Nursing Commons^™

Fantastic Four, Jaden Zumbahlen, Andrea Palmer

Doctor of Nursing Practice Projects

Clinical Issue
Heart failure claims one in four lives of those diagnosed each year. The term Guideline Directed Medication Therapy (GDMT) represents optimal medication therapy as defined by the American College of Cardiology Foundation and American Heart Association. Appropriate quadruple therapy results in an estimated 73% relative reduction in mortality over a two-year time span (Greene & Khan, 2021). However, there is a gap in proper GDMT stemming from suboptimal initiation and/or titration in the outpatient setting.

Project Implementation
Nursing staff in a rural midwestern cardiology clinic were provided with an in-service presentation discussing current guidelines and recommendations of GDMT …

Evaluating Equity: Examining Inclusionary Practices From Educational Organizations To Improve The Education Experience Of Lgbtqia+ Students, Jillian G. Torrento

Seton Hall University Dissertations and Theses (ETDs)

This qualitative study explored the ways in which education policy and practices within public schools are addressing the needs of minoritized populations with a particular focus on LGBTQIA+ students. This study first employed a document analysis to investigate the federal, state, and district-level equity practices that are mandated or elective in addressing the needs of marginalized populations and LGBTQIA+ students. Secondly, a critical discourse analysis was conducted to examine the specific language, word choices, and symbols found within the public documents that signify equitable practices pertaining to minoritized student populations and the LGBTQIA+ community. Ultimately, the goal of this study …

Implementing Cultural Competency Training Among Advanced Practice Providers At An Academic Medical Center: A Quality Improvement Project, Kierah Barnes

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Racial health disparities, inequities, and healthcare bias are long considered concerns for the healthcare community.Cultural competency training (CCT) is one solution that is gaining recognition as an effective intervention to address bias among healthcare providers, resulting in improved patient outcomes and assisting with reducing health disparities among minority populations. This quality improvement project was implemented at an academic medical center and designed for Advanced Practice Providers who completed the training to demonstrate an increase in their cultural competency post-test compared to the pre-test. The increase in CCT will hopefully impact the delivery of culturally conscious/competent healthcare and positive experiences to …

Prehospital Management Of Pediatric Behavioral Health Emergencies: A Scoping Review, Elizabeth V. Zorovich, Kathryn Kothari, Kathleen Adelgais, Rachael Alter, Lia Mojica, Aaron Salinas, Marc Auerbach, Carrie Adams, Jennifer Fishe

School of Nursing Faculty Publications

Pediatric behavioral health emergencies (BHE) are increasing in prevalence, yet there are no evidence-based guidelines or protocols for prehospital management. The primary objective of this scoping review is to identify prehospital-specific pediatric BHE research and publicly available emergency medical services (EMS) protocols for pediatric BHE. Secondary objectives include identifying the next priorities for research and EMS protocol considerations for children with neurodevelopmental conditions.

This is a scoping review comprised of a research literature search for publications from 2012-2022 and an internet search for publicly available EMS protocols from the United States. Included publications contain data on the epidemiology of pediatric …

Mental Health Navigators Bridging The Gap Of Care, Valentina Loreto-Ashley

DNP Qualifying Manuscripts

Individuals with schizophrenia are most vulnerable at time of discharge due to risk factors that lead to relapse, re-admission, suicide and/or danger to others. A successful discharge process can decrease overall care costs, promotes team collaboration, supports the therapeutic relationship between client and care provider, and helps the client to reach autonomy and self-efficacy. This DNP is a quality improvement project that aims at educating Mental Health Navigators about symptoms of schizophrenia, medications management, and community resources. Effectiveness of the educational intervention will be assessed as the differences between the pre- and post-test assessment score on insight or lack of …

A Multimodal Intervention Treatment Plan For Adults With Generalized Anxiety Disorder In Primary Care, Morgan Cullings

Evidence-Based Practice Project Reports

Generalized anxiety disorder (GAD) is a debilitating psychological condition that affects 3.1% of the American population and is one of the leading causes of disability (Anxiety and Depression Association of America, 2022; Baxter, 2014). The purpose of this evidence-based practice project was to implement a multimodal intervention to decrease GAD symptoms in adults in the primary care setting. The PICOT question that guided this project was: In adults, over the age of 18, who have been diagnosed with generalized anxiety disorder (GAD), does the combination of digital cognitive behavioral therapy (CBT) through a smartphone application, lifestyle modification education, and pharmacotherapy …

The Importance Of Charting And Documentation In The Nursing Profession, Charlotte J. Bradshaw

Honors Capstones

Honors Capstone Abstract

Nursing is a profession that can take you to endless different directions, not just in the hospital. Some may decide to work in a clinic, a school, or even laser hair removal centers. Although the setting and workday are different, one thing remains the same: charting. Charting is an everyday, every patient requirement for all nurses. Although this is unarguably one of most important skills to learn before becoming a nurse, most nursing schools do not have a class dedicated specifically to charting. This can create many problems for newer nurses who lack the experience and knowledge …

Standardization Of Perioperative Management Of The Breastfeeding Women, Amrutha Panakkal

Doctor of Nursing Practice Projects

Mother's milk is the optimal nutrition for the term and preterm neonates. The psychological and physiological stressors in the perioperative setting can impede a lactating mother's ability to breastfeed in the postoperative setting successfully. A best-practice guideline incorporating a stoplight color-coding chart and categories such as "safe," "caution," and "consider avoidance" was used to group medications according to their safety for anesthesia providers in a large urban academic medical center in Pennsylvania. The evidence-based guideline also provided links to the hospital policy, LactMed, and Hale database to streamline resources and aid in the rapid decision-making of anesthesia providers in identifying …

The Architects Of Healing And Hope, Bro. Ignatius Perkins, O.P.

Faculty Conference Presentations

Presented at the Salute to Nurses – National Nurses Week, May 8-14, 2023.

Introducing Motivational Interviewing Skills To Community Health Workers, Stella Antony

DNP Qualifying Manuscripts

Abstract

Background: Rural population accounts for 15% of the population in the United States of America. Rural residents have a higher risk of health disparities than urban populations. The significant health inequities in the underprivileged population include a higher incidence of chronic diseases, lack of access to healthy foods, unhealthy eating habits, lack of access to health care, poor socioeconomic status, lack of health insurance, cultural and language barriers, and lack of health literacy. Local Problem: The population in Fresno and Tulare Counties in Central Valley, California is underprivileged, lacks access to proper health care and has higher rates of …

Promoting Mindfulness Based Self-Care In Healthcare Staff, Harkirat K. Bajwa

DNP Qualifying Manuscripts

Background: Healthcare personnel (HCP) like physicians, nurses, advanced practice nurses etc. are at high risk of stress, burnout, and compassion fatigue (CF). Nearly half of the physicians and one-third of the nurses experience burnout in the United States. The physical and mental health of HCPs is impacted by burnout and CF, leading to increased practice errors and decreased patient safety.

Local Problem: HCPs have poor knowledge about mindfulness and its benefits. Mindfulness-based self-care measures are not promoted in HCP.

Methods: An extensive database search was done to find evidence about using mindfulness-based strategies to relieve burnout, stress, and compassion fatigue …

Telehealth And Its Impact On The Management Of Type 2 Diabetes Mellitus, Melissa N. Toulios

Evidence-Based Practice Project Reports

Diabetes mellitus type 2 (T2DM) is a growing epidemic that affects millions of people throughout the world. The recent COVID-19 pandemic has created many new challenges, including access to health care for treatment of chronic diseases, such as diabetes (Robson & Hosseinzadeh, 2021). Telehealth has offered a promising approach to improve the management of diabetes(Bellman, 2021). People with diabetes are less likely to manage their diabetes through the usual care because of risk of contracting COVID-19 (CDC, 2022). The purpose of this EBP project was to evaluate the effectiveness of T2DM management through a telehealth approach. This project has addressed …

An Exploratory Qualitative Study Of Oncology Nurses’ Experience In Providing Care For Terminally Ill Patients In Salmaniya Medical Complex In Bahrain, Layla S. Turki, Leena Khonji, Magda Bayoumi

The Qualitative Report

Oncology nurses are essential in palliative care for cancer patients, especially at end-of-life stages. Caring for terminally ill cancer patients is stressful, accompanied by negative and positive feelings, but oncology nurses have an unavoidable responsibility. However, little is known about oncology nurses' experience in the Kingdom of Bahrain caring for terminally ill cancer patients in their final weeks or days. This study aimed to explore the experience of oncology staff nurses in providing care for terminally ill patients in the Kingdom of Bahrain, and the research answered those questions: (a) What is the experience of oncology staff nurses in providing …

Supporting Adoption Of Atraumatic Care By Rural Hospital Nursing Staff Through Education, Angie Sowers

Doctoral Projects

Problem Statement: While atraumatic care is often practiced in children's specialty hospitals, it is less likely to be a part of the care provided in rural hospitals (Li et al., 2018). Nurses in this setting may not feel equipped or supported to provide atraumatic care.

Purpose: The purpose of this DNP Project is to support increased knowledge and utilization of atraumatic care by nursing staff providing care for pediatric patients in rural community hospital through a professional development education program. Methods: An educational program development project was created, implemented, and evaluated to support the utilization, awareness, and knowledge of atraumatic …

Evaluation Of The Effectiveness Of The Ihi Joy In Work Framework Among Nurses, Jezlynn M. Vonnahme

Doctor of Nursing Practice Projects: College of Nursing

Background: Registered nurses are leaving the bedside at alarming numbers with many of them suffering from burnout, a decrease in compassion satisfaction, a lack of joy in work, and/or lack of work-life balance. It is critical these issues within nursing are identified and mitigated in order to reduce the number of nurses planning on leaving the bedside as 33% of nurses are currently considering leaving their role or reducing their hours. This statistic does not help with the current nursing shortage and its prediction to continue to grow with employment needs for nurses expected to increase 9% more than any …

Implementation Of A Nurse-Led Clinical Algorithm For Pressure Injury Prevention Associated With Non-Invasive Ventilation Medical Device Use, Capri Steinkuhler, Kaitlin Rogge

Doctor of Nursing Practice Projects: College of Nursing

Purpose and Aims

Medical device related pressure injuries (PI) account for as much as 61-81% of all hospital reported wound incidents (Gefen et al., 2020) and are frequently caused by respiratory devices such as non-invasive ventilation (NIV). Use of NIV in critically ill patients dramatically increased during the pandemic. PI are one of the leading causes of injury to hospitalized patients and lengthens hospital stays (National Pressure Injury Advisory Panel [NPIAP], 2019). The NPIAP recommends routine skin assessment under devices, proper mask fit, protective barrier, moisture reduction, and interdisciplinary collaboration to prevent PIs from NIV masks. This feasibility study’s purpose …

Implementation Of Chronic Obstructive Pulmonary Disease Action Plan On The Step Down Critical Care Unit: A Pilot Study, Peter Chambers, Kaelee Dameron, Carolyn Kiefer

Doctor of Nursing Practice Projects: College of Nursing

Background: Hospital readmissions due to chronic obstructive pulmonary disease (COPD) exacerbations are a significant economic and resource burden on the United States healthcare system. Current professional guidelines for the prevention of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) include providing patient-focused education with a written action plan such as a COPD Action Plan.

Aims: The primary purpose of this project was to determine if providing an educational intervention to patients admitted for AECOPD would reduce hospital readmission rates for COPD and improve patient outcomes. Method: We performed a quasi-experimental pilot study of 10 participants admitted with a COPD exacerbation …

Pediatric Diabetic Ketoacidosis Fluid Composition And Rate In Care Of Type 1 Diabetic Patients, Gabriel Hansen, Janae Langner, Michaela Tarpley

Doctor of Nursing Practice Projects: College of Nursing

Objective

Complications of diabetic ketoacidosis (DKA) include iatrogenic hyperchloremia and acute kidney injury (AKI). The objective of this study was to evaluate the association of decreasing sodium chloride (NaCl) composition in standard DKA fluid resuscitation and the rates/severity of hyperchloremia and AKI in pediatric patients.

Methods

In December 2020, Children’s Hospital and Medical Center (CH&MC) changed the standard base composition of DKA fluids from 0.9% to 0.675% sodium chloride (NaCl) and increased the fluid resuscitation rate for patients over 30kg as a quality improvement project. A retrospective chart review analyzed patients admitted with DKA from January 2019-December 2021, excluding patients …

Evaluating Nurse Use And Satisfaction With Video-Based Discharge Education For Adults With Heart Failure, Krystyna Simon Rn, Bsn, Molly Hendrickson Rn, Bsn, Windy Alonso Phd, Rn, Fhfsa

Doctor of Nursing Practice Projects: College of Nursing

Background

Heart failure (HF) readmission rates are high and influenced by self-care practices and self-efficacy for managing chronic disease. Using digital education via tablet can help improve the discharge education process and may increase self-care knowledge.

Objective

The purpose of the study is to assess the current discharge processes implemented for HF patients in cardiovascular units at a Midwestern academic medical center.

Methods

Participants for this two-phase study were recruited from two inpatient cardiovascular units within a 700-bed, Midwestern academic medical center. Phase one used a pre-post quasiexperimental design to evaluate a discharge educational intervention using the teach-back method in …

Identifying The Effects Of The Covid-19 Pandemic On Individuals With Dual Diagnoses (Mental Health And Substance Use) At Centerpointe Residential Treatment Center, Casey Granger, Dakota Sonderup, William Stowell-Flores

Doctor of Nursing Practice Projects: College of Nursing

Background: Social distancing measures associated with the COVID-19 pandemic began on March 28^th, 2020in the United States. With these implemented measures, the mental health of the population was worsening due to isolation, closures, and fear. Rates of anxiety, depression, and co-occurring substance abuse increased as well. CenterPointe is a behavioral health organization that has a residential treatment facility in Omaha, Nebraska for patients with mental health and substance use disorder dual diagnoses. They utilize the DLA-20 tool with their patients at intake, every 90 days, and at discharge. The DLA-20 is a standardized tool that assesses an individual’s …

Self-Managment Of Urinary Incontinence In Women, Abbey Klein

Theses & Dissertations

Urinary incontinence is experienced by approximately 60% of adult women in the United States and negatively impacts many aspects of physical and psychological health. Many women do not seek care for urinary incontinence due to social stigma. However, those who do seek care do not often receive treatment options that align with clinical guidelines. Urinary incontinence self-management has been used interchangeably in the literature with other terms, like self-care and coping, but no conceptual definition has been delineated. The overall purpose of this dissertation was to describe urinary incontinence self-management in women. To accomplish this, a concept analysis was conducted …

Center Based Cardiac Rehabilitation Outcomes Associated With Covid-19 Pandemic: A Retrospective Comparative Cohort Study, Haley Williams, Kayla Woodworth

Doctor of Nursing Practice Projects: College of Nursing

Background: Traditional cardiac rehabilitation (CR) is a multidisciplinary, multifaceted program for cardiac patients. Throughout the Covid-19 pandemic, health care, including center-based CR (CBCR) programs, were closed to in-person sessions. Even with the return to CBCR participation, patient outcomes may have been affected by this disruption in care. The goal of this study was to determine if CR participation outcomes differed before and after CBCR program closure due to Covid-19.

Methods: A retrospective comparative cohort design was used to examine CR participant outcome data before and after the Covid-19 pandemic. Convenience sampling of CR participants at a large, urban …

Primary Care Management Of Breast Cancer Screening, Katelyn Phillips, Lainey Brown

Doctor of Nursing Practice Projects

Breast cancer remains the most prevalent cancer diagnosis and is the second leading cause of cancer death among women in the United States. Mammograms have been identified as an effective screening tool that can detect breast cancer in the early stages of the disease, before symptoms develop, and allow the possibility of a cure. The project aimed to identify women in the primary care setting with outstanding mammography orders and implement a more systemic outreach program to improve patient adherence. The intervention was a telephone outreach program in which the students conducting the project contacted patients with unsatisfied mammogram orders …

Infrared Thermography (It) And Subepidermal Moisture Scanning (Sem) To Identify Early Tissue Injury And Reduce Hospital Acquired Pressure Injuries In Patients Undergoing Procedures Greater Than Four Hours In Duration, Irish Mills Parker, Makaela Waddell, Alexa Johnson

Doctor of Nursing Practice Projects: College of Nursing

Objective: The purpose of this pilot feasibility study was to more effectively prevent hospital-acquired pressure injuries in high-risk patients by using infrared thermography and subepidermal moisture scanning to identify early signs of tissue injury from pressure. Methods: Data was collected in the Cardio-Vascular Intensive Care Unit (CVICU) and cardiac medical-surgical care floors at Nebraska Medicine. Inclusion criteria are adults, scheduled for a surgery or procedure(s) predicted to last four or more hours, and planned admission to the ICU afterward. Participants were scanned with FDA-approved infrared thermography (IT) and subepidermal moisture (SEM) scanners before their procedure, two hours post-procedure, and then …

Increasing Communication Of Patient Daily Goals During Interdisciplinary Rounds In An Inpatient Pediatric Cardiac Unit, Sage Bailey

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Ineffective communication between interdisciplinary team members in a pediatric inpatient setting results in poor documentation compliance and decreased staff satisfaction of daily goals. The use of a standardized patient daily goal sheet improves effective communication among interdisciplinary team members. The primary aims of this study were to improve RN satisfaction and knowledge regarding interdisciplinary communication, improve verbalization of patient daily goals in daily rounds, increase the number of daily goals verbally discussed and improve the quality of documentation in the electronic medical record (EMR). Methods: Data were collected on a pediatric academic 30-bed cardiac care unit involving 100 nurses. …

Referral Triage To Improve Neurology Access, Melinda Mata

Doctor of Nursing Practice Scholarly Projects

The demand for neurology consultation far outweighs the number of specialists, thus causing long wait-times for consultation. Other contributing factors to obtaining timely consultation include, quality of information sent with the referral, insurance authorization, triage process, and appointment availability. This retrospective quality improvement study explored the effects of a referral triage process on reducing appointment wait time. All referrals were sent to one fax number and a new standard referral and triage process was implemented with specific operators with defined roles and responsibilities. The initial results following intervention implementation did not show improvement in wait times. Comparing the new triage …

Icu Nurses’ Adherence To The Cdc’S Central Line Bundle: A Qualitative Study, Cherie Burke, Cherie Burke

Electronic Theses and Dissertations

Background: Central line associated bloodstream infections (CLABSIs) are one of the most common healthcare associated infections and result in prolonged hospital stays, significant morbidity, and increased costs to the healthcare system. Adherence to the CDC central line maintenance bundle has been shown to be effective in decreasing CLABSI yet these infections continue to be a problem. ICU nurses play a vital role in managing central lines and adhering to the maintenance guidelines, however different situations may arise during the care that may impact CLABSIs.

Objectives: 1) To determine nurses’ adherence to the CDC’s maintenance central line

bundle; 2) To determine …

Situation Awareness And Cognitive Load In Nursing Students Managing A Computer-Based Virtual Reality Simulated Deteriorating Patient, Tracy Chesney

Electronic Theses and Dissertations

Background: When a patient’s baseline clinical state shifts to a worse clinical state requiring a transfer to a higher level of care within the healthcare system, it is the hallmark of a deteriorating patient situation. Up to 37% of newly licensed nurses fail to identify and manage a deteriorating patient partly due to inexperience and a lack of expertise, contributing to lower situation awareness (SA), specifically in cue perception. Long-term memory schema development leads to expertise that allows individuals to develop higher SA necessary to identify and effectively manage patient deterioration. Expert nurses access long-term memory schema in managing deteriorating …

School-Based Development And Implementation Of An Educational Toolkit, Chantel M. Kilford Ms

Doctor of Nursing Practice (DNP) Projects

The purpose of this evidence-based change in practice is to increase knowledge and confidence among healthcare providers and teachers within a high school setting by providing an educational tool kit about behavioral disorders in children. The disorders that will be focused upon are conduct disorder, oppositional defiant disorder, and common co-morbidities of these disorders. There will be education about an appropriate childhood, evidence based mental health assessment tool that assesses childhood mental health, including how to score the tool and interpret the results. Evidence suggests that healthcare providers and teachers are not confident or knowledgeable about identification, assessment, and behavioral …

Post-Partum Deprssion: An Educational Intervention For Nursing Staff In A Rural Hospital Obstetrics, Tonya Jewell

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Postpartum depression (PPD) is a type of depression that has occurred in women during pregnancy or after the delivery of a child. In the United States, approximately 13.2% of postpartum women were diagnosed with postpartum depression. Research indicated that early identification of PPD led to the best outcomes for postpartum mothers. Routine postpartum depression education and screening for postpartum depression did not exist in the perinatal unit at a Southeast Georgia rural hospital. Lack of nursing knowledge and skill were two barriers identified to screening patients for PPD and providing discharge education. The study provided an educational intervention to provide …