Medicine and Health Sciences Commons^™

Improving Post-Discharge Engagement Of Mental Health Patients In The Veterans Affairs South Texas Healthcare System, Nneoma Lewis

Doctor of Nursing Practice

Discharge from a hospital is a high-risk period for mental health patients, as 20% experience an adverse event within 30 days of discharge. Poor discharge engagement can lead to complications for recovery, which include an increased risk for readmissions, longer length of stay, increased risk for suicide, and death. Hospital stays cost the United States $377.5 billion dollars per year; there is pressure for hospitals, health plans, and providers to examine the admission and discharge processes to improve healthcare delivery, transition of care, and patient health outcomes. At a South Texas VA, 67.66% of mental health patients attended all their …

An Integrative Review: Best Practices For Educating And Engaging Care Partners Of Patients With New Ostomies, Lauren Flook Brown

Master of Science in Nursing Final Projects

PURPOSE: The purpose of this integrative review was to identify and synthesize the best practices of engagement and education for care partners of patients with new ostomies to support adaptation.

METHODS: Five-stage integrative review process: (1) problem identification, (2) systematic literature search, (3) data evaluation, (4) data analysis, and (5) presentation.

RESULTS: Four themes with sub-themes emerged to understand effective engagement and education of care partners: (1) care partner influences on patient outcomes; (2) care partner needs; (3) barriers to care partner adaptation; and (4) diverse engagement strategies. Each theme and sub-themes related to care partners could not be separated …

Transformational Leadership And Structural Empowerment For Nurse Managers To Improve Nursing Job Satisfaction, Engagement, And Retention, Leah M. Gehri

Doctor of Nursing Practice Projects

Problem Description

Low nurse job satisfaction and engagement have historically been associated with high attrition. While it is too soon to fully quantify the impact of Covid-19 on nurse satisfaction, engagement, and turnover, evidence is emerging that high chronic fatigue and persistent feelings of being overwhelmed are causing nurses to either leave the bedside or quit nursing altogether, exacerbating existing nurse staffing challenges caused by a decades long nursing shortage that, pre-pandemic, predicted a national deficit of over one-half million nurses by 2030. The financial impact of competing for experienced nurses, and recruiting, hiring, and training new nurses to replace …

The Heart And Soul Of Engagement In The Float Pool Team, Kymberly Dexter

Master's Projects and Capstones

Problem: The assistant nurse manager (ANM) role is considered an entry-level management position and is not intended as a permanent career role. The unintended consequence is that there is a high rate of organizational turnover, making it challenging to build and retain a solid, cohesive, and productive team.

Context: A new manager of a float pool team in a 166-bed community hospital found that with little financial investment, a significant impact is made by holding a safe space for listening to the ANM team and designing education and training around what is most important to frontline managers.

Interventions: A baseline …

Team Engagement & Obstetrics Transformation Committee, Colette Dumais, Faye Weir, Lynn Willey, Kristen Heanssler, Brittany Babb, Suneela Nayak, Natalia Johnson, Rebecca Brookes, Obstetrics Transformation Committee,Maine Medical Center

Operations Transformation

Gallup defines employee engagement as the involvement and enthusiasm of employees in their work and workplace. Employee engagement helps to measure and manage employees' perspectives on the crucial elements of workplace culture. Based on over 50 years of employee engagement research, engagement employees produce better outcomes (better patient care) than other employees. Based on the unit survey, team members, with the support of local leaders, formed the Transformation Committee. This Committee was developed as a shared governance, team led model to address process improvement needs and create a culture of active engagement in problem solving.

Engaging Caregivers To Use An Evidence‑Based Intervention For Medicaid Benefciaries With Alzheimer’S Disease: A Pilot Study, Sandra Lee Spoelstra, Alla Sikorskii, Monica Schueller, Viktoria Basso, Autumn Baldwin

Peer Reviewed Articles

Background This pilot study aimed to adapt an intervention, engaging informal caregivers to help clinicians with providing care to improve (or maintain) physical function of individuals with Alzheimer’s Disease or other dementias. To the best of our knowledge, for the frst time, we report on use of the intervention in those with Alzheimer’s Disease or other dementias.

Methods This was a 5-month mixed methods cohort study in a convenience sample of clinicians, caregivers, and benefciaries at 3-Medicaid Home and Community-based Service sites in Michigan. Two content experts and 5 caregivers modifed the intervention. We trained 116 clinicians to engage caregivers …

Predictors Of Engagement In Nursing Professional Practice: Transforming Organizational Culture In The Post-Covid Healthcare Environment, Jennifer Garnand

Dissertations

Cultivating the shared belief that individuals matter within an organization enhances the empowerment of staff and supports enthusiastic engagement in organizational efforts aimed toward a common mission, vision, and goals (McShane & Von Glinow, 2019). The nursing profession has been plagued by an unprecedented decrease in engagement and diminished job satisfaction, particularly following the prolonged tenure of the COVID-19 pandemic, leading to subsequent attrition amidst a staffing crisis. This quantitative predictive correlational study seeks to determine whether proactive and persevering characteristics, professional identity, and passion of nurses are predictors of engagement in a post-COVID healthcare environment. The research was based …

Factors Associated With Advance Care Planning Engagement In Healthy Young Adults, Pablo J. Vasquez

Dissertations & Theses (Open Access)

Background: Advance care planning (ACP) is a process that supports individuals at any stage of health in understanding and sharing their personal values and goals pertaining current or future medical needs with their families and healthcare providers. Although ACP is applicable to adults of any age and any stage of the health continuum, it is widely associated with older or terminally ill populations, and the need for end-of-life (EOL) planning in healthy young adults is generally found unnecessary. The National Institutes of Health supports the expansion of ACP research in understudied populations. Investigating ACP in healthy young adults support such …

Community Isolation Project, Natalie M. Danhof, Lydia Santucci, Abigail Dempsey, Nathaniel Navarro, Ivy Mills, Samantha Thompson

Nursing Leadership in Community Engagement Projects

Introduction

The authors of this summary are nursing students at Seattle Pacific University, and the project goal is focused on understanding feelings of isolation in elderly communities and whether fostering social activities, such as Bingo, would improve social interaction between residents in this community.

For the past two years, the COVID-19 pandemic has altered various aspects of social interaction. From masking to social distancing, societal norms and expectations evolved in a manner that promoted isolation and minimal interaction to inhibit the spread of Covid infection between individuals. Of the general populace, the most vulnerable and at risk for infection are …

Electronic Patient Portals: Promotion Of Access By Healthcare Workers Increases Patient Engagement, Dena Todd

Doctoral Dissertations and Projects

The use of technologies within healthcare settings has become an essential part of patient care. The Health Information for Economic and Clinical Health (HITECH) Act of 2010 contained requirements for healthcare providers to ensure the Meaningful Use (MU) of electronic health records. More specifically, electronic patient portal (EPP) systems were a part of this legislation since healthcare organizations needed to demonstrate they were providing patients with access to their personal health information. A major concern was that healthcare organizations not offering EPP access were at risk of losing federal funding. This integrative literature review explores strategies which can be deployed …

Effective Management Of Diabetes Mellitus Type Ii In A Military Treatment Facility, Jozy Merizier Smarth

Walden Dissertations and Doctoral Studies

In the United States, 34 million people have diabetes and 79 million have prediabetes. Currently, one in nine Americans are diagnosed with diabetes and it is projected that one in five will have diabetes by 2025 and one in three by 2050. The practice-focused question answered by this project addressed the question if implementing a staff education program improved staff’s knowledge about self-management education and intent for providers and staff to promote a formal diabetes self-management education (DSME) program in an overseas military treatment facility. The site has 47% of empaneled beneficiaries with diabetes mellitus Type II with an elevated …

Retention Strategies For The Current Nursing Workforce, Jennifer Higgins

Walden Dissertations and Doctoral Studies

Retaining a robust nursing workforce is essential to care delivery. As the generation gap in the nursing field widens, retention strategies that align with the current nursing workforce must be considered. Rapid turnover is a looming concern as baby boomers retire and millennials become the leading generation in the nursing workforce. Nurse leaders must identify and deploy strategies that will provide a meaningful work environment to retain nurses in this majority group. The purpose of this project was to address the gap in practice of rising turnover, low nurse engagement, and reliance on premium labor to deliver care. The sources …

Huddle Implementation In The Perioperative Setting, Tina Thomas

DNP Projects

Background: Communication is essential for safe and effective patient care. In the perioperative setting, information sharing is critical to care coordination. Lack of communication between caregivers can lead to medical errors. Evidence shows that huddles lead to increased communication, satisfaction, and engagement between team members resulting in better patient outcomes. Huddles are short, less than 10-minute gatherings that focus on the daily schedule, identify potential obstacles, explain unique needs, and discuss preceding day issues.

Objectives: This project aimed to evaluate the effectiveness of huddles on employee satisfaction, engagement, and communication of healthcare workers while also determining if huddles were …

Incorporating Quality Improvement And Problem-Solving Into A Unit Safety Huddle, Kay M. Rowles

Theses and Graduate Projects

The complex nature of healthcare creates significant risks of harm to patients. Safety huddles are a mechanism some hospitals utilize to raise awareness of safety concerns and minimize risks. Typically occurring at the start of each shift, safety huddles generally take the form of a brief, structured discussion with visual management for information sharing. In addition, safety huddles create a safe space for nursing staff to escalate concerns, supporting a culture of safety. This quality improvement project describes the expansion of a safety huddle process that has become a mere ritual at the start of each shift on a 25-bed …

Leveraging High Reliability And Transformational Leadership To Create A Healthy Work Environment, Megan Gillespie, Megan Gillespie

DNP Qualifying Manuscripts

Background: Nurse leaders must create a collaborative work setting to promote a healthy work environment (HWE). The Joint Commission reported in 2014 that 71% of physicians and nurses reported disruptive behavior was linked to medical errors. The culture of a team sets the foundation of safety for patients and nurses. A HWE is necessary to ensure agility, progress and effectively strive for zero harm. Nurse executives are challenged to empower front-line leaders to create a HWE conducive to open communication, psychological safety and results in a setting where employees can thrive.

Problem Description: There is an epidemic of bullying and …

Implementing Modern Management In Nursing, Ashley E. Hall

MSN Capstone Projects

Throughout the recent years, there has been occurrence of massive nursing shortages across the country. While there are many explanations as to why these shortages could be occurring, one very common explanation is that of poor leadership. As it now stands, the training for new leaders is a “trial by fire” style of orientation. New leaders either have a short training period consisting of minor introductions and gathering of various system access, or no training for their new position whatsoever. This style of orientation leads to poor outcomes for the leader as well as the team they are put in …

Program Evaluation Of Parent Engagement Activities In The Pediatric Cardiac Intensive Care Unit, Cheryl A. Bos

Doctoral Projects

Introduction: Leaders of a six-bed pediatric cardiac critical care unit identified the need to evaluate family engagement in patient care activities prior to implementing quality improvement initiatives. This program evaluation identified staff and family perception of barriers and facilitators to parent engagement in the Pediatric Cardiac Intensive Care Unit.

Methods: Data were collected through quantitative and qualitative methods. Surveys collected staff baseline and parent pre-/post-hospital perception of the role of family engagement in caring for the child.

Results: The Questionnaire of Factors That Influence Family Engagement survey of 58 registered nurses indicated the nurse workflow (τb = .579, p = …

Inspiring Nurse Leader Connectedness To Improve Patient Experience, Shauna Maxson

Doctor of Nursing Practice Projects

Objectives:

1. Interventions targeted at improved communication, retention, empowerment, and encouragement will be utilized to enhance the practice environment of incumbent and future nurses in the emergency department. Nurse connectedness will be improved 25% over baseline following implementation of interventions to positively augment practice environment.

2. Patient experience scores in the emergency department will be sustained at benchmark, or greater, following efforts to improve nurse connectedness.

Design: Prospective, single-center, non-randomized, pre- vs. post-

Data Sources: Scholarly, peer-reviewed journal articles and texts, results from pre- and post-intervention completion of Utrecht Work Engagement Scale, Press Ganey patient experience scores

Review Methods: Review …

Preceptor As Frontline Leader Utilizing Emotional Intelligence, Dwanette Judkins

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem - This paper describes a DNP project implemented in an acute care hospital in 2020. The hospital implemented a nurse residency program, with an evidence-based preceptor role development (PRD) component, which proved to be beneficial in growing the nursing workforce and building infrastructure; however, nurse turnover increased.

Context – Preceptors expressed feeling unsupported and not valued. The nurse executive team recommended the recognition committee expand its efforts to develop strategies to develop frontline leaders by building preceptor resiliency and increase retention. Preceptor development could positively impact the nursing workforce.

Intervention - The DNP student, was the executive sponsor …

From Team Huddle To Team Cuddle: Rekindling Caring, Self-Compassion, And Joy In Work!, Amerizza Quemada

Master's Projects and Capstones

Problem: The healthcare industry suffers from a high level of burnout and unhealthy work environments, which has been heightened by the COVID-19 pandemic. The consequences of burnout may be expressed in both individuals and teams as a lack of caring, disengagement, incivility, and staff turnover.

Context: One department in an integrated healthcare organization displayed a pattern of annual low employee engagement scores and alleged workplace bullying. Team members also observed that employees failed to speak up when experiencing incivility. The Clinical Nurse Leader (CNL) student determined that an improvement initiative was needed to create a culture of caring to improve …

Transformational Leadership - An Integrated Evidence Review, Marta L. Hudson

DNP Qualifying Manuscripts

Abstract

For chief nurse executives to survive in contemporary healthcare organizations must cultivate nurse leaders who are poised to produce nurse job satisfaction and subsequently, patient outcomes, including quality and patient safety. The article describes an integrated evidence review of the relationship between transformational leadership and nurse job satisfaction. The author identifies implications for practice and further research.

Conversations With Health Care Providers And Parents Before Autism Diagnosis: A Qualitative Study, Norah L. Johnson, Wendy Krueger, Elizabeth Jilek, Kristin Haglund

College of Nursing Faculty Research and Publications

Introduction

The purpose of this study was to explore communication with health care providers from the perceptions of parents before their child's diagnosis of autism spectrum disorder and provide some examples of how communication may contribute to the autism diagnosis.

Method

This study used a qualitative descriptive design with multiple individual structured in-person interviews.

Results

Three themes captured parents’ (n = 8) descriptions of the phases of communication during their children's diagnoses including, (1) anguished questioning, (2) urgently seeking help, and (3) expecting a diagnosis. In addition, three themes characterized the communication style that parents needed, although not always …

Improving Patient And Provider Engagement By Utilizing Ask Me 3®, Joseph G. Smith, Msn, Arnp, Fnp Bc

Doctor of Nursing Practice Projects

Background: Patient and provider engagement in healthcare has an impact on health outcomes.

Purpose: To study the implementation of the Ask Me 3 (AM3) tool, a tool that encourages patients to ask three questions about their health to their care provider. The aim of the project is to explore the level of patient and provider engagement by patients` reports of their perception of engagement with their provider and in understanding their diagnosis.

Methods: The setting was a small urban family practice in the Pacific Northwest. Every patient that checked in for their appointment, excluding pediatric and younger than 18 years …

Job Satisfaction, Engagement, And Motivation For Nursing Leadership Among Millennial Registered Nurses, Oluwaseyi Stover

Walden Dissertations and Doctoral Studies

There is a shortage of nursing leaders because current nursing leaders who are in the baby boomer generation are retiring. Millennial RNs are needed to fill vacant nursing leadership positions, but millennial RNs are not satisfied in their jobs and lack motivation and engagement, which impedes their interest in nursing leadership positions. The purposes of this quantitative, descriptive, correlational study, guided by King’s theory of goal attainment, were to examine the relationship between job satisfaction, motivation, engagement, and the aspiration of millennial RNs for nursing leadership positions in the acute care hospital setting, and the combined effects of job satisfaction, …

Engaging Patients With Dementia In The Acute Care Setting: A Quality Improvement Initiative For Staff, Andrea Lee

DNP Scholarly Projects

Caring for dementia patients in the acute care setting can be challenging. Staff is trained to manage the acute illness and the symptoms of dementia can impact that care. Training for the care and management of the patient with dementia is not routinely provided for the acute care setting. According to the Alzheimer’s Association (2018), 5.7 million people are living with Alzheimer’s Dementia with the numbers projected to continue to rise. Training in the management of symptoms can alleviate stress and complications for not only the patient but staff members as well. The goal of this project is to educate …

Correlational Impact Of Workload, Teamwork And Retention Rate For Clinical Nursing Units, Phillip J. Nutter

Master of Science in Nursing Theses and Projects

Healthcare organizations face an impending shortage of over one million nurses. Staff turnover adds costs to healthcare and decreases the morale of the unit. Teamwork has been shown to be related to engagement as engagement has been shown to be related to retention. Understanding how teamwork mitigates increasing workload at the unit level is critical to reducing turnover at the nursing unit level. This research explored relationships between teamwork and productivity and teamwork and retention rates for nurses. The Neuman Systems Model was used as the framework to guide this retrospective correlational analysis with teamwork as a flexible line of …

Peer Support For Addiction In The Inpatient Setting, Rebecca Sweeney

DNP Scholarly Projects

Background: In 2006 the Institute of Medicine reported that combined mental illness and substance use disorder was the second leading cause of disability and death in women and the highest cause in men. More recent data obtained from the 2016 National Survey on Drug Use and Health (Ahrnsbratz et al 2016) indicates in 2016 only one in ten of the people who need treatment, receive it. At Cambridge Health Alliance’s Everett Hospital, the site of this pilot project, opioid overdose and acute alcohol intoxication comprise one in every ten visits in the Emergency Department. In January of 2018, CHA partnered …

Teamstepps: A Foundation For Shared Governance In A High-Risk Obstetrical/Neonatal Service Line, Genevieve Wright

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Declining registered nurse (RN) engagement in the maternal child health (MCH) department, despite improvements in RN staffing, some reductions in nurse-patient ratios, the addition of support staff resources, and a focus on quality and safety.

Context: The project setting is an MCH department of a 184-bed community hospital, part of a large national organization, serving a diverse population in Northern California. The initial stakeholders included RNs, managers, and assistant managers; the team was later expanded as the project developed (see Appendix A).

Intervention: The original aim of this project was to improve nurse engagement among frontline nurses through …

Reexamining Overuse Of Frequent Observation For New Admissions On Psychiatric Units To Increase Nurse/Patient Engagement, Samuel Novela

Master's Theses

People in California who suffer from mental health conditions are often admitted involuntarily to hospitals on 72 hour psychiatric evaluation holds if they are deemed imminently dangerous to themselves, or others, or are gravely disabled. Observational patient safety checks are performed and based on patient acuity and hospital standards. Variations exist among different clinical settings with regard to best practices and the patient subpopulations that may warrant less frequent safety checks. Nurses experience different levels of satisfaction with regard to frequency of safety checks because there is no national consensus on which subsets of patients may require them. A senior …

An Exploration Of Barriers To Health Care Access Among Uninsured Patients: Using The Moderating Effect Of Patients’ Enablement, Enedelia L. Jessup

Electronic Theses and Dissertations

ABSTRACT On March 23, 2010, Congress passed the Patient Protection and Affordable Care Act (ACA) to increase value of care, improve clinical outcomes, decrease health care costs, and increase affordability in health care access. The purpose of the study attempts to examine the moderating effects of patient enablement impacting barriers, low socio economic status, and unmet basic needs, toward health care access in uninsured populations post ACA. Only certain aspects of patient enablement in self-management of an individual’s health care goals have been conducted with uninsured populations with barriers toward health care access. The research design was a quantitative, exploratory, …