School of Nursing DNP Final Projects
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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 Subject "Anesthesia"
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Item 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.eduThe 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.Item Development, Implementation, and Evaluation of a Standardized Hand–Off Communication Tool at Children's Hospital of Michigan(2022-08-04) Balde, Isabela; Thurman, Nicole; Hranchook, Anne; hranchoo@oakland.eduPoorly communicated information during postoperative patient hand-offs can result in medical errors that compromise patient safety. Applying a standardized communication hand-off tool encourages consistency and accuracy during transfer of patient information, subsequently reducing communication failures that are associated with preventable medical errors. The aim of this evidence-based quality improvement project was to design and apply a standardized hand–off tool for use between Certified Registered Nurse Anesthetists (CRNAs) CRNAs, Pediatric Anesthesia Fellows, Anesthesiologists, and Pediatric Intensive Care Unit (PICU) Fellows and RNs at Children’s Hospital of Michigan. The tool was developed in collaboration with an interprofessional team and incorporated input obtained from a pre-intervention survey that the stakeholders identified as critical to communicate during transfer of care for their patient population. The communication tool was piloted for one month following which a postintervention survey was administered to assess the perceptions of the CRNAs, Pediatric Anesthesia Fellows, Anesthesiologists, and PICU Fellows and RNs regarding the tool’s use and functionality. The tool was modified according to this input and is under consideration for permanent adoption by Children’s Hospital of Michigan.Item Evaluation of a COVID-19 Surgical Scheduling Guideline using the Appraisal of Guidelines for Research and Evaluation AGREE II Instrument(2023-08-11) Olmsted, Carolyn; Hintzman, John; Shannon, Lori; lshannon@oakland.eduIntroduction/Background Since the beginning of the SARS-COVID-19 pandemic in February 2020, the operating room and surgical care has undergone vast change. At its start, COVID-19 infection caused many elective surgeries to be canceled, operating room schedules to be altered, and inquiries of how healthcare should change in order to continue providing the best care during unprecedented circumstances. Hospital administration, healthcare workers, and patients began searching for valid information to guide best practice. COVID-19 has been found to severely affect the physiology of the circulatory and pulmonary systems of patients. With new discovery of pathophysiologic consequences of COVID-19 infection, the need for well-founded guidelines to assist clinicians in managing surgical and anesthetic care is realized. Guidelines surrounding the treatment of surgical patients infected with COVID-19 were formed during a time of crisis when evidence was limited and instability in healthcare delivery occupied much of healthcare team efforts. This period of uncertainty, paired with the volume of patients infected with COVID-19, may have contributed to the development of unclear guidelines as well as inconsistencies in following established guidelines that were meant to direct surgical and anesthesia care during times of peak infection of the COVID-19 pandemic. Method: The main purpose of this Doctor of Nursing Practice (DNP) final project was to evaluate a clinical practice guideline (CPG) designed to be used by anesthesia providers to guide timing of surgery for patients diagnosed with COVID-19 in a major midwestern hospital in Michigan. The surgical scheduling guideline was evaluated for overall quality, development, and reporting using the AGREE II instrument and following instructions from AGREE Enterprise. The quality improvement methodology for this project followed the Agency for Healthcare Research and Quality’s “Plan-Do-Study-Act'' model for testing an implemented change. The appraisal team consisted of four appraisers that examined the CPG guideline. All items within the AGREE II instrument were given a score on a Likert scale ranging between 1-7 (strongly disagree = 1 and strongly agree = 7). Quality scores corresponding to six domains of the AGREE II instrument were calculated in addition to a compilation of the overall quality of guideline scores. Results The guideline received low appraisal scores for the domain categories contained in the AGREE II instrument. All quality scores for the six appraised domains were low except for Domain 4: Clarity of Presentation (65.28%). In addition, the guideline received an overall low guideline quality rating of 25%. Although all domain scores and the final appraisal score were low, three out of four appraisers would recommend the guideline for use with modifications. Discussion Large contributors of poor appraisal scores were the lack of available supporting evidence and explicit language needed for continual use and improvement. In developing future practice guidelines that will assist in upholding the delivery of safe surgical and anesthesia care even during an unprecedented crisis such as the COVID-19 pandemic, it is essential to include source materials to lend transparency for clinician use. Additionally, guidelines intended to influence patient care outcomes should include explicit evidence and language that states the desired outcomes. Additions such as these would better ensure the assessed guideline would contribute to positive change in patient care.Item 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.eduImplementation 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.Item Magnesium Sulfate as an Anesthesia Adjunct: Establishing Opportunities for Enhancing Outcomes of Care(2022-08-09) Savalle, Olivia; Dolan, Hunter; Golinski, Mary; golinski@oakland.eduMagnesium sulfate can be utilized as an analgesic adjunct for patients undergoing surgery. It can lead to decreased postoperative pain scores, improved patient outcomes, better perioperative care, and it can curb the current opioid crisis. When administered as an analgesic adjunct, the sole reliance on opioids to manage perioperative pain is reduced therefore the associated adverse effects of opioids are also minimized. Magnesium Sulfate effectively provides pain relief for a multitude of different surgical populations, is relatively easy to administer, and is inexpensive. It works as an analgesic by noncompetitively blocking NMDA receptors as well as acting as a calcium channel blocker. A formal educational webinar was provided to Certified Registered Nurse Anesthetists (CRNAs) that are members of the Michigan Association of Nurse Anesthetists (MANA). The purpose of the webinar was to inform providers of the mechanism of action, efficacy, and benefits of intravenous magnesium sulfate as an opioid sparing analgesic adjunct in select surgical scenarios. A post-webinar evaluation was distributed to webinar attendees and their respective responses were evaluated. Overall, CRNAs responded positively and provided comments that the webinar was extremely informational permitted a greater understanding of the benefits to enhance patient care outcomes.