Journal of Doctoral Nursing Practice最新文献

Background: Detecting delirium accurately in older patients with heart failure (HF) is challenging for nurses due to difficulties in assessing baseline cognition, leading to inaccurate delirium assessment. Objective: The project aimed to evaluate the effectiveness of an educational intervention and a documentation tool in the electronic health record (EHR) to enhance delirium detection rates by up to 30% in patients over 65 years with HF. Methods: Delirium detection rates were assessed pre- and postimplementation through chart review spanning 8 weeks. The Chart-based Delirium Identification Instrument was applied to preimplementation (2023) and postimplementation (2024) data for comparison over 8 weeks. Additionally, the project included a pre-post survey to examine nurses' self-reported knowledge, confidence, and perspectives on delirium detection and management. Results: Nurses achieved a 100% detection rate by accurately identifying the sole case of delirium postimplementation. Notably, nurses accurately ruled out delirium in patients who tested negative. Additionally, they reported increased knowledge and confidence in delirium detection. Conclusions: The dual intervention of nurses' education and structural documentation support contributed to enhancing the nurses' ability to accurately identify delirium. The intervention facilitated the consistent identification and documentation of baseline cognition. The streamlined process ensured consistency and facilitated easy retrieval by nurses when completing the Confusion Assessment Method for delirium detection. Implications for Nursing: Combining nurse education and an EHR tool ensures equitable access to resources for accurate delirium detection among older patients with HF. Improving delirium detection rates helps provide targeted interventions, ultimately reducing disparities in delirium-related outcomes.

Background: Diabetes lifestyle interventions can prevent type 2 diabetes (T2D), the leading cause of death and disability, especially among marginalized populations. Preventing or delaying the progression of T2D involves modification of high-risk behaviors. Peer educators and lay health workers can effectively implement Diabetes Prevention Program (DPP) interventions. Objective: The objective of the study was to adapt and deliver an evidence-based, nurse-led, peer-facilitated DPP for homeless men with substantial risks for T2D. Methods: This pilot project utilized a phased approach for implementation science. It was implemented with formerly homeless men enrolled in a residential employment center within an urban environment. Results: Significant improvements were observed for meal-time portion control, daily physical activity, replacement of sugar-sweetened beverages with water, cutting back on cigarettes, and weight loss from baseline to week 12. Conclusion: Despite significant achievements in meeting their personal health behavior goals, the men revealed serious competing concerns. The peer facilitators (PF) and participants were concerned about the need for sustained employment so that they could meet their basic needs (i.e., income, food, housing, etc.). Implications for Nursing: The men found performing as PF beyond 12 weeks without pay to be unreasonable, although they were enthusiastic about improving their own health, as well as the health of their friends and family.

Background: Although Doctor of Nursing Practice (DNP) students have used rubrics to guide assignments, few have created PowerPoint slide decks for professional presentations. Students might benefit from a rubric that standardizes PowerPoint presentations on final DNP projects. Objective: The objective of the study is to conduct a quality improvement project to evaluate a literature-based rubric guiding students' PowerPoint presentations and the grading of final projects. Methods: Two faculty independently scored PowerPoint slides structuring final DNP project presentations for the literature-based rubric. They revised the rubric based on ratings and comments. Nine content experts rated the relevance of the revised rubric's criteria. Results: Three criteria differed at a statistically different level on the literature-based rubric's ratings. Interrater reliability was low. The rubric criteria were revised. Nine experts' ratings showed criteria on the revised rubric were relevant; their comments stimulated revisions. The Survey Content Validity Average was 0.88, suggesting the relevance of criteria. Conclusions: The rubric requires additional revisions. Posting the revised rubric in the student resource course of the learning management system might assist students to construct PowerPoint presentations in DNP courses and for professional presentations. Implications for Nursing: The rubric was shared with DNP Project Teams. Faculty will continue to evaluate the quality of the students' presentations.

Background: The goal of endotracheal tube (ETT) cuff inflation is to produce a pressure within the range of 20-30 cm H₂O to ensure a proper seal against the trachea without compromising mucosal perfusion. The gold standard for the assessment of ETT cuff pressure is a handheld manometer; however, due to a lack of availability, this is rarely performed. Using a 10-mL syringe for cuff inflation is a common practice but can lead to overinflation and higher-than-recommended pressures. Objective: The purpose of this quality improvement project was to evaluate the incidence of ETT cuff overinflation and determine if an educational intervention advocating for lower volumes would reduce the occurrence. Method: The authors evaluated 50 ETT cuff pressures before and 50 after an educational intervention proposing the use of a 5-mL syringe for cuff inflation rather than a 10-mL syringe. Results: Median cuff pressure significantly decreased from 60 cm H₂O in the preintervention phase to 30 cm H₂O in the postintervention phase using 5-mL syringes, a 50% decrease (p < .001). Conclusion: This project demonstrated that an educational presentation recommending a 5-mL syringe for ETT cuff inflation resulted in a significant reduction of cuff pressures. Implications for Nursing: Nurse anesthetists should be aware of the risk of overinflation of endotracheal tube cuffs. Implementing a volume-based inflation method into current practice will decrease this incidence and the harmful sequelae associated with high cuff pressure.

Background: Individuals experience vaccination hesitancy for many reasons. However, not receiving vaccinations leaves individuals at increased risk for vaccine-preventable illnesses. Individuals in rural areas are more likely to experience vaccine hesitancy. Objective: Motivational interviewing is an effective strategy for addressing behavior change, including vaccine hesitancy. This evidence-based practice project provided an education session for Michigan State University Extension Vaccine Team members, who deliver health care information statewide. Methods: An educational information session on motivational interviewing was delivered via Zoom. This session focused on employing motivational interviewing in rural populations to address vaccine hesitancy. A survey was administered to participants pre and postmotivational interviewing educational sessions to assess changes in knowledge and confidence in using motivational interviewing. Results: Participants' knowledge and confidence regarding motivational interviewing improved. They reported an increased understanding of the concept and confidence in deploying this technique to the rural population. Conclusions: This project highlights the process and need for delivering an educational motivational interviewing session to health care team members who regularly interact with the rural population regarding vaccine hesitancy. Implications for Nursing: Teaching individuals who regularly interact with the rural population the technique of motivational interviewing can help expand the reach of the discussions in health care settings.

Background: Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States despite the availability of effective preventive screening. Objective: This project was designed as a community awareness initiative to increase CRC awareness, knowledge, and intent to discuss and complete CRC screening. Methodology: This quasi-experimental study had a QI focus and used a convenience sample in a public setting assessing CRC awareness, knowledge, and intent to discuss and complete screening after participating in an inflatable colon tour. Results: CRC awareness and knowledge scores showed a statistically significant increase in posttest scores at p < .001. Posttour, there was an 82% and 133% increase in people who identified as "very likely" or "definitely" willing to discuss CRC with their healthcare provider and complete CRC screening within the next 6 months, respectively. Conclusions: In line with previous studies, the inflatable colon model was a successful means of increasing CRC knowledge, awareness, and intent to complete CRC screening. Implications for Nursing: This project is evidence that community events can successfully increase knowledge in underserved populations. Implementing community-based interactive education, such as an inflatable colon tour, is an effective way to incorporate evidence-based education for vulnerable populations.

Background: Surgical delays can lead to patient dissatisfaction and negatively affect hospital revenue. Maximizing operating room (OR) efficiencies is a high priority. A common metric for OR efficiency is first-case on-time start (FCOTS). Objective: The aims were to increase FCOTS rates to at least 50% and reduce delay time lost in minutes in the OR by 50%. Methods: A multidisciplinary/multifaceted approach was implemented and consisted of restructuring the preoperative assessment process, modifying the preoperative checklist, conducting a perioperative educational program, revising the anesthesia nurse practitioner (NP) work schedule, and notifying surgeons about losing first-case privileges if they arrived late. A total of 300 (150 retrospective and 150 prospective) charts were reviewed. After 3 months, pre- and postintervention data were analyzed. Results: The FCOTS rate increased from 15.3% to 30.7%, and the OR time lost in minutes decreased from 2,309 to 1,029. Conclusions: Delays in care negatively affect patient satisfaction and the hospital budget. A multidisciplinary/multifaceted approach is effective in reducing FCOTS rates. Implications for Nursing: Evidence-based strategies such as those used in this initiative may be implemented by NPs in institutions providing surgical services to optimize efficiency, decrease costs, and improve patient satisfaction.

Background: Over 30% of births in the United States occur via cesarean section despite increased risks to the birthing person and neonate. Evidence-based nursing practice related to fetal monitoring, patient positioning, and management of the second stage of labor can decrease the incidence of cesarean birth. Objective: The objective is to decrease the cesarean birth rate by 3% in a Midwestern suburban hospital. Methods: Baseline data on demographics, labor interventions, and birth outcomes were collected for 4 weeks (n = 85 births). The intervention included a sample of 24 labor nurses who took a pretest, viewed a narrated PowerPoint on methods to promote vaginal birth, and completed a posttest. Data were then collected for another four weeks (n = 90 births). Results: The mean improvement in posttest scores was 4.792 points, providing strong evidence that this education would result in a score increase between 3.9 and 5.6 with 95% confidence. There was no increase in the number of nursing interventions utilized during labor. The overall cesarean birth rate increased from 18.8% to 28.9%. Conclusions: The education was highly effective in increasing nurse knowledge, but this did not affect a change in nursing practice or cesarean birth rate. Implications for Nursing: High-quality education is not enough to change practice or outcomes. Additional research is needed on barriers that prevent the translation of knowledge into practice.

Background: Shared decision-making (SDM) has the potential to significantly improve patient outcomes by enabling clinicians and patients to make health care decisions as partners. However, its implementation in mental health care has been a slow process. Objective: The objective of the study was to implement SDM during outpatient mental health treatment planning. Methods: In an integrated health care clinic, mental health clinicians (n = 4) participated in SDM training to increase their use of SDM. The 9-item Shared Decision-Making Questionnaire Physician Version (SDM-Q9-DOC) tool was used in a pre-post design to evaluate the training's effectiveness in increasing the implementation of SDM during treatment planning. Results: SDM-Q9-DOC scores improved from a median of 49-54, suggesting a clinically significant improvement in SDM implementation. Project limitations included short duration and lack of feedback from clinicians and patients about their SDM experience. Conclusions: While guided SDM training can increase the use of SDM in outpatient mental health care, we acknowledge the existing barriers to its implementation. These barriers, including clinician pessimism, time constraints, lack of appropriate decision aids, and workplace expectations, should be further studied and addressed to enhance the implementation of SDM in the mental health setting. Implications for Nursing: Psychiatric nurse practitioners and registered nurses can assist with implementing SDM by encouraging effective communication between clinicians and behavioral health clients.

Background: Concussions are a significant concern in high school athletes. Implementation of effective baseline concussion testing procedures can aid athletic trainers and coaches with timely and accurate concussion diagnosis, as well as being used to develop a personalized treatment plan for postconcussion management. Objective: The purpose of this policy review was to (a) identify the gap between the current baseline concussion testing policy and practices in the high schools throughout the state, (b) highlight opinions that support the importance of and need for mandatory baseline concussion testing in high school athletes, and (c) identify potential revisions to the present policy to change how baseline concussion testing is done. Methods: A mixed-methods approach was applied, utilizing a Qualtrics survey to gather data from high school athletic directors in the state. The survey assessed current testing practices, perceived barriers, and potential benefits regarding baseline concussion testing.Thirty-three responses were received, revealing current testing practices, potential benefits, and perceived barriers of baseline concussion testing. While acknowledging the potential challenges, respondents recognized the overall benefits of baseline testing for athletes who are concussed. Conclusions: The findings of this project underscore the desire for standardized baseline concussion testing procedures in high school athletes and were used to recommend revisions to the current policy for testing in the state. Implications for Nursing: Revisions to the existing policy change have the potential to promote athlete safety, reduce the risk of long-term health consequences, and improve health outcomes for student athletes.