Other Nursing Commons^™

Proposed Evidence-Based Practice Guidelines For Using Esmolol To Blunt The Sympathetic Stress Response To Laryngoscopy And Intubation, Maya Kurdi

Doctor of Nursing Practice Scholarly Projects

Direct laryngoscopy (DL) and endotracheal intubation (ETI) are standard procedures performed during general anesthetic induction, which provoke a sympathetic stress response that can result in intraoperative hemodynamic instability. Traditional agents like lidocaine and fentanyl, commonly used to mitigate the stress response, have limitations and can lead to adverse effects. Recent literature suggests that esmolol, an ultra-short-acting, cardio-selective beta-1 adrenergic receptor antagonist, may be an effective alternative due to its rapid onset, short duration, and minimal side effects. This final scholarly project (FSP) aims to develop evidence-based practice guidelines for using esmolol as an adjunctive induction agent. A systematic literature review …

Implementation Of A Health Care Transition Pathway For Children And Adults With Inborn Errors Of Metabolism: A Pilot Project, Brittany M. Murray

Doctor of Nursing Practice Scholarly Projects

Background: Children with medically complex diseases require highly specialized care by a highly specialized team. Those with rare disease, including inborn errors of metabolism (IEMs), are a medically complex population and face significant challenges undergoing the health care transition from a child/family-centered model to an adult/patient-centered model of care. The project site follows patients with IEMs in the Metabolism Program, but previously did not have a coordinated process and had insufficient resources for patients/families for the health care transition.

Methods: The Plan-Do-Study-Act (PDSA) method was utilized as the model for improvement. Due to the complexity of the population and time …

Enhancing Nurse Competency: Proper Application Of Chlorhexidine Gluconate Dressings To Prevent Central Line Associated Bloodstream Infections, Joseph Earich

Doctor of Nursing Practice Scholarly Projects

Central line-associated bloodstream infections (CLABSIs) pose a significant risk to patient safety and healthcare outcomes. The proposed Doctor of Nursing Practice (DNP) project addresses the knowledge gap among nurses regarding the correct procedures for changing chlorhexidine gluconate (CHG) dressings on central lines. The goal is to enhance nurse education and adherence to best practices, thereby reducing the incidence of CLABSIs. The project employs a quasi-experimental design with a pre-test and post-test methodology. Nurses will complete a pre-test to assess their baseline knowledge of CHG dressing changes. The nurse will participate in a hands-on educational session to improve their understanding and …

Improving Health Literacy Related To Hypertension In A Minority Faith-Based Population, Kasaundra M. Beverly-Marshall, Kasaundra M. Beverly-Marshall

Doctor of Nursing Practice Scholarly Projects

Background: Insufficient research on health literacy related to cardiovascular disease highlights a gap in healthcare. Healthy People 2030 and local community health programs acknowledge gaps in research with future goals to improve health literacy.

Local Problem: The health literacy rate for Winnebago County, IL (41%) is higher than both the State of Illinois and national health literacy rates, which aligns with the results of a community needs assessment survey.

Methods: A community-based health promotion project using a pre-post study design uses the health promotion model to engage participants in advancing cardiovascular health outcomes.

Interventions: DNP student assisted participants in creating …

Reducing Acute Care Visits In Oncology: A Pilot Quality Improvement Project, Judy Metropulos

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: Patients receiving high-toxicity chemotherapy are at risk for post-infusion complications, which can result in unplanned hospital visits or admissions. Structured post-infusion follow-up may improve symptom management and reduce these events.

Local Problem: At North Region hospital, the 30-day post-infusion revisit rate was 31%, substantially exceeding the national average of 14.7%. A pilot program launched in 2021 reduced hospital visits by 7%; however, following its discontinuation due to staffing shortages and inadequate data collection, the rate subsequently increased, underscoring the need for sustainable interventions.

Methods: A quality improvement project was conducted in two, ten weeks phases. Phase 1 included …

Implementation Of Synchronous And Asynchronous Car-T Education For Emergency Room And Intensive Care Unit Nurses In Non-Oncology Units, Kylie Kuck

Doctor of Nursing Practice Scholarly Projects

Background: Chimeric antigen receptor T cell (CAR-T) therapy is a novel and promising cancer treatment for hematologic malignancies. This treatment is highly regulated by the Food and Drug Administration (FDA) and The Foundation for the Accreditation of Cellular Therapy (FACT) because of the known toxicities associated with treatment.

Local problem: In 2022, FACT published guidelines requiring formal education for both oncology and non-oncology nurses who care for these patients, including emergency room and intensive care unit nurses.

Methods: This quality improvement project provided education to emergency room and intensive care unit care nurses who are caring for CAR-T cell therapy …

Incorporation Of Mindfulness Application Use In Doctoral Nurse Anesthesia Curricula For Mitigation Of Stress And Anxiety In Student Registered Nurse Anesthetists, Kerrie Rodgers

Doctor of Nursing Practice Scholarly Projects

The nurse anesthesia specialty is highly stressful, with educational training being no exception. High didactic demands and intensive clinical experiences are placed on student registered nurse anesthetists (SRNAs), increasing stress and anxiety in their personal and professional lives. High levels of psychological distress can lead to inadvertent consequences in students’ mental, emotional, and physical health and can contribute to illness, burnout, substance use, and compromise in patient safety. Some degree of stress is necessary for motivation to succeed and perform at high levels, and encountering stress while enrolled in a doctoral nurse anesthesia program is expected and unavoidable. A search …

Final Scholarly Project: Clinical Guidelines For The Perioperative Management Of Patients With Opioid Use Disorder Requiring Anesthesia, Jessica Kayla Joos

Doctor of Nursing Practice Scholarly Projects

Opioids have highly addictive properties that allow for high levels of misuse. Since the early 1990s, the misuse and deaths rates related to narcotics have steadily risen in the United States. Efforts to identify individuals using opioids prior to surgery have proven difficult. The number of patients misusing opioids and reporting for surgery can only be estimated due to under-reporting related to fear and self-stigma. With 50 million surgeries in the U.S. annually and 3.32 million people misusing opioids monthly, the chances of a patient with Opioid Use Disorder (OUD) presenting for anesthesia are exceptionally high. Moreover, patients who rate …

Standardizing The Discharge Process To Reduce Copd Readmission Rates, Kristine Doligosa

Doctor of Nursing Practice Scholarly Projects

Background: Frequent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can lead to unfavorable patient outcomes and costly readmissions. Inadequate patient support during discharge and an inconsistent discharge process are factors contributing to high readmissions in this population.

Purpose: This quality improvement project aimed to reduce COPD-related hospital readmissions by standardizing the discharge process for patients admitted with AECOPD and identify patient risk factors for readmission.

Methods: Following a quantitative and quasi-experimental design, this project standardized the discharge process for patients admitted with AECOPD using the Re-Engineered Discharge Toolkit components and a discharge care bundle. The project was …

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. …

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 …

The Effectiveness Of Targeted Education On Improving Nurses’ Self-Efficacy In Caring For Psychiatric Patients On Medical Surgical Units, Rachel Shirey

Doctor of Nursing Practice Scholarly Projects

Individuals with mental illness are occasionally hospitalized on medical units, specifically medical-surgical units. Nurses working on medical-surgical units may find patients with mental illness more challenging due to the complexity of care they sometimes require. Nurses’ perceived ability to provide quality care for these patients is reduced in comparison to their perceived ability to care for patients without mental illness. Consequently, low self-efficacy can result in the provision of a lower quality of care for this population. The purpose of this quality improvement project was to improve the care that patients with mental illness receive while hospitalized on medical-surgical units. …

Ohio Forensic Nurse Examiners: Readiness To Care For Victims Of Sexual Assault With Disability, Deanna Nicole Smith

Doctor of Nursing Practice Scholarly Projects

Forensic nurse examiners (FNEs) care for crime victims in acute care settings. These nurses are specifically trained in trauma-informed care and evidence collection in cases of sexual assault, domestic violence, abuse, and human trafficking (RAINN, 2022). The scholarly project focuses on the care of victims of sexual assault living with disability, as this population is three times more likely to be victimized than any other population (NSVRC, 2022). The project literature review reveals a lack of data on preparation standards for FNEs on caring for victims with disability and providing accommodations during forensic examination. Currently, it is unknown if FNEs …

Mentorship In Retail Health - A Quality Improvement Project Initiative, Judith Thigpen

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Nurse practitioners (NPs) practicing in retail health face issues that complicate provision of care including isolation, lack of support staff, and non-clinical administrative and business duties. To address this, a national retail health company implemented a mentorship program for newly graduated, newly hired NPs. This quality improvement project will facilitate the implementation and evaluation of this mentorship program in one of the company’s regions in Georgia.

AVAILABLE KNOWLEDGE: Literature suggests that NPs believe that a mentor can help contribute to professional development, counter stress and anxiety, provide support, increase job satisfaction, and guide in critical decision making.

AIMS: 1. …

Revision And Deployment Of An Oral Anticancer Medication Adherence Toolkit, Kristine Lefebvre

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Oral anticancer medications offer state-of-the-art cancer treatment with the convenience and autonomy of self-care in the home. Professional organizations often provide expert guidance and resources to support the provision of high quality, safe, evidence-based care. LOCAL PROBLEM: Many institutions lack a formal oral anticancer medication program, including a process to assess and monitor adherence. Nurses and their colleagues look to the literature, training, collaboration with colleagues, and through practice tools and programs available through their specialty associations for support in their adherence work. The Oral Adherence Toolkit released in 2016 needed updating to reflect current best practices. METHODS: The …

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 …

Nurses In New Mexico: Their Awareness Of Safe Harbor As Reflected In A Survey During A Time Of Covid-19, Ashley R. Gonzales

Doctor of Nursing Practice Scholarly Projects

The healthcare industry is highly regulated to ensure patients receive safe, high-quality, patient-centered care. Even with these regulations, patient outcomes remain poor, given the high expenditure and percentage of the gross domestic product that healthcare comprises in the United States. Nurses make up the largest proportion of the healthcare field and are often overlooked when it comes to policies to ensure their practice remains safe and licenses protected. Nurses are the eyes and ears of their board-certified providers and detect subtle changes in a patient’s condition. However, such attention to detail can be executed only when the nurses can care …

Evidenced-Based Practice Guideline Development: Selection Of Local Anesthetics And The Additive Dexamethasone In Brachial Plexus Blocks, Sabina Lamichhane Wagle

Doctor of Nursing Practice Scholarly Projects

Brachial plexus blocks (BPB) are a type of regional anesthesia that inhibits the sensory and motor function of the upper extremity. The efficacy of a BPB depends on the type and dose of local anesthetics (LA), as well as the use of any additive agent. The selection of LA depends on the type, concentration, and volume of LA. Certain additives, such as dexamethasone, when added to BPB, were shown to increase motor and sensory block duration.

A chart audit conducted by the pharmacy and anesthesia departments revealed a significant variability of clinical practice in the use of LA and additives …

Implementation Of An Evidence-Based Bundle To Reduce Hospital Acquired Pressure Injury Harm Rates In The Intensive Care Unit: A Quality Improvement Project, Jessica Tripp

Doctor of Nursing Practice Scholarly Projects

A pressure injury (PI) is a condition in which prolonged pressure or shear causes localized damage to the soft tissue and skin and is usually over a bony prominence (National Pressure Ulcer Advisory Panel (NPUAP), 2016). PIs can increase morbidity and mortality, increase length of stay, increase infection rates, increase healthcare costs and decrease quality of life (Agency for Healthcare Research and Quality (AHRQ), n.d.; Coyer et al., 2017). PIs are largely preventable yet continue to occur, despite the growing number of high-quality research articles that focus on this problem. Quality improvement initiatives are an effective way to translate evidence-based …

Attitudes Towards Treating Injured Patients In Urgent Care, Erin Beverly

Doctor of Nursing Practice Scholarly Projects

There has been published literature on the topic of clinician bias and the effects of bias on patient care, however, a review of the literature did not yield any research on the topic of clinician bias towards treating patients injured in motor vehicle accidents (MVA’s). There has been concern about clinicians not preferring to see patients injured in MVA’s however this is only anecdotal. If this topic is to be addressed through quality improvement efforts, there should first be scholarly evidence to support these efforts. This study employed a prospective survey of a convenience sample of clinicians who practice in …

Eastern European Orthodox Christian Immigrant Women: A Pilot Study And Needs Assessment, Kimberly A. Babich-Speck

Doctor of Nursing Practice Scholarly Projects

The healthcare perceptions of the Eastern European Orthodox Christian immigrant women (EEOCIW) to the United States (U.S.) are under-represented in the literature. Although they appear similar to Americans, their cultural and religious traditions are outside the mainstream American culture. This pilot study and health needs assessment examines the women’s healthcare perceptions of 14 EEOCIW and identifies similarities and differences with 25 U.S. born Orthodox Christian women (USOCW). Between September and November 2020, interviews were conducted with Orthodox Christian immigrant women from Eastern Europe and Orthodox Christian women born in the U.S. Questions covered the perceptions of women’s healthcare, factors influencing …

Professional Quality Of Life Indicators And Turnover Intention In Forensic Nurses, Leigh Anne Meyer

Doctor of Nursing Practice Scholarly Projects

Background/Significance: Significant barriers to forensic nurse workforce development exist, affecting patient access to care. Retention of forensic nurses is a persistent problem. Turn-over of forensic nurses can be attributed to many factors related to professional quality of life, including compassion satisfaction (CS), burnout (BO) and secondary traumatic stress (STS).

Methods: A convenience sample of forensic nurse program coordinators was used to identify the effect of an educational session on professional quality of life and strategies for reducing stressors within the role on ProQOL-5 and TIS-6 scores using a pre- post-test quasi-experimental survey design. Correlation between professional quality of life indicators …

Nurse Educators Influence On Student Success, Callie Whittington

Doctor of Nursing Practice Scholarly Projects

Passing nursing licensure exams is important to promising nurses. The number of times a graduating nursing student must take The National Council Licensure Examination-Registered Nurse (NCLEX-RN), reflects upon the institution of higher education as a gauge of the quality of their training programs and preparation. Student outcomes are very important to overall standing of the nursing programs, as the first attempt NCLEX-RN pass rates affect status of the nursing program. The nurse educator’s role in student success is vital and the level of education for the nurse educator can play a valuable part in this as well.

The researcher of …

Improving End-Of-Life Care On Navajo Through Education, Johanna G. Bahe

Doctor of Nursing Practice Scholarly Projects

End-of-life care (EOLC) is an essential component of comprehensive healthcare and has been shown to improve the quality of life of patients and their families by preventing and relieving pain caused by physical, psychosocial, and spiritual complications. Many rural communities lack access to EOLC, specifically certified palliative and hospice services. The lack of this specialty in rural areas directly affects the experience of healthcare staff. The absence of education for rural healthcare staff and the importance of culturally sensitive care among indigenous people are key concepts in this study.

The purpose of this study was to measure the knowledge, confidence, …

Poster: The Beat Stops Here: A Nurse-Driven Protocol To Manage Telemetry Orders, Holly Dripps, Kirk Hummer

Doctor of Nursing Practice Scholarly Projects

At a large midwestem healthcare organization, cardiac telemetry monitoring orders are not aligned with clinical guidelines developed by the American Heart Association (AHA). A nurse-driven protocol, based on AHA guidelines, to manage cardiac telemetry orders may reduce telemetry usage. Donabedian' s quality improvement framework of strnch1re-process-outcomes was utilized as the theorical framework for this project, with the purpose to reduce telemetry days within 30 days on a selected acute care unit utilizing AHA guidelines. Project objectives included developing an assessment tool based on AHA guidelines, educating pe1iinent stakeholders on the nurse assessment tool, and implementation of the tool on the …

Poster: Impact Of Educational Modules On Knowledge Among Neuroscience Nurses Working In The Epilepsy Monitoring Unit (Emu), Shivani Bhatnagar, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

Background: Little data exists about nursing care and knowledge on an epilepsy monitoring unit (EMU). This study evaluated the impact of an educational series (three modules) on nursing knowledge and confidence in providing care, using a pre-test/post-test design. Objectives: There were three objectives for this study. The first objective was to improve nursing knowledge and competence in educating patients and families. The second, to increase nursing confidence in providing care and decision-making for the specialized patient population on the EMU. The third, to evaluate the effectiveness of educational modules. Subjects: Thirty-eight nurses working in the neuroscience unit participated in the …

Report:Impact Of Educational Modules On Knowledge Among Neuroscience Nurses Working In The Epilepsy Monitoring Unit (Emu), Shivani Bhatnagar, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

Background: Little data exists about nursing care and knowledge on an epilepsy monitoring unit (EMU). This study evaluated the impact of an educational series (three modules) on nursing knowledge and confidence in providing care, using a pre-test/post-test design. Objectives: There were three objectives for this study. The first objective was to improve nursing knowledge and competence in educating patients and families. The second, to increase nursing confidence in providing care and decision-making for the specialized patient population on the EMU. The third, to evaluate the effectiveness of educational modules. Subjects: Thirty-eight nurses working in the neuroscience unit participated in the …

Using A Kindle To Improve Parental Perceptions Of Pain In Their Children: A Dnp Scholarly Project, Andrew Gearhart

Doctor of Nursing Practice Scholarly Projects

Patient satisfaction is an important goal for health care providers, as it is associated with treatment success, and patients are more likely to adhere to medical treatments when they are satisfied. Emergency departments are among the lowest ranked healthcare settings nationwide in terms of patient satisfaction. Pediatric patients often experience pain and/or anxiety while in the hospital setting and are at an increased risk of having unpleasant experiences while receiving care. The purpose of this DNP scholarly project is to determine whether the introduction of a Kindle Fire tablet was effective in decreasing parental perceptions of pain while their child …

Advance Care Planning: Cardiopulmonary Resuscitation Education And The Veteran Population, Rhian Elizabeth Dalgord

Doctor of Nursing Practice Scholarly Projects

Cardiopulmonary resuscitation educational tools are prevalent in the realm of advance care planning and shared decision making. However, tools developed specifically in the interest of veterans are lacking. This deficit impedes the advance care planning process. Easy-to-use advance care planning tools that meet specific population needs can result in a threefold higher rate of usage. The purpose of this DNP scholarly project was to evaluate the use of the Honoring Healthcare Choices CPR educational handout through administration of the iDECIDE CPR Decision Aid Acceptability questionnaire to veterans (N=70) residing in a veterans nursing home in the Midwest. The iDECIDE CPR …

The Contemporary Use Of Nurse Practitioners In U.S. Emergency Departments, Jeffrey L. Bevan

Doctor of Nursing Practice Scholarly Projects

Problem: The increased demand for emergency care in the United States (U.S.) has been well-documented and there is growing utilization of nurse practitioners in U.S. emergency departments. However, little is known about the nurse practitioner (NP) role in the emergency department setting within the past five years.

Purpose: The purpose of this project was to describe the demographic characteristics of patients, patient conditions treated, diagnostic tests ordered, and procedures performed by nurse practitioners in a national sample of U.S. emergency departments.

Methodology: This secondary analysis used a non-experimental quantitative, descriptive exploratory design to review data from the National Hospital Ambulatory …