SU DNP Projects

Permanent URI for this collectionhttp://hdl.handle.net/11603/7334

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Postpartum Education Redesigned: A Quality Improvement Project
(2021-05-07) Jarman, Nicole; Nutt, Rita; Ruhl, Catherine; Hitches, Diane; Nursing; Doctor of Nursing Practice
The United States has the highest rates of maternal morbidity and mortality among all developed nations, and the majority of these cases have been deemed preventable. Many women who have just given birth are not aware of the complications that can occur during the postpartum period, making this a critical time for these patients to receive essential education. This project served to develop an evidence-based postpartum education program with the goals of increasing patient satisfaction and knowledge surrounding possible postpartum complications. A secondary goal of this project was to improve nurse satisfaction with patient education and discharge processes. The postpartum education process was restructured and included the use of a new education checklist designed by experts in postpartum nursing. Voluntary surveys were distributed to qualifying postpartum nurses and patients pre- and post-educational modification to ascertain for any changes in knowledge and/or satisfaction among the groups. Descriptive and inferential statistics were performed on all survey data. Post-implementation findings demonstrated statistically significant differences in the frequency that nurses reviewed possible complications, in patient confidence and knowledge regarding possible post-birth complications and in patient satisfaction with their current knowledge surrounding postpartum complications. The results of this pilot study justify continued use of the modified education checklist in order to increase postpartum patient knowledge of potential complications and assist in decreasing rates of preventable maternal morbidity and mortality.
Assessing Health Literacy of Patients with Heart Failure using the Newest Vital Sign Assessment Tool in Cardiology Offices
(2024) Esham, Kayla; Hart, Jennifer; Hearne, Steven; Helmuth, Bradley; Bunting, Lesley; Nursing; Doctor of Nursing Practice
Heart Failure (HF) continues to be a leading cause of morbidity and mortality in the United States driving health care costs higher and impairing health outcomes of patients affected. Accurate health literacy assessment and utilization promotes self-management of HF, improving health outcomes. This project implemented a practice change to assess patients’ ability to perform self-management. Identification of individuals with limited health literacy using the Newest Vital Sign (NVS) assessment tool promoted a more individualized plan of care to encourage adherence to complicated treatment plans. This office-based practice change was implemented from September through December 2023 in two cardiology offices in rural Maryland. Eligible participants were assessed using the NVS tool and given educational material on HF from an evidence-based resource congruent with their health literacy level. Descriptive and inferential statistics were used to determine if relationships existed between collected variables. Seventy-five, or 50%, of eligible patients were assessed using the NVS tool. Statistically significant associations were found between health literacy and the independent variables of marital status (p=.013) and educational attainment (p<.001) using Chi-Square. Spearman’s correlation demonstrated a positive relationship between educational attainment and health literacy level (p<.001). Implementation of the NVS tool increased provider awareness of patients’ health literacy levels and available resources to enhance self-management. Continued implementation of a health literacy assessment tool will ensure patients with HF receive patient-centered education that they can understand and comprehend; thereby, improving their engagement and overall health outcomes.
Improving the Mental Health of Students in Health Professions Programs
(2024) Reuwer, Kathryn; Waldron, Mia; Westerfield, Heather; Nursing; Doctor of Nursing Practice
Students enrolled in rigorous health professions programs experience psychological distress, most notably elevated levels of stress, anxiety, and depression, which can lead to academic burnout and predispose them to professional burnout when entering the challenging health care field. Implementing preventative measures within academic programs to promote the mental health of students is essential to establish a healthy and sustainable workforce. A Doctor of Nursing Practice project implemented a cognitive behavioral skills building program, Creating Opportunities for Personal Empowerment (COPE), for health professions students at a rural, community college. The goal of the project was to reduce the levels of stress, anxiety and depression among participants completing the program. The theoretical basis was cognitive behavioral theory which focuses on the connection between an individual’s thoughts, feelings, and behaviors. The Johns Hopkins Evidence-Based Practice Model guided the project development and implementation. Of health professions students enrolled (n=14), 10 completed the intervention and the post-implementation survey. Outcomes were self-reported ratings of stress, anxiety, and depression, measured by comparing pre- and post-implementation results of the Perceived Stress Scale-4, General Anxiety Disorder-7 (scale), and the Patient Health Questionnaire-9. A two-tailed Wilcoxon-signed rank test examined the difference between pre- and post-intervention scores. The analyses revealed a statistically significant decrease in anxiety levels (V=5.00, z=-2.08, p=.038) and depressive symptoms (V=0.00, z=-2.21, p=.027) post-intervention. PSS-4 scores decreased from pre- to post-intervention, however, participant stress level decreases were not statistically significant. Findings support continuation of the intervention, as two of the three outcomes demonstrated statistical significance.
Screening for a Traumatic Birth Experience to Increase Identification of Maternal Mental Health Issues in the Postpartum Period
(2024) Pelesky, Lauren; Hall, Nicole; Bennett, Charlene; Nursing; Doctor of Nursing Practice
Although birth is generally viewed as a positive experience, some patients perceive the experience to be traumatic. A traumatic birth experience (TBE) can result in perinatal mood and anxiety disorders, such as postpartum depression (PPD), childbirth related posttraumatic stress disorder (CB-PTSD), and suicidal ideations. The impact on the patient and family can be significant. This Doctor of Nursing Practice (DNP) project implemented screening for TBE during the newborn’s one-week phenylketonuria (PKU) appointment at a rural hospital. The purpose of this DNP project was to investigate the effectiveness of screening for TBE in the postpartum period to identify patients who were at a higher risk for developing maternal mental health issues. The middle range theory of traumatic childbirth guided the development and implementation of the project, focusing on the effects of traumatic birth on the patient, their partner, and the infant. The Johns Hopkins Evidence-Based Practice for Nursing and Healthcare Professionals Model directed the project. Data was collected in a pre-implementation phase (n=43) and a post-implementation phase (n=37), and referrals for follow-up care following PPD and TBE screening were analyzed to evaluate project outcomes. A Fisher’s Exact test compared TBE and referrals for follow-up, as well as TBE and the independent variables. Although the analysis was not statistically significant, screening was effective in identifying 8.1% of the patients as having a TBE (n=3) who would have not received referrals if TBE screening was not completed. This project was clinically significant, and continuation of screening is supported by the project site.
Implementing Maternal-Newborn Intraoperative Skin-to-Skin Contact to Increase Exclusive Breastfeeding Rates in the C-Section Population
(2023-11) Faith Andrews; Kayna Freda; Annette Barnes; Cristina Haas; Debra Webster; Nursing; Doctor of Nursing Practice
Skin-to-skin contact (SSC) is a low-cost, evidence-based practice intervention demonstrated to increase exclusive breastfeeding and provide numerous other maternal and newborn benefits. Including SSC for mothers requiring cesarean sections (C-sections) can be challenging yet important to enhance their care and birth experience. A Doctor of Nursing Practice (DNP) project integrated intraoperative SSC for patients undergoing C-sections to evaluate the impact on exclusive breastfeeding at a suburban, healthcare facility. Exclusive breastfeeding was defined as the newborn consuming only breastmilk with no supplementation of formula during the postpartum stay. Anderson’s mother-newborn mutual caregiving framework guided the project as it asserts that mothers and newborns are mutually dependent as they create a physiological and emotional caregiving experience beginning at birth. The Model for Evidence-Based Practice Change guided the development of an interprofessional implementation team and the integration. The initiation and duration of SSC and the exclusive breastfeeding rate for stable, consenting patients receiving C-sections (n=31) were obtained from chart reviews. This data was compared to a pre-implementation sample of C-section maternal-newborn couplets (n=31) to evaluate project outcomes. The z-test compared the two groups’ exclusive breastfeeding rates while the t-test and Chi-square test provided correlational analysis. Since SSC was not previously utilized, intraoperative SSC rates increased by 62% with 31 of 50 eligible patients participating and 58% (n=18) experiencing the recommended 15-minute duration. Exclusive breastfeeding rates increased by 9.7% to 41.9% with SSC; however, the impact was not statistically significant (p=0.214). Project findings demonstrated clinical significance and supported continuation of the intervention as maternal and newborn outcomes improved, and SSC was readily accepted by the healthcare team and mothers involved.
Early Identification and Intervention for Urinary Retention in Total Hip and Knee Replacement Patients
(2023-04) Messick, Angela; Campbell, William; Wilson, Kelly; Nursing; Doctor of Nursing Practice
Problem Statement: Post-operative urinary retention (POUR) is a potential complication after surgery. In the total joint replacement patient population, including total hip and total knee replacements, POUR can increase the length of stay, potential infections, bladder damage, and a decrease in the quality of life if it becomes a long-term complication. The goal of the DNP project was to bladder scan patients earlier, identify POUR earlier, and intervene earlier before these potential adverse events were to happen. Purpose: The clinical question of: "Can the late incidence of POUR be reduced in the total joint replacement population with early bladder scanning?" was used to guide the project. Using evidence-based practice to guide implementation, a protocol was developed in a regional hospital where bladder scanning was performed on arrival to the Post-Anesthesia Care Unit (PACU) along with intermittent catheterization if the bladder scan was over 500 milliliters. All total knee and total hip replacement patients were included. Methods: The Johns Hopkins Nursing Evidence-Based Practice Model was utilized to design implementation. Data was collected through chart reviews ten weeks pre-implementation and ten weeks post-implementation. All data was compiled into an Excel spreadsheet and analyzed. Results and Significance: Compliance with bladder scanning increased greatly, from 64% pre-implementation to 96% post-implementation. The average time until the patient was bladder scanned pre-implementation was one hundred and sixty eight minutes, and post-implementation was eighteen. The T-Value was found to be 12.8092 and the two-tailed P value is less than 0.0001, making the results statistically significant.
Reducing Early Warning System Unreported Events in an Acute Care Setting Using Education and a Communication Tool
(2023-05) Pennington, Dirk; Hall, Nicole; Bradley, Beverly; Nursing; Doctor of Nursing Practice
The inability of the healthcare team to identify and report Early Warning System (EWS) patient events can result in further patient deterioration and delays in providing needed care. The purpose of this DNP Quality Improvement (QI) project was to initiate a QI solution using evidence-based practice (EBP) to address unreported EWS patient events on inpatient medical and surgical units at one healthcare institution. This DNP project instituted education and re-education of staff on EWS and utilized an EWS Communication Tool (ECT) to reduce unreported EWS scores >4 or a score of >2 for a single EWS parameter thereby improving EWS response times and positively influencing patient outcomes. The data collected involved reported and unreported EWS patient events representing pre- and post- QI implementation. Using Social Cognitive Theory (SCT) as a framework and the Model for Improvement, the DNP student provided the medical/surgical staff EWS education, re-education, and the ECT. Data collected revealed that some EWS parameters were more frequently missed than others. Analysis also revealed a significant association between travel nurses in the post-QI implementation period and unreported EWS events. Both factors can be considered when planning future education. A positive finding was the increase in reporting for an EWS score of three in the post-implementation period. Continued implementation of the QI project’s interventions can help sustain this and other encouraging findings.
Forensic Nurse Identification of Elder Abuse: Implementing the Elder Assessment Instrument
(2023-04) Reges, Maureen; Keenan, Anastacia; Volz, Jessica; Nursing; Doctor of Nursing Practice
Elder abuse is a significant public health concern and is thought to be largely underrecognized. The Centers for Disease Control estimates 1 in 10 older adults, aged 60 years old and over, who live independently were abused the previous year. The National Council on Aging estimates up to 5 million older Americans are abused every year. Poor detection in the hospital of elder abuse (EA) can have profound health consequences. Systematic reviews suggest benefits of utilizing valid screening tools for EA such as the Elder Assessment Instrument (EAI). Jean Watson’s Theory of Human Caring provided the conceptual underpinning of the project as forensic nurses assist their older patients to meet their basic human needs of safety while offering support in a helping-trust relationship. The clinical question guiding this project is whether using the EAI for patients aged 60 years old and over for possible abuse by forensic nurses, improves identification of EA over a three-month time frame. Johns Hopkins Nursing Evidence-Based Practice model guided the project, which describe several cornerstones of nursing practice, education, and research. Pre-intervention (N=18) participants who were suspected abused by initial screening question, were referred to a forensic nurse for assessment using no specific method to identify abuse. Post-intervention (N=9) participants were referred to a forensic nurse and assessed using the EAI. Data analysis demonstrated improved identification in all four areas of abuse. Pre-intervention (N=18), nine participants had physical abuse not addressed and nine had neglect not addressed. The EAI provides a comprehensive approach to identifying elderly patients who may be victims of abuse and has the potential to improve health outcomes and prevent further abuse from occurring.
Assessing Antihypertensive Therapy Nonadherence in Cardiac Rehabilitation Patients using the Morisky Medication Adherence Scale (MMAS-8)
(2023-04) Parks, Natalie; Hart, Jennifer; Evans, Christopher; Ruff, Jeanne; Nursing; Doctor of Nursing Practice
In a patient population where disease states are being newly navigated and the emphasis is on improving cardiac health, promoting medication adherence can help prevent poor outcomes. The outpatient phase II cardiac rehabilitation (CR) program has no evidence-based process for assessing medication adherence. This project's aim was to implement the Morisky Medication Adherence Scale (MMAS-8) among CR patients to determine if it increased identification of patients not adhering to antihypertensives over the current practice, and to identify reasons for nonadherence. Using a between-subjects design, the pre-implementation group was retrospectively assessed for answers to the current questions (August 15-October 7, 2022) and the practice change group received the MMAS-8 (October 10-December 2, 2022). Descriptive statistics were used to compare the two groups and the Chi-Square test was used to determine associations among categorical data. Pre-implementation group (n=51), 45 out of 51, or 88%, were adherent and 6 out of 51, or 12%, were nonadherent. Practice change group (n=26), low adherence was 4 out of 26 (16%), medium 11 out of 26 (42%), and high 11 out of 26 (42%). Statistically significant associations: gender/adherence in pre-implementation group (X^2= 3.934, df= 1, N=51, p=0.047); age/adherence in MMAS-8 group (X^2= 9.672, df= 4, N=26, p=0.046) suggesting age may influence how beneficial the MMAS-8 assesses adherence. The MMAS-8 increased the number of identified nonadherent patients by approximately 400% (58% vs. 12%) and discovered eight reasons. Medication adherence can be improved using evidence-based measures. Quantifying and determining attitudes for nonadherence can provide insight and correct it earlier.
Enhancing Lung Cancer Screening through Team-Based Medicine and Electronic Clinical Decision Support (CDS) in Primary Care
(2023-05) Tyndall, Megan; Barnes, Annette; Donoway, Tammy; Braniff, Jordan; Nursing; Doctor of Nursing Practice
Lung cancer is the leading cause of cancer deaths in the United States, but mortality significantly decreases when found early and treated. Annual lung cancer screening promotes early detection yet remains underutilized, with 1-5% of at-risk patients completing the low dose computed tomography (LDCT) scan recommended. This evidence-based practice (EBP) project aimed to increase the number of at-risk patients referred for and completing potential life-saving screening. Using the U.S. Preventative Services Task Force 2021 guidelines, process improvements in primary care were identified from a synthesis of the literature. Evidence-based practice (EBP) implementation followed the Revised Iowa Model and included team-based education, modification of electronic maintenance alerts/clinical decision supports, and shared decision-making. Outcomes of patient identification, referrals, and completion rates were compared between independent samples three months prior to and during September to December 2022. Providers and the care team utilized EBP interventions with positive feedback. The modification of alerts was partially successful and prioritized for completion by the organization. Patient referrals increased (39 vs. 26 patients), and the proportion difference was statistically significant (p= 0.020). The completion rate also improved (26 vs. 17 patients) but was not statistically significant (p=0.934). The number of patients identified for initial LDCT scans also increased but was not statistically significant (p=0.273). Data analysis may be limited due to the short implementation period and small samples; however, the increase in identification, referrals, and completion rates for at-risk patients was clinically significant and supports sustainability of process changes to enhance lung cancer screening.
Using the Ottawa Model for Smoking Cessation to Improve Tobacco Cessation Efforts in Transitional Care
(2022-11) Schenk, Laura; DiBartolo, Mary; Bands, Vickie; Nursing; Doctor of Nursing Practice
Tobacco cessation improves health and prevents death in patients who smoke. An evidence-based practice (EBP) project was implemented within an outpatient transitional care office to improve tobacco cessation efforts. The purpose of this doctoral project was to determine if the Ottawa Model for Smoking Cessation (OMSC) increased tobacco cessation counseling and referral rates. Counseling rates were defined as the percentage of smokers who received advice about quitting smoking. Referral rates represented the percentage of smokers referred to tobacco cessation services through the Maryland Quitline. The OMSC intervention emphasizes a three-step approach of ask, advise, and act to guide tobacco cessation assessment, counseling, and referral. Additional intervention components included outreach, training, electronic health record (EHR) enhancements, resource materials, and follow-up. The Stages of Change Model provided the theoretical framework for the project, and EBP implementation was guided by the Iowa Model. Participant data was collected from the EHR pre- and post-implementation with a total sample size of 248 participants, (n=125 pre; n=123 post). Data were analyzed using a z-test to compare the two groups’ mean counseling and referral rates, a t-test for equality of subgroups, and Chi-square test for analysis of other demographic characteristics. After implementation of the OMSC intervention, counseling rates increased by 22.1% (p = < .001) and referral rates increased by 6.5% (p < .002). Age group and race/ethnicity had a moderate association with referral rates (p < 0.05). Project findings provided support for this EBP change within the practice setting.
Development and Implementation of a Lesbian, Gay Bisexual, Transgender, and Queer+ Inclusion Toolkit to Increase Relevant Health Screenings
(2022-12) Wood, Stacey; Hall, Nicole; Philipsen, Nayna; Nursing; Doctor of Nursing Practice
Lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) individuals may face challenges within the healthcare system that relate to discrimination, physical abuse, possible bias regarding their sexual orientation and gender identity (SOGI), or little to no training of providers regarding their unique health needs. To address these issues there are various trainings and recommendations available that increase awareness so healthcare persons can better provide culturally sensitive healthcare to this vulnerable population. The purpose of this Doctor of Nursing Practice project was to improve the healthcare LGBTQ+ individuals receive by using current care recommendations to develop and implement an inclusion toolkit to better meet the needs of these individuals. The focus population for this project was adult LGBTQ+ patients attending a nurse practitioner’s primary care clinic located within an underserved inner-city neighborhood with a large minority population. Data was obtained using convenience sampling of deidentified chart information before and after implementation of the inclusion toolkit’s recommendations. The intent of the inclusion toolkit was to increase the collection of SOGI data and the proportion of screenings performed for depression and sexually transmitted infections (STIs). Data was analyzed to determine if there was a postintervention increase in the proportion of screenings for depression and STIs completed and collection of SOGI data compared to pre-implementation baseline. Results of this quality improvement project provided information on the usefulness of an LGBTQ+ inclusion toolkit for enhancement of provider’s knowledge, practice, and awareness of the unique care needs of these individuals, with the aim of improving health outcomes.
Implementing the Heikes Screening Tool for Prediabetes and Type 2 Diabetes for Adult Patients in a Rural Primary Care Clinic
(2022-03) Bland, Laura; Keenan, Anastacia; Hardisty, Vicki; Nursing; Doctor of Nursing Practice
The problem identified showed inconsistencies in screening for prediabetes and type 2 diabetes by primary care providers at a primary care office in rural Maryland. After a complete literature review, a standardized screening process for identifying those at risk for prediabetes and type 2 diabetes was the solution to this problem. The purpose of this project was to standardize a screening process for prediabetes and type 2 diabetes. A standardized screening process was created to assure all patients meeting criteria for the American Diabetes Association (ADA) screening guidelines were screened properly for risk while delivering the standard of care to all patients. The goal was to increase screening by practitioners. This will aid in early diagnosis of the disease, thus leading to a decrease in diabetic related complications. Heikes screening tool was implemented using a standardized process involving an inclusion and exclusion checklist created by the ADA to identify those needing further screening. If a patient met inclusion criteria, a Heikes screening tool was completed. The patient’s risk was then identified from the screening tool and discussed in real time with the patient. Heikes screening tool was evaluated and measured by how many additional patients could be captured for being at risk with the use of a standardized screening process. The Heikes screening tool and process created a more standardized approach to identifying patients at risk for prediabetes and type 2 diabetes. Descriptive and inferential statistics were used to analyze this screening process. There was a final sample of 40 participants using convenience sampling. The screening process was able to identify and screen 22.5% of participants that had not been previously screened as evidenced by a chart review or patient reporting. The data also revealed participants who had a waist circumference of 38.4in or more had a 6.65% higher risk of being in the high-risk category for diabetes development through the Heikes screening tool (p < 0.001).
Implementation of a Bystander Intervention Model to Promote Referrals to and Enhance Utilization of Mental Health Resources by Students in a Community College Setting
(2022-05) Leeds, Lindsey; Powers, Jessica; Willey, Jeffrey; Barnes, Annette; Towner, Jennie; Nursing; Doctor of Nursing Practice
The coronavirus (COVID-19) pandemic increased college students’ risk and prevalence of mental health conditions. However, campus mental health resources have been underutilized, and referral of students in need hindered by bystanders' (i.e., faculty, staff, peers) lack of preparedness. This Doctor of Nursing Practice (DNP) project aimed to improve bystanders’ preparedness using evidence-based practice (EBP). Expected outcomes included increased referrals to and utilization of mental health resources and improved access to care for college students. Guided by Social Cognitive Theory and Bystander Effect Theory, the project also focused on the concepts of self-efficacy and confidence. Workshops, based on the BeVocal bystander intervention model, were provided virtually to volunteers from a suburban, community college’s faculty/staff and student populations. Participants completed anonymous surveys for demographic data and Gatekeeper Behavior Surveys for self-rated confidence, preparedness, and likelihood to act pre- and post-workshop. A postcard was developed and provided for participants as a resource post training. Significant improvement was found post-workshop in participants’ preparedness (p<0.001), self-efficacy (p<0.001), and likelihood to intervene (p=0.002) for both sample groups. A 115.09% increase in concerning behavior reports and an 87.54% increase in referrals to college mental health resources occurred during the four months after the workshop implementation. Access to mental health care for college students was promoted through community engagement and increased preparedness to recognize and refer. Based upon the results, the BeVocal bystander intervention model and workshops will be continued at the community college through a grant obtained for the program.
Implementation of a Diabetes Education Initiative in a Privately-Owned Family Practice
(2022-05) Ward, Howard III; Hart, Jennifer; Hofmann, Charles; Nursing; Doctor of Nursing Practice
Of the 34 million Americans living with diabetes mellitus (DM), approximately 95% have type-2 diabetes mellitus (T2DM), which is characterized by insulin resistance and gradual loss of insulin production (Centers for Disease Control and Prevention [CDC], 2019). Inefficient use of insulin causes excess glucose to build up in the bloodstream placing individuals at high risk for target organ damage (CDC, 2019). In rural and underserved areas of the country, the prevalence of T2DM among Americans continues to grow at an alarming rate (CDC, 2019). This office-based quality improvement project utilized a pre-test post-test design to assess patient self-care knowledge of T2DM before and after a standardized education session. The purpose of the education was to reinforce patient understanding of DM, as well as promote healthy lifestyle modifications to effectively manage the disease in patients residing in a rural, underserved area. This project aimed to answer the following question: “In adults 18 years of age and over recently diagnosed with T2DM, does early implementation of standardized disease-specific education increase patient Revised Diabetes Knowledge Test (RDKT) scores and compliance with T2DM management over standard care?” Participants were recruited from a privately-owned family practice located in a rural, underserved area, and those patients with a recent or new diagnosis of T2DM were eligible to participate. Descriptive and inferential statistics were used for quantitative data analysis. A one-sample t-test showed statistical significance in the difference in pre-test and post-test scores before and after the education, t (4.922), p < .05. Findings from this DNP project have potential to contribute to the lack of data and improve clinical practice in other rural, underserved areas.
Implementing Discharge (D/C) Teaching for Sepsis Patients to Decrease 30-Day Readmission Rate
(2022-05) Owens, Denise; Willey, Jeffrey; Begley, Elizabeth; Jarboe-Costello, Joanne; Nursing; Doctor of Nursing Practice
Hospitals recognize sepsis as a serious medical condition and recognize that early treatment of sepsis improves patient outcomes and saves lives. Unfortunately, post-sepsis patients being discharged from the hospital may redevelop sepsis. Readmissions due to sepsis can negatively impact patient outcomes and lead to increased hospital costs. Despite these findings, many hospitals underuse resources (e.g., patient education and patient engagement) to prevent hospital readmission due to sepsis. The purpose of this evidence-based project was to determine whether a sepsis education program introduced by the nursing staff at time of discharge from the medical/surgical unit will reduce the number of 30-day readmissions to the hospital setting due to sepsis. Educating the patients at discharge about sepsis, the importance of understanding the signs and symptoms of early sepsis, and the steps to take if they meet the criteria in meeting sepsis was implemented. A needs assessment was done to serve as a basis for preparation of developing an evidence-based project within the hospital setting designed for healthcare providers to consistently provide sepsis education at time of discharge. The IOWA Model design was used to assist the healthcare team in translating the research findings into practice and to increase positive patient outcomes. Malcom Knowles’ Andragogy Theory was developed to understand and provide direction in meeting the needs of the adult learner. This theory assisted in the teaching of the healthcare team and the patients. Metrics, including readmission rates for patients being discharged with the diagnosis of sepsis were monitored to determine education program success. Measures included readmission rate and the compliance rate of sepsis education documentation at time of discharge. Data collection on readmissions and sepsis education documentation were collected through chart audits and stored in the organization’s secure drive.
Use of a Standardized Telehealth Visit Tool to Improve Care Outcomes of Veterans in Home-based Primary Care
(2022-04) Talley, Chrystal; Barnes, Annette; Bradley, Beverly; Nursing; Doctor of Nursing Practice
In the United States, approximately two million homebound, older adults have chronic health conditions and disabilities. Providing primary care to this high-risk population is challenging and requires evidence-based strategies to address higher treatment noncompliance, lower medication adherence, decreased continuum of care, higher risk for hospitalizations, and disproportionately high healthcare costs. This project implemented evidence-based practice (EBP) of a standardized telehealth visit tool to increase access to primary care for homebound veterans. Anticipated outcomes included an increase in telehealth visits, holistic documentation, and a decrease in emergency room (ER) visits post-implementation. A synthesis of literature highlighted best practices during telehealth visits to include utilization of a standardized tool. A telehealth visit tool was developed to guide visits conducted by nurse case managers and other providers in a home-based primary care (HBPC). During a three-month period, telehealth visits were offered to all veterans enrolled in the HBPC program located in the Northeast region in the United States. Data including demographics, number of telehealth visits, tool usage, and number of ER visits and hospitalizations with diagnosis were analyzed pre- and postimplementation. Telehealth visits improved access to care for homebound veterans with a 373.3% increase in the total number. The standardized tool assisted nurse case managers and providers to maximize the benefits of and promote continuity of primary care using telehealth. Hospitalizations and ER visits did not decrease, perhaps due to the short implementation period, an increase in COVID-19 cases, and the high-risk population’s multiple comorbidities.
Proposed Discharge Summary Checklist to Assist Residents Completing Discharges to the Transitional Care Unit
(2022-05) Mwaura, Tom; Freda, Kaynabess; Krenzischek, Erundina; Nursing; Doctor of Nursing Practice
Medical residents at a hospital in Maryland are responsible for completing discharge paperwork for patients destined for an affiliated transitional care unit (TCU). The hospital to TCU discharge process is complicated because patients are discharged from the hospital and subsequently readmitted to the TCU while maintaining continuity of care. New Medical residents at times find it challenging to navigate this hospital’s discharge to TCU process. The purpose of this Doctor of Nursing project was to evaluate the perceived usefulness of a proposed discharge checklist. Invitations were sent to all medical residents on a current rotation at the hospital n=18. The residents were asked to review a new discharge to TCU checklist that was designed for the project and then respond to a 6-item questionnaire. Descriptive statistics were utilized for data analysis. After reviewing the checklist, 17 residents completed the questionnaire. Fifteen participants indicated that the checklist would have been beneficial for them at the time they completed their first discharge to the TCU. All 17 participants agreed the checklist would be beneficial for future residents at the hospital. The project found that new residents at the hospital initially struggle with the discharge from hospital to the affiliated TCU process and that checklists can assist the residents in completing the required documents. A discharge checklist can eliminate the need to edit discharge paperwork, improve patient outcomes, improve patient throughput in the hospital, decrease readmission rates, save healthcare dollars, and improve quality ratings.
Design and Implementation of an Evidence-Based Solid Organ Transplant Patient Education Protocol
(2022-05) Rothstein, Amy; Allen, Kimberly; Mayfield, Allison; Nursing; Doctor of Nursing Practice
Kidney transplant recipients require comprehensive education about medications and caring for their new organ before discharge to prevent unwanted complications, including hospital readmission. Literature supports the need for comprehensive education to enhance outcomes. The purpose of this Doctor of Nursing Practice (D.N.P.) quality improvement project was to design, implement, and evaluate the impact of an evidence-based patient education protocol for kidney transplant recipients that focused on patient medication knowledge, nurse medication knowledge, patient satisfaction, and readmission rates at a transplant intermediate care (IMC) unit. Pender’s Health Promotion Model (HPM) guided the conceptual underpinnings, and the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model was used to organize the project. Evidence from a systematic review of literature was utilized to develop a standardized education protocol. Descriptive statistics were used to assess patient knowledge of medications and patient readmission rates pre- and post-implementation. Qualitative data analysis was performed to evaluate nursing knowledge surrounding patient education prior to implementation and their confidence in their delivery of education post-implementation. Analysis of patient 30-day readmission rates demonstrated a downward trend postimplementation. In addition, patients displayed satisfactory knowledge about their medications with an average score of 83.33% nurses who were more engaged during education sessions, and 75% of nurses felt more confident in their educational abilities. Results of this D.N.P. project supported how implementation of evidence-based patient education protocols can enhance and improve the process of medication education for both transplant patients and nursing staff to improve outcomes.
Using the One Minute Preceptor Framework to Improve Feedback Effectiveness
(2022-05) Meisel, Ashley; Seldomridge, Lisa; Skaarer, Eileen; Nursing; Doctor of Nursing Practice
The success of new graduate nurses, also referred to as orientees, is heavily influenced by the effectiveness of the preceptors supporting their transition from academia to practice. A vital aspect in the preceptor-orientee relationship includes the ability to provide effective feedback. Structured and continual training for preceptors on how to give effective feedback leads to improved new graduate performance. The purpose of this quality improvement project was to determine if the One Minute Preceptor (OMP) framework would improve the ability of preceptors to provide concise, timely, and constructive feedback to new graduate nurses in the acute care setting. The OMP framework is short, easy to implement, and has been used successfully by many disciplines for purposes of providing feedback to orientees in healthcare. Participants in this project included 14 preceptors of new graduate nurses in three inpatient units at an acute care hospital in the mid-Atlantic region. The participants were chosen because they completed standardized preceptor training and had oriented new graduate nurses within the past year. The preceptor group was asked to complete training on the OMP and pre- and post-intervention surveys were used to compare results. The second group of participants in this project included two new graduate nurses who completed their orientation on the same units. This group was asked to complete pre- and post-intervention surveys to assess their perception of effectiveness of feedback from preceptors to orientees. All data were collected using researcher-made surveys and results remained confidential.

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