Nursing Administration Commons^™

Pregnancy Loss In The Emergency Department, Gudrun Reiterhiltebrand

Master's Projects and Capstones

Abstract

The aim of this project is to improve the care for patients experiencing pregnancy loss in the emergency department (ED). Objectives are to enhance understanding of staff about the patients’ experience and their knowledge on how to best care for emotional needs, thus improving quality of patient care, work satisfaction, knowledge, confidence and comfort levels, while decreasing experienced stress. The project was implemented in a midsized community hospital with 117 beds, which discharged 74 patients with “interrupted pregnancies” over the previous year from the ED. The project was directed toward nurses, doctors, care partners, chaplains, and social workers. The …

Fall Prevention In The Ed, Ninojoseph Lacap

Master's Projects and Capstones

This project focuses on the prevention of patient falls in the emergency department (ED). Kaiser Santa Clara Hospital is an academic medical facility in the heart of Silicon Valley. The facility has a 46 bed ED with an average daily census of 220, specializing in stroke, pediatrics, heart, and left-ventricular assist device (LVAD) patients. For the calendar year of 2016 there were thirty-reported patient falls in the ED. The global aim is to reduce the patient fall rate by 35% for the 2017 calendar year. The project’s objective is to continue the road to patient safety and to have less …

Development Of A Formalized Mentorship Program, Rozlyn Bauer

Master's Projects and Capstones

The purpose of this project is to help increase retention of newly licensed registered nurses (NLRN) at a large community medical center. The medical center loses approximately 20 NLRNs per year which is costly for the medical center. The loss of NLRN can be attributed to decreased job satisfaction, poor nursing competence and lateral violence between the nursing staff. Evidence shows that mentorship is a proven, evidence-based approach to solving these issues and more (Hodgson & Scanlan, 2013).

Not only can mentorship help increase retention, address lateral violence, increase job satisfaction and nursing competence but, it can also help enhance …

Development Of A Formalized Mentorship Program For Newly Licensed Registered Nurses At A Large Community Medical Center, Javier Moreno

Master's Projects and Capstones

With mentorship being a key to addressing several issues at a large community medical center, the leadership of the institution engaged with students of a Clinical Nurse Leader (CNL) Program to conduct a thorough assessment. This paper addresses the charge for a standardized and formalized evidence-based approach to a nurse mentorship program to address key areas that enhance not only the work environment but also the quality of care. These key areas include the 1) promotion of professional development and engagement via 2) acquisition of skills necessary to achieve nursing competence, 3) address lateral violence, 4) increase in staff retention …

Identifying Ways That Institutional Staffing And Scheduling Committees Engage Nursing Staff In Resource Allocation At The Unit And Institutional Levels, Kevin M. Shimp

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The American Nurses Association (ANA) recommends that at least fifty percent direct care providers are involved in staffing and scheduling decisions at the institutional level (ANA Staffing, 2015). This recommendation coincides with Magnet recommendations for the staff most impacted by staffing levels. Magnet organizations are recognized for superior nursing processes and quality patient care, which lead to the highest levels of safety, quality, and patient satisfaction (ANCC, 2015). Existing research, largely at the unit level, shows that registered nurses in acute care environments have higher general work satisfaction and morale when they are engaged in decision making around staffing (Ellerbe …

New Nurse Huddle Pilot To Improve New Graduate Nurse Retention, Timothy Craddock

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Purpose: With the continued nursing shortage, it has become increasingly important for healthcare organizations to focus on nurse retention to maintain quality of care standards and maintain fiscal responsibility. The purpose of this project was to pilot a new graduate nurse huddle to improve retention of new graduate nurses.

Method: A new graduate nurse huddle was developed using past nurse residency cohort Casey-Fink Graduate Nurse Experience Survey data to focus on areas of poor performance. Mixed methods surveys were administered pre-huddle and post-huddle to measure participant intent to stay and perception of huddle value. Descriptive statistics were used to evaluate …

Implementation Of A Parental Notification System For The Improvement Of Well-Child Care Delivery, Frances Narvaiz

Doctor of Nursing Practice

This quality improvement project aimed to improve routine well-child exam rates in accordance with the American Academy of Pediatrics and Texas Health Steps recommendations through the implementation of a parental notification system. Missed well-child appointments impact health care by disturbing continuity of care and complicating preventive care services. Implementation of the parental notification system during June 2017 to August 2017 consisted of 100 patients from birth to 18 years of age for scheduled well-child visits in a pediatric clinic with a large Hispanic and Medicaid population. Interventions consisted of staff training, reminder phone calls 24 to 48 hours prior to …

The Development Of A Wayfinding Smart Phone Application As A Large Healthcare Facility Investment Opportunity, Jessie Fortson Marshall

Doctoral Projects

Health care is a continually growing field. New hospitals are constantly being built, while older facilities are experiencing renovation and expansion. With this growth comes a set of difficulties for patients as they try to navigate through large, multi-building facilities. Most large facilities have multiple parking garages, numerous buildings, and medical towers with an unending number of floors. Patients are forced to rely on directional signage to find their destination that is often insufficient. Attempting to navigate through large facilities is often overwhelming for visitors leading to frustration and stress.

New technology has allowed a convenient solution to this problem …

Examining The Relationship Between Registered Nurses’ Turnover And The Benefits Of An Affirming Climate Of Diversity As Mediated By Workplace Outcomes, James Mark Clardy

Human Resource Development Theses and Dissertations

The Affordable Care Act has created within health care a growing demand for primary care services in both the inpatient and outpatient settings. The anticipated growth in need for registered nurses (RN) of 19% by 2020 is compounded by a current estimated national turnover rate greater than 17%. Human Resource Development (HRD) practitioners in health care are challenged to develop and implement interventions that can influence turnover in RNs despite identifying variables that effect turnover. This research explored how RN turnover can be positively affected by a government mandated requirement that health care create a diverse workforce and cultural competency. …

Exploratory Pilot Testing Of The Psychometric Properties Of The Person Engagement Index Instrument Among Older, Community-Dwelling Adults, Ellen Swartwout, Taya Irizarry, Annette Devito Dabbs, Scott Barnett

Patient Experience Journal

The objective of this paper was to evaluate the psychometric properties of the Person Engagement Index with community dwelling older adults and determine the factors that impact this population’s capacity to engage in healthcare. This non-experimental pilot evaluation of the psychometrics of the Person Engagement Index was performed in a convenience sample of 100 community-dwelling older adults. Exploratory factor analysis was conducted using dimension reduction to determine the underlying structure of a person’s capacity to engage in healthcare. Results indicated good internal consistency with Cronbach’s alpha=.882 for the overall scale. Exploratory factor analysis with varimax rotation was conducted resulting …

Influence Of Work Environment Conditions On The Ability Of Critical Care Nurses To Provide Efficacious Nursing Care In Puerto Rico, Yolanda M. Torres

Doctoral Dissertations

The purpose of this study was to explore the conditions in the work environment that may contribute to caring efficacy of critical care nurses in Puerto Rico. The study measured nurses’ perceptions of the empowering structures in the work environment, and the relationship to their perceived caring efficacy and explored the correlation between sociodemographic factors of age, education, and experience of work empowerment and/or caring efficacy. The Conditions for Work Effectiveness Questionnaire and Caring Efficacy Scale were used to assess the association between the nurses’ work environment conditions and caring efficacy. The instruments were translated to Spanish and adapted to …

Relational Coordination: A Predictor Of Nurse Job Satisfaction, Organizational Commitment, And Turnover Intention, Rawaih Falatah

Doctoral Dissertations

The purpose of this cross-sectional correlational study was to examine the psychometric properties of the relational coordination scale among nurses in the Kingdom of Saudi Arabia (KSA). In addition, it examined the relationship between relational coordination (RC), job satisfaction, affective organizational commitment (AOC), and turnover intention. Finally, it identified potential moderators and mediators between these four concepts. The study population included staff nurses 22 years or older, who have worked in a healthcare setting for at least six months in the Kingdom of Saudi Arabia. Participants completed an online survey via Survey Monkey “Survey Monkey (www.surveymonkey.com).” A link to the …

Pots: Educating School Nurses, Stephanie Sherwood

Doctoral Dissertations and Scholarly Projects

The project used educational modules as a means for providing knowledge about postural orthostatic tachycardia (POTS) to school nurses. It evaluated knowledge of symptoms and the referral process. A pre and post-test were used immediately prior to and following an educational module to determine gained knowledge about POTS. Participants completed a survey evaluating their perceived knowledge and comfort level to evaluate POTS symptoms and refer patients for further evaluation. One hundred percent of participants demonstrated improvement in their post-test score confirming knowledge gained in all participants. All participants reported that the modules helped them about POTS, and they felt confident …

Perceived Knowledge And Perceptions Of Palliative Care Among Advanced Practice Cardiac Providers, Jordan Vance

Doctoral Dissertations and Projects

Providers of healthcare have continued to focus on addressing patients’ chronic health outcomes. When understanding how to manage chronic disease, there remains many opportunities in facilitation of better management. With such a wide range of individuals who suffer with a chronic condition, better management to address this population is essential. Palliative care aids in accomplishing this task. It was seen that there was a lack of education in relation to palliative care, with perceptions that continued to be a barrier to the utilization of the service. Due to the lack in education, the strongest barrier to palliative care service utilization …

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …

Interdepartmental Rounding, Peggy Anderson, Carrie Strick, R3 Med-Surg Unit, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Maine Medical Center Operational Excellence

Maine Medical Center

STRATEGIES FOR IMPROVING COMMUNICATION BETWEEN DOCTORS AND NURSES IN AN ACUTE CARE HOSPITAL

Effective interdisciplinary communication is imperative for safe patient care in an acute care hospital environment.

A surgical unit used their HCAHPs scores to assess how often patients perceived there was good communication between different doctors and nurses during their hospital stays. The data demonstrated that this occurred 22% less often than the national average.

As a result of a root cause analysis, a number of countermeasures were initiated with the goal of achieving scores greater than the national average. Post KPI inception in the second quarter of …

Patient Fall Prevention, R9 West Cardiovascular, Cathy Palleschi, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Maine Medical Center

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL

Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs.

The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented.

Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline …

Programs That Can Support Nurses To Reduce Compassion Fatigue And Secondary Traumatic Stress: An Integrative Literature Review, Molly Gruettner

Grace Peterson Nursing Research Colloquium

Compassion allows a nurse to empathize with their patient and their family, but it does not prepare the nurse to cope with stressful events. Repeatedly being exposed to traumatizing events, pain, distress, and suffering can lead to nurse burn-out and fatigue. Compassion fatigue is a unique form of burnout and secondary traumatic stress (STS) encompasses ideas of compassion fatigue and the two terms are often used interchangeably. Objective: The goal of this systematic integrated literature review is to discover interventions to reduce compassion fatigue and STS in trauma nurses Methods: A systematic integrated literature review study was conducted using Ebscohost …

Higher Medication Administration Errors Associated With Automated Dispensing System Usage, Jillian Cramer

Grace Peterson Nursing Research Colloquium

According to a report by The Institute of Medicine, medical errors were associated with up to 98,000 deaths and more than 1 million injuries each year in the United States. These errors can result in poor outcomes, which increase harm or death. According to the Pennsylvania Patient Safety Reporting System, up to 15% of errors reported cite automated dispensing cabinets as the source of the drug involved in the error.Nearly 58% to 70% of hospitals nationwide use automated dispensing cabinets. Nurses play a critical role in promoting patient safety by surveilling and intercepting any possible errors that could occur during …

Methods To Reduce Fall Risk, Christin Klineman

Grace Peterson Nursing Research Colloquium

Background: The reinforcement of patient, family, and staff education in addition to traditional fall risk interventions is critical to reduce the rates of falls in hospitalized patients.

Objectives: The purpose of this integrative literature review is to analyze whether or not performing initial falls risk assessments combined with patient and family education could potentially reduce the number of falls in hospitalized patients.

Method: An integrative literature review guided by Whittemore & Knafl was conducted using Cumulative Index of Nursing and Allied Health (CINAHL) Complete, ProQuest, PubMed and Google Scholar. A search was conducted using these terms: hospital, falls, fall prevention, …

Napping And Errors In Night Shift Nursing, Yoon-Hee Hong

Grace Peterson Nursing Research Colloquium

Napping and Errors in Night Shift Nursing

Yoon-Hee Hong, MS Candidate

Larry Maturin, MSN, APN, ACNS-BC, CEN, CCRN

DePaul University School of Nursing

Summer 2017

Abstract

Fatigue and sleepiness in nurses resulting from long 12-hour night work shifts were brought to the spotlight by a sentinel event alert published by The Joint Commission in 2011. By working these long hours, nurses place patient safety at risk. Napping mid-shift has been proposed as a means of reducing the physiological demands and mental decline of fatigue and sleepiness. However, implementation of napping and other fatigue relief measures by nurse managers has not …

Investing In The Float Pool: A Cost Effective Alternative For Staffing Shortages, Christen Straw

Master's Projects and Capstones

Abstract

Inpatient facilities have historically utilized contract nurses as a short-term solution to staffing shortages. Research suggests that utilizing the float pool provides a cost-effective alternative that has the potential to save the organization millions of dollars per year. This project aims to explore the financial impact of the float pool by increasing the volume of nurses by 50% within six months, individualizing the onboarding process to fit the needs of this complex department, and initiating a shared decision making model for identifying and implementing change. The overarching goal of this project is to provide a cost-saving alternative to staffing …

Business Intelligence Competencies: Making Healthcare Data Come Alive, Christina Bivona-Tellez

Doctor of Nursing Practice (DNP) Projects

Business Intelligence Competencies: Making Healthcare Data Come Alive While a wealth of healthcare related data exists, nurse leaders (NL) have yet to understand its implications and adopt analytical skills to lead in the transformation of care delivery. Information science is at a new frontier for nursing to embrace. It is critical for nursing leadership to advance and support business intelligence (BI) and interactive data visualization (IDV) skills across the organization and advocate for greater engagement of nurses in health system decision making. With these new tools and competencies, nursing and other health professions can innovate best practices, providing enhanced quality, …

Cultivating A Culture Of Compassion Among Newly Graduated Registered Nurses: An Evidence-Based Mobile Learning Toolkit, Benson Yeung

Doctor of Nursing Practice (DNP) Projects

Empathy, kindness, and compassion are some of the humanistic values essential to nursing practice particularly in today’s patient and family-centric healthcare environment. A genuinely empathetic and caring relationship between a nurse and a patient not only enhances the quality and safety of care but also contributes to patient satisfaction, compliance to treatment, and overall health outcomes. Debate amongst educators and researchers continues to grow as to whether these uniquely humanistic values are innate or if they can be taught. How do nurses acquire the knowledge, skills, and attitudes towards the delivery of compassionate patient care? What strategies are best suited …

Aligning Theory And Evidence-Based Practices To Enhance Human Flourishing In Nurse Executives, Jim D'Alfonso

Doctor of Nursing Practice (DNP) Projects

Today’s nurse executives lead highly complex and bureaucratic organizations undergoing sweeping reform at an unprecedented rate of change. Change and high levels of stress are the norm in health care, and ineffective stress management can hinder organizational performance and adversely impact personal wellbeing. The risks of nurse executive burnout and unprecedented turnover led to the development of a 4-hour program to teach theory-guided and evidence-based stress management techniques. The program was intended to increase awareness, enhance effective stress management skills, and improve the nurse executive’s ability to flourish in high stress environments. A pre-intervention and 6-month post-intervention assessment (n …

Readiness For Improving Safe Care Delivery Through Web-Based Hospital Nurse Scheduling & Staffing Technology: A Multi-Hospital Approach, Lisa Massarweh

Doctor of Nursing Practice (DNP) Projects

Hospital scheduling and staffing practices are linked to patient safety, nurse satisfaction, and cost outcomes (Steege & Rainbow, 2017). Staffing, while complex, is ultimately central to the overall success of the hospital. Demands to eliminate events that cause death or serious harm, produce high patient satisfaction scores while maximizing workforce productivity, test any administrator’s skillset. Providing qualified staff in the right place at the right time can be challenged by restrictive union contracts, variable patient acuities, staff attendance, and mandated staffing ratios. These demands may lead to overtime utilization. There is a growing understanding of the negative effects of healthcare …

Review Of Literature: The Clinical Nurses' Perception Of Their Role In Hospital Reimbursement, Mckinsey Patterson

Pursuit - The Journal of Undergraduate Research at The University of Tennessee

Background: Nursing-sensitive indicators (NSI’s) serve to measure the impact nurses have in promotion of quality care. Existing research highlights the value-based purchasing (VBP) system implemented by the Affordable Care Act (ACA). Few studies explore nurse perception.

Method: This review provides a state-of-the-science addressing NSI’s regarding delivery of quality care, hospital assessment related to value-based purchasing and the role of patient satisfaction regarding nursing care in the reimbursement of hospitals. Existing data related to nurses’ roles in VBP reimbursement efforts is described.

Results: A theme in the literature is that the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, …

Organizational, Nurse, And Patient Empowerment At A Magnet And Non-Magnet Hospital, Mai Yaseen

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose/Aims: To explore the relationships between organizational, nurse, and patient empowerment at a Magnet designated hospital versus a non-Magnet designated hospital. There are three aims to the study. Aim 1 examines the relationship between level of organizational empowerment and individual nurse self-empowerment (Self-efficacy). Aim 2 examines the relationship between individual nurse self-empowerment and patient empowerment. Aim 3 investigates if there are any differences in empowerment levels between a Magnet and non-Magnet designated hospital. Background: Patients must feel empowered to make decisions and participate in their care however; it is the healthcare provider’s role to prepare patients to make these decisions. …

Physician Orders For Life-Sustaining Treatment (Polst) Utilization In A Skilled Nursing Facility: An Educational Quality Initiative, Ryan Hazley Bsn, Rn, Dnp Student, Karl Steinberg Md, Cmd, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

According to expert reports and recent research, frequent clinician-patient conversations about individual end-of-life preferences are necessary to avoid unwanted treatment and to ensure that desired treatments are received. The ongoing diffusion of Physician Orders for Life-Sustaining Treatment (POLST) educational initiatives in skilled nursing facilities (SNFs) are vital to success of California’s POLST program, which is now recognized as only 1 of 3 mature POLST programs in the country. The purpose of this evidence-based practice project was to answer the question: Among staff in a skilled nursing facility, does implementing a formal POLST education program compared to current practice improve staff …

Breast Cancer Patient Preparedness For Transition To Survivorship: Individualized Survivorship Care Plans, Kimberly Beringer

Master's Projects and Capstones

Purpose. For breast cancer survivors, after-effects of surgery, radiation and chemotherapy can be substantial, and recurrence is a concern requiring constant surveillance. National healthcare organizations have promulgated guidelines that include providing individualized survivorship care plans (SCP’s). At a northern California oncology department, SCP’s will be prepared for breast cancer patients and delivered in-person by the oncology nurse navigator (ONN).

Method. The author worked with the ONN to develop the format and content requirements for the SCP’s. The ONN prepared individualized plans for patients and scheduled in-person appointments to deliver the SCP’s. A feedback survey to assess preliminary impact was then …