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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    Point-of-care ultrasound for Peripheral IV line procedures in the Neonatal Intensive Care Unit
    (Creighton University, 2024-05) Ahrens, Shirley
    Purpose: 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.
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    Implementation of Specimen Collection Protocol for Neonates with Persistent Hypoglycemia in the Neonatal Intensive Care Unit
    (Creighton University, 2024-05-09) Downs, Samantha
    Objective - 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.
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    Improving Provider-Patient Communication: Implementation of Communication Cards
    (Creighton University, 2024-04-30) Reinitz, Kim
    Improving Communication Between Patients and Providers in a Rural Hospital through Implementation of Communication Cards: A QI Project Kim Reinitz, MSN, APRN, FNP-C Cathy Carrico, DNP, APRN-NP, FNP Creighton University College of Nursing Purpose: The purpose of this DNP project is to improve patient and provider inpatient communication in a rural, acute inpatient prospective payment system hospital through the implementation of communication cards upon admission to the hospital in patients aged 65 and older over a 10-week period. Background: Effective communication between health care providers, patients, and their caregivers is essential to safe quality care, especially during the time of transition of care out of the hospital. Elderly patients are particularly vulnerable to adverse outcomes related to their hospitalization from admission to transition out of the hospital. Previous quality improvement projects have provided tools which have significant barriers to the elderly patient. Sample/Setting: Rural hospital, acute inpatient prospective payment system twenty-one bed facility. Population: Patients over 65 years of age, hospitalized, English speaking, with intact cognition. Methods: Using the 4 M’s Framework for care of older adults, a QI project was developed to improve communication of hospitalized older adults through the development and use of a communication card, which was given to patients by the hospitalist provider on admission and reviewed daily during rounds, throughout the hospitalization. On day of discharge, the patient was given a satisfaction survey to determine the impact and satisfaction of the communication card in improving communication with their provider. Results: Eleven Patient provider cards and patient perception surveys were completed. Most patients perceived a greater sense of satisfaction in their overall hospital care, identifying the care as helpful in improving communication with their provider. The few who did not identify improvement of greater satisfaction stated they had no issue with how their provider communicated and therefore did not identify an initial need for improvement. Conclusion: Increasing hospital provider-patient communication using a simple and inexpensive communication card beginning upon admission has been shown to improve both overall communication and satisfaction of their hospital experience. Targeted Levels of Sedation in the Critically Ill Chil
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    Quality Improvement Project: Social Supports Screening of the Adolescent Population in the Inpatient Psychiatric Hospital
    (Creighton University, 2024-04-30) Tristant, Amelie
    Background: Adolescent mental health is a pressing public health concern, with social support playing a crucial role in preventing psychiatric hospitalization. Existing literature emphasizes the importance of assessing social support to enhance coping mechanisms and resilience in adolescents. Problem Statement: Currently there is a lack of standardized screening tools to assess adolescents' support systems within psychiatric settings. This hinders healthcare providers' ability to identify social support deficits and tailor interventions to improve patient outcomes. Rationale: Implementing a social support screening tool can address this problem by enabling healthcare providers to systematically assess adolescents' support networks, correlate these with mental health status, and identify areas for intervention. Participants: The study involved adolescent patients aged 12 and above admitted to an inpatient psychiatric unit at a large Midwestern hospital. Methods: Data collection utilized the Multidimensional Scale of Perceived Social Support (MSPSS), alongside demographic information including age, ethnicity, and gender identity. Findings: Over six weeks, 56 MSPSS tools were completed, revealing trends including white females reporting the least social support and transgender individuals exhibiting low to medium levels. Most patients were female, with family-related questions scoring lowest. Conclusion: The project underscores the relationship between social support and adolescent psychiatric hospitalization. Recommendations include incorporating family therapy and emotional expression education during hospitalization. Implications: Implementing standardized social support screening tools can enhance healthcare providers' ability to identify and address social support deficits in psychiatric settings, ultimately improving patient outcomes and well-being. Continued research and practice refinement are crucial to further refine interventions for this population.
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    Targeted Levels of Sedation in the Critically Ill Child
    (Creighton University, 2024-05-09) Hale, Casie
    Purpose: The purpose of this quality improvement project was to educate Pediatric Intensive Care Unit (PICU) staff about post-intensive care syndrome (PICS) and to utilize the Richmond Agitation Sedation Scale (RASS) score to assess, monitor, and adjust sedation to pre-determined targeted levels to minimize the risk of over- and undersedation of all mechanically ventilated PICU patients. Background: PICS is a newly recognized condition which occurs in patients following an intensive care stay. This condition exhibits a wide spectrum of physical, psychological, and cognitive symptoms. The Society of Critical Care Medicine (SCCM) provides guidelines to reduce the risk of PICS through their ICU Liberation (A-F) Bundle that promotes strategies to reduce patient time spent on mechanical ventilation and enhance efforts to maintain appropriate levels of sedation. Sample/Setting: All day and night shift PICU RNs, regardless of full-time, part-time or per diem status, PICU residents, and pediatric intensivists. The intended target population was pediatric patients that were mechanically ventilated in the PICU. The project was implemented in a 12- bed PICU at a Midwestern children’s hospital. Methods: A coordinated education and targeted level of sedation protocol was implemented and evaluated with descriptive statistics. All PICU RNs received PICS education. The nurse driven, goal-directed, sedation protocol was updated to include a targeted level of sedation. A multidisciplinary rounds (MDR) checklist guided discussions for determining individualized targeted levels of sedation. The MDR was utilized during daily rounds. Results: A total of 18 patients were included which represented 114 sedation days. Out of the total number of sedation days, there were 77 days in which a targeted RASS score was prescribed and located in the chart (68%). Of the 77 ordered RASS scores, 40 (52%) met the targeted level. Conclusion: The MDR checklist appears to be a reasonable strategy to promote prescription of targeted sedation levels for mechanically ventilated PICU patients. The nurse driven sedation protocols demonstrated some success (52%) in achieving targeted levels of sedation suggesting that further education to promote uniform sedation practices should be considered.