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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Advance Care Planning in the African American Faith Community: Taking Fear out of the Conversation
(2024) Kirby, Michelle; Parker, Kim; Griffin, Kotaya
Introduction: Advance Care Planning (ACP) helps individuals decide about future care by reviewing their values, goals, and wishes. Conducting ACP education in the African American community's place of worship and enlisting the pastor's support is a way to develop trust among parishioners. This scholarly project seeks to increase understanding of advance care planning and encourage participants to complete advance directives. Methods: The project offered two educational sessions and administered pre- and post-survey questionnaires to assess readiness to discuss advance care planning and complete advance directive documents. Results: The readiness to sign official papers naming a person or group of people to make medical decisions and talk to their decision-maker about the kind of medical care they would want if they were very sick or near the end of life, was significantly greater post-survey than pre-survey. Readiness to talk to their doctor about the kind of medical care and sign official papers was significantly greater post-survey compared to pre-survey. The project rendered four completed advance directives representing 11% of participants. Conclusion: The educational intervention provided knowledge about advance care planning and supported further sessions in the African American church.
Advancing Oncologic Emergency Preparedness: A Clinical Simulation Approach for Advanced Practice Providers in Oncology
(2024) Hemstetter, Sarah
Introduction/Purpose: Orienting advanced practice providers (APPs) in oncology is challenged by the intricate subspecialty knowledge required and limited exposure to high-stakes clinical scenarios during onboarding. Despite theoretical education on oncologic emergencies, a gap exists between theoretical knowledge and clinical experience. This Doctor of Nursing Practice (DNP) project explored the utility of virtual clinical simulation to enhance the education and training of oncology APPs, focusing on identifying and managing oncologic emergencies to increase confidence and comfort among APPs. Methods: Utilizing an evidence-based practice approach, new to oncology providers engaged in virtual simulation scenarios at two different time points. Participants were tasked with identifying and managing oncologic emergencies. Objective data, including performance of critical interventions, was recorded for each participant to gauge improved competency. Subjective data, including participants self-reported comfort and self-efficacy was also recorded. Lastly, participants completed a simulation satisfaction survey. Results: Reported results encompassed differences in pre- and post-simulation self-reported knowledge and confidence scores. Completion of critical interventions in the first and subsequent simulation sessions was also analyzed. Results were analyzed using a combination of statistical methods including both non-parametric and parametric testing including one sample t-tests, wilcoxon signed rank test, and basic descriptive statistics. Discussion: The discussion focuses on the overall outcomes of the intervention and potential future implications for advancing oncologic emergency preparedness among APPs in oncology.
An algorithm to guide the transition of care for the heart failure patient: A quality improvement project
Lang-Coleman, Kristen; Carter, Patricia
Purpose:The increase in hospital re-admission rates is a national concern. Patients aged 65 years and olderwith chronic health conditions, such as heart failure (HF), have high rates of 30-day hospitalreadmissions. This issue was observed in a palliative care organization, whereby a traditionalhospital discharge model was followed. A gap in the literature was using a nurse practitioner(NP)-led transition of care model (TCM) to tackle this problem. A DNP scholarly project wasimplemented with the aim of decreasing hospital readmissions for HF patients.Methods:A NP-led TCM was designed, which included a quality tool to manage HF patients after beingdischarged home. A pre-test/post-test design was utilized to compare hospital readmission datafollowing use of the NP-led TCM model. Feasibility and efficacy of the tool were also assessed.Results:Following the implementation of the NP-led TCM, hospital readmission rates for HF patientsdecreased to zero. Findings also supported the tool’s efficacy.Discussion:Compared to a traditional hospital discharge model, the NP-led TCM reduced hospital re-admission rates for HF patients. Findings from this project can add to the current body ofevidence regarding strategies to mitigate hospital re-admission rates for elderly patients withchronic conditions. As a result, hospitals will be more likely to receive quality incentives andprevent reimbursement penalties associated with readmissions and the lives of this vulnerablepopulation may be improved.
An Antibiotic Stewardship Program for Sinusitis in an Urgent Care Setting: A Quality Improvement Project for Advanced Practice Providers
Slattery, Meagan; Simmons, Staci; Gosnell, Jason
Introduction: Sinusitis is commonly diagnosed in the urgent care setting. According to evidence-based practice guidelines, most cases do not require antibiotics. Current clinical practice guidelines support a target antibiotic prescribing rate of less than 12% for upper respiratory infections, such as sinusitis. Inappropriate antibiotic usage can cause adverse effects, ranging from mild rashes and gastrointestinal distress to life threatening antibiotic resistance and colitis. In the chosen network for this project, 56.9% of patients received antibiotics when diagnosed with sinusitis between April and September 2023. Methods: All non-physician advanced practice providers (APPs) within the urgent care network were invited to view an educational PowerPoint presentation regarding current evidence-based practice guidelines for sinusitis. Participation in the intervention was voluntary and anonymous. Post-intervention prescribing patterns were evaluated to determine the efficacy of the intervention. Results: The results of the intervention demonstrated a statistically significant reduction in antibiotics prescribed by APPs for the diagnosis of sinusitis. The antibiotic prescribing rate improved to 46.3% during the six-week period following the educational intervention, a reduction of 10.6%. Conclusion: While this quality improvement project did not achieve the desired antibiotic prescribing rate of 12%, the educational intervention was effective at lowering the overall rate of antibiotics prescribed for sinusitis. Limitations include a short follow-up period and the voluntary nature of participation in the educational intervention.
Antibiotic Stewardship in Urinary Tract Infection Therapy
Shelton, Deanna; Graves, Ann; O'Dea, Douglas; Glenn, Christina; University of Alabama Tuscaloosa
Introduction: Urinary tract infections (UTI) are common reasons women are treated in the primary care settings. But UTI therapy often does not follow the most current evidence-based clinical practice guidelines (CPG). Antibiotic stewardship for primary care providers (PCP) is recommended by the Centers for Disease Control and Infectious Diseases Society of America. It is important to analyze clinic level antibiotic stewardship for appropriate antibiotic therapy for UTI. Review of Evidence: Research supports four main elements of outpatient antibiotics stewardship: commitment, action for policy and practice, tracking and reporting, and education and expertise. When PCP monitor prescribing practices within a clinic, data can be gathered, and feedback given that allows for assessment of prescribing practices and education to reinforce the use of evidence-based CPGs. These practices can help improve discernment related to antibiotic stewardship. Implementation plan: A gap analysis was conducted to review current, internal data related to antibiotics prescribed for UTI therapy. A comparison of current data to CPG determined the percentage of prescriptions that align with CPG. A two-fold intervention consisted of 1.) Education of PCP on the CPG related to UTI therapy; 2.) Implementation into practice of the CPG related to UTI therapy. Evaluation: Pre and post intervention chart review data compared effectiveness of the practice change education. Conclusion: The percentage of providers that more closely followed CPG related to antibiotics in UTI therapy did increase.
Antihypertensive Education to Improve Patient Outcomes: A Quality Improvement Project
McKerrocher, Paul; Hines, Cheryl B.; Jennings, Whitney; University of Alabama Tuscaloosa
Introduction/Purpose The purpose of this quality improvement project was to improve compliance with the 2014 American College of Cardiologists/ American Heart Association (ACC/AHA) Joint Task Force Clinical Practice Guidelines recommendation regarding the continuation of prescribed antihypertensive medications throughout the perioperative period by implementing a patient education initiative, which used the teach-back method of instruction, and evaluated the effectiveness of the education as evidenced by the incidence of patients presenting for their endoscopy procedures with hypertension requiring pharmacological intervention, procedure delay, or procedure cancellation. Methods Data was collected from patients’ electronic health records (EHR) using a retrospective cohort design. The preintervention group consisted of data from all endoscopy patients with the diagnosis of hypertension and taking at least one prescribed antihypertensive medication, and having procedures during the six weeks prior to implementation of the 2014 ACC/AHA Joint Task Force Clinical Practice Guidelines. The post intervention group consisted of data from all endoscopy patients with the diagnosis of hypertension and taking at least one prescribed antihypertensive medication, and having procedures during the six weeks following implementation of the guidelines. Results A chi squared analysis was utilized to compare the data from preintervention and postintervention groups regarding the incidence of hypertension significant enough to require pharmacological intervention, case delay, or case cancellation, both before and after Antihypertensive Education to Improve Patient Outcomes: A Quality Improvement Project 4 implementation of the education intervention. The P-value was also calculated using the chi squared analysis, X^2 (1, N=1044) =7.71, p= .00548. No incidence of case delay or cancellation were experienced in either test group. A 70.5% decrease was experienced in the incidence of patients requiring pharmacological intervention during the 6 weeks period when patients were provided the antihypertensive patient teaching via the teach-back method, compared to the previous 6 weeks. The calculated P-value was .00548, indicating a statistically significant improvement. Conclusion The statistically significant decrease in the incidence of patients requiring pharmacological intervention for hypertension supported the need for permanent inclusion of the antihypertensive patient teaching, via the teach-back method, in the preoperative procedures at the project site. The GI clinic has continued to include this patient teaching method in their preoperative patient contacts after completion of the project.
Assessing Provider Adherence to Music Therapy in Parturients Undergoing Awake Cesarean Section: A Quality Improvement Project
Matson, Nikola
Low patient satisfaction with cesarean section (C/S) birth is a widely documented phenomenon which carries substantial risk for compromised health. Music therapy is a technique that can reduce stress and improve satisfaction when applied intraoperatively. Methods: The Kosucu et al. (2017) survey instrument was adapted for the research. The survey was administered pre- and post- intervention of an educational offering. Data was collected on the presumed impact of music therapy on patient mood, stress, anxiety, and pain and on practitioner implementation of music therapy. Results: A paired sample t test showed a statistically significant increase in the practitioner’s presumption of positive impact on mood, stress, anxiety, and pain between the pre and post survey scores. The paired sample t test showed no statistically significant increase in the practitioner’s adherence to music therapy between the pre and post survey scores. Discussion: The results of this study indicate a clear statistical correlation between music therapy education and presumptive positive impact of music therapy on mood, stress, anxiety, and pain. The study also cites reasons for not implementing music therapy. These include lack of time; concerns about increased workload; and lack of institutional support. Music therapy represents a low cost, low risk method of improving patient outcomes. Therefore, additional study is warranted with respect to effective educational techniques, institutional attitudes, and removing obstacles to implementation in the operating environment.
Assessing Stakeholder’s Attitudes and Perceptions Towards Treatment of Opioid Use Disorders in the Justice-Involved
Sullivan-Congden, Scott M.; Hooper, Gwendolyn; Martin, Wendy; University of Alabama Tuscaloosa
Purpose–Examine stakeholder perceptions and readiness for change regarding implementing an evidence-based treatment improvement protocol for opioid use disorder in Justice-Involved individuals residing within a state prison system. Methods–A one-time electronic survey was distributed to stakeholders using Qualtrics©. Data were analyzed using SPSS 27.0, and results tabulated. Results–The data increased understanding of stakeholder perceptions of current treatment protocols for opioid use disorder, demonstrating the need for focused education.Conclusions–Currently utilized in the system under examination are traditional evidence-based practices. The ideal future state is the replacement of older treatment practices with newer evidence-based protocols in the treatment of opioid use disorder. Internal data has now been gathered, via electronic survey, into the current stakeholder appraisal of the therapeutic benefits of OUD treatment. The data supports the need for stakeholder OUD disease and treatment education to affect a future practice change.Clinical Implications–Offering current evidence-based practice in treating OUD, a chronic illness, can improve patient outcomes. Increased understanding of barriers to providing the best evidence-based protocols is necessary for current and future practice. The research data suggests education helps navigate change. Beneficial interventions increase outcomes, decrease levels of mortality and morbidity, and increase social determinants of health.
Attitudes Toward Suicide and Self-Harm in the Detention Environment: An Educational Intervention for Nursing
Krüg, Michael Stephen
Suicide is a significant public health threat and a leading cause of death in U.S. detention facilities. Detention suicide rates are estimated to be three times greater than in the general population, and suicide is ranked as the number one cause of preventable death among all persons in custody. Nurses are routinely challenged with assessing suicidal detainees, and the attitudes toward suicide and self-harm can positively or negatively influence the outcomes of detention suicide prevention programs. Methods: The Attitudes Toward Prisoners Who Self-Harm (APSH) Scale was administered to nurses (n=21) working in a large U.S. Immigration and Customs Enforcement detention facility to determine current attitudes toward detained non-citizens related to self-harm and suicide. A 30-minute instructional education intervention regarding suicide risk evaluation was provided, followed by a communicative shared experience intervention between the nurses. A secondary survey was obtained 30 days after the training intervention to evaluate any change in nurses' attitudes, pre-intervention versus post-intervention. Results: A repeated measures design was utilized, and paired t-tests were used to evaluate the results from the two 5-point Likert surveys that were collected. The measures were processed with Intellectus Statistics software (Intellectus Statistics [Online computer software], 2023) to evaluate and determine any change in the nurses' attitudes.
Cancer Patients and Anxiety in the Pre-Surgical Ambulatory Setting
Scruggs, Susan S.; Collins-Yoder, Angela; Obringer, Kelley J.; University of Alabama Tuscaloosa
Introduction / Purpose: This primary research is aimed at identifying and scoring pre-procedural anxiety in cancer patients that undergo outpatient port placement. Identification of signs and symptoms of heightened levels of anxiety is common in the surgical setting. Determining a baseline level of anxiety in cancer patients can guide future studies and aid in determining proper protocols to plan for and treat anxiety in the outpatient setting. Hopefully, the future will consist of a routine anxiety score upon diagnosis and treatment options can be discussed early in the disease progress. Methods: Evaluation of anxiety levels will be assessed using the General Anxiety Disorder scale (GAD 7) as it is the most frequently used assessment tool for measuring anxiety levels in patients (Jordan, Shedden-Mora, & Löwe, 2017). The patients will be asked to self-score their anxiety levels upon arrival at the out-patient center on the morning of their port placement. The self_x0002_scoring assessment will provide useful data information to assist and guide the anesthesia clinician to properly evaluate and treat anxiety both pre-procedurally and intra-operatively. The anesthesia model selected for this evaluation will be limited to monitored anesthesia care (MAC)/ conscious sedation cases in the outpatient setting. Results: 5 Results after project completion revealed that 31.25% of participants scored ten or greater on the GAD 7 assessment tool used in pre-operative holding. Eleven males and twenty-one females participated in the study (N=32). A score of 10 or greater is considered significant and that anxiety is present (Jordan et al., 2017). The average age of the participants was 63 with a standard deviation of 11.9. The participants average weight in kilograms was 77.03. The anesthesia time in minutes from in the operating room until recovery hand-off in the post anesthesia care unit (PACU) averaged 57.19 minutes. Intravenous fentanyl average dose was 106.25 mcg and midazolam averaged 4.17 mg per participant. Of the participants that scored greater than 10 on the GAD 7 tool, 50% were males. Thusly, male cancer patients experienced heightened anxiety at a greater level of 45.4% whereas the female participants only reported heightened anxiety 23.8% of the time. The most prevalent cancer diagnosis in the convenience sample was lung cancer at a rate of 21.8%. Discussion: Surgery in an outpatient setting is quite common, it is also routine to be nervous or anxious on the day of the procedure. Generalized anxiety is a disorder that interferes with daily functioning and those that experience this phenomenon are overly concerned about routine matters such as health, finances, death, work related problems and inter-personal relationships. Symptoms can include excessive worry, intestinal issues, insomnia, irritability, exhaustion, trembling, muscle tension and aches, and can sometimes lead to more serious additional psychiatric issues (Mayo Clinic, 2018). 6 Based on the findings of the study this investigator recommends follow-up studies regarding anxiety recognition in patients diagnosed with cancer, and that early intervention and treatment options be discussed with patients and their caregivers. Future studies should aim at prevention of generalized anxiety disorders by treating anxiety with the initial diagnosis of cancer. Further studies should be aimed at prevention of anxiety in males that are facing cancer. This study finds that men experience anxiety at a much greater level than female patients and a larger study should be completed to confirm this finding. Additional studies should aim at treatment options and then after treatment do a repeat evaluation of anxiety levels with a proper scoring tool to evaluate and compare treatment modalities within this patient population . Expanding on existing studies should include males with anxiety when facing a cancer diagnosis, as well as statistical data on the quantitative data available for those that are being treated. Studies should be completed evaluating the use of anxiety evaluations for patients newly diagnosed with cancer and explore what treatment modalities provide the most appropriate relief for this patient population. Overall, further research should be done to expand on generalized anxiety disorders for cancer patients and anxiety evaluations should be considered as part of the full physical assessment for these patients. A gap in care exists between patient diagnosis of cancer and port placement for chemotherapy. Additional studies can be compiled to compare port placement surgery with tumor reduction or any surgery a cancer patient may face. Because cancer patients are diagnosed by routine findings on exam with their primary care physician, the referral process can be 7 overwhelming and rapid causing the diagnosis of anxiety to be of little importance. At times, this referral process to oncology, radiation, or surgery is rapid and necessary for proper treatment and best outcomes causes the patient to experience a myriad of emotional challenges. Anxiety is a commonly undiagnosed problem. Because nearly one-third of participants in this study reported significant anxiety, physicians should include an anxiety assessment as part of the clinical plan for cancer patients undergoing treatment. Proper recognition and consideration of anxiety issues will lead to better patient care and planning and provide a more wholistic plan of care for this patient population and the unique set of circumstances in which they find themselves.
Central Line-Associated Blood Stream Infection Prevention in a Long Term Acute Care Hospital
Rainey, Patricia; Wood, Felecia; Oster, Cynthia; University of Alabama Tuscaloosa
Introduction/Purpose: Preventing a central line-associated bloodstream infection (CLABSI) is a challenging, complex patient safety issue. Between 12% and 25% of patients that develop a CLASBI will die. CLABSI prevalence at the site of this project was above target. The target for FY21 was a standardized infection ratio (SIR) of 0.91, and prior to intervention, SIR was 1.81 year to date with an upward trend. The purpose of this project was to develop standard work to decrease CLABSIs and improve prevention strategies. Methods: An interprofessional team improved CLABSI prevention processes through targeted rounding and collaboration in this 50-bed Long-Term Acute Care Hospital (LTACH) by applying evidence-based practice and establishing shared responsibility for central line removal in the long-term acute care patient population to eliminate CLABSIs. Results: The implementation of targeted, interprofessional rounding to evaluate central line necessity decreased central line days by 18%, decreased the number of CLABSIs by 29%, decreased the CLABSI Rate per 1,000 Patient Days by 23%, decreased the SIR by 16%, and increased the number of days since last infection by 55%. Data indicated a beneficial effect of intervention on metrics tracked without reaching statistical significance. Discussion: Interprofessional team collaboration improved the process of evaluating central line necessity through applying evidence-based practices to reduce CLABSIs. Establishing standard processes increased central line removal and improved patient outcomes.
Confidence and Perceived Benefit of Nurses Participating in a Simulation-Based LearningExperience for Male Urethral Catheterization:A Quality Improvement Project
Roberts, Chelsey; Hooper, Gwendolyn; Lee, Sondra
Introduction: Men undergoing urethral catheterization are at increased risk of urethral trauma, infection and long-term sequela resulting from insufficient training, depleting skills, or lack of knowledge bynurses who perform this procedure. The use of simulation and training oversight by an experienced urology nurse practitioner has the potential to address loss of competency in practicing nurses’ skills and improve confidence in male catheterization thereby decreasing iatrogenic urethral injuries and infection.Purpose:The aim of this quality improvement project was to assess nurses’ skills, knowledge, and confidence in male Foley and coudé catheter placement utilizing clinical simulation to improve future outcomes for men undergoing this procedure.Methods: Fifty Registered Nurses (RNs ) practicing in the perioperative department were invited to participate in a clinical simulation-based learning experience for male catheterization. Prior to simulation, the hospital’s policy and procedure checklist was provided to each RN for review. A5- point Likert scale survey assessing respondent characteristics, confidence, skills, and perceived benefits of simulation training was administered before and at the completion of the educational experience. Skills assessed included the use of sterile technique, and methods for catheter placement in a male patient.Results: The project outcomes showed discrepancies in knowledge and skills for techniques in male catheterization including failing to insert the Foley catheter to the bifurcation, failing to obtain urine output prior to balloon inflation, uncertainty about how to insert a coudé catheter and sterile draping and cleansing the urethral meatus when using the catheter insertion kit. Finally,5RNs were found to be unfamiliar with their hospital’s policy for this skill. Results of a Wilcoxon signed rank test revealed a highly significant increase (p<.001) in both performing male urethral catheterization, as well as nurse confidence after the simulation educational intervention.Discussion:This educational intervention showed clinically significant outcomes in increasing nurses’confidence and skills in performing male catheterization and identified gaps that could compromise the care of male patients undergoing urethral catherization.
COVID-19 Impact on Chest Pain Presentations in a Rural Emergency Department
Miller, Samuel L.; Cuellar, Norma; Lee, Amy S.D.; Cosue, Lamberto; University of Alabama Tuscaloosa
Introduction: Greater than (5%) of all Emergency Department (ED) patients present with chest pain related symptoms nationally. EDs in the United States will see approximately five million patients annually presenting with a complaint of chest pain (Pollack & Perman, 2017). These numbers can be exacerbated during times of stress, specifically during a national pandemic with presenting symptoms mimicking anxiety, respiratory or psychiatric issues. These visits can quickly erode the existing resources of a rural hospital ED. While many rural EDs are equipped to handle chest pain emergencies, during public health crisis (i.e. COVID-19), the ability to implement evidence-based interventions in a timely manner can be a critical challenge due to infection control measures and limited staffing. Project Goals/ Objectives: The purpose of this project was to compare if benchmarks of patients presenting with chest pain have treatment delays during COVID-19 pandemic as compared topre-COVID-19 in the ED of a small rural hospital. The measures were reviewed with an emphasis on the effects caused by the COVID-19 pandemic to develop an innovative, interdisciplinary initiative to reduce time delays in patients receiving ED services. Results: Increased delays in Door to ECG, Total Length of Stay, Door to Transfer and Door to Lab times were noted in the post COVID-19 period . While Visits to the ED decreased pre_x0002_COVID-19, it significantly increased after COVID-19 began. However, Door to Provider times significantly improved after the pandemic response in March 2020. Running head: EXAMINING IMPACT OF COVID-19 ON RURAL ED 4 With respect to variability, increased variability was noted in the post COVID-19 period for the measures of Door to ECG, Door to Transfer, and for Total Length of Stay. Further examination of latency in data trends suggested that these changes took place five to seven months after the March 2020 response to COVID-19. Discussion: This project emphasized a need to look at the overall processes in the flow of the chest pain patient in this rural ED. While delays were minimized during the COVID-19 pandemic overall, timing metrics failed to meet both the internal and external benchmarks used within the facility before the COVID-19 pandemic and during the COVID-19 pandemic. Areas needing improvement will be prioritized to include processes which present both high risk and high occurrence rates. Improvement priorities will include processes which can be corrected with additional training and rearrangement of current flows which impede the timeliness of care.
Creating a Culture of Transformational Leadership to Decrease Inpatient Falls
Cusick, Frances; Welch, Teresa; Wadsworth, Barbara; University of Alabama Tuscaloosa
Introduction/ Purpose: Optimization of patient outcomes, with the absence of adverse events, is the epitome of quality healthcare and the focus of healthcare institutions. Falls have consistently been associated with the quality of nursing care in the acute care, inpatient setting. As one of the largest segments in healthcare, nursing, and in particular nurse managers, have a significant role in advancing organizational quality initiatives, therefore their leadership behaviors need to foster change and create a supportive work environment. The 370-bed community medical center, which consistently strives to achieve quality patient care with zero adverse events resulting in patient harm, has faced challenges particularly as it relates to inpatient falls. Despite the implementation of evidence-based prevention protocols the incidence of falls continued to exceed national and organizational benchmarks therefore an imperative existed to explore initiatives to drive quality patient care. Methods: An evidence-based nurse manager leadership development program was implemented, which included a nurse manager’s self-assessment of leadership behaviors along with a transformational leadership education course. Pre- and post-implementation aggregate data of fall rate per 1,000 patient days were utilized for measurement. Results: This quality improvement project resulted in an overall decrease of 44% in inpatient fall rates, within three months, as measured by inpatient fall rates per 1,000 patient days, on participating inpatient telemetry units. Results indicate that the overall fall rate for the three units with t = 2.623 and p = 0.015 demonstrated a statistically significant improvement in fall rates pre and post-project implementation. The Pearson correlation co-efficient (r = 0.45) also indicated a significant and positive relationship between pre & post-project implementation aggregate data. Discussion: Project outcomes indicated similar findings to the literature, that the adoption of transformational leadership behaviors and practices in acute care settings improves overall patient safety outcomes including inpatient falls. Each of the inpatient telemetry units, whose nurse managers participated in the project, exhibited a significant decrease in fall rates over the three months following program implementation, which suggests a correlation between the evidence-based leadership development program, transformational nurse managers, and an improvement in fall rates. Conclusion: Implementation of an evidence-based comprehensive leadership development program in this 370-bed community medical center, which utilized the transformational leadership theory as a framework, significantly decreased inpatient fall rates. Instituting this program throughout the organization with stakeholder engagement, as a component of both onboarding and continuing education, has the potential to improve quality patient care with a decrease in inpatient fall rates.
Decreasing Hospital Readmissions with Advanced Care Planning
Shadoan, Beth; Welch, Teresa; Duke, Jennifer; Haamankuli, Hiboombe
Patients with progressive and terminal disease processes such as chronic kidney disease (CKD), congestive heart failure (CHF), and chronic obstructive pulmonary diseases (COPD), acute myocardial infarction (AMI), and coronary artery bypass graft surgery (CABG), are at a higher risk for hospital readmissions due to the progressive nature of the disease processes and the continuation of symptoms that worsen over time. Regardless of recent hospitalizations, once symptoms escalate, the common response for patients and families is to return to the hospital. To reduce readmissions health care providers should address goals of care and advanced care planning prior to discharge. The palliative care patient navigator is typically the initial person on the interdisciplinary health care team to initiate this conversation. Patients who receive palliative care consults for patient-centered goals of care and advanced care planning conversations early in the disease process will have an increased understanding of symptomology and symptom management allowing them to utilize community-based resources and have more autonomy in the management of their care. As a result, return visits to the hospital are decreased, patients can remain at home to manage episodes of symptom exacerbation and improve the quality of life. Methods: As a collaborative project between the quality and case management departments, this evidence-based process improvement project was designed to reduce 30-day readmission rates for high- risk patient populations. The Gunderson Lutheran Health system Advanced Disease Coordination Respecting Choices model was used to frame the development, implementation, and evaluation of the project. All inpatients readmitted to the hospital within 30-days of discharge were screened using the BOOST tool method within the electronic medical record (EMR). Patients with BOOST scores >15 demonstrate the highest risk for readmission. Those with a score >15 and who met inclusion criteria were triaged and seen by the Palliative Care team for appropriateness of the Respecting Choices Advance Care Planning education and assistance completing health care goals and advanced directives. All patients who received goals of care and advance care plan conversations, were also referred to interdisciplinary teams for follow up and identified discharge needs. The goal of the program was to discharge patients with a specific plan for treatment with the necessary resources for symptom management at home to prevent frequent hospital readmissions. Results: The evidence-based project was implemented over 30 days during the month of August 2023 with aggregate 30-day readmission data collected for September 2023 on October 1. Data collection and analysis began immediately with a comparative analysis of baseline data collected June 2023 and post implementation data from September 2023. The goal of the project was to reduce the hospital readmission rates by 10% within 30 days of implementation. And to increase the amount of advanced care plans/advanced directives by 20%. The goal was surpassed by 15% reduction in hospital readmission rates within 30-days post project completion. The amount of advanced care plans/advanced directives was 9%. Discussion: Comparative analysis pre and post implementation data revealed a 15% decrease in 30-day hospital readmissions. This information has been presented to stake holders proposing continuation of the process to address 30-day readmissions with advanced care planning.
Developing Clinical Judgement: The Building Blocks of Quality Nursing Care
(2024) Geyer, Andrea; Parker, Kim; Filson, Rebekah
Introduction/Purpose: Developing clinical judgment is a skill necessary to provide safe, quality patient care yet, it is a skill that cannot be taught. The development of clinical judgment occurs only after a nurse has experienced several situations frequently and can reflect on these scenarios to synthesize and evaluate the nursing process at work. Incorporating a task-layered, married state model into the senior nursing practicum experience can provide the repetitive, frequent experiences needed to enhance clinical judgment development while also offering a supportive, joint approach to patient care while working with an experienced nurse. Methods: Using quantitative data from the Lasater Clinical Judgement Rubric, this project assessed and analyzed the preceptor perspective of senior nursing students' pre- and postintervention clinical judgment scores. Results: Qualitative data was abstracted from pre- and post-intervention surveys completed by the nurse preceptors. The data was arranged to identify a mean score for both pre-and postintervention surveys. The data was used in a paired t-test, which identified whether a correlation between clinical judgment development and a task-layered, married-state approach to the senior practicum experience existed. Discussion: This project sought to understand a potential solution for the development of clinical judgment in pre-licensure nursing students. Healthcare organizations may consider partnering with nursing schools to standardize the teaching approaches used during the senior practicum experience. This may also strengthen the pipeline of newly licensed nurses for an organization and assist in closing the staffing gap most organizations are facing due to the COVID-19 pandemic.
Development of Resources to Promote Nurse Anesthetist Engagement in Policy Advocacy
Sullivan, Elaine; Reede, Lynn; Simmons, Staci; University of Alabama Tuscaloosa
Introduction: Studies have shown that advanced practice nurse engagement in politics and practice advocacy is associated with improved access to healthcare and lower rates of health disparity among vulnerable populations. However, among certified registered nurse anesthetists (CRNAs) in Massachusetts, engagement has been historically low despite several urgent practice issues CRNAs currently face. Lack of knowledge, confidence, and political skill may be factors. The purpose of this project was to assess baseline political astuteness, provide an educational intervention aimed at increasing political awareness and activities, and evaluate the effectiveness of the intervention. Methods: A single cohort, non-randomized, pre-post survey design was used to measure the difference in political astuteness levels before and after the educational intervention. A modified version of the Political Astuteness Inventory (PAI) tool was utilized to measure participants’ levels. Demographic information was collected. Results: Five participants completed the study (N=5). Although political astuteness levels increased from 24.8 to 29 following exposure to the educational policy toolkit, changes did not reveal a statistically significant improvement (p = 0.11). Discussion: The educational policy toolkit described in this project can be a useful model for future educational initiatives provided by state associations.
Dexmedetomidine for Cardiac Surgery Education Intervention
Sellers, Nathaniel; Hines, Cheryl B.; Brown, Howard
Cardiac surgery is the definitive treatment for many cardiac defects. Cardiac surgery is a high risk surgery that is associated with a systemic inflammatory response that can lead to increased morbidity and mortality postoperatively. Dexmedetomidine is a presynaptic alpha-2 agonist that reduces sympathetic outflow via negative feedback and has been shown to reduce this systemic inflammatory response. This is associated with improved postoperative outcomes. There was a knowledge gap on the benefits of dexmedetomidine in cardiac surgery amongst anesthesia providers. Methods: An educational intervention was provided to the anesthesia staff on the current literature for the uses of dexmedetomidine in cardiac surgery. The retrospective chart review was completed five weeks prior to the intervention and five weeks after the intervention. Statistical analysis was carried out and results were presented to the anesthesia staff. Results: This has led to increased usage of dexmedetomidine in cardiac surgery. Dexmedetomidine was used during cardiac surgery in 88% of cases prior to the intervention vs. 98.6% in the postintervention group. Discussion: Dexmedetomidine has shown promising results in improving patient outcomes when used in cardiac surgery. By educating the cardiac anesthesia staff, the cardiac anesthetists have gained a better understanding of dexmedetomidine in cardiac surgery. This led to increased usage.
Diabetes Management in Rural Mississippi Before and During the COVID-19 Pandemic: A Program Evaluation
Sparks, Whitney B.; Bartlett, Robin; Glenn, Christina; Robertson, Donald; University of Alabama Tuscaloosa
Introduction: Management of type 2 diabetes mellitus (T2DM) in rural Mississippi was impacted by the onset of the COVID-19 pandemic resulting in an increase in telemedicine patient care visits. There is little evidence concerning the long-term quality outcomes of telehealth management of chronic diseases such as T2DM; thus, there is a need for examination of patient outcomes associated with telehealth provided care. Methods: To evaluate the efficacy of telehealth in T2DM management, a rural Mississippi clinic was home to a program evaluation to compare A1C measurements of patients with T2DM seen in face-to-face office visits during the year prior to the onset of COVID-19 to those seen during the pandemic which included a mixture of telehealth and face-to-face visits. Results: Pre COVID-19 data included 430 male and 531 female patients (face-to-face visits only). Post COVID-19 data included 507 male and 593 female patients (combination of face-to-face and telemedicine visits). Mean A1C levels were not statistically significantly different for patients between the two years compared; however, participants who received a combination of face-to-face and telehealth visits were more likely to have an uncontrolled A1C. There were no gender differences in A1C in the pre or post COVID 19 groups. In the post COVID-19 group, age was not significantly associated with A1C level (controlled vs. uncontrolled); however, in the pre COVID-19 group, age was significantly associated with A1C control (ages 18-45: 12.2% uncontrolled vs. ages 46-75: 6.4% uncontrolled). There was no significant change in follow up compliance. Discussion: Because few patients actually participated in telehealth visits, there are insufficient data to determine if telemedicine is an efficacious strategy to provide chronic diabetes management in this rural clinic. More data from telehealth visits are needed to determine telemedicine’s impact in rural outpatient diabetes management.
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.

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