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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Improving Adolescent Depression Screening in Pediatric Primary Care
(2024) Taylor, Amanda; Sartain, Andrea; Weiss, Robert
Introduction: Adolescent depression has been brought to the forefront of pediatric mental healthcare in recent years due to the COVID-19 pandemic. With an increased burden brought upon this age group, healthcare providers must adequately screen for depression. The standard of care is that all adolescents are screened for depression annually. To improve this screening process, the ideal place to start is in pediatric primary care. Methods: Adolescents at the project site complete a Patient Health Questionnaire-9 (PHQ-9) depression screening during annual well visits allowing symptoms of depression at other times throughout the year to go undetected. The project intervention included implementing PHQ-9 depression screenings at all visits, both well and sick, for patients ages 12 to 18 to capture additional positive screenings. Results: For patients ages 12 to 18, a total of 261 clinic visits occurred during the project’s implementation phase. Well visits accounted for 158 while the remaining 103 were sick visits. Positive depression screenings were noted for 24 adolescents, 11 at well visits and 13 at sick visits. Therefore, the rates of positive depression screenings at sick visits were considerably higher than those obtained at well visits. Discussion: Once the implementation of additional depression screenings occurred, data were analyzed to determine the clinical significance of continuing PHQ-9 screenings at all adolescent clinic visits. Based on statistical analysis, more frequent adolescent depression screenings prove to be beneficial in identifying patients experiencing depression. Conclusions: The project intervention was proven to be successful as PHQ-9 screenings administered at sick visits yielded additional positive depression screenings for patients that may have otherwise gone undetected. By implementing more frequent depression screenings, patients at risk for depression may be identified earlier and receive appropriate treatment. Subsequently, receiving earlier intervention and treatment for depression will in turn improve long-term patient outcomes.
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.
Identifying Obstructive Sleep Apnea Risk in the Preoperative Setting Utilizing the STOP-Bang Questionnaire: A Quality Improvement Project
(2024) Parker, Nicole; Martin, Rebecca; Kajani, Mizra
Introduction/Purpose: Patients with a medical diagnosis of obstructive sleep apnea (OSA) and those with undiagnosed OSA have a greater chance of having an adverse event during endoscopy procedures related to their medical condition. This Doctor of Nursing Practice quality improvement (QI) project aims to address the lack of obstructive sleep apnea screening during the preoperative assessment at an endoscopy center by implementing and evaluating a preoperative screening protocol. Methods: A multidisciplinary, evidence-based quality improvement (QI) project was implemented in an ambulatory adult endoscopy center to address an identified gap in best practice. Participants were preoperative endoscopy patients. The STOP-Bang Questionnaire was added to the preoperative assessment protocol. Pre- and post-chart reviews evaluated the screening protocol by examining the rates of patients who were identified as at-risk for OSA before and after the intervention. The data was analyzed using descriptive statistics. Results: This scholarly quality improvement (QI) found a statistically significant difference (p < 0.001) in the identification of patients who were at risk for obstructive sleep apnea when using the STOP-Bang Questionnaire (SBQ) during the preoperative assessment compared to the identification of patients with a known diagnosis of OSA. A Chi-square test confirmed strong associations between risk categories and total scores, validating the risk categorization system of the STOP-Bang Questionnaire. Descriptive Statistics found the STOP-Bang Questionnaire to be an effective tool for screening preoperative patients for OSA risk. Discussion: The STOP-Bang Questionnaire (SBQ) is a reproducible, evidence-based screening tool for OSA that has a known impact on identifying patients at risk for airway obstruction and perioperative medical complications. Early detection of OSA patients may diminish or eliminate potential adverse events. Preoperative protocols that support the use of preoperative screening for OSA can improve the overall quality and safety of care provided to patients undergoing endoscopy procedures.
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.
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.
Post Traumatic Stress Disorder (PTSD) Screening of Military Veterans in a Civilian Primary Care Setting
(2024) Geter, LaToyus; Martin, Rebecca; Oropo, Sikirit
Introduction/Purpose: Military Veterans are at high risk for post-traumatic stress disorder (PTSD) related to their military service, yet evidence demonstrates that healthcare professionals' lack of knowledge is a factor in underdiagnosis. Implementing a valid screening tool for PTSD in the civilian primary care setting can increase the likelihood of identifying symptoms and offering prompt, appropriate treatment for healing to occur. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a five-item screening tool used in the primary care setting to identify individuals with possible PTSD. The purpose of this quality improvement project was twofold: first, to enhance civilian clinic providers' knowledge of PTSD in Veteran patients, and second, to implement routine screening of Veteran patients for PTSD symptoms using the PC-PTSD-5. Methods: Participants consisted of Veteran patients referred from the United States Department of Veterans Affairs (VA) for compensation and pension exams. Patients who self-identified as Military Veteran were also invited to participate. On the day of their visit, Veterans underwent screening using the PC-PTSD-5. Patients who screened positive were referred for further evaluation, following the established guidelines provided by the VA. Results: The results of the project were an increase in clinic staff knowledge of PTSD symptoms and an increase in screening for PTSD. Discussion: Identifying and effectively treating PTSD was paramount to mitigating adverse outcomes associated with this disorder among Veterans. Introducing a validated screening tool in non-VA primary care clinics held significant importance in ensuring comprehensive care for this vulnerable population. By improving screening processes and enhancing provider awareness, this project positively impacted the lives of Veteran patients by facilitating timely identification and intervention for PTSD.
Organizational Readiness for Change Assessment: Transitional Job Re-entry Program for Non-work-related Injuries, Chronic Disease, or Illness
(2024) Wactor, Aiesha; Welch, Teresa; Simon-Waterman, Christie
Introduction: Medical debility can occur at any time during an employee’s career, leading to missed days, lost wages, and disengagement from the work environment. The implementation of an evidence-based transitional return to work program with temporary job modifications or role change has the potential to benefit both the employee and the employer. Methods: Readiness for change was assessed following an educational presentation presenting the Retaining Employment and Talent After Injury/Illness (RETAIN) initiative as a framework for a transitional return to work program for institutional stakeholders. A pre and post intervention assessment of readiness was assessed using the Organization Change Recipients Belief Scale (OCRBS) a valid and reliable tool for the measurement of organizational readiness for change. Results: Due to the low response rate survey findings were not statistically significant. The pre and post intervention survey data demonstrated principal support as the highest scoring determinant for readiness for change at 94.5% and 73.6%. The discrepancy determinant was the lowest scoring determinant with 82% and 60.5% respectively. Findings for the remaining determinants of organizational change resulted pre and post scoring for valence 86%/62%, appropriateness 85.8%/68.4%, and efficacy 86.2%/66.2%. Discussion: Assessing an organizations readiness for change provides valuable insight to the potential facilitators and barriers to sustainable change by providing insight from key stakeholders. Additional readiness for change assessments should consider including marketing strategies to improve awareness, participant incentives, and frequent email reminders to increase participation rates.
The Use of an Enhanced Recovery Bundle in Surgical Spine Patients to Reduce Opioid Requirements, Improve Patient Comfort, and Shorten the Length of Stay
(2024) Schafer, Kierste; Welch, Teresa; Franker, Lauren
Purpose: The number and cost of spine surgeries have increased over the past decade. Various perioperative interventions continue to provide care for spine surgical patients despite evidence indicating that Enhanced Recovery After Surgery (ERAS) consistently decreases the stress response to surgery and improves patient outcomes. Methods: A multidisciplinary evidence-based quality improvement (QI) project was implemented in a community-based acute care facility to address an identified gap in best practice. As the gold standard in perioperative care, the ERAS protocol provided a preoperative oral carbohydrate drink (CHO), acetaminophen, and gabapentin to existing interventions for a more complete ERAS spine bundle. Results: This scholarly quality improvement (QI) project found a statistically significant reduction in total morphine milligram equivalents (TMME) required in the post-anesthesia recovery unit (PACU). Patients had improved comfort that was not statistically significant, in the PACU with a reduction in the need for postoperative nausea and vomiting (PONV) medications, and the length of stay (LOS) in the PACU increased slightly but was not statistically significant. Discussion: Enhanced Recovery After Surgery (ERAS) guidelines are reproducible evidenced-based practice models with a known impact on patient outcomes and satisfaction without an increase in readmission or complications. The use of a QI ERAS spine bundle found that patients not only required less narcotics in the PACU but also needed less PONV medication for comfort. This QI ERAS bundle is evidence that the use of multimodal analgesia and CHO combined with existing ERAS spine interventions is vital not only to reduce patient exposure to unnecessary narcotics but improve comfort. Individually, these interventions do not appear impactful, but patient outcomes are positively impacted when bundled together in a care bundle or model. LOS can be a challenge to quantify and evaluate for accuracy when bed and staffing shortages are a constant problem to patient recovery and workflow in a facility post-pandemic. For the future, a better LOS measurement could have been the arrival time in PACU to discharge home. Additional QI ERAS projects evaluating patients’ TMME post-surgery to discharge home, and patients’ satisfaction surveys would be a valid next step in improving an ERAS spine bundle. These findings also show the impact of inexpensive and simple interventions for other surgical specialties in reducing TMME and improving patient comfort.
Wound Dressing Decision Tree for Home Health Nurses
(2024) Rogers, Riley Clay; Johnson, Paige; Perry, William Barton
Introduction: This project aims to provide an educational tool for home health nurses to assess types of wounds and determine the most suitable wound treatment for patients. Having an educational tool regarding wound care treatment and wound care knowledge can show expected outcomes of a decrease in wound healing time, a decline in cost related to wound care, and an increase in knowledge among home health nurses. Methods: This quality improvement project used a pre-intervention design to assess the nurse’s knowledge at baseline before an intervention using the wound dressing decision tree and, lastly, a post-intervention assessment to determine the increase in the nurse’s knowledge of wound care. Intervention: After pre-test results were collected, a presentation was given regarding what specific wound dressings to use based on the characteristics and descriptors of the wound and how each dressing works. The Pretest and Posttest results were six weeks apart. Using a series of Wilcoxon signed rank tests, the International Business Machines Statistical Product and Service Solutions (IBM SPSS) version 29 was used to compare the pre-and post-intervention results. Results: 14 participants completed the pre-test, 12 participated in the learning intervention, and 11 completed the post-test. A series of Wilcoxon signed rank tests were performed to compare the number of correct answers on the pre-test and post-test. For specific questions, the number of correct answers increased post-test compared to the pre-test; however, these increases were not statistically significant. Discussion: The educational intervention showed no statistical significance between the two tests, even though the home health nurses expressed that the wound dressing selection tool was beneficial to them.
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.
Evaluating the Effectiveness of Gastric Ultrasound Training for Practicing Certified Registered Nurse Anesthetists
(2024) Patrick, Shannon; Bratcher, Lee; Westover, Shad
Introduction/Purpose: The purpose of this project was to train Certified Registered Nurse Anesthetists (CRNAs) in the use of gastric ultrasound to evaluate stomach contents in patients at risk for aspiration prior to surgery. GLP-1 agonists delayed gastric emptying, which increased the risk for aspiration on induction of anesthesia, necessitating a reliable tool for preoperative assessment of gastric contents. The proposed solution was the implementation of gastric ultrasound, an inexpensive, non-invasive, simple skill, recognized for its accuracy in determining gastric contents. Methods: The literature review underscored the rising use of GLP-1 agonists, their impact on gastric emptying, and the inadequacy of existing fasting guidelines. Gastric ultrasound, identified as a valuable point-of-care tool, lacked integration into anesthesia training. The study outlined a targeted intervention to educate practicing CRNAs, focusing on the Indication, Acquisition, Interpretation, and Medical-Decision Making (I-AIM) framework for gastric ultrasound interpretation. The project design involved a pre– and post-intervention assessment using a questionnaire and the Ultrasound Competency Assessment Tool (UCAT). The educational intervention included a didactic presentation and hands-on training. CRNAs scanned a standardized volunteer model under various gastric states, and their competency was reevaluated two months later. The project’s setting was an anesthesia group in Boise, Idaho, serving a diverse patient population. Results: Nine Certified Registered Nurse Anesthetists (CRNAs) participated in this study to evaluate their competency in performing gastric ultrasound after completing a structured training program. Before the training, participants completed a pre-questionnaire to assess their baseline knowledge and experience with ultrasound. None of the participants had received formal education in Point-of-Care Ultrasound (POCUS) or gastric ultrasound, though 78% reported using ultrasound in their clinical practice for nerve blocks and invasive line insertions. Their self-rated entrustment scores averaged 1.67 (SD = 0.50), indicating low confidence and competence. Following the training intervention, the CRNAs were evaluated six weeks later using the UCAT. In preparation, all participants scored a 3. For image acquisition, the mean score was 2.56 (SD = 0.53), and for clinical integration, the mean score was 2.11 (SD = 0.60). Entrustment scores significantly improved, with a mean post-training score of 2.75 (SD = 0.46). A paired t-test confirmed the significance of this improvement, t(8) = -5.50, p = 0.00057. Discussion: This study evaluated the effectiveness of a structured training program in enhancing CRNAs' competency in performing gastric ultrasound. The pre-educational questionnaire highlighted a gap in formal training, with most participants lacking experience in POCUS and gastric ultrasound. Post-training evaluations showed significant improvements in preparation, image acquisition, and clinical integration, demonstrating the program's effectiveness. The significant increase in entrustment scores indicated that CRNAs gained confidence and competence in performing gastric ultrasound independently. The results suggest that a structured training program can effectively equip CRNAs with the skills needed to integrate gastric ultrasound into clinical practice, improving patient safety and clinical outcomes. To further enhance skill retention and autonomy, follow-up practice sessions are recommended, including refresher training, extended hands-on practice, simulation scenarios, and competency reassessment.
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.
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.
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.
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.
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.
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.
Implementing Evidence-Based Practice Guidelines for the Anesthetic Management of Patients Prescribed Peripartum Anticoagulants
(2024) Carr, Katharine; Lee, Amy; Haddad, Liz
Introduction/Purpose: Anticoagulants are frequently prescribed to pregnant patients to minimize potential complications associated with a venous thromboembolism. The American College of Gynecologists and Obstetricians recommends that a protocol regarding anticoagulant medication holding time prior to neuraxial anesthesia be available on each labor and delivery unit; however, the local anesthesia group did not have a protocol available at its clinical site prior to this project. This quality improvement project was designed to improve the care of patients taking anticoagulants during labor and delivery by creating a clinical guideline (CG) for anesthesia and anticoagulant management. Methods: A new CG based on the 2018 Society for Obstetric Anesthesia and Perinatology Consensus Statement was implemented by a private anesthesia group on the labor and delivery unit of a large community hospital. Anesthesia staff members attended a 30-minute educational presentation about the new CG two weeks prior to its implementation. Thirty-days post-implementation, anesthesia staff were emailed a link to complete an anonymous AGREE-REX (Appraisal of Guidelines Research and Evaluation – Recommendations EXcellence) tool. The AGREE-REX tool was developed to measure the clinical credibility (quality) and implementability (ease of use) of CGs. Data collection occurred over 30 days. Results: The results of the AGREE-REX survey demonstrated that anesthesia providers found the new CG both clinically credible and easy to implement on the labor and delivery unit. All the calculated scaled scores were above the 60% threshold. In addition, 100% of participants concluded the survey by recommending that this CG be used on the labor and delivery unit and other appropriate contexts. Discussion: The new CG ensured that evidence-based practice standards were met and that the care of this patient population followed a clear plan in terms of medication holding times and recommended laboratory testing. Any possible confusion about the plan of care was eliminated. After this quality improvement project, the new CG will become the standardized care plan on the labor and delivery unit enhancing patient safety, and both staff and patient satisfaction.
Reducing Readmission using the Re-Engineered Discharge: A Quality Improvement Project—Evaluation and Analysis
Zeller, Nicole; Barron, Keri; Jennings, Ryan
Introduction/Purpose: One out of every five patients hospitalized for heart failure (HF)- related complications are readmitted within 30 days of previous admission. Readmission, as a healthcare quality index, provides a metric to investigate strategies to improve HF outcomes. The Re-Engineered Discharge (RED) protocol is a comprehensive transitional care tool created to improve overall patient outcomes and self-efficacy. The purpose of this quality improvement project was to evaluate the RED protocol’s effect on readmission rates in patients admitted with HF at a small, Midwestern hospital. Methods: This project used a convenience sample of adult patients, ages 18 years or older admitted to the hospital with HF during a 60-day period. All patients (N = 7) who met the sample criteria received the RED transitional care protocol delivered by a trained cardiac care nurse. Following the implementation, the researcher performed a chart audit over 30 days to identify readmission status, collect data, and verify the integrity of RED implementation. Results: The readmission rate was 28.6% among the study group, which was above the hospital’s baseline rate of 25.42% in August. The readmission index was 0.91 in the study group versus the hospital’s overall index (1.07). The findings regarding the secondary data was consistent with the literature results that demonstrated increased HF incidence among older adults (age range, 58 - 91), females (four females versus three males), and increased occurrence in higher socio-economic status persons. The most common secondary diagnoses were hypertension (N = 7), osteoarthritis (N = 4), hyperlipidemia (N = 4), atrial fibrillation (N = 3), and diabetes mellitus (N = 3). The protocol fidelity was 100% for all steps, except for the follow up phone call (78%), validated through self-report and chart audit. Discussion: The project does not statistically support use of the RED protocol as a means of reducing readmission; however, the literature continues to support the individual steps of the protocol. Further study is necessary to validate the protocol. This project sought to inform transitional care guidelines in acute care institutions to improve patient outcomes and reduce readmission.
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.

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