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 Go Wish Together for Pediatric Solid Organ Transplant Families(Creighton University, 2024-12-13) Owens, TrudieAbstract Purpose statement: The purpose of this quality improvement project was to improve the care of patients and families of the pediatric solid organ transplant team by focusing on patient and family- centered goals of care using primary palliative care skills and the Go Wish Together conversation tool. Background: There is significant morbidity and mortality for solid organ transplant recipients. Referrals to palliative care (PC) in this adult and pediatric population are inconsistent and often late, near the patient’s end of life. Improving quality of care through utilization of PC services can contribute to hospital savings through a reduction in LOS and reduced charges and can reduce nursing attrition. The post-transplant period can be complicated by significant symptom burden, however, referrals to palliative care in the adult and pediatric population are inconsistent and often late or at end of life. Practice change and Implementation strategies: A convenience sample of families with pediatric patients admitted under the care of the SOT team at Nebraska Medicine was used. The process was introduced with written and verbal information by the provider to initiate the Go Wish Together Conversation Card game process. Caregivers were directed to divide the cards into categories of “very important”, “somewhat important” and “not important”. Category content wase explored and discussed with the provider. A dot phrase was utilized to communicate participation in the project and family wish preferences were entered on a “sticky note” within the electronic medical record as a reference to be utilized during team rounds. Evaluation: This project was implemented over a six-week period with eight parents of pediatric solid organ transplant parents in the pediatric and pediatric intensive care units at a large, urban academic health center in the Midwest. “For my child to be free from machines” and “To manage appetite changes and nutrition plans for my child” were the most frequently categorized in the very important category. Conclusions and implications for practice: A focus on family-centered goals proved to be welcomed and beneficial in helping highlight family challenges and gaps in support that exist not only within the hospital environment, but within the larger context of these families’ lives. Use of the conversation tool allowed an opportunity for caregivers to discuss their experiences and receive resources that otherwise would not have been addressed. - No Thumbnail Available
Item Increasing Awareness of Interprofessional Collaboration in Healthcare among High School Students(Creighton University, 2024-12-14) Zander, KatieThe status of the health care system needs a healthcare workforce prepared for interprofessional collaboration (IPC). The need to improve IPC in healthcare is urgent. IPC practice requires interprofessional education (IPE) to be present during the educational process. IPE and IPC are familiar terms in nursing, medical, pharmacy, physical therapy, and other healthcare professional educational programs, however it is noted that by the time a student has selected a healthcare professional path they have preconceived attitudes, notions, and ideas regarding their future profession and its position in the hierarchical healthcare system. Integration of teams and the knowledge of IPC will help students understand their roles in relation to other’s roles in interprofessional collaboration. To have a well performing interprofessional team trust, respect, and equality are necessary. Education on the need for IPE and IPC is needed early in the educational process, prior to the selection of a career path in health care to increase the effectiveness of IPE, IPC, and healthcare outcomes. The purpose of this DNP project was to develop and evaluate interprofessional education programing for high school students interested in nursing and other health professions at the Nebraska HOSA State Leadership Conference in Omaha, Nebraska in Spring 2024. The planning phase of this program development and evaluation project included creating a logic model outlining the following activities: a letter to parents prior to the event explaining the project, participant recruitment strategy, obtaining a demographic data from participants, and developing a lesson plan for the IPE sessions. Each conference session utilized a pre and post survey, team activities, IPE videos, discussion/debrief with a short lecture. An evaluation tool, the W(e) Learn Interprofessional (IP) Program Assessment Tool was completed by advisors/teachers in attendance. The Tool for Observing the Construction of Knowledge in Interprofessional Teams (TOCK-IP) was completed by a faculty member observing a student group in each session. Implementation data was analyzed for simple descriptive statistics. Nine, sixty-minute sessions were completed over a two-day period. Initial data shows that eighty-six students participated in the pre-survey activity, with seventy-two completing the post-survey. This is less than the 50% of conference attendees, however more than 75% of students attending the sessions completed both surveys. A few barriers to student attendance included concurrent sessions, competitions, and difficulty finding room. The Tool for Observing the Construction of Knowledge in Interprofessional Teams (TOCK-IP) was completed on one group in each session as well as five W(e) Learn Interprofessional (IP) program assessment surveys were completed by advisors and/or teachers in attendance. The program plan worked well and subjective oral and written feedback received was positive. Student responses in the post survey reflects that > 89% of participants found the session promoted problem solving, was engaging, enjoyable, and provided a deeper appreciation of collaborative practice in patient care. Nursing and medicine were among the top choices for future professions. Results indicate that high school students provided with introductory education on IPE are more aware of IPC and IPC’s importance in their future career. - No Thumbnail Available
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.