Nursing (Doctor of Nursing Practice)

Nurse residency programs (NRPs) have been instrumental in assisting to bridge the theory-to-practice gap commonly experienced by new graduate nurses (NGNs). NRPs have also proven useful in improving retention, work satisfaction, confidence, and competence (Spector, et al., 2017; Ulrich, et al., 2010; Rosenfeld, & Glassman, 2016). Despite the overwhelming literature to support implementation of NRPs in all hospitals, to date, in the United States, only 31 hospital sponsored NRPs are accredited by the Commission on Collegiate Education in Nursing (CCNE) (AACN, 2019). Currently, public documentation on the number of NRPs accredited by the American Nurses Credentialing Center (ANCC) are unavailable. Additionally, in Pennsylvania, only 2 hospital sponsored NRPs have obtained national accreditation. NRP accreditation holds health care organizations accountable and proves these programs have demonstrated quality. For an organization to undergo a significant change initiative, such as accreditation, a state of readiness must be present or created (Franquiz & Seckman, 2015).

Human Papillomavirus (HPV) is the most common sexually transmitted infection causing cervical, oropharyngeal cancers and genital warts. In the United States (U.S.), it is estimated that one in four individuals are infected, with an additional 14 million new cases of HPV infections occurring annually. HPV contributes to 17,600 cancers in women and 9,300 cancers in men annually. HPV vaccine is the most effective way to protect against HPV related cancers. However, there is a lag in HPV vaccination due to barriers such as: health care providers hesitancy to promote the HPV vaccine, low baseline knowledge of HPV and HPV vaccine, safety concerns, cost and system barriers. Studies show that there is low overall knowledge of baseline HPV and HPV vaccine among college students. The purpose of this study is to determine if an educational video intervention increases baseline knowledge of HPV and HPV vaccine in the attendees on a college campus in Northwestern Pennsylvania. To test this, a study design consisting of an educational session that utilizes an HPV educational video, followed by a brief question and answer session was developed. A questionnaire is implemented pre- and post-intervention to analyze HPV knowledge in participants. There were 22 participants who completed the study. Comparison analysis between the pre- and post-knowledge assessments show statistically significant improvement of results after viewing the educational documentary on HPV. The likelihood of getting a perfect score on the assessment increased by 13.7%, equating to a 70 percent reduction of incorrect answers from viewing the educational video.

This study examined whether use of an electronic medical record (EMR) to prompt screening of eating disorder risk among a college female population improved identification of risk for the disease. Data were obtained via a convenience sample of patients accessing a university health service gynecology clinic. The SCOFF tool is a well-validated 5-item questionnaire with sensitivity of up to 87.5% and specificity of 95% for bulimia nervosa and anorexia nervosa. Clinicians were prompted by EMR to administer the tool to all gynecology patients seeking care not related to eating disorder symptoms. A comparison of positive identification of eating disorder risk from the previous year, during the same time frame when EMR prompt was not embedded, was conducted via an EMR data search. Results show a relationship between eating disorder risk identification and EMR prompt (p = .0047). The study concludes that ease of use of the SCOFF tool combined with the EMR prompt improves screening for eating disorders in the college health setting.

Background: Hypertension, or high blood pressure, is a chronic medical condition characterized by elevated blood pressure levels persistently exceeding the normal range. Hypertension is a crucial public concern and the leading cause of kidney disease and cardiovascular diseases, including heart attacks and strokes, and is the most frequent diagnosis seen in medical treatment in the US and worldwide. Adequate education, lifestyle modifications including physical activity, heart-healthy diets, and medication adherence are essential for patients with high blood pressure to be able to manage their disease and live with the best quality of life. Many studies have indicated the effectiveness of educational programs in reducing blood pressure and improving the health status of patients with hypertension.

Aims and Objectives: The purpose of this evaluation is to determine whether a formal single hypertension educational program will improve knowledge of management, increase motivation to change health behavior, and improve and promote medication adherence among the senior population.

Design: A pre-test and post-test study were conducted.

Methods: In this evidence-based education program, 33 older adult patients were recruited from the senior citizen community-based center in Philadelphia, PA. The intervention included education focused on improving knowledge of blood pressure, lifestyle changes, medication adherence, and motivation for behavior change. Outcomes were measured utilizing The Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB-Scale) and Hypertension Knowledge Test (HKT), a 12-item National Heart Lung & Blood Institute questionnaire.

Results: The program showed promising results that have positive implications for future practice and research. Of the participants that completed the study (N=33) of African descent, 27.7% were of Caucasian descent, 72.3%, 60.61 % were women, and 39.39% were men. The data collected reflected the participants' intentions regarding disease knowledge, medication adherence, and behaviors pre- and post-intervention. Findings suggest that community-based tailored education programs can successfully produce better HTN management by increasing hypertension knowledge, improving adherence to treatment regimens, and encouraging lifestyle changes among senior adult populations.

Conclusion: This educational intervention successfully identified improvement in senior adults' knowledge and increased motivation to change their blood pressure management health behaviors, leading to improved blood pressure control. It is hoped these results will be more widely used. Further investigation and future research would be more effective in meeting these goals in later programs to gain a more in-depth understanding of managing hypertension among senior adult communities.

Alcohol Use Disorder (AUD) is a chronic medical condition characterized by an impaired ability to control or stop the use of alcohol, despite the adverse social, occupational, and health consequences (APA, 2013; Witkiewicz, Litten & Leggio, 2019). The purpose of this study was to identify the presence of stigma and perceived negative attitudes of nurses working with patients diagnosed with AUD in all areas of practice, with the aim of decreasing stigma and enhancing positive attitudes in nurses caring for patients with AUD through an educational intervention. The literature is well established that nurses feel unprepared educationally to care for patients with AUD, and also hold negative attitudes and perceptions of working with patients with AUD (Haskins, et. al, 2014). This research will conduct a pre-and post-survey of registered nurses’ attitudes and perceived stigma followed by an educational intervention to evaluate whether the education is a positive critical element that can help to reduce stigma and improve negative attitudes nurses may hold toward caring for patients with AUD. This research is a quality improvement project to collect and use data that is meant to drive change that has practice and policy changing implications. The Seaman-Mannello Survey was used as a pre-and post-survey to measure the efficacy of the interventional education video. A convenience sampling of 76 registered nurses from three Northwestern Pennsylvania hospitals was used. The goal of this research study was to investigate the effectiveness of an educational intervention that, if significantly effective, can be used on a larger scale to decrease stigma and improve attitudes of nurses toward patients with AUD. The results found no significant relationship between the provided educational intervention and reduced stigma or improved attitudes of nurses while working with patients with AUD. Although a positive relationship could not be established, it was inferred from the pre-and post-survey scores, ongoing education is still needed and may impact the care of individuals with AUD.

Heart failure (HF) readmissions are incredibly burdensome to hospitals across the country. In 2020, approximately $563 million in penalties from the Center for Medicaid and Medicare Services (CMS) were assigned based on higher than average admission rates (Allen, 2019) with a significant portion related to HF. Our facility has consistently had readmission rates higher than the CMS national benchmark. This is both detrimental to our patients and the cause of assessed yearly CMS reimbursement penalties, which significantly impacts payment for care delivered. There has historically been a very incomplete and disjointed care transition post-discharge for our HF population.

Research has supported health literacy as one of the determinants in diabetes management (Fang et al., 2020; Kim & Utz, 2019; Robatsarpooshi et al., 2020; Van der Heide et al., 2014). Low health literacy has led to poor health outcomes in diabetes management (Poureslami et al., 2017; Van der Heide et al., 2014; Wang et al. et al., 2016). Research lacks interventions aimed at improving diabetes self-management for individuals with low health literacy (Jiang et al., 2019; Kim & Utz, 2019; Vandenbosch et al., 2018). This doctoral quality improvement project aims to evaluate the relationship between health literacy and diabetes self-management skills after participation in a web-based educational pilot program for adult patients with Type 2 diabetes in a rural community in Western Pennsylvania.

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.

On average, humans spend one-third of their lives fulfilling basic sleep needs (Cirelli, 2019). Theories suggest that sleep improves immune responses, reduces energy, allows for the recuperation of cognitive functions, and removal of waste; however, the exact function is unknown (Zielinski, McKenna & McCarley, 2016). Research has revealed when sleep is chronically disrupted the individual experiences a reduction in their quality of life, an increased risk for mortality as well as cerebrovascular and cardiovascular events (Chattu, Sakhamuri, Kumar, Spence BaHammam & Pandi-Perumal, 2018). Ever changing variables that affect sleep in the hospital setting have created a need to ask the question, what happens when such disruptions occur in an environment like the hospital? Therefore, the primary purpose of this study was to identify adverse outcomes associated with insufficient sleep experienced by hospitalized non-critical older adults in literature.

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.

Homeless people with chronic disorders need routine follow up to control chronic diseases and prevent exacerbations. Returning to the clinic for appointments or other interdisciplinary collaboration without a reminder is challenging. An intervention that involves automatic text message reminders could increase the return to the clinic for follow-ups, minimize ‘no shows’, and improve the overall health of homeless people with chronic diseases.

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.

Crisis events, both manmade and natural, could materialize at any time on the campus of a higher education institution, and often have a detrimental impact to the mental health of those experiencing the event. There is already a high prevalence in mental health disorders in college-age individuals and crisis events can often precipitate immediate and long-lasting effects to mental health regardless of an individual’s mental state. Educational institutions have a duty to develop comprehensive crisis management plans that address safety of mental health, as well as physiological, before, during, and after crisis events.

Social media plays a significant part in the lives of many teens. Inappropriate use of social media can cause negative consequences. Studies show that cyber-bullying, lack of family interaction, lower self-esteem and depression are among these consequences. Unfortunately, studies also show that many parents lack the knowledge to monitor their children’s social media use.