Thousands of people die each year due to preventable medication errors. Barcode medication administration (BCMA) systems can reduce medication errors at the point of care, thus increasing patient safety. The purpose of the project was to gather evidence regarding BCMA usefulness in reducing medication errors. Kurt Lewin's 3-step change theory was used to guide this project. The nature of this project was a systematic review of the literature pertaining to the effectiveness of using BCMA systems to reduce medication errors in at the point of care in the hospital setting. The Johns Hopkins nursing evidence-based practice model and tool kit was used to evaluate each article. The review comprised one systematic review, one integrative review, and 6 before-and-after observational studies. The results of each study indicated that the use of a BCMA system could reduce medication errors but not completely eliminate them. The findings of this project contribute evidence that BCMA systems can assist the clinician in safely administering medication. Dissemination of the evidence will contribute to a positive change by promoting greater understanding of the effectiveness of using BCMA systems in all areas that administer medication.

African American men have a significantly higher incidence of prostate cancer, they are diagnosed at a later age, have more advanced stages of cancer at diagnosis, and higher mortality rates than other ethnic group. The purpose of this project, guided by the Ottawa decision support framework and the health belief model, was to investigate whether church leaders could be trained to deliver an educational program about the value of prostate cancer screening to African American males in a church setting. The 2 participants were church leaders in a predominantly African American church. The participants were taught about prostate cancer and the value of screening using videos and informative brochures developed by the National Institute on Aging, the American Cancer Society, and the Centers for Disease Control and Prevention. A researcher-designed pre- and posttest questionnaire was used to measure learning. Data were analyzed using a paired sample t test. Although small sample size may have contributed to lack of statistical significance, the mean score comparison showed knowledge acquisition, thus enabling the trainers to offer the information to members of their congregation, who could then make informed decisions. This study demonstrated the value of using unconventional educational settings, such as churches, to reach populations who might be unaware of their health risks. The results show that church leaders can be trained to have a positive impact on the physical health of their congregations and promote social change by encouraging health care practitioners to investigate alternative settings and methods to educate vulnerable populations about diseases and disease prevention.

The rate of obesity in American adults has increased dramatically over the last decade. Obesity has reached epidemic proportions and demands attention to reverse the current trend. This project was developed to evaluate a quality improvement initiative implemented in 2016 to address the problem of obesity in a rural southeastern primary care clinic setting where underserved populations are treated. The quality improvement (QI) initiative was developed using the plan-do-act-check model and the evaluation of the initiative was the focus of the current project. The project question asked if a quality improvement initiative for weight loss monitoring and counseling could improve health outcomes for a rural clinic setting. The project examined the impact of the initiative's outcomes of weight and body mass index (BMI) and lipid profiles. Deidentified data from 10 patients who were treated in the clinic during a 3-month time period before the QI initiative was implemented and 10 patient records during the 3 months after the QI initiative was in place for 3 months were obtained from the clinical site and were entered into SPSS for analysis. Results of an analysis of variance demonstrated that after the QI initiative was in place, BMI improved (p < .001) in the 3- month post intervention period compared to the pre-intervention levels. Similarly, total cholesterol levels (p <.001) were decreased post intervention. LDL cholesterol did not show a significant difference at the 3-month post-intervention stage although HDL cholesterol improved. Results demonstrate that a QI initiative that addresses weight loss in a rural clinical setting can improve health outcomes and promote positive social change in a rural underserved community.

Neonatal abstinence syndrome (NAS) is a public health concern that is increasing in the United States due to the use of illicit drugs by pregnant women, which exposes the fetus to these substances. NAS results in increased infant morbidity and prolonged stay in the hospital, which can lead to increased cost of care. The inability of the nurses to care for at-risk infants can lead to inconsistent NAS scores, which can affect the infant's care treatment. The project examined the effectiveness of educating the neonatal intensive care unit (NICU) nurses on the correct use of the modified Finnegan Neonatal Abstinence Tool (FNAST) and implementing a practice protocol in the management of infants experiencing NAS, thereby reducing inconsistencies in NAS scores. Implementing clinical guidelines and proper use of the modified FNAST can lead to early intervention and treatment of infants exhibiting withdrawal symptoms. An educational session was conducted, pretests and posttests were used to evaluate the NICU nurses' baseline knowledge of the correct use of the modified FNAST and their acquired knowledge after the educational intervention on the correct use of the modified FNAST. The goal of the project was met with the NICU nurses experiencing knowledge gain evidenced by a 30% increase between the pretests and posttests and obtaining consistent NAS scores by applying the correct technique of scoring. The mastery of the use of the modified FNAST brought about social change by impacting positive attitudes and behaviors among the NICU nurses and enhancing collaboration between the physicians and nurses.

Nurses play a crucial role in promoting educational programs aimed at informing women about their reproductive health. However, the role of nurses in providing the health related information is not well defined. Guided by the continuum model, this project evaluated nurses' perceived role in promoting the reproductive health of women during the preconception period. Twenty nurses from 2 outpatient offices wrote responses to an open-ended questionnaire. A summary of the responses indicated that 70% of the participants refer women to community-based programs to enhance awareness for preconception care. Twenty percent of the nurses indicated that they have an educational program for preconception at their practice sites. However, 70% of the participants responded that their organization does not have a standardized procedure for educating women on the preconception period. Ninety percent of the respondents clearly defined their role in educating women on preconception care and 80% reported offering preconception counseling at every clinic visit. In addition, 60% of the nurses (n = 12) were knowledgeable about reproductive health of women. Preconception care to women could be improved by increasing nurses' knowledge regarding important preconception topics and developing standardized educational materials to distribute to women in the preconception period. Organizational policies and procedures for providing preconception education into the standard of care may be developed. Enhancing nurses' roles in educating women during the preconception period may reduce the number of unplanned pregnancies, lower maternal deaths, and reduce maternal and infant mortality.

Caring is central to the nursing profession and important to patients and family members who expect nurses to display caring attributes. The acute care hospital in this study did not have an education program on caring practices for nursing staff although the organization acknowledged the importance of and need for a culture of caring practices in the organization. The purpose of this project was to design an educational program based on Watsons' theory of caring for registered nurses at the acute care hospital where the project took place. Rosswurm and Larrabee's model for change and Watson's theory of caring were the frameworks used to guide the project. The practice-focused question asked if a caring nursing education program could be developed after assessing the level of caring of the staff in addition to evidence-based practice literature. The Caring Factor Survey-Care Provider, a 20-item survey, was used to have staff rank Watson's 20 caring factors on a 7-point Likert scale. Data from the surveys were collected from 37 registered nurses on the medical surgical nursing unit; then, results were tabulated and used in the development of a caring education curriculum. Results indicated a mean range from 4.70 to 6.75 with perception of being respectful of patients' individual spiritual beliefs and practices (mean score of 6.75) ranking highest and creation of a helping and trusting relationship lowest (mean score of 4.70). Items where staff scored a mean score less than 5 were incorporated into the education curriculum. The caring educational program may bring positive social change to the acute care hospital by changing the culture of nursing and nursing practice toward an awareness of caring and caring science.

Each year, over 50 million surgical and nonsurgical inpatient procedures are performed and yet, shared decision making between patients and health care providers is not achieved. Obtaining patients' informed consent is part of a nurse's daily routine during admissions and before a procedure. The purpose of this project was to evaluate evidence to answer the practice-focused question regarding support for a policy change to implement a nurse-driven informed consent protocol. The systematic literature review was conducted using the adapted literature review by Souz, Silva, and Carvalho, which consisted of 6 levels for evaluating evidence. A total of 15 articles were graded using the updated Johns Hopkins nursing evidence-based practice model. Evidence from the literature review showed that nurses had several roles in the informed consent process: advocate, communicator, and witness. A modified Real Time Delphi 2 round survey was used to measure an expert panel's reaction to the systematic review and to evaluate a nurse-driven informed consent protocol. The results showed consensus from the expert panel (n=16; 81% agreement) for implementing a nurse-driven informed consent protocol, with Cronbach's Alpha, α = .70 for internal consistency and reliability, and Fischer's exact test yielded p = 1.0, showing no differences between staff nurses and managers in advocating for a policy change. Implications for positive social change include improving a nursing process, and impacting patient outcomes, and encouraging collaborative decision-making in health care.

Type 2 diabetes is a major chronic health disease in the United States. A main concern of clinicians treating patients with Type 2 diabetes is poor glycemic control. The goal of this project was to improve glycemic control in Type 2 diabetic Hispanic adult patients in a private family practice clinic through the implementation of biweekly telephonic intervention focused on diabetes management by an advanced practice nurse/nurse practitioner. The project was guided by the chronic care model as a framework. The intervention was conducted over a 12-week period with 50 patients, ages 18 to 65. Data were collected from chart and log reviews, personal interviews, telephone calls, and use of questionnaires. Data were de-identified and used for secondary analyses. The interviews and telephone calls focused on self-care activities and daily practices related to the disease management. There were statistically significant reductions in fasting blood sugar (p=.042) and glycated hemoglobin results (p=.002) as well as improvement in diabetes self-care activities over the 12-week project timeframe. Qualitative data supported patients' recommitment to diabetes self-care management through daily blood sugar testing, attention to diet, exercise, and daily journaling. This project might lead to positive social change through improved disease management and better glycemic control. The project might also enable the Type 2 diabetic patients to make health and lifestyle choices that positively influence their day-to-day health.

Abstract The use for electronic health records (EHRs) by 2015 is being mandated through incentive payments for health care providers. Evidence-based literature has shown that almost half of the hospitals in the Unites States have not adopted EHRs, and many nurses have not been educated to effectively use them. In order to enhance and sustain EHR adoption by hospitals, nurses need to be educated on EHRs' usability. The purpose of this project was to develop an evidence-based EHR educational project for nurses on how to enter nursing assessments, document patients' medical data, and communicate effectively with patients and health care providers. The development of this educational project was guided by Ajzen's theory of planned behavior. An advisory committee of 5 members determined the effectiveness and usefulness of the project. The advisory committee was comprised of the director of nursing, the director of information technology, a nurse manager, a nursing informatics specialist, and a staff nurse. Findings from the advisory committee indicated the project was in alignment with the objectives for meaningful use of EHR adoption by hospitals, conformed to the quality standards established by the agency for which this project was developed, and provided educational materials that were helpful in enhancing staff nurses understanding of EHR usability. In addition, feedback from the nurses who reviewed the educational project indicated that they were concerned about frequent upgrades and customization that were being made in Epic and the project was useful in enhancing staff nurses understanding of Epic usability. This project has the potential of increasing staff nurses' efficiency in using the Epic EHR system.

Obesity is a crucial health care issue that has a global effect on the health care industry. Not only does obesity decrease the patients' quality of life, it also places an astronomical burden on health care delivery systems. The purpose of this quality improvement project was to establish a weight management program derived from evidence-based research. The research question is can the utilization of mindfulness meditations and practices with traditional weight loss methodologies produce sustainable weight loss? Pender's health belief model was the conceptual framework utilized to guide and provides structure for this project. The health belief model has been utilized in numerous health care studies and has provided researchers with tremendous insight on various health care issues. The goal of the project was to provide the inhabitants in a metropolitan city located in the Midwest region of the United States with weight management strategies that would support a declination in the number of patients struggling with obesity in that region. This project developed a turnkey solution to a community health problem consisting of the following strategies: executing mindfulness meditations and practices as part of their daily rituals, reading food labels and making healthier food selections, exercising 30 to 40 minutes a day, and documenting their progression or obstacles in a journal. Since the project consisted of only 20 participants, it is recommended that a larger population and region be utilized for future studies. This project has the potential for societal change by improving the quality of life of and productivity of patients struggling with obesity by decreasing their chances of developing chronic illnesses which can become debilitating.