Nursing Commons^™

Asthma Care By Unlicensed Personnel In The Elementary School Setting: A Training Program, Teresa Eligio

Doctoral Projects

This Quality Improvement project (QI) aims to improve the competence and confidence of unlicensed school health staff in identifying asthma symptoms, reading an asthma action plan, asthma care, emergency response, medication delivery tools, and trigger reduction in the school setting. The QI project transpired in an Elementary School District in Los Angeles County, CA. The Project Manager, an asthma instructor trained by the American Lung Association, provided evidence-based Asthma-Basics training for health clerks (HCs), substitute health clerks (SHCs), licensed vocational nurse health clerks (LVN HCs), school office coordinators (SOCs), school office attendance clerks (SOAs), and substitute school office staff (SDO). …

Formalized Diabetes Education In A Safety-Net Clinic, Haley N. Wanic

Doctoral Dissertations & Projects

Uncontrolled diabetes mellitus in a Hispanic population can be helped through a quality improvement project focused on progressive verbal and written diabetes self-management education (DSME) Purpose of this article is to review the background, an organizational assessment, a literature review, results of the quality improvement project that took place at a safety-net clinic in the Midwest. This project included four patients and data was analyzed through descriptive statistics. Results include improved hemoglobin (Hg) A1c, minimal workflow adjustments for providers, completed microalbumins, and written education given to patients. In conclusion, the quality improvement project showed positive trends in outcome measures over …

Empower You: An Adult Type 2 Diabetes Mellitus Management Program With Utilization Of A Mobile Phone Application, Kelsey Jahn

Evidence-Based Practice Project Reports

In 2018, 34.2 million Americans had diabetes and there continues to be 1.5 million Americans diagnosed with diabetes every year (ADA, 2018). Due to this increasing prevalence, self-management of type 2 diabetes mellitus (T2DM) is essential to disease management. The PICOT question for this project was: In adults with T2DM with a hemoglobin A1C (HbA1C) greater than 8% in a diabetes specialty clinic (P), what is the effect of a multimodal smartphone application (I) compared to prior nonuse of the application (C) on average blood glucose readings (O) over an 8-week period (T)? The project was completed in a large, …

Screening And Follow Up For Postpartum Depression: How To Improve Practice, Mallory Matusik

Evidence-Based Practice Project Reports

Postpartum depression (PPD) is one of the most common mental health conditions, affecting one in seven women during their reproductive years (American College of Obstetricians and Gynecologists [ACOG], 2018). The purpose of this evidence-based practice (EBP) project was to improve screening and management of PPD using the Edinburgh Postnatal Depression Scale (EPDS) screening tool and a protocol for appropriate treatment and follow up care for PPD. A protocol was created by the project leader with information on screening and diagnosis, follow up, and treatment for PPD. The protocol also included information on how to assess for suicidal and/or homicidal ideation …

Back To The Basics With Smart Goals: A Multimodal Intervention For Adults Who Have Type 2 Diabetes, Alyssa L. Snyder

Evidence-Based Practice Project Reports

Diabetes, the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2020a) and the ninth leading cause of death worldwide (World Health Organization [WHO], 2020), has increased by 70% over the last two decades (WHO, 2020). Type 2 diabetes (T2D), the most prevalent type accounting for 90% to 95% of diagnosed cases (CDC, 2020a), affects individuals of all ages and often results in major health problems including stroke, heart attack, and kidney disease. The purpose of this patient-centered, evidence-based practice (EBP) project was to evaluate the effectiveness of a multimodal intervention on hemoglobin …

Walking Is Worthy: Walking For Hypertension, Ashleigh Y. Peterson

Evidence-Based Practice Project Reports

Elevated blood pressure (BP), or hypertension (HTN), can cause a cascade of detrimental effects to the body. It is associated with increased risk of stroke, angina, myocardial infarction, heart failure, peripheral artery disease, end-stage renal disease, and abdominal aortic aneurysms (Whelton et al., 2018). HTN is also a major risk factor for the development of cardiovascular disease (CVD), which is the United States’ (U.S.) leading cause of death in men and women (U.S. Preventive Services Task Force [USPSTF], 2020). The PICOT question for this project was: does an eight-week (T) structured walking program utilizing a smartwatch for step counts and …

Nursing Students' Moral Courage Development Through Incivility Simulation Education, Melissa Madden

Nursing Theses and Dissertations

Objectives: The purpose of this study was to determine if the use of an incivility simulation intervention and incivility educational module would increase nursing students’ perceived moral courage more than an incivility educational module alone.

Hypotheses: Nursing students’ moral courage scores would increase more in response to an incivility simulation intervention and educational module than for those who received the incivility educational module intervention alone.

Methods: The NLN Jeffries Simulation Theory framed the proposed intervention using a quasi-experimental pre-test-post-test comparison group design. A convenience sample of 66 students was utilized from one university across two classes. The Moral Courage …

Mixed Method- How Do Medical-Surgical Nurses Provide Compassionate Care To Patients In The Face Of Adversity?, Diane D. Kret

Theses & Dissertations

Compassion is a quality that is the very essence of nursing. Nurses, as professionals, seek to alleviate suffering. It is through providing compassionate, connected care that nurses can relieve their patients’ suffering. In the midst of adversity such as taking care of ill and dying patients, especially in the Covid-19 pandemic, nurses have been challenged with providing compassionate care despite the increased toll that this may have on them. There is evidence that exposure to these events can cause compassion fatigue and burnout. When these signs of compassion fatigue or compassion burnout are not addressed, nurses have decreased job satisfaction …

Dnp Final Report: Physical Activity In Bariatric Surgery Patients: An Evidence-Based Quality Improvement Project, Amber Buehler

DNP Final Reports

Background: Research evidence supports that increasing physical activity has been shown to reduce weight and prevent weight regain after bariatric surgery. There is currently no specific exercise recommendation or program at the Center for Metabolic and Weight Loss Surgery at Dallas.

Objective: To implement an evidence-based project surrounding physical activity to reduce weight regain in patients 12 months post bariatric surgery.

Methods: The 12-week program will consist of 3 times weekly 1 hour virtual exercise classes led by the Nurse Practitioner and/or Nurse. Patients will be screened for current physical activity via survey using the IPAQ at the beginning and …

A Mixed Methods Study Of Cultural Competence Among Nursing Students In Kenya, Sylvia Waweru

Nursing Theses and Dissertations

Significance and Background: Kenya has been experiencing an increase in cultural and ethnic diversity. As a result of cultural differences, health disparities among ethnic groups in Kenya are increasing. A component of patient centered care involves the incorporation of cultural aspects of health and illness in the delivery of nursing care. Understanding cultural competence of nursing students will provide guidance on educational needs related to cultural competence.

Purpose:. The purpose of this study was to assess nursing students’ cultural competence (CC) in the areas of cultural awareness, knowledge, sensitivity, skills, encounters and desire. Nursing students’ views on caring for …

Examining The Effect Of Mentoring On New Hire Aprns, Rochelle Kelly

Doctor of Nursing Practice Projects

Novice advanced practice registered nurses (APRNs) are at risk for isolation, transition difficulties, and burnout. These elements can lead to job dissatisfaction which can negatively impact employee turnover but improving job satisfaction can help retain novice APRNs. Establishing a built-in support system, such as an assigned mentor, upon hire of the novice APRN can improve job satisfaction for both the novice APRN and the experienced mentoring APRN. Improvements in clinic processes, such as implementing a mentoring program, allow the novice APRN to advance their career to an experienced APRN while retaining career satisfaction. Decreasing turnover can lead to significant cost …

Game-Based Refresher Training For Registered Nurse Providers Of Neonatal Resuscitation, Renee Billner-Garcia

Doctoral Projects

Based on evidence suggesting resuscitation provider knowledge and skill decay can occur as soon as four weeks post-training, the American Heart Association (AHA) recommends more frequent resuscitation refresher training. While current resuscitation training and education practices center on simulation training, its cost in terms of supplies, equipment, and personnel may be creating barriers to increasing the frequency of refresher training. This quality improvement project implemented a game-based, refresher training for registered nurse providers of neonatal resuscitation with a focus on improving the time to initiation of positive pressure ventilation (PPV) per Neonatal Resuscitation Program (NRP) guidelines. Using commonly available free …

Esmolol Compared To Fentanyl On Hemodynamic Effects: A Scoping Review, Anna Mccleskey Bsn, Rn, Srna, Landon Mcdonald Msn, Rn, Cnl, Tim Moore Bsn, Rn, Srna, Jamie Pitcock Bsn, Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose The purpose of this DNP project is to compare the efficacy of esmolol to fentanyl in attenuation the hemodynamic response associated with direct laryngoscopy.

Specific Aims Compare the effects of esmolol to fentanyl on patient heart rate during laryngoscopy. Compare the effects of esmolol to fentanyl on patient mean arterial pressure during laryngoscopy.

Transferring Patients To A Higher Level Of Care, Chiquita Rockiemore Rn, Msn, Olubunmi Osinloye Bsn, Rn, Angela Uta Bsn, Rn, Tracy Mcclinton Dnp, Ag-Acnp-Bc

Doctor of Nursing Practice Projects

The purpose of this study is to determine whether the transfer of critically ill patients, who require a higher level of care, to another facility impacts morbidity and mortality within 24-72 hours post transfer

Dnp Final Report: Skilled Nursing Facility Readmissions: An Evidence-Based Telemedicine Innovation Project, Debra B. Graham

DNP Final Reports

Background: Nationally, 20% of patient readmissions occur within the first 48 hours after arrival to a skilled nurse facility (SNF), and 40-68% of these readmissions are potentially avoidable. Since 2016, the Centers for Medicare and Medicaid penalized SNFs when their return to hospital (RTH) percentages was above national benchmarks. The four SNFs in this project experienced rising transfer rates and diminished RTH percentages since 2017, despite using in-house providers Monday through Friday. Furthermore, there was no provision to address patients’ changes in conditions after hours.

Purpose: This evidence-based practice (EBP) project aimed to standardize the care provided to …

Academic-Practice Partnerships: Building The Post-Pandemic Nursing Workforce, Heather M. Van Housen

DNP Qualifying Manuscripts

As the healthcare industry recovers from the disruption of the COVID-19 pandemic, nursing workforce development across the continuum from entry-level nursing student to faculty development has come into focus as a top priority. This article discusses the benefit of increased academic-practice partnership models to meet the growing demand for registered nurses. These partnerships increase clinical placements for nursing students and provide opportunities for practicing nurses to prepare for a clinical instructor role.

Implementing An Osteoporosis Screening And Treatment Protocol For Patients With Fragility Fractures, Lyndsey Slape

Cohort X

Osteoporosis is a global health concern that can be identified and treated with appropriate screening and medical management. The number of fragility fractures that occur will continue to rise with an aging population and is a key predictor of osteoporosis. However, many patients with fragility fractures do not receive the recommended post-fracture care. Poor bone health places patients at increased risk for secondary fracture and has serious emotional, physical, and financial consequences (Kanis et al., 2021). Understanding the benefit of identifying osteoporosis and preventing secondary fractures in an orthopedic clinic has proven advantageous in optimizing bone health and reducing fracture …

Introduction Of Semaglutide As An Effective Option For Obese Patients Motivated To Lose Weight, Crystal Garcia-Martinez

Cohort X

Obesity has become a global crisis with a tremendous impact on patients and costs reaching billions of dollars each year. Prevention and treatment of this condition will be crucial to ongoing efforts to prevent its long-term complications. Health care providers may have the opportunity to educate patients and address weight management issues before serious complications develop. The United States Centers for Disease Control and Prevention, the American Heart Association, and many publications in the medical literature focus on methods that might be used to target weight loss with diet and exercise. Unfortunately, many patients have had little to no success …

Improving Patient Discharge In The Ambulatory Surgical Setting Utilizing A Preoperative Educational Video, Leeann Kluth

The Eleanor Mann School of Nursing DNP Capstone Projects

Background: Use of ambulatory surgery centers providing outpatient surgical procedures has grown due to medical advances, short stays that reduce costs, and convenience for the patient. However, due to the reduced time between diagnosis and surgery, there is a decreased amount of time available for education and discharge teaching. Historically, discharge education is provided after surgery in written form while the effects of anesthesia and pain medication impair a patient’s ability to retain information. This leads to increased reports of uncontrolled pain, poor comprehension, and higher rates of adverse events due to poor comprehension of discharge orders.

Methods: The development …

The Ketogenic Diet: Its Effectiveness As An Adjuvant Therapy For Cancer, Rheaonn Marin

Nursing | Senior Theses

This paper explores a total of six research studies and will contain a literature review and proposal for further study regarding the effectiveness of the ketogenic diet as an adjuvant cancer therapy. Each study addresses a variety of different factors involved in KD implementation, ranging from effects on body composition and lipid profiles, to self-proclaimed quality of life, to tumor expression and progression under a KD regime. Ultimately, each were divided into three separate categories depending on the aspects of research that were covered. Two studies, by Hagihara et.al and Jansen and Walach respectively, discuss the potential benefits of KD …

Assessing Preventative Lifestyle Interventions In The Filipino-American Population To Decrease Risk Of Type Ii Diabetes, Brandon Christopher Flores

Nursing | Senior Theses

Background

Type II Diabetes is a concerning global health issue and must be addressed. Given the unfortunate risks of T2D in the Filipino populations, prevention efforts must begin in this select population. There is strong empirical support for utilizing lifestyle interventions such as nutrition and physical exercise to prevent these diseases in adults; but it is not clear whether the same holds true for Filipino populations.

Objective

This thesis examines lifestyle management efforts such as weight reduction, family support, nutrition changes, and physical activity to prevent type 2 diabetes in Filipino-Americans.

Methods

The methods of the thesis will present a …

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 …

Identifying The Impacts Of Burnout On Bullying During The Covid-19 Pandemic, Janmarko Lapitan

Nursing | Senior Theses

Background: Bullying and burnout has the potential to negatively impact nurses both at work and in their everyday lives and has been studied on various occasions. However, during the COVID-19 pandemic, burnout amongst nurses has been on the rise. Researchers have studied incidences where patients have bullied health care workers. However, no such study has been carried out to examine bullying between nurses during the pandemic.

Purpose: The purpose of this study is to find whether burnout levels in nurses impacted bullying between nurses during the COVID-19 pandemic.

Methods: The research literature will discuss bullying and its effects on patients, …

Screening For Tnf Response Prior To Initiation Of Biologic Therapy For Precise Targeted Therapy, Miguel A. Rodriguez

Cohort X

Objective: A quality improvement project to improve outcomes in rheumatoid arthritis (RA) patients who are anti-CCP positive by starting targeted biologic/targeted synthetic DMARDs (b/tsDMARDs) therapy after screening for tumor necrosis factor inhibitor (TNFi) response. Using a targeted therapy approach, patient’s disease activity was checked before and after intervention. The goal was to achieve a clinical disease activity index (CDAI) of <10, showing low disease activity. Methods: Quality improvement model used was the Plan-Do-Study-Act cycle to aid in implementing change to improve patient outcomes. Quality improvement project used Lewin’s change theory. The project allowed for change in provider behavior and organization by using a systemic approach and strategies to improve patient outcomes. Lewin’s change theory consists of three parts: unfreezing, changing, and refreezing. The project unfroze the traditional way of prescribing biologic therapy. The screening tool for TNFi response was the change used to find TNF inhibitor non-responders prior to or during biologic therapy. The refreezing part of the theory is to continue screening for TNFi response after the project to ensure the most proper biologic is chosen. Results: A total of 27 patients were screened with TNFi nonresponse prediction tool during a 6-week period. 10 patients were predicted non-responders to TNFi therapy. 15 patients had no prediction of non-response to TNF inhibitor therapy. Two patients were not resulted due sample quality issues. Test results information, the patient’s clinical picture, and therapies were adjusted accordingly. Conclusion: The use of the TNFi nonresponse prediction screening tool allowed for the 10 predicted non-responders to avoid TNFi that would be traditionally started on first line treatment. These 10 patients saved time, money, health, disability, and joint deterioration by starting or continuing proper treatment.

Thiazide-Like Diuretics As First-Line Treatment To Improve Blood Pressure Management, Raquel Okubo

Cohort X

Background: Thiazide diuretics are currently the first-line treatment for hypertension (HTN). This class of drugs includes hydrochlorothiazide (HCTZ) and the thiazide-like diuretic, chlorthalidone (CTDN). The quality improvement project began in the fall semester with a 10- day reflective practice log to assess my current practice. A review of the clinical practice log allowed me to evaluate my current practice and identify three opportunities to improve my practice. I developed three potential PICOT questions and selected one for the QI project with the guidance of my Doctor of Nursing Practice (DNP) chairperson. I performed a literature review to gather the best …

Empagliflozin And/Or Metformin: A Combination Approach For Uncontrolled Type 2 Diabetes, Maria Crespin

Cohort X

Background: Current guidelines recommend metformin as the first-line agent therapy for the management of Type 2 Diabetes (T2D) when diet and exercise are insufficient. When monotherapy with metformin is intolerant or contraindicated, or not sufficiently effective to reach the glycated hemoglobin (HbA1c) target, a second anti-diabetic agent as an alternative or add-therapy to metformin is recommended by all guidelines. The quality improvement project was initiated in the fall semester with a 10-day reflective practice log to assess my current practice. A review of the clinical practice log allowed for evaluation of my current practice and identify three opportunities to improve …

Chemotherapy Induced Painful Peripheral Neuropathy: A Treatment Option, Maria M. Acevedo

Cohort X

BACKGROUND: Cancer diagnosis and treatment are tragic issues for patients. Besides the psychological aspects associated with therapeutic interventions, chemotherapy-induced painful peripheral neuropathy (CIPPN) is one of the long-term side effects of intravenous chemotherapeutic agents used to treat cancers. This type of neuropathic pain has not effectively responded to medications for peripheral neuropathy treatment. Duloxetine is effective in decreasing CIPPN. This evidence-based research investigates the practice changes that can be implemented to reduce the pain ratings of survivors with CIPPN.

METHODS: In this practice improvement project, patients with CIPPN who reported a rating of ≥3 on the pain scale with the …

Effects Of Evidence-Based Discharge Instructions On Follow-Up With A Healthcare Provider In Patients Presenting With Mtbi-Like Symptoms To A Health Clinic At A Rural Sports Camp In The Pacific Northwest In The U.S., Eva G. Bergner

Doctor of Nursing Practice Scholarly Projects

Mild traumatic brain injury (mTBI) is a major public health burden affecting both children and adults in the U. S. (Sarmiento et al., 2019; Schuchat, Houry, & Baldwin, 2018). The management of mTBI at summer camps is not well characterized in the literature. Epidemiologic studies on summer camps have reported that 25% of all injuries were to the head, face and/or neck (Kolberg et al., 2020; Robinson, Arbogast, Garst & Corwin 2019). The purpose of this project was to evaluate the impact of evidence-based instructions for follow-up with a healthcare provider in patients presenting with mTBI-like symptoms to a health …

The Difference In Quality Of Care With Patients Who Face Language Barriers In The Hospital, Camille Serrano

Nursing | Senior Theses

Background

This thesis aims to explore the difference in quality of care between those who are admitted into the hospital with a language barrier and those who are admitted with none. Communication was identified to be the most essential aspect of stable, effective, and successful nursing. One of the primary and most crucial roles as a nurse is to advocate for their patient, however due to this immutable health disparity the quality of care is spread so thin that those with diverse linguistic backgrounds are not receiving equal levels of care. When the efficacy of communication is lost, a nurse’s …

Safety Measures In The Epilepsy Monitoring Unit: An Organizational Assessment, Tina Yates

Doctor of Nursing Practice Scholarly Projects

Long-term video-electroencephalography (EEG) monitoring in the epilepsy monitoring unit (EMU) is an elective procedure and generally safe. Clinical experts determined the EMU protocols at a level-4 comprehensive epilepsy center were not followed correctly. The project is a retrospective chart audit incorporating Ray’s Bureaucratic Caring theoretical framework with Donabedian’s conceptual model. The project objective is to evaluate if safety measures protocols are implemented appropriately in the EMU and determine whether a need exists for quality improvements.

The project reviewed patients admitted to the EMU from September 2021 through November 2021 who developed a generalized tonic clonic (GTCs) seizure with electrographic epileptiform …