Scholarly Projects (DNP)
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This collection contains the scholarly projects students produced toward completion of their DNP degree.
All content in these collections is open to the public under the agreement stipulated in the non-exclusive distribution license signed by the student upon entering the program.
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Item Implementation of The Comfort Promise to Reduce Pediatric Procedural Pain: A Quality Improvement Project(2024-08) Feltner, BrittanyAbstract Purpose: The purpose of this quality improvement project was to implement the Comfort Promise for needle procedures and evaluate the implementation process and nurses' perception of its use. Background: Ineffective proactive pediatric pain control leads to needle phobia, anticipatory fear, and avoidance of future medical care. Both the American Academy of Pediatrics and the American Pain Society released position statements urging providers to address gaps in acute pediatric pain. The Comfort Promise is an agreement between the caregivers and the patient that considers strategies such as age-appropriate distraction, positions of comfort, topical numbing, and oral sucrose or breast feeding for infants to decrease children’s pain with needle procedures. Sample/Setting: Nurses working on a 14 bed midwestern pediatric unit caring for patients ages 0-18 admitted to the pediatric hospitalist service requiring needle procedures for lab draws, intravenous access, intramuscular or subcutaneous medication, or immunizations. Methods: The nurses’ responses pre/post implementation of the Comfort Process evaluated their pediatric pain management. Chart audits determined integration of the patient’s comfort measure preference and utilization of those specific strategies during needle procedures. Results: Nurses’ post intervention responses demonstrated an increase in comfort measure use from 10% to 41%. Physical restraint use during needle procedures decreased from 26% to 8%. Chart audits suggested that 50% of FYI patient preferences matched the measures utilized during the needle procedure. Conclusion: The integration of the Comfort Promise indicated the potential for enhancing nursing knowledge of pediatric pain management and promoted collaboration between patients and nurses to optimize the pain experience during needle pokes. Keywords: pediatric, procedural pain, needle pain, pain control, childhood pain, painful procedures, Buzzy, topical anesthetic, distraction, comfort promise, intravenous access. - No Thumbnail Available
Item Addressing Post-Intensive Care Syndrome with Family-Centered Interventions(Creighton University, 2024-08) Day, CandraThe advancements in medical technology and interventions has revolutionized the definition of a successful patient outcome. The traditional success of medical treatment was based on a patient’s ability to survive an illness. With a progressive application of evidence-based interventions and technological advances, researchers and healthcare providers are beginning to shift the measurement of positive healthcare outcomes on the long-term morbidity surrounding critical illness. Empirical research findings recognize the long-term consequences of intensive care treatment in the pediatric population. Severe psychological disorders, such as PTSD, depression and anxiety, is estimated to affect 20% of ICU survivors within 1 year of discharge. As a result of the interdependent relationship between a child and caregivers, family members frequently report psychological and emotional trauma as a result of their child’s critical illness. This can have a profound impact on a family’s quality of life, hence directly impacting the care and well-being of the child. Healthcare providers and parents play a pivot role in a child’s recovery path from a critical illness. Awareness of post-intensive care syndrome can allow for early recognition and interventions. The aim of the QI project was to provide education to healthcare team members on post-intensive care syndrome, implement an ICU diary pilot program and assess the usefulness of the diary. The education module demonstrates a significant gap in knowledge concerning post-intensive care syndrome in healthcare team members with a high receptibility. With increased awareness, the healthcare staff team can provide early interventions to decrease the prevalence and severity of PICS within the pediatric population. Diaries offer a cost-effective method of provided family-centered care that can potentially mitigate adverse psychosocial outcomes and improve long-term outcomes of caregivers of critically ill children. - No Thumbnail Available
Item Addressing Social Determinants of Health in Diabetes Education(Creighton University, 2024-07-06) Cabasa, CarishaBackground: Social determinants of health (SDOH) play a significant role in patient outcomes, particularly among individuals with chronic conditions such as diabetes. This quality improvement (QI) project aimed to implement a new process to assess and address SDOH for patients receiving Diabetes Self-Management Education and Support (DSMES) services within a healthcare system in the Pacific Northwest region of the United States. Methods: The project involved conducting staff training, development of resources and tools to support the new process, implementing social needs screenings for new patients receiving DSMES consultations, entering referral requests for care management for patients with positive screens in the electronic health record (EHR) and measuring the staffs’ attitudes towards change through pre- and post- implementation surveys. Results: The QI project revealed critical insights into the prevalence and types of social needs among patients. The screening process identified that over 10% of the participants had significant social needs, highlighting a pervasive issue despite the small sample size and stringent inclusion criteria. Among the patients who screened positive, housing instability was the most prevalent, affecting 100% of these patients, followed by financial strain and food insecurity, each reported by 67%, and utility needs, which affected 33%. Out of the three patients who screened positive, only two referrals were forwarded to care management, indicating a breakdown in the process. The staff survey results indicated an increased understanding of the necessity of the change initiative, from 83% pre-implementation to 100% post-implementation. However, satisfaction with the change initiative decreased from 50% to 33%, and feelings of inclusion in the rollout dropped from 83% to 67%, indicating areas needing improvement in change management and staff engagement. Conclusion: The findings of this QI project underscore the importance of addressing SDOH in patient care, particularly for those with chronic conditions like diabetes. While the project successfully identified and addressed critical social needs, it also highlighted the challenges in implementing such initiatives, including the need for better communication, workflow and EHR integration, and system-level support. To sustain the benefits of addressing SDOH, it is essential to focus on improving change management strategies, ensuring adequate resource allocation, and fostering a supportive environment for healthcare staff. By addressing these areas, healthcare organizations can enhance patient outcomes and create a more effective and inclusive approach to managing SDoH. - No Thumbnail Available
Item Point-of-care ultrasound for Peripheral IV line procedures in the Neonatal Intensive Care Unit(Creighton University, 2024-05) Ahrens, ShirleyPurpose: The purpose of this project was to improve success rates and knowledge for point of care ultrasound in the NICU via development, implementation, and evaluation of an educational program given to selected staff in the NICU. Background: Point of care ultrasound (POCUS) is used in a variety of adult specialties. However, neonatal specialists have been slow to adopt point of care ultrasound because of limited training, costs of equipment, and medical liability concerns. Several studies have shown that using point of care ultrasound for central line procedures improved attempt rates and procedural time and decreased complications. Providers find it difficult to locate the catheter tip position on x-ray alone. Researchers have suggested that ultrasounds are a superior tool to radiographs when determining central line position. Population: This quality improvement project was conducted in a 16 bed, level III NICU in a community hospital. Nine staff members reviewed the information. Methods: An ultrasound education about POCUS was implemented with input from key stakeholders in the NICU. Chosen NICU staff were trained in the use of the ultrasound and provided printed materials for continued use of the equipment. Simulation activities were utilized during the education. Data was collected before and after implementation of the education. An informal survey was done prior to and after the education to ensure that the goals were met for implementation. Information was also reviewed after education to ensure that staff had the resources needed to continue use of the ultrasound. Results: There were improvements in the need for education as noted by the staff members. Ongoing education is still needed to assist the staff to become more proficient with POCUS. Data for ongoing usage of point of care ultrasound in this level III unit is ongoing. Conclusion: Implementation of the use of ultrasound can improve delivery of care and decrease time to insertion and limit overall x-rays in this newborn period. Further staff education will lead to continued use and improvements in the accuracy of reading ultrasound for line placement at the bedside. - No Thumbnail Available
Item Implementation of Specimen Collection Protocol for Neonates with Persistent Hypoglycemia in the Neonatal Intensive Care Unit(Creighton University, 2024-05-09) Downs, SamanthaObjective - The purpose of this quality improvement project was to assist bedside staff with identifying specific laboratory testing or protocol for neonates with persistent hypoglycemia in the Neonatal Intensive Care Unit (NICU). Background - Hypoglycemia can be expected during the first few hours of an infant’s life, but those with risk factors are more susceptible to persistent hypoglycemia. For timely diagnosis and intervention to avoid neurological sequalae, providers and bedside staff must work together to recognize characteristics of persistent hypoglycemia. At Children’s Nebraska, a Level IV NICU, the challenge of efficiently obtaining laboratory specimens for hypoglycemia infants was identified. Methods – Participants included bedside clinical staff and patients in the NICU. An algorithm encompassing current AAP and PES guidelines and additional tests requested by endocrinology medical staff for specimen collection and resources regarding specimen collection was implemented. Bedside staff completed education and a pre-/post-survey to assess perceived knowledge, and a chart review of current and retrospective NICU patients whom required follow up testing after persistent hypoglycemia episodes was completed. Results - Six infants experienced persistent hypoglycemia during the data collection period, but all infants did not receive proper follow-up testing. Therefore, focus of this study transitioned to clinical nursing staff. An increase in knowledge of persistent hypoglycemia and confidence in gathering specimens was observed. Conclusion - Further data collection to include a large patient sample size is needed to assess timeliness of specimen collection for patients, but the success of nursing staff increasing their perceived knowledge is invaluable to diagnosis and provision of efficient, quality care.