School of Nursing DNP Final Projects

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https://hdl.handle.net/10323/11352

The School of Nursing at Oakland University offers a DNP Program that builds upon the university’s long tradition of civic engagement and reform-oriented advocacy. The DNP program provides students with a holistic perspective that enables them to exercise high-impact, results-based health care leadership. The completion of a DNP Final Project is required for graduation; it demonstrates synthesis of the course work and lays the foundation for future scholarship. The Doctor of Nursing Practice Project Handbook provides more specific information and policies related to the project.

Beginning in 2021, the DNP Final Projects are collected here and made publicly available.


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Browsing School of Nursing DNP Final Projects by Author "Bittinger, Andrea"

Now showing 1 - 4 of 4
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    Developing, Implementing, and Evaluating a Dexmedetomidine Infusion Protocol as an Opioid Sparing Technique in Spine Surgery
    (2023-06-05) Galea, Peter; Ayres, Joshua; Bittinger, Andrea; bitting2@oakland.edu
    Background: Opioids have been the cornerstone treatment for surgical pain despite their negative side effects including the development of chronic postsurgical pain. Enhanced Recovery After Surgery helps to improve patient outcomes by using multimodal analgesics and limiting opioid administration. Dexmedetomidine is a sedative with notable opioid-sparing capabilities. Purpose: This quality improvement project aimed to develop and implement an evidence-based protocol that incorporated a dexmedetomidine infusion for patients undergoing spine surgery. Data was collected to analyze whether the results were consistent with the literature. Methods: Baseline data was collected prior to implementation of the protocol for 50 patients. An educational briefing regarding the protocol implementation was then completed for the anesthesia providers at Kalamazoo Anesthesiology to ensure familiarity with the protocol and benefits of dexmedetomidine as an analgesic. Post-implementation data was collected for all patients who received the full protocol correctly as well as any patients who received the correct dosage of dexmedetomidine. Results: Only 11 patients received the protocol in full while another 19 received at least the correct total dosage of dexmedetomidine. Out of all of the outcomes assessed, none reached statistical significance. However, time to rescue analgesic (p = .835) as well as PACU discharge time (p = .50) was shortest in the full protocol group. Interestingly, average opioid administration in each area was lowest among the partial protocol group. Conclusion: This quality improvement project’s results did not align with the current evidence likely in part due to lack of provider adherence. This project did however show a possibility of a decreased time to rescue analgesic and PACU discharge times which could be a reflection of a more balanced anesthetic when a dexmedetomidine infusion is utilized.
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    Developing, Implementing, and Evaluating an Opioid-Sparing Thyroid/Parathyroid Anesthesia Protocol: A Quality Improvement Initiative
    (2022-08-01) Brainard, Cody; Roggentine, Kayla; Bittinger, Andrea; bitting2@oakland.edu
    The recent scrutiny around opioid use and abuse in the United States has been alarming. As anesthesia providers, we are tasked with managing both acute and chronic pain in a variety of settings. A balanced, opioid-sparing technique has been demonstrated to be effective for a variety of different surgical procedures in the literature. In this paper, we discuss opioid-sparing anesthetics for patients undergoing thyroid and parathyroid surgery. This project was completed by doing a retrospective chart review before and after the implementation of an opioid-sparing protocol. The protocol was developed from an evidence-based literature review on the subject. Primary outcomes were evaluating the protocol’s effect on postoperative nausea and vomiting (PONV), overall pain scores at multiple stages throughout the stay in PACU, respiratory depression, and total opioid dose in morphine-milligram equivalents (MME). Secondary outcomes were time spent in PACU and protocol compliance. A total of 30 patients meeting inclusion criteria received the protocol from November 2021 through February 2022. When compared to a similar pre-intervention cohort, those that received the protocol had significantly less PONV (10% in protocol group vs. 90% in pre-protocol group). Other outcomes that were analyzed had no statistical significance. Since thyroid/parathyroid surgeries are not associated with significant perioperative pain, an opioid-sparing anesthesia for these surgeries may decrease negative outcomes associated with opioid administration.
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    Increasing Diversity in the Nurse Anesthesia Profession by Implementation of a Diversity-Based Educational Workshop for Michigan High School Students
    (2023-07-14) Zoet, Ross; Thakore, Shivani; Bittinger, Andrea; bitting2@oakland.edu
    Implementation of a Diversity-Based Educational Workshop for High School Students Background / Purpose: In the United States, our society continues to diversify, yet our healthcare profession is not keeping up with the demographics of the U.S. population. The nursing profession is falling short in relation to having a diverse workforce, as persons of color represent only 16.8% of all nurses, and, only 11% of Certified Registered Nurse Anesthetists (CRNAs) (AANA, 2019). The gap in racial and cultural representation in the health care system is evident: there is not a diverse CRNA healthcare workforce. The current representation of the nurse anesthesia workforce for the individuals and communities they serve emphasizes Method: This was a proof-of-concept workshop to educate a diverse group of high school students on all aspects of the nurse and nurse anesthesia profession through a lecture-type informational presentation, hands-on simulation / skills lab experience, and participation in a CRNA led discussion panel. A resource tool kit was provided for each student encompassing information on financial aid and scholarship information, contacts for in-state nurse anesthesia programs, local and national diversity-focused nursing organizations, and a time-framed guide called, “My Path to Becoming a CRNA” that lists the steps from high school to entering a nurse anesthesia program. Results: Statistical analysis was performed through comparison of pre- and post-event surveys. A total 34 surveys were completed by the workshop participants and utilized as part of the sample size. Basic descriptive statistics, frequencies, means and standard deviations were calculated. In addition, a t-test was used to compare the means of pre-and post-test data. There was statistical significance found (p<0.01) for 9 out of 10 questions asked. The survey results indicated that upon completion of the workshop, students felt they had a better understanding of the role of a CRNA and had an increased awareness of scholarship and financial resources that are available in nursing. Additionally, 79% of students (n=27) agreed that they were interested in a career in nursing and 73% of students (n=25) agreed that they were interested in a career in nurse anesthesia. Discussion / Conclusion: This workshop was successful in enlightening diverse high school students about the careers of Nursing and Nurse Anesthesia. We were able to not only describe and show some of the skills related to nursing and nurse anesthesia, we were also able to give valuable resources to guide those interested in how to pursue this career path. If repeated in other areas of the state and country, workshops like this can help to decrease the cultural gap we have in the CRNA profession within the next 7 – 10 years.
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    The Prevalence of Postoperative Nausea and Vomiting Following Cardiac Surgery and Evidence-Based Guidelines to Prevent
    (2022-07-28) Takahashi, Stephanie; Trudgen, Mara; Bittinger, Andrea; bitting2@oakland.edu
    Postoperative nausea and vomiting (PONV) continues to cause concern and side effects for patients following general anesthesia. Extensive research and recommendations exist guiding care for non-cardiac surgery patients. Evidence is, however, limited for cardiac surgery patients due to risks of QT prolongation, arrhythmias, and the use of fast-track anesthesia. Cardiac surgery patients present unique challenges due to their increased risk of arrhythmias and opioid requirements. Research supports utilizing the Apfel risk scoring system to determine which cardiac surgery patients should receive prophylactic medication. Routine antiemetics are not appropriate in the cardiac surgery population, but the developed Apfel with cardiac indicators tool can be utilized to treat patients based on their risk level. The study’s purpose was twofold, first to determine the prevalence of PONV and assess for statistically significant relationships and second to develop a risk assessment tool. The following variables were examined for significant effects: opioid dosage, presence of arrhythmias, QT prolongation, and times between postoperative milestones. A retrospective chart review of 100 patients was completed. In total, 46% (n = 46) of patients reported feeling nauseated after surgery, 11% (n = 11) reported to have vomited, and 49% (n = 49) received at least one dose of a rescue antiemetic. Gender was the only significant predictor of PONV (p=.021). Opioid dosage was not found to be associated with reports of nausea (p= .467). Study results coincide with previously published research and identifies a need for prophylactic treatment of PONV in the cardiac surgery population. The authors recommend utilization of the Apfel with cardiac indicators tool to guide risk factor assessment and prophylactic treatment.