Journal of Doctoral Nursing Practice最新文献

Background: Hyperphosphatemia is a modifiable risk factor for cardiovascular morbidity and mortality in patients on hemodialysis. However, despite efforts to control hyperphosphatemia, it remains a prevalent issue among adult patients on maintenance hemodialysis worldwide. Objectives: An intensive multidisciplinary educational program focusing on diet control and medication compliance was developed to lower the incidence rate of hyperphosphatemia and serum phosphorus levels among adult patients on hemodialysis and to improve their understanding of hyperphosphatemia control. The objectives were to decrease the incidence rate of hyperphosphatemia and the mean phosphorus level among participants by 10% and to improve their knowledge assessment scores by 30% within 3 months. Methods: The education program was implemented at a hemodialysis clinic serving adult end-stage renal disease patients. Education was delivered via videos, pamphlets, and bimonthly one-on-one follow-up sessions. The incidence rate of hyperphosphatemia, mean serum phosphorus levels, and knowledge assessment scores were measured before and after the intervention. Descriptive and comparison statistics were used in data analysis. Results: Following the intervention, the incidence rate of hyperphosphatemia decreased by 45% within the intervention group and by 18% across the entire dialysis clinic. The mean serum phosphorus level within the intervention group decreased by 16% after intervention (p = .007). Additionally, the intervention group showed a statistically significant improvement in knowledge assessment test scores (p = .018). Conclusion: The intensive multidisciplinary education program effectively educated patients with hyperphosphatemia about phosphorus control, reduced the incidence rate of hyperphosphatemia, and helped lower serum phosphorus levels to within a normal range. Implications for Nursing Practice: Advanced practice registered nurses can play an important role in improving patient outcomes and management of hyperphosphatemia.

Background: People with newly acquired hepatitis C virus (HCV) infections are usually asymptomatic and unaware of the disease. Approximately 70%-85% of people infected with the virus develop a chronic infection causing severe long-term health problems. The incidence rate of hepatitis C infections in Kern County is higher than the State of California's overall rate. In Kern County, a 31% increase in the incidence rate of HCV infections occurred from 2014 to 2018 compared with a 3% increase in California. Objective: This study aimed to improve HCV screening rates in patients 18-79 years old at a family practice clinic. Methods: A descriptive practice change design used a retrospective and prospective method to compare HCV screening rates pre- and postintervention of an office policy implementation combined with provider education. Results: In 400 patients in the age group of 18-79 years treated at the clinic in October 2020, 4 weeks before the policy change project implementation, 1.0% of the cohort was screened for HCV. In the postintervention period, 30% of the 44 eligible patients were screened. The increase in the percentage of the cohort screened from 1.0% to 29% was significant (χ² [df = 1] = 87.719, p < .001). Conclusion: The education of the health care team to ensure buy-in and understanding of the clinical practice change and the development and implementation of a new screening policy yielded an enhanced HCV screening rate at this family practice clinic. Implications for Nursing: Advance practice registered nurses (APRNs) can significantly participate in the reduction of poor health outcomes related to chronic HCV infection by consistently screening all qualified patients between the ages of 18 and 79 years by 2030. APRNs can join the call to action by providing HCV screening services at a local level.

Background: Nurse practitioners are well positioned to promote health and improve health outcomes of individuals. Those who receive additional education in population health leadership are further prepared to lead efforts to improve population health outcomes. Objective: The purpose of this paper is to describe a 28-month, part-time post-Master of Science in Nursing (MSN) population health Doctor of Nursing Practice program designed for nurse practitioners and highlight project exemplars that demonstrate the integration of population health into advanced nursing practice. Methods: The program is thoroughly described, including alignment with the Council of Public Health Nursing Organizations (CPHNO) competency domains. To demonstrate the application of population health competencies into advanced practice nursing, project summaries from 2012 to 2020 were reviewed. Results: The program review showed clear alignment between major assignments and CPHNO competency domains. Fifty-one project summaries were reviewed. Authors present select project exemplars that highlight various ways students incorporated population health into their projects. Conclusions: To lead efforts to promote population health across the care continuum, nurse practitioners must have advanced knowledge and skills to address factors that influence the health of the populations they serve. Implications for Nursing: Nurse educators must design, implement, and evaluate strategies to prepare nurse practitioners to integrate population health into practice.

Background: Females with bleeding disorders benefit from management to control heavy menstruation. Multidisciplinary pediatric menstrual bleeding disorder clinics offer a wide range of beneficial services; however, not enough data exist regarding the use of structured management pathways to deliver positive patient outcomes. Objective: Identify evidence-based interventions and develop a clinical pathway for providers of a multidisciplinary pediatric menstrual bleeding disorder clinic, including assessment of patients' baseline and postvisit knowledge of treatment options, reportable symptoms, and provider pathway satisfaction. Methods: A structured management pathway and educational treatment forms were developed and implemented in the clinic. Female participants experiencing heavy menstruation completed knowledge questionnaires before/after clinic visit with health care providers during which educational handouts were reviewed. Providers completed satisfaction surveys following patient visits. Results: Nine participants completed pre/postvisit knowledge questionnaires with statistically significant improvement in knowledge (p = .03). Providers expressed overall satisfaction with pathway and educational materials with overall mean satisfaction Likert scale scores >4 of 5. Conclusions: Multidisciplinary clinics can improve patient care. Benefits of such structures continue to guide evidence-based practice and are important to maintain patient-centered care. Implications for Nursing: Integrating standardized practices through a clinical pathway and formal educational materials increases patient knowledge and provider satisfaction.

Background: Low or limited health literacy is a significant problem in the United States as one in three adults in the United States has inadequate health literacy. Low or limited health literacy contributes to poorer health outcomes for patients and increases costs to the consumer and health care system. Strategies that health care professionals can utilize to overcome these barriers include Health Literacy Universal Precautions, Teach Back, and using simple language. Objective: Standardized health literacy training was inconsistent for community health workers (CHWs) resulting in CHWs having difficulty communicating health-related information to the vulnerable populations they serve who often have low to limited health literacy. A contributing factor is the lack of standardized health literacy training, for nonlicensed health care workers. The aim of this study was to evaluate the CHWs' knowledge about health literacy and self-efficacy after targeted health literacy training. Methods: A pre-test, teaching intervention, and posttest were administered by the principal investigator using the Health Literacy Knowledge and Experience Survey (HLKES-2) to measure the CHW's knowledge and self-efficacy by comparing pre- and postdata results. Five virtual 2.5-hour targeted health literacy training courses were conducted by the primary investigator over a 4-month period. The participants (n = 50) were a sample of CHWs across several regions of the state of Pennsylvania. Results: There was a statistically significant difference between both the pre- and posttest scores of the HLKES-2 after the training (p < 0.0001) in the CHW's health literacy knowledge and a statistically significant change (p < 0.03) in their self-efficacy. Demographics revealed statistically significant changes (p < 0.003) that the higher the education (i.e., secondary education or higher) the better the scores on the HLKES-2 survey. Conclusions: Confident, knowledgeable health care workers can enhance health outcomes for patients with low health literacy in many settings. The combined use of education and technology within standardized, targeted health literacy training can promote support of CHWs. Implications for Nursing: Nursing holds a key role in supporting the education of CHWs. This quality improvement study showed a positive correlation between the targeted health literacy training participation and higher knowledge levels and self-efficacy of the CHWs.

Background: Pediatric oncology patients experience multiple prolonged hospitalizations, procedures, and cytotoxic chemotherapy with significant adverse effects. The American Academy of Pediatrics recommends formal trauma screening to avoid re-traumatization and identify risk factors to provide appropriate intervention. Objective: This practice improvement project aimed to implement the use of the Child Trauma Screen Tool upon admission to a pediatric oncology unit. This practice improvement project aimed to implement the use of the Child Trauma Screen Tool, educate the nursing staff, and improve their comfort level with providing trauma-informed care in the pediatric oncology unit. Methods: A pre- and postsurvey design was used to assess pediatric oncology nurses' knowledge, attitudes, and self-reported competence in trauma-informed care by utilizing the Attitudes Related to Trauma-Informed Care Scale and Trauma-Informed Care Provider Survey. An educational session was provided on trauma-informed care basics and the Child Trauma Screen tool. Results: Survey results found that nurses' attitudes towards trauma-informed care improved posteducation with a statistically significant change, p < .02. The nurse's knowledge posteducational session was significantly higher than preeducational intervention, p < .015. A Wilcoxon rank test found that the nurse's self-reported competence posteducational session was significantly higher than preeducational intervention, p < .003. An audit was conducted to monitor adherence to screening tool usage; eight screening assessments were completed of the (n = 10) screened. Conclusions: Following the educational session on trauma-informed care basics and the Child Trauma Screen tool, nurses' attitudes, knowledge, compliance, and self-reported competence on trauma-formed care and the use of the Child Trauma Screen Tool improved. The results of this practice improvement project demonstrate the feasibility of using the Child Trauma Screen Tool. Implication for Nursing: The findings of this quality improvement project highlight the importance of integrating trauma-informed care principles by implementing The Child Trauma Screening Tool upon admission. Nurses can identify patients at risk for trauma-related distress and provide appropriate interventions to avoid re-traumatization. The statistically significant improvements in nurses' attitudes, knowledge, and self-reported competence underscore the value of structured education on trauma-informed care. Additionally, the feasibility of the screening tools use suggests that routine trauma screening in the pediatric oncology units can enhance patient-centered care. Future initiatives should focus on sustaining compliance, expanding trauma-informed education, and assessing long-term patient outcomes and staff engagement.

Background: At an urban public acute care hospital, a gap existed in the safety and efficacy of early mobilization (EM) of intensive care unit (ICU) patients, with the need for an evidence-based intervention. A literature review revealed that a nurse-driven mobility protocol could safely achieve early mobility in ICU patients. This quality improvement project aims to utilize a nurse-driven mobility protocol to determine its effects on EM of ICU patients. Objective: The purpose of this quality improvement project is to determine if the implementation of an early mobility program using the Bedside Mobility Assessment Tool (BMAT) would impact patient mobility compared to standard practice over eight weeks in the ICU setting of an urban Hospital in New York City. Method: The Bedside Mobility Assessment Tool (BMAT) was used to conduct a pilot project on all critically ill patients aged ≥18 years admitted to the 17-bed ICU in an acute care hospital. Kotter's Eight-Step Change Process underpinned by the Plan-Do-Study-Act method of change was used to implement and guide the change process. Result: A nonrandomized convenience sampling of patients was used to attain a total of N = 306 patients (n = 133 preintervention and n = 173 implementation). Between the preimplementation (patients previously mobilized using standard practice) and implementation groups (patients mobilized using BMAT), there was a statistical significance in mobilization rates observed with pre-implementation (n = 56, 42%) and postimplementation mobility rates (n = 132, 76%). Conclusion: EM of critical patients in the ICU using a nurse-driven protocol with the BMAT assessment tool proved efficacious in promoting early patient mobility activities in this setting. This project should be continued and disseminated to other units.

Background: U.S. federal regulations have shifted health care systems to focus more on providing quality of care than quantity of care. Patient experiences that include nursing communication are important quality measures that have a positive impact on satisfaction ratings. Objective: This quality improvement project aimed to demonstrate that using nurse bundling strategies and employing servant leadership principles to influence nurses' caring behaviors toward patient care may improve patients' ratings on treatment with courtesy and respect. Methods: Registered nurses (RNs) in the emergency department (ED) were observed for 8 weeks in January 2020 using validated measurement tools and completed an electronic, 23-item Servant Leadership Questionnaire (SLQ) survey. Results: Bedside shift reporting observations were the lowest reported strategy. The Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey results did not improve from the previous quarter's data but increased and sustained in the three following quarters. The SLQ survey demonstrated statistically significant increases (p = .0191) from preintervention to postintervention. Conclusion: Though RNs were aware of servant leadership principles, further exploration is warranted to strengthen structures and processes related to nurse bundling strategies and the development of other ED-specific measurement tools and the patients' perception of courtesy and respect, an HCAHPS measure. Implications for Nursing: Expanding RN sample size, including other ED staff members, performing random leadership rounding, and using ED-specific measurement tool are nursing implications.

Aim: The aim of this quality improvement project was to provide multisession trainings that teach the fundamentals of motivational interviewing (MI) to inpatient behavioral health care workers who lack education and proficiency in these techniques. Background: MI is a therapeutic communication approach that explores a person's mixed feelings or ambivalence and aims to encourage a positive behavior change. It was first developed for patients struggling with substance use disorders to assist them in making decisions regarding their sobriety. Methods: Participants attended three 2-hour MI educational sessions, which spanned 6 weeks. Instruction was through an interactive online module. After each educational session, participants engaged in role-play scenarios. Participants received ratings on their adherence to MI skills. Prior to the first and following the last educational session, participants completed an anonymous online survey to measure individual knowledge of MI fundamentals. Results: Through role-play adherence ratings, MI consistent fundamental skills, such as open-ended questions and reflective statements, demonstrated proficiency. The remaining MI consistent fundamental skills, MI style or spirit, and affirmations did not reach proficiency. MI consistent complex skills did not reach proficiency but did progressively increase in adherence. MI inconsistent skills that should be avoided all met adherence proficiency, other than close-ended questions. Conclusion: This quality improvement training demonstrated that through multiple internet-based educational sessions and role-play scenarios, proficiency in two MI consistent fundamental skills and knowledge increased. Continued efforts to create more educational and practical opportunities for knowledge retention are encouraged.

Background: Sound clinical judgment (CJ) is essential for providing quality patient care. Newly licensed nurses lack the previous experiences needed to inform CJ, which could result in harm. Objective: This project aimed to evaluate the effectiveness of in situ and structured debriefing on the development of CJ among newly licensed nurses during their orientation. Methods: A quasi-experimental nonequivalent control group posttest design was used to compare CJ among newly licensed nurses who used in situ and structured debriefing during their initial orientation to those who did not use debriefing methodology. Results: CJ was improved through in situ and structured debriefing. Newly licensed nurses also perceived debriefing as valuable for analyzing their performance and developing a personal improvement plan. Conclusions: Debriefing during orientation has the potential to improve CJ among newly licensed nurses and promote patient safety. Implications for Nursing: Nurse leaders must implement methods to improve CJ among newly licensed nurses to address the existing decline in competency. Given their benefits, efficiency, and cost-effectiveness, debriefing methodologies should also be considered to promote CJ development among nurses transitioning to new care environments and advanced practice roles.