Nursing Administration Commons^™

Infusing Evidence-Based Practice Into The Cayman Islands Health Services Authority Nursing Culture, Melissa Ring

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Background: James Madison University and Cayman Islands Health Services Authority (HSA) entered into a collaborative agreement the summer of 2020. There was a lack of organizational structure surrounding implementation and systemization of evidence-based practice (EBP) models and a disconnect between nurse manager knowledge and EBP implementation within HSA.

Methods: The population for this evidence-based project was 21 HSA nurse managers from the inpatient setting. Pre-intervention survey results informed organizational readiness, nurse manager knowledge and ability to implement, and guided the intervention that included the creation and implementation of a website toolkit for EBP. An EBP model was selected for nursing. …

An Evidence-Based Project: Exploring Nurse Manager Communication Competencies And Skill Development, Micaela Ross

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Abstract

Evidence supports effective communication skills as essential for patient safety and organizational success. Evidence is also clear regarding ineffective communication and its negative impact. The purpose of this project was to determine an area of communication skill development needed among nurse managers of the participating island hospital and support positive change in knowledge, understanding, and ability to use effective communication skills. The aim was to improve communication skills among these nurse managers.The objectives were to determine a specific skill need, provide a focused educational intervention, and evaluate skill improvement. Pre-intervention survey results revealed a self-identified priority of effective communication …

Optimizing Interprofessional Rounds To Reduce Extended Length Of Stay In Complex Patients, Christina May P. Santiago

Master's Projects and Capstones

Problem: Organizations have taken measures to reduce the length of stay by addressing logistical issues such as care coordination across the continuum. This becomes especially important for patients being discharged to skilled nursing facilities (SNF), where placement can be impeded due to complex care needs. In March 2021, the facility accounted for 20% of all extended length of stay (ELOS) patients across the organization. The average ELOS was 36 days, with 42% of these patients being discharged to a SNF.

Context: The Extended Length of Stay (ELOS) team functions at a mesosystem level within twenty-one medical centers across Northern …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

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 …

Creating A Pipeline To Increase Diversity In Executive Leadership Positions, Trarina Harris

Doctor of Nursing Practice (DNP) Projects

Background: Minority nurse leader presence at the executive leadership level is suboptimal, with insufficient pathways to increase representation. The lack of diversity in executive leadership threatens efforts to improve patient care and reduce disparities (Jerome Harris, 2021).

Local Problem: Practices to increase the diversity of executive nurse leaders at a pediatric medical center have had very little to no impact. Frontline nurses and nurse executives are not racially or ethnically representative of the increasingly minority patient populations served.

Context: As a commitment to increasing workforce diversity, the medical center developed an executive-level Racial Equity Taskforce, which aligned with the …

Manager Onboarding To Improve Knowledge And Confidence To Lead, Christine (Tina) K. Asiimwe

Doctor of Nursing Practice (DNP) Projects

Background: Primary care (PC) is increasingly the setting for affordable, coordinated, end-to-end patient care, with PC managers in charge of organizational performance. While PC managers are central to high-functioning teams, they often receive inadequate onboarding.

Local Problem: Primary care onboarding competes with other operational priorities and faces time constraints, lack of mentorship, and cost.

Context: At an integrated healthcare system, a need was identified to develop structured, role-specific onboarding for newly hired PC managers to improve knowledge and confidence to lead.

Interventions: Bauer’s Four Cs framework for onboarding guided the development of a manager onboarding program for 12 new PC …

Nurse Practitioner-Led Care Pods: A Team Communication Enhancement Model, Miranda Saint-Louis, Miranda Saint Louis

Doctor of Nursing Practice (DNP) Projects

Background: Communication has become a key performance measure in the shift to value-based healthcare. Given the impact of communication failures on patient harm, length of stay, and dissatisfaction with care, new models of care with better communication through structured teamwork and interdisciplinary collaboration are needed.

Problem: In a 16-bed geriatric medical/surgical unit of a New York City multispecialty community hospital, the workflow structure unintentionally created inconsistent handoff communication, gaps in continuity of care, missed care events, and inattention to the patient’s priorities in the care plan. A gap analysis identified communication deficiencies that impacted team effectiveness and patient care …

Patient Coordinated Care Response Team, Joshua Fox

Master's Projects and Capstones

Section I: Abstract

Problem: Communication between medical professionals and patients is a critical element to patient satisfaction and safety. The 2020 patient overall satisfaction scores for the local Roseville hospital were 73%. These data demonstrated an opportunity to enhance processes and the culture at the local Roseville hospital to meet the communication needs of its patient population.

Context: A patient coordinated care response team was developed to improve communication for newly diagnosed cancer patients or other life-altering diagnosis patients.

Interventions: A survey was completed to establish the current state of patient satisfaction with communication practices with healthcare providers in the …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Nurse Manager Communication Associated With Staff Nurse Satisfaction Or Retention, Svetlana Periut

Master of Science in Nursing Final Projects

Background: Nursing communication is a significant part of a nurse's job, especially when communicating with their patients, patient's families, and the healthcare team. Communication is the center of attention of many studies, and the way nurse leaders relate massages can influence an organization’s outcomes, including nurse satisfaction and retention. This integrative review aims to analyze communication styles, behaviors, and instruments used by hospital unit nurse managers to increase staff nurse satisfaction and retention.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis were used in the literature search and review. The Johns Hopkins Evidence-Based Practice Model and Guidelines were …

Development And Implementation Of An Evidence-Based Practice Mentor Fellowship, Stacy L. Alves

Doctor of Nursing Practice (DNP) Projects

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017).

Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation.

Context: …

Nursing Management To Reduce Hospital Readmissions After Percutaneous Coronary Interventions- Integrative Review, Jeena S. Daniel, Doreen Wagner

Master of Science in Nursing Final Projects

Abstract

Percutaneous coronary interventions (PCIs) are considered life-saving techniques in the event of myocardial infarction and remain the standard of care for managing acute heart attack. Given the success of the procedures, decreased complications, and the economic advantage over open-heart surgery, coronary interventions continue to be the preferred treatment choice. However, amidst the growth and success of these procedures, readmissions after percutaneous coronary interventions have been identified and still prevail among hospitals. Hence, the goal was to conduct an integrative review to identify and synthesize literature on the interventions that help reduce readmissions after percutaneous coronary interventions and illuminate nurses' …

Manager Onboarding To Improve Retention, Knowledge, And Confidence To Lead, Christine Asiimwe

Doctor of Nursing Practice (DNP) Projects

Objective: The purpose of this paper is to review the literature on manager onboarding best practices and their impact on turnover intention, knowledge, and confidence to lead teams in primary healthcare settings.

Background: Primary care onboarding is often insufficient due to competing operational priorities, time constraints, lack of mentorship, and cost. With primary care increasingly the setting for affordable, coordinated, end-to-end patient care, primary care managers must be well-prepared to lead the care team.

Methods: A review of the literature identified best onboarding practices associated with job satisfaction and turnover, reduced time to proficiency, increased knowledge, and confidence to lead. …

Bullying In The C-Suite: A Nurse Leader Perspective, Kimberly Ann Colonnelli

Doctor of Nursing Practice (DNP) Projects

An estimated 35% of American workers have experienced bullying, and in 80% of those situations, the perpetrator was a supervisor or boss. 1 However, the reality is that bullying can come from anyone in the workplace, including subordinates. Victims are generally well liked and good performers, making them feel like threats to a bully’s power base. Bullying, unlike harassment, is not a legally defined behavior, so no laws currently exist to punish it. Victims are, therefore, at the mercy of their bosses, supervisors, co-workers, and human resource departments for protection or relief. Bullying is not a singular event, but rather …

The Relationship Between Collective Nursing Knowledge And Nurse Turnover: An Application Of Nursing Intellectual Capital Theory, Pamela Russman-Chambers

Doctorate of Nursing Science Dissertations

The value of a healthcare organization is vested in the expertise, intellect, and wisdom of employees. Nursing knowledge resides both within the individual nurse and the collective knowledge embedded in organizational structures and practice environments. Healthcare organizations rely on their ability to utilize this knowledge to deliver high-quality care to patients. Hospitals wanting to gain a competitive advantage and achieve financial stability must be adept at acquiring, cultivating, and using the nursing knowledge stocks of the organization. When this knowledge can be utilized to mitigate healthcare issues and improve patients' health, this collective knowledge or intellectual capital is often the …

Leadership Rounding To Improve Patient Satisfaction In Pediatric Ambulatory Care, Tara J. Haskell

Student Scholarly Projects

Practice Problem: Low patient satisfaction has been linked to poor treatment compliance, patients leaving the practice, staff decreased job satisfaction, and high staff turnover (Haskard Zolnierek & DiMatteo, 2009; Prakash, 2010). Magnet reporting has identified wide discrepancies in ambulatory clinics, with some clinics reporting below benchmark patient satisfaction ratings.

PICOT: In pediatric ambulatory and primary care services, how will the implementation of leader-led customer service rounding, compared to current practice, increase family and/or patient satisfaction over 4 weeks?

Evidence: Key findings are that the rounding needs to be population-specific, intentional, and swiftly followed up when problems are identified. The body …

Aspects Of The Physical Work Environment And Nursing Work, Yolanda Keys

Nursing Theses and Dissertations

Objective: The purpose of this body of work is to inform nurse leaders and design professionals of opportunities to leverage the physical environment to enhance the overall work environment for nurses.

Background: The environments in which nursing work takes place need to support the staff who work within them. Healthy work environments have been shown to improve outcomes for patients, nurses, and organizations; however, the contribution of the built environment to the overall work environment for nurses is not fully understood.

Methods: Included in this portfolio are three studies: 1) a descriptive study exploring the experiences of …

New Graduate Nurses’ Experiences Of Engaging In A Leadership Role In Hospital Settings During The Covid-19 Pandemic, Justine Jeanelle Ting

Electronic Thesis and Dissertation Repository

New graduate registered nurses are often expected to assume leadership roles and responsibilities quickly upon entering practice. Since the emergence of the COVID-19 pandemic, new nurses may find their leadership capabilities tested even further as the demands of leadership have been made increasingly complex in the context of an infectious disease outbreak. The purpose of this interpretive descriptive study was to explore new graduate registered nurses’ experiences of engaging in frontline leadership roles in hospital settings during the COVID-19 pandemic. In-depth interviews were conducted with 14 participants across Ontario. Content analysis revealed four main themes: nominated and necessitated into leadership …

Reddit And Nursing During Covid-19: A Summative Content Analysis, Julia C. Savin

Electronic Thesis and Dissertation Repository

Purpose: The purpose of this thesis was to explore what self-identified nurses discussed on the nursing SubReddit during the Covid-19 pandemic between March 2020 to May 2020.

Methods: The Hsieh and Shannon (2005) summative content analysis with emergent categorical development was used to categorize the naturalistic data.

Findings: Through analysis, six content categories were identified from the nursing SubReddit: (a) employers’ approaches to the pandemic; (b) emergency preparedness in response to the pandemic; (c) shared experiences; (d) nursing students and new graduate nurses; (e) coping; and, (f) gratitude to nurses.

Implications: (a) Leadership that is communication-focused will improve the quality …

Evaluation Of Telemedicine As An Option For Providing Safe, Accessible, Care To Young Adults In A University Setting, Diane Lynch

Seton Hall University Dissertations and Theses (ETDs)

Previously underutilized, telemedicine has been implemented within a wide variety of health settings as a safe and efficient way of delivering healthcare during the COVID-19 pandemic. Maintaining operations during the pandemic made implementation of telemedicine an important aspect of college and university health center reopening plans. The purpose of this project was to evaluate the acceptance and quality of a telemedicine program implemented at the health center of a medium sized private university.

Data were collected via patient and staff surveys to measure satisfaction with the program and a retrospective review of electronic medical records was conducted to obtain data …

Spiritual Care Competency Of Critical Care Nurses: A Literature Review, Julia O. Rohm

Bachelors of Science in Nursing

While caring for their patients, nurses often encounter spiritual needs. In a study with 241 hospice, palliative care, and holistic nurses, “all respondents (100%) indicated they had encountered a patient with spiritual needs throughout their nursing clinical practice” (Lukovsky et al., 2021, p. 32). Despite the prevalence of spiritual needs, many nurses feel unable to confront spiritual issues among their patients. According to a survey conducted among 4054 nurses from the UK, “almost 93% of the nurses surveyed believed spiritual care should be addressed, yet only 5.3% felt always able to meet the spiritual need of patients on a regular …

Retention Of Nursing Assistants In Assisted Living Using Stay Interviews: A Qualitative Case Study, Daphne H. Dominguez

Doctor of Education (Ed.D)

The expectation of the impact of an aging population and the future availability of nursing staff is a significant challenge for senior living communities around the world. Lack of nursing staff retention has driven managers to hire quickly, denying residents living in long-term care communities the care they need. Exploratory, qualitative design, using case study research, was used for this study to learn what motivates resident care attendants (RCAs) to stay employed in assisted living communities of senior living. Richard Finnegan’s five stay interview questions were used to interview nine RCAs from various assisted living communities in Louisiana. The data …

The Holistic Self-Care Learning Experience Of Rn-To-Bsn Students: A Phenomenological Study Of Meaning And Value, Elaina C. Mahlan

Doctor of Education (Ed.D)

The health of the nursing workforce is a critical aspect of high-quality health care and community health promotion, but extensive research indicates that too many nurses neglect selfcare and suffer negative health outcomes. While nursing education must provide self-care learning experiences to improve the health of nurses, the value and influence of a learning experience must be interpreted from the learner’s point of view. The purpose of this phenomenological study was to elicit the personal value that RN-to-BSN students ascribed to a self-care learning experience within a holistic nursing course at a public university. The holistic nursing paradigm offers a …

Intent To Stay, Moral Distress, And Nurse Practice Environment Among Long-Term Care Nurses, Amil Tan

Dissertations, Theses, and Capstone Projects

Background: Many long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed at least in part to moral distress and a negative nurse practice environment. Licensed nurses working in long-term care facilities experience ethical challenges such as lack of resources, use of restraints, end-of-life issues, and caring for residents with dementia that, if not resolved, can lead to moral distress- especially if left unresolved. Long-term care administrators and nurse managers increasingly strive to improve leadership support for long-term care staff that will positively affect the nurse practice environment.

Aim/Purpose: The purpose …

The Art Of Emotional Intelligence: Decreasing Lateral Violence Among Nurses, Cheryl Ann Brugger

Theses and Graduate Projects

Nurses work in stressful and complex work environments and, unfortunately, can be subjected to lateral violence. Lateral violence is described as repetitive actions and behaviors of verbal and emotional abuse or acts of incivility from one nurse(s) to another on equal levels of the organizational structure; the behaviors are meant to threaten, harm, or intimidate. Nurses will not stay in an environment that is negative, hostile, and demoralizing; lateral violence can decrease nursing retention rates and increase turnover and job dissatisfaction. Nurses leaving the profession contributing to shortages, poor patient outcomes, and safety concerns. Enhancing nurses’ emotional intelligence may assist …

Testing A New Workflow To Integrate The Voice-Of-The-Customer In Readmission Analysis For Skilled Nursing Facility Readmissions From Home, Stephanie Edurese Bilbao

Master's Projects and Capstones

Abstract

There are multiple layers of oversight across the healthcare delivery system. Measuring acute hospital readmissions has been identified as an important outcome measure of quality care. Our patients are one of the major stakeholders in the healthcare system. One role of a clinical nurse leader is to integrate evidence-based leadership practices that identify and assess outcomes, mitigate risk, enhance health promotion, deliver highly effective patient care, and ensure transparent relationships with stakeholders. Rationales for examining and re-designing the readmission analysis workflow based on the customer’s experience are discussed in this paper. The global aim of the project is to …

Exercise As Self-Care To Combat Nurse Burnout, Jessica Petefish

Theses and Graduate Projects

The demands on nurses continue to grow, inducing stress and other symptoms of burnout. Nurse burnout can cause short and long term physiological and psychological symptoms. Nurse burnout not only affects nurses but has implications for patients and hospitals as well. Exercise has been proven to have many health benefits and the ability to alleviate symptoms of burnout. Nurses on a hematology/oncology unit cited burnout as their reason for leaving the unit. This project proposes a walking program as a self-care method to reduce symptoms of nurse burnout. Utilizing Jean Watson’s Theory of Human Caring and her idea of self-care …

The Use Of Isbared/Ishaped And Elimination Of Reviewing Patients’ Chart Before Handoff To Decrease Incremental Overtime, Sheila Bucao

Master's Projects and Capstones

Problem: Incremental overtime was found to majorly impact the financial well-being of a stroke unit. From an allocated budget of 22 hours per pay period, the unit’s incremental overtime averaged 40 hours. The stroke unit had skilled-mix competencies, further complicating handoffs. The absence of a standard reporting method means that reviewing patients’ charts takes approximately 10 to 15 minutes, extending what should be a quick, but thorough nurse knowledge exchange.

Context: The body of evidence reviewed indicated that pertinent information to patient care is not left out or missed when a standardized tool is used during handoff. Based on Lean …

Peer-To-Peer Emotional Support For Second Victims Of Hospital Adverse Events, Jessica L. Van Leuven

Master's Projects and Capstones

Abstract

Problem: Psychological impact of trauma on healthcare workers is profound, and if left unaddressed can debilitate its victims, depress morale, and undermine safety culture. When adverse events occur and focus is placed on providing care and support to patients and their families, the emotional support needs of healthcare workers must also be acknowledged.

Context: Frontline workers in the oncology unit of the medical center that is the setting for this project experience emotional distress as “second victims” of adverse patient events. Close relationships develop between providers and patients during long-term treatments. When unanticipated or adverse patient events there can …