Journal of Doctoral Nursing Practice最新文献

Even if everything is done right in justifying the clinical benefit of a healthcare initiative, it cannot be sustainable if, first and foremost, the temperament of the practice environment, including the wider institutional hierarchy, is not accurately gauged. The purpose of this article is to provide the Doctor of Nursing Practice (DNP) researcher with a systematic structure enabling a review of the larger context of the proposed clinical innovation. This review supports a DNP-led healthcare initiative through self-analysis of the researcher's role; forging a relationship with a mentor; the analysis and mitigation of institutional, collaborative, and organizational barriers; and negotiating strategic partnerships with colleagues and departments and sharing their work and expertise. The blueprint that can change the interface of these elements is the creation of a specific research advisory committee (RADCOMM). The RADCOMM can be the impetus for transforming the institution into a place for learning, personal and professional growth and development, and patient safety, as well as one that results in new common resources and improved practice scholarship. The next generation of scholars and their capacity to understand their position in healthcare is inherently inhibited by not integrating the role and value of practice scholarship. The success of a DNP-led healthcare initiative, however, can positively affect the researcher's mental health, productivity, and career satisfaction.

Background: There are numerous benefits to academic practice partnerships. While there is great emphasis on the new graduate nurse transition to practice, there is less intention placed on the new nurse practitioner (NP) role transition. In a rural teaching hospital, leadership perceived a need for more support to successfully transition NPs into hospitalist practice roles. Objective: One academic practice partnership developed and implemented a grant-funded program to support advanced practice registered nurses (APRNs) transition to practice at a rural teaching hospital. Methods: Informed by the results of a needs assessment, faculty and practice partners delivered lecture content in a face-to-face setting during scheduled hours. Results: Although the content was well received, attendance to and engagement with the program were suboptimal. Conclusions: Upon reflection, the program team gained valuable lessons regarding role expectations, intentional interdisciplinary collaboration, timing, alignment, delivery format, and the need for a dedicated program coordinator. Implications for nursing: APRN transition programs can provide much-needed support with dedicated structure, clear communication, and individualized content. It can also be a recruitment and retention strategy for healthcare organizations.

Background: Depression and anxiety occur in 7.8% and 19.1% of the US population, respectively. About half of those patients are diagnosed in primary care. Objective: The purpose of this quality improvement project was to improve the screening and diagnosing of anxiety and/or depression among adult patients at a primary care clinic by implementing an evidence-based mental health screening interview technique. Methods: The team implemented a mental health screening interview technique that incorporates background, affect, trouble, handling, and empathy and motivational interviewing techniques in addition to self-report surveys. Pre- and post-intervention surveys were conducted to assess providers' perceptions of the new interview technique. ICD-10 code data were gathered to assess the effectiveness of the new mental health screening interview technique. Results: The number of documented diagnoses of single-episode major depressive disorder decreased by 18%, recurrent major depressive disorder increased by 34%, and anxiety disorders increased by 3%. There were more favorable provider perceptions of the new screening interview technique versus the traditional screening method. Conclusions: The results show an improvement in provider comfort and providers preferred the new mental health screening when using an evidence-based mental health screening interview technique. Implications for nursing: The results show the potential benefits of using a structured mental health interview with self-report screening tools when diagnosing anxiety and depression in primary care.

Background: Mentorship is a vital part of the nursing profession. The evidence suggests that competent mentors aid in facilitating role transitions, improving job satisfaction, enhancing patient care, and decreasing nursing turnover. Advanced practice registered nurses (APRNs) have the skills and knowledge to provide safe, high-quality, patient-centered care; however, they may be lacking in mentorship abilities. Objective: Currently, there is no formal mentorship training in the organization, which may cause variability in the mentoring of new staff. The focus of this project was to create a staff educational intervention to improve the mentoring competency of surgical APRNs. The knowledge gap, lack of mentoring education given to APRNs acting as mentors to novice practitioners, was noted, and this project identified a staff educational intervention on mentorship training that was developed and implemented. Methods: The project practice-focused question asked if a formal APRN mentorship training program geared toward the six elements of mentoring (as measured by the Mentoring Competency Assessment [MCA]) increased the mentoring competency of APRNs serving in a mentorship role. Benner's theory guided the planning and development of this project, while the MCA was used for the self-reflection survey. Following a pretest survey, participants experienced an educational intervention geared toward mentoring and mentoring competencies. Formal APRN mentorship training program with an educational intervention that addressed the six domains of mentoring competency geared toward increasing the mentoring competency of APRNs who serve in a mentorship role. Results: A total of 18 surgical APRNs (N = 18) with more than 2 years of experience participated in the staff educational intervention. There was a statistically significant difference in six of the 26 individual items and in the overall pretest mean scores and the posttest mean scores (z = -3.41, p < .01), indicating that the APRN mentorship training increased the mentoring competency of the APRNs. Conclusion: The results of this quality improvement project demonstrated how an educational intervention geared toward mentoring competencies can increase the knowledge among a group of APRNs. Educating APRNs in mentorship competencies may enhance mentorship abilities and result in positive patient and organizational outcomes. Implications for Nursing: Educating APRNs in mentorship competencies may enhance mentorship abilities and result in positive patient and organizational outcomes.

Background: Diabetes is the seventh leading cause of death in the United States and the leading cause of lower limb amputations, adult-onset blindness, and renal failure. It is estimated that 34.2 million Americans have a diabetes diagnosis, and the prevalence of this condition has continually increased over the last two decades. This study includes patients at a large, suburban primary care practice in southwest Ohio who were considered to have uncontrolled diabetes based on their last Hemoglobin A1c of greater than 9%. Compliance with recommended annual screenings among this population was 15%. Objectives: The aim of this project was to improve glycemic control and increase the number of patients who received the recommended annual screenings through the implementation of nurse practitioner-driven, diabetes-focused "Right Care" visits.C Methods: This quality improvement pilot study consisted of interventions implemented over the four plan-do-study-act cycles. Each cycle included a test of change that was identified based on data from previous cycles to ensure continuous improvement throughout project implementation. Four interventions were evaluated including the utilization of a diabetes registry, implementation of a "Right Care" checklist during "Right Care" visits, use of a patient engagement tool with a focus on individualizing diabetes medication regimens, and implementation of a team-engagement plan. Results: Average Hemoglobin A1c reduction was 2.4% post-"Right Care" visit. Compliance with the annual screening bundle increased to 44% over 8 weeks. Utilization of the patient/provider relationship increased visit compliance by 18%, and the team engagement plan decreased work-related stress by 12%. Conclusions: The implementation of "Right Care" visits led to improved glycemic control and increased compliance with the recommended annual screenings among patients with an A1c greater than 9%. The patient engagement tool identified key factors related to diabetes medication adherence and team engagement decreased work-related stress and improved annual fundoscopic exam screening compliance. Implications for Nursing: Nurse practitioner-led "Right Care" visits utilize the knowledge and skills of advanced practice registered nurses to improve glycemic control in patients with uncontrolled diabetes.

Background: Measurement-based care (MBC) is a method for demonstrating performance outcomes but is rarely used in behavioral health settings despite it being an evidence-based practice. As psychiatry moves to value-based care and payment for performance, the adoption of MBC will be essential. Objective: The purpose of the study was to test proactive reporting of patient self-reported measurement tool results to providers on treatment outcomes to promote the adoption of MBC. Methods: The study entailed a mixed methods design with a pre-/post-test quantitative measurement of scores on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 and a semistructured qualitative interview with providers following data collection. Results: Results showed, during the intervention period, statistically significant decreases in anxiety scores for all patients. Depression symptom decreases trended toward significance for female patients. After initial disregard for scores, all providers found a benefit to continued use of MBC. Conclusions: Identification and removal of barriers can assist in the adoption of evidence-based practices in healthcare. Implications for Nursing: Successful change can be accomplished with minor adjustments to an already-established workflow and a team approach to the process.

Introduction/Purpose: Diabetes self-management education and support (DSMES) can be a very valuable service for many patients with diabetes. Unfortunately, despite its expected benefits, many patients do not receive DSMES through a quality, structured program. The purpose of this quality improvement project was to determine if integrating a diabetes education program utilizing the Association of Diabetes Care and Education Specialists (ADCES)7 Self-Care Behaviors into diabetes care in a primary care clinic could improve glycemic control and body mass index (BMI). Methods: The DSMES services provided were in accordance with the ADCES and the American Diabetes Association National Standards. The program included a 1-hour face-to-face service incorporating the ADCES7 Self-Care behaviors. A retrospective chart review was conducted to extract outcome data from N = 54 random medical records. This data was then analyzed to evaluate the program's effectiveness. Pre- and postintervention data from medical records were analyzed for eligible patients who participated in the DSMES service (ages 18-75 with type 2 diabetes, hemoglobin A1c [A1c] >8%). Results: Paired t tests were used to determine significant changes in BMI and A1c parameters pre- and postintervention. Preintervention A1c (M = 9.5, SD = 1.7) and BMI (M = 33.2, SD = 7.8) and postintervention A1c (M = 7.8, SD = 1.5) and BMI (M = 32.2, SD = 7.9) indicate that DSMES significantly reduced A1c, t(53) = 8.1, p = <.001, and BMI, t(53) = 4.4, p = <.001. Models were then adjusted for pretest measures, age, gender, and time since diagnosis in a regression analysis. In models adjusted for pretest measures, age, gender, and time since diagnosis was significantly predictive of the postmeasure of BMI (B = .41, p = .01, R² = .96) and postmeasure of A1c (B = .28, p = .04, R² =.41). Discussion: This project demonstrated that integrating a simple, cost-effective diabetes education service consisting of ADCES7 Self-Care Behaviors in a primary care practice could bridge gaps in diabetes management and significantly improve patients' BMI and A1c. Long-term utilization of this service may also enhance patient satisfaction, improve the patient's health, and reduce healthcare costs related to diabetes.

Background: The pilgrimage of this Doctor of Nursing Practice project was to bring postpartum depression (PPD) out of the shadows and into the light. A gap existed in a postpartum ambulatory setting with the screening, detection, and treatment of PPD. Objective: A quality improvement project with an evidence-based standard of care for PPD screening was implemented with every postpartum patient. Methods: The Edinburgh Postnatal Depression Scale-10 (EPDS-10; Cox, et al., 1987) was used as a reliable and valid screening instrument to screen 46 postpartum women. Results: Screening for PPD increased from 10.9% to 95.8% after the implementation of the EPDS. Referral and treatment of PPD increased from 1.8% to 19.6%. Conclusion: This project established an evidence-based standard of care that can be implemented with every postpartum patient and brought nine women out of the shadows with the hope that they can find the light to recover from PPD. Implications for Nursing: Screening for PPD is recommended by experts and is a Healthy People 2030 goal (ACOG, 2018; USPSTF, 2018). Universal screening with a validated tool may lead to improved compliance with screening, detection, and treatment of PPD. The outcomes of this project inform and prepare clinicians for the predicted mandate of national screening for PPD.

Background: Preparing graduate-level nurses to provide care via telehealth could both increase access to care and decrease healthcare costs. However, many nursing schools do not provide telehealth experiences, especially at the graduate level. Objective: The aim of this project is to incorporate telehealth simulations in the doctor of nursing practice (DNP) curriculum at the University of Miami School of Nursing and Health Studies. Methods: This quality improvement project used a posttest-only design. The Ottawa Model of Research Use guided the project. DNP students completed a peer-to-peer telehealth simulation scenario via Zoom. Results: DNP students demonstrated confidence with an average score of 2.875 out of 3. DNP students' teaching performance scores were 2.7 out of 3. DNP students demonstrated effective overall telehealth performance with a mean score of 13.74 out of 15. Conclusion: DNP students may benefit from increased opportunities to practice telehealth, including the use of peer-to-peer simulation, to be aptly prepared for contemporary nursing practice.

Background: Globally, cervical cancer is the fourth most common cancer in females, with more than 70% caused by the human papillomavirus (HPV) genotype 16/18. The high mortality rate could be reduced with early intervention through the administration of the HPV vaccine. Objective: The purpose of this project was to increase the HPV vaccination rates in the primary care setting by bundling the HPV vaccine with routine vaccines (Tdap), meningococcal, and influenza. Method:The electronic medical record was used to identify patients due for the HPV vaccine series. Each patient received a vaccine reminder letter detailing each vaccine recommended during the visit and their rights to accept or decline the vaccines. Results: Findings revealed bundling the vaccine increased the HPV vaccination rates up to 400% when compared with the previous year. Conclusion: This implementation process has the potential to improve the health of the population by increasing the HPV vaccination rates and decreasing the high mortality rates and costs associated with cervical cancers or precancers. Implications for Nursing: The evidence-based practice of bundling the HPV vaccine, educating the staff, and providing written information to the patients is recommended for advanced practical registered nurses to improve the health of the population.