Nursing Commons^™

A Guideline-Based Approach To Increase Early Mobilization In The Pediatric Patient Following Cardiothoracic Surgery, Kayla Keeven

Dissertations

A Guideline-Based Approach to Increase Early Mobilization in the Pediatric Patient Following Cardiothoracic Surgery

Problem: Prolonged bedrest during the post-operative period contributes to complications that lengthen hospital stay and increase mortality and medical costs. Early mobilization is recognized as safe and feasible in critically ill children. However, there is no standardized procedure nor method of identifying patients who are safe to mobilize in a pediatric cardiac intensive care unit (ICU).

Method: The quality improvement (QI) project employed a descriptive observational design utilizing a retrospective-prospective method to assess the effects of implementing an early mobilization guideline in a pediatric cardiac ICU. …

Management Of Post-Extubation Dysphagia Using The Yale Swallow Protocol, Nicole West

Dissertations

Abstract

Problem: Post extubation dysphagia (PED) increases the patient’s risk for long term complications contributing to increased healthcare cost. Intensive care settings rarely use standardized swallow screening assessments for patients post extubation leading to variation in the evaluation of PED. Variation in the assessment of swallowing post extubation can lead to the missed diagnosis of patients with dysphagia.

Methods: This quality improvement (QI) project was a prospective cohort study implementing an evidence-based swallow screening protocol, the Yale Swallow Protocol (YSP), in an intensive care unit. This study was conducted over four months, which included a pre survey, education, implementation, and …

Neonatal Hyperbilirubinemia And Phototherapy: The Implementation Of Seminal Clinical Practice Guidelines, Christina Coleman

Dissertations

Problem: On a postpartum care and pediatric unit from February 2022 to December 2023, the average monthly percentage of neonatal patients greater than 35 weeks gestation with hyperbilirubinemia who were treated with phototherapy before it was medically supported by the current guidelines was 42.855% (N=668). The department’s goal was to decrease this number to 10%. Initiation of phototherapy with a subthreshold bilirubin level exposes many infants to an unnecessary treatment modality which can prolong the infant’s length of stay in the hospital and can be associated with adverse effects, such as maternal-infant bonding and breastfeeding rates.

Methods: The …

Implementing A Brief Intervention For Smoking Cessation In An Inpatient Psychiatric Facility, Erika Gotway

Dissertations

Abstract

Problem: Smoking is a leading cause of various preventable diseases, and those who experience mental illness smoke cigarettes at a higher rate than the general population. Brief intervention is a type counseling that has proven successful in encouraging smokers to quit. The “5 A’s” is a type of brief intervention which stands for: Ask, Advise, Assess, Assist, Arrange. Addressing the smoking epidemic among individuals with mental illness is not only essential for improving their overall well-being, but also for reducing health disparities and enhancing the effectiveness of existing mental health interventions.

Methods: The approach to this project was a …

360 Degree Clinical Competence Evaluation For Pediatric Hospitalist Advance Practice Provders, Elizabeth A. Schickler

Dissertations

Problem: Advanced practice provider (APP) peer reviewed clinical competencies is an expected part of professional, organizational, and The Joint Commission (Joint Commission) requirements, however, is not well defined and subject to organizational application and interpretation. Providers favor peer review as a means to improve professional practice. There is a lack of data to support frequency of feedback and method of feedback to support readiness to change practice and comfort giving and receiving feedback.

Methods: The quality improvement project utilized an analytical experimental design.

The Cardin Hospitalist Advanced Practice Provider - Readiness Assessment (CHAPP-RA) tool was implemented to a convenience sample …

Implementation Of The Process Improvement Toolkit For Hospital Acquired Pressure Injuries, Christina Bearden

Dissertations

Problem: Approximately 2.5 million people within the United States receiving inpatient medical care will develop a pressure injury each year (Padula & Demarmente, 2018). Pressure injuries (PI) are a multifactorial complication that can often be avoided with general prophylactic measures. Despite this, inpatient settings around the United States continue to see a rise in PIs.

Method: The quality improvement initiative utilized a descriptive, observational design. The turn team toolkit was implemented and monitored over a two-month period. Patient descriptors and quantitative data were collected through a retrospective chart review. The primary data collected was on pressure injury rates and staff …

Evaluation Of A Smoking Cessation Program In Primary Care, Yolanda Duncan-Watt

Dissertations

Abstract

Problem: The adult tobacco smoking rate exceeds 12.5%. The problem is the insufficient attention given to smoking cessation education in low socioeconomic status(SES) communities. There is a lack of access to and awareness of smoking cessation programs for low-income populations.

Methods: This quality improvement (QI) study will use a descriptive, observational approach. A retrospective medical record review will be conducted to determine the rate of individuals who got the smoking cessation intervention and the rate of those who successfully quit one month after the intervention. Data was collected throughout the spring of 2024, during primary care visits and phone …

Improving Nurse Response To Seizure Events In A Pediatric Epilepsy Monitoring Unit With Use Of A Standardized Process, Stacey Obst Paule

Dissertations

Problem: Nurses responding to seizure events in the pediatric epilepsy monitoring unit (EMU) should initiate a neurological exam in addition to managing seizure activity. When nurses respond to these events, however, there can be significant variability, which can result in diagnostic inaccuracy and adverse patient outcomes. The purpose of this project is to implement a nursing response checklist and neurological assessment guide to standardize the process of response to seizure events in the pediatric EMU.

Methods: This quality improvement (QI) project utilized a cohort study design. Standardized tools were placed in an accessible area outside patient rooms. Education was provided …

Implementation Of Skin-To-Skin Immediately Post C-Section: A Pilot Study, Miah Vernor

Dissertations

Skin-to-skin contact during the golden hour is a practice that has numerous health benefits following the delivery of a newborn. These benefits include a healthy transition to extrauterine state, initiation of breastfeeding, thermoregulation, and more. However, the mode of delivery affects how often this practice is done. Parents who deliver vaginally are routinely offered the opportunity to perform skin-to-skin immediately after delivery whereas birth parents who deliver by cesarean section are not always offered this same benefit due to various reasons. A quality improvement project was conducted on an 18-bed labor and delivery unit at a Midwest hospital. This project …

Implementation Of Skin-To-Skin Contact Immediately Post Cesarean Birth: A Quality Improvement Project, Sophia Cooke

Dissertations

Problem: Skin-to-skin contact implemented within the first hour of a newborn’s life improves health outcomes for both mother and infant. One of these health outcomes includes exclusive breastfeeding. The purpose of this quality improve project was to implement an infant securement device within the operating room after cesarean section births to decrease the time to initiate skin-to-skin contact and increase exclusive breastmilk feeding rates at discharge.

Methods: This study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A pre-test, post-test design was utilized to compared retrospective and prospective data. The retrospective data was collected to assess …

Evaluation Of The Grief Of Mothers Affected By Perinatal And Traumatic Loss, Landry Crabtree

Dissertations

Problem: The experience of a perinatal loss can be traumatic for mothers, and complicated grief reactions are common for those who have experienced a perinatal loss. An increase in perinatal loss resources is needed in the United States. The purpose of this program evaluation was to assess outcomes of a pilot perinatal loss support program on the grief of women who have experienced a perinatal loss.

Methods: This project was an evaluation of a perinatal loss support program that employed evidence-based strategies in both individual and group therapy sessions. A retrospective design was used, and data on perinatal …

Implementation Of Postnatal Depression Screening: A Pilot Study, Mollie Gulino

Dissertations

Abstract

Background: Postpartum depression (PPD) is a prevalent problem among women during their childbearing years, affecting approximately 1 in 7 women. Alarmingly, about 50% of PPD cases go undiagnosed and untreated, contributing to poor maternal outcomes, including suicide, which is a leading cause of maternal mortality in the United States.

Issue: Despite its prevalence and severe consequences, PPD often goes unrecognized due to inconsistent screening practices. Current guidelines vary by organization and lack consistent, evidence-based criteria.

Objective: This pilot program aimed to implement universal PPD screening with a validated tool at the six-week postpartum follow-up visit. The goal was to …

Implementation Of The Edinburgh Postpartum Depression Screening Tool For Postpartum Depression In A Midwest Primary Care Clinic, Makenzie Garrison

Dissertations

Problem: Postpartum depression is a prevalent health concern in postpartum women. Screening practices to identify postpartum depression are inconsistent. The purpose of this quality initiative is to determine if the implementation of the Edinburgh Postpartum Depression Screening Tool (EPDS) to screen for postpartum depression in the primary care setting increases the detection of postpartum depression in postpartum women from delivery to one year postpartum.

Methods: This quality improvement project utilizes a descriptive, observational design. A retrospective medical record review was utilized as well as a 12-week data collection period. Retrospective medical record reviews were conducted to assess the rate of …

Implementation Of Quantitative Blood Loss Following Cesarean Section Birth, Layna Victoria Schultz

Dissertations

Problems: Postpartum hemorrhage (PPH) is a significant problem due to potential harm and is a main contributor to maternal morbidity (ACOG, 2019). According to ACOG, of maternal deaths in the United States, 11% are caused by PPH and 54-93% of the deaths related to PPH could be prevented (ACOG, 2019). When institutions adopt quantitative blood loss (QBL) protocols for improved accuracy in blood measurement, PPH can be identified sooner, allowing for earlier intervention. Inaccurate estimation of obstetric blood loss by health care providers is a primary cause of delayed staff response to PPH (ACOG, 2019).

Methods: This quality improvement (QI) …

Nursing Staff Education On Enhanced Recovery After Surgery Related To Nurse-Patient Pain Communication, Kathleen Ranne

Walden Dissertations and Doctoral Studies

Perioperative pain is a significant challenge in terms of care of surgical patients which requires effective communication by nurses to improve patient outcomes and satisfaction. The communication component of the Enhanced Recovery after Surgery protocol is a foundation for improved patient outcomes and pain management. The problem that was identified in this Doctor of Nursing Practice project was lack of staff education during the perioperative period related to nurse-patient communications regarding pain management. Using the analysis, design, development, implementation, and evaluation model of instructional design, the purpose of this DNP project was to plan, implement, and evaluate a staff education …

Prelicensure Baccalaureate Nursing Faculty’S Experiences Of Providing Incivility Awareness Education To Students, Emily Vanessa Pappa

Walden Dissertations and Doctoral Studies

This study investigated prelicensure baccalaureate nursing faculty’s lived experiences of providing incivility awareness education to students. The problem was that previous research regarding incivility awareness education to prelicensure baccalaureate nursing students focused on pilot studies to find effective strategies and students’ receptiveness to educational approaches, but it lacked the nurse educators’ experiences of delivering the education. The purpose was to explore the lived experiences of nurse educators providing incivility awareness education to prelicensure baccalaureate nursing students. with at least 1 year of teaching experience in prelicensure baccalaureate nursing programs and had taught the topic of incivility awareness. Using the qualitative …

Evaluation Of An Advanced Practice Provider Residency Program, Amber Juetten

DNP Projects

The primary care physician shortage can be mitigated by effective preparation and placement of qualified advanced practice providers (APPs) (Zhang et al., 2020). APP residency programs have shown to increase confidence and competency, which leads to an increase in productivity, job satisfaction, retention, and has a positive financial impact on the organization (Minichiello et al., 2020; Nutting et al., 2022; & Han et al., 2018). Potential concerns around the skills and confidence of new APPs has been the impetus for this DNP project, which aimed to provide an APP residency program that provided the support needed for an effective transition …

Increasing Stroke Symptom Awareness In The Hispanic Community, Karina Barabash

DNP Projects

Ethnic and racial minorities are at higher risk for many health conditions including coronary artery disease and stroke (Mital et al., 2021). The Hispanic population specifically faces more risk factors, less knowledge of stroke symptoms, and higher probability of death and disability post stroke (Eisenstein et al., 2018). Unless this gap is addressed, ethnic and racial minority patients will continue to experience higher rates of death and disability from stroke, compared to non-Hispanic White patients. Therefore, the purpose of this project was to provide clinic-based stroke education in Spanish to Hispanic community members. The goal was to increase awareness of …

Mhealth Intervention For Elevated Blood Pressure Among College Students: Single-Arm Intervention Study, Dieu-My T. Tran, Catherine E. Dingley, Roger Bonilla

Nursing Faculty Research

Background: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population.

Objective: The purpose of this study was to …

Depression Screening For Nursing Home Residents, Victor Chukwuocha

Walden Dissertations and Doctoral Studies

The project focused on depression among nursing home residents, an underrecognized and undertreated condition that affects quality of life. Few studies have been conducted on the subject of depression screening for nursing home residents, resulting in a lack of understanding among the nursing profession on managing specific conditions. At a nursing home, there was a need to address depression. The practice-focused question used in this project addressed the process of the translation of evidence to develop a staff education project for depression to enhance the knowledge of nurses working with nursing home residents. The project followed an evidence-based approach to …

Neonatal Nurses’ Intention To Stay In The Nicu, Carolyn Penn-Griffin

Walden Dissertations and Doctoral Studies

Neonatal nursing leaders and national health care organizations within the United States are concerned about the recent shortage of skilled and experienced neonatal intensive care unit (NICU) nurses that may reduce the quality of care delivered to NICU patients. NICU nurses are passionate about caring for premature and ill full-term infants and providing educational and emotional support for their parents, some NICU nurses remain in the NICU long-term, yet others contemplate leaving the specialty. The purpose of this qualitative interpretative phenomenological research guided by Martin Fishbein and Ajezen’s theory of reasoned action was to explore the lived experiences of NICU …

Implementation Of A Crna Clinical Faculty Preceptorship Workshop: A Quality Improvement Project., Sarah Veeneman

Doctor of Nursing Practice Papers

Background/Significance: Certified Registered Nurse Anesthetists (CRNAs) undergo extensive didactic and clinical training when earning their doctoral practice degrees. However, there is inconsistency of preceptor clinical training.

Purpose: The purpose of this quality improvement project was to improve the consistency in preparedness of CRNA clinical faculty preceptors who train nurse anesthesia residents (NARs).

Methods: A pre-post approach was used. A MeSH search was conducted that resulted in 13 studies that were examined for quality and applicability for this project. The Plan-Do-Study-Act model was the framework to guide this quality improvement project.

Intervention: Participants attended one 3-hour educational training workshop. …

Implementation Of A Mindfulness Approach To Emotional Regulation In A Public High School., Kaelin Cherise Shay

Doctor of Nursing Practice Papers

According to the Gallup and Walton Family Foundation-State of American Youth Survey for 2023, schools in the United States received an average grade of C+ when it comes to supporting their students’ mental health, highlighting a potential area for improvement in the school system (Wilcoxon & Marken, 2023). This quality improvement project aimed to teach high school students about emotional regulation using a mindfulness platform and evidence-based techniques designed for the school environment. The sessions focused on improving the students’ understanding of emotions and emotional regulation and helping them apply techniques to regulate emotions in a healthy manner.

This project …

Evaluation Of An Educational Training On Telehelath Utilization Rates And Hospital Readmissions In A Home Health Setting., Gabrielle A. Coomer

Doctor of Nursing Practice Papers

Background: Hospital readmissions are on the rise and continue to be a concern within healthcare due to their effects on the quality of care and healthcare costs. Telehealth strategies have been utilized across healthcare settings to improve hospital readmission rates.

Purpose: The purpose of this project was to evaluate the effectiveness of a telehealth training program in increasing telehealth utilization rates and reducing the acute care hospitalization rate within a single home health agency.

Intervention: A 30-minute PowerPoint presentation on the definition of telehealth, goals, and benefits of telehealth, patient eligibility, special considerations for clinicians, billing and coding guidelines, …

Daily Alarm Rounds: Enhancing Interdisciplinary Communication And Reducing Perceived Alarm Burden In Bedside Nurses., Shelby Mangeot

Doctor of Nursing Practice Papers

Purpose: The Joint Commission established alarm management as a national patient safety goal in 2013 and has continued this goal through 2023 (2022). This goal mandates hospitals to prioritize alarm system management and establish evidence-based techniques to manage and reduce nuisance alarms. The purpose of this quality improvement project was to provide bedside nurses with education about excessive alarm burden and evidence-based alarm management techniques, then implement a daily bedside alarm rounding tool to enhance interdisciplinary communication and address patient alarm limits during daily rounds.

Methods: After extensive review of the literature, prompts discussing daily alarm limits were added to …

Lgbt Cultural Competence Education For Nurse Leaders In A Large Metropolitan Healthcare System: Quality Improvement, Trevor Mcguffin, Andrew Mitchell

Doctor of Nursing Practice Papers

Background: In the United States, seven percent of adults identify as LGBT. The LGBT population is disproportionately affected by health disparities and barriers to care when compared to the cis-heterosexual population. Due to healthcare providers’ limited LGBT health education and experience, inconsistencies in LGBT culturally competent care perpetuate health disparities and barriers to care for the LGBT population.

Purpose: The purpose of this quality improvement project was to educate nurse leaders on LGBT cultural competency and facilitate nurse leaders’ behavior change.

Methods: This quality improvement project consisted of three LGBT cultural competence modules and two guided behavior change pathways. Outcomes …

Thoughts From The Frontline - July 2024, Tennessee Center For Nursing Advancement, East Tennessee State University

Thoughts from the Frontline Newsletter

No abstract provided.

Addressing Caregiver Burden Among Oncology Caregivers: An Educational Intervention., Alexandria Salois

Doctor of Nursing Practice Papers

The incidence of cancer is on the rise, the number of cancer diagnoses are increasing at an alarming rate with advanced technologies and available evidence. Cancer care has also shifted from the inpatient setting to mostly outpatient. With this, a large portion of the responsibility has been transferred to the caregiver of that patient (Kent et al., 2019). Historically, caregivers have not been at the forefront of research, however, the concept of caregiver burden is beginning to emerge. A gap exists in addressing the needs of caregivers in both evidence-based data and with the local community cancer support group, Gilda’s …

Evaluation And Implementation Of Mindfulness Module To Reduce Burnout Among Emergency Department Nurses: A Quality Improvement Project, Katie Waltrip

Doctor of Nursing Practice Papers

BACKGROUND: Nurses working in the ED experience higher burnout rates than those working in other healthcare settings. Defined as emotional exhaustion, depersonalization, and a low sense of personal accomplishment, burnout is associated with increased work absences and turnover and decreased patient satisfaction and quality care. Burnout must be examined and addressed for emergency nurses to continue providing quality care.

PURPOSE: This quality improvement project aimed to evaluate burnout among nurses working in the ED prior to and immediately following a 9-week mindfulness-based intervention.

METHODS: A Plan-Do-Study-Act model was utilized along with application of supporting evidence from the literature and an …

Promoting Healthy Habits Among Children In A Residential Facility., Tiffany Jones

Doctor of Nursing Practice Papers

Background: Childhood obesity has been a significant public health concern in the United States. The prevalence of obesity among children and adolescents has increased over the past few decades. There are serious implications for immediate and long-term health. It poses serious health risks and economic challenges.

Setting: This quality improvement project will take place at a residential psychiatric treatment facility and therapeutic foster care program for children and adolescents with mental health or behavioral issues. This facility is in the suburbs of Louisville, Kentucky.

Purpose: The purpose of this project is to boost physical activity and improve knowledge about nutrition …