Digital Commons Network^™

Quality Improvement Initiatives And Interventions For Decreasing Falls In The Hospital Setting, Fredlyn Lolange

Walden Dissertations and Doctoral Studies

Patient falls in health care settings are a widespread and severe problem, and they often happen as a result of a complex set of causes. In the United States, between 3.3 and 11.5 falls occur per 1,000 patient days. Reducing the incidence of falls in a health care setting would bring significant positive change and decrease the incidence of harm to patients in the hospital setting. This staff education project’s purpose is based on addressing falls, a safety concern and a health issue that continues to put patients at an increased risk. Theories used to inform the project include the …

Differences Between Nurse-Led Intervention Topics, Longevity, Changed Practices, And Sustainability Planning, Robin Anselm

Walden Dissertations and Doctoral Studies

Though health care providers use evidence-based interventions (EBIs), a knowledge gap exists regarding lasting change associated with doctorate-prepared nurse interventions and sustainability planning. This quantitative cross-sectional descriptive design guided by the five pillars of the United Nations sustainable development goals (SDGs) was used to examine the differences between doctorate-prepared nurses’ sustainable EBI topics, intervention longevity, changed clinical practices, and sustainability planning. The dynamic sustainability framework, the adult learning theory, and the social learning theory framed this study. The design included a survey of 1,365 nurse anesthesiologists using a questionnaire composed of the Program Sustainability Assessment Tool (PSAT) version 2 and …

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 …

Clinical Care Protocol For Enhanced Nurse Competency In Caring For The Patient With An External Ventricular Drainage (Evd) Device, Lauren Orson

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: The focus of this Doctor of Nursing Practice Project surrounds the need for an evidence-based clinical nursing protocol to augment nurse competency and therefore streamline care to patients with an external ventricular drain (EVD).
Methods: A clinical protocol alongside tailored education was used to promote nurse competency for EVD management. A pre-implementation survey was completed evaluating the nurses’ baseline competency when managing an EVD. The nursing protocol was then implemented for bedside use. After 2 months, the survey was completed once again and paired for statistical analysis.
Results: Statistical analysis using the Wilcoxon signed-rank nonparametric test with dependent matched …

Managing Nurse Leader Stress To Promote Leader Retention, Rebecca Sue Hawkins

Walden Dissertations and Doctoral Studies

Nurse leaders are a health care group that has been provided limited support to managestress and burnout symptoms, yet the impact of leader stress burden on staff satisfaction, patient outcomes, and their own health is vital to the provision of safe, high-quality health care. The problem of leader fatigue and burnout is the ability to retain current leaders and recruit the next generation. The purpose of this staff education project was to address leadership burnout due to stress and the lack of knowledge of how to manage stress in the moment. A combination of Watson’s theory of caring and Ray’s …

Differences Between Nurse-Led Intervention Topics, Longevity, Changed Practices, And Sustainability Planning, Robin Anselm

Walden Dissertations and Doctoral Studies

Though health care providers use evidence-based interventions (EBIs), a knowledge gap exists regarding lasting change associated with doctorate-prepared nurse interventions and sustainability planning. This quantitative cross-sectional descriptive design guided by the five pillars of the United Nations sustainable development goals (SDGs) was used to examine the differences between doctorate-prepared nurses’ sustainable EBI topics, intervention longevity, changed clinical practices, and sustainability planning. The dynamic sustainability framework, the adult learning theory, and the social learning theory framed this study. The design included a survey of 1,365 nurse anesthesiologists using a questionnaire composed of the Program Sustainability Assessment Tool (PSAT) version 2 and …

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 …

Development Of A Standardized Novice Neonatal Nurse Orientation Program, Joanne Rau Pasinski

Walden Dissertations and Doctoral Studies

Abstract Neonatal intensive care units (NICUs) are fast-paced units requiring skilled nurses to care for a unique patient population. Orientation of new nurses to the NICU can be challenging for both the orientee and the preceptor. Offering an evidence-based practice orientation program by an accredited organization that is specific to NICU can be a valuable tool for both the preceptor and the orientee as well as enhance nurse, patient, and organizational outcomes. The project question explored if use of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) 15-module nursing orientation program for RNs in a NICU increased their …

Lived Experience Of Women Veterans Navigating The Veteran Healthcare System, Candance Willett

Walden Dissertations and Doctoral Studies

Many women veterans who navigate the Veterans Affairs (VA) healthcare system across the United States have felt that their voices have not been heard regarding their input and lived experiences concerning inclusion to the quality-of-care delivery for their health needs. The purpose of this study was to explore the lived experiences of women veterans who were currently facing or had previously faced difficulty navigating the VA healthcare system. The framework used for this qualitative study was interpretive phenomenological analysis. The qualitative method used was hermeneutics which was designed by Edmund Husserl and Martin Heidegger. Semi structured interviews were of 12 …

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 …

Staff Education Program To Reduce Burnout Among Health Care Professionals On A Long-Term Care Unit, Emelda Mati Che

Walden Dissertations and Doctoral Studies

AbstractBurnout negatively impacts the performance of health care providers, decreasing the quality of care provided to patients and affecting patients’ experience. This problem is evident in health care staff on long-term care units (LTCUs) as they strive to meet their patients’ chronic and acute care needs. Health care professionals often lack adequate knowledge on how to manage work-related stress and reduce the issue of burnout in this work environment. The health care professionals working on the LTCU at the local continuing care retirement facility were identified as lacking knowledge to manage work-related stress and burnout. Addressing this problem is essential …

The Clinical Inquiry Process Diagram (Version 4), Roy E. Brown

VCU Libraries Faculty and Staff Publications

The purpose of the diagram is to provide a clear understanding of the clinical inquiry process and to highlight the similarities and differences between research, performance improvement, and evidence-based practice. While it is not meant to be comprehensive, it serves as a tool to facilitate a shared understanding of when a particular question may lead to one of these three areas of clinical inquiry.

The author would like to acknowledge the following for their ideas and willingness to provide feedback to improve this latest version of the diagram.

• Kady Martini, DNP, RN, EBP-CH, NEA-BC (The Ohio State University School of …

A Digital Transformation Framework For Biopharma Manufacturing, Frederick K. Johnson

CGU Theses & Dissertations

In the current climate of economic uncertainty and social unrest, biopharmaceutical (biopharma) companies face the challenges of changes in consumer behavior, cyber threats, and technological advancement. At the same time, their top priorities are global market growth, strengthening R&D, and undergoing digital transformation (Dx). Given these developments, biopharma organizations must choose a Dx framework as they engage in the digital transformation of their businesses in this high-stakes environment. However, there are significant problems with existing Dx frameworks. Most models are generalized frameworks designed to sell consulting services. Some focus on the enterprise or the manufacturing operations, but not both, and …

A Quality Improvement Initiative: Addressing Workplace Violence Toward Nurses To Promote A Culture Of Safety In An Inpatient Psychiatric Facility, Ernestina Danso

DNP Scholarly Projects

This quality improvement initiative aimed to address workplace violence against nurses in inpatient psychiatric facilities and promote a culture of safety. The QI project involved 27 participants, including inpatient psychiatric nurses and mental health counselors from Cahill 4 and 7 West units at the Cambridge Campus. The primary objective was to identify challenges that hindered the effective utilization of the Broset Violence Checklist (BVC) tool for referring patients to sensory modulation rooms.

Pre- and post-intervention surveys were conducted to assess participants' self-reported knowledge and barriers to BVC and sensory room utilization. Educational sessions covering workplace violence, debriefing techniques, and the …

Nurses’ Experiences With Trauma-Informed Care In Patients With Psychological Trauma, Ade J. Vinton

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic increased the need for research and discussions about trauma, trauma-informed care (TIC), and care delivery processes. Little is known about how nurses recognize, assess, treat, and support patients who experience trauma although knowledge of TIC is important for delivering care to trauma survivors. The purpose of this qualitative descriptive study was to explore nurses’ perceptions of TIC principles and their experiences delivering care to patients with psychological trauma. Harris and Fallot’s TIC theory was used to guide the study. Purposeful sampling was used to recruit ten nurses for individual semi structured interviews using open-ended questions conducted via …

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 …

Decreasing Post-Operative Ventilator Time In The Cardiovascular Surgical Patient: A Nursing Education Quality Initiative, Amanda J. Bruno Roberts

DNP Scholarly Projects

Extended mechanical ventilation times after open heart surgery can contribute to complications prolonging recovery and length of stay, as well as increasing mortality. Standardized staff education of immediate post-open-heart recovery and ventilator weaning protocols, combined with the use of ABCDE and VAP bundles can reduce these complications. At Hospital X during summer of 2022, the average length of time patients remained mechanically ventilated after open heart surgery increased. After an initial needs survey was distributed to nursing staff, a set of novel QR codes was created to simplify and centralize training for staff in the ICU to facilitate early extubation …

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 …

The Struggles Black Women Face In Federally Qualified Community Health Centers In South Carolina: A Phenomenological Exploration Of Women In Leadership Positions, Sharon Black

Dissertations

This qualitative interpretive phenomenological study examined the professional lived experiences of Black women who hold leadership positions within Federally Qualified Community Health Centers (FQHCs) in South Carolina. The researcher examined their experiences through the lens of Belenky’s (1986) Ways of Knowing framework, focusing on self-expression, voice, and how the participants processed their leadership experiences. In addition, the study draws on Crenshaw’s Intersectionality and Black Feminist Post-structuralist theories. The study explores the difficulties, successes, and strategies these women use, focusing on stereotypes, challenges in leadership roles, diversity of experiences, and the importance of voice themes.

The study provides practical suggestions for …

Heparin Vs. Saline: Evaluating Evidence-Based Best Practice For Maintaining Patency Of Implanted Ports, Shannon D. Murdock

Master's Theses and Capstones

Background Implanted ports are frequently used for central venous access in the adult oncology population. Maintaining patency of these ports is important for continuing uninterrupted treatment and supportive care for oncologic patients. Historically, heparin solution has been used as a locking solution for implanted ports to prevent occlusion. However, evidence shows that 0.9% sodium chloride (normal saline or NS) as a lock solution is equally effective as heparin solution at maintaining implanted port patency and poses less risk to patients.

Local Problem In an ambulatory adult oncology clinic serving Seacoast New Hampshire, a gap was identified between clinical practice where …

Implementation Of Night Shift Rounding To Improve Nursing Communication And Reduce Days Of Intubation In The Intensive Care Setting, Lisa Wilkinson

Walden Dissertations and Doctoral Studies

Multidisciplinary rounds are the gathering of various health care providers who have a shared interest in a patient’s well-being to discuss the plan of care and the patient’s progress through their hospital stay. This multidisciplinary group of staff can be the providers, the nurse, charge nurse, social worker, pharmacist, dietician, respiratory, chaplaincy, and occupational and physical therapists. On night shift at the project site, this rounding process did not occur, leaving the staff feeling they were not involved in the plan of care. The purpose of this quality improvement evidenced-based project was to create a process change, introduced to the …

Health Leadership And Management Practices That Support Accountability For Results, Peter Kayiira Byansi

Walden Dissertations and Doctoral Studies

Although leaders are expected to nurture and sustain a culture of accountability for results, little is known about how health leaders in developing countries perceive, interpret, demonstrate, and promote accountability in their day-to-day practices. The purpose of this generic qualitative study was to explore the management and leadership practices that leaders of public and non-profit health support organizations in Uganda utilize to embody and support accountability for key stakeholders’ results. Data from in-depths interviews with 13 participants at the governance, senior management, and middle management levels were analysed using thematic data analysis. Riggio's conceptualization of using multiple perspectives and disciplines …

Reducing Opioid Prescribing By Using The Center For Disease Control Guidelines, Christina Marie Peters

Walden Dissertations and Doctoral Studies

Opioid abuse is a serious national health crisis resulting in overdose and increased mortality in chronic pain patients. The purpose of this evidenced-based, quality improvement (QI) project was to improve primary care provider’s (PCP) awareness of The Center for Disease Control and Prevention’s (CDC) opioid prescribing guidelines to reduce opioid prescribing at this project site. The Donabedian model of structure, process, and outcome was used as the framework for this QI project. Lewin’s change management model of unfreezing and freezing was used as a guide to implement organization change by creating problem awareness, seeking alternative methods, and integrating the new …

Comparison Of The Effects Of Telehealth Versus N95 On Nurse-Patient Communication, Tony Christopher Bloomfield

Walden Dissertations and Doctoral Studies

Telehealth and face masks are some of the infection control measures nurses use while attending to patients. Nurses provide the most patient care in hospital settings and thus spend the most time with patients in their recovery journey. Because communication is paramount to the role nurses play as health care professionals, there is a substantial need to investigate how infection control measures affect the quality of nurse-patient communication. The purpose of this quantitative cross-sectional study was to describe the relationship of methods aimed at maintaining social distancing between nurses and patients to nurse-patient communication and to compare differences in the …

Dnp Final Report: Vascular Access In Burn Patients: An Evidence-Based Practice Project, Amanda Venable

DNP Final Reports

Vascular access in burn patients is a challenging aspect of care that affects the healthcare team and patients daily. The goal in this evidence-based practice project at a southern United States burn center was to improve the quality of the vascular access process by reducing the use of Central Venous Lines (CVL) and unsuccessful venipuncture attempts. The following practice question was formed: In hospitalized burn patients (P), how does a vascular access team with ultrasound-guided peripheral IV capability (I) compared with no vascular access team and standard IV insertion (C) affect central line days (O1) or patient experience (O2) during …

Experiences And Attitudes Regarding The Availability And Usage Of Telemedicine Services Among Providers During A Pandemic, Keya Gaston Brooks

Walden Dissertations and Doctoral Studies

Telehealth became a prominent fixture in the way healthcare was delivered during COVID-19. Providers were forced to offer telehealth as an optional mode of care. Although little research was available, studies about the experiences and attitudes of providers regarding their intention and willingness to use telemedicine before the pandemic was exiguous. The purpose of this study was to understand providers perception and use behavior patterns regarding the acceptance and adoption of telemedicine during the pandemic. Data collected from the COVID-19 Healthcare Coalition Telehealth Impact Survey was used to help characterize the experiences and attitudes of providers regarding telehealth utilization during …