Other Nursing Commons^™

Data Quality: Integral To Cauti Surveillance And Improvement In Non-Critical Care Units, Mary Grace Daria

Master's Projects and Capstones

Background: Urinary tract infections (UTIs) are the most common type of healthcare-acquired infection (HAI), with 75% approximately associated with urinary catheter use. The key to preventing UTIs is to avoid the use of indwelling urinary catheters (IUCs). This study explores denominator data extract logic modifications to increase IUC data capture and accuracy. It is set in a 249-bed acute care, teaching hospital in the Diablo Service Area in Northern California.

Problem: The electronic system used to extract the CAUTI denominator data is inconsistently capturing the IUC device days from the electronic medical record (EMR). This has regulatory reporting ramifications and …

Improving Triage Accuracy In The Emergency Department, Catriona E. Clohessy

Master's Projects and Capstones

Problem: Hospital Z’s emergency department was experiencing a triage inaccuracy rate that exceeded the accepted national benchmark of 10%. This quality improvement project aimed to reduce triage inaccuracy to less than 10% in the emergency department at Hospital Z, through improved education and availability of supplemental reference materials.

Context: This quality improvement project was conducted in a 40 bed emergency department at Hospital Z. This microsystem serves a diverse patient population from the surrounding community that experience a variety of conditions requiring emergency medical intervention.

Interventions: Clinical Nurse Leader nursing students partnered with unit leadership to create a new ESI …

Improving Triage Accuracy In The Emergency Department, Vince Harrington

Master's Projects and Capstones

Problem: Mistriage was occurring at higher than acceptable rates. In turn, this caused poor staffing levels and patient outcomes. This project seeks to improve triage accuracy according to the Emergency Nurses Association’s (ENA) Emergency Severity Index (ESI) algorithm.

Context: The Emergency Department in a prominent bay area hospital that was experiencing high rates of mistriage.

Interventions: The staff nurses were required to attend a retraining on the Emergency Nurses Association (ENA) Emergency Severity Index (ESI) algorithm. Following the retraining, a follow up online exam with sample patients must be passed at 100%. Furthermore, badge buddies containing the ESI algorithm will …

Reducing Care Companion Utilization In Medical-Surgical And Telemetry Units, Mary Jane B. Sagabaen

Master's Projects and Capstones

Abstract

Problem: The facility highly utilized sitters or care companions, negatively impacting the staffing plan, budget, and productivity. An average of 56 hours of care companions were used daily. This greatly exceeded the budget of 33 hours a day. Reassigning Patient Care Technicians (PCT) as care companions resulted in inadequate nurse support for patient care and increased cost for additional staffing needs. Despite this, the fall rate remained higher than the target.

Context: The patient population is mainly 65 years old and above, sometimes with confusion, dementia, delirium, and at high risk for falls and elopement. The culture included promptly …

Patient Education Improvement Initiative For Self-Management Of Congestive Heart Failure Among Senior Residents Of A Long-Term Care Facility, Abigail A. Abella, Brooke Sheck, Daniela Ramos, Ivy H. Nguyen, Mary Tran, Roshni Nagarajan

Master's Projects and Capstones

The purpose of this quality improvement project was to use evidence-based practices to determine if personalized education on disease self-management would lead to improved treatment adherence in a residential facility. The target population consisted of four elderly female patients who had been diagnosed with congestive heart failure (CHF) and were struggling with the self-management of their disease. Contributing barriers to effective CHF self-management were determined using a root cause analysis, and included a lack of educational templates, declining cognitive ability of the residents, and no electronic health record (EHR). Using the Self-Determination theory, the interventions were implemented. Phase one was …

Give Love With Lovenox: Reducing Pulmonary Embolism Risk In The Postpartum Unit Through Lovenox Prophylaxis Nursing Education, Guadalupe Sierra Arroyo

Master's Projects and Capstones

Problem: This quality improvement project aims to improve nurse education on Lovenox prophylaxis to reduce pulmonary embolism occurrence post-discharge amongst high-risk postpartum women who underwent vaginal/cesarean deliveries and to increase patient medication compliance in the Family Baby Unit (FBU) at Hospital X.

Context: The quality improvement project occurred on the Family Baby Unit (FBU) at Hospital X. This 25-bed unit has recently had an increased rate of pulmonary embolisms post-discharge due to poor Lovenox medication adherence amongst patients and lack of education among nurses.

Intervention: Data was collected in the microsystem. This data was collected through questionnaires to assess nurses' …

Lovenox Prophylaxis: Improving Lovenox Nurse Education In A Postpartum Unit, Amy T. Nguyen

Master's Projects and Capstones

Problem: This quality improvement project aimed to increase nurse education about Lovenox

prophylaxis within the postpartum unit to reduce risks of pulmonary embolism among high-risk postpartum women in the postpartum unit. Context: A microsystem assessment was completed by Clinical Nurse Leader (CNL) students in the postpartum unit at Hospital X located in the southern Bay Area. This unit accommodates 25 beds and provides care for postpartum mothers after both cesarean section and vaginal births. Intervention: An anonymous pre-intervention survey was distributed to the registered nurses on the unit. Educational handouts were created and distributed to the nurses on the unit. …

Improving Triage Accuracy In The Emergency Department, Maia E. Baglin

Master's Projects and Capstones

A Northern California emergency department (ED) faced increased triage inaccuracy. An analysis of 400 random ED visits from January to April 2023 discovered a 23% mistriage rate, with under- and over-triage rates at 16.25% and 6.75%, respectively. Mistriage creates an imbalance in unit acuity, leading to inappropriate staffing levels. Potential breaks in the triage process, include inaccurate triaging by the screener or triage nurses, as well as delays in the providers inputting initial orders, leaving patients waiting without appropriate care orders. An educational training focusing on the updated Emergency Nurses Association Emergency Severity Index (ESI) algorithm version 5 was mandated. …

Resocialization Of An Inpatient Handoff Sepsis Bundle Checklist On A Medical-Surgical Unit, Sophia Kawada

Master's Projects and Capstones

Problem: In September 2023, it was found that only 25% of nurses were familiar with an inpatient handoff sepsis bundle checklist (IHSBC) on a Medical-Surgical Unit in Hospital A. This evidence-based project aimed to improve resocialization of the IHSBC such that compliance to the bundle continues to be maintained well above the benchmark of 75%. Context: Clinical Nurse Leader (CNL) students at the University of San Francisco conducted a microsystem assessment of the Medical-Surgical Unit at Hospital A. This hospital aimed to maintain high rates of compliance with the IHSBC. Interventions: Resocialization of the IHSBC was completed in October, and …

Engaging In Research: Reflections From Summer Undergraduate Research Assistants, Elyse Sumarsono, Julia Raugh

Wisdom & Compassion: The LUSON Journal

The aim of the journal was to organize the reflections of two undergraduate nursing students regarding the journey of navigating through summer research along with faculty. Through this reflective experience, research assistants were able to identify many benefits that come with participating in the research conduction process that should encourage other undergraduate students to involve themselves in future research. Research assistants were challenged to take on new and unknown tasks in a high-level research study, which ultimately enhanced skills for future academic success and professional careers as nurses.

Implementation Of An Evidence-Based Guideline To Improve Vital Sign Assessment And Documentation In The Emergency Department, Mary Darden Mason, Jennifer Lynn Smith, Laura Sturla

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: The emergency department (ED) is a fast-paced area at risk for medical errors. Studies have found that patients with abnormal vital signs (VS) experience preventable adverse events and worse process outcomes, such as extended length of stay (LOS) times and increased readmission rates. Despite ongoing reports of VS inconsistencies, there remains a lack of evidence-based VS assessment and documentation standards across healthcare, which results in missed opportunities to mitigate deficits in quality of care.

LOCAL PROBLEM: The project site, a 19-bed rural ED in Maryland, lacked a standardized process delineating VS assessment frequency for the ED nurses, …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Teela Sade Miller-Buford

Master's Projects and Capstones

Abstract

Problem: This quality improvement project aims to enhance early sepsis management and sepsis bundle compliance among Emergency Department nurses to reduce the risk of sepsis-related deaths and hospital length of stays.

Context: A group of students studying to become Clinical Nurse Leaders (CNLs) evaluated Hospital A's Emergency Department (a clinical microsystem) located in the greater Bay Area. This microsystem provides diverse emergency care for patients with various medical conditions and diagnoses. The CNL students concentrated on patients diagnosed with sepsis for their quality improvement project.

Interventions: Although time constraints prevented the implementation of interventions, the CNL students proposed recommendations …

Evaluation Of Registered Nurses’ Knowledge And Confidence In Encouraging Cardiac Surgery Patients To Participate In Digital Education, Katelin A. Welch, Jewyl Gibson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Background: Cardiac surgery remains a necessary means of medical management for cardiac disease. Patient anxiety is a common mental health challenge experienced by cardiac surgical candidates. Preoperative educational videos can reduce anxiety and improve the surgical experience.

Local Problem: This project was conducted for hospital nurses caring for cardiac surgery patients. Cardiac patients are assigned digital education to educate them about their procedures. Regardless of availability, nurse and patient engagement of the material is low. Competing nursing priorities prevent nurses from disseminating education to cardiac surgery patients, thus increasing patient anxiety. Educating nurses on utilizing digital surgery …

The Leadership Experience Of Academic Chief Nurse Administrators In The State Of Georgia During The Covid-19 Pandemic Upon Return To Campus After Full Virtual Instruction: A Qualitative Study, Susie Jonassen

Dissertations

The impact of the COVID-19 global pandemic has been rated as the highest factor of intent to leave the profession in nurses serving in a leadership role. During the pandemic, crisis leadership swept across academia partly because nursing academia was not prepared for the rapid transition to virtual instruction. The reopening of nursing programs, while pandemic restrictions were still required, caused unprecedented disruptions and stress for academic leaders. One-third of nursing faculty anticipate retirement within the next two years. With the present burnout and shortage of nursing academia leaders, there was a need to explore the lived experience of academic …

The Implementation Of Nurse Practitioner Residency Programs To Increase The Employment Retention Of New Graduates, Roni-Jo Panganiban

Master of Science in Nursing Family Nurse Practitioner

This review explores the effectiveness of Nurse Practitioner (NP) residency programs in addressing role strain, burnout, and retaining new graduates. It emphasizes the factors contributing to NP resignations and proposes formal residency programs to improve job satisfaction and retention rates. Research highlights benefits such as enhanced preparedness, credibility, and better patient care, advocating for increased program accessibility and funding. Additionally, the application of the theory of planned behavior underscores compliance with regulations, evidence-based practice, and environmental influences for patient safety in advanced practice registered nursing. The literature review on NP residency programs draws from six empirical articles, focusing on job …

Psychosocial Consequences Of Diagnosed Malignant Melanoma, Savanna Eve Smallwood-Corcoran, Mary Johnson, Lindsay Frazier

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Psychosocial consequences frequently accompany the diagnosis of malignant melanoma (MM), such as fear, anxiety, burden, and distress. Patients are not receiving the proper psychiatric care needed to address the psychosocial consequences they are experiencing. Patients diagnosed with MM have expressed a lack of assessment and supportive care by providers to address psychosocial consequences they are experiencing.

LOCAL PROBLEM: The setting for the quality improvement project was a private dermatology clinic in Knoxville, Tennessee. There was no standard procedure for anxiety screening at the site. Comparable to published studies, there is a lack of procedures for screening patients …

Initiating A Skin-Care Bundle In The Emergency Department To Decrease Hospital-Acquired Pressure Injuries In Geriatric Patients, Suzanne Babcock, Pamela Hardesty

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Adults 65+ comprise 15.2% of the United States (U.S.) population and 17.9% of Emergency Department (ED) visits. Aging causes changes to skin, including thinning and loss of elasticity. Annually, in the U.S., 2.5 million individuals develop Pressure Injuries (PI), causing 60,000 deaths. Hospital acquired PIs in the U.S. cost $26.8 billion annually, over $10,000/patient and increase the length of stay by greater than four days.

LOCAL PROBLEM: This project occurred in a 27-bed Geriatric Accredited Emergency Department in a southeastern U.S. city where patients 65+ comprise 40% of the patient volume annually. PIs can begin developing within two hours. …

Massive Transfusion And Shock Index, Kasey House

MSN Capstone Projects

Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.

While initiating an MTP …

Emergency Department Patient Navigator Post Chest Pain Diagnosis Discharge, Nancy Simoes

Seton Hall University Dissertations and Theses (ETDs)

Abstract The most common complaint seen in the Emergency Department, along with abdominal pain, is nonspecific chest pain. Often, these complaints cause prolonged lengths of stay in the ED, followed by hospital admissions and subsequent readmissions for various reasons. When thinking about these various reasons, the question for prevention of readmission comes to mind. What could we do as a department to keep patients from continuously using the Emergency Department as a primary point of care instead of outpatient facilities when necessary? Project Aim: The purpose of this quality improvement project was to initiate the need for a patient navigator …

Purposeful Rounding For Fall Reduction, Deborah Grant Rn

Master's Projects and Capstones

Objective. The quality improvement project aimed to study the effects of purposeful rounding on falls in a long-term care unit. The focus was on CNAs who provided care for 6 residents each, with a current census of 36 residents in the long-term care setting. Problem. Many of the residents are at risk for falls due to immobility, medication, and environmental hazards (Centers for Disease Control and Prevention, 2022). Context. Research has found that the key reasons residents call for staff include needing to use the bathroom, to address pain, to address positioning, and to address IV pumps and alarms (Studer …

Lactation Benefits, Experiences, And Education In Bereaved Mothers: A Literature Review, Grace Davis

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Background: Parents who lose an infant through miscarriage, elective termination, or stillbirth experience perinatal bereavement (Centers for Disease Control and Prevention, 2022). A bereaved mother’s grief could be influenced by lactation as most will still experience lactation regardless of their loss. Generally, these women are solely taught to suppress their milk production, oftentimes resulting in discomfort, leakage, clogged ducts, and even mastitis (Carroll et al., 2020). To prevent adverse effects, bereaved mothers need a comprehensive list of options and education regarding lactation including donation, expression, and suppression. Bereaved mothers' lactation experiences, education, and benefits are vital areas to be …

Transformational Leadership Training For Leaders, Kristie Gilliland

Electronic Theses and Dissertations

The purpose of the study was to evaluate the impact of transformational leadership training on improving a leader’s skills and knowledge in performing daily operations and interacting with frontline staff, decreasing attrition. Ineffective leadership contributes to staff dissatisfaction, poor performance, and attrition. The literature supports transformational leadership is effective in leading teams of nurses and contributes to staff autonomy, staff satisfaction, decreased attrition, and improved patient outcomes. A quasi-experimental research study was completed on a leadership team in a managed care organization. Fourteen leaders with anywhere from 1 to more than 6 years of leadership experience were evaluated. Lewin’s change …

Attention-Deficit/Hyperactivity Disorder And Teachers, Samantha Ann Tierney, Samantha Ann Tierney

Honors College Theses

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common disorder, estimated to affect 5% of all children and adolescents. The current rate of diagnosis is steadily increasing. This increase in the number of students with ADHD affects educators, who have a large role in the success of students with ADHD. Despite this, many teachers are not prepared to deal with the extra challenges that come with teaching students with ADHD. Teachers may not be properly taught how to deal with children who have ADHD in their classrooms or the role they have in these children’s lives. The purpose of this study is to …

Promoting Patient Mobility To Decrease Hospital Length Of Stay, Saira Kinuthia

Student Scholarly Projects

Practice Problem: Promoting patient mobility may reduce hospital-acquired complications and length of stay (LOS). Evidence-based studies have established that there is a correlation between immobility and an increased length of stay in the hospital. How can nurse-driven mobility interventions effectively increase patient mobility and reduce the risk of complications and length of hospital stay?

PICOT: The PICOT question that guided this project was: For veteran patients in the Progressive Care unit (PCU) of a medical center (P), will using the Johns Hopkins Highest Level of Mobility tool (JH-HLM) (I) compared to not using a mobility tool (C) decrease hospital length …

Reducing Hopelessness In Patients With Parkinson’S Disease: Educational Intervention, Kara R. Callear, Pamela Hardesty

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Reducing Hopelessness in Patients with Parkinson’s Disease: Educational Intervention

BACKGROUND: Parkinson’s disease (PD), features several non-motor manifestations, including cognitive dysfunction, which impacts patients and their families. Depression, hopelessness, and anxiety are all prevalent in the psychiatric conditions of PD. In fact, at least 50% of those diagnosed with PD will experience some sort of depression, hopelessness, or anxiety disorder after diagnosis (Ray & Agarwal, 2020). The specific purpose of this project was to help patients with PD diagnosis feel less hopeless and more resilient when coping with their symptoms of PD.

LOCAL PROBLEM: The project setting was a …

Improving Oncofertility Discussions And Referrals: Implementation Of A Formal Fertility Preservation Program, Mackenzie Danielle Browning, Melissa Marie Hessock

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Impaired fertility is a risk of life-saving cancer treatment in adolescents and young adults (AYAs). Despite this known risk and clinical practice guidelines that stress their importance, treatment-associated fertility risk education and preservation referrals are often neglected in this population.

LOCAL PROBLEM: The site of this evidence-based practice improvement project is an outpatient hematology-oncology clinic serving adults with varying cancer diagnoses. The site did not have a standardized approach to ensure treatment-associated fertility risk education and fertility preservation referrals were provided to AYAs with newly diagnosed cancer. The purpose of this project was to implement a formal fertility preservation …

Nurse Leader Rounding To Provide Fall Prevention Strategies, Kerri Philipbar

Student Scholarly Projects

Practice Problem: Falls while patients are hospitalized are all too common. It was identified that the 300-bed facility in Southeast Georgia had a clinical practice gap with inpatient falls. Inpatient falls cause unnecessary pain and suffering to the patient and families. In addition to the negative effects to the patients, it creates a hardship to the organization. Increased length of stay and additional testing and treatments are charged to the hospital because of a fall.

PICOT: The PICOT question for this project is as follows: In adult patients in an acute care setting (P), does nurse leader rounding to …

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

The Impact Of Self-Compassion Strategies To Reduce Stress And Support The Transition To Practice For New Graduate Nurses: A Pilot Project, Charity Michelle Ballmann

Electronic Theses and Dissertations

Abstract The purpose of the study was to analyze the impact of self-compassion exercises to reduce stress and support the transition to practice for new graduate nurses. As the years pass, one thing remains a consistent topic in healthcare, and the need for nurses remains constant. The nursing staffing shortage gap seemingly widened further as the COVID-19 pandemic created additional challenges for healthcare systems, patient care, and employees. Retention of the workforce and an intentional focus on new graduate nurses' well-being have become increasingly important. New graduate nurses are a pipeline for the nursing workforce. Supporting the transition to practice …

Exploring The Unmet Care Needs Of Women With Chronic Obstructive Pulmonary Disease (Copd), Jessica Madiraca

MUSC Theses and Dissertations

The primary objective of this study was to examine the feasibility of study procedures to and explore the unmet needs and potential barriers of women with advanced COPD who may need palliative care (PC). This multi-method study was guided by the adapted Hierarchy of Needs Model and explored unmet care needs, assessed knowledge of PC services, and identified barriers that women experience when receiving or during the implementation of PC. Further exploration of PC needs by sex provided information on unmet care needs of women with advanced COPD. Participants were recruited through convenience sampling by using COPD Patient-Powered Research Network …