Medicine and Health Sciences Commons^™

Increased Discharge Compliance Through Mental Health Follow-Up, Robert H. Kirby

MSN Capstone Projects

Emergency departments are being strained to their breaking points as a result of the recent COVID pandemic. These departments are in need of programs that can help to reduce stress on not only limited budgets but also reduce the strain on their overwhelmed staff. One such strain on emergency departments and their limited resources is the readmittance of mental health patients as a result of non-compliance of the discharge instructions. The change project looks to address whether following up 10 days post discharge can increase discharge instruction compliance and ultimately reduce readmissions. The aim of the project is through the …

Implementing Purposeful Rounding As A Quality Improvement Project To Improve Patient Satisfaction In The Emergency Department, Kersten O'Brien

Master's Projects

Purpose: The purpose of this paper is to describe a quality improvement project to develop and implement a purposeful rounding protocol to improve patient satisfaction and call light rates which affect both patient and nursing staff satisfaction in the emergency department (ED). Importantly, patient satisfaction scores in the ED tend to be low but high scores are related to improved competitive advantage, reimbursement rate, patient outcomes, and nursing staff interruptions.

Methods: A literature review was conducted to determine best practices. Using the lean process and the Plan-Do-Study-Act (PDSA) model, this information was used to identify opportunities for improvement and to …

Improving Door To Transfer Times For St Segment Elevation Myocardial Infarction In Small Emergency Departments: A Quality Performance Improvement Project, Amber Ryals

Doctoral Projects

Heart disease is a leading cause of death in the United States (Centers for Disease Control [CDC], 2020). ST-elevation myocardial infarctions are around 38% of all coronary syndrome patients that present to the emergency department (Akbar et al., 2020). Smaller, outlying facilities can be at a disadvantage due to the lack of readily available specialties and services, such as a cardiac catheterization laboratory, which has the potential to cause a delay in inpatient care. With standardized cardiac protocols in place at many facilities, initial identification and treatment of myocardial infarctions are begun long before a patient enters a facility, often …

Nurse-Initiated Protocols For Chest Pain In The Emergency Department, Matthew Hodges

Student Scholarly Projects

Practice Problem: Emergency department crowding inhibits the ability to provide safe patient care to chest pain patients and negatively impact patient outcomes. A Veteran Affairs emergency department has identified a similar concern and implemented a nurse-initiated protocol to decrease the length of stay and improve patient outcomes.

PICOT: This evidence-based practice (EBP) project was guided by the following PICOT question: In the emergency department (ED), how does a nurse-initiated protocol (NIP) for chest pain (CP) patients compared to no protocol use influence length of stay (LOS) in the ED over 8 weeks?

Evidence: The reviewed literature supported the evidence of …

Promoting Recognition And Rescue: Human Trafficking Screening, Erin E. Pittman

MSN Capstone Projects

The exploitation of human beings is a serious public health concern (Centers for Disease Control [CDC] 2018). The United States Department of Justice (2018) defines human trafficking as an act of coercing a person’s labor services or commercial sex acts. Family Nurse Practitioners play a significant role in the identification of victims, especially those practicing in emergency departments. A majority of healthcare providers have yet to establish a standardized screening tool and there is little evidence regarding the impact these screening tools have in recognizing victims of human trafficking (Emergency Nurses Association, 2018). This alarming information brings about the clinical …

Implementation Of A Wellness Program For Emergency Department Medical Professionals., Madeleine Chesney

Doctor of Nursing Practice Papers

Background: Current data from the ANA HealthyNurse Survey 2018-2019 states that 70 percent of nurses that were surveyed report putting the health, safety, and wellness of their patients before their own. Additionally, in a study conducted between 2011 and 2017 of over 5,000 physicians less than 50 percent stated that they had enough time for their personal and family life. This data supports the urgent need to focus on the promotion of self-care and wellness for medical professionals. Objective: The purpose of this quality improvement project was to provide an opportunity for emergency department medical professionals to work toward improving …

Understanding The Knowledge, Perceptions, And Advocacy Of Family Presence During Resuscitation By Emergency Department Registered Nurses, Myranda Prather

Doctor of Nursing Practice Scholarly Project

Although recommended by current evidence-based literature, family presence during resuscitation (FPDR) continues to be inconsistently implemented in healthcare facilities. This study aimed to assess and understand nurses’ knowledge, perceptions, and advocacy of family presence during resuscitation in the emergency department. For this cross-sectional descriptive study, an anonymous electronic survey was administered via email to all nurses employed in the emergency department at a local healthcare facility. Hard copies of the survey were also distributed in-person. Data collection occurred over a three week period. The data were coded and entered into a computer software statistics program for analysis. Descriptive statistics were …

Fascia Iliaca Blocks For The Treatment Of Hip Fractures In The Emergency Department, Megan Hahn

Doctor of Nursing Practice Projects

Due to the aging population, the number of falls are increasing, leading to an increased number of individuals with hip fractures presenting in emergency departments (ED). Opioids are often administered for intraoperative pain related to hip fractures, which may result in a number of adverse effects, especially in the elderly. There is strong evidence suggesting that the use of fascia iliaca blocks (FIBs) in the ED can minimize opioid use, and improve patient outcomes and recovery. FIB is a compartment block that delivers local anesthetic around the lumbar plexus to provide analgesia associated with hip fractures.

The purpose of this …

Improving Caregiver Health Literacy Of Pediatric Febrile Illness: A Patient Care Initiative, Rebecca T. Shipley

DNP Final Reports

Background: Pediatric fever, though typically harmless and incredibly common, can cause substantial fear and anxiety for caregivers unfamiliar with how to manage or treat this condition at home. Studies evaluating pediatric emergency department (ED) rates have repeatedly found fever to be a leading reason for clinical evaluation. Local EDs record percentages as high as 40% of pediatric patients seek evaluation primarily for fever. Purpose: Provide educational resources for high-risk populations to reference at home regarding fever so that avoidable ED visits decreased and caregiver knowledge of fever improved. Methods: An educational program was implemented at a pediatric primary care clinic …

Acuity-Based Staffing: Improving Patient Outcomes And Staff Satisfaction, Natalie Long

MSN Capstone Projects

Traditionally, nurse staffing practices have been based on a nurse-patient ratio model and have not incorporated patient acuity. More recent literature has shown that acuity-based staffing can improve patient outcomes and staff satisfaction. The Emergency Department (ED) is an area that has fluctuating patient acuity and volume. To incorporate acuity in to staffing in the ED, the acuity mix over the past year can be used to calculate required nursing hours, therefore providing the number of required nurses for that facility. The calculated number of staff can then be distributed over a 24 hour period. By incorporating acuity in to …

Implementation Of A Provider In Triage Program In A Level Iii Emergency Department, Rachel Parmer Mph, Msn, Fnp- Bc

Doctor of Nursing Practice Projects

Background: This project implemented a Provider in Triage (PIT) system in a small emergency department (ED) in Washington State. The employment of a PIT to decrease patient waiting time and improve ED flow was supported by a literature review. A needs assessment was conducted, which indicated potential benefit from a PIT system, particularly because several ED metrics are worse than national average.

Aims/Objectives: This project aimed to develop, implement, and evaluate a PIT system by employing ED Advanced Practice Clinicians (APCs). The objectives consist of evaluating the impact of a PIT system on the percentage of patients who leave without …

Alcohol Screening, Brief Intervention, And Referral To Treatment Protocol In The Emergency Department, Malvis Ndips Achonduh Tamon, Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: The impact that results from inappropriate alcohol consumption poses challenges to public health. The rate of alcohol-related visits to the Emergency Department (ED) has increased, which has resulted in an increased annual cost of alcohol-related visits. ED serves as a common portal of entry into the healthcare system for many patients and offers a unique opportunity to impact drinking behaviors.

Objectives: To increase the number of alcohol screenings and brief interventions when indicated to adult patients who visit the ED and increase ED nurses' knowledge regarding alcohol misuse and indications for brief interventions.

Methods: An educational module was delivered …

Communication, Leadership And Organizational Support Facilitates Successful Transition Into Practice For Nurse Practitioners In The Emergency Department, Cheryl Anne Soco

College of Science and Health Theses and Dissertations

Background and purpose: Post-graduate programs, specialized academic programs, and national health organizations like the Institute of Medicine (IOM) have identified and begun addressing the gap in knowledge, skills and factors for successful transition into practice. The purpose of this study is to examine the relationships and differences among the personal and community resources which promote successful transition for Nurse Practitioners (NP) that practice in the Emergency Department (ED) and the skills or procedures they find difficult to perform independently.

Methods: A descriptive, correlational-comparative study design was conducted using an online survey administered to a convenience sample of NPs with …

Communication, Leadership And Organizational Support Facilitates Successful Transition Into Practice For Nurse Practitioners In The Emergency Department, Cheryl Soco

College of Science and Health Theses and Dissertations

Background and purpose: Post-graduate programs, specialized academic programs, and national health organizations like the Institute of Medicine (IOM) have identified and begun addressing the gap in knowledge, skills and factors for successful transition into practice. The purpose of this study is to examine the relationships and differences among the personal and community resources which promote successful transition for Nurse Practitioners (NP) that practice in the Emergency Department (ED) and the skills or procedures they find difficult to perform independently.

Methods: A descriptive, correlational-comparative study design was conducted using an online survey administered to a convenience sample of NPs with …

Essential Trauma Care Documentation: Redesigning A Community Hospital’S Trauma Flow Sheet, Murphy Neenan

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Poor trauma documentation has negative consequences on continuity of care, results in errors related to treatment, and yields increased time to order completion^{2, 3}. Nursing staff at a community hospital emergency department (ED) expressed frustration when utilizing the existing trauma flow sheet. The purpose of this project was to redesign and implement an evidence-supported emergency department trauma flow sheet for efficient and comprehensive documentation of trauma encounters.

Methods: A new trauma flow sheet was developed through a focus group session and semi-structured interviews. A PDSA model for improvement was introduced to facilitate future initiatives to improve trauma …

Improving The Relationship Between Emergency Nurses And The Behavioral Health Patient, Alea Bundy

Master of Science in Nursing Theses and Projects

There is an increasing number of behavioral health patients entering through the emergency department for behavioral health treatment and crisis intervention every day. Workplace violence against nurses has also increased leaving some nurses feeling anxious and fearful of interactions with behavioral health patients. The increase of behavioral health patients and unstable situations have created a gap in communications and has strained the nurse patient relationship yielding poor patient outcomes. The purpose of this project is to educate nurses on the care of the behavioral health patients and improve nurse-patient relationships for better outcomes for the patient. The framework for this …

Predictors And Outcomes Of Invasive Mechanical Ventilation, Ailin Puckett

DNP Research Projects

Objective: Invasive mechanical ventilation (IMV) is lifesaving and one of the most common interventions implemented in the intensive care unit (ICU). More than half of the patients in the ICU require IMV within the first 24 hours after ICU admission. This project aimed to evaluate and predict the mortality rate of hospitalized patients on IMV by examining their risk factors, such as patient demographic characteristics, disease status, social environment, and discharge status.

Methods: The National Inpatient Sample (NIS) database 2016 was used to identify patients requiring IMV. Mortality was the dependent variable. Independent variables had four major categories. First, patients’ …

Preparing For Obstetrical Emergencies In The Emergency Department, Tracy Littlehale

Doctor of Nursing Practice Projects

Emergency Department nurses must maintain the skills to manage OB emergencies in the ED, especially in hospitals with no OB unit. Limited contact with OB patients diminishes the self-confidence, knowledge and skill of ED nurses, which may minimize their ability to recognize OB problems in a timely manner. As increasing numbers of patients with OB emergencies are expected to seek care in rural EDs due to closure of rural OB units and rising OB risk factors, maintenance of OB skills by ED nurses is critical. Simulation has been identified in the literature as an effective strategy to help nurses advance …

Clarifying Workforce Flexibility From A Division Of Labor Perspective: A Mixed Methods Study Of An Emergency Department Team, Sarah Wise, Christine Duffield, Margaret Fry, Michael Roche

Research outputs 2014 to 2021

Background: The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly.

Methods: The explanatory sequential mixed methods study was set in the …

Barriers To Reporting Workplace Violence In Emergency Departments: A Systematic Review, Kari Gaston

Walden Dissertations and Doctoral Studies

Underreporting of workplace violence by emergency department (ED) nurses is a global practice concern. When workplace violence is not reported, the breadth of the issue is not reflected in the data, which is necessary to support legislative action, regulatory requirements, and organizational changes to prevent violence. The purpose of this systematic review of literature was to appraise and synthesize evidence regarding ED nurses’ barriers to reporting workplace violence. The practice-focused question addressed the barriers to reporting workplace violence according to emergency nurses. The theory of planned behavior was the theoretical framework for this project. Melnyk and Fineout-Overholt’s critical appraisal of …

Improving Suicide Prevention In The Emergency Department, Crystal Hartis Andrews

Walden Dissertations and Doctoral Studies

Suicide is a leading cause of death and a significant public health problem in the United States, especially among the youth population. The wide variability of screening practices and limited educational programs for nurses in terms of identification and management of individuals at risk for suicide exists. The purpose of this project was to conduct a systematic review to identify evidence available in support of adequately preparing nurses to conduct suicide screening and inform suicide prevention efforts for youth in emergency departments. Results from the literature review were correlated to formulate recommendations for improving suicide screening practices through the provision …

Homeless Tailored Primary Care And Access To Ongoing Primary Care Services, Jessica J. Stoefen

All Graduate Theses, Dissertations, and Other Capstone Projects

Homelessness is an increasing problem worldwide. The system for providing medical care to individuals experiencing homelessness is currently a patchwork of multiple different agencies. Many individuals do not utilize routine primary care (PC) services, instead present to emergency departments for nonemergent care. A systematic literature review was conducted using Cochrane Database of Systematic Reviews, CINAHL Plus with Full Text, Consumer Health Complete – EBSCOhost, and PsycINFO from 2014-2019 with the exception of Cochrane which was searched from 2009-2019, to evaluate if tailored PC clinics focused on providing PC services with additional supports to homeless individuals were more effective at engaging …

The Influence Of Adaptive Challenge On Engagement Of Multidisciplinary Staff In Standardising Aseptic Technique In An Emergency Department: A Qualitative Study, Amanda Towell-Barnard, Susan Slatyer, Helen Cadwallader, Michelle Harvey, Susan Davis

Research outputs 2014 to 2021

Aims and objectives: To explore the challenge of engaging multidisciplinary staff in standardising aseptic technique (AT) in an emergency department (ED) in an Australian tertiary hospital, and to better understand the enablers and barriers to implementing practice change within this setting.

Background: Healthcare‐associated infections are the most common complication for patients in acute care. A clinical practice framework developed in the United Kingdom (UK) standardised AT practice to reduce potential infection risk. One Australian tertiary hospital drew upon this framework to similarly improve clinical practice. It was understood that standardising practice would require some practitioners only to revisit and demonstrate …

A Modified Screening Tool To Evaluate Risk Of Unanticipated Return Visits To The Emergency Department In The Geriatric Population, Tabitha Riley

DNP Projects

Purpose: To compare the Modified Screening Tool for Identifying at Risk Seniors (mSTIRS) against the Triage Risk Screening Tool (TRST) and the Identification of Seniors at Risk (ISAR) for predictive value and assess the relationship between presenting complaint with unanticipated return visit (URV) occurrence in geriatric patients.

Design: A prospective, observational study conducted at a large academic medical center. Descriptive statistics and psychometric analyses were used to analyze the association between demographics, clinical data, and to evaluate the modified screening tool.

Methods: 38 geriatric participants in the Emergency Department (ED) were enrolled and 21 completed the study. The screening tools …

Implementing Safeplan: A Communication Template For Emergency Nurses Caring For Psychiatric Patients, Michele Leigh Rudisill

Doctor of Nursing Practice Projects

This DNP Project explored the impact of introducing a communication template for emergency department (ED) nurses to use during handoff when caring for psychiatric patients. This need was identified as ED nurses are now caring for psychiatric patients for longer periods of time in the ED setting, sometimes weeks to months, due to limited inpatient mental health resources and resources in the community. ED nurses’ perceptions were surveyed and the need for a standardized, yet flexible communication template was identified. The literature was reviewed, and no such template was identified specific to ED nurses caring for the psychiatric patient population. …