Nursing Commons^™

Introduction Of A Policy Adherence Plan In An Outpatient Buprenorphine Treatment Clinic., Stacie Switzer Cheney

Doctor of Nursing Practice Papers

Abstract

Background: Medication-Assisted Treatment (MAT) is one of the most effective pharmacological therapies for opioid dependence. Regular urine drug screening to include random urine drug screens at least once a month is a key factor in improving quality care for those receiving treatment in an outpatient MAT clinic.

Problem: A rural outpatient MAT clinic has a current random urine policy that is not being utilized when treating clients with Opioid Use Disorder (OUD). This increases the risk of diversion and misuse of buprenorphine/naloxone (Suboxone), thus increasing the risk of overdose and death for OUD patients.

Environment: This project was implemented …

Effects Of Preoperative Chlorhexidine Gluconate (Chg) Cloths Educational Intervention For Preoperative Staff On Chg Knowledge And Surgical Site Infection Rates: A Quality Improvement Initiative., Deven Leffler

Doctor of Nursing Practice Papers

Abstract

Background: Surgical site infections (SSIs) are the most common cause of a surgical complication and account for 38% of all hospital acquired infections (HAI). The cost of caring for SSIs in the United States can range from $3.5-$10 billion annually.

Purpose: The purpose of this DNP Quality Improvement (QI) initiative was to improve preoperative staff’s knowledge and application of the Food and Drug Administration (FDA) approved 3-minute application scrub time for the 2% CHG cloths and reduce SSIs for an acute care hospital located in Louisville, Kentucky.

Methods: Quality improvement was initiated using the Plan, Do, Study, Act (PDSA) …

The Impact Of Social Determinants Of Health And Acculturation On Quality Of Life In Older Chinese American Adults With Chronic Pain: A Quantitative Study, Chi Lam

Dissertations

Despite a rapid increase in the older Chinese American adult population, there are very few research studies examining the impact of social determinants of health and acculturation on the quality of life in older Chinese American adults. The purpose of the study was to determine the impact of social determinants of health and acculturation on quality of life in older Chinese American adults with chronic pain. This quantitative, descriptive correlational study utilized Madeleine Leininger’s Transcultural Theory as its theoretical framework. Two research questions guided this study: (1) Was there a difference in the quality of life in older Chinese American …

Improving Central Line-Associated Bloodstream Infection Prevention Bundle Compliance To Reduce Infection Rates In A Pediatric Cardiac Intensive Care Unit., Aubree Croghan

Doctor of Nursing Practice Papers

Background: Central line-associated bloodstream infection (CLABSI) is the most common healthcare-acquired infection in pediatrics. A pediatric acute care facility in Kentucky created a specialized care team in an effort to track CLABSI bundle compliance and reduce central line infections. While rates of infection decreased, a significant number of infections still occurred and staff adherence to facility evidence-based policies and infection prevention interventions remained low.

Purpose: To reach the facility’s goal of zero central line-associated bloodstream infections, a quality improvement (QI) project was developed to improve staff knowledge of care and increase staff adherence to policy.

Methodology: To create the QI …

Improving Prediabetes Screening, Diagnosis, And Referral To A Diabetes Prevention Program In The Primary Care Setting., Brittany Morguelan

Doctor of Nursing Practice Papers

Improving Prediabetes Screening, Diagnosis, and Referral to a Diabetes Prevention Program in the Primary Care Setting

Table of Contents

Abstract……………………………………………………………………………………………4

Background………………………………………………………………………………………..5

Purpose…………………………………………………………………………………………...10

Literature Review……………………………………………………………………………...…10

Conceptual Framework…………………………………………………………………………..15

Setting………………………………………………………………………………………...….17

Context…………………………………………………………………………………………..18

Procedures/Intervention…….……………………………………………………………………19

Ethical Considerations…..……………………………………………………………………….20

Measures…………………………………………………………………………………………20

Data Analysis……………………………………………...……………………………………..22

Results……………………………………………………………………………………………23

Discussion……………………………………………………………………………...………...26

References……………………………………………………………………………………….33

Appendix A: Implementation Timeline…………………………………………………………40

Appendix B: IROC Quality Improvement Leadership Approval Letter………………………...41

Appendix C: PCP Referral Process and Diabetes Prevention Program Referral Order………...42

Figure 1: Monthly Number of N-DPP EHR Referrals by PCPs…………………………………….43

Figure 2: Monthly Total PCP Screening HbA1c/FBG Orders vs. Monthly Results HbA1cs……44

Figure 3: Demographic Analysis: Patients with a Documented Prediabetes ICD-10 (R73.03/R73.0)………………………………………………………………………………………….45

Abstract

Background: Prediabetes is a …

Utilizing A Reminder Tool To Improve Post-Hypoglycemia Recheck Rates On A Medical Surgical Unit., Laken Heitz

Doctor of Nursing Practice Papers

Diabetes is a growing epidemic with profound implications on the healthcare system. One of many possible complications is hypoglycemia, which is any value below 70 mg/dL. Inpatient hypoglycemia is a patient safety concern, and its treatment requires nursing adherence to strict protocols including a recheck within 15 to 30 minutes after treatment. However, evidence from the literature and project site demonstrated low rates of timely post-hypoglycemia rechecks. The purpose of this project was to provide education to all MIPS nurses regarding the utilization of a reminder tool for post-hypoglycemia rechecks. The intervention plan included reviewing the current hospital-wide hypoglycemia policy, …

Remote Blood Pressure Monitoring Program: Program Evaluation., Brittany Walker

Doctor of Nursing Practice Papers

The prevalence of hypertension is high at the local, state, and national levels. In 2021, 39% of Kentucky adults were diagnosed with high blood pressure (CDC, 2021). Primary care providers are utilizing remote blood pressure monitoring (RBPM) to assist with the management of hypertension. Literature reveals that remote BP monitoring alone, without the use of other interventions such as counseling and education, may not effectively control blood pressure (Uhlig K, et al, 2013). This project evaluated the RBPM program utilized at a federally qualified health center in Louisville, KY. Patient engagement within the RBPM program includes BP measurement, communication with …

A Quality Improvement Project: Implementing Safe Sleep Practice In A Neonatal Intensive Care Unit., Morgan Demyer

Doctor of Nursing Practice Papers

Significance: The American Academy of Pediatrics (AAP) recommends safe sleep practices (SSP) to reduce infant sleep-related deaths. Annually 3,500 babies die due to improper sleeping conditions, and Kentucky is among the lower-performing states for infant sleep safety. The AAP recommends initiating SSP with infants in neonatal intensive care units (NICU) and recently expanded recommendations in 2022. Presently, there is no regulation of healthcare clinician education regarding SSP or role-modeling behavior in the in-patient setting.

Purpose: This scholarly project aimed to improve knowledge and awareness of SSP by improving clinician knowledge and behavior of SSP use in NICU and …

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Guide And Algorithm Creation For Hepatitis B Vaccination And Tuberculosis Testing Requirements For A Nursing Program., Jumoke Owolabi

Doctor of Nursing Practice Papers

This project developed a guide and algorithm for hepatitis B vaccination and tuberculosis (TB) testing requirements for nursing students at the University of Louisville [UofL] School of Nursing [SON] before clinical placement. Clarifying the requirements for hepatitis B vaccination, testing, and tuberculosis testing was paramount for clinical compliance because the current policy was determined to be ambiguous. The literature review revealed discrepancies with policies for hepatitis B and TB among countries and with individual institutions confirming the need for aligning with evidence-based vaccination guidelines. Based on these findings, an evidence-based guide and algorithm were created. Feedback from the clinical compliance …

Improving Maternal And Infant Health: A Quality Improvement Initiative To Recognize Postpartum Depression In The Neonatal Intensive Care Unit., Amy Barry

Doctor of Nursing Practice Papers

BACKGROUND: While postpartum depression (PPD) is a significant problem in the postpartum population, emerging literature suggests that PPD is disproportionately concentrated and underdiagnosed among mothers of infants admitted to the neonatal intensive care unit (NICU).

PURPOSE: The purpose of this project was to institute a PPD screening protocol within a Level III NICU to identify mothers exhibiting signs of distress and initiate social work referrals.

METHODS: A quality improvement project implemented utilizing the Plan-Do-Study-Act (PDSA) framework and a pre-and-posttest design.

INTERVENTION: Staff education regarding PPD symptoms and the project’s protocol occurred via electronic means. Mothers of NICU infants who remained …

Perceptions And Experiences Of Nursing Students And Faculty Members Regarding Implementation Of The Bs-Nursing Program, Abdul Karim, Yasmin Amarsi, Yasmin Parpio, Laila Akber Cassum, Munira Amirali, Shakir Rehman

School of Nursing & Midwifery

Objective: To explore the perceptions and experiences of nursing students and faculty members regarding the implementation of the baccalaureate nursing programme in public-sector setting.
Methods: The descriptive, exploratory, qualitative study was conducted at the Khyber Medical University, Peshawar, Pakistan, from April 15, 2020 to April 15, 2021, and comprised undergraduate nursing students and faculty members. Because of the coronavirus disease-2019 pandemic, the subjects were interviewed through telephonic call using a semi-structured interview guide. Data was analysed using the Creswell's analysis approach.
Results: Of the 15 subjects, 10(66.6%) were students aged 21-24 years; 7(70%) males and 3(30%) females. The remaining 5(33.3%) …

Self-Care Narratives: Life Stories Of Rural Adults Managing Chronic Illness Without Insurance, Jean E. Montgomery

Nursing Dissertations - Archive

Uninsured rural adults with chronic illness are more likely to experience worse outcomes than insured individuals. Without access to healthcare or insurance, self-care is an important variable in the management of chronic illness in this rural population. Although rural safety-net programs have been implemented for decades, research on the effectiveness of these programs and self-care is rare and limited. Rural health disparity persists while voices from this marginalized population have gone unheard. The purpose of this study was to give them a voice by capturing first person storied accounts of self-care from chronically ill, uninsured, rural non-elderly adults and to …

The Relationship Between Nurse Professional Development Practitioners’ Perceptions Of Empowerment In The Workplace And Intent To Stay Post Covid-19 Pandemic, Tashiana Roberts-Jackson

Nursing Dissertations - Archive

Nurse Professional Development (NPD) practitioners in the acute care hospital setting are often undervalued despite their crucial role. During the COVID-19 pandemic, they demonstrated adaptability by rapidly transitioning to virtual formats for onboarding nursing staff, while also shouldering the responsibility of ensuring staff competency in caring for COVID-19 patients. Additionally, NPD practitioners faced heavy workloads, having to retrain nursing staff who worked in indirect patient care roles, while also filling in during critical staffing shortages. To date, no studies have been found that explored key factors that predict intent to stay in the NPD practitioner population pre- or post-pandemic. Thereby, …

The Journey From Drug Addiction To Drug Withdrawal: A Christian Gospel Rehabilitation Program In Taiwan, Pi-Ming Yeh

ETSU Faculty Works

Background

World Drug Report estimates the number of opioid users at 53 million and identifies opioids as responsible for two thirds of the 585,000 people who died as a result of drug use in 2017.

Purpose

The purpose of this study was to analyze the testimonies of 30 people regarding their journeys from drug addiction to drug withdrawal in Taiwan.

Methods

This was a qualitative research design. The sample inclusion criteria were as follows: (a) being a drug abuser, (b) completed the Christian Gospel Drug Withdrawal Program or church-sponsored program, and (c) shared their related testimony on the Good TV …

Increasing Job Satisfaction Of Nurses Using A Mindfulness-Based Program: A Quality Improvement Project, Melissa A. Haggerty

DNP Projects

Significance and Background

Job dissatisfaction among critical care nurses can result in poor mental health, increased incidences of burnout, increased stress levels, and lower quality patient care. Evidence supports mindfulness practices and their ability to improve job satisfaction by promoting calmness, decreasing stress, and reducing anxiety. In a cardiothoracic intensive care unit (CTICU) in a large teaching hospital in the New York metro area, there was no strategy in place to address low job satisfaction among nurses.

Purpose

Implement a Mindfulness-Based program for CTICU nurses to engage in mindfulness exercises during their shifts and at home. Compare reported job satisfaction …

Exploring The Lived Experiences Of Dysphoric Milk Ejection Reflex During Postpartum Breastfeeding: A Phenomenological Study, Stephanie Herr, Jessica Devido, Richard Zoucha, Jill Demirci

Electronic Theses and Dissertations

This study sought to explore the lived experiences of Dysphoric Milk Ejection Reflex (D-MER) during postpartum breastfeeding. A phenomenological method based on Giorgi’s phenomenological underpinnings was used. The setting for this study was virtual interviews in a secure online platform. The sample consisted of 13 participants, self-identifying as experiencing D-MER. Semi-structured interviews, with thematic analysis of transcription were conducted. Four major themes were identified: 1) Breastfeeding concessions and toleration; 2) Something does not feel “normal”; 3) I remember a feeling like this before 4) This is real, and recognition is validating. Conclusions were that women of this study value the …

The Use Of Mindfulness-Based Stress Reduction To Reduce Stress And Burnout In Nurses, Sherri Foreman

MSN Capstone Projects

The Mindfulness-Based Stress Reduction Program (MBSR) has been used effectively in multiple clinical settings to reduce workplace stress and burnout in nurses. The MBSR’s cost-effective approach to stress management can be implemented into any healthcare facility’s policy. The topic of MBSR’s effect on stress and burnout has been identified as essential due to nurses working in fast-paced, stressful work environments. These work environments lead to increased stress and burnout. The International Council of Nurses surveyed nurses before and after the pandemic. There were 40% of nurses that reported symptoms of burnout before the pandemic compared to 70% of nurses after …

Mental Health And Parenting Among Young Adults Experiencing Homelessness With And Without Their Children, Rebecca Bergh

Dissertations and Theses (Open Access)

Background: Parent-child separation and custody loss are common among parenting young adults experiencing homelessness (YAEH). These experiences may be traumatic for YAEH, a population already vulnerable to mental health disorders and high levels of trauma. Little is known about how YAEH who have their children with them compare to YAEH separated from their children in terms of mental health and risk and resilience factors. Further evidence is needed to better understand the parenting and mental health support needs among YAEH, particularly surrounding parent-child separation.

Aims: This study aimed to examine the characteristics of (1) parenting YAEH living with their children …

Exploring The Novice Nurses’ Perceptions Of Communication Dynamics In The Operating Room, Lasandra Brown

Dissertations and Theses (Open Access)

Background: Communication among the multidisciplinary team members in an operating room setting is essential for effective and safe patient care. Studies have previously addressed communication breakdowns among team members, and miscommunications have been demonstrated to significantly challenge efficiency in the operating room. Novice nurses play an integral role in the success of operating room procedures and must possess strong communication skills that facilitate optimal patient outcomes.

Purpose: The aim of this study was to explore novice nurses’ perceptions of factors that influence the dynamics of team communication in the operating room setting.

Methods: An inductive thematic, qualitative analysis of 11 …

Exploring The Influence Of Postnatal Depression On Neonatal Care Practices Among Mothers In Western Kenya: A Qualitative Study, Florence Achieng, Alloys K’Oloo, Hellen Barsosio, Simon Kariuki, Helen Nabwera

Obstetrics and Gynaecology, East Africa

Background: Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya, which bear the global burden of neonatal morbidity and mortality.

Objectives: To explore how PND influences neonatal feeding and care practices among women in the early postnatal period in rural Western Kenya.

Design: A cross-sectional study.

Methods: Semi-structured interviews were conducted at 2-weeks postpartum among mothers of newborn infants identified <72 h old from the postnatal wards and clinics across five health facilities in Kisumu County of Western Kenya. They were all screened for features suggestive of postnatal depression using the Edinburgh Postnatal Depression Scale.

Results: Twenty-four mothers were interviewed, 13 of whom had features suggestive of PND. All mothers experienced health or socio-economic adversities in the perinatal period, including traumatic deliveries, financial constraints, and challenging relationships with partners/other family members. Feeding difficulties due to …

Increasing Repeat Lactate Collection For Sepsis Bundle Management Of Care, Rahwa Teklehaimanot

Master's Projects and Capstones

Abstract

Problem: In 2020, sepsis was the leading cause of mortality in this Northern California Hospital Organization. This QI project aimed to reduce the number of fallouts for collecting repeat lactate levels to less than two per month, from a baseline of five per month, within three months.

Context: This Northern California Emergency Department serves a broad range of patients, from pediatrics to geriatric patients, with an average daily census of 80-90 patients. In this 20-bed Emergency Department, approximately 650 patients were diagnosed with sepsis in 2022.

Intervention: The hospital sepsis committee collaboratively developed a new standardized workflow for sepsis …

Group B Streptococcus: A New Perspective, Susan Harris

MSN Capstone Projects

Group B streptococcus (GBS) is a major cause of illness and death in young infants across the nation. Current guidelines suggest pregnant women should be screened from thirty-five-to- thirty-seven-weeks gestation. Although screening may be negative at that time, the expectant mother could become colonized with GBS before delivery. GBS is a pathogen that lives in the gastrointestinal and genitourinary tract of fifteen to twenty percent of women of childbearing age (Moorhead et al., 2019). GBS does not become a problem until it is passed from colonized mothers to the neonate during delivery (Virranniemi et al., 2019). When GBS is passed …

Alarm Fatigue Prevention Benchmark Project, Lauren James

MSN Capstone Projects

Healthcare technology is constantly evolving to find ways to help provide better outcomes for patients. Clinical monitoring is technology that helps healthcare staff recognize deterioration of the patient which allows them to intervene earlier, which increases the patient’s chance for survival. The monitors are connected to the patients to monitor vital signs such as heart rate, oxygen saturation, respirations, and blood pressures. They allow staff to get real time feedback of the patient’s condition and determine if the patient is getting better or any interventions need to be done due to clinical deterioration.

However, all technology has setbacks and downfalls. …

"Evidence That The Woman's Ovarian Cycle Is Driven By An Internal Circamonthly Timing System" Data, Mary Schneider

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

No abstract provided.

Application Of Teaching Regarding Injury Appearance In Darker Pigmented Skin Patients: A Quality Improvement Project, Tiffany Akiba

DNP Projects

Significance and Background: The skin is the largest organ of our body, and skin injury prevention begins with accurately inspecting skin. Current practices stress on looking for any signs of redness which often signify that the skin is possibly injured or compromised. However, darker skin tones do not appear red when injured. Assessing for redness is a practice that is suited better for lighter skin tones.

Purpose: Provide education to providers on current skin assessment practices of darker skin tones.

Methods: The IHI Model of Improvement was used for this project, and the Plan-Do-Study-Act cycle was used to test for …

Implementing An Integrated Psychology, Social Services, And Pediatric Diabetes Clinic, Joan P. Totka, Jacquelyn Smith, Sandra Brown, Maharaj Singh, Elaine Parton, Dawn Cvecko, Heather Fortin, Peter M. Wolfgram

College of Nursing Faculty Research and Publications

Objective:

Integrated behavioral health services are rarely implemented as a shared space practice in pediatric diabetes specialty clinics. This paper outlines the clinical outcomes, lessons learned, facilitators, and barriers for supporting youth with diabetes and behavioral health issues whose hemoglobin A1c (A1c) was higher than the target range and their families.

Methods:

Using the Iowa Model of implementation, we redesigned the “Regular Engagement And Connection for Health” (REACH) program to integrate health psychology and social services in a shared space clinic for monthly or bimonthly diabetes visits (REACH+). This clinic focused on partnering with families, screening for behavioral and social …

Identification Of Child Survivors Of Sex Trafficking From Electronic Health Records: An Artificial Intelligence Guided Approach, Aaron Murnan, Jennifer J. Tscholl, Rajesh Ganta, Henry Ofori Duah, Islam Qasem, Emre Sezgin

College of Nursing Faculty Research and Publications

Survivors of child sex trafficking (SCST) experience high rates of adverse health outcomes. Amidst the duration of their victimization, survivors regularly seek healthcare yet fail to be identified. This study sought to utilize artificial intelligence (AI) to identify SCST and describe the elements of their healthcare presentation. An AI-supported keyword search was conducted to identify SCST within the electronic medical records (EMR) of ∼1.5 million patients at a large midwestern pediatric hospital. Descriptive analyses were used to evaluate associated diagnoses and clinical presentation. A sex trafficking-related keyword was identified in .18% of patient charts. Among this cohort, the most common …

Palliative Care Interventions Among Adolescents And Young Adults With Serious Illness: A Scoping Review, Amy R. Newman, Ansley E. Kenney, Elizabeth Witkowski, Jeffrey Karst, Stacee Lerret, W. Hobart Davies, Charles B. Rothschild

College of Nursing Faculty Research and Publications

Objective:

To map the range of multidisciplinary palliative care interventions that are available to adolescents and young adults (AYAs) with serious illness.

Methods:

Scoping review methodology as outlined by Arksey and O’Malley.

Results:

Twenty-two articles describing nine specific AYA-focused, multidisciplinary palliative care interventions were included in this review. Interventions focused on supporting advance care planning, facilitating treatment decision making, managing pain, and promoting resilience, psychosocial well-being, and quality of life. Interventions were delivered face-to-face and via different eHealth platforms and were targeted to AYAs with cancer, HIV/AIDS, and cystic fibrosis in both inpatient and outpatient settings.

Conclusions:

Few evidence-based multidisciplinary …

Baby Boomer Gay Men’S Lived Experiences With Primary Healthcare: A Qualitative Study, Aaron J. Loeb

Dissertations and Theses (Open Access)

Background: Baby boomer gay men have experiences discrimination in healthcare settings. Members of the LGBTQIA+ population are often studied as a single entity, which fails to account for the distinct cultural and social generational differences within this population that may affect their experiences of health care. A paucity of research is available on baby boomer gay men’s perspectives about primary healthcare experiences. Such knowledge is necessary to improve inclusiveness in healthcare settings and health outcomes.

Purpose: The purpose of this study was to describe baby boomer gay men’s lived experiences with primary healthcare. The specific aims are to describe: (1) …