Addressing The Inpatient Penicillin Allergy: Implementing A Nurse-Driven Allergy Assessment Tool To Enhance Antimicrobial Stewardship., Shelby Ryan Bliss

DNP Projects

Background: In an acute care setting, more than half the inpatient population receives antibiotics. Approximately 10% of the general population reports an allergy to penicillin. It has been replicated in the literature with data that of those who report a penicillin allergy, up to 95% are incorrectly identified. When a patient is admitted to the hospital with a penicillin allergy on their electronic health record, they are at higher risk for adverse events such as a hospital acquired infection, the occurrence of an antibiotic resistant bacteria related to receiving broader therapy and increased healthcare utilization.

Purpose: The purpose of this …

The Measurement Of The Impact Of Well-Being Resources On Moral Distress And Burnout Following The Covid-19 Pandemic In Front-Line Nurse Leaders, Benjamin Hughes

DNP Projects

Background: Due to the COVID-19 pandemic, there is significant burnout among front-line nursing staff. Little literature has been published about the measurement of burnout among front-line nursing leaders, such as nurse managers and directors, nor the interventions used to help with this ever-growing issue among this group. Since the pandemic began, there have been many resources identified to help front-line staff members with burnout, but none specifically looking at what has worked or been utilized by front-line nursing leaders.

Purpose: The purpose of this project was to describe what well-being resources were identified as being effective in decreasing moral distress …

The Effect Of Relational Aggression Training On New Emergency Department Nurses, Mary Wethington

DNP Projects

BACKGROUND: Relational aggression (RA) in nursing is widespread. One group often at risk for exposure to RA is the newly licensed nurse. RA can lead to a negative work environment which can cause poor patient outcomes and high nurse turnover.

PURPOSE: The purpose of this study was to evaluate the effects of an educational program on RA in the emergency department with newly licensed registered nurses. This was conducted using one pre and two post surveys. The surveys evaluated the nurses’ knowledge of RA self-awareness before and six weeks after an educational session.

METHODS: This was a single-site, single-unit pretest …

The Effects Of Cultural Competency Training On Providers Knowledge, Skills And Attitudes Towards The Latino Population, Jennifer L. Peppiatt

DNP Projects

Background: Providers in the United States (U.S.) healthcare system need to understand the cultural values, beliefs, and traditions of the growing Latino population. As a result, academic institutions are incorporating cultural competency training in their curricula. However, a noticeable knowledge gap exists for those currently practicing in the healthcare arena, impacting patient and provider satisfaction and healthcare outcomes.

Purpose: The purpose of the study was to obtain a baseline assessment of the cultural competence of a select group of Advanced Practice Providers (APPs) caring for the Latino population at the University of Kentucky and provide a targeted educational intervention, followed …

Black Hearts Matter: A Comparative Study Of Sociodemographic, Clinical, And Psychosocial Characteristics In Black And White Persons With Heart Failure, Hannah M Anderson Hughes

Theses and Dissertations

Heart failure (HF) is a chronic, progressive, debilitating illness that disproportionately affects Black individuals, often leading to poor quality of life (QOL). Various sociodemographic, clinical, and psychological characteristics are related to QOL in patients with HF. Because most studies do not include representative Black samples or report findings from racial subgroup analyses, these relationships and any existing racial differences are not well understood. The purpose of this descriptive, comparative study was to explore the relationships among sociodemographic, clinical, and psychological characteristics and QOL in patients with HF and to determine if there were racial differences between Black and White individuals. …

Knowledge, Attitudes, And Expectations Among Certified Nursing Assistants Providing Oral Care To Individuals With Alzheimer's Disease Or Another Form Of Dementia Utilizing Music Therapy, Gina Dunn

EWU Masters Thesis Collection

Purpose: Current literature was aimed to explore CNAs attitudes, knowledge, and expectations on the use of music for individuals with Alzheimer’s Disease (AD)/dementia while providing oral care.

Methods: A single survey, 5-point Likert scale survey that included demographic and qualitative questions, was posted on a private CNA Facebook group page. The survey was posted to explore attitudes, knowledge, and expectations of CNAs towards the use of music therapy. Data was analyzed using descriptive statistics, Chi-square, and thematic coding.

Results: A convenience sample of (N = 55) CNAs participated in the study. IBM SPSS® version 28.0.1 was used to analyze the …

Implementation Of An Amiodarone Infusion Nurse Practice Guideline To Reduce The Incidence Of Phlebitis: A Quality Improvement Project, Kristen N. Cottrill

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Patients have an increased risk of developing phlebitis when amiodarone is delivered through a peripheral intravenous catheter. In a 32-bed cardiac surgery step-down unit, patients experienced phlebitis at a rate of 28.57% despite following manufacturer recommendations. Individual interventions targeted at amiodarone-related phlebitis have presented mixed results, however, when an amiodarone infusion practice guideline was established, the rate and severity of phlebitis consistently decreased across studies. Purpose: This project aimed to implement an evidence-based amiodarone infusion guideline to reduce phlebitis development or severity in cardiac-surgery step-down patients without a central venous catheter who received a peripheral intravenous infusion of amiodarone. …

Raising Awareness Of Second Victim Phenomenon And Supportingyou: A Quality And Safety Initiative, Megan Renee Bryant

Graduate Theses, Dissertations, and Problem Reports (ETD)

Current literature has established a need for practice change in management of healthcare-related critical incidents. Peer-support programs have been cited as the most impactful resource healthcare professionals request following a critical incident (Daniels & McCorkle, 2016). SupportingYOU, a peer-support program, is in the process of expansion at a large academic children’s hospital in northern West Virginia in anticipation for the opening of a new facility. The specific aim of this project was to raise awareness of second victim phenomenon (SVP), SupportingYOU, and perception of awareness of resiliency. Interventions included multi-formatted educational sessions on SVP and SupportingYOU via PowerPoints, brochures, flyers, …

Purposeful Nurse Hourly Rounding: Plan To Decrease Patient Falls During A Pandemic, Robbie Masangkay

Doctor of Nursing Practice (DNP) Projects

Problem: Patient falls remain a critical and persistent safety problem in healthcare today. The prolonged impact of the COVID-19 pandemic raises leadership concerns regarding the safe care of high-risk COVID patients and mitigating the increased stress and potential risks of infection to clinical staff.

Context: This Doctor of Nursing Practice (DNP) scholarly project details implementation of an evidence-based purposeful nurse hourly rounding (PNHR) pilot project designed to decrease the incidence of patient falls on a designated COVID-19 unit.

Measure: A modified PNHR rounding tool was implemented to guide focused elements for key nurse/patient interactions.

Interventions: …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

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 …

Nurse Practitioner-Led Care Pods: A Team Communication Enhancement Model, Miranda Saint-Louis, Miranda Saint Louis

Doctor of Nursing Practice (DNP) Projects

Background: Communication has become a key performance measure in the shift to value-based healthcare. Given the impact of communication failures on patient harm, length of stay, and dissatisfaction with care, new models of care with better communication through structured teamwork and interdisciplinary collaboration are needed.

Problem: In a 16-bed geriatric medical/surgical unit of a New York City multispecialty community hospital, the workflow structure unintentionally created inconsistent handoff communication, gaps in continuity of care, missed care events, and inattention to the patient’s priorities in the care plan. A gap analysis identified communication deficiencies that impacted team effectiveness and patient care …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Patient Placement Matters: The Impact Of Unnecessary Lateral Movement On Patients, Jacqueline Strinden

Doctor of Nursing Practice (DNP) Projects

Patient Placement Matters: The Impact of Unnecessary Lateral Movement on Patients

Abstract

Background: National trends to decrease the number of licensed beds have created inpatient capacity constraints which have resulted in increased unnecessary lateral patient movement events, which contribute to decreased patient safety and quality of care. The incidence of adverse events increases significantly when multiple unnecessary lateral relocations result from secondary efforts to relieve hospital capacity constraints and improve efficiency.

Problem: At a 352 acute care hospital, 12,906 patient movement events were evaluated over a baseline period of three months resulting in an average of 1.48 unnecessary lateral patient …

Investigating Relationships Between Diabetes Distress, Diabetes Self-Care Behaviors, Intention To Use And Actual Use Of A Personal Health Record Within 30 Days Of Hospital Discharge In Persons With Type 2 Diabetes, Khaliah Fisher-Grace

Electronic Theses and Dissertations

Background: Diabetes distress (DD) is defined by emotional and behavioral challenges caused from diabetes and its management. Diabetes self-care behaviors can be compromised by DD. Personal Health Record (PHR) use has been associated with improvements in HbA1c, blood pressure, and LDL-C, but the relationship between DD and PHR use is unknown. Aims: 1) to determine differences between sociodemographic variables and intention to use and actual use of PHR in hospitalized persons with Type 2 Diabetes Mellitus (T2DM), 2) to investigate the relationship between DD, intention to use a PHR and actual use of a PHR within 30 days of hospital …

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 …

Targeting Nstemi Readmissions: Education To Protect The Hearts Of Our Patients, Gisha Gireesan

Master's Projects and Capstones

Section I: Abstract

Problem: January and February 2021 data showed a rise in readmissions for the NSTEMI population. This is significant as 2020 had a readmission rate of 5.6% and 7.3% in 2019. This sudden increase in readmissions within the first two months of the year is a cause for concern and immediate action is needed.

Context: 2020 had a reduction in cardiac catheterizations due to the multiple canceled cases during the COVID 19 pandemic. As the cases were being rescheduled along with new cases in 2021, the institution experienced an uptake in readmissions.

Interventions: The staff of department 220 …

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 …

Implementing Staff Education To Reduce Stress And Increase Resilience, Samantha Lambert, Mariana Corpus, Sherry Chesak, Susanne M. Cutshall, Diane M. Forsyth, Habibo A. Haji

Nursing DNP Projects

Purpose: Persistent levels of high stress among nurses impact work activities and job performance, leading to burnout, compassion fatigue, lower job satisfaction, high workplace turnover, and diminished quality of patient care (Lin et al., 2018). Nurses who demonstrate resilience are better able to adapt to unexpected events with a positive attitude, self-esteem, and tolerance (Huang et al., 2020). The purpose of this project was to decrease stress levels and improve resilience among nursing staff, utilizing education on holistic stress management and resilience techniques.

Methods: A four-hour mindfulness-based education course was provided to staff members (N=76). Components included an initial two-hour …

Manager Onboarding To Improve Retention, Knowledge, And Confidence To Lead, Christine Asiimwe

Doctor of Nursing Practice (DNP) Projects

Objective: The purpose of this paper is to review the literature on manager onboarding best practices and their impact on turnover intention, knowledge, and confidence to lead teams in primary healthcare settings.

Background: Primary care onboarding is often insufficient due to competing operational priorities, time constraints, lack of mentorship, and cost. With primary care increasingly the setting for affordable, coordinated, end-to-end patient care, primary care managers must be well-prepared to lead the care team.

Methods: A review of the literature identified best onboarding practices associated with job satisfaction and turnover, reduced time to proficiency, increased knowledge, and confidence to lead. …

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' …

Patient Placement Matters: A Systematic Review Of The Impact Of Multiple Patient Placement, Jacqueline Strinden

DNP Qualifying Manuscripts

Abstract

Background

Inattention to the frequency of patient movement has been correlated with system-induced harm events, diminished favorable health outcomes, and reduction in patient and staff satisfaction. The incidence of adverse events increases significantly when multiple unnecessary lateral relocations result from secondary efforts to relieve hospital capacity constraints and improve efficiency.

Methods

A systematic review of literature was conducted to evaluate the impact of adverse events, patient and staff perceptions, and resource utilization on frequent patient placement events.

Results

Results of the analysis demonstrate that increased adverse events, negative patient and staff perceptions, increased workload, and resource utilization is significantly …

Practice Development Trajectories Of Experienced Nurses: Adaptive Experts, Routine Experts, And Non-Experts, Dee Mulcahy

Nursing ETDs

This qualitative study examined practice development among experienced, acute care nurses (n = 9) with at least 10 years of experience. Using an interpretive biographical approach, with participants’ written practice narratives and in-depth interviews, the study focused on how the work environment and life experiences influenced or impeded practice development. Participants were classified as routine- or adaptive experts (n = 3 of each type) with one intermediate case and two not readily classifiable. Antecedents to becoming a nurse included family influences, personal interests, altruistic values, and financial need. Experience was necessary but not sufficient for adaptive expertise. Compared …

Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach

Doctoral Projects

The lack of preoperative warming has a direct relationship to perioperative hypothermia complications which include, but are not limited to: increased infection rate, coagulopathies, and increased myocardial oxygen consumption; all contributing to poor patient and facility outcomes. Implementation of an evidence-based educational module with visual aid can potentially increase the utilization of active warming techniques in the preoperative setting by perioperative staff. The DNP Project investigated barriers to preoperative warming by perioperative staff at a large teaching hospital in the southeastern United States. Barriers were assessed by a voluntary survey sent to 87 perioperative staff members. Twenty-two surveys were completed …

Implementation Of A Pre-Anesthesia Take-Home Evaluation (Pathe) As A Means Of Process Improvement: A Best Practice Recommendation, Russell Gray, Hunter Brown, Trey Galloway

Doctoral Projects

The pre-anesthesia evaluation (PAE) is a vital component to anesthesia providers when choosing an appropriate anesthetic plan for patients requiring surgery. The PAE, pre-anesthesia risk-factor assessment, and provision of pre-anesthesia instructions are standards of care implemented in order to assess the patient’s likely outcome of surgery and anesthesia as well as stratify any known risk factors to optimize surgical/anesthetic outcomes. Any disruption in this process could potentially lead to decreased patient/provider satisfaction, reduced patient compliance with pre-anesthetic instructions, reduced patient safety, and unnecessary financial burden.

After the completion of a literature review, the need for a best practice recommendation was …

A Performance Improvement Project To Improve Hand-Off Communication Documentation Within The Surgical Services Department, Bobbie J. Wich, Millie Escalona, Judy E. Bowling, Ana L. Santos

Nursing & Health Sciences Research Journal

Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary …

Implementation Of An Oral Hygiene Protocol For Adults Patients On Acute Care Units, Sharon J. Boler

Student Scholarly Projects

Practice Problem: Patients diagnosed with non-mechanically ventilated aspiration pneumonia can result in increased levels of care, longer lengths of stay, and are 8.4 more likely to die while hospitalized. Oral hygiene protocols have led to promising outcomes, evidenced by fewer cases of aspiration pneumonia in adult patients on medical surgical units.

PICOT: The PICOT question that guided this project was in adult non-mechanically ventilated hospital patients, does an Oral Hygiene Protocol (OHP) compared to current practice affect hospital acquired aspiration pneumonia during hospitalization.

Evidence: Fourteen studies met inclusion criteria that support the implementation of an evidence – based oral hygiene …

Bedside Shift Reporting: A Benchmark Project, Clydea C. Hale

MSN Capstone Projects

Patient care is forever changing to improve satisfaction, safety, and overall treatment. Over the past few years, patients and their families are more invested in their overall care in the hospital and expect to be informed every step of the way. A common complaint from patients or their families is that one nurse or staff did not know the individuals care or treatment plan, there were no shift goals to work toward discharge, and the nurse did not update the patient/family with changes in care. All of these complaints along with the patient satisfaction scores and communication between the treatment …

Evidence-Based Individualized Discharge Educational Intervention For Coronary Artery Disease (Cad) Patients; A Benchmark Project, Sumita Thapa

MSN Capstone Projects

Coronary artery disease (CAD) is the leading cause of death worldwide, whereas, in the United States, 16,800,000 people are affected, resulting in 450,000 deaths annually. Patients’ perceptions of self-management related to treatment adherence, lifestyle modifications, and risk-factor management are significant indicators of outcomes following a cardiac event. To promote self-management in CAD patients, this benchmark project aims to determine the impact of individualized education interventions by establishing a standardized nurse-led educational intervention in the cardiac unit that emphasizes adherence to self-management and treatment regimen to improve quality of life and prevent rehospitalization due to worsening cardiac events. The evidence-based findings …

Understanding Colorectal Cancer: Increasing Screening Rates Amongst Young- And Middle-Aged Adults By Enhancing Prevention Potential, Sarah Agudelo

Nursing | Senior Theses

As nurses, working towards the best health outcomes for our patients is critical to our care. A large aspect of this care includes being knowledgeable of risk factors and precautions to take to avoid conditions and illnesses. Colorectal cancer remains to be a highly preventable disease, yet it is one of the top five leading causes of cancer deaths in the nation. Preventing colorectal cancer requires the efficient use of screening and education, while also addressing barriers of inconvenience and affordability. This senior thesis delves deeper into colorectal cancer prevention by asking the research question: For young and middle-aged adults, …