Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

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Objective: Educate staff nurses on a new standardized clinical care pathway (SCCP) for Nuss Procedure patients to decrease the length of stay, decrease hospital costs, decrease postoperative complications, and improve pain control. Design: Evidence-based practice improvement initiative. Setting/Local Problem: An inpatient surgery unit at a local pediatric medical center with no previous standardized care plan for Nuss Procedure patients. Participants: All staff nurses working on the inpatient surgery unit of a pediatric medical center. Intervention/Measurements: An SCCP was created by a multidisciplinary care team. All staff nurses on the inpatient surgery unit at a local pediatric medical center were assigned an online education module to evaluate pre/post-knowledge of nursing care from a standardized clinical care pathway for patients after receiving the Nuss Procedure. Chart audits were completed to assess staff nurses’ utilization of the SCCP on patients undergoing the Nuss Procedure to assess patient outcome measures and length of stay. This project aimed to enhance policies and protocols and decrease Nuss patients’ length of stay, which in turn improves patient outcomes and healthcare costs. Results: Fourteen out of 32 staff nurses completed the nursing education module, with a 44% compliance rate. Pre-test score (M = 9.07, SD = 1.27). Post-test score (M = 10.71, SD = 0.47). Patient length of stay decreased from M = 4.2 days in 2020 to M =2 days in 2022 (p = 0.001). Chart audits revealed that the nursing staff adhered to charting patient diet and hygiene, not ambulation or incentive spirometry use. Conclusion: Implementation of an SCCP leads to decreased postoperative length of stay in Nuss Procedure patients. In nursing staff, post-knowledge assessment scores were higher than pre-knowledge assessment scores. The nursing staff adhered to charting measures pre-populated in the electronic charting system but showed poor compliance in charting interventions that needed to be manually added to the patient chart. Adherence to a daily patient checklist could not be assessed due to the misplacement of the checklists upon patient discharge.

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