Digital Commons Network^™

Clarifying Workforce Flexibility From A Division Of Labor Perspective: A Mixed Methods Study Of An Emergency Department Team, Sarah Wise, Christine Duffield, Margaret Fry, Michael Roche

Research outputs 2014 to 2021

Background: The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly.

Methods: The explanatory sequential mixed methods study was set in the …

Education Strategies For The Interdisciplinary Team Of An Early Mobility Protocol, Malori Paplow

Nursing Capstones

Implementation of early mobility protocols in the intensive care unit has been well documented to prevent multiple complications associated with prolonged immobility and to improve patient outcomes. Expectations to implement evidence-based healthcare is growing and the most difficult steps in the process is education and implementation, and it is often left to busy nursing leaders who may be unprepared for the challenge. The literature provides little direction for nurses regarding when to use specific educational strategies when implementing an early mobility protocol, especially amongst the interdisciplinary team. The purpose of this paper is to create an evidence-based education plan for …

Expanding Magnetic Resonance Imaging Access For Patients With Cardiovascular Implantable Electronic Devices, Rosalie Geronimo

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Patients with non-conditional cardiovascular implantable electronic devices (CIEDs), which lack magnetic resonance imaging (MRI) components, are unable to undergo MRI.

Context. The Heart Rhythm Society guidelines for patient device management and Centers for Medicare and Medicaid Services requirements for persons with specific expertise in implanted permanent devices to manage CIEDs during MRI spurred policy, procedure and staffing changes.

Interventions. The evidence-based change-of-practice project comprised of workflow development, policy and procedure changes, implementation of required staffing support to manage the CIED during an MRI.

Measures: The outcome measure was to improve access to MRI for patients with CIEDs, measured …

Improving Identification Of Ssi In Snf, Jennifer Teng Yuan Yu

Master's Projects and Capstones

Educational deficit in basic wound assessment can lead to failure to recognize early signs of infection or wound deterioration. Despite many challenges towards wound care, there are potential opportunities to reduce patient injury and clinical outcomes through continuing education. The purpose of this paper is to review literature on current wound care knowledge in nurses and assess existing wound care knowledge in nurses at a skilled nursing facility. A 10-question pre-test wound assessment quiz based on the Bates-Jensen Wound Assessment Tool (BWAT) selected by the Wound Care Coordinator (WCC)/Wound Care Specialist (WCS) was given to 22 nurses: 5 Registered Nurses …

A Formal Hcahps Teaching Program Targeting Communication Improves Hcahps Scores, Bobbie Davis

Master's Projects and Capstones

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey given to patients after discharge from an inpatient unit is a validate tool used to determine the level of patient experience. Organizations across the country, including the Northern California Academic Medical Center, have implemented many initiatives aimed at improving these scores. HCAHPS scores for the hematology/oncology unit at this medical center remain low even after previous education efforts. The aim of this quality improvement project was to improve the patient experience, as evidenced by HCAHPS scores, with the implementation of an HCAHPS teaching program for nursing staff, focusing on …

Transitions Of Care: Raising Awareness And Improving Identification Of The Social Determinants Of Health, Stephanie Le

Master's Projects and Capstones

Problem: Hospital readmission rates have steadily climbed in the United States and the cost of unplanned readmissions can be detrimental. It has been identified that greater discharge preparation and quality care coordination greatly impacts the patient’s plan of care and reduces the risk of unplanned 30-day readmissions. Transition programs help reduce the psychosocial barriers that prevent patients from being able to self-manage their conditions outside the acute setting and help patients effectively navigate the through the continuum of care.

Context: Research has shown that when the social determinants of health (SDOH) barriers are identified appropriately and early-on, this can decrease …

Exploring Relationships Among Environmental And Intrapersonal Variables And Evidence-Based Practice Implementation, Amanda N. Canada

Nursing Theses and Dissertations

Evidence-based practice (EBP) is not consistently implemented within healthcare settings; although many organizations claim it is how they deliver care in the 21^st century. In a review of the literature, multiple intrapersonal variables were found to impact the inconsistency with which EBP is applied and the success of its implementation within nursing practice. Organizational culture and perceived stress can influence the uptake of EBP beliefs and can affect EBP implementation. Clinicians who have more confidence in their EBP knowledge and skills are expected to implement best practices. Underpinned by Social Cognitive Theory, a model was developed to guide study …

Practicing Leadership Skills Through Peer Mentoring And Teaching: The Lived Experience Of Bsn Students, Alicia Bright

Nursing | Faculty Scholarship

Although leadership theory is introduced in baccalaureate nursing curriculum, opportunities to practice and develop leadership skills are limited for undergraduate nursing students. This study explores the experience of advanced nursing students who provided mentoring and tutoring to beginning nursing students. The experiences they describe are interpreted in light of literature on leadership education in undergraduate nursing schools, as well as that of peer mentoring and peer teaching. These advanced students described opportunities to practice and reflect on leadership skills and attributes. Peer mentoring and peer teaching programs may be an effective and efficient way of helping nursing students gain leadership …

Increasing Adult Annual Wellness Visits, Martha Caceres

Doctor of Nursing Practice

The purpose of this quality improvement project was to increase adult annual wellness visits in a high-volume family practice clinic. The significance of an adult annual wellness exam is health maintenance, disease prevention, early disease detection, and management of chronic diseases. Approximately 133 million Americans are diagnosed with at least 1 chronic disease, including cancer, diabetes, and heart disease, and 1 in 4 adults are diagnosed with multiple chronic diseases (Raghupathi & Raghupathi, 2018). In 2011, the Affordable Care Act mandated insurance companies to remove deductibles for preventative health services, relieving the financial burden of out-of-pocket expenses (Borsky et al., …

Quality Improvement Initiative To Increase Comprehensive Eye Exams In Patients With Diabetes, Julia Khoury

Doctor of Nursing Practice

Diabetic retinopathy is the most common microvascular complication associated with poorly controlled diabetes. Yet, only 60% of the diabetic population receives an annual eye examination by an eye specialist. Retinal imaging increases surveillance of retinopathy, however, it does not take the place of a comprehensive eye examination by an ophthalmologist or optometrist. The aim of this quality improvement project was to increase comprehensive eye examinations in patients with diabetes aged 18 to 75 years in a family practice that recently purchased a retinal imager. This quality improvement project occurred over a 10-week period. Project objectives included increasing comprehensive dilated eye …

Advanced Practice Providers: How Do We Improve Their Organizational Engagement?, Molly Condit, Paula Hafeman

College of Nursing Faculty Research and Publications

Advanced practice providers (APPs) are integral members of the multidisciplinary health care team, providing access to high quality and cost-effective patient care. Despite the consistent increase in demand for APPs, these practitioners often lack role clarity, frequently resulting in poor job satisfaction and retention. Establishing an advanced practice provider council within organizations is a positive step in providing APPs with a platform for increasing their visibility, peer support, and decision-making power, thereby improving their engagement within the organization.

Seven Steps To Successful Change: How A Large Academic Medical Center Prepared Patients For Organizational Change, Brian Carlson, Madison Agee, Terrell Smith, Paul Sternberg Jr, Jason Morgan

Patient Experience Journal

Vanderbilt University Medical Center (VUMC) launched a new electronic health record (EHR) in a “big bang” implementation that saw the new software go live across multiple hospitals, clinics and geographic locations in a single morning. The organization rightly focused most of its energy on preparing its nearly 25,000 employees for the impacts of the transition, but it also considered the effects that would be felt by its patients and families. Survey data indicate that patient satisfaction scores demonstrably dip before, during and after an EHR implementation, and take approximately a year to recover. A team at DMC employed a seven-step …

Comparison Of A Self-Audit Tool To Accrediting Health Care Agencies’ Standards Of Care In A Corrections Setting, Matthew C. Widerman

Doctoral Projects

Millions of individuals enter correctional facilities each year and require health services. Inmates are bound to a set of rules, wherein they are thought of as objects of surveillance, punishment, or rehabilitation, rather than as patients. In addition to standards of care defined by national accrediting bodies and state boards of practice, correctional facilities also have state laws that define expected health services for incarcerated persons. All health care providers have a responsibility to provide the highest quality care, but in prisons, patients are still inmates bound to correctional rules. Policies and procedures guide health care practices in correctional facilities, …

The Relationship Between Psychological Contract Breach, Organizational Identification, And Organizational Agility Among Nursing Faculty Members, Yaldez Zeineldin

Nursing

Psychological contract is defined as the unwritten or hidden agreement between both the employers and the employees to ensure reciprocity and safe productive work environment. The concept of the relationship between Psychological Contract Breach (PCB) as one of many recognized antecedents of organizational identification has been emphasises for years. Organizational Identification (OI) is defined as the extent to which both the organisation and the employee’s identities are overlapped. Organizational Identification (OI) has many benefits. For instance, it has a robust effect on the employees’ cognitive abilities, attitude, and behavior including their organizational agility and acceptance to the external and internal …

Association Of Nurses’ Sanctification Of Work With Work-Related Outcomes And Patient Satisfaction, Hazel M. Ada

Loma Linda University Electronic Theses, Dissertations & Projects

Nurses working in hospitals face many intrinsic stressors, including widespread job dissatisfaction, burnout, and frustration. These challenges, in turn, may affect patient care. Nursing often attracts individuals who wish to serve others, and some may find the expression of spirituality on the job helpful in finding meaning, satisfaction, and value in their work (Kociszewski, 2004). Sanctification of work (SoW) is a promising facet of spirituality defined by researchers as an individual’s experience of their work as a manifestation of God or sacred qualities that affects their effectiveness and engagement on the job (Walker, Jones, Wuensch, Aziz, and Cope, 2008). In …

Getting To Zero: Creating An Infrastructure To Support Fall Prevention In A Medical–Surgical Unit, Krys Elgarico

Master's Projects and Capstones

Problem: Hospital falls are a growing national patient safety concern that cause anxiety, pain, distress, serious injuries, and increased health care utilization. Despite the presence of a well-developed falls prevention protocol since 2017. Internal data from an inpatient medical-surgical telemetry (MST) unit indicate the largest number of fall-related events among the hospital’s departments.

Context: Practice improvement project was initiated in a 217-bed community hospital to determine barriers and potential success factors. This MST is a dynamic, 48-bed unit providing care to mainly geriatric patients who require continuous telemetry monitoring and complex medical, trauma, and surgical services. Senior leaders in the …

Hospital Acquired Pressure Injury Prevention: A Quality Improvement Project, Sukhjit Dhillon

Master's Projects and Capstones

Abstract

Hospital Acquired Pressure Injuries (HAPI) can be costly for the hospitals and devastating for the patients. Most pressure injuries are considered preventable, but despite that a lot of Americans die from pressure injury related complications each year. Hospitals spend billions of dollars on pressure injuries which can be used for other treatments. A quality improvement project was created to address these concerns and improve patient care. There were 5 cases of HAPIs on the telemetry/stroke unit prior to the start of this project. Interventions were created to improve the outcome. After careful review of the related literature, HAPI prevention …

Reducing Falls Through An Education Intervention To Increase Nurse-Promoted Mobility In Hospitalized Patients., Tamara Slater

Doctor of Nursing Practice Papers

The aim of this project was to determine if educating registered nurses (RNs) on the importance of nurse-promoted patient mobilization could increase RN knowledge on patient mobility and reduce the rate of patient falls on a cardiology/neurology nursing unit in a southeastern area of the United States. This project was a quality improvement project with a pre-test/post-test design. The intervention included a teaching session for RNs and posted reminders. The teaching session included information on the use of a mobility algorithm, where to locate mobility equipment, and the physical therapy referral process. The reminders included flyers posted around the unit …

Implementing An Updated Evidenced-Based Maintenance Central Line Bundle (Clb) Policy: Monitoring Adherence And Central Line Associated Blood Stream Infections (Clabsis) In A Medical Intensive Care Unit (Micu)., Kimi Hart

Doctor of Nursing Practice Papers

Purpose: The purpose of this project was to update the current policy of CLB maintenance of CVCs by incorporating the latest recommendations from the literature, providing education and disseminating the new policy. Outcomes were measured by evaluating the effect on policy adherence and incidence of CLABSIs in a medical intensive care unit (MICU). Policy adherence was defined by the completion of CLB maintenance components.

Methods: This study included a pre- and post-interventional design utilizing a retrospective chart review to evaluate adherence to CLB maintenance interventions and incidence of CLABSI rates pre and post-implementation of a new CLB maintenance policy that …

Implementation Of A Smart Tool In The Electronic Health Record To Improve Interdisciplinary Discharge Communication And Hospital Readmission Rates, Katelin Umland

Nursing Capstones

In the department of Inpatient Psychiatry at a large mid-western academic medical center, interdisciplinary discharge communication between registered nurses, social workers, advanced practice providers, and physicians has presented as a problem. Patients are frequently discharged from the hospital without being seen by all necessary disciplines and concomitantly discharged without needed supplies, medications, resources, or follow-up appointments in place. This current discharge method negatively affects patient care, causes workflow disruption for all disciplines, and is known to be a contributing factor in increased hospital readmission rates. The purpose of this Doctor of Nursing Practice (DNP) project was to improve interdisciplinary communication …

Introduction Of Auricular Acupuncture, Monica Lyons

Doctoral Projects

The overall purpose of this quality improvement project was to assess if there was an interest to add auricular acupuncture to a substance abuse program. The two guiding questions of the Doctor of Nursing Project were (a) how can auricular acupuncture be helpful when treating patients with substance abuse in a selected organization? (b) what information is needed for both staff and patients to make an informed decision regarding auricular acupuncture? The Promoting Action on Research Implementation in Health Services (PARiHS) framework was used as the theory framework for implementation of evidence-based research into an organization. The facilitator in the …

Reducing Central Line-Associated Bloodstream Infections In The Intensive Care Unit By Improving Compliance With Dressing Changes And Curos Caps Use, Jennifer Khaziga Kilel

Doctoral Dissertations and Projects

Background: Reducing central line-associated bloodstream Infections (CLABSI) is a topic of global importance due to associated risk of sepsis, increased length of hospital stay, high healthcare cost, and increased morbidity and mortality among critically ill patients in the intensive care unit (ICU). The mortality rate of patients who acquire CLABSI 15-25% The cost of CLABSI treatment per event is greater than US $16,500. Central cine-associated Bloodstream Infections affect the organization’s national ranking in patient quality and safety as well as reimbursement from the Centers for Medicare and Medicaid (CMS). The aim of the quality improvement project was to improve the …

Increasing Nursing Competence And Confidence During Obstetric Emergencies Through Simulation: A Quality Improvement Project, Tram Wallen

Dissertations

Problem: This quality improvement project aimed to improve the knowledge and confidence of the mother/baby nursing staff during postpartum hemorrhages through in situ simulation. PPH is a leading cause of maternal death. Hospitals across the U.S. lack a standard approach to managing obstetric emergencies; the complications of childbirth are often identified too late. Multidisciplinary simulation-based team training has been associated with improved outcomes in obstetrics.

Methods: A convenience sample of 26 registered nurses (RNs) that care for postpartum patients attended a one-hour instructor-led presentation followed by in situ simulations of postpartum hemorrhage. A knowledge assessment and confidence survey were administered …

Optimizing Intraprofessional Communication At Patient Handover, Allison Crabtree

Doctor of Nursing Practice Projects

This performance improvement project aimed to increase the communication competency of nurses during intraprofessional interactions at patient handover. An educational program focused on optimizing communication among nurses was implemented in a community-based, not-for-profit, rural hospital. The course was designed to incorporate a variety of instructional strategies to meet learner needs. Consistency and standardization of the patient handover process was a central theme. Topics of the course focused on the use of a standardized communication tool, the relationship of communication on patient safety, the importance of clear and effective communication, the role of the nurse as gatekeeper and facilitator of patient-specific …

Pre-Discharge Bnp: A Policy Change To Reduce Hospital Readmission, Melissa Duckett

Doctor of Nursing Practice Projects

Heart Failure (HF) is the leading cause of hospital readmission for patients 65 years of age and older. A pre-discharge B-type natriuretic peptide is a strong predictor of hospital readmission and mortality. The annual cost for admission of patients with HF is greater than $17 billion. Diagnosed heart failure patients continue to be discharged without the physician knowing their current BNP levels. The Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP) requiring the Center for Medicare and Medicaid Services (CMS) to reduce reimbursement to hospitals with high readmission rates. A change in policy should be initiated to include …

Advance Practice Pediatric Nursing Council., Emily Mountjoy Mcrae

Doctor of Nursing Practice Papers

Advance Practice Registered Nurses (APRNs) continue to grow in numbers in the inpatient hospital setting, as well as within children’s hospitals and subspecialty groups. As the number of APRNs continues to increase, thoughtful consideration within organizations is needed to address leadership specific to this population of healthcare professionals. The goal of this quality improvement initiative was to generate quantitative data to determine if the formation of a Pediatric Advance Practice Nursing Council in a children’s hospital was successful in improving APRN communication, collegiality, and networking. However, the formation of our APRN council was significantly impacted by a multitude of barriers. …

Missed Shots: Increasing Flu Vaccine Documentation Utilizing A Clinical Reminder In A Student Health Clinic, Noelle Simms

Doctor of Nursing Practice Final Manuscripts

Objectives: The primary purpose of this evidence-based practice project is to increase influenza vaccination documentation in the student health setting utilizing a standardized clinical reminder.

Participants: 1,337 undergraduate and graduate students at a private university is Southern California.

Methods: A clinical reminder template was created and added to the intake form in the electronic medical record. The medical assistants complete the template with the patient. The provider then orders the vaccine or educates the patient based on the documented refusal reason.

Results: During the 10-week implementation period there was a 46% increase from baseline in flu vaccine documentation at the …

Do Not Miss Your Shot: Improving Follow-Up In Patients Receiving Long-Acting Injectable Medications, Mary O'Hara

Doctor of Nursing Practice Final Manuscripts

Background: Serious mental illness including schizophrenia and bipolar disorder affects 1 in 24 adults in California. These chronic disorders are difficult to treat and often sabotaged by medication nonadherence. Long-acting injectable (LAI) medications are one strategy to combat medication nonadherence. Effectively providing treatment with LAI medications can be challenging at the clinic level.

Objectives: Reduce the number of days without medication by reducing the number of days between injection due date and injection administration for patients receiving LAI medications.

Design: Establish appointments for all injection visits. Standardize visit protocol for injection encounters to optimize provider time. Arrange immediate follow-up and …

Healthy Aging In The Community Initiative, Didem Kadriye Unver

Master's Projects and Capstones

In 2016 the Sequoia Health Care partnering with Peninsula Family Services developed a non-profit and free program called 70 Strong. It is a personal resource guide for the 60 and above client base for activities and services from Redwood City to Foster City to encourage independence amongst the older population. It includes a wide array of categories, such as fitness and social activities, volunteer opportunities, transportation, enrichment, and support groups. This is not an acute healthcare provider; however, it is a primary prevention effort by Sequoia Healthcare District to increase wellness among the older population in the county. The purpose …

Clinical Practice Guideline Adherence: Primary Prevention Of Cardiovascular Disease In At-Risk Adults, Sharnita L. Rice

Evidence-Based Practice Project Reports

The American College of Cardiology (ACC) and the American Heart Association (AHA) (2013; 2016), as well as the American Diabetes Association (ADA) joined forces to create clinical practice guidelines (CPGs) recommendations for healthcare providers (HCPs) to follow with the aim of preventing cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality in the United States. The Centers for Disease Control (2017a) estimates CVD costs 325 billion dollars annually. Although CVD has an astronomical cost associated with it, CPG adherence continues to be an issue among HCPs and improvement is warranted. The purpose of this EBP project …