Medicine and Health Sciences Commons^™

Exploring The Relationship Between Nurse Supervisor’S Servant Leadership Behavior And Nursing Employee’S Self-Assessment Of Engagement And Burnout In Nigeria, Michael Otuwurunne

Seton Hall University Dissertations and Theses (ETDs)

Burnout is a problem among workers in Nigeria, especially among nurses (Ozumba, & Alabere, 2019). This study examined whether there was a significant relationship between the employee perception of the servant leadership behaviors of the nurse supervisor and the employee’s self-rating of burnout: exhaustion and disengagement, and servant leadership behaviors of the nurse supervisor, and engagement: vigor, dedication, and absorption. Exhaustion refers to an intensive physical, affective, and cognitive strain while disengagement refers to the distancing of oneself from one’s work, and experiencing negative attitudes toward the work object, work content, or one’s work in general (Demerouti et al., 2001). …

The Dedicated Education Unit: Increasing Capacity And Confidence, Heather Marie Van Housen

Doctor of Nursing Practice (DNP) Projects

Background: In the American Association of Colleges of Nursing (AACN) 2020 annual survey, nursing schools turned away 66,274 entry-level applications to baccalaureate nursing programs in the United States due to a faculty shortage and clinical placement sites (AACN, 2021).

Local Problem: Hospitals need more qualified nurses to meet community needs. The need for clinical faculty and additional clinical placement sites disrupts the workforce pipeline through local nursing schools. A new approach to clinical education is needed to prepare more students for the growing complexities of independent nursing practice.

Methods: Dedicated Education Unit (DEU) implementation to expand pre-licensure nursing student clinical …

Implicit Bias In Nursing: Raising Awareness, Fostering Change, Jeanette C. Sandoval

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Extensive research evidence demonstrates that implicit bias can lead to differential treatment of patients based on race, gender, weight, age, income, language, and insurance status. Evidence-based interventions that couple implicit bias mitigation with therapeutic communication skills can contribute to the delivery of equitable care.

Local Problem: Implicit bias in healthcare occurs when unconscious behavior that is not favorable to the patient population served perpetuates unequal treatment and contributes to poor healthcare outcomes.

Methods: Knowledge of implicit bias in the nursing staff was assessed through a validated and reliable survey tool before and after participation in an online LMS …

Using Critical Incident Debriefing After Code Blue Events To Support Registered Nurses, David L. Boyd

Doctor of Nursing Practice (DNP) Projects

Using Critical Incident Debriefing after Code Blue Events to Support Registered Nurses

Section I: Abstract

Background: During a code blue event (CBE), the environment becomes highly stressful and intense. Nurses rapidly transition from performing life-saving procedures on their patients to carrying out their usual duties. Without proper debriefing, nurses cannot properly process their emotions leading to increased burnout and secondary traumatic stress (Stamm, 2010).

Local Problem: In 2021, the nurses at Providence Saint John’s Health Center (2021a) responded to 110 CBEs, a 43% increase from 2020. Without a process for critical incident debriefing (CID), these nurses were exposed to trauma …

Responding To A Deteriorating Patient: An Educational Intervention For Outpatient Clinic Nurses, Angela N. Ikeme

Doctor of Nursing Practice (DNP) Projects

Responding to a Deteriorating Patient:

An Educational Intervention for Outpatient Clinic Nurses

Background: Dynamic and evolving healthcare practices require nurses to continually acquire knowledge and confidence to provide optimal care. Organizations that recognize nurses’ educational needs and develop strategies to meet them empower nurses to improve the quality and safety of patient care.

Local Problem: The need for a continuing education program to improve outpatient clinic nurses’ knowledge, skills, and self-confidence prompted the implementation of this project.

Method: Single cohort education intervention as a test of change to assess the knowledge and confidence participants acquired in a pre- and …

Predicting The Risk Of Falling With Artificial Intelligence, Ann Aquino

Doctor of Nursing Practice (DNP) Projects

Predicting the Risk of Falling with Artificial Intelligence

Abstract

Background: Fall prevention is a huge patient safety concern among all healthcare organizations. The high prevalence of patient falls has grave consequences, including the cost of care, longer hospital stays, unintentional injuries, and decreased patient and staff satisfaction. Preventing a patient from falling is critical in maintaining a patient’s quality of life and averting the high cost of healthcare expenses.

Local Problem: Two hospitals' healthcare system saw a significant increase in inpatient falls. The fall rate is one of the nursing quality indicators, and fall reduction is a key performance indicator …

Implementing An Infant-Driven Feeding Practice Model, Ann P. Nguyen

Doctor of Nursing Practice (DNP) Projects

Neonatal feeding practices have been the focus of many quality improvement studies due to large variations in care practices. Traditionally, the model for neonatal feeding has been a volume-based approach, one that focuses on a prescribed quantity consumed rather than the infant’s physiologic and developmental maturity (Fry et al., 2018). Recent literature has emphasized the benefits of a more developmentally supportive feeding approach in neonatal intensive care units (NICU), the infant-driven feeding model (IDF).

The IDF model focuses on individualized care, quality of the feed, and continuous assessment of feeding cues both before and during the feeding experience. Current literature …

Improving Patient Safety For Surgical Clearance: A Preop One Stop Shop, Anna Benedictos

Doctor of Nursing Practice (DNP) Projects

Problem: Medical clearance is required for patients scheduled for surgery, also known as “patient optimization.” Ineffective and inefficient patient optimization is a major contributor to surgery postponements, procedure cancellations, and patient dissatisfaction.

Context: Ambulatory care clinics often lack resources to medically clear patients prior to scheduled surgery. Poor surgical optimization continues to occur on the same day of surgery, resulting in case cancellation or delay in a suburban, 169 bed community hospital with 9 operating rooms and approximately 500 surgical procedures per month.

Interventions: A nurse-led PreOp One Stop Shop (POSS) utilized a standardized checklist to perform preoperative surgical assessment. …

Save The Children Community Health Worker Program – Adverse Childhood Events Prevention, Jieun Lee

Doctor of Nursing Practice (DNP) Projects

Background: Adverse childhood experiences (ACEs) are potentially traumatic events that occur between the ages of 0 to 17 in which are directly associated, in a dose–response manner, to many of the most common and serious health problems in the United States.

Local Problem: 62% of California residents have experienced at least one ACE, and 16% have experienced at least four ACEs. ACEs are linked to nine of the ten leading causes of death in the United States Adults with four or more ACEs are 37.5 times more likely to attempt suicide, 3.2 times more likely to have chronic lower respiratory …

Exploring The Perceptions Of English-Speaking West African Born Registered Nurse Graduates From United States Entry Level Nursing Programs Regarding Academic Factors That Contribute To Retention And Success In United States Nursing Programs, Afua Ampiaw

Seton Hall University Dissertations and Theses (ETDs)

Background: The United States (U. S.) population is becoming more racially and ethnically diverse. To ensure equity in healthcare access and outcomes between majority and majority populations, there is need for minority representation in the health professions including nursing to reflect their representation in the general population. Nevertheless, ethnic minorities are underrepresented in the nursing profession. One of the many issues identified to compound this problem is the lack of retention and success of ethnic minority people in U.S. nursing programs. While the English-Speaking West African (ESWA) population in the U.S. forms about 5% of the 45 million immigrant population …

Standardized Patient Education For Patients' Initial Chemotherapy Through An Integrated Telemedicine Platform, Karen D. Dougherty

Seton Hall University Dissertations and Theses (ETDs)

Telemedicine has demonstrated a high level of satisfaction in a variety of health settings as a safe and efficient method of delivering healthcare. The purpose of this project was to implement an Advanced Practice-led Quality Improvement (QI) initiative pilot to evaluate the standardization of chemotherapy education through an integrated telemedicine platform. This Doctor of Nursing Practice (DNP) project used interventions noted in the literature review to assess and evaluate core concepts of knowledge, satisfaction, utilization, and program acceptance. This project aimed to utilize evidence-based processes to increase knowledge about the chemotherapy treatment routine, to raise awareness and develop skills to …

How Pediatric Emergency Department Nurses Initiate And Provide Care To Children And Families With Limited English-Proficiency, Caroline Meza

Seton Hall University Dissertations and Theses (ETDs)

Effective pediatric emergency care requires ongoing communication between the pediatric patient and their family. There may be additional challenges for pediatric emergency nurses (PENs) to consider in their efforts to provide safe quality nursing care to pediatric patients and families with limited English proficiency. The purpose of this study was to explore and describe the experience of PENs who are engaged in providing care to pediatric patients and families with limited-English proficiency (LEP) in a pediatric emergency department. Using an interpretive description method, semi-structured interviews conducted with 15 PENs and five certified professional medical interpreters (CPMIs) were analyzed. The study …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Spencer Forest

Master's Projects and Capstones

Problem: This quality improvement project aims to increase SEP-1 sepsis bundle compliance among nursing staff at a 16-bed emergency department through targeted continual staff education on sepsis screening and best practices. Currently, the unit is experiencing cases of sepsis fallout and is not meeting the 90% threshold on three treatment metrics as defined by the institutional sepsis bundle time goals. Bundle compliance that adheres to the time goals decreases incidences of sepsis fallout and overall days in the hospital, while increasing positive patient health outcomes.

Context: A microsystem assessment was completed along with a staff gap survey to determine areas …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Gregory James Trevino

Master's Projects and Capstones

Problem: Providing high-quality sepsis care in a San Francisco Bay Area emergency department (ED) is an organizational priority, however Centers for Medicare & Medicaid Service (CMS) SEP-1 sepsis bundle compliance has decreased to an average of 79% compliance since October of 2022. It was revealed that CMS SEP-1 sepsis bundle compliance issues have resulted in increased patient fallouts.

Context: A microsystem assessment was conducted by the quality improvement team to help identify gaps in practice. After an assessment survey of nursing staff, it was revealed that barriers such as physician order sets, lack of communication, lack of staffing during peak …

Educating Labor And Delivery Nurses On Evidence-Based Birthing Positions To Promote Fetal Descent During First And Second Stage Labor, Sophia Nguyen

Master's Projects and Capstones

The goal of this project was to increase confidence of labor and delivery nurses in utilizing evidence-supported birth positions during the first and second stages of labor in order to aid in fetal descent and labor progression. Current statistics demonstrate climbing trends in cesarean deliveries, which have been associated with increased maternal morbidity and mortality. One nurse intervention that can reduce failure to progress, a main contributor to cesarean sections, is the use of various evidence-supported maternal birth positions such as ambulation, assisted squat, sitting, backwards sitting, lunging, throne, side-lying with peanut ball, hands-and-knees, and throne position. This evidence-based practice …

Increasing Compliance Through Nurse Education On The Bundle, Zachary Harrison-Evans

Master's Projects and Capstones

In an effort to decrease complications and events connected to sepsis in the ED, there is room for improvement with relation to sepsis care and compliance rates. Timely sepsis management and gains in compliance/adherence rates are hindered by SEP-1 fallouts and requirements related to knowledge gaps concerning sepsis bundle procedures, nurses' attitudes about implementing the protocols, and disparities in nurse/physician order sets. It has been determined that the use of standardized protocols and order sets are not being utilized. This is a process gap and a critical area for improvement. Inadequate fluid and lactate documentation, a lack of education, and …

Implementing Nurse Education On Evidence-Based Birthing Positions For First And Second Stages Of Labor To Promote Fetal Descent, Momoko Ueda

Master's Projects and Capstones

Cesarean deliveries can increase the risk of maternal and newborn complications. A cost-effective method to reduce unnecessary cesarean deliveries is through maternal repositioning during the first and second stages of labor. Research has shown that flexible sacrum positions such as standing, squatting, kneeling, lunging, hands and knees, side-lying, and use of a peanut ball reduces the duration of labor, lowers rates of cesarean deliveries, and promotes fetal descent. This project aims to increase nurse confidence in these evidence-based labor positions by implementing nurse education in the labor and delivery unit at a Bay Area County hospital. A pre-survey identified current …

Early Sepsis Recognition: Improving Sepsis Education In A Medical-Surgical/Telemetry Unit, Kathileen Tran

Master's Projects and Capstones

Problem: This quality improvement project aimed to increase sepsis education and bundle compliance within the medical-surgical/telemetry unit to improve sepsis mortality and morbidity rates.

Context: A microsystem assessment was completed by Clinical Nurse Leader (CNL) students in the medical-surgical/telemetry unit at Hospital X located in the San Francisco Bay Area. This microsystem cares for patients diagnosed with sepsis, congestive heart failure (CHF), electrolyte imbalance, and alcohol withdrawal.

Interventions: Due to time constraints, an intervention was not implemented; however, the students provided recommendations for interventions to the leadership team for follow up. The recommended interventions encompass implementing sepsis protocol reference cards, …

Increasing Sepsis Bundle Compliance Through Nurse Education, Parth S. Papaiya

Master's Projects and Capstones

There exists opportunities for improvement in regards to sepsis management and compliance rates in efforts to reduce sepsis-related complications and incidents in the ED. SEP-1 fallouts and requirements linked to education gaps about sepsis bundle protocols, nurses’ attitudes about implementation of the protocols, and differences in nurse/physician order sets present as deterrents for timely sepsis management and improvements in the rates of compliance/adherence. Denouncing the usage of standardized protocols/use of order sets have been identified as a process gap and a much needed opportunity for improvement. It is presumed that the failure to implement, in addition to improper documentation of …

Therapeutic Gardening For Addiction Recovery, Hugo A. Rivera Lopez

Master's Projects and Capstones

Problem: The use of evidence-based alternative forms of therapy like horticulture therapy and therapeutic gardening is underutilized in substance use recovery programs in the United States. As the country continues to struggle with addiction, it is important that recovery programs look to and incorporate these alternative therapies into official curricula. Currently, 46.3 million individuals living in the United States are living with a substance use disorder (U.S Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration, 2022).

Context: The intervention was implemented at an all-male substance use treatment facility in San Jose, CA that houses up …

Exploring Sepsis Bundle Compliance In The Medical-Surgical/Telemetry Unit, Kerry Rebecca Reinbold

Master's Projects and Capstones

Abstract

Problem: Sepsis creates complications for patients and nursing staff. Increasing sepsis bundle compliance has been shown to decrease patient mortality. This quality improvement project utilized a self-administered questionnaire to better understand the opinions of nursing staff on the Medical-Surgical/Telemetry unit and explore ways to improve sepsis bundle compliance.

Context: The microsystem is a 32-bed Medical-Surgical/Telemetry unit at Hospital X, a 244-bed, not-for-profit hospital serving the Bay Area of California.

Interventions: A questionnaire distributed to nursing staff on the unit was the primary intervention. Through microsystem assessment, questionnaire results, and direct conversations with staff; active and passive data were obtained. …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Amanda H. Tran

Master's Projects and Capstones

Problem: According to a pre-survey collected, approximately six percent of medical-surgical nurses report expert knowledge with the “Inpatient Handoff Sepsis Bundle Checklist,” a checklist that details interventions to be taken when a patient is diagnosed with sepsis. About thirty-five percent of these nurses also report expert confidence levels in caring for sepsis patients. Therefore, there is an opportunity to provide education so that nurses may confidently and competently care for sepsis patients.

Context: A medical-surgical unit at Hospital A affiliated with a large, non-profit, integrated healthcare system located in the San Francisco Bay Area.

Intervention: Create an educational handout to …

Educating Nursing Staff On Evidence-Based Maternal Positioning To Promote Fetal Descent During The First And Second Stages Of Labor, Maryellen Barillas, Maryellen Barillas

Master's Projects and Capstones

This project aims to increase the confidence of nurses using birthing positions to aid with mobility to assist with fetal descent and decrease the duration of labor in the first and second stages of labor. Lack of mobility and increased duration of labor are associated with the use of cesarean sections, which is an invasive surgery with potential complications. A knowledge gap in a South Bay Area hospital exists in current evidence-based birthing positions. Recent evidence shows that flexible sacrum positions, which are any upright positions that take the weight off the sacrum, promote vaginal deliveries, and improve birthing outcomes. …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Shirley Chen

Master's Projects and Capstones

Problem: This project was implemented to decrease patient fallout rates through timely compliance with sepsis management according to the SEP-1 bundle. The SEP-1 bundle is already implemented in the emergency department. However, a microsystem assessment indicated barriers are preventing the achievement of the SEP-1 bundle milestones.

Context: This 16-bed emergency department (ED) at an urban Bay Area hospital provides 24-hour emergency services to individuals who suffer from medical injuries, accidents, and other serious health conditions. A random audit of the electronic health system (EHS) revealed that this emergency department consistently fails to meet the sepsis management time goals by 90%. …

The Use Of Therapeutic Gardening In Addiction Recovery, Sophia Agne

Master's Projects and Capstones

Problem: Numerous recent studies have emerged detailing the benefits of horticultural therapy on mental health and wellness. Despite this, substance use disorder treatment facilities rarely include an outdoor component in their programming. The project seeks to examine the advantages of incorporating therapeutic gardening as a complementary part of addiction treatment.

Context: The microsystem where the study was conducted was at a 32-bed residential substance abuse treatment facility for adult men who have previously been involved in the criminal justice system. The treatment approach employed at the facility aligns with the Integrated Dual Disorder Treatment (IDDT) curriculum, which emphasizes mental health-informed …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Jillian J. Abinader

Master's Projects and Capstones

Problem: A sepsis protocol and bundle has been implemented in an urban Emergency Department to help screen patients and treat sepsis efficiently and effectively. The benchmarks from the bundle are not being met consistently every month and are below the targeted 90%.

Context: A microsystem assessment and a gap survey sent out to nurses, helped determine that there is room to improve nurses’ knowledge and confidence about sepsis and the sepsis bundle workflow. Sepsis is one of the most expensive and burdensome conditions in U.S. hospitals. Literature supports staff education to improve sepsis bundle compliance.

Intervention: A video was created …

Increasing Sepsis-Bundle Adherence On A Medical-Surgical/Telemetry Unit: A Quality Improvement Project, Tiffany Liu

Master's Projects and Capstones

Problem: Sepsis is a life-threatening complication of infection that can lead to tissue damage, organ dysfunction, and death. Early recognition and intervention are crucial in the management of sepsis. Delays in sepsis care can lead to adverse health outcomes and even death. Sepsis bundles are guided by evidence-based practice. They serve as guidelines for effective and timely management of sepsis. Adherence to these sepsis bundles is associated with overall improved morbidity and mortality.

Context: This quality improvement project was led by Clinical Nurse Leader (CNL) students from the University of San Francisco. It was implemented at a 244-bed …

Therapeutic Gardening For Mental Health In Substance Use Recovery, Stephanie E. Schafer

Master's Projects and Capstones

Abstract

As the clinical nurse leader (CNL) in this project, I used the “[CNL]

Essential 1: Background for Practice from Sciences and Humanities” (Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice, 2013) and its competencies to focus on designing nursing care for a clinical or community-focused population based on biopsychosocial, public health, nursing, and organizational sciences and to synthesize evidence for practice to determine appropriate application of interventions across diverse populations. With the help of the CNL competencies and collaboration with the healthcare team, we created and implemented a therapeutic garden for residents in a substance use …

Therapeutic Gardening For Addiction Recovery, Hayley Milleson

Master's Projects and Capstones

The following study examines the potential benefits of implementing therapeutic gardening and outdoor activities as a supplemental resource for adult males with a history of substance abuse issues who have been affected by the criminal justice system and are seeking sobriety while in a residential treatment program. The goal is to investigate how therapeutic gardening can add to traditional addiction treatment methods. Through a review of current evidence-based practice, this study focuses on how alternative interventions such as therapeutic gardening and outdoor activity can improve overall mental health and well-being, promote a sense of community, improve social connections, alleviate stress …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Christopher N. Guinto

Master's Projects and Capstones

Problem: Results from a voluntarily anonymous pre-survey about sepsis revealed that a majority of the seventeen nurses assessed themselves below an "expert knowledge '' level. The survey results present an opportunity to improve the nurses’ knowledge and confidence in nursing response and improve patient outcomes with sepsis.

Context: The quality improvement (QI) project was conducted on a medical-surgical unit in a large Northern California hospital.

Intervention: A QI team initiated evidenced-based practice research and created an educational sepsis handout for nurses to increase sepsis knowledge and confidence.

Measures: The self-assessment pre-survey would be compared to the responses from the post-survey. …