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Full-Text Articles in Medicine and Health Sciences
Implementation Of Lymphedema Education Toolkit For Nurse Coordinators, Heather Gee
Implementation Of Lymphedema Education Toolkit For Nurse Coordinators, Heather Gee
Master's Projects and Capstones
Problem: Lymphedema is a chronic condition that develops secondary to cancer treatments such as chemotherapy, radiation, and surgical removal of affected lymph nodes. This swelling in patient’s limbs can cause discomfort and limit mobility, however lymphedema is often not detected until later stages, delaying treatment and patient education.
Context: This quality improvement project was conducted at Hospital S Women’s Cancer Center, an outpatient center specializing in advanced treatments for breast and gynecological cancers. This center has a multidisciplinary team focusing on both the medical and surgical aspects of oncology treatment.
Interventions: An evidence-based lymphedema education toolkit was created for nurse …
Give Love With Lovenox: Improving Nurse Education On Lovenox Prophylaxis To Reduce Pulmonary Embolism Risk On The Postpartum Unit, Jennifer G. Domingo Rn
Give Love With Lovenox: Improving Nurse Education On Lovenox Prophylaxis To Reduce Pulmonary Embolism Risk On The Postpartum Unit, Jennifer G. Domingo Rn
Master's Projects and Capstones
This quality improvement project aims to improve nurse education about Lovenox prophylaxis to reduce the risk of pulmonary emboli – post-discharge – amongst high-risk postpartum women who underwent vaginal and cesarean deliveries on the family baby unit. This project took place in a Family Baby/Postpartum Unit at Hospital SC. This unit has a total of 25 beds with an increased prevalence of pulmonary embolism following cesarean delivery. Nurses were given anonymous pre- and post-survey questionnaires and provided educational sessions with distributed handouts. A unit needs assessment was conducted using the 5 P’s. Out of the 72 nurses on the staff …
Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Christopher N. Guinto
Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Christopher N. Guinto
Master's Projects and Capstones
Problem: Results from a voluntarily anonymous pre-survey about sepsis revealed that a majority of the seventeen nurses assessed themselves below an "expert knowledge '' level. The survey results present an opportunity to improve the nurses’ knowledge and confidence in nursing response and improve patient outcomes with sepsis.
Context: The quality improvement (QI) project was conducted on a medical-surgical unit in a large Northern California hospital.
Intervention: A QI team initiated evidenced-based practice research and created an educational sepsis handout for nurses to increase sepsis knowledge and confidence.
Measures: The self-assessment pre-survey would be compared to the responses from the post-survey. …
Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Jillian J. Abinader
Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Jillian J. Abinader
Master's Projects and Capstones
Problem: A sepsis protocol and bundle has been implemented in an urban Emergency Department to help screen patients and treat sepsis efficiently and effectively. The benchmarks from the bundle are not being met consistently every month and are below the targeted 90%.
Context: A microsystem assessment and a gap survey sent out to nurses, helped determine that there is room to improve nurses’ knowledge and confidence about sepsis and the sepsis bundle workflow. Sepsis is one of the most expensive and burdensome conditions in U.S. hospitals. Literature supports staff education to improve sepsis bundle compliance.
Intervention: A video was created …
Esp In Nursing: Building Communicative Competence For Internationally-Educated Nurses, Sami Vuong
Esp In Nursing: Building Communicative Competence For Internationally-Educated Nurses, Sami Vuong
Master's Projects and Capstones
The nursing shortage in the United States has been an ongoing issue due to nursing burnout and retirement. Together with the COVID-19 pandemic, it has further exhausted the healthcare system’s resources and healthcare providers. In order to sustain the healthcare system in society, a large number of internationally educated nurses (IENs) have been transferred to work in the United States. As a result of different nursing practices, cultures, and communication styles, many IENs experience language and cultural barriers at work. Difficulty in communication influences the quality of patient care provided, which can lead to negative health outcomes for patients and …
Increasing Colorectal Cancer Screening Rates In The Psychiatric Inpatient Unit, Diane R. Ventura
Increasing Colorectal Cancer Screening Rates In The Psychiatric Inpatient Unit, Diane R. Ventura
Master's Projects and Capstones
Increasing Colorectal Cancer Screening Rates in the Psychiatric Inpatient Unit
Abstract
Problem: Colorectal cancer is one of the leading cancer deaths in the United States. The Psychiatric Inpatient Unit has a colorectal cancer screening compliance rate of 40% compared to the statewide average of 80%.
Context: The Psychiatric Inpatient Unit is a 58-bed inpatient intermediate care facility mental health program in Northern California. Upon review of the EMR, most PIU nurses give verbal instructions and patient education on colorectal cancer screenings when due. Still, no printed handout was provided to the patients upon review of the EMR.
Intervention: Review of …
Usp<800> Hazardous Drug Safe-Handling In The Medical-Surgical Microsystem: A Cnl Quality Improvement Project, Ananda T. Le
Usp<800> Hazardous Drug Safe-Handling In The Medical-Surgical Microsystem: A Cnl Quality Improvement Project, Ananda T. Le
Master's Projects and Capstones
Problem: The USP General Chapter <800> guidelines protect healthcare workers from hazardous drugs (HD) and are enforceable by hospital regulatory organizations. Hospitals should increase their safe handling and administration of these drugs to be compliant and protect their workers. This quality improvement project aimed to improve nurse compliance with the safe handling of USP <800> drugs on the medical-surgical microsystem within 16 weeks.
Context: This clinical nurse leader (CNL) quality improvement project was implemented on two medical-surgical microsystems in a San Francisco Bay Area hospital system.
Interventions: The team conducted passive observational data collection and active observation in the form of a …
It’S Their Lifeline: Preventing Central Line Associated Blood Stream Infection In An Adult Intensive Care Unit, Jacenda Lee Rangel
It’S Their Lifeline: Preventing Central Line Associated Blood Stream Infection In An Adult Intensive Care Unit, Jacenda Lee Rangel
Master's Projects and Capstones
Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm.
Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of …
In-Basket Teamwork: Divide The Work And Multiply The Success The Registered Nurse Role In Ambulatory Clinic Ehr In-Basket Management, James Smoot
Master's Projects and Capstones
Electronic Health Record (EHR) in-basket results (e.g., lab results, pathology reports, etc.) must be reviewed and acted upon in a timely manner by clinical staff in order to provide safe and effective care to ambulatory patients. Delays in reading results are significant contributors to medical errors. A large backlog of in-basket results that have never been appropriately filed is both a safety concern and a symptom of other clinical workflow issues. EHRs have shifted a greater proportion of administrative and triage roles onto providers, contributing to provider burnout. This paper synthesizes some of the best evidenced-based practices available for the …
Pressure Injury Documentation And Reporting: A Quality Gap, Mary Ann Laslo
Pressure Injury Documentation And Reporting: A Quality Gap, Mary Ann Laslo
Master's Projects and Capstones
Abstract
Problem: Inaccurate and incomplete pressure injury (PrI) assessment and documentation leads to inaccurate reporting of PrI quality reporting measures to the Centers for Medicare and Medicaid Services. Inaccurate, incomplete documentation of pressure injuries and wounds adversely affects the quality of care, financial reimbursement, and hospital reputation as well as increasing the risk of litigation to medical providers. Barriers to accurate and complete documentation by the nurses were inaccuracy in identification of PrIs Stage 1 or greater and knowing what and where to document the information in the electronic medical record.
Context: This quality improvement project attempted to improve nurse …
Improving Care Experience Of Total Joint Home Recovery Patients Through Nursing Education, Earvin Ledi
Improving Care Experience Of Total Joint Home Recovery Patients Through Nursing Education, Earvin Ledi
Master's Projects and Capstones
Problem: At a Northern California hospital (NCH), there is a current effort to ensure the perioperative patients are satisfied with their care. These patients receive the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey after surgery. The scores regarding discharge process and patient knowledge over the last five quarters have fluctuated between the 10th percentile and the 36th percentile. NCH relies on patient satisfaction scores to better serve their members.
Context: NCH understands the higher the scores, the more members they will retain and the higher the overall income. Based on the low OAS …
Preceptor Education And Structured Onboarding Process, Charles Morato
Preceptor Education And Structured Onboarding Process, Charles Morato
Master's Projects and Capstones
Problem: Staff nurse retention is an ongoing problem for this intensive care unit (ICU). Through exit interviews from staff who left, inadequate onboarding and education made them feel unprepared for their job and not part of the team. The preceptors on the unit have never been trained on the roles and responsibilities of being a preceptor. The current onboarding process consists of pairing new hires with a preceptor who either happens to be willing to do it that day or someone who has been there the longest. There is no consistency or personalizing the orientation information to the new hire. …
Implemented Nurse Education To Improve The Effective Use Of The Sapphire Pca Pump: Achievement Of Quality Pain Control, Fanta Keita Zable
Implemented Nurse Education To Improve The Effective Use Of The Sapphire Pca Pump: Achievement Of Quality Pain Control, Fanta Keita Zable
Master's Projects and Capstones
The Sapphire ™ Infusion System Patient-Controlled-Analgesia (PCA) pump is a device that is used to administer high pain medication to manage a patient’s pain level after an invasive procedure such as surgery. In order to achieve this goal, nurses must be able to use the sapphire equipment efficiently to prevent medication overdose and underdose, as well as to preserve safety for both the patients and the nurses themselves. In addition, nurses must be able to document accurately on EPIC. The purpose of this project, led by the team of Clinical Nurse Leader (CNL) students from the University of San Francisco, …
Prospectus For Creating A Nurse Suggestive Acuity-Based Staffing Model In Ambulatory Infusion Settings To Improve Patient Safety And Quality Of Care, Yongli Qiu
Master's Projects and Capstones
Due to the lack of reliable and valid infusion nurse suggestive acuity-based staffing model, ambulatory infusion settings are burden with potentially compromised patient safety, poor quality of patient care with over-scheduling of unexpected complex patients, limited resources related to nurses and infusion chairs, the dissatisfaction of patients and family members, and infusion nurses’ burn out. This project seeks to determine the appropriate nurse to patient acuity-based point ratio in staffing and scheduling factors that influence nurse staffing model, and established nurse staffing strategies. This three-month project was conducted with the infusion nurses, a nurse manager, a nurse supervisor, an assistant …
Improving Knowledge And Attitude Of Primary Healthcare Givers Towards Vulnerable Populations: A Quality Improvement Project, Kimberly Shankel
Improving Knowledge And Attitude Of Primary Healthcare Givers Towards Vulnerable Populations: A Quality Improvement Project, Kimberly Shankel
Master's Projects and Capstones
Improving Knowledge and Attitude of Primary Healthcare
Givers Towards Vulnerable Populations
Kimberly Shankel
University of San Francisco
Abstract
Problem
This project aims to improve patient satisfaction for vulnerable population patients while in hospital, namely transgender and gender non-conforming people. A major roadblock for this population in seeking medical care is their fear of discrimination when accessing healthcare, resulting in a delay, or avoidance of medical care. Multiple studies agree there is a need for nursing education on cultural competence to improve care and satisfaction for vulnerable populations.
Context
The site for this quality improvement project is a small suburban hospital …
Raising Oas Cahps Scores: Using Patient Education, Katrina Pangilinan
Raising Oas Cahps Scores: Using Patient Education, Katrina Pangilinan
Master's Projects and Capstones
At the Golden Gate Endoscopy Center (GGEC), the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) survey results on patient satisfaction have been below the 50th percentile for the last three quarters of 2018. Patient satisfaction scores are a quality measure for the patient care experience and important for the success of the organization and its providers. Based on patient comments from previous surveys, patients feel that the center does not explain the possible side effects of the anesthesia in a way they can understand. Other patient comments and concerns included confusion regarding dietary restrictions …
An Innovative Discharge Intervention: A Quality Improvement Project, Yvonne Swain
An Innovative Discharge Intervention: A Quality Improvement Project, Yvonne Swain
Master's Projects and Capstones
Abstract
Problem: This project aims to decrease the discharge time of a patient from the hospital once the discharge order has been written. Current discharge times are averaging over 3 hours, leading to a breakdown in the patient throughput process. A patient survey was conducted to determine the reason for prolonged discharge times. The survey revealed that patients are not aware of their day of discharge, which may lead them to being discharged without transportation home. Many studies conclude that there are improvement opportunities around discharge planning and communication.
Context: This quality improvement initiative takes place in a 26-bed, medical-surgical/telemetry …
Catheter-Associated Urinary Tract Infection Reduction: A Quality Improvement Project, Wallace Kramm
Catheter-Associated Urinary Tract Infection Reduction: A Quality Improvement Project, Wallace Kramm
Master's Projects and Capstones
Abstract
Problem: Hospital-acquired infections are preventable harm that occurs to patients while in the hospital. Catheter-associated urinary tract infection (CAUTI) is a preventable hospital-acquired infection that continues to plague hospitals nationwide. The Centers for Disease Control and Prevention estimates that there are more than 13,000 CAUTI related deaths in the United States annually (Scanlon, 2017). In addition to the harm caused to patients by CAUTIs, the estimated $500 million yearly cost for CAUTI treatment has created a fiscal burden on healthcare systems (Scanlon, 2017). Decreasing the rate of CAUTI by decreasing overall number of catheters is the goal of this …
Nutrition Education To Improve Health Outcomes In Community Dwelling Older Adults, Sara Giessinger
Nutrition Education To Improve Health Outcomes In Community Dwelling Older Adults, Sara Giessinger
Master's Projects and Capstones
Abstract
The proportion of people age 60 and over is growing faster than other age group, and will double by 2050 from approximately 605 million to 2 billion worldwide, in addition to the 80 and over population quadrupling by the same time. Non-communicable diseases such as obesity, cancer, coronary heart and lung disease, diabetes, hypertension, insulin resistance, and hyperlipidemia,represent 63% of deaths annually worldwide. Due to the immense contact nurses have with clients, they play a key role in screening, referrals and education to guide this demographic to improved health outcomes through nutrition and physical activity interventions (Xiaoyue, Parker, Ferguson, …
Clostridium Difficile: An Investigation On A Medical Surgical Unit, Neftali Cabezudo
Clostridium Difficile: An Investigation On A Medical Surgical Unit, Neftali Cabezudo
Master's Projects and Capstones
The objectives for this CNL Internship Project were to: (1) identify the strongest contributors to the rising trend of Clostridium difficile cases on this medical-surgical unit, (2) review all Clostridium difficile cases for correlational factors that are of significant relevance, (3) examine current unit practices and adherence to established policies, and (4) provide recommendations for enhancing existing prevention strategies. The population examined included male adults between 56-83 years old being treated for other medical conditions. The methods used to address this clinical issue included a joint venture between nursing and housekeeping staff to ensure proper terminal cleaning and a renewed …
Development Of A Formalized Mentorship Program For Newly Licensed Registered Nurses At A Large Community Medical Center, Javier Moreno
Development Of A Formalized Mentorship Program For Newly Licensed Registered Nurses At A Large Community Medical Center, Javier Moreno
Master's Projects and Capstones
With mentorship being a key to addressing several issues at a large community medical center, the leadership of the institution engaged with students of a Clinical Nurse Leader (CNL) Program to conduct a thorough assessment. This paper addresses the charge for a standardized and formalized evidence-based approach to a nurse mentorship program to address key areas that enhance not only the work environment but also the quality of care. These key areas include the 1) promotion of professional development and engagement via 2) acquisition of skills necessary to achieve nursing competence, 3) address lateral violence, 4) increase in staff retention …
A Clinical Nurse Leader Initiative: Promoting Mobility Among Long-Term Care Facility Residents, Ulyses Reamico
A Clinical Nurse Leader Initiative: Promoting Mobility Among Long-Term Care Facility Residents, Ulyses Reamico
Master's Projects and Capstones
Maintenance of mobility during hospitalization or stay in long-term care facility result in improved patient outcomes including but not limited to decreased incidence of falls, non-pharmacological pain intervention, and prevention of further functional decline. In a 45-bed rehabilitation unit of a Veterans Affairs (VA) health care facility, a clinical nurse leader (CNL) initiative was done to promote mobility among the patients to mitigate functional decline. The patients, also referred to as clients or residents in long-term care facilities, were aged between 20s and 90s. The resident population consisted of patients admitted for physical rehabilitation after a stroke or surgical procedure, …
Improving Patient Care Outcomes By Standardizing Change Of Shift Report, Marie Gutierrez Msn, Bsn, Rn
Improving Patient Care Outcomes By Standardizing Change Of Shift Report, Marie Gutierrez Msn, Bsn, Rn
Master's Projects and Capstones
The change of shift is one of the most crucial times during a nurse’s day. It is a time where vital patient information is passed off from one nurse to the next. There is evidence that the root cause of many sentinel events and poor patient outcomes in related to communication breakdown during the change of shift report process. The Joint Commission has identified communication as the primary cause for preventable medical errors with handoffs accounting for 80% of these instances. Change of shift is an elaborate communication process that involves the transition of care between nurses as well as …
Breast Cancer Patient Preparedness For Transition To Survivorship: Individualized Survivorship Care Plans, Kimberly Beringer
Breast Cancer Patient Preparedness For Transition To Survivorship: Individualized Survivorship Care Plans, Kimberly Beringer
Master's Projects and Capstones
Purpose. For breast cancer survivors, after-effects of surgery, radiation and chemotherapy can be substantial, and recurrence is a concern requiring constant surveillance. National healthcare organizations have promulgated guidelines that include providing individualized survivorship care plans (SCP’s). At a northern California oncology department, SCP’s will be prepared for breast cancer patients and delivered in-person by the oncology nurse navigator (ONN).
Method. The author worked with the ONN to develop the format and content requirements for the SCP’s. The ONN prepared individualized plans for patients and scheduled in-person appointments to deliver the SCP’s. A feedback survey to assess preliminary impact was then …
Safe Sleep In The Nicu Environment For Sids Prevention, Renee J. Aumua
Safe Sleep In The Nicu Environment For Sids Prevention, Renee J. Aumua
Master's Projects and Capstones
Abstract
Sudden Infant Death Syndrome(SIDS) remains a leading cause of death for infants less than one year of age. Historically, Neonatal Intensive Care units have been exempt from following SIDS safe sleep guidelines recommended by the American Academy of Pediatrics(AAP) for SIDS prevention due to patient medical status and environment. However, in 2011 these guidelines were updated by the AAP to include NICU specific recommendations. This is a very important change due to this patient population being at a higher risk for SIDS than the term, well newborn. The Safe Sleep project was conducted in a 35 bed, tertiary care …
Admission Handoff Between Emergency Department And Inpatient Units, Amanda A. Briones
Admission Handoff Between Emergency Department And Inpatient Units, Amanda A. Briones
Master's Projects and Capstones
When admitting a patient from the emergency department (ED) to an inpatient unit, a handoff report is conducted. There are many ways the ED nurse can go about delivering this report to the inpatient or floor nurse. Each ED nurse tends to this task in their own way, providing the information they deem important. Due to the absence of standardization, handoff reports have the ability to lack important information regarding the patient and can even lead to compromising the safety of the patient.
The purpose of this project was to gain a comprehensive understanding of the current handover process of …
Improving Preadmission Testing Nurses' Knowledge Of Aortic Stenosis And Transcatheter Aortic Valve Replacement, Alberta Lynn Canale
Improving Preadmission Testing Nurses' Knowledge Of Aortic Stenosis And Transcatheter Aortic Valve Replacement, Alberta Lynn Canale
Master's Projects and Capstones
Abstract
The purpose of this Clinical Nurse Leader (CNL) project was to reduce gaps in nursing knowledge through staff education. Guided by the CNL theme of educator and information manager, the goals were to increase PreAdmission Testing (PAT) nurses’ knowledge of severe/critical aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) procedure and patient selection, and satisfaction with knowledge by 10%. Rapid growth of the TAVR program has contributed to a gap in nursing knowledge leading to inconsistent patient care and education. An educational program was developed and spread through a series of Plan-Do-Study-Act cycles. Pre- and post- implementation surveys were …
Recovery-Oriented Care And Inpatient Psychiatric Nursing Practice, Julia M. Mclaughlin
Recovery-Oriented Care And Inpatient Psychiatric Nursing Practice, Julia M. Mclaughlin
Master's Projects and Capstones
For the past 15 years, major organizations such as the World Health Organization (WHO), Substance Abuse and Mental Health Services Administration (SAMHSA), and U.S. federal government have been committed to shifting mental health services from the medical model of care to the recovery-oriented model of care (Moller & McLoughlin, 2013). However, not all identified recovery-oriented practices have been fully implemented throughout mental health services, specifically in acute care settings. In 2015, San Mateo Medical Center’s acute psychiatric nursing staff completed McLoughlin’s (2005) Recovery Self-Assessment- Registered Nurse (RSA-RN). Data showed that 34% of nursing staff did not believe that the nurses …
Improving Management Of Inpatient Blood Glucose, Rachael K. Misitano
Improving Management Of Inpatient Blood Glucose, Rachael K. Misitano
Master's Projects and Capstones
Epidemiologic studies indicate blood glucose management in the hospitalized patient population is not adequate; with approximately 30% of patients reporting values >180mg/dl. Patients with increased blood glucose levels pose a higher mortality risk as well as increased risks for dehydration, hypotension, renal injury, decreased wound healing, immunosuppression, and an overall increase in hospital length of stay (AACE, 2015). This project aims to improve inpatient management of blood glucose levels by facilitating MD-RN communication through a reduction in the current reportable blood glucose level. This project took place on a 17 bed adult medical-surgical unit at a large academic hospital in …
Reinventing The Medical Request Process In A Correctional Healthcare Setting, Leah Murphy
Reinventing The Medical Request Process In A Correctional Healthcare Setting, Leah Murphy
Master's Projects and Capstones
This project was developed as part of a Clinical Nurse Leader course of study with the goal of gathering and evaluating microsystem data, and the creation and implementation of a process improvement project. The project was conducted in a correctional setting which houses male and female detainees with a wide variety of medical needs. The project addressed long wait times for detainees who have submitted a request for services from the medical department. The goal of this project was to reduce wait times for medical requests, and provide service for a greater number of patients. This project is needed because …