Medicine and Health Sciences Commons^™

Implementation Plan For Emr And Beyond, Lori Katterhagen

Doctor of Nursing Practice (DNP) Projects

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties …

Improving Value Based Purchasing Through The Implementation Of The Clinical Nurse Leader Role: The Chief Nursing Officer’S Case For Change, Leanne M. Hunstock

Doctor of Nursing Practice (DNP) Projects

The healthcare industry is focused on the implementation of the Affordable Care Act, the payment reform package from Centers for Medicare and Medicaid Services and the development of Accountable Care Organizations. The decisions, behaviors, and practices of medical and clinical staff directly impact patient care, quality, and subsequently cost and reimbursement. The imperative to balance quality and patient safety with cost effectiveness requires a complex orchestration of all the elements of care within the clinical microsystem. A priority is to support and enable bedside nurses’ daily practice, priorities, and decision-making. This can be accomplished through the implementation of the Clinical …

Innovative Approach To New Nurse Residency, Meaningful Use And Health Care Reform, Pamela V. Stanley

Doctor of Nursing Practice (DNP) Projects

The project’s aim was to examine the financial impact of replacing registered nurse (RN) travelers, RN registry and RN overtime with new graduate RNs. Newly graduated RNs are often viewed by hospital administrators as a more costly staffing resource. This project contributes knowledge regarding the potential cost savings with the utilization of a centralized float pool incorporating new graduates. In addition, it contributes a novel idea for reducing organizational costs of implementing an electronic medical record with the utilization of new graduates as super users.

A new graduate program, which incorporated the use of a formal preceptor and mentoring program, …

The Design, Implementation And Evaluation Of A Technology Solution To Improve Discharge Planning Communication In A Complex Patient Population, Susan M. Manfredi

Doctor of Nursing Practice (DNP) Projects

Unnecessary delays in discharge planning can extend the length of stay (LOS) and add non-reimbursable days for socially and medically complex patients thereby increasing the financial burden to healthcare organizations. The literature supports enhanced discharge communication strategies and the use of checklists to facilitate safe and timely discharges. Following root cause analyses of significant discharge delays, one hospital identified gaps in communication as key precursors associated with discharge planning breakdown when discharging patients to skilled nursing facilities. Review of these events demonstrated the need for concurrent communication strategies between multidisciplinary care team members in planning for complex discharges.

Following a …

Lean Management Principles To The Creation Of Postpartum Hemorrhage Care Bundles, Bethan Faulkner

Doctor of Nursing Practice (DNP) Projects

Postpartum hemorrhage (PPH) is the number one cause of pregnancy-related death in the US. The Maternity local improvement team (LIT), co-led by an Obstetrician and Board Certified Clinical Nurse Specialist found that each month the maternity unit averages 40 PPHs with 1-2 resulting in an emergency. Over a 6-month period, the LIT decreased response time for emergencies significantly. Supply retrieval time decreased by 99.9%, MD response time decreased by 81%, and Family Centered Care increased by 100%. They recently turned their attention to prevention. Given the lack of literature on preventing PPH in postpartum units, the team developed a PPH …

Transforming The Journey For Newly Licensed Registered Nurses: A Community Based Transition-To-Practice Program In Ambulatory Care Settings, Cathryn A. Halford Dnp

Doctor of Nursing Practice (DNP) Projects

Abstract

In response to the job shortage for newly licensed registered nurses (RNs), transition to practice and residency programs have been established in many areas of the country including the San Francisco Bay Area. The programs were designed as demonstration projects to assist new graduates by increasing their competence, confidence, and skills, and their employability. Evidence from new graduate programs suggests that the programs provide an important bridge that is necessary for the critical transition from classroom to clinical practice and from newly licensed RN to qualified nursing professional. The University of San Francisco (USF)

Transition-To-Practice (nurse residency) program in …

The Creation And Implementation Of Interprofessional Simulation Leadership Scenarios, Angeline C. Delucas

Doctor of Nursing Practice (DNP) Projects

Healthcare is in a historical state of change creating an era that requires superior leadership skills. Leaders face burgeoning challenges in a competitive environment ensconced in reform. Today’s dynamic healthcare environment demands that nurse and interprofessional leaders be astute in a variety of areas including: fiscal responsibility and accountability, organizational politics, interpersonal skills, human resources, communication, conflict resolution, and emotional intelligence. Some areas such as fiscal management are considered hard skills, or skills which can be taught, while others such as conflict resolution are referred to as soft skills, or skills that are learned through experience. Though soft …

Influencing Change In Healthcare Providers: Communication Strategies For A New Era In Healthcare, Ceonne Raasikh

Doctor of Nursing Practice (DNP) Projects

Effective provider communication is the key to patient engagement. However, many providers are not able to effectively communicate with patients, in part due to low health literacy. Evidence in the literature supports the use of specific strategies aimed at improving communication with patients. The purpose of this quality initiative was to influence providers to adopt new communication strategies with their patients. Pharmacists, nurses and physicians were invited to participate in a free, full-day, educational event. During the event providers were alerted to the issue of health literacy and provided communication strategies to improve patient comprehension and engagement. Following the presentation, …

Improving The Implementation Of The Acute Care Nurse Practitioner (Acnp) Role: Development Of Acnp Role Implementation Guidelines, Megan Elizabeth Liego

Doctor of Nursing Practice (DNP) Projects

With the implementation of the Patient Protection and Affordable Care Act (PPACA) and the Value Based Purchasing (VBP) initiative, hospitals and the health System have rolled out a strategic goals of focusing on meeting the VBP objectives and standardizing care within their hospitals. To help meet these goals and improve patient care, many hospitals have looked toward the implementation of the acute care nurse practitioner (ACNP) role in the hospital setting. There is a lack of guidelines, though, on how to implement the ACNP role. This has led to several barriers, which have created variation in practice and outcomes across …

Interprofessional Roles Shoulder Dystocia: Maximizing Safety In Community Hospitals, Elizabeth Yznaga

Doctor of Nursing Practice (DNP) Projects

Prompted by evidence that clinical simulations improve patient safety, team simulations are emerging in hospital settings. Accrediting organizations such as the U.S. Joint Commission on Accreditation of Healthcare Organizations and the American College of Obstetricians and Gynecologists (Joint Commission, 2004, American College of Obstetricians and Gynecologists, 2002) have recommend simulation of obstetrical emergencies, including shoulder dystocia for hospital teams. National patient safety mandates for simulation training of critical events have not been available to small, rural hospitals because of lack of talent and equipment, creating a gap in resources. Other than demonstrations by manikin companies, this author has currently been …

Self-Management Of Unpleasant Auditory Hallucinations: A Tested Practice Model, Robin Buccheri, L Trygstad, M Buffum, P Birmingham, G Dowling

Nursing and Health Professions Faculty Research and Publications

Individuals who experience auditory hallucinations (AH) frequently report hearing unpleasant voices saying disturbing things to them, making derogatory remarks about them, or commanding them to do something, including harming themselves or someone else. The Self-Management of Unpleasant Auditory Hallucinations Practice Model was developed to help psychiatric-mental health nurses in both inpatient and outpatient settings implement evidence-based nursing care for voice hearers who are distressed by unpleasant voices. The model's utility extends to nursing education, administration, and research. The model is comprised of three parts: (a) Assessment of Voice Hearer's Experience, (b) Nursing Interventions, and (c) Voice Hearer's Expected Positive Outcomes. …

Addressing Gaps In Quality And Safety Education During Pre-Licensure Clinical Rotations, Susan Pauly-O'Neill, Elizabeth E. Cooper

Nursing and Health Professions Faculty Research and Publications

United States national reports have called for improvement in healthcare professions education to better address patient care outcomes. In response, an initiative titled “Quality and Safety Education for Nurses (QSEN)” has been adopted by nursing programs across the nation, which describes the six main competencies to be included in nursing curricula. As early adopters of the QSEN competencies, the University of San Francisco nursing faculty promptly threaded the material throughout the 4-year Bachelor’s of Science in Nursing (BSN) curriculum. Confident that the topics were well covered in the classroom, we then sought to learn how often our students practiced these …

People Who Inject Drugs, Hiv Risk, And Hiv Testing Uptake In Sub-Saharan Africa, A K. Asher, J A. Hahn, Marie-Claude Couture, K Maher, Page

Nursing and Health Professions Faculty Research and Publications

Dramatic rises in injection drug use (IDU) in sub-Saharan Africa account for increasingly more infections in a region already overwhelmed by the HIV epidemic. There is no known estimate of the number of people who inject drugs (PWID) in the region, or the associated HIV prevalence in PWID. We reviewed literature with the goal of describing high-risk practices and exposures in PWID in sub-Saharan Africa, as well as current HIV prevention activities aimed at drug use. The literature search looked for articles related to HIV risk, injection drug users, stigma, and HIV testing in sub-Saharan Africa. This review found evidence …

Liberation Health And The Role Of The Public Health Leader, Courtney Keeler

Nursing and Health Professions Faculty Research and Publications

The following short report lays the groundwork for rethinking the practice and implications of public health leadership in the context of liberation health. Liberation health reduces to a universal idea:health is freedom. In short, everyone holds a subjective notion of health and, within certain bounds, has the right to promote and maintain that health. This report briefly describes liberation health, discusses the implications of liberation health for public health leadership, and outlines two needed transformations in moving towards a liberation health model of leadership. The report details areas for future research on this topic among public health leaders …

A Comparison Of Two Teaching Methods For Pediatric Medication Administration: Multimedia And Text-Based Modules, Renee Granados

Doctoral Dissertations

A Comparison of Two Teaching Methods for Pediatrics: Multimedia and Text-based Modules to Teach Pediatric Medication Administration

Nurse educators are in a position to design and develop effective methods that consider the cognitive structures and how the mind processes information to teach pediatric medication content to nursing students. The majority of methods teaching medication administration use only one mode: the visual mode. One mode to present leaning material does not take advantage of the additive effects of using two modes to present learning material.

The purpose of the study was to compare the effectiveness of two teaching methods to present …