Hospital administrators strive to reduce readmission and over use of the acute care setting for chronic health conditions. Historically hospitals have focused on readmission prevention strategies to improve the transition of patients from the hospital to the community and although the causes of a hospital readmission may span multiple providers along the continuum of care, the hospital is currently the only provider being penalized. The project facility implemented a readmission reduction strategy, Re-Engineered Discharge (Project RED), as a means to reduce readmissions and yet continued to have high readmission rates for heart failure (HF) patients. The continued high rate of readmissions led to the practice focused question, which examined the process of developing a discharge phone call script specific for HF patients as a way to reduce readmissions for HF patients. Kristin Swanson's structure of caring model provided the nursing framework for this project with a purpose to plan a telephone call follow up program for HF patients after hospital discharge. The project planning was accomplished in conjunction with the facility's readmission reduction team/LEAN team, resulting in a script about the most prevalent issues among HF patients. Kotter's 8 step change model will be used as a guide for the implementation of the telephone call follow up program at a later date. Readmission rates for HF patients will be monitored monthly as an outcome evaluation measure. Project team members provided evaluation of the project which demonstrated satisfaction and success of the planning process. The results of this project will bring about social change by providing access to healthcare providers regardless the socioeconomic status of the patient and by decreasing the use of acute care setting unnecessarily for chronic conditions.

In September 2016, the Centers for Disease Control and Prevention (CDC) determined that more than one-third (36.5%) of U.S. adults have an obesity problem. According to the CDC, this issue results in other medical conditions such as type 11 diabetes, hypertension, cancer, heart disease, and stroke. This project was designed to evaluate the effectiveness of an evidence-based weight reduction program for obese individuals at a medical facility in the North Central United States. The methodology used consisted of a retrospective chart review of pre- and post-data for 45 people who participated in the medical facility's weight-reduction program over a 6 month period. Results showed an average weight loss of 19 pounds by participants in the program. A t-test for dependent samples was conducted to compare pre-and post-program weights. Findings suggested a statistically significant difference (p < .001) decrease in weight before and after participation in the program. Effect size, measuring the magnitude of the difference between pre- and post-program participant weight, was (d = 0 .58). Findings of this project suggest that the program has merit and worth as a weight management aid for the context in which it was developed and implemented. The inclusion of other clinics in the weight loss program serves as potential transferability of knowledge in obesity management to similar contexts. Extending the program to a full one year may yield further benefits. A periodic follow-up with participants in the program may lead to opportunities for longer-term evaluation. This project contributes to social change by empowering participants in weight reduction and health management.

Childhood obesity has reached an epidemic level in the United States, growing exponentially and posing a great risk to the current and future health of the American people. The trend of increasing incidence of overweight and obesity in children has been occurring for decades; there is a need for multimodal preventative solutions to control the rate of growth. Sufficient evidence has shown a correlation between the feeding of 100% fruit juice to infants as dietary supplements and childhood obesity. Therefore, the purpose of this project was development of a guideline for 100% fruit juice feeding in children that is adaptable to the 2017 American Academy of Pediatrics evidence-based policy statement and educational materials to guide providers in their recommendations for fruit juice consumption in children. The project leveraged information from literature review to develop an obesity prevention and control guideline. Evaluations of the guideline were provided by nurse practitioners using the Appraisal of Guideline, Research and Evaluation II. Nine nurse practitioners at the study site evaluated the guideline. The nurse practitioners' score for overall quality was rated at 93% indicating that the guideline met its objective of providing a plan for improving 100% fruit juice consumption in children. All participating nurse practitioners agreed that the guideline and materials were well prepared, easy to understand, and achievable. Provider education and implementation of the guideline will impact the health of very young children. As a result, vital social change can be achieved in children through positive influence and the empowerment of nurse practitioners to provide obesity control and prevention using the recommended prescriptions for 100% fruit juice consumption for infants and children.

Lack of education in the outpatient setting related to causes, complications, and prevention of obesity is associated with high rates of obesity in adolescents 12 to 19 years of age. The gap in the adolescents' and family members' knowledge of obesity contributes to the adolescents' high calorie consumption and the development of obesity. The purpose of this project was to develop a staff education guideline for use by clinicians to educate adolescents and their families on how to develop nutritious food plans and decrease obesity. The project practice question asked whether educating the primary care providers in the primary care setting increased the effectiveness of clinicians' efforts to educate adolescents and families on proper nutrition, obesity, and healthy eating. Development of the educational guideline was guided by Pender's health promotion model and Bandura's self-efficacy theory to effect the behavioral change needed to achieve the project goals. The pre- and posttest design was used with Jump Up & Go! Physical Activity and Nutrition Survey results for data collection from the electronic medical records of 20 adolescents. Results were analyzed using descriptive statistics and revealed that the staff educational guideline was 90% effective in increasing the clinicians' efforts to educate adolescents and families about obesity. Results also showed that the program was 80% effective in increasing adolescents' and family members' knowledge of obesity, assisting them in making nutritious choices to decrease obesity. The social change implications of the adolescent obesity staff educational guidelines are aligned with using evidence-based practice guidelines to increase provider efforts to empower adolescents and their families to eat well and stay healthy.

Nurses are exposed to traumatic patients and high stress regularly; this repeated exposure can increase rates of compassion fatigue and vicarious trauma. When nurses are not properly educated about compassion fatigue and vicarious trauma, it can impact their ability to provide effective patient care and result in harmful effects including insecurity, altered cognitive functioning, loss of empathy and diminished self-esteem. This project focused on educating psychiatric nurses regarding compassion fatigue and vicarious trauma. The theory guiding the project was the Neuman's system model. Fifty-six psychiatric nurses were administered a pretest consisting of 10 multiple choice test questions. They were educated on the concepts of vicarious trauma and compassion fatigue using a presentation and handouts. After the education was completed, participants were administered a posttest with the same 10 multiple choice questions. An evaluation tool consisting of Likert-scale questions to evaluate the presentation was also completed after the posttest. The pretest and posttest scores were analyzed using a learning-scores-gained formula. The results showed that the mean pretest score was 89.2% while the posttest score was 97.1%. The aggregate score difference was 7.9, indicating a group knowledge gain of 7.3 %. The majority scores for the educational presentation evaluation were outstanding and all feedback was positive. This project would benefit nurses by increasing their knowledge on compassion fatigue and vicarious trauma leading to positive social change by improving their workplace environment and reducing nursing turnover.

Falls and falls with injury are a leading contributor to decreased quality of life for adults aged 65 and older. Complications associated with fall occurrences include death, long term disability, decreased mobility, decreased quality of life, and psychological effects. The practice focused question addressed in the project asked if the use of a standardized publicly available assessment for falls risk will assist registered nurses in learning more about the patient's fall risk. To address the question, the Stay Independent Check Your Risk for Falling Questionnaire (SICRFQ), obtained from the CDC website, was used as the basis for an education program for nurses to evaluate patient risks for falls. The theory of planned behavior guided the project which resulted in nurses gaining increased knowledge of falls risk assessment using the SICRFQ instrument. Findings from this staff education project indicated that 85% (n=29) of from a general practice unit registered nurses participating in the project reported that the education and the SICRFQ instrument would assist them in engaging and educating patients and families on fall risk avoidance; and 97% (n=33) indicated they would use the instrument for assessing patients. Use of the SICRFQ instrument will assist registered nurses in improving patient safety through accurate assessment of falls risk and potentially decrease falls in their unit thus promoting positive social change.

Through discussion with the community health system's administration, it was identified that their current nursing orientation program was not well structured or comprehensive. The nursing staff also reported dissatisfaction with the current program. Therefore, a Doctor of Nursing Practice project commenced to develop an evidence-based nursing orientation program for Registered Nurses (RN) and Licensed Practical Nurses (LPN) at a community health system in Virginia. The Competency Outcomes Performance Assessment model guided development of the project through a comprehensive literature review to identify evidence-based data for competencies, learning strategies, and performance evaluations. This review highlighted the importance and benefits of nursing orientation programs as well as the use of evidence-based strategies. As a result of this review, an evidence-based nursing orientation program was developed to meet the needs of the nursing staff as well as the organization. The evidence-based nursing orientation program was translated into an electronic format with an accompanying manual to be used when nurses are hired by the community health system. An advisory board from the organization reviewed the program and their feedback was incorporated. Social change is expected to occur, as nurses will be better prepared for their new position with increased job satisfaction and also to provide optimal care to patients from the community. This project addressed a gap in the literature for generalized nursing orientation programs. Publication in a peer-reviewed journal or oral presentation at the Virginia Community Healthcare Association annual conference was selected for project dissemination.

The Centers for Disease Control and Prevention (CDC) estimates that catheter associated urinary tract infections (CAUTIs) account for 40% of all the hospital acquired infections in the United States. The use of an indwelling catheter is common in hospital settings. Improper placement, assessment, and maintenance can increase the risk for CAUTI, increase the length of stay, and cause harm to the patient. The purpose of this project was to decrease CAUTI rates in a critical care unit by educating nursing staff on the use of the CAUTI bundle and the CAUTI maintenance tool. The practice questions focused on (a) whether an education program for nursing staff on CAUTI extends the knowledge of nurses in managing patients with indwelling catheters and (b) if an education program for nursing staff on CAUTI decreases the incidence of CAUTI. Malcolm Knowles's theory of adult learning guided this project. Data on CAUTI incidence pre- and post-education program reflected zero CAUTI incidence in the month following the education program with 96% of the nursing staff following the CAUTI protocol. Participants completed a post program evaluation. All participants identified that they agreed or strongly agreed that the program met the objectives identified on the evaluation form and that the content extended their knowledge of the topic. This project may contribute to social change by impacting the potential for patients to have less infection leading to decreased hospitalizations and improved quality of life.

Bariatric surgery is a major surgery that has become a frequent procedure in North America; growth in the number of bariatric surgery procedures has resulted in an increase in readmissions after the procedure. A systematic review of the literature using the shifting processes model as a guide was used to answer the practice-focused questions regarding reasons for hospital readmissions for postoperative bariatric surgery patients and strategies that reduce complications of the procedure. Providing Innovative Service Models and Assessment chart (PRISMA) was used to quantify 17 studies that met the inclusion criteria. Results demonstrated that the reasons for readmissions after bariatric surgery were related to leakage of the surgical site, infections, bowel complications, and lack of family support or other support system at home. Strategies reported in the literature that were effective in reducing complications included having a support system and preoperative and discharge education for bariatric patients. The most effective method to prevent readmission following bariatric surgery was careful preoperative assessment and screening for comorbidities, particularly gastrointestinal disorders. The results of this project may promote positive social change by providing evidence-based information for professionals and consumers to prevent readmissions following bariatric surgery.

Diabetes is a chronic disease that can be self-managed to control the disease and its adverse consequence. The purpose of this systematic literature review was to examine the barriers to patients' successful adherence to the self-management plan and to examine strategies used to improve patients' compliance with self-care behaviors. Three practice-focused questions focused on the personal characteristics or factors influencing patients' compliance with self-management, the barriers to patient compliance regarding diabetes self-management, and the effective strategies used to improve patients' compliance with diabetes self-management at primary care clinics. The literature review used the preferred reporting items for systematic reviews and meta-analyses model and the Johns Hopkins nursing evidence-based practice models. Findings showed that implementation of strategies using technology messages and texts can significantly decrease hemoglobin A1c levels, reduce complications of people with diabetes, and bring about social change by minimizing the prevalence of diabetes in the United States. The implementation of the project's outcomes can improve proper self-management practices among patients with diabetes, decrease the diabetes incidence among adults, and minimize health-related complications.