Journal of Doctoral Nursing Practice最新文献

{"title":"Effects of Self-Monitoring Physical Activity Using Technology in Primary Care: A Pilot Intervention.","authors":"Wanda L Csaky,&nbsp;Louise H Knox,&nbsp;Ashley Helvig Coombe,&nbsp;Tamara Tanner,&nbsp;Angela Haynes-Ferere,&nbsp;Carrie Scotto","doi":"10.1891/JDNP-D-20-00038","DOIUrl":"https://doi.org/10.1891/JDNP-D-20-00038","url":null,"abstract":"<p><strong>Background: </strong>Physical activity (PA) is a primary factor in reducing the risk of chronic diseases, yet only half of U.S. adults meet recommended levels.</p><p><strong>Objective: </strong>To evaluate a PA self-monitoring pilot intervention using technology in obese adult primary care patients.</p><p><strong>Methods: </strong>The project had a prospective, single group, pretest/posttest design using an accelerometer with a smartphone app. Obese adult primary care patients (<i>N</i> = 31) were followed over 6 months. Demographic (age, race, sex, marital status, educational level) and PA-relevant (PA, body mass index [BMI], self-efficacy for exercise [SEE]) data were collected at enrollment. PA and BMI were recorded monthly for 6 months. SEE was reassessed at 6 months.</p><p><strong>Results: </strong>PA and BMI showed gradual improvement; however, changes in PA (<i>p</i> = .130), BMI (<i>p</i> = .326), and SEE (<i>p</i> = .877) at 6 months were not statistically significant. A strong, negative relationship was found between PA and BMI (<i>r</i> = -.727, <i>p</i> < .01). Anecdotal data indicated the smartphone app was acceptable to patients.</p><p><strong>Conclusions: </strong>Data-supported clinician-initiated PA self-monitoring with a smartphone app was acceptable and showed favorable trends in improving PA and BMI in obese adult patients.</p><p><strong>Implications for nursing: </strong>Prescribing PA self-monitoring using technology may be easily implemented.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39272678","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 Suicidal Ideation Screening and Suicide Prevention Strategies on Adult Nonbehavioral Health Units.","authors":"Anne C Lindstrom, Melinda Earle","doi":"10.1891/JDNP-D-20-00049","DOIUrl":"10.1891/JDNP-D-20-00049","url":null,"abstract":"<p><strong>Background: </strong>Suicide is a risk in hospitalized patients within and outside of behavioral health units. Williams et al. (2018). Incidence and method of suicide in hospitals in the United States. Williams et al. (2018), suicides occur annually in hospitals, 14%-26% of occurrences outside of a behavioral health unit.</p><p><strong>Objectives: </strong>The purpose of this project was to improve compliance with universal patient suicide ideation screening and targeted actions for patients screening positive admitted to nonbehavioral health units.</p><p><strong>Methods: </strong>Electronic medical record (EMR) changes to support screening and targeted patient safety measure documentation were implemented. Nursing education was provided to support these changes. Pre- and postassessments were used to measure knowledge gained from the education. A compliance report was generated from the EMR to measure compliance with universal screening and patient safety measures.</p><p><strong>Results: </strong>In a 4-month period, screening compliance improved by 20.6%, bedside safety companion use was 100%, suicide precautions, documentation 82.5%, and a behavioral health social work note documented 76% of the time.</p><p><strong>Conclusions: </strong>Universal screening improvement is feasible and has the potential to improve patient safety. Implementation should be considered across health care organizations.</p><p><strong>Implications for nursing: </strong>Providing nursing education and easier EMR workflows for nursing documentation of suicide screening and prevention strategies improves patient safety.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39095925","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":"Correct Execution of the Nasopharyngeal Swab: A Fundamental Method to Improve Diagnosis of SARS-CoV-2 Infection.","authors":"Giacomo Spinato, Cristoforo Fabbris, Anna Menegaldo, Silvia Marciani, Piergiorgio Gaudioso, Maria Cristina Da Mosto, Daniele Frezza, Paolo Boscolo-Rizzo","doi":"10.1891/JDNP-D-20-00040","DOIUrl":"10.1891/JDNP-D-20-00040","url":null,"abstract":"<p><strong>Background: </strong>Severe acute respiratory infection Coronavirus 2 (SARS-CoV-2) infection has spread all over the world since December 2019. Treatment of the syndrome represents an important challenge for all physicians. Spread prevention relies on a correct diagnosis which is performed with nasopharyngeal swabs.</p><p><strong>Objective: </strong>To describe the proper execution of the swab with a few simple steps.</p><p><strong>Methods: </strong>Figures and video recording.</p><p><strong>Results: </strong>A few simple steps are presented within this paper in order to perform easily nasopharyngeal swab for SARS-Cov-2 diagnosis and for other possible infectious diseases of the airways tract.</p><p><strong>Conclusions and implication for nursing: </strong>Nasopharyngeal swab may be performed in an easier way than usually thought. This method may also be used for any other microorganism detection. By following simple steps, a correct diagnosis can easily be obtained.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39095926","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 the Perception of Patient-Centered Wellness in a Virtual Population During the COVID-19 Pandemic.","authors":"Sybilla Myers, Christopher Kennedy","doi":"10.1891/JDNP-D-20-00078","DOIUrl":"10.1891/JDNP-D-20-00078","url":null,"abstract":"<p><strong>Background: </strong>Perceived health-related quality of life (HRQOL) is fundamental to well-being and is a meaningful way to measure physical and mental health.</p><p><strong>Local problem: </strong>No standard method exists for measuring perceived HRQOL during the COVID-19 pandemic in participants as they attempt to improve their self-determined wellness goals. An implementation plan that considers the social distancing limitations imposed can be used to predict an individual's likelihood of long-term success.</p><p><strong>Methods: </strong>During the four, 2-week plan-do-study-act (PDSA) cycles, the Social Cognitive Theory model informed the implementation of the four core interventions. To guide iterative changes, the data was analyzed through Excel and run charts.</p><p><strong>Interventions: </strong>The four core interventions were the shared decision-making tool (SDMT), health mobile app tool (HMAT), wellness tracker tool (WTT), and the team engagement plan.</p><p><strong>Results: </strong>Among 28 participants, perceived quality of life increased by 70%, engagement in shared decision-making increased to 82%, app use and confidence increased to 85%, and goal attainment reached 81%.</p><p><strong>Conclusions: </strong>The SDMT, health app, and wellness tracker created a methodical plan of accountability for increasing participant wellness. The contextual barrier of the COVID-19 pandemic added a negative wellness burden which was mitigated by creating a patient-centered culture of wellness.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39095927","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":"Survey of Nursing Faculty Preparation for Guiding DNP Quality Improvement Projects.","authors":"Debra Bingham, Margaret Hammersla, Anne Belcher, Lucy Rose Ruccio, Susan Bindon, Kathleen Buckley, Jeff Martin, Shannon Idzik","doi":"10.1891/JDNP-D-20-00036","DOIUrl":"10.1891/JDNP-D-20-00036","url":null,"abstract":"<p><strong>Background: </strong>Quality improvement (QI) projects comprise the majority of University of Maryland School of Nursing (UMSON) Doctor of Nursing Practice (DNP) projects.</p><p><strong>Methods: </strong>An online survey was completed by 51% (<i>n</i> = 38) of faculty, who teach or mentor DNP students, and was analyzed using quantitative and descriptive methods.</p><p><strong>Results: </strong>Faculty were somewhat or not familiar with developing a QI charter 68.4%, human error theory and error proofing 63.2%, driver diagrams 60.5%, characteristics of high-reliability organizations 60.5%, and Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines 55.3%. The faculty were most interested in learning more about (<i>n</i> = 97 responses) were human error theory and error proofing (28.9%), SQUIRE guidelines (26.3%), statistical process control (21.1%), and implementation strategies and tactics (21.1%). The most commonly identified challenges included identifying QI projects (24%), project time constraints (16%), keeping up-to-date on QI concepts, methods, and tools (12%), and balancing professional workload (10%).</p><p><strong>Conclusions: </strong>Gaps in self-reported QI knowledge indicate there is a need for further development of DNP and PhD prepared faculty at the UMSON.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38933353","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 Delirium Screening in an Intermediate Care Unit.","authors":"Christyn A Gaa, Bimbola F Akintade","doi":"10.1891/JDNP-D-20-00035","DOIUrl":"10.1891/JDNP-D-20-00035","url":null,"abstract":"<p><strong>Background: </strong>Delirium occurs in as many as 82% of hospitalized patients. Use of a valid and reliable tool allows for early detection and management to mitigate adverse effects, including a decrease in patient falls.</p><p><strong>Objective: </strong>To conduct a quality improvement project to implement the confusion assessment method (CAM) tool in an intermediate care unit and measure delirium screening compliance, feasibility of the tool, and the effect on reported patient falls.</p><p><strong>Methods: </strong>Web-based training using a 14-item pre-post assessment for knowledge comprehension. The CAM tool was added to the electronic health record (EHR), and documentation compliance was measured for eight weeks. Afterwards, a nurse perception survey was distributed, and 60-day pre- and post-intervention patient falls were compared.</p><p><strong>Results: </strong>Forty-seven nurses completed the training. Post-test averages were higher than the pre-test (<i>p</i> = .16); five answers showed significant improvement (<i>p</i> < .02). Screening and documentation compliance were 79.1%. Twenty-one nurses completed the perception survey, demonstrating agreement that delirium CAM screening is a feasible intervention. Patient falls were reduced by 57%.</p><p><strong>Conclusion: </strong>Addition of the CAM tool into the EHR-enhanced screening compliance.</p><p><strong>Implications for nursing: </strong>Early delirium detection may reduce patient falls. The CAM is a feasible instrument and delirium screening is a worthwhile intervention.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38933352","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 an Evidence-Based Bundle to Reduce Early Labor Admissions and Increase Adherence to Labor Arrest Guidelines: A Quality Improvement Initiative.","authors":"Michelle Telfer, Jessica Illuzzi, Diana Jolles","doi":"10.1891/JDNP-D-20-00026","DOIUrl":"10.1891/JDNP-D-20-00026","url":null,"abstract":"<p><strong>Background: </strong>At many hospitals, the cesarean birth rate among nulliparous term singleton vertex (NTSV) pregnancies is higher than World Health Organization benchmarks. Reducing NTSV cesarean birth is a national quality imperative. The aim of this initiative was to implement an evidence-based bundle at an urban community teaching hospital in at least 50% of labors in 60 days in order to reduce early labor admissions and increase adherence to evidence-based labor management guidelines shown to decrease cesarean birth.</p><p><strong>Methods: </strong>Chart audits, root-cause analysis, and staff engagement informed bundle development. An early labor triage guide, labor walking path, partograph, and pre-cesarean checklist were implemented to drive change. Four Rapid Cycle Plan Do Study Act cycles were conducted over 8 weeks.</p><p><strong>Results: </strong>The bundle was implemented in 58% of births. The bundle reduced early labor admissions labor from 41% to 25%. Team knowledge reflecting current guidelines in labor management increased 35% and 100% of cesareans for labor arrest met criteria. Patient satisfaction scores exceeded 98%.</p><p><strong>Conclusions: </strong>Implementing an evidenced-based bundle was effective in reducing early labor admissions and increasing utilization of and adherence to labor management guidelines.</p><p><strong>Implications for nursing: </strong>Implementation of evidence-based bundles has the potential to achieve meaningful quality improvements in maternity care.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38913714","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 Holistic Care Skills for Advanced Practice Registered Nurses: Integration of a Complementary and Alternative Medicine Course into a Doctor of Nursing Practice Curriculum.","authors":"Jill Schramm, Tiffany Uranga, Amber Birkle, Regina Thorp, Laura Taylor","doi":"10.1891/JDNP-D-20-00077","DOIUrl":"10.1891/JDNP-D-20-00077","url":null,"abstract":"<p><strong>Background: </strong>Complementary alternative medicine (CAM) is an expanding domain of healing practices harmonized with Western medicine to provide comprehensive treatment of individuals as holistic beings. Patients and healthcare providers worldwide are increasingly inviting and employing CAM practices into healthcare delivery routines. Implementation of courses to introduce CAM into Advanced Practice Registered Nurse (APRN) programs exposes future practitioners to current best practices for integrative treatment strategies and encourages consideration when developing a holistic patient-centered care plan.</p><p><strong>Objective/methods: </strong>A case presentation of an interprofessional CAM course delivered to military graduate nursing students with a pretest posttest course survey to evaluate student's confidence and knowledge of CAM theory and practices. The format included online modules, evidence-based literature critique, knowledge checks, and an immersive hands-on immersion experience.</p><p><strong>Results: </strong>A total of 240 pre-/postcourse surveys were completed by military graduate nursing students (<i>N</i> = 140) participating in a CAM course. Statistically significant increases in CAM knowledge, communication, and skills confidence levels were found. Following participation in the course, nearly all students (97%) agreed CAM is important and benefits future advanced practice.</p><p><strong>Conclusion/nursing implications: </strong>CAM is a compendium of holistic healing modalities increasingly being utilized by patients worldwide with similar requests for alternative care techniques from healthcare providers. Military APRN students participating in a CAM course increased knowledge and confidence, and garnered appreciation for an expanded skill set to augment future practice. Case presentation is compelling for standard inclusion of CAM and similar graduate interprofessional courses into all APRN programs.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38971487","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":"Linking Underserved Patients to Social Services Using the SScAR Tool.","authors":"Kimberly A Sand","doi":"10.1891/JDNP-D-20-00033","DOIUrl":"10.1891/JDNP-D-20-00033","url":null,"abstract":"<p><strong>Background: </strong>The need to screen for social determinants of health (SDOH) is well documented in the literature. Addressing SDOH also requires linking patients to available social service resources.</p><p><strong>Objective: </strong>This Social Screen Assess and Refer (SScAR) Quality Improvement (QI) project purpose was threefold: (1) develop an agency specific tool to screen for SODH; (2) implement this tool in all new patient evaluations; and (3) provide referral to patients for necessary social services.</p><p><strong>Methods: </strong>The SScAR tool adapted questions from published screening tools and created new questions centered on available social services. A pilot study implemented the tool. Documentation of social needs before the pilot, SScAR utilization during the pilot, number of social needs, and referrals made were measured.</p><p><strong>Results: </strong>Documentation of SDOH screening significantly improved with the tool (α .05, χ²(1) = 21.85, <i>p</i> < .001). Follow-through referral to specific social resources only increased by 5%.</p><p><strong>Conclusions: </strong>The SScAR is a feasible tool for identifying SDOH needs and creates a mechanism for linking patients with social services.</p><p><strong>Implications for nursing: </strong>Future studies must measure social service referrals, utilization of social services, and the resulting impact on specific health outcomes such as blood pressure, hemoglobin A1c, and cholesterol.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38971489","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":"The Impact of Telephonic Follow-Up Within 2 Business Days Postdischarge on 30-Day Readmissions for Patients With Heart Failure.","authors":"Victoria M Chestnut, Karen Vadyak, Matthew M McCambridge, Michael J Weiss","doi":"10.1891/JDNP-D-19-00079","DOIUrl":"10.1891/JDNP-D-19-00079","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a chronic condition associated with high rates of hospital readmissions. The prevalence and costs of HF are expected to rise dramatically by 2030 (Heidenreich,et al., 2013).</p><p><strong>Objective: </strong>A 24-month, retrospective study was conducted using electronic medical record (EMR) chart review, seeking to identify if postdischarge follow-up phone calls decreased 30-day readmissions in individuals with HF.</p><p><strong>Methods: </strong>The study included 705 adult participants who were admitted to the hospital for HF. Some received a postdischarge call within 2 business days of discharge, and some did not.</p><p><strong>Results: </strong>Participants who received the postdischarge call were less likely to be readmitted (20.1%) than participants who did not receive a postdischarge call (28.8%; <i>p</i> = .007). Participants who received the postdischarge call were more likely to have a follow-up visit within 14 days (70.1%) than participants who did not receive a postdischarge call (30.2%; <i>p</i> < .001).</p><p><strong>Conclusions: </strong>The findings from this study may help to drive future transitional care strategies for individuals diagnosed with HF.</p><p><strong>Implications for nursing: </strong>Nurse-led transitional care interventions offer potential solutions to ensure safe, effective hospital discharges.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38758592","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}