Journal of Doctoral Nursing Practice最新文献

Background: At many hospitals, the cesarean birth rate among nulliparous term singleton vertex (NTSV) pregnancies is higher than World Health Organization benchmarks. Reducing NTSV cesarean birth is a national quality imperative. The aim of this initiative was to implement an evidence-based bundle at an urban community teaching hospital in at least 50% of labors in 60 days in order to reduce early labor admissions and increase adherence to evidence-based labor management guidelines shown to decrease cesarean birth.

Methods: Chart audits, root-cause analysis, and staff engagement informed bundle development. An early labor triage guide, labor walking path, partograph, and pre-cesarean checklist were implemented to drive change. Four Rapid Cycle Plan Do Study Act cycles were conducted over 8 weeks.

Results: The bundle was implemented in 58% of births. The bundle reduced early labor admissions labor from 41% to 25%. Team knowledge reflecting current guidelines in labor management increased 35% and 100% of cesareans for labor arrest met criteria. Patient satisfaction scores exceeded 98%.

Conclusions: Implementing an evidenced-based bundle was effective in reducing early labor admissions and increasing utilization of and adherence to labor management guidelines.

Implications for nursing: Implementation of evidence-based bundles has the potential to achieve meaningful quality improvements in maternity care.

Background: Complementary alternative medicine (CAM) is an expanding domain of healing practices harmonized with Western medicine to provide comprehensive treatment of individuals as holistic beings. Patients and healthcare providers worldwide are increasingly inviting and employing CAM practices into healthcare delivery routines. Implementation of courses to introduce CAM into Advanced Practice Registered Nurse (APRN) programs exposes future practitioners to current best practices for integrative treatment strategies and encourages consideration when developing a holistic patient-centered care plan.

Objective/methods: A case presentation of an interprofessional CAM course delivered to military graduate nursing students with a pretest posttest course survey to evaluate student's confidence and knowledge of CAM theory and practices. The format included online modules, evidence-based literature critique, knowledge checks, and an immersive hands-on immersion experience.

Results: A total of 240 pre-/postcourse surveys were completed by military graduate nursing students (N = 140) participating in a CAM course. Statistically significant increases in CAM knowledge, communication, and skills confidence levels were found. Following participation in the course, nearly all students (97%) agreed CAM is important and benefits future advanced practice.

Conclusion/nursing implications: CAM is a compendium of holistic healing modalities increasingly being utilized by patients worldwide with similar requests for alternative care techniques from healthcare providers. Military APRN students participating in a CAM course increased knowledge and confidence, and garnered appreciation for an expanded skill set to augment future practice. Case presentation is compelling for standard inclusion of CAM and similar graduate interprofessional courses into all APRN programs.

Background: The need to screen for social determinants of health (SDOH) is well documented in the literature. Addressing SDOH also requires linking patients to available social service resources.

Objective: This Social Screen Assess and Refer (SScAR) Quality Improvement (QI) project purpose was threefold: (1) develop an agency specific tool to screen for SODH; (2) implement this tool in all new patient evaluations; and (3) provide referral to patients for necessary social services.

Methods: The SScAR tool adapted questions from published screening tools and created new questions centered on available social services. A pilot study implemented the tool. Documentation of social needs before the pilot, SScAR utilization during the pilot, number of social needs, and referrals made were measured.

Results: Documentation of SDOH screening significantly improved with the tool (α .05, χ²(1) = 21.85, p < .001). Follow-through referral to specific social resources only increased by 5%.

Conclusions: The SScAR is a feasible tool for identifying SDOH needs and creates a mechanism for linking patients with social services.

Implications for nursing: Future studies must measure social service referrals, utilization of social services, and the resulting impact on specific health outcomes such as blood pressure, hemoglobin A1c, and cholesterol.

Background: Heart failure (HF) is a chronic condition associated with high rates of hospital readmissions. The prevalence and costs of HF are expected to rise dramatically by 2030 (Heidenreich,et al., 2013).

Objective: A 24-month, retrospective study was conducted using electronic medical record (EMR) chart review, seeking to identify if postdischarge follow-up phone calls decreased 30-day readmissions in individuals with HF.

Methods: The study included 705 adult participants who were admitted to the hospital for HF. Some received a postdischarge call within 2 business days of discharge, and some did not.

Results: Participants who received the postdischarge call were less likely to be readmitted (20.1%) than participants who did not receive a postdischarge call (28.8%; p = .007). Participants who received the postdischarge call were more likely to have a follow-up visit within 14 days (70.1%) than participants who did not receive a postdischarge call (30.2%; p < .001).

Conclusions: The findings from this study may help to drive future transitional care strategies for individuals diagnosed with HF.

Implications for nursing: Nurse-led transitional care interventions offer potential solutions to ensure safe, effective hospital discharges.

Background: Hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. To address this, a large Midwestern hospital initiated a practice guideline. Practice guidelines should improve outcomes, but implementation of these remains challenging. At the time of initiation of the guideline, no implementation or evaluation plan was conceived.

Objective: Evaluate the implementation and unit impact of a guideline for the management of hypertensive disorders of pregnancy in a large academic health system in the Midwest.

Methods: Six objectives, guided by the constructs of the Ottawa Model of Research Utilization, were operationalized to evaluate the implementation and unit impact of the guideline.

Results: The guideline implemented was consistent with national recommendations. Intervention education was inconsistent across provider types. A survey of staff revealed insight into a unit in the midst of practice change. A chart review revealed below-target management of patients with severe range blood pressures. Not following the guideline was associated with hospital readmission.

Conclusions: Guideline implementation can be efficiently and holistically evaluated with a model-based framework, even in projects that were not initiated with such an approach.

Implications for nursing practice: Nurses provide expertise in model-based approaches that result in comprehensive evaluations of quality improvement processes.

Background: After open heart surgery patients often develop symptoms associated with congestive heart failure (CHF), or fluid volume overload. To prevent heart failure-related symptoms in the postoperative period patients must be educated on heart failure self-care.

Objective: To decrease the percentage of postoperative open heart surgical patients with CHF-related questions and concerns from 44% to 30% by March 2020.

Methods: A cardiac surgery educational booklet and an educational electronic health record template were identified to guide a CHF educational pathway. Intensive care staff nurses provided patient education after surgery. PDSA cycles were performed in succession to roll out the quality improvement (QI) initiative.

Results: Of patients experiencing postoperative issues, 44% of patients developed symptoms or concerns related to heart failure. Upon implementation of the CHF-focused pathway 15% of patients were exhibiting symptoms or concerns related to CHF, out of all patients with postoperative issues.

Conclusions: CHF, and fluid volume overload continues to be a difficult pathology requiring close management and follow up. After open heart surgery, providing concise, CHF-focused education results in reduced CHF-related patient concerns after discharge.

Implications for nursing: By providing a disease-focused patient education nurses can reduce the complications that patients develop after an inpatient hospital.

Background: Doctor of Nursing Practice (DNP) programs must assure that attention to safe quality healthcare is threaded throughout the curriculum and prepare students to lead quality improvement (QI) initiatives in healthcare systems.

Objective: This article illustrates the integration of implementation science, QI methods, process and evaluation tools, and faculty enrichment as strategies to strengthen QI projects in a DNP program.

Methods: A three-phased approach to implement strategies to strengthen QI projects in a DNP program and to enhance faculty engagement was undertaken. A needs assessment drove the development of strategies to strengthen QI in a DNP program.

Results: Outcomes of implementing strategies to strengthen QI in a DNP program showed rapid uptake of the concepts of QI process models into course content within the DNP curriculum.

Conclusions: Strategies consisted of assessment of courses for gaps in QI content, faculty enrichment sessions on implementation science, QI processes and models, QI metrics and data analytics, embedding new content in the DNP program courses and the use of a rigorous evaluation tool for QI projects.

Implications for nursing: When provided with QI mentors and tools, DNP students are prepared to lead QI initiatives in healthcare systems to improve the safety and quality of healthcare.

Background: Bupropion is being abused due to effects that are comparable with methamphetamine and cocaine. Current research indicates several interventions that can prevent prescription medication abuse.

Objectives: A research study was performed at two healthcare organizations to evaluate whether education on prevention-based interventions increased self-efficacy of healthcare staff in addressing potential and ongoing bupropion abuse and whether the education reduced the rate of bupropion prescribing.

Methods: The study sample consisted of 43 staff members who completed a paper-based preeducation survey, attended a 1-hour educational session, and completed a paper-based posteducation survey.

Results: There was a 42% increase in total staff self-efficacy scores along with significant differences between pre-/postsurvey scores (p ≤ .001). After education prescribers answered they plan to change prescribing practices and the number of bupropion prescriptions filled decreased.

Implications for nursing: Future practice recommendations should include education on bupropion abuse and implementation of prevention interventions to reduce the occurrence of the abuse of bupropion.

Conclusions: The research findings suggested that education on interventions for bupropion abuse prevention improved healthcare staff self-efficacy in the management of potential and ongoing bupropion abuse, influenced prescribing practices of prescribers, and decreased the number of bupropion prescriptions. This research can be used to continue providing education to help prevent further cases of bupropion abuse.

Background: Nurse practitioner (NP) fellowship programs assist the novice NP in transitioning to advanced practice while emphasizing building confidence and competence. The Veteran's Health Administration (VHA) offers an NP primary care fellowship program. The purpose of this project was to develop an acute care transition to practice fellowship program at a Midwestern VHA hospital.

Methods: A prospective, descriptive design utilizing a convenience sample of senior adult-geriatric nurse practitioner (AGNP) students during a pilot study of an acute care fellowship program. Outcome measures included evaluation of skills interpreting electrocardiograms (ECG), chest x-rays (CXR), and self-reported confidence in performing these skills over the initial 6-week period of the 12-month program.

Results: There were three participants (N = 3, 100%). There was a 33% increase in self-reported confidence of readiness to practice at completion of the pilot. However, ECG scores decreased 66% and CXR interpretation scores decreased 33%.

Implications for nursing: Despite training and targeted clinical experiences in ECG and CXR interpretations during an acute care fellowship, competence in these skills decreased while self-reported confidence increased at the end of 6 weeks. Continued education and training throughout the 12-month program is recommended to increase the novice NP's competence in these skills while transitioning to their new role.

Objective: To provide an acute care fellowship to facilitate with transition into advanced practice while increasing confidence and competence in the novice NP.

Conclusion: The novice NP may benefit from an NP fellowship program.

Background: Atherosclerotic cardiovascular disease (ASCVD) is a major contributor to nationwide morbidity, mortality, and healthcare costs in the United States. Over 92 million adults have at least one form of ASCVD, and annual costs for treatment are anticipated to surpass one trillion dollars within the next 15 years.

Objective: The objective of this study was to evaluate the medication therapy of a population of adults in comparison to the American College of Cardiology/American Heart Association (ACC/AHA) recommendations for statin therapy for ASCVD risk reduction.

Methods: The adult population receiving care from a group of hospital outpatient clinics was examined using a database query. Rates of ASCVD in a multicounty area were compared and provider adherence to current guidelines was assessed.

Results: Rural counties showed higher rates of ASCVD. Rates of statin medication prescribing for patients of each ACC/AHA statin benefit group ranged from 66.2% to 74.8%.

Conclusions and implications for nurse practitioners: Adherence to guidelines varied among counties and optimal adherence was not achieved. Providers were also more likely to prescribe statin medications to men than women within each group regardless of risk. These findings can assist nurse practitioners and other providers in addressing areas of nonadherence to guidelines.