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Effectiveness Of Breastfeeding Shift Champions On Exclusive Breastfeeding, Comfort Obi

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Purpose. This project evaluated the effect of breastfeeding support on breastfeeding and exclusive breastfeeding rates among postpartum mothers in immediate postpartum period. The breastfeeding support was provided by breastfeeding shift champions (BFSC) following childbirth.

Design. A convenience sample of BFSCs, aged between 18 and 44 years, was utilized.

Method. Pre-and post-intervention questionnaires were used to evaluate breastfeeding knowledge of BFSC. Breastfeeding and exclusive breastfeeding rates were extracted, pre- and post- intervention, from electronic medical records of newborns and their mothers.

Data analysis. Descriptive and inferential statistics were used for data analyses. Descriptive data were displayed using frequency …

Multicenter Handoff Collaborative, Philip E. Greilich, Joseph R. Keebler

Publications

Communication and team-based care are at the heart of patient safety. As anesthesia professionals, we witness this at its very best and worst when transferring patients to and from the operating room (see article by Dr. Lorinc on types of transfers in this issue). In response, we have an opportunity to take a leading role in redesigning the most ubiquitous teaming event in hospitals in a manner that promotes team-based behaviors. The impact of unreliable handoffs on communication failures and medical errors is well known. To combat this issue, mandates by The Joint Commission (TJC) in 2006 and the American …

Population Health Research: Early Description Of The Organizational Shift Toward Population Health Management And Defining A Vision For Leadership., Kristi L. Caldararo, David B. Nash

College of Population Health Faculty Papers

As health care delivery systems adapt to the changing marketplace, many struggle to define a clear strategy that will prove successful in managing the health of entire populations. The federal government continues to put increasing pressure on organizations to shift away from the traditional way of delivering episodic care and move toward managing populations as a whole-before, during, and after a patient presents in a health care facility. Private payers have begun to follow suit as risk-based payer contracts and bundled payment models become increasingly popular. For organizations to adequately influence the health outcomes of a population, they must be …

Health Literacy: Cancer Prevention Strategies For Early Adults., Robert Simmons, Susan C. Cosgrove, Martha C. Romney, James D. Plumb, Rickie O. Brawer, Evelyn T. Gonzalez, Linda G. Fleisher, Bradley S Moore

College of Population Health Faculty Papers

Health literacy, the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make health decisions, is an essential element for early adults (aged 18-44 years) to make informed decisions about cancer. Low health literacy is one of the social determinants of health associated with cancer-related disparities. Over the past several years, a nonprofit organization, a university, and a cancer center in a major urban environment have developed and implemented health literacy programs within healthcare systems and in the community. Health system personnel received extensive health literacy training to reduce medical jargon …

Implementing The Weefim System In Outpatient Pediatric Rehabilitation, Chelsea Ratilainen

Master's Projects and Capstones

Abstract

This project was designed to achieve an unmet criteria in the accreditation process for the outpatient pediatric rehabilitation program at a local, community hospital in the greater Bay Area. The clients range from 6 months old to 20 years old with functional disabilities. The Commission of Accreditation of Rehabilitation Facilities (CARF) requires that applicants demonstrate outcome measure data over a 6 month time period. During the self-evaluation process this was noted to be a deficiency in the department’s efforts. The WeeFIM system was chosen as the first tool to implement in the department. This is a functional improvement measurement …

A Roundtable On Cross-Sector Collaboration And Resource Alignment For Health Equity: Meeting Summary, Onyemaechi Nweke

Journal of Health Disparities Research and Practice

Cross-sector collaboration is a highly recommended strategy to eliminate health inequities nationally and globally. In the federal sector, it is evolving into an important approach for solving complex social problems, as evidenced by its steady proliferation the past few decades. Despite the increased adoption of cross-sector collaboration, it is still not a default strategy or preeminent option for managing complex social problems. In September 2015, the Federal Interagency Health Equity Team (FIHET) hosted a Roundtable event to discuss opportunities and strategies to foster widespread adoption of cross-sector collaboration and resource alignment. The Roundtable featured several expert panelists and participants from …

Mapping The Alignment Of Programmatic Mission, Functions And Outcomes With The Attainment Of Health Equity: An Overview Of The Approach And Initial Outcomes Through The Lens Of The Usda’S Cyfar Scp Program, Onyemaechi Nweke, Kara Ryan, Mpp, Bonita Williams, Phd

Journal of Health Disparities Research and Practice

Eliminating health disparities is a priority across national agenda and initiatives such as the National Partnership for Action to End Health Disparities (NPA), the National Prevention Strategy, and Healthy People 2020. To advance this priority under the NPA, the Federal Interagency Health Equity Team (FIHET), which is an NPA federal cross-sector and collaborative platform, initiated a voluntary pilot “health equity mapping” exercise in 2014. This exercise served as a strategy to clarify the strategic alignment between participant federal partner program missions, goals, and activities, and the goal to end health disparities and promote health equity. The mapping process included an …

Implementing Risk Tools To Prevent Hospital Readmission, Tara O'Connor

Master's Projects and Capstones

Implementing Risk Tools to Prevent Hospital Readmission

Tara O’Connor

Abstract

Background: Readmission reduction is one of the most important opportunities for reducing cost in today’s health care system.

Global Aim: To operationalize risk tools to reduce hospital readmissions by 5 percent by the end of 2017.

Project Aim: To develop new transitions program (TP) processes that operationalizes the risk tools and ensures 70 percent of all readmission risk score patients referred receive a post discharge phone call within 48 hours, and are assessed for their risk of medication management issues as part of their initial assessment, by August 1^{st, …}

Evaluation Of A Pilot Multidisciplinary Debriefing Program: Promoting Pediatric Provider Emotional, Social, And Spiritual Wellbeing, Allison E. Reynolds

Doctoral Projects

Regular exposure to trauma, such as the act of bearing witness to intense suffering and pain of pediatric patients and families, has a significant effect on healthcare professionals. Despite the fact that traumatic situations in pediatrics are a reality, there is little education and few interventions focused on how to prepare and support healthcare providers to care for dying children and families or for other clinically challenging situations. Pediatric residency program directors within a large, freestanding children’s hospital identified a subjective need for support for their pediatric residents in dealing with clinically challenging situations faced during residency, motivating residency program …

Teaching And Learning Courageous Followership: An Action Research Study, Karen Walker Schwab

Theses & Dissertations

Followership has been shown to be a developmental stage of leadership. Yet, there is a lack of followership theory in the health-care context. The purpose of this qualitative action research study was to explore how introducing Chaleff’s dimensions of courageous followership influences the undergraduate nursing students’ views of the follower role and informs their nursing practice. Secondary research questions asked how knowledge of these dimensions influences the nursing students’ views while advocating, collaborating, and addressing lateral violence. Using purposeful sampling, 12 participants were recruited for this study. After attending a followership seminar, they completed online reflections and participated in individual …

The Role Of Leader Empowering Behaviors On Work Engagement And Intent To Stay Among Staff Nurses In Acute Care Hospitals, Ingrid Kindipan

Nursing Dissertations - Archive

Leader empowering behavior is a facilitative process where employees perceive their leader to allow self-management and self-leadership of employees. Leader empowering behaviors can be perceived by employees as either enabling or burdensome. The purpose of this descriptive correlational study was to examine the relationship of leader empowering behaviors with nurse demographics, work engagement and intent to stay. A convenience sample of nurses (N = 212) employed in various nursing units within four hospitals completed an online survey related to perceived leader empowering behaviors, and the nurse’s level of work engagement and intent to stay in his/her organization of employment. Overall, …

Resisting Technology-Enabled Change Within Healthcare Organization, Yong Kwang Adrian Yeow, Wee-Kiat Lim

CCX Research

Instead of the predominant view of resistance as one that occurs between the management and those lower in the hierarchy, we consider how acts of resisting would unfold between peer actors within a technology-enabled change project for a large university hosptial. Drawing on institutional politics, we highlight the importance of understanding organizational resistance as a set of interrelated skillful acts, where the actions of resisters are not only co-constitutive with actions of agents of change but also interrelated across resisters at different levels of the organization. This case also illustrates how resisting actions could play out across an entire change …

Development Of A Patient-Centered Medical Home Toolkit At An Integrated Primary Care Clinic, Lyndsay A. Randall

Doctoral Projects

Health care spending in the United States far exceeds that of other high-income countries (Squires & Anderson, 2015). In 2013, the U.S. spent 17.1 percent of its gross domestic product (GDP) on healthcare, which was almost 50 percent more than the next highest spender noted as France (Squires & Anderson, 2015). While the U.S. spends more on healthcare than other countries, multiple other health outcome measures are worse including life expectancy, heart disease, diabetes, and chronic respiratory illnesses (Squires & Anderson, 2015). Today’s healthcare system is highly fragmented, lacking the necessary coordination within the primary care setting. Better care coordination …

Conditions Facilitating Managers' Adoption Of Organizational Interventions Designed To Prevent Mental Health Problems In The Workplace, Caroline Biron, France St-Hilaire, Geneviève Baril-Gingras, Marie-Esther Paradis, Shirley Chabot, Rébecca Lefebvre, Hans Ivers, Michel Vézina, Pierre-Sébastien Fournier, Mahée Gilbert-Ouimet, Chantal Brisson

Rapports de recherche scientifique

De plus en plus d’évidences scientifiques montrent que les risques psychosociaux (RPS), tels une demande psychologique élevée, une faible latitude décisionnelle, un faible soutien social et un déséquilibre entre les efforts et la reconnaissance reçue au travail, contribuent au développement de problèmes de santé psychologique, de troubles musculosquelettiques de même que de maladies cardiovasculaires. Ces atteintes à la santé figurent parmi les principales causes d’absence du travail pour maladie. La littérature sur les interventions préventives en santé psychologique concerne principalement les interventions visant à modifier certaines caractéristiques individuelles (par exemple les habitudes de vie des travailleurs) plutôt que …

Driving Organizational Change From The Bedside: The Aacn Clinical Scene Investigator Academy., Susan R. Lacey, Caryl Goodyear-Bruch, Adrienne Olney, Dave Hanson, Marian S. Altman, Natasha S. Varn-Davis, Debbie Brinker, Ramón Lavandero, Karen S. Cox

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes.

OBJECTIVES: To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes.

METHODS: The curriculum of the Academy included leadership topics, communication, change concepts, quality …

Finding Common Ground: Learning From Leaders Who Have Utilized Conflict Transformation Behaviors In The Mental Health Field In The United States, Tamarah E. Tilos

Dissertations

Purpose: The purpose of this study was to discover and describe how exemplary leaders establish common ground and produce breakthrough results in the mental health field by utilizing the 6 domains of conflict transformation: collaboration, communication, problem solving, process, emotional intelligence, and ethics.

Methodology: This thematic, phenomenological study was accomplished through examination of the lived experiences of exemplary leaders with firsthand experience transforming conflict and finding common ground. The target population for this study included executive-level leaders of nonprofit organizations, governmental institutions, state and national associations, and private businesses serving adults and children with mental illness, developmental or behavioral disabilities, …

Implementation Of The National Asthma Guidelines In A Residential Pediatric Clinic, Patricia A. Foster-Staples

Dissertations

Abstract

Purpose: Foster care children admitted to residential facilities are a unique and vulnerable group, many presenting with undiagnosed or poorly managed asthma. The alarming rate of residents admitted to a particular residential primary care clinic with a diagnosis of asthma led to the project question: “Based on record reviews, does staff education about the importance of utilizing the national guidelines for asthma education influence the implementation of such guidelines in a residential pediatric clinic?” The purpose of this quality improvement project was to implement a systematic process to influence practice change. The project was conducted over a period …

Color-Blind Racial Attitudes: Microaggressions In The Context Of Racism And White Privilege, Jared F. Edwards

Administrative Issues Journal

Interest in institutional racism, White privilege, and microaggressions appears to be growing. We are living in times when the impact of race and racism are debated—when even the existence of racism is debated along with the appropriateness of examining the worst parts of U.S. history. This special-issue invited article includes a brief examination of historical information and current context in which racism and microaggressions exist, leading to their connections to Color-Blind Racial Attitudes (CoBRAs). Reviewed research on CoBRAs addresses teacher training, educational practices, experiences on college campuses, and organizational management.

Foundational Knowledge And Other Predictors Of Commitment To Trauma-Informed Care, Stephanie Anne Sundborg

Dissertations and Theses

Trauma-informed care (TIC) is an approach to service delivery based on the understanding of the prevalence of psychological trauma among service users, knowledge about the impact trauma has on engagement to services, and recognition that service settings can be re-traumatizing. For more than a decade, momentum has been building on this topic. Practitioners are pursuing the knowledge and skills needed to implement trauma-informed service delivery, while organizations are building infrastructure and processes aimed at supporting this approach. Disciplines across many human service sectors are eager to incorporate TIC into policy and practice. Despite this enthusiasm, implementation efforts are slow. Acquiring …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Gavage Program For The Preterm Infant, Amanda K. Guina

Master's Projects and Capstones

Preterm infants in the Neonatal Intensive Care unit, are susceptible to hospital acquired infections due to their immature immune systems. To mitigate this occurrence a change project will be implemented to decrease the incidence of nosocomial infection in this population. The project will be focusing on preterm infants working on full nipple feeds. Our project is aiming to discharge this population home with a nasogastric tube to work on feedings, rather than remaining in the hospital. Chart Audits were conducted pre-program and found approximately 18 patients acquired blood stream infections and 2 acquired MRSA. The method used to assist in …

Improving Breastfeeding Rates By Using Glucose Gel To Treat Newborn Hypoglycemia, Madena Barak

Master's Projects and Capstones

Newborn hypoglycemia occurs in 5-15% of newborns during the postnatal period (Weston et al., 2016). Typical treatment for hypoglycemia includes supplementing with formula, which causes a decrease in breastfeeding rates, decreasing patient satisfaction, and interfering with maternal-infant bonding. To combat this issue, a large community hospital in Southern California used Lewin’s Theory of Planned Change to implement an alternative intervention for the treatment of newborn hypoglycemia. Evidence based articles as well as collaboration with surrounding hospitals was used to support the use of oral dextrose gel instead of supplemental formula to treat newborn hypoglycemia. The hospital’s revised treatment protocol on …

Implementation Of The Reengineered Discharge Process And Transitional Care Management At A Rural Critical Access Hospital, Chad L. Wilfong

Doctoral Projects

Healthcare in the United States is changing from a fee-for-service to a value based healthcare delivery system. One area of national focus is reducing 30-day hospital readmissions by providing high-quality transitions-of-care. Patients leaving the hospital without proper assessment of home care needs, patient education, and coordination of care run into barriers managing health conditions, which contributes to hospital readmissions. Poor transitions-of-care contribute to deterioration of health leading to acute care utilization and hospital readmissions, which is costly for healthcare organizations, insurance payers, and individuals. In 2017, the value based healthcare structure will be decreasing reimbursement to hospitals that have 30-day …

Enhancing Clinical Manager Self-Efficacy Through A Change Management Academy, Chet Hurley Doering Iii

Doctor of Nursing Practice Scholarly Projects

Healthcare systems are facing increased pressure to develop their clinical managers’ abilities and competencies leading change. Clinical managers that are equipped with these capabilities can influence greater quality and safety outcomes for patients. Literature and industry findings both strongly suggest that leaders who possess increased self-efficacy are more effective leading change. This is demonstrated at the unit and system level through improved project management, successfully executing strategic initiatives, retaining staff, and being more fiscally responsible. There are significant clinical and business advantages for healthcare systems that foster change management skills for their clinical managers When organizations do not provide support, …

Combating Workplace Violence: An Evidence Based Initiative, Diana L. Giordano

Evidence-Based Practice Project Reports

Patient/visitor violence against healthcare (HC) employees is a type of workplace violence (WPV) and considered a dangerous hazard within HC occupations (Bureau of Labor Statistics, 2015). Lack of recognition of the true incidence and underreporting of WPV may contribute to a false sense of security within a HC facility (HCF). Therefore, fully addressing the problem may be met with administrative resistance, resulting in poor employee perceptions of support and commitment for a zero-violence environment. A retrospective analysis was conducted on the HCF’s online incident reports, security request calls, and data from a previously deployed WPV employee survey. The emergency department …

Preparing For The Merit-Based Incentive Payment Structure: A Value-Based Business Plan, Ali R. Saheb

Doctoral Projects

The notion of delivering value-based care while maintaining corporate vitality in health care is a multifaceted process. Shaping a business model to reflect this process requires the alignment of quality implications, reimbursement initiatives, a framework that takes into account stipulations on reimbursement for different types of clinicians, and an understanding and preparedness for emerging guidelines and nationally recognized structures for quality indicators. When organizations recognize the need for change, but are not yet prepared to implement it, a comprehensive business plan can help the organization visualize a path to success. In this project, the foundation of requirements for a value-based …

Return On Investment Comparison Of Three Payment Models For Chronic Care Management Under Medicare In A Northwestern Physician Hospital Organization, Megan J. Madole

Doctoral Projects

Chronic disease is the most prevalent and costly health condition. The coordination of care provided to those with multiple chronic conditions (MCCs) is suboptimal and fragmented. This population is among the highest utilizers of healthcare, and accounts for the majority of Medicare expenditures annually. Chronic care management (CCM) programs represent evidence-based initiatives shown to improve outcomes, reduce hospital and emergency department utilization, and reduce healthcare costs. Centers for Medicare and Medicaid Services (CMS) have provided various payment models for reimbursement of CCM services. Primary care practices have stated that inadequate reimbursement and confusing payment models are barriers to CCM implementation. …

Organizational Factors Associated With Quality Perinatal Care, Lisa H. Akers

Dissertations, 2014-2019

Provisions for perinatal care are an integral part of quality healthcare and are increasingly moving to the forefront of quality care measures in the healthcare setting (Agency for Healthcare Research and Quality, 2012; National Quality Forum, 2012; & The Joint Commission, 2010). Previous literature specifically focused attention to general quality of care, but recently there has been a call for a more comprehensive approach to measuring quality in the perinatal care setting, which necessitates the need for a better understanding of what is currently being offered (Collins & Draycott, 2015). Until now the literature has remained limited on the association …

Pediatric Hematology/Oncology Outpatient Care: The Effect Of A Standardized Collaborative Medication Reconciliation Process, Traci R. Pulliam

Evidence-Based Practice Project Reports

Pediatric patients are at an increased risk for medication errors and can benefit from processes that facilitate and promote medication safety (Stone et al., 2010). Medication reconciliation (Med Rec) is a valuable tool in improving patients’ medication safety and reducing adverse drug events (The Joint Commission, 2015). The purpose of this evidence-based practice (EBP) project was to improve the accuracy of the Med Rec process in a Midwestern pediatric hematology/oncology outpatient clinic by developing, promoting, and evaluating a standardized, collaborative Med Rec process. The Stetler EBP model guided the implementation of the intervention, with the goal of integrating current evidence …

Umass Memorial Healthcare Information System Job Ladder, Matthew Simoncini, Vamsi Kavuru, Antariksh Nanda, Tahaseen Mahaboob Basha, Vikram Patil

School of Professional Studies

The capstone project report emphasizes the importance of a job ladder and the need of an hour to implement it at UMASS Memorial health care. The scope of this project is to create a well-established job ladder at UMASS with pre-defined standards on job levels related to Information Technology department that would facilitate in hiring, developing and promoting employees at various stages.