Journal of Doctoral Nursing Practice最新文献

{"title":"Decreasing New Patient No-Show Rates at a Mental Health Clinic by Process Improvement.","authors":"Meagan Carson","doi":"10.1891/JDNP-2021-0061","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0061","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Objective:</b> 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. <b>Methods:</b> Policy change for how new patients were scheduled was implemented, and other improvements were made. <b>Results:</b> The no-show rates decreased from an average of 21% preintervention to an average of 13% postintervention. <b>Discussion:</b> 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. <b>Conclusions:</b> In an outpatient mental health clinic, the implementation of multifaceted, evidence-based process improvement strategies successfully reduced no-show rates for the first appointments. <b>Implications for Nursing:</b> 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.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Decision-Making in Heart Failure.","authors":"Sarah Young, Kelly Bosak","doi":"10.1891/JDNP-2024-0075","DOIUrl":"https://doi.org/10.1891/JDNP-2024-0075","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Objective:</b> This study aimed to explore patient and provider perceptions of shared decision-making (SDM) for the cardio-microelectromechanical system PA pressure monitoring device. <b>Methods:</b> A convenience sample of eight patient-provider dyads at an academic cardiology clinic completed the SDM questionnaire in the clinic before the procedure. <b>Results:</b> The majority of providers reported complete agreement that SDM occurred. Patients' survey responses varied but remained positive. <b>Conclusions:</b> 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. <b>Implications for Nursing:</b> This investigation has implications for advanced practice nursing to initiate the SDM process.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Time to Antibiotic Administration in Pediatric Oncology Patients With Fever.","authors":"Christina M Cotton","doi":"10.1891/JDNP-2025-0004","DOIUrl":"https://doi.org/10.1891/JDNP-2025-0004","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Objective:</b> This quality improvement project aimed to reduce the time from patient presentation to antibiotic administration in a pediatric oncology center. <b>Methods:</b> 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. <b>Conclusions:</b> 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.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the Healthy LifeStars Program for Children.","authors":"Sara Edwards, Jeanie Bochenek, Kate Sustersic Gawlik, Randee Masciola","doi":"10.1891/JDNP-2024-0039","DOIUrl":"https://doi.org/10.1891/JDNP-2024-0039","url":null,"abstract":"<p><p><b>Background:</b> Childhood obesity continues to rise globally with the potential for serious consequences to a child's physical and mental health and alarming economic impacts. In the United States, approximately one in five children is obese. The literature suggests that providing young children with foundational knowledge and skills to lead a healthier life can change the trajectory of chronic disease, improve population health outcomes, and lower health care costs across the United States. <b>Objective:</b> Second graders receiving a 12-lesson healthy habit program will demonstrate a 10% increase in healthy behaviors and beliefs 4 weeks postprogram completion. <b>Method:</b> This quality improvement (QI) initiative was delivered at three elementary schools using a consistent coach, the Healthy LifeStars Program, an evidence-based healthy habit education program that included 12 lessons and began with a mindfulness activity. Pre- and postintervention surveys were used to assess students' health behaviors and beliefs. <b>Results:</b> The pre- and postintervention survey scores indicated a small effect, as measured by Cohen's d, clinical significance, and an overall positive shift toward improved health behaviors and beliefs. One of the three participating school districts demonstrated a 7.5% increase in healthy behaviors 4 weeks postprogram completion. <b>Conclusion:</b> The QI initiative illustrates how implementing a school-based intervention can address the global health concerns of childhood obesity and increase the overall health and wellness of children. <b>Implications for Nursing:</b> As leaders in health, nurses are in an opportune position to lead, collaborate, and organize initiatives with interdisciplinary teams and families to promote improved health outcomes in children.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Best Practices Through Policy: Keeping Patients on Chronic Opioid Therapy Safe in Primary Care.","authors":"Sen Zhao, Carrie Ann Matyac","doi":"10.1891/JDNP-2024-0070","DOIUrl":"https://doi.org/10.1891/JDNP-2024-0070","url":null,"abstract":"<p><p><b>Background:</b> The Centers for Disease Control and Prevention opioid prescribing guidelines for chronic pain were developed to combat morbidity and mortality associated with the escalating opioid crisis; however, implementing these guidelines is challenging. Clinic policies focused on treatment recommendations for chronic opioid therapy (COT) are needed to assist clinicians in safely managing pain. The purpose of this quality improvement project was to assess whether the implementation of a COT clinic policy improved provider adherence to evidence-based opioid prescribing guidelines based on state regulations in a nurse-led primary care clinic. <b>Objectives:</b> This project aimed to establish chronic opioid management best practices to improve provider adherence to state guidelines in a nurse-led primary care clinic. <b>Methods:</b> A quasi-experimental pre-post-intervention design was utilized with a sample of five providers and 33 COT patients. <b>Results:</b> Paired-sample <i>t</i> tests were used to assess the effect of COT policy implementation. Overall, no statistically significant differences were noted; however, policy implementation resulted in improved documentation of six key COT measures. Medium effect sizes were observed for completed opioid contracts (Cohen's d = .43), utilization of nonopioid pain therapies (d = .36), and urine drug screens (d = .39), indicating a moderate impact of the intervention in these areas. <b>Conclusions:</b> The findings suggest that education and implementation of a clinic opioid policy in primary care practice are effective in meeting evidence-based practice guidelines for COT. The importance of broad stakeholder engagement and ongoing support for policy adoption was highlighted. <b>Nursing Implications:</b> This project provides valuable insights into improving the safety of pain management in primary care to improve prescribing practices and mitigate risks associated with COT.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WhatsApp Mentorship Group: An Intervention to Provide Mentorship to Advanced Registered Nurse Practitioners Learning Reproductive Health Procedures.","authors":"Beth S Long, Kayla A Harvey","doi":"10.1891/JDNP-2024-0047","DOIUrl":"https://doi.org/10.1891/JDNP-2024-0047","url":null,"abstract":"<p><p><b>Background:</b> Access to manual uterine aspiration (MUA) training in the United States is precarious and fraught. WhatsApp, the instant messaging platform, is used in medical education and peer collaboration. Advanced registered nurse practitioners (ARNPs) lack sufficient access to mentorship for learning MUA. <b>Objective:</b> This pilot study examines the effect of participation in a WhatsApp Mentorship Group on perceived mentorship for ARNPs learning MUA. <b>Methods:</b> Study design was quasi-experimental. ARNPs attending a reproductive health conference completed a survey measuring mentorship. Participants were invited to join the WhatsApp Mentorship Group. Within the group, mentors posted predetermined questions biweekly to stimulate conversation, answer clinical practice questions, and provide access to educational media files. <b>Results:</b> Following participation in the WhatsApp Mentorship Group, mean informational support levels increased by a statistically significant 5% (<i>p =</i>03). <b>Conclusion:</b> WhatsApp may be a viable option for expanding mentorship among ARNPs. <b>Implications for Nursing:</b> ARNPs may benefit from further inquiry into the use of WhatsApp for mentorship, including fellowships. Engagement data from this study suggest a bimodal level of mentorship perception.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 Weight Loss Protocol: An Evidence-Based Translation Project.","authors":"Meghan Allred","doi":"10.1891/JDNP-2024-0021","DOIUrl":"https://doi.org/10.1891/JDNP-2024-0021","url":null,"abstract":"<p><p><b>Background:</b> Obesity is a prevalent chronic disease associated with many comorbidities and increased mortality rates. Primary care providers are critical in addressing obesity through an evidence-based weight loss protocol. <b>Objective:</b> This Doctor of Nurse Practice project aimed to develop and implement a standardized, evidence-based holistic weight loss protocol, incorporating glucagon-like peptide-1 (GLP-1) medication, semaglutide, and motivational interviewing within a patient-centered framework. <b>Methods:</b> In this quality improvement project, 10 nondiabetic participants with a body mass index (BMI) ≥ 27 kg/m² were recruited from a suburban clinic in Cypress, TX. Data such as body weight, BMI, and blood pressure were collected in addition to Impact of Weight on Quality of Life-Lite (IWQOL-lite) survey responses. Data were then analyzed in Excel using the paired <i>t</i> test with statistical significance being <.05. <b>Results:</b> Participants lost a significant amount of weight (<i>p</i> < .05) and had a significant decrease in BMI (<i>p</i> < .05). Postintervention physical function, self-esteem, and work-related experiences improved significantly (<i>p</i> < .05) based on the IWQOL questionnaire pre- and postintervention. Diastolic blood pressure also significantly decreased (<i>p</i> < .05). <b>Conclusions:</b> This weight loss protocol, guided by evidence-based practice alongside GLP-1 medication, semaglutide, revealed positive outcomes in weight reduction, BMI, and quality of life. This protocol offers providers a promising approach to managing obesity in primary care settings. <b>Implications for Nursing:</b> Implementing this evidence-based weight loss protocol can empower advanced practice nurses (APRNs) to address obesity effectively. Motivational interviewing, holistic patient-centered care, ongoing support, and education are critical features to sustaining weight loss for obese patients. This protocol provides a structured approach for APRNs in guiding nondiabetic overweight and obese patients toward sustainable weight loss.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Nuisance Telemetry Alarms in the Adult Inpatient Setting.","authors":"Angela L Feurer, Suzanna Fitzpatrick, Barbara Wise","doi":"10.1891/JDNP-2024-0061","DOIUrl":"https://doi.org/10.1891/JDNP-2024-0061","url":null,"abstract":"<p><p><b>Background:</b> Excessive generation of clinical alarms can result in ignored alarms and staff alarm fatigue putting patient safety at risk. A retrospective chart review reported an average of 19.44 alarms/patient/hour were generated on two 26-bed acute care units. Evidence supported implementing an alarm bundle. <b>Objectives:</b> This quality improvement project aimed to implement an evidence-based bundle to reduce the number of nonactionable telemetry alarms occurring on two adult acute care inpatient units in a large community hospital. <b>Methods:</b> Weekly audits were used to assess workflow adherence. Run charts were used to show process adherence from audit findings. <b>Results:</b> Adherence to daily electrode sticker changes was 80% (<i>n</i> = 118) and 75% (<i>n</i> = 110) for electronic medical record (EMR) documentation. Error with Lead V sticker placement occurred at 34% (<i>n</i> = 50) frequency. Once, a shift parameter documentation was 75% (<i>n</i> = 194) and 86% (<i>n</i> = 117) for customized parameter documentation. Frequency of nurse-driven heart rate parameter customization was 17% (<i>n</i> = 44). Adherence to the use of standby was 75% (<i>n</i> = 166). <b>Conclusions:</b> Safe clinical judgment was used in customizing parameters for patients experiencing heart rate significantly above or below parameter threshold. <b>Implications for Nursing:</b> An evidence-based alarm bundle can be introduced safely and reduces nonactionable alarms in the adult acute care setting.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing the Stress in Presenting to Preceptors: Teaching DNP Students the SNAPPS Model.","authors":"Kimberly Castillo, Danielle Chaplin","doi":"10.1891/JDNP-2024-0066","DOIUrl":"https://doi.org/10.1891/JDNP-2024-0066","url":null,"abstract":"<p><p><b>Background:</b> When nurse practitioner students start clinical rotations, they may feel unprepared to present patient case information to their preceptors. Although preceptors understand the benefits of active learning, when students provide weak or tangential presentations from lack of a structured model, preceptors may fall back on observational and passive learning due to time management constraints. <b>Objective:</b> This article shows an example of teaching SNAPPS during an on-campus skills lab and the outcomes for students and faculty. <b>Methods:</b> Students were taught the SNAPPS model during a skills lab in advanced health assessment. Utilizing case studies in a role-play format, they practiced acquired course skills and presented patient information using SNAPPS. The students completed surveys both before and after the skills lab. A Likert scale was used to measure their confidence levels at both points of time. <b>Results:</b> A Wilcoxon signed-rank test revealed a statistically significant increase in student confidence across all postsurvey scores (<i>p</i> < .05). <b>Conclusion:</b> Interactive case studies with SNAPPS practice enhance student confidence prior to clinical rotations. <b>Implications for Nursing:</b> As an active learning model, SNAPPS may ease the burden on preceptors and make them more receptive to having students.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperphosphatemia Control: A Quality Improvement Initiative for Adult End-Stage Renal Disease Patients on Hemodialysis.","authors":"Yiping Maggie Zeng-Wang, Sheria Robinson-Lane, Jessica Marsack, Michelle Pardee, Elizabeth A Duffy","doi":"10.1891/JDNP-2024-0054","DOIUrl":"https://doi.org/10.1891/JDNP-2024-0054","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Objectives:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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 (<i>p</i> = .007). Additionally, the intervention group showed a statistically significant improvement in knowledge assessment test scores (<i>p</i> = .018). <b>Conclusion:</b> 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. <b>Implications for Nursing Practice:</b> Advanced practice registered nurses can play an important role in improving patient outcomes and management of hyperphosphatemia.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}