Nursing (Doctor of Nursing Practice)

Can seniors learn what is included in an AWV through an educational presentation, thus leading to an increase in participation and possible improving of overall health? This study aims to investigate if an educational presentation will be effective in increasing the knowledge of an AWV for senior citizens through a pre and post-test. The pre- test and post test will assess their level of knowledge. It will be a quantitative study using a 10 question survey. The seniors will take the survey once before the presentation and then again after the presentation. The participants will be using a Likert scale to rate the importance of a variety of questions that are included in an AWV. Participants over the age of 65 will be eligible for the study, regardless of sex, gender, religious affiliation, or cultural background.

Cardiac arrest is a global issue. Research has been done over the years to create the golden standard within the American Heart Association (AHA) that chest compressions matter. The research now is advancing beyond just the quality aspect. The new knowledge of the quality has led more researchers into the specific timing which is known as the ratio of chest compression fraction (CCF) time. The initiative behind the implementation of this project was to address the problem that the institution did not have any means of measuring either the quality of manual compressions or the CCF. CCF is the time doing compressions divided by the overall time of the cardiopulmonary resuscitation event.

Education was provided to staff on ways to reduce interruption: pre-charge defibrillator, establish pulse prior to holding compression and hoover over the chest for next compressor on the opposite side of the patient. In addition to education on current protocols, a manual compression feedback device was used to monitor real-time feedback. Quality improvement implementation of the measurement of CCF. Data was collected by using a manual feedback device. Reviewing the quality % of compressions. Data was collected for baseline, then post-implementation of education regarding the importance of measuring CCF.

Data were compared for pre and post-intervention, by reviewing overall patient outcomes and looking at the 30-day post resuscitation mark. The post-intervention data included 10 patients. Six of the patients had CCF greater than 80%, Four events used the manual compression feedback device, and two with the mechanical compression device. Four patients had a return of spontaneous circulation at the time of the resuscitation event. However, there were zero survival patients at the 30-day post-resuscitation mark. The data had no difference between the pre and post-interventions for the 30-day survival rate.

Urinary tract infections (UTIs) are the most commonly treated infection among nursing home residents; patients are commonly treated even in the absence of signs or symptoms of a UTI being present. This research study’s objective is to reduce the amount of unnecessary antibiotic prescribing and assess the impact of educational interventions in nursing home residents that have asymptomatic bacteriuria (ASB). The design of this research study is quasi-experimental. The setting is Butler Memorial Hospital, a non-profit organization and an independent community hospital with 296 beds located in rural Pennsylvania. Population of interest includes nursing home residents that present to Butler Memorial Hospital’s Emergency Department with consecutive positive urine cultures. A multifaceted educational intervention will be provided to Emergency Department staff to reduce the number of unnecessary antibiotic prescribing in ASB cases. There were 105 in the sample population that resided in an institutional facility for the elderly that were seen in Butler Health System’s Emergency Department. Out of the DEFERRING ANTIBIOTIC PRESCRIBING IN NURSING HOME RESIDENTS WITH ASYMPTOMATIC BACTERIURIA 4 105-sample population, 73 were encountered before educational intervention. Twelve out of the 73 pre-educational sample population met the study’s inclusion criteria. Out of the 105 sample population, 32 were encountered after educational intervention. 4 out of the 32 post-educational sample population met the study’s inclusion criteria. In conclusion, this pilot study showed that there was a 3.9 percent overall reduction in nursing home residents that were being inappropriately diagnosed with a UTI and placed on unnecessary antibiotics when in fact they had ASB and met the criteria to defer prescription. While this was a small change the potential for changing prescribing habits with educational programs is encouraging and more studies should be done with larger samples sizes.

Background: The problem of interest is focusing on an increase for education within the forensic interviewing process for individuals within the multidisciplinary team and community stakeholders. The PICO question is: Does the development of an assessment tool kit for the child forensic interviewing process increase knowledge of qualified observations evidence by the multidisciplinary team and stakeholders. The Theoretical foundation for this research will aim to develop and present a toolkit that will enhance and positively affect the knowledge and practices of the forensic interview, based on the Iowa Method of Evidence-Based Practice and a Knowledge-to-Action structure.

Methods: Methods utilized a pre-survey, presentation, and post-survey; which entailed an example of setting the stage introduction, rapport, encouraged narrative, facilitators, interview instructions, narrative practices, and follow-up questioning. The analysis of the forensic interview consisted of a model structure in which the multidisciplinary team was given a pre-survey questioning acquired knowledge from previous education, a presentation entailing a structured conversation with a child intended to elicit detailed information about a possible event or events that the child has experienced or witnessed, and a post-survey that measured knowledge gained.

Results, conclusion, implications, and recommendations: The scholarly project gathered information through the pre/post surveys focusing on assessing the information interviewers typically review prior to conducting the forensic interview. The surveys revealed a lack of uniformity within the protocols and the preparation practice, as well as the observational viewers. Summary of data collected, there were limitations to the results which stemmed from a lag in the post survey sent out, as well as a decrease in response from the attendees. In conclusion, there was evidence of learning, which was observed through the results obtained.

The Pearson correlation was used with the result sought after to determine if there was a linear relationship between two quantitative variables, whether a positive or negative correlation. In this scholarly study, the variables were the pre and post survey measuring gain of knowledge by participants. Each question results were reviewed as data to the survey response, with a total of ten questions; both pre and post survey. The pre-survey there were 19 responses. The post-survey resulted in nine out of nineteen responses. Four questions had no statistical significance, however, the remaining questions relating to rapport with the child, impartial attitude, ground rules of the interview, appropriate process, open-ended questioning, and a value with discoverable evidence demonstrated a statistical significance.

In hospitalized patients, the transition from hospital to home can lead to adverse events, negative outcomes, ER visits, and hospital readmissions (Backman et al., 2021). A poor transition of care can also be reflected in low Care Transition scores in HCAHPS surveys. The Care Transition questions reflect how well the patient felt prepared to manage their own care at home.

This quality improvement initiative answered the following research question: “In hospitalized adult patients, how does collaborative care transition planning compared with traditional discharge planning affect Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores one month after implementation”?

The theoretical framework is Larrabee’s model of Evidence-Based Practice. Methods include comparing the Care Transitions scores the month prior to implementation to those from the month following implementation.

There was a decrease in scores the month during implementation, but then increased in the month after. While not a part of the initial data collection, there was also an improvement in patients’ average length of stay. It can be concluded that the increase in communication amongst the healthcare team during the huddle did play a part in the efficiency of managing patients’ plan of care.

The nursing implications include the need for increased communication. When the healthcare team works together, it improves the patients’ transition from hospital to home. Future research may focus on length of stay as an important variable. A limitation of this study was a lack of consistency in collaborative rounding. Additional research in this area is needed.

A lack of support and understanding by healthcare professionals can contribute to cascading events in the quality of their patients, newborns, and communities’ lives from experiencing birth trauma. Women who experience a traumatic birthing experience without support can hinder their feelings of having more children, create relationship problems, negatively affect the bonding with their newborn, and they may avoid medical interventions that are like their birthing experience such as pap smears (Birth Trauma Association, 2018). This project aims to answer, “Does implementing trauma-informed care practices education to perinatal nurses increase their knowledge, attitudes, and practices of trauma-informed care after educational implementation?” Trauma-informed care (TIC) is a concept that is grounded in a set of four assumptions and six principles. A trauma-informed approach to nursing care is inclusive of trauma-specific interventions; whether it includes assessment, treatment, or recovery supports, it also incorporates key trauma principles into the targeted organizational culture. The results of the project noted a positive Pearson correlation from p= 0.1 to 0.6 in all areas of the nurse’s knowledge, attitude, and practices (KAP) from pre- to post-survey results. These results conclude that educating perinatal nurses does positively impact their KAP and is beneficial to implementation. This implementation impacts future perinatal nursing and maternal newborn dyads for generations. The ability to change cultural thinking from “What is wrong with you?” to “What happened to you”? This demonstrates an improvement in care and is the first step in healing for all past and future trauma survivors.

Background: Alcohol use disorder (AUD) has among been reported in 10-32% of hospitalized patients. The evidence suggests the need for screening and early management of alcohol withdrawal syndrome (AWS). Methods: This project included 2 phases - retrospective and prospective chart reviews. Demographic variables (age, gender, race) and length of stay were examined. Statistical tests were conducted to compare data from the phases. The outcome variables examined were the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale. Results: Of 61 patients in phase 1, most (72.5%) were males, had an average age of 47.1 years, and a length of stay of 8.1 days. Most (96.7%) of the patients were placed on CIWA at admission. In one patient, there was not a prompt initiation of the CIWA protocol and alcohol withdrawal treatment, which may have resulted in a reduced incidence of delirium and a shorter hospital stay. Of the 16 patients in phase 2, most (81.3%) were males, Caucasians (62.5%), with an average age of 49.3 years and a mean length of stay of 5.5 days. There were no significant differences at p<.05 between characteristics in the two phases of the study. In phase 2, 7 of 16 patients (43.8%) had a PAWSS score >=4, indicating that these patients were at high risk. 5 of these 7 patients experienced severe withdrawal symptoms making this a true positive PAWSS score. The PAWSS scores were not recorded for 9 patients in this study phase, and 7 of these patients had CIWA score >=16, indicating that the patients may experience severe withdrawal symptoms. Conclusion: As the problem of AUD continues to exist, more detailed information about the use of PAWSS and CIWA to assess alcohol withdrawal is needed. Improving strategies to evaluate the effect CIWA management may be warranted.

Sepsis is a clinical condition that requires early identification and initiation of evidence based interventions to improve mortality and outcomes. A quality concern that has been
identified is that the emergency department at the practice site is not actively screening for sepsis patients. This has resulted in difficulty meeting three-and six-hour sepsis
bundle metrics. The purpose of this quality improvement project is to implement a sepsis screening methodology to correct this gap in practice. The door to lactic acid collection metric will be used to determine if any statistical improvement was made after the implementation of a sepsis screening tool. The screening tool selected for the project will be the qSOFA tool as this is one of the easiest tools to use and implement. The quality improvement project used a quantitative methodology with quasi-experimental design. The results demonstrated a statistically significant improvement in the collection times of lactic acid post-implementation. The results further support the use of sepsis screening in the emergency department setting for rapid identification and treatment of sepsis conditions. Emergency nursing plays a pivotal role in the identification and treatment of this condition as nurses are often the first healthcare professional a septic patient will encounter.

Atrial fibrillation is the most common dysrhythmia and has significantly impacted healthcare staff and systems. Catheter ablations remain the most effective tool in the treatment of
atrial fibrillation, and yet these have often contributed to hospital admissions and costs. Sameday discharges are a safe and cost-saving method being used more in this patient population. This study was completed to evaluate and compare same-day discharge versus admission following catheter ablation.

In the study, there were 321 patients who underwent catheter ablation for atrial fibrillation over 12 months from July 2021 to July 2022. Of these 321 patients, there were 74 same-day discharges. 30-day readmission rates for both samples were similar, with 4 (4%) patients readmitted following same-day release and 3 (2%) patients readmitted following observation or inpatient admission. 90-day readmission rates for both samples were also similar at 2.7% for same-day discharges and 1.2% for observation/inpatient admissions. There was a cost savings of at least $37,000 using same-day discharge versus at least $123,000 in costs for admission for observation or inpatient. Based on this study, the use of same-day discharge in catheter ablation for atrial fibrillation is reaffirmed as safe and cost-effective and should be considered in routine practice.