Journal of Doctoral Nursing Practice最新文献

{"title":"Evaluation of Implementation and Unit Impact of a Hypertensive Disorder of Pregnancy Guideline: A Model-Based Approach.","authors":"Nora Drummond, Alissa Carver, Joanne Bailey","doi":"10.1891/JDNP-D-20-00028","DOIUrl":"10.1891/JDNP-D-20-00028","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. To address this, a large Midwestern hospital initiated a practice guideline. Practice guidelines should improve outcomes, but implementation of these remains challenging. At the time of initiation of the guideline, no implementation or evaluation plan was conceived.</p><p><strong>Objective: </strong>Evaluate the implementation and unit impact of a guideline for the management of hypertensive disorders of pregnancy in a large academic health system in the Midwest.</p><p><strong>Methods: </strong>Six objectives, guided by the constructs of the Ottawa Model of Research Utilization, were operationalized to evaluate the implementation and unit impact of the guideline.</p><p><strong>Results: </strong>The guideline implemented was consistent with national recommendations. Intervention education was inconsistent across provider types. A survey of staff revealed insight into a unit in the midst of practice change. A chart review revealed below-target management of patients with severe range blood pressures. Not following the guideline was associated with hospital readmission.</p><p><strong>Conclusions: </strong>Guideline implementation can be efficiently and holistically evaluated with a model-based framework, even in projects that were not initiated with such an approach.</p><p><strong>Implications for nursing practice: </strong>Nurses provide expertise in model-based approaches that result in comprehensive evaluations of quality improvement processes.</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":"38771903","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":"A Focus on Congestive Heart Failure-Related Patient Education After Open Heart Surgery: A Quality Improvement Project.","authors":"Preston Briggs","doi":"10.1891/JDNP-D-20-00007","DOIUrl":"10.1891/JDNP-D-20-00007","url":null,"abstract":"<p><strong>Background: </strong>After open heart surgery patients often develop symptoms associated with congestive heart failure (CHF), or fluid volume overload. To prevent heart failure-related symptoms in the postoperative period patients must be educated on heart failure self-care.</p><p><strong>Objective: </strong>To decrease the percentage of postoperative open heart surgical patients with CHF-related questions and concerns from 44% to 30% by March 2020.</p><p><strong>Methods: </strong>A cardiac surgery educational booklet and an educational electronic health record template were identified to guide a CHF educational pathway. Intensive care staff nurses provided patient education after surgery. PDSA cycles were performed in succession to roll out the quality improvement (QI) initiative.</p><p><strong>Results: </strong>Of patients experiencing postoperative issues, 44% of patients developed symptoms or concerns related to heart failure. Upon implementation of the CHF-focused pathway 15% of patients were exhibiting symptoms or concerns related to CHF, out of all patients with postoperative issues.</p><p><strong>Conclusions: </strong>CHF, and fluid volume overload continues to be a difficult pathology requiring close management and follow up. After open heart surgery, providing concise, CHF-focused education results in reduced CHF-related patient concerns after discharge.</p><p><strong>Implications for nursing: </strong>By providing a disease-focused patient education nurses can reduce the complications that patients develop after an inpatient hospital.</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":"38758593","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":"Strategies for Strengthening Quality Improvement Projects in a Doctor of Nursing Practice Program.","authors":"Karen Swisher Kesten, Mercedes Echevarria","doi":"10.1891/JDNP-D-20-00034","DOIUrl":"10.1891/JDNP-D-20-00034","url":null,"abstract":"<p><strong>Background: </strong>Doctor of Nursing Practice (DNP) programs must assure that attention to safe quality healthcare is threaded throughout the curriculum and prepare students to lead quality improvement (QI) initiatives in healthcare systems.</p><p><strong>Objective: </strong>This article illustrates the integration of implementation science, QI methods, process and evaluation tools, and faculty enrichment as strategies to strengthen QI projects in a DNP program.</p><p><strong>Methods: </strong>A three-phased approach to implement strategies to strengthen QI projects in a DNP program and to enhance faculty engagement was undertaken. A needs assessment drove the development of strategies to strengthen QI in a DNP program.</p><p><strong>Results: </strong>Outcomes of implementing strategies to strengthen QI in a DNP program showed rapid uptake of the concepts of QI process models into course content within the DNP curriculum.</p><p><strong>Conclusions: </strong>Strategies consisted of assessment of courses for gaps in QI content, faculty enrichment sessions on implementation science, QI processes and models, QI metrics and data analytics, embedding new content in the DNP program courses and the use of a rigorous evaluation tool for QI projects.</p><p><strong>Implications for nursing: </strong>When provided with QI mentors and tools, DNP students are prepared to lead QI initiatives in healthcare systems to improve the safety and quality of healthcare.</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":"38758594","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":"Educational Intervention for Bupropion Abuse Prevention.","authors":"Brittany Debeltz","doi":"10.1891/JDNP-D-19-00067","DOIUrl":"10.1891/JDNP-D-19-00067","url":null,"abstract":"<p><strong>Background: </strong>Bupropion is being abused due to effects that are comparable with methamphetamine and cocaine. Current research indicates several interventions that can prevent prescription medication abuse.</p><p><strong>Objectives: </strong>A research study was performed at two healthcare organizations to evaluate whether education on prevention-based interventions increased self-efficacy of healthcare staff in addressing potential and ongoing bupropion abuse and whether the education reduced the rate of bupropion prescribing.</p><p><strong>Methods: </strong>The study sample consisted of 43 staff members who completed a paper-based preeducation survey, attended a 1-hour educational session, and completed a paper-based posteducation survey.</p><p><strong>Results: </strong>There was a 42% increase in total staff self-efficacy scores along with significant differences between pre-/postsurvey scores (<i>p</i> ≤ .001). After education prescribers answered they plan to change prescribing practices and the number of bupropion prescriptions filled decreased.</p><p><strong>Implications for nursing: </strong>Future practice recommendations should include education on bupropion abuse and implementation of prevention interventions to reduce the occurrence of the abuse of bupropion.</p><p><strong>Conclusions: </strong>The research findings suggested that education on interventions for bupropion abuse prevention improved healthcare staff self-efficacy in the management of potential and ongoing bupropion abuse, influenced prescribing practices of prescribers, and decreased the number of bupropion prescriptions. This research can be used to continue providing education to help prevent further cases of bupropion abuse.</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":"38758596","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":"A Game Changer: Adult-Geriatric Acute Care Nurse Practitioner Fellowship for the Veterans Health Administration.","authors":"Karen Scaglione, Vanessa Loyd","doi":"10.1891/JDNP-D-20-00031","DOIUrl":"10.1891/JDNP-D-20-00031","url":null,"abstract":"<p><strong>Background: </strong>Nurse practitioner (NP) fellowship programs assist the novice NP in transitioning to advanced practice while emphasizing building confidence and competence. The Veteran's Health Administration (VHA) offers an NP primary care fellowship program. The purpose of this project was to develop an acute care transition to practice fellowship program at a Midwestern VHA hospital.</p><p><strong>Methods: </strong>A prospective, descriptive design utilizing a convenience sample of senior adult-geriatric nurse practitioner (AGNP) students during a pilot study of an acute care fellowship program. Outcome measures included evaluation of skills interpreting electrocardiograms (ECG), chest x-rays (CXR), and self-reported confidence in performing these skills over the initial 6-week period of the 12-month program.</p><p><strong>Results: </strong>There were three participants (<i>N</i> = 3, 100%). There was a 33% increase in self-reported confidence of readiness to practice at completion of the pilot. However, ECG scores decreased 66% and CXR interpretation scores decreased 33%.</p><p><strong>Implications for nursing: </strong>Despite training and targeted clinical experiences in ECG and CXR interpretations during an acute care fellowship, competence in these skills decreased while self-reported confidence increased at the end of 6 weeks. Continued education and training throughout the 12-month program is recommended to increase the novice NP's competence in these skills while transitioning to their new role.</p><p><strong>Objective: </strong>To provide an acute care fellowship to facilitate with transition into advanced practice while increasing confidence and competence in the novice NP.</p><p><strong>Conclusion: </strong>The novice NP may benefit from an NP fellowship program.</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":"38771904","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":"Provider Adherence to Prescribing Guidelines for Statin Therapy.","authors":"Sarah Cornwell, Kim Curry","doi":"10.1891/JDNP-D-20-00013","DOIUrl":"10.1891/JDNP-D-20-00013","url":null,"abstract":"<p><strong>Background: </strong>Atherosclerotic cardiovascular disease (ASCVD) is a major contributor to nationwide morbidity, mortality, and healthcare costs in the United States. Over 92 million adults have at least one form of ASCVD, and annual costs for treatment are anticipated to surpass one trillion dollars within the next 15 years.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the medication therapy of a population of adults in comparison to the American College of Cardiology/American Heart Association (ACC/AHA) recommendations for statin therapy for ASCVD risk reduction.</p><p><strong>Methods: </strong>The adult population receiving care from a group of hospital outpatient clinics was examined using a database query. Rates of ASCVD in a multicounty area were compared and provider adherence to current guidelines was assessed.</p><p><strong>Results: </strong>Rural counties showed higher rates of ASCVD. Rates of statin medication prescribing for patients of each ACC/AHA statin benefit group ranged from 66.2% to 74.8%.</p><p><strong>Conclusions and implications for nurse practitioners: </strong>Adherence to guidelines varied among counties and optimal adherence was not achieved. Providers were also more likely to prescribe statin medications to men than women within each group regardless of risk. These findings can assist nurse practitioners and other providers in addressing areas of nonadherence to guidelines.</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":"38758589","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":"Monitoring Prediabetes Screening in Two Primary Care Offices in Rural Appalachia: A Quality Improvement Process.","authors":"Rebecca T Clark, Christine M Mullins, Jean C Hemphill","doi":"10.1891/JDNP-D-20-00027","DOIUrl":"10.1891/JDNP-D-20-00027","url":null,"abstract":"<p><strong>Background: </strong>One-third of the U.S. population has prediabetes, but 90% remain undiagnosed because healthcare providers are not screening for this condition.</p><p><strong>Objective: </strong>The purpose of this quality improvement project was to monitor prediabetes screening and identification, and implement evidence-based recommendations including registered dietician referral.</p><p><strong>Methods: </strong>This project involved using an evidence-based screening tool to measure individual risk of prediabetes. Aggregate data was collected to evaluate screening implementation, evidence-based recommendations offered by providers, and assess patient risk factors.</p><p><strong>Results: </strong>The percentage of patients at risk for prediabetes was 41.3% (<i>n</i> = 111). The most frequent risks were identified as overweight, history of hypertension, family history of type 2 diabetes mellitus (T2DM), and older age. Providers offered education on weight loss 68.5% (<i>n</i> = 76) and exercise 76.6% (<i>n</i> = 85) but referred 33.3% (<i>n</i> = 37) patients for nutrition education. The screening rates were 52.3% (<i>n</i> = 176) and 72.5% (<i>n</i> = 244) in clinics A and B respectively.</p><p><strong>Conclusions: </strong>A gap remains in using evidence-based recommendations to decrease risk of prediabetes. Prediabetes screening identified a greater percentage of persons in this population.</p><p><strong>Implications for nursing: </strong>There is a need for consistent practice of evidence-based recommendations. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.</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":"38758591","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":"Flipping the Classroom to Optimize Clinical Decision-Making in the Didactic Setting.","authors":"Karen Marie Arca-Contreras","doi":"10.1891/JDNP-D-20-00050","DOIUrl":"10.1891/JDNP-D-20-00050","url":null,"abstract":"<p><strong>Background: </strong>Deliberate inclusion of clinical decision-making nursing skills in the didactic setting will assist students in potentially making better patient care decisions. This can be optimized through use of the flipped learning andragogy. Flipped learning promotes an interactive classroom environment. It fosters teamwork and collaboration. Direct content instruction is the responsibility of students.</p><p><strong>Objective: </strong>This cohort pilot study investigated how the flipped and nonflipped approach to teaching impacted clinical decision-making and student participation.</p><p><strong>Methods: </strong>The Clinical Decision-Making in Nursing Scale (CDMNS) was administered to the students in the flipped classroom and the nonflipped classroom on week 1 and week 6. A student participation checklist was used to observe class activities at three separate intervals (baseline, mid-semester, and end-semester). A repeated measures analysis of covariance was conducted with Instruction Group as the between subjects factor (Flipped and Nonflipped) and Time (preinstruction and postinstruction) as the within subjects factor, and covarying age. The Time by the Instruction group was significant. The Flipped group showed an increase in Clinical decision-making scores (<i>p</i> < .001) after instruction while the Nonflipped group did not (<i>p</i> = .40).</p><p><strong>Results: </strong>The Flipped group (<i>n</i> = 24) showed an increase in Clinical decision-making scores (<i>p</i> < .001) after instruction while the Nonflipped group (<i>n</i> = 23) did not (<i>p</i> = .40). The Flipped classroom showed 100% participation at baseline, mid-semester, and end of semester. The Nonflipped classroom showed overall lower levels of participation, with 42%, 33%, and 39% at each point respectively.</p><p><strong>Conclusion/implications for nursing: </strong>Students who were taught using the flipped instruction were able to apply what they learned in relevant case studies, virtual simulations, and practice National Council Licensure Examination RN (NCLEX-RN) type questions. Through teamwork and collaboration, students had time to practice clinical decision-making skills. This was evident in the increased CDMNS scores and increased levels of participation over time in the flipped group when compared to the nonflipped group.</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":"38758595","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 Nurse Education on Heart Failure Readmissions and Patient Education.","authors":"Kimberly Mattina, Beverly W Dabney, Mary Linton","doi":"10.1891/JDNP-D-19-00076","DOIUrl":"10.1891/JDNP-D-19-00076","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) has become a national concern, with approximately 5.7 million adults in the United States suffering from this life-altering disease. Improved education of these patients prior to discharge helps patients manage their disease adequately and reduce symptom exacerbations.</p><p><strong>Objective: </strong>This quality improvement initiative aimed to determine the effectiveness of an educational intervention in improving nurses' knowledge of HF discharge teaching and documentation of this education in patient charts.</p><p><strong>Methods: </strong>This project was conducted at a Magnet-recognized acute care hospital with 39 critical care step-down beds. Twenty-nine nurses employed on the step-down unit participated in the educational intervention. Pre/post nurse knowledge and chart review data were analyzed.</p><p><strong>Results: </strong>There was a statistically significant increase in the percentage of patients receiving HF education from unit nurses from preintervention 77.0% (<i>n</i> = 81) to postintervention 96.4% (<i>n</i> = 138) (<i>p</i> < .001). There was also a statistically significant increase in the mean number of days patients were educated from 1.64 to 2.58 days (<i>p</i> < .001). Nurse knowledge also increased from pretest (69.7%) to posttest scores (100%) (<i>p</i> < .001).</p><p><strong>Conclusions: </strong>Providing HF educational opportunities enhanced nurse knowledge and increased their documentation of HF education in patient charts.</p><p><strong>Implications for nursing: </strong>Nurse educators may use the study results to improve nurse education and practices aimed at reducing HF readmissions.</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":"38758590","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":"Establishing a Telehealth Program in Primary Care for the Treatment of Opioid Use Disorder.","authors":"Katherine J Coulter,&nbsp;Mary F Hintzsche","doi":"10.1891/JDNP-D-19-00068","DOIUrl":"https://doi.org/10.1891/JDNP-D-19-00068","url":null,"abstract":"<p><strong>Background: </strong>More than 130 Americans die from opioid overdose each day. To address the opioid epidemic, opioid treatment programs are in place to treat substance use disorder. These programs have seen an influx of patients and are not able to accommodate the number of patients. Primary care practices can help with the crisis by providing an office-based opioid treatment (OBOT) program.</p><p><strong>Objective: </strong>To describe the necessary steps and considerations to put in place for implementing a telehealth OBOT program. Establishing a telehealth program for patients controlled on medication-assisted treatment can improve access to care, improve patient compliance, and redirect the workflow of the family practice.</p><p><strong>Methodos: </strong>After a literature review of established OBOT programs, state and federal laws, Medicare and reimbursement policies, a telehealth opioid treatment program was designed for private primary care practice.</p><p><strong>Conclusions: </strong>Primary care practices can should implement an office based opioid treatment program via telehealth to improve workflow and accessibility to care.</p><p><strong>Implications for nursing: </strong>To offer improved access to care for patients with opioid addiction and seamless workflow in the office-based setting, primary care practices should consider establishing their telehealth OBOT program based on the following recommendations.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38724243","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}