Medicine and Health Sciences Commons^™

An Integrated Review: Outpatient Care And Management Of Fever And Neutropenia Among The Pediatric Oncology Population, Sarkis Makarovich

DNP Qualifying Manuscripts

Abstract

In the pediatric population, comprehensive cancer treatment and its associated side effects significantly impact their physical and emotional well-being. Though chemotherapy drugs are valuable agents against cancer cells, they also damage healthy dividing cells, such as bone marrow, thus weakening the immune system. Febrile neutropenia (FN) and associated infections remain the most critical complications of the extensive chemotherapy regimen and can threaten life if not appropriately addressed. Appropriate primary evaluation and treatment of FN in children with cancer includes administering proper broad-spectrum antibiotics. Ongoing research has focused on improving quality of life (QoL); yet, FN has persisted as the …

A Job Satisfaction Evaluation Of Nursing In The United States And Greece Utilizing The American Nurses Association's Scope And Standards Of Practice, Audrey Narhi

Honors Projects

Nursing is a multifaceted profession that is constantly evolving with the health needs of the populations it serves. Professional organizations within the field utilize evidence-based practice to provide guidelines of what best-practice nursing is. This study aims to evaluate if the American Nurse's Association (ANA), a professional nursing organization in the United States, supports the realities of nursing in a rural US hospital. An international perspective is also considered by evaluating the same principles to a urban hospital in Athens, Greece. Categories that align with ANA Scope and Standards, including workplace environment, career development, supervisor relationships, and personal work practice, …

An Evidence-Based Teaching Plan For Preventing Wrong-Site Block Placement During Regional Anesthesia, Mark A. Michetti, Kristen E. Newbrough

DNP Scholarly Projects

Wrong-site regional anesthetic block placement is a threat to patient safety and quality perioperative care. The adverse outcomes for patients, providers, and institutions demonstrate safety risks that are linked to inconsistent use of comprehensive guidelines in clinical practice. The purpose of this Doctor of Nursing Practice Project is to create a comprehensive evidence-based Teaching Plan for preventing wrong-site block (WSB) placement during regional anesthetic induction and for use in institutions by anesthesia providers to prevent wrong-site anesthetic block placement. The teaching plan focuses on four main constructs to prevent WSBs, which include the incidence of WSBs, the consequences of WSBs, …

Breastfeeding After Maternal Anesthesia: A Guideline Development, Megan Berens

Doctor of Nursing Practice Scholarly Projects

Postoperative breastfeeding recommendations for lactating mothers by anesthesia providers are inconsistent and often inaccurate. Inappropriate recommendations have led to withholding of breastmilk to the infant, unnecessary disposal of breastmilk, surgical delay, exposure of an infant to high levels of drugs in breastmilk, and early cessation of breastfeeding. The purpose of the scholarly project was to develop a set of evidenced-based practice guideline recommendations and a proposed implementation plan for anesthesia providers to use in support of breastfeeding mothers who recover from surgery. Many studies in the literature indicate that there are inconsistencies in postoperative breastfeeding recommendations by anesthesia providers. When …

Experiences Of Sex Workers In Chicago During Covid-19: A Qualitative Study, Randi Beth Singer, Sarah Abboud, Amy K. Johnson, Jessica L. Zemlak, Natasha Crooks, Sangeun Lee, Johannes Wilson, Della Gorvine, Jahari Stamps, Douglas Bruce, Susan G. Sherman, Alicia K. Matthews, Crystal L. Patil

College of Nursing Faculty Research and Publications

COVID-19 exacerbated health disparities, financial insecurity, and occupational safety for many within marginalized populations. This study, which took place between 2019 and 2022, aimed to explore the way in which sex workers (n = 36) in Chicago were impacted by COVID-19. We analyzed the transcripts of 36 individual interviews with a diverse group of sex workers using thematic analysis. Five general themes emerged regarding the detrimental impact of COVID-19 on sex workers: (1) the impact of COVID-19 on physical health; (2) the economic impact of COVID-19; (3) the impact of COVID-19 on safety; (4) the impact of COVID-19 on …

Robotic Team High Reliability Organization’S Communication Evaluation Tool, Joanne F. Mercurio

Regis University Student Publications (comprehensive collection)

Multidisciplinary team communication in robotic surgery presents several safety considerations for the intraoperative surgical patient. It is an important consideration since the surgeon and the operating room team are geographically distanced with the surgeon at the console, and the other team members situated at the patient bedside. Scrubbed team members are performing such functions as positioning the robotic arms as well as exchanging instruments, while the remaining interprofessional team members are coordinating multiple patient care activities. It therefore becomes imperative that the recognition of the potential for miscommunication is of paramount importance, and strategies need to be generated that will …

United States Pharmacopeia General Chapter <800>: Improving Safe Handling And Administration Of Hazardous Drugs, Courtney Clark

Master's Projects and Capstones

Problem: This quality improvement project is dedicated to increasing the safe handling and administration of United States Pharmacopeia (USP) General Chapter Hazardous Drugs (HDs) within the Medical/Surgical unit to minimize the risk of exposure to patients, healthcare personnel, and the environment.

Context: The quality improvement project was implemented in two Medical/Surgical units in Hospital A in the San Francisco Bay Area. The patient population of these units has the highest receipt of HDs outside of a traditional Hematology/Oncology unit.

Intervention: The proposed intervention is the use of active and passive observation to assess compliance with USP protocols within the two …

Improving The Timing Of Insulin Administration In Adult Acute Care Patients, Hollie Gow, Harold Girado, Venessa Rodriguez, Lourdes Talavera, Leyner Martinez, Pierce R. Buzzi Davidson, Esty Trimino, Dayana M. Aguilera, Catherina Chang Martinez, Annette Caravia, Joy Mitts, Shelli Anne Marie Chernesky, Diana Maria Lopez, Hector Gonzalez, Sandy Jones, Sara Perez, Nell Mayendia Blanco, Orlando Bodes Ramil, Christopher Scott, Andrea Calvo, Jan V. Roy, Yaribey Lopez, Margie Martin, Angelines Diaz, Yessenia Muniz, Joey Carralero

Nursing & Health Sciences Research Journal

Background: The correct timing of insulin administration in diabetic patients admitted to the hospital is important for the prevention of transient and serious glycemic deviations that could lead to negative patient outcomes. In November 2021, a South Florida Hospital identified an area of opportunity for quality improvement related to the process of subcutaneous insulin administration. In addition to bar code scanning, manual verification of the insulin dose by the primary nurse and another nurse was required prior to administration. Patients were experiencing delays in the timing of their insulin dose and nurses were reporting frustration with the process. Methods: The …

Strategies To Prevent Inadvertent Retained Surgical Items: An Integrative Review, Amanda J. Snape, Jed Duff, Oya Gumuskaya, Kerry Inder, Alison Hutton

Journal of Perioperative Nursing

Background: The surgical count process is currently the recommended strategy for preventing unintentionally retained surgical items (RSIs) in Australia. Despite this, RSIs still occur and remain an internationally recognised issue and sentinel event associated with morbidity and mortality. There are numerous new and emerging strategies to prevent inadvertent RSIs, apart from the surgical count, and many involve the use of technology. These strategies are not currently specified in Standards for Perioperative Nursing in Australia (the ACORN Standards).

Aim: To provide an integrative synthesis of the literature to identify current and emerging strategies for preventing RSIs during surgical procedures.

Design: An …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Safety Measures In The Epilepsy Monitoring Unit: An Organizational Assessment, Tina Yates

Doctor of Nursing Practice Scholarly Projects

Long-term video-electroencephalography (EEG) monitoring in the epilepsy monitoring unit (EMU) is an elective procedure and generally safe. Clinical experts determined the EMU protocols at a level-4 comprehensive epilepsy center were not followed correctly. The project is a retrospective chart audit incorporating Ray’s Bureaucratic Caring theoretical framework with Donabedian’s conceptual model. The project objective is to evaluate if safety measures protocols are implemented appropriately in the EMU and determine whether a need exists for quality improvements.

The project reviewed patients admitted to the EMU from September 2021 through November 2021 who developed a generalized tonic clonic (GTCs) seizure with electrographic epileptiform …

Increasing Awareness Of Personal Harm Reduction Interventions In The Clinical Setting: A Quality Improvement Project, Shawn Theberge

DNP Scholarly Projects

Abstract

The ever-rising concern for safety in the healthcare setting has become increasingly prevalent and levels of hostility and violence more publicly visible. Over the last decade both patients and clinicians have been targeted in healthcare facilities at record levels. These incidents have created an environment of not only risk but increased anxiety and feelings of uncertainty for most clinical personnel. The study will initially measure clinician’s viewpoint of the clinical setting that they work in; and over the span of the project, track and evaluate the effects of the interventions on clinicians’ overall feelings and perceptions. The expected outcome …

Using Simulation To Improve Covid-19 Code Blue Outcomes, Charity Shelton

Doctor of Nursing Practice (DNP) Projects

Background

Healthcare workers in the acute care setting must be ready to respond to emergencies at any given time. The recent COVID-19 pandemic put strains on the healthcare workforce that have brought challenges and new competencies for how healthcare workers safely respond to emergencies. To ensure healthcare workers maintain these competencies, specific training must occur to improve emergency response and outcomes. Specifically, there needs to be training for healthcare workers to respond to COVID-19 code blue emergencies safely and with skilled interventions.

Problem

A code blue in the acute care setting is a medical emergency that requires nurses, physicians, and …

Decreasing Patient Fall Rates In The Microsystem, Kevin Dwayne Sanchez Camaya

Master's Projects and Capstones

Abstract

Problem: Falls are considered never events, yet continuously occur in the inpatient setting. Falls,

especially falls with injuries, impact the patients, the staff, and the hospital. Falls cause extended lengths of stay, affect the morale of the patients and the staff, and are non-reimbursable events.

Context: There have been an increased rate of falls within a medical/surgical/telemetry unit

microsystem at a Northern California hospital despite standardized screening and prevention tools. The unit can house up to 52 patients and is the designated Covid unit of the hospital at the time of this project.

Interventions: The interventions include optimizing the …

Use Of Simulation To Improve Nurse's Response To Covid-19 Code Blue: A Literature Review, Charity Shelton

Doctor of Nursing Practice (DNP) Projects

Background

Healthcare workers in the acute care setting must be ready to respond to emergencies at any given time. The recent COVID-19 pandemic put strains on the healthcare workforce that have brought challenges and new competencies for how healthcare workers safely respond to emergencies. To ensure healthcare workers maintain these competencies, specific training must occur to improve emergency response and outcomes. Specifically, there needs to be training for healthcare workers to respond to COVID-19 code blue emergencies safely and with skilled interventions.

Problem

A code blue in the acute care setting is a medical emergency that requires nurses, physicians, and …

Caregiver Decision-Making Concerning Involuntary Treatment In Dementia Care At Home, Vincent Ra Moermans, Angela Mhj Mengelers, Michel Hc Bleijlevens, Hilde Verbeek, Bernadette Dierckx De Casterle, Koen Milisen, Elizabeth Capezuti, Jan Ph Hamers

Publications and Research

Background: Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment.

Objective: To identify and describe family caregivers’ experiences regarding care decisions for situations that can lead to involuntary treatment use in persons living with dementia at home.

Research design: A qualitative …

Evidence-Based Recommendations For Assistive Technologies For Safety In Dementia Care, Lee A. Diener

Culminating Experience Projects

A Quality Improvement (QI) project in a Midwestern Continuing Care Residential Community (CCRC) was designed to examine the evidence-base of four assistive technology platforms marketed as safety platforms as means to improve outcomes for older adults residing in memory care environments. Using the Evidence-Based Design Model Socio-Technical Systems Theory, survey data and observational data collected from the organization were considered with respect to the evidence-base supporting each technology. Ten organizational priorities derived from collected data were used to develop an Evidence-Based Assistive Technology Fitness score for each of the AT platforms reviewed. This methodology provides a means to evaluate planning …

Facilitating Implementation Of In-Room Whiteboards In The Skilled Nursing Environment Using The Parihs Framework, Ashley Lubbers

Dissertations

The application of research to practice is a difficult task to successfully carry out for many healthcare professionals and organizations. The Promoting Action on Research Implementation in Health Services (PARIHS) framework is a tool that acts as an implementation guide for translating research evidence to practice. This study explored the use of an adapted version of the PARIHS framework as a guide to implementing in-room whiteboards in a skilled nursing facility (SNF) on their short-term rehabilitation wing. While the utility of in-room whiteboards has been demonstrated in the acute care setting, there are few studies of their use in SNFs. …

Improving Therapeutic Communication In Mental Health Nursing: A Quality Improvement Project, Patricia A. Nill

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over 46 million adults in the United States (U.S.) live with a mental illness. Locally in Nevada, the psychiatrist to patient ratio is approximately 700:1, and patients are seen primarily in the inpatient setting, if seen at all, due to the wait average of 85 hours in the hospital emergency rooms for access into mental health hospitals or specialty units of a general hospital. Moreover, costs for mental health mood disorders alone are estimated at over seven million dollars annually. The Institute of Medicine (IOM) opined the need for change in healthcare to redesign practice and clinical communication with patients …

An Intervention To Improve Nurses’ Knowledge, Perceived Safety, And Confidence In Identifying And Managing Workplace Violence: A Translation Of Evidence Into Practice, Kayla Sullivan

UNLV Theses, Dissertations, Professional Papers, and Capstones

The Occupational Safety and Health Administration (OSHA) reports that over two million workers are victims of workplace violence (WPV) (Papa, 2013). Registered nurses are subjected to high risk for workplace violence from patients and visitors, with 25.5% reporting at least one victimization incident (Gillespie et al., 2013). Research indicates that WPV has a significant impact on nurses' quality of working life, job satisfaction levels, turnover rates and has also been shown to negatively impact efficiency and productivity (Gacki-Smith et al., 2009). ED nurses are at substantial occupational risk for workplace violence. Emergency departments have been identified as areas within the …

Reducing Patient Risk For Suicidal Behaviors With A Safety Bundle Of Best Practices With Non-Psychiatric Patients, Olayemi Akindele

Student Scholarly Projects

Practice Problem: Suicide is a public health condition that affects people globally. The increased suicidal behaviors of patients in a medical-surgical unit demanded an effective screening protocol to identify high-risk patients.

PICOT: In patients 18 years and older on a medical-surgical unit, does the implementation of the Columbia Suicide Severity Rating Scale (C-SSRS) tool and application of a Safety Bundle of Best Practices (SBBP) increase early identification of suicide risk with decreased patient self-harm behaviors, compared to the current standard practice of no assessment tool or safety bundle of best practices within 12 weeks?

Evidence: Ten studies served as evidence …

Does Ipe Improve Patient Safety?, Katie Henson

Student Research Poster Presentations 2021

No abstract provided.

Does A “Just Culture” Improve Patient Safety?, Wanda Lucille Parks

Student Research Poster Presentations 2021

No abstract provided.

Impact Of A Standardized Situation, Background, Assessment, And Recommendation Tool On Satisfaction And Communication In The Perioperative Area, Salomy Abraham

Walden Dissertations and Doctoral Studies

AbstractEffective communication among health care providers is critical to maintain patient safety during the handoff of care. Communication breakdown during handoff can lead to medical errors and sentinel events. The perioperative area is a vulnerable area that is prone to communication errors due to the involvement of providers from various disciplines and the nature of the quick patient turnovers within the perioperative area. To ensure proper communication during the handoff in the perioperative area, a unit-specific handoff tool is required. The focus of the project was to implement a standardized situation, background, assessment, and recommendation (SBAR) communication tool in the …

Illicit Substance Use In Acute Care Hospitals: Creating A Safe Environment, Christina Sanford

Doctor of Nursing Practice (DNP) Projects

Problem: In January 2019, a medium-sized acute care hospital in Northern California reported new safety concerns related to patients using illicit substances in the hospital.

Context: Leaving the hospital AMA is an increasing problem in acute care hospitals among patients who use illicit substances, with a rate of 25% to 30% (Ti & Ti, 2015). Grewal et al. (2015) conducted a study of over 1,000 illicit substance users who had experienced a hospitalization, where 43.9% reported use of illicit substances while in the hospital.

Intervention: The project was the creation, implementation, testing, and evaluation of multiple interventions to improve …

Transformational Leadership For Frontline Leaders, Marta L. Hudson

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Transformational leadership (TL) represents the gold standard of leadership styles in contemporary healthcare organizations. The transformational leader's ability to motivate, influence, stimulate, inspire, and attend to followers' individual needs is an antecedent to job satisfaction, quality, and patient safety. The project aimed to improve TL constructs among frontline leaders (managers and assistant nurse managers). Based on the results of a needs assessment, these frontline leaders were provided an opportunity to improve their TL style.

Context. Leadership development is a strategic priority for a medium-sized medical center in a healthcare system in Northern California. Frontline leaders within patient care …

Huddle And Safety, Jaelynn Hall Bsn, Rn

MSN Capstone Projects

The purposed evidence-based practice (EBP) project focuses on a nursing intervention (team huddles) to increase safety and reduce inpatient fall rates. Negative outcomes to consider from an inpatient fall are harm and injury to the patient along with increased health care cost for the patient as well as hospital facility. Accrued cost associated with an in-patient injury resulting from a fall is not reimbursed according to the Centers for Medicare and Medicaid Services. The additional cost for hospital-acquired falls is estimated to be $6,694 (95% CI: -$1,277 to $14,665) (Agency for Healthcare Research and Quality, 2017). This was only related …

Pregnancy Bridge Program For Psychiatric Patients, Adam Barnett

Doctor of Nursing Practice

The National Institute of Mental Health (2017) estimates that 9.2 million people age 18 years and older are diagnosed with bipolar disorder in the United States. Research has shown pregnancies in women with mental health problems have higher rates of poor outcomes and complications (Epstein et al., 2014; Freeman, 2007; Rusner et al., 2016; Scrandis, 2017). Aim. The purpose of this scholarly project is to provide standardized patient education, increase urine human chorionic gonadotropin screening rates, and to set up a gynecologic care bridge for patients considering pregnancy and are diagnosed with bipolar disorder. Evidence. The Centers for …

An Exploration Of The Numeracy Skills Required For Safe, Quality Nursing Practice, Anna Wendel

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to explore the numeracy skills required for safe, quality nursing practice. Using a descriptive mixed methods design, this study answered two research questions: 1) What numeracy skills do nurses perceive as important for providing safe, quality nursing care in the first three years of practice? 2) How do nurses incorporate numeracy skills into daily patient care during the first three years of practice? Early career nurses from a not-for-profit health care organization in the mid-Atlantic region of the United States (n=109) responded to an online survey tool developed by the student investigator that ranked …

Bedside Shift Report Improves Patient Safety, Scott Meyers

MSN Capstone Projects

In the inpatient setting, Parkland Health & Hospital System has continued to have patient falls with injury above its target goal. This occurred every month throughout 2019. Additionally, multiple egregious IV medication administration errors occurred over the last year related to nurses bypassing established safety practices.

An evaluation of evidence-based literature reveals that the practice of bedside shift report (BSR) leads to a reduction in both patient falls and medication administration errors. Indeed, BSR is evidence-based practice (EBP) that promotes an overall environment of safety, quality care, and improved communication between nurses and patients. Additionally, there is virtually no risk …