currently there is no routine depression screening in place.

METHODS: This QI project implemented universal depression screening at the student health …

Effective Therapies And Nursing Approaches: Improving Cognition In Older Adult Stroke Patients, Selyna Baltazar

Nursing | Senior Theses

Background

Ischemic stroke occurs in thousands of older adults throughout the year. Due to the lack of oxygen entering the brain, many patients experience a decline in cognitive function due to ischemic stroke. Cognition is the ability to understand, learn, and remember information which is needed for completing daily tasks. Modern technology has allowed for patients to survive ischemic strokes but has yet to provide proper screening tools and methods for stroke-related cognitive impairment.

Objective

To investigate the best practices for identifying, treating, and caring for patients with a cognitive injury related to a stroke. A review of the research …

Hepatitis C Screening, Confirmation, And Referral Improvement Project, Maria E. Mcmahon

Doctor of Nursing Practice Scholarly Projects

Hepatitis C is an illness caused by the blood-borne Hepatitis C virus (HCV), and usually becomes a chronic condition. Left untreated, HCV can lead to severe liver disease and liver failure. Newer treatments are effective and well tolerated, but most people with chronic HCV are not accessing treatment due to several factors that will be discussed. The primary objectives of this quality improvement project were to improve the treatment cascade, provide education to providers and patients, and facilitate screening, virus confirmation, and referral to treatment, in a Federally Qualified Health Center.

Dnp Final Report: Psychosocial Screening For Oncology Patients, Robyn V. Beard

DNP Final Reports

Background: Patients with cancer often face severe distress related to fear of death, body disfigurement, financial stress, and lack of support system. This distress may lead to physical and emotional symptoms that bring patients to seek care at emergency departments, delay care or make poor health choices, and increase utilization of prescription drugs. With the already over burdened healthcare system, addressing these psychosocial needs is vital to improving patients outcomes as well as improving healthcare expenditure. Purpose: The purpose of this evidence based practice project was to improve perceived quality of life for oncology patients through detailed screening and behavioural …

Increasing Colorectal Cancer Screening Adherence: A Scoping Review, Megan E. Billingsley Bsn, Rn, Tiameria T. Ford Bsn, Rn, Mikayla E. Vican Bsn, Rn, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Rates have steadily increased in recent years due to high rates of obesity, smoking, and sedentary lifestyles. Screening for the disease can lead to early detection and reduced morbidity/mortality, yet screening rates remain low. Existing literature is extensive in discussing methods to increase CRCS adherence; therefore, a scoping review allows for increased understanding of barriers to CRCS and how to address those barriers to increase screening compliance.

Methods A literature search was completed from September 2020 to October 2021. Multiple databases were used, including …

Caring For The Caregiver: Improving Screening For Caregiver Presence During The Inpatient Stay., Brittany Mendo, Florence Weierbach Phd

Epsilon Sigma at-Large Research Conference

Informal caregiver burden and burnout can cause worsened outcomes of care for both the recipient of care and the caregiver’s overall health. Experiencing increased levels of distress by the caregiver may be the deciding factor for the elder remaining in the home or being placed in a long-term facility for care. Thus, healthcare professionals must be diligent in assessment for presence of a caregiver on admission, as well as identifying needs and providing education of resources within the community upon discharge. The purpose of this project is to implement admission screening for caregiver presence during the inpatient stay, with the …

Comparing An Evidence-Based Screening Tool To Standard Substance Abuse Screening Questions In Identifying Pregnant Women At Risk For Substance Abuse, Nicole Y. Romero

Doctor of Nursing Practice Scholarly Projects

The purpose of the study project was to compare a nonspecific substance screening questionnaire with a well validated, evidence-based substance screening tool designed specifically for the pregnant population Evidence has shown use of an evidence-based screening tool improves maternal and fetal outcomes and reduces the risk of missed cases, stereotyping, and stigma. This study project utilized the social learning theory model, which defines human behavior as a reciprocal, continuous interaction among cognitive, behavioral, and environmental determinants. A pilot observational study project was conducted within a focal organization in a specified women’s health clinic over a 12-week period comparing their currently …

Implementation Of Education And Use Of A Screening Tool To Assess Palliative Care Needs In The Critical Care Setting, Megan Stoeckinger

DNP Projects

Purpose: The purpose of this study was to measure palliative care knowledge, attitudes, perceived empowerment, and familiarity of the Supportive Palliative Care Indicators Tool (SPICT) among critical care nurses and advanced practice providers (APPs) before and after viewing a web-based educational video on an adult medicine intensive care unit (MICU).

Methods: This study was a one group pre- and post- implementation assessment using a web-based educational video and electronic surveys. The population included critical care nurses and advanced practice providers (APPs). This study spanned the timeframe between January 2022 and March 2022.

Results: Paired t-tests comparing pre-intervention …