Family Practice Nursing Commons^™

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

Veterans Direct Admission Reassessment Tool Validation For The Reduction Of Rapid Response Code Blue, And Code Stroke Team Activations In Newly Arrived Direct Admission Veterans, Joshua Monroe Wells

DNP Projects

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified …

Enhancing A Pressure Injury Prevention Bundle In A Skilled Nursing Facility, Lorillie Soleta

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: The purpose of the project was to address the increase in pressure injuries in a skilled nursing facility, which had risen from 6% to 10% despite the implementation of a prevention bundle. The project aimed to evaluate and enhance the effectiveness of existing interventions.

Aim of the Project: The aim was to add evidence-based interventions to the existing pressure injury prevention bundle. The desired outcome was to decrease the number of acquired pressure injuries.

Review of the Evidence: Research indicated that pressure injury prevention bundles were more successful when incorporating offloading interventions. These offloading measures, including frequent turning and …

Reduce Extended Length Of Stay By Reducing In-Hospital Falls, Norberto Benitez

Master's Projects and Capstones

Abstract

Problem: Every year, there are many in-hospital falls (IHFs). Nationally there are between 700,000 to 1 million falls recorded each year. Hospital falls financially burden our healthcare industry, costing approximately 34 billion annually. Context: In a local hospital in Northern California, Marin County, the microsystem has had an extraordinary number of in-hospital falls (IHFs). To date (June 2023), 13 falls have been recorded thus far; the microsystem is on track to beat the previous year's record number of 21 falls in a calendar year. Interventions: The MSN–CNL student proposed re-educating staff, resetting expectations, and reestablishing workflow. We also sought …

“One University’S Covid-19 Pandemic Mitigation Response And Anxiety Construct: A Summative Program Evaluation”, Ann Hodgin

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

The effects of the COVID-19 pandemic continue to ripple through everyday life. In December 2019, an outbreak occurred in China. Subsequently, the World Health Organization identified SARS-CoV-2 as a new type of coronavirus that quickly spread around the globe (Nazario, 2022). As of May 31, 2023, there were 6,938,353 confirmed deaths worldwide from COVID-19 (WHO, 2023).

A needs assessment completed by the University identified that a program evaluation of the university’s COVID-19 response was warranted. Therefore, this program evaluation was conducted to assess the effectiveness of the policies and protocols implemented at a Catholic University in Southwestern Pennsylvania to …

Assuring A Continuum Of Care For Heart Failure Patients Through Post-Acute Care Collaboration, Purnima Krishna

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure (HF) patients have a high risk of rehospitalization after discharge from acute care. Post-discharge management of HF patients requires coordinating services outside the hospital, such as skilled nursing and home health care to address patients’ complex needs.

Local Problem. High HF readmission rates negatively impact a hospital’s efficiency and pose a risk of financial penalties. In the project setting, the HF patients discharged to skilled nursing facilities and home health agencies had a higher rate of 30-day readmission than patients discharged to home.

Methods: Fourteen post-acute care (PAC) facilities were selected for the interventions. The …

Formal Unit-Based Shared Governance To Improve Nurse Engagement, Tracey A Larsen

Student Scholarly Projects

Practice Problem: Nurse engagement is a key driver of nurse satisfaction and nursing retention. Shared governance is an evidence-based practice proven to increase nurse engagement through shared decision-making and results in higher work satisfaction.

PICOT: The PICOT question that guided this project was (P) in an ambulatory nursing clinic (I) what is the effect of a shared governance unit-based committee (C) compared to current practice (O) on nurse engagement (T) over 10 weeks?

Evidence: An exhaustive literature search resulted in 61 peer-reviewed articles. Eleven studies were included after filtering for duplicates and keywords and evaluating for strength and quality …

Strengthening New Hampshire’S Primary Care Workforce Pipeline: Utilization Of Alternative Scheduling Models, Elizabeth Harrison

DNP Scholarly Projects

Abstract

BACKGROUND: Traditional clinical scheduling coupled with the current reimbursement system have created systematic barriers leading to decreased clinical education opportunities. Alternative scheduling models such as longitudinal integrated clerkships, one preceptor to two students and wave scheduling have the potential to eliminate these barriers and provide financial gains and increased access to care.

INTERVENTION: Interventions to meet this quality improvement project's objectives included (1) pre-intervention planning (2) focus groups, (3) video presentations and (4) a pilot program of alternative scheduling models in clinical practice.

RESULTS: A pilot program utilizing the alternative scheduling models increased the relative value units (RVU) of …

Evidence-Based Best Practice For Transitions Of Care: A Policy Review On Medication Reconciliation Standards, Lovelyn Chizoba Ogbennah

Student Scholarly Projects

Practice Problem: Medication reconciliation (MR) is crucial in care transitions among healthcare facilities. Developing evidence-based discharge planning strategies, improving communication, optimizing electronic health record intelligence interoperability, and stakeholder engagement will promote a better transition process for patients and healthcare providers.

PICOT: The PICOT question that guided this project was: In an urban-based adult skilled nursing facility, how does an evidence-based structured review, and revision of current MR policy and procedures, compared to the existing MR policy, affect the clarity of the process for communication between clinicians during transitions of care over a 10-week review cycle?

Evidence: Fifteen …

Implementing Faculty Development Modules To Increase Readiness For Addressing Social Determinants Of Health, Implicit Bias And Equity In Course Content, Claudia Ngafeeson

DNP Scholarly Projects

Implicit bias is viewed as an unconscious and involuntary attitude that lies below the surface of consciousness but can influence behavior, and cognitive processes (Maina et al., 2018). Social determinants of health are considered to be the conditions in which people are born, grow, live, work, and age; these circumstances are usually shaped by the distribution of money, power, and resources at global, national, and local levels, which in turns determines the distribution of the value of medical care. Existing literature on implicit bias has been fragmented in different fields such as; cognitive psychology, business ethics, and higher education, but …

Does Nurses Confidence Improve After Attending A Training For Teaching Home Infusion Patients?, Carol Menorah Young Dnp

Doctor of Nursing Practice Scholarly Projects

Discharge can be a difficult step for patients and their families and a challenging task for nurses. Poor instructions have a negative impact on the patient population. In addition, improper and incomplete discharge information negatively affects the posthospital recovery period and may cause the patient to return to the hospital for the same episode of care. Returning to the hospital emergency room or readmission for the same episode of care will increase the dangers to the patient’s health and recovery plan and increase the cost of individual healthcare. The patient population ranks the quality of discharge information via their responses …

Full Practice Authority: Determining Readiness Among Nurse Practitioner Students In Mississippi, Betty Hoffman

Doctoral Projects

Full practice authority has been granted to nurse practitioners by many states. These practitioners are educated and trained as full primary providers of health care. Full practice authority for nurse practitioners is not granted in Mississippi, which currently ranks in the lowest positions for health care in the United States. The low ranking can be attributed to a lack of providers and access to services.

This project seeks to explore attitudes and understanding of nurse practitioner students in the State of Mississippi regarding full practice authority. A survey will be electronically distributed to determine what is already known and understood …

Manager Onboarding To Improve Knowledge And Confidence To Lead, Christine (Tina) K. Asiimwe

Doctor of Nursing Practice (DNP) Projects

Background: Primary care (PC) is increasingly the setting for affordable, coordinated, end-to-end patient care, with PC managers in charge of organizational performance. While PC managers are central to high-functioning teams, they often receive inadequate onboarding.

Local Problem: Primary care onboarding competes with other operational priorities and faces time constraints, lack of mentorship, and cost.

Context: At an integrated healthcare system, a need was identified to develop structured, role-specific onboarding for newly hired PC managers to improve knowledge and confidence to lead.

Interventions: Bauer’s Four Cs framework for onboarding guided the development of a manager onboarding program for 12 new PC …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Decreasing Patient Fall Rates In The Microsystem, Kevin Dwayne Sanchez Camaya

Master's Projects and Capstones

Abstract

Problem: Falls are considered never events, yet continuously occur in the inpatient setting. Falls,

especially falls with injuries, impact the patients, the staff, and the hospital. Falls cause extended lengths of stay, affect the morale of the patients and the staff, and are non-reimbursable events.

Context: There have been an increased rate of falls within a medical/surgical/telemetry unit

microsystem at a Northern California hospital despite standardized screening and prevention tools. The unit can house up to 52 patients and is the designated Covid unit of the hospital at the time of this project.

Interventions: The interventions include optimizing the …

Nursing Management To Reduce Hospital Readmissions After Percutaneous Coronary Interventions- Integrative Review, Jeena S. Daniel, Doreen Wagner

Master of Science in Nursing Final Projects

Abstract

Percutaneous coronary interventions (PCIs) are considered life-saving techniques in the event of myocardial infarction and remain the standard of care for managing acute heart attack. Given the success of the procedures, decreased complications, and the economic advantage over open-heart surgery, coronary interventions continue to be the preferred treatment choice. However, amidst the growth and success of these procedures, readmissions after percutaneous coronary interventions have been identified and still prevail among hospitals. Hence, the goal was to conduct an integrative review to identify and synthesize literature on the interventions that help reduce readmissions after percutaneous coronary interventions and illuminate nurses' …

Evaluation Of Telemedicine As An Option For Providing Safe, Accessible, Care To Young Adults In A University Setting, Diane Lynch

Seton Hall University Dissertations and Theses (ETDs)

Previously underutilized, telemedicine has been implemented within a wide variety of health settings as a safe and efficient way of delivering healthcare during the COVID-19 pandemic. Maintaining operations during the pandemic made implementation of telemedicine an important aspect of college and university health center reopening plans. The purpose of this project was to evaluate the acceptance and quality of a telemedicine program implemented at the health center of a medium sized private university.

Data were collected via patient and staff surveys to measure satisfaction with the program and a retrospective review of electronic medical records was conducted to obtain data …

Testing A New Workflow To Integrate The Voice-Of-The-Customer In Readmission Analysis For Skilled Nursing Facility Readmissions From Home, Stephanie Edurese Bilbao

Master's Projects and Capstones

Abstract

There are multiple layers of oversight across the healthcare delivery system. Measuring acute hospital readmissions has been identified as an important outcome measure of quality care. Our patients are one of the major stakeholders in the healthcare system. One role of a clinical nurse leader is to integrate evidence-based leadership practices that identify and assess outcomes, mitigate risk, enhance health promotion, deliver highly effective patient care, and ensure transparent relationships with stakeholders. Rationales for examining and re-designing the readmission analysis workflow based on the customer’s experience are discussed in this paper. The global aim of the project is to …

The Changing Face In The Workplace: The Arrival Of The Millennial Generation, Sarah Clonch

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The entrance of the Millennial generation into the nursing workforce signifies a bright future for the nursing profession and the nursing workforce. This study began with a current review of available research that identified the Millennial generation and their views toward job satisfaction and work engagement, as compared with Baby Boomer and Generation X nurses.

PubMed, CINAHL Complete, and Google Scholar databases were employed to find 15 peer-reviewed articles for evaluation. The research findings suggest that Millennial nurses have lower rates of job satisfaction and work engagement, compared to nurses of older generations. Overall, the extracted data results were significant …

Evaluating Va Nurse Acceptance Of Virtual Healthcare Technology During The Coronavirus Outbreak, Francesca Bryan-Couch

Doctor of Nursing Practice Scholarly Projects

At a regional Veterans Administration (VA) hospital, nurses performing case management were unable to perform face-to-face visits with patients due to coronavirus. Care coordination and discharge planning efforts occurred through telephonic case management to preserve personal protective equipment and reduce transmission rates through social distancing. Trust and rapport between patients and nurses were reduced without personal contact. Peplau’s theory of interpersonal relations described six nurse roles and three phases of relationship development required to create therapeutic nurse-patient relationships. Connectedness was a key concept considered to be the path to a successful meaningful therapeutic nurse-patient relationship (Hrabe, 2005).

To evaluate current …

Effect Of A Self-Care And Self-Awareness Education Program On Resilience To Burnout And Depression In Clinically Experienced Nursing Students, Andrew Taylor

Undergraduate Honors Theses

The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn

Evidence-Based Practice Project Reports

Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …

Creating Restful Environments: Applying Evidenced-Based Interventions To Increase The Patients Perceptions Of Room Quietness At Night, Timothy Marks

West Chester University Doctoral Projects

Florence Nightingale first described the detrimental effects of noise on patients as an element nurses could control. Hospitalized patients who sleep in the hospital are at risk for poor periods of rest from unwanted noise in the care environment. This Doctor of Nursing Practice Project will assess interventions aimed at increasing the patient’s perception of quietness around the care environment at night for a pilot population. Swanson’s Theory of Caring will be utilized as a framework for the project. Outcomes of nursing interventions were reviewed for the improved patient perception of the care environment at night and resultant health outcomes. …

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

Evaluation Of The Effect Of Milner-Fenwick Video-Based Education And Teach-Back On Knowledge Acquisition In Atrial Fibrillation Patients, Melissa Czarapata

DNP Projects

PURPOSE: The purpose of this study was to evaluate if video education impacts knowledge acquisition and health literacy in patients with atrial fibrillation. METHODS: This study employed a descriptive, pretest-posttest single site comparative design. Baseline health literacy was assessed before video education was completed using the Atrial Fibrillation Knowledge scale. Health literacy regarding atrial fibrillation was again assessed for the same participants immediately after video education was completed and again in 7 to 10 days through the use of the Atrial Fibrillation Knowledge scale and teach-back questions. RESULTS: There was no statistical significance found when comparing scores before and after …

Nurses Role In Health Home Mixed Methods Study, Jacqueline S. Prokop

Nursing Theses and Dissertations

Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the U.S. health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. With the enactment of the Affordable Care Act (ACA), new chronic disease health home opportunities have emerged to address the existing structural and process gaps found in primary healthcare. The nurse’s role is integral to health homes as they empower nurses to play a greater role in improving patient experiences, population health, and lowering healthcare costs. Three research manuscripts presented …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Provider Based Interventions To Mitigate Risk For Opioid Pain Medication Abuse Among Adult Patients In A Primary Care Setting, Sheree Lamara Conley-Donaldson

Doctoral Projects

Mental and substance use disorders are predicted to exceed all physical disease processes causing major disability by 2020. Misuse and overdose of opioid pain medications is a significant public health concern in the United States. Approximately 1 in 4 patients receiving prescription opioids in primary care settings struggle with misuse. Half of all opioid prescriptions are written by primary care providers, including nurse practitioners. The purpose of this DNP project was to determine if nurse practitioner providers are implementing evidence-based practice guidelines including screening, brief intervention, and referral to treatment (SBIRT) to mitigate risk of prescription opioid pain medication misuse …