Medicine and Health Sciences Commons^™

Psychological Safety And Conflict Management Among Nurse Practitioners In Interprofessional Teams, Scott Faust

Electronic Theses and Dissertations

This quantitative correlational study explored the relationships between perceived psychological safety, conflict management styles, and perceived conflict management success among nurse practitioners (NPs) operating in interprofessional acute or critical care teams in the United States. Despite existing literature on conflict management and psychological safety, there is a noticeable gap concerning the interplay of these factors, specifically among NPs. A multi-item survey was developed from validated measures to assess psychological safety, conflict management success, and conflict management style. The final sample included 944 NPs. The findings revealed a statistically significant difference in the scores of perceived psychological safety, depending on the …

Bridging The Gap: Educating Medical-Surgical Unit Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Meara J. Matthews

Master's Projects and Capstones

Problem: Sepsis is a life-threatening response to infection that remains one of the leading causes of death worldwide. Based off results obtained from a pre-education survey of nurses on a medical-surgical unit in a large hospital organization, there is an opportunity to increase knowledge and confidence level regarding sepsis and care of septic patients so that nurses are prepared to detect sepsis early and intervention can begin.

Context: The project is being conducted in a medical-surgical unit at a large hospital organization in Northern California. The data from the survey includes 17 nurses on the unit who completed the pre-education …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Jessica Lee

Master's Projects and Capstones

Sepsis is a deadly condition if not treated promptly and urgently. To help lower the mortality rate from Sepsis, education on Sepsis is essential for nurses at all levels and experience. Opportunity at a healthcare organization in Northern California arose when it was found through a survey that about 6 percent of Medical-Surgical nurses have "expert knowledge" of the sepsis bundle elements. Only about 35 percent of these nurses who reported having "expert knowledge" are confident in treating sepsis patients. A team of clinical nurse leader students implemented a quality improvement project. The project was designed to expand nurses' knowledge …

The Impact Of Palliative Care Education On Acute Care Nurses, Heather Sadler

Doctor of Nursing Practice Projects

The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to improve acute care nurses’ knowledge of evidence-based palliative care interventions utilizing the framework from the End-of-Life Nursing Education Consortium (ELNEC) training modules. Increasing the knowledge, comfort, and competence of acute care nurses has the potential to improve end-of-life care delivery in the acute care setting. A lack of access to specialized inpatient palliative care service teams was identified in a rural county in the Southeastern United States. This county is served by a small, criticalaccess hospital. The frontline nursing staff of this facility regularly provides end-of-life …

Effects Of Inadequate Nurse Staffing And Need For Standard Nurse-To-Patient Ratios To Increase Patient Safety In Acute Care Settings, Macey Schwenker

The Eleanor Mann School of Nursing Undergraduate Honors Theses

This study includes articles including research regarding the effects of the current nursing staff shortage and overtime on patient care and outcomes. A systematic review of research was conducted guided by PRISMA guidelines and consists of articles collected from PubMed. Studies were taken place in the United States, England, Taiwan, Singapore, United Kingdom, Brazil, South Korea, Sweden, India, and Australia involving hundreds of thousands of participants. Methods include mean ratio, regression models, surveys, and questionnaires. Nurse staffing shortages, overtime, and inadequate staffing increased the risk of patient mortality and decreased overall patient safety and quality of care in acute care …

Discharge Care Bundle To Reduce Copd 30-Day Readmission Rates In A Hospital Acute Care Unit, Dao Vang

Student Scholarly Projects

Practice Problem: Chronic obstructive pulmonary disease (COPD) readmissions severely impact patients’ health, mortality, and quality of life and increase unnecessary healthcare use and spending. Utilization of a protocol and discharge care bundle to reduce the readmission rate for COPD patients is critical to combat the problem.

PICOT: The PICOT question that guided this project was in adult patients 65 years or older admitted to a hospital acute care unit for acute exacerbation of COPD (P), does a protocol and discharge care bundle (I) compared to no protocol and no discharge care bundle (C) reduce the 30-day hospital COPD readmission rate …

Music Intervention And Its Effect On State Anxiety: An Integrative Literature Review, Courtney Olek

Nursing Masters Papers

Approximately 5 million patients are admitted to Intensive Care Units (ICU) in the United States for acute or life-threatening medical problems or injuries annually. The ICU patient experience has been described in the literature as dehumanizing, stressful, and anxiety provoking. Given the adverse physiological and psychological effects of sustained state anxiety, it is important anxiety is effectively managed in the ICU environment. Standard care for management of anxiety often relies heavily upon sedative medications and are correlated with poor outcomes when used in high doses and over a long duration. The SCCM recommends nonpharmacologic adjunctive measures to decrease the occurrence …

Smoking Cessation: A Nurse-Led Approach To Address Gaps In Patient Care, Katie L. Durham

Master of Science in Nursing Theses and Projects

Currently, the rate of smoking in the US is 13.7%. While this value represents the lowest rate of smoking in documented US history, cigarette smoking remains the leading cause of preventable death, disease, and morbidity. Healthy People 2030 has set a goal to reduce the rate of smoking to 5%. Though many patients report wanting to quit smoking, nearly half report they did not receive advice from a healthcare professional to do so. Many recommended smoking cessation tools and resources remain underutilized by both clinicians and patients. To help mitigate this issue, this project sought to develop a nurse-led smoking …

Reducing The Use Of Physical Restraints Of The Elderly In The Acute Care Setting, Rachael Malone

Master of Science in Nursing Theses and Projects

The aim of this MSN project is to identify and improve the gaps in education regarding physical restraint use in the acute care setting on the elderly patient population. When admitted into hospitals, elderly patients are at much greater risk for being placed in physical restraints due to little education regarding alternative measures to physical restraints and inappropriate assessments. The purpose of this project is to implement education about the detrimental factors and consequences patients may suffer once placed in physical restraints and improve the use of alternative measures to physical restraints. This project will be evaluated by acute care …

Program Evaluation Of The Rapid Response System Prior To And During A Covid Surge, Sarah Born

Doctor of Nursing Practice (DNP) Manuscripts

Between the years 2004-2008, the Institute for Healthcare Improvement (IHI) and The Joint Commission made a recommendation for healthcare facilities nationwide to implement rapid response systems (RRS). Rapid response systems consist of four limbs: recognition and alert (afferent); response and providing timely patient management (efferent); delivering support and oversight (administrative), and monitoring the RRS patient outcome data (quality improvement). The intent of implementing RRS was to increase patient safety and outcomes within the acute care setting. The following question (PICO) formed the basis of the project: “How does the current rapid response system workflow compare to the rapid response system …

The Art Of Nurse Mentoring: A Framework Of Support, Diane S. Kramer, Victoria Y. Mccue, Eve Butler, Andrea S. Prentiss, Maria M. Ojeda, Kayce K. Tugg, Vivian Fuentes, Sally Bonet

Nursing & Health Sciences Research Journal

Introduction: Nursing mentoring relationships are vital to the advancement of personal and professional growth in nursing. Mentoring has been identified as an effective method to decrease turnover resulting in retention of experienced nurses. Despite the benefits of a mentoring relationship, barriers exist in creating and cultivating a formal mentoring program in the hospital setting.

Methods: A qualitative descriptive study approach that explored nurses’ perceptions of a mentoring culture within a hospital environment. Open-ended, conversational-style interviewing techniques with a semi-structured interview guide were utilized to gain a full description of nurses’ perceptions of a mentoring culture within a hospital environment.

Results: …

Implementing An Evidence-Based Practice Change For Alcohol Withdrawal In An Acute Care Hospital, Theresa Carroll

Student Scholarly Projects

Practice Problem: Alcohol Use Disorders (AUD) affects a significant portion of the population in the United States. When AUD is either unrecognized or inadequately treated in the acute care setting it can lead to medical complications, increased length or stay (LOS), increased healthcare expense, and increased patient mortality.

PICOT: In a population of adult patients admitted to an acute care hospital progressive care unit (P), how does applying an initial evidence-based screening tool to detect risk for moderate to severe alcohol withdrawal, the PAWSS (I), compare to no standard screening or assessment for potential alcohol withdrawal symptoms (C) affect the …

Self-Efficacy: Nurses’ Perceptions Of Caring For Patients Living With Diabetes, Victoria Yaros Mccue

Student Theses, Dissertations and Capstones

Diabetes is an epidemic that affects over 415 million people worldwide. In the United States, the number of people diagnosed with diabetes is projected to triple to over 60 million by 2060. With this surge, the number of hospitalizations across the country has significantly increased. Direct care nurses play a vital role in the management of patients living with diabetes. The purpose of this research study was to explore and describe medical-surgical nurses’ perceptions of self-efficacy related to caring for patients living with diabetes. This study's guiding research question was: What are nurses’ perceptions on the influences that impact self-efficacy …

Huddle And Safety, Jaelynn Hall Bsn, Rn

MSN Capstone Projects

The purposed evidence-based practice (EBP) project focuses on a nursing intervention (team huddles) to increase safety and reduce inpatient fall rates. Negative outcomes to consider from an inpatient fall are harm and injury to the patient along with increased health care cost for the patient as well as hospital facility. Accrued cost associated with an in-patient injury resulting from a fall is not reimbursed according to the Centers for Medicare and Medicaid Services. The additional cost for hospital-acquired falls is estimated to be $6,694 (95% CI: -$1,277 to $14,665) (Agency for Healthcare Research and Quality, 2017). This was only related …

Is Anybody Listening?: Factors Affecting Pain Management In Veterans Within An Acute Care Rehab Setting, Laura Oseghae

Doctor of Nursing Practice

Background: In the United States, pain is a widely discussed issue due to the opioid epidemic stemming from a history of pain mismanagement. Clinical guidelines for successful pain management techniques are readily available for providers to incorporate into the individualized patient care plan.

Purpose: The purpose of this project is to improve pain management through implementation of the VA pain management guidelines and improved interdisciplinary team communication.

Objectives: This project aims to decrease the number of patients reporting moderate to severe pain, enhance staff/provider communication, and improve the provider’s overall process for managing pain with an individualized treatment plan.

Interventions: …

A Collaborative Approach To Reduce The Spread Of Covid-19 In A Large Urban Hospital In South Florida, David Schneider, Roberto L. Roman Laporte

Nursing & Health Sciences Research Journal

The novel Coronavirus has proven challenging for many healthcare organizations. Hospitals are pressed to secure sufficient personal protective equipment to ensure the safety of their healthcare personnel and various strategies have been implemented to stop the spread of the virus. There are still many unknowns about COVID-19 and hospitals are rapidly adapting to new information while trying to maintain the safety and wellbeing of healthcare personnel. Baptist Hospital of Miami developed a collaborative data driven plan to monitor, disseminate vital information, and implement various strategies to protect employees and patients during the pandemic.

Clostridioides Difficile Infection Rates And Diabetes Mellitus In The Acute Care Hospital Setting: A Pilot Retrospective Study, Abigail Howe

Honors College

Clostridioides difficile infections (CDI) are bacterial infections severely affecting an individual’s health and financially affecting health care settings. These infections are a persistent health care issue despite implementation of preventative measures. Research on the risk of acquiring CDI for individuals with comorbidities is scarce. Diabetes mellitus (DM) may negatively impact an individual’s immune system and consequently increase the risk of CDI. The purpose of this pilot study was to determine if the incidence of DM differed between patients who had CDI and patients who did not have CDI. After receiving an Internal Review Board (IRB) exempt status, electronic medical records …

Development And Psychometric Analysis Of The Patient Preferences For Engagement Tool, Teresa Jerofke-Owen, Mauricio Garnier-Villarreal

College of Nursing Faculty Research and Publications

Background

Assessing patients’ preferences for engaging in healthcare is needed to inform the planning and delivery of individualized healthcare. Unfortunately, patients are often not engaged in their care to the extent that they would like, leading to patient feelings of disempowerment and frustration.

Objectives

The purpose of this study was to (a) develop and (b) psychometrically test the Patient Preferences for Engagement Tool (PPET), a clinical assessment tool that can be used by nursing staff to identify patient preferences for engagement in healthcare. The usability of the PPET was also examined for both nurses and patients participating in the study. …

Advance Directives And Intensity Of Care Delivered To Hospitalized Older Adults At The End-Of-Life, Marsha Helen Tyacke, Jill L. Guttormson, Mauricio Garnier-Villarreal, Kathryn Schroeter, Wendy Peltier

College of Nursing Faculty Research and Publications

Background

Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL).

Objectives

This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults.

Methods

A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care.

Results

Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, …

Effectiveness Of De-Escalation Training To Medical-Surgical Nurses, Tammy L. Sullivan

Doctor of Nursing Practice Projects

Nurses are the most common victims of workplace violence and typically are not equipped deliver appropriate prevention interventions. Although most violent episodes occur in the emergency department and mental health units, violence towards nurses on the medicalsurgical units is on the rise. Patient perpetrated aggression and violence is positively correlated with poor patient outcomes and length of stay. In addition to the physical effects on the nurse, there are psychological effects that can impact their career and personal life. The direct and indirect cost for an organization includes decreased productivity, increased absenteeism, and turnover. In potentially violent situations, nurses must …

Engaging Patients With Dementia In The Acute Care Setting: A Quality Improvement Initiative For Staff, Andrea Lee

DNP Scholarly Projects

Caring for dementia patients in the acute care setting can be challenging. Staff is trained to manage the acute illness and the symptoms of dementia can impact that care. Training for the care and management of the patient with dementia is not routinely provided for the acute care setting. According to the Alzheimer’s Association (2018), 5.7 million people are living with Alzheimer’s Dementia with the numbers projected to continue to rise. Training in the management of symptoms can alleviate stress and complications for not only the patient but staff members as well. The goal of this project is to educate …

Nurses’ Aesthetic Responses And Emotional Judgements To Senior Leaders’ Symbolism, Lucinda A. Easler

Walden Dissertations and Doctoral Studies

Stress can be heightened during a merger; understanding how acute care nurses who work in a hospital undergoing a merger, experience senior leaders’ use of symbolism may help to promote hospital and leader sustainability. Executive symbolism unfolds into aesthetic experience, normally considered a response to art, with few studies of its existence and benefit to organizational life. The purpose of this phenomenological-hermeneutic study guided by Parker’s aesthetic theory was to examine acute care nurses’ emotional responses and experiences with senior leaders’ use of executive symbolism in the midst of the organizational change. Interviews with 11 acute care registered nurses were …

The Validity And Utility Of Violence Risk Assessment Tools To Predict Patient Violence In Acute Care Settings: An Integrative Literature Review, Manonita Ghosh, Di Twigg, Yvonne Kutzer, Amanda Towell-Barnard, Gideon De Jong, Mary Dodds

Research outputs 2014 to 2021

To examine risk assessment tools to predict patient violence in acute care settings. An integrative review of the literature. Five electronic databases – CINAHL Plus, MEDLINE, OVID, PsycINFO, and Web of Science were searched between 2000 and 2018. The reference list of articles was also inspected manually. The PICOS framework was used to refine the inclusion and exclusion of the literature, and the PRISMA statement guided the search strategy to systematically present findings. Forty-one studies were retained for review. Three studies developed or tested tools to measure patient violence in general acute care settings, and two described the primary and …

The Paediatric Nurse Practitioner: The Evolution Of A Role, Velerie Kiers, Caitlyn Shea, Elissa Ladd Dr

Manipal Journal of Nursing and Health Sciences

The paediatric nurse practitioner (PNP) is an advanced practice nursing role aimed at providing high quality care to children of all ages. Paediatric nurse practitioners are credentialed to provide a wide range of services dependent on their role as a paediatric nurse practitioner, i.e. primary care, acute care or neonatal. There are two possible paths that can be taken to become a paediatric nurse practitioner: the traditional path or apply for direct entry nursing program after completing Bachelor’s degree. This article describes the path to paediatric nurse practitioner practice.

Older Adults’ Implementation Of Discharge Instructions Following An Acute Care Hospital Stay, Brenda Miller

Dissertations

Discharge instructions are a self-care guide for patients after discharge from an acute care hospitalization. The discharge process starts on admission to the hospital and continues until discharged. Many patients rely on informal caregivers to provide support after a discharge. However, it is often unclear whether the patients or caregivers completely understand instructions provided during the discharge process. Key concepts related to how discharge instructions were implemented following discharge to home have been understudied from the patient’s and informal caregivers’ perspectives. Developing effective discharge instructions based on study findings may assist in reducing 30-day hospital readmission rates.
This study was …

Implementation Strategies To Increase Uptake Of Hester Davis Tool Tailoring Of Fall Prevention Interventions, Beena Philip

Doctoral Projects

Introduction. Falls are the most common cause of injury to patients in acute care hospitals globally and higher incidences of falls with injury are reported in the hospitalized elderly. Falls can result in physical and emotional injury, long-term pain, functional impairment, disability, loss of income, increased hospital stay and mortality. Research demonstrates individualized, multifactorial fall prevention interventions are most beneficial in preventing falls and related injuries. This paper reports whether accurate fall risk assessment using the Hester Davis, proactive use of 5T’s (toileting, tolerating pain, tidy, turn, technology), appropriate gait belt use, individualized interventions and intentional toileting for patients with …

Reexamining Overuse Of Frequent Observation For New Admissions On Psychiatric Units To Increase Nurse/Patient Engagement, Samuel Novela

Master's Theses

People in California who suffer from mental health conditions are often admitted involuntarily to hospitals on 72 hour psychiatric evaluation holds if they are deemed imminently dangerous to themselves, or others, or are gravely disabled. Observational patient safety checks are performed and based on patient acuity and hospital standards. Variations exist among different clinical settings with regard to best practices and the patient subpopulations that may warrant less frequent safety checks. Nurses experience different levels of satisfaction with regard to frequency of safety checks because there is no national consensus on which subsets of patients may require them. A senior …

Prevention Of Functional Decline In Hospitalized Geriatric Patients: An Evidence-Based Mobility Pilot Project On An Acute Care Elderly (Ace) Unit, Hannah Grushkowsky

Doctor of Nursing Practice Final Manuscripts

Problem: Functional decline is the leading complication of hospitalization in the elderly. Loss of functional independence during hospitalization results from the inability to maintain function during hospitalization compounded by acute illness. Potential negative outcomes from decreased function include increased length of stay (LOS), morbidity, and added discharges to a skilled nursing facilities (SNF).

Introduction: A mobility-based protocol created by an interdisciplinary team was implemented for three months on an 8 to 12-bed specialized Acute Care Elderly (ACE) medical-surgical floor. The purpose of the project was to evaluate if an evidence-based practice (EBP) mobility protocol can decrease discharges to SNFs, falls, …

Using Critical And Transformative Theory To Describe Basic Palliative Care In The Acute Care Setting, Tammy Neiman

Theses and Dissertations

The population of chronically ill, older adults is expected to grow in the coming years as the baby boomer generation ages. The Institute of Medicine recommends that all healthcare providers have a basic competency in palliative care, also referred to as basic palliative care. The definitions and descriptions to date are vague and do not provide an in-depth description of how basic palliative care differs from the care provided by specialists. The purpose of this study was to describe nurses’ understanding and perceptions of basic palliative care in the acute care setting. Focus group and individual interviews were utilized for …

An Education Intervention To Increase Rounding And Toileting And Reduce Falls In A Hospital Acute Care Of The Elderly (Ace) Unit, Amelia Grayson

Doctoral Projects

Introduction: Falls are the most common accident reported in acute care hospitals and patients who are 65 and older are the most vulnerable. Falls can lead to physical and emotional injury, reduced mobility and functioning, increased length of hospital stay, increased healthcare costs, and admission to long-term care facilities. In 2008, the Center for Medicare & Medicaid Services (CMS) has eliminated reimbursement to hospitals for treatment of injuries resulting from a fall during hospitalization. Research on fall prevention in adult acute care found multifactorial interventions that address multiple risk factors for falls are the most successful at prevention. This …