Journal of Doctoral Nursing Practice最新文献

{"title":"An Evidence-Based Approach to Protecting Our Biggest Organ: Implementation of a Skin, Surface, Keep Moving, Incontinence/Moisture, and Nutrition/Hydration (SSKIN) Care Bundle.","authors":"Erin Kennedy","doi":"10.1891/JDNP-2021-0040","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0040","url":null,"abstract":"<p><p><b>Background:</b> The skin, surface, keep moving, incontinence/moisture, and nutrition/hydration (SSKIN) bundle is a resource to aid in care planning when at risk of pressure injuries. The bundle uses best practices to minimize variations in care. <b>Objectives:</b> The objectives of this quality improvement (QI) pilot project were as follows: (a) increase nurses' knowledge of pressure injury prevention, (b) increase nurses' knowledge of the use of the SSKIN bundle, and (c) to pilot the use of an SSKIN bundle in the clinical setting designed to standardize nursing interventions and documentation. <b>Methods:</b> Nurses completed a module on pressure injury prevention that included a pre- and posttest to determine knowledge. Education on the use of the SSKIN bundle was provided, followed by a posttest to establish understanding and knowledge gained. The bundle was utilized in the acute inpatient rehabilitation unit for 4 weeks, and compliance was assessed using the \"all-or-none\" approach (100% compliance). At the conclusion of the pilot project, staff nurses completed a post-survey created by the QI leader (Likert scale format). The survey included topics on the ease of learning to use the bundle, improved knowledge, perceived reduction in variation of care, perceived facilitation of discussion on skin, opinions on whether the bundle should be instituted hospital-wide, and incorporation of the bundle into the electronic health record (EHR). <b>Results:</b> There was an increase in pressure injury prevention knowledge from an average score of 88.89% on the pretest to 98.15% on the posttest. The mean score on the SSKIN bundle posttest was 93.75%. The bundle ran for 4 weeks and was initiated for ten patients during 74 shifts. Compliance with all components of the bundle was 77%. <b>Conclusion:</b> A pressure injury prevention initiative, such as the SSKIN bundle, can be a useful tool to help standardize nursing interventions and documentation. <b>Implications for Nursing:</b> Results revealed Nutrition as the component with the highest degree of noncompliance. Practice recommendations include documenting every patients nutrition information, regardless of Braden score.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":"16 1","pages":"62-80"},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9601233","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 Adherence to Treatment Plans in Diabetes Patients With Neuropathic Foot Wounds.","authors":"Ann-Marie Irons,&nbsp;Mary Elizabeth Pounders","doi":"10.1891/JDNP-2021-0050","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0050","url":null,"abstract":"<p><p><b>Background:</b> In southeast states, diabetes continues to rise. Medical expenses are higher for -individuals diagnosed with diabetes-related complications, and poor outcomes are associated with missed appointments for wound treatment. <b>Objective:</b> The aim of this clinical practice contribution was to implement interventions to increase adherence to appointments and treatment plans in an outpatient wound clinic. <b>Methods:</b> Project participants over 18 years of age who were at risk for or have neuropathic foot wounds and are on weekly treatment regimens were recruited. Clinic staff were surveyed on the perceived success of and willingness to continue the interventions. <b>Results:</b> All staff surveyed agreed or strongly agreed that an automated reminder system and incentive program would make a significant impact on the patient's quality of life and worth the time and effort for staff to continue implementation. No patients in the control group required admission to acute care for treatment. <b>Conclusions:</b> Going forward with implications for future practice, these interventions demonstrated both the importance of adherence to outpatient appointments and opportunities to promote patient engagement. <b>Implications for Nursing:</b> Improving attendance at outpatient clinic appointments is significant for the delivery of quality patient care. By managing chronic conditions in the outpatient setting, complications can be reduced.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":"16 1","pages":"36-43"},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9601234","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":"Family Health of Patients With Heart Failure and Their Family Members Before and During the First COVID-19 Lockdown.","authors":"Mahdi Shamali,&nbsp;Hanne Konradsen,&nbsp;Birte Østergaard,&nbsp;Erla Kolbrun Svavarsdottir","doi":"10.1891/JDNP-2021-0012","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0012","url":null,"abstract":"<p><p><b>Background</b>: Family health plays a vital role in the self-care and lifestyle modifications in families living with heart failure. <b>Objective</b>: To investigate the family health of patients with heart failure and their family members before and during the first COVID-19 lockdown. <b>Method</b>: This was a cross-sectional study design. We included 34 participants before and 34 participants during the first COVID-19 lockdown. Independent <i>t</i>-tests were conducted for comparison of the mean scores of the family health and its dimensions. <b>Results</b>: There was no significant difference between the total score of family health during the first COVID-19 lockdown compared to before the first COVID-19 lockdown in patients and family members. However, the <i>values</i> and <i>ill-being</i> dimensions of family health in patients and <i>ill-being</i> dimension in family members were significantly decreased during the first COVID-19 lockdown. <b>Conclusion</b>: This study indicated the positive and negative impacts of COVID-19 lockdown on family health. <b>Implications for Nursing</b>: Our results may help nurses to identify vulnerable patients with a low level of family health to tailor the best support to them.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":"15 3","pages":"144-149"},"PeriodicalIF":0.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674436","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":"Practicing Upstream: Race-Based Trauma Care Training For Veteran's Health Administration Nurse Practitioners.","authors":"Vanessa Loyd,&nbsp;Karen Scaglione","doi":"10.1891/JDNP-2021-0013","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0013","url":null,"abstract":"<p><p><b>Problem</b>: The Advance Practice Registered Nurses (APRNs) employed by the Veterans Health Administration (VHA) lack race-based trauma training for Veterans that have experienced psychological, physiological, and emotional trauma. The VHA is responsible for the health of this culturally diverse patient population with complex health conditions. APRNs without prior military experience may have trouble obtaining an accurate history and physical exam due to their inexperience with the military's cross-cultural environment. This quality improvement pilot project aimed to incorporate race-based trauma training into a new adult geriatric acute care nurse practitioner's (AGACNP) fellowship curriculum. The study question is: In acute geriatric acute care nurse practitiioner's, what are the effects of race-based trauma training on competency and confidence in providing care to Veterans when hospitalized? <b>Methods</b>: A prospective descriptive design utilized a purposeful sample of senior adult-geriatric nurse practitioner (AGNP) students, due to the unforeseen circumstances of not hiring AGACNPs s for this pilot, for the first 6-weeks of a new acute care fellowship pilot program. Outcome measures included evaluating skills in identifying racial differences and confidence in applying culturally sensitive care. <b>Results</b>: Participant (<i>N</i> = 3) self-reported confidence increased by .33 (20%) in providing culturally competent and race-based trauma care, and an improvement in identifying race-based differences by .33 (17%) at completion of the pilot. <b>Implications</b>: Results indicated improvement in confidence and competence when providing race-based trauma care within 6 weeks. Continued training and evaluation throughout the 12-month fellowship are recommended.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":"15 3","pages":"150-156"},"PeriodicalIF":0.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674437","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 Quality of Life After Liver Transplantation-The First Experience from Serbia.","authors":"Branislav Oluić,&nbsp;Stipislav Jadrijevic,&nbsp;Ivana Pantic,&nbsp;Sanja Dragasevic,&nbsp;Dusan Popovic,&nbsp;Milica Stojkovic Lalosevic,&nbsp;Zeljko Vlaisavljevic,&nbsp;Alireza Abdi,&nbsp;Tamara Milovanovic","doi":"10.1891/JDNP-2021-0026","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0026","url":null,"abstract":"<p><p><b>Background</b>: Liver transplantation (LT) is the most effective treatment for patients with end-stage liver disease, which dramatically effects patient's quality of life (QoL). The aim of this study was to evaluate the impact of socio-demographic and clinical factors on different QoL domains of patients who underwent orthotopic LT. <b>Methods</b>: A cross-sectional study included a total of 43 patients who underwent a LT from 2013 to 2018. Socio-demographic and clinical data were recorded in each patient. The QoL was estimated using two validated questionnaires: 36-Item Short Form Health Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ). <b>Results</b>: Male patients obtained significantly higher scores than women, in the domains of general health perception (83.2 ± 16.3 vs. 71.0 ± 18.4; <i>t</i> = 2.229, <i>p</i> = .031) and physical component summary (69.0 ± 7.2 vs. 62.0 ± 11.4; <i>t</i> = 2.451, <i>p</i> = .019). There were no significant differences in other domains of SF-36 and CLDQ. Etiology of the underlying liver disease and the presence of post-transplant complications showed no effect on score values of SF-36 and CDLQ domains (<i>p</i> < .05). Time from LT showed negative medium correlation with role limitations due to physical health problems (<i>S</i> = -0.417, <i>p</i> = .005), while no other significant correlations were noted in other items of SF-36 and CLDQ. <b>Conclusions</b>: Men had higher scores in the domain of general health perception and physical component summary following LT than women. With the increase in time from LT, patients experience a decrease in limitations due to physical health problems. The audit and improvement of QoL is an essential part of the individualized long-term health-care approach to LT patients.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":"15 3","pages":"137-143"},"PeriodicalIF":0.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674438","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":"Prescribing Opioids for Chronic Pain: A Quality Improvement Project.","authors":"Geetha Ajay","doi":"10.1891/JDNP-2021-0052","DOIUrl":"10.1891/JDNP-2021-0052","url":null,"abstract":"<p><strong>Background: </strong>Several healthcare providers have failed to follow proper opioid prescribing practices to treat chronic pain in recent years. Therefore, the nation is experiencing an epidemic of opioid addiction, which has destroyed many lives. This quality improvement project aims to assess healthcare providers prescribing practices using the Centers for Disease Control and Prevention's guidelines to treat chronic pain.</p><p><strong>Method: </strong>The methodology used was the Plan-Do-Study-Act framework. A total of 120 charts were reviewed before the pre and post-implementation of the CDC's guidelines to assess the prescribing practices of health care providers. Also, the QI project follows SQUIRE's 2.0 guidelines to describe the prescribing practices of providers. SQUIRE is a framework that helps researchers report new knowledge on improving patient care in the health care system. The literature review section in this article illuminates current evidence of using opioid guidelines and had provided guidance on how to improve opioids prescribing practices among providers. The guidelines can be retrieved at http://squire-statement.org/index.cfm?fuseaction=Page.ViewPage&PageID=471 OUTCOMES: Using the CDC's guidelines helps to assess the prescribing practices of health care providers, the prescription rates of opioids dropped from 33.3% pre-implementation to 16.7% post-implementation.</p><p><strong>Conclusion: </strong>Opioid prescriptions are a significant contributor to the rising opioid epidemic; therefore, educating clinicians about safe prescribing practices is crucial.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33470272","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 Depression Screening in Primary Care.","authors":"Marlene Lindsay,&nbsp;Veronica B Decker","doi":"10.1891/JDNP-2021-0005","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0005","url":null,"abstract":"<p><strong>Background: </strong>Depression is a serious problem in the United States. It not only impacts chronic illness and healthcare utilization, but it can also result in death, intentional or unintentional. Despite the seriousness associated with depression, it continues to be underdiagnosed and undertreated. The primary care setting provides an ideal location to screen and initiate treatment for depression in individuals who would otherwise not be screened.</p><p><strong>Objective: </strong>The objective of this evidence-based practice project was to improve the diagnosis and treatment of depression in an adult primary care office.</p><p><strong>Method: </strong>An intervention consisting of a HealthWatcher reminder for depression screening, the administration of the PHQ-9 instrument, and a treatment algorithm was incorporated into the office workflow. The charts of a pre-intervention random sample were compared to a post-intervention random sample to test for significant differences in depression screening and treatment rates.</p><p><strong>Results: </strong>Using the chi-squared test, the post-intervention sample screening rate was significantly higher than pre-intervention sample rate (90% vs 23.3%; χ² = 54.3, <i>df</i> = 1, <i>P</i> < .000).</p><p><strong>Conclusion/implications: </strong>It is feasible to improve the diagnosis and treatment of depression for adult primary care patients by modifying office protocols and using the PHQ-9 screening instrument and a treatment algorithm.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":"15 2","pages":"84-90"},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40586986","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":"Utilization of Pediatric Standing Orders by Triage Nurses in a Free-Standing Emergency Department.","authors":"Randy Hamm","doi":"10.1891/JDNP-2021-0024","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0024","url":null,"abstract":"<p><strong>Background: </strong>Pediatric pain-related complaints continue to be a common presenting factor of most emergency departments (EDs). Studies have shown that several barriers in assessing and treating pediatric pain exist, including nursing knowledge regarding appropriate pain level assessment.</p><p><strong>Objective: </strong>This quality improvement study aimed to provide and evaluate specific education regarding pediatric pain management for free-standing ED triage nurses to expedite medication administration during the triage phase of an ED visit.</p><p><strong>Method: </strong>This pre/post-test intervention study was used to measure whether the education provided to nurses working in a primarily adult patient free-standing ED increased the utilization of triage standing orders related to pediatric pain management.</p><p><strong>Results: </strong>Paired sample <i>t</i>-tests results indicated a statistically significant increase (<i>p =</i> .000) in the percentage of patients that received pain medication during the triage phase of an ED visit after specific education was provided to triage nurses.</p><p><strong>Conclusion: </strong>Free-standing ED triage nurses are more likely to follow and implement triage standing orders if education explicitly related to pain management in pediatric patients has been provided.</p><p><strong>Implications for practice: </strong>Pediatric pain management education should be revisited annually to re-educate nurses on the importance of early interventions.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":"15 2","pages":"112-122"},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40586987","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":"Preliminary Development and Testing of the Risk Assessment Checklist for Self-Injury in Autism-Medical (RACSA-M).","authors":"Lisa B Alberts,&nbsp;Tracy L Kettering","doi":"10.1891/JDNP-2021-0034","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0034","url":null,"abstract":"<p><p>Self-injurious behavior (SIB) is a major treatment focus for clinicians treating children with autism spectrum disorder (ASD). A review of the literature identified medical conditions that may be risk factors for an individual engaging in SIB. This study involved the creation and preliminary validation of a standardized assessment checklist: Risk Assessment Checklist for Self-Injury in Autism-Medical (RASCA-M) for the physical, behavioral, and diagnostic evaluation of non-verbal children with autism and SIB living in a residential setting. Preliminary content validity, criterion-related validity, and interobserver agreement were established. The RACSA-M is a promising instrument to assess underlying medical issues in non-verbal children with ASD and SIB.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":"15 2","pages":"75-83"},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40586984","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":"Quality Improvement in Teen Pregnancy Prevention: Follow-Up to a \"Focus on Fidelity\".","authors":"Brooke A Flinders,&nbsp;Alexis Zehler","doi":"10.1891/JDNP-2021-0028","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0028","url":null,"abstract":"<p><strong>Background: </strong>In teen pregnancy prevention (TPP) evidence-based program replication, fidelity toolkits (FTKs) provide structure to ensure that essential curricular components are delivered as intended.</p><p><strong>Objective: </strong>The purpose of this project was to extend quality improvement efforts (Flinders, 2017) through analysis of FTKs from four years of TPP implementation.</p><p><strong>Methods: </strong>An evidence-based TPP program was delivered to females, 15-19 years of age (<i>n</i> = 1,658) from four suburban Ohio counties. Fidelity rates were calculated by agency staff and undergraduate nursing students. Grounded theory was used to identify themes from the narrative sections of the FTKs. Plan-Do-Study-Act methodology (Agency for Healthcare Research and Quality, 2008) guided this quality improvement work.</p><p><strong>Results: </strong>Staff fidelity was reported as 98.38%. Student fidelity was reported at 99.05%. Key themes, identified as a result of the qualitative analysis, were categorized as participant factors, site factors, or presenter factors.</p><p><strong>Conclusions: </strong>Toolkits created an effective safeguard to ensure the replication of the evidence-based TPP program, with fidelity.</p><p><strong>Implications for nursing: </strong>Undergraduate students are capable of implementing evidence-based programming, with fidelity, to meet the educational needs of their communities. Analysis of narrative comments from toolkits can influence FTK revisions to improve program delivery.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":"15 2","pages":"105-111"},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40586983","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}