Journal of Doctoral Nursing Practice最新文献

Background: Although Doctor of Nursing Practice (DNP) students have used rubrics to guide assignments, few have created PowerPoint slide decks for professional presentations. Students might benefit from a rubric that standardizes PowerPoint presentations on final DNP projects. Objective: The objective of the study is to conduct a quality improvement project to evaluate a literature-based rubric guiding students' PowerPoint presentations and the grading of final projects. Methods: Two faculty independently scored PowerPoint slides structuring final DNP project presentations for the literature-based rubric. They revised the rubric based on ratings and comments. Nine content experts rated the relevance of the revised rubric's criteria. Results: Three criteria differed at a statistically different level on the literature-based rubric's ratings. Interrater reliability was low. The rubric criteria were revised. Nine experts' ratings showed criteria on the revised rubric were relevant; their comments stimulated revisions. The Survey Content Validity Average was 0.88, suggesting the relevance of criteria. Conclusions: The rubric requires additional revisions. Posting the revised rubric in the student resource course of the learning management system might assist students to construct PowerPoint presentations in DNP courses and for professional presentations. Implications for Nursing: The rubric was shared with DNP Project Teams. Faculty will continue to evaluate the quality of the students' presentations.

Background: The goal of endotracheal tube (ETT) cuff inflation is to produce a pressure within the range of 20-30 cm H₂O to ensure a proper seal against the trachea without compromising mucosal perfusion. The gold standard for the assessment of ETT cuff pressure is a handheld manometer; however, due to a lack of availability, this is rarely performed. Using a 10-mL syringe for cuff inflation is a common practice but can lead to overinflation and higher-than-recommended pressures. Objective: The purpose of this quality improvement project was to evaluate the incidence of ETT cuff overinflation and determine if an educational intervention advocating for lower volumes would reduce the occurrence. Method: The authors evaluated 50 ETT cuff pressures before and 50 after an educational intervention proposing the use of a 5-mL syringe for cuff inflation rather than a 10-mL syringe. Results: Median cuff pressure significantly decreased from 60 cm H₂O in the preintervention phase to 30 cm H₂O in the postintervention phase using 5-mL syringes, a 50% decrease (p < .001). Conclusion: This project demonstrated that an educational presentation recommending a 5-mL syringe for ETT cuff inflation resulted in a significant reduction of cuff pressures. Implications for Nursing: Nurse anesthetists should be aware of the risk of overinflation of endotracheal tube cuffs. Implementing a volume-based inflation method into current practice will decrease this incidence and the harmful sequelae associated with high cuff pressure.

Background: Individuals experience vaccination hesitancy for many reasons. However, not receiving vaccinations leaves individuals at increased risk for vaccine-preventable illnesses. Individuals in rural areas are more likely to experience vaccine hesitancy. Objective: Motivational interviewing is an effective strategy for addressing behavior change, including vaccine hesitancy. This evidence-based practice project provided an education session for Michigan State University Extension Vaccine Team members, who deliver health care information statewide. Methods: An educational information session on motivational interviewing was delivered via Zoom. This session focused on employing motivational interviewing in rural populations to address vaccine hesitancy. A survey was administered to participants pre and postmotivational interviewing educational sessions to assess changes in knowledge and confidence in using motivational interviewing. Results: Participants' knowledge and confidence regarding motivational interviewing improved. They reported an increased understanding of the concept and confidence in deploying this technique to the rural population. Conclusions: This project highlights the process and need for delivering an educational motivational interviewing session to health care team members who regularly interact with the rural population regarding vaccine hesitancy. Implications for Nursing: Teaching individuals who regularly interact with the rural population the technique of motivational interviewing can help expand the reach of the discussions in health care settings.

Background: Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States despite the availability of effective preventive screening. Objective: This project was designed as a community awareness initiative to increase CRC awareness, knowledge, and intent to discuss and complete CRC screening. Methodology: This quasi-experimental study had a QI focus and used a convenience sample in a public setting assessing CRC awareness, knowledge, and intent to discuss and complete screening after participating in an inflatable colon tour. Results: CRC awareness and knowledge scores showed a statistically significant increase in posttest scores at p < .001. Posttour, there was an 82% and 133% increase in people who identified as "very likely" or "definitely" willing to discuss CRC with their healthcare provider and complete CRC screening within the next 6 months, respectively. Conclusions: In line with previous studies, the inflatable colon model was a successful means of increasing CRC knowledge, awareness, and intent to complete CRC screening. Implications for Nursing: This project is evidence that community events can successfully increase knowledge in underserved populations. Implementing community-based interactive education, such as an inflatable colon tour, is an effective way to incorporate evidence-based education for vulnerable populations.

Background: Surgical delays can lead to patient dissatisfaction and negatively affect hospital revenue. Maximizing operating room (OR) efficiencies is a high priority. A common metric for OR efficiency is first-case on-time start (FCOTS). Objective: The aims were to increase FCOTS rates to at least 50% and reduce delay time lost in minutes in the OR by 50%. Methods: A multidisciplinary/multifaceted approach was implemented and consisted of restructuring the preoperative assessment process, modifying the preoperative checklist, conducting a perioperative educational program, revising the anesthesia nurse practitioner (NP) work schedule, and notifying surgeons about losing first-case privileges if they arrived late. A total of 300 (150 retrospective and 150 prospective) charts were reviewed. After 3 months, pre- and postintervention data were analyzed. Results: The FCOTS rate increased from 15.3% to 30.7%, and the OR time lost in minutes decreased from 2,309 to 1,029. Conclusions: Delays in care negatively affect patient satisfaction and the hospital budget. A multidisciplinary/multifaceted approach is effective in reducing FCOTS rates. Implications for Nursing: Evidence-based strategies such as those used in this initiative may be implemented by NPs in institutions providing surgical services to optimize efficiency, decrease costs, and improve patient satisfaction.

Background: Over 30% of births in the United States occur via cesarean section despite increased risks to the birthing person and neonate. Evidence-based nursing practice related to fetal monitoring, patient positioning, and management of the second stage of labor can decrease the incidence of cesarean birth. Objective: The objective is to decrease the cesarean birth rate by 3% in a Midwestern suburban hospital. Methods: Baseline data on demographics, labor interventions, and birth outcomes were collected for 4 weeks (n = 85 births). The intervention included a sample of 24 labor nurses who took a pretest, viewed a narrated PowerPoint on methods to promote vaginal birth, and completed a posttest. Data were then collected for another four weeks (n = 90 births). Results: The mean improvement in posttest scores was 4.792 points, providing strong evidence that this education would result in a score increase between 3.9 and 5.6 with 95% confidence. There was no increase in the number of nursing interventions utilized during labor. The overall cesarean birth rate increased from 18.8% to 28.9%. Conclusions: The education was highly effective in increasing nurse knowledge, but this did not affect a change in nursing practice or cesarean birth rate. Implications for Nursing: High-quality education is not enough to change practice or outcomes. Additional research is needed on barriers that prevent the translation of knowledge into practice.

Background: Shared decision-making (SDM) has the potential to significantly improve patient outcomes by enabling clinicians and patients to make health care decisions as partners. However, its implementation in mental health care has been a slow process. Objective: The objective of the study was to implement SDM during outpatient mental health treatment planning. Methods: In an integrated health care clinic, mental health clinicians (n = 4) participated in SDM training to increase their use of SDM. The 9-item Shared Decision-Making Questionnaire Physician Version (SDM-Q9-DOC) tool was used in a pre-post design to evaluate the training's effectiveness in increasing the implementation of SDM during treatment planning. Results: SDM-Q9-DOC scores improved from a median of 49-54, suggesting a clinically significant improvement in SDM implementation. Project limitations included short duration and lack of feedback from clinicians and patients about their SDM experience. Conclusions: While guided SDM training can increase the use of SDM in outpatient mental health care, we acknowledge the existing barriers to its implementation. These barriers, including clinician pessimism, time constraints, lack of appropriate decision aids, and workplace expectations, should be further studied and addressed to enhance the implementation of SDM in the mental health setting. Implications for Nursing: Psychiatric nurse practitioners and registered nurses can assist with implementing SDM by encouraging effective communication between clinicians and behavioral health clients.

Background: Concussions are a significant concern in high school athletes. Implementation of effective baseline concussion testing procedures can aid athletic trainers and coaches with timely and accurate concussion diagnosis, as well as being used to develop a personalized treatment plan for postconcussion management. Objective: The purpose of this policy review was to (a) identify the gap between the current baseline concussion testing policy and practices in the high schools throughout the state, (b) highlight opinions that support the importance of and need for mandatory baseline concussion testing in high school athletes, and (c) identify potential revisions to the present policy to change how baseline concussion testing is done. Methods: A mixed-methods approach was applied, utilizing a Qualtrics survey to gather data from high school athletic directors in the state. The survey assessed current testing practices, perceived barriers, and potential benefits regarding baseline concussion testing.Thirty-three responses were received, revealing current testing practices, potential benefits, and perceived barriers of baseline concussion testing. While acknowledging the potential challenges, respondents recognized the overall benefits of baseline testing for athletes who are concussed. Conclusions: The findings of this project underscore the desire for standardized baseline concussion testing procedures in high school athletes and were used to recommend revisions to the current policy for testing in the state. Implications for Nursing: Revisions to the existing policy change have the potential to promote athlete safety, reduce the risk of long-term health consequences, and improve health outcomes for student athletes.

Background: Advanced practice nurses (APNs) have been responding to worldwide changing patient comorbidities, inequalities within access to care, and a shortage of primary care physicians. The scope of practice for these nurses has been expanding internationally but varies across different jurisdictions. For a period of time during the COVID-19 pandemic, APN trainees' opportunities to work with international mentors in-person were limited. Objective: This study aimed to evaluate the effectiveness of a virtual seminar series in supporting growth in clinical judgment, skills in nursing leadership, and advocacy to optimize APNs' scope of practice. Methods: A preexperimental study was conducted in one cohort of students in the Doctor of Nursing (DN) program at The Chinese University of Hong Kong. A total of 10 prerecorded seminars were presented by nurse practitioners (NPs) in Canada on various disease topics. The evaluation of these seminars focused on the effectiveness of teaching by each speaker and the perceived confidence of learners in carrying out each domain of the APN scope of practice. Results: The study found that the virtual seminar series was effective in improving learners' perceived confidence in carrying out each domain of the APN scope of practice. The perceived teaching effectiveness of each speaker was also evaluated and found to be positive. Conclusions: The virtual seminar series was an effective strategy in supporting newly graduated APNs' professional transitions, particularly when opportunities for collaboration and education were limited due to the COVID-19 pandemic. Implications for Nursing: Mentorship, experiential learning, interprofessional training, and professional socialization are vital strategies for supporting APNs' professional development. The virtual seminar series can be an effective strategy for supporting APNs' scope of practice growth, especially in the current global pandemic context.

Background: The prevalence of childhood asthma in the United States is 6.5%. During the COVID-19 pandemic, a Federally Qualified Health Center (FQHC) implemented metered-dose inhalers (MDIs) with spacers instead of nebulized albuterol to reduce aerosolization of pathogens and reduce costs. Objective: The objective of the study is to assess the safety, efficacy, and efficiency of a change to the asthma exacerbation protocol at an urban FQHC. Methods: A retrospective chart review compared nebulized albuterol versus an MDI with a spacer in pediatric patients experiencing asthma exacerbation. The evaluation aimed to measure (a) the 30-day return to care in either the emergency department (ED) or clinic, (b) the total number of treatments administered, and (c) the documented use of an oral steroid with albuterol treatments. Results: Return to clinic was the only statistically significant variable. Zero MDI patients returned, whereas 61% of those nebulized returned within 30 days (p < .00001). Conclusions: Albuterol MDI with a spacer was more effective than a nebulizer in reducing follow-up visits to the clinic and was effective at reducing ED visits within 30 days. Implications for Nursing: Treating asthma exacerbations in the primary care clinic with an MDI is effective and reduces cost and airborne exposure.