Medicine and Health Sciences Commons^™

Fall Prevention, Linda Fang

Master's Projects and Capstones

Fall Prevention Abstract

Background: According to the CDC, the medical cost for falls was approximately $30 billion in 2012. When a patient falls, and gets serious injury, these costs could sum up to $14,056 per patient. As a result, hospital stays per patient are observed to increase by approximately 6.3 days longer than those patients who haven’t encountered falls.

This study focused on identifying high fall risk patients, and developing a plan of care to reduce the occurrence of falls in a hospital setting. Nurses using safe fall interventions techniques have been proven to inspire fall preventions.

An assessment of …

Job Embeddedess Of Nurses Working In South Central Appalachia’S North Carolina Counties, Susan L. Adams Mrs.

Electronic Theses and Dissertations

Nurses working in the North Carolina counties of South Central Appalachia (NC-SCA) are a unique subset of nursing professionals. A continued nursing shortage is projected in this area while staffing has improved in other areas of SCA. The purpose of this research was to ascertain the level of job embeddedness of nurses working in NC-SCA in order to offer guidance regarding retention of nurses working in this area. Actively working licensed practical nurses, registered nurses, and advanced practice nurses (nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists) from 29 North Carolina counties included in South …

Improving Discharge Planning Using The Re-Engineered Discharge (Red) Program, Sterling L. Roberts, Leslie C. Moore, Brian Jack

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

The 12-actionable items of the Re-Engineered Discharge Program (RED) are equipped to address essential areas to prevent hospital re-visits. Evidence supports the use of nurses to complete these essential components of hospital interventions. The aims of this project were to: 1) assess nurses’ readiness to learn prior to receiving education on the RED Program, and 2) measure the utilization of the RED discharge process from patient chart reviews following an educational intervention focused on the RED 12-actionable items. Participants (N = 69) scored high M = 219.8 (SD 23.7) on the Self-Directed Learning Readiness – Adult Scale, indicating the nurses …

The Development, Implementation And Evaluation Of An Educational Program For Staff Nurses To Identify And Manage Risk Factors For Ischemic Stroke In Patients With A History Of Migraine, Scottia Jones

Nursing Masters

The literature findings demonstrate that patients with migraines have a significantly high incidence of ischemic stroke (Kurth, 2010). Migraine is a common neurological disease that is defined very poorly and is estimated to affect between 1 % and 10% of men and 3 % and 20% of women within the United States (Buring & Hennekens 1995). Decreasing migraine frequency and management of modifiable stroke and cardiovascular risk factors'-, such as hypertension, high cholesterol and smoking can help decrease risk of stroke occurrences (Tietjen, 2005). Therefore, to decrease stroke occurrence, it is imperative that staff nurses are educated on the importance …

Nurse Perspectives On The Work Impacts Of Decentralized Nursing Unit Design, Susan Mcdevitt

Electronic Theses and Dissertations

This study investigated nurse perspectives on the work impacts of a decentralized inpatient unit model. The study involved two rural acute-care hospitals in rural Nebraska that moved from a centralized to a decentralized inpatient unit design. The researcher conducted focus group discussions with staff and nursing management at both facilities with a total of 28 participants. In addition, the participants completed a 12-item questionnaire using a five-point Likert scale for responding. Focus group discussion and questionnaire were designed to investigate the areas of quality of care, communication, documentation, stress and wellbeing, and transition. Data gathered revealed that on all survey …

A Whooping Cough Education Module For Wic Clients In Utah, Karlen E. Luthy, Alicia Anderson, Janelle L. B. Macintosh, Renea L. Beckstrand, Lacey M. Eden, Ryan Amy, Christopher I. Macintosh

Faculty Publications

Background: Clients in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are required to complete education modules quarterly to maintain eligibility. The purposes of this project were to: (1) create a whooping cough vaccination education module for WIC clients; (2) evaluate baseline perceptions of WIC clients on the whooping cough vaccine and disease; and (3) evaluate whooping cough knowledge following completion of the module. Problem: A decline in vaccination rates among infants and children using WIC services was reported by a local WIC program director who requested whooping cough vaccination education materials. This quality improvement project included …

Interdepartmental Rounding, Peggy Anderson, Carrie Strick, R3 Med-Surg Unit, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Maine Medical Center Operational Excellence

Maine Medical Center

STRATEGIES FOR IMPROVING COMMUNICATION BETWEEN DOCTORS AND NURSES IN AN ACUTE CARE HOSPITAL

Effective interdisciplinary communication is imperative for safe patient care in an acute care hospital environment.

A surgical unit used their HCAHPs scores to assess how often patients perceived there was good communication between different doctors and nurses during their hospital stays. The data demonstrated that this occurred 22% less often than the national average.

As a result of a root cause analysis, a number of countermeasures were initiated with the goal of achieving scores greater than the national average. Post KPI inception in the second quarter of …

Diverticulitis, Amanda Fantino

Nursing Student Class Projects (Formerly MSN)

Diverticular disease affects approximately 2.5 million people in the United states and it accounts for more than 280,000 hospitalizations per year (Mulligan, 2015). In 2004, the treatment cost for diverticular diseases was approximately 3.6 billion dollars, this is a huge expense for health care in this country (Schneider et al., 2015). “Diverticulosis is the presence of diverticula in the absence of inflammation” (Wilkins, Embry, & George, 2013). In the United States one study found that those with diverticulosis have a twenty-five percent chance of developing diverticulitis in their lifetime (Wilkins, Embry, & George, 2013). The number of patient in the …

Study Of Nurses' Attitudes And Practices Towards Pain Evaluation In Nonverbal Patients, Rebekah Lovin

Montview Journal of Research & Scholarship

Pain, and the appropriate treatment of it, has recently come to the forefront of issues addressed with healthcare providers. Since the cornerstone of pain management is an appropriate assessment, methods of accurate pain evaluation are necessary. This need is particularly important in the population of patients who cannot express their pain. While pain assessment tools are available for use with nonverbal patients and hospitals typically mandate the use of one of these tools, actual compliance with such policy may not actually occur. Various barriers, such as education in the use of a tool, time, and the personal views of the …

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 …

Improving Communication And Satisfaction Through Hourly Rounds, Karen E. Sondeno

Master's Projects and Capstones

The focus of this CNL project is quality improvement using high quality hourly rounds to achieve improved patient satisfaction and communication with nurses. It was determined by reviewing survey results that patient satisfaction and nurse communication is below National levels. Data shows that rounds are not being done well on a medical unit before the improvement project. It is proven that patients receive and perceive higher quality care and communication with increased nurse presence at the bedside. The population of the medical unit has high numbers of confused/dementia, and dual-diagnosis patients. It was determined that the unit would benefit from …

Healing Touch: Enhancing Quality Of Life, Julia Mccann-Khludenev

Evidence-Based Practice Project Reports

Healing touch (HT) is a non-invasive energy therapy used in the management of symptoms of various health conditions. HT utilization has demonstrated enhanced comfort and relief of symptoms such as chronic pain, post-traumatic-stress, depression, and anxiety. The purpose of this evidence-based practice (EBP) project was to promote awareness and appointment compliance rate of HT amongst veterans, and also to determine effectiveness of HT intervention on symptom relief and well-being. The PICO question was: “For Veterans, what is the effect of HT education material and mail notification on appointment compliance rate, and HT delivery on symptom relief and well-being as compared …

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 …

The Application Of Grounded Theory: An Example From Nursing Workforce Research, Latoya J. Lewis-Pierre 4572586, Joann Kovacich, Linda Amankwaa

The Qualitative Report

The application of grounded theory was the conduit to theory development in this study. The intent was to explore nurse manager, educator, preceptor, and new graduates’ perceptions of workplace readiness for new graduates entering an Intensive Care Unit. Research participants were drawn from five different ICUs: Medical, Coronary Care, Surgical, Neuroscience, and Trauma. One-on-one interviews were conducted to collect participants’ perspectives on readiness to practice in the ICU. Using grounded theory, four themes emerged giving rise to the novice nurse embracing the ICU theory (NNEIT). Reflections on the type of grounded theory used, reasons for the selection, challenges faced in …

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 …

Implementation Of A Standardized Handoff During Transition Of Care From The Emergency Department To The Intensive Care Unit, Melinda Abbring

Evidence-Based Practice Project Reports

Patient safety and nursing communication are crucial to the nursing handoff during transition of care from the emergency department (ED) to the intensive care unit (ICU). The Institute of Medicine published To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm (2001) highlighting ED handoffs as a safety measure. In 2006, the Joint Commission recognized handoffs with the National Patient Safety Goal 2E. The purpose of this evidence-based practice project was to determine if implementation of a standardized handoff would improve nursing communication and patient safety during transition of care from the ED to the …

Implementation Of A Multifactorial Fall Prevention Protocol, Laura Wilkerson

Evidence-Based Practice Project Reports

According to the Joint Commission Center for Transforming Healthcare (2016), moderate to severe injuries from falls on average add 6.3 days to a hospital stay and cost approximately $14,056 per patient hospitalization. The purpose of this evidence-based practice (EBP) project was to implement a multifactorial approach to identify patients at risk for falls on admission to the orthopedic/neurosurgical unit and provide individualized interventions necessary to prevent falls. The Iowa Model of Evidence-Based Practice and Orlando’s Nursing Process Discipline facilitated the implementation of this project. A total of 45 staff members on the unit were educated on the multifactorial fall protocol …

A Quality Improvement Project To Improve Blood Specimen Acceptance Rates In An Emergency Department, Christian Hankins

DNP Scholarly Projects

Purpose: The purpose of this project was to implement a quality improvement project to improve blood specimen acceptance rates at a specific Emergency Department (ED) using strategies to enhance knowledge, improve motivation, and reinforce skill. Background: Specimen acceptance rates continue to fall outside of the recommended target rate of 98% or higher at a specific ED. In this particular ED, the responsibility for specimen collection has shifted away from phlebotomists and towards nurses, many of whom have received little to no phlebotomy training. Without proper blood collection techniques, specimens are more likely to be rejected, and re-collection of rejected blood …

Commuting Away: The Experiences Of Rns Who Live In Rural Communities And Commute Away For Employment In Non-Rural Communities, Laurie Jo Johansen

Nursing Capstones

A lack of healthcare providers, including RNs, creates barriers for the U.S. rural population to access adequate healthcare services. One contributing factor to the scarcity in rural areas is the increasing numbers of RNs commuting away from rural communities for employment—14% in 1980 to 37% in 2004 (Skillman, Palazzo, Doescher, & Butterfield, 2012).

This descriptive phenomenology study investigated the experiences of RNs living in rural communities who commuted away to non-rural settings for employment. Purposeful sampling with snowballing was used to recruit 16 RNs for the study, allowing for understanding a rich variation in the professional experiences of RNs, as …

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. …

Effects Of Therapeutic Music On Pain In Spinal Surgery Recovery, Michael Poulsen

Evidence-Based Practice Project Reports

Pain is one of the most common experienced symptoms reported by more than 80% of postoperative patients. Approximately 77-98% of postoperative patients report pain following their procedure with 40- 80% having moderate to severe pain. Pain is shown to elevate stress levels manifesting in increased heart rates, blood pressures, and oxygen demand. Inadequate pain control can develop into surgical complications causing surgical failure, blood clots, pneumonia, and chronic pain. Complimentary and alternative medicine such as music can be used in combination with opioid medication help improve pain control leading to successful surgical outcomes. The purpose of this evidence-based practice project …

Improving Nursing Attitudes Toward Suicide Prevention In The Emergency Department: The Implementation Of An Adolescent Suicide Risk Screening Tool, Julie A. Simpson

Evidence-Based Practice Project Reports

The Center for Disease Control ranked suicide as the second leading cause of death for American adolescents (2015). This crisis of adolescent suicide warrants evaluation and improvement of current suicide prevention practices. The Emergency Department (ED) offers 24-hour services and may be the only organized healthcare for utilized by some individuals. Nurses are the front-line provider of care in the ED and this role offers opportunity to identify an adolescent with increased suicide risk. The purpose of this EBP project is to evaluate nursing attitudes toward suicide prevention by implementing the best practice screening tool for adolescent suicide risk assessment. …

Fall Prevention In An Acute Care Hospital: The Challenges Encountered By Patients, Staff And Administrators, Barbara J. Watson

Electronic Thesis and Dissertation Repository

Abstract

Falls are frequent and often serious events that take place in hospitals. Healthcare providers find it challenging to minimize fall risk factors. In fact, just being in a hospital is a risk factor in itself! The aim of this thesis was to investigate the reasons behind patient falls, identify gaps in prevention strategies and suggest additional recommendations to improve patient safety. A mixed method approach was used to interpret the data and uncover the reasons for falls.

The first study was a secondary data analysis where 7,721 patient falls were examined. The data were taken from the hospital’s central …

Warmth And Competence Traits: Perceptions Of Female And Male Nurse Stereotypes, Randolph E. Gross

Dissertations, Theses, and Capstone Projects

A nursing shortage looms ahead; 1.03 million new nurses will be needed by 2022 to meet society's healthcare needs. A major barrier to recruitment of women and men are nurse stereotypes. The literature suggests four female and four male stereotypes exist; however, no quantitative research exists that explores perceptions of non-nursing undergraduate students. Approximately, 90% of college students do not consider nursing as a career option, and 72% have misconceptions of what nurses do in reality.

According to social cognitive theory's Stereotype Content Model (SCM), perceptions are viewed through a combination of two dimensions: warmth and competence. The author devised …

Nurse-Physician Collaboration And Satisfaction, Fatima Brewton

Nursing Theses and Capstone Projects

The purpose of the study was to examine the effects of interdisciplinary rounds (IDR) on a neurology medical-surgical inpatient unit. Existing research shows that IDR improves nurse-physician relationships and satisfaction and improves patient outcomes. Using the Collaboration and Satisfaction about Care Decisions (CSACD) tool developed by Baggs, nurse-physician collaboration and satisfaction was measured pre and post implementation of interdisciplinary rounds. Twenty-one nurses and five physicians participated in the study which included education sessions, a two week trial of IDR, and a pre and post survey. Nurses and physicians in this sample perceived a significant increase in collaboration (X = 5.6563, …

Mindfulness-Based Stress Reduction (Mbsr) In Reducing Stress In Nursing Students: An Integrative Review And Toolkit, Donna J. Petko

Doctor of Nursing Practice (DNP) Projects

Background: Across the country, nursing students are experiencing alarming amounts of stress. While stress is a common phenomenon, it has been shown to negatively impact nursing student performance and general health. One solution to this issue is mindfulness-based stress reduction (MBSR). Reported effects of MBSR include stress reduction; mindfulness; improvements in self-esteem; increase in general health; a decrease in anxiety; and an increase in empathy. Because MBSR is not widely included in nursing curricula, students are not learning stress reduction techniques needed to manage daily stress. Purpose: To address this gap, a DNP project was implemented at a university site. …

Nurse Perceived Barriers To Effective Nurse-Client Communication, Sara J. Brandenburg

Honors Undergraduate Theses

Successful client care depends on effective nurse-client communication. It is essential in meeting clients' needs, providing quality care, and maximizing positive client outcomes. The intent of this thesis was to explore nurse perceived barriers to effective nurse-client communication. A literature review was conducted and nine articles were identified as addressing nurse perceived barriers to communication. Four major barriers were identified: nurse comfort and knowledge, environment, time, and culture and language. Research on interventions to address nurses' perceptions of barriers to effective nurse-client communication may provide a better understanding of communication barriers and address issues created by ineffective communication with clients.

An Evidence-Based Mentorship Program For Experienced Nurses, Roma Allen

Walden Dissertations and Doctoral Studies

Turnover of experienced nurses is a component of the nursing shortage, which has created a lack of expert nurses administering bedside care. The project site is a Chicago suburban hospital with an average first year turnover of experienced nurses at 35%. This rate is above the 27% first year turnover reported by the Metropolitan Chicago Healthcare Council. This project focused on development and evaluation of an evidence-based mentorship program supported by theory that can contribute to an increase in experienced nurse retention. A detailed literature review references causative factors of turnover, such as an increasing workload, a multigenerational and aging …

Impact Of A Standardized Tool On Handoff Quality In Nurse Change-Of-Shift Reports, Wilma Lonzame Ayala

Walden Dissertations and Doctoral Studies

Within the context of healthcare delivery, human lives are at risk when health care professionals fail to communicate effectively. Audits by The Joint Commission from 1995 to 2005 revealed that 65% of sentinel events occurred as a result of staff miscommunication, prompting the requirement that standardized handoff tools be deployed. Therefore, this project was completed to improve safety in the hospital through implementation of a standardized tool that could enhance the quality of nurse handoff communication. Mohorek & Webb's (2015) linear model of communication, which emphasizes the importance of encoding, transmission, and decoding in the communication process, provided the framework …

Exploring Barriers And Consequences Related To Nurses Reporting Child Abuse, Asmita Devkota

Honors Undergraduate Theses

Background: Child abuse is a pervasive and serious problem in the United States. Over 3 million children are the victims of some kind of physical assault by adults. Due to their prolonged contact with children and opportunity to report, nurses should be trained to accurately assess, identify, and manage cases of child abuse. The purpose of this study was to examine student’s experiences with Child Protective Services, and explore their confidence and attitudes related to identifying and reporting child abuse. Factors associated with non-reporting were identified.

Methodology: This was an exploratory, descriptive study. Students enrolled in the online …