Nursing Commons^™

Implementing Antimicrobial Stewardship For Healthcare Providers In An Urgent Care Setting To Reduce Antibiotic Misuse For Respiratory Infections, Ashley Pauldin

Doctor of Nursing Practice Projects

Background: Antimicrobial resistance has been identified as a major threat by the World Health Organization (WHO), and antimicrobial stewardship is a key strategy to overcome resistance. A major contributing factor to this crisis is the inappropriate use of antibiotic prescriptions in outpatient settings. Although evidence-based guidelines on appropriate treatment for acute upper respiratory infections (URIs) have been developed, the need for improving provider and patient awareness and knowledge in the urgent care setting is critical.

Purpose: The purpose of the DNP project was to implement antimicrobial stewardship guidelines in the urgent care facility to decrease the misuse of antibiotic prescribing …

Utilizing Multimodal Communication Strategies To Improve Average Risk Women Veteran Patient Participation In Returning Colorectal Fecal Immunochemical Test Kits, Shuntae Hooten

Doctor of Nursing Practice Projects

Background: Cancer is one of the most dreadful diseases present in today’s world. It is responsible for millions of deaths worldwide. The disease is debilitating to one’s physical and emotional well-being. Cancer impacts not only the affected individual but also those close to them. When colorectal cancer is identified early via preventive screenings, it has a greater chance of responding to treatment, therefore, increasing the chances of survival. The fecal immunochemical test (FIT) kit plays a pivotal role in the early detection of colon cancer. Schreuders et al. (2016) revealed that FIT kits have better adherence, usability, and accuracy, citing …

Evaluation Of The Implementation Of The Munro Pressure Ulcer Risk Assessment Scale To Mitigate Pressure Ulcers In The Perioperative Setting, Sherry Lynn Grandison

Doctor of Nursing Practice Projects

Background: The process of implementing appropriate skin assessment and documentation throughout the patient’s operative experience assists in the early detection of pressure ulcers.

Purpose: This Doctor of Nursing Practice (DNP) project had two goals. The first was to determine a practical tool that would ensure that surgical nurses demonstrate competence and comply with the process of identifying compromised skin integrity, and the second goal was to effectively communicate the findings with other clinical team members.

Methods: The DNP project focused on the use of the Munro Pressure Ulcer Risk Scale Assessment Tool to identify pressure ulcers and to promote collaboration …

Increasing Medical-Surgical Nurses' Skills And Knowledge On Wound Assessment And Documentation Through An Educational Approach, Jewels Knight

Doctor of Nursing Practice Projects

Background: Hospital acquired pressure injury rates are increasing while other hospital acquired condition rates are decreasing. Pressure injuries are expensive and place patients at a higher risk of death. Accurate wound assessment and documentation to satisfy the present on admission indicator could positively affect hospital acquired pressure injury rates.

Purpose: The purpose of this process improvement project was to increase nurses’ skills and knowledge towards proper wound assessment and documentation and to increase nurses’ knowledge on why comprehensive skin assessments and documentation of the observations are important for positive patient outcomes.

Method: This project consisted of offering an educational …

Using The Cdc’S Healthcare Personnel And First Responders: How To Cope With Stress And Build Resilience During The Covid-19 Pandemic Education Resources To Reduce Burnout Of Intensive Care Nurses At An Urban Acute Care Hospital, Elizabeth Gilbert

Doctor of Nursing Practice Projects

Background: Nurse burnout is a serious problem, as documented by many studies. Burnout has been shown to lower quality of life, performance level, and organizational commitment while also increasing a nurses' desire to leave the job. Despite this knowledge, nurse burnout continues to be present, especially among nurses who work in intensive care units (ICUs). Hospitals need ICU nurses to care for critically ill patients; therefore, it is essential to educate ICU nurses on burnout and initiate measures to decrease burnout in this vulnerable population.

Purpose: The goals of this study are to explore nurse burnout in the medical intensive …

The Effectiveness Of A Virtual Shared Medical Appointment On Opioid Safety Education Participation In The Veteran Population Within A Va Health Care System, Jana Falkner

Doctor of Nursing Practice Projects

Background: From 2019 to 2021, there has been an increase in opioid prescribing, leading to the current death rate of 136 Americans per day from an opioid overdose (Centers for Disease Control and Prevention [CDC], 2021). In response to these shocking statistics, a Veterans Administration (VA) health care system initiated a face-to-face interdisciplinary opioid safety shared medical appointment (SMA). Although the face-to-face Opioid Safety SMA was successful in increasing opioid safety awareness, participation, and attendance for the SMA have declined over the last year.

Purpose: The purpose of the DNP project was to improve attendance for veterans participating in the …

Reducing Hospital Readmissions Through A Standardized Heart Failure Educational Program For Community Based Nurse Case Managers, Greta Abernathy

Doctor of Nursing Practice Projects

Background: Heart failure is a high-risk health condition that impacts a patient's heart, causing it to pump at a weaker pace than a healthier person's heart (Mayo Clinic, 2020). Associated with frequent hospital admissions, heart failure affects millions of Americans in the United States (Fleg, 2018) and results in repeated readmissions, costing thousands of dollars per admission and decreased quality of life.

Purpose: This DNP project aims to implement an evidence-based educational model of care for nurse case managers within a community setting focused on Heart Failure (HF) that will improve the heart failure patient's ability to self-manage their disease …

The Use Of The Centers For Disease Control (Cdc) Outpatient Antibiotic Stewardship Program To Reduce Unnecessary Antibiotic Prescriptions Written For Sinusitis In A Rural Urgent Care Clinic Setting, Melanie Maddox

Doctor of Nursing Practice Projects

Background: The discovery of antibiotics has been a significant success in fighting bacterial infections. According to the Centers for Disease Control (CDC), in 2018, inappropriate prescribing of antibiotics contributed to antibiotic-resistant conditions, which led to 2 million infections, and has killed about 23,000 Americans annually (Chaney, 2018: CDC, 2019). By 2050, 10 million people are expected to die globally due to bacterial resistance, with the cost potentially reaching $100 trillion (WHO, 2019).

Purpose: The purpose of the DNP Project is to decrease unnecessary antibiotic prescriptions for the diagnosis of sinusitis in a rural urgent care clinic and increase provider awareness …

A Multi-Modal Strategy To Activate Pronation For Acute Respiratory Distress Syndrome Patients, Meredith Mccrorie

Doctor of Nursing Practice Projects

Background: Acute Respiratory Distress Syndrome (ARDS) is an acute pulmonary process that compromises the health of patients in the Intensive Care Unit (ICU). ARDS can progress to irreversible fibrosis causing the lungs to become noncompliant, adversely affecting ventilation or gas exchange (Buckley et al., 2019). An ARDS diagnosis accounts for 30-40% mortality rate which is an improvement from 60% in the last two decades. The clinical course of this disease is highlighted by Acute Hypoxic Respiratory Failure (AHRF) evidenced by chest radiographs revealing bilateral dense consolidations. Manual pronation of ARDS patients has shown an increase in alveolar function with end …

Utilizing Multimodal Education To Impact Provider Documentation Of Post-Anesthesia Evaluation In A Rural Hospital, Jennifer Coffman

Doctor of Nursing Practice Projects

Background: Hospital policy, Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (TJC) require a post-anesthesia evaluation to be completed and documented no later than forty-eight hours following surgery or any other procedure requiring anesthesia. This evaluation is required any time general, regional, or monitored anesthesia has been administered to the patient and must be completed by a certified anesthesia provider. One rural hospital facility’s post-anesthesia documentation compliance has declined to 79%, compared to the previous quarter’s report of 95%.

Purpose: The Doctor of Nursing Practice (DNP) project aimed to improve post-anesthesia documentation through a multimodal educational intervention. …

Prenatal Education For Black Mothers And Their Support Persons As An Intervention For Improving Initiation Of Breastfeeding, Sandra King

Doctor of Nursing Practice Projects

Background: The benefits of breastfeeding are commonly known; however, the rates of exclusive breastfeeding among the Black community are less than those of other ethnic groups. Providing breastmilk or formula to an infant is an individual decision. Influential factors such as cultural background, employment status, socioeconomic status, level of education, and availability of support from family members and health care providers correlate with the method a mother chooses to feed her infant. Increasing breastfeeding initiation immediately after birth is a necessary precedent for uptake in the exclusivity of breastfeeding.

Purpose: This Doctor of Nursing Practice project aims to improve prenatal …

Implementation Of A Diabetes Self-Management Education Program In The Rural Health Care Setting To Improve Glycemic Control In The African American Adult Population, Patricia Jackson

Doctor of Nursing Practice Projects

Background: According to the Center for Disease Control (CDC), Type 2 Diabetes Mellitus (T2DM) is a significant epidemic health problem worldwide. Furthermore, with the generality of T2DM-associated complications increasing, individuals living with chronic diseases must be competent in self-management to prevent long-term complications (CDC, 2021). Therefore, this Project Investigator aims to decrease the reported home glycemic control and improve diabetes self-management education among African American individuals in rural healthcare using the DSMEP tool.

Purpose: The purpose of the DNP project was to implement and assess the Diabetes Self-Management Education Program (DSMEP) effect on African American individuals in the rural health …

Stroke Care: Achieving Recommended Door To Computed Tomography Times In Ambulatory Patients Presenting To The Emergency Department Of A Rural Hospital Through The Application Of American Stroke Association Guidelines, Ricardo Paitz

Doctor of Nursing Practice Projects

Background: Time matters in stroke care, and every second counts because the extent of irreversible neuronal damage increases over time (Saver, 2006). Therefore, the American Stroke Association (ASA) recommends a door to computed tomography time of 20 minutes or less for patients presenting with signs of acute ischemic stroke. This time metric in stroke care is often not met, resulting in the delay of care of patients which translates to poorer outcomes, including death and a decreased quality of life in patients who have suffered an acute ischemic stroke (Kamal, Sheng, et al., 2017).

Purpose: The purpose of this DNP …

Utilization Of Staff Education To Improve The Management Of Aggression And Violence In The Rural Inpatient Psychiatric Setting, Clara Ugwuibe-Ogunseye

Doctor of Nursing Practice Projects

Background: Workplace violence (WPV) is a global concern and an occupational hazard faced by healthcare professionals worldwide. Aggression and violence can result in serious injury to the patient, healthcare professional, other patients, or visitors and cause stress to healthcare workers, and increase work absences (Picot, 2021).

Purpose: This DNP process improvement project aim was to utilize an educational training program on violence risk assessment, therapeutic communication, and verbal de-escalation techniques, to improve the confidence of mental health nursing staff in using early intervention to manage aggressive, violent patients. This education and early intervention reduced rates of aggression and violence escalation, …

Reducing Admissions Of Adult Congestive Heart Failure Patients In The Acute Care Setting, Jamekia Calhoun

Doctor of Nursing Practice Projects

Background: Heart failure (HF) is a clinical diagnosis that affects about 1 to 2% of the population worldwide. Poor education regarding self-care behaviors after discharge has contributed to increased readmissions after acute hospitalization. Hospital readmissions cost is approximately one hundred thousand dollars. This increase in cost has forced the Centers for Medicare and Medicaid Service (CMS) to place penalties on organizations with high readmission rates. The organization may be penalized for increases in readmission rates by decreasing the percentage of the combined total Medicare payments received from the CMS (Centers for Medicare and Medicaid Services [CMS], 2021)

Purpose: …

Implementation And Evaluation Of A Post-Op Coronary Artery Bypass Graft Extubation Checklist To Reduce Prolonged Intubation In The Intensive Care Unit, Melissa Bailey

Doctor of Nursing Practice Projects

Background: Total intubation time of post-op coronary artery bypass graft (CABG) patients is set by the Society of Thoracic Surgeons (STS) guidelines. STS states that post-op CABG patients need to be extubated within twelve hours of end anesthesia time with a recommendation of fewer than six hours. The project site had a total intubation time of greater than seventeen hours before removing the outliers. The current process does not result in a total intubation time of fewer than six hours. Implementation of an extubation checklist was chosen as the intervention for this DNP project.

Purpose: This DNP project aims to …

Physical Activity And Breast Cancer Prevention Among Asian American Women, Jingxi Sheng

Theses and Dissertations

Asian Americans (AsAm) comprise about 7% of the United States population and are the only racial group for whom cancer is the leading cause of death. Breast Cancer (BrCa) is the most commonly diagnosed cancer in this population, with the highest incidence in the age of 45-49 years, which is 30 years younger than for non-Hispanic Whites. The incidence of BrCa has been increasing for over three decades in AsAm.

Physical activity (PA) is a modifiable protective factor for BrCa. Unfortunately, AsAm women have a low PA prevalence of meeting PA recommendations. The increased BrCa risk, younger age at diagnosis, …

Feto-Maternal Outcomes Of Pre-Eclampsia: A Retrospective Study, Linda Varghese, Neenumol Babu, Niya V.C

Manipal Journal of Nursing and Health Sciences

Introduction: Pre-eclampsia is a multisystem multifactorial disease unique to pregnancy with unknown aetiology which is characterized by blood pressure ≥140/90 mmHg after 20 weeks of gestation associated with proteinuria ≥300 mg/24- hour urine specimen. It complicates about 2-10% of pregnancies worldwide. Objectives: To determine the prevalence and evaluate feto-maternal outcomes of pre-eclampsia. Methods: This was a retrospective study conducted at Amrita Institute of Medical Sciences, (AIMS) Kochi from 1 August 2017 to 31 July 2018. This study was done by retrospective analysis of the delivery register (Labour room) and hospital medical records. Results: The prevalence of pre-eclampsia is 2.5% and …

Awareness And Health Promotional Behaviour Regarding Non-Alcoholic Fatty Liver Disease, Tintu Benjamin

Manipal Journal of Nursing and Health Sciences

The study was conducted to assess the awareness and health promotional behaviour regarding non- alcoholic fatty liver disease among female population at risk . Methods: this non- experimental research study was conducted among 149 females under risk of developing Non Alcoholic Fatty Liver Disease. Data collection tools used were a risk assessment checklist, a questionnaire to assess the knowledge and a rating scale to assess the health promotional behaviour. Results: overall awareness regarding Non Alcoholic Fatty Liver Disease among the risk population was average (47.69%).The reported health promotional behaviour regarding Non Alcoholic Fatty Liver Disease was good (67.03%). There is …

Nicotine Dependence Among Housekeeping Staff Of Tertiary Care Centre Of Odisha, India, Nanda Kumar Paniyadi Assistant Professor, Sam Jose Clinical Instructor, Asha P. Shetty Professor- Cum-Principal, Mansi Bajaj Nursing Officer, [email protected], [email protected], [email protected], [email protected]

Manipal Journal of Nursing and Health Sciences

Introduction: Tobacco intake associated with fitness dangers, morbidity, and mortality has been growing. The prevalence of tobacco use and nicotine dependence is very high among housekeeping staff compared to the general population. Nicotine dependence is one of the major public health problems in developing and developed countries. Very few studies are conducted on nicotine dependence among housekeeping staff in hospitals. Objectives: The objectives of the study are: to assess the nicotine dependence among housekeeping staff of AIIMS, Bhubaneswar, and to find the association between nicotine dependence and demographic characteristics such as age, gender, education, job experience, duration of use, age …

Determinants Of Nurse Turnover In Rural Primary Health Centres At Micro, Meso And Macro Levels Within The Health System Of Tamil Nadu, India: A Study Protocol, Ponnambily Chandy Ms, Bart Criel Dr, Lakshmi L Dr

Manipal Journal of Nursing and Health Sciences

Introduction: Nurses play a critical role in delivering patient care services at the grassroots level. But, frequent nurse turnover in rural primary health centres (PHCs) becomes a barrier in achieving health goals in Tamil Nadu (TN), which is the highest populated state in South India. Objective: The study aims to identify the determinants of nurse turnover in rural PHCs and to inform the policy-making at micro, meso, and macro levels within the health system of Tamil Nadu, India. Methods: We will adopt an integrative qualitative design consisting of five phases. In phase 1, we will do a rapid literature review …

Vanishing Twins Syndrome (Vts) - A Case Report, Meena Konsam Ms, Sonia R. B D'Souza Dr, Samir Kumar Praharaj Dr, Shyamala G Dr

Manipal Journal of Nursing and Health Sciences

Vanishing twin’s syndrome refers to the death of one of the co-twin foetus(es) during the early antenatal period. The cause of vanishing twins is unknown and most cases occur with in-vitro fertilization (IVF) conception. Transvaginal ultrasonography helps to detect lost twins during the early trimester. The complications that may arise among neonates born to women with a known history of vanishing twin syndrome are low birth weight and low Apgar score at birth.

Reducing Inpatient Falls And Falls With Injury, Constance Leigh Cannon

Electronic Theses and Dissertations

Patient falls are a costly problem for many inpatient hospitals and are exacerbated by poor training of nursing and ancillary staff. The researcher sought to determine if there was a difference in inpatient falls and falls with injury after a hospital facility in the Southwestern United States revised its fall prevention policy, reorganized its fall prevention committee, and provided new interventions for nurses assessing patients for fall risk. In this quantitative, retrospective, comparative project, the researcher reviewed data from 2017–2020 related to the facility’s fall prevention program, including its new interventions and efforts to involve patients in their safety and …

A Pilot Study To Determine The Incidence, Type, And Severity Of Non-Routine Events In Neonates Undergoing Gastrostomy Tube Placement, Daniel J France, Emma Schremp, Evan B Rhodes, Jason Slagle, Sarah Moroz, Peter H Grubb, Leon D Hatch, Matthew Shotwell, Amanda Lorinc, Jamie Robinson, Marlee Crankshaw, Timothy Newman, Matthew B Weinger, Martin L Blakely

Faculty, Staff and Student Publications

BACKGROUND: Non-routine events (NRE) are defined as any suboptimal occurrences in a process being measured in the opinion of the reporter and comes from the field of human factors engineering. These typically occur well up-stream of an adverse event and NRE measurement has not been applied to the complex context of neonatal surgery. We sought to apply this novel safety event measurement methodology to neonates in the NICU undergoing gastrostomy tube placement.

METHODS: A prospective pilot study was conducted between November 2016 and August 2020 in the Level IV NICU and the pediatric operating rooms of an urban academic children's …

‘If The Partner Finds Out, Then There’S Trouble’: Provider Perspectives On Safety Planning And Partner Interference When Offering Hiv Pre-Exposure Prophylaxis (Prep) To Women Experiencing Intimate Partner Violence (Ipv), Noelene K. Jeffers, Jessica L. Zemlak, Lourdes Celius, Tiara C. Willie, Trace Kershaw, Kamila A. Alexander

College of Nursing Faculty Research and Publications

Pre-exposure prophylaxis is an effective women-controlled HIV prevention strategy but women experiencing intimate partner violence fear partners’ interference and subsequent violence could limit its utility. This study explores provider perceptions of safety planning strategies to prevent escalating violence, mitigate partner interference, and promote daily oral PrEP adherence. We conducted interviews (N = 36) with healthcare providers (n = 18) and IPV service providers (n = 18) in Baltimore and New Haven. Using the Contextualized Assessment for Strategic Safety Planning model we organized data into two categories: the appraisal process and strategic safety planning. Themes revealed during …

Acquiring, Applying And Retaining Knowledge Through Debriefing For Meaningful Learning, Anne Loomis, Kristina Dreifuerst, Cynthia Sherraden Bradley

College of Nursing Faculty Research and Publications

Abstract

Acquiring, Retaining and Applying Knowledge Through Use of Debriefing for Meaningful Learning (DML).

Background

Developing competence in nursing care is a critical expectation of nursing students. Knowledge acquisition, application and retention are the primary building blocks of competence. DML debriefing offers an opportunity to ensure that students master critical components of nursing they might not otherwise learn and to remove epistemological roadblocks to knowledge development.

Methods

Eighty-two traditional prelicensure baccalaureate nursing students from a single school participated in the study. This quasi-experimental pretest, posttest study explored the impact of the use of Debriefing for Meaningful Learning compared with customary …

Coaching For Childbearing Health: A Theory Synthesis, Jennifer M. Ohlendorf, Lisa Anders

College of Nursing Faculty Research and Publications

This article describes development of a theory to guide nurses promoting perinatal weight self-management behaviors. The Coaching for Childbearing Health (CoaCH) Model was developed through synthesis of the Individual and Family Self-Management Theory with Transitions Theory, following Walker and Avant's process of theory synthesis. Qualitative data were integrated to provide perinatal context. The CoaCH Model is composed of context factors that shape a nurse coaching intervention, supporting patients' self-management efforts. Sustained engagement in weight self-management behaviors will impact the long-term health of both the birthing person and the child. This model is a testable framework for future perinatal health promotion …

An Unbelievable Ordeal: The Experiences Of Adult Survivors Treated With Extracorporeal Membrane Oxygenation, Krista A. Knudson, Marjorie Funk, Nancy S. Redeker, Laura K. Andrews, Robin Whittemore, Abeel A. Mangi, Lois S. Sadler

College of Nursing Faculty Research and Publications

Background: Extracorporeal membrane oxygenation (ECMO) is a rescue treatment option for adult patients with severe cardiac dysfunction or respiratory failure. While short-term patient outcomes, such as in-hospital mortality and complications, have been widely described, little is known about the illness or recovery experience from the perspectives of survivors. Subjective reports of health are important indicators of the full, long-term impact of critical illness and treatment with ECMO on survivors’ lives.

Objective: The objective of this study was to describe the experiences and needs of adults treated with ECMO, from onset of illness symptoms through the process of survivorship.

Methods: This …

“Into The Lion’S Den”: Covid-19 Experiences Of Black Adults With Sickle Cell Disease, Nadine Matthie, Dora L. Clayton-Jones, Coretta Jenerette

College of Nursing Faculty Research and Publications

Adults living with sickle cell disease are at risk for experiencing severe illness from coronavirus disease 2019 (COVID-19) due to the complexity of their disease. Additionally, self-management and navigating the healthcare system may be challenging during the COVID-19 pandemic. Therefore, we conducted telephone interviews with 25 participants to explore the experiences of Black adults living with sickle cell disease during the early months of the pandemic in the United States. Three overarching themes characterize their experiences: management of sickle cell disease was further complicated by the pandemic, fear of the virus contributed to physical and social isolation, and employment and …

Prevalence And Geo-Clinicodemographic Factors Associated With Hepatitis B Vaccination Among Healthcare Workers In Five Developing Countries, Precious Adade Duodu, Ernest Darkwah, Pascal Agbadi, Henry Ofori Duah, Jerry John Nutor

College of Nursing Faculty Research and Publications

Background

There is a four-fold risk for hepatitis B infection among healthcare workers compared to the general population. Due to limited access to diagnosis and treatment of hepatitis B in many resource-constrained settings, there is a real risk that only few healthcare workers with viral hepatitis may get screened or diagnosed and treated. Studies on hepatitis B vaccination among healthcare workers in developing countries are sparse and this bodes ill for intervention and support. The aim of the study was to estimate the prevalence and explored the associated factors that predicted the uptake of the required, full dosage of hepatitis …