Graduate nurses' transition from school to the work place is challenging and often leads to burnout. There was no graduate nurse residency program in women's services at the practicum facility. As a result, this facility had been unable to recruit or hire graduate nurses in the women's services unit. The purpose of this project was to develop a nurse residency program in women's services to address the lack of formal orientation for new graduate nurses at this facility. A graduate nurse residency program will provide further training for nurses to care for a more complicated population of pregnant women. Theoretical support for this project was Duchscher's, theory of transition, which suggests that allowing graduates time to adjust within a context of support allows them to develop their thinking and practice and helps them move through the stages of professional role transition. The project included a review of literature, development of a nurse residency plan, all materials needed to operationalize the program in the institution, and plans for implementing and evaluating the program over time within the context of institutional challenges, goals, and strengths. Collaboration with institutional stakeholders helped to ensure the contextual relevance of the program and ongoing administrative ownership to provide momentum for the program to move forward following delivery of the products of the DNP project to the institution. In sum, the products of this project comprise a turn-key solution to the institutional need for a graduate nurse residency program in women's services. Social change implications include possible improvement in the recruitment and retention of graduate nurses as well as the consistent development of competent and safe practitioners who will improve maternal and newborn outcomes at the facility.

The practice problem for this quality improvement project was the lack of engagement of chronic back pain patients at a Midwest clinic in evidence-based risk/benefit discussions regarding treatment options. The project was designed to explore whether practice guidelines increase patient engagement as measured by the Patient Activation Measure (PAM). Practice guidelines for interactive patient/nurse practitioner discussions regarding treatment options were developed, implemented, and evaluated. The concepts of chronic pain, chronic pain treatment options, and patient engagement were researched, and the evidence was evaluated using the Grades of Recommendation Assessment, Development, and Evaluation system. The clinical practice guideline was developed following the domains of Agree II. The project was based on the Chronic Care Model and Roy's Adaptation Model. Sources of evidence included literature on the PAM survey and development and implementation of a clinical guideline. To evaluate the project, PAM data were analyzed using a paired t test to compare means before and after implementation of the practice guidelines. The PAM mean score was 45.86 prior to guideline implementation and 76.62 post implementation. Paired t testing (p < .000) showed statistically significant increase in scores. Implications for the patient might be a decreased level of chronic back pain by patients' full engagement in treatment options. Contributions to positive social change include increased patient engagement because patients will experience control over treatment options and experience less pain as a result.

Catheter-associated urinary tract infections (CAUTIs) account for 40% of all nosocomial infections in the United States, affecting nearly 900,000 patients per year. The indwelling urinary catheter (IUC) is a widely utilized device in modern hospital environments, yet they are not always used appropriately in hospital settings and can result in prolonged use and improper management, increasing risk of infections and length of stay. Nurses are the primary champions to promote preventative measures, provide patient education, and evaluate evidence-based practice (EBP) strategies to decrease CAUTIs. The purpose of this study was to determine if nursing education on EBP guidelines could decrease CAUTI rates in hospitalized patients on a medical surgical unit. A quasi-experimental, one group, before-and-after design was used to evaluate changes in CAUTI rates before and after the educational intervention in a hospital in the southeastern United States among staff of 63 nurses. The baseline unidentified CAUTI rate of the selected population was provided by the organization prior to the educational intervention. There were 55 nurses who attended the educational session and the post-CAUTI rate was evaluated 1 month after the educational intervention. At the end of the study period, analysis of CAUTI rates were conducted using a chi square test to evaluate whether there was a significant difference in the CAUTI rates. A statistically significant difference was found in the pre-to post-CAUTI rate (p < 0.05). The results of this study demonstrated that educating nurses on the CDC- recommended EBP guidelines and providing them with leadership supports significantly decreased CAUTI rates on a medical surgical unit. These findings suggest that using an effective approach to decrease CAUTI rates can create social change and initiate additional planning strategies for all healthcare settings.

Yearly influenza (flu) immunization rates for hospital healthcare workers (HCW) continue to be lower than those suggested by the Centers for Disease Control and the World Health Organization. Vaccination is considered a valuable step in the process to protect patients against influenza infection. The goal of Healthy People 2020, and most hospital administrators, is that 90% of HCWs are being immunized. The objectives for this systematic literature review were to identify best practice recommendations for improving the vaccine rate among HCWs. The Cochrane methodology framed this systematic review, and Fineout-Overholt's and Melnyk's levels of evidence were used to evaluate the reliability of information and effectiveness of their interventions. Twenty articles that met the inclusion criteria (HCWs with direct patient contact, published between 2009-2016, and written in English) were reviewed. Eight articles met Melnyk's criteria for evidence Levels 5 to 7, 8 articles met the criteria for Levels 3 to 4, 2 articles were Level 2, and 2 articles were systematic reviews of randomized controlled trials (Level 1). The major influences for accepting the flu vaccine was for self-protection; the leading deterrent for receiving the flu vaccine was unbelief and questions about effectiveness. Best practice strategies to increase vaccination rates among HCWs include understanding cultural beliefs, practices, and diversities. Involvement of leadership will direct changes through future policy development. The impact of a progressive flu vaccine campaign can effectively promote social change when health care workers' concerns are addressed and vaccination rates improve. Together, quality of care for patients may also improve.

Glycemic control of the perioperative patient improves patient outcomes, specifically prevention of surgical-site infections. The prevention of surgical-site infections helps to reduce complications that can increase length of stay and readmissions, thereby increasing healthcare costs. The purpose of this project was to provide an educational module to the same-day surgery nurses on a clinical guideline to maintain glycemic control of the perioperative patient to prevent surgical-site infections. Lewin's change theory guided the development of a clinical practice guideline (CPG) for nurses to standardize the glycemic management of the perioperative patient. This project was conducted to determine whether educating nurses through the implementation of the CPG would help to ensure glycemic control of the perioperative patient. Twenty-nine nurses were educated and tested on the CPG for glycemic management of the perioperative patient; pretest and posttest results were recorded and data were analyzed. Posttest results showed an increase in test scores. Results indicated that nurses' knowledge about glycemic control and understanding of the importance of glycemic management of the perioperative patient increased. These findings can bring positive social change by helping to improve patient outcomes and cost savings through the prevention of surgical-site infections.

Research has shown that telephone drug reminder scripts can be an effective way to increase drug adherence and decrease health care costs for persons with Type 2 diabetes. The purpose of this project was to develop and validate a telephone drug reminder script for Type 2 diabetes patients based on evidence-based practice. Following a review of the literature, a telephone drug reminder script was developed for Type 2 diabetic patients to educate and improve drug adherence. Five local experts with at least 10 years' experience in diabetes treatment, education, and or research were asked to participate in the validation of the developed telephone drug reminder script. The 5 experts were placed in a quiet room and asked to review the developed telephone drug reminder script and complete an 18-question Likert-type survey on the design of the script, the content, and the process and time for completion. Each expert was given ample time to review and provide feedback on the developed telephone script. Descriptive analysis was used to analyze survey results. All local experts strongly agreed that the design was easy to follow and understand and that there was enough content to help improve Type 2 diabetic patient drug education and adherence. By improving drug education and adherence, 95% of the experts agreed that there would be a decrease in outpatient clinic visits for diabetic management. Revisions to the telephone drug reminder script were made based on the survey analysis. The validated telephone script will be used in a pilot study compared with standard of care in the future. The validated evidence-based telephone drug reminder script for Type 2 diabetic patients has the potential to improve patient outcomes and reduce health care costs for those living with Type 2 diabetes.

To increase continuity of care and reduce clinical errors, management in an inpatient rehabilitation unit of a private, nonprofit hospital chose to change the care delivery model to primary nursing; unit nurses had inadequate understanding of primary nursing, creating a gap in practice. The purpose of this project was to develop an educational program on primary nursing to address the question of how education on primary nursing would impact the understanding of the model among the nurses in the patient rehabilitation unit of the project site. Rogers's diffusion of innovation model provided a framework for developing the educational program. The educational program was supported by research and literature in addition to input from a project team comprising five participants, the unit manager, associate manager, and three charge nurses from the unit. The project evaluation process included an evaluation questionnaire that included 10 questions using a Likert-type scale. All team members scored outcomes as strongly agree and agree. Descriptive statistics indicated that all team members agreed the project goal was appropriate, the project objective was met, and that leadership was demonstrated throughout the project process. The implications of these findings for positive social change include improved nursing competencies and capabilities, tailored care and continuity to care, as well as improved organizational outcomes.

Central-line catheters save lives, but they can also bring about complications, such as hospital-acquired infections. The Institute of Healthcare Improvement has collected data indicating that using proper insertion techniques and maintenance care, known as "the bundle," can prevent bloodstream infections associated with central lines. Progress has been made toward that end: The bundle has been used in intensive care units in a variety of hospitals and reportable central-line infections have decreased by 38%. However, because infections continue to occur inside and outside intensive care units, more needs to be done to protect all patients from these deadly infections. The purpose of this project was to initiate a dedicated central-line access team to insert and maintain all central-line apparatus at the target hospital. One month of data was collected before and after implementing the dedicated team approach and included when the order was written, when the central line apparatus was inserted, who inserted the central line, the number of infections, and the number of complications associated with the central-line apparatus. According to the results, complications, such as infections and occlusions--known to be associated with central lines--decreased twofold and placement delays decreased by 3 hours (57%). The results support the establishment of a committed multidisciplinary team to insert and maintain all central lines. Hospital safety and quality departments will be interested in the methods and outcomes of this project that reduced central line-associated bloodstream infections, decreased treatment delays, and saved the patient and the healthcare organization from costly additional services.

Sickle cell disease (SCD) is a blood disorder that is inherited from both parents and affects millions of people globally. The symptoms of SCD may be debilitating and pose a significant challenge to nursing care. Hydroxyurea (HU), the Food and Drug Administration (FDA) approved treatment for SCD in adults is reportedly effective, but its usage is still minimal among adolescents with SCD. The purpose of this systematic review was to evaluate existing literature on the barriers to HU use in adolescents with SCD. The Johns Hopkins Nursing Evidence-based Practice (JHNEBP) Rating Scales guided this study. An extensive electronic search of Cumulative Index to Nursing and Allied Health (CINAHL), MEDLINE, Your Journal OVID, Academic search premier, and Cochrane Database of Systematic reviews of articles published in English from 2003 to 2013 was conducted. The 5 articles that met the inclusion criteria were organized, tabulated, and analyzed. The results suggest that inadequate knowledge about HU; physician concern about carcinogenic potential; lack of awareness of the National Heart, Lung, and Blood Institute (NHLBI) recommendations on HU use; and lack of belief in the benefits of HU contribute to providers' under-prescribing and minimal usage of the treatment. The implications for social change include knowledge useful for SCD patients, parents/guardians, care providers, and other researchers who are searching for direction in improving the quality of life of SCD patients. Long-term results may include increased HU usage, decreased pain episodes, fewer emergency room visits, and reduced patient mortality and morbidity.

Heart disease, including coronary artery disease, affects approximately 42 million women in the United States. Many of those affected are not aware they have the condition. Contributing to the problem is the fact that women are more likely than men to be misdiagnosed and undertreated for heart disease. Morbidity and mortality are high in women affected by heart disease, making the problem important to address. The purpose of this project was to understand the coronary artery or heart disease risk and the treatment for the condition provided for 31 participants at a cardiology service in the Northeast U.S. The project question focused on understanding how coronary artery disease manifest in women and the gender differences in treatment for men and women. A descriptive case design was used by gathering data from patient risk profiles and treatments. Participants were males and females aged between 30 and 80. Qualitative data were obtained through cardiology staff interviews and existing literature. The data were subjected to a content analysis to identify emergent themes. Findings indicated that the women experienced different cardiac symptoms to men, and these differences translated to misdiagnosis and resulting treatment ineffectiveness. This project contributes to social change through raising awareness of the gender differences in heart disease presentation so that providers can recognize and treat the condition effectively.