Nursing Commons^™

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Gregory James Trevino

Master's Projects and Capstones

Problem: Providing high-quality sepsis care in a San Francisco Bay Area emergency department (ED) is an organizational priority, however Centers for Medicare & Medicaid Service (CMS) SEP-1 sepsis bundle compliance has decreased to an average of 79% compliance since October of 2022. It was revealed that CMS SEP-1 sepsis bundle compliance issues have resulted in increased patient fallouts.

Context: A microsystem assessment was conducted by the quality improvement team to help identify gaps in practice. After an assessment survey of nursing staff, it was revealed that barriers such as physician order sets, lack of communication, lack of staffing during peak …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Leman E. Bush

Master's Projects and Capstones

Abstract

Problem: Sepsis is a life-threatening infection that needs immediate treatment. The ED uses sepsis bundle protocols to treat sepsis but the compliance rates for the order sets are below the institution’s guidelines.

Context: A Centers for Medicare and Medicaid Services (CMS) instituted a sepsis performance measure bundle in 2015 called (SEP-1) to promote cost-effective, high-quality care for septic patients admitted to the Emergency Department (ED) (Wang et al., 2020). The ED in a chosen San Francisco, CA acute care hospital has been experiencing unsteady sepsis bundle compliance rates. Sepsis is caught by 1.7 million American adults per year …

Educating Labor And Delivery Nurses On Evidence-Based Birthing Positions To Promote Fetal Descent During First And Second Stage Labor, Sophia Nguyen

Master's Projects and Capstones

The goal of this project was to increase confidence of labor and delivery nurses in utilizing evidence-supported birth positions during the first and second stages of labor in order to aid in fetal descent and labor progression. Current statistics demonstrate climbing trends in cesarean deliveries, which have been associated with increased maternal morbidity and mortality. One nurse intervention that can reduce failure to progress, a main contributor to cesarean sections, is the use of various evidence-supported maternal birth positions such as ambulation, assisted squat, sitting, backwards sitting, lunging, throne, side-lying with peanut ball, hands-and-knees, and throne position. This evidence-based practice …

Increasing Compliance Through Nurse Education On The Bundle, Zachary Harrison-Evans

Master's Projects and Capstones

In an effort to decrease complications and events connected to sepsis in the ED, there is room for improvement with relation to sepsis care and compliance rates. Timely sepsis management and gains in compliance/adherence rates are hindered by SEP-1 fallouts and requirements related to knowledge gaps concerning sepsis bundle procedures, nurses' attitudes about implementing the protocols, and disparities in nurse/physician order sets. It has been determined that the use of standardized protocols and order sets are not being utilized. This is a process gap and a critical area for improvement. Inadequate fluid and lactate documentation, a lack of education, and …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Amanda H. Tran

Master's Projects and Capstones

Problem: According to a pre-survey collected, approximately six percent of medical-surgical nurses report expert knowledge with the “Inpatient Handoff Sepsis Bundle Checklist,” a checklist that details interventions to be taken when a patient is diagnosed with sepsis. About thirty-five percent of these nurses also report expert confidence levels in caring for sepsis patients. Therefore, there is an opportunity to provide education so that nurses may confidently and competently care for sepsis patients.

Context: A medical-surgical unit at Hospital A affiliated with a large, non-profit, integrated healthcare system located in the San Francisco Bay Area.

Intervention: Create an educational handout to …

Educating Nursing Staff On Evidence-Based Maternal Positioning To Promote Fetal Descent During The First And Second Stages Of Labor, Maryellen Barillas, Maryellen Barillas

Master's Projects and Capstones

This project aims to increase the confidence of nurses using birthing positions to aid with mobility to assist with fetal descent and decrease the duration of labor in the first and second stages of labor. Lack of mobility and increased duration of labor are associated with the use of cesarean sections, which is an invasive surgery with potential complications. A knowledge gap in a South Bay Area hospital exists in current evidence-based birthing positions. Recent evidence shows that flexible sacrum positions, which are any upright positions that take the weight off the sacrum, promote vaginal deliveries, and improve birthing outcomes. …

The Use Of Therapeutic Gardening In Addiction Recovery, Sophia Agne

Master's Projects and Capstones

Problem: Numerous recent studies have emerged detailing the benefits of horticultural therapy on mental health and wellness. Despite this, substance use disorder treatment facilities rarely include an outdoor component in their programming. The project seeks to examine the advantages of incorporating therapeutic gardening as a complementary part of addiction treatment.

Context: The microsystem where the study was conducted was at a 32-bed residential substance abuse treatment facility for adult men who have previously been involved in the criminal justice system. The treatment approach employed at the facility aligns with the Integrated Dual Disorder Treatment (IDDT) curriculum, which emphasizes mental health-informed …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Jillian J. Abinader

Master's Projects and Capstones

Problem: A sepsis protocol and bundle has been implemented in an urban Emergency Department to help screen patients and treat sepsis efficiently and effectively. The benchmarks from the bundle are not being met consistently every month and are below the targeted 90%.

Context: A microsystem assessment and a gap survey sent out to nurses, helped determine that there is room to improve nurses’ knowledge and confidence about sepsis and the sepsis bundle workflow. Sepsis is one of the most expensive and burdensome conditions in U.S. hospitals. Literature supports staff education to improve sepsis bundle compliance.

Intervention: A video was created …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis: Bundle Elements, Grace Jenks

Master's Projects and Capstones

Problem: Based on the findings of a pre-survey conducted, it was observed that around 6% of the Medical-Surgical nurses who participated from Hospital A possessed "expert knowledge" of the "inpatient handoff sepsis bundle checklist." The results highlight the potential for educating and boosting the confidence of nurses working in a healthcare organization located in Northern California, enabling them to provide better care for patients afflicted with sepsis.

Context: The microsystem is a Medical-surgical unit situated within Hospital A, which is one of the 21 hospitals located in Northern California. Dr. Theresa Mostasisa conducted a survey on February 15, 2023, …

Increasing Sepsis-Bundle Adherence On A Medical-Surgical/Telemetry Unit: A Quality Improvement Project, Tiffany Liu

Master's Projects and Capstones

Problem: Sepsis is a life-threatening complication of infection that can lead to tissue damage, organ dysfunction, and death. Early recognition and intervention are crucial in the management of sepsis. Delays in sepsis care can lead to adverse health outcomes and even death. Sepsis bundles are guided by evidence-based practice. They serve as guidelines for effective and timely management of sepsis. Adherence to these sepsis bundles is associated with overall improved morbidity and mortality.

Context: This quality improvement project was led by Clinical Nurse Leader (CNL) students from the University of San Francisco. It was implemented at a 244-bed …

Educating Nursing Staff On Evidence-Based Maternal Positioning To Promote Fetal Descent During The First And Second Stages Of Labor, Daniela Gonzalez Acosta

Master's Projects and Capstones

This project aims to educate labor and delivery nurses on evidence-based maternal labor positions that promote fetal descent in the first and second stages of labor. In a labor and delivery unit in the San Francisco Bay Area Silicon Valley region, there is a gap in nurse knowledge relating to labor positions. Evidence supports upright and flexible sacrum positions, along with frequent repositioning promotes shorter labor duration, decreased vaginal tearing, and decreased rate of cesarean section deliveries.

A quality improvement project was conducted through education implementation using evidence-based practices utilizing a PDSA cycle for a semester. Educational content was created …

Supervised Deep Learning With Vision Transformer Predicts Delirium Using Limited Lead Eeg, Malissa A. Mulkey Phd, Aprn, Ccns, Ccrn, Cnrn, Huyunting Huang, Thomas Albanese, Sunghan Kim, Baijian Yang Ph.D.

Publications

UNLABELLED: Critically ill patients with COVID-19 experience high rates of delirium and coma. Whether delirium occurs through novel mechanisms in COVID-19 is not known. We analyzed the relationship among biomarkers of inflammation (C-reactive protein [CRP]), hypercoagulability (d-dimer), and lung macrophage activation (ferritin), and the primary composite outcome of delirium/coma next day. We also measured associations between biomarkers and next day delirium and coma independently, and delirium severity. DESIGN: Retrospective, observational cohort study. SETTING: ICUs at two large, urban, academic referral hospitals. PATIENTS: All consecutive adult patients admitted to the ICU from March 1, 2020, to June 7, 2020, with COVID-19 …

Implementing Ethics Education For Nurse Managers, Mona L. Lateyice, Rachel E. Marzec

Doctor of Nursing Practice Scholarly Projects

Background: Every day, nurses are faced with making decisions for patient care and may come across complicated ethical decisions. Ethical practice is essential in every health care organization in providing care and how they conduct themselves (ANA, 2015). Nurse managers are responsible for ensuring ethical standards are met by nursing staff.

Problem: Nurse managers are faced with ethical problems more than fifty percent of their work time (Aitamaa, 2019). There are studies that show nurse managers and nurses have difficulty solving ethical problems because they lack understanding of ethical principles (Huang, et al., 2020). Evidence shows nurses are deficient in …

Implementation Of A Decision Aid To Increase The Rate Of Routine Breast Cancer Screening Among Women Between 50 To 74 Years Old At A Federally Qualified Health Center, Dana Mars

Doctor of Nursing Practice Scholarly Projects

Background: Breast cancer is the most prevalent form of cancer in the U.S. Cancer screenings can result in prompt treatments and positive health outcomes. Disparities in screening rates are prevalent among vulnerable populations. At a Federally Qualified Health Center (FQHC), where the project occurred, the rate of breast cancer screening in 2021 (64%) was lower than the target set by the Healthy People 2030 (77%). This quality improvement project aimed to increase the rate of routine breast cancer screening among women aged 50-74 years old in the FQHC.

Methods: Previous studies have reported that decision aids on breast cancer screening …

Implementation Of Readmission Prevention Pathway To Reduce Skilled Nursing Facility Readmission, Bina Darai

Doctor of Nursing Practice Scholarly Projects

Background: Individuals admitted to Skilled Nursing Facilities (SNFs) are at risk of preventable hospital readmissions due to complex medical issues. Evidence indicates that many residents are transferred from SNFs to the hospital at least once. The Centers for Medicare & Medicaid Services penalizes facilities with high rehospitalization rates. Implementing an evidence-based strategy could reduce 30-day readmission rates in this setting.

Local problem: This project was conducted in a 34-bed Sub-Acute Care Unit in an SNF. The unit's 30-day readmission rate was high compared to the average rate at the SNF and the national benchmark, identifying a need to reduce readmission. …

It Is What It Is... Enduring The Never-Ending: The Lived Experiences Of Parenting Adult Children With Developmental/Intellectual Disabilities, Siri Gurunam Kaur Khalsa

Nursing ETDs

The parental home is the principal place of residence for adults with developmental disabilities/ intellectual disabilities (DD/ID) (Heller et al., 2007). More than 75% of the adult population with DD/ID living in the U.S. continue to have their basic needs provided by their parents (Williamson & Perkins, 2014). This is based on the estimated statistic that 1.0 to 1.58% of the U.S. adult population has a developmental disability (Anderson et al., 2019; Fox et al., 2015). About 2.9 million adults with DD/ID live with a parent of 55 years (Byun et al., 2006), with more than 25% of these parents …

A Rapid Review Of The Literature: Cardiovascular Disease Preventive Practices And Rural Black Women, Modjadji M. Choshi, Maria Devalpine

Virginia Journal of Public Health

Cardiovascular disease (CVD) is the leading cause of death among Black/African American women. Rural Black women have the highest CVD prevalence and are more likely to have modifiable risk factors such as high blood pressure, diabetes, and obesity than any other race. Accessible evidence-based culture-appropriate self-care programs for risk reduction and CVD prevention can address these disparities. This rapid review aims to provide a comprehensive collection of such programs. Methods. Searches were performed in PubMed, CINAHL, Web of Science, Psychinfo-Embase, and Scopus for studies reporting CVD prevention programs for rural Black women. Three articles met the inclusion criteria, with …

A Lifestyle Modification Intervention In Hispanic Adolescents With Nonalcoholic Fatty Liver Disease, Brianne Miller

Evidence-Based Practice Project Reports

U.S. population studies have confirmed that the Hispanic population has the highest prevalence and the worst prognosis for non-alcoholic fatty liver disease (NAFLD) (Katz et al., 2021). The purpose of this evidence-based practice project was to implement a multicomponent, lifestyle modification intervention in Hispanic pediatric primary care patients to combat the disease process and sequela of NAFLD. The PICOT question for this project was: In Hispanic adolescents aged 10-21 with obesity and NAFLD (P), what is the effect of a multicomponent, lifestyle modification intervention (I), on alanine aminotransferase (ALT) (O), over a 12-week time period (T)? A comprehensive literature search …

The Impact Of Personal Barriers To Incorporating The American Heart Association Diet, Aaron Bigando

Doctor of Nursing Practice Scholarly Project

The leading cause of death worldwide is cardiovascular disease. Diet is the most influential, modifiable factor related to the development and progression of cardiovascular disease. The American Heart Association developed a diet that delivers guidelines for diet. Therefore, identifying the most significant factors that hinder the effectiveness of the diet was necessary. These hindrances can be categorized as physical, psychosocial, and socioeconomic barriers. Demographic differences also impact diet.

A survey was developed to identify and account for the most common dietary barriers. The Barriers to Healthy Eating scale addressed different circumstances which impact diet. By using this scale, providers can …

Enhancing Provider Knowledge On The Benefits Of Larc Use In Teens, Lyndsay Camper

Doctor of Nursing Practice Scholarly Project

The present study investigated the effects of introducing an educational intervention to enhance the knowledge of family and obstetric providers in the rural area on the benefits of Long-Acting Reversible Contraceptive (LARCs) use in teens. Teen pregnancy is associated with many different health risks including eclampsia, endometritis, and systemic infections. These mothers are also at risk of poverty, lower education levels, reduced employment, and dependence on government assistance programs. Apart from their lack of knowledge on the different types of contraceptives available, many teens do not take their oral contraceptives appropriately. LARCs can include IUDs or implants that prevent unwanted …

Implementation And Evaluation Of A Diabetic Education Program, Brianna Cole

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to help create and evaluate a diabetes education program that was accessible to diabetic patients over the age of 18. This project was conducted through Enhanced Healthcare of the Ozarks clinic with the guidance and approval of the American Diabetes Association. There is currently one other diabetic education program available in Northwest Arkansas. The theme of this project was to provide education in individual and group settings regarding medication use, emergency situations, nutritional choices, and self-management techniques. These patients learned meal planning strategies, proper nutrition choices, functions of the body, self-management techniques, emergent situation …

Improving Advance Directive Documentation In A Primary Care Clinic In The Midwest, Teresa Hagedorn

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Teresa Gayle Hagedorn

Advance care planning (ACP) is a continuous communication process linking patients, family members, caregivers, and healthcare providers. Personal values, life goals, and preferences regarding future medical care are significant to every person as we will inevitably reach the end of life. Advance directives (ADs) promote patient autonomy and provide legal documentation of a patient’s wishes for future care. According to the National Institute of Health (2018), only 1 in 3 adults in the United States have a documented AD in their electronic medical records (EMR). This quality improvement project aimed …

Provision Of Formal Education To Nursing Staff: Kangaroo Mother Care Within Maternal-Child Units, Jessica Holly

Doctor of Nursing Practice Scholarly Project

Kangaroo mother care (KMC) is an evidence-based intervention that improves neonatal outcomes and reduces mortality in infants. KMC is not fully integrated into local hospital maternal-child departments and nursing professionals do not have a standard education offering concerning KMC. While the use of KMC is not entirely absent, nursing knowledge and understanding of its correct execution leads to lesser occurrences of KMC initiation. This scholarly project addresses nursing knowledge as a practice quality improvement. A literature review was completed, including searches through CINAHL, Merck Manuals, MEDLINE Plus Health Information, ProQuest, and UpToDate. A pretest, educational video, and posttest were then …

Impact Of Maternal Fetal Triage Index On Emergency Healthcare Providers, Samantha Shepard

Doctor of Nursing Practice Scholarly Project

IMPACT OF MATERNAL FETAL TRIAGE INDEX ON EMERGENCY HEALTHCARE PROVIDERS

An Abstract of the DNP Scholarly Project by

Samantha Shepard

Care of obstetrical patients in non-delivering facilities is increasing. Obstetrical service availability in rural areas has decreased by more than 50% in recent years, according to Hung et al. (2018). Healthcare providers in these areas lack confidence and competence due to lack of regular training and encounters with obstetrical patients. The Maternal Fetal Triage Index (MFTI) provides a standardized approach for triaging the obstetrical population. The purpose of this project was to determine if staff confidence and competency improves within …

Promoting Safety Through Advocacy And Practice: Nurse Input And Beliefs Regarding Hospital Fall Prevention Policies In The Inpatient Setting, Jimmy Milano

Doctor of Nursing Practice Scholarly Project

Throughout the evolving healthcare system, many issues in the hospital setting pose significant risk to patient safety and outcomes. Falls occur at detrimental rates that inevitably impact both the patient and the nurse. Of the several reasons one would choose to join the profession, nurses often seek the satisfaction of knowing the care they have provided impacted a patient, physically and spiritually. The healthcare system has allotted for variables in patient safety to promote safe outcomes and the reduction of fall risk, such as evidence-based practices and tools like cameras and assessments. However, the lack of nursing involvement in these …

An Emergency Department Resource Nurse Checklist, Aaron Tucker

Doctor of Nursing Practice Scholarly Project

Introduction: Like many hospitals across the country, a Southwest Missouri hospital emergency department (ED) is frequently crowded with patients. The resource nurse role is one method EDs use to help manage surges in patient care. A resource nurse is a registered nurse whose dedicated role it to help other nurses in the unit. Unfortunately, there are no specific written expectations to guide the resource nurse. The nurse often waits to be needed and productivity and dependability are highly variable. Purpose: Implementation of a checklist could prompt the resource nurse to be more productive, will provide written expectations for the role, …

A Pre And Post Survey Of How Teaching Interventions Of Anticoagulant/Antiplatelet Medications Affect Patient Outcomes In The Primary Care Setting, Renee Roth

Doctor of Nursing Practice Scholarly Project

With the elderly population expanding in the United States, primary care providers are having to place more emphasis on managing multiple disease etiologies and medication modalities in the outpatient clinic setting. Patients and providers struggle to overcome educational communication barriers that facilitate proper medication adherence and monitoring. The specific aim of this study was to evaluate whether antiplatelet management education increased the patients’ knowledge of medication understanding and possible adverse outcomes. Evaluation of antiplatelet knowledge was conducted in a rural health clinic in Columbus, Kansas. The study utilized an individual pretest-posttest design to patients who received self-management and monitoring education …

Evaluation Of The Train 2 Run Program At The Joplin Va Community Based Outpatient Clinic (Cboc), Jenifer Webb

Doctor of Nursing Practice Scholarly Project

THE EVALUATION OF A TRAIN 2 RUN PROGRAM AT THE JOPLIN VA CLINIC

An Abstract of the Scholarly Project

by Jenifer Webb, MSN, RN, FNP-C

The purpose of this project is to evaluate the effectiveness and satisfaction levels of participants in the Train 2 Run program that was started at the Joplin VA in Joplin, MO. The program was from May 3, 2022, to October 8, 2022, for a total of 5 months. The participants for this study were selected from the patients, family members, and staff who participated in the Train 2 Run program for a minimum of six …

Registered Nurse Education On Prevention Of Ventilator Associated Pneumonia In An Urban Midwestern Intensive Care Unit, Jodi Marie Weber

Doctor of Nursing Practice Scholarly Project

Ventilator associated pneumonia (VAP) is a preventable health condition causing increased hospital stays, over 35,000 deaths each year, and one of the costliest healthcare associated infections. VAP occurs when a patient develops pneumonia after being intubated and mechanically ventilated. Preventative measures are commonly in place amongst facilities, despite these measures VAPs still are occurring. Poor compliance with preventative measures have been observed in regards to oral care. Staff nurses in an intensive care unit (ICU) at a midwestern urban hospital were provided education on VAPs and preventative measures, with a focus on proper oral care. Staff nurses were given a …

3d-Wound Imaging: Precise, Consistent, And Efficient, Aubrey Halili

Doctor of Nursing Practice Final Manuscripts

Background: The most common method of obtaining wound measurements is the hand-ruler method. Studies show that the hand-ruler method results in the most inaccurate measurements with the lowest interrater reliability. Studies also show that using 3D-wound imaging yields the most accurate measurements with the best interrater reliability. 3D-wound imaging technology also increases efficiency by allowing users to obtain images and document assessments using one device at the bedside.

Purpose: The purpose of this project is to make the process of assessing wounds more efficient by decreasing the time spent on photographing, measuring, and documenting wound assessments by implementing the use …