Journal of Doctoral Nursing Practice最新文献

Background: At an urban public acute care hospital, a gap existed in the safety and efficacy of early mobilization (EM) of intensive care unit (ICU) patients, with the need for an evidence-based intervention. A literature review revealed that a nurse-driven mobility protocol could safely achieve early mobility in ICU patients. This quality improvement project aims to utilize a nurse-driven mobility protocol to determine its effects on EM of ICU patients. Objective: The purpose of this quality improvement project is to determine if the implementation of an early mobility program using the Bedside Mobility Assessment Tool (BMAT) would impact patient mobility compared to standard practice over eight weeks in the ICU setting of an urban Hospital in New York City. Method: The Bedside Mobility Assessment Tool (BMAT) was used to conduct a pilot project on all critically ill patients aged ≥18 years admitted to the 17-bed ICU in an acute care hospital. Kotter's Eight-Step Change Process underpinned by the Plan-Do-Study-Act method of change was used to implement and guide the change process. Result: A nonrandomized convenience sampling of patients was used to attain a total of N = 306 patients (n = 133 preintervention and n = 173 implementation). Between the preimplementation (patients previously mobilized using standard practice) and implementation groups (patients mobilized using BMAT), there was a statistical significance in mobilization rates observed with pre-implementation (n = 56, 42%) and postimplementation mobility rates (n = 132, 76%). Conclusion: EM of critical patients in the ICU using a nurse-driven protocol with the BMAT assessment tool proved efficacious in promoting early patient mobility activities in this setting. This project should be continued and disseminated to other units.

Background: U.S. federal regulations have shifted health care systems to focus more on providing quality of care than quantity of care. Patient experiences that include nursing communication are important quality measures that have a positive impact on satisfaction ratings. Objective: This quality improvement project aimed to demonstrate that using nurse bundling strategies and employing servant leadership principles to influence nurses' caring behaviors toward patient care may improve patients' ratings on treatment with courtesy and respect. Methods: Registered nurses (RNs) in the emergency department (ED) were observed for 8 weeks in January 2020 using validated measurement tools and completed an electronic, 23-item Servant Leadership Questionnaire (SLQ) survey. Results: Bedside shift reporting observations were the lowest reported strategy. The Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey results did not improve from the previous quarter's data but increased and sustained in the three following quarters. The SLQ survey demonstrated statistically significant increases (p = .0191) from preintervention to postintervention. Conclusion: Though RNs were aware of servant leadership principles, further exploration is warranted to strengthen structures and processes related to nurse bundling strategies and the development of other ED-specific measurement tools and the patients' perception of courtesy and respect, an HCAHPS measure. Implications for Nursing: Expanding RN sample size, including other ED staff members, performing random leadership rounding, and using ED-specific measurement tool are nursing implications.

Aim: The aim of this quality improvement project was to provide multisession trainings that teach the fundamentals of motivational interviewing (MI) to inpatient behavioral health care workers who lack education and proficiency in these techniques. Background: MI is a therapeutic communication approach that explores a person's mixed feelings or ambivalence and aims to encourage a positive behavior change. It was first developed for patients struggling with substance use disorders to assist them in making decisions regarding their sobriety. Methods: Participants attended three 2-hour MI educational sessions, which spanned 6 weeks. Instruction was through an interactive online module. After each educational session, participants engaged in role-play scenarios. Participants received ratings on their adherence to MI skills. Prior to the first and following the last educational session, participants completed an anonymous online survey to measure individual knowledge of MI fundamentals. Results: Through role-play adherence ratings, MI consistent fundamental skills, such as open-ended questions and reflective statements, demonstrated proficiency. The remaining MI consistent fundamental skills, MI style or spirit, and affirmations did not reach proficiency. MI consistent complex skills did not reach proficiency but did progressively increase in adherence. MI inconsistent skills that should be avoided all met adherence proficiency, other than close-ended questions. Conclusion: This quality improvement training demonstrated that through multiple internet-based educational sessions and role-play scenarios, proficiency in two MI consistent fundamental skills and knowledge increased. Continued efforts to create more educational and practical opportunities for knowledge retention are encouraged.

Background: Nulliparous cesarean birth rates have plateaued at 25% since 2019. Cesarean births contribute to 37% of severe maternal morbidity and can increase costs by longer lengths of stay, increased admissions to the neonatal intensive care unit, further postoperative complications, and an increased likelihood of subsequent cesarean births. Local Problem: At this community hospital, the rate of cesarean births for nulliparous, term, singleton, and vertex (NTSV) pregnancies rose almost 3% in 2022. This quality improvement (QI) project was aimed to decrease NTSV cesarean births by increasing effective maternal care by 80% at a community-based hospital. Methods: The Plan-Do-Study-Act model was applied for this rapid-cycle QI over 8 weeks with four 2-week cycles. The data were collected every other day, reviewed biweekly to inform data collection, and analyzed for the next test of change. Interventions: A patient screening tool was used to identify nulliparous mothers, and a patient effective care checklist tool was used to improve effective maternal care. Results: Staff utilization overall resulted in 81% screening of 215 mothers and identified 116 nulliparous mothers. The average effective care score was 84%. The checklist improved effective maternal care to 84% and reduced the NTSV cesarean births by 7%. Conclusion: Identifying nulliparous mothers on admission and then providing effective care to women in labor has the potential to decrease the NTSV cesarean birth rate. It can be utilized by every laboring mother, furthering the reduction of cesarean births.

Background: Sound clinical judgment (CJ) is essential for providing quality patient care. Newly licensed nurses lack the previous experiences needed to inform CJ, which could result in harm. Objective: This project aimed to evaluate the effectiveness of in situ and structured debriefing on the development of CJ among newly licensed nurses during their orientation. Methods: A quasi-experimental nonequivalent control group posttest design was used to compare CJ among newly licensed nurses who used in situ and structured debriefing during their initial orientation to those who did not use debriefing methodology. Results: CJ was improved through in situ and structured debriefing. Newly licensed nurses also perceived debriefing as valuable for analyzing their performance and developing a personal improvement plan. Conclusions: Debriefing during orientation has the potential to improve CJ among newly licensed nurses and promote patient safety. Implications for Nursing: Nurse leaders must implement methods to improve CJ among newly licensed nurses to address the existing decline in competency. Given their benefits, efficiency, and cost-effectiveness, debriefing methodologies should also be considered to promote CJ development among nurses transitioning to new care environments and advanced practice roles.

Background: Human trafficking is a major illegal industry prevalent in all regions of the United States, including health care settings. All humans are at risk of becoming trafficked because it does not discriminate against age, gender, location, sexual orientation, socioeconomic status, or education. Often during their enslavement, victims are seen in the emergency department setting but are not identified by health care staff. This can be due to a lack of proper screening questions or nursing staff not being adequately educated on the red flags evident in the presence of human trafficking. Objective: This quality improvement project aimed to develop an updated screening question to identify human trafficking victims within the emergency department. Methods: Nursing staff volunteered to participate and ask an updated screening question to all adult patients during their scheduled shifts. Results: This project successfully identified potential victims by an increase of 59.4% compared to the current screening question in place at this organization. Conclusion/Implications for Nursing: By increasing the education and confidence of the staff, screening can improve the identification of these victims. Unfortunately, most health care settings do not have specific screening tools to identify these victims, leading to many victims leaving the facility without being identified or possible resources being given.

Background: Adolescent vaping has dramatically increased, causes adverse health outcomes, and is considered a priority public health concern. Current screening is not age-appropriate, poorly captures vaping use, and inadequately prompts the provider, reducing awareness of use. Objective: The aim of the study is to improve adolescent vaping capture and increase provider awareness of use by implementing an age-appropriate screening tool. Methods: A quality improvement project was completed by utilizing the Plan-Do-Study-Act model, implementing the Hooked on Nicotine Checklist for Vaping (HONCV) screening, and then comparing those capture results to the current electronic health record (EHR) screening. Provider awareness was measured using pre- and postimplementation surveys. Results: A statistically significant difference in vaping capture was found after implementing the HONCV tool, p < .001, with an overall 10% increase in vaping capture. Provider awareness of adolescent vaping use as a direct result of the HONCV screening also significantly increased, p = .012. Conclusions: The HONCV screening tool is a more effective way of capturing adolescent vaping use and awareness by the provider of use than the current EHR screening. Implications for Nursing: Nursing can be instrumental in advocating for implementing the HONCV within the EHR to meet recommended practice standards for adolescent screening.

Background: Evidence shows that health care workers (HCWs) experience high levels of stress, heightened in recent years by the pandemic. Finding ways to alleviate this stress has become an important objective for health care systems. Mindfulness has been shown to reduce stress levels in HCWs. Objective: This systematic review aims to review efficient and feasible ways to deliver mindfulness to HCWs to reduce stress. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, the literature was searched using Google Scholar, CINAHL, and PubMed for relevant articles. Inclusion and exclusion criteria include the following: intervention was a mindfulness program, population must include nurses in subject pool, must have full text, no dissertations, newer than 2019, and in English language. The results were synthesized and presented by themes of how efficient and feasible mindfulness programs were created. Results: A total number of 25 studies were used in the review, with 1,099 participants in total. Identified themes related to program efficiency and feasibility included the types of mindfulness, feasibility, delivery methods, measurement of stress, and mindful awareness. Conclusions: A feasible program can be implemented for low to no cost using a mobile application device and daily consistent mindfulness. Implications for Nursing: Reducing stress in this fashion is both accessible for busy HCWs in their day-to-day work routine as well as a cost-efficient solution for health care systems.

Background: Detecting delirium accurately in older patients with heart failure (HF) is challenging for nurses due to difficulties in assessing baseline cognition, leading to inaccurate delirium assessment. Objective: The project aimed to evaluate the effectiveness of an educational intervention and a documentation tool in the electronic health record (EHR) to enhance delirium detection rates by up to 30% in patients over 65 years with HF. Methods: Delirium detection rates were assessed pre- and postimplementation through chart review spanning 8 weeks. The Chart-based Delirium Identification Instrument was applied to preimplementation (2023) and postimplementation (2024) data for comparison over 8 weeks. Additionally, the project included a pre-post survey to examine nurses' self-reported knowledge, confidence, and perspectives on delirium detection and management. Results: Nurses achieved a 100% detection rate by accurately identifying the sole case of delirium postimplementation. Notably, nurses accurately ruled out delirium in patients who tested negative. Additionally, they reported increased knowledge and confidence in delirium detection. Conclusions: The dual intervention of nurses' education and structural documentation support contributed to enhancing the nurses' ability to accurately identify delirium. The intervention facilitated the consistent identification and documentation of baseline cognition. The streamlined process ensured consistency and facilitated easy retrieval by nurses when completing the Confusion Assessment Method for delirium detection. Implications for Nursing: Combining nurse education and an EHR tool ensures equitable access to resources for accurate delirium detection among older patients with HF. Improving delirium detection rates helps provide targeted interventions, ultimately reducing disparities in delirium-related outcomes.

Background: Diabetes lifestyle interventions can prevent type 2 diabetes (T2D), the leading cause of death and disability, especially among marginalized populations. Preventing or delaying the progression of T2D involves modification of high-risk behaviors. Peer educators and lay health workers can effectively implement Diabetes Prevention Program (DPP) interventions. Objective: The objective of the study was to adapt and deliver an evidence-based, nurse-led, peer-facilitated DPP for homeless men with substantial risks for T2D. Methods: This pilot project utilized a phased approach for implementation science. It was implemented with formerly homeless men enrolled in a residential employment center within an urban environment. Results: Significant improvements were observed for meal-time portion control, daily physical activity, replacement of sugar-sweetened beverages with water, cutting back on cigarettes, and weight loss from baseline to week 12. Conclusion: Despite significant achievements in meeting their personal health behavior goals, the men revealed serious competing concerns. The peer facilitators (PF) and participants were concerned about the need for sustained employment so that they could meet their basic needs (i.e., income, food, housing, etc.). Implications for Nursing: The men found performing as PF beyond 12 weeks without pay to be unreasonable, although they were enthusiastic about improving their own health, as well as the health of their friends and family.