Digital Commons Network^™

Answering The “Now What?”: The Development Of A Transdisciplinary Breast Cancer Survivorship Nonprofit Organization, Vir-Iaesta Maniquiz Vergel De Dios

CGU Theses & Dissertations

Although patients are living longer or are surviving breast cancer, the side effects of treatment still leave patients struggling with quality-of-life issues. The lack of whole-person care leaves patients unequipped after treatment is complete, searching for answers and a way to survive on their own. The unintended consequence becomes a dramatic shift from the weekly/daily medical appointments during active treatment to a silence that can be daunting for many to navigate. Living Your Truth Empowered, shortened to LYTE Foundation, is an antiauthoritarian minded and anti-hierarchal nonprofit created to address the needs of the growing breast cancer survivor population. LYTE is …

Home Blood Pressure Monitoring Bundle For Hypertension Outcomes In Adult Patients Receiving Care In Public Health Clinics, Christine Jennifer Victorian

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Hypertension (HTN) that is not adequately controlled leads to cardiovascular disease, stroke, and heart disease. It affects 116 million adults (47%) in the United States (U.S.). The HTN compliance rate in a South Texas public health clinic was 64%, below the national benchmark of 76%. Home blood pressure monitoring (HBPM) was recommended in a joint statement by the American Heart Association (AHA) and the American Medical Association (AMA). Literature evidence revealed that the HBPM bundle increased BP control (< 140/90 mmHg) compliance.

Methods: A quality improvement (QI) bundle was initiated to address the low HTN compliance rate from a quality management perspective. …

Impact Of A Discharge Bundle On Boarding Hours In Acute Care Hospitals, Monica L. Herrera

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

The national epidemic of boarding hours in the emergency departments prompted the implementation of a discharge bundle in an acute care hospital. This bundle included an ADT nurse, discharge orders written prior to 11AM, and EVS shifting employee hours. Initial findings indicated a reduction in boarding time by 126 minutes.

Clinical Practice Guideline For The Management Of Depression In Primary Care, Estrella Catherine Villarreal

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: The prevalence of depression poses a significant challenge in primary care, emphasizing the urgent need to address this issue during patient visits. Primary care providers are at the forefront of managing depression, yet they encounter difficulties in screening, diagnosing, assessing, and treating this complex condition. Clinical guidelines serve as valuable tools for primary care providers and practices, offering support in identifying and addressing depression effectively. An evidence-based approach to treating depression in primary care, with a focus on collaborative interventions with behavioral health to enhance depression management for American Indian/Alaskan Native (AI/AN) communities.

Methods: The descriptive analysis was conducted …

Developing Toolkit For Adults With Autism Spectrum Disorder In An Oncology Outpatient Clinic, Brittany J. Johnson Dnp, Fnp-C

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Autistic adults are at higher risk of being diagnosed with co-occurring health conditions, and yet they are a vulnerable group for disparities in access and outcomes. One of the key barriers to better outcomes is poor patient-provider communication. This study the use of AASPIRE’s AHAT communication toolkit as a channel between healthcare workers and autistic adults to facilitate their appointments within the outpatient oncology department, as well as assessing healthcare providers’ knowledge and self-efficacy in caring for the patients. Sixteen healthcare providers (12 registered nurses and four patient care assistants) completed pre and post intervention surveys and utilized the AHAT …

Assessing Providers’ Readiness To Integrate Mat Services In A Primary Care Setting, Carmen Ingram-Thorpe

Theses and Dissertations

Opioid use disorder is a growing concern in the United States. Despite medication-assisted treatment (MAT) being a more effective treatment option than behavioral treatment alone, primary care providers’ rate of adoption and utilization of MAT has not matched the demand of the opioid crisis. The largest barrier facing our local community is the availability of organizations and providers that can and will actually provide MAT services. The purpose of this study was to identify factors that impact primary care providers’ readiness to treat individuals with opioid use disorder (OUD) using MAT. This study used the ADKAR model as framework, which …

The Anatomy Of Physician Fulfillment: Strategies Beyond Burnout, Brook Hale

Antioch University Dissertations & Theses

The persistent tension and power struggle between healthcare executives and physicians is a prevalent issue in healthcare organizations, often leading to a culture of organizational mistrust. This dynamic stems from perceived conflicting goals: executives are frequently seen as primarily focused on financial outcomes, while physicians are viewed as resistant to change. This study explored how physician fulfillment is experienced at work, with the ultimate goal of identifying potential interventions to bridge the gap between these groups. There is vast research and literature available regarding burnout in healthcare; this research focused on understanding what physicians find fulfilling in their work and …

Swimming Together Upstream: How To Align Mlp Services With U.S. Healthcare Delivery, William M. Sage, Keegan D. Warren

Faculty Scholarship

Medical-legal partnership (MLP) embeds attorneys and paralegals into care delivery to help clinicians address root causes of health inequities. Notwithstanding decades of favorable outcomes, MLP is not as well-known as might be expected. In this essay, the authors explore ways in which strategic alignment of legal services with healthcare services in terms of professionalism, information collection and sharing, and financing might help the MLP movement become a more widespread, sustainable model for holistic care delivery.

Clinical Practice Implementation To Address Ascvd Risk: A Practice Change In Primary Care, Elizabeth Wooten

Student Scholarly Projects

Practice Problem: Heart disease stands as the leading cause of mortality in the United States. While healthcare providers strive to identify and optimize prevention strategies, particularly in high-risk patient populations, notable gaps in care persist, notably in the management of modifiable risk factors such as low-density lipoprotein cholesterol (LDL). By harnessing the power of artificial intelligence (AI) integrated software within clinical settings, we can revolutionize the landscape of this devastating chronic disease.

PICOT: The PICOT question that guided this project was: In Primary Care Advanced Practice Providers (APP) caring for high-risk and/or very high-risk patients with atherosclerotic cardiovascular disease (ASCVD) …

Exploration Of Burnout, Emotional Thriving, And Emotional Recovery In An Academic Medical Center: A Mixed Methods Quality Improvement Project, Roxana Naderi, Katherine T. Morrison, Zuzanna Czernik, James E. Carter Jr, Katherine N. Dickerman, Alexandra Gallant, Lara Kirkbride-Romeo, Lauren Mcbeth, Angela Keniston, Kristin M. Jensen

Journal of Wellness

Introduction: Healthcare provider burnout, an indicator of wellbeing, impacts patient safety, provider distress, and employee turnover. In this mixed methods, multi-site quality improvement study conductedpandemic, we assessed employee wellbeing in a large clinical department.

Methods: Wellbeing surveys were sent electronically to Department of Medicine clinicians, researchers, administrators, and staff from August-September 2019 assessing perceptions of Burnout, Emotional Thriving (ET), and Emotional Recovery (ER). Qualitative responses were reviewed for themes using mixed inductive-deductive analysis. The initial coding was done by small teams with consensus obtained through large group discussions. This study was IRB-approved as non-human subjects research.

Results: Of the 671 …

An Implementation Of Combined Fecal/Gastric Occult Blood Testing In The Emergency Department, Desiree Long

Master's Projects and Capstones

Problem: The gastrointestinal occult blood test is a point-of-care (POC) test used to detect the presence of occult (hidden) gastrointestinal bleeding via stool or gastric contents. Existing fecal and gastric occult blood point-of-care (POC) testing requires separate and unique sampling cards and developer, respectively. Separate fecal/gastric tests are less definitive and take longer than a combined test. Fecal/gastric testing can be improved and more effective using a combined testing mechanism.

Context: This project includes the microsystem of the emergency department, which involves groups of medical professionals, such as groups of clinicians and staff working together with a shared clinical goal …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

How Exemplary Chief Nurse Executives Utilize The Six Domains Of Conflict Transformational Strategies To Establish Common Ground And Produce Breakthrough Results, Michael Thompson

Dissertations

Purpose: The purpose of this phenomenological method study was to identify and describe strategies that exemplary chief nurse executive leaders use to identify and establish common grounds to produce breakthrough results in healthcare by using the six domains of transformational conflict strategies: collaboration, communication, emotional intelligence, ethical behaviors, problem solving, and shared interest.

Methodology: As a part of the thematic phenomenological study, the research identified and described the lived experiences of eight exemplary chief nurse executive leaders in health care who used conflict transformational strategies to find common ground to produce breakthrough results. The target population for the study included …

Exploring And Identifying Healthcare Leaders Competencies Required For Effective Decision Making In A High Velocity Environment To Achieve Sustainability Under The Regulatory Compliance Tenets Of The Patient Protection Affordable Care Act, Sylvester Foote

Seton Hall University Dissertations and Theses (ETDs)

Background and Purpose of the Study: Healthcare organizations face challenges in efficiently accommodating increased participant demands with limited resources and capacity. The modern reimbursement environment prioritized the maximization of operational efficiency and the reduction of unnecessary cost (i.e., waste) while maintaining or improving quality. As healthcare organizations adapt, significant pressures are placed on leaders to make difficult operational and budgetary decisions (Hamrock, Eric, et al., 2013).

As healthcare goes through this transformation within its high velocity environment defined as environments in which there is rapid and discontinuous change in demand, competitors, technology and /or regulations, such that information is often …

Naloxone Education To Improve Distribution In Primary Care: A Quality Improvement Project, Joanna Boback

DNP Projects

Significance and Background: Opioid overdose is a major public health problem in the United States. The Centers for Disease Control and Prevention (CDC) developed guidelines for prescribing opioids which have not been widely integrated into practice. These guidelines specify co-prescribing naloxone with opioids as a form of harm reduction. A policy to reflect these recommendations was needed to guide prescribing at a Federally Qualified Health Center (FQHC) in Connecticut to increase low naloxone prescribing rates. Evidence supported the use of provider education to increase prescribing rates.

Purpose: Deliver education to providers across the health system on best practices related to …

Improving Utilization Of Clinical Pharmacy Services In A Health Professional Shortage Area, Samantha E. Tallman

Masters Projects

Background: Integration of clinical pharmacy specialists (CPS) into primary care has increased over the last decade. CPS are highly educated advanced practice providers and specialize in chronic disease and medication management, and offer additional support to both patients and PCPs. Despite their extensive training and expertise, the role of CPS is often unknown or misunderstood amongst PCPs and results in the underutilization of CPS services. As a result, referrals to their service remain low. The purpose of this quality improvement project is to increase referrals to embedded CPS and identify encounter types by associated diagnoses.

Objectives: Develop and implement a …

Nurses’ Perception Of Work-Environment Uncertainty And Readiness For Organizational Change, Aishah Alsolami, Hanan Alkorashy, Mysara Alfaki, Ahmed Alkarani

Makara Journal of Health Research

Background: Healthcare organizations have a dynamic work-environment that changes constantly. This study aimed to explore whether there is a relationship between work-environment uncertainty and nurses’ readiness to participate in organizational change.

Methods: A cross-sectional study was conducted at two tertiary hospitals. The sample size was 222 nurses. A self-report questionnaire was adopted, translated to Arabic, and used for collecting data; it consists of three scales, personal data sheet, organizational readiness for implementing change scale, and perceived environmental uncertainty in hospitals scale. Descriptive statistics t-test and analysis of variance were used to analyze the data.

Results: The level …

Pre-Transplant Evaluation Period Efficiency Through The Use Of An Electronic Scheduling Template, Christy Dawn Byrd

Student Scholarly Projects

Practice Problem: Candidacy for transplant evaluation is a complex and lengthy evaluation process. Delays in National Organ Registry have significant unfavorable impacts on patient outcomes as 22 people a day die awaiting a lifesaving treatment. Operational efficiencies can improve the pre-transplant evaluation period and significantly improve patient outcomes.

PICOT: In an outpatient transplant clinic (P), will leveraging an evidence-based scheduling template (I) compared to the current practice of first available appointment (C) reduce the evaluation period by 66% from a 3–4-week evaluation to a 1-week evaluation resulting in expedited listing on the National Organ Registry (O), when applied over …

Entrepreneurial Leadership Strategies For Catalyzing Innovation Performance, Jason D'Souza

Walden Dissertations and Doctoral Studies

Inadequate innovation performance has the potential for adverse business outcomes. Business leaders are concerned with inadequate innovation performance, as innovation is a significant driver of business growth. Grounded in entrepreneurial leadership, the purpose of this qualitative multi-case study was to explore entrepreneurial leadership strategies that some healthcare business leaders used to catalyze innovation performance. The participants were six business leaders within three healthcare sectors who contributed to strategic healthcare innovation decisions using entrepreneurial leadership strategies within the last 5 years. Data were collected using semistructured interviews and a review of organizational strategy documents and websites. Through thematic analysis, six themes …

Entrepreneurial Leadership Strategies For Catalyzing Innovation Performance, Jason D'Souza

Walden Dissertations and Doctoral Studies

Inadequate innovation performance has the potential for adverse business outcomes. Business leaders are concerned with inadequate innovation performance, as innovation is a significant driver of business growth. Grounded in entrepreneurial leadership, the purpose of this qualitative multi-case study was to explore entrepreneurial leadership strategies that some healthcare business leaders used to catalyze innovation performance. The participants were six business leaders within three healthcare sectors who contributed to strategic healthcare innovation decisions using entrepreneurial leadership strategies within the last 5 years. Data were collected using semistructured interviews and a review of organizational strategy documents and websites. Through thematic analysis, six themes …

The Relationship Between “Speak Up” Culture Level, Team Effectiveness, And Organizational Performance Among Clinical Laboratory Professionals, Emmanuel Udasco

Walden Dissertations and Doctoral Studies

The clinical laboratory plays a crucial role in aiding physicians to diagnose disease. With numerous studies on “Speak Up” culture well-documented among providers and nurses surrounding patient safety, gaps in literature exist concerning “Speak Up” culture that address team effectiveness and organizational performance within the clinical lab setting. The purpose of this quantitative correlation study was to investigate the relationship between “Speak Up” culture level, team effectiveness, and organizational performance among health care workers employed in the clinical lab. The high-performance work practices model was utilized as the conceptual framework to ground this study. Research questions assessed the link between …

Strategies To Improve Hospital Patient Satisfaction To Increase Performance-Based Reimbursements, Celso G. Silla Iii

Walden Dissertations and Doctoral Studies

Officials from the Centers for Medicare and Medicaid Services (CMS) created the hospital valued-based purchasing (VBP) program focused on controlling cost, inefficiencies, and quality-of-care. Hospital leaders are incentivized or penalized based on meeting quality outcomes and risk millions of dollars in reimbursement if they do not meet the quality-of-care standards specified in the CMS hospital VBP program. Grounded in the transformational leadership theory, the purpose of this qualitative multiple case study was to explore strategies hospital leaders used to improve patient satisfaction to increase VBP performance-based reimbursements. Participants included eight hospital leaders from seven hospitals in California who successfully implemented …

Disparities In Mental Health Technology Among African Americans: Breaking Cultural Inclusion Barriers, Nyoki Cosey-Brown

DSW Capstone Projects

Mental health technology is a healthcare delivery model of the future. The engagement in virtual healthcare was intensified when traditional healthcare methods were inaccessible during the federal restrictions implemented due to the COVID-19 pandemic. Utilizing digital apparatuses for healthcare improved the convenience, efficiency, and accessibility of various mental health services that were inoperable in past healthcare models. However, the historical constructs of stigma, discrimination, inequity, exclusion, and structural racism in mental healthcare were prevalent problems that remained present in virtual mental health platforms concerning the experiences of African-American patients and professionals who utilized the spaces.

This research explored mental health …

An Analytic And Systemic View Of The Digital Transformation Of Healthcare, Xuejuan J. Zhang

Full-Text Theses & Dissertations

Industry 4.0 represents a digital revolution that is driven by technologies that blur the lines between the physical and digital worlds. Industry 4.0, the latest industrial revolution, is poised to have a profound impact on all aspects of society. In order to understand how the healthcare industry is being transformed by the convergence of the physical and digital realms, a systems perspective is taken in this study. Two research questions are addressed regarding the opportunities and interventions that can be provided by both analytical and systems conceptions of digital transformation. I use a systemic literature review approach to address the …

Exploring The Benefits Of A Collaboration Between Behavioral Health Coaches And Clinicians, Devan White

Walden Dissertations and Doctoral Studies

This case study addressed how to best use health coaches in the field of behavioral health to improve the accessibility and outreach of a new program launched by the target organization that emphasizes coaching as an intervention for improving well-being and mental fitness. The purpose of this qualitative case study was to investigate the potential influence of coaching within the behavioral health field and explore how health coaches could partner with clinicians or behavioral health leaders to allow for more collaboration and accessibility to services. The RQs centered on how health coaches might support the treatment of those who have …

Increasing Access To Healthcare For Black, Indigenous, People Of Color (Bipoc) And Impoverished Populations In A Rural County Of North Carolina, Shawn Perry

Doctor of Education Dissertations

Rural healthcare has often lagged when compared to those in suburban areas and inner cities. Rural healthcare has often been less effective, lower in quality, and not as accessible. Access to healthcare has been a key factor in life quality and quantity for all. Utilizing a mixed-methods approach, qualitative and quantitative data was collected and analyzed which included the community health needs assessment (CHNA) data from the rural county (RC) and a double-blind survey distributed to organizational members by the partnering organization, the rural hospital (RH). The data identified that access to healthcare is a critical need for RC. Additionally, …

Distinctiveness In Hospital Safety And Security, Jimmy Reid Rollins Jr.

Doctor of Education Dissertations

The purpose of this research was to understand leadership and how these ideas feed into a professional dynamic of employee behavior, organizational leadership, motivation, and workplace culture, and how there is a real human interest as employees excel, grow, mature, and become better individuals.

Participants in this study were employees of a regional health organization and employed with the job title of public safety officer, public safety supervisor, or public safety administrator. This research used a mixed methodology approach in an explanatory design. A survey was completed followed by one on one interviews.

Conducting research into the safety and security …

Strategies To Improve Hospital Patient Satisfaction To Increase Performance-Based Reimbursements, Celso G. Silla Iii

Walden Dissertations and Doctoral Studies

Officials from the Centers for Medicare and Medicaid Services (CMS) created the hospital valued-based purchasing (VBP) program focused on controlling cost, inefficiencies, and quality-of-care. Hospital leaders are incentivized or penalized based on meeting quality outcomes and risk millions of dollars in reimbursement if they do not meet the quality-of-care standards specified in the CMS hospital VBP program. Grounded in the transformational leadership theory, the purpose of this qualitative multiple case study was to explore strategies hospital leaders used to improve patient satisfaction to increase VBP performance-based reimbursements. Participants included eight hospital leaders from seven hospitals in California who successfully implemented …

Improving Provider Retention Through Addressing Burnout At A Federally Qualified Health Center: A Quality Improvement Initiative, Emily Grattan

DNP Scholarly Projects

Background: Primary care providers employed by federally qualified health centers (FQHC) working with underserved populations experience high levels of burnout as patients are often medically complex, face healthcare disparities and societal stigmas. The aim of the project was to alleviate burnout and improve provider retention through introduction of organizational support measures. Participants involved were healthcare providers, as well as nurse management and senior leadership.

Methods: The quality improvement approach for this project utilized the Plan-Do-Study-Act (PDSA) cycle and a driver diagram to guide the selected interventions. Interventions were based on categories from Mayo’s Clinic’s Nine Organizational Strategies to Promote Engagement …

Successfully Transitioning Executives During Times Of Multidimensional Change: A Delphi Study Examining Organizational Practices In Large Hospital Systems, Lilicia Bailey

Theses and Dissertations

Healthcare is the fastest growing industry in the United States and globally. Economists forecast that as the population grows and life expectancy increases, the healthcare sector will continue expanding to meet consumer needs domestically and globally. Population aging and the emergence of global pandemics has substantially increased the demand for healthcare services and has created volatile, complex, uncertain, and ambiguous conditions that ignite social, economic, and workforce shifts within and outside the organization. While these factors require growth and agility within healthcare organizations, high turnover in the healthcare workforce threatens these organizations’ ability to effectively fulfill their mission. The high …