Digital Commons Network^™

Implementing Teamstepps® Training For An Interdisciplinary Healthcare Team To Improve Teamwork, Tina J. Dimarino, Msn, Rn, Cnor, Casc

Doctor of Nursing Practice Projects

Background: Ineffective teamwork and communication increase the risk of adverse patient outcomes. An evidence-based teamwork training intervention was implemented to improve teamwork and communication.

Aims /Objectives: The team participated in a TeamSTEPPS® training program. The aims and objectives were to improve the staff’s attitudes and perceptions of teamwork and communication; pre, post and sustained at 30-days, reduce the number of documented near misses and measure for daily use of the newly acquired skills.

Methods: This is a quality improvement project with a one group, pretest and posttest design. The TeamSTEPPS® intervention was presented to the healthcare team. Participants’ teamwork attitudes …

Mindfulness Training In Mitigating Implicit Bias: Improving Cultural Competency For Nurses Caring For Lgbt Individuals, Daniel Terrell, Msn, Rn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Equitable care remains a goal of the United States healthcare system, with cultural competency training used as one intervention to mitigate disparities. Cultural competency education is primarily based on racial and ethnic differences, often omitting other marginalized groups. Implicit bias consequences are not addressed in such training programs despite the association with health outcome disparities. Research related to implicit bias has demonstrated the ability to promote malleability in implicit associations.

Objectives: This project assessed a mindfulness meditation exercise intervention on nursing awareness in interacting with lesbian, gay, bisexual, and transgender (LGBT) patients. Additionally, an LGBT health education module that …

Improving Nurse Manager Job Satisfaction: An Urban Academic Quality Improvement Project, Patricia A. Winston, Ms, Rn, Nea-Bc, Fache

Doctor of Nursing Practice Projects

Background: It is important that the nurse managers are able to contribute to organizational vision, mission, and goals by influencing others, sharing the vision, and implementing it (Boyce, 2018). They are pivotal to the successful accomplishments of the hospital mission. The issue of recruiting, developing and retaining nurse managers is one that challenges many health care institutions, hospitals, hospitals, and health systems. The literature regarding this concern was reviewed and the paucity of useful science in this regard led to question of how to improve the job satisfaction and job retention of nurse managers at urban academic medical centers.

Objective: …

Improving Care Coordination For The Homeless Population Using Systematic Quality Improvement, Rutendo Nyasvisvo

Doctoral Projects

Background and Objectives: Care coordination for the homeless population is challenging due to the complexity of healthcare and the uncertain life circumstances of the homeless individual. Objectives were developed to guide care coordination for the homeless by utilization of the free clinic to create PCP referrals, appointments and tracking follow-up care to increase appointment attendance and improve health outcomes for the homeless individual.

Design: A quality improvement project.

Setting: A faith-based non-profit homeless shelter organization in the Midwestern United States.

Participants: Participants include 25 homeless guests, 5 staff members including a clinic coordinator, 3 registered nurses and 1 licensed practical …

Design And Implementation Of A Nursing Peer Review Program In A Two-Hospital Setting, Joan L. Goss Ms, Rn, Acns-Bc

Doctor of Nursing Practice Projects

Background and Purpose: The Institute of Medicine’s (IOM) landmark publication To Err Is Human: Building a Safer Healthcare System measured the impact of medical error on the American public in both unnecessary human suffering and unsustainable financial cost to the US healthcare system. Nursing literature suggests that peer review of safety events can help mitigate the impact of medical errors by increasing nurse accountability for practice and empowerment for leading change.

Methods: Fourteen volunteers were selected from over 900 direct care nurses to participate in a four-month Nursing Peer Review Program (NPRP) pilot. Structure, process, and outcome measures of implementation, …

Relationship Between Nurses’ Readiness And Institutional Readiness In Developing Nursing Career Paths In Public Health Centers, Tuti Afriani, Rr. Tutik Sri Hariyati, Dyah Fitri Wulandari

Jurnal Keperawatan Indonesia

Nursing career paths in public health centers have not been well established compared with nurses in hospitals. It is because the nursing career path has a different organizing system, which then becomes an obstacle in implementing the career path for nurses in primary health care. Therefore, this study aimed to identify the relationship between institutional and nurses’ readiness in implementing nursing career paths within public health centers. A cross-sectional study design with questionnaire as instrument was used in this research. A consecutive sampling technique was used to select 93 nurses from 13 public health centers. Furthermore, to identify the objective …

The Effects Of Administrative Support On Registered Nurse Well-Being During The Covid-19 Pandemic, Cassandra Fox

The Eleanor Mann School of Nursing DNP Capstone Projects

Attention to the well-being of nurses is necessary to ensure the healthcare system can operate effectively, particularly during the COVID-19 pandemic. The workplace environment and support from nursing leadership strongly contribute to nurses’ well-being. Currently, there is little evidence on the effect nursing leadership has on nurses’ well-being during the COVID-19 pandemic. This DNP clinical inquiry project sought to learn more about the effects of caring leadership behaviors on nurses’ well-being during the COVID-19 pandemic. A survey composed of questions from previously validated and reliable surveys used in the field of nursing was used to collect data. Neuman’s systems theory …

Dnp Final Report: Breaking The Cycle: Care Coordination Interventions And Sickle Cell Readmissions, Naphtali Edge

DNP Final Reports

Background

Approximately 100,000 people in the United States are affected by Sickle Cell Disease (SCD). Sickle Cell Disease represents the second highest readmitting diagnosis at Houston Methodist Hospital. The purpose of this study is to determine the impact of implementing care coordination interventions to reduce hospital readmissions of patients with SCD.

PICOT

In adult patients with SCD in the acute care hospital setting, how does care coordination intervention compared to no care coordination intervention affect the readmission rate for patients with SCD over a 3 – 6-month period?

Body of Evidence

Eleven studies were critical appraised and included in the …

Maintaining Postpartum Bleeding: Effects Of Tranexamic Acid, Shenider Dufort

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this literature appraisal is to determine the effectiveness of tranexamic acid (TXA) and its ability to stabilize postpartum bleeding. TXA is an antifibrinolytic pharmacologic drug found to reduce blood loss associated with trauma and patients undergoing major surgeries. When administered in combination with other uterotonics, the World Health Organization predicts the prophylactic use of TXA could globally improve the morbidity and mortality rates associated with postpartum hemorrhaging. Theoretical Framework: Kurt Lewin’s change theory was used in the development of this literature review. The Lewin change theory emphasizes the importance of change and development within a medical …

The Resilient Midwife, Sarah M. Dorsey

All Electronic Theses and Dissertations

Midwives have been shown to significantly improve birth outcomes; the World Health Organization proposes that 83% of maternal deaths, newborn deaths, and stillbirths could be prevented through midwifery care. However, burnout level in this profession is high; a 2017 survey of U.S. certified nurse-midwives and certified midwives revealed that 40.6% of these professionals were suffering from burnout. The purpose of this paper is to identify strategies to facilitate resilience and decrease burnout in the midwifery professionMethods: 1427 articles were screened to yield twenty research studies relevant to improving resiliency and decreasing burnout the midwifery profession. The twenty articles were summarized …

Improving Health Science Faculty's Comprehension Of Test Item-Analysis, Tunisia Love

Regis University Student Publications (comprehensive collection)

Background: Differences in testing can lead to student frustration and questionable evaluation of student learning. Inconsistency in testing practices include differing levels of Bloom’s taxonomy, Faculty-written items versus publisher test bank items, and variations in grading. Failure to provide quality student learning assessment and evaluation tools and methods can negatively impact both student and program outcomes. Performing analysis of test items can improve quality of and consistency in evaluation of student learning.

Objective/Purpose of the Project: This quality improvement DNP project investigated the impact of an educational intervention on multiple choice question (MCQ) test-item analysis on the Health …

Teamstepps In A Pediatric Operating Room, Lisa Kerrick

Regis University Student Publications (comprehensive collection)

Despite numerous patient safety and quality programs available and in use in the healthcare environment, adverse events in operating rooms continue to occur. The operating room is a complex and chaotic environment where teamwork is necessary for safe patient care. Team training is a strategy that improves teamwork. TeamSTEPPS is an evidence-based team training program designed to integrate teamwork into clinical practice. This project aims to determine if TeamSTEPPS communication tools and strategies improve the perception of teamwork and efficiency in a pediatric operating room. The outcome objectives for this project are to increase the perception of teamwork and improve …

Nurse Executives’ Intuitive Decision Making And Leadership Personality Styles During Organizational Change, Chaudron Carter Carter Short

Walden Dissertations and Doctoral Studies

Within the complex and multifaceted health care environment, nurse executives are challenged to effectively make decisions and lead organizations through change. How nurse executives make those decisions is determined in a variety of ways, one being through intuitive decision making. The purpose of this quantitative correlational study, guided by the dual process theory, was to examine nurse executives’ intuitive decision making and leadership personality styles during organizational change. The Agor Intuitive Management Survey and the Multifactorial Leadership Questionnaire were administered to 70 nurse executives recruited by direct email obtained from public hospital organizations’ websites and social media platforms. Regression analysis …

A Clinical Practice Guideline: Hospice Care In The Emergency Room, Samer Saad

Walden Dissertations and Doctoral Studies

Hospice patients use the emergency department (ED) for the management of symptoms, making it necessary for ED nurses to be equipped with the knowledge and skills to care for hospice patients. EDs should have staff specially trained to address end-of-life needs due to ED staff’s minimal knowledge of treating and managing hospice patients. When healthcare organizations fail to provide clinical practice guidelines (CPG) and collaborate with significant stakeholders adequately, gaps in care delivery can occur, and hospice care is often not delivered safely. Standardized guidelines on end-of-life care in the ED should provide adequate guidance for ED nurses in bridging …

Improving The Patient Experience With Case Management Follow Up Phone Calls: A Quality Improvement Project Evaluation, Karen Jarrell

Walden Dissertations and Doctoral Studies

In January of 2020, a follow-up phone call quality improvement initiative was implemented by the case management department of an acute care facility located in the Mid-Atlantic region of the United States, to improve the patients’ healthcare experience. The intent was to improve the Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores. This quality improvement (QI) project was conducted using the Plan-Do-Check-Act Cycle along with the Kotter’s 8-step change model. The purpose of the QI project evaluation was to determine if a QI initiative using follow up phone calls had a positive effect on increasing CAHPS survey scores. The …

Implementing A Hospital-Acquired Pressure Ulcer Intervention In The Icu, Audrey Gross

Doctor of Nursing Practice Projects

Background: Hospitals had been confronting greater incentives to prevent Hospital-Acquired Pressure Ulcers (HAPUs). HAPU rates had increased in the Intensive Care Unit (ICU) at an academic hospital over the past six months, especially regarding device related HAPUs.

Objectives: The primary purpose of this project’s implementation was to decrease the number of HAPUs in the ICU by 50% within a three-month timeframe. Secondary objectives were to achieve scores of 100% in terms of compliance with the Registered Nurse (RN) education module, post-test scores, and documentation.

Methods: This was a Quality Improvement (QI) project involving adult patients in the ICU of an …

Student Registered Nurse Anesthetist Perspective On The Impact Of A Clinical Mentoring Program, Sheila M. Mccarley

Doctor of Nursing Practice Projects

There is a competitive push for recruiting and retaining the Student Registered Nurse Anesthetist (SRNA) graduate. Retention efforts begin with their first clinical experience. Mentoring in the clinical setting is a critical factor in influencing the student nurse anesthetist's retention to practice. The purpose of this project was to assess whether mentoring in the local setting noted similar findings. The method involved a survey of student nurse anesthetists queried about perspectives on a clinical-based mentorship program. Certified Registered Nurse Anesthetist (CRNA) faculty members vetted the survey instrument before implementation. The project focused on students presently enrolled in their first-year clinical …

Clinical Practice Guidelines For Assessing And Reporting Workplace Violence Against Nurses, Janice Lynn Canfield

Walden Dissertations and Doctoral Studies

AbstractWorkplace violence consists of physically and psychologically damaging actions while on duty. In healthcare, under a cloak of secrecy concerning workplace violence, an underreported epidemic exists. This problem is important to address because workplace violence can affect the quality of care delivered and patient care outcomes.. The purpose of this project was to develop a nursing clinical practice guideline (CPG) to assist hospital-based nurses to identify risk factors for workplace violence, identify strategies to mitigate violence, and report workplace violence. This CPG can be an effective tool for nurses to better understand the scope and nature of violence in the …

A Quality Improvement Evaluation Of A Hospitalist Telemedicine Program, Kelly Marie Awes

Walden Dissertations and Doctoral Studies

Critical access hospitals (CAHs) encounter unique challenges in terms of providingquality resources to their community, often lacking quality measures and continuity comparable to larger regional and tertiary hospitals. One CAH in rural Minnesota implemented an overnight hospitalist telemedicine service to address concerns with provider resources and quality practice. An evaluation of quality improvement implementation was completed to address data regarding ER transfers and inpatient length of stay (LOS). Following the triple aim framework to improve patient care, population health, and decrease costs, Donabedian’s model of quality improvement was utilized. Three months of pre and postimplementation data were collected one year …

An Educational Program For Nurses To Improve Culturally-Appropriate Mental Health Assessment For Nigerian Immigrant Youth In Central Florida, Blessing Anyaiwe Onyekachi

Walden Dissertations and Doctoral Studies

AbstractNigerians, like other immigrants, face many health issues with rising waves of conflict and political instability that contribute to high migration rates. As a result, when they arrive in other countries, these immigrants not only have to deal with the trauma they left behind but face issues such as cultural stereotypes, stigma, lack of insurance, cultural and language barriers, poor communication, social discrimination, and low socioeconomic status. The question that this project addressed was whether an educational program for nurses would improve knowledge on culturally-appropriate mental health assessment for Nigerian immigrant youth in Central Florida. This was a nursing staff …

Smoothing Patient Flow By Improving Bed Turnover Time, Carrie Lanasha Percell

Walden Dissertations and Doctoral Studies

Bed Management Solutions (BMS) is a bed tracking system that provides real-time data into hospital activities, including admissions, transfers, discharges, bed turnover rates, and processing time frames. When BMS is used appropriately, it has the potential to improve bed turnover rates, reduce stress of clinical staff, improve patient satisfaction, and improve patients’ well-being. Delays in bed turnover times can create overcrowding, extended wait times, bottlenecking, delays in patient care, and significant patient flow problems. The purpose of this DNP project was to develop a staff education program to answer the question if the implementation of an educational training program could …

Examination Of Nurses’ Perceptions, Beliefs, And Conceptions Related To Rapid Bedside Implementation Of Prone Therapy During The Covid-19 Pandemic, Alyssa Poghen, Emily La Riviere

Doctor of Nursing Practice Projects

The COVID-19 pandemic of the SARS-CoV-2 virus created significant challenges for healthcare agencies and front-line healthcare workers. The SARS-CoV-2 virus has demonstrated a unique propensity to induce severe lung injury in the form of acute respiratory distress syndrome (ARDS). High rates of COVID-19 illness in the initial months of the pandemic in the United States led to a rapid influx of patients admitted to critical care units (CCUs) for ARDS. Prone positioning therapy (PPT) has shown substantial promise in treating refractory hypoxemia in people with severe ARDS but historically received poor acceptance as a first-line therapy. With the onset of …

Promotion Of Most Forms Through Education About Importance Of Advance Care Planning In Seriously Ill Patients, Nidhi More

DNP Projects

Abstract

Purpose: To establish the importance of early Advance Care Planning (ACP) and improve the utilization of Medical Orders for Scope of Treatment (MOST) forms in seriously ill patients by educating providers and nurses to identify patients who meet specified criteria. The goals of this intervention are reduction of readmissions and better quality of life for this patient population.

Methods: A quasi-experimental design was used for evaluation of an Educational intervention to promote MOST forms, Advance Directives (AD) and Palliative Care (PC) consults. A retrospective and prospective chart review was conducted to determine the number of patients who met criteria …

Improving Multidisciplinary Adherence To A Daily Goals Checklist In The Icu: A Quality Improvement Initiative, Chelsea Mccarty

DNP Projects

Abstract

Background: In November 2019, the University of Louisville Hospital merged and assumed operations of all KentuckyOne facilities. During the transition, a spike in hospital acquired infection rates ensued at Jewish Hospital, notably amongst the critical care units. In January 2020, a daily checklist was introduced to the critical care department. A Daily Checklist is a tailored communication tool designed to reduce communication error and improve adherence to patient safety measures. There continues to be a gap in adherence to the U of L daily checklist from both nurses and providers. Purpose: The purpose of this project was to improve …

The Impact Of A Change In Leadership, Taylor Collins

DNP Projects

Abstract

Background: Unmitigated stress in nursing results in moral distress, burnout, turnover and poor patient outcomes. Authentic leaders can improve the nurses’ work environment and satisfaction by improving communication and implementing supportive measures.

Purpose: The purpose of this study was to determine whether a change in executive leadership at BSW Grapevine Medical Center reduced nursing job stress as evidenced by improved nurse satisfaction, nurse retention, nurse engagement, patient satisfaction and care outcomes.

Conceptual Framework: Watson’s Theory of Human Caring

Design: This study is a quantitative, descriptive retrospective measurement of two points in time, before and after …

S.A.F.F.E.R. Airway Management: Evaluating The Effectiveness Of Checklist Implementation On Reducing Peri-Intubation Complications In An Air Medical Transport Service, Rachael M. Croley

DNP Projects

Background: Advanced airway management via endotracheal tube placement in the critically ill and injured is tenuous and presents a multitude of challenges that threaten patient safety. The potential for procedure-associated hypoxia, hypotension, and cardiac arrest during the peri-intubation period can be detrimental to overall patient outcomes. Purpose: The purpose of this project is to evaluate the effectiveness of the Standardized Airway Flow For Engineered Resuscitation (S.A.F.F.E.R.) checklist in reducing peri-intubation complications and provider perception of checklist implementation when performing advanced airway procedures.

Methods: A case-control analytical observational design study which included retrospective and prospective electronic medical record review to determine …

Evaluating The Sustainability Of A Colorectal Cancer Screening Improvement Intervention, Kimberly Bastin

DNP Projects

Background: Sustainability is a domain or characteristic of quality in healthcare that is not just about what may be delivered to patients today, but what can continue to be delivered to patients in the long term. Evidenced based interventions and quality improvement (QI) initiatives have led to major advancements in health care and have become expected in every clinical setting. Despite the amount of QI work taking place, there is limited evaluation of the sustainability of initially successful quality improvement efforts and a lack of evidence supporting best strategies and measures to ensure that improvement of goals and outcomes are …

Reducing The Readmissions Through Multidisciplinary Rounds In Older Adults, Fatima Rajapathy Tisseverasinghe

Walden Dissertations and Doctoral Studies

Hospital readmissions are a reflection of poor quality of care. The readmission rate in an acute care for the elderly (ACE) unit was above the national benchmark in 2017. The specific problem includes lack of communication, collaboration, and coordination among the interdisciplinary team. Further, in older adults, the problem is accentuated by health illiteracy, comorbidities, cognitive impairment, polypharmacy, and unclear discharge and follow-up care instructions. Poor care transition costs Medicare 17.4 billion dollars a year. Multidisciplinary rounds (MDRs) have been adopted by many hospitals as evidence-based interventions to reduce readmissions within 30 days. This Doctor of Nursing Practice (DNP) project …

Clinical Practice Guidelines For Nursing Orientation At A Small Clinic, Elizabeth Bemah

Walden Dissertations and Doctoral Studies

In the United States, the registered nurse turnover rate was 17.2% in 2018, a 0.4% increase from 2017. The nursing turnover rate at a small out-patient clinic in the northeast United States was 19.1% in 2019 and has not improved to date. The administrator at the out-patient clinic further indicated that the turnover rate has been approximately two nurses per month for the last 6 months and that the facility did not have a formalized nurse orientation program. Nursing orientation is one of the strategies for increasing the confidence levels and retention of newly hired nurses. The purpose of this …

Antibiotic Stewardship: Decreasing Antibiotic Use For Viral Upper Respiratory Infections, Merkessie Taresa Redix

Walden Dissertations and Doctoral Studies

AbstractOverprescribing antibiotics for viral upper respiratory infections is a common practice in the United States. This overprescribing of antibiotics can cause several health issues and increase health care costs. Despite the current guidelines recommended by the Centers for Disease Control and Prevention (CDC) the overprescribing of antibiotics by providers remains an issue. The purpose of this project was to educate providers on antibiotic stewardship for viral upper respiratory infections. The practice question was used to explore whether an educational program using concepts from Lewin’s change theory and Kolb’s learning theory would increase provider’s knowledge about the current evidence- based prescriptive …