Digital Commons Network^™

What Does It Take To Be A Champion? Transforming And Empowering The Unit-Based Skin Care Champion Role., Kelly Ryan Ms, Rn, Cwon, Cfcn, Laura Walker Rn, Bsn, Ccrn

Patient Care Services / Nursing

No abstract provided.

Personal Resilience, Workplace Civility, And Staff Retention In Behavioral/Mental Health Crisis Stabilization Units, Paula D. Stover

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

Retention of behavioral/mental health (BMH) staff is a critical need in public safety net systems, but a challenge to sustain. Chronic attrition in BMH settings is costly and can have adverse effects on client care. Researchers recommend investigation of personal resilience and workplace civility as potential retention factors. However, no studies explored relationships between these factors in BMH crisis stabilization units (CSU). A southeastern United States public safety net agency needed baseline data to inform workforce retention initiatives. A correlation design was used to measure relationships between personal resilience, workplace civility, and the intention to continue working at three CSUs …

Teach-Back Methodology To Improve Patient Satisfaction In An Urgent Care Setting, Candi Payne

Doctoral Dissertations and Scholarly Projects

The project used teach-back methodology to provide an evidence-based approach to improve patient satisfaction scores in an urgent care clinic. The teaching plan should include evaluation of patient teaching to determine effectiveness and patient understanding per The Joint Commission (TJC) for Ambulatory Care Center standards. The project was developed to assist nurses (N=12) with an evidence-based method to improve patient understanding and provide an opportunity to ensure comprehension to increase patient satisfaction scores from a one or two to a level three at the end of 30 days following implementation of teach-back. The scores revealed an increase of patient satisfaction …

Pots: Educating School Nurses, Stephanie Sherwood

Doctoral Dissertations and Scholarly Projects

The project used educational modules as a means for providing knowledge about postural orthostatic tachycardia (POTS) to school nurses. It evaluated knowledge of symptoms and the referral process. A pre and post-test were used immediately prior to and following an educational module to determine gained knowledge about POTS. Participants completed a survey evaluating their perceived knowledge and comfort level to evaluate POTS symptoms and refer patients for further evaluation. One hundred percent of participants demonstrated improvement in their post-test score confirming knowledge gained in all participants. All participants reported that the modules helped them about POTS, and they felt confident …

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 …

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 …

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, …

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 …

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 …

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. …

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 …

Acceptability Of The Md Anderson Symptom Inventory And Qualitative Analysis Of Barriers To Palliative Care Services For Rural And Non-Rural Populations, Daniel M. W. Johnson

Doctoral Projects

The United States health system strives to improve the care patients receive while reducing healthcare expenditures. A significant portion of the nation’s healthcare expenditure is spent on end of life care. Palliative care provides one solution to reducing healthcare expenditures while improving the patient experience. Reducing symptom intensity is one example of palliative care’s success. A midwest palliative care program was tasked to gather quality data on the service’s ability to manage patient symptoms.

The program selected the MD Anderson Symptom Inventory to improve symptom assessment and provide quality metrics for the organization. Additionally, research suggests rural populations have poorer …

Applying A Multidimensional Strategy To Mitigate Lateral Violence In A Small Rural Community Hospital In Western New York, Nicole M. Lewis

Nursing Doctoral

Providing registered nurses with education and strategies to mitigate lateral violence is an evidenced-based method for creating a culture of civility. A descriptive pilot study with registered nurses was conducted on two medical/surgical units at a small rural community hospital. Strategies included a review of organizational policies, a one-day educational retreat for unit managers and registered nurse champions, and an online educational toolkit on lateral violence for the staff nurses on the pilot units.

Improving Patient Outcomes: Early Mobilization Of Intensive Care Patients, Casey Teves

Honors College Theses

Early mobilization of intensive care patients has gained the interest of researchers within the last few years due to its safe and practical application and numerous benefits it can provide. Reviewing the literature on this topic reveals the substantial benefits of early mobilization and the detrimental effects of prolonged bed-rest. Despite recent evidence proving that this practice will increase quality of care, many intensive care units still utilize bed-rest as a standard. Understanding the barriers and facilitators of this change can help transform this research into practice and improve patient care outcomes. Nurses are the key facilitators in the initiative …

The Effect Of Routine Adult Phq-2 Depression Screen And Scheduled Follow-Up Protocol In The Primary Care Setting, Alex F. Bikowski

Evidence-Based Practice Project Reports

Healthy People has projected depression to be the primary cause of disability by 2020; therefore routine depression screening has been prioritized as a national healthcare initiative. The purpose of this Evidence-Based Practice (EBP) project is to demonstrate that routine implementation of the 2-item Patient Health Questionnaire (PHQ-2) depression screener, along with a scheduled follow-up protocol for adults in the primary care setting, can improve current mental health practices regarding the identification of depression by clinicians. The evidence supports use of the PHQ-2 for routine adult depression screening, as long as a scheduled follow-up protocol is available for positive screens. This …

Improving Lgbt Cultural Competence In Senior Nursing Students, Hallie Orgel

Evidence-Based Practice Project Reports

LGBT (lesbian, gay, bisexual, transgender) health care is considered a national priority by The Institute of Medicine (IOM, 2011) and HealthyPeople 2020 (2013). The shortage of LGBT culturally competent health care providers is a top contributor to the oppression and discrimination affecting LGBT health (2013). The purpose of the evidence-based practice (EBP) project was to improve the cultural competence of nursing students by improving their knowledge, attitudes, and skills in working with the LBGT population. A multi-method intervention was provided to seniors in a baccalaureate program. The project took place at a private Midwestern university and utilized a pretest/post-test design. …

Influencing College Influenza Vaccination Through A Multi-Component Campaign, Heather Strickler

Evidence-Based Practice Project Reports

Multiple influenza strains exist and college aged students are the most affected population from the H1N1 strain. The H1N1 influenza pandemic had high attack rates reported on campuses from 25% to 73% (Benjamin et. al., 2016; Uddin et. al., 2009). Only 8% to 40% of college students are vaccinated against influenza despite a target goal of 50% set by the American Healthy Campus 2020 (Benjamin et. al., 2016; Poehling, et. al., 2012). The purpose of this evidence based project was after implementing a multi-component influenza vaccination campaign to determine changes in intent to receive the vaccine among college students. To …

Use Of Research By Undergraduate Nursing Students: A Qualitative Descriptive Study, Salima Moez Meherali, Pauline Paul, Joanne Profetto-Mcgrath

The Qualitative Report

Research utilization (RU) is crucial to preparing the next generation of registered nurses, since they are expected to stay abreast of research, read and use existing research to improve their ability to solve problems, and make decisions independently in clinical settings. Also, baccalaureate nursing programs often identify RU as an expected curricular outcome. The purpose of this study was to identify nursing students’ perceptions about RU. In this study, we used a sequential mixed methods approach. In this paper, only qualitative analysis related to RU is reported. A qualitative descriptive design was used to address the study questions. A purposive …

How Nurse-Led Practices Perceive Implementation Of The Patient-Centered Medical Home, Rosemary Frasso, A. Golinkoff, Heather Klusaritz, Katherine Kellom, Helen Kollar-Mcarthur, Michelle Miller-Day, Robert Gabbay, Peter F. Cronholm

Communication Faculty Articles and Research

Purpose

The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model.

Methods

Data were collected through in-depth interviews with providers and staff in nurse-led practices.

Results

These data suggest two categories of processes that facilitate the integration of PCMH in …