Talk to a librarian 385.375.8361|library@rm.edu

Doctor of Nursing Program Scholarly Projects

Home/Learning Resource Center/RMUoHP Publications/Doctor of Nursing Program Scholarly Projects

Use “Ctrl+F” (Windows) or "Command+F" (Mac) for the internet browser search bar to find a specific name quickly.

2007

    Telepsychiatric Services Incorporated Within Northwestern Wyoming’s Rocky Mountains

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Albrecht, Herk

    Historically, this mountain region of Northwest Wyoming has not bee able to maintain “regular” or “reliable” access to psychiatric health care services provided by a psychiatrist. Lack of psychiatric service to this area is further axacerbated by the fact that there are no practicing psychiatrists within 120 miles of this remote area. The entrepeneur’s rationale and purpose was simply to fill the need (supply) for a practicing psychiatrist (demand) to ease the burden. This situation was evaluated to be a logical opportunity to employ telepsychiastry for this areas mental health population. It was anticipated that with the establishment of telepsychiatry, an affordable and convenient option would enable access to mental health care and provide for a continuity of care provided by a psychiatrist.

    Request this Article


    Telephone Management of Heart Failure Patients: A Nursing Clinical Project

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Amann, Isabelle T.

    Heart failure is a devastating syndrome that will affect one in every three adults in the United States. Heart failure management is costly and patients diagnosed with heart failure use a disproportionately high percentage of healthcare dollars. The management of heart failure patients is time consuming and complex. Nurse practitioners are well suited to provide quality care to this population of patients and through aggreeive management and education keep hospital patients from multiple readmissions.

    Request this Article


    Family Presence Self-Awareness of Clinical Department Head Administrators: An Interventional Design for the Acute Care Setting

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Baxter, Kara K.

    Problem: While most family members now have access to the delivery room to observe the beginning of life, those same family members are largely prohibited from viewing the resuscitative efforts of loved ones in the emergency room. Despite research to the contrary, most hospitals persist in prohibiting family members from being present during invasive procedures and/or resusucitation because of unfounded concerns. The lack of understanding about potential benefits of family presence leaves both clients and providers frustrated and potentially culpable. Purpose and Scope: The purpose of this capstone project was to describe the level of family presence self-awareness of clinical department head adminstrators within a selected healthcare organization before and after a family presence teaching intervention. The rationale for the project was that development of a family-presence policy for the selected acute care setting would foster family presence throughout the facility. Goal: The goal of the project was to successfully implement a family presence teaching intervention for clinical department head administrators within a healthcare organization. Objectives: First, to describe demographic characteristics of clinical department head administrators within a selected healthcare organization. Second, to describe pre-intervention self-awareness of selected clinical department head administrators within a selected healthcare organization related to family presence during invasive procedures. Third, to describe pre-intervention self-awareness of selected clinical department head adminstrators within a selected healthcare organization related to family presence during resuscitation interventions. Fourth, to describe post-intervention self-awareness of selected clinical department head administrators within a selected healthcare organization related to family presence during invasive procedures. Fifth, to describe post-intervention self-awareness of selected clinical department head administrators within a selected healtcare organization related to family presence during resuscitation interventions. Sixth, to measure changes in self-awareness before and after a family presence teaching intervention. Plan: Phase One: Conduct a needs assessment using a published evidence-based critique template. Phase Two: Deisgn a family presence teaching intervention using a Evidence Based Medicine approach. Phase Three: Implement an evidence-based family presence teaching intervention for a projected sample. Phase Four: Evaluate the level of family presence self-awareness before and after a family presence teaching intervention using the Self-Assessment Survey. Outcomes and Results: Using a triangulated intervention research design, results of the pre-intervention and post-intervention measures revealed a modest mean score increase in family presence self-awareness in the clincial department head administrators. Moreover, scaled reliability estimates based on internal consistency for the pre-intervention testing achieved significance, while the post-intervention testing also achieved signifiance with regard to the tool’s performance in this interventional design.

    Request this Article


    Effect of a Teaching Intervention

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Celaya, Mary S.

    The purpose of this capstone project was to describe the impact of Community Acquired Methcillin Resistant Staphylococcus Aureus at correctional facilities, describe interest in online continuing education based on a market analysis of correctional health Registered Nurses, and evaluate the impact of an online educational intervention on level of knowledge of correctional care nurses regarding wound manangement immediately following the intervention.

    Request this Article


    Conflict Resolution Model for Nursing: Intervention and Instrumentation

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Chronis-Kuhn, Jean

    The purpose of this capstone project is to describe conflict resolution styles among selected nursing home directors before and after a conflict management teaching intervention. The scope of the project was based on findings from a needs assessment which suggested that increased knowledge regarding conflict resolution styles may impact how participants approach and resolve conflict in the future.

    Request this Article


    Improving the Effectiveness, Efficiency, and Practicality of Nursing Home Provider Progress Notes: A Step Toward Electronic Medical Records

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Ezeokeke, Ogo

    Problem: Nursing home quality of care has increasingly been the focus of research literature where findings reveal that nursing home resident care is substandard while the multiple and complex needs of geriatric patients are not being adequately addressed. While nursing home residents have multiple and complex needs, there are numerous regulations that guide care to facilitate improved quality of care. In order to serve the geriatric population, providers must be able to identify and develop plans of care for their multiple and complex needs while also adhering to multiple and complex regulations. Purpose and Scope: The purpose of this project is to improve effectiveness, efficiency, and practicality, of nursing home provider progress notes used to document care by geriHEALTHsolutions geriatricians. The scope of the project was based on findings from a needs assessment that supported the need for improved documentation and the medical business of communication. Goal: The goal of the project was to successfully implement an improved progress note for nursing home providers within a selected healthcare organization. Objectives: First, to describe nursing home progress note needs from the perspective of nursing home providers within a selected healthcare organization. Second, to describe aggregate demographic characteristics of nursing home provider participants in a needs assessment for progress note. Third, to describe aggregate demographic characteristics of nursing home provider participants in an electronic medical record initiative for progress note. Fourth, to describe redesign efficiency of a nursing home provider progress note within a selected healthcare organization. Fifth: to describe redesign practicality of a nursing home provider progress note within a selected healthcare organization. Sixth, to describe redesign effectiveness of a nursing home progress note with a selected healthcare organization. Plan: Phase One: Conduct a literary needs assessment using a published evidence-based critique template. Phase Two: Develop and validate study instrumentation using an evidence-based medicine approach and proceed through institutional review board approval process. Phase Three: Evaluate data from an author-developed needs assessment questionnaire. Phase Four: Redesign and evaluate the new progress note for its efficiency, practicality, and effectiveness using an author-developed valid and reliable electronic medical record progress notes measurement tool. Outcomes and Results: Using a triangulated interventional research design, results of the needs assessment and post-intervention measures revealed and improved progress note for nursing home providers within the selected healthcare organization, with internal providers and nurse providers most in agreement with the change. Moreovever, scaled reliability estimates based on internal consistency for the author-developed electronic medical record progress notes measurement tool achieved subscale scores as follows: alpha =.95 for effectiveness; alpha = .90 for efficiency, and .98 for practicality.

    Request this Article


    Healthcare Provider Satisfaction with Medication Management After Implementation of Informatics

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Foster, Melissa Lewis

    The long term care facility at South Lincoln Medical Center located in rural Wyoming has a 24 bed capacity that maintains maximum occupancy. Each of the five healthcare providers rotates after hours call for the residents, and often are contacted for medication adjustments or analgesics, and do not have access to the list of medications for these residents. Utilization of an integrated Personal Digital Assistant (PDA) will allow the providers access to the medication list of the long term care residents. By tapping onto the resident’s name, a current list of prescribed medications, including drug to drug interaction appears on the screen. The purpose of the project is to determine if the healthcare providers would be more satisfied with medication management of these residents with access to a complete list of medications.

    Request this Article


    Staff Nurses and EBP : Filling the Gap Between Evidence and Practice

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Gilbow, Jennifer K.

    There is a paradigm shift in the provision of nursing care from reliance on traditions, principles of pathophysiology and expert advice to the delivery of evidence-based practice (EBP) resulting in improved patient outcomes. However, undergraduate nursing curricula do not encompass the principles of EBP leaving nurses unprepared to practice within the new paradigm. Educational programs regarding EBP components and principles are crucial in order to rectify this knowledge and practice deficit. The purpose of this project was to describe the level of knowledge, attitude and utilization of EBP among acute care staff nurses before and after an EBP educational intervention. The project sought to answer the following research question: In staff nurses working in acute care hospital, how effective is an educational seminar on EBP at impoving knowledge, attitude and utilization of EBP?

    Request this Article


    Stress and Health-Promoting Behavior: An Evidence-Based Intervention for Integrative Healthcare Providers

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Gourley, Janet M.

    Levels of stress in our society are increasing. One only needs to pick up a newspaper or listen to the news on any given day to confirm this fact. Stress reactions frequently require medical intervention and healthcare providers are expected to be knowledgable about stress in order to provide adequate care. Despite this need, some of these providers are often ill prepared to provide adequate stress education due to an identified lack of medical/professional training on the topic. Research has shown that upwards of 42% of healthcare professionals have never received training on treating clients with stress or those in stressful situations. This information demonstrates a real disconnect between healthcare provider’s basic knowledge about stress and their role in providing this important and relevant education to patients. The purpose of this capstone project was to raise the knowledge level of healthcare providers on the topic of stress. The educational program that was designed was an evidence based module on what stress is, sources of stress, its impact on patients and providers’ health and the management of stress. The rationale for this project was that since research has shown that some healthcare providers have a knowledge deficit about stress, while at the same time being expected to educate their patients on this topic, an educational program was needed to fill this gap.

    Request this Article


    Acute Care Staff Attitudes Toward Animal Assisted Therapy Before and After an AAT Teaching Intervention

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Hogue, Carol S.

    Problem: Animal Assisted Therapy (AAT) is emerging as a therapeutic healthcare intervention for a variety of health disorders, medical diagnoses and related conditions. The therapy is designed to promote improvement in human physical, social, emotional and/or cognitive functioning. Animal assisted activities provide opportunity for motivational, educational and/or recreational benefits using an animal that enhances quality of life. The introduction of AAT has been studied in long-term care facilities, but only recently has AAT been considered in acute care. Purpose and Scope: The purpose of this capstone project is to describe selected attitudes of nursing service staff members toward AAT within a selected healthcare organization before and after an AAT teaching intervention. The rationale for the project was that increased knowledge of the benefits of AAT in the acute care setting would foster interest in developing an AAT program within the healthcare facility. Goal: The goal of the project was to successfully implement an AAT teaching intervention for nursing service staff members within a selected healthcare organization. Objectives: First objective is to describe aggregate demographic characteristics of nursing service staff members toward AAT within a selected healthcare organization; second, to describe pre and post-intervention attitudes in nrusing service staff members regarding adverse impact of AAT within a selected healthcare organization; third, to describe pre- and post-intervention attitudes in nursing service staff members regarding organizational culture perspectives of AAT within a selected healthcare organization. Fourth objective is to describe pre- and post-intervention attitudes in nursing service staff members regarding dog acceptability of AAT within a selected healthcare organization; and fifth, to measure changes in attitudes in nursing service staff members regarding AAT before and after an AAT teaching intervention. Plan: Phase One: Conduct a needs assessment using a published evidence-based critique template. Phase Two: Design an AAT teaching intervention using an evidence-based medicine approach. Phase Three: Implement the evidence-based AAT teaching intervention for a projected sample of nursing services staff members at a selected acute care facility. Phase Four: Evaluate the level of attitudes toward AAT before and after the AAT teaching intervention using the Brisbane Animal Assisted Therapy Acceptability (BAATA) Test. Outcomes and Results: Using a descriptive-interventional research design, results of the pre-intervention and post-intervention measures revealed a modest mean score increase in selected attitudes of nursing service staff members toward AAT. Moreover, scaled reliability estimates based on internal consistency for the subscales improved signficance from Moody, King, and O’Rourke to this project’s pretest scores, and ultimately, this project’s posttest scores as follows: alpha = .87, .91, and .91 respectively for adverse impact; alpha = .70, .94, and .93 respectively for organizational culture; and alpha = ,78,.90, and .89 respectively for dog acceptability.

    Request this Article


    Continuing Legal Education Programming for Advanced Practice Registered Nurses: An Application in New Hampshire of Green’s Continuing Education Process

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Morrison, Constance A.

    An alarming trend is that the numbers of state board nursing actions against nurses has been steadily increasing since the 0.2-0.3 percent of all United States registered nurses who were annually disciplined at the turn of the twenty-first century. At the same time, the numbers of APRNs who have had increased responsibility and accountability in their scope of practice have also faced intensified scrutiny by these same boards of nursing. With the national trend of increased litigation, increased malpractice premiums, and increased civil, criminal, and board of nursing action, Continuing Legal Education Programming (CLEP) is vital. Yet, little of the literature reviewed for this project addressed the need for such intervention for APRNs, nor did the literature address testing of a model for continuing legal education. Purpose and Scope: The purpose of this project is to describe the need for and utilization of CLEP among APRNs in a selected state using the Green Continuing Education Process Model. The rationale for the project was that the design and implementation of CLEP would assist New Hampshire APRNs to increase their awareness of liability issues and knowledge of laws and risk management strategies relevant to practice. Goal: The goal of this project is to develop and implement relevant CLEP for APRNs leading to practice change in a selected state. Objectives: First, to construct and administer a CLEP needs assessment to a survey minimum of 50 and as many as 75 licensed APRNs in New Hampshire, that measures demographic information to include but not limited to length of experience as an APRN by December, 2006. Second, to develop and implement a one-day cost-effective CLEP Spring 2007 Seminar for APRNs incorporating the results of the CLEP needs assessment survey by March, 2007. Third, to evaluate CLEP Spring 2007 Seminar participant response regarding relevance to and change in practice as a results of attendance at the CLEP Spring 2007 Seminar by April, 2007. Fourth, to test a process for the ongoing planning and delivery of CLEP for APRNs, based on findings from the CLEP needs assessment and the outcomes measured in the CLEP Spring 2007 Seminar pst-evaluation survey. Plan: Phase One: Develop/Administer CLEP needs assessment survey; analyze data. Phase Two: Plan, develop and implement CLEP Spring 2007 Seminar. Phase Three: Collect and analyze data from post-seminar outcomes evaluation survey, and evaluate model and outcome measurements. Outcomes and Results: Green’s model and needs assessment/post-seminar evaluation surveys were adapted for use with continuing legal education programing for New Hampshire advanced practice nurses. Cronbach’s alpha measures for the pre-test and for the post-test were achieved in the samples. The CLEP model adapted from Green was found to be both valid and reliable. Key findings revealed that 80 percent of the CLEP participants believed CLEP to be relevant to their clinical practice while 88 percent made changes in their practice within 21-days following the CLEP intervention.

    Request this Article


    Patient Flow in a Hospital Urgent Care Unit: An Interventional Study

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Pruitt, Alicia C.

    Problem: Emergency Department overcrowding results in longer lengths of stay and decreased patient satisfaction. “Fast track” units within EDs answer many of the problems of overcrowding and long wait times for non-urgent patients, but are often underutilized or managed in similar methods as traditional ED settings, negating any perceived benefits of such a unit. As a result, patients seeking care for non-urgent problems experience waits of 2 to 6 hours for a service that takes minutes to complete. Purpose: The purpose of the project is to describe the patient flow in a hospital ED’s urgent care unit (UCU) before and after the implementation of selected interventions to improve patient flow. Objectives: The first objective is to perform a literature review to discover the current level of healthcare knowledge regarding: a) patient flow in EDs and UCUs, and b) identifying evidence-based methods to improve the process. The second objective is to evaluate the level of patient flow in a UCU before and after the implementation of selected interventions based on literature review to improve patient flow. Goal: Reduce length of stay for care in the selected UCU to an average of 90 minutes. Plan: Phase One: Perform a literary need assessment regarding the current level of application of patient flow improvement processes in UCUs associated with hospital EDs. Phase Two: Implement interventions to improve patient flow in a selected UCU. Phase Three: Evaluate the effect of interventions on length of stay. Outcomes: Three interventions were identified from the literature and implemented into practice in the selected UCU. LOS was compared in two data sets based on power analysis for alpha = .05, power = .80, and effect y = .50, from the same start/stop dates one year apart. The two groups were compared using qualitative descriptive statistics to describe patient flow in the UCU before and after the implementation of selected interventions to improve patient flow. The overall LOs decreased, and the goal of average LOS at or less than 90 minutes was met. The range and standard deviation of the two groups did not appreciably change, indicating consistent timing of patient encounters.

    Request this Article


    Improving the Quality of Life for People with Chronic Pain

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Rader, Richard

    Fifty to 75 million Americans live with chronic pain. Fourty percent of these pain sufferers are unable to work due to their pain. Most people who have chronic pain have tried several types of therapies to treat their pain including medication, physical therapy, and holistic techniques such as acupuncture or acupressure. The purpose of this project was to assist people with chronic pain take more control of their health, and improve the quality of their lives.

    Request this Article


    Developing a Diabetes Self-Management Education Program

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Rex, Loquintha

    Problem: Pre-diabetes is an insidious condition that commonly persists for many years while progressing on to diabetes type 2. As many as 39% of patients who present with a new diagnosis of type 2 diabetes already have the presence of diabetes complications at initial diagnosis. Diabetes has become an epidemic that continues to escalate annually. Diabetes can affect multiple organ systems and lead to serious debilitating complications. Ventura County is consumed with many diabetics. There are not any comprehensive diabetes education programs in the county. Purpose/Scope: The purpose of this evidence-based practice intervention was to evaluate the effectiveness of a Diabetes self-management education (DSME) program on patient’s health care utilization, medication use, self-efficaacy for diabetes and general disease management and ability to exercise, and glucose testing. A pres-test/post-test design was utilized to survey subjects participating in the program. The participants received education in four sequential sessions delivered at consistent time intervals over an eight week period. Goal: The goal of developing this program was to empower patients to develop the knowledge and skills necessary to improve health outcomes and to provide access to a diabetes self-management education program open to the general public residing in Ventura County in hopes to improve patient’s lives by reducing potential long-term diabetes complications following gaining knowledge of preventative care, improving early diabetes diagnosis, and reducing the workload of primary care practices. Objectives: the objectives of this project included: following the completion of the DSME program, the subject will gain improved scores on the Chronic Disease Self-Efficacy Scales: Exercise Regularly, Manage Disease in General, Health Care Utilizations, Glucose Testing, and self-efficacy to perform self-management behaviors comparing pre-course versus post-course scores. Plan: Phase I and II involved developing the proposal draft and submitting the document to the GPD. The proposal was submitted to the IRB and approved on 3/20/2007. The class content slides were finalized. Phase III involved recruiting subjects and advertising. The classes began April 9, 2007 and continued for four separate sessions through 5/14. Pre-test and post-test questionnaires were handed out to subjects on the first day and last day of classes. Following completion, the data was analyzed. Outcomes and Results: The pre-test and post-test mean scores were compared using paired t-test and the differences were statistically significant.

    Request this Article


    Cost Effectiveness and Global Assessment of Functioning Scores for Respiridone Long-Acting Injection Compared to Oral Resperisone

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Sanchez, Broc

    Schizophrenia is a costly psychiatric condition due to its refractory nature, frequent relapses, and need for hospitalizations that are often due to patients not habitually taking their psychiatric medications. Risperidone long-acting injectable, the first available long-acting atypical antipsychotic, was recently introduced and may be one method of improving patient compliance, thus potentially improving fuctioning and decreasing overall costs. However, few studies comparing Risperdal Consta� related to cost or Global Assessment of Functioning (GAF) scores have been done in the USA and none have addressed both matters. Due to the dearth in the research on effects and benefits of use of the long-lasting injectable in patients, the effects on cost and patient functioning of using the long-acting injectable over time are unclear. The expected implications for practice for this capstone project was that the patient taking Risperidone long-acting injectable (Risperdal Consta�) for six months may demonstrate improvement in the Global Assessment of Functioning (GAF) scores and decreased overall cost of psychiatric medications from initiation of this medication as compared to oral risperidone. Overall, cost containment and efficacy were expected from this medication (Risperdal Consta�) usage.

    Request this Article


    Family Satisfaction with End of Life Care in a Midwestern Veterans Administration Nursing Home

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Schams, Kathryn A.

    The Institute of Medicine recommends an evidence-based, patient-centered approach to end-of-life care in the U.S. that is evaluated according to a patient perspective framework. Pain and fatigue often limit the dying patient’s ability to participate in discussions about end of life and, as a result, family members are asked to describe the patient’s dying experience. Families have reported dissatisfaction with end-of-life nursing home care related to symptom management, emotional support, and communication with physicians. The purpose of the project was to facilitate an interdisciplinary, evidence-based quality improvement (QI) project with the Performance Improvement (PI) Department and Palliative Care Consult Team (PCCT) related to family satisfaction with end-of-life care in a Midwestern Veterans Administration long term care facility. The goal of the project was to evaluate and improve family satisfaction with end-of-life care at a Midwestern Veterans Administration Medical Center through and evidence based QI project. The objectives of the project included (a) to determine family satisfaction with end-of-life care in 2006, (b) to determine whether family satisfaction with end-of-life care varied according to the nursing home unit where care was provided, (c) to determine if any specific aspects of care, such as respect for the patient and relief of pain had a significant impact on overall satisfaction with care, (d) to determine differences in family satisfaction with end-of-life care from 2004 to 2006, and (e) to develop a QI project related to family satisfaction with end-of-life care, based on annual survey trends. The focus and feasibility of the project were determined in Phase I. Phase II included a review of records to measure family satisfaction with end-of-life care in the facility. Phase III consisted of disseminating the results to the organization, and developing a logic model to evaluate the facility’s pain program and make recommendations for improvement. Phase IV involved the adoption of the proposed pain management program by the administration throughout the facility. Differences in three areas associated with family satisfaction with end-of-life care reached statistical significance over the three year period. The number of families reporting spiritual discussions with staff increased from 2004 to 2006, as did the number reporting that the decedent received care consistent with his/her wishes. More family members, however, identified an unmet need for pain control in 2006 than 2005. The capstone project was presented to the PI Director, PCCT, and staff on the hospice unit. The capstone project was approved for implementation in the facility by the PI Director.

    Request this Article


    Nurse Practitioner Attitudes Toward Professional Website Hosting Before and After a Web-Based Tutorial Intervention

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Schmeltz, Cindy

    Problem: The health care environment system of today is knowledge intensive. Information can be utilized and tranformed into data in which to share knowledge and improve professional awareness. Obtaining knowledge is available to anyone with access to the internet. The Berks County Nurse Practitioners (BCNP) currently lack internet presence. The current method of communication is through phone, traditional post service or email. Attitudes and comfort levels toward electronic communication could influence their willingness to utilize this mode of interaction. The ability for computers to facilitate professional communication has profound implications. Today’s health care professional will need to utilize and incorporate internet technology to remain informed and aware of professional issues throughout their careers. Purpose and Scope: An identified need of BCNP organizational membership was to improve professional awareness, communication and networking within members of the organization. Recent advances in information technology can provide new opportunitites for enrichment through the development of a nurse practitioner website. The revolution of electronic communication provides more information gathering options and increased accessibility to members. This project seeks to describe nurse practitioner member attitudes toward professional website hosting before and after a professional web-based tutorial intervention for the purpose of developing an organizational website.

    Request this Article


    Feasibility Plan for Rural Healthcare, LLC

    Published Year: 2007
    Program: Doctor of Nursing Practice

    Taylor, Carol Lee

    With an increase in aging and uninsured in the U.S. population, there has been an increase in individuals seeking primary health care. In addition,many physicians have left rural communities or only stay a short time and many independent Nurse Practitioners (NPs) have started their own practices. In many instances, nurse practitioners have identified difficulties in the management aspect of their businesses as well as problems meeting the need to increase health care access and satisfaction for the clients. While many authors have discussed satisfaction and access to health care, the financial difficulties that arise in a private practice often need improvements for the enterprise to be sustainable. Approximately 30 years of comparison studies have demonstrated NPs are equitable to physicians concerning quality of care, satisfaction, and cost effectiveness. The purpose of this project is to ascertain if the NP owned Rural Health Care (RHC), a Limited Liability Company (LLC) located in rural New Mexico (NM), will meet the objectives in providing better access to care and client satisfaction by improving the business management systems and thus increase profits compared to the past performance. With more management efficiency and profits, it is expected that access to care and client satisfaction will be improved and will add to the retention of clients and ultimately, revenues. The market and risk analysis revealed the need for a NP enterprise and the study demonstrated a good outcome. After an evaluation of the positive results, a repeat study is recommended to test the vailidity and reliability of the modified survey.

    Request this Article


    Client Satisfaction With Perceived Healthcare Following a Parental Teaching Intervention

    Published Year: 2007
    Program: Doctor of Nursing Practice

    White, Dorothea Dee

    Background and Problem: Over the past several years, growing attention has focused on the emergence of antibiotic resistant bacteria. As a result of this attention, extensive studies have been conducted to describe the emerging threats of infectious desease that no longer respond to the traditional repertoire of antibiotics. The lack of understanding about the potential adverse affect of antibiotic therapy when diagnosed with a viral infection leaves both clients and providers frustrated and potentially dissatisfied. Purpose and Scope: This investigation sought to describe the level of parent satisfaction with perceived healthcare following a parental teaching intervention for a child with viral infection. The study was that of a quantitative design using descriptive methodology and based on an evidence-based practice systematic review as defined by Sackett, Straus, Richardson, Rosenburg, and Haynes. The survey tool was the Client Satisfaction Tool by Bear, Covelli, and Bruneli. Parents (N=60) of ill children, ages 1 to 12 inclusive were asked to particiapte and given supportive care instruction for a viral infection diagnosis. The teaching intervention included potential adverse effects of antibiotic therapy when diagnosed with a viral infection and homecare techniques to alleviate viral sequelae. Data was analyzed by using descriptive statistics (mean, median, and mode) and standard deviation with SPSS� software. Goal: Successfully implement a parental teaching intervention for viral infections without antibiotic use within a selected healthcare organization. Objectives: 1. Decrease misuse of antibiotics for viral infections among children ages one to twelve years through parental teaching intervention. 2. Increase parent knowledge about the appropriate use of antibiotics in children with infections between ages 1 to 12 years with parental teaching intervention. 3. Foster high level of parental satisfaction with healthcare following parental teaching intervention for supportive care of a viral infection. Plan: Phase One: Conduct a needs assessment using a published evidence-based critique template. Phase Two: Desgin a parental teaching intervention using the Evidence Based Medicine (EBM) approach, in which key findings from the systematic review of literature is compared to available current practice guidelines, resulting in best practice recommendations. Phase Three: Following RMUoHP IRB approval, implement the evidence-based parental teaching intervention for projected sample (N=60) of parents of an ill child with viral infection. Phase Four: Measure level of parent satisfaction with perceived healthcare following the selected teaching intervention using the Client Satisfaction Tool. Outcomes and Results: Two measures of satisfaction (overall and total score) revealed high levels (96.6% and 98%) of parent satisfaction with perceived healthcare following parental teaching for a child with viral infection. Reliability of the instrumentation was additionally tested in the sample (N=60), and revealed a statisically significant strength (r=.85; �p�< .000) for the tools performance in this population.

    Request this Article


2008

    Client Satisfaction with Nurse Practitioner Delivery of Care Following a Skilled Intervention

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Downey, Nancy

    Problem: The healthcare system in the United States has increased in complexity, resulting in new and expanded opportunities for nurse practitioners. Activities previously performed only by medical doctors are now becoming increasingly within the scope of practice of the nurse practitioner. Little information is known about how patients perceive this healthcare change. Nurse practitioners often manage patients with acute and chronic disorders and numerous studies have shown that patients are satisfied with their delivery of care. Specifically, the question of client satisfaction with nurse practitioners delivery of care following a skills intervention, specifically performing a paracentesis for patients with large volume ascites is examined. Purpose and Scope: The purpose of this capstone project was to describe patient/client satisfaction with nurse practitioner delivery of care following a skilled intervention. The performance of an invasive procedure, usually done by medical doctors, specifically, an abdominal paracentesis for large volume ascites in patients with liver cirrhosis, was examined at two Department of Veterans Affairs Medical Centers, Long Beac California and Portland Oregon. The findings of the project will serve to describe the patient/client population and to examine the results of a twelve item Client Satisfaction Tool (CST) of the procedure performed by nurse practitioners. Goal: The goal of the project was to successfully implement a client satisfaction project in a selected population within two healthcare organizations. Objectives: This project had three overarching objecives. The first was to describe the demographic characteristics of the patients enrolled in the project within the two selected healthcare organizations. Second was to summarize of the Client Satisfaction Tool collected from the two Department of Veterans Affairs Medial Center sites. Third was to formulate conclusions and make recommendations based on the findings. Plan: Phase One: Conduct a needs assessment using a literature review. Phase Two: Design, plan, and develop the evidence-based project. Phase Three: Implement the Client Satisifaction project in Long Beach, California and Portland Oregon. Phase Four: Evaluate the analyzed the collection data. Outcomes and Results: Forty patients completed the CST questionnaire and provided demographic information. Twenty patients/clients were enrolled at each site. Using a triangulated research design, scaled reliability estimates based on internal consistency for the Oregon sample achieved significance while the California sample also achieved significance. On a scale of 1 to 5 with 1 being the lowest and 5 being the highest, the mean scores for the Oregon sample was 4.78 and the mean score for the California sample was 4.64. The findings revealed that patients/clients were very satisfied with nurse practitioner delivery of care following the skilled intervention.

    Request this Article


    Nurse Practitioner Knowledge of Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS): An Evidence-Based Practice Perspective

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Galler, Diana L.

    Problem: In the United States today, an estimated 15 million men are troubled by symptoms of benign prostatic hyperplasia (BPH) and, as the prevalence of prostate problems increases with age, this number will only increase as the aging population arises. The significant impact BPH symptoms have on quality of life (QoL), when combined with the high cost of medical/surgical treatment, have made BPH an important healthcare issue. Moreoever, the majority of men suffering from lower urinary track symptoms (LUTS) are initially seen by primary care providers for evaluation and treatment. With the number of nurse practitioners (NPs) employed in primary care, NPs must demonstrate knowledge regarding prostate pathophysiology, assessment, and current treatment options in order to decrease symptoms, prevent complications, and improve QoL. Therefore, the purpose of this Evidence-Based Practice (EBP) project was to describe the level of NP knowledge regarding BPH and LUTS before and after participation in an online educational intervention. Purpose and Scope: The purpose of this project was to describe the level of NP knowledge regarding LUTS and BPH before and after participation in an online educational intervention. A systematic review of healthcare evidence documented the need for an understanding of prostate pathophysiology, patient assessment, and diagnostic testing for BPH, in addition to evaluation and medical management according to the Guidelines on the Management of Benign Prostatic Hyperplasia and other clinical and best practice guidelines evaluated. Goal and Objectives: The goal of this project was to increase NP knowledge of current evidence-based findings in the evaluation and medical management of LUTS and BPH. The objectives of the project were to: (a) Describe NP pre-intervention level of knowledge regarding evaluation and medical management of LUTS/BPH, (b) Develop an evidence-based online teaching intervention to address NP level of knowledge regarding evaluation and medical management of LUTS/BPH, including pharmocological treatment options, and (c) Describe NP post-intervention level of knowledge regarding evaluation and medical management of LUTS/BPH. Plan: Phase One: Conducted a needs assessment using a published evidence-based critique template. Phase Two: Designed an online teaching intervention using an evidence-based medicine approach. Phase Three: Implemented an evidence-based online online tutorial for participants. Phase Four: Evaluated pre-intervention and post-intervention level of NP knowledge regarding evaluation and medical management of LUTS/BPH before and after NP participation in the online teaching intervention using a knowledge subscale adapted from a 28-item instrument developed by Kerfoot et al. Outcomes and Results: Using descriptive-interventional methodology, the findings from the project revealed a modest increase in NP knowledge from an aggregate percentage performance of .77 at pre-test to an aggregate percentage performance of .83 at a post-test. Moreover, scaled reliability estimates based on internal consistency for the instrument achieved significance with regard to the tool’s performance in this interventional design.

    Request this Article


    Diagnostic Reasoning Skills and Accuracy Of Diagnosis in Nurse Practitioner Students: An Androgogical Intervention Using the Hermeneutic Model

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Gilbert, Marcia A.

    Problem: Diagnositic reasoning is an essential skill of the nurse practitioner (NP). The Information Processing (IPM) and Hermeneutics Models (HM) of diagnostic reasoning are used by NPs to accurately diagnose patients. NPs use diagnostic reasoning models differently as they develop from novice to expert. An appraisal of the skill acquisition of novice or student NPs, in diagnostic reasoning skills, and the outcome of making accurate clinical diagnoses, has not been assessed. This lack of understanding of how students develop these essential skills and how successful they are in accurately diagnosing patients leads us to question the current educational instruction and clinical evaluation methods. Purpose: The purpose of this capstone project was to develop an educational program, based on both models of diagnostic reasoning, and examine the students’ accuracy in diagnosis. The rationale for the project is that skill acquisition in diagnostic reasoning is an essential skill of the NP. Goal: The goal of the project was to successfully implement and educational program for novice FNP students as they develop their diagnostic reasoning skills, examine which skills they use, and assess the students’ accuracy in diagnosis. Objectives: First, describe the composite and mean demographic characteristics of the sample of convenience of FNP students. Second, explain the androgogical method currently used to educate FNP students in the IPM of diagnostic reasoning. Third, determine the pre-intervention diagnostic reasoning skills used by the FNP student and the accuracy of diagnosis using patient vignettes. Fourth, develop and administer the intervention of interest of androgogical instruction method of the HM of diagnostic reasoning. Fifth, administer the post-intervention to determine the diagnostic reasoning skills used by the FNP student and the accuracy of diagnosis using patient vignettes. Sixth, evaluate the change in diagnostic accuracy and skills used from diagnostic reasoning models. Plan: Phase One: Conduct a literature review/needs assessment using a published evidence based critique template. Phase Two: Design a teaching module for the intervention of interest, the HM of diagnostic reasoning. Phase Three: Obtain IRB approvals from Rocky Mountain University of Health Professions and Regis University. Implement project. Phase Four: Evaluate the change in diagnostic accuracy and the reasoning skills of the students utilizing the Nurse Practitioner Performance Tool (NPPT), several anchor questions in Likert scale format, and one open-ended question related to the development of the students’ reasoning skills. Outcomes and Results: Project results show that after the educational intervention the post test scores were higher than the pre-test scores. Additionally, participants used skills from both models of reasoning in diagnosing patients on NPPT. Themes from the lived experience of learning diagnostic reasoning were also discovered.

    Request this Article


    Putting Evidence into Practice: A Nurse Practitioner Perspective

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Harrison, Donald

    Problem: Research conducted by nurses on patient problems of concern contributes to the development of evidence based nursing practice (EBP). Making EBP a sustained reality is a major endeavor that is vital to the profession of nursing. This relates, among other factors, to a lack of sufficient research especially by Advance Practice Nurses (APN) and may be traced back to the lack of opportunity and education on how to retrieve relevant and current scientific data. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of the curricula of the APN and should be introduced early in the program so as to encourage self-directed learners and competent patient outcome researchers. Purpose and Scope: The purpose of this project is to describe the level of nurse practitioner student knowledge regarding EBP before and after an EBP teaching intervention. This study seeks to answer the following research questions: According to the literature, what is the current level of nursing knowledge regarding EBP? What is the level of nurse practitioner student knowledge regarding EBP before and after an EBP teaching intervention? The rationale of this project was the assumption that increased knowledge of Evidence Based Practice/Clinical Practice Guidelines (EBP/CPG) will prepare nurse practitioner students to be critical thinkers to support EBP research, and to be able to retrieve relevant scientific data to enhance best practice. Goal: The goal of this project was to successfully implement an educational intervention to improve the knowledge of a group of FNP students on retrieving and utilizing EBP/CPG for best practice and improved patient outcomes. Objectives: The short term objective was to determine whether a three hour educative program increases the knowledge base of FNP students at University of Texas El Paso-School of Nursing (UTEP-SON). The study variable, level of nurse practitioner knowledge regarding EBP, was tested using the EBPQ pre and post intervention. The long term objective is to have UTEP-SON adjust their curriculum to include a class on the retrieval and utilization of scientific data that will assist future NP’s in enhancing best practice and safe clinical intervention to improve the patients’ lives via healthcare interventions. Plan: Conduct a thorough literature review. Develop an educative intervention on EBP/CPG skills on how to retrieve appropriate scientific data using PICO as a baseline. Following approval from IRB at RMUoHP and UTEP-SON approval present teaching intervention to students. Review and analyze data from demographics, measure statistics from pre/post interventional test utilizing SPSS Software. Outcomes and Results: Using a triangulated interventional research design, results of the pre and post intervention test revealed that a short three hour educative class on EBP increased the knowledge base 11% from 69% to 8%.

    Request this Article


    The Duke Activity Status Index (DASI) in Rural Rocky Mountain Women: Tailoring an Evidence-Based Perspective

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Kidner, Maria C.

    Problem: Rural women often underestimate their health risks and symptoms, yet they may be at risk for cardiac disease. However, rural women are often not tested for functional capacity largely because they tend to present later in the disease process due to poor detection, poor utilization of healthcare services, or lack of provider knowledge resulting in poor outcomes and increased mortality combined with the geographical challenges of rural areas. Thus, having a validated and reliable tool for these women could immensely augment the capacity of rural providers to provide tailored care based on evidence-based research enabling appropriate decisions on testing, risk-stratification, and treatment evaluations. Purpose and Scope: to describe the level of cardiac functional capacity using the Duke Activity Status Index (DASI) and exercise treadmill test (ETT) metabolic equivalents (METs) calculations in rural women in the Rocky Mountains to determine if the relationship of the DASI to METs is similar to that in published literature. Goal: To seek to describe the level of cardiac functional capacity using the DASI and ETT calculated METs rural women living in the Rocky Mountain West with the findings to close the gap of nursing knowledge about the need for tailoring healthcare for rural Rocky Mountain women with potential cardiac disease. Objectives: First, describe the sample cohort in terms of demographics, lifestyle, medical history, and current symptomology. Second, explore the relationships of the DASI METs to actual METs obtained in a corhort of rural Rocky Mountain women who underwent an ETT for evaluation of CVD. Third, discern whether altitude is relative to DASI METs and actual METs. Fourth, determine whether the hemodynamics of mean arterial pressure, pulse pressure, and/or heart rate recovery data impact the predictive value of DASI METs. Plan: Phase One: Conduct a needs assessment using systematic review of literature. Phase Two: Design a clinical research project for the evaluation of the DASI survey to recently obtained ETT and obtain IRB approval. Phase Three: Implement the clinical project upholding evidence-based medicine, research ethics, and protection of human rights for a project sample. Phase Four: Analyze the data for correlations of the DASI METs to actual METs and compare to outcomes in previously published literature using descriptive statistics and Pearson Correlation coefficient. Outcomes and Results: Although the DASI correlates to rural women who achieved a functional capacity greater than 7 METs, there is no correlation to women of lower functional capacity and all women over-estimated their functional capacity by the DASI. This result deviates from published literature and suggests that the DASI survey should not be used in this rural female population for risk-stratification as recommended in the 2002 ETT guidelines to identify women with poor capacity. Evidence-based practice needs to be tailored to the specific population of interest to provide the best care.

    Request this Article


    Perceived Acute Care Competency: An Interventional Study on the Seven Domains of Acute Care Nurse Practitioner Competencies

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Laffoon, Carl L.

    Problem: The National Panel for Acute Care Nurse Practitioner Competencies has defined seven domains of acute care nurse practitioner competencies. Since 2004, the complexity of healthcare delivery has rapidly progressed to the point that increasingly advanced practice nurses (APNs) are expected to provide acute care healthcare delivery, despite their level of specialty certification. A systematic review of the literature documents high-quality, cost-effective care when APNs are utilized to alleviate the nursing shortage in the acute care setting. Purpose and Scope: The purpose of this Evidence-Based Practice (EBP) project was to describe the level of perceived acute care competency in APNs before and after their participation in an online educational intervention based on the seven domains of acute care nurse practitioner competencies. Using descriptive-interventional methodology, the study variable of perceived acute care competency was tested in participants before and after an online educational intervention using a tool developed for the scope of the investigation by Laffoon and Davidson. The instrumentation included a 22-item 5-point Likert-scale questionnaire with 3 subscales assessing comfort, competence, and confidence in APN delivery of acute care. Goal and Objectives: The goal of the project was to successfully implement an online teaching intervention for APNs regarding the seven domains of acute care nurse practitioner competencies. The objectives were: (a) to describe aggregate demographic characteristics of the APN participants, (b) to describe APN pre-intervention perceptions of acute care competency, (c) to describe APN post-intervention perceptions of acute care competency, and (d) to describe APN perceptions of acute care competency before and after participation in an online teaching intervention regarding the seven domains of acute care nurse practitioner competencies. Plan and Evaluation: Phase One: Conduct a literary needs assessment using a published evidence-based critique template. Phase Two: Design an online teaching intervention using the EBP approach. Phase Three: Implement an online teaching intervention for a projected sample of APN participants in a national online forum listserve. Phase Four: Evaluate the level of APN perceived acute care competency before and after APN participation in the online teaching intervention regarding the seven domains of acute care nurse practitioner competencies. Outcomes and Results: Pre-intervention and post-intervention measures revealed a modest increase in ANP perceived knowledge from an aggregate score of 5.76 at pre-test to an aggregate score of 7.54 at post-test. Moreover, scaled reliability estimates based on internal consistency for the pre-intervention testing achieved significance, while the post-intervention testing also achieved significance with regard to the tool’s performance in this interventional design.

    Request this Article


    Evidence-Based Practice Interventional Study Regarding Erectile Dysfunction

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Nomamiukor, Dora An

    Problem: According to recent estimates, erectile dysfunction (ED) affects about 30 million men in the United States. Moreover, the Massechusetts Male Aging Study (MMAS) has noted that 52% of men ages 40-70 years experience the condition. With media and pharmaceutical attention given to ED in middle aged men, there exists a need to correct misperceptions regarding the condition. A systematic review of the literature using techniques by Davidson revealed a need for patient education that involves shared decision-making with regard to the knowledge and treatment options for patients with ED. Purpose and Scope: The purpose of this Evidence-Based Practice (EBP) project was to describe the level of client knowledge in men with ED before and after participation in an ED clinic teaching intervention. The educational program addressed general knowledge regarding ED as well as treatment knowledge in terms of self-care. Using descriptive-interventional methodology, the study variable of ED knowledge was measured before and after participation in an ED clinic using the author-developed Erectile Dysfunction Basic Knowledge Assessment (EDBKA) questionnaire. The instrumentation included a 10-item questionnaire with 2 subscales assessing ED knowledge regarding the condition and treatment options. Goal and Objectives: The goal of the capstone project was to describe level of ED client knowledge in a population of Veterans. The overall objectives of the project were to: (a) design an evidence-based educational program on ED, and (b) to describe the level of ED client knowledge regarding ED before and after ED client participation in the ED teaching intervention. Plan: Phase One: Conduct a needs assessment using a published evidence-based critique template. Phase Two: Design and ED teaching intervention using an EBP approach. Phase Three: Implement an EBP teaching intervention for the projected sample. Phase Four: Describe the level of ED knowledge before and after participation in the ED program using the EDBKA. Outcomes and Results: Pre-intervention and post-intervention measures revealed an increase in ED knowledge from an aggregate percentage performance of .77 at pre-test to an aggregate percentage performance of .95 at a post-test. Moreover, scaled reliability estimates based on internal consistency for the EDBKA achieved significance at pre-test and at post-test with regard to the the tool’s performance in this interventional design. Although further inquiry is warranted, the findings suggest that patient education that involves shared decision-making with regard to the knowledge and treatment options for patients with ED can increase ED knowledge with focused educational intervention regarding the concept, and that shared decision-making following patient education is a practice change outcome worthy of further consideration.

    Request this Article


    Attitudes Toward the Use of Therapy Animals in the Clinical Setting

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Peck, Katherine L.

    Problem: For most people, becoming ill or infirm is stressful. Moderate to high stress and anxiety inhibit healing and the achievement of the best quality of life possible. Animal Assisted Therapy (AAT) is the use of an animal as a therapeutic intervention and as an integral part of the treatment team. AAT is used in a variety of settings and has been shown to reduce both physiological and emotional symptoms of stress. Yet, nurses are reluctant to suggest AAT, perhaps due to attitudes that individuals may have toward the use of animals in healthcare. A systematic review of healthcare evidence reveals that AAT is a high-quality and cost-effective nontraditional therapy for a variety of conditions. Purpose and Scope: The purpose of this project was to describe nurse attitudes toward the use of therapy animals in the clinical setting before and after participation in an AAT teaching intervention. The intervention included the uses, benefits and risks of AAT. Using descriptive-interventional methodology, the study variable of nursing attitudes toward the use of therapy animals in the clinical setting was measured before and after participation in an AAT teaching intervention using the Brisbane AAT Acceptability. Goal and Objectives: The goal of the capstone project was to evaluate attitude change towards AAT in nurses. The objectives of the project were: (a) To design an evidence-based educational program on AAT, (b) To implement the educational program, and (c) To measure changes in attitude(s), changes in both positive and negative attitudes, pre-and post the intervention. Plan: Phase One: First develop and evidence-based educational program on AAT concerning the risks and benefits of the use of AAT. Second, secure a valid and reliable tool for measuring attitude change in nurses. Phase Two: Obtain IRB approval and recruit participants. Phase Three: Administer the tool and pre-and-post implementation of the program. Phase Four: Analyze and report the data. Outcomes and Results: Pre-intervention and post-intervention measures in a convenience sample of nurses, revealed a modest increase in favor of the overall attitudes toward AAT from an aggregate score of 2.41 at pre-test to an aggregate score of 3.41 at post-test. Moreover, reliability estimates based on internal consistency for the instrument revealed stability in this sample while test-restest reliability for each subscale in this sample achieved significance at pre-test and at post-test.

    Request this Article


    Using Psychiatric Service Dogs for Psychiatrically-Disabled Patients: An Evidence-Based Intervention

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Peterson, Lana J.

    Problem: The use of service dogs for the psychiatrically disabled patient is a fairly new utilization of the service dog statute under the Americans with Disabilities Act (ADA). There is an overall lack of knowledge among healthcare providers regarding the use of service dogs and there is an even greater lack of awareness of Psychiatric Service Dogs (PSD). Despite the more than 6 million non-institutionalized people in the U.S. who have a mental health disability, less than a quarter of the estimated 40,000 service dogs are in use for those persons that are neither blind nor deaf. Purpose and Scope: This project seeks to describe the level of provider attitudes and knowledge regarding the use of Psychiatric Service Dogs (PSD) for psychiatrically-disabled patients before and after an online educational intervention. Advance Practice Nurses are in a position, as primary care providers, to influence healthcare for the mental health population through evidence based practice. Goal: The goal of the project was to bring about change in attitude and knowledge by increasing Advance Practice Nurses’ (APNs) knowledge on the use of PSDs for psychiatrically-disabled patients. Objectives: To describe the aggregate characteristics of the demographic sample. To describe the level of provider attitude and knowledge regarding PSD before and after the administration of the Psychiatric Service Dog Knowledge and Attitude Scale through the statistical data. Lastly, to evaluate the reliability of the tool designed for this study. Plan: Phase One: Perform a literary needs assessment and develop an educational intervention on PSD. Phase Two: Development of a knowledge and attitude scale based on the summary of literacy evidence and evidence-based practice guidelines. Phase Three: Study implementation, data collection, statistical analysis and project evaluation. Outcomes and Results: The study is a triangulated design using mixed-methods of interventional-descriptive: qualitative and quantitative means. The pre and post tests were analyzed for statistical significance. The statistical data was used to compile conclusions on the success and usefulness of the education intervention, the reliability of the Psychistric Service Dog Knowledge and Attitude Scale and add to the body of knowledge inthe area of Pyschiatric Service Dogs.

    Request this Article


    Journal Club Initiative: Bringing Evidence Based Practice to the Bedside Nurse

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Pfenning, Stacey A

    Problem: The appropriate utilization of the evidence-based practice (EBP) process by nurses is vital to providing cost effective, safe, and up-to-date patient care. However, the literature reveals several barriers to nurses’ utilization of EBP, contributing to a perceptible disparity between current research and bedside care. The barriers identified in the literature included select nurse attitudes and lack of knowledge and skills related to research appraisal and the EBP process. Purpose and Scope: The aim of this capstone project was to determine select nurse attitudes, knowledge, and utilization of EBP before and after participation in a professional journal club, in the St. Alexius Emergency and Trauma Center (ETC). The rationale for this project included promotion of the EBP process among beside nurses to facilitate cost effective, safe, and up-to-date patient care. Goal: The goal of this EBP project was to successfully implement a professional journal club for nurses in the ETC, fostering practice inquiry, retrieval and appraisal of the evidence, and dissemination of findings among peers. Objectives: First : To establish the relevant aggregate demographic characteristics of the convenience sample of nurses participating in the project. Second: To measure participants’ pre-invention attitudes, knowledge, and utilization of EBP. Third: To measure participants’ post-intervention attitudes, knowledge, and utilization of EBP. Fourth: To describe changes in participants’ attitudes, knowledge, and utilization of EBP before and after the journal club initiative. Plan: Phase One: Established need through review of literature and completion of a published evidence-based critique template. Phase Two: Designed a journal club to include an orientation and two club sessions. Phase Three: Implemented and managed a professional journal for St. Alexius ETC nurses over a nine-week period of time. Phase Four: Evaluated selected nurse attitudes, knowledge, and utilization of EBP through anonymous, voluntary completion of the Clinical Effectiveness and Evidence-Based Practice Questionnairs (EBPQ) before and after the journal club initiative. Outcomes and Results: This triangulated interventional-descriptive study evaluated the pre-intervention and post-intervention measures, which revealed significant mean score increases and strong correlations in participant’s knowledge and utilization of EBP. Cronbach’s alpha measures for the pre-EBPQ and post-EBPQ achieved significant internal consistency and reliability for this sample.

    Request this Article


    Pressure Ulcer Prevention in Long-Term Care: An Evidence-Based Practice Interventional Study

    Published Year: 2008
    Program: Doctor of Nursing Practice

    Vatanadilok, Tan

    Problem: In Long Term Care Facilities (LTCFs), about 70% of all pressure ulcers occur in persons older than 70. The direct care costs associated with pressure ulcers in LTCF exceed $3.5 billion, while costs related to legal liability are even more substantial. Litigations in LTCF are likely to favor LTCF residents in up to 87% of cases while prevention of pressure ulcers offers high-quality, cost-effective outcomes. A systematic review of healthcare evidence reveals that while the development of pressure ulcers can have a devastating impact of LTCF populations, simple EBP steps such as using supporting surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin can have a positive impact on reducing physical and emotional pain and associated healthcare costs. Purpose and Scope: The purpose of this Evidence-Based Practice (EBP) project was to describe the level of healthcare knowledge regarding pressue ulcer prevention (PUP) before and after participation in a PUP teaching intervention for LTCF staff. Using descriptive-interventional methodology, the study variable of nursing knowledge regarding pressure ulcer prevention was measured before and after participation in the PUP teaching intervention by the Pressure Ulcer Knowledge Tool. The instrumentation included a 47-item questionnaire with 3 subscales assessing knowledge regarding ulcers, wounds, and prevention/risk. Goal and Objectives: The goal of the project was to successfully implement a PUP teaching intervention to LTCF staff. The objectives were: (a) to describe aggregate demographic characteristics of the LTCF participants, (b) to describe PUP pre-intervention level of knowledge, (c) to describe PUP post-intervention level of knowledge, and (d) to describe PUP level of knowledge before and after LTCF staff participation in a PUP teaching intervention. Plan and Evaluation: Phase One: Conduct a literary needs assessment using a published evidence-based critique template. Phase Two: Design a PUP teaching intervention using the EBP approach. Phase Three: Implement a PUP teaching intervention for selected LTCF staff. Phase Four: Evaluate the level of PUP knowledge before and after LTCF staff participation in the PUP teaching intervention. Ouotcomes and Results: Pre-intervention and post-intervention meaures revealed a statistically significant increase in PUP knowledge from an aggregate percentage performance of .81 at pre-test to an aggregate percentage performance of .98 at post-test. Moreover, scaled reliability estimates based on internal consistency for the full instrument achieved significance with regard to the tool’s performance in this interventional design. Although further inquiry is warranted, the findings suggest that LTCF staff can increase PUP knowledge with focused educational intervention regarding the concept, and that PUP education in LTCF may serve as a practice change outcome worthy of further consideration.

    Request this Article


2009

    Advancing Primary Care Practitioners’ Knowledge in the Management of the Diabetic Patient with Hypertension and/or Hyperlipidemia: An Application of Evidence-Based Practice Algorithms

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Al-Marashi, Sabah I.

    Background of the Problem: There are 23.6 million people with type 2 diabetes mellitus in the U.S. The annual medical cost of diabetes-related complications is $174 billion. The American Diabetes Association (ADA) has called for the aggressive treatment of diabetes and yet only 7.3% of diabetics are meeting evidence-based practice (EBP) target goals of A1C<7%, blood pressure (BP) <130/80 and low density lipoprotein (LDL) < 100. Clinical inertia has been a contributing factor to why only a small number of patients with diabetes are treated to target. Clinical inertia is defined as the primary care providers’ (PCPs) lack of knowledge of current EBP recommendations or an unwillingness to use such knowledge to intensify the medical management of patients with diabetes when indicated. Purpose and Scope: The project manager sought to advance PCPs’ level of knowledge in using EBP algorithms for the management of diabetics with hypertension and/or hyperlipidemia to achieve the ADA’s recomended targets. PCPs’ knowledge of these algorythms was assessed by administering a pre-test prior to a presentation on diabetes’ management and a post-test following a presentation intended to measure gains in knowledge. Goal: The project manager’s goal was to use a teaching intervention to increase PCPs’ knowledge of the ADA’s current standards for the treatment of diabetes through the use of EBP algorithms at the medically indigent diabetes clinic (MIDC). Objectives: The project manager’s objective was to increase access to diabetes management for medically indigent patients at the MIDC by advancing the knowledge of the volunteer PCPs regarding current ADA treatment recommendations for the patient with diabetes, and/or hypertension and hyperlipidemia. Plan: Phase One: The project manager reviewed the evidence-based literature on clinical inertia as well as the literature that supports the use of algorithms in improving patient care and increasing PCP’s knowledge of EBP guidelines. Phase Two: The project manager designed a teaching intervention based on the ADA’s recommended EBP guidelines and treatment algorithms for the management of diabetes, hypertension and hyperlipidemia. Phase Three: The project manager administrated the modified Diabetes Knowledge Questionnaire, before and immediately after a teaching presentation on diabetes management, to a sample of 30 PCPs, at the Outpatient Diabetes program. Phase Four: The project manager analyzed and reported the results of the study. Outcomes and Results: The project manager noted a modest increase on post-intervention performance scores. There was a significant increase in the number of providers who reported that they would utilize algorithms for the treatment of diabetes, hypertension and hyperlipidemia in their practice at the MIDC. Scaled reliability was estimated based on internal consistency for the pre and post-intervention testing.

    Request this Article


    Advanced Practice Nurse Assessment and Management of Childhood Obesity in Primary Care

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Bautista, Beatriz G.

    Problem: According to Jordan-Welch and Harbaugh, childhood obesity has reached epidemic proportions, yet there is no change on the horizon despite the release of EBP guidelines regarding primary care assessment and management of childhood obesity by the American Medical Association (AMA) in 2007. A systematic review of the literature revealed that primary care providers can have a dramatic impact on high-quality and cost-effective care when addressing childhood obesity in families, yet providers are reluctant to engage children and their families due to a lack of confidence regarding the topic. Purpose and Scope: The purpose of this Evidence-Based Practice (EBP) project was to describe the level of Advanced Practice Nurse (APN) confidence in primary care assessment and management of childhood obesity before and after participation in an online educational intervention on childhood weight management. Using descriptive-interventional methodology, the study variable of APN confidence in primary care assessment and management of childhood obesity was tested using a tool developed by Beno et al. and adapted for the purposes of this interventional design. The adapted instrumentation included a 22-item 5-point Likert-scale questionnaire regarding assessment and management of childhood obesity. Goal and Objectives: The goal of the project was to successfully implement an online teaching intervention for APNs regarding primary care assessment and management of childhood obesity. The objectives were: (a) to describe aggregate demographic characteristics of the APN participants, (b) to describe APN pre-intervention confidence in primary care assessment and management of childhood obesity, (c) to describe APN post-intervention confidence in primary care assessment and management of childhood obesity, and (d) to describe APN confidence in primary care assessment and management of childhood obesity before and after participation in an online educational intervention on childhood weight management. Plan and Evaluation: Phase One: Conduct a literary needs assessment using a published evidence-based critique template. Phase Two: Design an online teaching intervention using the EBP approach. Phase Three: Implement an online teaching intervention for a projected sample of APN participants in a national online forum listserve. Phase Four: Evaluate the level of APN confidence in primary care assessment and management of childhood obesity before and after participation in an online educational intervention on childhood weight management. Outcome and Results: Pre-intervention and post-intervention measures revealed a statistically significant increase in APN confidence in primary care assessment and management of childhood obesity from a mean total score of 39% at pre-test to a mean total score of 99% at post-test. Moreover, pre-test/post-test performance measures were found to be statistically significant, while reliability estimates based on internal consistency for the instrumentation also achieved significance with regard to the tool’s performance in this interventional design.

    Request this Article


    Graduate Nursing Student Satisfaction with Instructor Student Interaction in an Online Practicum Class Before and After Addition of Audio-Visual Feedback

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Berg, Barbara

    Problem: Online distance education has become the wave of the future in higher education. Students in the face-to-face classroom environment were able to use voice, body language, and facial expressions of the instructor to add to the feedback experience as part of their learning. The online experience was usually conducted in a text only environment and lacked those cues. Although software programs existed for audio and visual interaction from the instructor to the student, these programs were costly, required orientation for use, and entailed increased time to implement within a course. However, use of audio-visual technology would be an important application to explore for individualized feedback in the online environment. Purpose/Scope: The purpose of this capstone project was to investigate student satisfaction with instructor-student interaction with the addition of audio-visual instructor feedback in a graduate online nursing practicum course. Goal: The goal of the project was to successfully implement an audio-visual feedback intervention in response to submitted Practicum Journal entries and to measure online student satisfaction with this additional intervention. Objectives: Project objectives included to describe aggregate demographic characteristics of practicum graduate nursing students, to describe pre-intervention student satisfaction with instructor-student interaction, and to describe post-intervention student satisfaction with instructor-student interaction. Plan: Phase One: Conducted a literature review/needs assessment using a published evidence-based critique template. Phase Two: Secured an instrument for measuring student satisfaction with interaction in online courses. Phase Three: Obtained IRB approvals from Rocky Mountain University of Health Professions and the university. Implemented project and collected data. Phase Four: Evalutated student satisfaction with interaction in online course utilizing the Sherry, Fulford, and Zhang Interaction Instrument and an anchor question in Likert scale format. Outcomes and Results: A total of 28 students completed both the pre-intervention and post-intervention online surveys. Statistically significant mean scores were not discovered between the pre-intervention survey and the post-intervention survey for the 14 Interaction Instrument question responses. However, the anchor question that identified the students’ current level of satisfaction with interaction in online graduate nursing courses revealed a statistically significant difference in means from the pre-intervention survey to the post-intervention survey responses. Furthermore, unsolicited email and course evaluation positive responses to the addition of audio-visual feedback received by the course faculty indicated appreciation of inclusion of the audio-visual feedback in the course.

    Request this Article


    Buddy Support and Diabetic Self-Care Adherence: An Evidence-Based Perspective

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Bird, Sally A.

    Problem: According to the American Diabetes Association, diabetes affects approximately 20.8 million people in the United States. Diabetes Self-Management Education (DSME) helps diabetics adhere to better levels of diabetes self-management resulting in improved blood sugar levels, thereby postponing complications of this progressive disease. Studies show that DM patients with adequate social support manage their diabetes more effectively and improve quality of life. Purpose and Scope: This evidence-based practice project sought to describe the level of diabetic self-care adherence before an after an educational intervention with or without a buddy. By integrating best research evidence with clinical expertise inviting buddies will enhance effectiveness of DSME classes at a selected healthcare facility. Goal: The goal of this practice change project was to provide evidence-based support that DM patients attending a DSME class with a buddy resulted in improved adherence to self-care activities compared to DM patients attending without a buddy. Objectives: Review research related to buddy support as a social support mechanism to enhance successful life-style change interventions. 1) Collect data as determined by the administration of the SDSCA to DM patients attending DSME classes. 2) Compare recorded responses to the SDSCA measure for DM patients attending DSME classes with and without a buddy at the initial class and at the 3-month follow-up. 3) Evaluate and compare participant AIC levels before and 3-months after the DSME. 4) Identify implications for clinical practice. 5) Identify study limitations and implications for further study. Plan: Phase One-Secure support from the diabetes educator and CEO of the hospital, seek approval for use of the SCSCA and obtain IRB approval. Prepare and print a demographics page and print the SDSCA measure. Phase Two-Collect SDSCA measure data with A1C levels at the initial class and at the 3-month follow-up class. Phase Three-Compare the results, perform the statistical analysis, and write up the findings. Outcomes and Results: T-test for the effect of the buddy on the A1C levels revealed a significant difference for those attending with a buddy. General diet choices were not improved for those attending with a buddy. Specific diet choices for those attending with a buddy were statistically significant. Each of the other constructs showed positive improvements and while not statistically significant, they were clinically significant for participants attending with a buddy compared to those attending without a buddy.

    Request this Article


    Nurse Practitioner Knowledge Regarding Adult Attention Deficit/Hyperactivity Disorder (ADHD): An Evidence-Based Intervention

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Collom, Chad D.

    Problem: According to emerging research, adult Attention-Deficit/Hyperactivity Disorder (ADHD) is an often misunderstood psychiatric diagnosis that can be easily overlooked in the clinical setting. A systematic review of the literature revealed that improper treatment may include decreased knowledge of diagnosis, fear of treating adults with stimulant medications, or disbelief that ADHD persists into adulthood. Purpose and Scope: The purpose of this Evidence-Based Practice (EBP) project was to describe the level of nurse practitioner (NP) knowledge regarding adult ADHD before and after NP participation in a teaching intervention addressing adult ADHD. Using descriptive-interventional methodology, the study variable of NP knowledge regarding adult ADHD was tested using a tool developed by Rostain, Power, and Atkins and adapted for the purposes of this interventional design. The adapted instrumentation, the Nurse Practitioner Adult Attention-Deficit/Hyperactivity Disorder Knowledge Survey (NPAAKS), included a 20-item 3-point Likert-scale questionnaire regarding assessment, diagnosis, and treatment of adult ADHD. Goal and Objectives: The goal of the project was to successfully implement an online teaching intervention for NPs regarding primary care assessment, diagnosis, and treaatment of adult ADHD. The objectives were to: (a) describe aggregate demographic characteristics of the NP participants, (b) describe pre-intervention NP knowledge regarding adult ADHD, (c) describe post-intervention NP knowledge regarding adult ADHD, and (d) describe the level of NP knowledge regarding adult ADHD before and after NP participation in a teaching intervention addressing adult ADHD. Plan and Evaluation: Phase One: Conduct a literary needs assessment using a published evidence-based critique template. Phase Two: Design an online teaching intervention using the EBP approach. Phase Three: Implement an online teaching intervention for a projected sample of NP participants through a national online listserve. Phase Four: Evaluate the level of NP knowledge regarding adult ADHD before and after NP participation in a teaching intervention addressing adult ADHD. Outcomes and Results: Pre-intervention and post-intervention measures revealed a significant increase in level of NP knowledge regarding adult ADHD following NP participation in the online teaching intervention addressing adult ADHD. Self-reported NP knowledge regarding adults ADHD increased from a mean score of 3.98 at pre-test to a mean score of 7.42 at post-test. Moreover, participant total score performance on the NPAAKS increased from a mean score of 24.02 at pre-test to a mean score of 56.72 at post-test, while reliably estimates based on internal consistency for the instrumentation also achieved stability with regard to the tool’s performance in this interventional design.

    Request this Article


    Level of Emotional Intelligence Among Advanced Practice Nurses: An Interventional Design for the Clinical Practice Setting

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Emerick, Nadia R.

    Problem: The nursing literature has suggested that the lack of Emotional Intelligence (EI) among nurse leaders has been one of the major contributing factors for nurse dissatisfaction leading to higher rates of nurse turnover and a decline in the rate of nurse retention. Many researchers have also argued that the lack of EI competencies among nurses reduced the art of nursing science to the role of a technician, which has compromised the quality of care, the healthcare outcomes and increased cost. Therefore; the concept of EI has become one of the most essential factors in the success equation necessary for transformational leadership in patient safety and workforce issues as nurse leaders can no longer use outmoded ways to lead organizations. Although some educators and practitioners embraced the construct, yet the nursing research base on the constuct continues to be scarce and requires further investigation in various areas in nursing. Purpose and Scope: The purpose of this capstone project was to measure the level of EI among advanced practice nurses as healthcare leaders’ pre, post and six weeks after an educational intervention on EI. the rationale for the project was to predict the need for more education and training on EI among advanced practice nurses. Goal: The goal was to help enhance and improve the advanced practice nurses’ emotional awareness of self and others by stimulating their personal insight, and direct them towards modification of behavior rather than personality. Objectives: First, describe demographic characteristics of the participants. Second, describe the pre-intervention level of EI among nurse practitioners. Third, describe the post intervention of EI among nurse practitioners. Plan: Phase One: Conduct a needs assessment using published an evidence-based critique template. Phase Two: Design a PowerPoint teaching intervention using an evidence-based approach. Phase Three: Implement an evidence based teaching intervention for a projected sample of (N=50). Phase Four: Evaluate the level of EI before and after a teaching intervention on EI six weeks after the teaching intervention on EI using the Emotional Intelligence compentency Inventory survey. Outcomes and Results: Using descriptive-interventional reseach design, the pre-intervention and post-intervention scores measured the mean increase in the level of EI among advanced practice nurses. Consistency for the pre-intervention teaching achieved significance of 0.864, while the post test achieved significance of 0.864 with regard to the tool performance in this interventional design. Findings revealed a signficant relationship between knowledge and practice change at follow up. Males were found to have higher self assessment and self management skills than female participants.

    Request this Article


    Advanced Practice Nursing Attitudes Toward Complementary and Alternative Therapies and Valeriana

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Helminiak, Joseph J.

    Problem: Herbal remedies have been used to treat ailments for centuries, yet there exists a dichotomy concerning complementary and alternative therapy (CAT) knowledge between patients and providers, with mainstream providers having little interest in CAT discussions with patients. Valeriana officinalis (Valerian) is one such substance that has been used for hundreds of years to treat anxiety and insomnia although research efforts by qualified health professionals have lagged behind. This is especially true with regard to areas of concern such as herb efficacy and drug interactions. Purpose and Scope: The purpose of this Evidence-Based Practice (EBP) project was to describe Advanced Practice Nursing (APN) attitudes toward CAT and the use of Valerian before and after participation in an online teaching intervention. Using descriptive-interventional methodology, the study variable of APN attitudes toward CAT and the use of Valerian was tested using a tool designed as a 20-item 5-point Likert scale instrument with 2 subscales assessing attitudes toward CAT and the use of Valerian, or ATCAT. Goal and Objectives: The goal of the project was to successfully implement an online teaching intervention for APNs regarding CAT and the use of Valerian. The objectives were: (a) to describe aggregate demographic characteristics of the APN participants, (b) to describe pre-intervention APN attitudes regarding CAT and the use of Valerian, (c) to describe post-intervention APN attitudes regarding CAT and the use of Valerian, and (d) to describe APN attitudes toward CAT and the use of Valerian before and after participation in an online teaching intervention. Plan and Evaluation: Phase One: Conduct a literary needs assessment using a published evidence-based critique template. Phase Two: Design an online teaching intervention using the EBP approach. Phase ThreeL Implement an online teaching intervention for a projected sample of APN participants through a national online listserve. Phase Four: Evaluate APN attitudes toward CAT and the use of Valerian before and after participation in an online teaching intervention. Outcomes and Results: Total participant scores improved on the ATCAT instrumentation, with self-reported knowledge regarding the Valerian constructed achieved a slightly smaller increase. Moreoever, scaled reliability estimates based on internal consistency for the test-retest CAT construct achieved significance at pre-intervention, while the post-intervention testing also achieved significance with regard to the tool’s performance in this interventional design.

    Request this Article


    Critical Thinking Dispositions and Skills in Chinese Nurses Before and after a Critical Thinking Educational Intervention

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Lamb, Mary J.

    Problem: Critical thinking (CT) is an essential element in the delivery of healthcare. For this reason, CT has become a much sought after outcome of nursing education. The emergence of CT as a primary outcome of nursing education is not just a western phenomena; it has become a focus of nursing education in Asia as well. In Hong Kong, nursing educational leaders cited CT as a vital outcome of the higher education core curriculum. Despite the increased focus on the need to develop CT in nurses, little is known about the CT dispositions and skills of Chinese nurses. Purpose and Scope: The purpose of this evidence-based practice project was to identify and describe the CT dispositions and skills of Chinese nurses before and after a CT educational intervention. Goals and Objectives: The goal of this project was to construct and carry out a critical thinking educational intervention for Chinese nurses and to measure the critical thinking dispositions and skills of course participants before and after the educational intervention. The short term objectives of this study were: to identify the demographic characteristics of age, educational level, and years of work experience of a sample o f Chinese nurses, to measure and describe the CT dispositions and skills of a sampl of Chinese nurses before a CT educational intervention, and to measure and describe the CT dispositions and skills of a sample of Chinese nurses after a CT educational intervention. The long term objective of this study was to add to the body of knowledge concerning the CT dispositions and skills of Chinese nurses. Plan and Evaluation: Following a proposed timeframe the project plan consisted of four phases. Phase One: the carrying out a needs assessment and literature review. Phase Two: Identification of CT evaluation instruments and development of the CT educational intervention materials. Phase Three: gathering of demographic data, implementation of the intervention, and measurement of the pre-intervention and post-intervention CT dispositions and skills of a sample of Chinese nurses. Phase Four: the compilation and analysis of the pre-intervention and post-intervention data. Outcomes and Results: Utilizing a descriptive interventional research design, quanitative analysis of the pre-intervention and post-intervention data from two instruments revealed a significant increase in the overall CT dispositions and skills for this sample of Chinese nurses. Cronbach’s alpha measures for the pre-intervention and post-intervention data were achieved for this population.

    Request this Article


    Advance Practice Nursing Attitudes Toward Dermatological Quality of Life and Phototherapy in the Treatment of Acne Vulgaris

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Quartullo, Tirsa Carolina

    Acne vulgaris is one of the most common dermatological conditions seen in both primary care and specialty care alike. It is a debilitating condition that not only affects patients physically, but psychologically, emotionally and socially as well. Depending on the severity of the disease, patients often experience psychosocial disturbances that affect routine daily activities and relationships. Disturbances may include depression, anxierty, and or social isolation. Today, various treatment modalities exist where clinicians may alter and configure treatments to meet the individualized needs of each patient. Treatment modalities may include either traditional approaches in which oral and topical therapies are employed or alternative treatments such as narrow and broad spectrum light therapy, photodynamic therapy and lasers. Although the evidence supports the need for provider recognition for the potential disabilities, decreased quality of life, and alternative treatments for patients afflicted with acne vulgaris, prevailing attitudes of providers indicate little appreciation for meeting the bio-psychosocial needs of these patients. Purpose and Scope: The purpose of this project was to describe Advanced Practice Nurse (APN) attitudes toward dermatological quality of life and the use of phototherapy in the treatment of acne vulgaris before and after participation in an online teaching intervention. Goal: The goal of this evidence-based project was to increase provider awareness and further close the gap the healthcare knowledge about how to best intervene on behalf of patients diagnosed with acne vulgaris. Objectives: The first objective of this evidence-based project was to describe aggregate demographic characteristics of APNs that chose to participate in this evidence-based project. The second objective was to describe pre and post-interventional attitudes of APNs toward dermatological quality of life. The third objective was to describe pre and post-intervention attitudes of APNs regarding acne. The fourth objective was to describe pre and post-intervention attitudes of APNs regarding treatment for acne vulgaris. The last objective was to measure changes in attitudes of APNs toward dermatological quality of life and the use of phototherapy before and after participation in an online teaching intervention. Plan: Phase one of this evidence-based project was to perform a needs assessment. Phase two was to select an evidence-based practice nursing intervention applicable to the need. Phase three was to implement the evidence based intervention to a sample size of 50. Phase four includes the analysis and evaluation of APN attitudes toward dermatological quality of life and the use of phototherapy in the treatment of acne vulgaris. Outcomes and Results: For the purpose of this study, a descriptive-interventional research design was used. Results of the pre-intervention and post-intervention measures revealed an improvement in APN dermatological quality of life and acne treatment self-assessments and statistically significant improvements in attitudes toward dermatological quality of life, acne, and acne treatment attitudes after participating in an online teaching intervention.

    Request this Article


    Level of Knowledge and Skill of Nurse Anesthetists Before and After a Selected Teaching Intervention with the Fiberoptic Bronchoscope for Intubation

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Raskiewicz, Caroline L.

    Problem: Nurse anesthetists experience little difficulty with oral and nasal intubations on the majority of surgical patients. However, there are patients that present with unanticipated difficult airways, and anesthesia providers are required to have the knowledge and the skill to use various techniques to secure the airway. The fiberoptic bronchoscope (FOB) is an essential airway tool that requires a level of knowledge and skills to operate; yet, many nurse anesthetists, find fiberoptic-guided intubation difficult to perform. Anesthesia providers and patients are stakeholders at risk in underutilization of life saving techniques such as FOB. Therefore, it is necessary for nurse anesthetists to develop a level of knowledge and skill to be confident in the use of the FOB for intubation of the trachea. Purpose and Scope: The purpose of this capstone project was to assess the level of knowledge and skill of nurse anesthetists with the FOB for intubation before and after a selected teaching intervention. The rationale for the project was for nurse anesthetists to know and become familiar with the proper steps in FOB for intubation and to use the instrument clinically. In addition, a protocol or set of guidelines for the anesthesia departments of a primary care facility is proposed along with an annual review of the FOB for intubation. A yearly review will ensure project sustainability. FOB is a component of the curriculum in the school of nurse anesthesia and as a part of the curriculum the project is sustainable and useful for future anesthetists. Goal: The goal of the project was to successfully implement a select teaching intervention with the FOB for intubation by nurse anesthetists to enhance patient care within a primary healthcare organization and its affiliated clinical site nurse anesthetists. Objectives: First was to describe demographic characteristics of nurse anesthetists. Second was to describe pre-intervention knowledge and skill of nurse anesthetists related to FOB for intubation. Third was to desribe post-intervention knowledge and skill of nurse anesthetists related to FOB for intubation. Fourth was to statistically measure knowledge and skill before and after a selected teaching intervention with FOB for intubation. Plan: Phase One: A needs assessment was conducted using published evidence. Phase Two: A select teaching intervention for nurse anesthetists was designed using an Evidence Based approach. Phase Three: An evidence-based teaching intervention was implemented for a projected sample. Phase Four: The level of knowledge and skill before and after a selected teaching intervention was evaluated, using the Global Rating Index for Technical Skill (GRITS). Outcomes and Results: Using a descriptive research design, results of the pre-intervention and post-intervention meaures revealed the level of knowledge and skill with FOB for intubation. The scale of reliability on internal consistency for pre-intervention testing achieved significance of. Post-intervention testing achieved significance with regard to the instrument’s performance. In this interventional design study, the GRITS tool was the ideal assessment for the level of knowledge and skill for the nurse anesthetist.

    Request this Article


    Billing and Coding Knowledge, Confidence, and Performance Among Primary Care Healthcare Providers

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Sallas Bruney, Teresa

    Problem: Billing for pimary care sevices is a skill needed for successful independent practice. When primary care services are provided, clinicians are frequently called upon to assign a numerical code based on the complexity of the care provided. Third party payers recognize these codes, and base their reimbursement to providers upon them. Studies have affirmed the lack of knowledge of primary care providers regarding accurate coding. Carefully crafted educational interventions can produce changes in healthcare provider knowledge and clinical practice. Refinement and improvement of written patient documentation, improved accuracy of billing and coding, as well as improved, appropriate reimbursement for primary care NPs and physicians could improve the quality of the healthcare services provided, strengthen the financial health of a primary care practice, and lead to increased availability of primary care services to patients. Purpose: The purpose of this study was to describe the need for and provide an educational intervention to improve the billing and coding knowledge, confidence, and performance of primary care providers in a seleceted state. The rationale for the project was that by crafting an educational intervention based on best practices that met the needs of the targeted group, primary care providers might improve the quality of healthcare services provided. Goal and Objectives: The goal of this project was to design and implement a billing and coding educational intervention leading to changes in the clinical practice of primary care NPs and physicians. Objectives were to conduct a needs assessment regarding the billing and coding needs of primary care healthcare providers in North Central Florida, develop and implement a 2 hour, cost-effective, billing and coding educational symposium, assess demographic information of the population of interest, and evaluate symposium attendee responses regarding changes in billing and coding knowledge, confidence, and performance before and after the symposium. Plan: Phase One: Conduct formal and informal needs assessment; analyze responses. Phase Two: Plan, develop, and implement a billing and coding educational symposium. Phase Three: Collect and analyze data before and after the educational symposium, and evaluate outcome measurements. Outcomes and Results: Key findings revealed significant changes in the billing and coding knowledge and confidence of primary care APNs and MDs after the educational symposium. Respondents also reported significant changes in clinical practice as a result of having attended the symposium. Ninety percent of respondents reported changes in their billing and coding practices and improvements in their written patient documentation. Sixty eight percent of respondents reported that as a results of their attending the billing and coding symposium, their practice colleagues had also changed their billing and coding practices.

    Request this Article


    Patient Decisional Conflict and Informed Consent: An Advanced Practice Nursing Perspective

    Published Year: 2009
    Program: Doctor of Nursing Practice

    Veal, Richard L.

    Problem: Advanced Practice Nurses (APN) are expected to convey meaningful information, establish trust, and encourage autonomous decision-making on behalf of patients when seeking informed consent although recent research indicates that informed consent is rarely accomplished. Evidence further indicates that the current format for obtaining consent often practiced by most providers is delivered in brief, perfunctory, and extemporaneous manners, devoid of detail, with patient cues suggesting the process is merely a pro forma ritual. Purpose and Scope: The purpose of this Evidence-Based Practice (EBP) project was to describe the level of APN knowledge about patient decisional conflict with informed consent before and after APN participation in an online teaching intervention. Using descriptive-interventional methodology, the project outcome variable of APN knowledge about patient decisional conflict with informed consent was measured using an adapted version of the orientation to the Decisional Conflict Scale (DCS) by O’Connor. Goal and Objectives: The goal of this project was to successfully implement an online teaching intervention for APNs about patient decisional conflict with informed consent. The objectives were: (a) to describe aggregate demographic characteristics ofthe APN participants, (b) to describe the pre-intervention level of APN knowledge about patient decisional conflict with informed consent, (c) to describe the post-intervention level of APN knowledge about patient decisional conflict with informed consent , and (d) to describe the level of APN knowledge about patient decisional conflict with informed consent before and after APN participation in an online teaching intervention. Plan and Evaluation: Phase One: Conduct a literary needs assessment using a published evidence-based critique template. Phase Two: Design an online teaching intervention using the EBP approach. Phase Three: Implement an online teaching intervention for a projected sample of APN participants through a national online listserve. Phase Four: Evaluate APN knowledge about patient decisional conflict with informed consent before and after APN participation in an online teaching intervention. Outcomes and Results: Total participant performance improved on the adapted DCS instrumentation, with self-reported knowledge about decisional conflict achieving a similar increase, while self-reported knowledge about informed consent achieved at a slightly higher increase. The findings suggest that the use of a standardized, scripted, healthcare-specific, and patient-tailored consent is more effective in achieving desired patient outcomes where the desired patient outcome is an effective patient decision, one that is informed, consistent with patient values, and one with which the patient is satisfied.

    Request this Article


2010

    Implementation of an Evidence-Based Formal Preoperative Education Program for Cardiac Surgery Patients

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Acosta, Gloria J.

    Background: Preoperative education is a common feature of the preparation for many surgical procedures. It is anticipated that this education will results in beneficial outcomes for the patient. Comprehensive preoperative education for cardiac surgery patients sets the stage for reducing patients’ anxiety, increasing their perception of postoperative pain, shortening the length of their stays, and improving their satisfaction with healthcare. Investing the time in preparing cardiac surgery patients preoperatively; enhances the consistency of information given, assists in eliminating information gaps, and prevents postoperative complications. Foreground: Patients facing cardiac surgery are vulnerable due to their multiple stressors, possible co-morbidities, and of courses their cardiac history. Sought out after the results of patient satisfaction surveys was to provide formal preoperative education for cardiac surgery patients by investing in the impact, improvability, and inclusiveness for preoperative cardiac surgery education. Methods: Providing a formal preoperative education to patients eliminates education process gaps, permitting staff to identify opportunities to improve hospital communication, satisfaction. Four approaches were addressed. First, have all cardiac nursing staff been educated in the formal preoperative education process? Next are patients provided with consistent, knowledgeable patient education prior to surgery to facilitate having minimal psychological complications postoperatively? Third, are patients provided with enhanced quality of preoperative education to increase insight, perception, and knowledge of the cardiac nursing staff related to cardiac teaching? Lastly, are patients provided with a well-established reputable preoperative cardiac surgery protocol for the hospital? Evidence-Based Practice Framework: The Iowa Model of Evidence-Based Practice to Promote Quality of Care was used to implement the practice change. It provides a systems or organization perspective. Benner’s “From Novice to Expert Philosophy” application to nursing of the Dreyfus Model of skill acquisition was incorporated to evaluate the nurses’ proficiency in educating patients and to assess additional education needs amd skills for members of the healthcare team involved in this process. Findings/Results: All cardiac nurses employees in units affected by cardiac nursing staff can reduce patients’ anxiety; decrease their perceptions of postoperative pain, shorten length of their stays, and improve their satisfaction with healthcare. Implemented was a well-established multidisciplinary preoperative education protocol. To accomplish this evidence-based preoperative practice change, the nursing staff was educated in a consistent formal process for the cardiac surgery population.

    Request this Article


    Ankle-Brachial Index: Implementation of Evidence-Based Chronic Disease Management

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Alexander, Jackie Lea

    Project Ankle-Brachial Index (ABI) is an evidence-based health system point of care change project. The purpose was to pilot a program providing primary care team education to enable peripheral arterial disease (PAD) clinical practice guideline (CPG) implementation as a route to improve chronic disease management and self-care. The question was whether provision of this program will facilitate PAD CPG implementation within the primary care setting evidenced by comparison of pre and post PAD/ABI workshop knowledge base along with ABI measurements completed in the primary care setting. The shift in funding and health care focus on chronic disease prevention and management is recognized as crucial to remedy the regional health care crisis. Innovative plans to support health system change are sought to promote collaborative care and resource efficiency. The goal is improved chronic disease management and self-care promotion. The project plan was to foster knowledge transformation to enable point of care change by providing PAD/ABI workshops to primary care practice teams serving low-income population. There are three project objectives: Innovation of primary care chronic disease management through ABI measurement, and PAD education presented in workshops. Participating sites were provided an ABI Tool Kit and clinicial specialty support over a 3-month period to generate revenue and incorporate ABI measurement into their practice affording ABI Tool Kit purchase to sustain the practice change. The practice change is evidenced by ABI assessments during the 3-month post workshop interval and ABI Tool Kit procurement. Collaboration enhancement between primary care providers, and specialty clinicians to support PAD assessment and management within primary care. Collaboration was gained through post workshop survey to assess outcomes and evaluate the workshop. Resource efficiency enabled by inclusion of ABI assessment in primary care settings as a means of providing cost effective PAD care. The point of care change was evidenced by post workshop tally of ABI assessments with and end-point of medical management or appropriate timely specialty care referral. The theoretical framework consisted of the Model for Change to Evidence-Based Practice (EBP) applied to the Chronic Care Model with incorporation of Self-care Theory. The EBP Change Model provided a strategic practice change guide for integration of the Chronic Care Model in the primary care setting. Self-care Theory is crucial given the shift in the health care paradigm from provdier responsibility for chronic disease care to provider support of health care consumer self-care management. Thus, a comprehensive project structure exists. The findings support program potential to enable PAD CPG implementation for improvement in chronic disease care. Findings support that ABI measurement can be effectively tasked to medical assistants when supervised by knowledgable providers. The findings also support that engaging in ABI measurement is challenging to incorporate into primary care practice, but offers providers a valuable tool to improve PAD care. There is considerable complexity in health cyctem point of care practice change. Further refinement of the workshop format and delivery is recommended. Longer post workshop interval for skills acclamation and incorporation into the practice environment along with increased focus on reimbursement documentation could improve outcomes.

    Request this Article


    Improving Access to Care for Patients with Limited English Proficiency

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Ballard, Valerie

    People with Limited English Proficiency (LEP) confront multiple obstacles when trying to access health care. They report decrease in satisfaction, quality of care and often poor outcomes. There is a strong sentiment among American institutions that immigrants should learn English and that langauge barriers should not be the problem of hospitals and staff. This project evaluated policies and procedures already in place at the clinic, benchmarked these against standards of federal and state regulations of practice, with the goal to improve operations for staff and improve access and standard of care for patients with LEP. The purpose of this capstone project was to answer the question: For the Hispanic patients of limited English proficiency at this clinic will improvements in communication lead to improvements in access to care? The primary intervention was to increase the availability of medical interpretation either face to face or through mechanical devises. Everyday operations when serving patients with LEP were benchmarked against regulation standards. The staff was surveyed for suggestions. Signage, language services and medical information handouts were made available to patients with LEP. After Institutional Review Board Approval, Hispanic patients were asked to return a satisfaction survey. Results identified medication issues and after office appointment communication as areas that still needed resolution. Easier access to appointments and better understanding of provider instructions at the time of an appointment were viewed as positive accomplished outcome goals. This project was the catalyst for the short term goal of improving communication between staff and patients with LEP at a New Jersey clinic. Continued monitoring, revisions and updating must be an organizational goal in an effort to benchmark evolving practice change. Long term goals of this project will be to improve and continually monitor cost-effective ways to communicate with patients who identify themselves as having Limited English proficiency. Failure to do so will negatively affect the quality of care accessible to patients with LEP. This in turn will put increased demands on a broken healthcare system that is unable to financially support itself. Eventually, this organization will be the basis for community support to not only Hispanic patients with LEP, but all peoples of different cultures.

    Request this Article


    Percutaneous Nerve Stimulation for the Performance and Education of Peripheral Nerve Block Administration

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Craig, William John

    Problem: Studies and anecdotal reports support the use of percutaneous stimulation to facilitate the administration of peripheral nerve blocks as well as an effective training adjunct. A gap between the evidence and actual implementation exists, both in clinical practice and education. It appears the majority of nurse anesthetists are not aware of the benefits associated with this technique or how to successfully implement it into their practice. Purpose and Scope: The purpose was to explore the exposure, basic knowledge competency attainment, and opinions of nurse anesthetists at different stages in their careers regarding the use of percutaneous stimulation for prelocation of target nerves to enhance education, training, and performance of PNB administration before and after viewing a web-based educational video. Their new found knowledge will serve as a basis to add percutaneous stimulation to their armamentarium of skills. Goal: A primary project goal was to increase nurse anesthetist’ awareness and understanding of percutaneous stimulation as a technique to simplify peripheral nerve block administration to and as a beneficial adjunct for training. Objectives: The first objective was to obtain demographic characteristics of the participant sample to assess for generalizability. The pre-intervention questionnaire was to explore baseline knowledge and opinions regarding the use of percutaneous stimulation. The objective of the interventional video was to teach nurse anesthetists how to implementn percutaneous stimulation, understand the benefits, and motivate them to add it as a technique to their practice. The objective of the post-intervention questionnaire was to assess the change in providers’ knowledge competency and opinions regarding the use of percutaneous stimulation. Plan: Phase One: Conduct a needs assessment analysis through an evidence based literature review and consultation with specialty experts. Phase Two: Develop a demographic, pre-intervention questionnaire, interventional education video, post-intervention questionnaire to fufill the purpose, scope, and goals of the project and submit for Institutional Review Board (IRB) approval. Phase Three: Conduct face validation of project instruments, make appropriate methodological changes and submit changes for IRB approval. Phase Four: Implementation of the Internet based project and data collection. Phase Five: Data analysis and outcomes results to include demographics and pre-intervention to post-intervention questionnaire response comparison. Outcomes and Results: Demographics aligned with Benner’s Stages of Skill Acquisition Theory as participants represented various stages of development both as anesthesia providers and more specifically in the administration of peripheral nerve blocks. Demographics mirrored a sample population reflecting experience categories of the overall nurse anesthesia population. The changes in pre to post-intervention questionnaire responses validate the educational video as an influencial training tool and support the use of percutaneous stimulation technology.

    Request this Article


    Aromatherapy for Postoperative Nausea and Vomiting, Attitudes, Knowledge, and Practice Patterns of Perianesthesia Nurses Before and After an Educational Intervention

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Evans, Thomas J.

    Problem: Postoperative nausea and vomiting (PONV) affects an unacceptable proportion of surgical patients and can contribute to mobidity and unintended hospitalization. Nausea has a complex etiology and pathophysiology. Medications are costly and plagued with limitations. Therefore, nausea continues to be a dilemma despite conventional therapy. Purpose and Scope: The purpose of this capstone project was to describe Texas perianesthesia nurses attitudes, knowledge and practice patterns regarding aromatherapy as a complementary therapy for PONV before and after participation in an educational intervention. Nurses will translate new education to a practice change and use fast acting and low cost isopropyl alcohol aromatherapy to reduce PONV and improve patient care outcomes. Goal: The goal of the project was to implement an aromatherapy educational intervention for Texas perianesthesia nurses, and foster acceptance and application of isopropyl alcohol aromatherapy as a beneficial holistic nursing intervention. Objectives: First, to describe the demographic characteristics of Texas perianesthesia nurses taking part in the study. Second, describe and measure post-intervention changes in perianesthesia nurses’ use of aromatherapy for demographic characteristics of interest. Third, describe and measure changes in perianesthesia nurses’ knowledge for demographic characteristisc of interest. Fourth, describe and measure post-intervention changes in perianesthesia nurses’ attitudes toward complementary and alternative medicine for demographic characteristics of interest. Fifth, meaures the post-intevention change in perianesthesia nurses’ knowledge of aromatherapy. Sixth, measure the post-intervention changes in perianesthesia nurses’ attitudes toward complementary and alternative medicine. Seventh, describe and measure perianesthesia nurses’ practice patter after the intervention and time intervnal. Plan: Phase One: Conduct needs assessment using a published evidence-based critique template. Phase Two: Complete project plan and educational intervention using an evidence-based approach and submit to Institutional Review Board. Phase Three: Implement intervention and complete data collection. Phase Four: Using adapted instruments, describe or measure nursing attitudes, knowledge, and practice patterns of aromatherapy for PONV before and after an educational intervention and submit the results. Phase Five: Report and dissemintate information. Outcomes and Results: Using an alpha level of .05, the post-intervention data demonstrated a significant increase in knowledge and positive attitudes. Even though 74.1% of participants used aromatherapy prior to the study, 50% of participants elevated their use of aromatherapy after the time interval. Although the participants experience practice barriers, they sought out additional resources for information, were more satisfied with the therapy and felt it was beneficial for patients. Finally, relationships of interest between demographics and attitudes, knowledge, and use of aromatherapy had limitations but represent information that can be of interest for future investigations.

    Request this Article


    Implementation of a Disease Management Program to Enhance Self-Care Behaviors for Rural Adults with Heart Failure

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Fliris, Cathy

    Background: Heart failure (HF) affects 5.7 million Americans. It is Medicare’s second largest diagnosis-related group and second largest expenditure group. Studies utilizing disease management programs (DMPs) supported the use of advanced practice nurses (APNs) to successfully manage complex HF patient self-care needs in the clinic. Project Significance: Heart failure management is a great challenge to primary care providers (PCPs), patients, and their families. Primary care providers have knowledge gaps and uncertainty about the complex pathophysiology of HF as well as the evidence-based HF disease management program (DMP) clinical practice guidelines (CPGs) for chronic management of HF, especially in rural areas. However, DMPs are not widely implemented systematically by PCPs in urban or rural settings and thus have failed to improve costly outcomes significantly. Implementation of DMP CPGs of self-care of HF in a rural setting was the purpose for this system practice change project. Setting and Participants: A rural, APN-owned, primary care clinic in a rural community in Wyoming. Three APNs participated and 22 patients with HF were identified by HF diagnosis codes. Theoretical and Evidence-Based Framework: Dorothea Orem’s Self-care Deficit Theory of Nursing and Rosswurm and Larrabee’s Model for Evidence-Based Practice Change. Objectives: (1) Literature-based needs assessment; (2) Practice-based needs assessment of knowledge and use of HF DMP CPGs on self-care behaviors; (3) Description of pre-implementation HF self-care behavior teaching documentation by chart audit; (4) Presentation of results of chart audit; (5) Education of APNs and staff on the project, DMP CPGs rationale, how to implement a prompt system to increase utilization and documentation of DMP CPGs; (6) Implementation of the CPGs for four months; (7) Description of the post-implementation level of HF self-care behavior teaching documentation by chart audit; (8) Presentation of chart audit results of change in utilization and documentation before and after the CPG implementation; (9) Evaluation of the success of the CPG implementation by staff questionnaires; and (10) Discussion of ways to improve implementation and plan for sustainability. Methods: The project used a needs assessment questionnaire and chart audit and feedback format for measuring pre- and post-implementation for documentation of APN teaching of self-care, with results presented by PowerPoint presentation. Descriptive statistics were used to quanitify chart audit results. A post-implementation questionnaire was administered about successes and failures of the project and discussion was facilitated about ways to improve implementation and plan for sustainability. Results: Initial chart audit showed a baseline of zero documentation. Of a total of 22 patients identified with HF, 9 received documented self-care behavior teaching from the three APNs. Of the 12 patients seen in the clinic during the project, 9 received the teaching. The project demonstrated increased APN knowledge of HF self-care teaching, successful implementation of HF DMP DPGs into rural practice, and awareness of their practice patterns. Conclusion: Heart failure DMP CPGs on self-care behaviors can be successfully implemented in a rural primary care clinic practice by APNs. Provider education, chart audit and feedback, and consistent monitoring are effective means of implementing and measuring practice change. The APNs plan to sustain the project with the two modules found to be most important and pratical for patients on HF causes and medications.

    Request this Article


    Remediation for At-Risk Nursing Students

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Gibson, Linda

    The United States healthcare system is facing a crisis. Currently there are insufficient numbers of RNs to meet the healthcare needs of the aging population. It is imperative that each nursing student position be filled with a qualified applicant who will complete the program with the capability of passing the National Council Licensure Examination for Registered Nurses. Attrition is a problem in nursing programs. Currently RN programs in the United States have a 50% attrition rate. One reason is academic failure in nursing courses. Nursing students at-risk of failing a nursing course must be supported in the mastery of course content in order to be successful and to progress. Early remediation allows students to master content early in the nursing program and as they progress instead of waiting until the end of the program to begin remediation. The nursing program at which the capstone project took place has an attrition of 25.9% due to failing grades in nursing courses. Faculty and administration share the belief that a 25.9% attrition rate is unacceptable. It is the expectation that more nursing students who begin the nursing program will graduate. A remediation program was made available to all nursing students and attendance was expected for at-risk nursing students. The objectives of the remediation program were to: decrease attrition; help nursing students move from novice and advanced learners to proficient learners; pass each nursing course; pass course examination, the nursing program exit examination, and the NCLEX-RN on the first attempt; and to graduate qualified practitioners. The Johns Hopkins Nursing Evidence-based Practice Model was utilized to guide the development of a remediation program. This model is a three step process utilizing the acronym PET. The “P” represents developing a practice question. The “E” represents finding and evaluating the best evidence from research studies, and “T” represents translating the best evidence into practice. The remediation program implemented as a part of this project was successful in retaining students in the two nursing courses with the highest attrition rates: Fundamentals is taken in the first semester of the nursing program and Medical/Surgical Nursing I in the third semester. The attrition rate decreased from 25.9% to 9.3% in Fundamentals, and from 11.1% to 0% in Medical/Surgical Nursing I. The remediation program will continue in these two nursing courses. Remediation will be added to other courses as students progress in the program which has high attrition rates. Long term objectives will be evaluated to determine if early success in decreasing attrition will result in positive results on the program exit exam and NCLEX-RN pass rates.

    Request this Article


    Implementation of a Mentoring Program for Graduate Nurse Practitioners Newly Hired Within a Community Health Center to Increase Job Satisfaction and Decrease Turnover

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Hanks, Deborah

    As a result of the current legislative changes there will be a projected shortage of about 45,000 primary care physicians by 2020 to treat the newly insured who have chronic medical conditions, especially those living in rural and urban areas who receive their medical services in community health centers. Nurse practitioners (NPs) will necessarily become and indispensible component of the national health care system to meet the needs to provide medical care for the chronically ill. Current literature confirms the growing need for experienced NPs to mentor students and inexperienced NPs to achieve excellence in practice and ensure achievement of career goals. Despite this, NP mentors are a rare commodity. During the process of becoming and advanced practice nurse, every nurse practitioner (NP) has been mentored by an experienced NP; it is not possible to become an independent NP without the support and guidance of experienced mentors. An integral part of a practice-based discipline such as advanced practice nursing requires a commitment from NPs who have previously forged the path to independence. Over the last few years, the available numbers of NP mentors have declined, resulting in limited access to health care for patients and overuse of emergency departments (EDs) for primary care services. This Capstone Project explores the financial and social impact a Community Health Center (CHC) endured in 2007 resulting from a lack of NP mentors for new hire NPs. A mentoring program was developed by the senior NP with input from colleagues at the CHC following Cohen’s framework for an effective mentoring program.

    Request this Article


    An Evidence-Based Service for Parents: An Educational Intervention Within the Newborns’ First Week of Life

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Hooper, Nicole

    Routine newborn care encompasses not only the evaluation and health maintenance of the infant, but also includes the counseling and education of parents or other caregivers. Anticipatory guidance is a key part of providing care to the health newborn. Educating parents about the care of their baby, especially new parents, is of the utmost importance. An appropriate intervention to provide this education is the implementation of the American Academy of Pediatrics (AAP) health supervision clinical practice guideline (CPG). Furthermore, the implementation of the health supervision CPG via an office visit within the newborns first week of life allows the health care provider to evaluate the well-being of the infant and provide both anticipatory guidance and education on newborn care to the patients. Local services providing education and information on routine newborn care to parents was discontinued due to availability of the proper staff and financial instability. Following the discontinuation of these services, the local pediatric clinic received a 48% increase in the number of office phone calls from parents of newborn infants. The goal of this project was an effective implementation of a health supervision CPG based on the recommendation of the AAP. The objectives of this project were to ulimately increase the quality of health care provided to newborn infants in a private pediatric practice, as outlined in Health People 2010, and improve parental self-efficacy in providing newborn care with the utilization of Bandura’s self-efficacy theory. In turn, decreasing the number of phone calls received from the parents of newborns. The implementation process was guided by the utilization of the Rosswurm and Larrabee evidence-based practice (EBP) model. Parental expectation surveys were given to the parents at the conclusion of the visit to evaluate self-efficacy of the parent with newborn care and satisfaction of the visit. Out of the 107 visit performed, 99 surveys were collected; which represents 92% of the parents completing the surveys. Out of the nine questions evaluating parenting self-efficacy, 0% of the patients answered, “I cannot do.” In turn, on the 10-point Likert scale the majority of the parents circled the numbers 8, 9, 10 that correlate to “Certain I can do.” Ninety-nine percent of parents felt that the information they received in the visit was beneficial and could help them more effectively care for their newborn. Following the implementation of the CPG, phone calls from parents of newborn infants decreased 67% as well. As health care providers, the most important benefit is that the practice has the capability of providing better and more effective health care to our patients and families. Importantly, this visit is easily sustainable which can allow for a continued benefit to patients.

    Request this Article


    A Multidisciplinary Approach for Decreasing the Prevalence of Childhood Obesity

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Jordan-Marshall, Betty J.

    Obesity is affecting children throughout the nation. Approximately 12.5 million have a body mass index (BMI) classifying them as overweight or obese. Rates have been reported to be increasing with each grade level in Texas schools. As a result, these children have an increased risk for developing chronic diseases and decreased quality of life. However, few parents exhibited concerns regarding their child’s BMI associated healh risks. Through collaboration with the staff of a family practice clinic and the staff of a nearby school; we were able to implement a health-promotion/disease-prevention (HP/DP) project that focused on decreasing the prevalence of overweight and obesity among children eleven to eighteen year of age. The Stetler Model and the Interaction Model of Client Behavior (IMCB) guided the implementation of the project. This framework provided a unique and individualized approach for focusing on individual characteristics and the external factors that influenced dietary and physical activities that contribute to children’s health risks. Children, who were seen in the family practice clinic or attended the local school, were screened to determine their health risks associated with their BMI. These screenings provided a collective contribution of factors that affected each child’s health. Evidence-based (EB) strategies targeting dietary and physical activities were implemented for those having a BMI equal to or greater than the 85th percentile on the growth chart. Interventions focused on increasing awareness and motivating changes in health habits. Professional competencies and communications fostered parental decisions and enhanced the utilization of the strategies provided by the EB guidelines. Professionals and advocates provided motivation that initiated individualized decisions that influenced the diet and physical activities that were affecting their health. Data collected from the school’s health records and clinical charts for children who were seen in the primary care clinic was analyzed six months after the implementation of this project. An analysis of the data confirmed the prevalence of obesity and the lack of parental concern. The outcomes revealed an increase in the awareness of the need to initiate healthy dietary and physical activity behaviors that would promote health. An enlightening realization of the links between the presence of disease in family members and the health risks associated with being overweight or obesity was indicated after the first visit in most cases. The family history indicated the most significant impact on motivating changes in health habits. The HP/DP project proved to be beneficial in assisting providers, schools, and parents with identifying and managing the health risks associated with children’s BMI. It provided a unique, new collaborative, multidisciplinary service that bridged the gap between client singularity and the desired health outcomes. Sustaining this project and expanding the setting into other schools, clinics, and community settings would increase the potential for achieving optimal growth and development among children, resulting in a decrease in the prevalence of obesity among children.

    Request this Article


    Implementation of Strategies Within a Diabetes Guideline to Improve ALC Testing

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Joseph, Milly

    Within the United States the number of patients affected by diabetes is rapidly increasing. With that increase, a growing cost in dollars and lost productivity is also expected. Poorly managed diabetes as a result of an ineffective health care system or lack of patient involvement leads to increased complications of the disease and ultimately a poor outcome. Accordingly, it is essential for health care providers to improve patient engagement in disease management and quality of care and outcomes. In the San Joaquin Valley of Central California, prevalence of diabetes continues to escalate and the latest statistics provided by the California Department of Public Health estimates one in ten persons in the San Joaquin Valley has diabetes. Applying strategies demonstrating even small improvements in A1c testing and resulting in obtaining optimal values can help to combat morbidity and mortality in the San Joaquin Valley of California. The Agency for Healthcare Research and Quality (AHRQ) suggested diabetes care has continued to fall short of recommended standards of care. A high priority should be given to using evidence-based practice (EBP) in any such strategy. The AHRQ suggests the implementation of at least two quality improvement strategies can have some impact on patient compliance with disease management. To meet this challenge, a practice change utilizing two strategies to improve patient engagement in their disease management was proposed and implemented. The practice change in diabetes care included: (a) telephone reminders for glycosylated hemoglobin testing; (b) disease management monitoring by the nurse practitioner. The Ottawa Decision Support Framework was used for this project. This framework presents a systems approach to evaluate patient needs and health beliefs while working toward the implementation of interventions to improve wellbeing. This framework offers guidance in the evaluation of values and beliefs. For this project utilizing interactive and focused approaches to improve diabetes management and the evaluation of the effect of those interventions on diabetes processes were seen as a worthwhile endeavor. A transformational system change that provided patients with diabetes phone reminders for A1c testing was implemented within a family practice clinic. The electronic record was queried for evidence of A1c testing and results. The project nurse practitioner served as the care manager and oversight of patients with diabetes. The practice change implemented provided a more focused approach to diabetes with the added benefit of more timely feedback. There were 311 patients included in the project intervention. Conclusions indicated an improved testing compliance but failed to show improvemet in A1c value. However, this may be an indication of initial increased testing frequency of patients with poor glycemic control. Initial increases in A1c percentages should be expected in the short term as a result of capturing those patients who were poorly controlled and those failing to test at regular intervals prior to the intervention. Implementation of these two practice change strategies are a cost effective approach to diabetes care leading to improvement in outcomes for patients with diabetes. Improvement in the outcomes can lead to an overall cost decrease to the health care system as a whole. More work is needed to improve A1c control in patients having difficulty achieving glycemic control. Strategies that may assist this desired goal should be readilty embraced and implemented in all health care settings.

    Request this Article


    Facilitating Practice Guideline Implementation Through an Evidence Based Practice Education Intervention to Promote the Use of the Bougie Intubation Introducer

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Kauffman, Scott

    One of the most pervasive aspects of American health care in today’s environment is the drive to maintain and improve high quality health care while reducing the costs of that care. Health care costs account for approximately 16% of the gross domestic product, triple the amount from the previous five years. Anesthesia providers are constantly urged to include cost consciouness in their decisions, balancing the natural desire to provide the highest quality of care with the overall priorities of both the health care system and the individual patient. Anesthesia professionals remain targets for limiting health care expenditures. This fact is due in part to anesthesia professionals, directly and indirectly, accounting for 3 to 5% of the total health care costs in this country. Airway management is the cornerstone of anesthesia practice. The proper management of the airway, including the ability to intubate the trachea, is paramount. In 1993, the American Society of Anesthesiologists (ASA) identified the need for improved strategies to manage the patient’s airway. This led to the development and implementation of clinical practice guidelines (CPG) for the management of the difficult aiway. These CPGs provide a systematic approach to airway management using algorithm charts. Within these practice guidelines, several alternative devices or adjuncts are identified to assist with intubation. Many of these adjuncts have been used for years and have documented favorable patient care related outcomes. The long term goal of this project was to implement a practice change to influence care at the point of patient contact. The short term goal of this project was to put into practice an evidence-based practice (EBP) intervention to facilitate the use of the ASA CPG for the management of the difficult airwat by CRNSs. The outcomes improved cost efficiency, decreased traumatic intubations, and improved access to affordable care by incorpoprating the CPGs into their practice. The objectives of the practice change were to facilitate the use of the CPG by decreasing their knowledge deficit regarding the Bougie. The construction and implementation of the EBP change followed the steps discussed in The Model for Evidence-based Practice Change. Pre intervention and post intervention data was gathered for 3 months. By decreasing CRNAs knowledge deficit through the EBP intervention and outcome indicators were all favorable. The quantitative analysis and target outcomes of the intervention demonstrated that the intervention was highly effective. CRNAs increased the use of the Bougie 533% which improved cost efficiency. The decrease in traumatic intubations was also decreased by 100%. Access to affordable care was demonstrated with the 533% increase in usage of the Bougie. Collectively, the favorable outcomes confirmed that the overall quality of care was improved. This data was gathered from a quality assurance data collection tool which identified the airway adjunct and adverse events during difficult airway management. The Bougie is now the most commonly used airway adjunct at the sponsoring facility. This EBP educational intervention was effective and facilitated the use of the CPG which increased the use of the Bougie at the point of care.

    Request this Article


    Attitude and Knowledge of Health Care Practitioners Concerning Chronic Low Back Pain

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Lundemo, Barbara C.

    Problem: Approximately 80 million people in the United States are affected by chronic low back pain (CLBP) at some time in their lives. It disables more people than cancer or heart disease and costs the American people more than 100 billion dollars a year in medical costs. Pain can be debilitating, causing not only physical strain but also serious financial, social and quality of life issues for many pain sufferers. Practitioner fo not always understand the causes of CLBP, and this lack of understanding has led to inadequate assessment and treatment for these patients. Chronic low back pain has continued to be a challenge for healthcare professionals. The knowledge and attitudes of these healthcare practitioners plays an important role in the treatment and referral of patients with CLBP. Purpose and Scope: The purpose of this Capstone Project was to describe healthcare provider attitude and knowledge regarding patients with chronic low back pain (CLBP) before and after an online CLBP teaching intervention. The rationale for the project was to increase healthcare practitioner’s awareness of evidence-based guidelines regarding the management of CLBP, with subsequent implementation of adequate treatment plans. Goal: The goal of the project was to successfully implement an evidence-based teaching intervention pertaining to assessment and treatment strategies for healthcare practitioners treating CLBP. Objectives: The first obejctive was to describe the demographic characteristics of healthcare practitioners who participated in an online survey concerning their knowledge and attitude regarding CLBP. The second objective was to describe the pre-intervention self-awareness of the selected healthcare practitioners relating to their knowledge and attitude regarding the assessment and treatment of CLBP. The third objective was to describe the post-intervention self-awareness of the selected healthcare practitioners knowledge and attitude regarding the assessment and treatment of CLBP. Fourth was to measure changes in self-awareness of knowledge and attitude of the assessment and treatment of CLBP before and after an evidence-based teaching intervention. Plan: Phase One: Administer a survey using a tool developed from a summary of the literacy evidence regarding CLBP. Phase Two: Design a teaching intervention using an Evidence Based Medicine approach. Phase Three: Implement a teaching intervention based on evidence-based treatment guidelines for CLBP for a projected sample. Phase Four: Evaluate the level of attitude and knowledge self-awareness before and after an evidence-based teaching intervention using an alpha coefficient procedure. Outcomes and Results: The analysis of this project suggests that the teaching intervention had the desired positive effects. The post-test knowledge and attitude measures were significantly correlated. Participants also reported significantly more comfort and more positive attitudes following the intervention.

    Request this Article


    An EBP Educational Project: Identifying Barriers and Behavior Change

    Published Year: 2010
    Program: Doctor of Nursing Practice

    McConachie, Angela

    Background: Evidence Based Practice (EBP) is a popular topic due to the cost effective, safe and current practice it provides. There are benefits to EBP, but also barriers to implementation by the nurse at the bedside. These barriers prevent utilization of the Evidence Based Practice education received and true behavior change. Foreground: The hospital used for this project is a top tier, large, academic, magnet hospital that is located with a 13 hospital organization. The administration has been discussing and educating employees on EBP for several years, but has not witnessed nurses translating that into bedside practice. Methods: A qualitative, focus group design was used to identify whether nursing behavior changed at the bedside after completing an EBP educational intervention, Evidence Equals Excellent (EEE). The EEE graduates were used to form consistancy in educational background relating to EBP and place of employment. EBP Framework: Two theories are intertwined to describe, organize, and create a theoretical foundation for this project. The first is a model by Rosswurm and Larrabee, which encompasses a systematic approach to implement EBP. The last stage within the model relates to maintaining EBP, this project will determine if ths hospital is maintaining EBP after educational intervention. The second is a change theory, Change Curve Model, to address whether fruition and true behavior changed occured. Finding/Results: Descriptive data was compiled using the demographic findings. Although nurses were recruited, only management personnel participated, no staff nurses. Behavior change was identified as well as several key barriers to change. Barriers such as lack of direct management support, no “buy in” from unengaged staff nurses, resistance and the large size of the organization. Conclusion/Recommendations: The data obtained by this project will aid the hospital administration to further facilitate behavior change as well as provide perceived barriers to address. The recommendations are to disseminate the information not only to appropriate individuals at the hospital and corporate level to facilitate EBP usage at the hospital, but to all caregivers at the bedside.

    Request this Article


    Improving Identification and Management of Patients with Hepatitis C by Increasing Awareness Through Educational Intervention

    Published Year: 2010
    Program: Doctor of Nursing Practice

    McIntyre, Vicki Lynn

    Background: Hepatitis C virus (HCV) account for a large proportion of cases of chronic liver disease, liver disease deaths, and cases of hepatocellular carcinoma (HCC), and is the predominant reason for undergoing liver transplantation. Chronic liver disease is the tenth leading cause of death among adults in the United States, causeing approximately 25,000 deaths annually; and the Centers for Disease Control and Prevention predicts that deaths due to HCV will double or triple in the next 15 to 20 years. Nurse practitioners face a rapidly changing healthcare environment. They must stay current in an environment in which medical information, technologies, and relationships with other healthcare systems are constantly in flux. A large body of literature documents the gap between scientific evidence and actual practice, underscoring the need for change in medical care. Foreground-Local Significance: According to the Arizona Department of Health Serivces (ADHS), from 1998 through 2006 there were 65,916 cases of chronic HCV infection reported in Arizona; Cochise and Pima Counties reported 881 and 9,241, respectively, for a total of 10,122 cases. ADHS receives approximately 8,000 HCV-positive reports per year. As a result, the total number of reported HCV-positive individuals in Arizona has grown to more than 80,000. ADHS estimates Arizona to have a hepatitis population of over 120,000. This equates to at least 30,000 infected individuals in Arizona who do not know about their infection. Methods-Goals, Objectives, Evaluation: The goal of this project was to facilitate empowerment of nurse practitioners to develop the knowledge, skills, and utilized practice guidelines to improve health care outcomes for patients with HCV in southern Arizona through changes in their clinical practice. The objective is improved identification by nurse practitioners of patients infected with HCV, in order to improve the management of HCV and facilitate access to specialists. The pre- and post questionnaire responses were evaluated and compared for practice change. Evidence-Based Practice Framework: A model for evidence-based practice, created by Rosswurm and Larrabee, was used to under gird this project. In the present case, the model is intended to help achieve the overarching goal of enhancing nurse practitioners’ knowledge leading to changes in practice with regards to patients with HCV. Conclusion/Recommendations: Evaluation of the effectiveness of the educational intervention involved 22 subjects over a two-month period. The results were positive with regard to practice change. Using the model for evidence-based practice led to changes in implementation of professional guidelines. To better understand individuals’ ability to sustain the changes in practice, ongoing evaluation on a quarterly or at least a semiannual basis over a two-year period of longer would be beneficial. Due to time constraints, these phases fall outside the scope of the DNP project.

    Request this Article


    Impact of Nurse Practitioner Managed Heart Failure Clinic

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Mowery, Allison

    Heart failure (HF) affects a significant and growing number of Americans and carries a considerable cost to society. The incidence and cost of HF continues to increase with HF being the most common cause of hospitalization in the United States. Cost estimates for HF in 2008 are $69.4 billion dollars. HF care delivery has been identified by the author’s healthcare system as a major strategic concern. Within this health care system there was no formal process in place for coordination of disease management and implementation to goal of evidence based therapies (EBT) for the HF population. The author, along with leaders from this health care system determined a need for better coordination and use of EBT for this patient population. Multidisciplinary care, use of proven pharmacologic and non-pharmacologic therapies, nurse directed education and intervention have been shown to be effective in reducing readmission and improving quality of life (QoL) of the HF patient and have been reported in the literature. In this paper the development and implementation of a nurse practitioner (NP) facilitated and managed heart failure clinic which provided comprehensive, coordinated, evidence based care for this patient population is presented, also in this paper is a discussion of the patient outcomes as a result of participation in this disease management HF clinic. This Capstone Project consisted of a quality improvement project which examined the impact of an NP facilitated and managed HF clinic on adherence to evidence based guidelines for HF on use of proven therapies, QoL, and readmissions and was implemented at a large referral center hospital with adult HF patients considered for participation. These patients were followed in the HF clinic by NPs working in collaboration with HF subspecialist cardiologists and received individualized, intensive education on self care strategies and risk factor modification. Participating patients also received medical management of their HF in order to better coordinate care and increase the use of EBT. This author chose to use Bandura’s self efficacy theory as a theoretical framework for this project as self care strategies are based on theories of self efficacy. For the evidence based practice model this author selected the Rosswurm and Larrabee model to use as the framework for the development and implementation of this clinic. This author proposed that NP facilitated care of this patient population would prove to be effective at decreasing readmission, improving QoL and, improving use to goal of proven therapies. The results demonstrated thus far have been supportive of this assumption as use of EBT and QoL increased and readmissions decreased as a result of participation in this disease management HF clinic. The author believes that this practice change with a solid foundation in evidence based practice has proven effective and should be expanded throughout the author’s health system. Recommendation is also made to use this clinic as a model for other chronic diseases in order to improve outcomes for other populations of patients.

    Request this Article


    Integrating Palliative Care in the Intensive Care Unit: An Evidence Based Practice Change

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Ogilvie, Carrie C.

    Problem: Patients in the intensive care unit (ICU) hang in a delicate balance between life and death and this uncertainty creates anguish for patients and families. They need information, guidance and support as they try to navigate the course of a critical illness; however, studies indicate these needs are not met. The primary recommendation for meeting these needs is integrating palliative care (PC) into the comprehensive care of critically ill patient. Although Clinical Practice Guidelines (CPGs) were developed to help facilitate this integration, gaps in adherence to the CPG were identified within a selected health care organization. Purpose: The primary purpose of this capstone project was to evaluate the provision of evidence-based PC to critically ill patients by assessing the level of adherence to CPGs. A secondary purpose was to promote evidence-based practice by identifying strategies and developing interventions to enhance the provision of evidence-based PC in ICU. Goal: The goal of this project was to identify and implement an evidence-based practice change that would improve the provision of PC to critically ill patients. Objectives: First, determine current state of PC provision in the ICU. Second, locate and analyze the best evidence regarding the provision of PC to critically ill patients. Third, design interventions and develop strategies that supported the provision of evidence-based PC in the ICU. Fourth, implement and evaluate the effectiveness of the practice change on improving the provision of evidence-based PC. Fifth, integrate PC into the comprehensive care of all critically ill patients as standard practice and set a measurement for ongoing monitoring. Plan: This project was an evidence-based practice change and the plan consisted of five phases, which mirrored the five aforementioned objectives. The plan engaged key stakeholders throughout the process. Outcomes and Results: Key findings revealed an improvement in the adherence to CPGs for PC and reduction in resource utilization. Baseline CPG adherence rate was calculated at 59% and increased to 73% after the implementation of the practice change. Additionally, practice changes that improved the provision of PC care to the imminently dying patient were directly associated with a decrease in resource utilization and included a reduction in ICU length of stay by 0.8 days; a reduction in direct costs by $4200; and a cost avoidance of $2.5 million.

    Request this Article


    Attitudes Toward Menopause in a Faith-Based Community: An Interventional Study

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Parrish, Becky L.

    Problem: Postmenopausal women were commonly prescribed hormone replacement therapy, thought to be cardio-protective, when the 2002 results of the Women’s Health Initiative (WHI) reported increased risks of coronary artery disease, stroke, and breast cancer. Since then, menopausal women have been concerned and confused about the use of hormones and often choose no hormone therapy or seek alternative treatments options because they are ill informed. Researchers have shown that women who have menopause knowledge, positively correlated with positive attitudes regarding menopause. Purpose and Scope: The purpose of this study was to describe attitudes toward menopause in a selected faith-based community women’s ministry before and after an educational program regarding menopause. Goal: The goal of this project was to educate 45 to 65 year old women about the common changes women experience in menopause and the current treatment options available. This education will increase their knowledge of menopause thus improving their attitudes and perceptions regarding menopause. Objectives: First, to describe demographic characteristics of women within a selected faith-based community women’s ministry. Second, to describe pre-intervention self-awareness regarding attitudes toward menopause by women within a selected faith-based community women’s ministry. Third, to describe post-intervention self-awareness regarding attitudes toward menopause by women within a selected faith-based community women’s ministry. Fourth, to measure changes in a self-awareness attitudes toward menopause before and after an educational intervention. Plan: Phase One: Conducted a needs assessment by evaluating current evidence regarding menopause, women’s perceptions of menopause and recommended treatment options. Phase Two: Developed an educational intervention regarding menopause and current recommended treatment options. Phase Three: Implemented an evidence based menopause education intervention for a projected sample. Phase Four: Evaluated women’s attitudes toward menopause before and after an educational intervention using the Attitude Toward Menopause. Outcomes and Results: Using a triangulated interventional research design, results of the pre-intervention and post-intervention measures revealed a modest mean score increase in self-awareness attitudes toward menopause in women within a selected faith-based community women’s ministry. Moreover, reliability estimates based on internal consistency for the study instrumentation achieved significance, as compared with previous demonstrated reliability by Battistoni.

    Request this Article


    Laboring Epidural Hydration and Its Effects On LATCH Scores

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Pecora, Anthony

    Three groups of eleven participated in an evidenced-based practice project. All participants were between the ages of eighteen and thirty-eight and had an uncomplicated vaginal delivery. Each patient received continuous lumbar laboring epidurals according to strict departmental protocol. Breastfeeding dyads received continuous laboring epidurals (CLE) from three anesthesia providers. LATCH scores, which are breastfeeding documentation numbers, were collected immediately after birth once again in the well-baby clinic three days after discharge from the hospital. The LATCH system has been found to have a high interrater reliability in construct validity. LATCH is a breastfeeding charting system that provides a systematic method for gathering information about individual breastfeeding sessions. The three anesthesia providers were selected based upon their current practice in relation to the amount of Hartmann’s solution infused before the CLE was placed. The first anesthetist placed laboring epidurals without a routine fluid bolus of Hartmann’s solution. The second anesthetist commonly infused 500 milliliters of Hartmann’s solution before inserting a laboring epidural. The third anesthetist infused 1000 milliliters of Hartmann’s solution before inserting a laboring epidural as a part of their routine practice. There were no changes in current practice for the purpose of this evidence-based practice project. The amount of total intravenous fluid infused was measured and recorded. If intravenous overhydration affects breastfeeding behaviors, neonates whose mother’s received larger amounts of Hartmann’s solution will demonstrate lower LATCH scores.

    Request this Article


    Telehealth and Low Back Pain

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Radford-Goad, Linda

    Telehealth delivery of Physical Therapy to Occupational Workers with Low Back Pain (LBP) is a practice change project that uses information technology to diagnose, treat and monitor the occupational worker with LBP, while in a different physical location than the expert providing the care. Telehealth technology is the use of communications technology to transmit medical information from one location to another and has evolved to remove geography as a barrier to care, thus allowing patients to receive care when and where they need it. Telehealth is seen as a venue for improving healthcare access in vulnerable populations, rural areas and in specialty areas. LBP is a significant health care problem in the industrialized world with a major economic impact in the United States, with total costs related to this condition exceeding $100 billion per year. Additional costs are accrued in terms of medical treatment, lost productivity and nonmonetary costs such as diminshed ability to perform usual activities, which then decreases quality of life. Therefore, due to the significant health care problem and the expensive nature of LBP, innovative and effective management needs to be obtained to prevent progression to chronic LBP which is even more complex and costly. The objectives are to utilize Telehealth technology for physical therapy to make this specialty more accessible to occupational workers with LBP. The tools used to evaluate this technique of delivery, are a Telehealth survey, adapted from the Utah Telehealth Network, and the Oswestry Low Back Pain Scale that is used globally by physical therapists to determine the percentage of disability inflicted by the LBP. The purpose of this project is to launch a practice change project to test the utilization of Telehealth technology in an on-site clinic at a Textile Mill for a prompt evaluation, assessment, and treatment of occupational workers with LBP. This will be accomplished by a Doctor of Physical Therapy that specializes in the Mechanical, Diagnosis and Treatment of the spine certified by the McKenzie Institute. This is commonly known as the McKenzie Method which will be the term used for this project and paper. This project seeks to answer the questions: can physical therapy delivered via Telehealth technology provide appropriate delivery of physical therapy to occupational workers with LBP and can occupational workers have improved LBP management with the use of the McKenzie Method physical therapy that is delivered via Telehealth technology? The theoretical foundation used for this project is an Evidence Based Practice (EBP) Change Model and will be used as the framework to guide the project and discussed in detail later in this paper. The framework used for LBP and physical therapy is The Physical Therapy Model to guide LBP treatment which attempts to organize a comprehensive physical therapy strategy for optimal LBP management. The findings of the Telehealth delivery of Physical Therapy to Occupational Workers with LBP suggested that Telehealth delivery of physcial therapy was an appropriate technique to access this specialty and that the McKenzie Method was successful in decreasing LBP while increasing self-treatment and management of the LBP and recommended it’s use for a more timely access to physical therapy.

    Request this Article


    Reducing Obesity at a Local Charter School

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Reveles, Kathryn

    Background: Pediatric obesity is escalating and predisposes children to a multiple of health risks. These risks are magnified in the poor and predominantly Hispanic population residing along the US-Mexico border where health disparities are rampant. Foreground: Many low-income families rely on school meals – breakfast, lunch, and after-school snacks – to feed their children. An analysis of a typical lunch at a local charter school (EPCS) found unacceptable low vegetable, fruit, and whole grain. Because children eat what is available, healthier school meals will help build life-long eating habits and school-age children receiving school meals are prepared onsite. Methods: The administrator of the community organization that ran the charter school and associated clinic championed the change project. Healthier school meals were implemented by a multidisciplinary team of stakeholders, including parents and children. Clinic staff measured indices of weight pre- and post-implementation. EBP Framework: An integrative model was utilized to guide this change process. The Prochaska model for change enhanced Team Strategies and Toold for Enhancement Performance and Patient Safety (TSTEPPS) by identifying behaviors over the change process that influenced outcome. Findings/Results: External funding provided the means to build a state-of-the-art kitchen at the school. Faculty and students from a local community college culinary arts program staffed the kitchen. Students, parents, and team members enjoyed the taste of school meals prepared on-site using AHA guidelines. No difference in indices of obesity changed over the 14-week school meal program. As expected, weight circumference-to-height ratio predicted central adiposity across all grades. The rate of obesity tripled between pre-kindergarten and third grade. Conclusion/Recommendations: Continued monitoring of the EPCS students BMI and wc:ht needs to occur to document future changes in the overweight and obese percentages, especially with the addition of increased physical activity. In addition, continuing to utilize wc:ht ratios will assist in establishing pediatric standards for the measurement. One school, one meal at a time is a small but important step toward reducing pediatric obesity rates.

    Request this Article


    Quality of Life for Individuals Enrolled in Heart Failure Telemonitoring

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Schmaling, John

    Problem: The incident of heart failure (HF) is a growing health problem in the United States. Approximately 5 million people have HF and over 550,000 people are newly diagnosed each year leading to 6.5 million hospital days per year. Heart failure management is costly and patients diagnosed with heart failure account for a high percentage of total healthcare dollars. One method for the management of HF has been telemonitoring programs. These programs have demonstrated significant improvement in symptom management of the disease, decreased mortality and decreased hospital days. While telemonitoring has improved management of the disease, little is known how HF telemonitoring programs affect perceived quality of life. Given that many individuals place a higher significance on quality of life rather than quanitity of life, determining if a HF telemonitoring program can significantly improve individual perceived quality of life is an important aspect to consider when managing the disease. Purpose and Scope: The purpose of this capstone project was to determine whether enrollment in a HF Telemonitoring program improved perceived quaility of life. Measurements of quality of life were made initially and again after two months using the Minnesota Living with Heart Failure (MLWHF) questionnaire. Project Processes: First, identify a study population of 32 participants who meet the inclusion criteria. Second, describe participants’ characteristics using demographic data including age, gender, marital status, ethnicity, diagnoses, living situation and medications. Third, measure perceived quality of life initially and again after two months using the MLWHF questionnaire. Finally, determine the statistical significance of the two quality of life measurements. Plan: Phase One: Determine there was a lack of knowledge in the area of HF disease management and quality of life. Phase Two: Submit IRB application. Phase Three: Obtain approval for capstone project from insurance company. Phase Four: Obtain IRB approval for project. Phase Five: Collect data initially and again after two months in the proposed sample population. Phase Six: Evaluate data. Phase Seven: Complete Written report. Outcomes and Results: This was a quasi-experimental study using a convenience sample of 32 participants living in a Southwestern state who are enrolled in a HF Telemonitoring program. Quality of life was measured initially and again after two months. It was determined that there was a significant difference in the perceived quality of life between the two time periods. Recommendations: Future projects should focus on expanding the sample size as well as the experimental time frame in order to examine how quality of life can change over the course of long term telemonitoring.

    Request this Article


    Advanced Practice Nursing Knowledge Regarding the Use of Trigger Point Injections in Primary Care Management of Myofascial Pain

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Seago, Diane

    Despite sound evidence to the contrary, trigger point injections containing steroids are being used to treat myofascial pain. According to Frost, Jessen, and Siggaard-Andersen injections to relieve taut muscle can be effective, even if saline is used. Even so, providers persist in the administration of steroids, which are potent anti-inflammatory medications, and have numerous side effects such as myotoxicity of the muscle tissue. Purpose of Scope: The purpose of this Evidence-Based Practice (EBP) project was to describe Advanced Practice Nursing (APN) knowledge regarding the use of trigger point injections in primary care management of myofascial pain before and after participation in an online intervention and at a six-week follow-up. Using descriptive-interventional methodology, the study variable of APN knowledge about the use of trigger point injections in primary care management of myofascial pain was measured using a ten-item knowledge instrument developed by the Project Investigator (PI). Goal and Objectives: The goal of project was to successfully implement an online intervention regarding the use of trigger point injections in primary care management of myofascial pain for APNs and to determine APN knowledge before and after participation in an online intervention and at a six-week follow-up. The objectives were to: (a) describe aggregate demographic characteristics of the APN participants, (b) describe pre-intervention APN knowledge, (c) describe post-intervention APN knowledge, (d) describe six-week follow-up APN knowledge, and (e) describe APN knowledge regarding the use of trigger point injections in primary care management of myofascial pain before and after participation in an online intervention and at a six-week follow-up. Plan and Evaluation: Phase One: Conduct a literary needs assessment using a published evidence-based critique template. Phase Two: Design an online intervention using the EBP approach. Phase Three: Implement an online intervention for a projected sample of APN participants through a national online listserve. Phase Four: Evaluate APN knowledge regarding the use of trigger point injections in primary care management of myofascial pain before and after participation in an online intervention and at a six-week follow-up. Outcomes and Results: Results of the pre-test revealed performance means below the calculated expected mean of 5.5; myofascial pain pre-knowledge mean score was 4.48 while trigger point injections pre-knowledge mean score was 4.24, demonstrating that participant self-perceived knowledge was lacking. Results of the post-test perceived knowledge regarding myofascial pain increased to a mean score of 7.64 and perceived knowledge regarding trigger point injectios increased to a mean score of 7.54, demonstrating a significant increase in self-perceived knowledge. At six-week follow-up, perceived knowledge regarding myofascial trigger point injections increased to a mean score of 8.14, demonstrating retention of self-perceived knowledge. Test-retest performance data demonstrated similar findings. Cronbach’s Alpha performance for test-retest reliability demonstrated reliability in this sample.

    Request this Article


    Collaborative, Interdisciplinary Quality Improvement Project to Improve Weaning from Mechanical Ventilation

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Snow, Judy A

    Problem: Critically ill patients in Intensive Care Units often require mechanical ventilation and may require sedative and analgesic medications to optimize ventilator benefit. Mechanical ventilation, as well as sustained use of these medications, can influence duration of ventilation, length of stay and development of co-morbidities. Use of evidence based Clinical Practice Guidelines (CPGs), in the form of a protocol, can guide care of these patients. Communication and collaboration in the Registered Nurse (RN)/Respiratory Therapist (RT) team who care for these patients and apply this protocol is imperative. Purpose: The purpose of this project was to identify current levels of adherence to a CPG based protocol specific to mechanically ventilated patients at a specific community hospital and to determine barriers to that adherence, and develop a plan for improved adherence to the CPG based protocol. Goal: The goal of this project was to facilitate improved teamwork, communication and collaboration in the RN/RT team through development of a plan to improve adherence to a CPG based protocol for mechanically ventilated patients. Objectives: First, to describe current levels of adherence to a CPG based protocol specific to mechanically ventilated patients, compare those levels to published literature and communicate the information to staff. Second, to invite staff to identify barriers to protocol adherence. Third, to prioritize identified barriers. Fourth, to invite staff suggestions for improvement to identified barriers and outcome measures for success. Fifth, to compare these suggestions to literature. Sixth, to invite staff to develop a plan to improve adherence to the CPG based protocol. Plan: In this four phase quality improvement project current data regarding protocol adherence was considered, staff was engaged to identify barriers to adherence and make suggestions for improvement, their suggestions were compared to evidence-based literature and a new plan was developed. Outcomes and Results: Key findings revealed baseline adherence rates to the CPG based protocol ranging from 35.3 to 78.8%. Staff identified sixteen barriers to protocol adherence. Staff prioritized barriers of difficulty with process timing, concerns regarding absence of RTs during the process, prolonged ventilation related to timing of physician rounds, process disruption by morning X-Rays, and discontinuation of sedation. Staff made multiple suggestions for improvement in the process, centering around the themes of process timing, elements of safety screening for the spontaneous awakening trial, technique for discontinuing or decreasing sedation, technique for restarting sedation, and clarification of the description of agitation. Collaboration and communication in the RN/RT team resulted in development of a new process for application of a CPG based protocol, with the goal of improved adherence.

    Request this Article


    Implementation and Evaluation of a Glidescope® Teaching Demonstration

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Stimpson, James

    Purpose: The purpose of this study was to design, implement, and evaluate a GlideScope teaching demonstration to healthcare providers, with a main focus on anesthesia providers. Advanced airway equipment combined with improper training on its use is of no use at all. Endotracheal intubation is a skill that anesthesia providers take great pride in and strive to perform to perfection. As airway experts, anesthetists are charged with keeping the patient safe during the surgical procedure while ensuring amnesia and analgesia. It is with this purpose in mind that this project manager sought to implement a teaching intervention and return demonstration with the GlideScope. Advances in new technology have improved the safety and ease of which intubation is accomplished. No single intubation technique is suitable for all patients, thus making it imperative that anesthesia providers arm themselves with all possible airway devices to ensure a safe operative experience. Method: This project involved an analysis by the project manager of a GlideScope intubation. The project manager then provided a teaching intervention on GlideScope use and again evaluated the participant performing GlideScope intubation on a mannequin. Pretest/post-test analysis was used to document the change in learner outcomes. Results: This project showed a strong correlation between proper educational preparation and the use of the GlideScope. All provider levels showed increased skill and knowledge level after attending the GlideScope teaching intervention and subsequent return demonstration. Conclusion: Conventional Macintosh and Miller laryngoscope blades are routinely used to place endotracheal tubes (ETTs) under direct visualization of the vocal chords. Occasionally, the anesthetist will encounter a patient with a difficult airway has been the flexible fiberoptic bronchoscope, but recently the development of a new type of fiberoptic scope, the GlideScope, has been introduced. The GlideScope provides a significantly improved view of the vocal chords, however, placing the ETT through the narrow, delicate vocal chords can be quite challenging, if not impossible. Through proper training, the GlideScope can be used with greater efficacy and with safer outcomes in not only the urgent nature of the trauma and intensive care patient, but also the patient with normal anatomy under routine conditions. This project documents a direct correlation between educational preparation of the provider and improved results with the GlideScope intubating device.

    Request this Article


    Implementing a Clinical Practice Guideline on Human Papillomavirus Immunization in a Family Practice Clinic

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Tomlinson, Debbie Sue

    Background: Human papillomavirus (HPV) is a common virus. There are more than 100 types of HPV. About 70% of cervical cancers cases are caused by only 2 of the 15 cancer-causing types of HPV these two are called HPV 16 and HPV 18. Approximately 1 in 4 females between the ages of 14 and 59 has HPV. Over a lifetime, about 8 in 10 women will have at least one HPV infection. The availability of an HPV vaccine has positioned primary care providers (PCPS) to play an active role in ensuring its successful implementation. However, there needs to be a systematic approach to increasing HPV vaccination rates during the clinical encounter. Furthermore, providers must be aware of common knowledge, attitudes and belief barriers associated with HPV and the vaccine that are often encountered during clinical visits. Foreground: Primary care providers are uniquely positioned to deliver an HPV vaccination strategy to their communities since most preventive care service occur in the outpatient setting. In 2006, the United States Food and Drug Administration approved the first HPV vaccine for females between the ages of 9 and 26 to protect them against the 6, 11,16, 18 HPV strains. Phase I and III clinical trials have shown the vaccine to be efficacious in preventing cytologic abnormalities, genital warts, and vulvar or vaginal neoplasia. Prevention rates were high in these studies, ranging 89-100%. The availability of the HPV has positioned primary care providers (PCPs) to play an active role in ensuring its successful implementation. However, there needs to be a systematic approach to increasing HPV vaccination rates during the clinical encounter. Several clinical practice guidelines (CPGs) released by guideline developers allow the PCP to systematically by develop statements to assist practitioners and patient decisions about appropriate health care for specific circumstances. Prior to this project, none has been adopted by the providers at the clinic where this project took place. Methods: The objective of this project was to establish a system in which females could receive the HPV vaccine series. A needs assessment was done to determine the number of females in the practice that met the criteris for vaccination using the billing code from the electronic medical record (EMR) system. Next, a meeting to discuss the project with the stakeholders to assure everyone was vested in the project occured. Third, the clinic staff was educated about the project to guarantee integrity and consistency. Fourth, a timeframe was developed to implement the CPG. Lastly, a reminder system was devised for the second and third injection to assure females completed the series. Framework: The theoretical foundation for this project is the Health Belief Model (HBM). The evidenced-based practice model utilized for this project was the Rosswurm and Larrabee’s model. Additionally, the mnemonic utilized for motivating interviewing of female patients was the 5 A’s. The 5 A’s stand for awareness, assess, address, acceptability and activate. Findings/Results: When visiting with the stakeholders, patients and caregivers, it was very apparent that they were unaware of the prevalence of the HPV infection and the development of the HPV vaccine. All groups were eager to learn about the HPV infection and vaccine, as well as prevention. Additionally, during interviews with females that were sexually active, most were agreeable to be immuized against the HPV infection. Although in visiting with parents or legal guardians about immunizing young females there was more hesitation. Post the implementation of the CPG, there was a notable increase in the percentage of females receiving the HPV vaccine. However, the most concerning finding was that the family practice clinic was not enrolled in the state immunization program requiring the females to go to the local health department for the vaccine. Conclusion/Recommendation: If health care providers endorsed the immunization females wanted to know more about HPV and many got immunized. Although educating patients about the negative effects of HPV and steps to take for prevention were paramount, immunization was essential. In addition, it was recommended that the clinic be enrolled in the state immunization program to reduce the number of missed opportunities to immunize females against this disease.

    Request this Article


    Evaluation of Evidence-Based Practice Education and Implementation of Evidence-Based Practice Standing Orders in a Community Oncology Infusion Center

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Waitman, Kathryn

    Nurses working with adult patients suffering from advanced cancer are in a position to recognize and evaluate symptoms impacting quality of life such as anemia and dyspnea, and to identify patients who may be experiencing uncontrolled symptom management. Relying on verbal orders to manage symptoms related to cancer or treatment draws infusion center staff away from the infusion center and patient care to obtain orders from the providers. While it is necessary at times to consult face to face with providers from certain aspects of patient care, there are situations in which standing orders facilitate an improvement in patient care by decreasing time away from the infusion center by infusion center staff as well as decreasing variations between patients when standardized protocols would provide best practices acorss the population of hematology/oncology patients. When a staff member is away from the infusion center there is an increased potential to create situations where remaining care givers are relied upon to monitor additional patients along with their own patient load. When staff members are away for extended periods of time there is a potential risk for alterations in safe care. As a practice issue, the healthcare team is responsible for facilitating not only the delivery of care, but continuity of care. The purpose of this project was to educate the nursing staff on Evidence-Based Practice and implement standing orders based on Evidence-Based Practice Clinical Practice Guideline policies. This project seeks to answer the following question: Did education of Evidence-Based Practice and implementation of Evidence-Based Practice standing orders in a community oncology infusion center decrease the amount of time infusion center staff are away from the infusion center for orders related to symptom management?

    Request this Article


    Improving Patient Satisfaction with a Hospitalist Program

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Whelan, Marjorie

    Purpose: To purpose of this project was to improve patient satisfaction with the Hospitalist program at a community hospital through an education program geared towards primary care providers and their patients. Hospitalists allow primary care providers to care for an increased number of outpatients without having to change their hours of operation and allows for prompt attention to emergencies for the hospitalized patient. Patients cared for by Hospitalists have a lower length of stay, decreased cost, and lower mortality relative to their immediate availability. The value of Hospitalist services have not kept pace with patient satisfaction. Patients may see this as fragmentation of care, lack of continuity in Hospitalists on a day to day basis, communication issues with the primary care provider, and lack of education to the patient while hospitalized and from the primary care provider to their patients prior to hospitalization. Goals and Objectives: to provide service that is leader in customer satisfaction, to create a seamless service between primary care providers and their patients, and to have a patient service driven discharge plan. Education of the community members and private providers to the benefits of the Hospitalist service will clear misconceptions, facilitate a seamless service between primary care providers, their patients, and the hospitalists in addition to alleviating patient anxiety regarding learning about Hospitalists for the first time when hospitalized. Plan: Brochures were developed explaining the Hospitalist service and made available in the hospital, including a picture and brief biography on each of the providers, Hospitalists were provided with business cards so patients may know who cared for them, patients are contacted within seventy-two hours of discharge to validate understanding of their discharge plan, primary care providers will received an admission and discharge dictation on their hospitalized patients within twenty four hours. Still patient satisfaction with the care provided by Hospitalists was poor. To achieve improved patient satisfaction: provider surveys were developed and distributed to design a program of partnership with the primary care providers with the goal of providing the Hospitalist brochures to patients from the primary care provider offices. Outcomes: Patient satisfaction with care provided by the Hospitalist improved after brochures explaining the Hospitalist program were distributed to primary care provider offices. Provider questionnaires identified dissatisfaction with the discharge notification method and timeliness of the discharge dictation. Provider satistfaction with the quality of care provided to the provider improved after the initiation of a discharge notification system; calling provider offices daily informing the offices of the discharge of their patients.

    Request this Article


    Early Childhood Caries Prevention in Primary Care: A Clinical Practice Change

    Published Year: 2010
    Program: Doctor of Nursing Practice

    Wilkey, Susanne F.

    Background: Dental caries, or early childhood caries (ECC), is the most common chronic illness in children in the United States. While ECC affects children of all ages and across all sectors, it disproportionately afflicts those from low-income households, children who are uninsured, children who are geographically isolated, those from minority groups, children from families that have immigrated to this country, and/or children on Medicaidor SCHIP insurances. Each of these factors independently creates risk. Multuple factors compound to create high risk for ECC development. Children impacted by advanced ECC frequently miss school, struggle with academic performance, have impaired speech and language development, and/or may experience negatively affected self-esteem. To reduce this childhood chronic health disparity, and evidence-based practice change to provide oral health screening and fluoride varnish (FV) for children between 0-36 months was implemented in a federally-qualified, community health center (CHC).

    Request this Article


2011

    Nurse Practitioner Recognition and Response Regarding Domestic Violence: An Interventional Project

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Achen, Susan M.

    Problem: Approximately one in four women in the United States will experience Domestic Violence at some point in her life. The American Medical Association (AMA) and the Joint Commission on Accreditation of Healthcare Organizations (TJC) both recognize this as a high priority public health concern. Research demonstrates the importance of screening every woman for Intimate Partner Violence (IPV) each time she seeks health care. However, research also shows that less than 15% of female patients report being asked about Domestic Violence. Purpose and Scope: The purpose of this capstone proejct was to describe the level of NP recognition and response regarding DV before and after an online DV educational intervention. Since studies show that less than half of all Nurse Practitioners screen their patients for IPV, the health care community must explore ways to disseminate crucial information relevant to domestic violence. This intervention sought to offer current information and available resources to NPs in an online educational program. For this project, “intimate partner violence” and “domestic violence” are used interchangeably and “describes physical, sexual, or psychological harm by a current for former partner or spouse”. Goal: The goal of this project was to successfully implement an online educational intervention for Nurse Practitioners. Objectives: First, describe demographic characteristics of participating NPs. Second, describe pre-intervention NP recognition and response regarding DV. Third, describe post-intervention NP recognition and response regarding DV. Plan: Phase One: Conduct a needs assessment using a published evidence-based critique template. Phase Two: Design an online educational intervention using an evidence-ased medicine approach. Phase Three: Implement an evidence-based educational intervention for a projected sample. Phase Four: Evaluate the level of NP recongition and response regarding DV before and after an online DV educational intervention, using the tool developed by Hinderliter. Outcomes and Results: Using a triangulated interventional research design using mixed-methods of interventional-descriptive and content analysis, results of the pre-intervention and post-intervention measures revealed a modest mean score increase in family presence self-awareness in the clinical department head administrators. Moreover, scaled reliability estimates based on internal consistency for the pre-intervention testing achieved significance, while the post-intervention testing also achieved significance with regard to the tool’s performance in this interventional design.

    Request this Article


    Inserting the Hormonal Intrauterine Device in Nulliparous Women: A Practice Change

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Attaway, Penny

    Background: More than a quarter of pregnancies worldwide are unintended, contributing to large numbers of death for women and many abortions. Nearly half of all pregnancies in the United States are unintended, even though long-acting, reversible methods of contraception are available. Unintended pregnancy can cause significant harm for families and communities – emotional, social and economic. It is associated with an increased risk of morbidity for woman and serious complications for the infant. Foreground: In 2009 the Center for Disease Control and Prevention reported that the state of Illinois had a 43% rate of unintended pregnancy. Modern methods of contraception, such as the hormonal IUD, offer women freedom to plan their families and result in significant improvements in social and economic well-being. Evidence-Based Practice Framework: This project introduced the evidence-based information to the health care providers of a women’s health clinic, regarding the use of hormonal IUD for the nulliparous woman. To improve quality, the following models and theories were utilized: Rosswurm and Larrabee’s model, the ACE-Star model, and von Bertalanffy’s general systems theory. Methods: The evidence-based practice protocols were introduced to the health care providers regarding the FDA-approved use of the hormonal IUD for nulliparous women of child bearing age for contraception. Clinical practice guidelines were utilized to facilitate the process. The providers and billing clerks were contacted on a monthly basis for the purpose enhanced communication and data collection. Findings/Results: Introducing the best evidence to a group of health care providers generated an increase in the number of hormonal IUDs that were inserted for nulliparous women. Each month of the project resulted in several women who received an effective, long-term and reveraible method for contraception. Recommendations: Recommendations are to share the information with health care providers by including it in continued education seminars and publishing the findings in professional magazines. The goal is that more nulliparous and multiparous women will be offered the opportunity to use the hormonal IUD for contraception. Wider usage of more effective, safe and reversible contraception will results in social and economic beenfits for society.

    Request this Article


    Implementation of a Train the Trainer Program for Diabetes Education

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Borino, Noreen

    Type 2 Diabetes Mellitus is becoming a health problem that presents significant physical, emotional, and financial strain on the health care system. T2DM has become an epidemic with high morbidity and mortality rates. Uncontrolled T2DM is the number one cause of blindness, kidney failure, cardiac problems, and lower extremity amputations. In the United States, the number of patients affected by T2DM is on the rise causing concern over increased financial cost and lost productivity. Nevada is in close comparison with the nation having 7.9% of adults affected compared with 8.3% of adults nationally having T2DM. With the rising problem healthcare providers are in a vital position to increase patient awareness, to develop patient involvement and to improve health care outcomes through education. Ineffective patient education contributes to, and may increase complications from, uncontrolled T2DM. While employed at a rural clinic in Nevada, this project director (PD) recognized a need for T2DM education. Approximately 25% of patients from this clinic had T2DM. The clinic owner reported approximately 10% of these patients went without improvement in lab scores and were in need of education. This PD noted that the staff was not appropriately trained to provide the T2DM patients with education. The need for a system change to train staff in diabetes self-management education (DSME) became evident. The Capstone system change involved the implementation of ‘Train the Trainer Program for Diabetes Education.’ The Evidence-based framework guiding the system change was Larrabee’s Model for Evidence-based Practice Change. The theory, which helped guide the class structure, was the Theory of Goal Attainment developed by Imogene King. This theory believes goals help to achieve success. King’s Transaction Process Model was used for class structure, process and outcomes, with the Conceptual Interacting Systems Framework, for building participant interactions in class. The model was also used for participant interactions between trainer/nurse and class participant/patient. This model advised a tool for evaluation using a pre/post test with evaluation for assessment of outcomes. The educational component came from American Diabetes Association (ADA). Evidence-based DMSE was provided on weekly bases for six weeks. Funding was provided by the committe from the state of Nevada program on community development. The results of the system change proved that an evidence-based, cost-effective method for T2DM education in a rural clinic, in Nevada, benefited both patient and staff.

    Request this Article


    Creating Organizational Change by Implementing a Pain Resource Nurse Program

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Brown, Sherry

    Background: Lack of pain management is a global healthcare problem. There is evidence that suggests nurses and other healthcare professionals lack knowledge related to pain management and have attitudes which hinder appropriate pain management. Pain Resource Nurse (PRN) Programs have demonstrated efficacy in improving knowledge and mentoring nurses in pain management practices. Method: Seventeen nurses participated in a two day PRN training program to prepare them to be resources for nurses and other health care professionals related to pain and pain management. Pre-test and post-test were completed by the PRNs to assess baseline knowledge and knowledge gained through education and experience. The impact of the PRNs on knowledge and attitudes of general staff nurses was measured also with pre-test and post-tes methodology. Process audits were done as part of an ongoing assessment of documentation regarding pain and compliance with pain assessment and management policies. Evidence Based Practice Framework: The EBP Frameworks that were used for this project was the Advancing Research and Clinical Practice through Close Collaboration (ARCC) Model and the Diffusion of Innovation Model. Findings/Results: There were statistically significant improvements in the PRN post test knowlege and attitude survey scores, with the greatest improvement at six months. The PRNs provided education for their peers in a variety of ways: one-on-one education, in-services, a self learning module, and a pain fair. The general staff had statistically significant improvement in the post-test scores as compared to their pre-intervention scores. Process audits showed a small improvement in some areas but varied month by month. Conclusions: The PRN initiative did have a positive impact on improving knowledge and attitudes related to pain management and there was a small improvement in the process audits used to evaluate practice related to pain management.

    Request this Article


    Implementation of Self-Testing of the International Normalized Ratio

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Clayton, Jacqueline R.

    Background: Warfarin therapy (WT) is indicated for managing oral anticoagulation therapy (OAT) in persons with atrial fibrillation, deep vein thrombosis, pulmonary embolism, or a mechanical heart valve to reduce the risk of a stroke. Global Significance: A stroke is the leading cause of disability and the third leading cause of death in the United States, with an estimated annual total cost of $57.9 billion. Given the aging of our population, it is projected that 7.5 million individuals will hav atrial fibrillation in the United States by the year 2020 based on an expected prevalence of 13.5% for individuals greater than 75 years of age. The project manager cared for 50 patients on WT during the project. Medical expertise is needed to manage OAT in a safe manner. Frequent international normalized ratio (INR) testing was required until the recommended range was achieved. The quality of life was affected for persons due to the numerous food, alcohol, and drug interaction precautions, because of OAT, and the need to return to the physician’s office for blood tests. Foreground: There were significant gaps associated with WT: a lack of patient knowledge of WT; a lack of knowledge by the healthcare provider (HCP) that self-testing was a viable option for managing WT. The evidence-based framework for this project was the precede/proceed planning model. Methods: A literature review and synthesis for self-testing was conducted to identify the best evidence and current guidelines. The purpose of this project was to change the methodology of how the the INR was tested in this rural farming community. The change involved the way blood testing was collected; participants collected their own blood sample. The following primary outcome measures were tracked prior to launching self-testing and for the month after implementation: each participant’s INR pre- and post-self-testing, therapeutic range pre- and post-self-testing, adverse drug event (ADE) rate pre- and post-self-testing, and self-reported satisfaction with self-testing. Findings/Results: The project utilized available technology, and simplified the processes involved with INR monitoring using a portable coagulometer. The data provided the participant with knowledge on the actual blood level and eased the particpants’ distress or worries related to anticoagulation. Freedom to travel was a benefit for participants. The concept of self-care was evident in the participants’ willingness to self-test. The project results agreed with the predicted outcomes. Self-testing attenuated OAT as it reduced the morbidity and mortality rate. The INR results were within therapeutic range throughout the project. The project manager was able to leverage resources to support self-testing, as cost-effectiveness and time-saved were evident with little financial impact on the medical practice. Conclusion/Recommendations: The project manager recommended self-testing of the INR to augment the plan of care. Instituting access to care with self-testing provided a tool for testing the INR in the privacy of the participants’ home, detected subtle drifts out of the recommended therapeutic range, and provided access to care.

    Request this Article


    An Evidence-Based Approach to Implement a Standardized Heart Failure Discharge Protocol

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Commet, Urana

    Background: Heart failure (HF) is a serious condition and a major health problem in the United States with significant associated costs. Despite major advances in treatment, standardized performance measures, and evidence-based national guidelines, heart failure continues to be a substantial cause of mortality and morbidity. Since the early 1990s, improving patient safety and chronic disease outcomes has become a national priority. In an effort to improve the healthcare delivery process, a healthcare accreditation organization, The Joint Commission (TJC) developed evidence-based performance measures for HF and three other chronic diseases. Other organizations, such as the Institute of Medicine (IOM) and the Institute for Healthcare Improvement (IHI), have started campaigns with targeted interventions for improving the care of patients with HF. Foreground: Healthcare organization compliance with performance measures is one of the requirements for obtaining and maintaining accreditation and certification status from TJC. While a group of hospitalist providers at local facility, accredited by TJC, recognized the effects of HF, they were not consistently complying with the HF performance measures. Additionally the group did not have a standardized protocol in place for the performance measures or for the discharge process for patients with HF. Objectives: The capstone project was an evidence-based outcomes management plan directed at improving the care of patients with HF by changing clinical practices. The short term objectives of the project were to: (a) create a standardized HF discharge protocol based on the four HF performance measures (b) implement the protocol at the facility for patients with HF admitted to the hospitalist provider’s service and (c) evaluate the hosptialist provider’s compliance with the four HF performance measures both before and after implementation of the protocol. Long-term project objectives included laying a foundation for future development and use of standardlized discharge protocols for all patients admitted to the facility. Evidence-Based Practice/Theoretical Framework: The evidence-based framework used for the project was A Model for Change to Evidence-Based Practice. The six steps of the model provided the structure and guided the project. The findings in the literature reviewed for the project provided the theoretical framework; the use of a standardized protocol based on performance measures has the potential for significant improvement in the care and outcomes of patients with HF. Results: The use of a standardized HFdischarge protocol did increase the facility hospitalist provider’s compliance with the four HF performance measures. After protocol implementation, statistical analysis continually improved, with 100% compliance in all four measures in four of the five months evaluated by the facility. Two out of the four months evaluated by the hosptialist management company, after initiation of the protocol, had 100% compliance in all four measures. Conclusion: Prior to implementation of the standardized HF discharge protocol, the hospitalist group provders in the facility were not consistent with meeting the four HF performance measures of TJC. Statistical data revealed the group’s compliance to be as low as 80% at times and only occassionallyat 100% but never in all four HF measures. After implementation of the protocol, compliance of the hospitalist provders consistently improved. The facility’s data showed 100% compliance in all of the HF performance measures in four of the five months after implementation. While only four months post implementation data from the hospitalist management company was available for review, those statistics also showed improved compliace with 100% in all four measures in two of the four months. Evidence-based interventions provide the road map for optimal treatment of HF and have the potential to facilitate improved outcomes in patients with HF. This is even truer if the interventions are in a standardized format and executed by a team approach. To date, there have been few studies to evaluate the process for successful implementation for these interventions into clinical practice. More emphasis needs to be placed on incorportating best evidence into everyday medical care.

    Request this Article


    The Implementation of the Oswestry Disability Index in an Outpatient Pain Relief Institute

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Commet, Vern

    Background: Low back pain is prevalent worldwide and is a disabling factor of almost epidemic proportions. One in four United States adults has experienced at least one daylong episode of low back pain. Low back pain is also one of the most common presenting complaints in the primary care outpatient clinic. Literature has shown that 15-40% of low back pain may be attributed to a facet-mediated cause. In 2008 the Department of Health and Human Services’ Office of the Inspector General released findings showing that the request for treatment of chronic low back pain from facet injections alone submitted to Medicare reached a staggering $307 million in 2006. An estimated 63% of those treated did not meet qualifications as defined by Medicare for the treatments, resulting in $96 million in improper payments to providers. Foreground: The new Local Coverage Determination (LCD) requires documentation of the use of a specific pain and disability measuring tool. The purpose of the capstone project was to implement the patient-rated Oswestry Low Back Pain Disability Index (ODI) at a local pain relief institute. The ODI descibes adult patients’ level of perceived disability regarding their facet-generated back pain. The use of the ODI can assist the providers of the institute in complying with the Medicare LCD. Medicare reimbursement denials reached $400,000 in 2009 at the institute, secondary to the changes instituted by the Medicare LCD. The long term objective of the project was to help maximize Medicare reimbursements. The medical director and his group were concerned about the delay, if not total lack of care due to a fear of not being reimbursed by Medicare. Objectives: The goal of the capstone project was to change provider practice in order to comply with the Medicare guidelines and to use the ODI to guide the plan of care for patients with facet-generated back-pain. The two-fold change, was first to provide educational training for the providers and staff in the use and purpose of the ODI in meeting compliance of a patient disability measuring tool, in relation to Medicare proposed requirements. And second was to identify ways that staff could ensure the use of the ODI at initial intake appointments and during post treatment. Methods: The project director (PD) performed a two-month post-initiation retrospective chart review and a four-month retrospective chart review to evaluate providers’ scoring and documentation of the use of the tool in the patients’ charts at intake and during post-treatment follow-up visits. The PD reported on the findings of provider and staff compliance with the use of ODI to providers and staff at regular intervals, two and four months after initiation. Outcomes: At the two-month review of charts, 99% of new patients were given the ODI to fill out in their intake data. By four months, compliance reached 100%. For every treatment group outlined in the project, incremental improvements were achieved by the four-month review. Unintended consequences experienced included that many patients did not return for their one-month follow-up appointment if they had shown significant improvement at the two-week follow-up. This skewed the data on the one-month follow-up appointments both at the two- and four-month reviews.

    Request this Article


    Evaluation of Implemented Group Visits with A Self-Management Tool for Patients with Pre-Diabetes

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Doyle, Kathryn

    One of the global emerging epidemics of non-communicable diseases is Type 2 Diabetes Mellitus (T2DM). The adverse consequences of T2DM are a lowered life expectancy of up to fifteen years and an increased risk of heart disease. T2DM is the leading cause of kidney failure lower limb amputations, and adult-onset blindness. As of 2010, eight percent of the United States population, or 24 million Americans, have T2DM and an estimated 57 million people have ‘pre-diabetes’. In California, a University of California Los Angeles (UCLA) study found that T2DM has increased nearly 26 percent between 2001 and 2007. Orange county, California has an increase in the number of persons with T2DM from five percent in 2001 to seven percent in 2003. A solution in addressing the increase in T2DM cases is through and evidence-based system change implementing group visits led by a Certified Diabetic Educator (CDE) with a self-management tool for patients with pre-diabetes. The intended goal of such a program in a community clinic setting was a reduction or delay in conversion rates of pre-diabetics becoming T2DM. The Capstone system change took place in a North Orange County, California community health clinic. The Capstone system change involved the evaluation of implemented group visits with a self-management tool for patients with pre-diabetes. The classes were once a week, one hour in length, and taught over a four week period. The goal is to refer and provide timely, evidence-based, culturally appropriate, preventative health care for the pre-diabetic patients to delay the progression to T2DM. A six step framework developed by Larrabee was used to guide the development of the Capstone system change. The theoretical perspective of the Health Promotion Model designed by Pender was also used to emphasize the preventive health aspect throughout the Capstone system change. Researchers have shown educational group visits for T2DM and pre-diabetes can lead to improved clinical outcomes, is cost effective, improves patient satisfaction, and leads to greater self-efficacy for the patient. Incorporating a system change to include evidence-based group visits for T2DM and pre-diabetes is a recommended, feasible and affordable method in delaying the onset of T2DM for community clinics. For this Capstone system change, the group visits were an effective, culturally appropriate, efficient, and cost effective method of delivering preventive health care.

    Request this Article


    Implementation of Asthma Treatment Guidelines: An Evidence-Based Practice for Clinicians

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Ekeocha, Patience O.

    Asthma is a chronic respiratory disease that affects adults, children, and the elderly. Asthma has taken a toll on the economy of its sufferers, families, and health care providers. In the United States, approximately 23 million people have asthma. More than half of these individuals had at least one asthma attack in the previous year. This translates into an average of four days missed from school each year per asmthmatic child and two and a half days missed for work per asthmatic adult; 11 million outpatient medical visits; 2 million emergency room visits; nearly 400,000 hospitalizations; and approximately 4,000 deaths annually. In Maryland, approximately 12.9% of adults and 13.6% of children have a history of asthma. In 2007, asthma accounted for 9,800 hospitalizations and roughly 38,000 emergency department (ED) visits. Foreground: Students with asthma at a historically Black university were more likely to use the hospital ED than students with other chronic illnesses. A quality improvement (QI) needs assessment project conducted in the University Health Clinic (UHC) from February 2010 to April 2010 showed than 935 students with asthma visited the ED comapred to the 351 students with asthma that attended the clinic. The purpose of this project was to develop a Clinical Practice Guidelines (CPG) and a protocol for Evidence-Based Practice (EBP) for clinicians in the UHC. Goal: The short-term goal for this capstone project was to ensure that clinicians adhere to the Guidelines for the Diagnosis and Management of Asmthma CPG in the UHC for the treatment and management of asthma. The long-term goal is to decrease the frequent ED visits by students with asthma. Plan: The Change Theory, “unfreezing, movement, and refreezing” in Marquis and Houston was used as a theoretical foundation to accomplish the plan project. Rosswurm and Larrabee’s EBP Model was used to guide the implementation of the capstone project. The plan included a pre- and post-test and a self-education package based on the CPG. The pretest assessed the clinician’s base knowledge.

    Request this Article


    Implementation of a Standardized Protocol for the Identification and Treatment of Hospitalized Patients at Risk for Venous Thromboembolism

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Falke, Sharon L.

    There are nearly 900,000 cases of venous thromboembolism yearly in the United States with over 300,000 deaths, a figure that exceeds that of most other diseases. This incidence rate is echoed in global studies, with an acknowledged poor adherence to clinical practice guideline recommendations for the prevention of this serious hosptial-acquired condition. Venous thromboembolism is the primary patient safety concern for many of the health care regulating bodies, including the Centers for Medicare and Medicaid, National Quality Forum, and The Joint Commission. It has been recognized as the most preventable cause of hospital deaths; therefore, many insurance payers will limit reimbursement for the added cost of care required in the event of this complication. Arizona hospitals are in the median range when evalutated for compliance with the guideline recommendations and for initiating venous thromboembolism prophylaxis, with a moderate improvement noted in those partiicpating in more closely monitored programs. This capstone project was initiated at a small community hospital that initially had an abysmal rate of adherence with the prevention protocol, and seldom acknowledged the disease risk during patient assessments, with the goal of improvement in regulatory comliance and amelioration of patients safety with a reduction in morbidity and mortality. The theoretical foundation for this project was the Rosswurm and Larrabee conceptual model and the constructivism adult learner theory; additionally, protocols and an audit-feedback system were used as a reinforcement tool. This project was initiated as part of the admission process for inpatients, with each patient expected to be assessed for venous thromboembolism potential within 24 hours using the Caprini risk assessment model. The hospitalist clinicians were provded copies of the model along with the accompanying instruction tool during an educational briefing. Once they were aprised of the disease risks, patient benefits, regulatory requirements, and financial incentives, copies of the risk assessment tool were placed on each medical chart and at each dictation station as a reminder of the protocol. During the first month of this project evaluation, an improvement was noted in guideline adherence from 23% to over 59% of patients assessed for risk and of those found to be at risk, the percentage of patients actually receiving treatment increased from 31% to 77%, demonstrating significant improvement. The expected improvement outcome is 25% to 40% with the use of similar methods as this project. The primary adverse effect of chemoprophylaxis is hemorrhage; however there were no incidences of increased bleeding noted during this evaluation and three incidents of deep vein thrombosis in untreated patients, clearly illustrating the importance of this therapy. This project demonstrated the critical importance of recognizing the risk for thromboembolism, determining the appropriate therapy with consideration for confounding factors, and administering that therapy for an adequate time period. This project supports the recommendations of the clinical practice guidelines and the governmental regulations surrounding the issue, and provides the hospital with a framework for compliance with accreditation and regulating core measures.

    Request this Article


    Implementing an Evidence-Based System Change into the Anesthesia Protocol for the Management of Postoperative Nausea and Vomiting

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Fox, Chris S.

    Background: The most frequent, adverse postoperative complications today are postoperative nausea and vomting (PONV), viewed as the most stressful side effects of anesthesia. The use of complementary alternative medicine (CAM) has increased significantly in Western countries, particularly in the United States. The Institute of Medicine reports CAM is more socially, medically and politically accepted than ever before. The Pericardium Six Accupressure Wristband (P6AW) is a CAM technique designed and utilized to reduce PONV. Compelling scientific research findings from randomized control trials support the use of the P6AW to manage PONV. The two-fold focus of this Capstone project was to educate health care team members regarding the CAM method and to implement a practice change for the anesthesia care provider, by adding the P6AW as an option to the preoperative protocol. Foreground: Today, healthcare budgets are decreasing while costs are increasing. The American Hospital Association reported that hospitals are increasingly adding CAM practices to conventional services. A practice change of adding an economical, noninvasive and non-pharmacologic alternative to reduce PONV is a positive step to confronting the healthcare crisis. Methods: This anesthesia problem was addressed at a rural hospital, where data was collected from the existing perioperative quality assurance (QA) survey indicating a 30% PONV occurence rate. After delivering educational in-services and one-on-one demonstrations a pilot study was conducted using the P6AW on consenting anesthesia patients as an adjunct to manage PONV. Evidence Based Practice Framework: The Model for Change, developed by Rosswurm and Larrabee, was chosen to provide a pragmatic strategic six-step guide for this evidence-based practice change. This Capstone project had three objectives; Innovation-by providing evidence on the benefits of the P6AW to reduce PONV; Resource Efficiency-implementing the P6AW option into the anesthesia protocol used as a cost effective adjunct to reduce PONV and; Collaboration-enhanced dialogue between all stakeholders to improve the quality of care and satisfaction by reducing PONV. The two outcomes measured were the frequency of P6AW use and PONV occurrences. Findings: The results of the Needs Assessment correlated with the universal 30% occurrence rate of PONV. The collected data from the pilot study revealed 89% of patients used the P6AW implemented by the anesthesia providers with a decreased incidence of PONV from 30% to 18%. Conclusion: This project was designed to enhance the knowledge to expand proficient management of PONV. This Capstone project generated an increased awareness of the anesthesia complications of nausea and vomiting and explored the challenge of an evidence-based system change implementing an economical CAM technique without compromising outcomes or safety.

    Request this Article


    Implementation of Clinical Practice Guideline for Detection of Depression in Older Adults with Dementia at a Long-Term Care Facility

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Francis-Windle, Cherise M.

    Dementia and depression are very common disorders among older people and their presence, both isolated and specifically combined, results in a decreased quality of life in the well-being of the aged. As the population ages, more patients are being diagnosed with dementia and depression. An abundance of patients in long-term care facilities (LTCFs) exist who have dementia and accompanying depression that largely goes undetected and untreated. After a careful review of the literature and anecdotal evidence gathered by the principle investigator (PI), sufficient evidence existed that linked undetected depression in patients with dementia in LTCFs to lack of knowledge among nurses regarding detection of depression in patients with dementia. Patients with dementia who reside in LTCFs are a vulnerable population. These patients are most often frail and in some instances cannot speak for themselves. Depending on the severity of dementia, they are unable to even recognize depression in themselves and thus unable to communicate to their providers that they have depression. The purpose of this Capstone project was twofold: first, to increase awarenes and knowledge level of nurses regarding detection of depression in patients with dementia who reside in the LTCF, and second, to implement the clinical practice guideline (CPG) for detection of depression in older adults with dementia. For this Capstone, the PICO framework was used to identify the clinical question. Rogers Diffusion of Innovations provided a systems/theoretical perspective. The Johns Hopkins Nursing Evidence-Based Practice Model was the selected evidence-based practice framework used throughout this Capstone. A teaching session was conducted at a selected LTCF. All 15 nurses who work at this facility were encouraged to participate in the educational intervention. A total of 13 nurses participated. A pre-test was conducted using the established tool, Detection of Depression in Older Adults with Dementia Knowledge Assessment test. Immediately following the teaching intervention, a post-test was conducted to determine whether there was a change in awareness of knowledge level of the participants. A one-month follow-up was completed using the same test to evaluate the nurses’ level of understanding regarding the implementation of the guideline. Findings suggest that nurses, once educated on the prevalence and lack of treatment of depression in patients with dementia in the LTCF, became better advocates for these patients. The results demonstrated that once nurses were taught how to detect depression in this population, they were better prepared to implement the clinical practice guideline and detect depression in patients with dementia in the LTCF. The PI found that patients with dementia often have unrecognized depression mostly because of a lack of knowledge of nurses regarding the detection of depression in these patients with depression. Results showed that once empowered with heightened awareness and increased knowledge level, nurses implemented the clinical practice guidelines. As a result of continuing education in this practice setting, more patients with dementia were diagnosed with depression; prompt treatment was started with anticipation of an improved quality of life for this vulnerable population.

    Request this Article


    Implementation of the Use of a Timeout Checklist in Non-Operating Room Settings

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Goshu, Wonedwossen A.

    Background: Errors in healthcare can be catastrophic and devastating, not only for the patient and family, but also for healthcare providers and the medical institutions involved. The magnitude of medical error in the United States is widespread according to the Institute of Medicine (IOM). While the specific incidence of wrong-site surgery is largely unknown, in 1996 the Joint Commission on the Accreditation of Healthcare Organizations (TJC) introduced a policy that addresses what is referred to as sentinel events. Since the implementation of the policy, operating room (OR) reporting identified errors in ambulatory settings, inpatient operating rooms, and other inpatient settings. Wrong-site surgery incidents were reported in all surgical specialties. Despite increased patient safety awareness in the healthcare industry, procedural errors remain a major problem. Foreground: An initial assessment was conducted with the sample RNs revealing a lack of awareness and knowledge of the utilization of a dedicated timeout checklist for patients undergoing invasive procedures outside the OR. This lack of awareness was further substantiated through documentation evaluation of several non-OR procedures, affirming lack of adherence to the time-out protocol. Failure to implement TJC recommendations in non-OR settings creates the risk of serious errors occurring. Adhering to universal protocol timeouts prior to beginning surgery must be applied to non-OR procedures to improve patient safety. The need existed to increase the culture of safety regarding non-OR procedures. Evidence-based Practice Framework: The intent of this Capstone was to implement the clinical practice guideline in the use of timeout checklists for surgical procedures performed outside of the OR setting. The theoretical foundation for this project was Roy’s Adaption Model. Rosswurm and Larrabee’s Model for Evidence-based Practice Change was the selected practice framework applied throughout this capstone. Methods: A comprehensive educational training was conducted at a large, nonprofit hospital located in Southeast Teas. The staff training was conducted with six Registered Nurses (RN) regarding utilization of non-OR checklists. Charts were reviewed to compare the utilization of checklist documentation before and after the training implementation. After staff training, a significant increase in timeout documentation was noted suggesting that educating staff nurses is effective in improving utilization of timeout checklists for surgical procedures performed outside the OR setting. Conclusion: Findings from this capstone suggest that provider education, chart audit and feedback, and subsequent monitoring for sustainability are effective means of implementing and measuring practice change. Educating nurses to adhere to universal protocol timeouts prior to beginning procedures both inside and outside the OR will have significant impact in preventing wrong-person, wrong-procedure, and wrong-site errors. Sustaining this practice will result in improved patient safety. In addition, nurses, hospital administrators, and the overall healthcare system will also realize a significant benefit.

    Request this Article


    Advanced Practice Nursing Attitudes About Executive Cognitive Impairment and Knowledge Regarding Dementias of the Frontal Lobe, Type 2

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Hathcock, Kimberly E.

    Problem: America is aging, with those 65 years and older estimated to account for 20% of the population by 2030. With aging comes chronic disease and many older adults possess two or more. The inability to appropriately manage these chronic disease processes leads to debility and increase use of medical services. Dementia is a chronic disease, which the majority of health care providers fail to recognize especially those dementing processes that affect the frontal lobe and executive cognitive functioning. Purpose and Scope: The purpose of this capstone project was to describe the Advanced Practice Nurses’ (APN) attitudes concerning executive cognitive impairment (ECI) and knowledge regarding dementias of the frontal lobe, Type 2 dementia. The rationale for the project was that an educational intervention to APN’s would increase recognition of Type 2 dementia, ECI, in the APN. Goal: The goal of this capstone project was to successfully implement an educational intervention on the internet for APN’s concerning ECI and Type 2 dementia. Objectives: First, to determine the level of the healthcare provider’s knowledge, regarding ECI, frontal lobe dementia, Type 2. Second, describe the demographic characterisics of APNs’ who elected to participate in an online educational intervention program. Third, describe the APNs’ attitudes about ECI and knowledge regarding dementia of the frontal lobe, Type 2, before participation in an online teaching intervention. Fifth, measure changes in attitudes about ECI and knowledge regarding dementia. Plan: Phase One: Conduct a needs assessment using an evidence-based (EB) critique template. Phase Two: Design an online teaching intervention using an EB medicine approach concerning ECI and Type 2 dementia. Phase Three: Implement an ECI and Type 2 dementia online teaching intervention for a projected sample. Phase Four: Evaluate the level of attitudes related to ECI and knowledge of Type 2 dementia before and after an online teaching intervention using an adapted tool by Turner, et al. Outcomes and Result: Fifty APNs participated in the on-line educational session. Results demonstrated that the confidence level of the APNs was greater prestest than post-test. Scores on the post-test increased from a mean of 0.7013 to 0.8320.

    Request this Article


    Fostering Telemedicine Adoption: an Interventional Application of the Technology Acceptance Model

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Hunter, Mari

    The healthcare system within the United States is experiencing increasing stress related to issues of access to care, affordability, healthcare provider shortages, rising cost of provision of care, and deteriorating financial milieu of the population in general. Responding to these conditions is forcing healthcare providers to open their practices to new methodologies for delivery of services such as increasing technological accessories to meet patient needs. Successful adoption of new healthcare technologies, requires initial recognition by those needing to adopt change of the need for change, awareness of any benefit inherent in a particular change, and acceptance of the change as a positive experience. Unfortunately, the trend in healthcare has been to implement new methodology or technology without attention to assessing readiness for change. Responsiveness of healthcare providers towards engendering change is thus slowed immensely and many programs to meet patient needs with technology fail early, before full benefit can be recognized. Purpose and Scope: The purpose of this project was to describe the level of knowledge, attitude, perceptions, and behaviors regarding telemedicine among Nurse Practitioners (NP) before and after an educational intervention derived from evidence based studies on telemedicine. The change in attitude and perception resulting from the educational intervention was measured to assess the effectiveness of providing preliminary information to foster telemedicine acceptance and ensuing change in practice patterns. Goal and Objectives: The goal of this project was to assess potential cause for lack of NP utilization of telemedicine. The objective was to increase the pool of NPs recognizing telemedicine as a viable practice adjunct to address healthcare disparities. Plan: Phase One: Formation of Problem-Intervention-Comparison-Outcome (PICO) questions, search for evidence answering PICO question, critically appraise data gathered, identify assessment tools for technology adoption and develop outcome measurement methodology. Phase Two: Develop educational intervention with pre and post-test to be placed on-line in web based format through NP list-serves for self selection of participants. Phase Three: Analyze and disseminate data. Outcomes and Results: Results were strongly positive for improved acceptance of telemedicine after an educational presentation via power point on the benefits of use and responsiveness of the technology to meet current and evolving patient and healthcare needs. Self selection utilizing an on-line format may bias the results in favor of those already comfortable with the use of some technologies.

    Request this Article


    Implementation of a Low Molecular Weight Heparin Protocol for Deep Vein Thrombosis

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Jacobs, Melinda

    Southern Arizona Veterans Affairs Health Care System (SAVAHCS), located in Tucson, had no outpatient protocol for first event uncomplicated lower extremity deep vein thrombosis. The majority of these patients presented to the emergency room or were seen by their primary care providers. The purpose of this practice change project involved the development and implementation of an outpatient protocol using LMWH. The secondary objectives included identification of Veterans’ described barriers to home treatment, evaluation for reduction in cost, and quantification of admission rates pre- versus post-protocol.

    Request this Article


    Initiation of Evidence-Based Guidelines for the Treatment of Exacerbation of Asthma in A Rural Convenient Care Setting

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Keene, Terry

    Convenient care clinics are becoming part of the landscape of the healthcare system throughout the country. Clinics owned and operated by Nurse Practitioners are becoming more prevalent in states where the practice laws allow for independence in practice. One such practice was started in 2006 by a Nurse Practitioner (NP) in a rural area of Washington State. there were few options for access to care within this small town except for using the local emergency department of the hospital. The traditional medical offices had no same day appointments and obtaining care for common illnesses in a timely manner was challenging. The clinic was created to address the healthcare needs of the community. This NP owned and operated clinic is open for extended hours during the week and is open on weekends. The NPs working at this clinic provide episodic care for all walk in patients. The services are paid by either insurance or out of pocket expense by the patient. The owner of this clinic understands and embraces the benefits of using evidence-based guidelines for the care of the patients. Although there have been no formal guidelines for treatment of acute issues such as exacerbation of asthma used in this clinic since it opened, the clinic has the equipment needed to care for patients in an urgent setting. The owner has purchased spirometer and nebulizers for the assessment and treatment of acute exacerbations of asthma. One of the more common diagnoses seen at this clinic is acute exacerbation of allergies and asthma. When the owner of the clinic was approached about using evidence-based clinical practice guidelines for the treatment of asthma, she was immediately enthusiastic. The electronic medical record, is use at this clinic would facilitate the capture of data. The purpose of this capstone project was to initiate and evidence-based clinical practice guideline and to measure outcomes in the treatment of asthma exacerbations in a convenient care setting. This project intends to answer the question: what are the clinical outcomes for patients treated for exacerbation of asthma using evidence-based clinical guidelines in a convenient care setting? The theoretical foundation for this outcome project is the Johns Hopkins Nursing Model. This model provides a framework for measurement of nursing outcomes. The model describes three major elements: identification of the practice question, gather evidence relating to the practice question and translation of the findings. Under translation, there are four elements: plan the intervention, implement the intervention, evaluate the intervention and communicate the findings. The plan for this project will follow this framework. The Project Director hypothesized that the standard treatment of acute exacerbations of asthma using evidence-based clinical practice guidelines will enhance the patient experience and become integrated into the everyday practice of the clinic. It is further theorized that the successful implementation of this clinical practice guideline would facilitate the use of clinical practice guidelines for other diagnoses. The overall arching goal is to improve patient outcomes by the use of evidence-based clinical practice guidelines in everyday practice.

    Request this Article


    Improving Nutritional Status: Clinician Adherence to an Evidence-Based Enteral Nutrition Protocol

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Kelly, Miranda L.

    Background: Nutritional support of critically ill patients is an important aspect of critical care. The American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) and the Society of Critical Care Medicine have developed guidelines for enteral nutrition reflecting the latest evidence-based practice. the guidelines recommended early nutritional support, utilization of protocols, and enteral nutrition (EN) as the preferred choice of nutritional support. The Institute of Medicine also recommends utilization of evidence-based practice, guidelines, and protocols for health care delivery. Foreground: Despite these recommendations, the Medical Intensive Care Unit (MICU) of a community based Magnet recognized hospital had not implemented the guidelines. Incidental observations noted during multidisciplinary rounds in the MICU and a performance improvement review found variability related to ordering and management of EN. These findings supported implementation of an evidence-based EN protocol. Methods: A system change project was implemented with the support of providers, staff, and administration of the MICU. The project consisted of implementation of an EN order form and algorithm for management of gastric residual volumes (GRV). The objectives focused on clinical adherence, the amount of EN received, and the time frame that EN was temporarily discontinued. The objectives and outcomes of the study were related to clinician adherence, but the ultimate outcome was improved nutrition for the MICU patients. Evaluation of the project was based on chart reviews comparing similar groups pre- and post-implementation and focus groups with staff and providers. Evidence-Based Practice (EBP) Framework: To direct and develop the project two theoretical frameworks were utilized. Rogers’ Diffusion of Innovation Theory guides the diffusion of new ideas and provided a general framework. Larrabee’s Model for Change to Evidence-Based Practice was also utilized as it provides a framework specific to implementing EBP. Findings/Results: Clinical adherence to overall utilization of the EN protocol was 67%, which exceeded the project goal. There was a reduction in the time that EN was started in the post implementation group, but it was not statistically significant. There was a statistically significant reduction in the time the patients’ reached their feeding goal rate after EN was implemented. The average time was reduced from 35 to 18.5 hours, with 74% of the patients reaching their goal rate within 24 hours. Conclusions/Recommendations: Implementation of the ENN protocol has positively implacted the nutritional support patients are receiving in the MICU and SICU of the community hospital. The guidelines and protocol provide consistency in the care of the patients. Professionals in the MICU and SICU want to provide the best quality care and the EN protocol provides the avenue to do that. Recommendations for the future involve expansion of the EN protocol use to all adults patient care areas in the community hospital, as well as the hospital system. Also increasing the amount of GRV in which feedings are temporarily discontinued, from the 200mL utilized during the project to 300mL will more closely align with the guidelines.

    Request this Article


    An Evidence Based Practice Change Toward Attainment of Colorectal Cancer Screening

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Levy, Robyn A.

    Colorectal cancer (CRC) is the second leading cause of cancer related death in the United States. In 2010, it is estimated that 142,570 cases of CRC will be diagnosed and the number of CRC deaths will equal 51,370. Most cases of CRC can be prevented by early screening and detection of precancerous polyps. Five year survival rate, if detected and treated early, is 91%. An estimated 30,000 to 44,000 lives a year could be saved if CRC screening is performed on all adults over the age of 50 years. Foreground: The impact of clinical educational counseling is important to improve compliance to CRC screening. Barriers must be understood and interventions developed to increase attainment of CRC screening. This project helped to define the level of education, attitudes, and stage of commitment are by the average risk patient age 50-65 years in a primary care setting before and after a clinical storytelling educational intervention regarding colorectal cancer and screening. Methods: Twenty-five average-risk patients agreed to participate in completion of a pre-intervention survey about CRC knowledge, attitudes, and stages of commitment toward attaining CRC screening. The participants were counseled about CRC and screening using a scripted storytelling education format and the use of an educational pamphlet. Six weeks later, a telephone interview took place to evaluate patient response to the counseling session and their stage of commitment to screening. A chart audit was then done 3 weeks later to determine whether screening took place. Descriptive statistics were performed to evaluate the data. EBP Framework: The framework for this capstone project was the Model for Evidence-Based Practice Change. The Theoretical foundation was based on the blended theory of (a) Imogene King’s Theory of Goal Attainment, and (b) Transtheoretical Model (TTM) of International Behavior Change. Findings/Results: The needs analysis prior to the project revealed 50% of patients were counseled to have screening, with only 16% receiving screening. After instituting the storytelling educational intervention, the rate of screening of the 25 participants was 56%. The stages of change at post-counseling were statistically significant toward positive movement in attainment of screening. The participants agreed to the readability and understanding of the pamphlet. The storytelling intervention was interesting, offered new information, and participants were able to relate personally with the story character. The reported stages of change at the 6-week follow-up were statistically significant with completed CRC screening. Those participants that completed screening were reported in the contemplation and or action stages. Conclusions/Recommendations: Movement toward a systematic utilization of clinical practice guidelines and the measurement of outcomes from the use of a storytelling educational intervention, supplemented with an informational pamphlet and the scheduling assistance by the office staff have facilitated patients to attain early colorectal cancer screening. A continuous monitoring plan has been developed to continue adherence to clinical practice guidelines for colorectal cancer screening.

    Request this Article


    Teaching Intervention on Concept Maps to Increase the Critical Thinking Skills Among Undergraduate Nursing Students

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Mathew, Annie A

    The current health care environment is placing increasing demands on nursing educators to prepare graduates who are able to think critically and solve problems in a variety of clinical practice areas. In an effort to prepare nursing students to deliver safe quality care, critical thinking becomes an essential component to nursing education, and learning to think critically is now widely accepted as a basic goal in nursing education. Currently, the Advanced Technologies Institute Critical Thinking Assessment test is used when students enter the nursing program to obtain a baseline measure of critical thinking. The aggregate results of the year 2008 and 2009 revealed that the nursing program’s percentile rank is 25% below the national percentile rank. This raised the question: Would implementation of a different teaching methodology, namely concept maps, increase critical thinking skills among undergraduate nursing students? The objective of the project was to improve and enhance critical thinking skills by changing the way nursing students think through implementation of concept maps in the clinical setting. The project outcome was to develop effective critical thinkers who translate theoretical knowledge into practice through the use of concept maps to to optimize patient outcomes in the clinical setting. The undergraduate nursing students developed three concept maps that were submitted to a repeated measure of analysis of variance (ANOVA). The results demonstrated that the nursing students manifested a higher concept map score at the third concept map than the second, indicating that the teaching intervention was effective at increasing the critical thinking skills of the nursing students. The evidence-based model used for the project was Rosswurm and Larrabee’s “Model for Evidence-Based Practice Change” and the theoretical model used was Ausubel’s “Assimilation Theory of Meaningful Learning”. The findings of the project revealed that participants demonstrated an increase in their critical thinking skills through the development of three consecutive concept maps. The literature reviewed for this project reflected that concept maps enhance the construction of knowledge in multilinear ways that help students with their ability to conceptualize and increase critical thinking. Students were able to develop the correlations and relationships to the concepts thus gaining an insight into the patient’s problems, identifying nursing diagnoses, implementing, and evaluating the nursing actions at the point of care. The results were reported in the aggregate to the director of nursing and faculty members along with the recommendation to make a practice change to include concept maps in the nursing program curriculum beginning Fall Semester, 2011.

    Request this Article


    The Implementation of Group Office Visits for the Management of Diabetes Mellitus

    Published Year: 2011
    Program: Doctor of Nursing Practice

    McDonald, Teresa A.

    Diabetes has reached epidemic numbers in the United States. The National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) has determined the prevalence of diabetes in the U.S. to be 23.6 million or 7.7% of our nation’s population. Diabetes mellitus is a chronic illness that can be quite debilitating for the patient, the patient’s family, as well as the current health care system. Too frequently patients are informed they have diabetes and yet are given very little information about the disease and how to effectively manage it. Patients are seen by their provider for a median of 16 minutes, every 3 months, thus allowing very little time for the patient to ask questions or obtain education. By providing these patients with the necessary skills to manage diabetes, they become empowered to take change of this disorder, thus minimizing the risk of both short and long-term complications often associated with diabetes. The McColl Institute for Healthcare Innovation developed the Chronic Care Model (CCM). This renowned healthcare model recognizes the important elements necessary to promote high-quality chronic disease management. The elements of this model include self-management, decision support; the delivery system design; the community, the organization of health care and clinical information systems. With the implementation of the CCM, patients are more informed and therefore more motivated to manage their health and the healthcare team more efficiently delivers evidence-based care tha that the patients that is culturally appropriate and useful. For the implementation of an evidence-based practice change, the theoretical framework of Rosswurm and Larrabee was utilized for this capstone project. Additional explanation of this framework is found later in this paper. This capstone project focused on three aspects of the CCM: the delivery system design, the health system, and self-management. Group office visits were offered to those patients with type 2 diabetes who were at that time, seen in the traditional one-on-one office visit. In 2008, a survey intitled Assessment of Chronic Illness Care, developed by the MacColl Institute for Healthcare Innovation, was completed at a rural health clinic in northern California. The purpose of the survey was to determine the status of health care provided in the clinical setting. The clinic’s overall score indicated there was limited support for chronic illness care in the organization. Beginning in January 2010, six groups of patients with type 2 diabetes were formed, each limited to three participants. Each group met for three visits once every three months over a six-month period. After the completion of every group office visit, the patients completed a patient satisfaction questionnaire. The group visit format was extremely well accepted, each of the participants stated they preferred this method of healthcare delivery of the management of diabetes. Based upon the outcomes of this capstone project, it is recommended that patients with diabetes mellitus be offered the choice of participating in group office visits of the traditional one-on-one visits for the management of their chronic illness. Patients benefit by learning to manage diabetes by implementing lifestyle change and gaining peer support from others in the group. In addition, providers are more efficient and productive, thus more satisfied as well.

    Request this Article


    Implementing a Standard Protocol for Breast Cancer Prevention

    Published Year: 2011
    Program: Doctor of Nursing Practice

    McQuade-Jones, Bambi

    Implementation of evidence-based practice in the current healthcare climate will facilitate professionalism and promote the discipline of nursing. This Capstone Project was designed to create a standard protocol with current evidence-based clinical practice guidelines in the area of breast cancer education and prevention in a vulnerable population. According to the American Cancer Society, breast cancer is a worldwide disease that has impact on individuals and families in multiple areas including health, finances, loss of productivity and self esteem. The Capstone Project director implemented an evidence-based system change to investigate the multifactor concerns of breast cancer in a Community Health Center. The Capstone Project successfully enhanced the standard of care for female patients concerning breast cancer education, screening and prevention through an evidence-based model of care created by Rosswurm and Larrabee at a local Community Clinic. Additionally, Kotter’s well built business model was incorporated through the aspect of a change in the organization to promote the successful integration of the evidence-based system change demonstrated by the staff’s willingness to accept the standard protocol. Furthermore, significant to the implementation of the standard protocol was the inclusion of the Health Promotion Model by Pender that served as an impetus for education and promoting health for the patient. Two main areas were involved in the system change for the Capstone Project. First to educate the staff and create a team approach for promotion and standardization of evidence-based practice to care for underserved women concerning breast cancer awareness and prevention, and second to improve patient adherence to evidence-based current Clinical Practice Guidelines for breast cancer prevention. Results of the Capstone Project showed improved adherence to the evidence-based Clinical Practice Guidelines presented by the National Guideline Clearinghouse concerning breast cancer prevention and screening.

    Request this Article


    Implementing Evidence Based Practice Principles of Diabetes Care for Commercial Motor Vehicle Operators

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Moore, Karen S.

    Background: Diabetes continues to be a health concern for a large segment of the United States population. Management of diabetes requires attention to diet, activity, medications and health monitoring to avoid the sequela of disease. For the commercial motor vehicle operator, long in-service hours, lack of healthcare follow up, primary dietary intake from restaurants, as well as very little in the way of regular physical activity, complicates the diabetes management equation further. While much research exists on diabetes and its management, very little has been done to address the unique issues of the commercial motor vehicle operator population. Foreground: For providers in an occupational health clinic charged with determining a commercial motor vehicle operator’s suitability to drive, concerns regarding diabetes and its management are a daily issue. Although diabetes management is coordinated by the primary health care provider, the role of the occupational health care provider in the education and provision of evidence based information is not to be ignored int he commercial motor vehicle operator population. Methods: A needs assessment was completed and an evidence-based presentation on diabetes was given to the healthcare provider staff at an occupational health clinic. A process for dissemination of an evidence-based educational handout directed at commercial motor vehicle operators with diabetes was discussed with the clinic staff. The healthcare provider staff then disseminated the educational handout to commercial motor vehicle operators with diabetes during the project period. EBP Framework: An organizing framework in combination with two theories guided this project. Rosswurm and Larrabee’s Model for Change to Evidence Based Practice provides a systematic process for developing and implementing a practice change. Lewin’s Theory of Change served as the theoretical foundation for the process. The diabetes educational handout was based on the work of Nola J. Pender, PhD, RN, FAAN. Findings/Results: Evaluation of the evidence-based practice intervention was derived by determining the number of diabetes education handouts provided to commercial motor vehicle operators with diabetes during the project period and comparing that number to the number of commercial motor vehicle operators who were eligible to receive the educational handout. The results of the project demonstrate that the number of commercial motor vehicle operators seen at this occupational health clinic and impacted by diabetes was 12.33% which remains above the national estimate of total population of persons with diabetes of 8.3%. Further, the patients with diabetes who were evaluated by the routine, full time providers were more likely to receive the evidence-based educational handout than those that were seen by a locum tenens provider. Conclusion/Recommendations: As patients who were seen by the routine, full time providers were more likely to receive an evidence-based educational handout, additional process improvement needs to occur to assure sustainability of an evidence based practice change when a medical practice relies on multiple locum tenens providers for staffing.

    Request this Article


    Effect of Implementing a Reminder System Intervention for Type 2 Diabetes Mellitus Patients

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Nystrom, Patsi

    The rising incidence and prevalence of diabetes mellitus and its associated chronic complications have become major out-of-control health problems impacting the national healthcare system. The need for comprehensive community-based models for prevention, detection, and treatment of diabetes and associated co-morbidities is critical. Diabetes is the most costly chronic disease in the United States, costing an average $15,000 per patient per year; the disease afflicts 1 in 100 Americans, and its incidence has risen by 65% over the last ten years. The purpose of this paper is to present concepts for implementing a reminder system to recall individuals with type 2 diabetes mellitus (T2DM) and to discuss project implementation of such in a clinical setting. The vast numbers of individuals with diabetes and their need for regular exams and lab testing challenge providers to adequately manage this group. In this paper is a discussion of the application of an evidence-based practice systematic approach to treatment for diabetes, commonly called Staged Diabetes Management (SDM) that helped set the stage for implementing a new reminder system in the quest to reduce morbidity/mortality of patients with diabetes. After a literature search that confirmed the need for a practice change using structured guidelines, clinic staff developed tools for identifying and tracking patients. The Iowa Model of Evidence-Based Practice guided the steps to successful design, tool development, and methods for implementing and evaluating the process. The same-patients six-month project compared number of visits to the two previous years before the intervention. The result was that 29 of 30 patients in the project increased their number of visits allowing the opportunity to implement SDM protcols. Post project results indicated steady improvement of HgA1c results.

    Request this Article


    Pain Management in the Acute Care Setting

    Published Year: 2011
    Program: Doctor of Nursing Practice

    O’Nan, Deborah Bryant

    In1970, Graffam recognized that nurses had difficulty recognizing, responding, and treating patients in pain. Uncontrolled pain in an acute care facility can lead to many problems such as post-operative complications, activation of the sympathetic nervous system, increased pulse, increased respirations, increased blood pressure, increased in-hospital days, and, left untreated, chronic pain. Despite recommendations by the Joint Commission Organization and the Institute of Medicine for improved pain relief measures, patients continue to complain of unrelieved pain. Foreground: Results of the Press Ganey patient satisfaction surveys at a hospital in Henderson, Kentucky, indicated that nurses continue to recieve low patient satisfaction scores in the area of pain management. The Nursing Practice Council and the hospital’s pending Magnet Status require improvement in nursing performance, and patient satisfaction scores, including pain management. Current and future strategic plans for the hospital require that all Press Ganey survey scores be higher than 70%. The current scores are significantly below that target, especially in the area of pain management. Methods: The primary investigator of this project developed and implemented a system change project to address this performance gap at the hospital. The project began with a focus group comprised of bedside nurses that met to discuss the barriers to successful pain management. After the focus group meetings, the primary investigator developed and taught an evidence-based learning module on pain management to the nurses on the medical floor at the hospital. The investigator based the education module on focus group input, literature reviews, and evidence-based practice guidelines. Press Ganey survey results were the means of evaluating the outcome of this specific system change project. Purpose: This project had both short-term and long-term goals. The short-term goals were the results of nurses’ application of knowledge learned in the pain management module. The patients would report improved satisfaction with care and improved inpatient and HCAHPS survey scores in the area of pain management. (b) Long-term goals are the hospital will meet its strategic planning goals related to effective pain management and improved patient satisfaction survey scores. Findings/Results: Following a system change intervention grounded in evidence-based pain management, the Press Ganey Inpatient Surveys and the HCAHPS survey scores showed improvement. Conclusion/Recommendations: Based on the results of this project, the primary investigator recommends that the hospital continue the evidence-based project on pain management to the balance of the hospital nursing staff now and (b) mandate education on pain management to the entire hospital staff on an annual basis. Patient satisfaction in the future will play a role in hospital reimbursement.

    Request this Article


    Initiation of a Call System for Pain Clinic

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Paul, Arlette

    Frequent hospitalizations and emergency room (ED) visits can have an impact on the quality of care and quality of life of patients with chronic pain complaints. For the patients with sickle cell disease (SCD), pain is the most common reason for having multiple ED visits and hospitalizations. Poor pain control can be the results of multiple system problems and/or personal difficulties that are not addressed outside of the acute care setting. In this situation, quality of care is affected because access to community care is not well coordinated with the acute care setting. The frequency of hospital admissions, the multiple times the patients visit the ED and the increased in no-show clinic visits are the variables that was reviewed. The effects of these variables were the focus of this project in addition to, what is required to impact change in the behavior of the clinicians and patients and how a call system can enhance compliance to clinic visits. Carr defines pain as “an unpleasant sensory and emotional experience associated with actual and potential tissue damage”. The classifications of pain are location, severity, intensity and duration. These classifications of pain affect the patient with SCD. Pain is considered a hallmark of SCD and the number one reason for patients to seek medical care. The type of pain most commonly encountered by SCD patients of all ages is referred to as acute painful episodes or more commonly as painful crisis. In January 2009, the Comprehensive Sickle Cell Centers (CSCC) across the nation. This CSCC in the New York area operated for 20 years and provided comprehensive services to the local community and the metropolitan area. The population has since used the services of the emergency room and inpatient beds to compensate for what is no longer available. In an effort to enhance the compliance with the clinic visits the pain management clinician believes a change in practice behavior can impact that change. Engel’s biopsychosocial model is a generated model or an approach that posits that biological, psychological and social factors that all play a significant role in human functioning in the context of disease or illness. The biological component of the biopsychosocial model seeks to understand how the cause of the illness stems from the functioning of the individual’s body. The psychological component of the biopsychological model looks for potential psychological causes for a health problem such as self-control. Pain, being a health problem that affects a patient’s psychologically. The design for the project was a quantitative correlational model that measured the number of times the patients kept their scheduled clinic appointments against the number of times they visited the ED and the number of hospitalizations in a sixty-day period, comparing the findings with any sixty-day period before the project. The outcome was to identify if the clinician’s practice change impacted on the number of ED visits. The objective was to evaluate the clinician’s compliance in the change in practice behavior with the call system. The outcome was that a total of 2.75 fewer ED visits were made and 0.9167 fewer hospital admissions.

    Request this Article


    Awareness of HPV, Cervical Cancer and HPV Vaccine Among U.S. Nurse Practitioners

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Peters-Herron, Alberta

    Cervical cancer is a preventable disease, yet each year approximately 10,370 new cases are diagnosed annually 3,170 woman will lose their life to this disease. Research has established a link between cervical cancer and human papillomavirus (HPV) infections. Most HPV infections clear without medical interventions. However, the concern for healthcare providers is the women who develop persistent HPV infection. Persistent HPV infections can lead to abnormal Pap Tests. Unfortunately, woman with abnormal Pap tests results often receive aggressive medical treatments. Aggressive medical treatments can lead to increasing healthcare costs. By initially administering the HPV vaccine as a preventive strategy for cervical cancer to all age appropriate females, over treatment and healthcare costs will greatly be reduced. Foreground: To assist healthcare providers with the management of abnormal Pap test results and to decrease related healthcare costs, CPGs were updated in 2006. During the same year, te American Cancer Society introduced CPGs for HPV vaccine use to prevent cervical cancer and its precursors. The HPV vaccine is a proven, preventative strategy for cervical cancer. Yet, adherence to CPGs remains a problem for women’s health, adult, family and pediatric nurse practitioners in primary care setting. Therefore, nurse practitioners working in primary care settings should follow the CPGs guidelines to manage women with abnormal Pap test and administer HPV vaccine to age appropriate females. Methods: A survey with a 6 weeks follow-up questionnaire was placed on surveymonkey.com. Participants were sent postcards with instructions for the survey, if they were interested in participating in this project to go to the link provided on the postcard. Two hundred and forty nurse practitioners agreed to participate in this project. EBP Framwork: The Ace Star Model of Knowledge Transformation by Stevens was the EBP framework used for the project. The theoretical model for the project was Levine Theory of Adaptation. Findings/Results: Key findings from this project are that NPs in primary care setting throughout the U.S. was aware of the guidelines and was using the guidelines in practice. The data from the survey indicates that women’s health NPs seem to adhere to CPGs for managing abnormal Pap test more than adult, family or pediatric NPs. Ninety of participants agreed that 11-12 year-old females should receive the HPV vaccine but this was not reflected in the response, which was low, to giving the Vaccine. Conclusion/Recommendations: Nurse practitioners are adhering to CPGs for the management of abnormal Pap test. Womens’s health NPs seem to be doing a better job of adhering to CPGs. The specialty area did not make a significance difference in vaccine administration.

    Request this Article


    Implementation of Quality and Performance Evaluations in Managers of Operations in a Retail Health Care Setting

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Scott, Teri W.

    As a Nurse Leader, I have recognized how difficult it is connect the practice of healthcare and the business of healthcare. In the current economic times it is vital to make that connection in order to maintain the high level of care required to manage patients and to attract and retain the best workforce possible. It has consistenly been a struggle to value, monetarily, the work done by nurses in order to discuss the financial needs of nursing departments and organizations. Generally, as quality of care or quality of providers goes up so does cost. Combining the business and practice of healthcare means not only finding the monetary value but also managing the practice as efficiently and effectively as possible. As I struggled with this, the opportunity to find a capstone project coincided with an opportunity to explore this very concern in the organization I was working in. This paper discusses the problem and the process change that could start to address this disconnect in the practice and the business of healthcare in a large retail health organization. The project does this through performance management specific to the goals of the organization thereby supporting the overall business. An employee engagement survey in a large retail health care organization identified the lack of understanding of how performance was measured as the top concern of the employees. To address this concern Quality and Performance (Q&P) Evaluations for Clinic Level Providers were developed, piloted, and then fully implemented. These evaluations consisted of 11 metrics that were truly affected by the provider and support the goals of the organization in clinical quality and customer service, and to certain extent revenue. In attempting to make a closer connection to the success of the organization and the role of the Managers of Operations (MOs) it was proposed to develop a similar tool where the metrics directly supported the goals of the organization relative to revenue, combining of the practice and the business of healthcare in this organization. The primary objective was to develop a Q&P with metrics that were objective, clearly affected by the MOs, and supported the organization goals. That could connect the practice and business of healthcare and allow nurse leaders to address the value of the nursing staff and nursing services in a variety of settings. The evaluation of the tool, the value of of the metrics, and the results on the Q&P compared to the budget, reports on quality, and customer service will identify success in the project or shortcomings of some part of the change. Any shortcoming would them be address and changes incorporated into the project, implemented and then re-evaluated. The Johns Hopkins Nursing Evidence Based Practice Model was selected for this practice change. This model is a nursing model and was developed for organizational changes thereby very easily utilized in this project: an organizational change in an organization that is about 95% nurses. The model was successfully integrated throughout the change. Many barriers become a reality in the implementation of the change that the author believes affected the results. The presumtion based on the literature and the pilot project is that when individuals understand the metrics and goals of those metrics of their performance evaluation, so long as they have control of those in some way there will be positive movement toward the goals. The lack of clarity in presenting the metrics, goals, and value of the metrics relative to the organizations goals seemingly changed the presumption of positive progress by the selected pilot group of MOs. The recommendation from the author is to recreate the change in another organization where the communication and support of the tool are enthusiastic. The leadership must value the metrics and those metrics must support the organizations goals and truly by influenced by the individual being evaluated. The author plans to implement similar evaluations in her current organization for providers and managers.

    Request this Article


    Chemotherapy DVD: Effects on Anxiety and Depression in People Newly Diagnosed with Cancer

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Sebastian-Deutsch, Amy

    Problem: People newly diagnosed with cancer (CA) frequently experience some level of anxiety and depression (A&D) related to their disease and CA treatment. Due to chemotherapy (C) complexities and treatment toxicities, patients must be educated about their treatment. How best to deliver this critical education has been a challenge for oncology nurses, and warranted investigation. While the literature cited the benefit of C patient teaching, there was scant evidence on the use of chemotherapy patient teaching DVDs (CPTDVD), as an education method to help decrease A&D levels in people newly diagnosed with CA. In addition, an on-line search revealed the most current video to be nine years old. Purpose and Scope: The purpose of this capstone project was to examine the level of A&D in people newly diagnosed with CA who were C naive, before and after the addition of a CPTDVD to a standard patient teaching intervention. The rationale for the project was the use of a DVD in addition to standard teaching could possibly decrease the levels of A&D experienced by people newly diagnosed with CA. Goal: The goal of the project was to develop an up to date CPTDVD and successfully implement its use in multiple healthcare organizations. Objectives: The following were project objectives: 1) produce a current CPTDVD, 2) describe the demographic characteristics of newly diagnosed, chemotherapy naive, people with solid tumor CA, 3) examine/describe the levels of A&D in people newly diagnosed with CA after a teaching intervention that includes the use of a CPTDVD. Plan: Phase One: Completed study proposal, secured funds to create and produce a current CPTDVD, created and produced a current CPTDVD, and gained two IRB approvals for proposed study. Phase Two: Implemented and evidence-based patient teaching intervention which included a CPTDVD, and evaluated the levels of A&D before and after the patient teaching intervention, through use of the Hospital Anxiety and Depression Scale (HADS) as the measurement tool. Outcome and Results: A paired sample two-tailed t-Test was used to determine if there was a difference in A&D, as measured by a modest, mean score improvement in levels of A&D, from pre to post intervention. Results revealed that the mean of post A score was statistically significantly lower than the mean of pre A score. Thus, there was a decrease in the level of A after watching the DVD. There was no statistical difference, for the means of pre and post D. The D level was not altered. Regression analysis was performed on demographic data. Results were not significant; likely due to a small sample size.

    Request this Article


    An Evidence-Based Practice Guideline for the Recognition of Malnutrition in Elderly Patients with Chronic Obstructive Pulmonary Disease

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Stumpf, Elizabeth

    COPD is the fourth leading cause of death in the United States and is projected to be the third leading cause of death for both men and women by 2020. The Burden of Obstructive Lung Disease (BOLD) initiative estimates that 10.7 million people in the US have COPD and the costs for COPD are estimated at $832 billion over the next 20 years. In the person with chronic obstructive pulmonary disease (COPD), nutritional disorders are associated with higher morbidity, lower exercise tolerance, increased dyspnea, and lower health-related quality of life. COPD is also a systematic disease with manifestations extending beyond airflow obstruction to include nutritional changes, skeletal muscle disfunction, and cardiovascular effects. Weight loss and protein-calorie malnutrition are prominaent aspects of chronic pulmonary failure and progressive weight loss is observed in one third to one half of patients with COPD. It is unique among leading causes of death in western society given that prevalence, associated morbidity and mortality continue to rise. In the elderly population, the prevalence of malnutrition is common with up to 12% of mobile elderly, 20% of medical outpatients, 85% of nursing home residents, and 50% of hospitalized elders being malnourished. A valid and reliable tool to identify malnutrition that has been used in various elderly populations is the Nestle MNA Mini-Nutritional Assessment. The MNA is available at no cost, can be completed in 5 minutes, and has an interactive version that can be completed online. This tool can assist in the identification of malnourished patients before severe changes occur in weight or serum protein levels. The purpose of this capstone project was the implementation of an evidence-based practice guideline for the recognition of malnutrition in elderly patients with COPD using the Nestle Mini-Nutritional Assessment (MNA) tool in an outpatients setting. The objective for this project was to improve healthcare delivery for the elderly population with COPD utlizing the MNA tool in the implementation of an evidence-based guideline. The project was guided by the Johns Hopkins Nursing Evidence-Based Practice Model and paralleled the goals of the Institute of Medicine. A total of 36 patients with a COPD diagnosis, ages 65 to 90 years, participated in the project with 56% demonstrating either malnutrition or a risk for malnutrition by the MNA. The interactive version of the MNA was utilized, allowing the printed report to be scanned into the patient chart. Data was gathered by the Advanced Practice Nurse. Patients who were deemed malnourished or at-risk for malnutrition were referred to a registered dietician for further evaluation. The MNA will be a part of routine COPD care for this population of patients. This project has allowed for transformational change in this area of pulmonary care for elderly patients with COPD.

    Request this Article


    A Teaching Intervention to Improve the Self-Efficacy of Internationally Educated Nurses

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Tan, Rhigel A.

    Internationally educated nurses (IEN) are an essential part of the nursing work force In the United States (U.S.). The current nursing shortage in the United States, which started in 2001, is the longest on record. According to Health Resources and Services Administration (HRSA), there are as many as 800,000 nurses are needed by 2020. Increasingly, the U.S. health care system relies on international nurses to meet staffing needs. Most international nurses in the United States come from Asian countries, especially the Philippines, India, Korea, and increasingly China. According to Xu, Zaikina-Montgomery and Shen, 2010, a significantly higher proportion of international nurses were in direct patient-care positions compared with their American counterparts, based on the data of 2004 National Sample Survey of Registered Nurses (NSSRN). IEN need to have a successful transition into their unfamiliar practice setting. Due to conflicting professional and socioeconomic expectations, a growing body of literature has documented a range of challenges experienced by international nurses during their transition to U.S. health-care environment and the American society. This project set out to reveal how much impact a computer-assisted patient simulator experience had on the perceived self-efficacy of IEN. This interventional project demonstrated the impact of teaching using computer-assisted patient simulators on the perceived self-efficacy of IEN, using Bandura’s Self-Efficacy Theory. Rosswurm and Larrabee’s Model for Change to Evidence Based Practice (EBP) was utilize as the systematic process for change model to address and guide the steps in developing this project. A repeated measure ANOVA with time point was used to determine whether there was a significant difference between the participants’ baseline self-confidence score and students’ follow-up self-confidence score in managing a cardiac event after a computer-assisted simulation experience was imposed. IEN were exposed to a computer assisted simulation experience, a strategy that increases the perceived self-efficacy of internationally educated nurses. The goal of this project was to successfully implement a teaching intervention using computer assisted human patient simulation that will improve the self-efficacy of internationally eucated nurses, as they transition to the U.S. nursing work force. The project manager (PM) believes that a systematic process for change project utilizing the evidence-based practice related to simulation has served as a solid foundation that enhanced the self-efficacy of the IEN working in the selected facility where the project was piloted. It is the author’s recommendation to use the facility as a model for other health care facility employing IEN in order to improve safety and quality of care as rendered by these special nurses population.

    Request this Article


    Identifying Trends in Serum Glucose Levels During the First Twenty-Four Hours After Coronary Artery Bypass Grafting Surgery

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Taylor, Christine

    Health care providers need to acquire an understanding of the steps involved in surgical wound healing and an awareness of the factors, which promote or delay the healing process to enable them to assist their clients through the peri-operative period. This acquired skill is necessary to (a) ensure quality care, (b) facilitate the cost effectiveness of care, (c) improve patient, provider, and facility outcomes, and (d) increase patient satisfaction. One factor that influences surgical wound healing in patients who have undergone coronary artery bypass grafting (CABG) surgery is serum glucose levels. Knowledge of when serum glucose levels increase assists healthcare providers formulate effective protocols for serum glucose control to facilitate surgical wound healing and the prevention of surgical site infections.

    Request this Article


    Nurse Practitioner Skills Acquisition in Musculoskeletal Evaluation: An Evidence Based Practice Project for Employee Health

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Vrban, Jonathan

    Problem: This capstone project met a need for expanding clinical skills by providing a clinical skill refresher course. The course provided a review for the nurse practitioners working in employee health for a large HMO in Northern California for the evaluation and treatment of musculoskeletal injuries. This education now allows them to see injured employees and provide diagnosis and treatment on the first visit, based upon state Workers’ Compensation guidelines. Purpose and Scope: The purpose of this capstone project was to describe the level of nurse practitioners skills acquisition in musculoskeletal evaluation before and after a teaching intervention. The teaching intervention was offered to nurse practitioners working for a large HMO in employee health in Northern California. Goal: The first goal was a successful clinical refresher course for the nurse practitioners, so they would begin evaluating and treating injured employees in the employee health department. The second goal was a larger organizational goal for the Departments of Occupational Medicine and Employee Health Services for the organization, wanting nurse practitioners to see all of our own injured workers initially in employee health. Objectives: First, describe aggregate demographic characteristics of nurse practitioners working in employee health for the participating HMO. Second, to describe pre-intervention self-assessed confidence and knowledge of musculoskeletal injury evaluation and treatment by nurse practitioners working in employee health. Third, to describe post-intervention self-assessed confidence and knowledge of musculoskeletal injury evaluation and acquisition of clinical skill for physical examination techniques demonstrated in the intervention program using the OSCE. Fifth, to measure change in practice before and after the teaching intervention covering musculoskeletal injury evaluation and treatment by nurse practitioners working in employee health. Plan: Phase One: Conduct a needs assessment using a confidential online survey. Phase Two: Design a musculoskeletal teaching intervention using an Evidence Based Medicine approach. Phase Three: Implement an evidence-based teaching intervention for a projected sample. Phase Four: Evaluate the level of self-assessment of confidence and knowledge in the evaluation and management of musculoskeletal injuries before and after a family presence teaching intervention using a confidential online survey. Outcomes and Results: Using a triangulated interventional research design, results of the pre-intervention and post-intervention measures revealed a mean score increase in confidence and knowledge of evaluation and treatment of musculoskeletal injuries. Reliability estimates based on internal consistency for the pre-intervention testing achieved significance.

    Request this Article


    Introduction of Simulation Technology Using Medium-Fidelity Simulator at a School of Nursing in an African Country

    Published Year: 2011
    Program: Doctor of Nursing Practice

    Wakhu, Douglas O.

    Problem: Changes in higher education, nursing education, include an evolution of teaching strategies. Lecture is no longer accepted as the sole teaching strategy. Faculty are integrating use of technology in their teaching and promoting active involvement of the students in the learning process. Simulation teaching using fidelity human patient simulators in nursing education is gaining worldwide acceptance. While this may be the case in the developed countries, it does not hold the same for under-developed countries. The lack of these technological advances in nursing education is more apparent is African countries. Faculty therefore must have a solid foundation of concepts and knowledge on simulation technology and build upon those concepts, to ensure a more effective, efficient and satisfying learning experience for he learner. Purpose and Scope: The purpose of this project was to introduce medium-fidelity simulation for teaching and integration of simulation into the curriculum at school of nursing that prepares students in a bachelor’s level education for initial registration for nurse licensure. The project scope included designing, developing, implementing and evaluating medium-fidelity human patient simulation laboratory in the school. The rationale for the project was that by developing a simulation laboratory there would be integration of simulation into the nursing school curriculum. Goal and Objectives: The primary goal of the project was to assess the school of nursing laboratory facility and faculty use of simulation. A second goal was to design and develop a medium-fidelity simulation laboratory. The third goal was to provide training to nursing faculty related to the operation of laboratory equipment and the process of conducting activities utilizing simulation as a teaching strategy with the objective of integrating simulation teaching into the nursing school curriculum. Plan: In the initial phase of the project a needs assessment was based on current trends in nursing education, simulation teaching. This was followed by designing and developing simulation laboratory focusing on simulation as instructional strategy after which implementation of simulation teaching activities for the faculty were conducted. In the final phase evaluation of integration of simulation into the course commenced. Outcomes and Results: Key findings revealed significant changes in the teaching strategies amongst the nursing school faculty. Seventy one percent of the nursing school faculty attended the simulation laboratory training sessions. Four scenarios were incorporated into the lessons into the adult health nursing course within the first week after implementation and ten by the end of third week. Faculty is writing scenarios using program templates that came with the software.

    Request this Article


2012

    Incorporating Parental Training into Care of Children with Oppositional Defiant Disorder

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Abuor, Rebecca

    Background: Behavioral disorders among children have become a major area of concern in our society, and frequent reasons why children are referred for interventions. Oppositional defiant disorder (ODD) is a leading cause of referral for youth mental health services. Mental health is now the leading cause of disability in world youth. Children with ODD are at risk for serious crimes as teenagers with high possibility for Juvenile Delinquency (JD) if not treated effectively. Foreground: Although there is overwhelming research evidence showing the best treatment approach to children with ODD, evidence-based practice (EBP) standards were not utilized at one local child and adolescent outpatient clinic. Current treatment practice at the outpatient clinic is lacking parental training (PT). EBP Framework: The framework for this project was Neuman’s System model. This model emphasizes on a more holistic approach in treating the whole person. The practice parameters for treatment of ODD recommended a comprehensive approach to treating ODD which includes: a) use of psychotropic medications where indicated, b) child skills and behavior training and c) parental training using both individual and group therapy. Review of literature supports this as the most effective approach to treatment of ODD. Methods/Plan: The plan was to incorporate parental training into the care of children with ODD as outlined by evidence-based practice standards. Goals and Objectives: The project’s overall goal was to incorportate PT into care of children with ODD using evidence-based guideline recommendations. The objective was to educate the providers at the clinic about how to use EBP recommendations and as part of the comprehensive treatment for children with ODD. Conclusion: Clinicians’ awareness of and adherence to evidence-based practice has been shown to improve patient outcomes. Effective treatment of ODD children will be evidenced by decreased patient visits to clinic, decreased school referrals/suspensions and eventually decreased delinquecy with the juvenile justice system.

    Request this Article


    Evaluation of Occupational Medicine Program

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Ballard, Kevin

    In August 2010, a quality improvement assessment conducted by the occupational medicine marketing team of a large multi-state healthcare system revealed dissatisfaction with current occupational medicine service in a rural northern plains multi-specialty lack of timeliness of mandatory reports and inconsistency with work restrictions. Similar problems are recognized within all aspects of the United States healthcare delivery system. The Institute of Medicine documented lack of are coordination and fragmentation of care as systemic problems that increased costs and decreased quality of care. In September 2010, based on this assessment an occupational medicine project team was formed to investigate the needs for an occupational medicine service line. In October 2010, the team recommended the implementation of an Occupational Medicine Program based on the sports medicine care delivery model. Changes were made to improve the satisfaction of local and area employers, maintain quality care for injured workers and decrease the risk of competitors moving to the local area. The program was developed based on two theoretical frameworks. Bartanlanffy’s Open System Theory and Lewin’s Change Theory provided guidance for the practice change developmet and assessment. These frameworks and application of Larrabee’s Evidence-based Care Model supported use of the best evidence to develop and implement the program. The objective of the practice change was to deliver quality cost effective occupational medicine services that satisfied the injured worker, employer and insurance carriers. The pilot phase was launched on January 1, 2011, allowing the project team to test and refine processes developed for the service line. The Occupational Medicine Program was fully implemented on April 1, 2011. The purpose of this capstone project was to conduct short term evaluation of the practice change. Evaluation focused on employer satisfaction and satisfaction of the project team with internal processes. These evaluations were conducted with clinic generated survey instrument. A pair of retrospective chart audits detailed medical record evidence on fragmentation of care, inconsistency of work restrictions and lack of timely report completion from both prior to and after service line implementation. The chart audit data supported the problems identified in the prior assessment. The 2011 chart audit showed increased compliance with service line metrics. The employer satisfaction surveys showed increased satisfaction of ninety-four percent at the nine month data point, while the project team survey showed no dissatisfaction with internal processes. There were problems indentified through the surveys which required rapid improvement events to facilitate process refinement to meet the needs of both the internal and external stakeholders. Satisfaction with internal processes and increased employer satisfaction provide a sound foundation for the occupational medicine service line. Long term sustainability will require further assessments of clinical finanicals, employer lost work day data, Press-Ganey scores for patient satisfaction and insurance carrier metrics for cost of care. These assessments are not within the timeframe of this capstone project. These assessments could be added to this project to give a complete short and long term evaluation.

    Request this Article


    Medical Outreach Team for Homeless Veterans

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Broad, Lauriann Mahealani

    Background: Approximately 23 percent of the homeless populations in the United States are veterans according to a recent national survey. One reason is veterans have had difficulty finding employment after being discharged from active duty service in the military. Another reason is that many veterans suffer challenges putting the war behind them. Twenty percent suffer from post-traumatic stress disorder (PTSD), major depression and 19% with brain injuries. Others suffer from substance abuse. Still others have no family support. Suicides are also on the rise with rates doubled compared to non-veterans. Many are disabled. Across the country, more than 75,000 veterans are homeless on any given night, with more than 1.5 million veterans at risk of becoming homeless. Foreground: Hawaii’s jobless rate for veterans is 8.3 percent, two percentage points above the state’s overall rate and slightly more than the national unemployment rate for veterans. Evidence Based Practice Framework:The Rosswurm and Larrabee evidence-based framework was used in this capstone to guide best practices. The framework served to guide the capstone project in integrating an evidence-based practice change. Project information was collected and reviewed pertinent to supporting outreach medical care for homeless veterans. The literature reviews supported the feasibility of an outreach team to include interventions promoting health improvement and heightening the quality of lives. Major stakeholders in the VA such as the VA director, rural health director, primary care and mental health providers were educated about the current lack of access to medical care for homeless veterans and how an outreach team could impact this deficit. Methods: The objective of the capstone was to fill a gap in healthcare for homeless veterans who lack or have limited access to medical and social services. A pilot was planned and inititiated to fulfill the capstone objective. To fulfill the pilot plan, an outreach team was assembled consisting of a nurse practitioner and nursing students. The team provided medical care to homeless veterans on the island of O’ahu. Findings/Results: Data was collected and showed that outreach medical team services improved access to health services for homeless veterans in Hawaii. Recommendations/Conclusions: The success of the pilot demonstrated that a medical outreach team could serve as an important resource for homeless veterans residing in the community who have found it too challenging for whatever reason to access medical care and social services at VA facilities. The researcher estimated that there might be as many as 500 homeless veterans residing in the state of Hawaii who are in this situation and may be served by an outreach program.

    Request this Article


    Evaluation of Implementation of Regional Coordinators

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Conway, Kelly

    Background: Homelessness has become one of the most visible and intractable problems, magnifying the social and structural shortcomings of all societies around the globe. Homelessness captures not only those without a roof over their heads, but those who are locked into any number of maladies and disabilities including econommic hardship, mental illness, substance abuse, domestic failure, unemployment and social stigma. Foreground: While the focus of helping the homeless has been on housing, research reveals that 20-30% of the homeless population is veterans, 50% of whom are reported to have mental illness and 70% who are reported to suffer from substance abuse. In 2009, it was estimated that there were more than 136,000 homeless veterans. Although these numbers declined to nearly 76,000 in July 2011 they are expected to rise again as more veterans return home as the Iraq and Afghanistan conflicts wind down. Unfortunately, it has been found that though the need is great for medical care by homeless veterans, up unitl very recently only 20% of have taken advantage of DVA healthcare entitlements; an outcome that exacerbates their long term health. EBP Framework: Evidence-Based Practice (EBP) and Interprofessional Collaboration (IPC) initiatives at the highest federal executive and congressional levels have charged the Department of Veterans Affairs (DVA) to end veteran homelessness by the year 2015. Theoretical Models include those of Larrbee, Lewin, Kotter, Maslow and Schein. Methods: As an integral part of this new initiative, this capstone project has been organized and proposed to increase the access of homeless veterans to DVA homeless services by providing IPC in remote regions through the implementation of region coordinators whose job is to facilitate several key new policies including: 1) no wrong door; 2) coordination of an enhanced homeless program staff through regional teams; and 3) increased collaboration with and between the DVA and community partners. A survey instrument was utilized to evaluate the IPC of the regional team staff. Findings/Results: As compared to the literature, IPC, although with relatively few studies, has positive results in patient outcomes and staff collaboration. Implementation of Regional Coordinators has led to decreasing barriers to access to care and increased collaboration across homeless programs. Conclusion/Recommendations: Project outcomes include increased access to care for homeless veterans, increased interprofessional collaboration and communication of regional team members, and enhanced community partnerships.

    Request this Article


    Development of a Health Promotion Program for Filipino Americans

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Delossantos, Oliva

    Background of Problem: Healthy People 2020 is a national agenda set by the Department of Health and Human Services (DHHS) to promote health and prevent diseases. One overarching goal of Healthy People 2020 is to eliminate health disparities among different segments of the population. Filipino Americans, the third largest minority population in the United States, continue to experience striking health disparities, which includes higher rates of diabetes and cardiovascular diseases. The health of the Filipino Americans is integral to the well-being of the nation, therefore, there is a need to develop health promotion programs to improve health and achieve health equity. Foreground of the Problem: The benefits of physical activity as primary health promotion and cardiovascular disease prevention have been well established. After residing in the United States for a period of time, Filipino Americans often gain weight from physical inactivity. The adherence to exercise is considered “a matter of priorities”. There is a vital need to encourage Filipino Americans to be physically active in their leisure time and increase the levels of physical activity. Evidence-Based Practice Framework: Pender’s Health Promotion Model (HPM) is the conceptual nursing framework used for the study. The Rosswurm and Larrabee Model is the evidence-based practice model that guides in the systematic approach in developing the Health Promotion Education Program (HPEP) for Filipino Americans. Method: A one-day health promotion educational program on physical activity is implemented for a small Filipino American community in a large city in Texas. The goal of HPEP is to increase awareness and knoweldge of physical activity and its health benefits thus decreasing health disparities and improving the health of the Filipino Americans. All participants completed the pre-test survey as adapted from the Active Australian Survey Tool. An interactive demonstration and participation of different types of physical activity exercises follows after the lecture-discussion. All participants completed the post-test survey two weeks after the education intervention. Findings/Results: Data from the pre- and post-surveys were used to determine the changes in the level of physical activity as a result of the evidence-based project. The results showed the participants have increased their frequency and duration of physical activity to achieve sufficient time to attain health benefits regardless of age, gender, and number of years in US. Conclusions/ Recommendations: The Health Promotion Educational Program empowered the Filipino Americans members of a social community in a large city of Texas to adopt health lifestyle through physical activity self-efficacy that they can incorporate in their daily lives. The health of the Filipino Americans is intergral to the well being of the nation, therefore, there is a strong need to continue developing health promotion interventions to eliminate health disparities and improve the health of all citizens.

    Request this Article


    Implementation of Testosterone Replacement Guidelines

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Durant, Karen

    Low testosterone (LT) levels affect approximately four million men in the United States, but only about 5% received treatment. Testosterone is the most important male sex hormone. It helps the body produce and maintain adult male features. Testosterone deficiency syndrome can cause significant morbidity and substantial reduction in quality of life. Testosterone therapy can be safe if appropriate evaluation is done prior to treatment and during therapy. Basin et al. and Darby and Anawalt emphasized that there is a need for a standardized plan for men receiving testosterone replacement therarpy. Drug manufacturers are bringing this issue to the public’s attention through direct-to-consumer advertisement. Due to aggressive marketing to the public, it is urgent that an evidence-based protocol be implemented as an increasing number of men will be inquiring about testosterone replacement. The project addressed the question: Do adult males with testosterone deficiency syndrome received appropriate evaluation pre and post initiation of testosterone replacement therapy? To answer the question, and evidence-based standardized testosterone replacement protocol derived from the Endocrine Society’s Guidelines for Testosterone Therapy in Adult Man with Androgen Deficiency Syndromes was implemented in an independent famil practice clinic. In the clinic, the number of men inquiring about testosterone deficiency and replacement has increased in the past few years. The evidence-based practice framework that was used to guide this project was derived from the Larrabee’s Evidence-Based Practice Change Model. The Theory of Unpleasant Symptoms was selected to provide the theoretical guide for the project. Primary care providers implemented testosterone replacement per the Endocrine Society’s Guidelines for Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes. Practice change outcomes were evaluated through chart audit before and after implementation of the guidelines. Over a three month period of time a total of 22 charts were reviewed. Baseline evaluation found the majority of patients were having their initial testosterone check by providers per guidelines but few providers were ordering the confirmatory testosterone level as recommended in the guidelines. Few patients were receiving the recommended lab evaluation prior to starting replacement therapy/. Approximately one third of all patients over 40 had a pre or post therapy digital rectal exam. The majority had post initiation of therapy lab but the prostate specific antigen (PSA) was often not completed. Patient care providers and medical assistants willingly implemented the Endocrine Society Guidelines for Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes. This was evident in the post evaluation as improved outcomes were identified.

    Request this Article


    Implementation of a Guideline to Improve Appropriate Antibiotic Use

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Edwards, Shieghetha L.

    Antibiotic overuse and resistance are not only local issues, but are global problems as well. Major causes of antibiotic resistance are over-use and misuse of antibiotics. South Africa, Kenya, China, India, and Vietnam are just some of the countries that have major concerns regarding antibiotic overuse. At the family and urgent care practice setting, there was a concern regarding antibiotic overuse. There was not a standardized protocol to treat acute otitis media. They treat according to their knowledge base and local standards. Two evidence-based practice frameworks were used to guide this project. The Transtheoretical Model of Change was used to understand the steps of change for the project. The Rosswurm and Larrabee’s Model was used to guide the steps of change. The objectives of the project were increased adherence to national standards, decreased antibiotic use, and decreased follow up visits. Outcomes were improved patient care and the practitioner’s adherence to protocol. Retrospective chart reviews were conducted to evaluate practitioner compliance with the protocol. The wait and see prescription (WASP) protocol was found and discussed with the providers. The providers were educated on how and when to use the protocol. Providers were instructed on what to discuss with patients and parents/guardians. Additionally, patient education materials were shared with the providers. For the most, practitioners adhered to the recommended protocol. The majority of the patients who were eligible received a WASP. There was inadequate documentation as to how much education patients received regarding the WASP. After thorough consideration, the project director makes the following recommendations: 1.) develop a standardized protocol for treating other illnesses where it is questionable whether the etiology is viral or bacterial. 2.) look to other avenues to identify more prudent use of antibiotics across the board.

    Request this Article


    An Algorithm for Femoral Nerve Blocks for Patients Presenting to the Emergency Department with Fractured Femurs

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Frisch, Charles A.

    Pain is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus. In the United States more than 300,000 patients a year suffer from fractured femurs. This can be a debilitating injury that can lead to major life style changes. Patients admitted to the Emergency Department of a critical access rural hospital with the diagnosis of a fractured femur are stabilized and transferred to a tertiary medical center for definitive treatment. Prior to this intervention, they were treated with intrevenous pain medications. Further pain medications during transport were often denied due to the level of care that the transporting EMT could provide. An initial needs study was performed to determine the pain treatment for patients admitted to the Emergency Department with a diagnosis of a fractured femur. This initial study showed that patients were woefully undertreated for their pain. It was determined that this patient population needed more definite treatment for their pain prior to transfer. Femoral nerve blocks provided a method of treating the pain associated with a fractured hip. The question was how to increase the use of these blocks in the Emergency Department. An algorithm was developed and introduced to the medical and nursing staff of the Emergency Department. After the introduction of the algorithm a follow up study was performed to determine if the number of femoral nerve blocks for patients with fractured femurs was increased. The quality improvement tool of PDSA was used for a model. The purpose of PDSA is to establish a relationship between changes in processes and outcomes. Rosswurm and Larrabee model for a change to evidence-based practice was used for a guide in this study. They give six steps in implementing evidence into practice. An additional theory is of constructivism learning. Jean Piaget stated that knowledge is assimilated and internalized by learners. Constructivism emphasizes the importance of the learner being actively involved in the learning process. Glaserfeld emphasizes that the learner’s construct their own understanding and that they do not simply mirror and reflect what they learn. After the algorithm was implemented only two patients met the inclusion criteria. Developing an algorithm for femoral nerve blocks with patients with fractured femurs seems to increase the usage of femoral nerve blocks in selected patient population. They also had less pain when treated with traditional intraveous pain medications. Recommendations include continuing to use the algorithm in the selected patient population and to develop other algorithms for nerve blocks for patients with other types of long bone fractures.

     

    Request this Article


    Implementation of an Education Program for Patients Undergoing Breast Reconstruction

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Kamperman, Kathryn

    Patients or persons who have undergone breast reconstruction are at times ill prepared for the surgical experience, which results in excess phone calls, unnecessary office visits and anxiety for the patient and his or her caregiver. In 2010, nearly 1.5 million people were diagnosed with breast cancer worldwide. According to the American Cancer Society, an estimated 230,480 new cases of invasive breast cancer were expected to be diagnosed in women in the United States along with 57,650 new cases of non-invasive breast cancer. In California, Marin County has the highest breast cancer rate. California counties with the lowest rates include Imperial and the combined rates for Lassen, Modoc and Plumas. A six step framework developed by June H. Larrabee guided the development of the Capstone system change. Merle Mishel’s Uncertainty in Illness Theory provided the theoretical perspective for guiding this capstone project. Research shows post mastectomy reconstruction has been shown to provide substantial psychosocial benefits for women who undergo mastectomy for the treatment of breast cancer. Despite this, it remains the minority of breast cancer patients undergoing mastectomy who elect tot pursue breast reconstructive options. Authors have identified considerable dissatisfaction with doctors’ lack of attention to patient education. In addition, a correlation has been established between inadequate preparatory information and dissatisfaction following post mastectomy reconstruction. A solution for the unprepared surgical patient is through an evidence-based system change implementing an education program where providers are trained to better prepare patients prior to undergoing breast reconstructive surgery. The capstone system change took place at a National Cancer Center located in Northern California. The capstone system change involved the evaluation of implementing an education program for providers to better educate the breast reconstructive patient. Providers wer educated over a one week period. For one month, clinicians provided both verbal and written instructions to the breast reconstructive patient for preoperative, hospital and postoperative care. In addition, patients received a phone call within the week prior to surgery to answer any last minute questions the patient or family may have had. The intended goal was to reduce the number of postoperative phone calls, and better prepare the patient and family regarding breast reconstructive surgery. Incorporating a system change to better educate the patient who had breast reconstruction is necessary to improve patient satisfaction with the overall surgical experience. For this capstone system change, provider education resulted in a better prepared breast reconstructive surgical patient.

    Request this Article


    Incorporating a Published Tool to Standardize Sex Education in the Pediatric Primary Care Setting

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Lujano, Julio

    Background: Adolescent sexual activity is a tremendous health care issue in the United States. Every year, roughly nine million new sexually transmitted infections occur among teens and young adults. By their 19th birthday, seven in 10 teens of both sexes have had intercourse. The United States continues to have one of the highest teen pregnancy rates in the developed world. Foreground: Even when parents provide information, their knowledge about contraception or other sexual health topics may often be inaccurate or incomplete. Strong evidence suggests that comprehensive approaches to sex education help young people both to withstand the pressures to have sex too soon and to have healthy, responsible and mutually protective relationships when they do become sexually active. Many pediatricians say they feel ill-prepared or uncomfortable serving as sexuality educators. Yet, many are asked to do so, because of their close contact with children and families. Methods: Realizing the ramifications of adolescent sexual activity and lacking a consistent, comprehensive sex education curriculum, the health care professionals at a private, pediatric practice opted to standardize the content of the sex education lecture provided to teenagers and their parents during routine well examinations using a pre-published tool endorsed by the American Academy of Pediatrics. EBP Framework: An integrative model was utilized to guide this change process. Lewin’s Unfreezing-Change-Refreezing Model for change enhanced the Team Strategies and Tools for Enhanced Performance and Patient Safety (TSTEPPS) Model by identifying behaviors over the change process that influenced outcome. Findings/Results: Utilization of the pre-published guideline during the patient encounter served as both a reliable starting point to begin a discussion about sexuality and as a reminder to the health care provider of the six subtopics, which needed to be addressed during the standardized sex lecture. The pre-published guideline did not prove to be a meaningful catalyst to get health care providers talking more about sexuality. Conclusions/Recommendations: Even in health care, the topic of sexuality continues to be a universally shunned topic. More research is needed to identify factors which inhibit a medical provider from deliverig a comprehensive sex education lecture.

    Request this Article


    Promoting Primary Care Provider Confidence in Differential Diagnosis of Bipolar Disorder and Use of Mood Disorder Questionnaire

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Nazirpour-Caloor, Seyed-Hassan

    Globally, million people suffer from mental illness and available data indicates that the prevalence of bipolar disorder (BPD) in the United States ranges from 3.5% to 6.5%. In the primary care setting, most patients with BPD are in the depressed rather than the manic or hypomanic phase of the illness. Because the depressive episodes in BPD may be indistinguishable from those inthe major depressive disorder, missed diagnosis many occur. Late diagnosis can lead to otherwise avoidable direct and indirect costs to patients, their families, and the health care delivery system. Research reflects high prevalence of missed diagnosis of BPD in the primary care setting, where the majority of initial antidepressant medications are prescibed by primary care providers. Although mania or hypomania is a necessary component for diagnosing patients with BPD, depressive symptoms dominate the course of this illness which makes it challenging for clinicians to make an accurate diagnosis. It is estimated that 6.5% of New Mexico State residents, where the project took place, have severe mental illness, including BPD. Several research findings maintain high prevalence of missed diagnosis in primary care settings, making it essential to diagnose this mental health disorder early and accurately. The purpose of this capstone project was to promote confidence of differential diagnosis BPD in primary care providers by encouraging utilization of a valid and reliable Mood Disorder Questionnaire (MDQ) and by initiating a change in the current culture of repeated missed diagnosis or misdiagnosis of the bipolar disorder spectrum. This capstone project was based on a theoretica question, stemming from years of interviewing and treating patients with BPD in the primary and psychiatric care settings: Can utilization of a simple form (MDQ), promote primary care providers’ confidence in differential diagnosis of BPD in the primary care settings? To accomplish this objective, MDQ forms were utilized by seven different providers at their primary care settings. Methodologies that were instrumental in the accomplishment of this project included the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) and the Leading Change model by Kotter. Results of retrospective quantitative ratio analysis showed participating provders’ incremental confidence increase in differential diagnosis, treatment, or prompt referral of patients with BPD. The results of this project concur with several research studies conducted previously in utilizing MDQ forms for differential diagnosis of BPD. The outcomes reflected that utilization of the MDQ is instrumental in promoting appropriate treatment of patients with BPD, and the project leader strongly suggests MDQ form utilization as a routine screening instrument for all patients who seek treatment for depression in primary care settings.

    Request this Article


    Implementing a Protocol Change: How Nurse Practitioners Screen for Childhood Obesity

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Niemiec, Maricca

    Background: Childhood obesity has tripled in the last thirty years. Children ages 6 to 11 years of age increased in weight from 6.5% in 1980 to 19.6% in 2008. The World Health Organization (WHO) estimates that approximately 42 million children under the age of five years old is overweight. The Institute of Medicine recommends “catalyzing and supporting the establishment of guidance on standards for evaluating the quality of evidence for which standards are lacking”. In 2005 report written by WHO, 52% of deaths were attributed to obesity and they predict by 2020 that it will increase to 60 percent. Foreground: In the United States approximately 17% or 2.5 million children aged 2 years old to 19 years old age obese. In Florida 10 to 20% of children are overweight of obese. Children who attend school are required by Florida law to have a physical exam prior to entry. Part of the physical exam requires height, weight, and body mass index (BMI) as an option. EBP Framework: Rosswurm and Larrabee’s conceptual model for translating evidence into clinical practice was used in the systems change of the capstone project. The theoretical framework to help guide the capstone project was Orem’s Self Care Deficit Theory. Method-outcomes: Several outcomes included from the capstone projected were observed. The nurse practitioners (NP) changed how they screen for obesity by measuring BMI and WC. The NPs were able to provide education on obesity risk factors to the parent or guardian by discussing the HEAT initiative. Retrospective chart evaluations were performed on all children who visited the clinic from November 21, 2011 to February 21, 2012. One hundred sixty-seven charts were audited; approximately 81% of the charts audited demonstrated the practice change. The healthcare providers discussed the risk for chronic illnesses. Findings/Results: The charts of one hundred and sixty-seven children were audited. The NPs were able demonstrate the practice change on 81% of the children examined. Out of the audited charts, forty did not demonstrate the practice change and were not included in the data collection. Conclusion: The capstone project implemented a companywide change in the clinic setting. The NPs screened for childhood obesity utilizing BMI and WC and educated family about healthy lifestyle behaviors. Waist circumference was added as a permanent measurement in the electronic medical record.

    Request this Article


    Implementation of Grading Rubric to Enhance Consistency in Grading Concept Maps

    Published Year: 2012
    Program: Doctor of Nursing Practice

    O’Neil, Vicky L.

    Nurses work in complex environments due to the rapid advances in research and technology, the high number of patients with multiple chronic illnesses, and the aging of America. These all require critical thinking skills for assessing and handling complex patient problems. However, many graduate nurses lack critical thinking skills and are unprepared for the realities of their jobs. One innovative instructional technique used at the project site is concept mapping; however the manner in which concept maps are graded is not consistent. The lack of consistency in grading student work results in student frustration, anxiety, and discouragement. Additionally, data collected for quality improvement efforts is of questionable quality. The purpose of this evidence-based project was to implement a grading rubric to enhance consistent grading of concept maps by first and second semester nursing faculty. Short-term goals included enhancing consistent grading of concept maps by first and second semester faculty and to engage faculty with evidence-based educational practices. Objectives for the short term period were to 1) utilize change strategies to implement use of the grading rubric, 2) have all first and second semester faculty utilize the rubric to grade three concept maps during the fall, 2011 semester, and 3) have a score of at least 7.5 out of 10 for questions one through seven on the faculty survey. Long-term goals were to enhance consistent grading of all student work, collect quality data for quality improvement purposes, and to decrease student anxiety, frustration, and discouragement. The long-term objective was to enhance faculty consistency in grading all student work. The plan was to implement the use of a grading rubric using Kingdon’s change theory, Rosswurm and Larrabee’s evidence-based practice model, and Wojner’s outcomes management model. Outcome measures included all participants will utilize the rubric to grade concept maps and faculty satisfaction with using the rubric will be equal to or greater than 7.5 out of 10 on the faculty survey. All participants completed the survey, but all questions were not answered. All characteristics of the grading rubric received a rating of 8 out of 10 or higher, except for clarity and ease of use. Overall the comments were positive and indicated acceptance of the grading rubric. Negative comments included the scoring was skewed, ease of use and reading the criteria was difficult.

    Request this Article


    Weight Maintenance Using Internet Technology

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Ostrander, Peggy

    In 2010, 68% of adult Americans in the United States were considered overweight, with 34% considered obese. Weight loss can be achieved, but weight maintenance is frequently the bigger challenge as most people who achieve weight loss regain it within a few years. Successful weight reduction requires a continued long-term weight maintenance program. Due to the continued obesity epidemic, medical researchers and professionals search for interventions that can reach large numbers of the population in a cost-effective and timely manner. Nationally, poor participation and high attrition rate of completion of weight maintenance programs are identified during weight maintenance. Most people regain a high percentage of their initial weight loss within three to five years. As a result, participants are experiencing difficulty in maintaining weight loss. Currently none out of nearly 3,000 potential weight maintenance patients are participating in the Institute of Health Promotion (IHP) clinic monthly group weight maintenance class, and only three to eight weight maintenance patients are utilizing monthly one-on-one format. The purpose of this project was to increase participation in weight maintenance by identifying components of successful weight loss maintenance programs, develop and implement delivery via the Internet, using e-mail, video e-mail, website, and other technology. This change in delivery method was to implement a weight management training program that can potentially reach a large weight maintenance population, therefore reducing weight regain during the maintenance phase. The evidence-based practice (EBP) framework for this project was based on Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP). The process consists of Practice question, Evidence, and Translation (PET). The process began with indentification of the practice question: In weight maintenance patients, will changing from face-to-face program to Internet program increase participation? After the question was determined, the evidence search ensued. The evidence was synthesized and appraised. Based on the appraisal results, it was determined the evidence supported the identified change in practice. The primary objective was to increase the number of qualified participants utilizing a maintenance program by changing from face-to-face to online program. The intended outcome was that patients would integrate skills learned from maintenance program as evidenced by weight stabilization. Evaluation consisted of collecting participation data from website usage, e-mail module “opens,” and phone/Skype interactions. Also, evaluation included obtaining feedback from stakeholders, collecting and analyzing data from Process Evaluation of Participation in Internet Weight Maintenance Project tool from participants, collecting post pilot data and comparing with baseline data and making minor adjustments inthe implementation plan. Projected project outcomes were met: maintenance of baseline weight throughout the online maintenance program and improved participation in program compared to current rates.

    Request this Article


    Implementation of Interventions to Decrease Interruptions and Distractions During Medication Administration

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Powers, Rebekah

    Background: Medication administration in acute care settings is a critical time when potentially fatal errors threaten patient safety. Researchers have shown that unsafe systems lead to the majority of medication errors. The advancement of technology has been touted to help reduce the risk of error during medication administration, yet errors still occur. Environmental factors can play a huge role in precipitating medication errors during administration. Distractions on the patient care unit can be numerous and interruptions during the administration of medication have been recognized as factors affecting safe medication administration. Foreground: During quality improvement observation rounds it was noted interruptions and distractions were occuring during medication administration. On the post-surgical unit, nurses experienced an average of 11.66 interruptions and/or distractions per medication administration round. The use of computers on wheels to deliver the medications to the patients using bar code medication administration place the nurse in the busy hallway during medication pass. Conclusion: This project raised awareness on how errors can happen when nursing staff are interrupted or distracted during medication administration. It further demonstrated how a team effort along with other protocols and the wearing of a visible symbol by nurses can help prevent interruptions and distractions during medication administration. Future research needs conducted regarding the integration of bar code medication administration (BCMA) into practice setting to prevent unplanned safety issues.

    Request this Article


    Implementing the Reflective Narrative

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Raia, Lucille

    Nurisng care for active-duty-servicepersons sustaining a blast and subsequent polytrauma injuries is a developing specialty within the Veterans Health Administration (VHA). Polytrauma is defined as two or more injuries sustained in the same incident affecting multiple organ systems. These injuries have changed the definition of traditional rehabilitation and acute care because of unique, unpredictable, and unfamiliar presentations. Moreover, because of the complex needs of these servicepersons, health professionals found themselves in a new practice paradigm for the entire VHA organization; the dominant patient population changed from older veterans to younger individuals with new and dynamic physical and psychosocial issues. Therefore, expert direct care nurses (DCNs) who provided care based upon sound rehabilitation principles and evidence-based practice principles were now faced with yet undiscovered and evolving standards of professional practice. The outcome of this capstone project was to implement the reflective narrative as a staff development modality in preparing expert nurses. The reflective narrative is an educational technique using the nurse’s own story of the patient-significant encounter as a method to improve clinical and patient-centered skills and knowledge. The evidence supporting this modality is convincing and serves to unmask the wisdom of decision-making in patient care. This report summarizes the evidence supporting reflecting narrative, how it is framed conceptually and preliminary outcomes of its implementation in the polytrauma system of care and its sister nursing units.

    Request this Article


    Resistant Staphylococcus Aureus (CA-MRSA) Awareness Before and After a CA-MRSA Teaching Intervention Request

    Published Year: 2012
    Program: Doctor of Nursing Practice

    Robertson, Sherri

    Methicillin-resistant Staphylococcus aureus (MRSA) is no longer and infection confined to a hospital setting. The epidemiology of MRSA is now changing and appearing in healthy community-dwelling individuals with no risk factors for the acquisition of MRSA. This is known as community-acquired methicillin-resistant Staphylococcus aureus, one of the “super-bugs.” Education of the providers and the community is a key factor in helping to slow or prevent the spread and transmission of CA-MRSA. Beam and Buckley stated that the absence of proper education and preventative guidelines are perhaps contributing to CA-MRSA. Additional studies looking at educational interventions on CA-MRSA awareness and knowledge are needed to identify if these educational interventions increase preventative practices by providers and help decrease CA-MRSA occurrences and transmissions. Purpose: The purpose of this project was to identify the level of awareness of CA-MRSA among providers in South Central Mississippi before and after a teaching intervention on CA-MRSA. The intent was to determine whether there was an increase in the awareness of the providers and an increase in the CA-MRSA preventative educational practices. Goal: The goal of this project was to successfully implement a CA-MRSA PowerPoint teaching intervention and measure differences between pretest and posttest surveys. Objectives: Project objectives included to describe aggregate demographic characteristics of the providers in rural South Central Mississippi, to describe pre-intervention CA-MRSA awareness for providers in rural South Central Mississippi, to describe post-intervention CA-MRSA awareness for providers in rural South Central Mississippi, to measure and describe the changes in CA-MRSA awareness before and after a CA-MRSA teaching intervention, and to determine and describe if providers’ exhibit increased CA-MRSA preventative educational practices following the CA-MRSA teaching intervention. Plan: Phase one of the planning phases for this project involved a literature review/needs assessment using a published evidence-based critique template. Phase two included securing an instrument for measurement along with developing a researcher prepared tool. IRB approval was obtained in phase three from RMUoHP followed by implementation of the pilot for validity and reliability of the researcher prepared tool. Implementation of the capstone project and collection of data then followed. Phase four involved evaluation of intervention. Outcomes and Results: A total of thirty providers completed the online pretest, posttest survey and teaching intervention. There were significant increases in posttest survey data. This project may provide the foundation for futher provider-based interventional studies, development of nationwide policies for emphasis to providers for increased CA-MRSA awareness, knowledge, and increased preventative practices. Thus, with increased CA-MRSA preventative instruction from the providers to patients and community, there will be a decrease or prevention in the further spread of CA-MRSA transmissions and occurences.

    Request this Article


2013

    Intervention to Improve Colorectal Cancer Screening Rates in Primary Care

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Abiodun-Adelokiki, Titilola

    Background: Colorectal cancer (CRC) is the second leading cause of cancer related deaths in the United States and one of the most preventable and treatable cancers. In 2010, an estimated 142,570 newly CRC cases were diagnosed and approximately 51,370 CRC related deaths were recorded. Evidence supports a 91% treatment success rate if detected early meaning that nearly 30,000 to 44,000 lives per year could be saved if all adults 50 years and older were screened for CRC. Foreground: The impact of primary care providers on patients’ screening behavior is vital to improving the rates of CRC screening in primary care. Barriers must be identified and understood, interventions developed and implemented to attain higher CRC screening rates. EBP Framework: The Advanced Research and Clinical practice through close Collaboration (ARCC) EBP model served as framework. The Control Theory (CT) and the Cognitive Behavior Theory both form the theoretical foundation for the ARCC model which is particularly suited to organization-wide practice change, and strongly supports a patient centered approach to care delivery. Methods: With the organization’s leadership consent, the organization’s readiness for EBP was established using the Organizational Culture & Readiness for System-wide Integration of Evidence-based Practice (OCRSIEP) scale. Five primary care providers consented to participate in a pre-intervention survey about their current practice, knowledge and attitudes towards CRC screening. The participants were guided through the use of the web-based Nevada Colorectal Cancer Partnership screening tool. A chart audit was done on 60 randomly selected charts of patients seen in the 8-week period prior to intervention to establish a baseline for CRC screening at the clinic. Findings/Results: Descriptive analysis of retroactive charts review was used to examine post-intervention screening activities at the clinic. A review of data from 60 randomly selected charts of patients seen at the clinic during the 8-week intervention period revealed a comparative increase in providers’ post-intervention CRC screening activity rates of 56.25% depicted by 22.5% screening rates. Conclusions/Recommendations: Provider focused educational intervention supported by the introduction of clinical practice guidelines, informational cupports by clinic nurses, provision of informational pamphlets and scheduling assistance by the clinic clerk and staff, facilitated a change in providers’ behavior to consistently and routinely discuss CRC screening with patients during clinic visits. A plan is now in place for continuous monitoring of adherence to CRC screening activities at the clinic.

    Request this Article


    Targeting Childhood Obesity and Cardiovascular Health

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Barber, Jasmine

    Background: Pediatric obesity and cardiovascular diseases are conditions which continue to increase globally. The continued increase of both disease states extends beyond pediatric years adding health risks into adulthood. Both conditions can be positively impacted by lifestyle and behavior modifications gained through effective patient education. Foreground: Nationally the childhood obesity rate continues to climb. Healthy People 2020 includes obesity and cardiovascular disease as health initiatives in the pediatric population. The pediatric population residing in some Southeastern states have a rate of obesity greater than 20% exceeding rates of other regions. A meeting with a local medical director of a pediatric wellness center revealed a desire to improve the practice approach to include health initiatives consistent with Healthy People 2020. The principle investigator and practice founder agreed upon an endeavor to incorporate the American Academy of Pediatrics (AAP) “Expert Panel of Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents” (CVH) as the accepted method to direct patient treatment and care. Methods: A multidisciplinary treatment team implemented the CVH guidelines with each patient visit and an electronic health record (EHR) flagged elevated blood pressure readings at the wellness center. Wellness center patient’s charts randomly audited by the principle investigator (PI) showed the CVH guidelines and system flags. PI checklists evaluated indices in care and elevated blood pressure readings. Larrabee’s Quality Nursing Care Theory was the theoretical framework: The model guided thorough implementation of the practice change. Implementation steps are: Assess need for practice change; Locate best evidence; Integrate and maintain change in practice; critically analyze evidence; implement and evaluate change in practice; and design practice change. Findings/Results: Implementing CVH proved instrumental in providing constancy of an evidence-based approach in care of hypertension and provided an opportunity to educate providers and to ensure future congruency in care. They realized the need and opportunity to target the pediatric obesity epidemic within wellness center. Conclusions/Recommendations: An upgraded EHR would lower the burden of time necessary to overcome numerous barriers and restrictions. A larger patient population would assist in complete and successful implementation and assesssment of the change.

    Request this Article


    Using Clinical Practice Guidelines To Improve Diabetes Mellitus Care

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Cadle, Harriet E.

    The purpose of this project was to determine if providers at a Family Practice are providing diabetes care based on standards of care as outlined by the American Diabetes Association. More than 25 million people in the United States were diagnosed with diabetes within the past year associated with a death rate of 7% annually. Additionally, diabetes can lead to comorbid conditions such as hypertension, hyperlipidemia, cardiovascular disease, retinopathy, and neuropathy, all of which lead to an increase in mortality and morbidity as well as increased medical cost. Administrators at the practice perform regular random chart evaluations to determine if care is being provided based on ICD9 codes for various chronic diseases. During a recent review, the review indicated that 47% providers did not meet the standards of care for diabetes patients. The impact could lead to comorbid conditions with increasing risks of heart attacks, stroke, amputation, blindness, and renal diease annually. Necessary objectives to achieve these outcomes are improvement in providing care that aligns with the standards of care for diabetics which includes timely measurement of hemoglobin AIC values, fasting lipid panels, liver function tests, renal test, annual dilated eye examinations, periodic diabetic foot examinations, dental care, and if necessary, mental health evaluations. In order to accomplish this practice change, Rosswurm and Larrabee’s six step model for implementing evidence-based practice was utilized. Implement this change. The theoretical framework chosen is the Service Quality Model, also known as customer service framework. From the preliminary findings of the chart review, 47% of time providers did not follow the standards of care for diabetic patients. This particular problem has been demonstrated nationally throughout the literature. One exmaple is a study conducted by White, Beech, & Miller, showing that “significant disparities in both the processes of care and health outcomes relevant to diabetes management persist across the country”. Additionally, O’Conner et al., and Kirkman, Williams, Caffery & Marrero, state that the “gap between recommended diabetes care and care actually received by patients is substantial” and “chart audits and reviews of administrative databases have shown that the quality of diabetes care is suboptimal”. Once our project began our care for diabetic patients greatly improved from 47% of the time to 75% of the time diabetic care was provided by this clinic. In conclusion, the care for diabetic patients has been shown to be suboptimal throughout the United States. This project has demonstrated that staff and provider education along with ongoing dialogue can improve diabetes care.

    Request this Article


    Educating Clinicians on the Accurate Use of the Palliative Performance Scale

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Davis, Travonia

    Background: When faced with a terminal illness, patients’ under hospice services want to know their estimated length of survival. Not knowing leads unrealistic plans of care and unknown life expectancy rates. Foreground: Patients rely on the use of prognostication so that proper planning and discussions of the end-of-life can be had. It is not only the patient who benefits from the use of an accurate prognostic tool but also family, friends, and all involved in the patients’ medical care. Because individuals with a terminal illness need and want an estimated length of survival, having a clinician that is knowledgeable in the accurate use of the Palliative Performance Scale (PPS) will allow for accurate prognostication and open lines of communication. Methods: An RN Case Manager was a strong advocate for this change project. The Palliative Performance Scale was implemented by a multidisciplinary team of stakeholders, including administrators who opposed the project at the beginning. EBP Framework: A conceptual model was used to guide this change process. Lewin’s model of change improved the organizational environment by accessing and addressing barriers to the change process that directly influenced outcomes. The ARCC model assessed an organizational readiness for an EBP change and guided the change project through steps that allowed for EBP implementation and sustainability. Findings/Results: The implementation of the Palliative Performance Scale was funded by the organization at a low-cost, a one-time fee for an educational on-line program that offered instructions on the accurate use of the Palliative Performance Scale and offered 1.2 Continuing Medical Education hours. Education on the accurate use of this prognistic tool has enhanced clinician accuracy rates and improved prognistication for patients’; as evidenced by chart audits over a two month timeframe and an increased understanding of the Palliative Performance Scale as voiced by staff. Conclusion: Frequent monitoring of computerized documentation that reflects clinician accuracy rates in the use of the Palliative Performance Scale will allow for the assessment of retained education and improved prognostication. Monitoring accuracy enhances clinician knowledge and increases accurate estimated survival lengths that promote patient decision making and planning at end-of-life.

    Request this Article


    Implementing And Evaluating Adherence To A Clinical Practice Guideline For Reproductive Life Planning And Folic Acid Use

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Dean, Patricia Pamela

    Background: A Global Health Council 6-year study revealed the world’s 1.3 billion woman of childbearing age have experienced a total of more than 1.2 billion pregnancies. Of these, over 300 million were unintended and nearly 700,000 women lost their lives as a result of these pregnancies. One third of these deaths were from a myriad of problems associated with these pregnancies. Foreground: Each year in the United States, 12% of babies are born premature, 8% are born with low birth weight, and 3% have major birth defects. Of women giving birth, 31% suffer pregnancy complications, 11% smoke during pregnancy, 10% consume alcohol, 69% do not take folic acid supplements, 31% are obese, and about 3% take prescription or over-the-counter drugs. In addition, about 4% of women have preexisting medical conditions such as diabetes that can negatively affect pregnancy if left unmanaged. EBP Framework/Methods: Larrabee’s models of evidence-based practice change as well as Kotter’s leading change model were used to facilitate the new practice change and evaluation of clinicians’ adherence. The pilot project ran for four weeks and was devoted to one clinic with four clinicians. The data collected were: (a) the reproductive risk assessment of every woman of child bearing age, (b) discussion and education regarding having a reproductive life plan, and (c) discussion on the use of folic acid or prescription given for the use of folic acid. Findings/Results: The data showed 100% adherence to the guidelines for all four clinicians. The clinicians addressed with every woman of childbearing age who sough care the need for spacing and managing health conditions to potentially increase the level of preconception wellness, bringing about healthier women, healthier pregnancies, and healthier babies. Conclusions/Recommendations: Risks associated with poor pregnancy outcomes remain prevalent among women of reproductive age in the United States. Therefore, the clinicians’ adhering to the new practice guidelines and promoting women’s wellness at every family planning visit increases the potential to impact the health and well-being of women. At the conclusion of the pilot, the project manager recommended that the organization write a grant to request funding from Title X to dispense free folic acid to women seen at the clinic who are of childbearing age and to those who plan to conceive in the next four to six months.

    Request this Article


    Perinatal Depression Screening Program

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Foci, Emina

    Perinatal depression is one of the most common perinatal complications. It occurs in up to 19% of pregnant or postpartum women. It can negatively affect pregnancy outcomes and compromise the parent-infant relationship, in turn impacting childhood development. Perinatal depression screening is recognized as an effective means of identifying perinatal depression. The American College of Obstetricians and Gynecologists recommends screening pregnant and postpartum women. Maternal depression occurs five to ten times as often as gestational diabetes and at least as often as pregnancy-induced hypertension. Screening for perinatal depression is a logical step toward optimizing patient health outcomes. Prior to the implementation of this project, there were no screening processes, tools, or guidelines in place for identifying mothers at risk for perinatal depression at the project site. Clinicians were not trained to educate patients on perinatal depression or to address it fully with treatment and patient education of perinatal depression. Considering the prevalence and risks associated, it is important to implement a perinatal depression screening process and a referral system with resources to for those who screen positive. The project proposed to address this by implementing a depression screening process. The Edinburgh Postnatal Depression Scale was used as the screening tool or perinatal depression. The project goal was to screen 90% of perinatal care patients for perinatal depression. The process included educating the clinic staff to properly administer, score, document and address the Edinburgh Depression Scale score. The outcomes were specifically geared towards assessing the efficacy of the perinatal screening process. Chart reviews were used to determine that the clinic staff was correctly documenting the depression tool score and correctly imputing the electronic health record alert for next perinatal depression screening. Although the outcomes were not met, the project was successful in educating the clinic staff on the importance of perinatal depression screening and the negative outcomes of untreated perinatal depression. The MA and front office staff were introduced to evidence based practice. Nevertheless, the change has taken place and perinatal depression screening continues to be part of the daily clinic process. The perinatal depression screening process can easilty be applied and modified to various settings.

    Request this Article


    Implementation of Support Group Services in the Management of Bariatric Weight Loss

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Friedman, Sabrina

    The problem of obesity is a national as well as a global health issue. From a global perspective, according to data published by the International Obesity Task Force, at least 1.1 billion adults are overweight, and 312 million of these are obese. Approximately one-third of American adults have obesity, a disease defined by a body mass index (BMI) greater than 30kg/m. According to statistics from the Centers for Disease Control (CDC), The State of California has a rate of 24% obesity. Unfortunately, all 50 states have a rate over 20% and 12 have rates over 30%. This data is collected from the CDC’s Behavioral Risk Factor Surveillance System, which is a self-report of weight and height. Goldberd and Limbrunner state that bariatric surgery can perform miracles in changing weight and radically decreasing comorbidities in the obese patient, but it is just a tool and does not change the patient’s mental state. A significant number of candidates for bariatric surgery have a psychiatric diagnosis such as depression or anxiety prior to surgery. A psychiatric diagnosis can impact weight loss outcomes and success. The group support environment can provide a safe environment for emotional and social learning. Most importantly, the group can provide a sense of belonging. The EBP framework utilized for this project was the Model for Evidence-Based Practice Change by Larrabee. To facilitate the implementation of Larrabee’s EBP Model, the outcome management framework, Six Stigma; the adult learning theory of Andragogy; and the Situational Leadership Model were integrated into the EBP steps as approrpriate. The objective of this project was the successful implementation of a bariatric support group. The selected outcome measures focused on practice change and included: (1) development of applicable psychoeducational curriculum, (2) implementation of the support group pilot with a multidisciplinary team approach, and (3) provider satisfaction with the program design and implementation approach. An evaluation survey was administered upon completion of a pilot study of this project to obtain feedback on the appropriateness of the objectives, the content, the speaker’s presentation skills, and the overall program. The results indicated that the program objectives, content, and speaker skills were appropriate.The provider participants rated the overall program a mean score of 4.6 out of 5.0 on a 5-point Likert scale. A support group is a valuable tool in managing weight loss post-bariatric surgery. It is important that this modality is offered to patients consistently and that providers are willing to meet the needs of these individuals. Also, it is critical that the insurance companies offer this service through their plans and provide adequate reimbursement.

    Request this Article


    Implementation of a Screening Tool to Determine Eligibility for Thrombolytic Therapy for Acute Ischemic Stroke Management in the Emergency Department

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Hall, Darene A.

    Stroke is the fourth leading cause of death in the United States and a major cause of adult disability. In California, heart disease and stroke are the third leading causes of death and they continue to be an enormous economic burden in the state. Tissue-type plasminogen activator is a proven intervention for acute ischemic stroke (AIS) patients. The benefit of intravenous t-PA is time-dependent and the national guidelines advocate hospitals complete the clinical and imaging evaluation of AIS patients and start intravenous t-PA therapy within 60 minutes of patient arrival in those without contraindication.

    Request this Article


    Palliative Care in the Elderly: A Guide for Clinician Education

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Harding-Omar, Milagritos Jessica

    The number of frail elderly patients living in nursing homes is predicted to quadruple over the next 30 years. More elderly adults are living with multiple medical conditions and co-morbidities that lead to higher number of long-term disabilities, increased use of limited health resources, and poorer quality of life toward end of life. However, palliative care approaches are underused by most health care provders. There is a national need to improve the use of palliative care by developing new health care models for clinicians, training of more palliative care clinicians, and evaluating the use of palliative care in long-term care facilities. This capstone projected explored the perceptions of palliative care among clinicians in a private practice by using a Likert-type questionnaire. The objective of this project was developed to enhance clinicians’ knowledge, skills, and attitudes needed to provide effective palliative care to elderly patients. The methods used were educational forums which were offered to the clinicians to allow them to share their clinical expertise and experiences with terminally ill and to develop a professional self-reflection on how clinicians deal with the death of patients as well as the ethical, legal, cultural, and religious issues at the end of life. The outcome results accomplished in this capstone project were used to develop a new policy among the interdisciplinary teams of the clinic and health care facilities that servie the elderly. This capstone project explored several aspects of palliative care, including the meaning and benefits, history, and new innovations and recommendations for palliative care in the elderly recommended by the World Health Organization, the American Geriatric Society, The Institute of Medicine, Medicare and Medicaid Services, The Agency or Healthcare Research and Quality, The National Institute of Health, The Department of Health and Human Services and Health People 2020. Research for this project was obtained from the National Guidelines Clearinghouse, PubMed, the National Institute for Health and Clinical Excellence and Evidence Medicine Guidelines. Qualitative and quantitative research was obtained from different medical and nursing articles to compare the current project with national and international standards for palliative care in the elderly. The conclusion of the project was based on input obtained from healthcare providers at a medical practice. The project was proven to be successful in implementing the new policy at a medical practice where all the providers implemented palliative care as a standard of practice among the geriatric population in order to provide quality end-of-life care. The success of this capstone project hopes to implement palliative care guidelines geared towards the geriatric population that goes beyond this small medical practice and makes a difference in the medical community.

    Request this Article


    Nutritional Screening in Geriatric Patient Undergoing Total Joint Replacement

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Herrington, Amy

    Of older adults hospitalized, 40-60% are malnourished or at risk for malnutrition. Progression to malnutrition may be subtle or undetected. Geriatric patients face nutrition related complications including: loss of muscle mass, compromised immune systems, increased complications with illness and premature death. These complications can manifest themselves as falls, prolonged hospitalizations, readmission following discharge and pressure ulcers. While individual outcomes related to these complications are important, the cost of adverse events affects the overall financial health of the entire healthcare system as most are non reimbursable by Medicare, Medicaid and many private insurances. The facility houses the only elective total joint replacement program in the healthcare enterprise. From February 1, 2012 through April 30, 2012, 342 total joint replacement were performed. Of these, 57.67% of the patients were 65 and older. Only 7.6% of the consults were triggered by a nurse admission risk screen. Utilizing the ACE Star Model, this project evaluated nursing adherence screening patients for malnutrition during pre admission testing (PAT) utilizing the Mini Nutritional Assessment Short Form (MNA-SF) created by Nestle. Additionally, nursing adherence consulting dietary for the nutritionally compromised patients was evaluated. Kotter’s 8 Step change model was used to drive the system change during PAT. This program was evaluated every 7 days for 90 days. The goal was to achieve 80% adherence in screening and intervention. Nursing screening adherence was measured by comparing the number of eligible patients to the number of patients screened with the MNA-SF. Nursing intervention adherence was evaluated by comparing the number of patients scoring less than 12 on the tool to the number of patients that had immediate dietitian consult triggered by the nursing staff. During the pilot, 193 patients were eligible to be screened using the MNA-SF. Of these, 88% were screened. Of the 169 patients, 5% were found to have scores less than 12. Nursing consulted the dietitian for 77%. The number of at risk patients identified with the tool was lower than the baseline and literature references. In review of the completed tools, it was found 4% contained errors which may have impacted identification. The MNA-SF focuses on low BMI. Only 11% received a nutritional consultation based on a low BMI while 88% identified had psychologic or neurologic changes. Overall, 69% of the patients had a BMI greater than 25 and of those 18% had a BMI of greater than 35. BMI less than 19 or greater than 35 is tied to increased Medicare reimbursement. Moving forward, inclusion of BMI, psychologic and neurologic triggers as components of the nutrition screen across the Enterprise may lead to improved patient outcomes and improved revenue.

    Request this Article


    Closing the Gap in Evidence-Based Practice in Seventh Semester Nursing Students

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Knisley, Janet

    A major healthcare initiative has emerged which focuses on the utilization of evidence-based practice (EBP) to influence care. The adoption of EBP into the organizations, hospitals, and agencies has proven to increase positive patient outcomes. Colleges and universities have been charged to graduate Bachelors of Science in Nursing (BSN) prepard nurses with confidence in utilizing the EBP process. Studies have shown upon graduation, BSN nurses have a gap in their knowledge in utilizing the EBP process. Increasing knowledge through guided practice can close the gap for graduating nurses as they enter clinical experience, work, and the nursing field. A Midwestern faith based College recognized that nursing students lack the knowledge concerning EBP. This College decided to adopt a curriculum change, adapted from the Concept Based teaching model by Dr. J. Giddens. The adoption of this model allows for the nursing students, in all semesters, to develop strategies for post-graduate implementation. Rosswurm and Larrabee model threaded with Lippitt’s change theory was the framework to guide the DNP capstone project. Utilizing the two models, the purpose of this paper was: Population: seventh semester BSN nursing students; Implementation: a seventh semester in a BSN program allows students to practice knowledge gained of the EBP process gained in a classroom and prior clinical practice. The student, armed with the knowledge of the EBP process, can recommend changes in the clinical practicum; Comparison: not being used in the DNP capstone project; Outcome: faculty assessing the knowledge gained in the seventh semester in a BSN program. The EBP Belief Scale questionnaire, a pre- and post-questionnaire, was utilized to assess if the seventh semester BSN nursing students knowledge in EBP was increased. The Critical Skills Appraisal Programme (CASP) research tool was utilized to assess their ability to locate scientific articles. Twenty-three participants, from the critical care course, participated in this project. Results revealed changes to the curriculum were needed: 1) Inclusion of the Learning Outcomes Measurement (LOM) Assessment was needed to assist faculty and administrators in determining if the Concept Based Teaching curriculum change was successful to meet current goals/outcomes by the College; and 2) Moving the nursing capstone project to the eighth and last semester so that faculty can evaluate whether or not a nursing student has an in-depth understanding of EBP. Further research could include assessing graduates at six months using the EBP Belief Scale questionnaire. This assessment could determine if a nurse who completed the new curriculum gained sufficient knowledge of EBP for clinical bedside care. Nursing educators hold important roles in the future of healthcare practices. The challenges placed before educators are to empower new graduate nurses with knowledge and completence in EBP.

    Request this Article


    Implementation of the Risk for Suicide Questionnaire in the Primary Care Setting to Identify Adolescent at Risk for Suicide: A Practice Change

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Komolafe, Johnson A.

    Background: The purpose and objective of this project was to implement the use of the Risk for Suicide Questionnaire (RSQ) screening tool to identify adolescents at risk for suicide at a primary care clinic in the state of Maryland. The epidemic of suicides among youths is a source of significant and preventable loss of life. Suicide is the third leading cause of death among youths aged 15 to 19 years, accounting for approximately 2,000 of the overall number of deaths in this age group each year. In 2001, suicide rates in the United States were 12.9 per 100,000 among male youths and 2.7 among female youths. Despite this high prevalence and known risk factors, most suicidal adolescents do not access mental health care services. Suicidal adolescents may be less likely to seek help for mental illness, a few adolescents who attempt suicide receive appropriate assessment and follow-up care. Moreover, many children and adolescents at risk for suicide are not identified by primary care providers and many youth who die by suicide visit a non-psychiatric clinician such as a counselor in the months before their deaths. Foreground: Since 2004, there has been an increase in the numbers of adolescents threatening and committing suicide, in Washington D.C., according to National Institute of Mental Health. Hence, the onus of detection has fallen on primary care providers (PCP). Primary care clinics are logical settings where screening that leads to intervention can be initiated. EBP Framework: The ACE Star Model was used to guide the overall plan of this project and the Force Field Model of Change developed by Lewin was used to guide the implementation process of the capstone project. Methods: The short term goal of this project was to have PCPs implement RSQ and identify teens at risk for suicide. PCPs were educated on the use fo RSQ. Data generated was entered into Excel software for analysis. Descriptive statistics and an appropriate measurement level were applied. Findings/Results: Results from this study showed that 100% of the primary care providers at this clinic adhered to the use of the RSQ as part of the psychosocial evaluation of adolescent seen at this clinic. Conclusion/Recommendations: The outcome of this project improved the knowledge of PCPs and enhanced their ability to screen for suicide risk in adolescent population. On-going suicide prevention trainings are necessary for PCPs according to evidence-based suicide prevention protocols.

    Request this Article


    Improving Nursing Practice: Using the Mini Mental State Examination and Confusion Assessment Method Screening Tools for Mental Status Assessment

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Lavelah-Travers, Jatu

    Background: Delirium is costly and fatality rate with recurrence is high. A year health costs of delirium per person ranges from $16,303 to $64,621. The national cost of delirium if between $38 billion and $152 billion yearly. About 56% to 65% individuals admitted to hospitals become delirious. Evidence reports that early recognition of risk factors, and diagnosis can result in prevention of delirium. Reports linked superficial mental status assessment with inadequate nursing practice. Foreground: Impact of nurses using standardized screening tools to conduct mental status assessment is important for the survival of patients and costs containment of effective quality care. Evidence indicates that screening is the most importance aspect of delirium prevention compared to its management. Mental status assessment with Mini Mental State Exam and Confusion Assessment Method can improve nursing practice and decrease negative impact of delirium. EBP Framework: The Clinical Scholar Model served as theoretical framework through teamwork, consultation and collaboration. The Cognitive Behavior Theory is the theoretical foundation for the model and is behavior change oriented for quality patient care, practice improvement and clinical excellence. Methods: The organization’s leadership support, organizational readiness for EBP was established with the Organizational Culture and Readiness for System-wide integration of Evidence-based Practice. Nurses participated in pre/post-intervention survey events about their practice now and after knowledge, attitudes toward mental status screening using the MMSE and CAM. Nurses’ belief in EBP were measured by the Evidence-based Practice Beliefs tool (EBPB). Their behavioral in implementing evidence-based activity was measured by the Evidence-based Practice Implementation scale (EBPI). All charts were reviewed for 8-week prior to and after intervention periods. Findings/Results: Descriptive data from retrospective charts review was used to compare pre/post intervention results on using the MMSE and CAM for mental status assessment of incoming patients within the 8-week pre/post intervention time. Improvement was 100% after the interventional period of nurses using the MMSE and CAM tools with consistency for mental status assessment. Conclusions/Recommendations: Educational intervention encouraging collaboration, teamwork and nurses accountability for their individual nursing care can improve nursing practice and patient care. Interventional strategy guided by the CMS and CBT have shown to improve nurses behavior in implementing patient care based on EBP. Strategies are developed to remove barriers to implementing EBP intervention through marketing and risk analysis for sustainability of practice change.

    Request this Article


    Increasing Access to Health Care Through Faith-Based Hypertension Screening

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Moscicki, Henry E.

    Background: Hypertension is a common and often asymptomatic disease that is easily treatable by health care providers. Undiagnosed, untreated, and uncontrolled hypertension places a substantial strain on the health care delivery system. Through hypertension screening, faith-based communities have become a source to increase access to health care for parishioners without health insurance or no primary care provider. Foreground: There are 3,829 parishioners enrolled in the Catholic parish for this project. According to Health People 2020, one in four Americans does not have a primary health provider or access to health services. One in five Americans does not have medical insurance. This project has exposed those parishioners at risk for hypertension, without health insurance or a primary care provider, through the faith-based hypertension screening program. Evidence Based Practice (EBP) Framework: The faith-based hypertension screening program was guided by Larrabee’s Evidence Based Practice (EBP) Model. Methods: Blood pressure screening was conducted by the faith-based nurses of the parish, after completing the Welch-Allyn Blood Pressure (BP) Training Module. Referrals were made to local providers who have agreed to treat those parishioners without health insurance or a primary care provider for a minimal or no cost. The short term outcome was to provide access to health care. Findings: Two hundred eighty-five parishioners were screened for hypertension, 68 were referred to their primary care provider. Six parishioners were referred for access of care to a local provider. The average age of parishioners screened was 68. There were 25 diabetics and 18 smokers. Mean blood pressure for the project was 132/77. Conclusion: Faith-based hypertension screening programs are effective in identifying at risk parishioners for hypertension.

    Request this Article


    Implementing the POLST as a Method of Communicating End-Of-Life Wishes

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Skinner, Claudia

    Background: Nationally, extensive gaps have been identified in the patient wishes for end-of-life care and the actual treatment interventions ordered by physicians. Advance directives are leaving families with difficult decisions to make when translating the patient’s end of life wishes. The physician order for life sustaining treatment (POLST) form more succinctly describes the patient’s wishes and is associated with decreased use of unwanted life sustaining treatments that often lead to increased patient pain, prolongation of suffering and increased cost of care. The POLST is a directive with the authority of a physician’s order that clearly spells out the patient’s care and treatment wishes. It was designed for patients with progressive chronic illness, frailty or advanced age with a life expectancy of 12 months or less. Local Significance: Patients in the critical care unit were receiving futile cares and medical interventions not consistent with their wishes. Few patients had documentation of their wishes. Evidence-Based Practice Framework and Change Model: The June Larrabee Model for Evidence-Based Practice Change was used as a framework for the practice change. Kotter’s Change Management Model was used as a theoretical model for guiding the organizational change. Methods: Palliative Care Nurse Practitioners (PC NP) used the surprise question, that of “would you be surprised if the patient were to die within the next 12 months” to decide upon inclusion for patients. The POLST form was utilized to guide advance care planning discussions and document of the patient’s end of life wishes. Objectives and Outcomes: Short term objectives included obtain input from key stakeholders, locate and analyze the best evidence, define the patient population, develop and present and education program, collect baseline data on the current use of the POLST and pilot the use of the POLST. Long term objectives included implement the POLST, create a forum to debrief, spread the project throughout the medical center while celebrating the successes, and disseminate the findings. Outcome measures included increased use of the POLST with increased consistency between the POLST and the physician’s orders for resuscitation resulting in a reduction of invasive procedures and improved quality of care at end-of-life. Results: Patients admitted with a POLST form increased from three percent to 15.9% during the implementation phase. Use of POLST form within the project site increased from zero percent to 52% of patients who meet criteria post implementation. Consistency between physician’s orders for cardio/pulmonary resuscitation and patient’s wishes was 85% after implementation. Conclusion and Recommendation: Success was realized for increased use of the POLST. Spread of the POLST to the integrated delivery system and to the local skilled nursing facilities must occur for sustainment. In addition, an important next step is to lobby for legislative support to have nurse practitioners sign the POLST form, as currently only a physician may sign.

    Request this Article


    Educational Intervention to Implement the COG Guidelines

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Smith, Daniel Evans

    Brief Overview: With improved treatment for pediatric cancers, there are increasing numbers of survivors living well into adulthood. In 2005, there were more than 325,000 pediatric cancer survivors in the United States. As this population ages, their care is eventually transitioned from their oncology to local primary care providers. Health care providers are often not familiar with identifying and managing the long-term effects associated with the treatment of pediatric cancers because their training did not provide clinical experience with this population, and until very recently, there were no established practice guidelines for the long-term management of these survivors. A pediatric oncology/hematolgy specialty hospital in the southern United States has a specialty clinic (After Completion of Therapy [ACT]) that follows pediatric cancer survivors from five years after date of diagnosis and two years off therapy until they are either eighteen years old or ten years from their date of diagnosis. The ACT Clinic uses the Children’s Oncology Group (COG) Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers (COG Survivorship Guidelines) as their clinical practice guidelines to direct risl-based care. This project tested the effectiveness of an interactive educational intervention that teaches graduate medical trainees about the COG Survivorship Guidelines. The PI of this scholarly project used both the evidence-based practice model known as the Stetler Model and the evidence-based practice change plan known as the Interaction Model of Client Health Behavior to create this change within the ACT clinic. The program was offered to graduate medical trainees visiting the ACT clinic during their rotation. The objective of this program was to improve clinician’s knowledge and comfort level in caring for pediatric cancer survivors. Intervention effectiveness was assessed by the adequacy of a trainee-developed survivorship care plan in response to a fictional patient scenario. Intervention: This project tested the effectiveness of an interactive educational intervention that taught graduate medical trainees about the COG Survivorship Guidelines. The intervention involved a 45-minute didactic session with a nurse practitioner (PI), followed by observation of an actual patient encounter with the nurse practitioner. Intervention effectiveness was assessed by the adequacy of a trainee-developed survivorhsip care plan in response to a fictional patient scenario. Data Management: The PI collected the trainee-developed survivorship care plans in a large envelope. This information was reviewed for appropriateness of the care plan relative to the long-term effects associated with the treatment of pediatric cancers. Conclusion: Successful implementation of Educational Intervention of the COG guidelines was achieved. The rotating clinicians that participated in the intervention verbalized an increased comfort and knowledge level in the use of the guidelines in practice. Subsequently the guidelines have been incorporated as a core requirement for successful completion of the rotation through the ACT clinic.

    Request this Article


    Targeting Adult Obesity in Primary Care

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Smith-Lucas, Karla

    Before the end of the day, about 822 people will die from an obesity related illness. In 2010, a minimum of 72 million Americans were obese. Diabetes, heart disease and other chronic health conditions are more common to those who are overweight or obese. Obesity is prevalent and costs as much as $147 billion each year in the United States. What is more startling, most patients are not advised by their providers about the hazards of obesity or how to reduce weight. Although there are evidence-based recommendations encouraging physicians to advise their patients about obesity and obesity management, research suggests that this remains inadequate. The National Institutes of Health (NIH) issued guidelines endorsing that healthcare practitioners guide obese patients to lose weight. This capstone project was directed towards improving condition recognition and management by improving the rate of adherence (among providers) to the best practice guidelines and reducing practice variances. The Model for Evidence-based Practice Change by June Larrabee was the evidence-based practice (EBP) framework used to carry out this project. This six-step process is used to help practitioners integrate evidence-based changes into the clinical setting. The clinic providers implemented the National Heart, Lug and Blood Institute (NHLBI) guidelines on the management of adults overweight and obesity. This evidence-based clinical practice guideline (CPG) standardized care; provided the most current and effective care practices. During pilot study, participating providers assessed and managed all patients according to the NHBLI guidelines. One hundred and thirty randomly selected charts (meeting the inclusion criteria) were audited for adherence to the guidelines. Data was collected during the implementation period for 10 weeks to measure adherence to guidelines. Outcomes focused on achieving a minumum of 50% adherence to CPG one month after implementation and 65-85% adherence thereafter. The process was then evaluated for use as standard policy and procedure. Overall, the providers improved in assessment and management of overweight and obesity adults according to the NHLBI guidelines. Fifty-Six percent 56% of the patients were assessed and managed according to standards set by NHLBI overweight and obesity guideline. Most patients received near goal weight-related assessment but less than half of the patient receive moderate level advice regarding management. As a major health issue in the United States, being overweight or obese has a toxic effect on the quality of life for families and healthcare cost for all. Research suggests that evidence-based interventions are ideal for addressing obesity and facilitating improved outcomes. Little research has evaluated the procedure for successful implementation of these interventions into outpatient clinical practice. This capstone project is a step towards future research on applying guidelines in small outpatient clinical settings where funding is not supported by large hospital networks.

    Request this Article


    Implementation of the Body Mass Index as a Tool for Obesity Assessment

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Sutliffe, Edward J.

    Background: Overweight and obesity, while preventable, has nearly doubled worldwide since 1980. The World Health Organization estimates that 65% of the world’s populations live in countries were ovderweight and obesity kills more people than underweight. According to the Centers for Disease Control, overweight and obesity in the United States have reached epidemic proportions affecting all age groups, genders and ethnicities. Foreground: Montana’s obesity statistics reveal that nearly two-thirds fo adults are overweight per Body Mass Index (BMI) guidelines. A review of the current literature pertaining to obesity and health confirms that assessment and education regarding obesity is a major component in the treatment process for obesity and weight management. The current screening tool of choice for obesity assessment is the BMI. Evidence Based Practice (EBP) Framework: Larrabee’s Model of Evidence Based Practice was used to guide this capstone project in achieving practice change. Additionally, the Health-Belief Model was applied as a theoretical framwork examining provider attitudes regarding obesity and education. Methods: Weight and height assessment was performed by participating providers and compared to the BMI to determine overweight and obesity. Clients were educated about their weight and obesity risk using the BMI template and weight, height, BMI and education was documented in the client chart by the provider. Findings: Upon project completion, a retrospective chart review was performed of 324 Department of Transportation physical examinations. Results of this project revealed 207 client records contained documented height, weight, BMI and education. Conclusion: Findings were reflective of literature regarding barriers to education and documentation including human error, changes in established practices, time restraints, and provider assumptions regarding client education. It was determined that further education with providers and ongoing assessment of documentation would be warranted to increase provider adherence to the proposed outcomes of this project.

    Request this Article


    Evaluating Pressure Ulcer Prevention in the Emergency Department

    Published Year: 2013
    Program: Doctor of Nursing Practice

    Willis, Michael L.

    Background: In October 2008, the Centers for Medicare and Medicaid Services (CMS) discontinued reimbursement for certain hospital-acquired conditions (HACs) which includes stage III/IV pressure ulcers (PUs). According to the CMS, stage III/IV PUs are considered hospital acquired if not documented as present on admission (POA). CMS defines POA as present at the time the order for inpatient admission occurs, conditions that develop during an outpatient encounter, including the ED, observation, or outpatient surgery. Patients referred to this facility are mostly frail elders with multiple comorbidities and limited mobility putting them at high-risk for developing new PUs, specifically suspected deep tissue injuries (SDTIs). The purpose of this QI project was to evaluate pressure ulcer prevention (PUP) interventions applicable to the ED. ED nursing staff was educated on PUP and identification using a pocket guide. The goal was to prevent hospital-acquired SDTIs in non-ambulatory patients with pre-existing full-thickness PUs held in the ED for 4 hours longer. EBP Change Model: Larrabee’s Model for Evidence-Based Practice Change was used to guide this project and Kotter’s concept of the guiding coalition from his process on leading change. Methods: Data was collected utilizing real-time chart review on all non-ambulatory patients with pre-existing full-thickness PUs identified by the ED nurses as POA. A daily log was maintained by the wound specialists on the number of patients admitted and whether PUs observed on patient assessment were POA or hospital acquired in the ED. Outcomes: There were no hospital-acquired SDTIs PUs among patients with pre-existing full-thickness PUs held in the ED for 4 hours or longer. PU prevalence was 3%, incidence 0%. No chronic wounds were incorrectly identified as PUs. Implications for Nursing: Evidence-based PUP interventions can and should be implemented in the ED. Focused PUP education can improve the ED nurse’s ability to correctly identify pressure ulcers from other chronic wounds and implement prevention techniques using a standardized pocket guide. ED nurses can be engaged to participate in PUP with access to expert resources and education.

    Request this Article


2014

    Evaluation and Implementation of Psychopharmacology Clinical Practice Guidelines for Borderline Personality Disorder

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Abimbola, Ebunoluwa

    The Diagnostic and Statistical Manual of Mental Disorders defines the main features of borderline personality disorder (BPD) as impulsive behavior and instability of emotions, interpersonal relationships, and self-image, and specifies nine criteria to demonstrate the presence of these features. Mental health conditions are the leading cause of disability-adjusted life years (DALYs) worldwide and account for 37% of healthy life lost from non-communicable diseases (NCDs). Personality disorder (PD) as it is currently classfiied, affects around 6% of the world population, and the differences between countries show no consistent variation. According to the Centers for Disease Control and Prevention, in 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year. In 2002 and 2003, mental illness cost the United States an estimated $300 billion annually, which included approximately $193 billion from lost earnings and wages, $24 billion benefits in 2002, and $100 billion in healthcare expenditures in 2003. The objectives of this project are: 1) to provide basic information and education to the providers on the implementations of evidence-based psychopharmacology CPGs for BPD using the National Institutes for Health and Clinical Excellence (NICE) psychopharmacology treatment algorithms. 2) to improve the understanding of the BPD diagnostic process using the DSM V diagnostic criteria and to incorporate the CPGs into practice. Rosswurm and Larrabee’s, 6-step model was used for this project. A 3-month retrospective chart review was performed before the project, and 3 months after the implementation of the clinical practice guidelines (CPGs) to determine the improvement in the diagnostic process and consistency in terms of psychopharmacology treatment. Using the same inclusion and exclusion criteria, the two groups were compared. The result of the project was done using a cross tabulation contingency table was created in SPSS, before the PID assessment was implemented; seven of the 60 patients reviewed were diagnosed with PID. After the implementation of the PID assessment, 22 of the 60 patients reviewed were diagnosed with PID. In this study, the odds of being diagnosed using the PID assessment are 4.38 times higher than the odds of being diagnosed without the PID assessment. In conclusion, there was increased use of the CPG and the outcome was the improvement in the BPD diagnostic process using the Personality Inventory for DSM-5-Brief Form (PID-5-BF)-adult form and the psychopharmacology algorithms.

    Request this Article


    Improving Patient Care Through Effective Communication and Conflict Resolution

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Ackman, Deborah

    The Indian Health Services (IHS) was originally a temporary agency started in 1955 to provide health care for eligible Native Americans, many with historically limited access to health care provided only by a small group of Public Health Service nurses assigned to reservations. As the native population grew, so did health disparities among indigenous peoples compared with the general United States population. Tribal leader concerns over this issue lead to meetings in the 1950s between congressional delegates and tribal leaders looking for ways to extend health care service. The result of these meetings resulted in rural clinics and small hospitals built on or bordering reservations overseen by the newly formed IHS. The original model of care provided urgent care on a walk-in basis to manage acute illness and emergencies, but did not provide for either continuing care or specialty referrrals. In 2005, IHS and tribal leaders again met to discuss widening disparities becoming evident as focus shifted from providing temporary fixes in the acute care setting to management of chronic disease, increased patient involvement in healthcare decision-making, and a growing emphasis on preventative care. A significant shift in providing primary care occurred with establishment of the primary care medical home (PCMH) in outpatient departments around the country where patients were assigned to a specific provider and healthcare team who would partner with them. IHS has a unique mission to provide evidence-based allopathic care in collaboration with traditional healing methods. The Institute for Healthcare Improvement (IHI) formulated a primary care model based on IHS’ specialized needs named Improving Patient Care (IPC) based on Wagner’s Chronic Care Model. In 2007, one Arizona reservation service unit was selected as a pilot site to trial IPC. It was implemented at the main hospital and all three remote clinics. One of these clinics was the focus of this project. The goal was to evaluate IPC and identify if improvements were needed to maintain relevance in today’s rapidly changing healthcare environment. Access to care, patient and staff satisfaction, and the effectiveness of team communication and customer service were specific areas of focus for the project. Larrabee’s Model of Evidence-Based Improvement was the supporting theory as it applied to both organizational and systems changes. Kotter’s Leading Change Model was also employed. An in-service addressing these issues was well attended, with strong staff participation and engagement. The in-service provided Team STEPPs material which covered communication, conflict resolution and effective hands-offs. Tools were provided to assist with maintaining consistency and staff was asked to provide feedback. Staff agreed that both communication and customer service in the past had not always been optimal and were willing to incorporate proposed changes. Several suggestions for future in-services were received for future in-services to build upon the initial training. Surveys and metrics reviewed a month after the in-service showed improvements in the focus areas reinforcing the effectiveness of IPC. Issues that remained were those that needed to be addressed at higher levels and were beyond local initiative.

    Request this Article


    Development of an E-Mentoring Orientation Program

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Bemis, Helen

    Background: Mentoring newly hired nurses can improve nurse retention and socialization within an organization. New hire orientation programs that includes mentoring have led to improved patient outcomes, patient satisfaction, and patient safety. Foreground: Presently, a nurse orientation program at a small, rural hospital does not offer formatlized mentoring program due to lack of resources and intermittent hiring of staff. Implementation of a mentoring program would provide a consistent and appropriate nurse orientation. Evidence-Based Practice Framework: The Model for Evidence-Based Practice Change was used as the framework for the project. The theoretical models used were Benner’s Novice to Expert theory and Adult Learning theory. Methods: An e-mentoring program was developed by the principle investigator (PI) in coordination with the hospital’s nursing leaders. The objective of the project was to implement an electronic mentoring or e-mentoring nursing orientation program. Newly hired nurses participated in the e-mentoring program and interacted with an assigned mentor during the project. The new nurses completed the Nurse Competency Survey (NCS) to assess improvement in competency. The participants completed both a pretest and posttest in an anonymous online format. Results were reviewed using descriptive analysis. Results: Four newly-hired nurses participated in the project. The pre-program scores on the NCS were 55%. The post-program scores from the NCS showed a reported increase of 32% in competency to an overall score of 87%. Conclusion and Recommendations: Findings showed that the inclusion of formalized mentoring within a new-hire nurse orientation program was beneficial. The comparison of the NCS results before and after the program demonstrated and increase in self-assessed nursing competency by the participants. Recommendations to maintain the system change included the addition of more e-mentoring modules and support for the hospital staff.

    Request this Article


    Implementation of Substance Abuse Prevention Education

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Bostic, Loretta Ann

    Background: Substance abuse is the number one most preventable health problem in the United States. Nurses represent a unique high-risk population, demonstrating distinctive risk factors and subsequent consequences that are very different from the general population. While the prevalence of substance abuse in the nursing profession is thought to mirror the general population, the consequent public safety concerns that arise are quite different. A nurse with substance abuse disorder who is unrecognized and untreated poses a serious threat to public safety. Theoretical Framework: The role of substance abuse prevention training as an intervention strategy to reduce risk for substance abuse disorder in nurses was explored through the theoretical framework of the health belief model and the theory of planned behavior. the Larrabee Model for evidence based practice change provided the framework for making the transition from evidence to practice. Design: This project is a quantitative data project that uses a pre-test post-test design. Substance abuse prevention education is implemented in a graduate nursing orientation program. The primary purpose of this project was to reduce risk for substance abuse disorder in nurses by raising awareness, improving knowledge and changing attitudes about addiction. It was expected that graduate nurse participation would result in the following outcomes: 1. demonstrate improved self-perceived awareness about addiction. 2. demonstrate improved knowledge about addiction risk. 3. demonstrate a positive change in addiction attitudes. Findings/Results: Eighty-four graduate nurses participated in the education. Fifty-five completed the pre-intervention surveys. Twenty-eight completed the post intervention surveys. Those who participated in the education perceived an improved level of awareness about addiction related to the learning objectives. Graduate nurses valued the educational opportunity and would recommend it to other nurses. Improvement in knowledge and attitude was demonstrated with a change in mean scores. However, statistical significance over time was not demonstrated. Conclusion/Recommendations: Many states have passed legislation to fund alternative to discipline programs through increased licensure fees, Since substance abuse prevention is a critical component for an effective alternative to discipline program, regulatory boards should direct funding toward research, development and implementation of substance abuse prevention programs aimed at reducing nurses’ risk for substance abuse disorder. Taking such action may help nurses with risk substance use avoid the progression toward depedence and this better protect public safety.

    Request this Article


    Beyond Professional Practice: Teaching Nursing Students to Care

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Bradshaw, Laurel

    Problem – Nursing requires a wide-range knowledge of illness, medications, and technology; however, it is not enough to simply possess these qualities to be a compentent effective nurse. Nursing also requires emotional aspects such as caring, nurturing, and compassion. Thus, changes must be made at educational institutions to devote more attention to cultivating caring among nursing students. Purpose: The purpose of this project was to explore the question, Do nursing students’ perceptions of caring change after completion of A Nursing Student’s Guide to Caring, a course aimed at nurturing the affective domain? This project investigated the value of caring as a productive framework for transforming nursing curriculum to enhance effectiveness and quality of patient care. Goal: The goal of this project was to plan, design, implement, and evaluate the effectiveness of a nursing caring curriculum. Design: Jean Watson’s model of human care and Sharon Dingman’s caring model were used as theoretical frameworks for this project. Both theories define behaviors and principles that contribute to the understanding of human caring. The Caring Dimensions Inventory instrument tool was used to measure second semester student nurses’ perceptions of caring. Pre and posttests helped determine whether student nurses perceptions of caring changed following completion of the course A Nursing Student’s Guide to Caring. The Johns Hopkins nursing evidence-based practice model acted as a guide for this project, as it focuses on the implementation of evidence-based practice via structured programs of nursing education. Kurt Lewin’s change theory supported this project which sought to change nursing students’ perceptions of caring with the letting go of old unproductive patterns and move towards a more productive change of establishing new perceptions of caring. Outcome: The intended outcome of this capstone project was to change nursing students’ perceptions of caring after completing A Nursing Student’s Guide to Caring course. Posttest perceptions of nurse caring did increase with statistical significance following instruction in the course. These findings can be translated to, a change in nursing students’ caring perceptions occurred following a focused caring educational intervention.

    Request this Article


    Prevention of Hospital-Acquired Pressure Ulcers

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Brinkman, Bevra S.

    Background: Governmental agencies have called upon healthcare organizations to take responsibility and accountability for those they serve. Almost 60,000 U.S. patients die from complications due to hospital-acquired pressure ulcers (HAPU). Healthcare costs increase when patients acquire a HAPU during hospitalization. Foreground: A rural Medical Center’s 42-bed Medical Unit acquired 12 HAPU in 2013. Negative patient outcomes resulted in lower patient satisfaction, increased healthcare costs, and loss of reimbursement monies for Medicare beneficiaries. Positive quality patient outcomes and the highly satisfied patient/family drive reimbursement monies for healthcare services. Frameworks: The Iowa Model of Evidence-based Practice (EBP), John Kotter’s Leading Change, and the Institute for Healthcare Improvement (IHI) Plan-Do-Study-Cycle models guided this DNP Capstone Change Project. Methods: The objective of this project was to provide an EBP Mentorship to decrease HAPU in 30 days by ensuring skin inspection was completed on every patient within 6 hours of admission, followed by timely re-inspection and, repositioning for all patients with a Braden Score of 14 or less. The outcome was to decrease HAPU using the Braden Scale as an evaluation tool. A sense of urgency permeated throughout the rural Medical Center to decrease HAPU. Findings/Results: The change project positively impacted the rural Medical Center by resulting in zero HAPU for the Medical Unit over 30 days. Conclusion/Recommendations: The impact of using an EBP Mentorship to prevent HAPU was remarkable. Recommendations from this project include measuring sustainable change over the next months and years.

    Request this Article


    Implementing an Evidence-Based System Change for Timely Referrals to a Chronic Kidney Disease Clinic

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Cumbee, Patricia A.

    Background: Chronic kidney disease (CKD) is a chronic condition with poor outcomes and high costs, which disproportionately affects African Americans and other minorities. Collaboration between primary care physicians (PCPs) and nephrologists in the care of patients with CKD is widely advocated, but preferences regarding collaboration are unknown. With the aging of the United States population and the increase in hypertension, diabetes mellitus, and obesity, the prevalence of CKD is increasing. PCPs can engage in strategies proven effective in reducing the progression of kidney disease. The National Kidney Disease Foundation evidence-based guidelines, the Kidney Disease Outcomes Quality Inititiative (KDOQI), provide information for PCPs regarding delaying progress of and early referral for CKD. The focus of this capstone project was to assess and identify CKD management-related needs among PCPs and to educate regarding the KDOQI guidelines. Evidence Based Practice Framework: The Model for Change, developed by Rosswurm and Larrabee, was chosen to guide this evidence-based practice change. This capstone project had three objectives: (1) Innovation – to present evidence on the benefits of early referrals for CKD. To explore the natural progression of patients idenitified as having CKD and the characteristics for an effective early referral program. (2) Economic Analysis – implementing early referral strategies into the primary care practice would be used to assess and synthesize its cost effectiveness. (3) Collaboration – improve and strengthen dialogue between all stakeholders to improve the quality of care and reduce the incidence of end stage renal disease. Methods: Physicians’ recognition of CKD and their attitudes regarding the care of patients with CKD was explored. A two-part questionnaire was used to evaluate the current knowledge and understanding of CKD of five PCPs. Results: Providers varied in their views of CKD and their embracing of the guidelines. Some sought to implement only the pay-for-performance targets and other chose to not to implement any of it. Most expressed both problems and skepticism concerning blood pressure targets and acknowledged educational gaps. At the end of the project four of the PCPs showed increased knowledge of how to recognize CKD and when to refer to a nephrologist. Conclusions: PCPs play a critical role in the early evaluation and intervention of patients at risks, stressing the importance of the PCP as a first line defense and timely specialist referral in renal care. A rise, albeit small, in the referral rate was and encouraging result-indicating an increase in physicians’ knowledge base. Future study is needed to delineate pathways and underlying reasons for PCPs’ late referral patterns. Individually addressing PCPs’ lack of knowledge and concerns can decrease late referral.

    Request this Article


    Improving the Nursing Profession: Implementation of a Nurse-Mentoring Program

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Daniels, Daphne

    The first two years of employment within an organization are identified as a crucial period for establishing oneself in practice, becoming part of an organization, and continuing employment. Use of mentoring programs in nursing has led to higher reported satisfaction, with increased retention rates. Globally, there is a gap between the supply of healthcare professionals and demand for these services. Nationally, there is also a shortage of healthcare professionals, while it is projected that the elderly population will experience the largest growth inthe next eight years, further exacerbating the workforce shortage. Currently, there is a lack of mentoring programs for nurses in a psychiatric hospital located in North Texas. This facility had experienced tremendous nursing staff turnover. Implementation of a pilot mentoring program for nurses employed at the hospital was undertaken to address the high nursing turnover rate. The objective of this project was to improve job satisfaction and increase a sense of community and belonging amongst nurses by way of a mentoring program. The Model for Evidence-Based Practice (EBP) Change framework was used to guide this capstone project of incorporating a mentoring program amongst nurses employed at the psychiatric hospital. Theoretical models used in this project included Lewins’ Stages of Planned Change, Herzberg’s Theory of Motivation, the Learner-Centered Mentoring Model and Knowles Adult Learning Principles. A mentoring toolkit was used to initiate the mentoring program at the hospital. the mentoring program took place over eight weeks, using three teams of mentor-mentees. Job satisfaction scores did improve, but not by more than 50%as projected. Qualitative evaluations revealed that participants desired the mentoring program to continue. All mentees recommended their mentor as future mentors. One participant expressed interest in leading the mentoring program past the project. Future mentoring will incorporate more participants and will occur over a timeframe of six months to one year. The literature suggests mentoring is a cost effective way to retain new and seasoned nurses; high quality mentoring can be effective in organizations that are time and resource limited. Research shows that mentoring is a support structure for nursing personnel and can function as a means to increase nurse job satisfaction. While the retention of nurses was beyond the scope of this pilot, there was statistically reliable improvement in nurse job satisfaction after implementing this mentoring program. Several tools utilized in this project can be broadly applied in nurse mentoring to quantify outcomes. This project could help to reduce nurse turnover rates in the psychiatric hospital by improving job satisfaction.

    Request this Article


    Effectiveness of an Educational Program for Clinican’s on Adherence of Type II Diabetics and Patient-Provider Communication

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Elkin, Darrell

    Background: Type II diabetes is a progressive and chronic illness largely caused by obesity and lack of exericise. If not properly controlled, diabetes can lead to debilitating complications and premature mortality. In 2007, the Centers for Disease Control (CDC) and Prevention estimated that nearly 24 million adults in the United States had type II diabetes. The number of diabetics in the US tripled between 1980 and 2007. Following current trends, those born in 2000 have a lifetime risk of 1 in 3 of developing diabetes mellitus. In 2007, the total cost of diabetes in the United States was estimated to be $174 billion, with the average diabetic spending 2.3 times more on medical expenses than their non-diabetic peers. Foreground: Increased adherence of Type II, Non-Insulin Dependent Diabetic clients at a local medical clinic within an urban city continues to be a problem. Ineffective communication has been identified as a barrier to effective treatment of diabetes. EBP Framework: the Model for Evidence-Based Practice Change served as the framework for the project. Methods: The aim of the project was to assess the impact of improved patient-clinician communication through an educational program to reinforce the practitioner’s awareness of the American Diabetic Associations’ clinical practice guidelines for the treatment of type II, diabetes. A volunteer sample of both doctors and advanced practitioners at the clinic attended the educational program; after an eight-week period, 141 medical records were chosen and reviewed. The charts chosen for post-review were done so after the date of the educational intervention. The post review measured the clinician’s increased communication, teaching and dialogue with the patient, as evident through their documentation, as well as, post educational laboratory results and weights. Results were measured by comparative analysis. Results: The findings show a positive change; significant improvement in clinician documentation; twenty four percent in A1Cs, 32% in lipid profiles and eleven percent in weights. One hundred percent of the participants perceived that non-adherence to a medical regimen could be directly related to the lack of patient-provider communication. Conclusion: Reviewing clinical practice guidelines make clinician aware of a disease process and help to formulate and effective treatment regimen; one which takes into account the patient’s culture, economic status, religion, and understanding of their illness. Such a plan may result in better patient-clinician communication, and in-turn, increase adherence to medical regimens to decrease co-morbidities and increase quality of life. Continued medical education, with more of an emphasis on non-traditional components, such as culture, economics, religion, family dynamics and education, could provide a solid foundation that may transform and exam room into a classroom for the teaching and learning of patients.

    Request this Article


    Evolution To EBP: A Journal Club Initiative

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Fritz, Lori

    Background: The Army Nurse Corps released the Patient CaringTouch System (PCTS) in April, 2011. One task within the initiative of shared accountability, the foundational component of the system, includes the Unit Practice Councils’ development of evidence-based practice (EBP) innovations. Problem: In an Army medical treatment facility located in the Southeastern United States, internal assessments demonstrated nursing staff lack understanding of EBP implementation and are not confident in their EBP beliefs. The purpose of this project was to provide EBP education and potentially strengthen nursing staff’s evidence-based practice beliefs. Methods and EBP Framework: The evidence-based practice education project was comprised of a lecture with a subsequent perpetual electronic journal club. The lecture provided the nursing staff with information on the process of EBP implementation using the Unit Practice Council (UPC) structure embedded in the Patient CaringTouch System. This project as well as the journal club employed the steps of Larrabee’s Model for Evidence-Based Practice Change to train nursing staff on the process of EBP implementation. The author, serving as an EBP mentor, conducted the electronic journal club and provided continuous education and guidance on the EBP implementation for the proposed practice innovations of the organization’s UPCs. Theoretical Considerations: Application Fawcett and Russell’s Conceptual Model of Nursing and Health Policy identified the obligation to the beneficiaries of the Army Medical Department as the impetus for the initiation of EBP implementation. the PCTS was the vehicle the Command chose to update nursing practice. Adoption of the Patient CaringTouch System and EBP implementation required a significant organizational culture change. This process was assessed and facilitated by using Roger’s Diffusion of Innovations change theory. Results and Conclusions: The EBP Belief Scale assesses a patient’s strength of beliefs in evidence-based practice. Participants in the project completed the scale prior to receiving any evidence-based practice education and again after participation in both the lecture and the journal club. The pre-and post-educational means were compared using the Paired t-test and demostrated the EBP educational project did not increase the 30 participants’ strength of beliefs in evidence-based practice.

    Request this Article


    Promoting Grading Consistency of Nursing Care Plans

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Herrera-Erdem, Orelia

    Background: A primary concern in health care is safe delivery of care. The nursing care plan (NCP) is the foundation for safe delivery of health care. There is evidence that new graduate nurses are lacking in this skill. Graduates report their insecurity in delivery of safe care. The Joint Commission National Patient Safety Goals, 2013 notes the need for standardization of health care. Foreground: The graduate nurses have for some time been reporting in their post-graduation surveys that the lack of consistency in the grading of NCPs has been a stressful, anxiety provoking and confusing experience for them. They report feeling insecure in their ability to provide safe care, and have felt this issue has kept them from experiencing a smooth transition into the workforce. This impacts the faculty’s goal of preparing the students to succeed. EBP Framework: The PICO framework was used along with Lewin’s Model of Change. The Pico framework was use to describe the target population, the interventions, the comparison maneuver and the outcome. Lewin’s theory of change was used because of his three stages of change – freeze, unfreeze, refreeze. Methods: The Project Director (PD) conducted private and individual interviews with the faculty using the grading rubric as the interview tool, review of the interview results by the PD, presenting an instructional module on the use of the grading rubric and proposed change, and asking the faculty to grade the same NCP using the information received during the presentation. The PD reviewed the graded NCPs, and submitted for statistical analysis. Findings/Results: The findings/results were faculty did not grade the NCP in a consistent or similar manner. The statistical analysis showed the grading rubric to not be reliable or valid. Conclusion/Recommendations: There is a need for standardization of faculty education as relates to NCP writing and grading, and a reliable grading rubric.

    Request this Article


    Impacting Multiple Sclerosis: Personal Trainer Fitness Program

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Mayer, Loretta

    Background: The Multiple Sclerosis (MS) Nursing National Guidelines promotes preventative health strategies as a focal responsibility of nursing. Multiple Sclerosis is the most common disabling disease of of young adulthood leading to unemployment. For persons with mutliple sclerosis (PwMS) exercising and maintaining function is a challenging health issue due to progressive disabling symptoms and complicating comorbidities. Lack of regular physical activity is likely to have a direct and costly effect on patients’ accumulative disability and the cost of rehabilitation. Foreground: The role of a nurse practitioner (NP) is multifaceted, as an expert collaborator of the inter-professional team caring for PwMS, and is a critical facilitator in the MS referral process. Nurse Practitioners are involved in disease, symptom, relapse, and rehabilitation management consistent with the Advanced Practice Nursing Model in MS. Studies have showed that NPs have the expert skill set of interpreting evidence-based practice (EBP) and translating it into clinical practice to improve patient outcomes. Methods: To maintain functional capabilities with the accumulation of disease is challenging, requiring an effective interdisciplinary healthcare team to provide strategies focusing on patient-centered care. This project was to evaluate NP referral practices in the fitness-promotion process to the Personal Trainer Fitness Program (PTFP) presented in a PowerPoint presentation (PPP) as an exercise fitness modality of supervised strength, resistance and endurance training. EBP Framework: The Academic Center for Evidence Based Practice Model (ACE) was used, in conjunction with Lewin’s change theory, as guiding frameworks for this project. The PICOT format identifies the project. The Stakeholders Include: NPs who care for PwMS, DNP student, personal trainer, physical therapist and PwMS who benefit by NP referrals. This project assessed the impact of the evidence-based knowledge on the NP decision-making process, as it pertains to increasing awareness and referring patients to a new exercise modality focusing on supervised strength, resistance and endurance fitness, as well as wellness. Findings/Results: Survey responses were 77, 46, and 30 consecutively. The results showed that NPs were confident in referring the PwMS to a fitness modality such as the PTFP. Ninety-three percent of the respondents who viewed the PPP would consider moderating their decision-making process to incorporate this exercise modality into their clinical practice. In cross-tabulation of the data, the NP respondents were well informed of the benefits of a PTFP and confident in making referrals for fitness. Referring to a PTFP was already incorporated into their referral practice in exercise promotion, as diagnosing and treating are within their scope of practice. The BSN respondents gained a greater awareness in considering referrals to a PTFP. Conclusions/Recommendations: The referral process appears to be related to awareness, knowledge base and scope of practice, which highlights the importance of incorporating evidence-based education into graduate and undergraduate levels of nursing.

    Request this Article


    Preventing Falls in Long Term Care: An Educational Nursing Intervention

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Mccarthy, Shauna

    Background: According to the American Geriatric Society, falls are a leading cause of serious injuries in older adults that can lead to hospitalization, nursing home admission, and even death. Falling is an even more frequent occurance among ambulatory residents of long-term care facilities than among older persons residing in the community. About half of ambulatory long-term care residents experience at least one fall each year. Foreground: Nursing Homes residents at both local and national level experience varying degrees of fall episodes. Though each facility follows standard guidelines set by the state, the total number and severity of falls and fall-related injuries does vary. All of these facilities are expected to implement annual in servicing of staff on fall prevention. Clinical Question: Does an Evidence-based education program on fall prevention, demonstrate increased knowledge gained and retained, by nursing staff in a Long Term Care (LTC) environment, resulting in reduced patient fall ratios. EBP Framework: Lewin’s change theory was the guiding framework for this project. The Clincial Scholar Model (CSM) guides the activation and dissemintation of practice innovations, while collaborating with other members in an interdisciplinary approach. Objective: The purpose of this paper is identified in the following PICOT format; Population: Nursing staff caring for Nursing Home residents. Implementation: an educational EBP intervention of fall prevention. Comparison: Evaluating patient fall ratios, and nursing knowledge pre and post educational in-service. Outcomes: Demonstrate improved fall ratios. Time: Over 1 month in a long-term care setting. Outcomes: The presentation of an educational format the nursing staff find easy to understand and thus remember and retain key curriculum as identified by a brief questionnaire, prior to an following the in-service. The facility documentation of a decrease in the ratio of falls over 1 month following the education on Fall Prevention to the nursing staff, compared to the prior month. Findings/Results: Forty-three nursing staff participated. The survey results showed an improvement in knowledge following the in-service, two of the test results scored lower following the in-service. Nursing home resident falls, decreased by 50%. Conclusions/Recommendations: Continuation of staff in-servicing is important to improve patient care outcomes. It is important to provide the teaching material in a brief and simplified format that is easy for all members of the nursing staff to understand.

    Request this Article


    Compliance with a Recommended Guideline for Clinical Management of Prehypertension in an Acute Psychiatric Setting: A Retrospective Study

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Mcphoy, Faye

    Background: Prehypertension presents a reason for growing concern among healthcare providers in acute psychiatry. Its potential for progression to hypertension and cardiovascular disease in patients with mental illness is significantly higher than in persons without mental illnesses. Research shows that in most cases, patients with mental illness have the unhealthiest life style, because of their diet and lack of physical activity in comparison to the general population, and further explained that people who suffered from schizophrenia have a life expectancy of 10 years less compared to those without mental illness. Foreground: An increase in prevalence of prehypertension in the inpatient mental health population that received psychiatric treatment at a large metropolitan hospital was a major concern, especially since many of those patients were as young as 20 years of age. It was also observed that the continued use of previous terms high normal blood pressure and optimal blood pressure in consideration of treatment may have been a factor in not assigning the serious treatment approach for prevention of prehypertension progression to hypertension and cardiovascular events. Evidence-Based Practice Framework: The model for change to evidence-based practice was used to guide this project. Method: The purpose of this project was to determine if prehypertension was being identified and treated in acute adult psychiatry using the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure guideline on preventing hypertension and cardiovascular disease. A retrospective investigatory review of patients’ electronic medical records was conducted. Only medical records from January 2012 throug April 2014 were reviewed. Data was collected to determine if blood pressures within prehypertension range were identified. Prehypertension was listed as a problem and an active physical exercise prescribed. Results and Conclusion: The results from this project identified a lack of prehypertension being specifically identified as a problem and an active physical exercise prescribed as one method of treatement. This compelling data formed the basis for a protocol on management of prehypertension in acute psychiatry.

    Request this Article


    Provider Educational Intervention to Improve Psychiatric Advance Directives Completion Rate

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Montalmant, Fritzner A

    Background: Mental illness is the most common cause of major disability in community settings worldwide. Patients with serious mental illness (SMI) are often unable to communicate their wishes during acute illness. However, evidence supports improved outcomes in patients with Psychiatric Advance Directive (PAD) on file prior to entering and acute phase indicating that primary care providers are very instrumental to patients’ response prior to acute illness. This forms the basis for this evdience-based system-change project intended to facilitate providers’ interest in discussing PAD and ultimately obtaining advance instruction (AI) and/or health care power of attorney (HCPA) from patients when these patients are most capacitated. Design: A combination of the Advancing Research and Clinical Practice through Close Collaboration (ARCC) EBP model. Orem’s Self-care Deficit theory, and Kotter’s Leading Change model form the framework for this project. Participants engaged in Advance Directive activities guided by a toolkit developed by Bazelon Center for Mental Health Law, and adopted by the National Mental Health Consumer’s Self Help Clearinghouse. Method: Utlizing the Bazelon toolkit, three consenting primary care providrs were guided in EBP methods to engage patients in PAD discussions and answer patients’ questions. Pre-implementation, 150 charts were randomly selected fro review of providers’ documentation of PAD behavior/activities in the 6-week before intervention. Post-intervention, 150 charts were also randomly selected for review and comparison. The PI was available in person, by phone and text to support, guide, and encourage patients throughout the period but was not present at patient-provider visits. Outcomes: The findings show a positive change in providers’ pre intervention of PAD discussion from 21% compared to post intervention rate of 51% over he 6-week period. Descriptive analysis of retroactive charts review of data from 150 randomly selected medical records of patients seen at the clinic during the period indicates an 85% increase in rates of provider who discussed PAD with patients during their scheduled visits over a 6-week of intervention period. Conclusion: These findings are consisent with several research studies, which suggest that when providers offer opportunities for PAD completion to patients with SMI, they are more likely to receive better health care and recover faster from acute conditions. It is recommended that primary care providers routinely offer Advance Directive discussions to their patients to facilitate and improve outcomes.

    Request this Article


    Assessing Nursing Students’ Perceptions of Jeopardy!® Game Teaching Method

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Nagai, Stephanie

    Background: Nursing instructors need to keep current in today’s teaching practices to meet educational standards required by the Accreditation Commission for Education in Nursing (ACEN). The traditional teaching practice to lecture only is considered outdated to meet the needs of today’s students. The millennial generation is accustomed to quick answers via the internet and may become impatient or easily bored in a non-virtual environment. Boredom may cause group dysfuction and a negative environment which hampers teamwork and productivity. The Jeopardy! game may provide an opportunity to increase the students’ knowledge, satisfaction, and build teamwork. Game teaching is an effective method of encouraging students to engage in classroom activity and restore a positive learning environment. Foreground: Game teaching methods are not commonly used as a teaching strategy at a local community college within an urban city. EBP Framework: The Model for Evidence-Based Practice Change by Larrabee was selected as a guide for the project. Methods: The aim of the project was to assess the nursing students’ perceptions of a game teaching method by implementing a Jeopardy! game for a registered nurse (RN) degree program in a community college within an urban city. A volunteer sample of nursing students participated in a Jeopardy! game and then completed the Comparison of Group and Individual Outcomes Between Jeopardy! and Traditional Classes Survey. Perceived learning, and students’ attitude toward the game teaching method was measured by the survey tool. Results were compared using descriptive statistics. Results: Eighty-six percent of the participants strongly agreed or agreed that taking the Jeopardy! examination enhanced their understanding of the material. Overall, 86% of the participants report that the Jeopardy! examination was a positive learning experience. Conclusion: The results provide supportive evidence that the Jeopardy! PowerPoint template provides a positive engaging learning environment for the students.

    Request this Article


    Impact of Hendrich II Fall Risk Assessment Tool Initiative on Nurses’ Perception of Fall Prevention

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Nyarunda, Charles

    Background: Falls are a prominent external cause of unintentional injury worldwide. Falls affect everyone, particularly 28-35% of people age 65 and older; increasing to 32-42% for those over 70 years of age. Falls account for 40% of all injury deaths; the rates vary depending in the country and the studied population. Fall fatality rate for people age 65 and older in the United States is 36.8 per 100,000 people, whereas in Canada, mortality rate for the same age group is 9.4 per 100,000. Mortality rate for people age 50 and older in Finland is 55.44 for men and 43.1 for women per 100,000. Foreground: Falls are a widespread health problem posing serious threats to patient safety. Accidental falls account for the most incidents reported in hospitals, complicating longer stays and burdening the healthcare system. Substatial costs are associated with falls, including costs of patient care associated with increased length of stay and liability. Fall-related injuries in older adults often reduce mobility, independence, and result in increased risk of premature death. EBP Framework: The Larrabee Model for evidence-based practice change and Roger’s Diffusion of Innovation served as frameworks for the project. Methods: the process included an educational intervention, recruitment of subjects, and management of data. The EBP Beliefs Scale including a pre- and post- knowledge test was the source of data, collected through various means. Records were kept of the group of nurses who attended each educational session. The impact of the educational intervention and the Knowledge, skills, and confidence of the nurses were measured, allowing the investigator to compare the results before and after the intervention to decipher if a change has occurred. Descriptive statistics and frequencies were utilized to analyze the data obtained from the pre- and post-test forms. Findings/Results: The findings show a positive change in nurses’ perceptions levels in attitudes, behaviors, and knowledge of Hendrich II Falls Risk Assessment Tool (HFRM) as evidenced by an improvement in pretest to posttest EBP Beliefs Scale survey scores. All categories show increase in nurses’ beliefs. Conclusion/Recommendations: The design of the project was quantitative; the descriptive analysis show positive change in EBP Beliefs scale scores of nurses’ perception of Hendrich II Fall Risk assessment Tool. In keeping with the Larrabee Model, Roger’s diffusion of innovations theory and PDSA Model, HFRM education intervention should continue and become part of the facility’s Fall Policy as more cycles are completed. A mandated full educational module presented by Staff Development should be instituted for all staff and disciplines involved in the educational intervention, implemented with staff competency evaluation.

    Request this Article


    Impact of an Established Online Module on Nursing Students’ Perceptions on Incivility

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Reyes, Anthony Delos

    Nursing educators are faced with a rising problem of incivility in nursing education. Nursing students who exhibit uncivil behaviors in academic settings will eventually compare for vulnerable patients. This is a patient safety concern, as these behaviors can result in a negative learning environment, hostility, violence, and medical errors. In fact, uncivil behaviors were identified as a root cause of more than 3,500 sentinel events over a 10-year time frame. In response to these reported events, the Joint Commission issued a sentinel event alert in 2008, declaring the need for health care facilities to address abusive/intimidating behaviors that can undermine a culture of safety. EBP Framework: The Model for Evidence-Based Practice Change served as the framework for the project. Methods: The aim of the project was to assess the impact of an established online civility training module’s effect on nursing students’ perceptions on incivility. A positive change in student perceptions on incivility as evidenced by an improvement in prestest to posttest Incivility in Nursing Education (INE) Survey score was the expected outcome. the INE Survey measured the nursing students’ perceptions of uncivil student and faculty behaviors and their perceived frequency. Results were compared using descriptive statistics. Results: Behaviors that are listed on the INE Survey may be classified to be uncivil. The findings show a positive change in student perception levels for the uncivil behaviors as evidenced by an improvement in pretest to posttest INE Survey scores. A rise from 14% to 57% of the participants report that both students and faculty are equally more likely to engage in uncivil behavior in the nursing environment. Eighty-six percent of the participants perceive that incivility is a moderate to severe problem in nursing education. Conclusion: Civility training may result in ehanced perception of unfavorable behaviors that disrupt the learning evironment for nursing students, an increase in student/faculty morale and retention, a positive learning evironment, and better long-term patient outcomes, satisfaction, and safety. For these reasons, it is imperative that nursing education leaders initiate future policy changes that formalize civility education. Adopting tools, such as the ready-to-use civility training module, can provide educators with a valuable resource that may foster a culture of safety and civility in th nursing academic environment.

    Request this Article


    RN-To-RN Peer Review: Implementing Peer-To-Peer Feedback

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Sharifian, Chitra

    Background: Patient safety is a concern and a focus of healthcare today. According to the Institute of Medicine, at least 98,000 people die in the hospital each year as a results of communication errors that could have been prevented. The Center for Medicare and Medicaid (CMS) indicated that the rate of medical errors due to poor communication was increasing and the death toll from preventive medical injuries approached 200,000 per year in the United States. Foreground: The Joint Commission reported that the primary cause of over 70 percent of sentinel events was communication failure. The Department of Veterans Affairs (VA) National Center for Patient Safety in America identified communication failure in healthcare as the primary root cause of 75 percent of more than 7,000 root cause analyses of adverse events nd close calls. Therefore, effective communication skills, including peer-to-peer review and feedback with a nurse colleague, are an essential component of excellent quality of care and patient safety. Method: Identifying a peer review process on a daily basis reinforces the entire discipline of nursing: To take effective action and create meaningful structures and processes that are grounded in evidence-based practice while improving patient outcomes. Using the PICO method as represented by; P: Surgical staff nurses at a 450 bed hospital, I: Peer Review and peer feedback in-services, O: Improve peer-to-peer communication and feedback that can lead into improved quality patient care. EBP: The Larrabee Framework provided a pragmatic, theory-driven model for empowering clinicians in the process of evidence-based practice. Conclusion: RN-to-RN peer review feedback is a vital component of patient safety as it will a) evaluated the quality and quantity of nursing care as it is delivered by the individual or group of practitioners; b) determine the strengths and weaknesses of nursing care, accounting for local and institutional resources and contraints; c) provide evidence for use, and base recommendations for new or altered policies and procedures to improve nursing care; and d) identify where practice patterns need more knowledge and research.

    Request this Article


    Implementation of a Diabetes Education Protocol in Patients with Chronic Mental Illness and Diabetes Mellitus

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Smith, Petsy

    Diabetes continues to be a serious health problem in the United States affecting approximately 8% of the population nationwide. This is a tremendous health concern, the estimated cost of treating diabetes has risen to $245 billion in 2012, a 41% increase from 2007. Persons with serious chronic mental illnesses and Diabetes Mellitus have several risk factors and behaviors that influence both intermediate and long-term diabetic outcomes. The administration of second-generation antipsychotic medications decreased physical activity, poor dietary habits, poor access and disparities in care in patients with chronic mental illness receiving less diabetes self-management education are significant factors. Research shows that for this unique population if given the appropriate diabetic self-care management that they need, they can achieve successful clinical outcomes. Foreground: For healthcare professionals, especially psychiatric staff whose responsibility it is to provide care for patients with chronic mental illness, uncontrolled Diabetes Mellitus (DM) is a daily concern. Patients, even when psychiatrically stabilized, lack the knowledge and skills set for adequate diabetes self-management to improve outcomes and improve their quality of life. Providing diabetic education involves a multidisciplinary team approach but is very often ultimately this responsibility of the nurse at the bedside. Psychiatric nurses are often more focused on psychiatric nursing care, and less emphasis is placed on educating and documenting their teaching on diabetes care. Their skills and knowledge about diabetes self-care need educational enhancement. Method: A retrospective random eletronic chart review of 150 charts in patients with chronic psychiatric illness and DM was conducted which show minimal documented diabetic teaching. Based on the results, an evidence-bsed diabetic educational presentation was given to nurses on a selected inpatient psychiatric unit. Printed Educational handout to be given the patients during the project period was also presented and discussed with the nurses. Twenty charts were reviewed post the education intervention. An evidence-based framework used for organization, in combination with two theories, guided this project. Rosswurm and Larrabee’s Model for Change to Evidence Based Practice provided a systematic process for developing and implementing a practice change. Lewins’s Theory of Change served as the theoretical foundation for this change process. The diabetic education protocol and educational intervention, utilized the nursing theoretical underpinning of Nola Pender. Findings/Results: The success of this evidence-based intervention was based on the findings of increased teaching and documented diabetic educational handouts during the project period. The results of this project demonstrated that when psychiatric nurses are provided with appropriate evidence based diabetic self-care education; patient teaching and documentation are increased.

    Request this Article


    Impact of an Education Module on Nursing Staff Perceptions on Bedside Reporting

    Published Year: 2014
    Program: Doctor of Nursing Practice

    Tegan, Alicia

    Background: The Joint Commission (TJC) evaluated sentinel events in healthcare and reported communication failure of care providers during patient handoffs as the most frequently cited root-cause. To improve patient outcomes and to avoid costly mistakes, it is recommended that the change of shift report should take place at the patient’s bedside. Foreground: Studies regarding nursing shift reports indicate that information given is inconsistent among nurses. Despite attempts at creating standardized reporting sheets and implementing reporting methods to guide nurses, a lack of consistency remains, which can be a detriment to patient safety. Bedside reporting is recommended by TJC, but is not currently part of the nurse to nurse shift handoff report at a local, rural hospital. Framework: The Johns Hopkins Nursing Evidence-Based Practice Model was utilized as a guide to find the best evidence to implement and in translating the studies into practice. Method: Pre and post surveys were used to collect data on nursing staff perceptions on bedside reporting. After completing a pre survey, an education module on bedside reporting was shared with participants. Survey results obtained from nursing staff after participating in education were compared to the survey results of nursing perceptions before completing the education module. Descriptive data was obtained by comparing perceptions before and after education. Results: The findings show a positive change in nursing stadd perceptions on bedside reporting as evidenced by an improvement in pretest to posttest survey scores. Post education, there was an increase from 45% to 68% of the participants perceiving bedside reporting as more comprehensive than current reports held in a break-room. One-hundred percent of the participants perceive that bedside reporting was a beneficial form of communication, compared to eighty percent pre education. Conclusion: Educating the nursing staff on bedside reporting has led to an increase in buy-in. This can result in the success and sustainability of bedside reporting on the nursing unit, after full implementation. Tools, such as the ready-to-use Studer Group Bedside Reporting Tool Kit, can provide nurse managers with a valuable resource that may foster the support and sustainability of bedside reporting in their departments.

    Request this Article


2015

    Nursing Clinical Skills Boot Camp Evaluation

    Published Year: 2015
    Program: Doctor of Nursing Practice

    Cleveland, Melissa

    Background: Best practice warrants the best results which should be a requirement in today’s health care. Evidence-based practice (EBP) is important in healthcare because it ensures that the best practice is the focus for the care that is being delivered. In the academic area it is necessary to educate nursing students about the importance of delivering the best care possible, which will improve all of outcomes. Effective care can be encouraged by coaching students in a Nursing Clinical Skill Boot Camp, which can increase students nurses’ confidence and decrease anxiety. EBP Framework: The John Hopkins Nursing Evidence-Based Practice (JHNEBP) Model was selected as a guide for this Capstone Project. The goal of the JHNEBP model is to assure the highest quality of care, which is the ultimate goal of every health care professional. Methods: The primary aim of this capstone project was to develop a system change. This system change would be used to improve overall care that the students give in the clinical area during their preceptorship phase of the nursing program, by increasing the nursing students’ confidence and deceasing the nursing students’ anxiety. A preceptorship is defined as a period of practical experience and training for a student in nursing that is supervised by an expert or specialist in the nursing field. A Nursing Clinical Skills Boot Camp Evaluation was designed to increase studeny nurses’ confidence and decrease student nurses’ anxiety, thus ensuring that nursing students are safe and competent prior to enterin into the clinical area during their preceptorship phase. Pre boot camp and post preceptored clinical experience the participants completed the Primary Care Experience Evaluation and the Student Satisfaction and Self Confidence in Learning surveys. Results: Analysis of the data revealed that the nursing students felt more confident and had a significant decrease in anxiety after attending the Nursing Clinical Skills Boot Camp Evaluation. Conclusion: Scheduling a Nursing Clinical Skills Boot Camp Evaluation is benefical for the private for-profit university’s nursing curriculum. The Nursing Clinical Skills Boot Camp Evaluation prepares the Baccalaureate of Science in Nursing (BSN) students to be successful and confident when the students enter into the last semester of the program. The assumption is that the student nurses’ will give competent nursing care to patients as a result of the increased confidence and decreased anxiety.

    Request this Article


    Evaluation of a Nurse Manager Orientation Program

    Published Year: 2015
    Program: Doctor of Nursing Practice

    Flores, Robert

    Background: Nurse Managers (NM) are crucial to the success of any hospital department. NMs are chosen around a misconception that nurses with expert clinical skills are prepared to lead effectively and this couldn’t be further from the truth. Studies indicate that NMs are often the least prepared to handle the challenges of their roles. Unstructured leadership development for NMs fails to offer experiences that assist them in developing the competencies of successful leadership and can result in role transition problems, lead to dissastisfaction for new NMs, as well as their unit staff. This, in turn, could negatively affect patient care quality, service, and safety. Foreground: Upon reviewing the current NM orientation at a healthcare organization in Houston, Texas, the nursing leaders of the organization agreed that the current NM orientation training did not provide the management and leadership training curriculum necessary for NMs to be effective leaders. In addition, when measured, mean scores from the Nurse Manager Skills Inventory (NMSI) pre-course knowledge assessment indicated a gap in knowledge in a pilot NM group. Evidence-Based Practice Framework: The evidence-based practice framework utilized to develop and guide this quality improvement project was Rosswurm and Larrabee’s six-step model for change. Methods: Six NMs completed pre/post-course knowledge assessment using the NMSI. Following the completion of the pre-course knowledge assessment, the NMs attended a training sessios where they received the Essentials of Nurse Manager Orientation curriculum. The mean for each of the 82 questions of the NMSI was calculated for the group and pre and post scores compared. Findings and Results: Overall result of the pilot group’s post-course knowledge assessment inventory was significantly different than that of the pilot group’s pre-course knowledge assessment. In total, 14 of 15 post-course knowledge assessment categories were above the competent level, as compared to 6 of 15 of the pre-course knowledge assessment. Results are consistent with the quantitative gains seen in similar studies found in the literature. Conclusion and Recommendations: There is an importance in utilizing NM orientation programs for developing new and experienced NMs and this is supported by the literature. The results of the project evaluation indicated that, when NMs are given the opportunity to attend a standardized orientation program, there is significant perceived improvement in their skill and behavior mean scores. Regardless of curriculum used for NM orientation, it is important to include additional learning opportunities, which may include weekly support group meetings with peers, mentorship or coaching time with another leader, additional classroom education to discuss real case studies, peer coach, or observational experiences.

    Request this Article


    Increasing RN Comprehensive Examination Scores with Continuity in Nursing Education

    Published Year: 2015
    Program: Doctor of Nursing Practice

    James, Tommie

    Background: Students entering nursing schools are encountering difficulties with completing the nursing program. This is a quality patient care concern, as this problem can result in a shortage of nurses to meet the demands of a constantly changing population. The competitiveness and success of nursing schools requires instructors from diverse backgrounds, instructors who possess a nuturing behavior, and instructors knowledgeable of the Evidence-Based Process and there is a slow process to gain these. The fore stated concern is the foundation for this capstone project. Experience in higher education demonstrates that some nursing students have difficulty succeeding in nursing school due to lack of continuity in the nursing curriculum. EBP Framework: The Model for Evidence-Based Practice (EBP) and Curriculum Changes served as the framework for this project. Methods: The purpose of this project is to examine factors that contribute to why nursing students are unsuccesful in an associate degree nursing curriculum. Nationally, normed nursing knowledge testing in the form of core courses, unit examinations, and comprehensive examinations used at the private for-profit college was used to assess the nursing students’ knowledge over the course of their two year program. Results were compared using descriptive statistics. Results: Analysis of the data provided by the results of the ATI comprehensive examinations and NCLEX examinations revealed a need to revise the nursing curriculum to keep up with the present century research and include EBP and continuity in the nursing curriculum. The results are documented in Appendices A and B, the higher pass rates were the results of continuity in the curriculum. Conclusion: Implementing the change in the private for-profit college might prepare the Associate of Science Degree nursing students successfully for the workforce. For this reason integrating continuity and EBP into the nursing curriculum are important aspects of the prevention of nursing students’ unsuccessful experience in nursing school.

    Request this Article


    Implementation of a Weight Reduction Protocol for Psychiatric Patients in a Primary Care Clinic

    Published Year: 2015
    Program: Doctor of Nursing Practice

    Langdon, Alice

    The epidemic of overweight and obesity is one of the most momentous problems confronting the United States health care system today. New data shows that the estimated cost of treating obesity has risen from 147 billion in 2008 and will grow to 344 billion by 2018 if there is no action to stop the growth. Persons with serious chronic mental illnesses and obesity have several risk factors and behaviors that affect both intermediate and long-term outcomes. The administration of second-generation antipsychotic medications, decreased physical activity, unhealthy dietary habits, deprived access and disparities in care are significant factors. Research shows that for this exceptional population, if practitioners were provided with the appropriate tools and resources to assist them with the management of obesity, successful clinical outcomes can be achieved. Foreground: For healthcare professionals, especially psychiatric providers and clinicians whose repsonsibility is to provide care for patients with chronic mental illness, obesity is a major concern. The providers were not utilizing the organizational and national policies, and regulatory mandate when providing appropriate services to obese patients with mental illness. Implementing a weight reduction protocol involves a multidisciplinary team approach. Providers are often focused on getting the work done, which resulted in decrease compliance with patient education and documenting side effects of medications and healthy lifestyles. Method: An evidence-based weight reduction educational presentation was presented to providers in the psychiatric clinic. In addition, tools and resources were distributed in order to assist the providers with the management of patients with obesity. An electronic chart review of 100% of the patients admitted from March 2015 to April 2015 were reviewed post educational intervention for adherence to the protocol and documentation of teaching in patients Electronic Medical Records (EMRs). The evidence-based framework used for linkage, in combination with two theories, guided this project. Rosswurm and Larrabee’s Model for Change to Evidence Based Practice provided a systematic process for developing and implementing a practice change. Lewin’s Theory of Change served as the theoretical foundation for this change process. Findings/Results: The success of this evidence-based intervention was based on the findings that providers are using the protocol and documenting in the patients EMRs. The results of this project established that when psychiatric providers delivered the appropriate recommended evidence based clinical guideline for the management of patients, patient teaching, and documentation are increased.

    Request this Article


    Program Evaluation of Implementing Follow-up Calls to Reduce 30 Day Readmissions

    Published Year: 2015
    Program: Doctor of Nursing Practice

    Lowe, Laura

    The information gathered through post-hospital discharge calls can serve as a catalyst for systematic changes in how care is delivered and communicated. Nearly 1 out of 8 patients discharged from a hospital report new or worse symptoms within 2-3 days after going home. Yet despite feeling worse, these patients are only minimally more likely to make follow-up appointments to address their new healthcare concerns. Readmission reduction is largely a new frontier, launched by changes in heathcare reimbursement incentives. Healthcare organizations are looking for sensible, targeted, and measureable approaches to manage the problem of readmissions. Readmissions are a demonstratable problem. Nearly 1 in every 5 Medicare patients admitted to a hospital in a year is readmitted within 30 days. By 90 days, the rate increases to 1 in 3. The cost to Medicare of these readmissions alone was $18 billion in 2007. Health promotion and illness prevention are integral components of the newest approaches to healthcare delivery. Many readmissions are related to medication safety events and readmissions are costly to patients and 3rd party payers. With reimbursement now being tied to patient outcomes, reducing readmissions will be significant to this organization’s net operating income. The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was used for this project process. Dorothea E Orem’s Self-Care Deficit Nursing Theory offers the explanation that both internal and external conditions arising from or associated with health states of individuals can bring about action limitation of individuals to engage in care of self. Readmissions from pre-implementation of discharge follow-up phone calls were compared to post implementation of the calls. For the intermediate outcome, there would be a desired downward trend of readmissions. Post-visit phone calls improve clinical outcomes, increase patient satisfaction, and decrease costly and unnecessary return visits to the emergency department as well as readmissions to hospitals.

    Request this Article


    Closing the Gap: Integrating Mental Health and Primary Care in a Psychiatric Community Setting

    Published Year: 2015
    Program: Doctor of Nursing Practice

    Nedd, Beverly

    Background: Millions of people are affected by mental disorders. Higher rates of morbidity and premature mortality compared to the general population are associated with the mentally ill, and have become a national concern. Non-adherence with primary care is one of the most common reasons for preventable deaths in the mentally ill. Mortality and morbidity in the mentally ill can decrease with access to medical care and collaborative medical treatment (Marder et al., 2004). This growing problem of premature deaths calls for urgent public action to integrate mental health, and primary care to improve process of care and clinical outcome (Davis et al., 2013). Foreground: Non-adherence with primary care is a major concern at our Behavioral Health clinic, among the mentally ill population. This problem has impacted different areas of providing patient care and must be addressed. Our Behavioral Health clinic are non-compliant with patients having a current physical exam in their charts, and OMH guidelines. Providers are hesitant about delivering psychiatric treatment, without the knowledge of a patient’s medical status. Mentally ill patients are at risk for medical comorbidities and need to be aware of their medical status. Evidence-Based Practice Framework: The Rosswurm & Larrabee evidence-based practice (EBP) model was used to guide project. Change Theory: Lewin’s Change Theory was also implemented in EBP change project. Method: The objective of the EBP change project was to provide primary care access to mentally ill patients and promote adherence of primary care treatment. This process began by implementing a brief EBP medical questionnaire into the intake/screening form. Patients with no primary care provider were referred to the same-day clinic for physical exam and comorbidity treatment. Patients adhered to having their physical exam done as a part of their admission process. Patients’ physical exam reports were retrieved and put into their charts. The quality improvement coordinator verified physical exam in charts, through random chart review. Results and Conclusion: Implementing a brief EBP medical questionnaire into the intake/screening form, has facilitated a positive change in patients seeking primary care and having their physical exams done, before receiving psychiatric treatment.

    Request this Article


    Operation Metro Life – Implementation of a Disaster Response Exercise

    Published Year: 2015
    Program: Doctor of Nursing Practice

    Pyler, Bonita Sue

    Disasters occur somewhere daily. They may not make the evening news. But to the local population affected by destruction, physical carnage, drought, terrorism, disease or weather related destruction; their worlds can change overnight, sometimes never returning to a previous state of affairs. The training of the all-inclusive medical community, to work together iwth sister agencies, as well as state and federal government agencies should be a priority for society as a whole in order to learn how to respond when a disaster strikes, no matter the type. All disasters start as local. If local responders are unable to manage the disaster, then neighboring communities provide additional resources. The federal government provides resources as means of last resort. Familiarity with resources, knowing who to call, and what to expect is imperative when minutes count. The evidence based theory chosen for this project was the Larrabee’s change model which has 6 steps: assess the need for change, locate evidence to support change, analyze the evidence, design a practice change, implement, and integrate into practice. Because this was a federally developed exercise, the Department of Homeland Security’s Exercise and Evaluation (HSEEP) training program management components were required to develop the exercise. Core components of HSEEP are exercise design and development, conduction, evaluation, and an improvement plan based on any areas needing attention. Both are a continuum of analysis, siple, applicable to medical, industrial and even personal practice. Operation Metro Lift was a disaster exercise, planned in conjunction with the Lyon, NJ Veterans Affairs Emergency Manager as part of a Super Bowl 2014 emergency response plan. An unexpected total government shutdown occured in the Fall of 2013, causing the exercise to be cancelled. Rescheduling occurred a few weeks later, however many of the planned participants were unable to attend, effectively changing the entire exercise plan. Ultimately, what was planned as a tabletop exercise ended up as a discussion shared among the participants. The DoD aeromedical evacuation process was highlighted showing the organizational process, the track system and evacuation of patients from their home of record and return (home) via power point. Discussion developed as federal agencies explored how they all could work to triage and distribute airlifted patients to select New Jersey hospitals. Conclusively, the end results paralleled that of literature, enforcing the need for continued exercise practice, development and scenario challenges designed to train personnel to learn what to work cooperatively, and become better prepared for the unknowne challenge’s the future may bring.

    Request this Article


    Closing the Knowledge Gap: An Educational Module on Vulvovaginal Atrophy for Recently Graduated Nurse Practitioners

    Published Year: 2015
    Program: Doctor of Nursing Practice

    Secor, Mimi

    National women’s health leaders have increasingly expressed concern regarding the adequacy of the women’s health content in adult nurse practitioner (ANP) and family nurse practitioner (FNP) programs and have also questioned the competency of recently graduated nurse practitioners in providing women’s health care. Concurrently, there has been a call to action focusing on the need for primary care to include comprehensive women’s health care services for increasing numbers of patients covered by health insurance under the Affordable Care Act. In addition, the Institute of Medicine has called for nurses, including nurse practitioners to practice to the full extent of their scope of practice. These mandates, together with the lack of literature assessing the knowledge and competence of recently graduated ANPs and FNPs in managing postmenopausal women with symptomatic vulvovaginal atrophy (VVA), underscored the need for this scholarly project. This scholarly project is significant to both education and practice. In education, it provides an example of an effective, online module to convey information to increase VVA knowledge that could be used by NP programs for their students. By extension, in practice, the module could be used by recently graduated ANPs and FNPs to increase knowledge of VVA, and thus, provide better care to patients who have symptomatic VVA. This educationaly focused project was based on Benner’s “From Novice to Expert” theoretical framework. Benner’s theory is based on the concept that knowledge is necessary as a foundation for skill progression. Steven’s ACE Star Model provided an evidence-based practice (EBP) framework that created a logical, step-by-step process for structuring this project. This scholarly project evaluated the effectiveness of a standardized educational module designed to increase the VVA knowledge of newly graduated ANPs and FNPs. Subjects were required to complete three online components including: a 10-minute pretest, a 30-minute standardized educational module, and a 10-minute posttest four weeks after viewing the educational module. A total of 120 subjects from around the country were enrolled, of which 59 met the inclusion criteria (graduated in the past 12 months) and 31 completed all three components of the project. Data analysis revealed a statistically significant increase in VVA knowledge on the posttest compared to the pretest for subjects who viewed the educational module. This indicated that the educational module was effective in increasing VVA knowledge of newly graduated ANPs and FNPs. This VVA educational module was an effective, easy to administer tool that could be used by ANPs and FNPs in practice to increase VVA knowledge and improve the quality of care provided to postmenopausal women with symptomatic VVA complaints.

    Request this Article


    Evaluating Effectiveness of Pain Management Education for Hospice Nurses

    Published Year: 2015
    Program: Doctor of Nursing Practice

    Spencer, Barbara

    The World Health Organization recognizes that millions of people world-side suffer from pain because of “ignorance of doctors and the lack of a standardized scientific approach” to correctly diagosis and properly treat pain. The Institute of Medicine (IOM) views pain as a US public health challenge. Pain puts a demand on the health care system. It is costly not only in terms of health care expenditures, but also disability compensation, loss of productivity at work and school, reduced income and quality of life. The IOM is aware that pain prevention and management receive little emphasis in most prelicensure education programs. The Joint Commission in conjunction with the National Pharmaceutical Council agree that a major intervention required to improve pain management practices is the implementation of educational curicula. The National Consensus Project of Quality Palliative Care is a consortium of Hospice and Pallative Care organizations and associations. They develop clinical practice guidelines that “set high expectations for excellence rather than basic competence”. The nurse or clinician needs to insure that education is provided and learning occurs in order for the patient and the family to be empowered and achieve full participation in their care. Examination of current pain management training at the clinical site for this project revealed many deficits starting with outdated pain management information and no formal education plan at orientation. Standardized, on-going pain management education did not exist. Nurses could not educate and empower their patients if nurses did not possess the skills or confidently provide the knowledge necessary to teach the patient and family. The Academic Center for Evidence-Based Practice (ACE) Star Model provided the evidence-based practice framework. The organization change model is based on the work of Kurt Lewin’s Force Field Analysis. Jean Watson’s Human Caring Theory was the nursing theory model employed. Finally, Patricia Benner’s From Novice to Expert Model sets the stage for curriculum development and continued education. The goal of this project was evaluating the effectiveness of employer-based pain management education for hospice nurses. Nursing outcomes included consistent and timely completion of the pain scale with accompanying narrative documentation. The patient outcomes included (a) pain control achieved within 48 hours and (b) actively managed pain control throughout illness. Monthly Performance Improvement Audits for pain management served as the evaluation tool. All nurses completed pain management training by December 2014. Pain audit results showed an increase in use of pain scale at each visit and an increase in number of patients achieving pain control within 48 hours. The results demonstrate that pain management education can have a positive impact on patient comfort and transition in hospice care.

    Request this Article


    Nursing’s Future is Strengthened by Formal Leadership Development

    Published Year: 2015
    Program: Doctor of Nursing Practice

    Stewart, Donna

    Emergent nursing leaders are often identified and promoted into leadership because of their excellent clinical skills. Undergraduate nursing school curriculum may include leadership content, but may not provide sufficient skill development to ensure confidence and the ability to lead in the healthcare environment. Nurses who move into management often find leading to be one of the biggests challenges of their careers. Lack of adequate leadership education and mentoring in a community hospital inspired the development of the yearlong Leadership Development Academy (LDA) for emerging leaders in healthcare. After several cohorts successfully completed the program, it was determined the LDA should be thoroughly evaluated to ensure the program and teaching methods met the needs of the participants. Boyer’s theory of scholarship, Benner’s theory of novice to expert, and Wagner and Weigand’s theory of return on investment were used to evaluate the LDA. The setting, perspective, intervention, comparison, and evaluation framework was used to develop the project plan; the ACE Star Model of EBP was used to support the process of evaluating the LDA. Evaluation of the LDA was based on feedback from graduates of the LDA conducted at the Memorial Hermann Texas Medical Center campus in 2014. A letter of participation/consent, which listed the objectives of the evaluation, the voluntary nature of participation, the use of audio recording technology, and confidentiality of information was provided to and reviewed with each participant by the principal investigator (PI). During the 30-minute evaluation interviews, participants were asked to provide feedback to specific questions about the LDA program and teaching methods. Qualitative results were compiled and evaluated by the PI. Evaluation of the LDA to ensure the content and teaching methods met the needs of the participants-good investment of their time-was the goal of this scholarly project. Analysis of the results revealed participants were enthusiastic in their recommendations that the program be not only continued but expanded in scope. The participants evaluating the LDA program and teaching methods considered the LDA effective. The skills of the participants were improved through education, mentoring, and introspection. Results indicated the participants found the program enjoyable and educational. Behavioral and organizational changes reported by participants were due to increased confidence and competency as leaders after completing the LDA. All participants planned to continue the mentoring relationship and leadership development because of the potential positive career impact. Possible changes to future LDA programs include lengthening class time to allow for in-depth discussion, leader shadowing, increased mentoring opportunities, and continued education.

    Request this Article


2016

    Evaluating the Effectiveness of HPV Education to Nursing Staff

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Allen, Maggie

    The human papillomavirus (HPV) infects approximately 14 million people annually. a crucial role of all health care providers is to reduce the risk of exposure through primary prevention. In order to lessen the risk of people contracting the virus, education regarding the virus must be passed from health professionals to patients – primary the first interaction via the nursing staff. This will in turn – provides the opportunity to increase vaccination rates, increase HPV knowledge, and confirm information about the virus. Using evidence-based practice to answer questions is a vital component for nursing interactions in a clinical setting. However, they must be educated foremost to achieve appropriate outcomes. Delivering fact-based information helps thwart parents and patients from believing false information. Having nursing staff participate in educating parents – as opposed to only the healthcare provider – helps improve the information that parents receive and helps parents make informed decisions for their adolescent. The Larrabee Model for Evidence-Based Practice Change outlines the approach to enhance the education process for the nursing staff at the selected pediatric clinic. EBS resources and the incorporation of nursing staff provide a multi-person approach and reduce previously failed approaches to provide accurate education. The evidence-based framework model selected helped identify the foundation of the project in order to produce best possible outcomes. The method used included a pre-test questionnaire, PowerPoint educational in-service, and a post-test questionnaire. Through a pre-test questionnaire, the nursing staff answered questions related to HPV, the vaccine, and statements related to the virus. A post-test questionnaire following the intervention was used to evaluate and determine if knowledge increased because of the educational intervention. The results of the questionnaire displayed growth, but through interaction via the inservice, this signified that the base knowledge of nursing staff is limited in relation to HPV and the HPV vaccine. Scores from pret-test questionnaires to post-test questionnaires increased by 57%. This project identified the lack of education the nursing staff has received about HPV and the vaccine, and how improving knowledge can affect long-term manangement of nursing staff to further educate their patient population. In conclusion, including the nursing staff and utilizing rapport built with parents will further influence parents and patients to make informed decisions can based on evidence-based information. Informed patients can accomplish several things: they can prevent parents them from potentially making misinformed judgements, can increase vaccination rates, and can overall increase cognizance of a virus that affects persons on a global level.

    Request this Article


    Evaluation of Perceived Change of Health-Related Quality of Life Among Women Attending a Midlife Women’s Clinic

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Buckley, Holly

    The aging of the baby-boomer generation has resulted in a rise of the population of women in the United States between the ages of 45 and 54 years. The hallmark health issue of midlife women is menopause and the menopause transition (MT). Symptoms associated with the female aging process have been shown to significantly affect health-related-quality-of-life (HRQoL). An increase in complex decision making factors and lack of updated knowledge in menopause treatment, have resulted in deferment by providers to treat menopausal symptoms. Studies have concluded inadequate updated of midlife women’s care is a detriment to women, leads to fragmentation of health care delivery and potentially reduces HRQoL. Health-related-quality-of-life has been recognized by the National Institutes of Health and the Centers for Disease Control as a significant indicator of population health and wellbeing. An organizational change to address the gap of women’s care during the menopause and MT, was the development of a consultative Midlife Women’s Clinic. The theory of Transistions, and the Steven’s Ace Star Model of Knowledge Transformation, provided the theory and evidence-based practice model for the development of the project. The objective of the project was to evaluate the perceived change of HRQoL of women attending a Midlife Women’s Clinic. The goal of the project was to improve HRQoL of women in midlife by providing an opportunity for education, decision making and treatment of menopause symptoms. The perceived change of HRQoL was evaluated by the self-administered Menopause Rating Scale (MRS), a menopause specific HRQoL tool. Evaluation was accomplished by comparing the completed MRS questionnaire from the initial and follow up clinic visits. The results of the project demonstrate a statistically significant improvement in the perceived HRQoL severity scores were compiled and interpreted from the Evaluation Form of the MRS. Recent literature identifies a gap of care for women in midlife related to treatment and knowldedge of menopause and the MT that can adversely affect HRQoL. The implementation of a Midlife Women’s Clinic appears to improve the perceived HRQoL menopause symptoms of women who were in attendance. Recommendations for future study would include; educational opportunities for student healthcare providers to learn updated menopause treatments by participation in this specialty clinic, development of community based seminars to disseminate knowledge about the menopause transition, and further study on the long term effect of the treatments offered on the impact of HRQoL.

    Request this Article


    Improving Follow-up Adherence Rates by Reliably Capturing Surgical Candidates in the Bariatric Patient

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Cooley, Melissa

    Background: Obesity is a disease that affects many Americans. This disease is leading many people fighting obesity to turn to bariatric surgery as the only option. While bariatric surgery is a proven effective option for weight loss, patients who do not adhere to the lifestyle changes and follow-up regimen may suffer from weight regain and other complications. Foreground: Clinicians working with bariatric surgical patients are now required by accrediting bodies to track adherence rate of follow-up appointments after bariatric surgery. Due to regulation with accreditation in bariatric surgery, facilities are required to maintain a minimum of 80% adherence to follow-up appointments. EBP Framework: The Stevens Star Model provided the framework for the evidence based practice change of increasing follow up adherence rates. In order to achieve a life-long commitment to lifestyle modifications from bariatric patients, a balance must exist with all aspects of the human system and the Neuman Systems Model guided this process in this project. Methods: Data analysis revealed a follow-up adherence rate below 80% in an outpatient clinic. The processes regarding behavioral health assessments capturing follow-up adherence was analyzed and determined to be insufficient; thus a new instrument was adopted. The behavioral health assessment instrument used in capturing follow-up adherence and other barriers to care was changed to a valid and reliable instrument. Data analysis of follow-up adherence rates was reanalyzed at 1 month after change to determine whether rates had increased. Findings/Results: Follow-up percetages increased from 75.9% to 88.9% in 30 days following surgery. The behavioral health licensed counselors completed the Millon Behavioral Medicine Diagnostic assessment for eight patients. The population that met qualifications for surgery was four. Conclusion/Recommendations: Due to the low number of qualified surgical candidates to follow after surgery, follow-up data will be re-evaluated again at one-year and the sample population will include all patients seen moving forward. Even though the follow-up percentages improved in one-month’s time, the low population numbers may have contributed to the improvement. Comparative data with other practices revealed the need for continual improvement. The goal of follow-up percentages should be re-evaluated to be above 95%.

    Request this Article


    ADHD Teacher Rating Scale: Better Understanding

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Creasy, Ashley

    Background: In the state of Tennessee, there are over 13% of children diagnosed with ADHD versus the 11% nationwide. The prevalence of ADHD is growing every year. Practitioners for evaluation of ADHD see children because parents or teachers are recognizing symptoms. The biggest concerns teachers have are for the child’s behavior and attention span while in the classroom. When a teacher in concerned with the child, they complete a behavioral scale. Practitioners use behaviors scales to help diagnose 9 out of 10 children for ADHD. EBP Framework: The EBP framework included in this project was the Stevens Star Model of Knowledge Transformation. The five steps in the Stevens Star Model helped mold this project by assisting in the research and data collection needed to ensure the project was evidence based. Methods: Teachers received the Vanderbilt ADHD Scale and then completed the Vanderbilt ADHD Scale based on a child case study. The teachers then attended an hour long in-service on ADHD and a breakdown of how to complete the Vanderbilt ADHD Scale. Three weeks later the teachers received a different child case study and a new Vanderbilt ADHD Scale. The teachers completed the scale again. Result: A comparison of the first and last scale was made on the remaining scales. The post Vanderbilt ADHD Scale demonstrated that 17 of the 25 teachers increased in the understanding of the Vanderbilt Scale. Conclusion: The teaching in-service was a success. There were areas that needed improvement, such as a more detailed case study distributed to the teachers. Overall, there were score improvements and the in-service contributed to increased knowledge.

    Request this Article


    Using Evidenced Based Practice to Train Nursing Students

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Devita, Michele

    Background: In rural healthcare, to adequately staff intensive care units (ICU) often new graduate nurses are hired directly into the ICU setting. Factors contributing to this hiring practice include the retirement of experienced nurses, and movement of potential staff to larger cities, both of which result in a limited number of experienced ICU nurses in the geographical area. This employment process places new graduate nurses into positions that require mature critical thinking skills. Typically new graduates have fundemental skills due to limited exposure to advanced protocols. EBP Framework: Utilizing Kurt Lewin’s Model, the project established a means to introduce a new protocol to the existing curriculum. The Star Model of Evidence-Based Practice guided the evidence gathering and the steps of implementation of the new protocol. The model’s ease of use fostered the adoption of evidence-based protocols into an established Associate Degree Nursing program. This project has become the protype for further curricula changes to incorportate additional evidence-based protocols that promote critical thinking techniques for students in clinical training. Methods: In attempting to enhance the critical thinking skills of the student nurses, this project introduced a new advanced protocol into the clinical curriculum of an Associate Degree Nursing program (ADN). Clinical training using the evidence-based practice (EBP) ventilator associated pneumonia (VAP) protocol exposed the students to the assessment and technical skillset associated with performing the VAP prevention protocol in an ICU setting. This process was designed to increase the students’ confidence and critical thinking abilities. Additionally, use of the protocol provided a formal educational structure employed between the staff nurses and the student nurses. This interaction enhanced the experienced nurses’ communication and mentorship of the students. The goals of the project were: to enhance the students’ skillset on the Centers for Disease Control (CDC) protocol for VAP prevention; to allow the new teaching initiative into the school’s future curriculum; and to enhance future students’ knowledge base on the CDC VAP bundle. Formal adoption of an evidence-based protocol by the ADN program’s curriculum commitee served as the project’s outcome measure. Finding/Results: Based upon the performance on the task checklist, the students demonstrated their ability to transfer the academic training into executable steps as verified by their receptors. The students’ performance revealed the evidence-based VAP protocol teachings were effective and the protocol was successfully submitted to the curriculum committee for adoption into the ADN program’s clinical curriculum with the support of the College of Nursing’s Director. Furthermore, the ADN faculty plan to use more evidence-based protocols to update and improvement the school’s clinical curriculum.

    Request this Article


    Reducing Violence In Adult Acute In-Patient Psychiatric Unit Using Environmental Centered-Care

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Gibson, Chikodiri

    Background: The increased number of incidents of aggression in the adult acute inpatient psychiatrry unit of a facility in a large metropolitan area higher than the national average for comparable units and averaging about 48 incidents a month with about half resulting to injuries created an urgency to make a change in practice. A national push to use less restictive interventions led to the proposal to the treatment team to explore the use of environmental centered care to reduce in incidents of aggression. Research shows that more than two-thirds of the patients committed as a danger to others are likely to engage in some type of violence 72 hours after admission. The current practice using restrictive interventions, such as restraint/seclusion and or medication had not been effective. Evidence-Based Practice Framework: A model for change to evidence-based practice was used to guide this project. This framework blends steps of evidence-based-practice process and aims at organizational diffusion of change. The framework aims at utilization of research findings in clinical decision making for change in practice. The framework model steps were used to identify the practice that needed change and article search was done. Evidence-based practices available were identified and change was implemented with monitoring process for sustainability of the change process. Methods: The purpose of this scholarly project was to use a non-restrictive intervention called environmental-centered care (ECC) consisting of use of relaxation music, and light and noise reduction to reduce the incidents of aggression during peak incidents time, which is mostly during nursing shift change based on the institutions data. ECC done twice a day over 2 hours and is part of the nursing assignment. Relaxation music is played at the nursing station and echoes on the unit, light is deemed and everyone speaks softly. Reminder signs remind staff and patients an hour before ECC starts. Findings/Results: The results from this project showed that the use of environmental-centered care twice a day reduced the total numbers of incidents of aggression in an in-patient psychiatric unit. The recommendation from this intervention is to prepare the patients each tie prior to initiation of treatment so as to keep the noise level at a minimal while engaging them to be still and relax. Conclusion/Recommendations: The finding that using environmental-centered care which is a non-restrictive intervention reduces the numbers of incidents of aggression is very encouraging. It shows that clinicians can effectively treat aggression without using medications and restraint. Clinicians should consider making environmental changes as part of treatment protocol when treating patients with aggressive and violent behavior.

    Request this Article


    Enhancing Evidence Based Practice Competencies of Advanced Practice Nurses through an Educational Series and Online Journal Club

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Jendro, Ginger

    National initiatives from the Institute of Medicine, the American Nurses Association, and others have stressed the importance of evidence-based healthcare. Advanced-Practice Registered Nurses (APRNs) need support systems that enable them to both access and perform scholarly research and to use technology and time-saving mechanisms in order to deliver evidence-based practice (EBP) and high-quality care that improves clinical outcomes. The EBP framework, provided by Rosswurm and Larrabee defined what is needed to appraise, fuse, and disseminate the current best evidence and the procedures for evolving and assimilating an EBP modification. The theoretical framework included Lewin’s Change Theory, which supported resolving resistance within a group through reorganizing attitudes toward making changes. The objective was to promote meaningful experiences in evaluating literature, improve appraisal skills, and encourage professional discussion and collaboration. The evaluation measures examined whether the intervention, using a podcast course on EBP and an online journal-club experience, modified attitudes toward and experiences with EBP. Participants took an EBP course online, carried out a literature-review exercise, posted an article summary on the website, reviewed summaries by other participants, and posted comments for discussion and collaboration, over a 6-week timeframe. The participants were 7 master and doctorally prepared APRNs, ranging in age from 32 to 58. Outcomes obtain using the modified Developing Evidence-Based Practice (DEBP) questionnaire revealed high positive, significant correlations between barriers to finding and reviewing research and perceived abilities and skills in finding and reviewing evidence as well as between barriers to modifying practice based on evidence and perceived facilitation and support in changing practice. No other significant differences were noted. Online journal clubs can educate participants on the EBP process and help them stay current with medical literature. For greater and long-term impact, barriers such as lack of time, motivation, personal interest, and participation need to be addressed. Future work could include examining and addressing the willingness to commit to online journal-club activities and EBP education, as well as motivation and readiness, technical skills, writing abilities, and time availability.

    Request this Article


    Evaluating Effectiveness of Provider Education in Implementing Dietary Counseling with At-Risk Pediatric Patients in Rural Oregon

    Published Year: 2016
    Program: Doctor of Nursing Practice

    King, Jennifer

    Childhood obesity has now become an epidemic among young people and it is estimated to increase over 10% by 2020. Oregon is currently ranked 14th in the nation for childhood obesity. In 2009, there were combined 26.7% of Oregon children who were considered either overweight or obese. Currently there is no consistency among providers on how to treat and counsel this increasing epidemic which is at its worse in the rural communities. There is a greater need of organizational change since this clinic is in rural Oregon and the availability to refer patients out to specialist and/or nutritionist is increasingly difficult. Counseling on diet and exercise rests on providers during well-child exams, thus having an educational brochure to facilitate discussion increases provider/patient relationship and knowledge. The health promotions model by Pender guided was used to guide the study and incorporates couseling of diet and exercise as it encourages patients to be an active participant in their own health promotion. Stevens Star Model of Knowledge Transformational learning is evident using the educational brochure to provide knowledge that is then applied. Objectives of this project was to assess the effectiveness of the implementation of a brochure on the Traffic Light Diet (TLD) with children who are at the 80% of higher of body mass index in a rural pediatric office in Eastern Oregon. TLD has been shown to be an effective way to teach both children and adults on a lifestyle of eating and implementing the brochure was effective. The goal was to increase the consistency and conversation between provider and patients/parents on the treatment of obesity. Perceived change was the consistency in the care of those pediatric patients who BMI is at or above the 80%. The Quality Improvement Manager (QIM), used date from the Electronic Health Record (EHR) by documenting specific ICD-10 codes after counseling, documentation and discussion was achieved. Following the educational intervention, 14 of 27 charts had documentation of discussion and distribution of the TLD brochure. While the percentage documentation rate is lower than published literature, extending the time frame of the project may yield higher documentation. The low number of charts reviewed may be related to fewer providers conducting WCC during the project. Recommendations are to encourage medical assistants (MA) to attach the educational brochure to the superbill as a reminder to providers to discuss and distribute the TLD. Additionally, increasing the age range in which the project was initially completed to ensure more children are educated on the importance of diet and exercise. Changing incidence of childhood obesity through one patient, one child, and one change at a time.

    Request this Article


    Integration of Oral Health Assessments into the Primary Care Practice Setting

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Leggett, Rebecca Ann

    Background: Millions of Americans continue to live with one or more oral diseases, including dental caries, which lead to periodontal disease. Periodontal disease continues to have a significant impact on those with chronic disease states, such as diabetes. Multiple reasons exist for why a significant improvement in oral health has not occurred since the original call to action was released. These reasons include lack of provider buy-in, access to dental providers, poor patient oral health literacy, and lack of finanical resources. Purpose: The purpose of this scholarly project was to integrate an oral health-screening tool for healthcare providers to use to guide oral health screening examinations in an effort to improve interdisciplinary care for patients who have been diagnosed with diabetes. This project was also designed to improve the documentation of discrete data elements of the oral health exam within the electronic health record (EHR) utilized in the Coordinated Care Organization (CCO). Methods: Using the Rosswurm and Larrabee Model for Change to Evidence Based Practice (EBP), a process improvement project was conducted implementing the Oral Health Assessment Tool (OHAT) in primary care practice setting within the CCO. Lewin’s Change theory provided additional guidance in asking the healthcare providers to implement this change project into their practice. Findings: The project was conducted as a pilot project in a clinic located in Southern Oregon over a four-week period of time where a total of fifty-five patients with a diagnosis of Diabetes Mellitus were evaluated. Of this number, thirty-one patients were screened using the OHAT flowsheet. A healthcare provider experience questionnaire was also administered at the conclusion and provided necessary feedback in how to improve upon the processes that were employed during the rollout of the project. Recommendations: Further study is needed in using the OHAT in additional clinical sites within the primary care practice setting in order to compare the original results with the new data. Additional continuing education on oral health for healthcare providers should include how to conduct oral health assessments, thus improving the comfort level of the primary care providers (PCP) and clinical staff in using the OHAT. Further work is also warranted on how to improve the communication between medical and dental care providers.

    Request this Article


    Evaluating Effectiveness of Provider Education in the Management of Upper Respiratory Complaints

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Leier, Rachel L.

    The overuse of antibiotics around the world has contributed to the emergence and spread of antibiotic resistant microorganisms. Infections such as the common cold, sinusitis, otisis media, pharyngitis, bronchitis, and upper respiratory infections (URI) account for the majority of over prescribing of antibiotics. Antimicrobial resistance is ultimately associated with poorer clincial outcomes and increased health care costs. The Stevens Star Model of Knowledge of Transformation provided the evidence-based practice framework. Kurt Lewin’s organizational change theory guided the steps for the desired provider behavior change. The purpose of the project was to increase the knowledge of primary care providers regarding the most recent evidence based clinical guidelines for the management of adults with upper respiratory complaints. The education method was a power point presentation delivered to each provider’s professional email account at the clinic. Specifically, documentation of elements confirming bacterial versus viral infections were addressed as was the appropriateness of antibiotic treatment. Use of first-line rather than broad spectrum antibiotics was emphasized. Following review of the PowerPoint, providers were encouraged to reflect upon their practice patterns relating to subjective and objective data of patients with upper respiratory complaints. The desired outcomes were: 1) improved documentation of bacterial versus viral subjective and objective findings in patients with upper respiratory complaints, and 2) reduction of prescribing of broad spectrum antibiotics for upper respiratory complaints without evidence of bacterial infection. 30 charts were reviewed prior to and 28 charts reviewed following the educational program. The desired outcomes were not achieved. Documentation of required elements to support prescribing an antibiotic did not improve following the educational presentation. Additionally, and increased number of patients received inappropriate prescriptions in the post-education period. Further study is needed to determine factors that most influence provider prescribing patterns and means to influence provider behavior. Community leaders, providers and policy makers must work together to reduce the emergence and spread of drug resistance organisms that contribute to increased health care costs and morbidity.

    Request this Article


    Implementing a Culture of Safety: Utilization of the GRASP-ED Protocol

    Published Year: 2016
    Program: Doctor of Nursing Practice

    O’Donnell, Briana

    Background: Emergency department (ED) crowding has been recognized as a growing problem. From 1995-2005, the annual number of ED visits in the United States increased nearly 20%, from 96.5 million to 115.3 million. Timeliness of care has to been shown to have a strong correlation with improved patient outcomes and increased patient satisfaction. Research indicates negative consequences of ED crowding. Attempts have been made to streamline and standardize the “front end” operations of emergency departments. Foreground: An ED located in Southern Idaho, currently assigns one nurse to the triage area. Because the assigned nurse often leaves the triage area to perform other duties, the waiting room is frequently left unattended by a healthcare provider. Administrative clerks are available but have no training in the skill of patients triage. In order to improve waiting room safety and optimize the triage process, the use of a GRASP-RN nurse was implemented in the triage area to improve door to triange time, door to room time, and triage to physician time. EBP Framework: The Revised Rosswurm and Larrabee model provided the framework for the evidence-based practice to optimize waiting room functioning. This model was designed to assist healthcare workers through the entire process of evidence-based change. Kurt Lewin’s change model was used to facilitate staff’s adaptation to change. Methods: Collected data included outcome measures of door to triage time, triage to room time, and room to physician time. Data was obtained monthly, starting in December and concluded in March. Findings/Results: Originally a rapid cycle of time process of employing time intervals with the initiated GRASP ED was to be used. However management recognized the potentital value of the implementation of the GRASP-RN and mandated staff participation in the project resulting in a transformational rather than incremental change in the triage process. Immediate change was implemented the first day of the process. Available data demonstrated minimal change in outcome measures following implementation of the GRASP-RN; however, data will be mined every 6 weeks after implementation and improvement in the stated is expected. Conclusion: GRASP-RN nurses are needed to improve the triage process and imperative to ensuring the waiting room is safe.

    Request this Article


    Implementation of Evidence Based Practice Education to Enhance Hand Hygiene Compliance

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Roberts, Ashley

    Background: Hand washing is the number one practice by nurses that can prevent the spread of infection. Proper hand washing and the understanding of this responsibility can improve patient care. The Joint Commission reported an overall 36% compliance in hand hygiene over the last three decades. The issue that every nurse is aware of the fact that hand washing it the most important intervention, but continues to dismiss this practice time after time. Evidence Based Framework: The formation of the project has been based on the Steven’s Ace Star Model. Through this framework, the problem has been identified, explored and an intervention has been chosen to create improvements through evidence based practice (EBP). Nightingale’s Environmental theory has been connected to this project to support the need for proper hand hygiene. Methods: Effort was made to increase compliance in hand hygiene, and implement evidence-based education to improve hand hygiene among nurses and other health care workers. With this effort, there has been a proposed plan for sustainability by continuing to employ frequent hand hygiene trainings at the health care facility. Findings: Findings reported from Infection Control reported an overall increase in awareness of proper hand hygiene. By using participants from the in service to monitor hand hygiene among nurses, new understand of proper hand hygiene was reported. More through grading was done and an increase in awareness of troubled areas that need to be targeted in all units found. Conclusion: Following the project, the conclusion can be drawn that awareness was increased from the intervention. By educating a small sample of nurse, word was spread and continued to filter throughout the facility. Other departments were made more aware of special areas such as hand hygiene pre and post patient contact that they had been suffering in and were not fully aware was included in hand hygiene.

    Request this Article


    Implementation of a School Suicide Prevention Program

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Russon, Sheila

    Background: In 2001, the U. S. Department of Health and Huan Services, National Strategy for Suicide Prevention, provided the first national program for suicide prevention and its specific call for evidence based practice to guide school based suicide prevention plans. In the 2013, the Utah legislature passed HB 154, Youth Suicide Prevention, requiring school districts and charter schools to implement a youth suicide prevention program for students in grades 7-12. School districts and charter schools shall require each licensed employee to complete two hours of professional development on youth suicide prevention within their license cycle. Evidence Based Practice Framework:The evidence based practice (EBP) model chosen for this scholarly project was the Rosswurm and Larrabee model. The model was selected to guide the process for change to evidence-based practice. The model represents principles of quality improvement, utilization of team-work, and evidence-based translation strategies to promote adoption of a new practice. The model is valuable in the systematic process of integrating evidence into practice at the individual level and served as the best evidence based practice model to provide structure for this project. Methods: The objective of this project was to offer and implementing a training program at a Utah high school that does not currently have a suicide prevention program in place. The project will be evaluated using a pre and post evaluation provided by the Question, Persuade, Refer, Gatekeeper representative. The pre and post evaluation measures the knowledge gained from the workshop. Findings/Results: Ten participants attended the training. The evaluation showed that all ten participants demonstrated an increase in knowledge, favorable attitudes, awareness, and help seeing behavior s following participation in this suicide prevention program. Conclusion/Recommendations: Teaching faculty, staff, and parents an EBP suicide prevention training has shown an increase in confidence to approach and identify a suicidal student. The training has been successful throughout many Utah high schools. It is recommended to combine the QPR Gatekeeper and Hope4Utah high schools. It is recommended to combine the QPR Gatekeeper and Hope4Utah programs due to both programs large success in schools.

    Request this Article


    Evaluation of an Implementation of a Formal Patient Education Process for an Aesthetic Medicine Practice

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Watts, Jennette

    Background: Patient education is a common feature for the preparation for many aesthetic procedures. Comprehensive pre-treatment patient education is fundamental for increasing perception of expectations required before the procedure, improved patient satisfaction and the reduction of complications. The Institute for Healthcare Improvement recongnizes that many complications could be prevented with proper patient education. The World Health Organization (WHO) focuses on improving knowledge of the healthcare team, using safety checklists to improve safety and communication, keeping records, and cultivating a team culture. Investing time in preparing patients for pretreatment enhances the consistency of information given, assests in eliminating information gaps, and prevents procedure related complications. Foreground: Patients undergoing aesthetic procedures need to be properly educated. Examination of the current patient education at the clinical site revealed that patients were unprepared for their procedure, causing frustration for patients and staff, reducing efficiency, and loss of revenue for the facility and the provider. When patients do not understand the potential complications, a greater propensity for patient dissatisfaction, frustration, and undesired outcomes exist. Patient education is an interdisciplinary team effort. The team cannot educate or empower their patients if they do not possess the skills or the ability to provide the instruction. The Project Director and the practice owner determined that an initial training in-service and an on-going education process related to procedure education for the patient needed to be developed and implemented. Evidence-Based Practice Framework: The Stevens Star Model of Knowledge Transformation provided the Evidence Based Practice framework. The organizational change model utilized was Kurt Lewin’s Change Theory. Jean Watson’s philosophy was the nursing model used to guide the elements of patient education and communication. Findings/Results: All team members affected by this practice change shall demonstrate and have annual documented competencies in this new patient education process. Conclusion/Recommendations: The results of this project concluded that the implementation of a patient education protocol had a positive impact on decreasing complications, improving patient satisfaction and improving productivity. The patient education protocol implemented was a multidisciplinary pre-treatment educational process with a checklist and a documentation tool. To accomplish this evidence-based practice change, the staff was educated in a consistent formal process for the aesthetic procedures at the facility.

    Request this Article


    Implementing Clinical Practice Guidelines for Patients with Chronic Kidney Disease

    Published Year: 2016
    Program: Doctor of Nursing Practice

    Winfrey, Stephanie

    Background: Chronic kidney disease (CKD) is becoming a global health concern. Uncontrolled hypertension (HTN) and diabetes mellitus (DM) are the leading causes of renal disease, resulting in a delay in proper intervention to prevent chronicity. Therefore, primary care providers (PCPs) need to use systematic evidence based clinical practice guidelines (CPGs) to delay renal progression. For this to occur, education awareness, medical nursing implementation of evidence-based guidelines in caring for patients with CKD is strongly encouraged. Kidney Disease Improving Global Outcomes (KDIGO) guidelines provide recommendations for PCPs to use in order to improve patient outcomes to make early referrals to nephrologists. Evidenc-Based Practice Framework: The Evidence-Based Model for Change developed by Rosswurm and Larrabee was chosen to guide the evidence-based practice change project. This framework supported the aim of the scholarly project: to educate PCPs the benefits of improving patient care to delay renal progression using the KDIGO guidelines in order to make early referrals to nephrologists. Methods: A chart audit from patient’s medical records was created to assess current referral practice from patients’ medical records. Shortly after the chart audit, the PCPs were asked to complete a questionnaire related to the use of CPGs and the use of KDIGO. After the questionnaire was completed, the PCPs were given an educational presentation to review the background of CKD and the benefits of implementing KDIGO guidelines. A second chart audit was conducted to ascertain if practice behaviors changed as noted by early referral ostensibly based on the guidelines. Results: The 19 PCPs in the practice all participated in the project and had varying ways in which they treated patients with CKD. Sixty-nine-percent of the providers were not aware of what or how CPGs guided their practice prior to the project and 31% were aware of both the CPGS and actively used KDIGO when making referrals. The second chart audit noted 90% of referrals made were guided by the KDIGO guidelines as patients were referred appropriate to nephrologists. Conclusion: The incidence of CKD is increasing and it has become a global concern. PCPs need to know their role is critical in the early evaluation and treatment of patients with CKD. More importantly, the use of KDIGO guidelines provides valuable evidence-based information to make early referrals and reduce the incidence and prevalence of the ESRD.

    Request this Article


2017

    Implementation and Evaluation of a Screening Tool for Early Delirium Detection

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Alexander, Jacquelyn

    Background: Delirium affects more than half of elderly hospitalized adults, with associated morbidity, mortality, increased length of hospital stay, higher than average hosptial costs, and poor outcomes. Despite the prevalence of delirium and associated hardships, delirium goes underdiagnosed, nationally. With the ever increasing aging population, hospitals and healthcare providers are challenged with this epidemiologic issue, requiring an evidence based approach to enhance the health and well-being of the older adults and preventing detrimental outcomes. EBP Framework: the Normalization Process Theory (NPT) and the Steven’s Star Model of Knowledge Transformation (SSMKT) model were selected to guide the implementation of the Short Confusion Assessment Method (CAM-S) tool in the acute care setting. The purpose of the project was to implement this CAM-S tool to answer the clinical question, “Will implementing the CAM-S instrument, on the orthopedic/neuology unit, among all nurses caring for hip fracture patients, as compared to no instrument, increase the number of patients detected with delirium in 30 days? Secondary data points included pre/post tool implementation length of stay (LOS), fall rates, and admission to skills nursing facility (SNF). Methods: Pre-intervention information established nurse knowledge/attitude disconnect regarding delirium and a poor geriatric care environment. The goal of the project was to evaluate the efficacy of implementing a delirium screening tool compared to no screening tool, in identifying more geriatric hip fracture patients with delirium, consistently and earlier. Post tool implementation, evaluated over 30 and 60-days, appraised the following measurements: hip fractures, 65 and older, incidence of delirium, falls, average LOS, discharge to SNF, CAM-S assessment used, CAM-S assessment score. Additionally, post tests and surveys were used to evaluate nurses’ knowledge of delirium and CAM-S’ feasibility of use. Finding/Results: The results of this project demonstrated an increase in delirium diagnoses and decreases in discharges to SNF and fall rates among all hip fracture patients, 65 and older. Post tool survey and test demonstrated nurses found the tool easy to use and recommended it for further use; however, further education on delirium symptoms need to be employed to enhance CAM-S use knowledge and interrater reliability. Conclusion/Recommendation: Delirium is a common and serious acute neuropsychiatric syndrome with core features of inattention and global cognitive dysfunction. If detection is delayed, the trajectory of the condition is detrimental. Implementing the CAM-S delirium tool helps nurses identify delirium sooner than without a tool proving profound benefits towards timely diagnosis of an interventions for delirium, preventing further devastation.

    Request this Article


    Implementation of Early Mobilization of Mechanically Ventilated Patients in the ICU

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Brown, Toni

    Background: Inactivity and immobility in critical care can result in medical complications, many of which prolong hospital stays and increase the time it takes for a patient to return to previous functional status. Neuromuscular weakness has been associated with prolonged ventilation time, increased hospital and intensive care unit (ICU) stays, and poor quality of life for survivors. The American Association of Critical Care Nurses, AACN, has recognized the association between immobility and poor patient outcomes. Promoting early mobilization of ventilated patients can decrease complications like weakness and poor rehabilitation potential. The purpose of this project was to improve identification of patients who may benefit from early mobilization thus shortening the time interval from intubation to initiation of mobility. EBP Framework: The Steven’s Star Model of Knowledge Transformation was utilized in this project. Application of the model ensured that evidence-based methods were adopted in order for staff to adopt the AACN progressive early mobilization protocol within the medical intensive care. Adoption of Dorothy Orem’s Self-care Deficit model was used to promote the delivery of care to patients allowing staff to restore patients’ self-care practices in regards to mobility. Methods: The project began with retrospective data collection. Comparison of this data was used to analyze outcomes. Steven’s model was used to guide the methodology of integration. Findings/Results: The outcomes analyzed were: time interval for initiation of mobilization, successful implementation of protocol, and incidences of mobilization activities performed with intubated patients. Initiating the protocol resulted with a significantly shorter time period for mobilization to become initiated. This project showed a successful protocol implementation rate of 90.9%. There was not a statistically significant increase in the amount of mobilization activities performed with intubated patients. Conclusion/Recommendations: Project findings indicated a correlation between initiating a protocol and a shorten time interval for mobilization to occur; this mobilization protocol created earlier mobilization for intubated patients. The protocol produced an increase in the incidences of mobilization activities, however, there was no statistical significant increase when compared to baseline data. The sustainability of this project requires that champions continue to work within the interdisciplinary team to promote mobilization for this patient population. Further studies need to be done with a larger sample size to obtain more accurate results.

    Request this Article


    Assessing Medication Adherence in Patients with a Diagnosis of Depression Utilizing the Ask 20 Barrier Adherence Survey

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Burkett, Evanna C.

    Background: Depression has the potential to negatively effect quality of life. Medication non-adherence is a common emerging concern in healthcare contributing to poor outcomes. Patients with mental illness may require additional observation, direction, information, and investigation. Reiterating the importance of routine follow-up visits and compliance with recommended medication regimen can promote positive outcomes. This is an important topic as according to the Centers for Disease Control and Prevention individuals ages 15 to 24 are at an increased risk of committing suicide even more specifically individuals ages 18 to 24. Evidence-Based Framework: The Iowa model was utilized as the Evidence-Based Practice Framework. The identified clinical issue is assessing medication non-adherence in patients with diagnoses of depression. The information will be assessed at a state organization, North Carolina A&T State University over a four-week timeframe utilizing the Ask 20 Adherence Barrier Survey. IRB approval was retrieved at North Carolina Agricultural and Technical State University and Rocky Mountain University of Health Professions. This topic is a priority in my field as high rates of suicide and psychiatric hospitalizations are associated with depression. The team consists of the project manager, my clinical faculty, and my clinical mentor. There is a high level of consistency with utilization of the Ask 20 Adherence Barrier Survey and there are no risks associated with utilization of this survey. There is sufficient evidence and mutliple studies that indicate that this project is necessary and beneficial. Method: The Ask 20 Adherence Barrier Survey tool was transferred to papaer, patients responded accordingly, thereafter the information was manually entered into the Survey Monkey database. Common barriers were identified, assessed, and documented with a greater score indicating greater barriers to adherence. Given the results, adding a tool such as the Ask 20 Adherence Barrier Survey quarterly to patients taking anti-depressant medications is recommended or an alternative tool to determine variances to barriers to medication non-adherence. Findings: The implementation of the Ask 20 Barrier Adherence Survey at NCA&TSU communicated the most common barriers to medication adherence at this institution. The most common barrier were patients forgetting to take their medications, forgetting things in general, and patients experiencing feelings of sadness or depression. Conclusions/Recommendations: Based upon the findings of this project use of an effective survey tool will identify known barriers for patients that are presently taking anti-depressant medications. Identified barriers will assist clinicians and other members of the healthcare team address and reduce barriers associated with medication adherence. Increasing knowledge of medication adherence will decrease morbidity and mortality rates, decrease psychiatric hospitalizations, and increase knowledge of the mechanism of action of medications.

    Request this Article


    Implementation of Multidisciplinary Patient Heart Failure Education

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Celani, Kindra Backman

    Background: Heart Failure (HF) is responsible for more than one million hospitalizations each year with a related cost of thirty billion dollars in the United States alone. Additionally, patients with HF who are hospitalized have a 25% chance of being readmitted within 30 days of discharge. The complexities and challenges of managing HF increase the risk of hospitalization and subsequent readmission to the hospital for patients with a HF diagnosis. Foreground: In the southwest (SW) region of Utah, there is a large elderly, retired and snowbird population. The SW region has one level 2-trauma center hospital with excellent cardiovascular services and the readmission rate at this facility is comparable to the national average. The facility utilizes a HF education program called MAWDS, an acronym for Medication, Activity, Weight, Diet, and Symptoms, documented only once by the registered nurse (RN). EBP Framework: The Iowa Model of Evidence-Based Practice and Merle Mishel’s Theory of Uncertainty in Illness guide the implementation of this clinical improvement project. The Iowa Model promotes the use of research to guide practice change decisions, facilitate problem identification, and development of solutions. The Theory of Uncertainty in Illness recognizes the importance of reducing uncertainty in all patients, especially patients with chronic illness. Methods: The objective of this project was to utilize the multidisciplinary team to provide and document HF education. This change was compared to the current method of HF education. The outcome measure data identified the difference in the number of patient HF education occurrences pre and post implementation. Findings & Results: The literature identifies poor care coordination, incomplete or ineffective discharge planning and education, poor recognition of symptoms, and confusion about medications as factors associated with high rates of hospital readmissions. Thorough multidisciplinary education and effective evaluation of patient understanding is critical to assess the patient’s motivation, ability to manage medications, keep follow-up appointments, participate in self-care, and monitor for signs and symptoms of worsening HF. Conclusion & Recommendations: A multidisciplinary approach to patient education increases the number of occurrences of education and opportunities to assess patient status by multiple disciplines. Multidisciplinary patient HF education is recommended to provide manageable amounts of information to promote patient comprehension.

    Request this Article


    Education on Safe Opioid Prescribing Guidelines for Acute and Chronic Pain in an Acute Care Setting

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Chou, Kristen A.

    Background: In the last decade, death rates associated with opiod pain medication have increased, with approximately 420,000 emergency department (ED) visits in 2011 related to misuse or abuse of narcotic pain relievers. In 2013, nearly 1.9 million individuals abused or were dependent on prescription opiod medication alone. National guidelines recommend methods for the assessment and treatment of acute and chronic pain in acute care settings, including routinely checking state Prescription Drug Monitoring Programs (PDMPs) for patients on controlled medications, and use of an abuse risk screening tool. An internal review of an urban Emergency Deparment found no standardized opiod prescribing guidelines for acute or chronic pain, and infrequent prescriber access of state PDMPs when prescribing controlled medications such as schedule II drugs. Framework: The purpose of this project was to educate ED providers on national guidelines for the prescribing of opiods, treatment of acute and chronic non-cancer back pain, and routine use of PDMPs when prescribing controlled medications. The system change involved educating prescribers on use of the Diagnosis, Intractability, Risk, and Efficacy (DIRE) tool, national guidelines for the assessment and treatment of acute and chronic back pain with routine use of PDMPs in the ED. This change process applied the Iowa Model of Evidence-Based Practice (EBP) and Rogers’ Diffusion of Innovations theory. Methods: For the purpose of this project, the desired outcomes were increased prescriber utilization of state PDMP, resulting in opiod prescriptions for qualifying patients per recommendations from published guidelines and patient DIRE score in chronic pain patients. Measured outcomes included documented PDMP review prior to opiod prescription, documented DIRE score for chronic pain patients, and treatment per guidelines recommendations for acute and chonic pain before and after provider education. Chart review of relevant encounters provided data on changes in prescriber behaviors after the intervention. Findings: A guided chart review identified encounters in which participating providers saw patiens for acute and chronic back pain. A Chi-square analysis was performed on two classes of medications which showed significant changes pre and post intervention. Providers frequently treated according to guideline recommendations for opiod prescriptions, though did not document PDMP review. No patients were seen for chronic back pain, therefore no documentation of the DIRE tool was indicated. Conclusion: Significant changes in prescriptions of non-steroidal anti-inflammatories and muscle relaxers were noted after provider education, though no change was noted in PDMP review. Future studies should focus on expanding provider involvement and greater study duration in order to capture significance. Multiple national agencies have developed EBP recommendation to guide prescribers toward safe and evidence-based prescription of opiods for acute and chronic non-cancer pain. Evidence suggests these methods will reduce abuse, misuse, and overdose-related death.

    Request this Article


    Streamlining the Process of Physical Activity Assessment and the Associated Physical Activity Prescriptions, Consults, and Education in the Primary Care Setting

    Published Year: 2017
    Program: Doctor of Nursing Practice

    De Jesus, Michael Roy D.

    Background: Physical activity is a significant aspect of promoting health and preventing diseases. It is one of the modifiable risk factors in managing chronic diseases such as obesity, diabetes, hypercholesterolemia, and hypertension. The Centers for Disease Control and Prevention recommends older adults to do at least two and a half hours of moderate-intensity aerobic activity and at least two or more days of muscle-strengthening activities every week. Routine engagement in physical activity is a significant part of health aging. The aims of this scholarly project were to implement a physical activity assessment tool and identify its effects on the rate of physical activity promotion among older adults in the primary care setting. Evidence-Based Practice Framework: The Stevens Star Model of Knowledge Transformation was the evidence-based practice model that was used to implementn this scholarly project. The theoretical framework for this scholarly project was the Theory of Reasoned Action. Methods: The design of the study was a pre- and post-design. Before the scholarly project implementation, the project leader conducted a one-on-one education on the proper use, scoring and interpretation of the RAPA Questionnaire with the primary care providers and their medical assistants. The project leader conducted the data gathering regarding the rate of physical activity promotions before and after the study. The data collection method was from the review of the primary care provider’s charting within the patient’s electronic health record. Findings: the data gathering was done pre- and post-implementation of the scholarly project. The total number of older adults seen one month before implementation was about 231 and 261 older adults were seen one month after the scholarly project implementation. The data gathered consisted of the rate of physical activity assessment and education, gender, and race. Chi-square test was conducted to analyze the available data. The patient demographics such as age, gender, and race did not have any significant differences between the pre- and post-implementation groups which mean that the samples were comparable. The rate of physical activity promotion increased from 27.3% to 46.5%. The pre- and post-implementation of physical activity promotion by the primary care providers showed a statistically significant difference with a P value of <0.001. Conclusion: Physical activityy has positive effects in maintaining health and preventing diseases. The utilization of a physical activity assessment tool within the primary care setting has a significant influence in the physical activity promotion by primary care providers.

    Request this Article


    Implementation of Text Message Appointment Reminder System to Reduce Missed Healthcare Appointment at Outpatient Clinic

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Ebuh, Georgette M.

    Background: Missed appointments at outpatient clinics are a significant problem inherent in local and regional healthcare systems in the United States, as well as globally. The outcome is costly to organizations and burdensome on organizational productivity, the healthcare system, and poor patient outcomes. The use of text message appointment reminders potentially offers a cost-effective and time-efficient strategy to decrease missed appointments, thus, improving the efficiency of outpatient healthcare delivery. Evidence-Based Framework: The organization change at the outpatient community clinic was to implement the use of a text messaging appointment reminder system in an attempt to reduce missed appointment rate. The Health Belief Model and the IOWA Model were used as theory and evidence-based practice model respectively for the development of the project. Method: The objectives of the project were: (1) to impement a text message reminder system to reduce missed appointments; (2) to maintain the standard practice of patient reminders using telephone calls; (3) and to reduce lost revenue from missed appointments. The goal of the project was to reduce the number of missed appointments at the outpatient community clinic. Evaluation was accomplished through comparing missed appointment rate during the text message implementation period with the missed appointment rate during the same period in the previous year. Data was collected using a self-developed data collection tool. The results of the project will be use to demonstrate the impact text messaging has on appointment attendance. Recent literature has provided evidence that text message reminders to patient care are effective in reducing missed appointment rate in outpatient clinics. Findings: The implementation of text messages to remind patients of their healthcare appointment reduced missed appointments to 1.94%, compared to 19.12% during the same time period in the previous year when text messaging was not used. Conclusions/Recommendations: Based on the findings of this quality improvement project, use of a text messaging reminder system is suggested in outpatient settings. Recommendations include: the clinic should consider the use of an automated text message system to help reduce staff workload, burnout and reduce human errors. Areas for future study: extend study to verify the impact of text message reminder system on missed appointments for a longer period of time, compare different populations and missed appointments, financial benefits and costs to the clinic and to the patient. An additional recommendation would be to focus on patient satisfaction rates.

    Request this Article


    Improving Nurse-Provider Communication

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Ezebuilo-Ukachukwu, Ifeoma

    Miscommunication or omission of critical patient information contributes to preventable medical errors that result in 98,000 patient deaths each year. Hand-off communication process are noted as major contributors to patient safety. Improved patient care outcomes have been demonstrated by implementation of a standardized hand-off communication tool. Standardized tools that are valid and reliable are available for use, but are only effective when consistently implemented. The Situation Background Assessment Recommendation (SBAR) communication tool is designed to improve the communication between nurses and other health care providers. Internal audits have demonstrated that some of the delay in treatment and unnecessary hospitalization was due to inappropriate communication in the nursing home. The SBAR change project employed Rosswurm and Larrabee’s Model of Evidence-Based Change to train the nurses on the process of the evidence-based practice SBAR implementation. The whole process was facilitated and assessed by Rogers Diffusion of Innovation Change Theory. The project measured outcome determined that the workshop increased the nursing staff awareness and knowledge in the importance of use of SBAR during acute patient change in condition and in nurse-provider communication. The Situation, Background, Assessment, and Recommendation Knowledge Acquisition Quiz (SBARKAQ) is a 10-item questionnaire that has been demonstrated to be valid and reliable with Cronbach alpha of 0.75. Participants in the project completed the pretest before receiving the education on SBAR. This enabled pre- and post education scores to be compared for statistical difference using the Paired Samples t test. In conclusion, it is vital that the information exchanged during nurse-physician interaction is concise, clear, and adequate to ensure the continuity of care. Because nurse-physician report has been identified as ineffective due to unsuccessful communication methods, limitations of time to share information, and the inability to know if the information exchanged was understood by the receiver, implementing the SBAR format tool demonstrated clinical significance for use during nurse provider communication after hours. This proposed change project, once sustained, will improve patient outcome and decrease healthcare expenses.

    Request this Article


    Improving Hand Hygiene Compliance in a Psychiatric Extended Observation Unit Facility

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Fuentes, Carlos

    Healthcare-associated infections (HAIs) have been among the leading threats to patient safety, affected one out of every 25 patients. More than 1.7 million patients acquired hospital infections, resulting in some 99,000 deaths annually. HAIs were responsible for adding billions of dollars to health care costs. Fortunately, most HAIs are preventable. The Centers for Disease Control and Prevention and World Health Orgranization recognize proper hand hygiene as a primary means of preventing HAI. Unfortunately, compliance rates of less than 50% of basic hand hygiene practices were woefully low. HH is the task that healthcare workers perform the most throughout daily activities of patient care. HCWs, such as nurses, provide the most interactions with patients. Therefore, cross-contamination was considered more highly transmitted by nurses than by any other HCWs. All personnel working on a unit/floor in the hospital or healthcare setting can be a mode of transmission for contributing to nosocomial infections. The single most important deterrent from HAIs is avoidance through practicing HH. This project will be guided by the evidence-based practice, the Advancing Research and Clinical practice through close Collaboration model an Kurt Lewin’s “Change Theory” model to translate EBP into the standard of care. The objectives for this project are to establish a baseline readiness for embracing principles of EBP from the staff employed in the psychiatric extended observation unit facility and to observe and describe changes to HH practices pre- and post-implementation of a 90-minute evidence based HH in-service that reinforces the World Health Organization’s 5-points of care. There is limited evidence on hand hygiene practices in psychiatric settings. Therefore, the benefit of this Doctorate of Nursing Practice (DNP) project is to increase the knowledge of HH practices and raise awareness of the HH practices within psychiatric employees.

    Request this Article


    An Evidence-Based Quality Improvement Approach to Compassion Fatigue in Critical Care Nurses

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Jones, Vivian Danita

    Background: Compassion fatigue (CF) is the cumulative physical, emotional and psychological effect of exposure to traumatic scenarios or events when working in a helping profession. Critical care nurses are at high risk for burnout and stress as evidenced by call-in days, use of employee assistance programs, turnover rates. Compassion fatigue has been shown to lead to negative outcomes such as 1) burnout, 2) turnover, 3) substance use or abuse, 4) compulsivity, and 5) dissatisfaction. Evidence-Bases Practice Framework: Jean Watson’s Philosophy and Science of Caring Model and her Caritas Processes served as the basis and model of the unit’s transformation towards staff’s professional satisfaction. The ACE Star Model of Knowledge Transformation operates as the guidance to the restorative effect to achieve with the project to combat CF. Permissions were granted to use these models. Methods: The purpose of this project was to create a departmental evironment of nurturing and caring practices leading to improved role satisfaction for nurses, improved quality of patient care, and enhancement of the department’s overall nursing practice environment. The Professional Quality of Life, version 5 (ProQOL5) questionnaire was used to identify the presence of CF among nurses in a surgical intensive care unit. Participants were asked to attend two informatl educational, debriefing sessions as a focus group and complete the questionnaire after attendance to reassess if the education on CF was effective in combatting CF and increasing compassion satisfaction. Permission was granted to use the PRoQOL5. Findings/Results: To test whether there was statistical significance between pre- and post- educational sessions, a one-tailed paired t test, alpha equal to 0.05 as criterion for sigificance was used for statistical analysis. Statistical significance was demonstrated between the test scores for compassion satisfaction and burnout. There was no statistical significance demonstrated between the test scores for secondary traumatic stress. Conclusion: Health care providers may not recognize CF as well as perceived, implying the need for education directed toward the recognition and management of CF. Educational and meaningful recognition help combat CF by offering a solution to lessen the damaging effect, all the while increasing professional satisfaction. Sacco, Ciurzynski, Harvey, and Ingersoll claimed that professional satisfaction, confidence and empowerment reflect in enhanced patient care and improved healthcare outcomes.

    Request this Article


    Reducing Transfer Times of Patients Admitted to the Intensive Care Unit From the Emergency Department

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Montgomery, Kelsie

    Background: Communication failure between healthcare providers is the leading cause of sentinel events. To emphasize the critical need to improve such communication, TJC cited improving effectiveness of communication as one of the National Patient Safety Goals. Handoff tools have been used to improve communication, however, in its review TJC found that over 1/3 of patient handoff tools that are currently used are defective. Foreground: Currently, transfer times have been reported to be delayed at the facility. Currently no standardized handoff tool exists for critically ill patients being admitted to the intensive care unit (ICU) from the emergency department (ED). EBP Framework: Rosswurm and Larrabee’s EBP model was used to guide the project in conjunction with Battey’s Humanizing Nursing Communication Theory and Ethics of Humanizing Nursing Communication. Methods: The project manager held an educational in-service for staff of the ED and ICU to educate about the revised hand off tool that was implemented. Data was collected prior to implementation on current transfer times through TeleTracking, the patient tracking software in place at the facility. The revised transfer tool was implemented for one month. During the month, times were tracked weekly and at the end of one month time. An overall comparison was done to evaluate effectiveness off the handoff tool. Results were disseminated to staff during regularly scheduled staff meetings. Feedback was gathered at that time from participants and anonymously via a suggestion box. Data was analyzed with the help of clinical mentor. Results: The baseline data, with a sample size of 963 admissions, had a mean transfer time of 1:33 (HH:MM). During the project implementation period there were 202 admissions which ended having an average time of 1:45, a 12 minute increase from the baseline sample. When looking at the data by week, the times decrease from week 1 compared to week 4. Using MiniTab statistical software to compare week 1 times to week 4, no statistical difference was noted between the transfer times in week 1 and those in week 4. While no statistical difference was noted, clinical significance was noted in comments from participants. Conclusion: The implementation of the hand off tool did not decrease transfer times. Feedback gathered from the nursing staff included comments that the handoff report went more smoothly, less clarifying questions had to be asked, all pertinent information was given during the handoff, and the verbal report was more organized.

    Request this Article


    Implementation of the Geriatric Depression Scale in a Clinic

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Okpala, Henrietta

    Background Depression is a serious public health concern across the lifespan especially in the elderly. Depression is a chronic condition, often with poor outcomes and high costs. Older people are at great risk of being depressed due to their predisposition to chronic health problems (CDC, 2015). Collaboration between primary care physicians (PCP) and psychiatrists in detecting elder depression is crucial. The American Psychiatric Association Practice Guidelines for the Treatment of Patients With Major Depressive Disorder; 3rd edition (2010), provide information for PCP’s regarding screening for depression among the elderly that present to the medical clinic. Five to ten percent of the elderly adults over sixty-five years in primary care suffer from depression (CDC, 2015). This figure includes between 10 to 20 percent of those who already have chronic medical conditions. The purpose of this project is to provide useful information about the Geriatric Depression Scale (Sheik & Yesavage, 1986) and educate medical practitioners at a medical clinic, so that they will adopt the scale in their assessment and diagnosis of elderly patients with depression. In 2011 alone, there was an increase from 51% to 64% of depressed patients seen in primary care. Elder suicide carries with it multiple risks such as physical illness, inability to function in daily life, fear of becoming burden, and social isolation. These risks underscore the importance of medical providers making early diagnosis of elder depression with an effective tool. Rosswurm and Larrabee’s (1999) Model of Evidence-Based Practice was used as the theoretical guide for this project. Methods included identifying the need for accurate and timely depression assessment of elderly patients in a clinical setting. Outcomes included the incorporation of the GDS tool in the overall assessment of elder patients in the clinic where the project was conducted. Findings indicated that of the fifty elderly assessed with the GDS during this project, 12 (24%) met requirements for a diagnosis of depression, which had been previously overlooked. In other words, these patients’ depression was not originally detected in their original general assessment. With early assessment for depression, the elderly can achieve a better quality of life and avoid the overall worsening of any comorbid illness due to an undetected and therefore untreated depression. This author concluded that all three objective of the study were met; namely, a) education and increased knowledge of participants about elder depression and its consequences; b) use of the General Depression Scale (GDS) to assess a sample of 50 elders for depression in the project clinic; and, c) adoption of the GDS by the project medical director as the elder depression assessment going forward.

    Request this Article


    Postpartum Depression Screening Program

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Peter, Esther Ogechi

    According to the results of a national survey of practices of public health nurses, 98% provide a new birth visit and of that, only 73% screen and treat postpartum women for depression as a part of their practice. When Postpartum Depression (PPD) goes undiagnosed, the ability of the mother to parents and bond with the baby can be severely undermined. Undiagnosed PPD can have long-term negative effects on the entire family. Besides affecting maternal wellbeing, PPD can have an impact on the healthy cognitive and emotional development of an infant. The scholarly project practice setting was an Obstetrics and Gynecology (OB/GYN) clinic at Harris County, located in the rural area of Houston, Texas. The setting did not have, or previously use any PPD screening tool to screen postpartum women prior to this project. No previous educational workshop was conducted for any screening tool or testing for PPD in this practice setting prior to this project. A needs assessment showed a higher likelihood of undiagnosed PPD as no assessment tool was utilized by Family Nurse Practitioners (FNPs) in an OB/GYN setting. The purpose of this project was to provide the FNPs at the OB/GYN clinic with improved knowledge of PPD screening with use of screening tools, and education resources to enhance their compliance to screen for PPD. Identifying the suitable intervention mechanisms to detect PPD early necessitates knowledge improvement improvement among the FNPs at Harris County OB/GYN for early routine PPD screening. Specifically, the use of educational workshop to improve knowledge deficit improvement in screening PPD using Beck’s Postpartum Depression Screening Scale (PDSS) was assessed, in addition to evaluating the studies that highlight the importance of PPD depression screening. A pretest and posttest questionnaire, developed by the project manager, was used during the workshop for the evaluation of knowledge improvement of PPD and the use of PPD screening tool knowledge by the FNPs at OB/GYN clinic in Harris County. The Stevens Star Model of Knowledge Transformation offers a framework for knowledge transformation to achieve evidence-based practice, and the five processes in this model were utilized with this scholarly project development. The Kurt Lewin Change Theory was chosen to guide this scholarly project. Lewin’s Change Theory is the theoretical framework that concentrates on the strains of organizational change. The project manager performed evaluation of knowledge deficit at baseline, and knowledge change at 6 to 8 weeks after the FNPs attended the one-hour educational workshop for reduction in deficit. Descriptive statistics methodology was utilized to determine effectiveness. Findings suggest positive changes among FNPs in relation to use of the PDSS screening tool, and PPD screening awareness.

    Request this Article


    Evaluation of Acknowledge, Introduce, Duration, Explain, and Thank You Communication Strategy

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Peterson, Thomas

    Background: The public reporting of healthcare statistical data is becoming an accepted way of improving quality. Patient satisfaction has been prominent in the United States for more than ten years and has been a prominent feature of the British health system reform. While the products of reporting have varied, this comparative information is becoming an important quality improvement instrument in most developed developed countries. The facility has seen a decrease in HCAHPS scores and implemented a quality improvement initiative to address these concerns. The focus of healthcare is changing and healthcare organizations will have to adapt to survive. EBP Framework: The evidence based framework that guided this capstone project is Rosswurm and Larrabee’s Change to Evidence-Based Practice. This model guides the project through the six-steps of change to evidence based practice. The six steps: Assess, Link, Synthesize, Design, Implement/Evaluate, and Integrate/Maintain were crucial for this project. The theory for this project was Kurt Lewin’s change theory. The unfreezing, change, and refreezing of the status quo provided a successful strategy. The three stages of the theory redirects staff from counter-productive patterns, engages in thoughts/attitudes about new practices, better productive patterns, and establishes the new pattern as the norm. Methods: The evaluation involved the nursing staff and their understanding and buy in of evidence based practice. This two-phase process occurred over a thirty-day period in 2017. Phase 1 was a reinforcement of the AIDET process via and in-service in the employee breakroom. Phase 2 involved staff completing a questionnaire that consist of staff responses to use of AIDET and an evidence based practice attitude scale that measures attitudes about the use of evidence based research to change practice. Findings: The findings showed that the staff performed AIDET with all patients and were receptive to using evidence-based practice to change how they communicate with patients. To improve quality nurses at the bedside the nurse will need to change how they communicate to patients. The comparison of HCAHPS scores from 2015 to 2016 show an increase in patients satisfaction in relation to communication, Further research is needed in the area of individual application of AIDET. Conclusions/Recommendations: The Affordable Care Act has changed healthcare from a pay service to a pay for performance and patient satisfaction will continue to be a changeable metric facilities and staff can do at the bedside. The improvement of communication in the ED can reduce the stress and improve patient outcomes. There needs to be more research into the application of AIDET on an individual patient basis.

    Request this Article


    Assessment of Celiac Disease in Primary Care

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Walker, Kelly Mason

    Background: Celiac Disease (CD) affects at least 3 million American and is now recognized as one of the most common lifelong disorders in Europe and the United States, with fourfold increased prevalence since 1950 in the U.S. 1 in 100 adults, and 1 in 80 children have celiac disease. CD is an immune-mediated genetic disease that causes small intestine enteropathy, which prevents nutition absorption. Classic characteristics of CD include diarrhea, abdominal pain and bloating. Primary care providers nationwide are unfamiliar with atypical CD because the signs and symptoms are often vague, and CD is not thought of as a potential diagnosis until a patient has suffered more severe complications. Undiagnosed celiac disease is a major cause of non-Hodgkin’s lymphoma. Most primary care providers recognize typical signs and symptoms of CD, but often were not as familiar with atypical or latent CD. CD has diverse presentations, ranging from malabsorption to fatigue to depression. EBP Framework: The Consolidated Framework for Implementation Research (CFIR) theory and the Johns Hopkins Nursing Evidence Based Practice (JHNEBP) model were selected to guide implementation of the “What is You Celiac Score” assessment tool into primary practice. The project is to implement this assessment tool to answer the clinical question, “will providers, using the “What is you Celiac Score” questionnaire, compared to no questionnaire, identify more patients with possible CD, to refer for testing, over a four-week period.” Methods: Retrospective chart reivew pre-intervention established that providers refer patients for CD testing based on signs and symptoms typically associated with classic CD. Providers were then educated on signs and symptoms of latent and atypical CD and a CD assessment tool was implemented to identify patients for testing. Providers were asked to use the tool when assessing patients, and at the end of the 4-week implementation period, data was collected and analyzed for efficacy of the screening tool, compared to clinical expertise alone, in identifying more patients, consistently and earlier. Findings/Results: Pre-intervention, nine patients out of approximately 7000 were assessed for CD, five were diagnosed with CD. Eighty-percent of those diagnosed with CD has a cancer diagnosis first. Post-intervention, sixteen out of approximately 600 patients were assessed for CD, seven were diagnosed and none had a cancer diagnosis before CD. Conclusion/Recommendations: Signs and symptoms of CD can often overlap with other conditions and it is vital that primary care providers and other providers learn about the multiple ways in which CD can present and have a heightened suspicion among patient populations. A CD tool helped providers streamline assessment and referral for CD testing.

    Request this Article


    Improving Nursing Documentation While Emphasizing the Importance of Comprehensive Charting on the Removal of Intravascular Devices: A Quality Improvement DNP Project

    Published Year: 2017
    Program: Doctor of Nursing Practice

    Wells, Carly Jane

    Background: Healthcare documentation not only allows for communication among healthcare providers and maintains patient care record keeping, it also archives essential information used to track, evaluate, and consider valuable healthcare interventions. When documented properly, this information can be used in research to assess international and national healthcare topics like standards of care, quality of care, complication and infection rates, and many more. When documentation is not complete ad comprehensive, a false representation can be made and a patient’s safety is at risk. The American Nurse Association suggests nursing documentation be clear, accurate, complete, and accessible, allowing nurses to be responsible and held accountable for their documentation. Foreground: The inpatient unit of interest for this project, like many other hospital units, demands several hours of direct patient care, potentially leaving little time for complete documentation. As a consequence, documenting on important aspects of a patient’s record, like the removal of any intravenous device (IVD), are missed or incomplete. When these pieces of information are missing, opportunities to provide accurate data regarding patients, fall short. Therefore, it was this project’s objective to influence staff nurses to be as comprehensive as possible when documenting overall, and to see an improvement on the removal of any IVD documentation after providing an educational in-service. Theoretical and EBP Support: Lewin’s Change Theory served as a supporting component in influencing and guiding the nurses of interest, transforming their care and making it a standard of practice when documenting on the removal of IVDs. In supporting this project’s development, the Johns Hopkins Nursing Evidence-Based-Practice (EBP) Model served as guiding feature in the specific steps of EBP in nursing. Methods: Once both Institutional Review Boards granted approval for this Quality Improvement project, chart audits were performed within a three-week time frame pre- and post- nurse in-service. The provided in-service was given to staff nurses, float pool nurses, and nursing students over an 11-day period. The in-service included pertinent aspects of documentation, steps to improve current practice, which was supported by current evidence, and time for discussion regarding potential barriers to complete documentation. Findings: A clinically significant improvement of 11% was seen in comprehensive documentation on the removal of IVDs on a specific surgical patient population. The findings of this project predictively aligned with literature that supports the use of health information technology, like the electronic health record, were data are accurately and efficiently collected, which can be used to generate knowledge that leads to improved outcomes. Although the practice improvement was seen in a limited amount of time, the direction was progressive, foretelling beneficial outcomes when these kinds of quality improvement projects are implemented.

    Request this Article


2018

    Impact of Therapeutic Lifestyle Changes to Reduce Cardiovascular Risk Factors in Firefighters

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Burden, Diana Marie

    Elevated total cholesterol (TC) is a major cause of disease burden in both the developed and developing world as a risk factor for cardiovascular disease (CVD). Globally, a third of ischemic heart disease is attributable to elevated cholesterol. The 2008 global prevalence of elevated cholesterol among adults was 39%. Overall, elevated cholesterol is estimated to cause 2.6 million deaths. Behavior changes are the cornerstone for treatment of hyperlipidemia. Evidence-based practice (EBP), along with nursing thepry, provides a foundation of care that proven to assist individuals with long-term lifestyle changes. Pender’s Health Promotion Model (HPM) first appeared in nursing literature in 1982. The purpose fo the model is to assist nurses in understanding the major determinants of health behaviors as a basis for behavioral education to promote healthy lifestyles. The use of EBP models supports the implementation of making practice changes within an organization. EBP models help to provide an organized approach to implementation, improve the use of resources, and facilitate evaluation of outcomes. The Academic Center for Evidence-Based Practice (ACE) developed the ACE Star Model as an interdisciplinary strategy for transferring knowledge into nursing and health care practice. This model has been successfully used in clinical and academic settings.

    Request this Article


    Evaluation of the Effectiveness of Interpersonal Communication and Relationship Enhancement Program (I*care) Using End-of-Life Professional Caregiver Survey

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Chepkwony, Abdi

    Background (global significance of problem): End-of-life (EOL) care is a global problem affecting 85% of the population. 56 million deaths occur worldwide each year. In the United States of America, the EOL care cost is about 10-12% of all healthcare spending. According to the Insititute of Medicine (IOM), a surprising number of patients with life-threatening and chronic illnesses receive curative treatment in the last week of their lives. Being in touch with our mortality helps us to prepare for EOL. Evaluating end of life programs that foster provider’s education is essential in improving patient quality of life during dying and bridging patient-provider’s relationship. Foreground (local significance): Each patient’s journey at EOL is unique. In the United States, 63% of Americans die in the hospitals. 80% of Americans prefer to die at home. Initiating a program that effectively addresses EOL discussion and equip providers with the knowledge and skills to communicate with patients during EOL can significantly improve patient quality of life during dying. EBP Framework: The Lewin’s theory guided the project. The theory prepares the institution to accept the need for change, make changes, and institutionalize the changes. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model guided implementation of the project. The ARCC model conceptual framework allowed successful system-wide implementation and sustainability of Evidence Based Practice (EBP) in the clinic. Methods (objectives, outcomes, evaluation): The initial project objective was set to educate providers on end of life teaching at MD Anderson Cancer Center. A need for an effective EOL provider education was identified after careful review and inter-department consultations. The project evaluated effectiveness of interpersonal communication and relationship enhancement program using the End-of-Life Professional Caregiver Survey (EPCS). The ARCC model guided implementation of the project. Findings/Results (as compared to the literature): 20 healthcare providers in unit were recruited and given educated on end of life communication and relationship enhancement using ICARE curriculum. EPCS survey indicated that provider’s skills in addressing EOL care improved after the education was provided. Compared to literature, similar results suggest improved patient quality of life with improved provider’s education addressing EOL care. Conclusion/Recommendation: The review of the literature showed that there is as strong relationship between provder’s EOL care education and patient quality of life outcomes at EOL. ICARE program topics focus on improving provider’s communication skills, ethical, cultural, societal expectations. Literature indicated that patient’s expectations relied on the provider’s knowledge to discuss EOL planning for the critically ill patients during admission and after discharge.

    Request this Article


    The Effect of Preprocedure Education on After Care for Nexpanon Implantation

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Diaz Leo, Jose

    Background: Undergoing a surgical procedure may cause high anxiety levels. It is believed that the anxiety levels rise in anticipation to bodily harm and possibility of experiencing pain after the surgical procedure. In addition to stress and anxiety, patients may also experience fear and concern. Nexplanon is a Long Acting Reversible Contraceptive (LARC) implanted in the patient’s arm surgically. Patients may receive verbal education related to possible side effects, bleeding patterns, and complications of Nexplanon. However, patients who do not receive printed health informatio may not remember the instructions given verbally. By providing patients who decide to obtain Nexplanon as a contraception method with printed health information, phone calls post procedure may be reduced or eliminated allowing the providers to focus on providing hands-on patient care. EBP Framework: The Neuman Systems Model focuses on the interaction of the client with stressors within and without the environment. The theory states that by strengthening the lines of defense, the client will be in a better position to cope with stressors. Providing the patient with printed health information will strengthen the client’s lines of defense and therefore stress and anxiety will be reduced. Rosswurm and Larrabee’s evidence-based practice model guides the scholarly project. Following the six steps on such model allowed for a successful implementation of the project. Emphasizing step number six “Integration and maintenance” ensured a practice change where the patients experienced less anxiety, and the phone calls received by the provider post procedure were reduced. Methods: The objective of the project was to measure the effect on phone calls received post procedure with questions that could be easily answered by providing the patient with printed health information. Chart reviews were conducted for a period of six weeks: three weeks prior to the implementation of the project and three weeks after. A simple tally sheet was used to determine the number of procedures performed as well as phone calls. At the end of the project the numbers were compared to determine if printed health information reduced the number of phone calls received post procedure. Findings: The office experienced a reduction in phone calls by 66.7%. Providing patients with printed health information prior to Nexplanon implantation indicated that there was a correlation between the printed health information given and a reduction in phone calls received. Conclusion: Printed educational materials proved to be an effective way to reduce phone calls with questions regarding Nexplanon in the post implantation period. The office with continue to deliver such material to all patients. More studies should be conducted in the same subject since there is a limited amount of evidence, particularly in an outpatient setting.

    Request this Article


    Implementation of Text Message Reminder to Promote Appointment Adherence in Outpatient Pediatric Clinic

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Dioh-Esona, Glory A.T.

    Background: Globally, non-adherence to healthcare appointments (NAHA) remains a challenge in outpatient clinics. In pediatric outpatient settings in the United States and locally, NAHA presents a significant financial burden to the patient and clinician, exposes vulnerable children to huge health risk, and reduces clinic productivity and efficiency. It has been reported that the implementation of text message (TM) reminders has been shown to enhance scheduled appointments adherence rates in outpatient pediatric settings. Therefore, NAHA rates of 18% to 22% at Baybol pediatric warranted a need for a different appointment reminder from its routine telephone call reminders. Evidence-Based Frameworks: The use of TM reminders to reduce NAHA will be guided by an evidence-based practice (EBP) model and theory. For this project, the Iowa Model of EBP was used to introduce, develop, and evaluate the appointment reminder change, while the Health Belief Model explained changes in health-related behaviors. Methods: This was a quality improvement project (QIP) with two objectives: (A) reducing no-shows by 2% and (B) establishing a reminder system that was cost effective to the clinic. A review of current literature involving the use of TM reminders compared to other modes of reminders had shown improvements in NAHA rates and proven to be more cost effective. The process involved data collected during the first two weeks of implementation with TM reminders and the last two weeks of post-implementation with the clinic’s routine phone calls from November 13th to December 9th 2017, with both data compared to the pre-implementation data of the corresponding periods in 2016. A two-item questionnaire was used to evaluate the overall effect on adherence rate by understanding how helpful the text message reminder was and what time frames were preferenced by parents. The outcome was aimed at a reduction in NAHA rates. The results will be used as evidence that TM reminders decreased NAHA and are most preferable to phone call reminders. Results: Following the implementation of TM reminders, there was an overall reduction of NAHA rates by 5%. Conclusions/Recommendations: NAHA is a global issue. This QIP showed TM reminder can enhance appointment attendance to improve service delivery and to improve profitability for the clinic. Recommendations with opportunities to improve are focused on correctly entering phone data in scheduling database and used a good timeframe suitable for parents, before implementing an automated TM reminder system. The potential financial benefit realized can improve patient-provider relationship. Further studies involving a larger population over an extended time are needed.

    Request this Article


    First Responder Symptom Awareness to Reduce Critical Incident Secondary Trauma: A DNP Project

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Filler, Leslie

    Background: First responders frequently respond to critical incidents (CI), causing stress, secondary trauma, and PTSD. Currently, first responders are provided with critical incident stress debriefing (CISD) training. Without pre-trauma exposure or pre-CI intervention, first responders are at a greater risk for increased secondary trauma symptoms (STS) and high risk of burnout, attrition, substance abuse, compassion fatigue, insomnia, post-traumatic stress, depression and suicide. Stigma is a huge factor, limiting those in need from asking for assistance. The increased incidence of first responder suicides contributed to national safety initiatives to prevent firefighter line of duty deaths and injuries. Evidence-Based Practice Framework: Kurt Lewin’s Change Theory was the basis behind the project. Lewin theorized an individual’s behavior can be changed by the three concepts and three stages. The John Hopkins Nursing Evidence-Based Practice guided the project to ensure the most up to date research findings and evidence based practices were correctly integrated into patient care. Methods: The Professional Quality of Life, version 5 questionnaire, the trauma screening questionnair (TSQ), the abbreviated PCL, and the PC-PTSD-5 questionnaire were used to collect data prior to and following the intervention. First responders were educated about CI including symptom awareness, single vs cumulative effects, secondary trauma, PTSD, compassion fatigue, and suicide prevention.Participants were introduced to an online learning module, online applications, and learning resources. Findings/Results: All nine participants had compassion satisfaction with no burnout or compassion fatigue; however, two were identified as at-risk for PTSD on the TSQ, three on the PCL and four on the PC-PTSD-5. Initially, knowledge about post-trauma symptoms and self-care increased 22.63% from baseline, however, after 30 days knowledge had improved 7.74% from baseline, indicating a decline in knowledge retention. Conclusion/Recommendations: First responders are at increased risk for PTSD yet may not be aware of CI symptoms including secondary trauma. Following a single educational intervention, knowledge retention declined quickly. Pre CI-exposure intervention is recommended as a primary prevention for symptom awareness.

    Request this Article


    Barriers to Implementation of Surgical Attire in the Operating Room

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Frazier, Bethann M.

    Background:The incidence of surgical site infection (SSI) is estimated to be 160,000 to 300,000 yearly and likely understated. Per Ban et al., The American College of Surgeons (ACS) reports surgical site infections (SSIs) cost approximately $20,000 per incident and increase the length of hospital stays by nearly 10 days. The ACS also reports that 60% of SSIs were preventable using evidence-based measures. Surgical attire guidelines are an evidence-based tool in continuing to ensure that care is taken to avoid the bacterial contamination of the operating room. Further, these protocols remain steadfast to deliver maximum quality outcomes and assurance that patients and staff remain safe from harm. The Affordable Care Act (ACA) directed the Centers for Medicare and Medicaid Services (CMS) to promulgate rules steering hospitals to improve patient outcomes in a several areas, including SSIs. Hospitals that fail to achieve quality measures face up to 1% reduction in reimbursements. The Association of periOperative Nurses (AORN) evidence-based Guideline for Surgical Attire has been recognized by CMS and others as one that decreases likelihood of SSIs. Yet, since the guideline’s release, the lack of perioperative personnel taking ownership of implementation of the guideline remains challenging and threatens financial stability of organizations. Purpose of Scholarly Project: The purpose of this scholarly project was to determine if informal yet concentrated education would decrease oppositional staff behaviors regarding appropriate surgical attire in the perioperative and operating room setting. Methodology: The project focused on educating perioperative staff about the significance of maintaining alignment with the AORN guidelines for surgical attire in the operating room setting. Educational materials regarding surgical attire protocols embedded with evidence-based research were presented to operating room staff via different forms of media. Baseline, primary, secondary, and tertiary audits were used to establish if oppositional behaviors diminished. Results: At baseline audit, the institution did not meet the 80% goal for compliance in two of the three AORN recommendations. There was minimal increase in compliance after educational materials were presented to operating room staff. The method of education was not effective and when done in the future should include a more structured platform. Recommendations: Practice change involves the amalgamation of individuals who have some type of conferred concern to work together to make the change. Supporting the AORN Guideline for Surgical Attire in the perioperative area will ensure alignment with optimal outcomes. Full implementation and evaluation of the AORN Guideline for Surgical Attire in the perioperative area is necessary for success. Yearly competency for every perioperative employee in accordance with the AORN guidelines is recommended in the classroom setting away from the workflow of the operating room. This action will ensure that all those who participate will be deemed compentent in surgical attire guidelines and active in the presentation of optimal facility-wide outcomes and institutional goals.

    Request this Article


    Medication Non-Adherence in Community Dwellers-Adults Age 65 and Older

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Gooding-Davies, Flora

    Problem: Medication non-adherence in community dweller adults age 65 abd older. Medications are prescribed by the healthcare providers at Clinton Primary Care Center with the expectations that they will be taken as prescribed. It is later discovered that this is not always the case. Some of the reasons as to why the medication regimen was not adhered to are because the medications are too expensive, the patient did not understand the directions, the idea that if one pill was good then two pills will improve the issue faster, the patient felt better and stop taking the medication, don’t like the taste, side effects, etc. Intervention: Telephone calls were made to all elderly patients that fit the inclusive criteria who were prescribed a new medication at Clinton Primary Care Center in Clinton, Maryland. The calls were placed to assess the patients’ understanding of their medications using the pre and post Medicine Knowledge Assessment Form questionniare and provide education. Subsequent calls were made to assess adherence with the Medication Adherence Self-Assessment Tool and to measure outcome. Comparison: Patients’ level of knowledge and understanding about the prescribed medications regime compared to score on an Adherence Self-Assessment Tool. Outcome: Increased patients’ medication adherence through education about prescribed medications. Time: 2 weeks.

    Request this Article


    Implementation of a Delirium Protocol in a Critical Care Unit

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Hogg, Kiersten Hackley

    Background: Delirium is a common acute disorder that is costly and can be fatal if not recognized early. Healthcare professionals are often not comfortable assessing for delirium or do not have adequate knowledge for delirium prevention. Delirium assessment tools if used by knowledgeable healthcare professionals can help to prevent delirium. Currently Saint Alphonsus in Ontario, Oregon does not have a standardized delirium assessment tool for the nursing staff to use on patients. EBP Framework: The evidence-based practice model that was used in the implementation of this intervention was the Stevens Star Model of Knowledge Transformation. In conjunction, the Virginia Henderson’s Need Theory was used as the theoretical model. Methods: The objective of the delirium protocol implementation was to increase nursing understanding and comfort with assessing for delirium. Outcomes were measured based on the results of a delirium pretest and posttest that looks at general nursing knowledge and comfort with delirium assessment. Evaluation of the intervention was based on outcomes being met with the potential for implementing the Intensive Care Delirium Screening Checklist into everyday practice. Findings/Results: The first 15 questions of the pretest and posttest which assessed delirium knowledge, had P values between 0.08 and 1.00. The last five Likert scale questions had a P value of 0.0587. This result close to being statistically significant but it limited by the small sample size. Conclusion/Recommendations: Delirium is given low priory but with added nursing knowledge and comfort in delirium assessment positive patient outcomes can increase. This implementation project found that nursing staff comfort with delirium assessment improved after receiving delirium didactic training and using a standardized delirium assessment tool. Limitations of the project will be addressed if repeated. Future recommendations include implementing training on other healthcare professionals such as certified nursing assistants and respiratory therapist who direct patient care and would be able to observe subtle patient changes.

    Request this Article


    Evidence Based Educational Program on Fall Prevention in Long-Term Care

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Maduforo, Kathryn Adebukola

    Background: According to the U. S. Preventive Services, unintentional falls among geriatrics aged 65 years and above are the most common cause of nonfatal injuries. Geriatric falls threatens their independence resulting in a cascade of individual and socioeconomic consequences. Falls causes unplanned visits to emergency departments, lead to hospitalization, are a major contributor to nursing home admissions in the United States, and result in accidental deaths especially in the geriatric population. Ambulatory residents of long-term care facilities experience more falls than older adults residing in the community as nearly half of ambulatory long-term care residents experience at least on fall per year. Focus: Residents of long-term care facilities, at both local and nationwide levels, are exposed to the risk of falls at varying levels, which may result in different levels of injury. The Department of Health and Human Services manages long-term facilities. Each facility if required to follow standard guidelines established by the state to promote resident safety to prevent injuries including falls through annual in-service trainings of all staff on all prevention strategies. Clinical Question: Does evidence-based educational program enhanced clinical nurses and techs knowledge on fall prevention strategies in a long-term care facility (LTC) and result in a drastic reduction in patient falls? Theoretical Framework: This scholarly project was guided by Lewin’s Change Theory. The EBP Framework: Steven’s Star Model of Knowledge Transformation served as an effective framework for investigating and implementing evidence-based practice (EBP) innovations while collaborating with other members in interdisciplinary teams. Objective: Using the PICOT format, the purpose of the project was identified. Population: The nursing staff in the Long-term Care setting. Implementation: An EBP educational intervention on fall prevention strategies. Comparison: Evaluating resident fall rates and staff knowledge pre- and post-educational in-service trainings. Outcomes: Improved staff knowledge and reduction in fall rates. Time: Over one-month pre and post educational in-service trainings in the long-term care setting. Findings/Results: Forty-five staff attended the presentation of evidence based educational in-service training. The format was easy for the clinical nurses and techs to understand. The fall prevention strategies points were easy to remember and retained as evidenced by a difference in the pre- and post-staff fall knowledge quiz. The outcome of proposed change with evidence-based educational program on fall prevention among the LTC residents was confirmed by the decrease in the falls ratio over one manth after the in-service training, compared to the fall ratio prior to the intervention.

    Request this Article


    Implementation of a Type 2 Diabetes Screening Tool in a Community Clinic

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Matteson, Ryan

    Background: Prevalence of diabetes is increasing worldwide, especially in the lower income and undereducated populations. Dallas, Texas has a proportionally higher prevalence of diabetes. Early screening and intervention is key to providing effective care and improving the quality of life. This project focused on implementing a diabetes screening tool in a free community clinic in Dallas, Texas. EBP Framework: Lewin’s change theory and Neuman’s change model were used a project framwok. Through addressing concerns of the client and unfreezing, unchanging, and refreezing, the process change in the clinic was guided by this framework. Methods: After IRB approval, a screening tool from the American Diabetes Association was implemented for all new patients that were not known diabetics with the Agape Clinic, and the tools were kept for three weeks. No patient identifiers were placed on the forms. If screened positive, the patient had glucose checked, and if neccessary an A1C. Findings/Results: The project measured the number of patients screened by a diabetes screening tool before implementation compared to after. The tools were evaluated for correct usage as well as correctly following guidelines based on tool scoring. The percent of patients screened increased to 80.16% Conclusion/Recommendations: The implementation of the screening tool was successful and proved beneficial. Twelve new diabetic/pre-diabetic cleitns were identified. The use of diabetes screening tools is recommended in order to adequately screen individuals effectively and efficiently.

    Request this Article


    Effect of Conflict Resolution Education on Nurse-Nurse Collaboration in a Community Hospital Setting

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Mayfield, Lori Ann

    “Conflict is inevitable in a dynamic organization”. In the facility in which the project was implemented, there is currently no conflict resolution education provided to nurses. Overton & Lowry pointed out that “conflict is associated with significant cost to organizations.” Conflict resolution and collaboration go hand-in-hand; “Although collaboration is a time-consuming process, it’s an integrated approach and a long-term resolution of conflict”. Therefore, the question arises: Does conflict resolution education increase nurses’ knowledge level in resolving conflict and improve collaboration amongst nurses?

    Request this Article


    Incivility in Nursing: An Educational Intervention and Quality Improvement Project

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Melle, Alison

    Background: Incivility among nurses continues to be a widespread problem despite national agencies mandating nurses foster safe and healthy work environments. Incivility affects patient outcomes in a negative manner; incivility decreases effective communication and increases physical and emotional distress among nursing staff who experience such behavior in the workplace. Incivility and bullying have been linked to sentinel events, medication errors, decreased quality of care, and poor patient outcomes. Incivility in the workplace can lead to decreased job satisfaction, more illnesses and absences among staff members, and lower nurse retention rates, all of which have a massive financial impact on the healthcare system. Governing bodies have mandated that incivility must be addressed as the negative impact to patients, nurses, providers, and health care systems is too great to ignore. Health care systems must implement interventions to address incivility. Framework: This quality improvement project incorporated Sister Callista Roy’s Adaptation Model with the Stevens Star Model of Knowledge Transformation for evidence-based practice change. Methods: An educational intervention was offered via a 14-minute PowerPoint presentation, created by the project manager, with the goals to increase the nursing staff’s ability to recognize workplace incivility, reduce workplace incivility on a nursing unit, and to increase confidence confidence in the staff members’ ability to respond to workplace incivility when it occurs. Staff were surveyed before and after the education, using the Workplace Incivility Civility Scale. Group mean scores were compared pre- and post-education using independent t-tests. Findings: The educational intervention helped staff recognize uncivil behaviors. The amount of uncivil behavior did not change significantly, as perceived by participants, although there was not a great deal of uncivil behavior observed initially. Staff members’ confidence in dealing with incivility did not increase significantly. Conclusion and Recommendations: There are no simple strategies to decrease incivility. Combating incivility requires a multi-faceted approach, including education of staff, implementing a practice change, and teaching staff cognitive rehearsal strategies while offering opportunities to practice the strategies learned. Educating staff to recognize uncivil behavior can decrease wuch behaviors, simply through increased awareness. Nurses can be receptive to such education and will benefit from education aimed at improving their ability to curtail uncivil behavior in the workplace. Recommend future education to offer more interventions and practice opportunities for the staff to improve their skills in handling incivility.

    Request this Article


    Implementation of Acute Stroke Early Mobilization Education Program

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Oluwasuyi, Olayinka

    Background: Stroke is one of the prevalent illness and common neurological disorder locally, regionally and globally; with fifteen million suffering from a stroke every year. Out of these, five million are deceased, and five million are forever paralyzed. For those who have experienced a stroke it is an important goal to regain functional independence. Therefore, the most relevant clinical outcomes of stroke is disability and mortality. Early mobilization after acute stroke is secure and associated with various advantages. However, early mobilization has been associated as a key fundamental of stroke treatment, with the time interval within which mobilization should be started to improve outcome after stroke. The internal data received from the local facility showed that patients with stroke spent at least 45 days in this facility to regain their functional recovery. On average, each patient receives one hour of physical therapy per day five days a week. Accepted patients in this facility have private insurance or Medicare. Medicare only covers the first 20 days of a patient’s stay with each additional day costing the patient $164.50. Evidence-Based Framework: The organizational change at the nursing home was to implement an acute stroke early mobilization education program in an attempt to reduce the length of stay, decrease readmissions, and improve functional mobility and quality of life. The Stevens Star Model of Knowledge Transformation Model and Virginia Henderson theory were used as the evidence-based practice model and the theory respectively for the development of the project. Method: The objectives of the project were: (1) to implement an early mobilization education program to abate the length of hospital stay, (2) to advance anatomic mobility, and (3) to reduce hospital readmission and immobilization complications. The objective of this scheme is to generate new knowledge to make an evidence-based positive change and to increase the staffs’ knowledge about the importance of early mobilization after acute stroke by providing education to the nurses and other healthcare providers in order the activities of daily living. Evaluation was accomplished through comparing the pre-questionnaires and post-questionnaire directly before and after the educational in-service presentation and one month’s post presentation during the implementation period of mobilization program. Data was collected using a self-developed questionnaire collection tool. The results of the project were used to demonstrate the impact of the mobilization education program. Recent literature provided evidence that early mobilization is effective in reducing hospital length of stay and decreasing disability. Findings: The implementation of an early mobilization program to a nursing education staff improved functional mobility to 87.5%, compared to 25% during the time period in the same year when early mobilization was not initiated. Conclusion/Recommendation: Based on the findings of this quailty improvement project, implementation of early mobilization education program is suggested in rehabilitation settings. Recommendations include: that an early mobilization education program should be embraced by all healthcare facilities because it minimizes/prevents complication, improves rehabilitation intervention, improves function disability and reduces hospital readmission. Areas for future study: extend study to verify the impact of early mobilization for stroke patients for a longer period of time as well compare different populations, financial benefits and costs to the facility and to the patient. An additional recommendation would be to focus on patient satisfaction rates.

    Request this Article


    Examining Changes Following Introduction of a Visual Prompt in Primary Care Provider’s Nutrition Counseling for Children with Abnormal Body Mass Index

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Salinas, Mario Romeo

    According to the Centers for Disease Control and Prevention (CDC), the childhood obesity rates nationwide were 24.9% amongst children between the ages of six through 12. The rates reported from the Texas State Department of Health revealed a 29.9% in children in the same category. Local data from The State of Obesity in Texas showed a rate of 35.7% in Laredo, Texas. The most recent US Preventative Services Task Force issued a level B recommendation for clincians to screen for obesity in children and adolescents six years older and offer or refer for comprehensive, intensive behavioral interventions to promote improvements in weight status. Healthy People 2020 has goals related to various ages and specific health topics. the nutrition and weight status 10 goal is to “Reduce the proportion of children and adolescents who are considered obese”. The intervention in this scholarly project included: 1) Identifying patients that met criteria. 2) Alert medical assistants to provide Traffic Light Diet (TLD) to health care providers (HCPs) based on weight and BMI. 3) The HCP addressed obesity and provided dietary couseling using the TLD brochure. Documentation of nutritional couseling was entered in the “Preventative Medicine” section of the electronic medical record (EMR). Comparison of pre- and post- implementation data revealed an increase in documentation addressing nutritional counseling for at risk Hispanic youth in Laredo, Texas.

    Request this Article


    Preoperative Education for the Improvement of the Preoperative Experience

    Published Year: 2018
    Program: Doctor of Nursing Practice

    Tervort, Thomas James

    Background: An estimated 243 million surgical procedures will take place in the world this year, and 7 million will have complications. Patients set up for an elective surgery in an outpatient clinic may not be receiving the best education that could be provided. Several phone calls are received in the clinic regarding surgical expectations, and surgeries are being canceled for this reason. Being anxious or nervous about an upcoming procedure is not uncommon but may contribute to negative outcomes. Additional educational material may reduce the anxiety a patient feels preoperatively. EBP Framework: Orem’s theory of self-care allows for an individual to function and develop skills to regulate or manage his or her own care. Providing a patient with educational material allows one to be successful in this endeavor. Rosswurm’s and Larrabee’s model for change allows one to manage anticipated changes in behavior and allows for greater ease of self-care. To simply teach is not sufficient, but integration of skill is important to make a change. Methods: The objective of this project is to determine if patients that receive this educational literature have decreased concerns related to the surgical procedure. Tallies of the number of calls and canceled surgeries were kept for a period of six weeks. Three weeks before Education implemented and Three weeks after. The numbers were compared to determine if standardized educational material is an effective teaching method. Findings: Literature on the subject indicates that there is a correlation between education and improved outcomes. The findings of this study were that a decrease in the number of patient phone calls and canceled surgeries were related to increased education through material handed to the patient at a preoperative appointment. A reduction in the number of inquiries was seen at a rate of 49.2% and a reduction in canceled surgeries at a rate of 66.7%. Conclusion: Educational material is effective in reducing stress of a patient scheduled for surgery. By providing a patient with proper educational material the patient becomes empowered with the ability for self-care. The number of calls to healthcare providers decreases and improves the providers focus on additional healthcare needs. Surgery cancelations decrease, which is a benefit to patients and providers, time, and finances improve. Additional studies would be beneficial due to the decreased amount of information on the subject currently available.

    Request this Article


2019

    Promoting Cardiovascular Disease Risk Screening in Primary Care

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Decker, Andrew

    Background: Despite significant modern-day advances in healthcare, cardiovascular disease (CVD) remains the number one killer in the United States and throughout the world. Many who do not succumb to a heart attack or stroke are left debilitated, and likely to experience a future event. The financial burden of CVD is significant and on the rise. The numbers of procedures and invasive surgeries performed to manage advanced disease are staggering. Primary care providers are well-positioned to initiate risk-reduction therapies, but many times fail to do so. Discussions about risk factors and treatment options are far-too often neglected. Better identification and management of at-risk individuals is needed in the primary care setting. Strategies should target patients and providers. EBP Framework: Stetler’s Model od Evidence-Based Practice, Lewin’s Change Theory, and Orem’s Self-Care Deficit Theory guided the implementation of the American College of Cardiology’s ASCVD Risk Estimator Plus (ASCVDREP) in a primary care setting. The literature supports a global risk assessment strategy that considers the synergistic effects of all risk factors. The provision of risk scores enhances risk perceptions and encourages clinician-patient discussions. These discussions serve to promote medication intervention, boost patient engagement, increase medication adherence, and benefit the patient-clinician relationship. Methods: A variety of strategies were devised to encourage patients and clinicians to utilize the ASCVDREP. A luncheon and presentation were prepared, along with posters, flyers, and risk assessment forms. Stakeholders and change agents were targeted to promote participation and sustained change. Readiness for change among clinicians was a concern addressed by the recruitment and involvement of all staff members to assist in implementation of the ASCVDREP. Frequent communication between the project manager and clinic staff was maintained throughout via phone calls, text messages, and frequent clinic visits. Clinicians’ perceptions of the ASCVDREP were assessed via a post-implementation clinician survey. Findings/Results: Increasing the overall prevalence of global CVD risk screening was a primary outcome measure. Patient risk was stratified into low, borderline, intermediate, and high-risk categories; and medication intervention between risk groups was assessed and compared. Patients in the intermediate risk group were most likely to receive medication intervention. Screening identified patients with uncontrolled risk factors who could benefit from more aggressive risk reduction strategies, namely blood pressure-lowering, cholesterol-lowering, and daily asprin therapies. Conclusion/Recommendations: The literature supports global CVD risk assessment in the primary care setting. More aggressive risk-reduction therapies to manage CVD risk are needed. The ASCVDREP aided clinicians in the stratification of patient risk and may have increased the initiation and/or intensification of risk-reduction therapies. Clinicians agreed the ASCVDREP beneiftted patient education, risk perceptions, and possibly medication adherence.

    Request this Article


    Implementation of the Pressure Ulcer Scale of Healing (PUSH) Tool in Longterm Care Facility

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Fongang, Samuel W.

    Background: Globally, health care-associated morbidity remains a significant challenge in long-term care facilties. The annual prevalence of pressure injuries in long-term care facilities is 5.4 percent. However, the prevalence of 7 percent of pressure injuries at Oakwood Nursing and Rehabilitation Center warranted the scholarly project to improve the consistent use of the Pressure Ulcer Scale for Healing (PUSH) tool. PUSH tool is a chart for assessing pressure injuries in order to monitor type, exudate, and tissues. EBP Framework: Educating nurses to improve their consistency in using the PUSH tool was guided by the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model. JHNEBP describes change implementation in three steps, practice question, literature review, and translation. The change agents should apply a stepwise strategy to complete these three steps. For this scholarly project, the JHNEBP model explained the practice question, evidence, search, and translation of findings to routine practice. Neuman’s systems theory had the components of the PUSH tool that nurses must understand to enable them to influence patients’ environment to improve healing. Methods: The objective of this scholarly project was to determine the consistency in the documentation of pressure injury after introducting a PUSH tool protocol by educating nursing staff members. The literature review of the benefits of a facility-based protocol on pressure injury preceded the educational program. Data collection occurred between 17 December 2018 and 16 January 2019 every 48 hours. Following conclusion of data collection regarding the PUSH tool, nurse participants completed the participant satisfaction survey. Results: A total of 38 participants in the nursing staff participated in the scholarly project in three shifts. Nurses used the PUSH tool to assess pressure injuries of 4 patients over 30 days. A descriptive statistical analysis involved calculation of the frequencies, percentage, and mean of the number of days of total use of the PUSH tool in order to determine the consistency. The consistency in using the PUSH tool among the four patients, by number of days out of 16, were 16, 15, 13 and 15 days, respectively. The mean days of consistent use of the PUSH tool was 14.75 out of 16 days and 38 of 38 nurses were confident in using the PUSH tool after teaching. This gave 92.19 percent in the consistency in using the PUSH tool. Overall, the four patients had a decrease in pressure injury size by 1.4 cm, 0.3 cm, 0.5 cm, and 1.0 cm with the fourth patient attaining a complete recovery from the pressure injury. Conclusion: The project focused on determining whether staff education impacted the consistent use of the PUSH tool in the long-term care facility. Education of the nurses about the PUSH tool improved their adherence to the new protocol in future practice to 92.19% consistency. In this case, the main benefit of the teaching program was an increase in the consistency in using the PUSh tool. Educating nurses improves their consistency in using the PUSH tool, hence improving wound healing monitoring and recovery.

    Request this Article


    The Use of Mindfulness Techniques to Increase Confidence in Clinical Performance Among Undergraduate Nursing Students

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Green, Beth

    The issue of anxiety-ridden nursing students is not a new phenomenon. The idea of learning a new skill or participating in real-life situations can provoke uneasiness. There is a gap in translation of knowledge and skill from the classroom and skills laboratory to the practical clinical setting in the form of uncertainty and apprehension. A need exists to aid nursing students in boosting confidence prior to clinical shifts. The National Council of State Boards of Nursing sites a responsibility to better prepare new graduate nurses and to make patient safety a top priority on a global level. Currently, at Roseman University of Health Sciences, there is no existing intervention to minimize anxiety and increase confidence for nursing students entering the clinical setting. There is no method in place to help students manage worry or enhance experience in real-life scenarios. A need exists to aid nursing students in boosting confidence prior to clinical shifts. The design of the Scholarly Project is based on the Stetler Model of Evidence-Based Practice. Bandura’s Social Cognitive Theory is rooted in a view of human agency and was used as the theoretical foundation of this project. The project approach provides a transformational level of change. Ideally, there will be a shift in academic culture that embraces the concept of mindfulness techniques on clinical perfomance. There is hope that the incorporation of mindfulness techniques will be integrated into the program curriculum to better prepare students for clinical performance. Evaluation of the project plan in terms of the degree in which it was implemented was carried out in what Stetler calls Phase V-Evaluation. At this time, a determination was made as to whether the goals and outcomes of the proposed intervention were met or not met, according to scoring on the Self-Efficacy Questionnaire Version 2016. Credible clinical and statistical evidence was discovered at the conclusion of the measurement period. Self-Efficacy Survey post-intervention scores revealed an increase in perceived self-confidence when measured against pre-intervention scores. At the conclusion of data collection for this project, students expressed interest in continuing the intervention because of the result they experienced personally. This project reinforces the need for and intervention to assist nursing students in decreasing anxiety and increasing confidence in the clinical setting. The data also suggest that the use of mindfulness techniques in the form of deep breathing and self-affirmations does indeed provide a positive outcome for the student.

    Request this Article


    Communication of Do Not Resuscitate Status in Outpatient Oncology: A Quality Improvement Project

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Hardwick, Sarah E.

    Documentation and communication of code status, specifically do not resuscitate (DNR) status, are important in many facets of healthcare. Like other settings, outpatient oncology is lacking consistency related to documentation and communication of code status. This inconsistency can lead to stressful scenarios for patients, families, and clinical staff in the event of a code. The focus of the scholarly project was to create a nursing process that would eliminate uncertainty surrounding a patient’s documented code status. The project took place in a rural, hospital-based, outpatient oncology/hematology/infusion center. The evidence-based practice quality improvement project was tailored around the clinical question, “Would implementing a visual aid system to flag patients who have DNR documentation within their electronic chart at the project site increase staff awarenes of patients who have DNR status in place?” Richard Ryan and Edward Deci’s Self Determination Theory was chosen as the guiding theory for the project, while Ian Graham’s Knowledge in Action Model acted as the guiding evidence-based practice framework. Rocky Mountain University of Health Professional’s Institutional Review Board deemed the project “not research.” Three objectives informed the scholarly project. The first objective implemented a nursing workflow process and physical visual aid system for staff to recognize easily patients who have DNR wishes in their electronic oncology record. The second objectives included increasing staff awareness when a patient was being cared for who had a DNR document on file. The final objective ensured zero resuscitations occurred on patients who had DNR wishes on file. Nursing included the project processes as a part of their daily workflow. Data was collected over a period of six weeks and later evaluated using the Chi-square analysis. Of 29 possible clinic days during the project, the nursing flowsheet and DNR flagging system was completed 27 to 93.1% of the time. Over six weeks, 42 incidences of patients with DNR on file within the site’s electronic record were found; these incidences were flagged 42 or 100% of the time. Further, of 24 days available for staff to include DNR status in a daily huddle, staff documented including the status 22 or 96% of the time. The project improved communication of important patient wishes equating to a safer environment for both patients and staff. We recommend the project is completed in a larger setting where staff and patients are more demographically diverse to increase transferability. Recommendations further include end of life or code status documents within a hospital and its clinic system be included as they might yield additional information on this topic.

    Request this Article


    Implementation of a Diabetes Nutritional Education Module for Nurses in Ambulatory Care Medical Clinic

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Haughton, Geraldine

    Background: The Center for Disease Control (CDC) revealed that 9.4% of the US population has diabetes. The number of individuals with diabetes in Brooklyn, where the intervention was conducted, exceeds that of other counties in New York State. Diabetic patients living in Brooklyn are not adequately receiving the medical attention and education they need to fight this debilitating disease. The project site, Kings County Hospital Ambulatory Care Clinic, serves many patients with diabetes, however diabetes nutritional education resources are lacking. Nutrition is a fundamental part of diabetes care. The main goals are to maintain normal blood glucose levels and to prevent complications of diabetes. However, insufficient diabetes education and knowledge continue to be serious challenges for patients. Nurses have also been found to be deficient in their knowledge of diabetes nutrition management and they face a dated evidence-based nutrition program. Thus, the need for nurses’ diabetes management education in the ambulatory care setting is paramount. Evidence Base Framework (EBP): Rosswurm and Larrabee’s Conceptual Model for Change to Evidence Based Practice offers a systematic process for developing and implementing the practice change. The diabetic educational protocol and intervention utilized the nursing theory underpinnings of Pender. Methods: The objective of the study was to assess the outcome of a diabetes nutrition education intervention among nurses practicing in ambulatory care. The study employed a convenience sample of 35 registered staff nurses working at a large urban ambulatory care clinic. Each of the 35 nurses completed a Diabetes Knowledge Test (DKT) before and after the educatio intervention. Descriptive statistics were computed for study variables, and paired t-tests and one sample t-test were used to conduct the inferential analysis of the impact of diabetes education intervention on nurses’ diabetes management knowledge as measured by the DKT. Findings/Result: The results of the study suggest that the diabetes education intervention had a significant effect on nurses’ diabetes knowledge, causing nurses’ DKT scores to increase by over 13 points. Oher results suggest that, prior to intervention, nurses’ knowledge of diabetes nutrition information was significantly lower than their knowledge of diabetes non-nutrition information, and that the interventio had a relatively greater impact on diabetes nutrition knowledge than on diabetes non-nutrition knowledge. Conclusion/Recommendations: Given that diabetes educational intervention improves nurses’ knowledge of diabetes management, we can expect that, provided with enhanced evidence-based nutrition information, nurses will induce positive behavior changes in their patients. Such changes can result in healthy food choices and improved health. Therefore, the study recommends that large urban ambulatory care settings implement ongoing educational training on diabetes management to increase nurses’ knowledge.

    Request this Article


    Civility: Providing Student RNs with the Tools to Navigate through Uncivil Situations

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Holland, Arlene

    Background: The term Incivility comes from the Latin term incivilis which means “not of a citizen” Incivility is a lack of civil behavior that may involve actions that range from eye rolling at an individual’s comment to potential physical harm of another living being. Incivility does not remain in one aspect of life; it follows wherever there is interaction between individuals. Incivility in the workplace has become an increasing problem leading to many negative effects that often spill over into many aspects of person lives. Walderman states that the incivility that exists in society is modeled after some of the most influential leaders we have currently in place. The world of health care is not exempt from workplace incivility. According to Khadjehturian, some of the same devestating effects that result from incivility in the workplace also extend into health care. The most devastating effect of incivility in nursing is the potential interruption of communication between members of the health care team leaving patients at an increased risk for compromised care. Foreground: In the State of Utah, according to Deseret News, a staggering 96 percept of employees stated that they have experienced incivility at work. Additionally, 48 percent of employees claim that they experience incivility on a weekly basis. Unfortunately, 94 percent of employees who have experienced such actions sArlentated that they will, or intend to get even with their offenders. According to McLean, violent behavior among RNs is condoned within the profession, and, as a result, bulying is considered an under-reported phenomenon. Evidence-Based Framework: This project will be grounded on Rosswurm and Laraby’s model of change. The six steps of this model include; 1) assess need for change 2) Link problem with interventions and outcomes 3) synthesize e best evidence 4) design a change in practice, 5) implement and evaluate the practice change and 6) integrate and maintain the practice change. This project will also be based on the Lewin change model. The initial step is to unfreeze or assess the need for change, change or implementation of the practice change, and finally to freeze or to maintain the change. Findings: The objective is to provde nursing students at Roseman University of Health Sciences, College of Nursing (CON) South Jordan campus, a tool to navigate through a crucial conversation safely, and to practice the skills they have learned to resolve conflict at a civil level. The desired outcome is to first identify what civility is and to improve the nursing student’s ability to prepare and prevent and uncivil encounter on the nursing unit with a member of the health care team. This will improve overall communication with RNs and increase patient safety. Evaluation of the nursing students will involve a comparison of the civility index scores using the Civility Index from Clark. Conclusion/Recommendations: Additional interventions be identified to target incivility at a nursing student level.

    Request this Article


    The Impact of STOPP/START Tool Education In the Hospice Setting

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Huhtala, Ed

    Patients taking an excessive number of medications can have medication errors, falls, and other drug related problems. This condition has a variety of definitions that all use one name, polypharmacy. Polypharmacy affects not only the United States but the whole world. Patients commonly have this problem at age 65 or older. As patients age, they develop more diseases. Each disease requires a medication to treat symptoms. Patients at the end of life take a large number of medications which contribute to this problem. To help manage this problem with patients who are terminally ill, this scholarly project uses the Rosswurm and Larrabee evidence-based practice model as a stucture to put the project together. The theoretical model used as a guideline to help medical staff become accustomed to change is the Lewin’s Change Theory. This theory assists staff in implementing new changes. Data collection is performed using questionnaires to measure how well medical staff learn from the education given to them. The project uses a prescribing tool as a reference for medical staff to assess how many approriate medications each patient is taking. The number of medications prescribed to patients is also tracked by using chart audits. The purpose of these objectives is to demonstrate a decrease in the number of prescribed medications. There is collaboration between nurses and physicians in using the prescribing tool. A PowerPoint presentation was completed for education to deal with the barrier of using the prescribing tool incorrectly. The results for the project were improved understanding of the prescribing tool as demonstrated by the questionnaires. A decrease in unnecessary medications to terminally ill patients was noticed by chart audits. From 59 patients, 18 medications were discontinued when using the STOPP/START tool as screening criteria. A paired t-test was used to compare chart audit results. The p-value was 0.0148 showing the intervention was effective. Pre and posttest questionnaires with the medical staff involved demonstrated a 60% increase in overall learning with the STOPP/START tool. Conclusion: This scholarly project brought an awareness of the importance of medication review through the use of the STOPP/START tool. Staff had improved understanding on why medications could be discontinued with an evidence-based rationale. This scholarly project addressed the problem of polypharmacy in the hospice setting. Sustainability of this project in the selected job setting was not feasible related to personal opinion. Some staff did not have interest in using the STOPP/START tool while others did. The STOPP/START tool will remain at the job site as a resource for those interested in its use.

    Request this Article


    Recognizing Suicidal Ideation in the Emergency Department

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Johnstun, Robert D.

    Background: Suicide is growing crisis in the United States and worldwide. Nearly one million people die by suicide each year. Suicide is one of the leading causes of death for all adolescents and young adults. The Centers for Disease Control (CDC) reported many states across the country have seen between an 18-58% increases in suicide rates from 1999 to 2016. The state of Utah is among the states with the highest rate of suicide during that time period. Many of these patients utilize the Emergency Department (ED) as a first line of care. The most common contributing factors of suicidal attempts include, relationship problems, crisis in the past or upcoming two weeks, problematic substance abuse, physical health problems, job or financial problems. Many patients that suffer from a mental health diagnosis, such as depression or anxiety will also be seen in the ED due to a suicidal ideation (SI). The first steo in preventing these acts is to properly identify those at risk for suicide, and providing proper referral. Since most of these individuals are presenting to the ED, it is of the upmost importance that these providers are properly equipped to identify these patients. The University of Columbia, in collaboration with other groups and accrediting bodies, constructed a universal screening tool called the Columbia Suicide Severity Rating Scale (C-SSRS). This tool was built to serve in many heathcare settings and has shown to be very successful in identifying those at risk for suicide. The C-SSRS has particularly shown that it can be used as a universal screening tool in the ED aiding providers in properly identifying suicide risk levels. Methods: The C-SSRS was documented using an Electronic Health Care Record (EHR). Nursing staff administered the C-SSRS tool to each patient that presented to the ED. Policy was modified to fit the C-SSRS triage criteria for low, moderate and high-risk evaluations. This policy change was approved by the forms committees. The project compared the number of false positives and true positives from the C-SSRS and confirmed these findings with the assessment of the licensed provider. A calculated Chi-square test/Fisher Exact Test provided the specificity and sensitivity of each scale. Findings: The result and findings of this project demonstrated a high sensitivity and specificity in the ED at St. Marks Hospital. During the 30-day study, 3618 patients were screened for suicidal ideation. Of those patients, 172 were found to be at risk for suicide ideation. Only four of those patients were found to have a false negative finding compared to provider documentation. Conclusion: The CSSRS accurately triaged and identified patients at risk of SI. A sample size of 3618 patients assessed is a very respectable sample for a 30 day window. Provider documentation correlated well with CSSRS assessment and P value was significant, giving staff a reliable and valid evidence-based tool for identifying suicidal ideation in the ED.

    Request this Article


    Teaching Self-Care to Reduce Nurse Burnout

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Kariuki, Josephine

    Background: Burnout is more common among nurses than with other healthcare workers. Burnout is estimated to be fifty percent and higher globally due to the work environment and job requirements and expectations and is projected to go higher due to healthcare changes. In Virginia, it is estimated that each nurse experiences a particular type of burnout. More than fiftt-nine percent of nurses in Virginia experience high burnout. EBP Framework: This project is guided by Watson’s theory of transpersonal caring. Watson believes that nursing is central to nurses and nurses need to promote self-care to others as well as themselves. Self-care promotes and maintains health. Aim: The purpose of thsi study is to determine whether teaching nurses about self-care will decreas the rate of nurse burnout. Methods: The Copenhagen Burnout interventory was utilized to meassure burnout before intervention, and again after intervention. T-test was used to compare the two means. Subjects were protected by limiting the collection of identifying information and limiting access to raw data. IRB approval stated that this is not a research but an evidence-based system change. Results: Self-care decreased the burnout level in nurses. Conclusion: Self-care decreased the burnout level in nurses. Conclusion: Self-care can reduce nurse burnout. It is not only the responsibility of nurses to practice selfcare but also the responsibility of the employer to provide a healthy working environment which promotes selfcare.

    Request this Article


    Improving Pneumococcal Vaccination Rates in Patients 65 Years and Older in a Rural Health Care Clinic

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Krebs, Kaleigh

    In both local and national sectors of the United States, missed pneumococcal immunizations in patients 65 years and older is a significant problem. The outcome of missed immunizations can create poor health outcomes for patients, and become burdensome to healthcare systems. The use of electronic medical record pneumococcal vaccination flags, and staff education hypthetically offers a solution to missed immunizations. Decreasing missed immunizations improves patient health by encouraging preventative medicine, thus reducing occurrences of pneumonia. Evidence-Based Framework: The quality improvement project, conducted at the Gordon Clinic, implemented staff education and EMR pneumococcal vaccinations flags in attempt to increase pneumococcal immunization rates in patients 65 years and older. The Stevens Star Model of Knowledge Transformation and Lewin’s Change Management Theory were used as the evidence-based practice model and theory to develop and guide the project. Method: The objectives of the project were to change provider practice through several system-wide interventions, including: (1) implementing staff education about the importance of pneumococcal immunizations in patients 65 years and older; (2) implementing and electronic medical record pneumococcal vaccination flag to serve as a staff reminder; (3) posting patient education flyers in the waiting rooms to increase patient knowledge. The goal of the project was to increase pneumococcal immunization rates in patients 65 years and older at the Gordon Clinic. Evaluation of the project was determined by comparing the number of pneumococcal immunizations adminstered during the post-intervention time frame, with the pre-intervention rate during the same period of time in the previous year. Data were collected using a self-made collection tool. The results of the project will be utilized to highlight the impact of staff education EMR pneumococcal flag use and patient education flyer placement on increasing pneumococcal immunization rates in patients 65 years and older. Findings: The implementation of staff education, EMR flags, and patient education flyers was associated with an increase in immunization rates to 7% immunized, compared to 3% during the same time period in the previous year, before implementation of this project. Conclusion/Recommendations: Based on the results of this quality improvement project, use of provider education, EMR flags, and patient education flyers is recommended in rural health clinic settings. Areas for future study include extending the study to include all immunizations across the life span, and studying the financial benefits and costs to the clinic and to patients.

    Request this Article


    Promoting Nurse Engagement in a Medical Oncology Unit

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Luback-Neves, Marie

    The healthcare industry is increasingly aware of the importance of nurse engagement. The Nursing Executive Center of the Advisory Board defined nurse engagement as “individuals who are inspired to do their best work, feel personally motivated to hel the larger organization succeed, and are willing to exceed the expected level of effort”. Nurses engaged in their work setting are dedicated, focused, and collaborative. Dis-engagement is present in nurses on a global level. There is evidence-based literature addressing nurses’ work engagement, nurse turnover, teamwork, and workplace incivility. Nursing engagement researchers represent the countries of Australia, Belgium, Cananda, Iran, Italy, Lithuania and the United States. Locally, Carson Tahoe Hospital (CTH) in Carson City, Nevada was the facility chosen for this project. The CTH is a non-profit regional hospital with 240 licensed beds. Specifically, the project focused on the medical oncology nurses’ engagement of this facility. The evidence-based practice (EBP) framework chosen for this scholarly project is the Stetler Evidence Based Practice Model. The theoretical framework applied to the project was the Relational-Culture Theory. This EBP model and theory provided the framework for this scholarly project. The goal of this project was to improve nurse engagement on the medical oncology unit of CTH. Schaufeli and Bakker’s Utrecht work engagement scale (UWES) was used as the evidence-based measurement tool. The UWES scale is proven to be both reliable and valid. Results of this project indicate a statistically positive correlation in nurse and participant engagement. Improved dedication, and vigor components were identified using paired t test. No change was noted in the absorption component of the UWES suing the paired t test. However, using the Wilcoxon nonparametric statistical tests indicated a positive results in all three components of dedication, absorption, and vigor. These results were comparative to those in the literature. In conclusion, this scholarly project, provided CTH Medical Oncology nurses and team, with an opportunity to improve their engagement. Future recommendations will focus on providing the education, team-building, and debriefing to the other team members of the Medical Oncology unit via their staff meetings. In addition, the education, skills, and debriefings will be shared with other departments at Carson Tahoe hospital and network.

    Request this Article


    The Effectiveness of Implementing PHQ9-A in Diagnosing of Depression in Adolescents Age 12 to 17 Years: A Quality Improvement Project

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Nganga, Peter Ngotho

    Due to the existence of a variety of mental disorders along with a myriad of causations, the researcher aims at developing instruments that factor in all the pertinent tenets in the diagnosis, treatment, screening, measuring, and monitoring mental illnesses. Today, depression is one of the most popular mental disorders that continues to impair the ability of affected individuals to perform at their optimal potential not only in the U.S., but globally. Depression accounts for the highest number of disabilities worldwide. Persistent Depressive Disorder (PDD) and Major Depressive Disorder (MDD) are some of the most common forms of depression, with MDD the leading cause of disability among Americans aged between 15 to 44.3 years old. IOWA is one of the popular evidence-based practice (EP) models that influences the decision-making process in clinical and other healthcare settings. The model was designed to adopt an interdisciplinary approach when utilized in the implementation of changes. The key features include its adherence to the problem-solving steps and utilization of the trial of change before full implementation. Peplau theory and Lewin’s theory of change are relevant theories for the actualization of the aims and objectives of this project. A sample size of 250 adolescents was used in this project with all the studies occuring in the clinic. Recruitment of the participants adhered strictly to the guidelines provided by the institutional review board (IRB). The two crucial inclusion features were the age and depressive tendencies of the participants. Out of the total 250 adolescents seen at the clinic in a period of 30 days, 170 patients were screened for depression using PHQ-9A tool in 30 Days; 15 out of 170 patients had high scores and were referred for a psych evaluation. From Day 1 to day 15, a total of 134 patients were seen, but only 69 were screened for depression. From Day 16 to Day 30, a total of 116 patients were seen, and 101 were screened. Data from the previous month, when no tool was used, indicated only 5 patients were presented and treated for depression. From Day 1 to Day 15, there was inconsistency because the screening was done by the practitioners during the assessment. From Day 16 to Day 30, it was agreed to let medical assistants give the tool to the patient to complete during registration, As a result, there was an increase in the number of those screened. Comparing data from the two months revealed that the PHQ-9 identified 15 patients as having depressive symptoms as opposed to 5 patients identified without the use of any tool. Even so, the inconsistency in the second month from Day 1 to 15 might have impaired the identification of more patients. There is a chance that the number of identified patients when using the PHQ-9 tool might have been higher had the medical assistants been consistent in their approach. Primarily, the high number of patients indicated that PHQ-9 has high efficacy in the diagnosis and screening for depressive symptoms in adolescents.

    Request this Article


    Reducing Health Disparities while Improving Diabetic Compliance within a Low-Income (Predominantly Hispanic) Population

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Niles, Shawna

    Diabetes is on the rise in the United States, according ot the CDC, 9.4% of Americans have diabetes. Diabetes affects all racial groups, however, Hispanics have a greater incidence of diabetes than any other group. The Hispanic population also has the lowest health literacy and face many barriers to health care. Hispanics are at risk for consequences related to uncontrolled diabetes. Connecting diabetic patients with primary care improves health and can reduce health disparities. The purpose of this project is to connect low-income diabetic patients with primary care. This system improvement project took place within a low-income health care system that is predominantly Hispanic. Diabetes is a problem within this community and often patients do no have a primary care provider. This project took place in a low-income urban area of Salt Lake City, Utah. Utah state goals include improving health and health care outcomes for Hispanics and low-income populations. This project was in-lin with national and state goals. Henderson’s Nursing Care Theory and Melnyk and Fineout-Overholt’s Evidence-Based Process (EBP) Model both served as guides for this system improvement project. Henderson’s Theory emphasizes empowering patients; this project empowered patients by giving them the resources and education to understand diabetes, better management diabetes, and understanding how primary care is beneficial for ongoing medical care and diabetic support. The EBP model simplified this project and served as a framework with steps to follow. Although this project’s main goal was to connect patients with primary care, there were other project objectives and goals to improve health literacy, specifically why primary care is necessary for diabetic management and the resources and support that are available. There were two groups that were measured, a pre-intervention group and an intervention group. The pre-intervention group had 40% follow up with primary care. The intervention group had a 70.8% follow up with primary care. A Chi-Squared analysis compare the two groups and found a p-value of 0.116%. The results were not statistically significant however were clinically significant and resulted in increased follow up appointments with primary care. Project results revealed improved access to primary care within this low-income (predominantly Hispanic) population. Other findings were an improvement in collaboration between these clinics and a renewed sense of teamwork and purpose. This process system also reduced health disparities through better access to primary care. According to the Hispanic population has difficulty navigating the system. The vision is to present this system process to Intermountain Health Care for a permanent change to better serve this low-income population. The Hispanic population is growing in the United States and it is necessary to give them access to care and support for diabetes management.

    Request this Article


    Use of the Distress Thermometer in Rural Outpatient Oncology

    Published Year: 2019
    Program: Doctor of Nursing Practice

    O’Neil, Megan Elizabeth

    Background: Up to 70% of patients with a cancer diagnosis report experiencing some type of distress. Patients who have distress are less likely to adhere to treatment plans, have a lower quality of life and more commonly suffer from depression. Globally, it has been determined that a cancer diagnosis is directly related to higher levels of distress. For this reason, internationally it is becoming a standard to screen all oncology patients for distress. In Cody, Wyoming, there is no formal distress screening that is utilized at the local cancer center. the Distress Thermometer is a formal, reliable, and valid screening tool used to access oncology patients for distress. EBP Framework: The Iowa model for EBP was utilized to organize and implement this DNP project. Additionally, Neuman Systems Model provided the theoretical framework for which this problem is based upon. Neuman’s emphasis on the prevention of outside stressors for all patients directly relates back to the goals of this project. Methods: A quasi experimental study was completed over a six-week period to assess the imapct of staff education on the response rate of patients completing the Distress Thermometer. Data was collected for a three-week period prior to staff education to determine the number of Distress Thermometers completed by each patient who was seen by a provider in a rural medical oncology clinic. A staff educational session was provided and data was collected for another three-week period post-intervention. This method was utilized to determine if the staff educational session would impact the number of patients who completed the Distress Thermometer. Findings/Results: After data analysis, it was determined that staff education had a clinically significant impact on the completion rate of the Distress Thermometer. There was a 30% increase in Distress Thermometer completion following the staff education session. Conclusions/Recommendations: The author concludes that staff education has the ability to influence patient completion of the Distress Thermometer. Additionally, it is this author’s recommendation that the use dof the Distress Thermometer be a continued practice in this medical oncology clinic. By utilizing the Distress Thermometer this clinic will be meeting both national and international standards to screen oncology patients for distress. Additionally, other national goals such as Healthy People 2020 will be met with the use of this psychosocial screening tool.

    Request this Article


    Workplace Violence Awareness in the Emergency Department at a Regional Hospital: A Quality Improvement Plan

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Olsen, Bradley James

    Introduction: Workplace Violence (WPV) is a problem in healthcare globally, nationally, and locally. Many national and credentialing organizations have recognized WPV as a problem and have suggested many interventions to help mitigate WPV. The three most common interventions are zero-tolerance, de-escalation techniques, and tools to report and predict violence. The tools to report and predict violence lead to interventions to prevent workplace violence. The most evidence-based tool for reporting and predicting workplace violence is the Broset Violence Checklist (BVC). Intermountain Healthcare has utilized a reporting tool called the Disruptive Behavior Report (DBR). In this project, the choice to use the DBR was based on its ease of use and the ability to track its usage. Methods: The objectives of the project are to educate staff on WPV, how to use the DBR to recognize behaviors leading to violence, and to create a safe work environment. The emergency staff at Intermountain Dixie Regional Medical Center were taught about workplace violence and the use of DBR, using a PowerPoint presentation during a mandatory department meeting in March 2019. Results: Discern Analytics 2.0 was used to see how many times the DBR was used the year before the intervention. The DBR was used only twice between 3/1/2018 and 3/1/2019. Following the intervention, the DBR was used eight times between 3/1/2019 and 6/16/2019, a four-fold increase in three and half months. Conclusion: Educating staff on the use of the DBR increased in its use; and therefore, made staff more aware of workplace violence.

    Request this Article


    Transitional Telephone Follow-up Call by Nurse Practitioner

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Romney, Denise

    Hospital readmission is a severe problem, costing the United States $12 billion to $17.4 billion annually, with Medicare beneficiaries 65 years and older accounting for a disproportionate share of the cost. For 30 days post-discharge from hospitalization or an emergency department (ED) visit, the highest rates of readmission and ED revisits occur among patients suffering from a chronic obstructive pulmonary disease (COPD), heart failure, hypertension, or diabetes. In New York City, the problem of chronic illness and hospital readmissions is acute. For example, at a local hospital, the chronic disease population exceeds 20,000, the readmission rate is higher than 40%, and it takes 40 days to gain access to follow-up care. Research shows the Transitional Care Model Program (TCM) decreases readmission 30 days after the discharge of patients with chronic diseases, thereby reducing healthcare cost and improving health outcomes. Evidence-Based Framework: Rosswurm and Larrabee’s Model for Change to Evidence-Based Practice and Meleis’ Transitions Theory Model Framework guided the quality improvement practice change. Methods: The primary objective of the study was to determine whether transitional telephone follow-up (TFU) calls to patients with chronic diseases at primary adult care clinic reduce avoidable readmission and ED revisits 30 days post discharge. The TFU call intervention was implemented by a nurse practitioner using the Re-Engineered Discharge Project (RED) toolkit telephone script. TFU calls were conducted 1-14 days post-discharge from hospital stays or emergency department visits. The study employed a sample of 60 patients randomly assigned to one of two groups of 30 patients each. The treatmet group received TFU intervention, while the control group, was not subjected to intervention. Using the IBM SPSS program, the study employed Chi-square and Unpaired T-test statistics to compare the readmission and ED revisits of the control and treatment groups. Findings: The results show that TFU call intervention had a significant association with ED revisits. ED revisits among the treatment group were 30% less than that of the control group. In terms of number of visits, ED revists among the treatment group were 0.4 revisits less than that of the control group. By contrast, the results failed to establish a significant associatiion between the intervention and readmissions. Other results showed that the intervention reduced healthcare cost by ad estimated $554 per patient. Recommendations: The study recommends that the Transitional TFU call intervention is implemented as standard practice in the primary adult clinic at Kings County Medical Clinic for patients with chronic diseases.

    Request this Article


    Mentoring for Mastery, Meaning, and Matriculation

    Published Year: 2019
    Program: Doctor of Nursing Practice

    Washburn, Sheila Dawn Matthia

    Background: Newly hired nurses in the emergency department face a complex variety of patients, conditions, and skills. Newly hired nurses come with a variety of education and past experience and often lack the knowledge needed to have competence and confidence. Perceptions of lateral violence and nurse-on-nurse incivility are magnified for the newly hired nurse during the first year. Those facing incivility are more likely to have decreased job satisfaction and productivity, was well as experience mental and physical side effects. This leads to burnout, which includes emotional exhaustion, lack of personal accomplishment, difficulty finding meaning in the job, and ultimately job turnover. Like the rest of the nation, the American Fork Hospital Emergency Department faces difficulty retaining experienced nurses. The Agency for Healthcare Research and Quality, Joint Commission, and the American Association of Critical-Care Nurses have all prioritized retention of nurses in their initiatives. Framework: Mentoring provides support, identification of tools and resources, as well as career assistance that guides the newly hired nurse through the critical period of change and trepidation. Nursing theorist Patricia Benner’s Novice to Expert Theory provides and excellent framework for a mentoring program. Benner explains the newly hired nurse has no real-world experience, which leads to a sense of incompetency, culture shock, and increased stress. A mentoring program is an effective way to identify the needs of the newly hired nurse and provides the opportunity to fulfill these needs. Methods: The Mentoring for Mastery, Meaning, and Matriculation workshop was designed to facilitate identification and recognition of mentors, tools and resources. Target outcomes included increased feelings of competency and confidence, improved integration into the social network, decreased perceptions of incivility, as well as reduced stress and burnout. These factors were measured using two well established outcome tools: (1) the English Utrecht Work Engagement Scale designed to assess enthusiasm and dedication, which are considered the reverse of burnout; (2) the Conditions for Work Effectiveness Questionnaire-II, which assesses access to information, support, and resources, as well as formal and informal power. Results: The Wilcoxon Signed-Rank test was performed using the data from the pre- and post-workshop surveys. The data indicated a statistically significant improvement in participants perceptions of vigor, absorption, access to information, access to support, access to resources, formal power, and informal power. All participants found the information presented in the workshop valuable. All five participants recommended future newly hired nurses participate in the Mastery, Meaning, and Matriculation workshop. For the purpose of evidence-based practice, it is recommended the program be implemented using a larger sample size, varying units, and be assessed over a longer period of time before assuming the results are applicable. Discussion: The Mentoring for Mastery, Meaning, and Matriculation workshop materials were turned over to the American Fork Emergency Department leadership team for review. The team will use post-workshop recommendations made by participants to make improvements. The remaining six nurses hired to the department within the last 24 months will be considered a control group. Intent to stay will be monitored for the next six months in order to assess the effects of the workshop on long-term commitment.

    Request this Article


2020

    Staff Education Regarding Suspension of DNR Status During Ambulatory Surgical Procedures

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Ahee, Ann Marie

    The Do-Not-Resuscitate (DNR) status was created in 1960. The complexity of clinical practices and procedures have dramatically shifted as well resulting in longer life expectancy. The current era of evidence-based practice and translation research has ushered in new opportunities and responsibilities for the health care team. The location of where care is delivered has also become more diverse. Yet, the legacy of DNR practices has failed to evolve as much as the evolution in healthcare itself. DNR status is part of the advanced directive (AD) and should be followed as the patien’s expressed wishes. The AD details what values patients have in regard to quality of life and is most useful in non-emergent situations. The AD informs the healthcare team about important issues such as endotracheal intubation and cardiopulmonary resuscitation (CPR) – all emergent conditions where the outcomes may affect the quality of life. Ambulatory surgery patients are generally presumed to be stable and carry a low risk of unexpected outcomes. However, emergent situations can arise and these situations present an ethical and clinical dilemma to providers when the patient has an active DNR. The American Academy of Nurse Anesthetists provides guidelines regarding the management of patients in the ambulatory surgical setting who have expressed their intentions through an executed AD and DNR. Rarely is the topic of what to do in the event of an emergency discussed with patients who have DNR status. Equally rare is the patients’ understanding that he AD and DNR can be temporally suspended or completely rescinded by the patient. This evidence-based quality improvement change project is tailored to the topic of educating staff members on the need for a policy change concerning DNR suspension in the ambulatory surgical center. Ian Graham’s Knowledge to Action Model was chosen as this evidence-based practice framework guide, and Richard Ryan and Edward Deci’s Self-Determination Theory was chosenas the theory to guide this project. Four objectives influenced this improvement project: 1) educating staff members on the current anesthesia policy, 2) educating staff members on what suspension of DNR status entails, 3) measuring the impact of knowledge gained regarding a change in DNR status among staff members, and 4) presentation of a new anesthesia policy to incorporate all levels of DNR suspension. Current DNR practices are outdated and must change. Change is difficult in most professions. However, change in healthcare is imperative, if forward movement is the goal. Maintaining a patients’ autonomy, while providing competent and comprehensive healthcare needs to be part of the forward goal that we seek to achieve.

    Request this Article


    Implementation of the Geriatric Depression Scale in Hospice Care

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Brewer, Alexis

    Background: Depression in hospice care is undertreated and misunderstood. The geriatric population have health concerns that increase the likelihood of depression and they are more susceptible to complications that are both pharmacological and non-pharmalogical. Early intervention by an interdisciplinary team can reduce feelings of helplessness and improve quality of life in the final months of life. Foreground: The state of Utah has the highest percentage of geriatric patients enrolled in the hospice benefit provided by Medicare. It is a Medicare requirement to incorporate interdisciplinary care to treat the whole person instead of the disease process. The incidence of depression can be more proactively treated through medications, counseling, spiritual care, volunteer support, assistance with activities of daily living care, music therapy, and management of other symptoms the patient is burdened with that contribute to feelings of depression. EBP Framework: Evidence-Based Practice and interprofessional teamwork have the highest chance of treating depression in the geriatric hospice population. Maslow’s Hierarchy of Needs was utilized in the project along with The Johns Hopkins 18-step Nursing Model. Methods: This project was designed to increase awareness, incorporate all disciplines for multidimensional care, and treat depression through regular assessment and intervention. This project used an educational approach to influence employee education and awareness on the toptic of geriatric depression. The project implemented the Geriatric Depression Scale (GDS-15) in addition to the current Edmonton Symptom Assessment System. Use of the scale directs care to the proper interventions the patients need in order to report decreased levels of depression upon re-evaluation. Findings/Results: The educational intervention along with the use of GDS-15 scale had positive results in increasing awareness of the patients’ level of depression. Implementation of the scale has encouraged the team to work together to treat the depressive signs and symptoms and has increased communication in care plans established for each patient. Conclusion/Recommendations: The project outcomes for this system’s change project include increased care for the patients with a positive GDS-15 scale, increased interdisciplinary team cohesion and teamwork, and increased use of depression care plans to chart patient needs and increase the team approach.

    Request this Article


    Improving Handoff Communication in the Orthopedic Perioperative Setting

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Calderon, Emily

    Breakdown in communication has plagued healthcare for decades. Poor communication among healthcare providers is considered one of the most frequent causes of adverse events. Adverse events in surgical services are linked to poor and inaccurate information sharing, unfamiliarity of surgical patients’ history, risk factors, blurred boundaries of responsibility, and inappropriate decision making. The Joint Commission addressed handoffs as a National Patient Safety Goal with the intent to improve handoff communication and decrease adverse events. The need exists in the perioperative setting to incorporate a standardized handoff tool and communication technique to minimize communication errors and increase staff satisfaction.

    Request this Article


    Early Mobilization

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Christensen, Coby L.

    Background: Physicians historically prescribed bedrest to treat various ilnesses and promote postoperative recovery. The practice is still common in delivering patient care. Evidence-based findings demonstrate the adverse effects of bedrest and immobility. More recently, evidence suggests that early mobilization is superior and more beneficial for patients during hospitalization than traditional bedrest. Purpose: The objectives of this scholarly project were to provide education about early mobilization and an evidence-based mobilization algorithm to the staff of a targeted cardiac progessive care unit and to increase knowledge and compliance with early mobilization. Methods: Using Ian Graham’s Knowledge to Action Framework (KTA) and Lewin’s Change Theory, nursing staff members received education on the benefits of early mobilization and the consequences of immobilization. Measures of change included staff members’ attitudes, opinions, and comfort leves. Means of measurements included a pre- and post-test. Electronic medical record documentation provided mobilization data before and after the education. Results: Utilizing the pre- and post-test, staff opinions, comfort level, and attitudes toward early mobilization all improved following the education t=4.660, p=.000. Mobilization data of 1034 patients were reviewed. Post-intervention mobilization data were significantly different than pre-intervention. Conclusion: Evidence-based education and mobilization aids increase staff members’ knowledge and can increase rates of mobilization patients in the hospital setting. Further studies should measure other patient outcomes, such as complication rates, length of stay, and staff satisfaction.

    Request this Article


    Heart Failure Inpatient Order Set Use and the Quest to Reduce 30-Day Readmissions

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Eaton, Nadine

    Heart Failure (HF) is one of the leading health syndromes with devastating effects on the public globally and nationally. World-wide nearly twenty-six million people suffer from HF, with a mortality rate of eighteen million yearly. The United States has a growing HF population, with approximately six million patients affected and an annual cost of over thirty-one billion dollars allocated to HF admissions and readmissions. Rates of readmissions, even after health care revolutions and rising awareness have largely stayed the same and will potentially rise in the future due to a large aging population. Through proper treatment and following predetermined guidelines set forth by the American Heart Association and the American College of Cardiology, readmissions can be reduced. Organizational order sets for HF are widely available but not used to the full extent. Order set use for effective and efficient treatment for HF could potentially lower HF thirty-day readmission rate which would prove previous studies relevant to current practice when applied in the proper setting and over a longer time frame.

    Request this Article


    Compassion Fatigue Among Pediatric Oncology Healthcare Staff

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Gormus, Courtney

    The issue of compassion fatigue among healthcare providers and support staff members is nothing new in the medical community. The idea of caring for terminally ill patients day in and day out can bring mental, physical, and emotional symptoms that jeopardize the healthcare staff member to patient relationship and ultimately compromise patient outcomes. There is a gap in healthcare settings throughout our nation where healthcare providers and staff members are not properly equipped with the self-care tools and the knowledge and awareness of how to cope with compassion fatigue. The Joint Commission has identified compassion fatigue and burnout as a current, serious problem within the healthcare community and has found that it is directly affecting patient outcomes and the personal wellbeing of healthcare staff members. Currently, at the pediatric oncology outpatient facility in which this project occurred, there is no existing intervention to decrease the prevalence of compassion fatigue, burnout, and secondary traumatic stress or increase of the prevalence of compassion satisfaction. There is no method in place to assist the staff member of this facility in coping with the high demand of daily patient caring. A need exists to aid these healthcare staff members in increasing their compassion satisfaction and ultimately improve outcomes through improved healthcare staff and patient relationships. This project reinforces the need for an intervention to assist healthcare staff members in decreasing compassion fatigue and increasing compassion satisfaction in the pediatric oncology clinical setting.

    Request this Article


    Education for Hospice Case Managers to Improve CAHPS-Hospice Survey Knowledge

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Haislip, Brittany Lee

    Providing expert care as a hospice case manager enables patients and families the ability to cope and work through uncomfortable symptoms and situations. It is the support that is given to families during this time that make the biggest impressions on care. Federally mandated pubic reporting requirements encourages transparency in health care quality. The CAHPS-Hospice Survey provides patients the ability to make informed decisions when choosing a provider for their care. The CAHPS-Hospice Survey is also a tool for families to use in rating their perception of care that their loved one received through the end-of-life. There is strong evidence that states, continuing education that is provided to the hospice case managers can have a direct influence on patient satisfaction scores. Education-based on patient an family expectations through the end-of-life is lacking within the organization. Hospice case managers are often able to provide guidance when confronting difficult and often painful decisions with patients and families. It is important that hospice case managers feel confident in their role to promote comfort, control pain and other symptoms, and provide support for the patient, family and those close to them at the end of life.

    Request this Article


    The Effects of an Educational Intervention on Compassion Fatigue as Experienced by Oncology Nurses

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Hoffman, Jaclyn C.

    The term compassion fatigue was developed in 1992 when it was noticed that nurses lost the ability to provide nuturing care to their patients when dealing with heartache. Compassion fatigue can cause a decline in social, physical, intellectual, spiritual, work and emotional health. These symptoms can cause callousness, isolation, lack of spiritual awareness, decreased energy, irritability, sarcasm, cynicism, anger, boredom, absenteeism, and the desire to quit. Nurses who experience chronic stressors at work at a higher risk developing compassion fatigue. The American Nurses Association has noticed a significant rise in the levels of fatigue among healthcare professionals and states that this has safety implications in the quality of care for patients as well as nurse’s overall health.

    Request this Article


    Effectiveness of Providers Education in Implementing Dietary Counseling to Adult Patients with Hypertension

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Igara, Aiwanehi

    Hypertension is a major risk factor for cardiovascular disease and is the primary or contributing factor to more than 360,000 deaths in America today. In Texas, the prevalence of hypertension is increasing. Thirty two and one half percent of adults are living with hypertension, which is higher than the national average. Lifestyle changes which comprises of smoking cessation, controlling blod glucose and lipids, healthy eating and physical activity, are the first line of prevention of hypertension and should be continued throughout the treatment and management of high blood pressure. The US Preventative Service Task Force recommends clinicialns offer behavioral counseling to promote a healthful diet to a patient with hypertension.

    Request this Article


    Postoperative Urinary Retention in the Recovery Room

    Published Year: 2020
    Program: Doctor of Nursing Practice

    LeBlanc, Kellie Lynn

    The clincal problem identified is that surgical patients are being sent from the recovery room to inpatient units with bladder discomfort and distension, as reported by the receiving nursing unit staff. After discussions with nursing staff and anesthesia colleagues, too cause analysis (RCA) was used to clarify the problem further. Understanding why problems happen can assist in changing the underlying systems and processes and can improve patient outcomes. This evidence-based quality improvement project aims to increase PACU nurses’ awareness regarding the potential of POUR and to inform nursing practice with EBPs for the evaluation and management of POUR in the recovery room.

    Request this Article


    Improving Asthma Education Through the Implementation of Asthma Action Plans in the Clinical Setting

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Llewellyn, Jeremy

    Asthma is a noncommunicable airway disease in which inflammation and constriction cause difficulty to move air in and out of the lungs. Asthma is a global problem with more than 1000 people dying daily throughout the world due to complications of asthma. There are 500,000 hospitalizations each year due to uncontrolled asthma symptoms in the United States costing 56 billion dollars in 2007. Utah suffers from similar trends with hospital bills doubling between 2001 and 2010. Utah strives to improve outcomes through achieving goals set by Healthy People 2020 and by the National Asthma Education and Prevention Program (NAEPP).

    Request this Article


    Screening for Eating Disorders in the Primary Care Setting

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Newman, Meghan

    Eating disorders may present with a range of abnormal behaviors and physical symptoms. Higher rates of eating disorders are found in European and American cultures, and lower rates in Latin and African cultures. Individuals suffering from eating disorders may not display obvious physical signs, especially initially. Increased provider knowledge regarding appropriate screening for and identification of eating disorders has the potential to increase incidence of earlier diagnosis and management of eating disorders. This may result in improved patient outcomes. Eating disorders significantly impact physical and psychological health. Increased provider knowledge of, and screening for eating disorders has the potential to increase the identification and management of these illnesses, thus positively impacting not only the individual but the community as a whole.

    Request this Article


    Implementation and Evaluation of Intraosseous Devices for Emergency Treatment

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Ovsepyan, Jacqueline

    This project’s purpose was to provide evidence-based quality IO access education, training, and policy implementation that is needed for emergency and ICU department nurses in this community hospital. This project gives clarity, directed purpose, accountability, and defined boundaries to the nurses, and it increases the likelihood of successful implementation of IOs. According to Fowler, Pierce, and Nazeer (2009), nurses have the potential to lead strategies to improve the healthcare system and improve positive patient outcomes.

    Request this Article


    Incivility in the Workplace: A Quality Improvement Project to Promote Civil Behaviors Among Nurses

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Pong, Valerie

    Workplace incivility is a growing problem among nurses globally. Uncivil behaviors have devastating effects on patients, nurses, and healthcare organizations. This was a quality improvement project with the objective to create awareness and increase the knowledge on incivility among nurses, educate nurses on ways to recognize uncivil behaviors, prevent and handle incivility.

    Request this Article


    Improving the Management of ADHD in Children

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Rangel, Georgette

    Attention deficit/hyperactivity disorder (ADHD) is a psychiatric disorder that displays age inappropriate levels of inattention, hyperactivity-impulsiveness or a combination of these characteristics. If not properly managed, the effects of ADHD can negatively impact a child’s life and continue to affect well into adulthood. Unmanaged ADHD in children can lead to lower occupational status, poor social relationships, commitment of criminal offenses and/or substance abuse. ADHD is the most common psychiatric disorder among children, therefore, healthcare providers play a vital role in screening and treating ADHD. However, studies have shown providers often feel they lack the knowledge and confidence in identifying and treating children with ADHD. The purpose of this project was to increase PCP knowledge and confidence to better treat the high prevalence of pediatric patients with ADHD. The “Model for Change to Evidence-Based Practice” framework by Rosswum and Larrabee provided guidance for this project through a systematic approach towards change. Understanding and using change theory frameworks can aid medical professionals or change agents to surge the likelihood of success. The Change Theory by Kurt Lewin guided a positive change. In order to meet the overall purpose of this project, these project outcomes had to be meet: 1) Increase awareness of the current evidence based clinical practice guidelines and algorithms on managing children with ADHD. 2) Provide and educate PCPs on the proper screening tools and referrals needed to managed ADHD in children. 3) Reduce the time from initial visit to treatment or medication for children with ADHD to improve patient outcomes. These outcomes were measured by assessing practices before and after the project implementation. According to the literature, there is a great significance on how poorly managed ADHD has a negative impact on a child’s life. Primary care provides are the gatekeepers in recognizing childhood mental health difficulties by using interview techniques, screening measures, levels of familiarity, and trainings. All project outcomes were met and the project was deemed successful. The p-value was .042189. The result was significant at p<.05. The results indicate that there was indeed an increase in comfort level among providers when managing ADHD in children after the educational in-service.

    Request this Article


    Implementation of a Discharge Checklist in the Post Anesthesia Care Unit (Pacu)

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Simpson, Mindy

    With improved technology and shorter procedure times, patients are being discharged from the Post Anesthesia Care Unit (PACU) at earlier in the recovery process. The effects of anesthesia and unclear communication from the healthcare provider can confuse the discharge process. Patients are at risk for poor health outcomes and decreased satisfaction related to their inability to understand discharge instructions after surgical procedures. The goal of the proposed project in this paper was to improve patient care by implementing a standardized discharge checklist in the PACU, improve communication between the nurse and the patient, and ensure all nurses are filling out the discharge checklist.

    Request this Article


    The Early Cardiovascular Disease Risk Screening and Cardiac Health Promotion in Armenians

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Topchyan, Yervand

    Background: Cardiovascular disease (CVD) is the number one cause of death globally. Ethnic and racial minorities, who are considered underserved populations, shoulder a high incidence of CVD because of disparities such as decreased access to healthcare, lack of education, and lack of health literacy. Primary prevention is one way of reducing CVD risk in these underserved populations. Armenians living in Glendale, California are a minority and underserved population, with additional cultural and genetic influences that put them at high risk of CVD. Evidence-Based Framework: The Early Cardiovascular Disease Risk Screening and Cardiac Health Promotion in Armenians project introduced CVD screening, education, and promoted cardiac health to a small sample of Armenians in Glendale, increasing cardiac health knowledge and promoting health behavior modification. This project used Peplau’s Theory of Interpersonal Relations as its theoretical framework. It also used the Stetler Model as the evidence-based practice model to guide the application of research findings into practice. Methods: The objectives of this project were as follows: in Armenians between the ages of 25 to 40 years who received early CVD risk screening, education, and cardiac health promotion campaign versus those without will increase cardiac health knowledge and promote health behavior modification in one month. This project was carried out at a local auditorium with 23 Armenian volunteer participants in three hours. The event included the ABCD Risk questionnaire as the pretest and posttest, educational presentation, and educational materials. The CVD risk of participants was calculated using QRISK and evaluation of the findings was analyzed using the difference between the pretest and posttest ABCD Risk Questionnaire responses using the paired t-test. Results: Findings of this community systems change project show statistically significant evidence to imply that a CVD risk screening, education, and health promotion campaign does increase the knowledge of CVD risk and promotes heart healthy behavior modification within a small sample of Armenians in Glendale. These findings were compared to the themes found in the literature review included in this manuscript. These themes include: risky behavior modification improves mortality and morbidity, increased risk of CVD in Armenians, and education and other culturally appropriate interventions help with health behavior modification in a community. Conclusion: The utilization of a health screening, education, and health promotion campaign is a good method to increase the rate of high-risk patients taking action in modifying their health behaviors. This project increased the evidence that this is true for a small sample of Armenians in Glendale. Author’s recommendation includes implementing this project in a clinical setting in the future, for increased participation and improved data collection.

    Request this Article


    Educating Providers and MAs on Medicine Review Using Brown Bag Medicine Review

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Uche, Comfort

    According to the US Institute of Medicine, injuries related to adverse events negatively affect approximately 1.5 million Americans yearly, causing a hospital spending increase of roughly $3.5 billion. Due to chronic disease, many adults age 65 and older depend on multiple medications. In addition, older adults typically see more than one practicioner and use multiple pharmacies, making it difficult to track their medications and to identify contraindications. Therefore, the provision of sufficient education in the area of clincial geriatric pharmacology can enhance the identification of polypharmacy. The purpose of this project was to educate healthcare providers and medical assistants (MAs) on the use of the Brown Bag Medicine Review (BBMR). The second purpose was to implement the BBMR by asking patients to bring their medicine when coming for an appointment at the clinic. Through the implementation of this project, proper and incease in medicine review was achieved.

    Request this Article


    Postpartum Depression Educational Intervention

    Published Year: 2020
    Program: Doctor of Nursing Practice

    Villagrana, Mary

    Postpartum Depression (PPD) is a worldwide problem, with 80% of cases being undiagnosed. About 10% of women with PPD meet criteria for major depressive disorder, which is a leading cause of disabiliy for women globally. Utah rate of PPD increased to 15.3% in 2017 from 14.9% the previous year. This increase is higher than the national average. Barriers to adequately diagnosing and treating PPD include providers’ lack of knowledge, confidence, and training. One way to address the problem is through providing education on PPD screening to healthcare professionals. Education on PPD screenig will lead to improvement in knowledge and confidence in screening for PPD.

    Request this Article


2021

    Implementing a Triage Tool for Patients with Abdominal Pain

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Catmull, Tyson William

    Abdominal pain is among the most common emergency department complaints, presenting unique diagnostic and treatment challenges. The broad range of differential diagnoses creates the risk of a missed diagnosis, over-investigation resulting in resource misappropriation, and undue intervention. Furthermore, nurses providing triage should have established triage and communication protocols in place. The South Jordan University of Utah community clinic (SJUC) is in the unique position of having an urgent and a stand-alone emergency department. The urgent care nurses triage patients with acute symptoms to either the urgent care or the emergency department (ED). There is currently not a standardized triage protocol in place. Evidence-Based Framework: The scholarly project was to implement the Emergency Severity Index by triage nurses for patients with abdominal pain. Outcome measures involved a cross-sectional analysis, comparing the Emergency Severity Index (ESI) score given to the patient at the time of triage to the resources used once the patient had been triaged to the emergency department. Patients that were triaged to the urgent care setting were given a presumptive score of four or five. Methods: Data was gathered over four weeks. Statistical analysis was performed using Fisher’s Exact test to determine if a statistically signficant relationship existed between the triage score given by the SJUC triage nurse and the resources used in diagnosing and treating the patient. Lewin;s theory of unfreezing-change-refreezing is the theoretical framework that has been selected for the scholarly project. The Iowa Model of Evidence-Based Practice to Promote Quality Care has been selected as the project’s evidence-based model. Findings and Conclusions: After reviewing the educational PowerPoint and implementing the ESI, there was an overall triage accuracy of 84%, with 100% accuracy in patients sent to the Emergency department (ED) and a 71% accuracy rate in patients triaged to urgent care. However, there was no previous data to review using a two-tail Fisher’s Exact test with an alpha of 0.05. The association between the intervention and outcomes was clinically significant, with a p-value of 0.0482. Based on the findings, it can be argued that providing the training on and implementation is clinically significant and prompts further studies of the ESI in the SJUC setting.

    Request this Article


    How Implementation of Obesity Stigma Education Changes Attitudes and Beliefs of an Interdisciplinary Primary Care Team

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Donnelly, Katie L.

    Obesity has been a growing issue globally with more than half a billion people worldwide having a body mass index (BMI) of 30 kg/m2 or higher. Obesity is a multifaceted problem involving physical, social, and psychological dimensions. Veterans are not exempt from this issue with the Veterans Affairs Department (VA) “estimating more tha 165,000 Veterans who receive their health care from the department have a BMI of more than 40, which indicates a serious condition called morbid obesity”. A review of the literature shows healthcare providers have been found to interact with patients with obesity poorly due to obesity stigma thereby perpetuating the problem. The John’s Hopkins Nursing Evidence Based Practice Model (JHNEBP) was utilized in the implementation of this quality improvement project. A Whole Health Clinic team of interdisciplinary providers caring for Veterans participated in this project. Bruner’s Discovery Learning Theory’s ideals are utilized to create an obesity stigma education for the providers. One goal of the education was to increase providers awareness of internal bias. Another goal was to assess whether the education changed any beliefs for attitudes of the providers. Prior to the education the team members completed two Likert scales. The team members repeated the surveys again post education. Results of paired t-tests of pre-and post-self- reported ATOP and BAOP surveys show no significant change in attitudes or beliefs regarding obesity for these participants. This finding does not agree with the current literature on this topic. The results of this study were unexpected. It is highly likely the project would have different results with a larger sample. It is also likely the results would be different if these were providers in a family practice clinic. It is recommended this project be replicated and expounded on with in a larger system of family practice clinic due to the increasing rates of patients with obesity in our nation and worldwide.

    Request this Article


    Diabetes Nutrition Education for Native Americans: A Quality Improvement Project

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Drummond, Elsha

    Background: Type II diabetes is a chronic disease that remains a leading cause of morbidity and mortality in the United States. On the national, state, and local levels, the Native American population has continued to experience higher type II diabetes rates than any other racial or ethnic group. In Utah, the overall health status of Native Americans is poorer than other Utahns. Normalization of blood glucose levels through nutrition management is a fundamental aspect of type II diabetes care. The project site, located in Salt Lake City, serves many Native American patients with type II diabetes; however, nutritional education resources are lacking. EBP Framework: Kurt Lewin’s Change Theory and The Model for Evidence-Based Practice Change by Rosswurm and Larrabee served as the framework for this quality improvement project. Methods: This project’s main objective was to evaluate the effectivenesss of an educational intervention focused on nutrition management of Native American patients with type II diabetes among providers at a single inner-city clinic. Once IRB approval was obtained, a provider in-service occurred. Project participants were comprised of a convenience sample of providers working at the clinic. A pre-survey post-survey design was used to measure the project outcomes. Findings/Results: This project measured the provider’s awareness and confidence in providing nutrition education for Native American patients with type II diabetes before and after a educational intervention. The project results suggested that an educational intervention aimed at increasing healthcare providers’ awareness and cofidence in using culturally congruent evidence-based tools for nutrition management of diabetes had a significant impact. Conclusion/Recommendations: Implementing an educational intervention increased provder’s awareness and confidence in providing culturally congruent nutrition education for the Native American patient with type II diabetes; therefore, it can be concluded that provided with evidence-based nutrition information, providers will induce favorable behavior changes in patients. Such dietary changes can improve the control of type II diabetes and reduce associated comorbidities. It is recommended that clinics serving Native American patients implement ongoing provider education related to culturally congruent nutrition management of type II diabetes.

    Request this Article


    Implementation of Developmental Screenings During Infant and Toddler Well Child Checks

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Evans, Haley Sheffield

    Background: While an estimated one in 160 children globally suffers from Autism Spectrum Disorder (ASD), and 15% of children in the United States have Developmental Delays (DD), only half of pediatricians report the use of appropriate screening tools during Well Child Checks (WCC). Because referring patients to Early Intervention (EI) has a significant effect on patient outcomes, the American Academy of Pediatrics (AAP) has formulated general guidelines regarding screening for DD and ASD during WCC to improve timely diagnosis and appropriate referral. Evidence-based Practice Framework: The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model is an approach to a clinical practice rooted in problem-solving. This model utilizes a three-step process called PET-practice question, evidence, and translation; to ensure that the most recent research and evidence are incorporated into patient care in a timely and efficient manner. This EBP model, in combination with Imogene King’s Interacting Systems Framework and Theory of Goal Attainment, serves as a guide for this project. Methods: This project aims to determine the effectiveness of implementing screenings for DD and ASD during WCCs. Outcome measures include utilizing the Ages and Stages Questionnaire-3 to screen for DD at 9, 18, and 30-month WCCs, and the Modified Checklist for Autism in Toddlers-Revised (MCHAT-R) to screen for ASD at 18- and 24-month WCCs. This intervention’s effectiveness will be evaluated by identifying the number of formal screenings performed at the recommended WCCs during the month of implementation, compared to those completed during the month prior to implementation. Findings and Results: The project’s implementation resulted in a 70.0% increased rate of DD and ASD screening. A McNemar’s chi-square test determined that the use of the ASQ-3 and MCHAT-R screening tools significantly increased rates of screening based on an alpha value of <0.05. In addition to improved screening rates, Post-Implementation positive result rates demonstrated a 9.8% increase compared to pre-intervention positive results. Conclusion and Recommendations: The implementation of the ASQ-3 at 9-, 18-, and 30-month WCC and the MCHAT-R and 18- and 24-month WCC had a statistically significant impact on the number of patients screening utilizing a formal DD and/or ASD screening tool. Following this intervention, the number of positive screenings increased by 9.8% but did not result in an incfreased rate of referral. By increasing the rate of formal screening tool use during WCC, this project brought Season’s Pediatrics in alignment with the current guidelines for the detection of DD and ASD recently outlined by the AAP. This early detection is crucial to ensure that infants and toddlers with DD or ASD are diagnosed and referred promptly to improve their expected outcomes, quality of life, and overall potential. Recommendations for future practice include and online approach to ASQ-3 screening. Future recommendations for research/projects include rates of screening based on ethnicity/race, language barriers, and referral to EI.

    Request this Article


    Implementing a Diabetes Education Program for the Clinical Staff in a Primary Care Clinic

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Germain, Daphnee Emmanuela

    Background: Nationally, 34.2 million people of all ages have diabetes: a total of 1.5 million new cases a year. A lack of diabetic knowledge among the clinical staff can cause a disadvantage in treating and assessing Type 2 Diabetes Mellitus (T2DM). Clinics that are not performing regular inservice diabetes education with the Medical Assistants (MAs) can significantly impact preventative care measurement and maintenance care. Evidence-Based Practice (EBP) Framework: The Plan-Do-Study-Act (PDSA) guided this project in practice. The PDSA model for EBP helped promote quality care and reinforced the framework and theories of this project. This model focused on processes and outcomes. The clinic utilized evidence-based findings on diabetic care and management to improve and sustain a continuous diabetic inservice training model. The PDSA multi-step model was the best model for this project because it identified the issues, research solutions and implemented a change in the process. Elements of the PDSA Model are to “identify a problem, determine a plan, form a team, and gather evidence. The Kurt Lewin Change Theory provided this project’s framework for this project to determine that change was needed for best clinical practice for inservice T2DM teaching. Methods: This was an evidence-based quality improvement project. By utilizing post-test surveys, the project manager effectively assessed learning and rated the effectiveness of diabetic education. The project intended to increase diabetic knowledge and confidence among the clinical staff through the utilization of the Diabetes Initiative Tool (DIT) surveys. The project aimed at concluding a pre-test survey, training with a DIT training presentation, post-test survey, and a final examination. Three medical assistants (MAs) received health coaching/education. The primary outcome was a change in confidence and diabetic knowledge, measured by the pre- and post-test surveys from the DIT. Findings/Results: Educational awareness and the need for continued inservice increased by 75%. The confidence level increased from 73.10% to 94.95%. This was done through documentation after the intervention in the post-survey. The number of staff knowledge and education of diabetes increased by a mean difference of 21 percent points. The MAs confidence level was measured by comparing the DIT survey results before and after the training session. Conclusion/Recommendations: To assess and educate patients with diabetes, providers must incorporate the entire clinical team, including MAs, with the information needed to treat and evaluate patients with diabetes mellitus. The two themes that supported this scholarly project were diabetic education and clinical staff confidence. The final recommendation is for the clinical staff to understand the potential risk associated with diabetes and provide the MAs with primary diabetic education to promote diabetic care and treatment.

    Request this Article


    Improving Hypertension Management in Primary Care

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Granberry, Laurie

    Hypertension (HTN) is “the most common condition seen in primary care and can lead to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately”. High BP is consistently of the most fatal health conditions in the US. Despite often having no warning signs, untreated high blood pressure increases the odds of suffering from poor outcomes from cardiovascular disease and stroke. This study focuses on managing HTN in an ambulatory care setting in San Jose, Ca. serving ethnically diverse and vulnerable populations. The Iowa Model for Evidence-Based Practice to Promote Quality Care, developed by Titler et al., “is well-known and highlights the importance of considering the entire healthcare system from the provider to the patient, to the infrastructure, using research within these contexts to guide practice decisions”. The theoretical framework of the Middle-Range Theory of Self-Care of Chronic Illness is applied to the study as the patient population is identified as having the chronic condition of HTN and the need for self-care strategies. The central phenomenon of self-care is defined as a “process of maintaining health through health-promoting practices and managing illness”. A second theoretical framework is Wagner’s chronic care model, a process improvement model to achieve improved coordination of long-term medical conditions within healthcare organizations. This project’s methodology is the utilization of a multimodel team approach in educating patients on hypertension management. Patients are selected as identified as having essential hypertension according to the EMR. A joint educational presentation utilizing PowerPoint to review HTN and its consequences with a demonstration on appropriate blood pressure measurement is provided. Community partners discuss food preparation/selection. After the presentation, there is a 6-7 – minute relaxation video. Patients are given a blood pressure machine and log to take home. There is also a brief survey for the participants to complete. There is a time set aside to meet with the provider and pharmacist to review medications. Patient confidentiality is respected throughout the process. In conclusion, effective group classes with collaborative efforts to address the critical risk factor of HTN can help patients lower their blood pressures, better maintain a steady medication routine and diet, provide strategies in helping to manage blood pressure, ultimately leading to an improved quality of life and reduced risk of death. This finding compares favorably to that of the literature review, which supports multimodal strategies in treating this chronic illness. Ultimately, the goal of this evidence-based outcomes project utilizing the Iowa model with self-care and chronic care theoretical frameworks as a guide will improve blood pressure results and provide strategies for providers and patients to help manage their chronic illness.

    Request this Article


    Impact of Crisis Intervention Tool, Code Lavender

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Lamina, Lauren

    Mental and emotional health is affected by the work environment. The literature has supported that occupations in healthcare are some of the most stressful occupations worldwide. Healthcare employees are at increased risk for compassion fatigue and negative mental health effects due to workplace setting stressors. Occupational stressors include twelve-hour work shifts, alternatinv day and night shifts, physically strenuous activities, and deeply relating to ill and dying patients and their families. Professional quality of life and mental health instability can lead to burnout. Burnout is an independent predictor of medical errors. Mean emotional exhaustion levels of hospital staff have been correlated to the number of hospital malpractice suits. Mean burnout levels among nurses in hospital settings are an independent predictor of healthcare-associated infections. Burnout can lead to staff turnover. Turnover rates directly impact healthcare costs and negatively impact the financial standings of healthcare organizations. By addressing compassion fatigue and hospital staff’s mental health prior to burnout and turnover, healthcare organizations have the opportunity to avoid irreversible damage. The literature clarifies that the mental health of healthcare staff is not adequately acknowledged and supported. In Oregon, COVID-19 has radically exacerbated healthcare staff’s shaky foundation with prior mental and emotional health instability and compassion fatigue symptoms. Critical care staff is especialy impacted during these times as they experience the most extreme illnesses, losses of inpatients, community members, and fellow teammates. Stressors include contracting the virus through their work, passing the virus to family members, increasing exposure to death, and constant workflow changes. The Change Theory by Kurt Lewin laid the foundation for organizational change. The “Model for Change to Evidence-Based Practice” framework by Rosswurm and Larrabee was used to provide direction for the project through a systematic approach towards change. The methods utilized to prove project success included the objective of instituting a crisis intervention tool, Code Lavender, for healthcare staff on a pilot unit in a hospital setting. Outcomes and evaluation of the intervention were assessed by self-report via the professional quality of life survey and pre- and post 30 days intervention of the Code Lavender intervention. Success was measured in the increased professional quality of life scores. According to the literature, healthcare staff is at increased risk for mental, emotional, and spiritual crises. Utilizing Code Lavender, addressed and supported employees’ mental status, thus potentially leading to decreased turnover and burnout and increased quality of care provided to patients. It increased self-reported professional quality of life. All project outcomes were met, and the project was deemed successful. The result was significant at p<.05. The results indicated that Code Lavender had been proven as a holistic intervention to benefit healthcare staff’s mental well-being.

    Request this Article


    Bundled Approach to School Hand Hygiene

    Published Year: 2021
    Program: Doctor of Nursing Practice

    LeVeck, Lindsey

    Background: A large body of literature suggests that hand hygiene (HH) is considered an integral part of infection prevention strategies. While the majority of initiatives focus on health care providers, school HH programs are gaining traction. Translational research suggests incorporating a similar multimodal, bundled approach to the school setting as seen in health care. This approach involves learning from administrators and teachers about perceptions of HH in the school, understanding perceived barriers to HH, implementing an age-appropriate educational plan, and directly observing behaviors to assess for change. The process analysis suggests a framework that includes identifying shortfalls in practice and behavioral adaptations to ensure long-term success. At the designated early childhood education center, hand washing is encouraged; however, no formal policy or program is in place. Evidence-Based Practice Framework: Stevens’ Star Model of Knowledge Transformation and Milio’s Framework for Prevention served as the framework for the quality improvement project. Methods: Based on the determination of best practices in community health and the designated site’s needs, a two-fold data collection method was designed: a formal proces evaluation of the program as a whole and a quasi-experimental pre-test/post-test survey to the teachers and staff. The survey is adapted from the WHO Hand-Hygiene Self-Assessment Framework. Findings/Results: The process evaluation of the bundled hand hygiene revealed two process indicators, or themes, followed throughout the program implementation: HH opportunities and HH reminders. Additionally, this project measured the teachers’ awareness of hand hygiene in the designated school before and after an educational intervention and program implementation. The pre- and post-survey design revealed significance for an increase in non-verbal reminders throughout the environment and significance for an increase in alcohol-based hand cleaners throughout the environment. Conclusions/Recommendations: Implementing a school-based, bundled HH program increased teachers’ awareness of HH practices throughout the school. Awareness and acknowledgement of HH opportunities through the child’s day increased and reminders beyond verbal cues were utilized more frequently. Therefore, it can be concluded that when implementing intentional measures at increasing HH in the school, the school as a whole will encourage a healthy HH environment. It is recommended that the school continue providing HH non-verbal reminders, adult modeling, and leadership support to HH.

    Request this Article


    Decreasing Compassion Fatigue in Community Coronavirus Testing Sites

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Looney, Lisa

    Background Macro to Micro: As of February 1, 2021, Coronavirus has reached over 25 million cases in the United States, with over 438,035 deaths. In Utah, there areover 346,624 cases and 1665 deaths. Simultaneously, Salt Lake County has experienced 130,042 cases and 679 deaths. Problem: The nurses and healthcare staff taking care of these patients are tired. Most of them have been working on the front line since March 2020. They have experienced situations that have possibly very different outcomes. The training they have received up to this point helped guide them, but the rules and guidelines change often. The hope was that by implementing education of what compassion fatigue (CF) is and ways to combat the issues, we would help nurses and healthcare workers function productively and rationally in their clinical environment. Theory: The cognitive theory by Aaron Beck would best fit for this scholarly project. In this theory, Beck generalizes some cognitions as faulty and labels them cognitive distortions. Evidence Based Practice Model: The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) seems to be the best fit for the project. The JHNEBP model is broken down into three main areas: practice question, evidence, and translation. Method: The main objective of data collection was to evalutate the level of CF in nurses and healthcare workers. This was done via a survey in Microsoft forms. The survey link was emailed to the participants both in December 2020 and January 2021. The email was sent to participants from the Salt Lake County Health Department to control who receives the email invitation. Microsoft Forms was anonymous and did gather data based on the ProQOL survey. Initially there were 21 responses from the first data collection. This data was evaluated for consistency and burnout (BO) measures. After the CF education was delivered, the same survey was completed. A total of 15 responses were received from the follow-up survey. The goal was to have scores improve, and CF decreased. It was hoped that staff retention increased through the COVID testing sites, with turnover decreasing. Results: The findings all came back not statistically significant. This could have been a results of inability to pair survey responses, small sample size, or only a one-month duration. Since there was not a lot of current literature this was not completed surprising. Conclusion: It is recommended that nurses and healthcare staff receive some education on CF, signs and symptoms, and ways to alleviate the issue. The literature reviewed suggests that CF in the nursing profession and healthcare workers is at epidemic proportions. Current research supports providing education on CF interventions; however, more research is needed to identify the most accurate CF assessments and interventions to counteract the effects.

    Request this Article


    VTE Prophylaxis in the Inpatient Setting

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Lott, Ammon Douglas

    Foreground/Background: Venous thromboembolism (VTE) include both pulmonary emboli and deep-vein thrombosis, and though both are avoidable events, PEs are believed to result in up to 10% of in-hospital mortalities. Between 350,000 and 600,000 individuals are affected annually by venous thromboembolisms in the United States, and over 100,000 individuals die yearly from pulmonary embolisms nationwide. Though VTE prophylaxis has been readily available for decades, the provided recommendations in surgical and medical patients are seldom applied. One recent global study involving approximately 70,000 patients across over 350 hospitals from 32 countries indicated that, though 50% of the hospitalized individuals examined were at risk for venous thromboembolism, only 50% of those patients received VTE prophylaxis, with reasons ranging from socio-economic issues to guideline ignorance, along with recommendation disagreements, fear of hemorrhagic complications, and resistance to alterations to previously established practices. Hospitalized individuals are at elevated risk of VTE due to their hypercoagulable state and immobility, and as a result, up to 25% of these individuals have VTE occurences. There is also significant mortality and morbidity associated with VTE development, including the risk of bleeding from therapeutic anticoagulation, prolongued hospital admission, and reduced survival and recurrent disease. EBP/Theory: The evidence-based practice model developed by Rosswurm and Larrabee has directed the creation of this project. This evidence-based model is derived from research and theoretical literature related to evidence-based practice, change theory, and research utilization. This model has guided the implementation of the clinical improvement project by assisting with the assessment of the necessity for change and concluding with the evidence-based protocol integration. This project also utilized Lewin’s 3 step change model, as this model demonstrates an appropriate methodology of processes meant to promote change, which is the ultimate goal of the project. Lewin’s 3-step change model describes three processes meant to impact forces that resist change and are known as unfreezing, moving, and refreezing. Methods: Objectives in this project included increased VTE prophylaxis knowledge and increased VTE charting. This project’s outcome measures were increased VTE prophylaxis Pretest/Posttest scores following the VTE prophylaxis educational presentation and increased VTE prophylaxis charting following the VTE risk assessment tool implementation. The evaluation was performed through a manual data review. Results showed no statistical significance in VTE prophylaxis charting post-intervention implementation compared to VTE prophylaxis knowledge and VTE prophylaxis charting prior to intervention implementation. Results/Conclusion: Due to the inexpensive nature of this project, it is recommended that similar projects like this be implemented and improved upon to bring about desired results.

    Request this Article


    Code Training: Assessing Confidence Through Simulations

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Lowder, Stephanie Rae Contreras

    Background: There are currently many training methods to become Advanced life support certified (ALS) as a provider. In other countries, this is taught as a five-day crash course. There is a traditional course that lasts two days total, in which there a classroom and live simulation component. However, the option is only in person every two years and leads to a lack of practice skills. The Veteran’s Affair Hospital System, including Salt Lake City Veteran’s Medical Center, has switched to a Resuscitation Quality Improvement (RQI) Program. This program varies with no in-person training and only online modules. A recent root cause analysis after a veteran’s death faulted recognition of a rhythm as a cause of death and required additional code training as RQI alone was not adequate. That confidence in skills acquisition needs to be increased. EBP Framework: Within this project, the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model was utilized, along with Kolb’s experiential learning theory (ELT). Methods: This projects objectives were to see if they can increase confidence with a didactic course and a mock code with two rhythms, a fine v-fib into PEA, followed by a debriefing. The outcome was an increase in overall confidence after this training. There were 51 total participants, it excluded two for missing pages, and these were then totaled into pre and post-test scores only. The evaluation method was a statistical analysis of a paired t-test for confidence questionnaires. Findings/Results: Compared to the literature where 12 of the articles showed that mock codes increased confidence in skills, this was in line with the literature, and mock codes increase confidence scores. The majority of staff who took part were nurses, females, most under five years of experience, less than five years in the hospital, and either from critical care or med Surg backgrounds. Most participants were newer to the profession and hospital. Conclusion: Overall, the confidence scores did increase within the education mock code sessions. This also leads to twice yearly code intervals to be required for inpatient staffing within the hospital. Overall mock codes offer safe hands-on training in an environment that supports the High-Reliability Organization (HRO) and the VA Healthcare System strives to cross the nation. There are limitations of sample size and ability to continue with this training given the rise of COVID-19 cases, the activation of the VA Healthcare System’s fourth mission, overburdening on local hospital systems, and taking on community patients.

    Request this Article


    Assessment of Oral Care Compliance Charting After Educational In-Service Intervention and Implementation of Oral Assessment Guide

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Maliwauki, Kylee Rae

    Background: In a macrocosminc view dental care in most countries is expansive, and the prevalence of dental caries and oral cancer is elevated throughout the world. Peridontal disease is one of the most common oral ailments. In a microcosmic view, oral health comorbidities are increased in individuals older than 18 years in the United States and include peridontal disease and decaying of the teeth. Fortunately, the edentulous patient is decreasing in America. On a community level hospital-acquired pneumonia (HAP) affects approximately 200,000 people per year and is the most common hospital-acquired infection. Recently on Utah Valley Hospital’s 9th floor, oral care has been provided to patients only 10.24% of the time, putting patient at risk of HAP, malnutrition, and joint replacement/heart valve replacement infections, as well as other comorbidities such as diabetes and peridontal disease. Framework: The frameworks utilized in this study include Kurt Lewin’s Change Theory and Iowa evidence-based practice model. They guided the implementeation of the realization for needed change, assisted in asking a question, and helped to employ strategies to initiate a culture of change on the specific hospital unit. Methods: This project’s objective was to implement an oral care intervention, with nursing staff, to determine if an increase in oral care compliance for patients could be assesssed. An educational in-service was provided at which the nursing staff were educated by the project manager and a dental hygienist to assess oral care in the patient’s oral cavity. The nursing staff were given a survey to assess barriers to oral care. The Oral Health Assessment Tool was given to nursing staff to assist in assessing the patient’s mouth, create oral care goals for the patient throughout the day, and chart when oral care was completed. They utilized this tool for two weeks after the initiation of the in-service. After which a post-project questionnaire was utilized to assess nursing staff opinion of what was beneficial/hindering in this project. Utilization of patient chart audits was utilized two weeks prior to and two weeks after the in-service to assess if the intervention showed an increase in oral care compliance. Findings/Results: No significant difference was assessed between the two independent variable groups. With an alpha value of 0.05, U=11855.5, z=-1.54, and p=.12 it has been found that there was no significant difference between the independent groups and their outcome variable. With this information, the null hypothesis cannot be rejected. Conclusion/Patient Outcome: Oral care compliance charting did not increase after educational in-service and implementation of an oral assessment tool. The main barriers to oral care assessed were lack of time, high workload and low priority. Benefits of this project assessed from nursing staff included implementation of an oral health assessment tool and an educational in-service describing oral care necessities. Limitations included COVID-19 patient admissions, nursing burnout, and nursing workload. Going forward, the inclusion of patient care technicians may be necessary to assess and increase in charting compliance.

    Request this Article


    Implementing Dietary Counseling Using Mediterranean Diet Brochure for Adult Patients with Cardiovascular Disease

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Martins, Constance

    Background: Cardiovascular diseases (CVD) are the leading cause of death globally, In the United States along, CVD is to blame for an estimated 17.8 million deaths in 2017. In Texas, 1.6 million adults had been diagnosed with Heart disease and stroke; they are the leading causes of death in Texas. According to TDHS, Heart disease claimed more than 43,000 lives and accounted for 22.8 percent of Texas deaths in 2015. About 336,462 hospitalizations of adult Texans are related to heart disease in 2016. Heart disease had cause Texans about $23 billion in 2016, and there is a likelihood that this problem will continue if care is not taken. The risk of CVD can be reduced by early detection, modifications on simple lifestyle changes such as tobacco cessation, blood pressure, cholesterol, diabetes monitoring, control, overweight and obesity management, physical activities, and healthy eating pattern. The Mediterranean diet pattern consists mostly of a plant-based diet with high amounts of fresh vegetables, fruits, nuts, dried beans, olive oil, fish, and salmon-rich in Omega-3 fatty acids. Herbs spices, wine have proven to reduce the risk. In additiona to lifestyle modification, primary care providers’ regular couseling can radically redue cardiovascular disease mobility and mortality in half. EBP Framework: Lewin Change Theory and Rosswurm and Larrabee Evidence-Based Practice (EBP) Model were used to guide the project framework. Unfreezing, moving, and refreezing guided the process of change, while 6 model EBP Model was used in different stages to guide the project. Methods: The purpose of this scholarly project was to standardize how PCPs provide dietary counseling to their patients and implement and evaluation and educational intervention to increase the frequency of nutritional couseling and documentation for CVD patients using the Mediterranean diet. Practitioners should be screened for cardiovascular diseases and providing counseling and interventions during an office visit. The electronic medical record was reviewed and documented with a “yes” or “no” for the presence of cardiovascular disease and Medi diet counseling provided through specific International Classification of Disease (ICD) 10 coding. The speciifc codes are ICD-10-CM, b)Z71.3, dietary counseling, and surveillance. The Chi-square goodness of fit test wasused to examine and determine if there were any changes in the Med diet counsling utilization post-intervention. Findings/Results: Following implementation of the Mediterranean diet brochure, a pre- and post- implementation data showed a significant increase in documentation from, 26.9% pre implementation to 95.8% post implementation. 26.9% to 95.7%, X2=264.9, df=1, p=<.05, indicating dietary counseling provided. Conclusion/Recommendations: The Mediterranean diet brochure’s introduction changed providers’ attitudes towards dietary counseling and health eating for patients with cardiovascular diseases. Subsequent studies are needed on a larger scale on the effect of dietary couseling and lifestyle modification for cardiovascular diseases.

    Request this Article


    Implementation of Chronic Care Management Eligibility in Primary Care

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Mecham, Kylee

    Background: Chronic conditions afflict many older adults 65 and greater. Globally, one in three currently suffers from multiple chronic conditions. Aside from creating negative health outcomes, these chronic conditions are the leading drivers of annual healthcare costs. Locally, Washington County, Utah, has a population of adults 65 years and older of 20.2%, almost double the national percentage of 14.9%. This reveals an opportunity for better management of chronic conditions. EBP Framework: The evidence-based practice framework that guided the implementation of this project was the IOWA Model, in conjunction with Kurt Lewin’s Change theory, which was applied to facilitate a process change. Methods: A chronic conditions sheet was utilized among the medical assistants (MA) at the Desert Edge Medical office in St. George, Utah, during a Medicare visit to identify those who qualify for chronic care management, and notification of this was given to the provider. Outcomes include chronic conditions sheets utilized by the MAs and the number of chronic care management patients identified to determine the significance of financial gain. Findings/Results: The results showed x2=5.000, df=1, p=.025 suggesting the proportions were not equal for each outcome. This is statistically significant and demonstrates that more patients were identified in January 2021 when the chronic conditions sheet was used than in January 2020. Using the chronic conditions sheet allowed 110 patients to be identified as eligible in January 2021. Conclusion: The data suggests that using the chronic conditions sheet allowed the Desert Edge Medical clinic to identify patients that qualify to receive CCM services. This initial step was needed to determine if it was feasible for the clinic to implement these services. It was concluded that it would not be feasible to offer CCM services in the clinic at this time.

    Request this Article


    The Effectiveness of Providers in Implementing Nutritional Counseling with Parents of Children with Body Mass Index Above Eightieth Percentile

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Mfuh, Yvette C.

    Background: Childhood obesity is a nationwide health crisis in the United States, with about 31.7% of children between ages 2-19 years considered overweight or obese. The US Preventative Service Task Force (USPSTF) recommends screening for obesity in children and adolescents six years of age. Texas ranks 19th out of 51 among all states and the District of Columbia. Lifestyle modifications, compromised of health eating and exercise, are the first-line treatment for the management of overweight and obesity. Nutritional counseling, among other interventions, is encouraged to promote weight management. EBP Framework: Lewin Change Theory and Rosswurm and Larrabee Evidence Based Practice (EBP) Model. Methods: This process change is aimed to enhance nutritional counseling by providers. The process change provides a standardized way for providers to provide dietary counseling to patients/parents using the traffic light diet brochure. The electronic medical record was reviewed and documented as “yes” or “no” for the presence of educational counseling. The Chi-Square Goodness-of-Fit Test was used to analyze and calculate differences in dietary counseling from pre to post-intervention. Findings/Results: Following implementation of the TLD diet brochure, the pre versus post-implementation data showed a significant increase in education and documentation from 25% to 85.4%, indicating a significant increase in nutritional counseling. Conclusion/Recommendation: The TLD brochure’s introduction increased the PCP’s behavior in providing dietary counseling. A follow-up study with a longer time frame is recommended to evaluate the effects of dietary counseling on these patients.

    Request this Article


    Improving Quality, Efficiency, and Perception of Nurse Handoff Report Through Situation, Background, Assessment, and Recommendation (SBAR)

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Rice, Andrew Paul

    Patient safety and medical errors are a major problem globally, nationally, and in the state of Utah. St. Mark’s hospital also has the need for improvement in patient quality of care and safety. Improved nurse handoff report is one recommendation to improve patient safety and quality of care and decrease errors. Situation, Background, Assessment, and Recommendation (SBAR) is a method that improves quality, efficiency, and satisfactions. It has also been shown to improve patient safety, quality of care, and decrease errors. The project’s objective was to improve the efficiency, quality, and satisfaction of nurse handoff report. An SBAR based handoff form was introduced to the staff. A pre- and post- intervention Handover Evaluation Scale was given to evaluate the increase of the quality, efficiency, and satisfaction of nurse handoff report. The Stetler model was used as an evidence-based practice model for framework. Both the Stetler Model and Story theory could function together to serve as a single framework for the project. Findings were consistent with the literature. There was an increase in the efficiency, quality, and satiisfaction of nurse handoff report. This was noted in the demographic of the clinical supervisor and change RNs. It was found that education may be an important factor in the success of an SBAR based handoff approach. SBAR based nurse handoff report should be implemented in practice. The approach could be adapted in a way that allows the process to become more efficient.

    Request this Article


    Using the Annual Wellness Protocol and Health Risk Assessment to Improve Patient Care

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Sanders, Lisa M.

    Background Summary: In the United States, 45% of all adults have one or more chronic diseases and, 60% of adults over 65 have two or more chronic conditions. The Medicare Annual Wellness Visit (MAWV), a once per year prevention-based visit, combined with a Health Risk Assessment (HRA), will increase the percentage of patients screened for preventable/modifiable conditions including depression, cancer, hypertension, substance use disorders, and cognitive impairments. The new protocol design was to close gaps in patient care and provide personalized health goals for the next twelve months. In 2020 the Community Health Clinic (CHC) accurately completed only two MAWVs. Implementing a protocol was based on CHCs’ high percentage of patients over 65 plus the higher health risks associated with rural communities. EBP Framework: The EBP model used was the Stevens Star Model of Knowledge Transformation was combined with the theoretical framework of Nola Pender’s Health Promotion Model (HPM). The two together help evaluate current, relevant issues in the primary care setting to formulate logical solutions. The Stevens Star Model provided the structure, whereas the HPM helped focus on health and not disease. The use of these two models ensured the project and change remained evidence-based. Methods: The project was designed around two interventions, the new MAWV protocol, and the educating intervention. The success of the first intervention was based on the number of MAWVs scheduled and complete. The Lunch-n-Learn education intervention’s effectiveness was based on the participants’ Pre/Post-surveys quantifying their level of confidence plus a chart audit for each completed MAWV in 2020 and 2021. Findings/Results: The completion rate of MAWVs increased by 350% compared to the same time period during 2020, along with 28 MAWVs scheduled during the first quarter. The Level of Confidence Survey increased by 134%, and the chart audit revealed that post-intervention chart accuracy was 85.7% compared to 22.2% accuracy in 2020. Conclusion/Recommendations: For future implementation, the workflow associated with each portion of the health risk assessment (HRA) needs to be established and part of the original role out. The recommendation is for CHC to increase the number of completed MAWVs for patients 65 and older. The increase will increase the early identification of chronic diseases, increase preventive services, and increase the number of patients who receive follow-up care.

    Request this Article


    Primary Care Promotion in an Urgent Care Setting

    Published Year: 2021
    Program: Doctor of Nursing Practice

    Scott, Bethany L.

    Background: Access to quality primary care is an important part of maintaining optimal health at the lowest cost. Nationally the number of patients with a primary care provider (PCP) is well below the stated national goal of Healthy People 2020, and the Utah range is lower still. Thus, a project was designed to promote primary care from Utah Valley InstaCare in Provo, Utah, with the following clinical question: Does urgent care staff education regarding interprofessional collaboration (IPC) and the importance of primary care increase the percentage of urgent care encounters in which primary care is discussed over six weeks? EBP Framework: This quality improvement project was guided by the Iowa Model of Evidence-Based Practice and Albert Bandura’s Social Learning Theory. Methods: Project objectives include education of InstaCare regarding the importance of primary care and IPC, education of patients regarding the role of primary care, and increasing the number of InstaCare visits in which primary care follow up was discussed. Following IRB approval, Orchard’s AITCS-II survey of staff perception of IPC pre-intervention and a survey of attitudes regarding future practice post-intervention yielded qualitative data. PCP information forms filled out by staff and the number of patients without a PCP given information regarding local PCPs before and after intervention yielded quantitative data. Participants were a voluntary sample of staff from Utah Valley InstaCare, including physicians, Nurse Practitioners, Physician Assistants, Registered Nurses, Medical Assistants, Radiology Technicians, and Patient Service Representatives. Findings/Results: Peer-reviewed research has shown quality primary care decreases all-cause mortality, improves mental health care, reduces emergency department visits, and improves the overall health care experience. Effective IPC plays a role in these outcomes, including decreased hospitalizations, reduced geriatric mortality, and fewer medical errors. Project results indicated a healthy culture of IPC and a willingness to learn more about IPC and collaboration with primary care. Comparison of PCP forms before and after intervention revealed statistically significant changes. Data also indicate InstaCare procedures for PCP verification upon registration needs improvement. Conclusion/Recommendations: Periodic reinforcement of InstaCare processes and the importance of IPC and primary care are necessary. InstaCare staff has mandatory educational modules due quarterly, to which it is recommended the educational PowerPoint and a quiz be added. This would expand the reach of the intervention from the voluntary sample at Utah Valley InstaCare to all InstaCare locations throughout Utah.

    Request this Article


2022

    Implementation of the John’s Hopkins Fall Risk Assessment Tool for Home Health in an Outpatient Practice Clinic in Adults

    Published Year: 2022
    Program: Doctor of Nursing Practice

    Diaz, John Paul

    Background: Falls are the second greatest cause of accidental or unintentional injury deaths and are a major public health concern on a global scale. Medical costs for falls were reported at approximately $50 billion for non-fatal injuries and $754 billion for fatal incidences. Injuries from falls, car accidents, opiod overdoses, and self-harm resulted in an estimated 2.4 million visits to emergency rooms and >700,000 hospital admissions among older persons in 2018. More than 90% of these visits were connected to unintentional falls. Falls are preventable and can be avoided through detailed safety measures such as screenings and interventions for risk factors. National efforts to mitigate expenditures and safety have been implemented and focused on preventative measures. Preventative measures to reduce falls are important for public health and safety. Objectives and goal of this project is to create an increased awareness of patients’ fall risks and appropriate use of the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) for Home Health through an educational presentation. The goal was to increase awareness of fall risks, thus creating a standard for ordering PT/OT/DME to reduce falls and improving patient outcomes in the home. Essentially, identifying patients at a moderate to high fall risk would create the awareness to implement a safety and prevention measure. Evidence-Based Practice Framework: Stevens Star Model for Knowledge Transformation and Henderson’s 14 Components of Basic Nursing Care. Methods: This scholarly project was implemented with the guidance of the Stevens Star Model for Knowledge Transformation. The JHFRAT was implemented after an educational session as and intervention to prevent fall and later was evaluated for occurences of interventions to prevent falls through a retrospective chart review. The project was completed at an outpatient practice clinic located in Salt Lake City, Utah over a two-week period. Findings: The 2 x 2 Chi-Square Test was used to determine statistical significance. The 2 by 2 values included Pre-intervention and Post-intervention and no PT/OT/DME and PT/OT/DME. A p-value less than 0.05 would result in a “not significant” statistical difference. The p-value for this chi-square analyses for this data was 0.0423. The outcomes data confirmed that there was no evidence of significant difference in the occurence of PT/OT.DME orders after evaluation of data. Recommendations: An investigation on further assessments and evaluation would be necessary to illustrate if an increase of interventions would decrease falls in an outpatient setting. Expanding this project to home health agencies for both RN and providers to make assessments would be more ideal in the home setting. In addition, further recommendations for the outpatient clinic include a resource for assessing fall risk in the home setting.

    Request this Article


    Promoting Colorectal Cancer Screening in a Community Health Center

    Published Year: 2022
    Program: Doctor of Nursing Practice

    Ikedinma, Nneka

    Background: Cancer is a disease marked by the uncontrolled development and spread of body cells to different areas of the body, and it is the major cause of mortality globally. Screenning has been identified as an efficacious means to lower cancer mortality and morbidity. Colorectal cancer (CRC) usually emerges from precancerous polyps found inside the colorectal cancer. Therefore, screening is essential because it can detect polyps that are precancerous, allowing for their elimination before they can develop into cancer. Nationally, the CRC screening rate is low. However, compared to the national CRC screening rate, the screening rate in Federally Qualified Health Centers (FQHCs) is very low. The population of patients seen in FQHCs is minority populations who are from low socioeconomic backgrounds. The project site is an FQHC called Berks Community Health Center (BCHC), located in Reading, Pennsylvania, and mostly serves Berks County. The current CRC screening rate of BCHC is low, and the scholarly project goal is to improve the Primary Care Providers’ (PCPs) knowledge and practice regarding screening for this disease and increase the CRC screening rate. EBP Framework: The evidence-based practice (EBP) model selected to guide the scholarly project was the Model for Evidence-Based Practice Change. The EBP framework provided a step-by-step approach for this change project, and the theoretical framework that guided this scholarly project was Kurt Lewin’s Change Management Theory. Methods: The scholarly project aimed to determine the effectiveness of a process change focused on implementing the American Cancer Society Guideline for Colorectal Cancer Screening, offering more than one CRC screening method and promoting patient reminder in improving providers’ knowledge and practice regarding screening for this disease and increasing the screening rate of BCHC. The six steps of the Model for Evidence-Based Practice Change guided and facilitated the change in practice. Upon IRB approval of the scholarly project, a provider in-service education was conducted. 12 pre- and post-intervention surveys were completed by the participants, and a paired sample t-test was used to identify the difference between the two variables. Findings/Results: The project assessed the providers’ knowledge and practices of CRC screening and the CRC screening rate to see how these factors changed before and four weeks after the implementation of a process change. The project results suggest that the intervention did not bring about any significant difference in providers’ knowledge and practice of CRC screening, but there was an increase in the CRC screening rate of BCHC four weeks after implementing the process change. Conclusion/Recommendations: The intervention did not result in any significant difference in providers’ knowledge and practice of CRC screening. Howevver, there was a 4.7% increase in the CRC screening rate of the clinic four weeks after project implementation. The scholarly project has shown that implementing the process change can increase the CRC screening rate but does not have any effect in providers’ knowledge and practice of screening for the disease. Consequently, promoting the factors addressed in this project will improve CRC screening rate.

    Request this Article


    Educator Nursing Skills : Maintain, Enhance, Advance

    Published Year: 2022
    Program: Doctor of Nursing Practice

    Mills, Carla B.

    Background: Advanced warnings and concerns were given regarding a worldwide, national, statewide, and local nursing shortage. COVID exacerbated it. Nurses have left the profession due to COVID burnout or optioned for early retirement. Nursing schools have increasingly turned away qualified nursing applicants because they are unable to accommodate the anticipated student influx with current, up-to-date, qualified educators. Evidence-Based Practice Framework: Dr. Patricia Benner’s Novice to Expert Nursing Theory, Control Theory, and the Model for Evidence-Based Practice Change provided the framework for this project. Its purpose was to survey the confidence levels of current nursing school instructors. A skills day offering educators updates on protocols and equipment was performed. Results demonstrated an elevation in educator confidence when instructing, demonstrating, and assessing hard skills in nursing instructors. Methods: Internet search engines were utilized on the topic of nurse educator skills enhancements returned approximately fifty articles. Their themes ranged from definitions tothe need of hard skills maintenance. Most articles found focused on continuing education (CEU’s) and certification or soft skills. Handbooks defined educator skills proficiencies and gaps. Little to no evidence specifically addressing nursing educator hard skills maintenance. Likert scale examples were used to formulate three identical confidence-level surveys: a pre-event (baseline), an immediately post event (growth), and a two-weeks post-event (level of growth retention). A skills day was planned to support specific hard skills enhancement. Findings: Data showed increased levels of educator confidence after participating in a skills day offering, demonstrating a positive outcome for this proposed practice change. A two-week post-event survey showed retained levels of confidence. Conclusions/Recommendations: An educator’s confidence in their ability to perform hard nursing skills declines if away from providing bedside cares for long periods of time. An instructor’s confidence bridges the educational gap between nursing hard and soft skills requirements. Educators participated in a skills-day and experienced a rise in confidence level. This, in turn, increased student competencies. Facilities must provide opportunities whereby educator hard skills proficiencies can be nurtured, enhanced, and blostered. When students view their instructors with trust, their confidence increases, and graduate as competent nurses in a professional working environment.

    Request this Article


    Intimate Partner Violence

    Published Year: 2022
    Program: Doctor of Nursing Practice

    Rood, Christopher Michael

    Background: Intimate partner violence (IPV) is a worldwide health crisis, and evidence shows that women are the primary victims. However, men and even children can also be victims of IPV. Victims of IPV typically experience physical, sexual, and/or emotional abuse that have lasting impacts. EBP Framework: The nursing theory used for this project was Kristen M. Swanson’s Theory of Caring, and the evidence-based practice model followed was Steven’s Star Model of Knowledge Transformation (SSMKT). Methods: The project aimed to improve providers’ confidence and willingness to render IPV screenings to adult patients. Outcomes were measured using the Likert scale questionnaire administered to participating providers before and after project implementation. Data from the questionnaires were evaluated using the Two-Tailed Wilcoxon Signed Rank Test. The HARK screening tool results were assessed for the number of positive vs. negative results. Participation in this project was voluntary for the healthcare clinicians, providers, and patients. No personal identifiers were utilized. Findings/Results: Project results demonstrated insignificance as none of the p-values for all eight questions completed by the participating providers were less than or equal to the designated alpha value. Thus, random variation can explain the testing results. Project findings were managed and disseminated during the final process outcome evaluation phase. Data was gathered, calculated, and discussed with the leadership of Tanner Clinic – Westside. Further discussion regarding process development, implementation, and aggregation of this screening tool to standard provider practice occurred. Conclusion/Recommendations: The upsurge in IPV incidence is an unfortunate and often obscure bi-product of the COVID-19 pandemic. Healthcare providers of all specialities, and more so those in family practice, must regularly screen their patients for IPV and take necessary action. The HARK screening tool is evidence-based, proven accurate, and simple for patients to complete, making it an appropriate screening tool for healthcare professionals to utilize in their daily practice.

    Request this Article


2023

    Increasing Appropriate Statin Use in Type II Diabetic Patients : A Quality Improvement Project

    Published Year: 2023
    Program: Doctor of Nursing Practice

    Beers, Christopher

    Background: Cardiovascular disease is the leading cause of death both globally and nationally. Type II diabetes poses a major risk factor in the development of cardiovascular disease. New guidelines for cardiovascular disease prevention aim to calculate patients’ ASCVD 10-year risk and treat with statin medication based on risk. EBP Framework: The Iowa Model Revised and Kurt Lewin’s change theory provided the framework for this scholarly project. These models guided the development, implementation, and evaluation of the scholarly project’s design. Methods: This scholarly project aimed to determine if practice change involving education intervention and an emphasis on calculating patient ASCVD 10-year risk would increase the number fo diabetic patients on appropriate cholesterol lowering therapy. After IRB approval, the project manager used a retrospective chart review to evaluate outcomes and gather data. Findings/Results: This proejct measured the number of patients statin use, those screening for ASCVD risk, and if a patient was on an appropriate intensity statin pre- and post-intervention. The project results indicated that the practice change increased the number of patients screening for ASCVD risk but did not increase the number of patients on statin therapy or appropriate statin intensity. All patients who declined statin use in this project cited effects as the primary reason. Conclusion/Recommendations: Incorporating a practice change into practice increased the number of patients screened for ASCVD risk but did not increase statin use or the number of patients on appropriate statin therapy. It can be concluded that this practice change is beneficial in increasing patients screened for ASCVD risk but that additional change is required to increase statin use in this population.

    Request this Article


    Increasing ASCVD Screening and Statin Therapies in Primary Care

    Published Year: 2023
    Program: Doctor of Nursing Practice

    Dechesaro, Courtney Rae

    Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide. The impact of ASCVD is largely known on the national, state, and local level. Arizona is listed as one of the state with the highest prevalence of this disease. Directions for the treatment and avoidance of ASCVD includes annual lipid panels and statin therapy as first-line treatments if lifestyle modifications prove futile. Increasing the number of patients being screened for ASCVD risk is paramount to decreasing morbidity and mortality associated with this condition. The location of the project site, Mesa, Arizona, has a large population of patients requiring annual lipid monitoring; however, and low number of patients have their ASCVD risk scores calculated at their visits. The main objectives aimed to evaluate the utility and effectiveness of an evidence-based ASCVD risk calculator tool for patients and providers at a privately-owned family practice clinic in Mesa, Arizona.

    Request this Article


    Revised Protocol for Application of the Stop Bang Screening Tool and Utilization of Stop Bang Scores at and Ambulatory Surgery Center

    Published Year: 2023
    Program: Doctor of Nursing Practice

    Hansen, Tamera Lee

    Obstructive sleep apnea (OSA) occurs when the airway of a patient becomes anatomically obstructed of collapsed and is often accompanied by periods of paused breathing called apnea, leading to cardiac difficulties that affect the heartbeat, heart rate, and the development of thrombus. It is reported that up to 60% of preoperative patients have undiagnosed OSA. More than one billion people in the world suffer from OSA, and in the United States, more than 80% of patients who have OSA are undiagnosed and untreated. In Utah, over 33% of adults report shortened sleep cycle, which is a symptom of OSA, and in Washington county in southern UTah, over 32% of adults report this same problem. When surgical patients present to an ambulatory surgical center for elective surgery, they should be screened for OSA quickly and easily because many of them have not been properly screened prior to this, and if OSA is present, then those patients are at risk for serious complications. The purpose of this project is to raise educational awareness and competency within the staff at the surgery center surrounding the use of the STOP Bang questionnaire (SBQ) for proper risk assessment for OSA, and to revise the OSA assessment process with the use of the complete SBQ and then utilize those SBQ scores to improve patient awareness and education on their risk for OSA.

    Request this Article


    Implementing the Use of the Scoff Questionnaire for Female Adolescents Admitted to a Behavior Treatment Center : A Quality Improvement Project

    Published Year: 2023
    Program: Doctor of Nursing Practice

    Livingston, Melissa

    Background: With an increasing number of severe eating disorders among adolescents, prevention and early identification is critical in helping these young people. Eating disorders appear with signs of depression, unhappy feelings or thoughts about body shape or size, food behaviors, family examples, life transitions, extracurricular activities, and psychological health. On the national, state, and local levels, the adolescent population has continued to experience many different problems associated with eating disorders. Logan River Academy, the project site serves many adolescents. Identification and screening can help facilitate proper referrals, where currently no interventions are being conducted. Evidence-Based Framework: Jean Watson’s Human Caring Theory and The Model Knowledge Transformation by Stevens served as the framework for this quality improvement project. Methods: In an effort to guide proper resources and referrals, this project’s main objective was to evaluate the effectiveness of a screening tool for female adolescents who are at risk for eating disorders. Once IRB approval was obtained, a staff in-service occurred. The project manager conducted the screenings with the help of nursing staff and facility managers. Project patients were comprised of admited female adolescents to the residential treatment center. Patient chart audits were conducted four weeks prior to implementation to see if nutritional screenings had been conducted on female patients. Project outcomes measured on improvement of outcomes from pre to post implementation. Findings: This project measured the effectiveness of the nursing staff and managers administering the screening tool to female adolescents and if proper referrals were obtained for the at-risk participations. The project results provded the project manager with data and awareness of the importance of proper assessment tools and follow through the referrals for those needing additional medical interventions. Recommendations: Implementation of the SCOFF screening tool increased awareness to the facility medical department and staff in helping direct and refer patient to sufficient and proper medical care. Therefore, the project site was more equipped to meet the needs of the female adolescents at a mental health residential treatment center who screened positive for an eating disorder. It is recommended that facilities that serve the adolescent population incorporate proper screening tools for eating disorders and adequate attention be given to at-risk patients.

    Request this Article


    Basic Hemorrhagic Bleeding Prevention Using the Stop the Bleed Program

    Published Year: 2023
    Program: Doctor of Nursing Practice

    Sollars, Jordan Taylor

    Background: Mortality due to hemorrhagic bleeding is a significant problem that remains an issue at a macrocosm to microcosm level. Hemorrhagic bleeding occurs in various settings, with increased unprovoked gun violence, acts of domestic terrorism, and traffic collisions. Global, national, state, and local levels have seen an increase in unprovoked gun violence involving the public, church communities, schools, and other instances. In Utah, senseless gun violence has caused programs to become available to help aid in the mortality rates associated with hemorrhagic bleeding prevention. The project site in Saratoga Springs contains many civilians who may know basic first aid; however, basic hemorrhagic bleeding prevention is lacking due to the limited resources available. EBP Framwork: Johns Hopkins Evidence-based Model and nursing theory Nancy Milio’s Framework for Prevention served as the framework for this quality improvement project. Methods: The project’s main objective was to evaluate the effectiveness of an educational intervention focused on basic hemorrhagic bleeding prevention through the Stop the Bleed (STB) program of a church-based youth aged 12-18 with little to no knowledge of bleeding prevention at a single suburban church building. Once IBR approval was obtained, the project manager participated in an in-service with the project site’s stakeholders. Project participants comprised church-aged youth 12-18 who attended the site’s weekly-held activities. A pre-survey and post-survey design was used to measure the project outcomes. Findings/Results: Using the STB program, the project measured the laypersons’ knowledge retention in providing interventional care when traumatic casualties occur before and after the educational intervention. The project’s null hypothesis was rejected, indicating increased knowledge retention of the youth with STB education and hands-on skills training. Conclusion/Recommendations: Implementating an educational intervention showed an increase in the layperson’s knowledge and ability to retain information on basic hemorrhagic bleeding control; therefore, it was concluded that with the provided education and evidence-based training, laypersons had increased knowledge measured by a pre-and-post-survey. The project manager recommended continuing to implement the STB program to the youth semi-annually or annually.

    Request this Article


    Sexual Assault Victims in the Emergency Room : Education on the Role of the Social Worker with Victims

    Published Year: 2023
    Program: Doctor of Nursing Practice

    Sphar, Stephanie J.

    Background: The International Association of Forensic Nurses (IAFN) has declared violence an international public health issue. Violence included “intentional and unintentional injury found in individuals who seek health care following acts of…intimate partner violence (IPV),… (and) rapes or sexual assaults…”. The Federal Bureau of Investigation (FBI) defined sexual assault as “penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim”. The National Intimate Partner and Sexual Violence Survey for the United States by the Centers for Disease Control and Prevention (CDC) stated, “More than one-quarter of women and approximately 1 in 9 men have experienced some form of unwanted sexual contact in their lifetime”. EBP Framework: This quality improvement project used the Rosswurm-Larrabee Model for Evidence-Based Practice Change and Kurt Lewin’s change theory. Methods: This project’s main objective was to evaluate the effectiveness of an educational intervention focused on the social workers in a local emergency department (ED). Providers and nurses int he ED were not educated. The project manager included the administration of the Illinois Rape Myth Acceptance (IRMA) scale, the introduction of the “Emergency Deparment SANE Worksheet for Acute Sexual Assault” developed by the hospital system, and a flowsheet on when to call a Sexual Assault Nurse Examiner (SANE). Once Internal Review Board (IRB) approval was obtained, an in-service was provided to social workers in a local ED. Participants were comprised of a convenience sample of (n=9) ED social workers. A pre-survey and post-survey data collection design was used to measure the project outcomes. Findings/Results: This project measured the use of the “Emergency Department SANE Worksheet for Acute Sexual Assault” with social workers who provide care in an ED setting for the victims of sexual assault. It also evaluated the social worker’s internal bias toward a victim of sexual assault. The project results suggested that using the reporting tool could result in consistent care for the victim throughout the ED in this healthcare system. Conclusion/Recommendations: The ED is often where a victim of sexual assault will first seek care. The project manager developed and intervention providing education regarding a standardized worksheet developed and used through the hospital system for sexual assault victims in the ED that would improve care. The project also served to identify internal bias in social workers will be better able to help the sexual assault victim successfully navigate the ED system.

    Request this Article


    Implementing an Organized Colorectal Cancer Screening Program

    Published Year: 2023
    Program: Doctor of Nursing Practice

    Stevenson, Angela

    Background: Colorectal cancer affects millions globally and is a significant source of disease burden and fatality. Nationally, colorectal cancer is the third most common cancer and is the second cause of fatality in cancer patients. Routine screening is necessary to catch many cancers before metastasis occurs. Colorectal cancer is becoming more common in adults under age 50, necessitating revised guidelines to start screening at age 45. Early screening can improve the five-year prognosis for colon cancer. Opportunistic screening programs are ineffective at targeting every eligible patient and offering screening. Organized screening programs that encourage patients to choose between stool testing or a colonoscopy more effectively identify every eligible patient in a provider’s patient panel. Identifying patients and offering screening can increase the number of patients who complete screening. EBP Framework: Kurt Lewin’s change theory served as the framework for this quality improvement project. Methods: The project’s primary objective aimed to increase the number of colorectal cancer screenings offered and completed in a single, family practice clinic. After receiving IRB approval, an organized colorectal cancer screening program was implemented, which involved sending an email to every patient aged 45 to 74 offering colorectal cancer screening, providing education about the benefits and risks of the various screening methods, and offering an easy way to request testing. One hundred eighty-seven patients were identified and offered screening. A two-proportions z-test was used to determine the difference between demographic groups and the statistical significant of the intervention. Findings/Results: The project aimed to identify and offer colorectal cancer screening to every patient aged 45 to 74 in a single-family practice clinic. The project results suggested that implementing and organized colorectal cancer screening program will increase the number of patients being offered and completing screening. Conclusion: Implementing an organized colorectal cancer screening program increased the number of patients being offered and completing screening compared to an opportunistic screening program; therefore, it can be concluded that implementing an organized screening can help decrease the overall cancer burden by increasing the number of patients getting screened. It is recommended that an organized screening program is more effective than an opportunistic screening program in consistently offering patient s colorectal cancer screening.

    Request this Article


    Educational In-Service Improves Diabetic Foot Ulcer Screening and Charting Interventions in the Primary Care Setting

    Published Year: 2023
    Program: Doctor of Nursing Practice

    Storer, Ashley Lyn

    Background: Type 2 diabetes (T2D) is a global epidemic impating adults on every continent. Most type 2 diabetic adults worldwide live in middle-class, lower-class, or poverty income levels. In America, T2D rates are rising steadily, along with medical costs and the burden on the community. Idaho faces the same prognosis if awareness does not change. T2D and related complications are among the few diseases that can be reversed wtih lifestyle changes. A more severe complication is a lower limb amputation due to a non-healing foot ulcer. Individuals with ill-managed T2D and a lower limb amputation have a poor prognosis and will die early from poor care. Primary care providers play a vital role in preventing foot ulcers by improving their standard of care for all at-risk individuals. A rural clinic in Idaho Falls, ID, served mostly middle-class to poverty-level individuals and was chosen as the project site for its potential to impact diabetic lives, raise the standard of care, and decrease disease-related hospitalizations and amputation rates. EBP Framework: In application, Lewin’s Change Theory implemented three phases, unfreezing, freezing/changing, and refreezing, as a guided theory for this project. Iowa’s Revised Model for Evidence-Based Practice was used as the framework to pilot this project at every step of the process. These strategies serve as the foundation for this quality improvement project. Methods: The objective of this project was to bring awareness to the primary care clinic on the risks of diabetes through an in-service, to improve charting and screening habits, and to open dialogue between providers and patients regarding the risks of developing foot ulcers, and then collaborate with other healthcare specialists. The evaluation was determined by comparing provider charts, pre, and post-in-service, for a total of ninety days. Findings/Results: The project findings proposed that many diabetic patients visit the clinic for conditions unrelated to diabetic complications. Approximately three in 15 adults who came to the clinic daily were diabetic or prediabetic. Less than one patient addressed diabetic concerns as their chief complaint among all providers. This project’s goal was to address diabetic risks for all patients at risk and to prevent foot ulcers from developing through evidence-based science to manange the condition. Conclusion/Recommendations: Implementing new charting templates to assess the diabetic foot and score the patient against the risk stratification table suggested that more tremendous efforts are needed to improve the standard of care for at-risk diabetic patients. These template were a guide for inviting open diabetic dialogue and a prompt to collaborate with other healthcare teams to prevent foot ulcerations. Outcomes from this project suggest that providers should include foot assessments or dialogue in every exam for at-risk patients and include a thorough foot assessment as the standard of care for related return appointments to decrease foot ulceration rates.

    Request this Article


Go to Top