Journal of Doctoral Nursing Practice最新文献

Background: HIV is a chronic infection that can lead to acquired immunodeficiency syndrome, a life-threatening condition. The highest number of new HIV diagnoses occurs in males, particularly Black men living in the southern region of the United States.  Black men tend to test less frequently than other races.   Objective: This pilot project was a quality improvement (QI) initiative to increase HIV screening rates among Black men who received healthcare at a Federally Qualified Healthcare Center (FQHC). Methods: The 8-week QI initiative was implemented during clinic hours. A retrospective chart review was performed to compare baseline with post-initiative HIV screening rates for eligible patients who received care in Birmingham, Alabama, which was shown to be low. Then, a risk assessment questionnaire was administered before providing educational materials to improve screening rates among Black men at an urban multisite FQHC. Results: HIV screening rates among Black men increased after the two-part initiative (20% and 21%, respectively). Conclusions: This QI initiative demonstrated that HIV screening rates could increase with tailored provider-initiated interventions, including risk assessment and educational materials. Implications for Nursing: A DNP or other healthcare providers could use this project to inform the development of a larger-scale QI initiative at an FQHC to improve HIV screening rates for under-resourced populations.

Background: Long clinic wait times can contribute to treatment delays and decreased patient satisfaction. Veterans are often waiting in the urology clinic for a prolonged period that delays treatments including possible surgical interventions leading to patient dissatisfaction. Purpose: The purpose of this quality improvement project was to decrease the overall procedural wait times in an outpatient urology clinic by implementing a Fast-Track procedural clinic. Methods: The Fast-Track procedural clinic was developed to expedite care for veterans actively under bladder or prostate cancer surveillance, employing lean methodology principles. We also utilized the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) tool to assess patient satisfaction with the newly implemented Fast-Track clinic. Wait times were collected and analyzed by SPSS statistical software to determine the effectiveness of a Fast-Track clinic. Results: The Fast-Track clinic was implemented to veterans presenting to the urology clinic for procedural appointments from June 2021 to December 2021. The usage of a Fast-Track clinic decreased the overall wait times from 131 to 75 minutes within 8 weeks (43% improvement). The OAS CAHPS tool found that 55% of veterans received easy-to-understand instructions pre-Fast-Track implementation, compared with 59% post-Fast-Track implementation (a 4% improvement). Furthermore, 82% of veterans reported that they did not receive written discharge instructions post-Fast-Track implementation compared with 32% pre-Fast-Track implementation. Conclusion: Incorporating a Fast-Track procedural clinic helped minimize wait times, leading to a reduction in procedural wait times and urologic surgical delays. Implications for Nursing: The implications for practice include future studies focusing on other strategies for improving clinic wait times including block schedules and qualitative measures in the urologic and other specialty areas.

Background: Developing rigorous doctor of nursing practice (DNP) projects continues to challenge faculty and doctoral students. To address project rigor, expert content validity methods have been applied to clinical projects. Students implement expert content validity processes to literature-based project components. Objectives: The objectives of this study are to describe some of the developmental phases of DNP projects during the courses of one DNP program and to explore one strategy for increasing the rigor of DNP projects, review details on expert-type content validity methods, and examine literature for projects implementing an alternate application of expert-type content validity and scoring approaches to components of DNP projects. Methods: Expert content validity methods are described for DNP projects, such as guidelines, teaching plans, support groups, and algorithms. They are used to judge components generated from initial content analysis strategies. Types of expert panelists and descriptions of scoring ranks on project components are presented to represent different expert content validity strategies. Results The steps are presented to support expert content validity processes. Conclusions: DNP projects challenge faculty and students to create systematically constructed quality improvement projects on important and interesting clinical problems. The expert context validity process is one approach of enhancing project rigor. Implications for Nursing: An outline offers steps to establish expert content validity for translational DNP projects.

Background: Despite much research and many interventions, the opioid epidemic continues to plague the United States. According to the Centers for Disease Control and Prevention (2021), 136 people die daily from both prescription and illicit opioids. Objective: The goal of this pilot quality improvement project is to examine how the implementation of the Opioid Risk Tool (ORT) in clinical practice might impact the beliefs and attitudes of nurse practitioners (NPs) toward prescribing opioid therapy. Methods: A pre-post design was utilized. A convenience sample recruited participants from a private NP Facebook group. The intervention included a prerecorded presentation on the ORT and the use of the ORT for 8 weeks. Results: While 46 NPs completed the presurvey, only 19 NPs completed the postsurvey. Statistical results did not yield significance, but there were several significant clinical trends discovered. Conclusion: Utilizing the ORT to screen for opioid misuse risks has been shown to improve providers' confidence in opioid prescribing. ORT guides providers in discerning patient risk for developing dependence on opioids. Implications for Nursing: Screening for opioid misuse risk is feasible. ORT adds to the clinical context in deciding a course of treatment in pain management.

Background: Chlamydia is the most common bacterial sexually transmitted infection (STI) in the United States, with an incidence of 1.7 million infections annually. It results in an estimated $691 million in lifetime medical costs. Objective: The objective of the project was to improve effective care for women at risk of chlamydia infection in a rural family planning clinic to 80% in 90 days. Methods: The Plan-Do-Study-Act process of quality improvement (QI) was implemented over four 2-week cycles. Qualitative and quantitative data were collected and analyzed iteratively and informed tests of change for each cycle. Results: Results indicated an improvement in effective care from a baseline of 42%-81%. Patient visit time decreased from 38 minutes at baseline to 23 minutes. Compared with pre-implementation, the number of positive chlamydia test results went from three to six, doubling the positivity rate, while the number of chlamydia tests billed increased by 32%. Conclusions: This project was successful in improving effective care. Implementing a standardized risk assessment decreased patient visit time. Implications for nursing: QI projects directed at meeting national standards for STI screening can be implemented in rural health clinics at low cost and with high impact.

Background: Varying protocols among sexual assault nurse examiner (SANE) programs lead to inconsistent patient care and indicate that evidence-based recommendations are not being utilized. To address this problem, an evidence-based treatment protocol designed to improve care provided to patients who have experienced sexual assault was implemented at an outpatient rape crisis center (RCC). In addition to implementing the new protocol, a SANE education program was provided. Methods: Retrospective chart reviews were conducted. A total of 21 protocol components were examined pre- and post-implementation of the quality improvement project. Additionally, a knowledge quiz and self-efficacy tool were administered before, immediately after, and 3 months after the SANE education program. Results: Before implementation, the overall compliance with the 21 protocol components was 42.1% for RCC exams and 17.9% for hospital exams. After implementation, the overall compliance increased to 85.3% for RCC exams and 56% for hospital exams. When examining protocol components individually, compliance varied dramatically. There was an improvement in SANE knowledge and self-efficacy when comparing pre- and post-scores; however, the results were not statistically significant and were found to have unequal variances. Conclusion: Nurses are ideally positioned to instigate protocol changes that will positively impact patient outcomes. Other nursing professionals can utilize the quality improvement project content, steps, lessons learned, and results to create similar evidence-based practice quality improvement projects to address gaps in practice.

The Behavioral Health Home model of care enables patients living with severe persistent mental illness to access both mental health and primary care services, leading to improved mental and physical well-being. This article presents the implementation and health outcomes of colocating a primary care provider within an outpatient psychiatric rehabilitation day program.

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.