Journal of Doctoral Nursing Practice最新文献

Background: Approximately 5%-8% of U.S. children have experienced an anaphylactic reaction. Studies assessing parent knowledge regarding the usage of epinephrine autoinjectors found that over two-thirds of parents could not correctly use autoinjectors. Family caregivers need education about triggers, prevention, symptom recognition, and plans of action for anaphylactic reactions. Objective: The overarching goal of this quality improvement project is to improve family caregiver management of food allergies in pediatric patients. Methods: The evidence-based, practice improvement project involved the development of a 5 ½-minute video with an allergy action plan that could be accessed via quick response code as an educational material provided to caregivers. A pre-post survey design was used to evaluate caregiver knowledge and satisfaction with the video-based educational program. Results: Outcomes showed that caregiver knowledge significantly increased (p = .007). All caregivers (N = 10; 100%) indicated high satisfaction with the education. Conclusions: The use of video-based education with an allergy action plan is a practical and sustainable way to bridge the gap of inadequate caregiver education. Leveraging the use of caregivers' smartphones to access video-based educational resources is a model that could be applied to various diseases and treatment regimens. Implications for Nursing: Nurses often struggle with time constraints to provide thorough patient education. This method may be a more efficient and effective way for nursing to provide supplemental patient education.

Background: Anxiety and depression are plaguing American teens. Cognitive behavioral therapy (CBT) is the first-line treatment, though few adolescents receive apprpriate help. Creating Opportunities for Personal Empowerment (COPE) is an evidence-based CBT program that has been adapted for online self-directed use for teens and young adults. Objective: This pretest-posttest study assessed the effects of online COPE on teen mental health including anxiety, depression, and quality of life (QOL) in a primary care setting. Methods: Ten adolescents with anxiety symptoms completed seven weekly online COPE sessions which included brief trainings on emotional regulation and problem-solving techniques. The degree of anxiety, depression, and QOL was measured at baseline and after completion of the program. Pre- and posttest scores were evaluated using Friedman and Wilcoxon signed-rank tests. Results: Clinically significant improvements were observed in nearly all measured outcomes. Anxiety improved by 61.3% (p = .018), depression improved by 57.1% (p = .018), and QOL improved by 31.6% (p = .018). Conclusions: Favorable results suggest that online COPE is effective for the improvement of anxiety, depression, and quality of life in adolescents. Implications for Nursing: Online COPE is a low-cost, accessible treatment option that can increase the availability of mental health care for those with barriers to traditional mental health therapies.

Background: Pediatric primary care providers are at the forefront for providing care/resources for adolescent patients suffering from depression. Objective: This study aimed to increase depression screening, identification, and management within the pediatric primary care setting. Methods: Universal depression screening for patients 12-21 years old using the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9M) for 2 months. Manual retrospective chart and coding reviews were completed for June and July 2021 and June and July 2022 to compare depression screening rates, correlation with depression diagnosis, referral to mental health specialists, and follow-up care received. A pretest and posttest were given to assess provider and staff knowledge of adolescent depression before and after an educational presentation. Results: Of 442 patients, three patients (1.4%) were identified and diagnosed with depression, unspecified (F32.A), with 12 patients (5.8%) being identified and diagnosed with an emotional/behavioral concern (F98.9). There were 14 referrals (6.8%) completed and 12 (5.8%) scheduled follow-ups; however, only 4 (1.9%) follow-ups were completed. The provider and staff scores increased by 2.5%. Conclusions: The PHQ-9M is effective in detecting adolescent depression, but provider and staff education are crucial. Implications for Nursing Practice: Universal depression screening using the PHQ-9M can be helpful in the identification and management of adolescent depression.

Background: Human trafficking (HT) is "the recruitment, transportation, transfer, harboring or receipt of people through force, fraud or deception, with the aim of exploiting them for profit" and affects approximately 17,000 individuals annually in the United States. The project site was in an adult emergency department (AED) in a large urban academic medical center, where routine HT screening did not occur. Objective: The purpose of this project was to implement a validated HT screening tool in an AED to identify victims and connect them to community resources. Methods: Staff nurses were educated on the Rapid Appraisal for Trafficking (RAFT) tool. Eligible patients presenting to the AED were screened for HT using the RAFT tool. If the patient answered in the affirmative to any of the RAFT items, they were offered a community resource list and an evaluation by social work. Results: Of 11,925 patient encounters, 195 patients were screened using the RAFT tool (1.6%). Among these, 139 screened negative, 10 screened positive, and 46 met the exclusion criteria. Resource acceptance varied among RAFT-positive patients: 80% (8/10) declined all resources, 10% (1/10) accepted only the community resource list, and 10% (1/10) accepted all available resources. Staff participation was limited to 36.5% (23/63) of nurses. Survey results (n = 23) showed strong support for the intervention, with 91.3% finding screening feasible to implement and 87% considering it necessary, while 95.6% rated the tool as easy to use. Conclusions and Implications for Nursing: Routine HT screening in the emergency department can increase the recognition of those experiencing HT for resource provision, including staff education, referral services, and reevaluation measures for an underserved population.

Background: Providing students with resources and knowledge about health care occupations and preparation for a professional role will have a long-term effect on their career path and the public health of their communities. Objective: The purpose of this project was to determine if a four-phase educational session would affect the knowledge of high school students to choose a health care-related career. Methods: Nursing models were incorporated to support the evidence-based practice, theoretical framework, and biblical framework. Implementation of this project occurred in an urban inner-city high school located in Texas. Consent forms were distributed to the classroom teacher 1 month before the project implementation. Both the parents and the students required signatures. All participants completed the questionnaires electronically. Subsequently, the project was approved by the Colorado Christian University Internal Review Board, informed consents were signed prior to participation, and agenda items were provided to students and school administrators before implementation. Educational information was disseminated to students using a PowerPoint presentation created by the project manager which served as a guide for the classroom sessions. Results: The findings of the educational sessions provided support that the students did gain knowledge. Conclusion: The sessions impacted their decision to pursue a health care-related field after graduation.

Background: The following executive summary is a summation of an education seminar completed as part of the requirements for a Doctor of Nursing Practice capstone project. The gap in practice is a need for more knowledge among health care professionals regarding waist circumference measurement (WCM) in the outpatient clinical setting. A lack of knowledge may lead to an underutilization of WCM and a missed opportunity to identify patients at higher risk for cardiovascular and cardiometabolic disease. Objective: To address the practice problem, an evidence-based practice question was developed to assess if an education seminar would increase the knowledge of health care professionals on WCM. Several sources of evidence support the importance of WCM, including multiple evidence-based practice guidelines recommending the use of WCM and body mass index to assess patients' cardiovascular and cardiometabolic risk. Mothods: A five-question rating scale assessment via Zoom polling was given to the participants before and after the education seminar. Results: Ten participants participated in the education seminar. Preassessment results revealed that 50% of the participants had little or no knowledge of WCM. Postassessment results showed that all participants indicated having knowledge or being very knowledgeable about all five questions. Conclusions/Implications for Nursing: Recommendations are to continue to present education seminars to health care professionals in the outpatient setting to increase the overall understanding of WCM. Ideas to increase recruitment include hosting the education seminar within prescheduled meetings at health care organizations, including local university faculty, offering incentives such as continuing education credits to participants, and sending reminders of the event. This increase in knowledge can translate to better preventative care for patients by utilizing WCM as a standard practice. More research must be completed to assess if increased utilization of WCM will lead to patients having fewer chronic diseases and healthier lives.

Background: Older adult patients with hip fractures are three times more likely to develop delirium on the first postoperative day. Delirium results in higher rates of functional decline and increased discharges to nursing home placement. Lack of an evidence-based delirium assessment/intervention protocol negatively affects patient recovery and discharge destination. Objective: The project aim is to decrease delirium prevalence through the implementation of an evidence-based delirium assessment/intervention protocol bundle. Methods: Participants in this pre-post implementation design pilot project included postoperative patients with hip fractures aged 50 years and above (N = 22) admitted to an orthopedic unit of a community hospital in south central Pennsylvania. Data were collected on the number of patients with documented delirium symptoms and delirium protocol bundle in place as compared with the number of patients with documented delirium symptoms in the same time frame of the previous year without delirium protocol bundle in place. Results: Implementation of the delirium protocol bundle resulted in a 68% delirium prevention rate, 27.5% reduction in delirium incidence on the first postoperative day, and a 36% increase in discharges to rehabilitation centers compared with long-term nursing home placement. Conclusion: Implementation of a delirium protocol bundle resulted in a clinically significant decrease in delirium prevalence. Implications for Nursing: The delirium protocol bundle provides an evidence-based resource to improve patient outcomes and enhance nurses' professional practice.

Background: Patients in the mental health community are at risk for worsening symptoms and declining mental health without treatment. Missed psychiatric appointments are both costly and detrimental to patient outcomes. Objective: The purpose of this project was to implement evidence-based strategies to improve workflow and scheduling with the goal of decreasing the new patient no-show rate. Methods: Policy change for how new patients were scheduled was implemented, and other improvements were made. Results: The no-show rates decreased from an average of 21% preintervention to an average of 13% postintervention. Discussion: No-show rates decreased by 43% during the intervention period, which is an estimated annual financial gain of $17,840. Although after project implementation the new patient no-show rate declined, staff compliance throughout project implementation was inconsistent. Conclusions: In an outpatient mental health clinic, the implementation of multifaceted, evidence-based process improvement strategies successfully reduced no-show rates for the first appointments. Implications for Nursing: Evidence-based interventions to reduce new patient no-shows can be effectively implemented across all outpatient mental health clinics, enhancing access to care and minimizing revenue loss.

Background: Pulmonary artery (PA) pressure can be monitored remotely by a microelectromechanical sensor permanently implanted in the PA. This allows fluid overload in heart failure to be managed in a more timely manner. Objective: This study aimed to explore patient and provider perceptions of shared decision-making (SDM) for the cardio-microelectromechanical system PA pressure monitoring device. Methods: A convenience sample of eight patient-provider dyads at an academic cardiology clinic completed the SDM questionnaire in the clinic before the procedure. Results: The majority of providers reported complete agreement that SDM occurred. Patients' survey responses varied but remained positive. Conclusions: Dyad perceptions of SDM for implantation of the pulmonary pressure monitoring device were positive and concordant. Future interventions to promote specific behaviors for SDM may be beneficial. Implications for Nursing: This investigation has implications for advanced practice nursing to initiate the SDM process.

Background: Timely administration of antibiotics in pediatric oncology patients undergoing chemotherapy is critical, particularly for those presenting with fever and a central line, due to their increased risk of severe infections. Objective: This quality improvement project aimed to reduce the time from patient presentation to antibiotic administration in a pediatric oncology center. Methods: Current practices were evaluated through retrospective data analysis, identifying delays and inefficiencies in the workflow. Interventions included staff education, streamlined communication protocols, and implementation of a standardized clinical pathway. Findings: Initial results indicate a significant reduction in antibiotic administration times, improving patient outcomes and enhancing adherence to national guidelines. Conclusions: This project highlighted the importance of process optimization and interdisciplinary collaboration in delivering timely, evidence-based care to high-risk pediatric populations. Future steps involve sustaining the improvements and expanding the model.