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).

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.

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.

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.

Problem Statement: According to the U. S. Preventive Services Task Force (2018), Falls are the leading cause of injury that are related to morbidity and mortality among older adults in the United States. In 2014, about 28.7% of adults aged 65 years or older had a history of fall resulting in 29 million falls in which about 37.5% required medical treatment or encountered restricted activity for a day or more while an estimated 33 000 resulted in death in 2015 (USPSTF, 2018). This is estimated to increase to seven falls per day by 2030 which makes it an important topic to address (CDC, 2021).
Objectives: The purpose of this project was to improve safety by conducting a retrospective review of a Quality improvement (QI) measures of an evidence-based fall prevention program in Assisted Living. PICO research question was identified as P- Older adult residents, I- Evidence Based Fall Prevention Guideline C- Comparing before and after fall prevention programs, O- Decrease in falls.
Methods: This research was completed in Southern New Jersey, United States. Participants were required to be at least 65 years of age and older. The squire guideline 2.0 was well used in this QI article. This study evaluated a QI fall prevention protocol of Physical Therapy (PT) that was instituted in the Assisted Living Facility (ALF). Data were obtained from EHR and paper records. For the purpose of this study, fall was defined as an inpatient’s unknowing, sudden drop to the floor with or without injury, regardless of height of drop, whether assisted or unassisted to the floor (NDNQI, 2020). A weekly number of falls were retrieved 6 weeks before intervention and 6 weeks after. Data was analyzed using t-test to compare outcomes and propose policy change.
Intervention: The IOWA model was used to do a retrospective review of the success of the program. It was used at the beginning of the QI project as a foundation for the project. The Iowa Model helped direct decision-making and EBP process from both the clinician and system’s point of view (Iowa Model Collaborative, 2017). This 12-week fall prevention program focused on falls before and after physical therapy for individuals 65 years and above. The EBP fall prevention program of PT was instituted during week 7 and monitored by all team members.
Result and Conclusion: Using the paired t-test analysis, findings revealed a significant difference in pre and post intervention of p< 0.05. There was a decrease in the number of falls post intervention when compared to pre-intervention data. All data are presented in graphs, charts and tables for description. This paper has about 51 pages including references and appendix with tables and graphs of statistical importance. All tables and graphs are original work of the authors. The pages can be reduced as the reference pages currently list all tables, graphs and figures already used in the body of the article. Given the large audience to your publication, this article will be very valuable to your professionals. It will help educate them or reinforce knowledge on how to reduce injury and high cost of care that are incurred from falls, and improve overall safety.

The purpose of this evidence-based practice project is to evaluate the effectiveness of a pilot mental health knowledge questionnaire tool used to assess for change in knowledge. Currently, there are limited tools being used to assess mental health and depression knowledge in vulnerable communities. This study’s objective and goal is to improve the current practice for community mental health education in vulnerable communities with the intent to increase awareness and dispel cultural misconception of mental health. A self-reported pre-test was administered to assess baseline knowledge of mental health and depression followed by the educational program on mental health and depression. The data was analyzed utilizing the Statistical Package for the Social Sciences (SPSS) 23 for descriptive and inferential statistics. The scores from a paired t-test were compared to determine the effectiveness of the educational intervention. This study sought participants aged 18 and older, fluent in speaking, reading, and understanding English. The findings reflect a positive improvement in knowledge recorded on the post-test responses. Results also showed an increase in correct responses on the post-test after the implementation of the mental health depression educational program. Finally, the promotion of educational programs on mental health and depression in vulnerable communities are beneficial in bring awareness of mental illness.

Migraines are a common and debilitating medical issue. Many patients are turning to complementary and alternative medicine to either augment or replace conventional medical treatment for this. However, it is unclear what their primary care providers’ attitudes are toward the use of CAM and the PCP’s knowledge base in this area. This study was designed to determine PCPs’ attitudes towards CAM and if a brief educational presentation regarding CAM modalities frequently used for migraines had any impact on their attitude towards CAM. There was a pre survey, a Power Point presentation discussing common CAM used for migraines, and a post survey. This was a small study, with 13 participants completing the pre survey and 10 completing the post survey. There was no significant difference between the pre and post intervention groups (p=0.46, significance level of <0.05). However, both groups had a mostly favorable attitude towards CAM. Gender, work setting, and credentials did not impact attitudes towards CAM. Acupuncture, relaxation therapy, massage, and chiropractic care were the CAM modalities that the providers felt the most comfortable discussing. The findings from this study can be used as a guide for future educational offerings and CAM services in the area. Suggestions for future research include offering a continuing medical education credit to boost participation.

Overweight and Obesity is defined, according to the CDC, as a weight higher than what is considered healthy for a given height (CDC, 2021). This is calculated using a screening tool for overweight and obesity. Overweight is regarded as a BMI of 25-30, and obesity is greater than 30. The latest data shows that adult overweight and obesity is increasing and has become a major global epidemic. Overweight and Obesity is a very complex health issue that has resulted from a combination of factors, including behaviors. This includes poor dietary patterns and inactivity. Lack of education in healthy nutrition is one of the issues contributing to overweight and obese adults. Other reasons can be psychosocial barriers that can include fear of judgment and uncertainty about the process of seeking help if one is obese. Other obstacles can consist of time commitment and the cost of programs. Being overweight and obese can lead to increased health risks like diabetes, heart disease, stroke, and certain cancers. According to the CDC, obesity is also associated with the leading causes of death in the United States (CDC, 2021). With this comes a significant economic impact as well. This small pilot study used participants in a brief online asynchronous. The criteria were people ages 18-65. Each volunteer participant gave written consent to participate and be evaluated during the program. Each volunteer participant answered the preprogram questionnaire, watched the virtually based PowerPoint presentation linked under YouTube, and then answered the same questionnaire to assess their new knowledge and willingness to change to a healthier lifestyle. The General Nutrition Knowledge Questionnaire was the tool used for evaluation. This questionnaire is a valid measure of nutrition knowledge that is consistent and reliable.

The virus responsible for Covid-19, acknowledged as a public health threat, has been causing global disease since it was first discovered in December 2019 in China. The CDC (2021) issued a call for action through its Science Agenda for Covid-19 to identify evidence-based interventions for interrupting disease progression in vulnerable populations such as those in emergency shelter settings.

This project focused on Covid-19 and its impact on the homeless population in northwestern Pennsylvania. The theoretical framework was the John Hopkins Evidence-Based Practice Model (JHEBP). A survey collected self-reported data on the practice and barriers to using personal non-pharmaceutical interventions (NPIs). Participants were adults ages 18 and over in one of two emergency shelters on the data collection date.

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.