Doctor of Nursing Practice Projects

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https://ir.ua.edu/handle/123456789/7250

The DNP is a practice doctorate in nursing which prepares graduates to function at the highest level of nursing practice. The DNP curriculum includes development of a clinical practice project. This “DNP project” is designed to synthesize scholarship in an advanced nursing practice specialty or an area of health care leadership. Practice immersion experiences provide the context within which the project is completed. Students develop the project under the direction of a team, including program faculty, the student, the clinical advisor, the faculty advisor, and alumni mentors.

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The impact of social media on social presence and student satisifaction in nursing education
(University of Alabama Libraries, 2014) Hollis, Holly Nicole; Houser, Rick; University of Alabama Tuscaloosa
The purpose of this study was to determine if social media has a place within the classroom and can enhance the student's learning experience by tapping into a medium in which they are already comfortable and familiar, and interact with on a daily basis. Social media has the potential to change the overall dynamic of the traditional lecture classroom, opening up new avenues of communication and learning that lecture classes alone are not able to offer. It can enhance the learning of students by promoting a digital learning community. Social media is also a cost effective tool for the institution, as it costs nothing for the faculty or student to join. This study involved assessing 49 nursing students who used social media, or Facebook to be more exact, compared to when they used a traditional online learning platform. A learning community, a place where instructors can be involved in building social presence, which involves instructors and students in a site-based format that helps assist continued collaborative development, was built into the class (Linder, Post, & Calabrese, 2012). Learning communities provide a way for the instructor to provide information to students, and then allows those students to discuss among themselves the subject assigned. A digital learning community may facilitate improvement in the students' online social presence.
Quality Improvement Project to Improve Diabetes Self-Management in Low Socioeconomic Status Individuals
(2020) Beeching, Stephanie A.; Lee, Amy; Bennett, Barbara; University of Alabama Tuscaloosa
Type 2 diabetes (T2DM) is a chronic metabolic disorder characterized by insulin resistance and higher than normal blood glucose levels. T2DM affects 422 million individuals globally. Long term complications of uncontrolled diabetes include blindness, limb amputation, heart disease and kidney disease. Diabetes diagnosis and complications are more common among minority populations and individuals with lower socioeconomic status. Expanding the knowledge base of the disease process and self-management can help with glycemic control and improve patient outcomes.
Evaluation of Documentation of Contraception Education for Solid Organ Liver Transplant Recipients
(2020) Dassas-Molin, Ruth; Collins-Yoder, Angela; Miloh, Tamir; Tekin, Akin; University of Alabama Tuscaloosa
Solid organ liver recipients who are of childbearing age are placed on immunosuppressive medications after receiving a transplant. These teratogenic immunosuppression medications are harmful to the developing fetus. Unplanned pregnancy in this patient population puts the recipient at high risk for fetal abnormalities and a high-risk pregnancy. Contraceptive education has scant published data for this population. Additionally, there is minimal data developed for low literacy educational interventions that would assist the transplant recipient to make informed choices. The purpose of this scholarly project was to determine documentation of the baseline occurrence of contraceptive counseling in a Florida clinic, and the evaluation of a low literacy contraceptive education brochure in the Miami Transplant Institute clinic liver patients.
Educating Anesthesia Providers to Implement Postoperative Nausea and Vomiting Risk Assessment as a Standard of Care
(2020) Brent, Kimyatta M.; Lee, Amy; Haddock, Gerald; University of Alabama Tuscaloosa
The prevention of postoperative nausea and vomiting (PONV) is a challenging task that must be addressed both to decrease patient dissatisfaction and postsurgical complications. PONV is a distressing and costly side effect of general anesthesia, leading to a prolonged post anesthesia care unit (PACU) stay and unplanned hospital admissions. The causes of PONV are multifactorial and can largely be categorized as patient risk factors, anesthetic technique, and surgical procedure. In high risk individuals, the incidence of PONV can be as high as 80%. Therefore, effective strategies in identifying risk factors and providing prophylaxis to patients can lead to higher patient satisfaction and better utilization of healthcare dollars. An extensive body of research exists on the causes, prediction, prevention, and treatment of PONV, which has resulted in the development of risk scores, guidelines, and evidence-based treatment protocols. Unfortunately, limited knowledge of the guidelines and low adherence to them are a well-known problem. The omission of properly identifying patients’ risk factors during the preoperative interview allows for inadequate coverage of PONV. The purpose of this evidence-based practice (EBP) change project was to use educational interventions to assist anesthesia providers with identifying PONV risk factors utilizing the Apfel assessment tool.
A Quality Improvement Initiative to Reduce Postoperative Hypothermia after Cardiac Ablation
(2020) Varner, Kerry L.; Hines, Cheryl; Huppert, Kimberly; University of Alabama Tuscaloosa
Hypothermia, a core temperature less than 36C, occurs in approximately 70% of all surgical procedures and can lead to numerous complications, including increased healthcare costs, discomfort, bleeding, and surgical site infections. ASPAN's Second Edition of Evidence-Based Clinical Practice Guidelines for the Promotion of Perioperative Normothermia (ASPAN 2010 Normothermia Guidelines) are cost-effective, easy to implement, and have demonstrated success in reducing hypothermia. The purpose of this quality improvement project was to determine if the integration of ASPAN 2010 Normothermia Guidelines reduced postoperative hypothermia and recovery time in patients undergoing cardiac ablation with general anesthesia.
Evaluation of a protocol for pediatric thyroidectomy guidelines to diminish post-operative hypoparathyroidism medication use
(2021) Marsh, Pamela; Collins-Yoder, Angela; Jennings, Sara; University of Alabama Tuscaloosa
Introduction/Purpose: The purpose of this retrospective study is to compare patients who received early preventative treatment in patients identified at risk for hypocalcemia, while avoiding treatment in those patients found to be normocalcemic. PICOT: In pediatric patients who underwent a total thyroidectomy at Valley Children’s Hospital (VCH), can implementation of post-operative hypoparathyroidism disease management guidelines decrease the amount of prescribed calcium and calcitriol. Methods: Approval for study and waiving of informed consent was obtained from the Institutional Review Board at Valley Children’s Hospital (IRB No. HSC2297) and The University of Alabama in Tuscaloosa (IRB No. 20-07-3767). This was a retrospective chart review study. Medical records of all patients undergoing a Total Thyroidectomy at Valley Children's Hospital between August 2018 – January 2021 were reviewed (N = 41). Exclusion Criteria: Age >21 years old, history of chronic renal insufficiency, patients taking medications known to affect calcium or PTH levels, known pre-operative hypocalcemia, and those who already have hyperparathyroidism or hypoparathyroidism Statistical Analysis: Parathyroid hormone levels and calcium levels were recorded as well as if there was medication use. The Fisher- Freeman-Halton exact test was used to evaluate medication in 4 separate groups. Results: Of the 41 patients that underwent total thyroidectomies, 25 (61%) of the patients did not need medication. Medication use was separated in to 4 possible outcomes. The variable PTH ≤ 10 pg/mL + S. Calcium < 8 mg/dL (A), PTH ≤ 10 pg/mL + S. Calcium ≥ 8 mg/dL (B), PTH > 10 pg/mL + S. Calcium < 8 mg/dL (C), PTH > 10 pg/mL + S. Calcium ≥ 8 mg/dL (D). In B and D group variables it was proven to have a statistical significance where p=
Interdisciplinary Pathway for Managing Urinary Tract Infections in Long-Term Care Facilities: A Practice Improvement Project
(2021) Gunter, Barry C.; Acker, Kristi A.; Harrison, Boyde J.; University of Alabama Tuscaloosa
Background: Urinary tract infections (UTIs) are one of the most common infections within residents of long-term care facilities. Antibiotics are commonly prescribed for patients in this setting without proper diagnostic criteria. For these reasons, proper diagnosis of UTIs should be a priority in order to decrease the antibiotic prescribing rates and untimely improve patient health outcomes. This practice improvement project was aimed at training interdisciplinary staff on evidence-based UTI surveillance and implementing a toolkit within a 148-bed long-term care facility to evaluate the effect on documented UTIs and antibiotic prescribing rates. Methods: This project was implemented in a 148-bed, long-term care facility in rural Northwest Alabama. A pre-post intervention was conducted to evaluate the education provided to interdisciplinary staff. The staff utilized a UTI toolkit and pre-post data concerning UTI rates and antibiotic prescribing rates was compared to determine the effectiveness of the UTI toolkit at reducing both UTI occurrence rates and overall antibiotic prescribing rates. Results: Using a pre-post questionnaire and a paired sample t-test, a comparison of the questionnaire results was made. Post-test scores were improved compared to pre-test scores. A comparison of the pre-intervention facility UTI rates and all-cause antibiotic prescribing rates versus postintervention rates was compared using McNemar’s Test. UTI rates and overall antibiotic prescribing rates were reduced in the post-intervention phase compared to the pre-intervention phase of the practice improvement project. Conclusion: This project improved assessment training for healthcare staff concerning UTI surveillance and reduced documented UTI rates and all-cause antibiotic prescribing rates.
Implementation of a Pre-exposure Prophylaxis (PrEP) Program for HIV Prevention in a Federally Qualified Health Center (FQHC)
(2021) Falconi-McCahill, Antoinette; Lee, Amy; Knights, Jayci; University of Alabama Tuscaloosa
Introduction/Purpose: Preventing new cases of Human Immunodeficiency Virus (HIV) infection is key to the Centers for Disease Control and Prevention (CDC’s) Ending the HIV Epidemic: A Plan for America initiative. In 2012, Truvada became the first medication approved in the United States to prevent HIV infection, yet it has not seen widespread use. Research has shown that healthcare provider awareness and attitudes are common barriers to pre-exposure prophylaxis (PrEP) prescribing. Alleviating these barriers requires that primary care providers (PCPs) receive the tools and knowledge to quickly address HIV risk factors and offer PrEP to their patients who need it. The purpose of this project is to determine if an educational session for healthcare providers and the introduction of an HIV Risk Assessment Tool into an EHR will decrease barriers to offering PrEP. Methods: An educational program was provided to the Internal Medicine/Family Medicine (IM/FM), Obstetrics & Gynecology (OB/GYN), and Pediatric healthcare providers in an urban federally qualified health center (FQHC). This program presented current guidelines regarding the assessment, management, and follow up of patients who are candidates for PrEP and was conducted during departmental group meetings. This education included using an HIV Risk Assessment Tool, which was introduced into the EHR during the training sessions. A questionnaire was administered to all healthcare providers at the health center before and after participating in the educational program. The use of the HIV risk assessment tool was queried, utilizing an EHR report after the project. Results: 5 Pre- and post-intervention questionnaire data were compared to determine the effect of the intervention. Provider likelihood to prescribe PrEP to specific groups and in particular situations increased among the IM/FM (P=.0001, P=.0001) and OB/GYN providers (P=.0034, P=.0034), but there was no significant change among the Pediatric providers (P =.4227, P=.1965). There were only three recorded uses of the HIV risk assessment tool. Discussion: Although there was increased awareness and acceptance of PrEP, the HIV risk assessment tool's use was minimal. These results suggest that provider willingness to prescribe did not translate into increased PrEP conversations with patients. The lack of significant change among Pediatric providers indicates a need for additional assessment of the barriers facing these providers and further support to promote acceptance of PrEP. Additional efforts are needed to progress from awareness and acceptance to incorporation of PrEP in the PCP visit.
Utilizing Palliative Care Principles to Improve Mood and Quality of Life in a Nursing Home: An APRN Initiative
(2021) Fox, Michelle; Acker, Kristi; Tetrick, David; University of Alabama Tuscaloosa
Purpose: The purpose of this DNP project was to implement nurse practitioner (NP) led palliative care (PC) services and to evaluate the practice change by measuring nursing home (NH) residents’ mood and quality of life (QOL). Methods: 20 patients residing in one NH in a single Midwestern state in the United States that met PC criteria (any chronic, serious illness) were included in the project. Patients received visits from a palliative/hospice trained NP once a week in addition to other facility services. Self-report measures of depression and QOL were administered at baseline and one month later. Repeated measures ANOVAs were performed to examine the change in mood and QOL over time. Results: 20 participants aged 44-88 years (average = 74.7 years, SD = 9.8 years) were enrolled, and 19 successfully completed four weeks of PC visits and questionnaires at baseline and four weeks. The average overall QOL z-score at the initial visit was -0.59 (SE=0.21) and average QOL z-score at the final visit remained -0.59 (SE=0.17). Results of repeated measures ANOVA showed no significant change in QOL score, F(1,18)=0.00, p=0.997, η2 p=0.00. Average PHQ-9 score at the initial visit was 9.90 (SE=1.11). At the final visit, average PHQ-9 score was 8.21 (SE=1.39). Repeated measures ANOVA showed no significant change in PHQ-9 score over time when examining the entire sample, F(1,18)=2.03, p=0.171, and the effect size was small, η2 p=0.101. However, when selecting for clinically significant depression symptoms (PHQ-9 score ³10) at baseline, there was a trend towards a decline in depression symptoms, F(1,10)=3.38, p=0.096, with a large effect size, η2 p=0.253. Though not statistically significant, the decline in depressive symptoms in this subset may be clinically meaningful. Conclusion: This project implemented PC focused visits with a NP in a single NH, with the goal of improving symptom burden, and focused on mood (PHQ-9) and QOL (MQOLexpanded). Despite limitations, results provide preliminary support for improvement in depressive symptoms among a subset of patients receiving PC services. Additional studies with a larger population are needed to determine if mood and QOL can be improved using PC services in the NH setting.
Improving Adherence to Public Health Follow-up Care Standards for Underserved Women with Abnormal Cervical Cytology
(2021) Phillips, Ginger; Lee, Amy; Hood, Krysta; University of Alabama Tuscaloosa
Background and Review of Literature: Although the overall incidence of cervical cancer has declined over the past few decades, this disease persists, particularly among underserved, low-income, minority women. Patient navigators can assist this vulnerable population group to achieve recommended follow-up care after an abnormal screening test by identifying and eliminating barriers associated with social determinants of health (SDOH). “The Protocol for Responding to and Assessing Patient’s Assets, Risks, and Experiences”” (PRAPARE) is an evidence-based standardized national social risk assessment tool that can be utilized in patient navigation programs in order to improve health outcomes. Purpose: The purpose of this quality improvement (QI) project was to implement a patient navigation program utilizing the PRAPARE-guided method to improve adherence to follow-up care standards in women with abnormal screening cervical cytology from rural public health clinics that serve low-income minority women. Methods: Show rates for four public health colposcopy clinics before and after the implementation of the PRAPARE intervention were measured and compared using Chi-Square analysis. The show rates included those appointments kept under usual follow-up care prior to the COVID-19 pandemic, appointments kept during the height of the COVID-19 pandemic, and those appointments kept after the implementation of PRAPARE-driven patient navigation. Implementation Plan/Procedure: PRAPARE-guided patient navigation, conducted by the primary investigator via phone calls and mail, allowed the navigator to recognize and respond to SDOH reported by the women that may have prevented them from adhering to public health follow-up care standards by providing them with community referrals and resources. PRAPARE-guided navigation was administered to 37 participants scheduled to received abnormal cervical cytologic follow-up care at four county colposcopy clinic sites over a three-month period. Results: Pre-COVID and COVID colposcopy clinic show rates under usual follow-up care were measured and compared to the show rates of the clinics after implementation of PRAPARE-driven patient navigation for four county health departments. The show rates for each health clinic were combined and compared for an overall total using Chi-Square analysis. The overall analysis revealed statistical significance (p <.05) x² (6.182, p=0.012903) for pre-COVID show rates (71%) versus post implementation show rates (87%). The overall COVID show rates (71%) versus post implementation show rates (87%), x² (5.0173, p= 0.024301) were also statistically significant. Conclusions: Adherence to recommended follow-up was improved in the patient cohort following evidence-based patient navigation. By utilizing a team approach, patient navigation programs in the public health setting have the potential to improve cervical disease outcomes, reduce the incidence and mortality rates of cervical cancer, and reduce costs associated with treatment.
Telehealth Utilization to Improve the Patient Care Experience within a General Surgery
(2021) Moseley, Jennifer; Carter-Templeton, Heather; Aying, Jennifer; University of Alabama Tuscaloosa
Introduction/Purpose: Patient satisfaction and quality of care are key components of the patient experience. Telehealth has been demonstrated to be an effective, safe and convenient way of providing care to postoperative patients. At the Veterans Health Administration Boston Healthcare System, approximately 20% of postoperative patients had unplanned patient-initiated contact with the medical center. A quality improvement project was carried out to evaluate whether the addition of a nurse practitioner led telehealth visit reduced the number of unplanned contacts by postoperative patients with the general surgery department. Methods: Patients were recruited through review of the general surgery operating room schedule by the principal investigator. Those patients who underwent anal procedures, colon procedures, cholecystectomy, foregut procedures and hernia procedures were offered an additional postoperative video visit. The patient supplied their email address and was scheduled for the telehealth visit utilizing the Veterans Video Connect software within the first week following surgery. Following their postoperative visit with their surgeon, their charts were reviewed to determine if there was any unplanned contact between surgery and their postoperative visit. The patients were sent a telehealth perceptions questionnaire (TMPQ) following their postoperative visit to evaluate their satisfaction with the telehealth experience. Results: There was no statistically significant difference in the number of unplanned patientinitiated contacts following the intervention. The telemedicine perception questionnaire results demonstrated that all respondents felt as satisfied talking to a nurse over VVC compared to in person. Further, 91% feel that VVC was a convenient form of healthcare delivery, and 77% feel it will be a way of healthcare delivery in the future. Discussion: Although there was no decrease in the number of unplanned patient-initiated contacts, the TMPQ data revealed that patients were satisfied with the telehealth intervention. The exact reason for the lack of decrease in the amount of unplanned contact is unknown, however it may be related to the relationship developed between the patient and PI. The patients may have felt more comfortable contacting the surgical department with their concerns. This area represents an area for future research.
Evidence-based Opioid Guidance in Acute Care: An Initiative for Advocating Provider Stewardship
(2021) Henderson, Jessica; Acker, Kristi; Shannon, Mary Ann; University of Alabama Tuscaloosa
Introduction/Purpose: The purpose of this project was to improve providers’ knowledge and utilization of the Prescription Drug Monitoring Program (PDMP) and World Health Organization (WHO) pain ladder when prescribing opioid pain relievers in the inpatient setting. Methods: Fifteen providers, a mix of physicians and nurse practitioners, in the inpatient setting were recruited to participate in the project. The investigator provided one on one educational sessions regarding the utilization and importance of the PDMP and WHO pain ladder. Providers who have a Drug Enforcement Agency (DEA) license were eligible for participation while providers without a DEA license were excluded. Providers took a pre-test that measured providers’ perceptions on their knowledge regarding the PDMP and WHO pain ladder. Providers then received a brief online educational session regarding the importance of the PDMP and WHO pain ladder. Following the education sessions, providers were given six weeks to implement their knowledge regarding the utilization of the PDMP and WHO pain ladder into practice to see if it affects their prescribing behaviors of opioid pain relievers. After the six-week period, providers were sent a link to a post-education test that looked at their perception regarding knowledge gained during the project. Results: A total of 15 participants were recruited for the project at baseline. Ten providers completed the initial survey but failed to complete the pre and post-education surveys. Fifty percent (n=5) of the participants completed the project in full. The lack of participation is assumed to be due to the surge in COVID-19 cases when the project gained approval and began implementation. Of the five participants, three were nurse practitioners (60%) and two were physicians (40%). Data was analyzed by calculating pre and post test scores. The total score a participant could get was 90. The average score pre-education was 53 and the average score posteducation was 72. The project resulted in a 35% increase in knowledge. Discussion: This project implemented online education for providers regarding the PDMP/Narxcare™ and WHO pain ladder. The providers took a pre-education survey and posteducation survey. These surveys allowed providers to rate their knowledge of clinical practice guidelines, the PDMP/Narxcare™, and their assessment on whether or not they felt proficient in prescribing opioid pain relievers. The low provider participation rate was felt, in part, due to the unprecedented surge in community COVID-19 cases at the time of project implementation. Despite limitations and barriers, results showed providers perception regarding their knowledge of the PDMP, WHO pain ladder and opioid prescribing improved after six weeks. Additional studies with a large population are needed to determine if this education would benefit all providers and not just hospital-based ones.
Effectiveness of a Community-Based Healthcare Worker Cancer Prevention and Referral Program in an Uninsured/Underinsured Minority Community
(2021) Sparks, Juanita; Lawson, Robin; Moore, Angelo; University of Alabama Tuscaloosa
Introduction/Purpose: Cancer is a leading cause of death in the United States. Healthcare disparities contribute to increased cancer prevalence among vulnerable populations. Strategies to fight cancer, such as use of a community-based healthcare worker (CBHW), is an innovative way to decrease cancer healthcare disparities. The purpose of this project was to evaluate effectiveness of a CBHW cancer prevention and referral program in an uninsured/underinsured minority community. Methods: A prospective pre-/post-intervention design was used. Participants attended once weekly 60-minute virtual education sessions conducted by a CBHW. Pre-/post-intervention survey data pertaining to knowledge of cancer prevention (health literacy), the number of due/overdue cancer screenings, and the number of positive cancer screen participants referred and connected to the appropriate cancer care/treatment were compared at the end of an 8-week period. Results: Results revealed a statistically significant improvement in participant knowledge of cancer prevention (p < 0.05) at the end of the 8-week period, but a statistically significant improvement was not seen in preventative cancer screenings (p = 0.104). None of the participants reported a positive cancer screening or the need to be referred to the patient navigator, therefore, zero referrals were made during the 8-week period. Discussion: The CBHW intervention led to improved knowledge of cancer prevention, but minimal improvement was seen in preventative cancer screenings among participants.
Increasing provider Attitude and Willingness of using the CBT-I in Treating Insomnia in Adults
(2024) Imo, Ugonma; Andrabi, Roohi
Introduction/Purpose: Insomnia is a sleep problem affecting many adults; especially, those with mental health issues (Roth, 2019). Insomnia has been linked to both physical and mental health issues. Providers in the clinical site for this project prescribe medications to manage insomnia. These medications have side effects that present safety risks to patients (Rossman, 2019). Cognitive Behavior Therapy for Insomnia (CBTI) has been recommended as the first-line evidence-based treatment for insomnia (Rossman, 2019). However, providers are not prescribing CBTI as a first-line treatment in the clinical site for this project. There was a knowledge deficit and lack of attitude related to the prescription of CBTI among the providers of the project site, as indicated by the surveys taken by these health providers. Therefore, we have conducted a quality improvement project to educate the health providers of this outpatient psychiatric clinic about the use of CBTI as the first-line treatment for insomnia in their adult patients who have insomnia. Methods Design: This is a quality improvement project with a pretest-post-test design. We developed an evidence-based educational PowerPoint program for the providers. We adopted the evidence-based guidelines for the treatment of insomnia from AASM (American Academy of Sleep Medicine, 2023). We recruited all the providers from the facility (N=5). INCREASING PROVIDER KNOWLEDGE 4 Data Collection Tools: We used the Evidence-Based Attitude Scale (Aarons, 2004) to Assess their attitude regarding the prescription of CBTI for the treatment of insomnia among adults. The data was collected before (T0) and after the delivery of the intervention (T1). Intervention: An educational PowerPoint video (30 min) was delivered to the participants. The content materials included the benefits of using the CBTI, the side effects of medications used for the treatment of Insomnia, and the ladder of the different treatment regimens recommended for insomnia. Data analysis: Descriptive analyses were used to analyze the data. The mean and S.D. were computed on the data from the pre-and post-surveys to see any changes in the knowledge and attitude of providers toward prescribing CBT-I as the first-line treatment from the pre-test to post-test phase of the study. Results: Our results showed changes in the provider's attitudes from the pre- to post-intervention phase regarding the prescription of CBTI as a first-line treatment for insomnia among adults. The providers expressed openness to trying new therapies/interventions. Discussion: Our result indicated that the educational program improved the attitude of providers toward prescribing CBTI among adults for the treatment of insomnia. This project could be conducted on a large scale in the future.
Waist Circumference as the Newest Vital Sign: An Evaluation of Abdominal Obesity in the Healthcare Setting
(2024) Hawkins, Ericka A.; Hooper, Gwendolyn; Mitchell, Jacob
Introduction/Purpose: Body mass index (BMI), which is based on the height and weight of an individual, has traditionally been the sole screening tool to identify obesity in the clinical setting. However, this measure alone does not take into account muscles mass, bone density, body composition, race and sex differences when it comes to detecting obesity. Waist circumference along with BMI help to better define cardio-metabolic risk factors for disease. For clinicians, combining BMI and waist circumference provides opportunities for counseling and effective interventions in managing obesity and other related metabolic diseases associated with abdominal obesity. The purpose of this project is to implement waist circumference measurement in addition to lifestyle education to better assess abdominal obesity and potential cardiometabolic risk in the primary care setting. Methods: A convenience sample of 30 patients, (12 male and 18 female) underwent measurement of their height, weight, as well as waist circumference over a 6-week period. A BMI was calculated for each patient and the waist circumference of each participant was measured. Educational handouts and counseling based on the recommendations of the American Heart Association were provided. Following the educational/counseling session, each participant was asked to complete a survey using a Likert-type scale to identify their willingness to make lifestyle changes in regard to exercise, diet, sleep and alcohol intake. Results: Pertaining to waist circumference and BMI, data were evaluated utilizing SPSS version 29. These results yielded a strong Pearson correlation co-efficient of 0.855 between BMI and waist circumference which was significant at the 0.01p-level (2-tailed). Normality P-P plots of the measured variables were found to be consistent with normally distributed data. Linear regression yielded the equation BMI=-15.579 + 1.173* WC with a two-tailed p-value of <.005. Applying the regression equation to a waist circumference of 40 yielded a calculated BMI of 31. The accepted BMI cut-off value as reported by the American Heart Association for obesity is 30. Discussion: The linear relationship between BMI and waist circumference indicates that waist circumference may be an alternative option for BMI in the clinical setting to predict central obesity and potential cardiovascular risk. Utilizing waist circumference and patient education on lifestyle change indicated patients who were classified as overweight or obese were motivated to adapt lifestyle changes in diet, exercise, sleep habits and alcohol use. Patients who were classified as having a normal BMI and waist circumference were not motivated to make any changes.
Improving Nurses’ Peripheral Intravenous Catheter Insertion Efficiency and Confidence Using Ultrasound Guidance
(2024) Papa-Torres, Anne Genevieve; Parker, Kim; Lee, Amy; Gilroy, Heidi
Background: A review of current hospital practices related to PIV insertion in a large tertiary community medical center identified practice variability and lacking policies compared to current evidence-based practices and standards of care. Together with other stakeholders, hospital practice guidelines and an ultrasound-guided PIV training program in alignment with current evidence-based practice standards of care were developed and implemented to improve nurses’ PIV insertion skills efficiency, confidence, and self-efficacy. Methods: The project design was a quality improvement project that included both process and educational interventions. Quantitative methods were utilized to measure nurses’ responses before and after implementation. The Learning Self-Efficacy Scale (L-SES) and level of confidence survey were used for data collection. Paired t-test was used to measure mean scores for frequency of PIV insertion attempts, average time in minutes for PIV insertion, nurses’ level of confidence, and learning self-efficacy. Results: The implementation of ultrasound-guided PIV catheter insertion training and the establishment of practice guidelines significantly improved nurses' confidence and efficiency in performing PIV insertions. The training significantly improved cognitive and several psychomotor skills and self-efficacy among nurses. Eight out of ten nurses stated the use of ultrasound guidance made PIV insertions more efficient. Discussion: A multi-pronged approach involving several stakeholders established clear practice guidelines and provided a training program in alignment with the standards of care to improve acute care nurses’ PIV insertion skills efficiency, confidence, and self-efficacy.
Walking for Wellness: A 6-Week Walking Group Intervention for Women with Polycystic Ovary Syndrome
(2024) Pettus, Alexandra; Simmons, Staci; Broad, Jennifer
Introduction: Polycystic Ovary Syndrome (PCOS) poses significant health challenges for affected individuals, necessitating effective lifestyle modifications. This Doctor of Nursing Practice (DNP) project addresses the impact of physical activity (PA) as a key lifestyle intervention for PCOS patients. The project's primary aim is to assess and encourage increased PA through a 6-week walking group intervention. The Rapid Assessment of Physical Activity (RAPA) Questionnaire is employed to evaluate baseline PA levels at the project's commencement and again at the conclusion of the intervention. While acknowledging the well-established advantages of PA in managing PCOS, there remains a notable gap in research addressing the efficacy of walking group interventions within this population. Existing literature highlights individualized exercise regimens or aerobic activities, overlooking the potential benefits of group-based interventions centered around walking. Therefore, the purpose of this Doctor of Nursing Practice (DNP) project is to address this research gap by implementing a walking group intervention tailored specifically for individuals with PCOS. By focusing on group-based PA, this project aims to enhance the overall health outcomes and quality of life for PCOS patients. Methods: The project involves PCOS patients aged 18-55, who participate in a structured walking group program. Baseline PA levels are compared to post-intervention levels, aiming to identify any significant changes. The project not only focuses on quantitative data analysis but also incorporates qualitative insights through participant feedback, exploring perceived barriers and facilitators to increased PA. Results: Two participants completed the Walking for Wellness six-week program with twelve sessions. Participant 1 attended eight sessions, shifting her RAPA score from active to underactive regular, and improved flexibility. Participant 2 attended ten sessions, increasing her activity level from underactive to underactive regular, with marked flexibility gains. Thematic analysis highlighted social connection, accountability, and emotional well-being as central benefits. Both participants reported enhanced motivation, mental well-being, and confidence to maintain regular PA due to the supportive group environment. Conclusions: This project sheds light on the possible benefits of a walking group intervention for promoting PA among PCOS patients. Findings contribute to the growing body of knowledge on lifestyle modifications for PCOS management, potentially influencing future treatment plans and improving health outcomes for individuals affected by this syndrome.
Quality Improvement Initiative: Streamline Inpatient Preoperative Anesthesia Assessment to Decrease Surgical Delays by Utilizing a Checklist
(2024) Kerce, Mylena; Paradise, Linda; Espadron, Nicholle
Introduction/Purpose: Delays and cancellations are detrimental to the operating room (OR) being efficient and cost-effective in the healthcare setting. Hospital systems must provide cost-effective healthcare to continue a healthy operating budget. The OR is a revenue generator for most hospital settings, however, if it is not managed efficiently, it can create large deficits. This concept is especially important in the OR given the many resources allocated to the department and the expense of running the department. Therefore, even the slightest of delays can be costly. There seems to be a multifactorial component supporting the underlying reasons for delays for inpatients scheduled for surgery. One area identified is the lack of a complete and thorough anesthesia preoperative assessment for inpatients resulting in day of surgery delays. Methods: The Plan Do Study Act (PDSA) method was used for this Quality Improvement project. This method guided a plan to implement an inpatient preoperative checklist to decrease day-of-surgery delays related to anesthesia. Data from six weeks before and six weeks after an implementation in-service was collected and analyzed from Excel reports provided by the preoperative nurse manager. Results: A Chi-square comparing pre-implementation of the inpatient preoperative checklist and post-implementation was performed to see if improvements were made in surgical delays on the day of surgery. Before the in-service (n=231), 178 had no delay and 53 had a delay (23%). After the in-service (n=442), 357 had no delay and 85 had a delay (19%). Although the Chi-square statistic was not statistically significant, X2 (1, N=673) = 1.2831, p = .257326, there was an improvement of on-time case starts from 77% preintervention to 81% post-intervention. Discussion: Even though not statistically significant, the 4% improvement in on-time cases is clinically significant. The implications of the improvement can be seen in saving healthcare dollars, improving patient satisfaction by decreasing wait times, and improving efficiency in the perioperative unit.
Implementation of Universal Perinatal Depression Screening in Outpatient Obstetrics
(2024) Loft, Breia; Henry, Carrie J.; Williams, Amanda
Introduction/Purpose: This project implemented universal perinatal depression screening during pregnancy in an outpatient obstetrical setting in alignment with current recommendations from the American College of Obstetricians and Gynecologists (ACOG). Undiagnosed perinatal depression has been associated with poor birth outcomes and compromised maternal/newborn bonding, and may contribute to maternal mortality, as suicide is the second leading cause of death among prenatal and postpartum patients. Perinatal depression often goes unrecognized because women are reluctant to reveal their symptoms to their providers. Therefore, universal perinatal depression screening during pregnancy is recommended. Methods: For this quality improvement (QI) project we conducted universal perinatal depression screening for pregnant patients in an outpatient obstetrical setting using two validated depression screening tools, the patient health qestionaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). We collected data to identify the number of patients referred for treatment after screening positive for perinatal depression after project implementation compared to the number of patients referred for treatment prior to project implementation. Results: During project implementation 408 patients were eligible for screening, and 378 (98%) were screened per protocol (Figures 2 and 3). Before project implementation, an 8-week retrospective chart review revealed a total of six of 547 pregnant patients screened for perinatal depression based on depression symptoms (0.01%). Thus, screening for perinatal depression during pregnancy increased from 0.01% to 98% during the project implementation. During project implementation, 78 (21.0%) of the 378 participants screened positive for perinatal depression, and 72 (93.0%) (see Figures 4 and 5) were referred for psychiatric services. The retrospective chart review showed that during the 8 weeks prior to project implementation, six pregnant patients were screened for perinatal depression and all six screened positive. Of those six, three (50%) were referred for psychiatric services. Thus, during project implementation, the referral rate for pregnant patients screening positive for perinatal depression increased) from 50.0% to 93.0%. Conclusions: This project established a foundation of perinatal depression screening in pregnancy to bring Regional One Health in alignment with the ACOG recommendations to screen pregnant women at least once during pregnancy as the first step in reducing the burden of perinatal depression in pregnancy. In our organization, this project accomplished the first step of establishing perinatal depression screening in pregnancy according to ACOG’s recommendation. We plan to expand this screening protocol into referral and treatment initiatives to provide our pregnant patients with optimal care.
The Standardization of Anti-Cancer Regimen Patient Education and Its Impact on Patient Satisfaction
(2024) Pugh, Kathleen Bennett; Simmons, Staci; Blackmon, Jawaunna
Introduction/Purpose: Educating patients is a critical nursing skill. Patient education is particularly important when initiating a new anti-cancer medication regimen. The standardization of anti-cancer medication patient education is imperative to ensure that all patients receive sufficient and consistent education. Standardizing this process creates a more cohesive clinic environment and satisfying experience for the patients. Despite the benefits of standardized education for this population, many clinics are lacking in this process. This process improvement project aimed to improve patient satisfaction through a standardized anti-cancer medication patient education process at a freestanding hematology and oncology clinic in the southeastern United States. Methods: A standardized anti-cancer medication patient education plan was created and implemented for all new oncology patients who were willing to participate. Patients were asked to complete an established Likert-style patient satisfaction survey prior to and after the standardized education process for comparison. Results: A mixed ANOVA was conducted to examine satisfaction ratings pre- and post-education. The analysis revealed a statistically significant, large main effect of satisfaction, F (1, 8) = 17.79, p = .003, 𝜂2 = .69, such that satisfaction ratings were higher post-education (M = 3.16) compared to pre-education (M = 1.10). There was not a significant main effect of gender, F (1, 8) = 1.37, p = .275, 𝜂2 = .15, and no significant interaction between satisfaction ratings and gender, F (1, 8) = 1.22, p = .301, 𝜂2 = .13. Discussion: Providing standardized patient education for oncology patients who are initiating a new anti-cancer medication regimen is critical for enhancing adherence, safety, and satisfaction with the overall clinical experience. The results of this project show improved patient satisfaction scores following a standardized education process.

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